bluuebunny/crossref_metadata_2025 huggingface dataset:
Sudden Sensorineural Hearing Loss: Evaluation of Steroid Therapy
Authors: Fukushima Hisaki , Hamamoto Masakazu , Morita Norimasa , Harada Tamotsu , Tachi Toshihiro
Published: September 2011

Objective

Determine the efficacy of a steroid regimen for patients with idiopathic sudden sensorineural hearing loss (SSNHL) and evaluate the relationship between outcome and initial steroid dose.

Method

A retrospective review of patients with SSNHL was conducted at our hospital from 2004 to 2008. The study group consisted of 272 patients in whom SSNHL was diagnosed. Patients received tapering courses of intravenous hydrocortisone (HC) with an initial dose of either 500 mg/d for 3 days or 300 mg/d.

Results

The overall recovery rates after treatment were 68% in total group. The time interval from onset of SSNHL to start of treatment was important for the outcome of hearing improvement. There is significant difference between the under and over 50 years old groups in improvement of HL. A total of 47% (n = 128) were treated with high dose (500 mg/d) HC, and 53% (n = 144) were treated with low dose (300 mg/d) HC. There were no significant differences between the high dose and low dose groups in terms of hearing outcome.

Conclusion

High dose steroid therapy had the same outcome as low dose steroid therapy against patients with SSNHL.
The Combination Effects of Early Intratympanic Dexamethasone Injection for Patients with Sudden Sensorineural Hearing Loss
Authors: Min Hyun Jung , Kim Jong Min , Kim Kuk , Park Chul‐Won , Jeong Jin‐Hyeok , Lee Seung‐Hwan
Published: September 2011

Objective

Intratympanic dexamethasone injection (ITDI) was generally used as salvage treatment for sudden sensorineural hearing loss (SSNHL) patients who failed initial systemic treatment or for patients who considered to have a hazard risk on systemic steroids. We investigated the effectiveness of combination therapy, early ITDI accompanied by systemic therapy on SSNHL.

Method

We gathered the data of 151 SSNHL patients who were refractory to systemic treatment for 5 days. The injection group was administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. The control group only received traditional treatment. We compared the last concrete hearing level and recovery rate.

Results

Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) injection patients (P =. 034). On the basis of Siegel criteria, 7 of 47 (14.9%) injection patients were recovered in Siegel criteria 1, and 10 of 47 (21.3%) and 13 of 47 (27.7%) injection patients were respectively recovered in Siegel criteria 2 and 3. In the control group, 15.4%, 8.7%, and 21.2% patients were recovered in Siegel criteria 1, 2, and 3, respectively. Depending on the degree of initial hearing loss, patients with severe hearing loss who were treated with ITDI showed significantly higher recovery rates than patients in the control group (83.8% vs 50.0%) (P =. 049).

Conclusion

Early combination therapy of intratympanic dexamethasone injection within 2 weeks accompanied by initial systemic treatment is effective for patients with refractory sudden sensorineural hearing loss, especially for patients with severe hearing loss.
The Contralateral Ear in Acquired Cholesteatoma
Authors: Schmidt Rosito Letícia Petersen , Selaimen Fabio André , Da Costa Sady Selaimen , Dornelles Cristina
Published: September 2011

Objective

Acquired cholesteatoma has been extensively studied. Theories that involve previous tympanic membrane retractions in its pathogenesis are the most accepted. However we do not know what happened in the contralateral ear. Our objective is to evaluate the prevalence of significant alterations in the contralateral ear of patients with acquired cholesteatoma.

Method

This is a transversal study. We evaluated 1015 patients with chronic otitis media in at least one ear and no previous surgery between August 2000 and January 2011. Otoendoscopy was carried out and recorded on the affected ear just as in the contralateral, which was classified as normal or abnormal.

Results

Two hundred and sixty patients with chronic otitis media with cholesteatoma were included. The mean age was 31.7 years, and 52.7% were male. Only 35.6% of the contralateral ears were normal or had minimal alterations, such as tympanosclerosis, neotympanum, and mild tympanic membrane retraction. The most prevalent alterations were moderate and severe tympanic membrane retractions (42%), followed by cholesteatoma (17%).

Conclusion

The results suggest that patients with acquired cholesteatoma have a greater probability of having some abnormality in the contralateral ear. The most common were eardrum retractions and cholesteatoma. This corroborates the idea that COM is not only an isolated event but a constitutional process with a high prevalence of bilaterality.
The Prevalence of Nose Base Asymmetry in General Population
Authors: Ottoline Ana Carolina , de Castro Lima Carla Freire , Mayerhoff Eric V. L. , Gomes Geraldo Augusto , Tomita Shiro
Published: September 2011

Objective

1) Evaluate the prevalence of asymmetry of the nasal base in the general population. 2) Quantify among the individuals who carried nasal base asymmetry how many were aware of the fact.

Method

Photos of the nasal base of 43 volunteers chosen randomly were taken using a macro lens. Individuals were classified as carriers or noncarriers of nasal base asymmetry. When any asymmetry was present, the image was shown to the carrier, asking whether they were aware or not of the asymmetry.

Results

Forty‐three individuals between 13 and 70 years old were photographed (16 male and 27 female). The mean age was 43.11 years. Nineteen (44.19%) individuals showed some asymmetry of the nasal basal view. Of these, only 4 (21.05%) individuals were aware of their deformity.

