bluuebunny/crossref_metadata_2025 huggingface dataset:
A Double‐Blind, Randomized, Placebo Controlled Trial Evaluating the Effects of a 5‐Day Course of Postoperative Prednisolone following Pediatric Tonsillectomy
Authors: Dawes Patrick J. D. , McCassey Emily
Published: September 2011

Objective

Evaluate the effect of a 5‐day course of oral prednisolone vs matched placebo on postoperative recovery following tonsillectomy in a pediatric population.

Method

A total of 195 children undergoing tonsillectomy were randomly allocated to 5 days oral prednisolone or placebo. These were presented in identical bottles and tasted similar. Pain and return of function were assessed on each of the first 8 postoperative days using a validated face pain scale and daily symptom questionnaires.

Results

There are no significant differences seen between placebo and control groups for any of the parameters assessed. These include; pain scores, nausea and vomiting, time to return to normal activity and oral intake, bedtime and sleep disturbance.

Conclusion

There is no significant difference in early outcomes following pediatric tonsillectomy between those given a postoperative oral steroid course compared to placebo.
A New Algorithm for Pediatric Airway Management Using the Intubating Laryngeal Airway
Authors: Barch Bennett E. , Jagannathan Narasimhan , Rastatter Jeffery
Published: September 2011

Objective

1) Evaluate the use of the intubating laryngeal airway (ILA) in providing safe endotracheal intubations in pediatric patients with difficult airways. 2) Present a management algorithm using direct laryngoscopy, rigid bronchoscopy, and the ILA for evaluating and securing the airway in pediatric patients with difficult airways.

Method

The medical records of patients in whom the ILA was used to secure the airway from January 2009 to January 2011 were reviewed. We documented the circumstances necessitating airway management, success of the ILA, airway evaluation findings, and medical conditions contributing to the difficult airway.

Results

A total of 50 patients had an ILA placed for airway management. Nine out of 50 (18%) were performed emergently. The median age was 59.8 months (range, 0.3‐244.1 months), and the median weight was 19.0 kg (range, 2.6‐86 kg). Four cases (8%) were unanticipated difficult airways, and 46 out of 50 (92%) were anticipated difficult airways. Comorbid conditions included craniofacial syndromes (n = 36), cervical spine instability or immobility (n = 9), and airway hemorrhage (n = 3). A total of 48 out of 50 (96%) patients were intubated on the first attempt through the ILA. In 2 patients intubation required a second attempt. The overall success rate using the ILA to secure the airway was 100%.

Conclusion

ILA is safe and effective in pediatric patients with a difficult airway as a conduit for tracheal intubation. Our proposed algorithm for difficult pediatric airway provides a safe means for anesthesiologists and otolaryngolgists to evaluate and secure the airway in these patients.
A Retrospective Review of Ventilation Tube Removal in Children
Authors: Arshad Faisal Ahmed , Mirza Showkat , Eng Chee‐Yean
Published: September 2011

Objective

Ventilation tube insertion is the primary surgical intervention in persistent otitis media with effusion. Around 7% of ventilation tubes require elective removal. The objective is to discover the tympanic membrane healing rate after ventilation tube removal and identify measures that improve this.

Method

Retrospective case note review performed for patients who had elective ventilation tube removed over an 8‐year period. Information gathered included if any concomitant procedure was performed to repair the tympanic membrane and final outcome of the tympanic membrane status.

Results

A total of 113 cases were included in this study. The average age at grommet insertion and removal was 5.8 years old and 8.3 years old, respectively. After ventilation tube removal the perforation edges were freshened in all cases. The majority of patients (84.1%) subsequently had an intact tympanic membrane. Additional procedures were performed on 19 ears, 6 with insertion of overlay absorbable material and 14 with a fat plug. Closure rate in these patients was 100%. Shah and Sheperd grommets had a significantly lower residual tympanic membrane perforation rate compared to T‐Tube and Titanium grommets.

Conclusion

Tympanic membrane closure rate after ventilation tube removal was 84.1%. Additional procedures, ie, overlaying of absorbable material, appear to improve the closure rate. We therefore advocate the technique. In selected cases such as T‐tube removal a concurrent fat plug myringoplasty may be appropriate.
Changes in Central Sleep Apnea Index Following Pediatric Adenotonsillectomy
Authors: Baldassari Cristina , Bryant Lucas , Kepchar Jessica J. , Choi Sukgi S.
Published: September 2011

Objective

Determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA).

Method

Retrospective review conducted at 2 tertiary children’s hospitals over 10 years. Children 1 to 18 years old who underwent adenotonsillectomy for OSA and had both pre‐ and postoperative full‐night polysomnography (PSG), with central sleep apnea (CSA) on preoperative PSG, were eligible. Criteria for diagnosis of CSA was CAI greater than 1.

Results

A total of 101 children with OSA had pre‐ and postoperative PSG. Fifteen of these patients had preoperative CSA. Ten of the children (66.7%) were male, and the mean age was 67.7 months (SD, 62.7). The mean preoperative CAI was 3.9 (SD, 2.9), while the postoperative CAI was 1.9 (SD, 4.8). The CAI ranged from 1.1 to 11.1. There was significant improvement (P =. 008) of the CAI following adenotonsillectomy. There was also significant improvement (P =. 004) of the obstructive apnea hypopnea index (OAHI), with the mean preoperative OAHI of 22.8 (SD 19.8) decreasing to an OAHI of 5.5 (SD 6.5) postoperatively.

