bluuebunny/crossref_metadata_2025 huggingface dataset:
Children with CHARGE‐Syndrome Associated Hearing Loss
Authors: Felton Mark , Feltham Penny , Henderson Lise , Andrew Rachel , Rothera Michael , Bruce Iain
Published: August 2013

Objectives:

1) Highlight ear anomalies (external, middle, and inner ear) and types of hearing loss in children with CHARGE syndrome (CS). 2) Use cases to discuss surgical options for treating hearing loss in CS children, including bone conduction implants and cochlear implantation.

Methods:

Six children with CS referred to our tertiary service for management of hearing‐loss were identified. Subsequently, 4 of these children were fitted with a bone conduction implant (Baha® system), and 2 underwent cochlear implantation. For the 4 Baha® system children, free‐field speech audiometry was used to monitor hearing postoperatively. For 3 of the children, Baha® system stability was measured with resonance frequency analysis at surgery and sequentially at follow‐up visits. The two children having cochlear implants were followed up with pure tone audiometry and speech perception scores.

Results:

Four cases of Baha® system implantation and 2 cases of cochlear implantation in children with CS are discussed including pre‐operative assessment/selection criteria, scans, and surgical planning; operative challenges; implant stability postoperatively and hearing benefit. The mean age at surgery was 9 years 11 months (4 years 9 months to 14 years 10 months), and mean follow‐up was 18 months (6 months to 25 months).

Conclusions:

Children with CS and mixed hearing‐loss are challenging when considering how best to maximize hearing potential. Some children with CS will also have external ear abnormalities, potentially limiting the use of conventional BTE HAs. Bone conduction implants and cochlear implants are an effective hearing solution for selected children with CS.
Cost‐Benefit Analysis of Polysomnography versus Clinical Assessment Score‐15 (CAS‐15) for Treatment of Pediatric Sleep‐Disordered Breathing
Authors: Konka Anita , Weedon Jeremy , Goldstein Nira A.
Published: August 2013

Objectives:

Determine the cost of medical care using the CAS‐15 versus polysomnography for children with sleep‐disordered breathing in terms of benefit measured by change in quality‐of‐life and behavior scores.

Methods:

93 patients from our original CAS‐15 study were included. Four clinical measures were used (Child Behavior Checklist [CBCL], OSA‐18, Pediatric Quality of Life Inventory [PedsQL], and AHI). Payment data were obtained for outpatient office visits, sleep laboratory admissions, and hospital admissions for T&A. Cost benefit analysis was performed between initial and final visits for two clinical pathways. In pathway 1, all children had polysomnography (PSG); those with positive studies were referred for T&A. In pathway 2, children with CAS‐15 >32 were referred for T&A regardless of PSG. Treatment costs were calculated in each pathway. Paired t‐test compared intra‐subject mean total cost (pathway 1 vs. pathway 2). Further analyses computed a change score for the 4 clinical measures (follow‐up minus baseline), producing 4 cost‐benefit ratios for each pathway. Paired t‐tests compared the mean of these ratios between the two pathways.

Results:

Of 65 PSG+ (15 CAS‐), 54 underwent surgery; of 28 PSG‐ (17 CAS‐), 7 underwent surgery. Model estimated costs demonstrate a mean cost benefit of $1172.06USD [SE $214.30] in pathway 2 versus pathway 1 (P<.001). CAS‐15 is also cost‐beneficial versus PSG in 3 of 4 clinical measures (CBCL [P =. 008], OSA‐18 [P <. 001], AHI [P <. 001]).

Conclusions:

We present evidence that in 3 of 4 clinical measures evaluated, CAS‐15 criterion is cost‐effective over PSG in the treatment of pediatric sleep disordered breathing.
Cystic Lesions of the Jaws in Children: A 15 Year Experience
Authors: Tkaczuk Andrew , Perry Katherine , Caccamese John , Ord Robert , Pereira Kevin
Published: August 2013

Objectives:

Review the clinical presentation, incidence, radiologic features, management, and outcomes of jaw cysts in children treated at a single tertiary care academic institution. Discuss the appropriate work‐up and expected outcomes of children presenting with signs or symptoms suggestive of a jaw cyst.

