bluuebunny/crossref_metadata_2025 huggingface dataset:
Vestibular Rehabilitation in Postural Control of the Elderly
Authors: Kasse Cristiane Akemi , Maia Denise , Gazzola Juliana , Thomaz Juliana Q.
Published: September 2011

Objective

Analyze the effectiveness of personalized vestibular rehabilitation therapy (VRT) associated with body balance training in postural control of elderly patients with chronic peripheral vestibular disorders assessing the Dynamic Gait Index (DGI) and static posturography (Balance Rehabilitation Unit‐BRUTM) before and after the treatment.

Method

Prospective study of 20 elderly with chronic peripheral vestibulopathy. The BRUT M parameters were the limit of stability and the area of body center of pressure in the followed conditions(C): C1‐stable surface/open eyes; C2‐stable surface/closed eyes; C3‐unstable surface/closed eyes; C4‐5 stable surface/visual‐vestibular interaction. The VRT consisted of personalized vestibular exercises associated with static and dynamic body balance training.

Results

All patients improved their symptoms after 12 to 16 sessions of VRT associated with balance training (50 minutes). The outcomes (mean; standard deviation) after therapy were: the limit of stability increased (Pre‐VRT: 133.8;51.9 cm2; Post‐VRT: 178.45;47.3 cm2; P =. 001), the area of body center of pressure in C2 (Pre‐VRT: 5.70; 6.31 cm2; Post‐VRT: 2.60; 1.95 cm2; P =. 01), C3 (Pre‐VRT: 13.48;8.69 cm2; Post‐VRT: 7.67; 3.86 cm2; P =. 001) and C4 (Pre‐VRT: 6.11; 4.67 cm2; Post‐VRT: 4.38; 2.57 cm2; P =. 053) decreased, and fall risk was reduced (DGI: Pre‐VRT=19.42; 4.07 points; Post‐VRT=22.21; 2.74 points; P =. 003).

Conclusion

Vestibular rehabilitation therapy associated with body balance training improved the postural control of elderly patients with chronic vestibular dysfunction, increasing the value of limit of stability with reduction of body oscillation in conditions without visual inputs and with somatosensory and visual‐vestibular conflicts, and reducing the fall risk.
Vibrant Soundbridge Middle Ear Implant in Romanian Patients
Authors: Cosgarea Marcel , Necula Violeta
Published: September 2011

Objective

The Vibrant Soundbridge (VSB) system helps hearing impaired people who, for various reasons, are unable to use conventional hearing aids. This study presents our experience and outcomes with the first eight patients we implanted with this device.

Method

Eight patients were implanted with a VSB in our department from 2006 to 2010. Seven of them had sensorineural hearing loss, while one case involved otosclerosis with mixed hearing loss. All patients received a VSB from Med‐El.

Results

Seven patients, aged between 18 and 72 years, were implanted with the VSB’s floating mass transducer attached to the incus, while the patient with otosclerosis underwent implantation at the round window. Preoperative pure‐tone audiograms, acoustic immittance tests, and speech intelligibility tests were conducted on all patients and compared with postoperative results. The postoperative PTA outcomes indicated no loss of residual hearing. Mean PTA have increased from a 60.20 ± 2.80 dB mean value to a 26.67 ± 2.60 dB mean value at 6 months after activation. All patients noticed improved high‐frequency perception and clearer sound quality with the VSB comparing to conventional hearing aids.

Conclusion

Vibrant Soundbridge middle ear implant is improving the hearing in patients who are unsatisfied with or cannot wear conventional hearing aids for different reasons. Poor sound quality and ear occlusion were the most important complaints that lead patients to decide on the surgery.
Adenoid Microbiology: Expanded Role of Resistant S. Aureus
Authors: Prosser John Drew , Patel Sagar , Borders Jack
Published: September 2011

Objective

1) Learn the most common bacteria cultured from diseased adenoid tissue, 2) learn the resistance patterns of these bacteria, and 3) compare growth patterns between different patient diagnoses.

Method

Adenoid bacteriology has been implicated in multiple infectious diseases of the head and neck. We examined core adenoid tissue from patients undergoing adenoidectomy for chronic adenotonsillitis, hypertrophy with obstruction, or chronic/recurrent otitis media for aerobic and anaerobic bacteria. Further we compared the bacteria isolated (both qualitatively and quantitatively) between groups.

Results

Multiple potentially pathogenic organisms were grown, including S pneumoniae (22.4%), M catarrhalis (19.2%), and H influenzae (13.2%). Interestingly Staph aureus (32.4%) was grown in higher numbers than S pneumoniae, H influenzae, and M catarrhalis. 24.5% of S aureus isolates were methicillin resistant (MRSA, 7.8% of all patients), and 60% were penicillin resistant (19.2% of all patients). Therefore 84% of the S aureus cultured were MRSA or penicillin resistant. Qualitative and quantitative analysis of potentially pathogenic bacteria revealed no significant differences between groups. However, there was a trend for a higher number of MRSA in patients with chronic adenoiditis versus those with hypertrophy.

Conclusion

Knowledge of common bacteria and resistance patterns guides antimicrobial therapy. Amoxicillin is currently the first‐line treatment for many conditions tied directly to adenoid microbiology. Therefore, the bacteria and resistance patterns of diseased adenoid tissue should be revisited with particular attention to the expanding role of resistant strains of S aureus.
Adenotonsillectomy Bleeding: Microdebrider vs Electrocautery
Authors: Stansifer Kyle J. , Barazsu Lindsay , Szramowski Molly , Buchinsky Farrel J. , Post James C.
Published: September 2011

Objective

1) Describe the intraoperative blood loss during adenotonsillectomy in a pediatric population during the transition to a new technique. 2) Confirm or refute the suspicion that intraoperative blood loss is greater when using the microdebrider than when using traditional curette and electrocautery techniques.