Conclusion

Children with OSA and mild central sleep apnea on preoperative PSG showed significant improvement in the CAI following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of central sleep apnea in children with OSA.
Clinical Indications for Modified Radical Mastoidectomy
Authors: Osborn Alexander J. , James Adrian L. , Papsin Blake C.
Published: September 2011

Objective

To establish clinically derived indications for modified radical mastoidectomy in the setting of cholesteatoma.

Method

We performed a retrospective review of 223 patients who underwent 265 operations for cholesteatoma in a single tertiary pediatric otolaryngology practice. Clinical characteristics of patients who underwent modified radical mastoidectomy were compared to those who underwent simple mastoidectomy or atticotomy.

Results

Of the 265 procedures, 10% were modified radical mastoidectomy. Congenital cholesteatoma was more common in the the canal‐wall‐up group, while recurrent cholesteatoma was more common in those who had a canal‐wall‐down procedure. The Mills score for those who had a modified radical mastoidectomy was significantly higher than those who underwent canal‐wall‐up procedures (4.9 vs 3.2, P <. 05). Furthermore, extremely poorly pneumatized mastoids and facial nerve dehiscence were both more common in the group who underwent modified radical mastoidectomy.

Conclusion

Posterior wall preservation or reconstruction is possible in the large majority of cases. Severity of Mills score correlated well with the need for a canal‐wall‐down procedure. This was further reflected by the fact that this group had a higher incidence of facial nerve dehiscence due to cholesteatoma.
Cochlear Implants under 6 Months
Authors: Colletti Liliana , Mandalà Marco , Colletti Vittorio
Published: September 2011

Objective

Compare the influence of cochlear implantation (CI) in infants under 6 months vs older infants and children with bilateral profound sensorineural hearing loss on auditory‐based outcomes.

Method

Twelve infants aged 2 to 6 months, 9 infants aged 7 to 12 months, and 34 children aged 13 to 48 months, bilaterally profoundly deaf, fitted with CI without associated disabilities, were evaluated longitudinally with the Category of Auditory Performance, the Infant‐Toddler Meaningful Auditory Integration, the Fanzago test, the PFLI test of Bortolini, and video analysis.

Results

The age at fitting CI ranged from 2 to 48 months, and the degree of hearing loss was bilateral and profound in all children. Age at CI implantation was a significant factor in outcome measures of speech production and spoken language skills. The 2 to 6 months group showed significantly better results at the Fanzago and PFLI test of Bortolini than the older children even after 5 years of CI use (P >. 05).

Conclusion

For the first time the decisive importance of fitting CIs before 6 months of age on communication outcomes becomes evident. Further studies on larger numbers of infants implanted under 6 months are necessary to validate the present findings.
Free Flap Reconstruction of Lateral Mandibular Defects: Indications and Outcomes
Authors: Dean Nichole R. , Rosenthal Eben L. , Virgin Frank , Magnuson J. Scott , Wax Mark K. , Carroll William R.
Published: September 2011

Objective

To evaluate outcomes following lateral mandibular defect free flap reconstruction.

Method

Patients undergoing lateral mandibular defect free flap reconstruction from 1999 to 2010 at 2 tertiary care centers were classified into 4 groups based on type of reconstruction: 1) radial forearm swing (n = 8), 2) radial forearm with bar (n = 5), 3) osteocutaneous radial forearm (n = 73) and 4) fibula free flap reconstruction (n = 51).

Results

The majority of patients were male (67%) and presented with advanced T‐stage (59%) squamous cell carcinoma (93%) involving the alveolus (26%) retromolar trigone (21%) or oral tongue (25%). The recipient site complication rate approached 35% and included infection and mandibular malunion (n = 9), exposed bone or mandibular plates (n = 7), venous congestion (n = 2), and flap failure (n = 6). Most patients demonstrated little to no trismus following reconstruction (81%) and were able to resume a regular or soft diet (61%). No difference in complication rates, hospital stay or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P >. 05).

Conclusion

Free flap reconstruction of lateral mandibular defects results in acceptable functional outcomes for the majority of patients including those who undergo osteocutaneous radial forearm free tissue transfer.
Demographic Influences on Antibiotic Use for Otitis Media
Authors: Sidell Douglas R. , Bhattacharyya Neil , Shapiro Nina
Published: September 2011

Objective

1) Understand epidemiologic antibiotic treatment patterns for acute otitis media (AOM). 2) Understand the potential impact of race and insurance status on the medical management of acute otitis media.

Method

Cases of isolated AOM in children.

Results

A total of 15.8 ± 1.5 million cases of AOM were studied (mean age, 3.6 years; 55.1% male). 15.0 ± 2.8% of children were Hispanic, and 10.4 ± 3.1% were black. Medicaid/SCHIP and private insurance covered 30.6 ± 4.4% and 69.4 ± 4.4% of children, respectively. Overall, 83.1 ± 2.2% of children received an antibiotic prescription. The most commonly prescribed antibiotics were amoxicillin (6.5 ± 0.9 million), beta‐lactamase inhibitors (2.6 ± 0.4 million), and third‐generation cephalosporins (2.3 ± 0.4 million prescriptions). On multivariate analysis, insurance status, ethnicity, race, age, and sex did not influence the likelihood of an antibiotic prescription during the visit (P =. 884, P =. 909, P =. 849, P =. 931, and P =. 102, respectively).

