bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Pediatric Obstructive Sleep Apnea Severity with Sleep Endoscopy Findings: A Pilot Study
Authors: Lam Derek J. , Weaver Edward M. , O'Neill Eleni I. , Milczuk Henry A. , MacArthur Carol J. , Shea Steven A
Published: September 2014

Objectives:

(1) Determine the association of a sleep endoscopy rating scale with pediatric obstructive sleep apnea (OSA) severity. (2) Assess the reliability of this rating scale.

Methods:

This was a retrospective cohort study of pediatric patients who underwent drug‐induced sleep endoscopy (DISE) from January to December 2013 at a tertiary care children's hospital. DISE recordings were reviewed by 2 blinded senior pediatric otolaryngologists. Severity of obstruction was scored 0, 1, or 2 for no, partial, or complete obstruction at 6 levels: nasal airway, nasopharynx, velum, oropharynx, tongue base, and arytenoids. Ratings at each level were summed for a total score from 0‐12. Associations of DISE scores with obstructive apnea‐hypopnea index (OAHI) and OSA‐18 scores were assessed using linear regression. Interrater and intrarater reliability were calculated using a kappa statistic with linear weighting.

Results:

Twenty patients were included (mean age 8.4 ± 5.1 years, 55% obese, mean OAHI 16.5 ± 15.6). Associations between OAHI and DISE scores were strongest for the nasopharynx (beta = 12.3, P =. 09) and total score (beta = 4.7, P =. 06). Associations between OSA‐18 and DISE ratings were strongest for the nasopharynx (beta = 11.1, P =. 08) and velum (beta = 12.8, P =. 07). There was fair‐moderate interrater reliability (kappa 0.24‐0.63) and moderate‐almost perfect intrarater reliability (kappa 0.52‐0.88) at individual anatomic sites.

Conclusions:

Although observed associations did not reach statistical significance, this pilot study suggests clinically important associations between DISE ratings and OSA severity and showed promising interrater and intrarater reliability.
Comparative Analysis of Transient Otoacoustic Emission in At‐Risk and Well Neonates
Authors: Akinola Moronke D. , Onakoya Paul A. , Tongo Olukemi O. , Lasisi Olawale A. , Adeniji Adedotun A.
Published: September 2014

Objectives:

(1) Describe the referral rate of hearing loss in well and at‐risk neonates as assessed with transient otoacoustic emission (TEOAE) audiometry. (2) Analyze the association between risk factors for hearing loss and TEOAE referrals.

Methods:

This was a 2‐staged cross‐sectional evaluation of hearing loss among 386 neonates; 276 well babies without any risk factors and 110 babies with at least 1 risk factor at the University College Hospital, Ibadan. Data were collected from January 2010 to April 2010. Their ears were evaluated for presence of TEOAE with wideband click of 80‐microseconds’ duration at 6 frequencies within 1.5‐kHz to 4‐kHz at 83 dB pe SPL (±3). Results were automatically displayed as pass or refer. Chi‐square test and logistic regression were used to determine the association between the risk factors and hearing loss. The level of significance was P <. 05.

Results:

The overall referral rate with TEOAE was 8.5%, 5.2% among the at‐risk and 3.3% for those not at‐risk (P =. 001). The following risk factors were found to be significant with a referral outcome with TEOAE; prematurity (P =. 001), multiple births (P =. 030), jaundice (P =. 001), and birth weight less than 1.5 kg (P =. 003). Logistic regression showed that prematurity was a significant predictor of hearing screening outcome with TEOAE (P =. 017).

Conclusions:

This study demonstrated that the prevalence of congenital hearing loss in newborns is high in our environment and those at‐risk have a higher probability of developing hearing loss.
Contact Laser and Skeeter Microdrill Repair of Choanal Atresia in Low‐Birth Weight Neonates: 10‐Year Study
Authors: D'Eredita Riccardo
Published: September 2014

Objectives:

Describe and demonstrate by video the transnasal endoscopic repair of bilateral mixed or bony choanal (BMCA/BBCA) in low‐weight newborns using 1.7‐mm diameter telescope and a 0.3‐ to 06‐mm diameter fiber‐delivered contact diode laser (CDL) at 810‐nm wavelength and combined use of Skeeter stapes microdrill.

Methods:

Prospective study at a tertiary‐care pediatric institution of 11 neonates with BMCA or BBCA, aged 3 to 11 days, weighing 1.8 kg to 2.5 kg. A transnasal endoscopic approach with contact diode laser and/or combined use of skeeter microdrill was applied in all children. All patients were stented bilaterally from 4 to 13 weeks. Patients were followed by serial weekly clinical examinations, rigid endoscope examination at stents removal and/or revision surgery, with subsequent revision surgery if needed. Second surgical revision was performed in 5 children, while 1 child required a third procedure. Five children required 1 procedure only. Further postoperative endoscopic examinations were scheduled for 3, 6, 12 months, and then an annual endoscopic examination was performed.

Results:

No complication after surgery was encountered, and all children were discharged the second day after surgery. Follow‐up time frame ranged from 1 to 10 years. Neither restenosis nor craniofacial growth abnormality was seen.

Conclusions:

BMCA/BBCA was successfully repaired using this narrow endoscopic contact combined microdrill/laser approach, with no complications and a reduced need for revision surgery compared with prior reports. This new surgical technique is demonstrated to treat BMCA/BBCA in small birth weight neonates. Further studies are warranted.
Delayed‐Onset Hearing Loss: Prevalence in Early School‐Aged Children
Authors: Pritchett Cedric , Pan Warren , Thorne Marc C. , Dakers Jennifer
Published: September 2014

Objectives:

(1) Demonstrate the prevalence rate of delayed‐onset hearing loss in the early school‐aged population for the academic year 2010‐2011 in a single county of southeastern Michigan, and the state at large. (2) Describe the statewide hearing screening program used in the above population.