Conclusion

Nasal base asymmetry is a prevalent deformity. Most of the individuals (78.95%) are unaware of it. It can generate controversy if the cause of the deformity was or was not a result of surgery. Nasal base asymmetries should always be photographed.
Viable, Proliferating Progenitor Cells
Authors: Oiticica Jeanne , Batissoco Ana Carla , Lezirovitz Karina , Barboza Luiz Carlos M. , Haddad Luciana Amaral , Mingroni‐Netto Regina Célia , Bento Ricardo F.
Published: September 2011

Objective

Compare conditions and outcomes of otosphere suspension cultures from dissociated organ of Corti of either mouse or guinea pig at postnatal day 3 (P3), and to evaluate the guinea pig as a potential cochlea donor for preclinical cell therapy.

Method

Organs of Corti were isolated from P3 guinea pig or mouse cochlea, dissociated, and cultivated under nonadherent conditions as cell clusters (otospheres), in DMEM:F12 medium, supplemented with epidermal growth factor (EGF), plus either basic fibroblast growth factor (bFGF) or transforming growth factor alpha (TGFÎ±), and submitted to immunofluorescence assays.

Results

Otospheres from mouse and guinea pig organ of Corti cultivated in vitro retained properties of inner ear progenitor cells, such as self‐renewal, proliferation, and differentiation into hair cells or supporting cells. The best culture outcome was observed when mouse‐derived cells were cultivated in the presence of TGFÎ± instead of bFGF. Otosphere cell sorting will be additionally tested by flow cytometry of dissociated mouse cells. These ongoing experiments will be useful for the phenotype characterization of the progenitor cells presenting the best proliferating index.

Conclusion

The expression of sox2 and nestin in guinea pig and mouse otosphere is supporting evidence for the presence of inner ear progenitor cells in P3 guinea pig. However, the proliferation and differentiation potential of mouse‐derived cells place this organism as a better model for studying early postnatal progenitor cell dynamics.
Would Caffeine Consumption Have Some Effect on the Perception of Tinnitus?
Authors: Schmidt Rosito Letícia Petersen , Vanni Bruna , Deutsch Konrado , de Brito Belline Vanessa
Published: September 2011

Objective

Caffeine has been implicated in the genesis of tinnitus. The current recommendation has been to avoid it, without any scientific evidence for this. Our objective is to examine whether the use of black coffee influences the tinnitus impact on quality of life.

Method

We included patients whose main complaint was tinnitus and its etiology presbycusis or noise‐induced hearing loss. It was questioned about the ingestion of black coffee and the amount of cups per day. For evaluation of tinnitus impact, we used the visual analogue scale and Tinnitus Handicap Inventory (THI).

Results

The study included 136 patients. The mean age was 63.8 years, and 57.5% were female. Of the total sample, 52% drank black coffee regularly, with an average of 2.5 cups per day. The 2 groups did not differ regarding gender and age. When we analyzed the consumption of black coffee, we found no statistically significant difference in both the visual analogue scale score and THI between groups. There was no significant correlation between the amount of coffee consumed per day and the score of the THI or between the visual analog scale scores.

Conclusion

This study showed that daily intake of black coffee does not influence the degree of discomfort and quality of life of patients with chronic tinnitus. There is currently no sufficient scientific evidence that supports the recommendation of suspension of its consumption in this group of patients.
A 10‐Year Review of Laryngeal Cysts in an Asian Pediatric Population
Authors: Tay Valerie S. , Ho Rachel , Tan Henry K.
Published: September 2011

Objective

1) Evaluate the presentation and treatment of pediatric laryngeal cysts in an Asian population.2) Determine the success rates of surgery, and recommend a preferred surgical method.

Method

A 10‐year (2000‐2010) retrospective analysis of the operative records of patients with laryngeal cysts at a tertiary children’s hospital in Singapore. A total of 29 patients were identified. All underwent microlaryngobronchoscopy under general anesthesia. We recorded the following: birth history, symptoms, operative details, and recurrence.

Results

Of the 29 children, 18 were boys, and 11 were girls. Only 8 children were preterm. Most of the children presented within the first 2 years of life. The 3 most common symptoms were stridor, respiratory distress, and hoarseness. There was a large proportion of patients with vallecular cysts (n = 14), accounting for nearly half of the cases. This is one of the largest published series to our knowledge. The most common treatment modalities used were CO2 laser marsupialization in 20 patients and excision with cold steel in 7 patients. Recurrence was documented in 4 patients (13.8%).

Conclusion

We recommend that laryngeal cysts in children should be removed surgically, due to the risk of airway obstruction. Our preference is carbon dioxide laser marsupialization during microlaryngobronchoscopy. There is a low recurrence rate, and there were no postoperative complications in our study.
Anthropometric and Cephalometric Evaluation after Metzembaun Septoplasty Performed in Children
Authors: Tamashiro Edwin , Itikawa Carla E. , Costa Denise , Valera Fabiana C. P. , Demarco Ricardo , Anselmo‐Lima Wilma T.
Published: September 2011

Objective

During septoplasty, important areas involved in nasal growth can be damaged, leading to a concern over whether septoplasty alters facial development. The aim of this study was to evaluate the effects of Metzenbaum septoplasty on nasal and facial growth in children.