Method

Retrospective evaluation of 148 children who underwent tonsillectomy and/or adenoidectomy by a single surgeon transitioning from curette and electrocautery to microdebrider in 2008. Primary outcome was percentage of circulating blood volume lost. Surgical methods were compared by multiple linear regression and chi‐squared to evaluate incidence of “bleeders” (>5% loss).

Results

Median age was 6.8 years (range, 2.2‐20.6 years). 84 had adenotonsillectomy, 39 had adenoidectomy, and 25 had tonsillectomy. Blood loss ranged from 0% to 15% (median = 2%) blood volume. Sixteen of 148 patients (11%) lost >5% blood volume. A total of 2.3% of blood volume was lost with adenoidectomy by curette or microdebrider compared to no adenoidectomy (P = 6e‐07). Microdebrider tonsillectomy was associated with more blood loss than electrocautery; an additional 1.7% of blood volume (P = 9e‐06). A total of 15 of 84 (18%) who had adenotonsillectomy lost >5% blood volume. 26% of microdebrider patients lost >5% blood volume compared to 12% of electrocautery tonsillectomy patients (P =. 16).

Conclusion

Adenoid and/or tonsil surgery can result in significant blood loss (>5% of blood volume), which occurred in 11% of our cases. Most of the blood loss is from the nasopharynx. Tonsillectomy by electrocautery is associated with significantly lower intraoperative blood loss than the microdebrider.
Airway System of Care Assessment with High Fidelity Simulation
Authors: Johnson Kaalan E. , Pio Brian , Oehler Jennifer L. , Kerrey Benjamin , Geis Gary , Houlton Jeffrey J.
Published: September 2011

Objective

1) Determine the capacity of high‐fidelity simulation in critical airway obstruction to assess the existing system of care at a pediatric institution. 2) Inform the development of a protocol for the multidisciplinary management of critical airway obstruction in the emergency department (ED) and the operating room (OR).

Method

Design was a prospective assessment, using simulation, of critical airway obstruction management at a pediatric referral center. Subjects were ED, OR, and otolaryngology (ENT) providers. We developed a novel simulation scenario of foreign body aspiration. Measures assessed included ED airway maneuvers, time to ENT arrival, and subject survey responses.

Results

Over 3 months, 67 providers participated in 6 simulations (3 complete in ED and 3 partial obstructions from ED to OR). The mean rating of simulation realism was 6.3 out of 7 (range, 4‐7). Twenty‐one of 67 (31%) providers stated they would apply something learned in the simulation to a real case. In 2 simulations, laryngoscopy was inappropriately performed and resulted in patient deterioration. In all simulations there was confusion about subspecialty consultation. ENT was consulted in all cases; the median time to ENT arrival was 6.8 minutes (range, 5.7‐9 minutes). Identified system deficiencies included a lack of ENT equipment in the ED.

Conclusion

High‐fidelity medical simulation is a safe, feasible, and effective method to assess current systems of care in high acuity, low frequency events. We will use the findings from these simulations to develop, implement, and reassess a protocol for the multidisciplinary management of pediatric critical airway obstruction at our institution.
Asthma and Foreign Body Aspiration
Authors: Saliba Joe , Mijovic Tamara , Nguyen Lily H. , Manoukian John J. , Daniel Sam J.
Published: September 2011

Objective

Determine the prevalence of asthma in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (sFBA) in the tracheobronchial tree, and to identify characteristics of patients who could benefit from a trial of anti‐asthma treatment prior to undergoing a diagnostic bronchoscopy.

Method

Retrospective chart review of children with sFBA in the tracheobronchial tree who underwent RB at the Montreal Children’s Hospital (2001‐2009). Patient characteristics such as delay between initial choking episode and first otolaryngology evaluation, clinical findings, radiologic findings, bronchoscopic findings, and history of asthma were analyzed.

Results

A total of 55 children underwent a RB for sFBA. Foreign bodies (FB) were found in 36 of these, one of which was asthmatic (2.78%, P <. 05). In the 19 children who had a negative bronchoscopy (no FB), four were asthmatics (21.1%, P <. 05). The mean time from the suspected initial choking event to the first otolaryngology evaluation was 27 days in asthmatics (range, 5 hours‐90 days; median, 14 days), whereas it was 7.2 days in nonasthmatics (range, 0.5 hours‐120 days; median, 16 hours). Otherwise, clinical and radiological findings were not significantly different in the asthmatic and non‐asthmatic groups.

Conclusion

Asthmatic children with sFBA are significantly more likely to have a negative bronchoscopy than non‐asthmatics, especially when there is a delay between the suspected choking episode and the first otolaryngology evaluation. Therefore, a trial of anti‐asthma treatment prior to performing a diagnostic bronchoscopy in this subgroup of patients is justified.
Utility of IMAP Flap in Hypopharyngeal Reconstruction
Authors: Young Lindsay E. , Argo Jimmy , Myers Larry L. , Neilan Ryan E.
Published: September 2011

Objective

1) Describe a novel use of the internal mammary artery perforator (IMAP) fasciocutaneous rotation flap for hypopharyngeal reconstruction.