Methods:

Audiometric records of the Oakland County Health Department and the Michigan Department of Community Health for children participating in school‐based hearing screening during academic year 2010‐2011 were identified. Cross‐sectional review of school‐based hearing screening results of children in kindergarten, first, second, and fourth grades was performed. Failures were identified and audiograms analyzed confirming hearing loss type. In individuals with sensorineural loss, state newborn screening registries were queried to determine those with true delayed‐onset. Demographics and degree of hearing loss on these individuals were collected. Prevalence using official state‐level enrollment and census data was calculated.

Results:

A total of 46,501 children (~83% of grade‐based cohort) participated in school‐based hearing screening. Of the 1701 children who failed screening pure tone audiometry, 119 were found to have delayed‐onset sensorineural or mixed hearing loss. Male predominance was slight (53%), and 46% had bilateral losses. Newborn hearing screening occurred in the first week of life in the majority (85%). A prevalence of 1.7 to 2.1 out of 1000 in Oakland County was calculated. Delayed‐onset hearing loss is projected to have affected between 1325 and 1347 children in this grade cohort statewide during the study period.

Conclusions:

Delayed‐onset hearing loss remains a not infrequent condition. School‐aged hearing screening programs offer a valid mechanism to identify children with this condition.
Epidemiology of Tympanoplasty in Children following Tympanostomy Tube Placement
Authors: Alrwisan Adel , Antonelli Patrick J. , Winterstein Almut G.
Published: September 2014

Objectives:

Quantify the incidence rate of tympanoplasty after tympanostomy tube (TT) insertion in children.

Methods:

This was a retrospective cohort study of healthy children <18 years old using Medicaid Extract Files from 1999 to 2004. All subjects received TTs and had at least 6 months continuous Medicaid eligibility prior to TTs. We followed patients for 2 years after TTs. The Kaplan‐Meier procedure was used to estimate time to tympanoplasty.

Results:

There were 270,408 children with billing records for TTs, and 141,243 met inclusion criteria with a follow‐up time of 217,431 patient‐years. Median age at TTs was 1.62 year, with 58.5% placed at <2 years. Subsequent tympanoplasty was performed in 963 (0.68%), with 324 at age 2‐4 years. The median age at tympanoplasty was 5.1 years. Median time from TTs to tympanoplasty was 450 days. The incidence rate of tympanoplasty was 44 cases per 10,000 patient‐years (95% confidence interval 41 to 47).

Conclusions:

Tympanoplasty following TTs is not uncommon. These repairs are commonly performed in preschool children and often within 2 years of TT placement.
Guinea Pig Model to Establish the Safety of Middle Ear Pellets
Authors: Hoskison Emma E. , Daniel Matija , Qureishi Ali , Lee Y. S. , Mulheran Mike , Bayston Roger , Birchall John P.
Published: September 2014

Objectives:

Effective treatments for otitis media with effusion (OME) remain elusive as many patients have recurrence. Direct drug delivery to the middle ear has the potential to maximize efficacy, minimize side effects, and provide a sustained release treatment, which is particularly important in the treatment of biofilms. Polymer‐based pellets are delivery vehicles for antibiotics and pellet placement in the middle ear is a potential future OME treatment. In vivo testing of these pellets in animal models is necessary prior to human application.

Methods:

Twenty‐four adult guinea pigs were divided into 3 (n = 8) treatment groups: biological controls, surgical controls, polylactic glycolic acid (PLGA) pellets inserted in middle ear. The surgical approach involved submandibular incision, dissection, and following digastric up to the middle ear bulla. Perforating the bulla wall facilitated a 2.5‐mm diameter pellet insertion. Auditory brainstem responses (ABRs) were recorded at 0, 1, 2, 4, and 16 weeks at 6 frequencies over 8 to 30 kHz. Analysis was performed using a paired t test with significance set at P <. 05 (Bonferroni correction).

Results:

Mean ABR thresholds across the 3 groups ranged between 42 and 49 dB SPL over 4 weeks. There were statistically significant threshold elevations between 4‐10db SPL in the surgical control and pellet groups although these were not considered physiologically significant.

Conclusions:

Using a guinea pig model, PLGA pellet insertion into the middle ear caused ABR threshold elevation of only 4‐10 dB SPL, supporting their use as a potential vehicle for middle ear drug delivery.
Management and Outcome of Airway Infantile Hemangiomas
Authors: Akyol Mehmet U. , Unal Omer F. , Gunaydin Riza O. , Senirli Rezarta T. , Kuscu Oguz
Published: September 2014

Objectives:

(1) Analyze the data of our series of cases of infantile hemangiomas (IH). (2) Describe the clinical characteristics and contemporary treatment modalities of the disease to general and pediatric otorhinolaryngologists.

Methods:

The medical records of children diagnosed with airway hemangiomas at Hacettepe University Hospital, Department of Otolaryngology between 2005 and 2013 were reviewed retrospectively. The study included 17 patients with IH of the airway. Four patients (23.5%) were male and 13 (76.5%) were female. All of the patients received medical treatment. Six patients (35%) did not respond to medical treatment and surgical intervention was needed. Five in the surgical group required tracheotomy.