Method

Children who underwent Metzembaun septoplasty before puberty had anthropometric (nasal length/height, columella length/nasal tip projection, nasal length/superior third, and height/width of the face) and cephalometric parameters measured (palatal length, middle third length, linear protrusion and angular protrusion of the face) and compared with normal standards reported in the literature.

Results

Sixteen patients were transversally analyzed (mean age of 13 years old by the time of surgery, and mean time of 4.3 years postoperative). In anthropometric evaluation, one patient presented with nasal length/height and nasal length/superior third of the face below normal values. Cephalometric evaluation demonstrated normal values in at least 81% of the cases. Overall, only one patient presented anthropometric and cephalometric below normal values, but did not complain about aesthetic or nasal patency. All remaining patients that had one measure value below normal range had no other parameters consistently low.

Conclusion

Metzenbaum septoplasty performed during puberty does not cause significant impact on the nasal or facial growth, as long as mucopericondrium and growth areas are maintained intact during the surgery.
AudGenDB: A Public, Internet‐Based, Audiologic/Otologic/Genetic Database for Pediatric Hearing Research
Authors: Germiller John A. , Crenshaw E. Bryan , Krantz Ian , Peterson Joy , Reinders Megan , White Peter , Italia Michael
Published: September 2011

Objective

Advances in hearing research often require data from multiple specialties and large patient cohorts. We have developed a biomedical computing infrastructure, AudGenDB, which incorporates audiologic, otologic, and genetic data, as a resource for researchers internationally. AudGenDB will soon be publicly accessible via the Internet. Here, we present AudGenDB’s current capabilities.

Method

A team of audiologists, otolaryngologists, geneticists, and medical informaticists has developed a large‐scale data repository with a robust, web‐based user interface. Data is extracted from the electronic medical record on every child who underwent audiometric testing at a single large pediatric center since 2006. Data will be updated monthly.

Results

AudGenDB currently contains 57,280 audiograms, 55,997 tympanograms, 16,784 ABR datasets, 15,059 radiology reports, and 22,604 surgical procedures from 37,273 patients. An intuitive user interface permits queries on demographics; hearing loss severity, type, and configuration; laterality; radiology interpretations; genetic data (eg, GJB2 mutational analysis; and existence of SNP array data. Users can view original temporal bone CT/MRI images from almost 5,000 complete studies and take detailed measurements. Ultimately, AudGenDB will provide access to high‐resolution genomic data, and will enable users to contact the custodians of original DNA samples. Public release of AudGenDB is expected later in 2011.

Conclusion

AudGenDB represents the first large‐scale database resource for pediatric hearing research. Using an intuitive web‐based interface, both beginner and advanced users can access abundant audiologic, otologic, radiologic, and genetic datasets. By design, this resource is self‐renewing and will continue to grow as we establish interfaces with additional pediatric centers.
Bacterial Tracheitis in Children: A Varied Entity
Authors: Del Mar Miranda Alba , Valdez Tulio A. , Pereira Kevin D.
Published: September 2011

Objective

Highlight the different presentations of bacterial tracheitis, which is a life threatening cause of airway obstruction in children.

Method

Review of 4 patients’ medical records who presented with differing signs and symptoms.

Results

Four types of clinical manifestations of bacterial tracheitis are presented with endoscopic appearances of the airway. Three patients were afebrile and nontoxic. Only 1 had a significantly elevated WBC. All 4 had different degrees of stridor. One had respiratory arrest. All were successfully treated with antibiotics and bronchoscopic debridement of the membranes. Cultures grew Staphylococcus aureus in 2, grew Moraxella catarrhalis in one, and were sterile in one. None required intubation.

Conclusion

Bacterial tracheitis needs a high index of suspicion due to its varied presentations. Certain forms have less severe clinical manifestations. These forms too require aggressive management, as they can result in airway obstruction from membranes and edema.
Complications in Tonsillotomy: A Systematic Review
Authors: Acevedo Jason L. , Shah Rahul K. , Brietzke Scott E.
Published: September 2011

Objective

Intracapsular tonsillectomy (or tonsillotomy) is a technique rapidly gaining acceptance. Multiple individual clinical trials have been performed, but there remains no clear consensus as to how tonsillotomy compares to traditional methods in regard to complication rates. The purpose of this study is to compile and critically analyze this data.

Method

MEDLINE was searched using multiple search terms, with the following inclusion criteria: English language, human subjects, and related to complications of tonsillotomy. Multiple tonsillotomy techniques were included. The results of these studies were summated, and the results were analyzed. Random effects modeling was used to calculate summary effect measures.

Results

Thirty‐three studies met inclusion criteria. The bleeding rate for tonsillectomy was 3.4% (P <. 01, 95% CI=0.027‐0.041, k=23) with a dehydration re‐visit rate of 3.4% (<0.01, 0.018‐0.049, 13). For tonsillotomy, the rates were 1.5% (<0.01, 0.012‐0.017, 31) and 1.4% (<0.01, 0.006‐0.022, 17), respectively. When stratifying for tonsillotomy technique, the rates were 1.5% (<0.01, 0.014‐0.017, 5) and 1.5% (<0.01, 0.014‐0.017, 4) for coblation and 0.8% (<0.01, 0.006‐0.01, 15) and 1.7% (<0.01, 0.007‐0.026, 10) for microdebrider. Number of days receiving analgesia was 7.045 (<0.01, 6.31‐7.76, 5) for tonsillectomy and 4.09 (3.19‐4.99, 7) for tonsillotomy. There was no difference in blood loss between groups.

