bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of MMR and Cidofovir as Adjuncts for Recurrent Respiratory Papillomatosis
Authors: Meacham Ryan K. , Thompson Jerome W.
Published: August 2013

Objectives:

1) Describe experience at a single institution using measles, mumps, rubella (MMR) vaccine and cidofovir as adjunct treatments after CO2 laser ablation for recurrent respiratory papillomatosis (RRP) in children. 2) Compare outcome measures and remission rates between MMR and cidofovir.

Methods:

Retrospective review from 2004‐2012 at a tertiary referral children's hospital. Subjects were younger than 18 years and required at least 1 year of follow‐up to be included for review. Remission rate was determined by a Derkay score of 0 for at least 6 months.

Results:

Of 20 subjects identified with RRP, 15 had been followed for at least 1 year. Five subjects were treated with cidofovir, 6 patients with MMR, and 3 with a combination of the above. One did not receive adjunct injections. Initial Derkay score was 12.6 for the cidofovir group and 11.0 for the MMR group (P =. 61). Average number of debridements received was 11.8 for the cidofovir group and 17.6 for the MMR group (P =. 33). Average days between treatments was 63.0 for cidofovir and 81.3 for MMR (P =. 43). Total months observed was 44.0 for cidofovir and 64.6 for MMR (P =. 29). Remission rate was 20% with the cidofovir group and 50% for the MMR group (P =. 54).

Conclusions:

There is no statistically significant difference in number of debridements needed, average number of days between debridements, or remission rates between MMR and cidofovir as adjunctive treatments for recurrent respiratory papillomatosis in children.
Higher Rates of Adenotonsillectomy or Adenoidectomy for Upper Airway Obstruction in Infants with Severe Laryngomalacia
Authors: Durvasula Venkata S. , Lawson Bradley , Bower Charles M. , Richter Gresham T.
Published: August 2013

Objectives:

Synchronous airway anomalies below the supraglottis are thought to compound the symptoms of laryngomalacia (LM). Upper aerodigestive obstructive lesions may also be present but have not been discussed. This study examines other sources of upper airway obstruction in infants with severe LM requiring supraglottoplasty (SGP).

Methods:

Data were compiled on infants who received SGP between 2004 and 2011. Those with neurological conditions, syndromes, or major comorbidities were excluded. The incidence, type, and timing of procedures to relieve upper airway obstruction above the larynx were examined in each infant within 4 years after SGP.

Results:

One hundred fifty‐six infants were included. Forty‐two (26.9%) had other sources of upper airway obstruction necessitating a surgical procedure beyond SGP. Thirty‐two patients required an adenoidectomy alone, either during or within 30 months of SGP. Nine patients required adenotonsillectomy. One patient required tonsillectomy alone. Among the patients who underwent adenoidectomy, tonsillectomy was required later in 6 patients. Age at the time of SGP significantly affected the incidence of additional procedures. Infants receiving SGP at an age greater than 6 months were more likely to require management of adenotonsillar hypertrophy (82.1%) than their younger counterparts (14.8%) (P < 0.05).

Conclusions:

Accessory upper airway obstruction due to adenoidal or adenotonsillar hypertrophy, both synchronous and non‐synchronous (occurring after) is more common in patients with severe laryngomalacia. Infants older than 6 months receiving SGP are more likely to require additional procedures to relieve upper airway symptoms. Management of accessory sources of upper airway obstruction should be explored in infants with laryngomalacia.
Incidence of Otitis Media in Preterm Infants
Authors: Shah Priyanka , Nation Javan J. , Cortez Josef , Sachdeva Livjot , Cohen David S. , Romero Roberto , Coticchia James M.
Published: August 2013

Objectives:

1) Determine if objective tympanometry findings correlate with the subjective endoscopy finding in diagnosing middle ear disease (AOM or OME) in premature infants. 2) Determine if the incidence of middle ear disease increases with lower gestational weight in premature infants.

Methods:

Our prospective study includes 76 preterm infants, (< 36wks) admitted to the Neonatal Intensive Care Unit (NICU) at Harper Hospital. Endoscopic otoscopy and tympanometry were performed to detect the presence of otitis media within the first 4 days of birth. The Fisher exact test was used for statistical analysis.

Results:

1) 44 ears had normal otoendoscopic findings, of which 35 had normal tympanometry findings (79.54 %). 63 ears had middle ear disease, of which 48 showed abnormal reading on tympanometry (76.19 %). 2) 26 babies weighed less than 1300 grams at birth (average gestational age 26.99 weeks), 23 of which had middle ear disease on otoendoscopy. 25 babies weighed more than 1300 grams (average gestational age 31.85 weeks), 12 of which had middle ear disease on otoendoscopy. A P value of 0.0025 suggests a significant correlation between low birth weight and middle ear disease.

Conclusions:

We demonstrate that endoscopic otoscopy technique correlates with objective tympanometry data, although there are several limitations to comparing these techniques. We provide evidence that the incidence of otitis media in LBW preterm infants is higher based on otoendoscopy.
Long‐term Safety of Tympanomastoid Obliteration for Children with Suppurative Cholesteatomatous Ears
Authors: Kuo Chin‐Lung , Shiao An‐Suey , Lien Chiang‐Feng , Liao Wen‐Huei
Published: August 2013

Objectives:

Analyze long‐term prognosis and safety in children with suppurative cholesteatomatous ears following tympanomastoidectomy with cartilage obliteration.