Results:

All patients with tracheotomies were decanulated and stridor in all of them either disappeared or significantly improved. Endoscopic examinations of all of the patients revealed an open and safe lumen. After beginning propranalol as the medical agent, only one patient needed surgical intervention. None of the patients had any major complications.

Conclusions:

Medical treatment with propranalol of subglottic hemangioma is the first line choice. If medical treatment options fail, surgical intervention should be considered. Overall purpose should be the patient's airway safety.
Mandibular Distraction Osteogenesis in Patients with Pierre Robin Sequence: Preoperative Assessment Determines Success
Authors: Bodily Nathan , Lypka Michael , Teichgraeber John F. , Yuksel Sancak , Oy Soham
Published: September 2014

Objectives:

(1) Understand the importance of an interdisciplinary approach to the selection of patients with Pierre Robin sequence for mandibular distraction osteogenesis. (2) Recognize that unfavorable outcomes can be linked to inaccurate preoperative assessment.

Methods:

A retrospective review of 10 consecutive patients with Pierre Robin sequence who underwent mandibular distraction from July 2011 to July 2013 at Children's Memorial Hermann Hospital was performed. Age at distraction, associated syndromes and medical conditions, pre‐ and postoperative sleep studies, and complications were evaluated. Follow‐up ranged from 6 months to 2 years.

Results:

A total of 10 patients with Pierre Robin sequence underwent mandibular distraction. Two had defined syndromal diagnoses and two had undefined chromosomal abnormalities. Average pre and postoperative AHI were 31.5 and 4.5, respectively. Average distraction length was 24 mm. Eight of the 10 patients who underwent distraction had successful outcomes defined by relief of obstructive apnea, reduction in AHl, and improved feeding at 2 months. Two patients had unfavorable outcomes. One did not respond to the distraction procedure and had a delayed diagnosis of spinal muscular atrophy, ultimately resulting in death. The other patient had multiple congenital anomalies and failed to respond to the distraction. The patient had significant laryngomalacia on post distraction repeat L and B, required tracheostomy, and later died of cardiac shunt failure.

Conclusions:

In the properly selected patient, mandibular distraction in patients with Pierre Robin sequence can be successful. Preoperative assessment involves both art and science, but ultimately determines the success or failure of the distraction procedure.
Medical and Surgical Management of Congenital Laryngomalacia: A Retrospective Case‐Control Study
Authors: Faria John , Behar Philomena
Published: September 2014

Objectives:

Compare the growth of infants with moderate to severe laryngomalacia who underwent supraglottoplasty to the growth of those treated with medical therapy alone.

Methods:

Retrospective case‐control chart review of patients treated between 2008 and 2013 in a tertiary care pediatric otolaryngology practice. 51 infants newly diagnosed with moderate to severe congenital laryngomalacia were included. A total of 17 infants underwent supraglottoplasty and 34 matched controls had medical management, which included acid suppression therapy, speech and swallowing therapy, and/or high‐calorie formula. The primary outcome measure was weight percentile recorded at the second clinic visit and at the last available follow‐up. The secondary outcomes were the need for tracheostomy or gastrostromy, development or persistence of failure to thrive, surgical complications, and new onset developmental delay. The management strategy was considered a success if none of the secondary outcomes occurred.

Results:

There was no difference in the mean weight percentile between the surgical and nonsurgical groups at the time of last follow‐up (P =. 89). Twenty‐nine (85%) patients in the medical management group and 12 (71%) in the surgical group were managed successfully. There were no statistically significant differences in the success rate between groups (P =. 27).

Conclusions:

Medical management and close observation of infants with moderate to severe congenital laryngomalacia may be a viable alternative to supraglottoplasty.
Modification of the Laerdal MegaCode Kid Mannequin Head to Simulate Aspiration of Peritonsillar Abscess
Authors: Fox Daniel P. , Larrier Deidre R.
Published: September 2014

Objectives:

(1) Validate a low‐fidelity mannequin model engineered to teach drainage of peritonsillar abscesses. (2) Pilot this mannequin model in instructing incoming otolaryngology residents on drainage of peritonsillar abscesses.

Methods:

A peritonsillar abscess (PTA) simulator was constructed through modification of the Laerdal MegaCode Kid Mannequin head using inexpensive components. Tonsils were constructed from Dermasol, and the peritonsillar abscess was simulated by placing a balloon filled with a mixture of water and body lotion behind the appropriate soft palate region. A feedback electrode was placed behind this to create an audible buzz if the needle went too far, simulating entrance into the carotid artery. The model was validated by a panel of experts through survey, and subsequently used to teach PTA drainage to PGY2 otolaryngology residents.

Results:

The expert panel unanimously agreed that they would use the device to teach PTA drainage to trainees. The model was then used to instruct a novice group (N = 6). The majority of this novice group reported that the session was a vital part of their training experience, and it was important to practice drainage of a PTA on a mannequin.

Conclusions:

We validated a mannequin task trainer for drainage of peritonsillar abscesses and successfully implemented it into a teaching session. Given the frequency of presentation of PTA, the need to become competent in the procedure early in residency, and the success demonstrated using our model, we believe the model could be inexpensively replicated at other institutions for more safely and effectively teaching the procedure.
Nonsurgical Radiofrequency Volumetric Reduction of Adenoidal Hypertrophy
Authors: Naraghi Mohsen
Published: September 2014

Objectives:

Adenoidal hypertrophy (AH) is the most common cause of pathologic mouth breathing in children. Medical treatment of adenoid hypertrophy includes treatment of allergies, nasal sprays, and antibiotics. However, in some cases AH continues to produce symptoms despite maximal medical therapy. Potential risks of anesthesia and complications of surgical procedures have led to the promotion of non‐surgical alternatives. During the past 3 years, advances in expertise and technology led to the new advent of using office based setting for nonsurgical procedures by the author as an innovative method for treatment of AH.