Method

Case series at university‐based tertiary care hospitals. We report 2 cases using the IMAP flap for hypopharyngeal reconstruction. We describe flap elevation and inset and the clinical course of the patients. Outcome measures were flap viability, pharyngocutaneous salivary fistula, and postoperative swallow function.

Results

Case 1 was a 59 year‐old male who underwent organ sparing protocol 5 years prior. He underwent laryngectomy for nonfunctioning larynx. Case 2 was a 58‐year‐old male with T4 squamous cell carcinoma of the larynx with pyriform sinus involvement. We performed a single flap in both cases. Each flap was based on the dominant internal mammary artery perforator vessels at the second and third intercostal spaces. There were no full or partial flap deaths. Both patients developed minor salivary fistulae that healed with conservative, nonoperative management. Both patients tolerated an oral diet within 5 weeks postoperatively.

Conclusion

The IMAP flap is ideally suited for hypopharyngeal reconstruction and should be included in the armamentarium of reconstruction options. It is easy to harvest, thin, and pliable, and the arc of rotation allows for tension‐free hypopharyngeal reconstruction. Salivary fistulas may occur.
Awareness of Otitis Media with Effusion among Children Store Consumers
Authors: Rashid Mamun , Chan John
Published: September 2011

Objective

A recent awareness campaign by Deafness Research UK involving distributing 120,000 leaflets to 6,000 general practitioners’ offices resulted in 42% of responders to the subsequent survey seeking further consultation. There is no equivalent data available for consumer awareness. We present a survey of awareness of this condition among children‐store consumers.

Method

Survey of parent shoppers at Mothercare, Adams, and the children’s clothing section at Debenhams in Manchester, UK.

Results

A total of 68 consumers took part. A total of 66% (45/68) were aware of glue ear. A total of 43% (29/68) were aware of grommets as a treatment for OME, but only 6% (4/68) were aware of conservative measures. A total of 97% (66/68) felt more information would be useful. A total of 44% (21/68) indicated that they would seek further consultation.

Conclusion

A total of 66% of children‐store consumers were aware of OME, but only 43% were aware of treatment options, and most thought surgery was the only option. Despite previous campaigns to increase awareness of OME, there is still need for wider awareness for this common treatable condition among the public at large.
Bilateral Infant Mastoiditis: An Unusual Clinical Entity
Authors: Goldsztein Hernan , Dobrosky Christine , Eisenman David J. , Pereira Kevin D.
Published: September 2011

Objective

Describe the clinical presentation and management of bilateral mastoiditis in infants.

Method

Retrospective chart review of patients under the age of one presenting with clinical evidence of bilateral mastoiditis.

Results

Two infants fulfilling inclusion criteria were identified. Both had clinical and radiologic evidence of bilateral mastoiditis with unilateral coalescent mastoiditis and an ipsilateral subperiosteal abscess. The patients required surgical intervention, including incision and drainage of the subperiosteal abscess and bilateral myringotomies with or without pressure equalizing tubes. Streptococcus pneumoniae was cultured from both patients. One patient also grew MRSA. Significant comorbidities were identified including neutropenia, history of recent meningitis, and prematurity.

Conclusion

Acute mastoiditis pursues an aggressive course in infants and can be bilateral. Streptococcus pneumoniae tends to be the most common offending organism. Bilateral disease should prompt investigation for significant co‐morbidities, including immune deficiencies.
Cephalometric Evaluation of Facial Pattern and Hyoid Bone Position in Children with OSAS
Authors: Valera Fabiana , Vieira Bruno B. , Itikawa Carla Enoki , Almeida Leila , Tamashiro Edwin , Anselmo‐Lima Wilma T. , Sander Heidi H.
Published: September 2011

Objective

The relation between craniofacial changes and OSAS in nonsyndromic children is not well established. The objective of the present study was to assess the development of face and hyoid bone in children with OSAS through lateral cephalometries.

Method

Twenty nasal breathing children aged 7 to 10 years were compared with 20 matched in age children polysomnographically diagnosed as OSAS patients. All children underwent otorhinolaryngological evaluation and cephalometries.

Results

Children with OSAS presented an increase in total and inferior anterior heights of the face when compared to nasal breathers. In addition, children with OSAS presented a significantly more anterior and inferior position of the hyoid bone than nasal breathers. No significant differences in superior anterior or posterior heights of the face were observed between groups.

Conclusion

The results suggest that there are evident and early changes in facial growth and development among children with OSAS, characterized by increased total and inferior anterior heights of the face, as well as a more anterior and inferior position of the hyoid bone.
Cochlear Implant Outcomes in Children with Aplasia/Hypoplasia of the Cochleovestibular Nerve
Authors: Musso Mary Frances , Baker Dian , Emery Claudia , Lin Jerry W.
Published: September 2011

Objective

Cochlear implant (CI) candidates undergo a preoperative workup including radiologic, audiologic, and neurologic testing to determine if they are candidates for implantation. A percentage of these patients are found to have aplasia/hypoplasia of the cochleovestibular nerve (CVN). Past literature has debated if this population of children benefit from CI.

Method

Retrospective review evaluating 17 children with radiographically diagnosed aplasia/hypoplasia of CVN. Eight of these children underwent cochlear implantation during the period from 2002 to 2009. The remaining 9 children were treated nonsurgically with hearing aids. Medical records, audiologic testing, imaging studies, and speech and language evaluations were reviewed.