Methods:

During a 30‐year period (1982‐2012), the medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies with cartilage obliteration were analyzed. The recidivism rates were calculated using Kaplan‐Meier survival analysis. Potential predictors of recidivism were entered into a Cox's regression model as covariates for multivariate analysis. These factors were sex, tympanomastoid obliteration, eardrum perforation, ossicular destruction, facial nerve dehiscence, history of ventilation tube insertion, craniofacial abnormality, surgical technique, and extent of disease.

Results:

Among a total of 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow‐up period was 11.6 ± 8.1 years. Recidivism was observed in 16 years in the CO group (12 recurrent and 4 residual) and 4 in the WO group (2 recurrent and 2 residual). The 10‐year cumulative recidivism rates were comparable between CO and WO groups (19% vs. 25%, P = 0.762, log‐rank). Multivariate analysis indicated that tympanomastoid obliteration was not a negative predictor of recidivism (P = 0.760), while surgical technique (canal wall up vs. down; hazard ratio = 5.86, P = 0.011) was a significant predictor. Major long‐term complications were not observed.

Conclusions:

This study provides long‐term evidence supporting the safety, feasibility, and effectiveness of tympanomastoid cartilage obliteration for children with suppurative cholesteatomatous ears.
Management of Pediatric Mandible Fractures
Authors: Sowder Justin C. , Friedman Adva B. , Key J. Michael , Richter Gresham T.
Published: August 2013

Objectives:

The use of conservative measures, mandibulomaxillary fixation (MMF), and closed reduction in children with mandible fractures has been advised due to developing dentition. Open reduction and internal fixation (ORIF) of mandible fractures with non‐resorbable plates has been the preferred procedure in young children at our institution. This study evaluates the outcomes of ORIF in the management of pediatric mandible fractures.

Methods:

A six year retrospective chart review of children, ages 18 years and younger, treated at a tertiary pediatric hospital for mandible fractures. Demographics, fracture site, mode of treatment, and complications were evaluated.

Results:

A total of 303 records of children evaluated for facial fractures were reviewed. Complete records of 62 patients who suffered from a mandible fracture were identified (M = 48, F = 14, mean age = 15 years (range 2‐18)). The most common fracture sites were angle (37%) and parasymphyseal (35%). Assault (53%) was the most common cause. Three patients were treated conservatively, and 1 was placed in MMF only. Fifty‐eight patients (93.8%) underwent ORIF, 6 of which were placed in MMF concurrently. Average follow‐up was 141 days (14‐800). Complications included plate removal in 11 patients (18.9%; 6 for extruded hardware), malocclusion in 8 patients (12.9%), and infection in 1 patient.

Conclusions:

Management of mandibular fractures in the pediatric population can be both challenging and controversial. Many authors advocate the use of MMF whenever possible secondary to the known potential complications of ORIF. This study suggests that conservative management or ORIF of selected displaced fractures, avoiding the need for MMF, has favorable outcomes.
Molecular Resonance Tonsillectomy in Children: Comparative Study over Standard Techniques in an 11‐Year Study
Authors: D'Eredita Riccardo
Published: August 2013

Objectives:

Learn the quantum molecular resonance (QMR) technology. An analysis of outcomes of QMR compared to standard cold‐knife (CK) and monopolar cautery (MPC) for pediatric tonsillectomy offers new possibilities, lowering postoperative morbidity.

Methods:

Eleven‐year, prospective, three‐group trial in a tertiary care pediatric institution. 857 children undergoing tonsillectomy were randomly assigned to QMR (n = 287), CK (n = 285) or MPC (n = 285) techniques. Main outcome measures included intraoperative time, blood loss, postoperative pain, weight loss, and random histopathologic examination on excised tonsils.

Results:

Histopathologic evaluation revealed reduced thermal injury with QMR over MPC (43 microns vs. 186, P <. 001) and was statistically associated with reduced muscular, blood vessel, and nerve fiber damage compared to CK (P <. 001). No intraoperative blood loss was observed in QMR. Significant reduced pain scores were related to QMR (P <. 002). The QMR patients regained normal diet and weight gain during the 10‐day postoperative period. One QMR, 15 CK, and 12 MPC patients experienced delayed bleeding.

Conclusions:

Molecular resonance for pediatric tonsillectomy resulted in reduced histopathologic thermal injury, lower pain scores, and reduced postoperative morbidity compared with CK and MPC techniques in an 11‐year study.
Peptide‐Based Hydrogels for Cranial Nerve Reinnervation
Authors: Abelardo Edgardo , Mahmoud Zahra , Birchall Martin A. , Woolfson Dek
Published: August 2013

Objectives:

Functionalize proteinogenic scaffold hydrogels with biomimetic peptides to enhance cell‐matrix interactions. Hydrogels are recently being tapped as adjuncts in tissue engineering. Rationally designed polypeptide‐based materials have advantage over other biomaterials for their ability to be engineered from the bottom up, tailored to the needs of specific potential application. We previously reported coiled‐coil fibrillar hydrogel networks called hydrogelating self‐assembling fibers SAF (hSAF), which were shown to support growth and differentiation of neural cells.

Methods:

Short biomimetic peptides were conjugated to hSAF fibres using biorthogonal copper‐based click chemistry.

Results:

The resulting functionalized hSAF hydrogel was shown to promote preferential direction of axonal growth, more mature fibroblast formation, and early angiogenesis.