Methods:

Sixty five children who were definitive candidates for surgical adenoidectomy were managed with radiofrequency treatment under endoscopy control without any need of general anesthesia. The age range was between 4 and 15. All children underwent direct endoscopic examination of adenoid before and after procedure.

Results:

The period of follow‐up was from 2 to 32 months. Patients experienced different degrees of improvement after nonsurgical procedure, according to a researcher‐based questionnaire. The results were impressive for some parents because of marked improvement by very simple procedure as compared to surgery.

Conclusions:

Nonsurgical radiofrequency reduction of adenoid size has multiple advantages: excellent magnified view of adenoid area, accurate reduction of central obstructing part of adenoid, nonbleeding, evaluation and treatment of other nonadenoid obstructing problems, complete preservation of normal nasopharyngeal structures, no general anesthesia, no operating room stress, no hospitalization, high safety, no complications, and better patient tolerance using this fast and easy procedure.
OSA and Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital
Authors: Ibrahim Shahrul I. , Anicete Rosslyn C. , Ang Annette Hui‐Chi , Balakrishnan Abhilash , Tan Henry K. K.
Published: September 2014

Objectives:

Obstructive sleep apnea (OSA) has been hypothesized to be protective against postoperative tonsillectomy hemorrhage, presumably due to the upregulation of prothrombotic factors. This study investigates this possible correlation in patients at our institution.

Methods:

A 6‐year retrospective case control study of tonsillectomy only and adenotonsillectomy cases done on children up to 16 years of age, from the end of January 2007 through the end of January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis were recorded.

Results:

There were 2320 tonsillectomy cases. A total of 1581 were adenotonsillectomies and 730 were bilateral tonsillectomies only. Thirty‐four cases returned to the operating room for hemostasis. Overall postoperative hemostasis rate was 1.47%. A total of 450 cases were listed as recurrent tonsillitis, 383 listed as OSA (confirmed on polysomnography [PSG]), and 1487 listed as adenotonsillar hypertrophy (no PSG done, presumed OSA). Of the 34 cases that returned to theatre, 9 were OSA cases, 8 were recurrent tonsillitis, and 17 were for hypertrophied tonsils (presumed OSA), giving a postoperative hemostasis rate of 1.39% for the OSA patients and 1.78% for recurrent tonsillitis.

Conclusions:

Despite the possible upregulation of prothrombotic factors in OSA, we found no real difference in postoperative tonsillectomy hemostasis rate in our patients, contrary to findings in other studies.
Otolaryngological Manifestations in Mucopolysaccharidoses
Authors: Gomes Erika F. , Vasconcelos Francisco D. A. , Alcantara Patricia , Cabral Ticiana , Ribeiro Erlane M.
Published: September 2014

Objectives:

(1) Describe the most prevalent findings of anamnesis and physical otolaryngologic examination in patients with mucopolysaccharidoses (MPSs), which are a lysosomal storage disorder group caused by deficiency of enzymes involved in catabolism of glycosaminoglycans. (2) Evaluate the importance of a multidisciplinary approach for MPSs patients.

Methods:

A descriptive cross‐sectional (prevalence) study performed in January 2014. Thirty‐four MPSs patients followed at a tertiary teaching hospital were invited, from which 25 participated from the study, with agreement of their families. Questionnaires were answered by their parents and a physical examination was done. The analyzed variables were otologic, pharyngolaryngeal, and nasal and respiratory signs and symptoms.

Results:

Among the evaluated patients, 52% (13/25) were male and 48% (12/25) female. The average age was 12.44 years at examination and 5.14 years at MPS diagnosis. The most frequent subtype was MPS VI (12/25). Hearing complaints were present in 60% (15/25) of patients, snoring in 44% (11/25), with witnessed sleep breathing pauses in 24% (6/25). The number of pharyngotonsillitis and upper airway infections was 1.68 and 3.36 episodes in the past year, respectively. Important findings on physical examination were: hyperplastic gums (60%‐15/25), modified Mallampati score IV (64%‐16/25), tonsil size grade III (60%‐16/25), flattened nasal pyramid (80%‐20/25), and tympanic retraction (24%‐6/25).

Conclusions:

There is a high prevalence of ear, nose, and throat manifestations that requires further investigation and possibly intervention, such as suspected respiratory sleep disturbances and hearing loss. There was a similar prevalence of respiratory tract infections as expected for age. Results support recommendation for multidisciplinary approach.
Pediatric Laryngotracheal Stenosis Management: 10 Years’ Experience at the Hacettepe University Otorhinolaryngology Department
Authors: Akyol Mehmet U. , Gunaydin Riza O. , Unal Omer F. , Yilmaz Taner
Published: September 2014

Objectives:

Analyze surgical treatment modalities for pediatric laryngotracheal stenosis.

Methods:

We retrospectively reviewed patients that underwent laryngotracheal surgery for stenosis between 2002 and 2012. Age, sex, etiologic factors, stenosis grades, comorbidities, surgical techniques, decannulation rates, and complications were evaluated. There were subglottic stenosis (SGS), posterior glottis stenosis (PGS), and tracheal stenosis (TS). Surgical details and outcomes were examined for endolaryngeal procedures, laryngotracheal reconstruction (LTR), partial cricotracheal resection (PCTR), and tracheal resection (TR).