Results

Meaningful Auditory Integration Scale (MAIS) scores were available for 6 out of 8 CI patients. The average MAIS score pre‐CI was 6.16. The average scores post‐CI were 46.6, 72.8, 70.25, and 75. Auditory Preschool Language Scale (PLS‐4) pre‐CI was 4.75, and post‐CI score was 23. The pre‐ and post‐CI Expressive PLS‐4 scores improved from 11.25 to 23.5. Phonetic inventory scores were 3.7 for vowel sounds and 3.17 for consonant sounds. Scores post‐CI were 10.8 for vowel sounds and 12.5 for consonants. Linear regression analysis revealed a significantly faster acquisition of consonant sounds with the CI group.

Conclusion

Children with CVN aplasia/hypoplasia who received a CI had improved audiologic and speech and language assessments post‐CI. The CI group averaged higher scores in vowel and consonant sound production, which was statistically significant. Long term follow‐up is needed to further evaluate outcomes of CI with CVN aplasia/hypoplasia.
Factors Affecting Blood Loss during Pediatric Tonsillectomy
Authors: Park Seok‐Won , Han Min‐Seok , Cho Chang‐Gun , Kwon Seong‐Keun , Song Jae‐Jun
Published: September 2011

Objective

1) Know the factors that can affect the amount of blood loss or the change of the hemoglobin or hematocrit level after adenotonsillectomy in children. 2) Find any quantitative correlations between factors and bleeding parameters.

Method

From 172 child patients receiving adenotonsillectomy, CBC was measured before and after surgery, and then hemoglobin and hematocrit loss percent was calculated respectively. We selected some factors that can affect operative bleeding parameters. Data were analyzed to find any correlation between the factors and bleeding parameters.

Results

Data were statistically analyzed with two‐tailed Spearman’s rho correlation test and multiple linear regression. Patient body weight factor correlated significantly with hemoglobin (P =. 018) or hematocrit loss percent (P =. 036), but not with estimated bleeding amount. Regression equation was [Hemoglobin loss percent = 7.172 ‐ 0.096x (body weight)(P =. 015)] and [hematocrit loss percent = 6.267 ‐ 0.086x (body weight) (P =. 029)]. Other factors such as surgery‐indicated main symptom, technique, application of adenoid packing, subjective bleeding, and adhesion severity did not correlate with any operative bleeding parameters.

Conclusion

We can estimate the usual reduction amount of the postoperative hemoglobin (hematocrit) level in children receiving adenotonsillectomy. Amount of reduction of hemoglobin (hematocrit) is larger when the child’s body weight is lower, though the absolute bleeding amount is not affected by body weight. The surgeon should be more careful when performing adenotonsillectomy on a lower weight child.
Immediate versus Interval Tonsillectomy for Peritonsillar Abscess
Authors: Matijasec Jackie , Perry Alvin , Cecola Patrick , Kluka Evelyn A. , Simon Lawrence M. , Hagmann Michael A.
Published: September 2011

Objective

1) Compare operative time and intraoperative blood loss in patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess. 2) Compare postoperative bleeding and readmission rates for patients receiving either Quinsy or interval tonsillectomy for peritonsillar abscess.

Method

Study design: Retrospective review. Setting: Academic tertiary pediatric hospital. Patients: Children treated between 2007 and 2011 for peritonsillar abscess. Patients were identified by searching the hospital database for all children treated for the ICD‐9 code 475 (peritonsillar abscess). Children who never received a tonsillectomy (CPT codes 42820/42821/42825/42826) were excluded.

Results

A total of 49 children received tonsillectomy for peritonsillar abscess from 2007 to 2011. Of these, 37 received a Quinsy tonsillectomy, and 12 received antibiotics with or without incision and drainage, followed by tonsillectomy a minimum of 2 weeks later. Total hospital days in treatment course was 2.2 days for the Quinsy tonsillectomy group and 2.3 days for the interval tonsillectomy group. Estimated blood loss was less than 20 milliliters for both groups. Operative time was 38 minutes for Quinsy tonsillectomy and 39 minutes for interval tonsillectomy. There were no posttonsillectomy hemorrhages. One patient in the interval tonsillectomy group required readmission for dehydration.

Conclusion

There were no significant differences in total hospital days, blood loss, operative time, or postoperative complications between Quinsy tonsillectomy and interval tonsillectomy in the treatment of pediatric peritonsillar abscess.
Kawasaki Disease Presenting as Retropharyngeal Cellulitis
Authors: Kurihara Risa , Yamazaki Hiroshi , Fujiwara Keizo , Kanazawa Yuji , Kikuchi Masahiro , Kikuchi Shogo , Naito Yasushi
Published: September 2011

Objective

Kawasaki disease (KD), which occurs in infants and children, is an acute multisystemic vasculitis of unknown etiology. Several reports mentioned retropharyngeal cellulitis as a rare manifestation of KD. The purpose of this study is to investigate the population and characteristics of KD manifested by retropharyngeal soft tissue swelling.

Method

A retrospective review of 213 patients (mean age of 2 years, age range of 7 months to 10 years) diagnosed as KD between 2005 and 2010.

Results

Enhanced computed tomography showed an abnormal low density area without ring enhancement in the retropharyngeal space in 9 cases (4.2%). All of them had fever and cervical lymphadenopathy as the first symptom. Though cervical lymphadenopathy is one of the 6 diagnostic features of KD (fever, skin rash, cervical lymphadenopathy, conjunctivitis, fissuring of lips, and strawberry tongue), the occurrence is reported to be the lowest (about 50%). They were treated by a pediatrician as suppurative lymphadenitis in 6 cases and as retropharyngeal cellulitis in 3 cases, and they were finally diagnosed as KD owing to ineffectiveness of antibiotics or emergence of the other symptoms.