Conclusions:

We have demonstrated in this study a chemically defined bottom‐up approach in biologic scaffold synthesis with straightforward technique in incorporating specific biomolecular signal under physiologic conditions, which promises a robust platform in tissue engineering such as cranial nerve reinnervation.
Pharmacologic Manipulation of Emergence after Adenotonsillectomy for Pediatric Obstructive Sleep Apnea: A Prospective Controlled Study
Authors: Isaiah Amal , Stein Rebecca , Shapiro Scott , Bellefleur Monique , Pereira Kevin D.
Published: August 2013

Objectives:

1) Elucidate the factors affecting emergence from anesthesia after adenotonsillectomy for obstructive sleep apnea (OSA) in children. 2) Highlight the advantages of a standardized anesthetic protocol in controlling peri‐operative events.

Methods:

A non‐randomized, prospective, observational study (n = 64) was designed to examine the relationship between the severity of OSA, as determined by apnea‐hypopnea index (AHI) and oxygen saturation (SpO2) nadir, and indices of recovery, including time to 1) emergence after surgery, 2) extubation following emergence, and 3) discharge from the post‐anesthesia care unit. A standardized anesthetic protocol was used in all patients using doses of opioids that inversely correlated with OSA severity.

Results:

A paradoxical yet significant reduction in recovery time was observed among patients with severe OSA following surgery; this reflected in quicker emergence, accelerated extubation, and shortened postanesthesia care unit discharge times (analysis of variance, Tukey‐Kramer post‐hoc tests, P < 0.001) besides a reduction in adverse events. In addition, the relationship between polysomnography (PSG)‐derived AHI and SpO2 nadir varied inversely with each of the recovery indices, as determined by a linear regression analysis (t‐tests, P <0.001).

Conclusions:

Emergence from anesthesia after adenotonsillectomy can be controlled by a standardized anesthesia protocol using different combinations of sedation and analgesia. The severity of sleep apnea and hypoxemia do not independently appear to play a significant role in recovery from anesthesia. By using a standardized anesthetic protocol with diminishing doses of opioids with increasing severity of OSA, our results indicate a striking departure from previously observed findings relating to post‐procedural respiratory complications following adenotonsillectomy.
Posterior Pharyngeal Wall Augmentation with Acellular Dermis Implant for Velopharyngeal Insufficiency
Authors: Johnson Kirsten , Meier Jeremy D. , Muntz Harlan R.
Published: August 2013

Objectives:

Review outcomes for children with velopharyngeal insufficiency (VPI) after posterior pharyngeal wall augmentation with an acellular dermis implant.

Methods:

Retrospective case series of children with VPI who underwent augmentation pharyngoplasty from 2002‐2011 at a tertiary care children's hospital. The posterior pharyngeal wall was augmented with rolled acellular dermis inserted in the subfascial plane. Pre‐ and postoperative nasometry, speech nasal endoscopy, and caretaker and clinician perceptual evaluation were reviewed.

Results:

Twenty‐four children with VPI (average age 8.8 ± 4.0 yrs) who underwent augmentation pharyngoplasty were identified. The majority of these children had a small gap noticed on speech nasal endoscopy. Of the 24 children, 5 were lost to follow‐up and were not assessed in the postoperative period. Average follow‐up for the remaining 19 patients was 17.6±20.9 months. Fifteen of the 19 patients (79%) had some improvement in VPI symptoms as determined by clinical perceptual evaluation, but only 8 children (42%) demonstrated complete resolution after the operation. One implant extruded. No major complications related to the surgical procedure were identified.

Conclusions:

We present a novel technique to treat VPI using an acellular dermis implant to augment the pharyngeal wall. Although this approach does not successfully treat all children with VPI, no major complications were seen in this series. Vital tissue that may be used for future speech surgery is preserved if this treatment option fails.
Prospective Quality‐of‐Life Assessment in Congenital Laryngomalacia and Its Treatment
Authors: Kilpatrick Lauren A. , Boyette Jennings R. , Hartzell Larry , Bower Charles M. , Richter Gresham T.
Published: August 2013

Objectives:

Disturbances in breathing or feeding may profoundly affect parental perceptions of an infant's health. Previous research into quality of life (QOL) for patients with laryngomalacia is limited to retrospective analysis. The purpose of this study is to prospectively evaluate the QOL of children with laryngomalacia and their parents and the impact of surgical and non‐surgical treatments.

Methods:

Pilot prospective analysis using the Laryngomalacia QOL Survey in patients with newly diagnosed laryngomalacia under age one year. A 29‐question survey regarding severity of symptoms related to overall health, airway, and swallowing is completed at initial and post‐treatment visits. Responses are quantified over a range from 1 to 5 (5 always or severe).

Results:

Twenty‐seven patients were enrolled in the study. Twelve were managed medically, and 15 underwent supraglottoplasty. The overall mean QOL score for patients treated medically was 2.57 (standard error SE 0.16) on initial visit and 1.67 (SE 0.16) post‐treatment (mean 3.9 months). Patients undergoing supraglottoplasty had an overall mean QOL score of 3.59 (SE 0.14) on initial visit and 2.22 (SE 0.22) post‐treatment (mean 3.5 months). Analysis of variance and post‐hoc testing revealed significant improvement between initial and follow‐up visits in both treatment groups (P < 0.01). Patients who underwent supraglottoplasty had significantly higher scores at initial visit (P < 0.01). No statistically significant difference was noted between patient groups post‐treatment (P > 0.05).