Methods:

Retrospective case series of pediatric patients age 16 and under who presented with a cystic lesion of the jaw to a tertiary care academic medical center from 1997 to 2012. Charts were reviewed for presenting symptoms, signs, radiological findings, pathology, intervention, and outcomes.

Results:

The charts of 76 pediatric patients evaluated for a jaw mass were reviewed. Twenty‐nine were diagnosed with a cystic jaw lesion. The most common cystic lesions were dentigerous cysts (45%) and odontogenic keratocysts (34%). Forty‐one percent of all cystic lesions were asymptomatic at presentation. The most common presenting complaint was local swelling, followed by incidental findings on panorex and dental irregularities (tooth impaction, gum change, or lesion). All patients, excluding one with an eruption cyst, required surgical intervention. Odontogenic keratocysts tended to have the worst outcomes, with frequent recurrence and an average of 2.5 procedures required.

Conclusions:

Pediatric jaw cysts are unusual, and data are scarce regarding their presentation and management. Many are asymptomatic and identified by panorex imaging of the jaws. Dentigerous cysts were the most common lesion seen in our series, closely followed by odontogenic keratocysts. Surgical intervention is required in the majority of patients. Odontogenic keratocysts may require additional procedures for cure.
Differences in DPOAE and AABR in Noise‐Exposed Infants in the Neonatal Intensive Care Unit
Authors: Liao Selena , MacArthur Carol , Martin William H. , Mace Jess , Lubianski Troy , Steyger Peter
Published: August 2013

Objectives:

1) Describe the differences in distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR) results in premature infants in the neonatal intensive care unit (NICU) with noise exposure. 2) Discuss optimal newborn hearing screen protocols for capturing at‐risk NICU graduates.

Methods:

Prospective observational outcomes study from August to the present. Subjects: Admissions to the NICU, <37 weeks gestational age. Setting: NICU. Outcome Measurements: DPOAE, AABR, and follow‐up audiometry collected by the Oregon Early Hearing Detection and Intervention (EHDI) program. Independent variables: Sound pressure levels and cumulative sound dosage. Preliminary analyses: This dataset represents preliminary data from an ongoing study with a target enrollment of 150 over 12 months.

Results:

The average sound pressure level per individual admission ranged from 57.4 to 67.8 dBA. DPOAE demonstrated a greater rate of abnormalities in the high frequency range of 4000‐10000 Hz (40‐45%) compared to lower frequencies (10‐15%). AABR generated only a 5% rate of referrals; however, 50% of DPOAEs obtained showed abnormal results in at least 2/3 of the high frequencies tested.

Conclusions:

All infants received sound exposures that substantially exceeded AAP guidelines. More abnormalities were found on DPOAE than AABR, with a significantly higher rate in the high frequencies compared to lower frequencies, consistent with possible noise‐induced cochlear dysfunction. Neonatal intensive care units should consider adding DPOAE to their hearing screen protocols so that infants at risk for noise‐induced hearing loss are not missed.
Efficacy of a Pediatric Airway Course for Otolaryngology Residents
Authors: Koh Lynn , Ang Annette Hui‐Chi , Tan Henry K. K. , Balakrishnan Abhilash
Published: August 2013

Objectives:

2012 marks the 10th anniversary of a popular hands‐on bronchoscopy course held annually for otolaryngology residents in Singapore. We set out to determine objectively the benefit of establishing such a course in a well‐rounded residency program by assessing the residents’ self‐perceived confidence level pertaining to management of the pediatric airway before and after the course.