Conclusion

A low density area on computed tomography in the retropharyngeal space was identified in 4.2% of KD. Early diagnosis is essential in KD because coronary artery lesions emerge in 50% of patients without treatment. If a young child has fever, cervical lymphadenopathy and swelling of the retropharyngeal space, KD should be within differential diagnoses.
Laser Epiglottopexy: Flexible versus Line‐of‐Sight Technique
Authors: Janus Jeffrey R. , Cofer Shelagh A. , Chinnadurai Sivakumar
Published: September 2011

Objective

Determine outcomes in children with epiglottic laryngomalacia treated with laser (CO2, LISA) epiglottopexy by both flexible (photonic band gap technology) and traditional direct line‐of‐sight techniques. These procedures are used as a monotherapy for the treatment of obstructive sleep apnea resulting from epiglottic retroflexion or sagittal collapse.

Method

Single center, retrospective review of patients with epiglottic laryngomalacia treated with laser epiglottopexy from 2005 to 2010. Outcomes measured include sex, age, gestational age, primary obstructive sleep apnea presentation, type of dynamic epiglottic collapse, polysomnogram information, medical comorbidities, and resolution of symptoms after surgery.

Results

Five cases were reviewed; 80% male, 20% female. The average age at treatment was 9.4 years. All patients had underlying medical comorbidities (Turner Syndrome, Bardet‐Biedl, etc). Various initial presentations include (can be more than one): 80% sleep disturbance, 80% apneic episodes, 20% cyanosis, and 20% snoring. A total of 80% had epiglottic retroflexion as the primary anatomic dilemma, with only one having sagittal collapse. Average AHI was 23.8. All received laser epiglottopexy (3 flexible laser, 2 line‐of‐sight). All but one received concomitant tacking sutures. Average operative time was 150 min. Average hospital stay was 5.2 days. All had symptom resolution at 135 days of average follow‐up.

Conclusion

Laser epiglottopexy, using either flexible technology or line‐of‐sight method, can be done safely, efficiently, and effectively as monotherapy for obstructive sleep apnea caused by epiglottic collapse. Advances in this technology and in these techniques may prove helpful not only in this specific problem, but for the treatment of laryngomalacia in general.
Late Onset Laryngomalacia in Neurologically Normal Children
Authors: Tanweer Faiz , Bateman Neil D.
Published: September 2011

Objective

Laryngomalacia in neurologically normal children over the age of 2 is uncommon. The purpose of our study was to determine the mode of presentation and mechanisms of obstruction. We retrospectively reviewed our hospital database to identify late onset laryngomalacia (LOM) patients who had confirmed endoscopic diagnosis of laryngomalacia.

Method

We retrospectively reviewed our hospital database to identify patients who had confirmed endoscopic diagnosis of laryngomalacia. Patients symptoms, age at diagnosis, co‐morbidities, medical and surgical intervention, and short‐term outcome (symptoms within 3 months) were recorded. Patients were excluded if they were symptomatic before 2 years of age or there were congenital anomalies involving upper aerodigestive tract.

Results

We identified 5 cases after searching our patient database over the past 5 years (from May 2005 to Jun 2010). Two patients presented with poor exercise tolerance at the ages of 13 and 14 years, while 2 younger patients (3 and 4 years) presented with obstructive sleep apnea (OSA) not relieved with adenotonsillectomy. All patients responded well to the surgery combined with antireflux therapy.

Conclusion

LOM presents with a variety of symptoms rather than the typical inspiratory stridor well recognized of infantile laryngomalacia. Our patients more commonly present as OSA or exercise induced inspiratory stridor. The mechanisms of late presentation appear to be unclear.
Management for Epistaxis in Children with Bleeding Disorders
Authors: Kibort Jonathan , Nelson Stephen , Sidman James D. , Grischkan Jonathan M. , Tibesar Robert J. , Lander Timothy
Published: September 2011

Objective

Medical management of epistaxis is the traditional standard of care in treating children with bleeding disorders. Our objective is to review our experience with physical intervention as a method of epistaxis management and to evaluate its safety and efficacy as an appropriate treatment for pediatric patients with an identified coagulopathy.

Method

Children with a known coagulopathy and who were treated for epistaxis were identified, and a retrospective chart review was performed. Medical records from 2000 to 2011 were reviewed and abstracted. The number of episodes, method of management used, type of coagulopathy, complications, and success rates for controlling the hemorrhage were recorded.

Results

Thirty‐five children with a total of 102 encounters for epistaxis met the study criteria. Sixty‐nine procedures (approximately 67.6%) did not require further surgical intervention during the intervention success period (21‐28 days after the initial procedure). Physical intervention was successful 57% of the time (21 out of 37 procedures) in patients with Glanzmann thrombasthenia. In children with von Willebrand disease, physical intervention prevented recurrent epistaxis 75% of the time (21 out of 28 successful procedures). For patients with acquired coagulopathies due to chemotherapy treatment for hematogenous malignancies, physical intervention proved successful in 76% of procedures (13 of 17).

Conclusion

Medical management is the traditional treatment for epistaxis in children with known coagulopathies. In treating children with known coagulopathies where medical management is unsuccessful, physical intervention is a safe, effective, and minimally invasive treatment that may decrease the frequency of recurrences for epistaxis in children with coagulopathy.
Pediatric Small Vessel AVMs Mistaken for Hemangioma
Authors: Chun Robert H. , North Paula E. , Jakubowski Luke A.
Published: September 2011

Objective

A majority of vascular anomalies in children are infantile hemangiomas (IH). However, some children with an atypical growth pattern can be suggestive of an AVM. This case series discusses the clinical presentation, diagnosis, radiology, pathology, and treatment of small vessel AVMs at a multidisciplinary vascular anomalies center.

