[Allergies in ENT]

Allergy is quite frequent and ENT syptoms are usually the visible part of a general disease. Questioning remains the most important part of the enquiry for clinical examination is usually poor if notdesapointing. Biological testings detailed in this paper may be of some help; In Africa, test-treatements using cheap and unharmfull drugs give often the best evidence of allergy. Seldom, ENT allergy may be or become life-threatening. Its detection and appropiate actions are briefly mentioned.

[Hypopharyngeal foreign body migration. Apropos of 2 pediatric cases]

Two children cases report of an ingested fish bone perforating upper digestive tract lumen and completely migrating to the retropharyngeal space in the neck are presented. It is an unusual presentation and we describe our management. In one case it was necessary to performed a cervicotomy to remove the foreign body. In other case the rigid endoscopy could remove the fish bone with forceps under direct vision. The literature is reviewed to improve the early recognition and treatment for these migrating foreign bodies.

[Rigid endoscopy and laryngo-tracheo-bronchial foreign bodies in children: observations apropos of 200 endoscopies conducted in a tropical setting]

Between 1986 and 1998, 200 rigid bronchoscopic procedures under general anesthesia were carried out at the Principal Hospital in Dakar, Senegal for foreign body extraction from the distal airways of 194 children. For the study period, the incidence of this accident was 3.7 p. 1000. Sixty-three percent of patients were male and 77 p. 100 were under 4 years of age. Most patients (69 p. 100) were examined within 48 hours after the accident. Examination of clinical records showed that aspiration was mentioned during anamnesis in only 56 p. 100 of cases. Persistent coughing (80 p. 100) and mild dyspnea (70 p. 100) were the most common symptoms. Auscultation of the lungs was negative in 25 p. 100 of cases and anterior x-ray of the neck and chest were normal or poorly informative in 59 p. 100. In 154 of the 200 procedures, extraction of the foreign body was successful from the trachea in 35 p. 100 of cases, the larynx in 13 p. 100, the right main stem bronchus in 31 p. 100 and the left main stem bronchus in 21 p. 100. In the remaining 46 cases, extraction was unsuccessful. The most frequent foreign body was a peanut. No deaths occurred in this series but cardiac arrest was observed in 6 patients during or immediately after endoscopy. This experience confirms the indication for immediate rigid bronchoscopy in cases involving aspiration or persistent respiratory symptoms. The high incidence of this accident suggests that information campaigns should be undertaken in health care facilities, households, and schools.

[Thyroglossal duct cysts, surgery and histology]

70 years ago Sistrunck described a specific procedure for the management of thyroglossal duct cysts. However, this surgical procedure is not performed often. In a review on 28 cases, the authors have determined whether the Sistrunck's operation was too extensive in the treatment of thyroglossal duct cysts. 28 surgicals procedures have been performed during five years, 6 Schlange's procedure and 22 Sistrunck's procedure. We have had 17% of complications with only one recurrence, after six months, with Schlange's operation. During the interventions, we have been able to see and feel a duct in only one case. This difficulty in determining the presence of a duct intra-operatively could suggest that there was no duct. So we have undertaken a histological study of all 28 specimens obtained from surgery. Results showed the presence of one or multiple tracts in 72% of cases. Finally, this study show that Sistrunck's procedure is still the best operation for treatment of all cases of thyroglossal duct cysts. All other operations, and particularly Schlange's procedure, are inadequate because they are in contradiction with histological and embryological studies.