bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Evaluation of Round Window Niche Visualization in Cochlear Implantation by Means of Computed Tomography
Authors: Kashio Akinori , Sakamoto Takashi , Karino Shotaro , Kakigi Akinobu , Iwasaki Shinichi , Yamasoba Tatsuya
Published: August 2013

Objectives:

Evaluate round window niche (RWN) visibility during cochlear implant (CI) surgery and to predict RWN visibility using high resolution computed tomography (HRCT).

Methods:

Sixty‐five ears from 19 adults and 46 children who received CI were enrolled. All patients were examined with HRCT and their surgical video was recorded. In the axial slice showing RWN, a line was drawn along the posterior wall of the external auditory canal (line A). Another line (line B) parallel to line A was drawn to get contact with the vertical segment of the facial nerve. Relationship between the band between lines A and B and the position of the RWN was classified into 3 types: RWN was 1) fully, 2) partially, or 3) not included in the band. The visibility of the RWN during CI was classified as A) fully, B) partially, or C) not visible.

Results:

From the surgical video review, 27 cases were classified as A), 21 as B), and 17 as C). All the 15 cases classified as 3) based upon CT findings were classified as C). Out of 19 cases classified as 2), 17 were classified as B) and 2 as C). Out of 31 cases classified as 2), 27 were classified as A) and 4 as B).

Conclusions:

The visibility of the RWN during surgery exhibited high correlation with preoperative predictions from HRCT findings. This method is useful to preoperatively predict the difficulty of exposing the RWN in CI surgery.
Results of Hearing Gain according to Ossicular Prosthesis Materials
Authors: Choi Young‐Seok
Published: August 2013

Objectives:

Compare the functional results and extrusion rates according to the type of ossciular prosthesis materials in POR and TOR cases.

Methods:

A retrospective analysis was performed. Sixty‐two patients were involved in POR cases and 70 patients were involved in TOR cases. In POR cases, Plastipore was used in 21 cases, hydroxy‐apatite in 20 cases, and titanium in 20 cases. In TOR cases, Plastipore was used in 20 cases, hydroxy‐apatite in 25 cases and titanium in 25 cases. We reviewed postoperative air‐bone gap (ABG; less than 20dB and more than 20dB) and extrusion rate for more than 1 year follow‐up period.

Results:

In POR cases, extrusion rates (ER) were 14.3%, 15.0%, 5.0% in plastipore, HA, and titanium prothesis, respectively. ABG less than 20dB were 71.4%, 80.0%, 85% in platipore, HA, and titanium, respectively. In TOR cases, ER were 30.0%, 20.0%, 8.0% in plastipore, HA, and titanium prothesis. ABG less than 20dB were 25.0%, 28.0%, 32.0% in plastipore, HA, and titanium prothesis, respectively.

Conclusions:

There were no differences in hearing gain results and extrusion rates between Plastipore, HA, and titanium prosthesis in POR and TOR cases statistically. But clinically, better hearing gain and low‐rate of extrusion were found in titanium prosthesis and this material is recommended in cases of ossicular surgery.
The Functional Comorbidity Index Is Useful to Predict Quality of Life
Authors: Weaver Edward M. , Levine Corinna G.
Published: August 2013

Objectives:

Comorbidity indexes adjust for comorbidity confounding on a specific outcome, but no index is designed specifically for a quality of life (QOL) outcome. The Functional Comorbidity Index was previously designed to predict physical function‐related QOL. The goals of this study: 1) Assess the Functional Comorbidity Index as a predictor of general QOL in sleep apnea patients (measured by SF‐36 component scores); 2) Compare the ability to predict general QOL between the Functional Comorbidity Index and the widely used Charlson Comorbidity Index.

Methods:

Between 2004‐2007 669 adults with sleep apnea were prospectively enrolled and data collected for the QOL outcome variables and the comorbidity indexes as independent variables. A random sample of 250 was analyzed with Spearman correlations between each index and QOL measures. Multivariate linear regression models calculated the ability to predict QOL (adjusted R2) adjusted for demographics and sleep apnea severity. Bootstrapping generated variances in the regression coefficients to test statistically for a clinically important (10%) difference between indexes.

Results:

Correlations of the Functional and Charlson Comorbidity Indexes with the mental component of QOL were ‐0.38 (P < 0.0001) and ‐0.07 (P = 0.2946), respectively. The Functional Comorbidity Index was clinically and statistically superior to the Charlson Comorbidity Index for predicting the mental component of QOL (adjusted R2 0.23 and 0.13, respectively, P < 0.001). Similar results were found for predicting the physical component of QOL.

Conclusions:

The Functional Comorbidity Index is useful to predict QOL and is a more robust predictor of QOL than the Charlson Comorbidity Index in sleep apnea patients.
Value of Hearing Handicap Elderly‐Screening in Predicting Hearing Impairment
Authors: Ho Eu Chin
Published: August 2013

Objectives:

Evaluate the usefulness of the Screening Version of the Hearing Handicap Inventory for the Elderly (HHIE‐S) questionnaire in screening for hearing impairment in the general population.

Methods:

We recruited subjects at a health awareness event organized by the ENT Department of a tertiary hospital. Members of the public were invited to fill in the HHIE‐S questionnaire and to undergo a four‐frequency pure tone audiogram (PTA), of which 37 subjects aged 25 to 82 years completed both.