Conclusion

Tonsillotomy appears to compare favorably with tonsillectomy and may offer a reduction in postoperative complications (bleeding and dehydration), as well as less use of analgesics. Subgroup analysis suggests that microdebrider tonsillotomy may have a lower bleeding rate than the coblation technique.
Congenital Oral and Pharyngeal Masses: Diagnosis, Management, and Prognosis
Authors: Rosenthal Laura H. , Bell Bruce M. , Drake Amelia F. , Zdanski Carlton J. , Harmon Paula J.
Published: September 2011

Objective

Understand the complex management and prognosis of patients with congenital oral and pharyngeal masses that cause cleft palate. To understand the multifaceted role of the pediatric otolaryngologist in the care of these patients.

Method

Retrospective study of all patients with oral or pharyngeal masses and cleft palate or velopharyngeal insufficiency treated in one year at a tertiary care institution. Charts were reviewed for age; gender; comorbidities; birth history; location and pathology of the mass; surgical treatment; and follow‐up care.

Results

There were 5 patients, 21‐months to 24‐years‐old, 3 of whom had other congenital anomalies. Three patients had large oral masses (2 hamartomas and 1 teratoma). Two patients had pharyngeal masses (teratomas). Four patients had cleft palate, all repaired by 1 year, 2 with later pharyngeal flaps. One patient with an intact but short palate underwent a pharyngeal flap at 6 year. One patient with a large oral mass had significant airway compromise at birth. Two patients underwent tracheotomy, and one was decannulated at 18 months. Additional surgeries were performed in all patients, including tympanostomy (2 patients), tonsillectomy (2 patients), maxillary and mandibular advancement (1 patient), and gastrostomy (1 patient).

Conclusion

Congenital oral or pharyngeal masses may cause cleft palate. Otolaryngologists are involved in care from initial airway management and excision to reconstruction and rehabilitation of speech and swallow. After excision, most patients will have a stable airway and tolerate an oral diet. Additional surgeries are often performed for associated comorbidities.
Diagnosis and Treatment of Juvenile Nasopharyngeal Angiofibroma: Impressions from a University Hospital
Authors: Barros Bruno B. C. , Prata Anelise A. S. , Macoto Eduardo M. , da Fonseca Viviane M. G.
Published: September 2011

Objective

Describe the characteristics of diagnosis and treatment of JNA at a teaching hospital.

Method

A retrospective cross‐sectional study was conducted by revision of medical records from patients treated for juvenile nasopharyngeal angiofibroma between January 2007 and October 2010.

Results

There were 11 patients, all males, with mean age of 15.18 years, who underwent surgery. Nasal obstruction was the initial symptom (54.55%), followed by epistaxis (45.45%). Stage II of Andrews was most commonly observed (54.55%). Preoperative embolization was performed in 45.45% of patients, and the most common approach was endoscopic‐assisted mid‐facial degloving (72.73%). Intraoperative blood transfusion was necessary in 72.73%, due to decrease in hemoglobin average from 13.18 to 8.54 g/dL. ICU hospitalization average was 2.78 days, and hospital discharge average was 8.18 days. Recurrence occurred in 2 cases, totaling 18.18% of failure. Preoperative embolization and use of endoscope reduced risk of relapser=0.77 (Pearson correlation).

Conclusion

We described our experience and found that preoperative embolization and use of endoscope reduced risk of relapse.
First Branchial Cyst: Is Imaging Necessary to Diagnose This Masquerading Anomaly?
Authors: Lim Keng‐Hua , Tan Henry K.
Published: September 2011

Objective

First branchial cyst anomalies are an uncommon cause of postauricular cyst and upper lateral neck masses in the parotid region. Most were misdiagnosed and underwent multiple surgeries. Imaging will help preoperative diagnosis and surgical planning. We aim to determine if imaging is really necessary preoperatively.

Method

Retrospective analysis of all patients with first branchial cysts treated between 2003 to 2010.

Results

Seven patients, 3 male and 4 female, aged between 10 months and 10 years, underwent excision of first branchial cyst. Four were Work type 1, and 3 were Work type 2. Two patients had CT scan preoperatively, and they were all type 2 variant. Imaging was performed because the initial diagnosis was cholesteatoma. Complete excisions were performed for all type 1 variant. Most cases were misdiagnosed and, hence, operated without scans. Nevertheless, most were completely excised except in one patient when the cyst was too near the facial nerve. There was no recurrence if resection was complete.

Conclusion

Complete excision is achievable without preoperative scan in type 1 variant. However, imaging is recommended in type 2 variant to delineate its relation to facial nerve. Consent for superficial parotidectomy with facial nerve monitor is recommended in type 2 variant for complete excision.
A Need for Targeted Otolaryngology Education among Primary Care Providers
Authors: Meyer Tanya Kim , Sardesai Maya G.
Published: September 2011

Objective

According to the National Center for Health Statistics, 3 of the top 10 most common reasons for physician visits pertain to otolaryngology, including cough, sore throat, and ear ache. We explored the gaps in otolaryngologic knowledge among a group of primary care providers attending an educational event.

Method

A brief web‐based anonymous survey regarding knowledge of basic otolaryngologic conditions was administered to primary care providers, both physicians and allied health practitioners.