Conclusion

The vast majority of children with acute otitis media are covered by health insurance. Ethnicity, race, and insurance type do not significantly influence antibiotic prescribing rates for AOM.
Early Intervention with Mandibular Distraction Osteogenesis
Authors: Mudd Pamela , Allen Gregory C.
Published: September 2011

Objective

Determine benefits of early intervention in neonates with symptomatic retrognathia who underwent bilateral mandibular distraction osteogenesis (MDO) within the first 90 days of life as relates to growth, need for supportive care, and further invasive procedures.

Method

Retrospective chart review of neonates who underwent bilateral MDO in the past 5 years. Inclusion criteria included MDO performed within the first 90 days of life. Outcome measures included length of hospital stay, growth, oral intake, supportive home care needs, and time to cleft repair.

Results

Twenty‐five patients were identified as meeting inclusion criteria. Mean age at distraction was 29 days and average discharge is POD#14. No patients required home oxygen on discharge, most patients were able to begin oral diet, and growth curves stabilized. No patients required tracheotomy. Early MDO intervention facilitates earlier and less complicated palate repair. A cost‐based analysis is included.

Conclusion

Early intervention with MDO in neonates facilitates decreased length of hospital stay, less need for supportive care, fewer invasive procedures, and improved growth stabilization. In addition cleft repair is done earlier and with less likelihood of complication. MDO is a cost‐effective and beneficial intervention in neonates with symptomatic retrognathia.
Factors Associated with Revision Adenoidectomy
Authors: Dearking Amy C. , Orvidas Laura J.
Published: September 2011

Objective

1) Determine if patient factors, such as indication for initial surgery, medical comorbidities, and patient age, are associated with adenoid regrowth and revision adenoidectomy. 2) Determine if surgical factors, such as surgical technique or level of surgeon’s training, are associated with adenoid regrowth and need for revision adenoidectomy.

Method

Retrospective review of children less than 18 years who underwent adenoidectomy or adenotonsillectomy between 1980 and May 2009. Charts of patients with revision adenoidectomies were reviewed for sex, age at surgery, indication for surgery, training level of surgeon, surgical technique, and history of allergies, asthma or GERD.

Results

Of 8472 surgical cases (54% male), 202 were revision adenoidectomies (2.4%). Children less than 2 years old at initial surgery had increased rate of revision (23.5% of revision cases compared with 4.7% of all surgical cases). Of patients with revision adenoidectomy, 31.1% had curettage and 68.9% had electrocautery or coblation adenoidectomy at initial surgery. Patients with revision adenoidectomy were 3 times more likely to have a PGY1 or 2 as surgeon in initial surgery. The revision patients were found to have a higher incidence of allergies (32%), asthma (23%), and/or GERD (16%) than the general population.

Conclusion

Several risk factors were associated with revision adenoidectomy. Children 3 years and under (especially under 2 years), at initial adenoidectomy have a higher incidence of revision surgery. Other factors identified with increased need for revision adenoidectomy include: medical history of allergies, asthma and/or GERD, and level of training of surgeon.
Food Hypersensitivity and Ear, Nose, and Throat Pathology in Children Less than 2 Years of Age
Authors: Paddack Angela Cogburn , Smith Chandra , Richter Gresham T. , Gibbons Troy
Published: September 2011

Objective

Explore the relationship between food hypersensitivity associated with cows milk protein allergy (CMPA) and common gastrointestinal and upper aerodigestive disorders found in children less than two years of age.

Method

Two‐year retrospective chart review of a common cohort of children less than 2 years of age, managed in both a tertiary pediatric gastroenterology and otolaryngology clinic. Comparison with a control pediatric population was performed.

Results

Of 191 children reviewed with CMPA, 141 demonstrated upper gastrointestinal (GI) complaints. Twenty‐five (18%) of these children had otolaryngologic (ENT) conditions refractory to standard therapy with the majority being chronic otitis media (70%) and oropharyngeal dysphagia (80%). In contrast, only 2% of patients in a GI control group demonstrated ENT disease. Dairy elimination improved GI symptoms in 92 patients, and ENT disease improved in 60%. ENT conditions improved in the control group via standard therapy.

Conclusion

This study suggests a relationship between CMPA and ENT concerns in children less than 2 years old, whereby food hypersensitivity can be associated with recalcitrant otits media and oropharyngeal dysphagia. Elimination diets can improve both GI and ENT conditions refractory to GERD therapy in patients with CMPA.
Impact of Endoscopic Sinus Surgery on Pulmonary Function in Children with Cystic Fibrosis
Authors: Rihani Jordan J. , McClay John E.
Published: September 2011

Objective

Determine the impact of endoscopic sinus surgery on pulmonary function in children with cystic fibrosis.

Method

Retrospective chart review of cystic fibrosis patients at a tertiary children’s hospital who underwent endoscopic sinus surgery between 1995 and 2010. Main outcome measures include presurgical and 1‐ and 6‐month postsurgical pulmonary function tests (PFTs).

Results

Sixty‐two children underwent 110 endoscopic sinus surgeries. Pre‐ and post‐PFT data (FEVI and FVC) were available for 66 surgeries. Postoperative, only 10 out of 66 children (15%) at 1 month and 11 out of 66 (16%) at 6 months showed improvement following surgery. A total of 41 out of 66 children (62%) at 1 month and 42 out of 66 (64%) at 6 months showed no difference, while 15 out of 66 (23%) at 1 month and 13 out of 66 (20%) at 6 months were worse following surgery. There was no difference in pulmonary function following primary (28/66 [42%]) or revision (38/66 [58%]) surgeries.