Results:

Conventionally, moderate or high scores on the HHIE‐S questionnaire are considered strongly suspicious of a hearing impairment. If hearing impairment is defined as four‐frequency average (0.5kHz, 1kHz, 2kHz & 4 kHz) PTA > 26dB in the better hearing ear, the sensitivity of the HHIE‐S questionnaire in screening for hearing impairment is 80%, but its specificity is low at 18%. The positive predictive value is 40% and the negative predictive value 57%. However, if hearing impairment is defined as four‐frequency average PTA > 41dB, the sensitivity of the HHIE‐S questionnaire in screening for hearing impairment is increased to 100% though its specificity remains low at 20%. The positive predictive value of the screening questionnaire is greatly reduced to 6%, though the negative predictive value rises to 100%.

Conclusions:

For general population screening, the HHIE‐S is too inaccurate to screen for slight and mild hearing loss, but it can be used to screen for moderate to severe hearing loss. However, all patients with moderate and high scores need a formal audiogram to confirm the hearing levels.
Analysis of Hearing Screening Test Findings of 11,575 Newborns in Turkey
Authors: Ulusoy Seçkin , Uğraş Hilmi , Cingi Cemal , Yılmaz Huseyin B.
Published: August 2013

Objectives:

Review the newborn hearing screening test data performed at Corlu State Hospital, Turkey, during the last 3 years.

Methods:

A total of 11575 newborns that were either born in this hospital or referred from other healthcare centers between September 2009 and September 2012 were included. TEOAE (Transient Evoked Otoacoustic Emissions) test and AABR (Automated Auditory Brainstem Response) were used as screening tests. After the newborn failed the initial TEOAE test, the test was repeated after 15 days. If the same result was obtained at the second test, the newborns were referred for ear, nose, and throat (ENT) examination. TEOAE and AABR screening tests were performed as the third stage evaluation.

Results:

Out of 11575 newborns, 593 (5.12%) had failed the test and were referred for ENT examination and further evaluation. Out of these 593 neonates, 474 (79.93%) passed the second step test at the referral center. 106 (17.87%) did not show up again, so we did not get any information about them. Unfortunately, bilateral and unilateral sensory neural hearing impairment was detected in 12 and 3 babies, respectively. Seven of these babies had risk factors such as family history of hearing loss and consanguineous marriages.

Conclusions:

Newborn hearing screening and early diagnosis are an problems in our field. The final hearing impairment ratio of our study was parallel to general statistics, but our false positive ratio seemed to be higher than that of other centers. It is important to do all tests at the same center concomitantly in order to decrease the false negative ratio.
Antibiotics and Ibuprofen Do Not Affect Post‐tonsillectomy Bleeding Risk
Authors: Bannos Cassandra , Kirby Alexann , Leslie Jessica , Lee Gi Soo , Roberson David W.
Published: August 2013

Objectives:

Determine if the use of ibuprofen or perioperative ampicillin affect post‐tonsillectomy bleeding risk. Investigate other potential risk factors for post‐tonsillectomy bleeding. As recommended by the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) tonsillectomy practice guideline, several members of an academic department stopped using perioperative ampicillin and also began using ibuprofen postoperatively. This quality improvement project was designed to determine whether these actions altered bleeding risk.

Methods:

Case control comparison methodology. A case was defined as any patient who returned to the operating room for cauterization. A control was defined as any patient who did not have known post‐operative bleeding. Four randomly selected patients (2 cases and 2 controls) were identified in each month from November 2010 to August 2012 (n = 88).

Results:

Ibuprofen (odds ratio [OR] = 1.13, P = 0.8), perioperative ampicillin (OR = 0.91, P = 0.9), and postoperative amoxicillin (OR = 1.0, P = 1.0) had no effect on bleeding risk. Several trends were identified: Use of a microdebrider (vs. cautery) was associated with decreased bleeding risk (OR 0.21, P = 0.04). Neurologic/psychosocial comorbidity was associated with increased bleeding risk (OR 2.93, P = 0.06). Positive pre‐operative bleeding risk assessment questionnaire was associated with increased bleeding risk (OR 1.76, P = 0.24).

Conclusions:

The use of ibuprofen and omission of perioperative ampicillin had no effect on the bleeding rate. The role of tonsillectomy technique, neurological/psychosocial comorbidity, and positive bleeding risk questionnaire are being examined prospectively.
Auditory Brainstem Response and Distortion‐Product Otoacoustic Emission Studies in Neonates at High‐Risk for Hearing Loss
Authors: Cohen David S. , Rudd Tracy , Nation Javan J. , Shah Priyanka , Shah Shivani , Cortez Josef , Coticchia James M.
Published: August 2013

Objectives:

1) Recognize that preterm infants less than 1300g have a well‐described and markedly increased incidence of hearing loss, possibly attributed to reversible early middle ear pathology. 2) Analyze if distortion product oto‐acoustic emissions (DPOAE) and/or auditory brainstem response (ABR) could be useful adjuncts when used in addition to tympanometry and otoendoscopy in evaluation of neonatal hearing and middle ear.

Methods:

Institutional review board approved prospective study at a tertiary care center neonatal intensive care unit with subjects undergoing ABR, DPAOE, tympanometry, and otoendoscopy studies within 72 hours of birth and in scheduled increments until discharge. From January 2010 to date, 77 neonates have been examined.

Results:

Our results confirmed that DPOAE could be a reliable and repetitive study from 24 weeks of gestational age and onward. When comparing traditional tympanometry to DPOAE, 85.7% of examinations with type B or C tympanometry also had an abnormal DPOAE result. Conversely, 62.5% of patients with type A tympanometry had a normal DPOAE result. Furthermore, in patients with a clinical diagnosis of AOM or OME, 66.7% percent had an abnormal DPAOE result. Regarding ABR threshold studies, there were several limitations with data acquisition due to incubator interference and background noise; thus, the potential of ABR in this population remains to be determined.