Results:

There were 44 patients. Prolonged intubation because of trauma was the leading primary cause of stenosis. Congenital stenosis and congenital heart disease operations were also present frequently. There were 20 LTRs, 13 endolaryngeal balloon dilatation, 7 PCTRs, and 4 TRs. Decannulation was successfully accomplished in 27 of 32 patients (84%). Overall success rate in airway management was 91% (40/44). Restenosis was observed after 8 LTRs and 2 PCTRs. Major complications were bilateral recurrent nerve paralysis, postoperative death due to sepsis, and accidental extubation with an overall rate of 6% (3/44).

Conclusions:

Pediatric airway surgery needs good multidisciplinary cooperation. Correct indication and precise surgical technique are important factors in determining the results. Endolaryngeal procedures should be performed only for membranous and/or low grade stenosis cases, otherwise they cause more tissue damage, leading to fibrosis that complicates the pathology. LTR with anterior and/or posterior grafting is suitable for grade II and III stenosis, while PCTR should be the first choice of treatment for grade IV stenosis. Open surgical procedures should be performed as a single stage surgery if possible.
Pediatric Parotidectomy: A 20‐Year Experience at a Single Institution
Authors: Britt Christopher J. , Kille Tony
Published: September 2014

Objectives:

Review a single institution's experience with parotidectomy in pediatric patients.

Methods:

A retrospective chart review was performed on children undergoing parotidectomy between 1994 and 2013. Data included presenting symptoms, tumor histology, postoperative complications, facial nerve weakness, and disease recurrence.

Results:

Forty‐two pediatric patients underwent parotidectomy. Preoperatively, 16 patients (38%) presented with an asymptomatic mass, 7 (17%) had pain, 18 (43%) had recurrent infection, and 6 (14%) had skin involvement. Surgical pathology revealed 20 (48%) infectious or inflammatory lesions, 15 (36%) benign lesions, and 7 (17%) malignant lesions. The infectious and inflammatory lesions included granulomatous infections (26%), hyperplastic lymphadenopathy (12%), and chronic sialadenitis (10%). Lymphangioma (14%) and pleomorphic adenoma (12%) were the most common benign lesions. Malignant lesions included one (2.4%) of each of the following: acinic cell carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, melanoma, scute lymphoblastic leukemia, Hodgkins lymphoma, and Langerhans histiocytosis. The patient with adenoid cystic carcinoma had recurrence of disease, and required a second extirpative surgery. Facial weakness occurred in 19 (45%) patients. Of these, 9 (47%) had infectious or inflammatory lesions. Permanent weakness occurred in 5 (12%) patients. The facial nerve was intentionally resected in one patient (recurrent adenoid cystic carcinoma); the other 4 had surgery for infectious or inflammatory lesions. Additional complications included facial pain (3 patients), wound infection, seroma, and Frey syndrome (one each).

Conclusions:

Short‐term facial paresis is common in pediatric parotidectomy, especially when surgery is for infectious or inflammatory disease. Parotid neoplasms are uncommon and malignancies are especially rare.
Perinatal Medical Risks Associated with Auditory Neuropathy Spectrum Disorder
Authors: Peng Kevin A. , Wu Edward C. , Haji Farnaz , West Alisha N.
Published: September 2014

Objectives:

(1) Determine perinatal medical factors associated with auditory neuropathy spectrum disorder (ANSD). (2) Compare risk factors associated with ANSD to those in sensorineural hearing loss (SNHL).

Methods:

Retrospective case‐control study of children diagnosed with ANSD at an academic tertiary care center between July 2009 and January 2014. Inclusion criteria for the ANSD group were normal otoacoustic emissions, absent or elevated middle‐ear muscle reflexes, and severely abnormal or absent auditory brainstem response waveforms. The ANSD group was compared with 2 age‐ and sex‐matched control groups: (1) normal‐hearing children and (2) children with SNHL.

Results:

Twenty‐two patients (15 male, 7 female) met ANSD inclusion criteria, and were matched to 2 control groups as described above. Case and control groups were assessed for the following perinatal risk factors: prematurity, low birth weight, hyperbilirubinemia, mechanical ventilation, and administration of ototoxic antibiotics. On multivariate logistic regression between ANSD and normal‐hearing groups, hyperbilirubinemia (P =. 006) and administration of ototoxic antibiotics (P =. 004) were significantly associated with an increased odds ratio (OR) toward developing ANSD. Comparing ANSD and SNHL groups, the only significant risk factor for development of ANSD was hyperbilirubinemia (P =. 005, odds ratio = 12).

Conclusions:

ANSD, a clinical spectrum of disease united by normal cochlear function but abnormal auditory pathway transduction, remains an enigmatic entity. In the present study, matched comparisons between ANSD versus normal‐hearing and SNHL control groups identified perinatal hyperbilirubinemia and ototoxic antibiotics as significant risk factors. Diligent hearing evaluation to diagnose ANSD in infancy, particularly among patients with a perinatal history of hyperbilirubinemia, is critical.
Primary Molar Crown Height in Children with Recurrent Acute Otitis Media
Authors: Teixeira Miriam S. , Andrews Rebecca G. , Swarts J Douglas , El‐Wagaa Jenna A. , Martin Brian S. , Casselbrant Margaretha
Published: September 2014

Methods:

This cross‐sectional study compared dental occlusion in 56 children (29 males and 27 females) between 5 and 7 years of age (mean of 5.8 years) enrolled in an ongoing, longitudinal study designed to characterize the changes in Eustachian tube (ET) anatomy and function between 3 and 8 years of age. Subjects with cleft palate, other syndromes predisposing to otitis media (OM), cholesteatoma, or past/current orthodontic treatment were excluded. Dental casts were made between 5 and 7 years of age and selected measurements on the casts from 29 children with a confirmed history of recurrent acute otitis media (rAOM) that required placement of ventilation tubes were compared to those from 27 children with no past history of middle ear disease.