Conclusion

Improvement of sinonasal symptoms achieved with endoscopic sinus surgery does not correlate with improvement in pulmonary function as measured by pre‐ and postoperative pulmonary function testing in children with cystic fibrosis.
Incidence of Plagiocephaly in Teens Born after “Back to Sleep” Campaign
Authors: Roby Brianne Barnett , Sidman James D. , Tibesar Robert J. , Finkelstein Marsha
Published: September 2011

Objective

Determine the incidence of positional plagiocephaly in teenagers born after the “Back to Sleep” Campaign but before orthotic helmet treatment became widely available.

Method

This is a cross‐sectional analysis. Subjects were selected if they attended participating high schools and were born after 1992, which is when the “Back to Sleep” campaign began. Skull measurements, including transcranial diameter, circumference, length, and width, were taken. Cranial vault asymmetry and cephalic index were calculated for each participant.

Results

There were 411 participants in this study ranging from age 14 to 18 years old, with the average age of 16.3 years. The diagnosis of plagiocephaly was made if cranial vault asymmetry was >1 centimeter. Brachycephaly was diagnosed if the cephalic index was >0.90. The incidence of plagiocephaly based on the above criteria was 1.3% in females and 2.7% of males. The incidence of brachycephaly was 0.9% in females and 1.6% in males. Of those noted to have abnormal facial characteristics (telecanthus, frontal prominence), 40% had plagiocephaly and 6.7% had brachycephaly.

Conclusion

The incidence of plagiocephaly in teenagers is significantly lower than the 20% to 48% incidence found in infants in previous studies, suggesting a significant number of infants will outgrow it. Physicians must recognize plagiocephaly and gain insight into which patients might benefit from treatment and which will likely have resolution without intervention.
Infantile Hemangioma: Evolving Trends in Surgical Management
Authors: Daramola Opeyemi O. , Drolet Beth , North Paula E. , Kerschner Joseph E. , Chun Robert H.
Published: September 2011

Objective

1) Present outcomes of surgically treated infantile hemangioma, and describe changes in surgical management with the advent of changes in medical therapy. 2) Highlight the role of imaging in surgical planning. 3) Identify risk factors for surgical complications.

Method

Retrospective chart review of patients in a multidisciplinary clinic diagnosed with infantile hemangioma involving soft tissue and skin between 2008 and 2010. Data relating to demographics, indications for surgery, histopathology analysis, postoperative care, and complications were collected.

Results

Of 1050 subjects, 109 patients (10%) underwent surgical intervention, and 78% of the lesions were in the head and neck. Ulceration, bleeding, and deformity were the major surgical indications. Seven patients underwent staged excision. Magnetic resonance imaging was utilized in diagnostic workup and preoperative planning in 15 cases. Adjunctive medical therapy was safely used in 26% of the surgical cohort. Head and neck lesions were more likely to receive adjunctive therapy (P =. 007) and had a higher complication rate. Overall complication rate was lower (6%) compared with our 2005‐2007 surgery cohort (1012 patients) with a complication rate of 17%.

Conclusion

Surgery continues to be a viable form of therapy for complicated infantile hemangiomas. Introduction of propanolol and vincrinstine for challenging lesions did not change the surgery rate but may partly explain the lower complication rate secondary to preoperative reduction of surgical bulk.
Injection Augmentation for Type I Laryngeal Clefts
Authors: El‐Hakim Hamdy , Mangat Harshdeep Singh
Published: September 2011

Objective

Describe a series of children diagnosed with type I congenital laryngeal clefts (LC‐I) and treated due to various presentations with endoscopic injection augmentation (IA).

Method

This is a retrospective study. The children were identified from a prospectively collected database. Only those who were treated with IA (using hyaluronic acid derivatives) and had a minimum follow‐up of 3‐months were included. We collected demographics, diagnoses, surgical procedures, number of IA, clinical outcomes, and complications.

Results

Over a period of 8 years, 32 patients were diagnosed with LC‐I. Fifteen had undergone IA over the past 3 years. Mean age at IA was 28.67 ± 17.54 months with a male‐to‐female ratio of 8:7. The indications were swallowing dysfunction (13) and atypical croup (2). Seven patients required repeated injections (mean of 2.57 injections). A total of 10 patients responded with resolution of symptoms in question. No record of complications was found.

Conclusion

IA is a brief, simple management option that succeeds in a number of children with LC‐I. It is minimally morbid and supplements other conservative approaches to treat the condition.
Jugular Bulb: Vestibular Aqueduct Dehiscence and Hearing Loss
Authors: Ann Kupfer Robbi , Hoesli Rebecca , Green Glenn E. , Thorne Marc C.
Published: September 2011

Objective

Determine the prevalence of dehiscence of the jugular bulb and vestibular aqueduct (JBVAD) in pediatric patients undergoing temporal bone computed tomography (CT) scans and assess the correlation between JBVAD and hearing loss.

Method

All patients 18 years of age or younger who underwent temporal bone CT scans and audiometric testing between 2004 and 2009 were retrospectively reviewed. JBVAD was determined by blinded review of CT images. Hearing loss was determined by review of audiometric data and correlated with imaging findings.