Conclusions:

This study suggests that DPOAE can be used as a reliable hearing evaluation in the neonatal population. Additionally, it may serve as a useful adjunct and insight into evaluating neonatal middle ear pathology, especially when combined with tympanometry and otoendoscopy.
Creating an Algorithm for Preoperative Cardiac Assessment of Adenotonsillectomy Patients with Obstructive Sleep Apnea
Authors: Huang Jane Z. , Hede Sannya V. , McHugh Catherine , Brock Linda , Larrier Deidre R.
Published: August 2013

Objectives:

Create guidelines in preoperative cardiac workup for obese pediatric patients with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (T&A). Specific objectives include: 1) Correlate body mass index (BMI) with postoperative complications. 2) Correlate BMI with cardiac pathology on preoperative and/or postoperative studies. 3) Determine if severity of OSA based on polysomnography (PSG) testing can predict postoperative complications.

Methods:

We conducted a retrospective chart review of over 110 pediatric patients with a BMI ≥ 25 kg/m2 who underwent T&A for OSA at a tertiary care children's hospital from January 2006 to December 2011, excluding syndromic features or pre‐existing cardiopulmonary disorders. Postoperative complications were analyzed in conjunction with BMI and severity of OSA based on polysomnography.

Results:

Preliminary analyses of cardiopulmonary pathology revealed 6 patients with right ventricular hypertrophy or dilation, 18 with tricuspid regurgitation, and 1 with reactive airway disease. There were no severe postoperative complications. Thirty‐four patients underwent a polysomnogram with a mean apnea‐hypopnea index (AHI) of 37.1 and a mean oxygen nadir of 80.5%. Increasing BMI was significantly correlated with higher AHI (P = 0.01, r = 0.5) but did not predict postoperative complications (P = 0.91). Preoperative oxygen nadir on PSG more closely predicted cardiac pathology, though results did not approach significance (P = 0.15).

Conclusions:

No adverse cardiopulmonary events were experienced by obese pediatric patients undergoing T&A, and hence, current data suggest that preoperative cardiac evaluation for obese children solely for the purpose of undergoing T&A is not routinely warranted.
Developing a Standard of Care for Pediatric Tracheostomy Decannulation
Authors: Maslan Jonathan , Kirse Daniel J. , Moustafa Farah , Whigham Amy S.
Published: August 2013

Objectives:

1) Recognize which diagnostic modalities are helpful to facilitate safe decannulation. 2) Provide data‐driven conclusions about pediatric tracheostomy management, given the recent American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) Consensus Statement on Tracheostomy Management (January 2013), which was based on expert opinion alone. 3) Define a pediatric tracheostomy decannulation protocol that can be extended to a large subset of patients.

Methods:

Study type: 10‐year retrospective review of one surgeon's pediatric tracheotomy decannulation methods. Inclusion criteria: Patients less than 18 years old. Setting: Tertiary care pediatric hospital. Outcome measurements: Airway endoscopy findings, sleep study results, capping trial tolerance, successful decannulation, and tracheocutaneous fistula repair and management.

Results:

167 patients underwent tracheotomy during this period, and 52 were decannulated. Of these, 22 had suprastomal granulation tissue removed and 4 patients had tonsillectomies, adenoidectomies, epiglottopexies, and/or supraglottoplasties prior to decannulation. Seventeen patients had subglottic stenosis; 9 underwent laryngotracheal reconstruction. Twenty‐five patients developed tracheocutaneous fistulas; 24 patients elected repair with 100% success rate.

Conclusions:

Decannulation of the pediatric patient requires a starkly different approach compared to the adult population, as many require surgical intervention prior to decannulation, and a much higher percentage of pediatric patients will keep a tracheocutaneous fistula. Our decannulation protocol includes daytime capping, rigid airway endoscopy to detect anatomic airway abnormalities, flexible endoscopy during simulated sleep to detect dynamic airway problems, and capped sleep studies. We also describe our novel trapdoor stomal flap technique, which has a 100% success rate for closure of tracheocutaneous fistulas.
Diagnostic Injection Laryngoplasty Predicts Success of Type I Laryngeal Cleft Repair: Results of Pilot Study
Authors: Skinner Margaret L. , Mavrothalassitis Orestes , Ishman Stacey L. , Au Yeung Karla J. , Collaco J. Michael , Lefton‐Greif Maureen
Published: August 2013

Objectives:

A pilot study to determine the effectiveness of injection laryngoplasty (IL) as a predictor for success of subsequent endoscopic laryngeal cleft repair (ELCR). Study Design: Case series with chart review. Setting: Tertiary care academic hospital.

Methods:

Retrospective analysis of children with type I laryngeal clefts who underwent IL and/or ELCR from September 2009 to January 2013.

Results:

Thirty‐six patients underwent IL with or without subsequent ELCR, and 11 underwent ELCR alone. Of those who underwent isolated ELCR, 8/11 (72.7%) had complete resolution of presenting symptoms. Of those who underwent IL, 29/36 (81%) had adequate follow‐up and 21/29 (72.4%) experienced compete resolution of presenting symptoms, similar to those undergoing ELCR (P = 0.679). Fourteen with complete response and 1 with partial response to IL underwent subsequent ELCR with adequate follow‐up. In all cases, response to ELCR was predicted by response to IL; 14 experienced complete resolution and 1 had partial resolution of presenting symptoms. While the rate of full resolution of symptoms following ELCR was better in the children undergoing previous successful diagnostic IL, it did not reach statistical significance (P = 0.072) due to the limited sample size.