Methods:

A self‐assessment style survey was administered to residents who attended the 2012 Pediatric Airway Course conducted by KK Women's and Children's Hospital, Singapore. The 2‐day course consisted of didactic lectures, practice of bronchoscopy techniques in a wet laboratory, and live surgery demonstration by visiting experts. Residents completed pre‐ and post‐course self‐assessments of their knowledge and skills pertaining to management of the pediatric airway. In addition, feedback was collected on the efficacy of the course. Descriptive statistics were obtained on pre‐ and post‐course data and were analyzed using T‐testing.

Results:

A total of 20 residents completed the survey. Following the course, there was a statistically significant improvement in the residents’ self‐assessment of their knowledge (P < 0.001) and skills (P < 0.001) pertaining to management of the pediatric airway. In addition, 100% of the residents agreed or strongly agreed that the course helped them learn skills and gain confidence in the management of the pediatric airway.

Conclusions:

Our findings suggest that a 2‐day dedicated pediatric airway course improves otolaryngology residents’ overall confidence in managing the pediatric airway. Future studies could include an objective assessment of the residents’ bronchoscopy skills following the same 2 day course.
Endoscopic Frontal Sinus Exploration in Children with Cystic Fibrosis
Authors: Taggart Michael , Meier Jeremy D. , Park Albert H. , Grimmer Johannes F. , Smith Marshall E. , Crockett David , Muntz Harlan R.
Published: August 2013

Objectives:

Frontal sinus exploration is uncommon in children. Delayed pneumatization of the frontal sinus, technical difficulties, and concerns for postoperative scarring and mucocele formation impact the incidence of this operation in the pediatric population. The objective of this study is to review outcomes after endoscopic frontal sinus exploration in children with cystic fibrosis (CF).

Methods:

Retrospective case series of children with CF undergoing endoscopic frontal sinus exploration at a tertiary children's hospital from 2004 to 2012. Pre‐ and postoperative pulmonary function tests (PFT), surgical complications, and the rate of revision operations were evaluated. Outcomes were compared to a cohort of children without CF that underwent endoscopic frontal sinusotomy for chronic sinusitis.

Results:

Twenty‐three children (12 with CF, 11 without CF) underwent endoscopic frontal sinusotomy. The average age was 11.3 years (range 7‐14) in the CF group compared to 13.5 years (range 6‐18) in the non‐CF population. Four of the 12 CF patients (33%) required at least 1 revision operation, compared to 1 of 11 control patients without CF (not statistically significant). No significant improvement in PFT was noted after surgery (mean FEV1% predicted pre‐operative: 97.3 ± 19.9, post‐operative: 96.7 ± 27.6). The average time from initial surgery to revision operation was 20.3 months (range 8‐30 months). No major surgical complications related to the procedure were identified.

Conclusions:

The revision rate for frontal sinus exploration in this series is similar to revision rates described in the literature for other sinuses in CF patients. PFT results did not change after the operation.
Epidemiology of OM Pathogens of Those Undergoing Tympanostomy Tube Placement in the Era of PCV13
Authors: Zhao Alice S. , Boyle Sean , Toma Mark S. , Engle Robert D. , Mouzakes Jason
Published: August 2013

Objectives:

Determine the microbiology of otitis media (OM) since the introduction of the 13‐valent pneumococcal conjugate vaccine (PCV13) in March 2010.

Methods:

The population included pediatric patients undergoing tympanostomy tube placement between August 2012 and June 2013. Middle ear effusion was sent for aerobic culture and antibiotic susceptibility testing. Statistical analysis will be performed to compare those who received PCV13 and those who only received the PCV7 vaccine. Preliminary data from August 2012 to December 2012 included 72 ears, of which 21 had fluid. Seven of these 21 ears cultured Staphylococcus aureus, Haemophilus influenza, and Pseudomonas aeruginosa. Three patients with positive cultures of Staphylococcus or Haemophilus were vaccinated with at least one dose of PCV13, and 2 patients that cultured Staphylococcus or Pseudomonas had the PCV7 vaccine. All of the cultures were susceptible to a quinolone.