Method

Retrospective case series of three patients. Chart review was obtained with IRB approval.

Results

Three patients presented with increasing head and neck masses at 12 months to 2.5 years. All patients had magnetic resonance imaging indicating likely infantile hemangioma. All patients underwent surgical excision, one requiring preoperative embolization. All pathology specimens were GLUT 1 negative and were diagnosed as small vessel arteriovenous malformations. Serial clinical photographs, imaging studies, and pathology will be presented.

Conclusion

Many pediatric vascular anomalies appear to be an IH, but atypical growth patterns should raise clinical suspicion of an AVM. Diagnostic error leads to inadequate treatment, disease progression, and increased morbidity. This series highlights the importance of clinical suspicion and a multidisciplinary team approach toward pediatric vascular anomalies.
Outcomes and Predictive Factors of Furlow Palatoplasty
Authors: Jacobs Britni , Muckala Jennifer , Sowder Derrick , Wooten Christopher , Goudy Steven L. , Zheng Wei
Published: September 2011

Objective

1) Describe patients with submucous cleft palates (SMCP) and velopharyngeal insufficiency (VPI) treated with furlow palatoplasty who later required subsequent surgery due to persistent VPI. 2) Identify risk factors predictive of revision surgery in SMCP patients in order to develop a clinical algorithm to apriori determine the most efficacious primary surgery based on preoperative evaluation.

Method

A retrospective review of 14 patients with SMCP undergoing furlow palatoplasty to correct VPI. Data reviewed included need for secondary surgery, syndrome diagnosis, velopharyngeal closure, and preoperative speech evaluations.

Results

A series of 14 patients having furlow palatoplasty between ages 3 and 16 (average age of 4.9 years) was identified. Three of these patients (21.4 %) required secondary correction of VPI via superiorly based pharyngeal flap an average of 2.3 years following the initial operation. There was no association between age at primary surgery or syndromic diagnosis and persistent VPI. Predictors of persistent VPI after palatoplasty were poor preoperative speech (P <. 03) and nasometry scores (P <. 09). Pattern of velopharyngeal closure was not predictive of further surgery, however an association between larger velopharyngeal gap and need for revision surgery was found.

Conclusion

Preoperative speech and nasal endoscopic assessment of patients with SMCP and VPI is predictive of patients who require palatoplasty alone or may benefit from primary velopharyngeal surgery.
Pediatric Maxillary Sinus Growth Curve
Authors: Thakkar Nirav , Schroeder James W.
Published: September 2011

Objective

Describe the growth pattern of the maxillary sinus in the pediatric population. This includes identifying growth spurts and comparing growth by side and gender. This data is intended to assist a surgeon recommending or delaying surgical treatment and to help with surgical planning.

Method

CT scans performed in patients under 18 years at a Children’s hospital from January 2006 through June 2009 were reviewed. Scans with sinus disease affecting the normal sinus anatomy were excluded. The height, width, and depth of the right and left maxillary sinuses were measured to characterize its growth pattern.

Results

The overall growth rate of each sinus from birth to age18 years is 1.98 mm3 per year. The growth from ages 1 to 7 years is 1.4 mm3 per year, 7 to 9 years is 3.1 mm3 per year, 9 to 12 years is 0.4 mm3 per year, 12 to 15 years is 4.8 mm3 per year, and 15 to 18 years is 1.5 mm3 per year. The predominant dimension contributing to growth during each growth spurt, ages 7 to 9 years and 12 to 15 years are height and depth respectively. The rate is 0.15 mm per year and 1.9 mm per year respectively.

Conclusion

Comparison of gender and side demonstrated no significant difference in height, width, or depth at each age. The maxillary sinus gradually grows from ages 1 to 7, 9 and 12 and 15 onward. Two growth spurts were identified from ages 7 and 9 and 12 and 15.
Pediatric Myringoplasty
Authors: Takahashi Emiko , Mishiro Yasuo , Sakagami Masafumi
Published: September 2011

Objective

Investigate “the true success rate” of myringoplasty for pediatric patients.

Method

This was a retrospective analysis of 72 myringoplasites performed at Hyogo College of Medicine between 2000 and 2009. Success was defined as an intact tympanic membrane (no perforation, no adhesion, no retraction, and no effusion) and preservation of hearing at 1 year after surgery.

Results

The graft success rate was 85%, similar to adult patients. However, the defined success rate was only 54%. There were 8 cases with graft failure, 3 cases with retraction pocket, 3 cases with OME, 3 cases with pearl formation, 2 cases with adhesion of tympanic membrane, and 2 cases with postoperative abscess needing re‐operation. The success rate was 70% in patients with normal contralateral ear and 37% in patients with diseased contralateral ear (eg, CMO, OME, cholesteatoma, and atelectasis). There was a significant difference concerning the state of the contra‐lateral ear.

Conclusion

The true success rate of a pediatric myringoplasty seemed to be lower than commonly expected and quoted to parents. The results are similar to other reports using a similar definition of success. We should especially pay attention to myringoplasty for patients with diseased contra‐lateral ears.
A Study into the Benefits of Bilateral Packing for Epistaxis
Authors: Hollis Sophie , Titoria Puneet
Published: September 2011

Objective

Theoretically there is a safety benefit in using bilateral nasal packs in managing epistaxis. Our study aims to show an additional benefit in this practice: the reduction to the deformity caused across the nasal septum with bilateral packing, therefore creating a safer and more pleasant patient experience.