Conclusions:

Diagnostic IL is an effective indicator for successful ELCR. This suggests that IL may be a useful diagnostic method to determine the degree of pathology presented by a type I laryngeal cleft in symptomatic patients and to predict the degree of success of subsequent ELCR. Future studies employing a larger sample size are recommended to confirm this relationship.
Evolving Indications for Tonsillectomy
Authors: Patel Hetal , Carr Michele M. , Straight Chelsey
Published: August 2013

Objectives:

Determine if there is a change in the trend of indication for tonsillectomy in a pediatric population over the last 9 years. Recurrent tonsillitis and obstructive sleep apnea are the two most common indications for tonsillectomy. Recurrent tonsillitis was the most common indication for tonsillectomy from the 1950s to 1980s. With the advent and effectiveness of antibiotic therapy for treatment of tonsillitis, however, recurrent tonsillitis has become a less prevalent indication.

Methods:

A retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 at a tertiary care children's hospital was performed. Patients were categorized by indication with the following group classifications: 1) Obstructive sleep apnea/sleep disordered breathing (OSA/SDB), 2) Recurrent tonsillitis and SDB/OSA, and 3) Recurrent tonsillitis alone. The data were analyzed using SPSS software.

Results:

A total of 2367 patients undergoing tonsillectomy were identified, 52% male, with mean age of 6.4 years. The frequency of OSA as an indication for tonsillectomy increased from 37% in 2003 to an average of 71% over the last 3 years. In 2003, 33% of children underwent tonsillectomy for recurrent tonsillitis alone. This dropped to a low of 10.5% in subsequent years. In the last half of 2011 and throughout 2012, the incidence increased to about 19%. Children with OSA and sore throats together as an indication for surgery has run about 12% over the last 5 years.

Conclusions:

Recurrent tonsillitis dropped in frequency around 2005, but more recently there has been a trend toward an increase in its frequency.
The Fetal Larynx and Pharynx: Structure and Development Described by 2D and 3D Ultrasound Examination
Authors: Shaul Chanan , Liberty Gad , Sichel Jean‐Yves
Published: August 2013

Objectives:

Define the structure and function of the fetal pharynx and larynx. We describe for the first time the various components of these anatomical sites by 3D multiplanar and render modes during the late 1st and 2nd trimesters. Understanding these structures’ normal anatomy and function may contribute to our evaluation of pathologies.

Methods:

Gravidae with singleton fetuses were enrolled. Transabdominal 3DUS scan of the fetal neck was acquired. The pharynx width and height, upper, middle, and lower larynx width, and larynx height were measured. We developed a new approach based on 5 spatial planes: posterior and anterior coronal planes and high, mid, and low axial planes. Multiplanar reconstruction (MPR) in post‐processing allowed adjustment of the volume to obtain the coronal plane of the area. Color Doppler was used to show fluid motion in the target area. 2DUS was also applied.

Results:

582 fetuses were examined during the late 1st and 2nd trimester of pregnancy. Components identified were the sphenoid bone, pterygoid processes, constrictor muscles, piriform sinus, uvula, epiglottis, aryepiglottic folds, arytenoid, cricoid, and thyroid cartilages, and the vocal cords. We defined the bilateral mode of movements of the constrictor muscles, aryepiglottic folds, and vocal folds, and bidirectional fluid jet flows through the larynx.

Conclusions:

The fetal larynx and pharynx can be visualized and measured with 3DUS in the late 1st and 2nd trimester. Knowledge of normal anatomy and biometry may prove useful in the evaluation of anatomic or functional pathologies involving the fetal upper respiratory tract.
Foreign Body Ingestion and Aspiration in the Pediatric Population: Analysis of 315 Cases
Authors: Truong Anh Q. , Funamura Jamie L. , Senders Craig W.
Published: August 2013

Objectives:

1) Determine the patient characteristics, presentation, location, and rates of associated injury in pediatric foreign body ingestion and aspiration. 2) Analyze the types of intervention and rates of postoperative complications.

Methods:

Retrospective analysis of all patients under the age of 18 who were evaluated for foreign body (FB) ingestion and aspiration at a tertiary care center between January 1, 2003, and December 31, 2012.

Results:

We identified 315 patients. 61% were male and 39% female, with an average age of 3.9 years (SD 3.9). 55.6% of FBs were found to in the esophagus, 22.2% in the airway, and 22% in the oropharynx or GI tract. The most common signs and symptoms at presentation were emesis (30.9%), choking/gagging (27.4%), coughing (24.0%), drooling (23.4%), and dysphagia (23.4%) with an esophageal FB and increased work of breathing (50.0%), cough (48.6%), choking/gagging (44.3%), wheezing (40.0%), and stridor (20.0%) with an airway FB. The most common FBs were coins (88.6%) and nuts/seeds (42.9%) in the esophagus and airway, respectively. Patients with a proximal esophageal FB were younger than patients with a distal esophageal FB (2.53 vs. 8.29 years). There was a 44% rate of superficial mucosal injury in the esophageal FB group. Rigid bronchoscopy and esophagoscopy were the most common methods of FB retrieval. There were no pneumothoraces and pneumomediastinum noted postoperatively.