Conclusions:

Prospective QOL assessment of children with laryngomalacia and their families reveals a significant burden of disease. Quality of life improves in all patients but may improve more significantly in patients managed surgically.
Risk Factors for Hearing Loss in the Setting of Pressure Equalization Tube Placement in Children
Authors: Sidell Douglas R. , Hunter Lisa , Lin Li , Arjmand Ellis M.
Published: August 2013

Objectives:

Pressure equalization tube (PET) placement is the most common surgical procedure performed during childhood. Current Academy guidelines recommend more aggressive management of children with otitis media with effusion (OME) who are at greater risk for speech‐language and developmental problems. This study was designed to examine risk factors for continued hearing loss following PET placement in children with chronic OME. A large clinical sample ascertained through electronic medical records is used.

Methods:

All pediatric patients undergoing PET‐placement between January 2009 andOctober 2012 at a tertiary‐care children's hospital who had audiometric tests were included. Demographics and patient diagnoses (craniofacial anomalies, allergies, prematurity, developmental delay, and speech‐language delay) were extracted. A multivariate regression model was used to identify an association between patient‐specific characteristics and the presence of pre‐ or postoperative hearing loss.

Results:

4083 children with 4792 visits were included (2433 males and 1650 females; mean age of 3.4 years). 1007 preoperative and 2655 postoperative audiograms were performed. In addition to known risk factors and patient diagnoses, male gender, younger age, and lower acoustic admittance were associated with preoperative hearing loss (P = 0.03; P = 0.01; P < 0.001). Postoperative hearing loss was associated with patient age, preoperative hearing loss, and lower equivalent canal volumes (P < 0.0001; P = 0.0078; P = 0.0035). Race and ethnicity were not determined to be risk factors.

Conclusions:

The results of this study identify several demographic and patient‐specific risk factors for hearing loss surrounding PET placement. These data may have important preoperative counseling and postoperative management implications.
Severity of Voice Handicap in Children Diagnosed with Elevated Lesions
Authors: Mudd Pamela , Zur Karen B. , Carroll Linda M.
Published: August 2013

Objectives:

Determine the impact of voice disability on children with dysphonia. The Pediatric Voice Handicap Index (PVHI) was used to assess impact on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness and overall severity of dysphonia was also determined.

Methods:

Institutional Review Board approved study to examine severity of dysphonia in children evaluated at a voice clinic between 2007 and 2011. Setting: Tertiary specialized hospital. Medical records of 33 children (11 females, 22 males) diagnosed with an elevated laryngeal lesion by a pediatric laryngologist were reviewed for voice disability using the PVHI. The PVHI is a 23 statement instrument for perceived handicap in functional, physical, and emotional aspectsand includes a talkativeness rating scale (1‐7 scale) and Visual‐Analog Overall Severity Rating of Voice (100 mm line), all judged by the child's parent/caregiver. Data were examined for young children (age 2‐5), children (age 6‐10), and adolescents (age 11‐17).

Results:

There was no significant difference between age groups for overall PVHI (mean 29.3), but all groups had significantly higher functional disability (mean = 16) compared to physical (mean = 8.2) or emotional (5.1). Talkativeness averaged 5.1, and VAS averaged 40. Talkativeness was significantly greater for the child age group (5.6) compared to the young child and adolescent groups. Masses were more common in males.

Conclusions:

Children with elevated lesions have significant voice disability (PVHI = 29.3), greatest for functional aspects of voice, and present across all studied age groups. Mean severity was 47.1, and mean talkativeness was 5.1.
Socioeconomic Status and Otitis Media in a Universal Healthcare Model
Authors: Ambrosio Art A. , Brigger Matthew T.
Published: August 2013

Objectives:

1) Determine the association between socioeconomic status (SES) and other risk factors in surgically managed otitis media within a model of universal healthcare. 2) Determine quality of life (QOL) outcomes of surgically managed otitis media in the Tricare health system.

Methods:

A prospective cross‐sectional study was conducted between June 2011 and December 2012 with dependent children of military families. Tricare provides equal access to care among all beneficiaries despite a wide range of income and education across enrollment. Caretakers of children scheduled for bilateral myringotomy and tympanostomy tube (BMT) placement were administered a demographic survey that encompassed proxies for SES and risk factors for otitis media. The validated OM‐6 QOL instrument was administered upon enrollment and 6 weeks postoperatively. The survey and OM‐6 were administered to a comparison group who did not undergo BMT. Categorical variables associated with BMT were analyzed by logistic regression, and OM‐6 scores were compared by non‐parametric tests of hypotheses.

Results:

120 children undergoing BMT were enrolled. Logistic regression demonstrated age less than 2 years old (P < 0.001), daycare attendance (P < 0.001), and Caucasian ethnicity (P = 0.001) as associated with surgery. Surgical QOL outcomes demonstrated a significant improvement in OM‐6 scores after surgical management from 11.7 (95% confidence interval [CI]: 10.5,12.9) to 2.2 (95% CI: 1.4,2.9).

Conclusions:

In a universal healthcare model serving over 2 million children, previously reported proxies of low SES were not associated with surgically managed otitis media contrary to reported literature. Caucasian ethnicity, young age, and daycare attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.
Surgical Intervention for Severe Sleep Apnea: Experience from a Tertiary Care Children's Hospital
Authors: Shah Jay R. , Greenberg Laura , Mehta Deepak
Published: August 2013

Objectives:

Review a 5‐year, single‐institution experience with patients undergoing adenotonsillectomy or tonsillectomy with or without lateral pharyngoplasty (LP) or other upper airway surgeries for severe obstructive sleep apnea (OSA).

Methods:

Retrospective review of subjects who underwent airway surgery for severe OSA at a tertiary care academic children's hospital between January 2007 and June 2012. Subjects were diagnosed with OSA by polysomnography, with severe OSA being defined by a combined Apnea‐Hypopnea Index (AHI) of >10. Outcome measures included pre‐ and postoperative symptoms, polysomnography data, and immediate postoperative outcomes.