Results

CT images and audiometric data were available for review in 927 patients (1854 ears). Overall prevalence of JBVAD was 8.6%, with a prevalence of 6.6% in right ears and 3.6% in left ears. JBVAD was present in 8.3% of patients with sensorineural or mixed hearing loss and 7.1% of patients without sensorineural or mixed hearing loss (P =. 51). Similarly, JBVAD was present in 5.5% of ears with and 4.6% of ears without sensorineural or mixed hearing loss (P =. 37).

Conclusion

The prevalence of JBVAD is 8.6% in pediatric patients undergoing temporal bone CT scans, 65% of which occur in the right ear. We were unable to identify any correlation between JBVAD and hearing loss. A major contribution to pediatric sensorineural hearing loss from JBVAD is excluded.
Laryngomalacia and Acid Reflux: A Systematic Review
Authors: Hartl Trevor , Chadha Neil K.
Published: September 2011

Objective

Laryngomalacia is widely described as having an association with acid reflux. Many otolaryngologists therefore employ empiric treatment with anti‐reflux medication in this setting. This study aims to identify and appraise the evidence for this association, and to explore the potential role for treatment of reflux in the management of laryngomalacia.

Method

A predefined protocol was employed to search Medline, EMBASE, the Cochrane Library, and Google Scholar. Included studies were those that explored the potential for an association between laryngomalacia and gastro‐esophageal and/or laryngopharyngeal reflux. The Oxford Centre for Evidence Based Medicine (CEBM) guidelines were applied to assess study quality of evidence.

Results

A total of 26 studies, representing 1295 neonates with laryngomalacia, were included. Study quality varied from CEBM 2a (n = 3 to 4 (n = 20). No randomized controlled trials were identified. While reflux definitions were diverse, overall reflux prevalence in this group was 59%. Evidence supporting an association between reflux and laryngomalacia included: the near ubiquity of acid reflux in dual‐probe pH monitoring in children with laryngomalacia (3 studies); case series and reports of laryngomalacia improvement with anti‐reflux therapy (5 studies); histologic evidence of reflux‐related laryngeal inflammation in children with laryngomalacia (2 studies); and implication of reflux as a cofactor in laryngomalacia symptom severity (12 studies).

Conclusion

The literature shows a co‐existence between acid reflux and laryngomalacia, but the evidence for causal association is limited. In view of the widespread use of anti‐reflux treatment in laryngomalacia, an RCT of anti‐reflux medication vs placebo appears well‐justified. This review provides a rational foundation for such an endeavor.
Long‐Term Quality of Life Outcomes in Children Undergoing Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Randhawa Premjit Singh , Chilvers Geoffrey , Cetto Raul , Narula Antony A. P.
Published: September 2011

Objective

Assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery for continued and long‐term improvement in quality of life using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a healthy United Kingdom population.

Method

A telephone survey was carried out using the CHQ‐PF28 questionnaire and administered to the primary care giver of 37 patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years after initial surgery at our university hospital tertiary referral center.

Results

A total of 33 patients (89.1%) from our initial cohort were contacted. The mean age was 10.6 years (median, 11 years range, 5‐16 years). The mean scores from our follow‐up study show improvements in 5 subscales and were statistically significant in 2 subscales (role limitations P <. 00001; bodily pain P <. 002) when compared to values obtained 3 months postoperatively. The 4‐year follow‐up scores showed further improvement in 5 subscales when compared with a healthy population. All subscales of the CHQ‐PF28 improved in the long term when compared to scores preoperatively.

Conclusion

Quality of life data are an important measure when deciding on a particular intervention. In the short term quality of life measures have been shown to improve. Our study demonstrates that the benefits of surgery are still persistent, and the children continue to improve in the long term.
Management of Obstructive Sleep Apnea in Children with Cerebral Palsy
Authors: Munson Patrick D. , Dunham Andrew , Bower Charles M. , Richter Gresham T. , Hartzell Larry D. , Guillory Ryan
Published: September 2011

Objective

1) Determine the efficacy of combined surgical techniques for improving obstructive sleep apnea (OSA) in pediatric patients with cerebral palsy (CP). 2) Evaluate the addition of tongue base suspension for children with CP that have moderate to severe OSA.

Method

Seven‐year retrospective chart review of 14 children with CP undergoing surgical management of OSA, including adenotonsillectomy (T&A) and uvulopalatopharyngoplasty (UPPP), with or without tongue base suspension (TBS). Response to treatment was determined by its impact on PSG parameters: apnea/hypopnea index (AHI) and arousal index (AI).

Results

Children with CP who received TBS had a mean preoperative AHI of 27.2 compared with an AHI of 6.8 in the group that underwent only T&A and UPPP (non‐TBS). AHI decreased by a mean of 16.5 (TBS) vs 5.0 (non‐TBS); (P value. 03 vs 04). AI also improved in both groups (33.1 to 20.7 and 11.0 to 5.8); (P value. 05 vs 10). Hospital length of stay was slightly longer for the TBS groups than the non‐TBS groups (mean 9.3 days and 6.6 days) but was not statistically significant (P =. 09). Average length of follow‐up was 52 months with no surgical complications.