Conclusions:

Aerodigestive FB ingestion and aspiration represent common problems in children. History, physical exam, and imaging are all key aspects of timely diagnosis, with rigid endoscopy as the mainstay of management.
Increased Resource Burden of Methicillin‐Resistant Staphyloccoccus aureus Orbital Cellulitis in the Pediatric Population
Authors: Smith Aaron M. , Nesemeier Ryan , Cash Elizabeth , Woods Charles , Chandran Swapna K.
Published: August 2013

Objectives:

Due to the colonization of the nares, the epidemic of community acquired Methicillin‐Resistant Staphyloccoccus aureus (MRSA) poses a risk of MRSA head and neck infections. Orbital cellulitis is one such infection that commonly follows sinusitis. This infection occurs posterior to the orbital septum, posing risk to nearby structures. The purpose of this study is to stratify the differences in epidemiology and resource use between MRSA orbital cellulitis and traditional non‐MRSA orbital cellulitis.

Methods:

We queried the 2009 Kid Inpatient Database, identifying all cases with a primary diagnosis of International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) code 376.01, orbital cellulitis. We then extracted these cases with a secondary diagnosis of ICD‐9‐CM code 041.12, MRSA, and compared the two groups using Statistical Analysis Software.

Results:

In 2009, the total number of cases for orbital cellulitis was 2502 with 133 having a secondary diagnosis of MRSA (5.3%). The median age for the MRSA group was older (8yo vs 5yo), with 15‐19yo 3.14 times more likely to have MRSA (RR 3.14, 95%CI 2.17‐4.56). Facial cellulitis was the most common comorbidity for the MRSA group (14%). The MRSA group was more likely to undergo orbitotomy (RR 2.39, 95%CI 1.56‐3.66), accruing higher median total charges ($12595 vs $10131).

Conclusions:

Although MRSA can colonize the nares, MRSA orbital cellulitis more commonly occurs with facial cellulitis. This infection increases with increasing age. Orbital infection with MRSA poses a higher resource burden, requiring more frequent invasive measures.
Innovation in Newborn Hearing Screening in Peru: Applying Design Thinking to Improve Health Policy
Authors: Czechowicz Josephine A. , Messner Anna H. , Janka David P. , Chaparro Juan C. , Rubio Javier A. , Calderon Gina Q. , Alarcon Jorge
Published: August 2013

Objectives:

1) Apply Design Thinking methodology to create an innovative national program for newborn hearing screening (NHS) in Peru. 2) Collaborate with Peruvian Ministry of Health to optimize implementation of a newly mandated national NHS program. 3) Provide a model for expanding NHS throughout the developing world.

Methods:

Descriptive study with focus groups and guided interviews. Design Thinking is a human‐centered approach to interdisciplinary problem solving that tackles complex problems with many stakeholders. Insight is gained through immersion, observation, and engagement. Study dates: June‐December 2012. Condition studied: Permanent congenital hearing loss. Subjects: Stakeholders involved in NHS. Policy‐makers: officials, politicians, academic physicians. Providers: audiologists, pediatricians, otolaryngologists, health workers. Recipients: neonates, mothers, hearing‐impaired children and families. Field sites included community clinics, tertiary care hospitals, ministry of health offices, schools for the deaf, audiology offices, and patient homes.

Results:

Interviewed 105 individual stakeholders at 14 sites. Data were captured in logbooks, photography, and video. Data obtained from this work were applied in the following ways: creation of a needs assessment tool for use in Peruvian hospitals to facilitate implementation of NHS; inclusion of NHS data in Peru's national electronic medical record; development of educational resources, both online and classroom‐based for providers of NHS.

Conclusions:

This work represents the first application of Design Thinking to innovate in health policy at a national level. Through publication of these methods, the authors hope to empower providers throughout the developing world to broaden access to NHS.
Hearing Loss and Depression in Brazilians
Authors: Schlindwein‐Zanini Rachel , Zanini Fabio D.
Published: August 2013

Objectives:

Hearing loss (HL) may be related to psychopathological aspects of the individual. The Sistema Único de Saúde‐SUS (health public system of Brazil) treats patients with HL by employing multidisciplinary teams. Our goal was to verify the level/seriousness of depressive symptoms on Brazilian patients with HL that are candidates for a prosthesis and to obtain other data such as age, schooling, and work.

Methods:

Transversal study in a Brazilian public hospital in 2012. To verify the seriousness of depressive symptoms (dependent variables) on a sample of 105 subjects with HL (independent variable), paired on both sexes, over 18 years old, using psychological interview and Beck Depression Inventory (BDI). The study was approved by the Universidade Federal de Santa Catarina Committee on the Ethics of Research on Human Beings.

Conclusions:

Most patients complained of bilateral HL. Observing the study about the severity of the depressive symptoms, it was found that the 59% had completed primary school, were working (68 adults), and presented depressive signs, in which 47% of the individuals showed minimal symptoms, 18% mild, 6% moderate, and 1% presented serious symptoms. Depression has psychological consequences on a person with HL and interferes with quality of life, family and work dynamics, and indicates a need for psychological intervention.
Pediatric Dysphonia: A Cross‐sectional Survey of Subspecialty Care Clinics
Authors: Johnson Christopher M. , Anderson Danielle , Brigger Matthew T.
Published: August 2013

Objectives:

1) Determine the prevalence of caretaker reported dysphonia in children undergoing medical evaluation. 2) Determine whether subspecialty pediatric clinics are associated with variable patterns of pediatric dysphonia compared to primary care.

Methods:

Cross‐sectional survey recording demographic data, caretaker perception of their child's voice, and the validated pediatric voice related quality of life (PVRQOL) instrument administered to caregivers of children undergoing evaluation in primary care and subspecialty clinics. Survey responses and PVRQOL scores were stratified by clinic type and compared to general pediatrics using Fisher's exact test for categorical data and the Wilcoxon Mann Whitney test for interval data.