Results

Thirty‐seven surveys were collected from 50 participants, of which 59% were allied health and 41% were physicians. Participants practiced in adult, pediatric, and family medicine. Gaps in knowledge were identified across several otolaryngologic subjects, including laryngology, rhinology, head and neck oncology, otology, sleep surgery, and pediatric otolaryngology.

Conclusion

There appear to be deficiencies in otolaryngologic knowledge among the primary care specialties. Increased exposure to otolaryngology rotations and lectures during training may increase understanding of common otolaryngologic diseases among these providers. It may also be beneficial to develop targeted programs for continuing medical education for these providers.
Management of Intratonsillar Abscess in Children
Authors: Ulualp Seckin , Koral Korgun , Deskin Ronald
Published: September 2011

Objective

Assess outcomes of medical and surgical treatment of intratonsillar abscess in children.

Method

The medical charts of infants and children who were treated for intratonsillar abscess between December 2009 and September 2010 were reviewed to obtain information on history and physical examination, imaging, management, and follow‐up assessment.

Results

Seven children (age range: 4 to 18 years) presented with difficulty swallowing and decreased oral intake. Trismus was present in 3 patients, and respiratory distress was present in 1. CT imaging documented unilateral abscess in 7 patients and phlegmon in the contralateral tonsil in 2. Inflammatory changes were observed in parapharyngeal space in 6 patients, prevertebral space in 1, and pyriform sinus and aryepiglottic folds in 3. One patient with respiratory distress underwent drainage of abscess prior to antibiotic treatment. In the remaining six children, medical treatment included clindamycin and corticosteroid in 4 patients and clindamycin, corticosteroid, and ceftriaxone in 2 patients.

Conclusion

In children with no airway compromise, intratonsillar abscess responded to trial of antibiotic therapy and corticosteroid. Surgical drainage accomplished clinical resolution of intratonsillar abscess in the presence of airway compromise or unresponsiveness to trial of medical treatment.
Pediatric Obstructive Sleep Apnea and Otitis Media with Effusion
Authors: Dreher Alfred , Patscheider Martin , Braun Thomas
Published: September 2011

Objective

Adenotonsillar hypertrophy causes obstructive sleep apnea (OSA) and otitis media with effusion (OME). Is there also an association between OSA and OME?

Method

A total of 150 children with suspected OSA aged 4 to 8 years underwent polysomnography and tympanometry.

Results

A total of 72% were diagnosed with OSAS (apnea hypopnea index (AHI) >1). 46% had an AHI >5. 36% of the children had a tympanogram type A (Jerger) on both ears (normally ventilated) and 22% a type B on both ears (suggesting OME). Using Kruskal‐Wallis test, children with an AHI 5 did not statistically significantly differ in the prevalence of normally ventilated ears and OME. Accordingly, Mann‐Whitney test showed that children with normally ventilated ears did not have a statistically different AHI, apnea index, hypopnea index or minimal oxygen saturation than children suffering from OME.

Conclusion

Children with OME are not more likely to be diagnosed with OSAS and vice versa. This finding indicates a stronger association between adenoid hypertrophy and OME respectively tonsillar hypertrophy and OSAS.
Pediatric Periorbital Infections: 5‐Year Retrospective Study
Authors: Marques Marta Canas , Santos Alberto , Simao Marco Alveirinho , Andrea Mario , Dias Oscar
Published: September 2011

Objective

Periorbital infections in the pediatric population are a common situation in hospital emergency care that can lead to visual loss, intracranial infection, or even death. We evaluated presentations and outcomes of pediatric periorbital cellulitis in order to understand different etiologies and stratifying risk populations that need different diagnostic and treatment approaches.

Method

We retrospectively reviewed the pediatric patients admitted at our institution with the diagnosis of periorbital cellulitis over a period of 5 years. They were classified in subgroups according to Chandler and cross‐referenced in demographics, clinical features, co‐morbidities, days of in‐hospital staying, CT findings, and treatment modalities.

Results

We identified 112 children with periorbital cellulitis, 63 pre‐septal and 49 post‐septal. There were statistically significant differences between the two groups in regard to age (P <. 001) and history of trauma or skin infection (P <. 001). Proptosis (P <. 001), diplopia (P <. 01) and ophthalmoplegia (P <. 001) were more frequent in post‐septal infections and surgical intervention was exclusive of this group. Subperiosteal abscess patients were significantly older (P <. 05), and all of them had diagnosis of acute sinusitis (P <. 05). Proptosis (P <. 05), ophtalmoplegia (P <. 05) and diplopia (P <. 05) were also differentiating features of subperiosteal abscess.

Conclusion

Pre‐septal infections are more common in younger children. Older children with subperiosteal abscesses need surgical intervention more often. Proptosis, diplopia, and opfthamoplegia are significant identifying features of post‐septal infections, particularly in surgical patients. Trauma or skin infections are relevant findings of pre‐septal infections. Post‐septal infections are mostly a complication of acute sinusitis.
Predictive Factors of Prolonged Hospital Stay in Tonsillectomy Patients
Authors: Carr Michele M. , Choby Garret , Setabutr Dhave
Published: September 2011

Objective

Tonsillectomy remains one of the most common surgeries performed in the pediatric population. Factors that are predictive of a prolonged stay after tonsillectomy are useful in planning postop care.

Method

A retrospective chart review was completed inclusive of all pediatric patients who had tonsillectomy at a tertiary medical center from March 10, 2010, to January 1, 2011. Preoperative variables were analyzed to determine predictors of extended hospital stay (defined as > 24 hours).