Results:

Two cultures of Staphylococcus and Haemophilus were resistant to Bactrim. The impact of PCV13 on the molecular epidemiology of OM will be profound, as two of the most common pneumococcal isolates from nasopharyngeal secretions in the post‐PCV7 era, serotypes 19A and 6A, are included in PCV13. This study is the first to assess the OM microbiology in a pediatric population vaccinated with PCV13. Our study is currently limited by sample size; however, this has increased, as colonization is higher in fall and winter.

Conclusions:

This initial lack of Streptococcus cultures indicates that PCV13 is likely to have a significant impact on antibiotic resistance and rate of pneumococcal disease during the initial years following licensure.
Genetic Analysis of Pakistani Families Segregating Prelingual Hearing Loss through OtoSeq
Authors: Holle Jennifer , Sivakumaran Theru A. , Riazuddin Sheikh , Friedman Thomas B. , Riazuddin Saima , Zhang Kejian , Ahmed Zubair M.
Published: August 2013

Objectives:

Evaluate the clinical use of OtoSeq, a massive parallel sequencing‐based mutation screening test, in identifying the genetic causes of prelingual hearing loss.

Methods:

We performed linkage analysis using three fluorescently labeled STR markers for known autosomal recessive nonsyndromic (DFNB) and Usher syndrome (USH) loci on our cohort of Pakistani families segregating prelingual hearing loss. In parallel, we screened one affected individual from some of these families enriched using OtoSeq to identify underlying genetic variants. Sanger sequencing was performed to confirm and study the segregation of identified mutations in each family. For novel mutations, normal hearing individuals from ethnically matched background were screened.

Results:

Hearing loss in 34 multi‐generational families was found to co‐segregate with USH1B (32 families), USH1D (1 family),and PDS (1 family) linked STR markers. Through OtoSeq, a microdroplet PCR‐based target enrichment followed by MPS, we identified 24 mutations in28 of these families, of which 13 were novel alleles. Sanger sequencing of these mutations showed 100% concordance with MPS data and co‐segregation of the mutant alleles with the hearing loss phenotype in the respective families.

Conclusions:

The OtoSeq determined the cause of hearing loss in 80% of cases. These results suggest: 1) OtoSeq diagnostic protocol would be a better, cost‐effective, and rapid alternative to current technologies for identifying the multiple genetic causes of hearing loss, and 2) OtoSeq platform should be periodically upgraded to include new deafness genes as they emerge.
Hospitalization Trends for Orbital Cellulitis in the Pediatric Population: 2003‐2009
Authors: Smith Aaron M. , Nesemeier Ryan , Cash Elizabeth , Woods Charles , Chandran Swapna K.
Published: August 2013

Objectives:

Orbital cellulitis occurs primarily following sinusitis. This infection resides posterior to the orbital septum with inherent risk to the eye, cavernous sinus, meninges, and brain. Fortunately, complications remain rare due to the advent of antibiotics. Surgical drainage through orbitotomy or ethmoidectomy may occur. We aim to characterize the demographic stratification, surgical treatment variation, and cost and resource use related to orbital cellulitis over time.

Methods:

We queried the Kid Inpatient Database for 2003, 2006, and 2009, identifying all cases of International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) codes 376.01, orbital cellulitis. Census data were used to calculate incidence. We used Statistical Analysis Software for our analysis. This study used a publically available, de‐identified database allowing exemption from the Institutional Review Board.

Results:

From 2003 to 2009, the incidence remained stable (3.2 to 2.8/100000 population). Males made up 60% of cases (relative risk [RR] 1.18, 95% confidence interval [CI] 1.16‐1.20). Children 0‐4yo were 1.92 times more likely to be afflicted than other age groups (RR 1.92, 95%CI 1.87‐1.96). Mean and median length of stay remained constant at 3 days. Orbitotomy was performed more frequently than ethmoidectomy (7.2% vs 1.3%, P < 00.1). Median total charges increased from $6225 to $10290.