Results:

A total of 406 complete surveys were analyzed. The mean PVRQOL score for all children was 90.6 (95%CI:88.7, 92.4). Compared to general pediatrics, PVRQOL scores were lower in developmental pediatrics (P =. 0004), genetics (P =. 0240), and otolaryngology (P =. 0332) clinics. Children in developmental pediatrics also were more likely to have a prior speech evaluation (P <. 001) and speech therapy (P =. 001). Otolaryngology patients were more likely to have undergone speech evaluation (P =. 030). Of note, no difference was found comparing PVRQOL scores in general pediatrics to gastroenterology (P =. 2086) or pulmonology (P =. 6633).

Conclusions:

Children undergoing evaluation in developmental pediatrics, genetics, and otolaryngology have lower PVRQOL scores than children evaluated in primary care. No other significant differences between subspecialty clinics were identified. These data reinforce that all practitioners caring for children should seek to identify voice disorders and highlight the importance of subspecialists who treat developmentally challenged children to exert particular vigilance.
Robotic‐Assisted Lingual Tonsillectomy in the Pediatric Population
Authors: Leonardis Rachel , Duvvuri Umamaheswar , Mehta Deepak
Published: August 2013

Objectives:

Assess the feasibility and outcomes of robotic‐assisted lingual tonsillectomy (RALT) in the pediatric population.

Methods:

Retrospective medical chart review performed using a tertiary care children's hospital database identified 16 pediatric patients who underwent RALT from March 2011 through December 2012. Demographic data, comorbidities, robot docking time, operative time, surgical blood loss, and postoperative course, including complications in the immediate and longer‐term postoperative period, were collected and analyzed.

Results:

All patients successfully underwent RALT using the daVinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA). Endotracheal intubation was used in all cases and did not interfere with visualization of the oropharynx. Optimal retraction allowed visualization of pertinent structures and maximized transoral access. A significant learning curve from the first 5 surgical cases to subsequent cases with respect to robot docking time and surgical blood loss was observed (9 versus 3 minutes and 7.4 versus 3.2 ml respectively, P <. 05). Operative time, estimated blood loss, and postoperative complication profile are within the expected and acceptable limitations for performing lingual tonsillectomy in the pediatric population.

Conclusions:

Technologic advances have allowed miniaturization of robotic instrumentation and have expanded the scope of surgical options for the pediatric airway. RALT is well‐tolerated and can be performed in the pediatric population with excellent success. It should be considered a feasible option for implementation at an institution‐based level.
Image Processing by Using the Wavelet Transform (PTI‐CDWT) to Diagnose Laryngopharyngeal Reflux Disease (LPRD)
Authors: Niwa Hideo , Horihata Satoshi , Makiyama Yasuhide
Published: August 2013

Objectives:

Develop Narrow Band Image (NBI) to diagnose LPRD by using a perfect translation invariance complex discrete wavelet transform (PTI‐CDWT).

Methods:

20 patients underwent NBI and Frequency scale for symptoms of GERD (FSSG). We performed image processing for pictures after NBI examination by using the application software of PTI‐CDWT that was developed at Toyohashi University of Technology in Japan. We looked into a correlation between PTI‐CDWT and NBI pictures.

Results:

Images detected by PTI‐CDWT were distinguished from linear wavelet transform to round wavelet transform. Patients with high score in FSSG tended to show round wavelet transform. On the other hand, patients with low score represented linear wavelet transform. PTI‐CDWT emphasized modulated nasopharyngeal epithelial cells with LPRD patients.

Conclusions:

LPRD is a common disease in the world. However, it does not have a definite diagnosis. Last year our group reported an applicability of NBI to diagnose LPRD. We showed one feature of nasopharyngeal mucosa pattern of NBI as mackerel cloud pattern. Wavelet transform are applied for signal and image processing of medical field. As image processing requiring a detail edge and directional components is important to estimate the images, one feature detection method of a discrete wavelet transform is to decompose the signal and image into each frequency component using low and high‐pass filters. PTI‐CDWT can detect more directions at various scales than previous wavelet transform. PTI‐CDWT could be applied as a useful diagnostic tool for LPRD.
Surgery for Reflux‐Induced Airway Disease: A Systematic Review
Authors: Sload Ryan L. , Brigger Matthew T.
Published: August 2013

Objectives:

1) Evaluate the current evidence regarding the efficacy and safety of anti‐reflux surgery for the treatment of severe gastroesophageal reflux related airway disease in children. 2) Provide evidence based recommendations regarding indications and outcomes of anti‐reflux surgery for airway disease in children.

Methods:

An a priori protocol was defined to identify all articles addressing anti‐reflux surgery for the treatment of reflux related airway disease in children where details regarding the diagnosis, treatment, and outcomes were clearly presented. The search was inclusive of all references available through January 2013 and included electronic databases to identify candidate articles as well as a comprehensive series of crosschecks. The two authors independently determined which references met inclusion criteria, extracted data, and assigned levels of evidence. Data were pooled using a random effects model due to significant study heterogeneity.

Results:

Thirteen articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I2 = 77%; P <. 001). However, each article uniformly presented cases suggesting that anti‐reflux surgery is efficacious and safe in treating children with severe reflux related respiratory disease. The pooled success rate for complete or partial resolution of symptoms after anti‐reflux surgery was 0.899 (95% confidence interval [CI]: 0.866, 0.932). The pooled success rate for complete symptom resolution after surgery was 0.697 (95%CI: 0.591, 0.803).