Results

A total of 210 patients were reviewed. Thirty‐three patients (15.7%) had hospital stays greater than 24 hours. Indications for tonsillectomy included obstructive sleep apnea (69.5%), tonsillitis (9.5%), and asymmetry (1.9%). Twenty‐eight (84.8%) patients had extended stays for poor oral intake. Fever and respiratory complications accounted for 0.06% respectively. Patients with extended stays were younger (P <. 001), weighed less (P <. 001), and had higher apnea‐hypopnea indices (P =. 043). Patients with a history of sickle cell crises or bronchodilator use, along with those who had state funded insurance (P <. 05), were more likely to have extended stays.

Conclusion

Factors from the history and physical of patients may predict which patients are at higher risk for extended hospital stays after tonsillectomy. Predictors of extended stays include younger and smaller children, those with a prior history of sickle cell crises, those using bronchodilators, and those with state funded health insurance.
Predictors of Bleeding Disorders in Children with Epistaxis: Value of Preoperative Tests and Clinical Screening
Authors: Elden Lisa M. , Reinders Megan , Witmer Char
Published: September 2011

Objective

Children with recurrent epistaxis despite medical therapy may be at higher risk of having a bleeding disorder. The objective of this study was to identify the prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery.

Method

Retrospective chart review from October 15, 2006 to December 31, 2010. Inclusion criteria: children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, and failed medical therapy requiring nasal cautery. Data collected: duration and severity of epistaxis, bleeding history, family history of bleeding. Screening CBC, PT and PTT were performed on all of patients.

Results

Of 248 subjects referred for epistaxis, 47 met study inclusion criteria (mean age 8.6 ± 3.8 years; male:female ratio 29:18). Coagulation studies revealed 12.8% (6/47) prolonged PT, 8.5% (4 /47) prolonged PTT, 10.6% (5/47) prolonged PT and PTT. Three with borderline levels proceeded to surgery. Twelve were referred to hematology secondary to abnormal coagulation studies. Of these, five patients (5/12, 42%) were diagnosed with a bleeding disorder (3‐type 1 von Willebrand’s disease (VWD), 1‐platelet aggregation disorder, and 1‐factor VII deficiency). Overall, 6.4% (3/47) had VWD in this cohort, which is higher than the reported prevalence of 1%.

Conclusion

Knowledge of whether a child has a coagulopathy prior to surgery can limit complications. In this highly selected group of patients with persistent epistaxis, 10.6% (5/47) had a bleeding disorder. It is important to consider hemostatic testing in high risk patients.
Remote Monitoring of Home‐based Noninvasive Ventilation in Children with Obstructive Sleep Apnea‐Hypopnea Syndrome and Concomitant Risk Factors
Authors: Sabo Liu
Published: September 2011

Objective

Investigate whether an internet‐based remote monitoring system could provide an effective, practical, and safe clinical pattern for children with obstructive sleep apnea‐hypopnea syndrome (OSAHS) who require home‐based noninvasive positive pressure ventilation (NIPPV) therapy on a long‐term basis.

Method

Three patients were treated in the unit from March 2009, and the results were analyzed. Variables of the ventilator were monitored with a remote monitoring system to observe the status of home‐based treatment. Interventions were administered as appropriate, and a questionnaire survey was conducted to investigate the performance of the remote monitoring system.

Results

As of April 1, 2010, pulmonary hypertension in 1 patient had been cured, while the other 2 patients remained in treatment. In all three patients, poor compliance and lower efficiency of the use of the ventilator were seen in early stages of treatment. After a period of remote monitoring and education, both parameters were significantly improved. A survey conducted with the patients’ families and their professional medical staffs revealed that the TELETREK remote monitoring system was safe, convenient, and easy to operate and helped save time and cost as compared to traditional regular follow‐up visits to the hospital.

Conclusion

Remote monitoring systems provide an effective, practical, and safe clinical pattern for patients with OSAHS and associated risk factors who need home‐based noninvasive ventilation therapy on a long‐term basis.
Sickle Cell Disease and Pediatric Adenotonsillectomy
Authors: Goldman Richard Andrew , Reese James , Johnson Charles M.
Published: September 2011

Objective

Determine the safety of a primarily outpatient management protocol for children with sickle cell disease undergoing adenotonsillectomy.

Method

A retrospective chart review was conducted of children with sickle cell disease undergoing adenotonsillectomy over a four year period beginning January 2007 at an academic tertiary care facility. Preoperatively patients underwent transfusion for hemoglobin less than 10g/dL. Postoperatively, they were monitored overnight and discharged the following day when possible.

Results

Fifteen pediatric patients with homozygous sickle cell disease and one patient with sickle beta thalassemia disease were identified, all of whom underwent adenotonsillectomy. The majority of patients (11) were discharged on the first postoperative day with the average length of postoperative admission for all patients being 1.5 days (range, 1‐5). Two patients (13 percent) experienced postoperative pain crises. There were no cases of postoperative bleeding, CVA, or acute chest syndrome.

Conclusion

Adenotonsillectomy in patients with sickle cell disease can be performed safely and effectively with careful outpatient preoperative management and brief postoperative hospitalization.
Steroids in Pediatric Bell Palsy: A Systematic Review
Authors: Pitaro Koby , Waissbluth Sofia , Daniel Sam J.
Published: September 2011

Objective

Conduct an updated systematic review on the outcome of Bell Palsy (BP) in children following steroid treatment.