Results:

The measurements included overbite (%), overjet (mm) and mandibular second primary molar crown height (mm) made using a calibrated perioprobe and occlusal relationships referenced to the first molar were assigned. A discriminant function analysis identified average crown height (Avg CH) only as a predictor of group assignment and this was confirmed using a general linear model where Avg CH controlled for age was significantly higher in the control group (P =. 005) but not different between sexes or among races. While the sample population was relatively small, the enrolled subjects were prospectively followed for disease course and the group assignment is expected to be highly accurate.

Conclusions:

The results support those for a previously published study that reported a lesser vertical dimension of occlusion to characterize children with ET dysfunction and ME disease.
Risk Factors for Refractory and Delayed De Novo Otitis Media Requiring Pressure Equalization Tube Insertion
Authors: Bowe Sarah N. , Vargo James D. , Abramoff Claire , Jatana Kris R. , Kang D. Richard
Published: September 2014

Objectives:

There is substantial information regarding environmental and clinical risk factors for otitis media in young children; however, limited data exist in 6‐ to 12‐year‐old patients and specifically those in which surgical intervention is performed. This study investigated potential risk factors for de novo or refractory otitis media in this older age group who required pressure equalization tube (PET) insertion.

Methods:

A retrospective study was performed at a tertiary care academic hospital for children 6 to 12 years old undergoing PET insertion between October 1, 2010, and September 30, 2011. The data were stratified into 2 separate age cohorts (6‐7 versus 8‐to 12‐year‐olds) for analysis.

Results:

A total of 263 patients met the inclusion criteria. PET insertion was more common in the 6‐year‐old age group (36%, 95/263), which decreased by age with a negative relationship. No significant sex‐based difference was observed. Presence of siblings (P <. 05), otalgia (P <. 05), otorrhea (P <. 001), nasal discharge (P <. 001), and trends of parental smoking (P =. 09) and hearing loss (P =. 06) were identified in the older cohort. No statistical significance was found for history of recurrent acute otitis media (RAOM), allergy, asthma, or atopy between the 2 groups (P =. 22‐.97).

Conclusions:

The older cohort (ages 8‐12 years old) had more infectious symptoms including otalgia, otorrhea, and nasal discharge than the younger cohort (ages 6‐7 years old). In contrast, history of RAOM, allergy, asthma, and atopy were not significantly different between these age groups. Overall, this study provides further understanding of pertinent risk factors in older children requiring new or recurrent PET insertion.
The Effect of Jaw Exercise on Trismus in Head and Neck Cancer Patients
Authors: Finizia Caterina A. , Pauli Nina
Published: September 2014

Objectives:

Trismus is a symptom that impacts daily life activities and adversely affects patient health‐related quality of life (HRQL). Radiation‐induced fibrosis is probably one of the most important etiological factors to trismus in head and neck cancer (HNC). The aim of this randomized prospective study was to compare 2 different jaw exercise devices, regarding improvement in mouth opening (MIO) and patient‐reported symptoms in HNC patients with trismus.

Methods:

The 50 study patients were enrolled in a 10‐week structured MIO training program and randomized to training with either TheraBite® device or Engström jaw device. The patients were regularly assessed by an oral surgeon and answered different questionnaires (ie, EORTC HN35 and the Gothenburg Trismus Questionnaire [GTQ])).

Results:

Both groups improved their MIO, 7.2 mm (22.9%) and 5.5 mm (17.6%) for TheraBite® and Engström, respectively. The largest increase in MIO was seen during the first 4 weeks of exercise. After the exercise periods 84% in the TheraBite® group (n = 21) and 60% in the Engström group (n = 15) no longer fulfilled the trismus criteria. A statistically significant improvement regarding trismus related symptoms in both groups with less pain, jaw‐related problems, and eating limitations after the exercise period was found (P <. 05 and P <. 01).

Conclusions:

Structured intervention with a jaw exercise device improved the mouth opening capacity with less trismus‐related symptoms in HNC patients. No statistically significant differences between the different devices were found. We suggest a feasible exercise program for radiation‐induced trismus in HNC patients.
Role of Cochlear Microphonics in Newborn Hearing Screening
Authors: Kwak Min K. , Chung Jae Ho , Lee Seung Hwan , Park Chul Won , Cho Seok Hyun , Jeong Jin Hyeok
Published: September 2014

Objectives:

Investigate the role of cochlear microphonics (CM) that could be simultaneously acquired in auditory brain stem response (ABR) test in neonatal hearing screening.

Methods:

From April 2013 to January 2014, hearing screening tests were performed on 51 newborns treated in neonate intensive care unit. The subjects underwent transient evoked otoacoustic emission (TEOAE) and auditory brain stem response (ABR). The amplitude of CM was acquired by applying 90 dB‐click sound of condensating and rarefacting polarity.