Conclusions:

The current literature suggests that anti‐reflux surgery is an effective and safe treatment for severe reflux related airway disease. However, the level of evidence lacks strength, and further investigation is warranted.
Trends in Hospitalizations for Pediatric Peritonsillar Abscess: 2003‐2009
Authors: Smith Aaron M. , Rife Eileen , Cash Elizabeth , Peyton Nathaniel , Woods Charles , Chandran Swapna K.
Published: August 2013

Objectives:

Peritonsillar abscesses (PTA) are the most common deep neck space infections. Although many of these infections are treated in the emergency department, these infections can become quite serious, compromising the airway or developing into Lemierre's Syndrome, requiring hospitalization. We embarked on this study to determine current hospitalized costs, length of stay (LOS), and demographic stratification of peritonsillar abscess.

Methods:

This study used the Kid Inpatient Database for 2003, 2006, and 2009. We queried this for International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) code 475.00, representing PTA. We obtained stratified data for this diagnosis. Hospital resource use was compared between teaching, non‐teaching, and pediatric facilities using Statistical Analysis Software. Census data were used to calculate incidences.

Results:

The number of hospitalizations and incidence increased (3608 to 4502, 3.7 to 4.5/100000population). Hospitalizations increased with increasing age (for 15‐19 yo vs other ages RR 2.18, 95%CI 2.14‐2.22). Percent of cases receiving surgical drainage decreased (41% to 34%). Median LOS remained constant at 2 days. Patients had longer LOS at pediatric hospitals (2.3d vs 2.14d vs 2.02d, P < 0.001) accruing more charges ($14763 vs $10587 vs $9120, P < 0.001). Pediatric and teaching hospitals performed more drainage than nonteaching (39.4% and 40.4% vs 36.1%, P < 0.001).

Conclusions:

Incidence of pediatric hospitalizations for PTA increased from 2003‐2009. These infections were more common among adolescents. Surgical management decreased. Overall cost per case increased, while LOS remained constant. The national emergence of community‐acquired MRSA during this time period may be related to the increase in incidence.
Tumors of the Pediatric Maxillo‐facial Skeleton: A 20‐Year Clinical Study
Authors: Perry Katherine , Tkaczuk Andrew , Caccamese John , Ord Robert , Pereira Kevin
Published: August 2013

Objectives:

Review the clinical presentation, radiologic features, management, and outcomes of jaw tumors diagnosed in children treated in a tertiary care academic center.

Methods:

Retrospective review of children age 16 and under who presented to the University of Maryland Medical Center between 1992 and 2012 and were diagnosed with a jaw tumor. Charts were reviewed for symptoms, physical exam, radiological findings, pathology, intervention, and outcomes.

Results:

The charts of 76 patients evaluated for a jaw mass were reviewed, and 22 were diagnosed with a jaw tumor. The two most common pathologies were ameloblastoma (27%) and ossifying fibroma (18%). Two tumors were malignant, both rhabdomyosarcomas. One‐third of patients presented asymptomatically with lesions found on surveillance panorex, while the remaining two‐thirds presented with evidence of a mass or swelling. All but one infant with a suspected lymphangioma underwent biopsy and surgical excision. Twenty‐seven percent of patients underwent more than one procedure, including secondary reconstruction, prior to a satisfactory outcome.

Conclusions:

Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass in the location. One‐third of patients are asymptomatic with a lesion identified on imaging. A majority of jaw tumors are benign but require surgical intervention for excision of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.
Upper Airway Obstruction in Children: Prevalence, Diagnosis, Repercussions, and Comorbidities
Authors: Di Francesco Renata C. , Gamero Mauro , Paulucci Bruno , Bento Ricardo F. , Brentani Alexandra V. , Escobar Ana M. , Grisi Sandra
Published: August 2013

Objectives:

Investigate the prevalence, diagnosis, and repercussions of upper airway obstruction in children under 5 years‐old and their impact in public health.

Methods:

A cross‐sectional study was conducted with 197 children under 5, randomly selected from a population of 1500, from November 2011 to December 2012. Parents answered to anamnesis about respiratory problems, upper airway infections, perinatal history, and feeding habits. They answered validated questionnaires about sleep disordered breathing and allergies. All subjects underwent a physical examination, and those who complained of respiratory problems also had nasal fiberendoscopy.

Results:

197 subjects (2.33 ± 1.09 y.o.), 107 boys. Prevalence of mouth breathing was 19.2%, nasal obstruction 18.2%, snoring 22.8%, rhinorrhea and sneezing 36.5%, and sleep disordered breathing (SDB) 7.1%. Diagnosis: adenoid enlargement (A) 8.6%, tonsil enlargement (T) 0.5%, tonsil and adenoid enlargement (T&A) 10.7%, rhinitis 21.9%, allergic rhinitis 7.6% (totalizing 49.6%). Fifty‐five point seven percent of children were exclusively breast fed for at least 6 months, and no correlation was found with nasal obstruction. Sleep disordered breathing symptoms were found in 7.1 % and were associated only with T&A (64.2%). Children with upper airway obstruction were prone to upper airway infections and visits to the emergency room.