Results:

A total of 300 subjects, 158 male and 142 female, underwent surgery. Eighty‐eight were considered “unhealthy” based on comorbidities. Ages ranged from 6 months to 19 years. 253 subjects (84%) were seen for follow‐up, and 130 (43%) subjects had postoperative sleep studies. The mean obstructive AHI preoperatively was 21.2 (CI: 16.8‐21.0) and postoperatively was 4.1 (CI: 3.1‐5.3). This was statistically significant. The average total length of stay was 2.2 days (CI: 1.9‐2.6). Fifty‐one percent (n = 152) of subjects were discharged on postoperative day one. Ninety‐five percent (n = 240) of subjects had either a complete or partial resolution of subjective symptoms.

Conclusions:

Surgery in children with severe sleep apnea is generally accepted. Our study is one of the largest studies that focuses specifically on subjects with severe sleep apnea. While there was some persistent OSA, our results show that subjects’ OSA improved significantly. Improvement of OSA after airway intervention may be multifactorial; our data show that patients may strongly benefit from surgery.
Using Exercise Stress Laryngoscopy in the Pediatric Patient with Exercise Intolerance
Authors: Sidell Douglas R. , Balakrishnan Karthik , Willging J. Paul , de Alarcon Alessandro
Published: August 2013

Objectives:

Exercise induced airway obstruction in the pediatric patient is a unique phenomenon with multiple potential etiologies. Because patients are frequently asymptomatic at rest, establishing an accurate diagnosis can be challenging. Exercise Stress Laryngoscopy (ESL) presents a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study is to demonstrate the diagnostic utility of pediatric ESL and to guide the treatment of patients with exercise intolerance.

Methods:

All patients undergoing ESL for exercise intolerance and airway symptoms at a tertiary care children's hospital were reviewed. Data extracted included patient demographics, exam indications, exam findings, and management recommendations.

Results:

A total of 37 patients, average age 11.8 years (range 5‐19), were included. There were 14 male and 37 female patients. A specific airway abnormality became evident upon exertion in 56% of patients undergoing ESL. Of these, 24% had focal supraglottic collapse, 43% had paradoxical vocal fold motion, 24% had combined dysfunction, and 9% had distal airway abnormalities. A focal airway abnormality resulting in a change in management occurred in 71% of patients. 57% of patients in this review had a history of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 83% received a focal diagnosis following ESL that resulted in treatment.

Conclusions:

Determining the etiology of exercise intolerance is often a challenge in the pediatric patient. ESL is a contemporary modality by which complex patients with undiagnosed airway symptoms can be effectively evaluated, frequently leading to effective treatment.
Utility of Cardiology Referral in Children with EKG Abnormalities on Polysomnogram
Authors: Baldassari Cristina , Peak Jessica , Baydoun Hind
Published: August 2013

Objectives:

1) Determine the incidence of cardiac disease in children with electrocardiogram (EKG) abnormalities on polysomnogram (PSG). 2) To assess whether demographic factors such as family history of heart disease improve the yield of cardiology referral in these subjects.

Methods:

Study Design: Case series with chart review. Setting: Tertiary childrens hospital. Children between 6 months and 18 years of age with EKG abnormalities on PSG who were referred to cardiology for evaluation were included in the study. Children with a known history of cardiac disease were excluded.

Results:

Sixty‐four children had EKG abnormalities on PSG and underwent cardiology evaluation. The mean age was 6.83 years (SD 4.81), and 64% of subjects were African‐American. The mean obstructive apnea hypopnea index (OAHI) was 8.8 (SD 13.2), and 43 of the children had obstructive sleep apnea (OAHI >1). The most common EKG abnormality on PSG was premature ventricular contractions. The majority of children referred to cardiology underwent echocardiogram (48/64) and Holter monitoring (44/64). Seven children (11%) had cardiac pathology, including tuberous sclerosis, mitral and aortic valve insufficiency, and bradycardia, identified during cardiology evaluation. Factors such as family history of heart disease (P = 0.87), severity of sleep apnea (P = 0.48), and history of prematurity (P = 0.50) did not increase the likelihood of diagnosing cardiac disease.

Conclusions:

Cardiac pathology in children with abnormal EKGs on PSG is common. Cardiology referral in such patients is warranted. Further research is needed to determine whether there are factors that increase the likelihood of identifying cardiac pathology on referral.
Validation of Sleep Nasopharyngoscopy (SNP) in Children with Snoring/Sleep‐Disordered Breathing
Authors: El Hakim Hamdy , Ramji Maleka , Cote David , Biron Vincent L. , Xu Caroline
Published: August 2013

Objectives:

Propose and validate a scoring system of the findings of sleep nasopharyngoscopy (SNP) for children with sleep disordered breathing (SBD).

Methods:

We conducted an inter‐ and intra‐rater agreement study on video documentations of SNP performed on children (non‐syndromic or dysmorphic) presenting with SDB. Videos used represented different types of pharyngeal findings including normal, collapse, mixed picture, or obstruction. Three “non‐expert” raters at various stages in their otolaryngological career rated the videos twice and independently. One calculation assumed equal spacing between categories, the second assumed unequal spacing between the first and the second two based on need for surgical intervention.