Results:

There were 68 ears with normal results in ABR, CM and OAE. Auditory neuropathy was suspected in 2 ears that had presence of CM and OAE with abnormal ABR waveform. Amplitude of CM correlated with reproducibility of OAE (p<.01) inversely correlated with latencies of wave I and III (P =. 016, P =. 010). The subjects with presence of OAE showed higher amplitude of CM than those with absent OAE (P <. 01). Mean CM amplitude of subjects with normal ABR threshold was higher than those with abnormal ABR, but there was no statistical significance. Five subjects who had normal ABR threshold showed no OAE response but CM was measured.

Conclusions:

Amplitude of CM had correlation with results of OAE and ABR test. CM might provide more stable information about cochlear hair cell than OAE test which could be easily influenced by condition of middle ear or external ear. We suggest CM as a useful supplementary tool for OAE test.
Role of Polysomnography in Children When Clinical Indicators of Sleep‐Disordered Breathing Are Met
Authors: Lam Herman P. , Ramadan Hassan H.
Published: September 2014

Objectives:

Sleep‐disordered breathing (SDB) affects approximately 12% of children, ranging from snoring to obstructive sleep apnea (OSA). Polysomnography (PSG) is the gold standard for diagnosing SDB and has been increasingly obtained in children. Some feel PSG is underutilized given recent clinical guidelines; however, others believe that if the clinical indicators for OSA are present, a PSG is unnecessary. The purpose of this study was to determine the effectiveness of clinical indicators in predicting PSG results in children.

Methods:

A retrospective review of PSG on children between 2 and 18 years old ordered by an otolaryngologist at West Virginia University between January 2011 and November 2013. Recorded variables included: age, sex, symptoms of gasping, snoring, restlessness, body mass index, previous adenoidectomy, tonsil size, and apnea‐hypopnea index (AHI). Statistical analysis was used to compare positive PSG with clinical indicators.

Results:

Ninety‐five patients were reviewed with 73 meeting inclusion criteria. Age range was 2 to 17 years (mean, 5.3 years) and mean AHI was 3.26. Gasping showed a statistical significant correlation with positive PSG (61.9% positive, P <. 05). Overweight/obese patients with gasping had a 73.3% positive PSG. Snoring and restlessness did not have a statistically significant correlation with positive PSG; however, restlessness was approaching clinical significance. One patient (25%) without gasping and restlessness combined had positive PSG. Gasping had a statically significant higher mean AHI of 4.3 compared to 2.2 without symptoms of gasping. Neither snoring nor restlessness showed statistically significant higher AHI.

Conclusions:

Gasping is an effective clinical indicator in predicting positive PSG and diagnosing OSA in children.
Treatment and Outcome of Otitis Media with Effusion in Cleft Palate Patients
Authors: Tan Amanda En‐Pei , Tan Bernard W. , Hoe Ying Min , Ang Annette Hui‐Chi
Published: September 2014

Objectives:

Otitis media with effusion (OME) is established to be universally present in children with cleft palate. It is found to be most prevalent during the age of 4 to 6 years. This problem may continue to recur in this group of patients, seeming to settle during adolescence. The aim of this retrospective study was to examine OME in cleft palate pediatric patients, with or without cleft lip, and determine the average number of ventilation tube insertions required for this group of patients from birth to 16 years of age.

Methods:

This retrospective study reviewed 258 pediatric patients who have undergone cleft palate repair and myringotomy with ventilation tube insertions in KKWCH during the period from 1990 to 2012. Information to be collated included: type of cleft, when repair of the cleft was performed, when ventilation tubes were inserted, and how many ventilation tube insertion procedures were performed.

Results:

The period of follow‐up ranged from 2 to 13 years. The ratio of boys to girls was 1.3 to 1. It was found that a large percentage of patients between 2 years to 13 years of age had 3 or less sets of ventilation tube insertions. The youngest to have received tube insertion was 7 weeks old. The oldest was 14 years old.

Conclusions:

OME in cleft palate patients may be a recurrent problem. Knowing the likely progression of the disease is useful when counseling the parents involved.
Use of Concentrated Light to Determine Middle Ear Effusion: The Laser Otoscope
Authors: Seth Rahul , Ford Matthew R. , Hawley Karen A. , Rollins Andrew , Krakovitz Paul R.
Published: September 2014

Objectives:

(1) Appreciate the current diagnostic limitations and significant misinterpretation rate (nearly 50%) of acute otitis media (AOM) and otitis media with effusion (OME) by general practitioners and pediatricians using the conventional otoscope. (2) Recognize the optical properties of middle ear effusion (MEE) and this innovation's ability to improve diagnosis using a concentrated (laser) light.

Methods:

Laser otoscopes were developed and designed with class IIIa lasers. The laser propagates with the incandescent light to illuminate on the tympanic membrane (TM). An institutional review board–approved prospective pilot study was completed at a tertiary care hospital. Study patients were 1 to 18 years and undergoing ear tube placement. The laser otoscope was used on each ear for assessment of MEE prior to myringotomy. The simple objective presence or nonpresence of a glow of the laser on the TM surface was recorded. Presence of a glow signified MEE due to the dispersion quality of light through liquid versus air. True presence of MEE was then determined with myringotomy.

Results:

Fifty ears (25 patients) were enrolled. Assessing only for a simple objective glow without any further interpretation of the middle ear contents yielded an 89.4% accuracy for determining MEE.