Conclusions:

The number of cases and incidence of orbital cellulitis remained constant. Numbers of cases decreased with increasing age. Costs per hospitalization increased, but lengths of stay remained constant. Orbitotomy was performed more frequently than ethmoidectomy; however, both procedures were infrequent. This suggests most providers follow recommendations of conservative treatment with antibiotics.
Implementation of Tonsillectomy Guidelines in a Pediatric Otolaryngology Practice
Authors: Stankova Lenka , Johnson Romaine F.
Published: August 2013

Objectives:

Describe the outcomes associated with following AAO‐HNSF guidelines regarding cessation of routine antibiotics usage after tonsillectomy.

Methods:

A retrospective cohort study at a tertiary care stand‐alone pediatric hospital of children who had a tonsillectomy performed by a single surgeon approximately 18 months before then after (January 2009 through August 2012) the release of American Academy of Otolaryngology—Head and Neck Foundation (AAO‐HNSF) guidelines regarding tonsillectomy. The guidelines were fully implemented for antibiotic use by the surgeon who served as a self‐control. Outcomes studied were secondary tonsil bleed rates, number of ER visits, readmissions, and parental calls. Descriptive statistics were applied for demographic data. Simple hypothesis testing, odds ratio, and relative risk calculations were done to determine outcomes.

Results:

1069 patients were included. 600 were exposed to antibiotics, and 469 were not. Average age was 7.1 years (range 1‐20). 51% were male. Overall secondary bleed rate was 3.5%, ER visit rate was 10.3%, readmission rate was 5%, and the parental call rate was 21%. When comparing patients exposed to antibiotics to those who were not, there were no statistically significant differences in any of the outcomes measures.

Conclusions:

Eliminating routine antibiotics usage, as recommended by the guidelines, does not appear to adversely affect outcomes in post‐tonsillectomy patients.
Management of Refractory Tympanostomy Tube Otorrhea with Ear Wicks
Authors: Dedhia Kavita K. , Chi David
Published: August 2013

Objectives:

Report our experience with ear wicks for the treatment of chronic tympanostomy tube otorrhea, failing to improve with oral and/or topical antibiotics.

Methods:

Retrospective review of 7 children with tympanostomy tubes and recurrent otorrhea failing medical management in 2012 at a tertiary care center. We describe the outcomes of patients after wick placement and Ciprodex ear drops.

Results:

The average age of patients in this study is 30 months (21‐48months). The average age of tympanostomy tube insertion was 17 months (8‐32 months). All patients had Armstrong grommet tubes placed. Three patients found effusions during time of insertion. All children failed previous topical and/or oral antibiotic treatment. An ear wick was placed during the clinic visit, and ciprodex drops were continued. Wicks were removed in approximately one week. Culture results showed 4 patients had Methicillin‐resistant Staphylococcus aureus and 3 had Pseudomonas aeruginosa. After wick placement, 7/7 (100%) patients’ otorrhea resolved. One patient had recurrent otorrhea at further follow‐up visit.

Conclusions:

Tympanostomy tube placement is one of the most common surgical procedures in children. Refractory otorrhea continues to be a complication that has a negative effect on patient quality of life and remains a challenge to treat. It can be difficult to adequately deliver topical therapy to young children. Placement of an ear wick improves topical delivery to the ear and may eradicate otorrhea in patients who failed prior topical and oral antibiotics.
Midline Approach to Pediatric Nasofrontal Dermoids
Authors: Ortlip Timothy , Ambro Bryan T. , Pereira Kevin D.
Published: August 2013

Objectives:

Highlight the surgical approaches and cosmetic considerations involved in the management of pediatric nasofrontal dermoid cysts. We reviewed the various surgical approaches in comparison to our own experience using the vertical midline incision.

Methods:

Case series of 4 different types of nasal dermoids, including 1 with an intracranial extension managed at a single tertiary medical center over a 2 year period.