Results:

Sixty‐three videos were rated by each observer (2 weeks apart). None were syndromic or dysmorphic patients. Intra‐observer agreement was 0.6442 ± 0.0835 (95%CI 0.4806‐0.8078), 0.7373 ± 0.0718 (95%CI 0.5965‐0.8781), 0.5853 ± 0.0789 (95%CI 0.4306‐0.74), for raters 1, 2, and 3. Weighted kappa was 0.593 ± 0.1864 (95%CI 0.2277‐0.9583), 0.85 ± 0.0884 (95%CI 0.6848‐1), 0.79 ± 0.0772 (95%CI 0.6458‐0.9506), respectively. Inter‐rater agreements between raters 1 and 2, 2 and 3, 3 and 4 were 0.8304 ± 0.0604 (95%CI 0.7119‐0.9489), 0.5168 ± 0.0827 (95%CI 0.3546‐0.697), and 0.5306 ± 0.0829 (95%CI 0.368‐0.693), respectively. Weighted kappa was 0.81 ± 0.1504 (95%CI 0.5231‐1), 0.72 ± 0.1147 (95%CI 0.5‐0.95), and 0.6658 ± 0.052 (95%CI 0.5253‐0.8), respectively.

Conclusions:

This is the first proposed scoring method for SNP in children. It is based on a generic interpretation of SNP into four types. Overall reproducibility among the three raters and their agreement was good.
Analysis of Headache Outcomes in Patients Treated with Endoscopic Sinus Surgery
Authors: Davis‐Malesevich Melinda , Rohayem Ziad , Catalano Peter J. , Wijewickrama Rohan C.
Published: August 2013

Objectives:

Assess the headache outcomes for patients treated with targeted endoscopic sinus surgery. Study Design: Prospective, non‐randomized.

Methods:

Consecutive patients (n=50) presenting to our clinic with headache as a feature of their presenting symptoms were recruited. Pre‐operative SNOT 20, HIT‐6 (Headache Impact Test) scores, and computed tomography (CT) analysis of multiple radiological parameters was calculated and compared to post‐operative measures.

Results:

Preliminary results for our cohort revealed an average pre‐operative HIT‐6 score of 61 and SNOT‐22 score of 49. Average post‐operative HIT‐6 score was 44 and SNOT‐22 score 19 (p<.0001). Patients had an average of 3 contact points identified on CT and average Lund‐Mackay score of 5. Median follow‐up was 3 months.

Conclusions:

Targeted endoscopic sinus surgery offers a reliable therapeutic modality in patients with headache as a feature of their presenting symptoms. Correlative CT findings and surgical technique are discussed.
Efficacy of Preoperative Itraconazole in Allergic Fungal Rhinosinusitis
Authors: Patro Sourabha K. , Verma Roshan , Panda Naresh K. , Singh Paramjeet , Chakrabarti Arunaloke
Published: August 2013

Objectives:

Gold standard treatment of allergic fungal rhinosinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals like itraconazole and steroids have shown varying success rates in delaying recurrences given postoperatively. Itraconazole decreases need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigates the efficacy of Itraconazole given preoperatively in AFS.

Methods:

A prospective study was carried out from July 2011 to December 2012 on twenty histologically proven patients of AFS, who were given Itraconazole preoperatively for 1 month, operated subsequently. They were compared with 20 matched controls of AFS cases, operated directly without preoperative itraconazole. Both groups were given oral steroids for 6 weeks postoperatively and followed for 3 months. Evaluations were done using symptomatic (SNOT score), radiologic (Lund Mackay scores) and endoscopic (Kupferberg Grades) parameters.

Results:

Symptomatology scores (SNOT20) decreased significantly (p=0.000) with Itraconazole. There was a significant decrease (p=0.005) in Lund Mackay scores reaching to 0 with complete resolution of disease in 15% cases with reduced hyper densities noted in all. Polyp sizes decreased and nasal endoscopic grades improved. Postoperative fungal cultures were positive in 45% compared to 79% cases among control group suggesting a decreased fungal burden. Total serum IgE decreased with itraconazole and had positive correlation (c.c=0.68) with postoperative fungal culture.

Conclusions:

We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative Itraconazole administration, decreasing the disease load significantly. It may prove to be a good preoperative adjunct needing further research.
EMLA Cream as Local Anesthetic for Endoscopic Radiofrequency Volumetric Inferior Turbinate Tissue Reduction
Authors: Martellucci Salvatore , Pagliuca Giulio , De Vincentiis Marco , Fusconi Massimo , Greco Antonio , Rosato Chiara , Gallo Andrea
Published: August 2013

Objectives:

Radiofrequency volumetric tissue reduction (RFVTR) is usually performed under local anesthesia. Although this is a simple procedure, patients often report perioperative discomfort. The aim of this prospective study was to determine the effectiveness of Lidocaine/prilocaine eutectic mixture (EMLATM cream) as a topical anesthetic for RFVTR. A comparison between EMLATM cream and lidocaine 10% in liquid formulation has also been made.

Methods:

200 consecutive patients undergoing RFVTR with topical anesthesia were enrolled in this randomized controlled trial from March 2010 to March 2012. The patients were divided into 2 groups: Group A included 100 patients treated with cotton pledgets soaked with lidocaine 10%, and Group B included 100 patients treated with EMLATM cream. Patients were evaluated before and after surgery using endoscopy and rhinomanometry. Four 10 cm Visual Analogue Scale (VAS) were submitted to each patient immediately after surgery and after 2 months to assess various aspects of perioperative discomfort.

Results:

A significant increase of nasal airflow and a subjective improvement of symptoms were observed without differences between the 2 groups. Subjective evaluation regarding perioperative discomfort showed a significant difference between Group A and Group B immediately after surgery and a slight but not significant difference after 2 months.