Method

We created a simple nasal model to illustrate the nasal septal cartilage as a structure that is anchored inferiorly, superiorly, and posteriorly, but with a free anterior edge. Using 7.5 cm Arthrocare RapidRhino packs and a manometer, we measured the septal deflection created using different pack pressures, unilaterally and bilaterally.

Results

By measuring the anterior deflection of the cartilage analogue (3 mm wide silicone sheeting) at 3 different fixed points along the anterior edge, we were able to demonstrate significantly less septal deflection when using bilateral packing with the same pressures, compared with unilateral packing. The dynamic nature of the model meant that the maximum deflection points varied between repetitions of the study, yet less septal deflection was seen with bilateral packing, particularly with higher inflation pressures, regardless of the starting deformity.

Conclusion

Our simple model shows that the nasal septal deformity with bilateral packing is reduced, compared with unilateral packing. We theorize that the reduced deformity shown with bilateral packing will make for greater patient comfort. We have commissioned a model with pressure sensors across the nasal septum to analyze this theory.
Pediatric Otogenic Sinus Thrombosis and the Role of Anticoagulation
Authors: Chun Robert H. , Sitton Matthew
Published: September 2011

Objective

1) Discuss the presentation, work up, and treatment of a series of pediatric patients presenting with otomastoiditis with sigmoid sinus thrombosis (OSST). 2) Review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis.

Method

Retrospective case series of 3 patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using Pubmed search terms “thrombosis and otitis media and anticoagulation” limited to English.

Results

Three patients were diagnosed with OSST. One patient presented with diplopia and otitic hydrocephalus. All patients were treated with anticoagulation following myringotomy with tubes and cortical mastoidectomy without thrombectomy. All patients were anticoagulated for 24 to 42 weeks with clinical recovery with resolution of thrombosis by MRI in less than 6 months. There were no major complications from anticoagulation use. Literature review of 50 patients with OSST showed that 60% had sigmoid aspiration or incision in addition to mastoidectomy, and only 64% of patients had anticoagulation. All patients had clinical recovery, with recanalization or resolution of clot in 16 patients.

Conclusion

The treatment of OSST is controversial. All patients presented had clinical recovery but 66% had anticoagulation and clot resolution in 19 out of 32. Two patients had hematoma with anticoagulation. This series and literature review highlights the controversy of surgical and medical management of OSST and the need for further investigation.
Practice Trends among Otolaryngologists Treating Hemangiomas
Authors: Mascarinas Christopher A. , Stefanov Dimitre G. , Butts Sydney
Published: September 2011

Objective

1) Compare the approaches to the treatment of hemangiomas between pediatric otolaryngologists and facial plastic surgeons. 2) Understand practice trends among otolaryngologists in the context of evolving standards of care in the management of patients with hemangiomas. 3) Identify the variables that influence therapeutic choices in treatment of hemangiomas.

Method

A 10‐question survey was sent to ASPO and AAFPRS members. Responses were collected between July and December 2010. All questions were based on a 5 point Likert scale from “Strongly Disagree” to “Strongly Agree” except 2 questions related to physician practice. Results were analyzed using t tests comparing mean scores.

Results

A total of 89 surveys from ASPO and 80 from AAFPRS were returned. Mean years in practice (15.4 AAFPRS and 19.7 ASPO) and patient volume (59.6% ASPO versus 29.49% AAFPRS treated at least 5 hemangioma patients yearly) differed significantly between both groups (P <. 01 and P <. 001, respectively). There was no association between years of experience and whether a physician agreed/strongly agreed with any question. There was a significant difference between percentage of ASPO and AAFPRS members agreeing/strongly agreeing with questions 2 to 7. These questions focused on the role of steroids, propanolol, laser therapy, and surgery.

Conclusion

Subspecialty affiliation was a significant factor in the majority of survey responses. There was greater use of steroids and lasers by facial plastic surgeons. More pediatric otolaryngologists reported using propanolol. Sources of differences in treatment philosophy should be elucidated. Standardized management approaches could potentially be generated across subspecialties in otolaryngology.
Preoperative Sleep Studies for Pediatric Adenotonsillectomy
Authors: Nayar Meenakshi , Fleming Jason , Wong Robynne
Published: September 2011

Objective

In 2008, an expert UK panel produced a consensus statement highlighting factors putting children at additional risk of having respiratory complications following adenotonsillectomy for sleep related breathing disorders. This audit, performed at a pediatric teaching hospital, assessed whether at‐risk children indicated by the guidelines were having appropriate preoperative investigations.

Method

A retrospective study conducted in the Royal Alexandra Children’s Hospital in Brighton over a 6‐month period. A total of 49 children having elective day case adenotonsillectomy fulfilled inclusion criteria. Patient notes were analyzed for demographics and past medical history to see if they fit the consensus criteria to undergo sleep studies preoperatively.

Results

The audit highlighted that the common indications putting children in the high risk group were weight (<15 kg), age (<2) and significant co‐morbidity. Despite 49% fulfilling criteria to have pre‐operative sleep studies, only 20% of this high risk group were investigated pre‐operatively. The most common complication was postoperative desaturations. Overall 10% of the audit population developed postop complications requiring enhanced level of care. 60% of these complications were in high risk patients who did not have pre‐op sleep studies and pre‐booked high dependency unit (HDU) provision. A total of 8 days of unplanned HDU care was needed.