Conclusions:

Upper airway obstruction is prevalent in about 20% of children. Breast feeding was not correlated to mouth breathing. Rhinitis is a common diagnosis. T&A is associated with SDB and infections, consuming high resources. Doctors must investigate and refer young children with upper airway problems to treatment in order to minimize large consumption of health resources.
The Importance of Informed Consent and Its Role in the Outcome of Surgical Liability Cases
Authors: Mady Leila J. , Choudhry Amad , Svider Peter F. , Choudhry Asad , Setzen Michael , Baredes Soly , Eloy Jean A.
Published: August 2013

Objectives:

Previous analyses have noted perceived deficits in informed consent (IC) in many otolaryngology malpractice lawsuits. However, no comprehensive analysis of IC in malpractice litigation across surgical specialties exists. Our objectives were to 1) examine IC in litigation across surgical specialties and 2) characterize factors in determining legal responsibility.

Methods:

Using the Westlaw Database, 694 jury verdicts and settlement reports since 2010 involving defendants practicing general surgery, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, and urology were examined for outcome, awards, procedure types, and alleged IC deficits.

Results:

Of 694 cases, 67.0% of decisions favored physicians. 25.4% resulted in damages awarded and 7.6% in out‐of‐court settlements. Although perceived IC deficits did not increase the likelihood of jury awards, a high number of cases (25.1%) identified IC as a factor. Plastic surgery (48.7%), ophthalmology (41.2%), and otolaryngology (33.3%) litigations were among the highest to identify IC deficits. Many cases in plastic surgery and ophthalmology with alleged deficits in IC involved elective procedures. In contrast, otolaryngology had a lower proportion of elective procedures in cases with alleged deficits in IC.

Conclusions:

Although perceived deficits in IC do not necessarily increase the likelihood of a negative outcome, it may play an important role in the initiation of malpractice litigation across surgical specialties. While otolaryngology had a relatively high rate of litigation involving IC deficits, it had a lower proportion of elective procedures in comparison to other surgical specialties in this analysis, suggesting elective interventions influence legal responsibility in a specialty‐specific manner.
Aspergillus Fumigatus Extract Suppressed mRNA Expression of the BAFF and IP‐10 in Epithelial Cells
Authors: Bhushan Bharat , Norton James E. , Gupta Dave , Sha Quen , Schroeder James W. , Schleimer Robert P.
Published: August 2013

Objectives:

Inhalation of spores from the Aspergillus fumigatus may cause local inflammation. The mucosal surface of the respiratory tract provides host defense mechanism. It is unclear why airway exposure to fungal pathogens leads to Th2 response. We report inhibition of Th1 biased epithelial inflammation by an Aspergillus extract (AE).

Methods:

Beas2B cells were cultured in a 37°C incubator in media with 5%FBS. Cells were treated with AE for 1h and were then stimulated with the TLR3 activator dsRNA for 6h. RNA was isolated and was reverse transcribed to cDNA. Real‐time polymerase chain reaction (PCR) analysis was performed in the presence of specific primers and fluorescently labeled probes. The estimation of cytokines including BAFF and IP‐10 was conducted using commercially available kits.

Results:

We conducted experiments assessing the ability of AE to modulate dsRNA induced expression of Th1 biased chemokines and cytokines by epithelial cells. Expressed genes analyzed included IP‐10, BAFF, IFIT‐1, and a few other Th‐1 biased chemokines. We observed that AE suppressed dsRNA induced expression of mRNA for BAFF and IP‐10 in Beas2b cells when compared with control (p<0.001). BAFF and IP‐10 protein expression was also significantly suppressed (P < 0.05). Furthermore we found no alteration of BAFF and IP‐10 mRNA expression in Beas2b cells when treated only with the diluent (without AE) and stimulated with dsRNA for 6 hours. We observed increased dsRNA induced IL‐8 mRNA expression in cells treated with AE.

Conclusions:

We found that AE strongly inhibits Th1 biased responses in epithelium as evident by decreased expression of Th1 biased cytokines.
Clinical Aspects of Alternaria alternata Sensitization in Patients with Allergic Rhinitis
Authors: Choi Suna , Shin Seung‐Youp , Lee Kun‐Hee , Kim Sung‐Wan , Cho Joong‐Saeng
Published: August 2013

Objectives:

Atopic sensitization to the mold Alternaria alternata (AA) has been associated with rhinitis and asthma. Fungal allergen exposure is associated with the development and severity of asthma in sensitized individuals. The contribution of indoor fungal allergen exposure to allergic diseases is still not completely clear. We explore the association of AA sensitization to other allergic diseases and study the influence on rhinoconjunctivitis symptom severity.

Methods:

2207 patients who were diagnosed with allergic rhinitis were enrolled in our study. After a skin allergy test, those with sensitivity to AA were placed in group A, and those sensitive to other allergens were placed in Group B. We evaluated the prevalence of other allergic disease and symptom severity using TNSS score.

Results:

Group A had 73 patients (6.4%), and Group B had 1053 patients. Group A had 8 patients with asthma (10.9%), 9 with atophy (12.3%), 6 with allergic conjunctivitis (8.2%), and 11 with sinusitis (15%) Group B had children under 14 years of age (35 patients), 7 with asthma (20%), 3 with allergic conjunctivitis (8.5%), 5 with sinusitis (14.2%), and 4 with asthma, allergic rhinitis, and atopic dermatitis (11.4%). In group A, TNSS score was higher than Group B, and it was statistically significant.

Conclusions:

Patients with allergic rhinitis may have other atopic conditions such as asthma or atopic dermatitis. Group B and those over 14 had a higher prevalence of other allergic disease. In group A, allergic rhinitis symptoms were severe. Allergen‐specific immunotherapy with standardized A. alternata extract will reduce symptoms of asthma and rhinoconjunctivitis.