Conclusions:

RFVTR is an effective technique in the treatment of turbinate hypertrophy. The unintentional passage of anesthetic liquid into the pharynx is likely the cause of greater discomfort. The higher viscosity of the EMLATM cream provides greater permanence on the nasal mucosa and a more effective anesthesia.
Endoscopic Management of Antrochoanal Polyps: A Single UK Center Experience
Authors: Hariri Ahmad , Choudhury Natasha , Saleh Hesham
Published: August 2013

Objectives:

Antrochoanal polyps (ACP) are benign lesions originating from maxillary sinus mucosa extending into the nasal cavity and choana. They are typically unilateral and rarely arise from other sinus groups. Their treatment is surgical, with various approaches reported. We aimed to evaluate the following outcome measures: 1) Report the first UK series of ACP managed endoscopically; 2) Analyze the rates of recurrences of ACPs from our case series.

Methods:

A retrospective review of adult patients with ACPs managed under our care was conducted. Demographic and clinical patient data were reviewed. The main outcome parameter measured was signs of recurrence.

Results:

23 consecutive patients were studied from an 8 year period, 14 males and 9 females, with a mean age of 37.7 +/‐ 14.4 years. This included 22 patients with typical ACPs and 1 with a rare sphenochoanal polyp. Two patients within our group were referred with recurrent ACPS for revision surgery. The mean follow‐up was 14.8 +/‐ 15.3 months, with a follow‐up of 24 and 12 months for the two revision cases. There were no recurrences in any of our patients.

Conclusions:

We describe the first series of endoscopic sinus surgery for ACPs from the UK. We have had no recurrent cases, with a mean follow‐up period of 14.8 months. We review the literature in endoscopic management of adult ACPs and describe our own surgical technique. Our approach allows complete removal of the polyp, including its site of origin using angled endoscopes and instrumentation, to minimize recurrence.
Evaluation of Herpesviruses 1‐6 and Community‐Acquired Respiratory Viruses in Patients with Nasal Polyposis
Authors: Garzaro Massimiliano , Cavallo Rossana , Costa Cristina , Boggio Valeria , Raimondo Luca , Riva Giuseppe , Pecorari Giancarlo
Published: August 2013

Objectives:

Evaluate human herpesviruses 1‐6 and community‐acquired respiratory virus (CARV) prevalence in nasal polyps, adjacent turbinates, and pre‐ and post‐operative cytological specimens from patients undergoing functional endoscopic sinus surgery (FESS) and to investigate cytomegalovirus (CMV)‐ and Epstein‐Barr virus (EBV)‐specific cellular immune response.

Methods:

Viral occurrence was evaluated in 35 consecutive patients, enrolled between September 2011 and October 2012, at different time points by molecular methods. CMV‐ and EBV‐immune response was evaluated by Elispot assay.

Results:

Overall, 21 patients (60%) were positive for at least one virus in at least one specimen; in particular, 12.1% of all specimens for HHV‐6 and 10.5% for EBV, followed by CMV and HSV‐1 (both 1.6%). EBV‐positivity tended to be higher in polyps, as well as HHV‐6 in turbinate mucosa, although no significant association was found. Only one pre‐operative cytological specimen was positive to parainfluenza virus‐1. As regards immune response, 63.2% of patients displayed a CMV‐responder status, whereas only 11.2% were EBV‐responders.

Conclusions:

The frequent detection of HHV‐6 in normal nasal mucosa could be explained by its diffusion in different tissues, whereas the higher EBV frequency in polyps could support a causative role or persistence in the inflammatory lymphoid tissue. No association between the development of nasal polyps, other herpesviruses, and CARVs seems to exist. Preliminary data suggest an altered immune response pattern to CMV and, particularly, EBV. The potential implications in CRSwNP remain to be defined.
FESS versus Balloon Sinuplasty as Long‐term Treatment for Pediatric Chronic Rhinosinusitis: A 2‐Year Postoperative Analysis
Authors: Thottam Prasad J. , Kieu Monica C. , Al Barazi Randa , Saraiya Sonal , Dworkin James P. , Belenky Walter M.
Published: August 2013

Objectives:

Chronic rhinosinusitis (CRS) is a common pediatric disease. For those affected, functional endoscopic sinus surgery (FESS) and balloon sinuplasty are surgical options for long‐term relief. Our objective was to examine the efficacy of these treatments in overall symptom improvement >2‐years post‐operatively.

Methods:

A 2‐group prospective blinded survey was conducted with 10 pediatric patients who underwent FESS and 11 treated with balloon sinuplasty from 2007‐2010. All had previously been reviewed in a 6‐month post‐operative comparative study and were diagnosed with CRS through CT scans and symptomatology. At >2‐years post‐surgery, symptoms and medications were compared using 1‐tailed independent t‐tests.

Results:

Mean age at time of procedure was 9.9 years (range 4.1 – 16.0); 65% were male. Both groups had similar Lund‐Mackay scores (FESS: Mean = 12.63; Balloon: Mean = 12.27) and overall symptoms prior to procedure (FESS: Mean = 4.78, SD = 2.73; Balloon: Mean = 4.60, SD = 1.26). Greater than 2‐year post‐operative follow‐up surveys demonstrated a statistically significant long‐term decrease in symptoms for balloon and FESS treatments (t = 4.34, P = <0.001). Balloon demonstrated a significant decrease in individual sinus symptoms (t=4.80, P = 0.001) when compared to FESS. Overall, a reduction in antibiotics and topical nasal spray was identified in both groups.