Conclusion

Combined surgical therapy improves OSA in children with CP. Children with CP and moderate to severe OSA (AHI>15) may safely benefit from the addition of tongue base suspension to T&A and UPPP to maximize treatment.
Middle Ear Ventilation in Children with Primary Ciliary Dyskinesia
Authors: Wolter Nikolaus Ernst , Dell Sharon , James Adrian L. , Campisi Paolo
Published: September 2011

Objective

1) To review the otological presentation of children with primary ciliary dyskinesia (PCD) treated medically and surgically. 2) To compare the audiological outcomes and complications of surgical management to medical management in children with PCD.

Method

A retrospective chart review was performed of all patients with PCD and OME presenting to a specialized clinic at a tertiary‐quaternary care hospital from 1991 to 2009. Patients were grouped into “medical management” and “ventilation tube (VT) insertion” groups to observe changes in hearing and postoperative complications.

Results

Of 32 patients with PCD and OME, 20 received VTs, and 12 were treated by medical management strategies. A median of one set of VTs (range, 1‐7) were inserted per patient. Audiometric pure tone averages improved from 28.1dB to 21.6 dB (P =. 036) following VTs, whereas patients managed medically had stable thresholds from 22.7dB to 23.6 dB (P =. 307). At least one episode of postoperative otorrhea occurred in 9 (40%) VT insertion patients during the study period, and four had multiple episodes. Otorrhea was well controlled with medical therapy with only one requiring tube removal.

Conclusion

Our data supports the use of VT insertion as an option for patients with PCD and OME with mild to moderate hearing loss. Patients should be counseled on the possibility of multiple insertions and the likelihood of postoperative otorrhea, although this was not a major problem in our study group.
Multimedia Approach to Adentonsillectomy Preoperative Counseling
Authors: Adams Mary Theresa , Chen Brian S. , Boseley Mark E. , Makowski Renee L. , Bevans Scott
Published: September 2011

Objective

1) Compare surgical risk retention in participants who received a handout or watched a video in addition to standard verbal preoperative counseling. 2) Determine if time from counseling to day of surgery affects risk retention.

Method

We performed a prospective randomized control study in March 2010 through February 2011 in participants who had children undergoing adenotonsillectomy. Those unable to perform pre‐ and postoperative testing were excluded. We compared the preoperative and postoperative test scores of those undergoing verbal counseling, counseling with handout, or counseling with video.

Results

A total of 27 participants were tasked to identify 9 risks of adenotonsillectomy. Preoperatively, participants identified an average of 6.5 (SD 1.08) in the counseling group, 7.1 (SD 1.9) in the counseling and handout group, and 6.77 (SD 1.5) in the counseling and video group; P =. 54. Postoperatively, participants identified an average of 5.3 (SD 1.4) in the counseling group, 6.5 (SD 2) in the counseling and handout group, and 5.3 (SD 2.1) in the counseling and video group; P =. 29. Time between preoperative counseling and day of surgery were inversely correlated with postoperative score, correlation coefficient ‐0.36; P =. 07.

Conclusion

Participants were not able to identify all of the risks associated with adenotonsillectomy. There was no difference in identification of risks associated with adenotonsillectomy among different modalities of counseling. Participants retained more information when there were fewer days between preoperative counseling and day of surgery.
Multivariable Analysis of Risk Factors for Supraglottoplasty Failure
Authors: Day Kristie , Wolf Bethany , Discolo Christopher , White David R. , Meier Jeremy D.
Published: September 2011

Objective

1) Review outcomes after supraglottoplasty forlaryngomalacia. 2) Identify risk factors for supraglottoplasty failure.

Method

This study is a retrospective case series evaluating patient outcomes after supraglottoplasty at an academic medical center between 2004 and 2010. Surgical failure was defined as need for postoperative revision surgery, tracheotomy tube, or gastrostomy tube. Multivariable logistic regression was performed to identify risk factors for failure.

Results

We identified 95 children who underwent supraglottoplasty. After excluding patients within adequate follow‐up data, 74 patients were included. Based on chart review, 12 (16%) of those patients were defined as failures according to the criteria above.

Conclusion

Outcomes after supraglottoplasty were comparable to previous reports in the literature. History of prematurity should be considered a risk factor for surgical failure.
Outcome of Sinus Balloon Catheter Dilation in Adenoidectomy Failures
Authors: Ramadan Hassan H. , Hester Samuel T. , Terrell Andrew M. , Bueller Hope A.
Published: September 2011

Objective

Adenoidectomy is the first line of surgical management for children with chronic rhinosinusitis (CRS). This procedure is successful in only 50% of patients. The goal of this study is to assess surgical outcomes in children undergoing sinus balloon catheter dilation who have failed previous adenoidectomy.

Method

This is a prospective review of children who had surgery for CRS between January 2006 and February 2010. Children included had persistent symptoms after adenoidectomy as documented by SN‐5 score and positive CT score. The main outcome measure was the SN‐5 score at 1‐year postprocedure.

Results

Twenty six children met inclusion criteria. The age range was 4 to 12 years with average age of 8 years (SD, 2.5). The average CT score, as graded by the Lund‐Mackay, was 7.3 (SD, 2.9). The minimum preoperative SN‐5 score was 3.0, with an average of 4.6 (SD, 0.9). The average time of postoperative follow‐up is 13 months (SD, 3.0). The average SN‐5 score at 1 year was 3.0 (SD, 1.2). This was a significant change from preoperative scores (P. 5 on the postoperative SN‐5, score was achieved in 22 children, equaling a success rate of 85%.