Results:

There were a total of 4 patients. The mean age at surgery was 2.5 years. The anatomic location of the nasal dermoids differed in each patient: 1) supratip, 2)upper dorsum, 3)tip and supra‐tip, 4)tip and upper dorsum. Computed tomography and magnetic resonance imaging was performed on all patients. There was one case of intracranial extension. All 4 patients underwent surgical removal of the lesions with excision of involved skin using the vertical midline incision. Nasal reconstruction was performed with local soft tissue flaps (1 patient), Alloderm® (2 patients), and bone dust pate (1 patient). The patient with intracranial involvement also underwent a frontal craniotomy to excise the intracranial component. All 4 lesions were histologically confirmed as dermoid cysts. Mean follow‐up was 1.5 years. There were no complications or recurrences. All patients had a cosmetically acceptable incisional scar.

Conclusions:

A vertical midline incision with modifications to excise involved skin provides a satisfactory and cosmetically sound approach to congenital lesions of the nasofrontal region. It affords adequate exposure for excision and reconstruction. A multi‐disciplinary team consisting of neurosurgery, facial plastics, and pediatric otolaryngology are needed to optimize outcomes.
National Trends in Pediatric Deep Neck Abscesses
Authors: Anderson Danielle , Johnson Christopher M. , Brigger Matthew T.
Published: August 2013

Objectives:

1) Identify the current public health burden of pediatric deep neck space abscesses. 2) Determine if reports of nonsurgical management of pediatric deep neck space abscesses has resulted in a change in national practice patterns.

Methods:

The 2000 and 2009 Kids’ Inpatient Databases were used to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009. Children diagnosed with deep neck space abscesses were identified by corresponding ICD‐9 codes. Database analyses generated national estimates of summary statistics and comparison of trends over the nine‐year period.

Results:

The estimated prevalence of deep neck abscesses requiring hospitalization in the United States increased from 2112 cases in 2000 (95% confidence interval [CI]:1837;2387) to 3617 in 2009 (95% CI:3263;3971). Total charges increased from $2,650,000 (95% CI:$2,030,000;$3,270,000) to $8,020,000 (95% CI:$6,870,000;$9,170,000) with a mean charge per admission increasing from $13,309 (95% CI:$10,557;$16,063) in 2000 to $22,492 (95% CI:$20,541;$24,444) in 2009. The mean length of stay trended down from 4.63 (95% CI:3.74;5.51) to 3.83 (95% CI:3.62;4.03) hospital days. The frequency of surgical management decreased from 52.4%(95% CI:0.476;0.572) to 41.4% (95% CI:0.386;0.443) of cases with parapharyngeal abscesses requiring surgical drainage more commonly than retropharyngeal abscesses.

Conclusions:

Recent reports of the increasing prevalence of pediatric deep neck space infections appear to be substantiated on a national level. As such, the public health burden has grown substantially in total charges and use. Although surgical drainage has long been considered the gold standard therapy, the past decade has seen this management strategy used in less than half of all children admitted.
Noise Exposure in the Neonatal Intensive Care Unit: A Prospective Study
Authors: Liao Selena , MacArthur Carol , Martin William H. , Lubianski Troy , Mace Jess , Steyger Peter
Published: August 2013

Objectives:

1) Describe the sound pressure levels experienced by premature infants in a neonatal intensive care unit (NICU) over an entire admission, compared to neonatal standards for sound exposure by the American Academy of Pediatrics (AAP) and Journal of Perinatology (JP), as well as adult standards by the National Institute for Occupational Safety and Health. 2) Determine whether this population may be at higher risk for noise‐induced hearing loss.

Methods:

Prospective observational outcomes study from August 2012‐ present. Condition Studied: noise‐induced hearing loss. Subjects: Admissions to the NICU, <37 weeks gestational age. Outcome Measurements: Sound pressure levels/cumulative sound exposure dosage. Independent Variables: bed type, location, number of patients per room, machine therapies. Preliminary Analyses: This dataset represents preliminary data from an ongoing study with a target enrollment of 150 over 12 months.