Conclusions:

FESS and balloon are both effective long‐term options in the treatment of pediatric CRS. Both procedures can be performed with minimal short‐ and long‐term complications. At >2‐years post‐sinus surgery, individuals who underwent balloon sinuplasty reported a greater decrease in overall sinus complaints when compared to FESS.
Impact of Endoscopic Sinus Surgery on Healthcare Use for Patients with Co‐morbidities
Authors: Benninger Michael S. , Holy Chantal E.
Published: August 2013

Objectives:

1) Analyze healthcare use of chronic rhinosinusitis (CRS) patients requiring endoscopic sinus surgery (ESS) based on co‐morbidities (asthma, polyposis, and prior surgery) in an all‐comer population. 2) Evaluate the effectiveness of ESS by sub‐populations, using healthcare use pre‐ and post‐surgery as a proxy for improvement.

Methods:

A retrospective database analysis was conducted using Marketscan. All patients with ESS (CPT 31254‐31288) in 2008 and at least 5 years continuous enrollment (medical and drug coverage) were included (n=8,827). Patients were grouped based on diagnoses of asthma, polyposis, or prior surgery. In‐ and outpatient medical and prescription history for all sinonasal procedures or diagnoses was analyzed. All costs were calculated on a per‐patient, per‐quarter basis.

Results:

Total cost of care 9‐12 months prior to surgery was: No comorbidity (NC): $195 (95% Confidence interval (95%CI) $178.24‐$205.13), Polyps (P): $183.60 (95%CI $164.17‐$203.03), Asthma (A): $484.56 (95%CI $443.30‐$525.82), Asthma and Polyps (AP): $534 (95%CI $460.10‐$609.80), and Revisions (R): $1,234.52 (95% CI $853.02‐$1,616.01). Costs increased 1.5‐3.5 fold prior to surgery (NC: $1,310.27, P: $1,358.11; A: $1,738.84, AP: $1,894.31, R: $1,782.03) and were followed by surgical costs ranging from $7,187.35‐$9,650.83. ESS was consistently followed by significant drops in costs, which remained stable thereafter. Ongoing CRS disease costs at 2‐year post‐operative averaged between $195.36 (NC ‐ 95%CI $172.66‐$218.06) and $669.35 (AP ‐ 95%CI $546.75‐$791.94).

Conclusions:

Patients with asthma and polyps have ongoing disease costs approximately 3‐fold greater than patients without those comorbidities. Prior to ESS, use increased significantly, reflecting unmanageable disease states in all patient subpopulations.
Improvement in Olfaction following Modified Endoscopic Lothrop Procedure
Authors: Tan Neil C.W. , Drilling Amanda , Jardeleza Camille , Wormald Peter J.
Published: August 2013

Objectives:

The Modified Endoscopic Lothrop Procedure (MELP) is performed for severe cases of chronic rhinosinusitis (CRS) refractory to standard medical and surgical treatments. It involves creating a wide neo‐ostium connecting both frontal ostia and the removal of bone between the frontal beak and the olfactory fossa. The posterior margins of dissection are the fibers of the first olfactory neurons; therefore, this procedure may influence sense of smell. The aim of this study was to assess the objective sense of smell pre‐ and post‐MELP.

Methods:

A prospective study of 20 patients with severe recalcitrant CRS undergoing MELP. Preoperative and postoperative sense of smell was assessed with the University of Pennsylvania Smell Inventory Test (UPSIT).

Results:

Mean UPSIT scores improved from 19.8 to 25.5 following MELP (p=0.0277, t‐test). The greatest improvement was seen in patients with a poor sense of smell preoperatively; mean UPSIT 11.6 to 22.4 (p=0.0026, t‐test). In patients with a good sense of smell preoperatively, this was not affected negatively by MELP; mean UPSIT 29.25 to 29 (p=0.9351, t‐test).

Conclusions:

Modified Endoscopic Lothrop Procedure can have a beneficial effect on postoperative sense of smell, and importantly, the operation does not cause any disturbance in sense of smell following surgery in this cohort of patients.
Self‐fabricated Pressure Clips for the Treatment of Ear Keloid
Authors: Hooda Anita , Yadav Samar Pal S.
Published: August 2013

Objectives:

Pressure therapy is an integral part of keloid treatment; however, because of its complex and peculiar shape it is not amenable to pressure therapy. A self fabricated pressure device can provide accurate pressure resulting in equal pressure distribution over the keloid. Moreover, the pressure adjustments can be made as the wire is bent in the middle like a safety pin.

Methods:

Study design: A prospective study. The study was undertaken from August 2009 to November 2012. Subjects studied: Eight cases of either sex in the age group of 15‐50 years. Setting: Pt. BDS Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Interventions: Pressure clips were used for ear lobe keloids both in the pre‐operative and post‐operative period. The pressure clips were fabricated using poly(methyl methacrylate) and consisted of two parts for the medial and lateral surface of the external ear and were joined together with 19 gauge orthodontic wires shaped like a safety pin. The shape and size of the clip was in accordance to the size and shape of the keloid in the pre‐operative period, while in the post‐operative period they were according to the size shape of the post‐operative scar area. Outcome Measurements: Keloid recurrence. Independent Variables: Age, sex, size, and location of the keloid.

Results:

In the preoperative period the pressure applied by the loop helped to reduce the size of the keloid. In the follow‐up post‐operative period the pressure applied by the loop showed very encouraging results with no recurrence seen over a follow‐up period of one year.

Conclusions:

Pressure clips in the preoperative period help to reduce the size of keloid, while in the follow‐up post‐operative period, it prevents recurrence of keloid.