Conclusion

Sinus balloon catheter dilation has previously been shown to be safe and effective in children. This current study demonstrates that balloon dilation is effective in children who have failed previous adenoidectomy. Balloon catheter dilation may be considered prior to proceeding to functional endoscopic sinus surgery in children with CRS.
Pediatric Enuresis, Sleep Apnea, and Adenotonsillectomy
Authors: Jeyakumar Anita , Armbrecht Eric S. , Rahman Syed I. , Mitchell Ron B.
Published: September 2011

Objective

To evaluate the prevalence of nocturnal enuresis in children diagnosed with sleep disordered breathing and the effect of adenotonsillectomy on enuresis.

Method

A systematic analysis of the literature was performed from 1980 to 2010 on patients who had documented sleep disordered breathing, along with data collection on enuresis. Data were noted if the patient underwent adenotonsillectomy (T&A) with follow‐up documentation on enuresis.

Results

A total of 14 studies (1998‐2010) were reviewed. The total number of subjects was 21,744 to 51.77% were male. The age range was 18 months — 19 years. The prevalence of SDB was 16.3% (3,550 subjects), and 31% (or 1,113 subjects) had preoperative enuresis. We analyzed 7 studies with post‐tonsillectomy follow‐up. Mean sample size was 194, median follow‐up was 6 months, and age range was 2 to 18 years. The preoperative and postoperative prevalence of enuresis were 32% (408/1,274 enrolled subjects) and 16%, respectively, based on the available sample of 587 subjects.

Conclusion

Sleep‐disordered breathing in children has a higher prevalence of nocturnal enuresis as compared with the general population. Adenotonsillectomy has a favorable therapeutic effect on enuresis in children with SDB. There is a need for further prospective trials.
Infections after Gracilis Free Flap Reconstruction
Authors: Lee Linda N. , Henstrom Douglas , Cheney Mack , Durand Marlene , Hadlock Tessa
Published: September 2011

Objective

Investigate the incidence, bacteriology, and clinical outcomes of surgical site infection (SSI) after gracilis transfer for facial reanimation, with a focus on determining the optimal perioperative antibiotics in these clean‐contaminated cases.

Method

A retrospective chart review was performed for facial paralysis patients who underwent gracilis free flap reconstruction from 2003 to 2010. Microbiology, medication allergies, type and duration of perioperative prophylactic antibiotics, surgery length, and ASA status were reviewed. Functional smile outcomes were compared between those who developed infections and those who were infection‐free.

Results

Since 2003, 110 patients have undergone 116 gracilis free flap operations for facial reanimation, with 6 SSIs. All of the infections occurred in patients receiving clindamycin, levofloxacin, and/or cefazolin perioperative antibiotics. None of the patients who received ampicillin/sulbactam developed a SSI. Surgical site cultures from infected patients grew alpha‐hemolytic streptococci, Haemophilus parainfluenzae, Fusobacterium, coagulase‐negative staphylococci, and Neisseria. Notably, there were no methicillin‐resistant Staphylococcus aureus (MRSA) infections. In the patients with SSIs, the mean oral commissure excursion improved by 7.49 ± 3.83 mm, which was not significantly different from noninfected patients with subjective excellent outcomes of 11.4 ± 7.1 mm.

Conclusion

In gracilis flap infections, the organisms identified were consistent with oral flora. Infections occurred in patients receiving prophylactic clindamycin, levaquin, and/or cefazolin, but not in those receiving prophylactic ampicillin/sulbactam. Infections were not associated with decreased functional outcome. These data may have implications for the optimal choice of prophylactic antibiotics.
Ventilation Tube Insertions for Pediatric Otitis Media with Effusion: With Adenoidectomy or Not
Authors: Wang Mao‐Che
Published: September 2011

Objective

Performing adenoidectomy or not in conjunction with ventilation tube insertion (VTI) to treat pediatric otitis media with effusion (OME) has been debated for decades. This study used population‐based data to determine the recurrence rate of persistent OME with adenoidectomy or not in conjunction with VTI.

Method

This study included all children less than 12 years old who underwent VTI in the year 2003 by using the NHI databank in Taiwan. We compare the recurrence rate and time to recurrence of persistent OME in children who received adenoidectomy in conjunction with VTI and VTI alone in a 3‐year follow‐up.

Results

From 2736 cases evaluated, the children having both adenoidectomy and VTI had a lower recurrence rate of OME than those who had VTI alone (P <. 0001). The children under the age of 8 years having both adenoidectomy and VTI had a statistically significant lower recurrence rate of OME than those who had VTI alone (P =. 0384 for age 0‐3years, P =. 0286 for age 4‐7years). There is no difference in OME recurrence with adenoidectomy or not in the age group 8 to 11 years (P =. 1539). There is no difference in time to recurrence in all age groups.

Conclusion

Combined adenoidectomy and VTI for pediatric OME can reduce OME recurrence of tube re‐insertion rate than that of VTI alone, especially in children under 8 years old. The time to recurrence seemed to be lengthened in the combined adenoidectomy and VTI group, but without statistical significance.
Vitamin D3 Deficiency in Children with Chronic Rhinosinusitis with Nasal Polyps
Authors: Mulligan Jennifer Konopa , Sansoni E. Ritter , White David R. , Wang Eric W. , Schlosser Rodney J.
Published: September 2011

Objective

Vitamin D3 (VD3) is a steroid hormone that acts on the immune system similar to oral steroids. In asthmatics VD3 deficiency contributes to increased Th2 skewing and steroid use. We examined if children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were VD3 deficient.