Results:

The average sound pressure level per admission ranged from 57.4 to 67.8 dBA. Neonates in enclosed beds experienced a trend toward higher decibel levels than those in open beds. Neonates on machines such as ventilators, continuous positive airway pressure (CPAP), or phototherapy were found to experience higher decibel levels.

Conclusions:

All infants received sound exposures that substantially exceeded AAP and JP guidelines of <45 dBA and <50 dBA for the NICU. Reducing NICU decibel levels should concentrate on bed design, individual alarm noise, and staff education regarding the sources and consequences of sound exposure. Newborn hearing screening protocols should consider additional testing to determine the risk of noise‐induced hearing loss.
Optimizing Outcome: Use of a Checklist for Otolaryngologists Overseeing Ex Utero Intrapartum Treatment (EXIT)
Authors: Yau Yuk Y. A. , Camilon Felizardo , Ahuja Gurpreet S. , Camilon Philip R. , Pham Nguyen
Published: August 2013

Objectives:

Evaluate elements necessary in the decision making and execution during ex‐utero intrapartum treatment (EXIT) and operation on placental support (OOPS) procedures to ensure superior outcomes.

Methods:

Retrospective review of neonatal head and neck obstruction cases from January 1998 to January 2013 at two tertiary referral centers. Main outcome measures: Data regarding prenatal care, delivery details, pathology of lesion, and postnatal course.

Results:

From 1998‐2013, 13 of the 15 cases of prenatally‐diagnosed potentially severe head and neck obstruction used an EXIT or OOPS procedure to secure the airway. The decision making process leading to whether an EXIT procedure needed to be performed was reviewed. Additionally, we analyzed elements that must be addressed in the checklist, including defined tasks for the specialties of perinatology, neonatology, anesthesia, fetal imaging, pediatric otolaryngology, and operative services to optimize outcome. Equipment and space needs are addressed as well. Multidisciplinary rehearsal of the procedure is strongly recommended, with the pediatric otolaryngologist leading the process. We offer a comprehensive checklist for the otolaryngologist overseeing such procedures.

Conclusions:

Medical checklists are increasingly being used to ensure safety and improve outcomes in complex patient care situations. Obstructive masses of the head and neck in the fetus present a difficult and potentially fatal clinical problem. Based on our experience, we offer the otolaryngologist a structured and well‐choreographed approach in dealing with such complex situations, with the incorporation of a comprehensive checklist for EXIT procedures.
Otogenic Lateral Sinus Thrombosis: Case Series and Controversies
Authors: Funamura Jamie L. , Nguyen Alexander T. , Diaz Rodney C.
Published: August 2013

Objectives:

1) Present a series of patients with an increasingly rare but significant complication of otitis media primarily affecting the pediatric population. 2) Review diagnostic and management algorithms for otogenic lateral sinus thrombosis. 3) Discuss controversies in medical and surgical management of lateral sinus thrombosis.

Methods:

Retrospective chart review of patients treated for otogenic lateral sinus thrombosis at a tertiary care institution from June 1996 through July 2012.

Results:

Over a 16‐year period, 6 patients were treated at our institution for otogenic lateral sinus thrombosis. Symptoms at presentation included fever, persistent nausea and vomiting, headache, seizure, and facial nerve palsy; duration of symptoms prior to diagnosis varied from 4 days to 3 weeks. Four patients were diagnosed with associated intracranial complications, and 1 was found to have a cholesteatoma. All 6 patients underwent a primary surgery by an otolaryngologist; 1 required a subsequent internal jugular vein ligation, and another required neurosurgical procedures for drainage of intracranial abscesses. Four of 6 patients were anticoagulated, and 1 developed significant anticoagulation‐related complication.