Conclusion

Standards of preoperative respiratory investigations were not being met, with children being listed for adenotonsillectomy without appropriate risk stratification. Information bulletins were disseminated across relevant specialties and risk chart posters were introduced to ENT consultation rooms. A repeat audit cycle will be completed in 6 months.
Prevalence of Hearing Loss in Twins
Authors: Anicete Rosslyn Capuno , Lazaroo Derek , Omar Haryani , Posas Maria Lina , Balane Pia , Tan Henry K.
Published: September 2011

Objective

Determine the prevalence of hearing loss in the twin population. Compare the degree of hearing loss between first‐ and second‐born twins.

Method

A retrospective review of twins born with hearing loss at KK Women’s and Children’s Hospital from 2005 to 2009 was done. Birth, medical history, and hearing test results were reviewed and recorded. Categorical and continuous data were analyzed using chi‐square tests and student’s t‐test respectively.

Results

A total of 1826 twins (913 sets) were born from 2005 to 2009. Twenty‐four out of 1826 (1.31%) twins have hearing loss. Mean gestational age was 32.15 (SD, ±4.36), and mean birth weight was 1.67 (SD, ±0.76). There is no difference in the degree of hearing loss between the first‐ and second‐born twins.

Conclusion

Hearing loss occurs in 1.3 per 1000 twins. The birth order of twins does not influence the degree of hearing loss.
Residual Obstructive Sleep Apnea in Children Less Than 3 Years of Age after Undergoing an Adenotonsillectomy
Authors: Nath Andrea , Suskind Dana L. , Baroody Fuad M. , Emani Janaki
Published: September 2011

Objective

Obstructive sleep apnea (OSA) is the leading reason for adenotonsillectomy in children. We aimed to evaluate polysomnographic characteristics of OSA in children under 3 years of age and, in a subset of these children who had pre‐ and postoperative sleep studies, potential persistence of OSA after adenotonsillectomy.

Method

We performed a retrospective chart review of children.

Results

A total of 283 children underwent a preoperative polysomnogram, and 70 had both pre‐ and postoperative polysomnograms. Their average age was 20.3 + 0.8 months. Adenotonsillectomy resulted in a significant reduction in apnea hypopnea index (AHI) from 34.8 + 4.8 to 5.7 + 1.6 events/hr (p + 1% to 89 + 0.8%) (p1 and 21% had an AHI>5). The only predictor of persistent OSA was the preoperative AHI, which was higher for the group with residual OSA (55+50) compared to the group without it (29 + 36) (P =. 02).

Conclusion

Adenotonsillectomy results in a significant improvement in OSA in children.
An Anatomic Model for Use in Surgical Skills Training of Tracheotomy
Authors: Ingram Amy , Bartlett Jennifer A. , Malone James P.
Published: September 2011

Objective

The objective would be to design a low cost, reproducible anatomic model to simulate tracheotomy in the surgical skills training laboratory. The model was adapted from a base model used previously for verification of proficiency (VOP) assessment of cricothyrotomy by general surgery residents.

Method

The following materials were used: ventilator tubing, vessel loops, a 2x4x9‐inch block of wood, red and white felt fabric, automotive ceiling headliner, cardboard, foam tape, adhesive spray, and foam. All materials were found easily at a local craft store or in medical discard.

Results

The model was assembled by securing ventilator tubing to a block of wood to represent the trachea. Thyroid and cricoid cartilages were fashioned and secured to ensure palpable landmarks. An anterior section of ventilator tubing was removed and replaced with foam tape to allow for a recyclable base. Finally, the thyroid and superficial tissue (including vessels and strap muscles) were assembled using headliner, felt, and vessel loops. After assembly was completed, four junior residents were able to successfully palpate each landmark, “ligate” vessels, identify and retract the thyroid isthmus, and perform a tracheostomy.

Conclusion

The model developed is a practical and reproducible anatomic model for simulation training of tracheotomy for otolaryngology residents and can be created utilizing inexpensive, readily available materials. In conjunction with a skills lab training session, this useful tool could play an important role in the overall evaluation of surgical competence.
Rigid Laryngoscopy Is Necessary to Diagnose Laryngeal Cleft
Authors: Neubauer Paul D. , Rosenthal Laura Swibel , Drake Amelia F. , Zdanski Carlton J. , Shah Rupali N.
Published: September 2011

Objective

1) Identify the signs and symptoms of a laryngeal cleft in children. 2) Compare diagnostic methods available for identifying laryngeal cleft and determine their utility.

Method

The charts of all patients diagnosed with laryngeal cleft in a tertiary care institution between 2009 and 2010 were evaluated retrospectively for age, gender, comorbidity, symptoms, bedside swallow evaluation, and results of imaging studies. Findings on flexible and direct laryngoscopy, both performed under general anesthesia, were compared.

Results

Six patients had a diagnosis of laryngeal cleft, confirmed by direct laryngoscopy, performed for cough and signs of aspiration. In 3 cases the pattern on a barium video swallow examination heightened suspicion of laryngeal cleft. Flexible laryngoscopy was performed on all patients by a pulmonologist. Laryngeal cleft was suspected in four cases but could not be confirmed. Direct laryngoscopy was performed by an otolaryngologist. Direct laryngoscopy, in which the arytenoids could be physically separated, allowed for definitive diagnosis of the cleft and identification of its type and severity in all 6 cases.

Conclusion

Video swallow and flexible laryngoscopy can raise suspicion of a rare laryngeal cleft in patients with otherwise common symptoms. A laryngeal cleft and its type can be definitively diagnosed by a direct laryngoscopy in which the inter‐arytenoid space is palpated.