Method

Plasma levels of 25‐hydroxyvitamin D3 were measured by ELISA in children (<21 years old) with AFRS (n = 9), CRSwNP (n = 4), CRS without nasal polyposis (CRSsNP) (n = 10), and controls undergoing surgery for adenotonsillar hypertrophy (n = 10). Levels were confirmed for patients being examined in clinic in CRSwNP (n = 4) and AFRS (n = 15).

Results

There was no difference in mean plasma 25‐OH VD3 between control and CRSsNP at time of surgery, 36.2 and 36.3 ng/ml respectively. Mean CRSwNP levels were 22.1 ng/ml and AFRS 17.7 ng/ml, both well below the minimum recommended level of 32 ng/ml and significantly lower than control and CRSsNP levels (p3 levels clinically confirmed that children with CRSwNP and AFRS were deficient (26 and 16.9 ng/ml, respectively). Presence of asthma did not appear to be associated with lower VD3, compared with nonasthmatic disease‐matched children. VD3 deficiencies were independent of race and gender.

Conclusion

Children with AFRS and CRSwNP were VD3 deficient and had levels significantly lower than the recommended level 32/ng mL. These results were confirmed clinically by mass spectrometry. Supplementation of VD3 deficient children may improve symptoms and reduce steroid use.
3D Reconstructions for Point‐of‐Care Computed Tomography
Authors: McClurg Stanley W. , Das Subinoy , Welling D. Bradley
Published: September 2011

Objective

Demonstrate improvements in diagnostic accuracy and efficiencies in health care delivery afforded by the use of 3‐dimensional reconstructions of point‐of‐care computed tomography (CT) in the office of the otolaryngologist.

Method

The Morita Accuitomo 3D CT scanner was used to obtain point‐of‐care CT images of the sinuses and temporal bones of patients at The Ohio State University Department of Otolaryngology in September of 2010. The advantages and limitations of 3D reconstructions in these cases were documented, and 3D videos were created.

Results

One hundred consecutive cases utilizing 3D CT scans were analyzed for areas of potential improved diagnostic accuracy. Reconstructions increased overall scan time by 35 seconds, on average. Representative cases of typical benefits and disadvantages seen in patients with sinus and ear disease were tabulated. Atypical cases where 3D CT provided unforeseen advantages, including patients with septal perforations and displaced ossicular prostheses, were also identified and analyzed. Three illustrative cases were selected for the creation of 3D videos.

Conclusion

3D reconstructions of point‐of‐care CT scans provide enhanced diagnostic accuracy and efficiency of health care delivery, with minimal additional time costs for several patients in this investigation. These findings support the further prospective study of the cost efficiency and potential for improved patient outcomes with this novel technology.
Allergen‐Specific Cytokine Production by Human Nasal Polyps
Authors: Singh Narinder , Faith Alexander , Hawrylowicz Catherine , Roberts David N. , Corrigan Christopher J.
Published: September 2011

Objective

Study the ex vivo allergen‐specific cytokine responses of cells derived from human nasal polyps. We hypothesized that nasal‐polyp derived human respiratory cells from atopic individuals would respond with reduced IL10 compared with cells from nonatopics.

Method

Thirty‐one nonsmoking adults with nasal polyposis requiring surgery were recruited. Atopic status was determined by skin prick tests. Polyps were harvested during routine surgery. After digestion with collagenase, cell suspensions were incubated with positive and negative allergen (cat, grass, or HDM) for 6 days. Cytokine detection was by cytometric bead array.

Results

IL‐10 was induced in nasal polyp cell suspensions derived from both atopics and nonatopics with the addition of allergen in a dose‐response fashion.

Conclusion

Our results indicate that IL‐10 producing T cells regulate Th2 cytokine production in nasal‐polyp derived human airway cells.
Interpolation Flaps for Nasal Reconstruction
Authors: Paddack Angela Cogburn , Spencer Horace , Frank Robert , Vural Emre A. , Key J. Michael
Published: September 2011

Objective

Determine whether the type (paramedian forehead [PMFF] vs nasolabial [NLF]) or the defect thickness (full vs partial) play a role in take rates of interpolation flaps in nasal reconstruction.

Method

A retrospective chart review was performed on patients who underwent nasal reconstruction with 2‐stage paramedian forehead or nasolabial flaps between 2002 and present. Defect characteristics recorded were thickness, size, location; flap type used for repair, utilization of cartilage grafts; and comorbidities, including diabetes, peripheral vascular or coronary artery disease, and smoking habits.

Results

A total of 107 total patients; 82 (76%) reconstructed using 2‐stage paramedian forehead flap; 25 (24%) using a 2‐stage nasolabial flap (NLF). A total of 47 PMFF and 12 NLF were used for full thickness defects. Overall failure rate was 5%, both partial and complete. Five PMFF failed (7%), 3 full thickness. One NLF failed (4%), also full thickness. Any use of cartilage in reconstruction did not affect failure rates. Both flaps with complete failure were used more distally, while partial failure flaps for more proximal defects. No comorbities were noted to have a significant effect on failure rates, 5 out of 6 failures were in smokers.

Conclusion

This study provides outcome data when interpolation flap reconstruction, with or without cartilage grafts, is offered. Overall success rates for nasal reconstruction using interpolation flaps in this study were 94%. Thickness of defect and type of flap did not affect outcome, while positive smoking status did significantly affect failure rate.