Method

Medline, Embase, Cochrane Library, and BIOSIS Previews databases were searched obtaining articles from years 2000 to 2010 without any language restriction. Articles describing children aged 0 to 18 years with BP treated solely with corticosteroids were included. The outcome measure was facial movements based on clinical scales.

Results

A total of 2293 papers were initially identified. Following review by 2 authors, 68 papers were analyzed in a hard‐copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies exclusively included children with BP where in 2; various etiologies of facial palsy were described. The nontreated groups were smaller than the treated groups. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House‐Brackmann scale, Yanagihara grading system, and clinical evaluation. Studies analyzed were retrospective cohorts or case‐series and were categorized as level 4 of evidence.

Conclusion

There were no controlled trials, and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.
Surgery for Pediatric Invasive Fungal Sinonasal Disease
Authors: Ardeshirpour Farhad , Belani Kiran , Sencer Susan , Sidman James D. , Lander Timothy
Published: September 2011

Objective

1) Evaluate the management and outcomes of immunocompromised children with invasive fungal sinonasal disease who were treated with radical surgery. 2) Compare outcomes of radical surgery with less aggressive surgical debridements described in the literature.

Method

From 1994 to 2007, eleven pediatric patients with invasive fungal sinonasal disease, who were treated by the same pediatric otolaryngologist, were retrospectively evaluated. Demographics, oncologic diagnoses, absolute neutrophil counts, symptoms, CT scan findings, biopsy and culture results, surgical procedures, anti‐fungal therapies, outcomes, and survival were among the data collected.

Results

There were 4 males and 7 females with an average age of 10 years (range, 2‐14 years). Ten of the patients had relapsed leukemias. Six patients had acute lymphoblastic leukemia, 5 had acute myeloid leukemia. The average number of severely neutropenic days prior to diagnosis of invasive fungal infection was 18 days (range, 8‐41 days). Seven patients had alternaria, 4 had aspergillus. Nine patients underwent an external medial maxillectomy, 5 of which were bilateral, and six underwent septectomy. All eleven patients (100%) were cured of their invasive fungal sinonasal disease and did not relapse. Three patients eventually died from other causes.

Conclusion

Invasive fungal sinonasal disease is a life‐threatening problem in immunocompromised children, especially with relapsed leukemia. Successful treatment depends on timely and aggressive surgical, anti‐fungal, and supportive therapies. This is the largest series of pediatric patients with invasive fungal sinonasal disease who underwent aggressive surgery with the best outcomes to date.
Swallowing Dysfunction and Preoperative Assessment for Gastrostomy and Fundoplication
Authors: Cheung Esther , Shah Jaecel , Roy Soham , Douglas William , Tsai Felix W.
Published: September 2011

Objective

Evaluate the need for gastrostomy and fundoplication in neonates following aortic arch surgery.

Method

Sixty neonates from 2007 to 2010 who underwent the Norwood procedure, aortic arch augmentation and reconstruction, or coarctation repair were reviewed retrospectively. Results of modified barium swallow (MBS), laryngoscopy, upper GI series (UGI), and 24‐hour pH probe were reviewed for patients who underwent gastrostomy tube placement with or without fundoplication.

Results

After aortic arch procedures, 32 neonates (53.3%) underwent gastrostomy tubes (GT); an additional 26 (43.3%) patients also underwent concomitant fundoplication. Of those with unilateral vocal fold immobility, 50% (8 out of 16) aspirated on MBS, 10 out of 18 (55.6%) revealed reflux on UGI, but only 2 out of 9 (22.2%) had abnormal pH studies. Of those with normal vocal fold mobility, 88.9% (8 out of 9) patients demonstrated aspiration on MBS, 9 out of 12 (75%) showed reflux on UGI with one malrotation discovered, and 2 out of 5 (40%) patients had abnormal pH probe studies.

Conclusion

Neonates who undergo aortic arch procedures are at high risk of aspiration and other swallowing abnormalities. In this study, over half underwent GTs and many also required fundoplication, although results of pH probe studies seem to be inconsistent and limited, and therefore, its clinical usefulness is questionable for this patient population.
The Benefit of Brain MRI in the Evaluation of Pediatric Dysphagia
Authors: Allis Terah J. , Romans Ryan , Goebel Deborah , Thomas Heather , Sewell Ryan
Published: September 2011

Objective

Determine rates of brain MRI abnormalities for dysphagia in a pediatric aerodigestive center. Examine trends in swallowing improvement based on brain MRI pathology and syndromic status. Recognize the incidence of Chiari malformations and the association with dysphagia. Be able to counsel families regarding likelihood of swallowing improvement based on abnormal MRI.

Method

Retrospective review of 222 pediatric medical records (2001‐2010) enrolled in an aerodigestive clinic. Swallow studies and brain MRI reports were reviewed. Patients were subdivided into syndromic and nonsyndromic, n = 62, 159. All patients with MRI for dysphagia were analyzed statistically for brain abnormalities, Chiari malformation, correlating with swallowing improvement and resolution.