Conclusions:

The laser otoscope is a novel, simple, and potentially extremely useful tool for assisting in otoscopic determination of fluid in the middle ear. Particularly among primary care givers, MEE assessment may be able to be increased from nearly 50% to nearly 90%, by simply assessing for a laser glow or no‐glow on the TM surface.
Utilization of Exome Sequencing for Diagnosis and Discovery of Genetic Causes of Sensorineural Hearing Loss
Authors: Tilton Richard K. , Noon Sarah E. , Wilkens Alisha , Jayaraman Vijayakumar , Brunton Joshua , Krantz Ian D. , Germiller John A.
Published: September 2014

Objectives:

Exome sequencing (ES) is a single platform test that screens the exons of nearly all genes and is increasingly being used in the clinical diagnosis of hearing loss due to the large number of genes etiologically implicated. Our goals were to explore (1) the utility and limitations of ES for diagnosis in children with sensorineural hearing loss (SNHL) and (2) its ability to discover novel genes causing SNHL.

Methods:

Thirty‐six children with bilateral SNHL underwent ES: 26 without an etiology for their SNHL after standard clinical testing, and a control group of 10 with known mutations. Exome variants were initially filtered using a list of 264 genes associated with hearing loss.

Results:

In the 10 children with known mutations, all were correctly identified by ES except 3 large deletions. Analysis of the 26 unknown samples found likely pathogenic mutations in 8 (31%). A definitive diagnosis was obtained in 1 additional child, who had an unusual MITF mutation that led to the diagnosis of Waardenburg syndrome. In one other family, a novel candidate gene was identified which previously has never been implicated in human disease. Affected children in that family had profound SNHL accompanied by malformation of the vestibular labyrinth. Mutations in this gene segregated as expected among the 8 family members.

Conclusions:

ES is a powerful tool for both diagnosis and discovery for genetically heterogeneous conditions like SNHL. Despite limitations inherent to using gene lists and only sequencing exons, this technology has great promise for helping ascertain the etiology of SNHL in children.
Advantages of Gloved Finger–Coated Polyvinyl Acetate Pack in Partial Inferior Turbinate Surgery
Authors: Woo Hyun‐Jae
Published: September 2014

Objectives:

Nasal packing is commonly used to control postoperative bleeding in patients undergoing inferior turbinate surgery. During packing removal, patients usually undergo severe pain and bleeding. The objective of this study was to investigate the efficacy and safety of glove finger‐coated polyvinyl acetate (PA) pack on hemostasis, pain levels, and wound healing after partial inferior turbinectomy.

Methods:

A prospective, randomized, double‐blinded controlled study was conducted on 30 patients undergoing partial bilateral inferior turbinectomy using microdebrider for hypertrophic rhinitis. Fifteen patients (control group) had both nasal cavities packed with PA pack (Merocel; Medtronic Xomed, Jacksonville, FL) and another 15 subjects (experimental group) had their nasal cavities packed with PA in a glove finger. Pain levels were assessed by patients on a visual analog scale 12 hours after surgery and at the time of packing removal. The amount of bleeding on removal was quantified by weighing it after removal.

Results:

Both nasal packs effectively prevented postoperative bleeding. However, bleeding on packing removal was statistically less frequent and less severe with PA pack in a glove finger (P =. 004). In addition, pain was statistically lower with PA pack in a glove finger than with PA pack alone (P =. 001). There was no significant difference in the outcome measure of wound healing.

Conclusions:

PA packing in a glove finger is a recommendable method in terms of pain, bleeding on packing removal, compared with PA pack only.
Aspergillus Fumigatus Extract Suppresses the mRNA Expression of the IP‐10 in Human Bronchial Epithelial Cells
Authors: Bhushan Bharat , Norton James E. , Gupta Dave , Sha Quen , Schroeder James W. , Schleimer Robert P.
Published: September 2014

Objectives:

Immunologic reactions to antigens released by Aspergillus fumigatus can cause infections such as allergic bronchopulmonary aspergillosis (ABPA). The mucosal surface of the respiratory tract provides host defense mechanism. The aim of this study was to investigate whether respiratory epithelial cells recognize A. fumigatus extract (AE) and initiate an immune response. We report inhibition of Th1 biased epithelial inflammation by an Aspergillus extract.

Methods:

BEAS‐2B epithelial cells were cultured in a 37°C incubator in media supplemented with 5% FBS. Cells were treated in duplicate with AE for 1 hour and were stimulated with the TLR3 activator dsRNA for 6 hours. RNA was isolated and was reverse transcribed to cDNA. Realtime polymerase chain reaction analysis was performed in the presence of specific primers and fluorescently labeled probes.

Results:

IFN‐β and dsRNA both induced IP‐10 mRNA expression in BEAS‐2B cells (IFN‐β 1081‐fold; n = 3; P <. 001) (dsRNA 3044‐fold; n = 3; P <. 001). When BEAS‐2B cells were pretreated with AE for 1 hour and then stimulated with IFN‐β or dsRNA for 6 hours, induction of IP‐10 mRNA was suppressed relative to levels produced by IFN‐β and dsRNA alone. Suppressive effects increased with increasing AE concentration. IP‐10 protein was induced by IFN‐β (control [undetectable] vs IFN‐β treated [16.6 ± 9.5 pg/mL] at 6 hours) and by dsRNA (control [undetectable] vs dsRNA [25.3 ± 6.9 pg/mL], at 6 hours, n = 3). We observed significant suppression of IP‐10 protein when cells were treated with 1:320 W/V AE concentration (16.6 ± 9.5 pg/mL control vs 2.4 ± 0.25 pg/mL AE treated: P =. 005, n = 3).

Conclusions:

We found that AE inhibits the IP‐10 mRNA and protein secretion in bronchial epithelial cells.