Results

Of 222 children with dysphagia 45 had brain MRI for dysphagia. A total of 14 had abnormalities. Eleven, 24%, were nonsyndromic with abnormal MRI. Two out of 11 were diagnosed with Chiari comprising 5% of MRIs performed for dysphagia in nonsyndromic children. One Chiari I patient did not undergo surgery and demonstrated improvement. No Chiari patients had resolution of dysphagia, yet 50% improved P =. 486. MRI did not correlate with symptom resolution. Nonsyndromic with abnormal MRI for dysphagia displayed 60% improvement vs 56% improvement with normal MRI, P = 1.0. Resolution rates were similar for patients with abnormal MRI (18% resolution rate) and normal MRI (22% resolution rate), P = 1.0.

Conclusion

At our institution children with persistent dysphagia undergo brain MRI to exclude Chiari malformation. Two malformations were diagnosed (5%), supporting MRI in dysphagia evaluation in diagnosing Chiari. However, it does not support MRI utility in predicting resolution, as there was no difference statistically between the brain MRI groups outcome.
The Effect of Adenotonsillectomy in the Production of IGF‐1 (Insulin‐like Growth Factor‐1) in Children
Authors: Pascoto Gabriela R. , Abreu Cassiana , Santos Fabio P. , Pignatari Shirley S. N. , Stamm Aldo E. C. , Weber Raimar
Published: September 2011

Objective

Airway obstruction caused by adenotonsillar hypertrophy is the main cause of snoring and sleep apnea in children and often associated with several other signs and symptoms, including growth development. The objective of this study was to evaluate the effect of adenotonsillectomy in the production of IGF‐1 (insulin‐like growth factor‐1) in children.

Method

A total of 26 children of both sexes with adenotonsillar hypertrophy with formal indication for adenotonsillectomy (study group) and 21 control children (with indication for surgery for other reasons, eg, postectomy) were submitted to evaluation of peripheral blood IGF‐1. The samples were taken immediately preoperatively and 30 days after surgery.

Results

The preoperative levels of IGF‐1 showed values within the normal range for age in both groups. Two children in the study group had values below normal for their age. The comparison of pre‐ and postoperative levels in children undergoing tonsillectomy showed a statistically significant increase (P <. 01) by Student t test for paired samples. The 2 children with preoperative values below normal for age recovered normal levels of IGF‐1 after surgery.

Conclusion

The data from our study suggest that adenotonsillar hypertrophy, resulting in snoring and sleep apnea can affect negatively the production of circulating IGF‐1, probably related to the disturbances of height and growth development, and demonstrate that adenotonsillectomy contributes to enhancing and restoring the values of IGF‐1.
An Audit of Adherence to SIGN Guidelines for Tonsillectomies: Completion of Third Cycle
Authors: Phua Chu Qin , Chan John , Mahalingappa Yogesh , Bhalla Rajiv K. , Rashid Mamun , Karagama Yakubu
Published: September 2011

Objective

It is important to ensure that our listing practice for tonsillectomy is in keeping with the best evidence available, as stated by the Scottish Intercollegiate Guidelines Network (SIGN). We audited the accuracy of documentation of the SIGN guideline indications for tonsillectomies to ensure appropriate listing of such patients.

Method

Medical notes of patients with recurrent tonsillitis presenting to our department were reviewed retrospectively to check for documentation of the SIGN indication for tonsillectomy. Three audit cycles were carried out, each over a 3‐month period.

Results

Prior to intervention, only 51% (25/51) patients undergoing tonsillectomy had documented evidence of adherence to SIGN guidelines for surgery. Interventions following the first audit cycle included presentation of audit findings, introduction of guideline templates for doctors to complete, and recruitment of medical secretaries to return the notes to doctors if documentation was incomplete. Postintervention, audit cycles 2 and 3 showed respectively 100% (30/30), and 92% (36/39) of patients had documented evidence of adherence.

Conclusion

The introduction of a simplistic model of intervention as above improved the local adherence to SIGN guidance for tonsillectomy and translated to safe and better care for patients. This model is easily replicable and can be used in other ENT departments to improve patient care.
Treatment of Lymphatic Malformations: A Systematic Review
Authors: Adams Mary Theresa , Saltzman Babette S. , Perkins Jonathan A.
Published: September 2011

Objective

1) Systematically review the literature pertaining to head and neck (H&N) lymphatic malformation (LM) treatment, and use individual level data presented in qualifying case‐series to compare efficacy, complications, and functional impact among surgery and sclerotherapy. 2) Evaluate whether treatment modalities differed by LM stage.

Method

Using Ovid and search terms lymphangioma, cystic hygroma, and lymphatic malformation, we performed a literature search yielding 6,292 references. Excluding references that did not: involve H&N LM treatment, include at least 5 patients, follow patients for one year, define treatment, and state complications, yielded 29 articles with individual level data.

Results

We pooled individual case data from case series, indentifying 157 patients treated with surgery and 132 patients treated with sclerotherapy. Advanced stage LM were more likely to be treated with surgery (24 (15.8%)) than sclerotherapy (34 (28.1%)). Advanced stage LM had increased levels of persistence in both surgically treated and sclerosed patients. One sclerotherapy treatment was used in 45 (34%), 2 in 35 (26.5%), and three or more in the remainder. The report of complications and functional impact was inconsistent among papers.

Conclusion

Currently no standardized reporting system of LM case series exists, making it difficult to compare treatments. Our data suggest that sclerotherapy may be more efficacious, with fewer side effects than surgery; however, our evaluation did not take into account the potentially confounding effects of LM stage, treatment indications, and complications.