Conclusions:

Although rarely encountered today, lateral sinus thrombosis remains a serious intracranial complication requiring both medical and surgical intervention with a multidisciplinary effort. Controversies exist as to the degree of surgical intervention and whether anticoagulation is necessary for treatment.
Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital
Authors: Ibrahim Shahrul I. , Low David Y. M. , Ang Annette H. C. , Balakrishnan Abhilash , Tan Henry K. K.
Published: August 2013

Objectives:

Tonsillectomies and adenotonsillectomies are among the most common procedures to be carried out in children throughout the world. Postoperative hemorrhages have previously been reported to be at a maximum expected rate of 13.9% with a mean of 4.5%. This study reports the postoperative hemostasis rate at the KK Women's and Children Hospital, Singapore, a tertiary pediatric hospital.

Methods:

Retrospective study of tonsillectomy and adenotonsillectomy cases done on children up to 16 years of age from the end of January 2007 till early January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis was recorded.

Results:

In total there were 2322 tonsillectomy cases. 1581 were adenotonsillectomies, and 741 were bilateral tonsillectomies only (without adenoidectomy). There were 33 cases that required return to the operating room for hemostasis, giving a postoperative hemostasis rate of 1.42%. There were no cases of bleeding from adenoidectomy. All 2322 cases were done with monopolar diathermy. Hemostasis intraoperatively was also done with monopolar diathermy. The operating surgeons ranged from first year residents to senior consultants.

Conclusions:

The postoperative hemostasis rate following tonsillectomy and adenotonsillectomy at KK Women's and Children's Hospital is 1.42%, comparable to the best rates quoted in the literature.
Sleep Apnea in Children with Down Syndrome and Laryngomalacia: Objective Outcomes after Supraglottoplasty
Authors: Sawyer Stephen W. , Stoner Julie A. , Digoy G. Paul
Published: August 2013

Objectives:

Examine the effect of supraglottoplasy in children who have Down Syndrome and findings suggestive of state‐dependent laryngomalacia (SDL) on measures of obstructive sleep apnea syndrome (OSAS) including the number of obstructive events per hour, apnea hypopnea index (AHI), and the minimum oxygen saturation.

Setting:

Tertiary care children's hospital. Study design: A retrospective review of 11 pediatric patients with DS, OSAS, and SDL between 2006 and 2012. The diagnosis of SDL was made via sleep endoscopy under light general anesthesia. All patients underwent pre‐ and postoperative polysomnography.

Results:

The number of obstructive events per hour (OAI) decreased following supraglottoplasy for 9 (82%, 95% CI: 48% to 98%) of the 11 patients, which was a statistically significant reduction in the number of events (P = 0.05). AHI and minimum oxygen desaturation was not statistically different after supraglottoplasty. Snoring improved or ceased in 60% of patients. Coughing associated with eating was worse in 2/10 patients postoperatively.

Conclusions:

Children with DS, OSAS, and SDL statistically improved after supraglottoplasty, though not in all measures. This response is less significant than in children without DS. Furthermore, this population may have increased risk of postoperative aspiration. Larger series in children with OSAS, SDL, and DS are needed to confirm these findings.
Trends and Comparison of Children Hospitalized for Retropharyngeal and Parapharyngeal Abscesses 2003‐2009
Authors: Smith Aaron M. , Cash Elizabeth , Myers John , Smith Michael , Navale Suparna , Woods Charles , Chandran Swapna K.
Published: August 2013

Objectives:

Following the peritonsillar space, two confluent spaces house the majority of pediatric deep neck space infections, the retropharyngeal and parapharyngeal sites. Surgical drainage and conservative antibiotic management exist as treatment options.

Methods:

We queried the Kid Inpatient Database identifying all cases of International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) codes 478.22, parapharyngeal abscess (PPA), and 478.24, retropharyngeal abscess (RPA) for 2003, 2006, and 2009. Comparisons were made between population level estimates using Statistical Analysis Software.

Results:

The incidence (0‐20yo) of both RPA (0.67 to 0.81/100000population) and PPA (1.46 to 1.84/100000) increased slightly. Males were more likely than females to be afflicted (60% vs 40%). The median age for RPA was younger (4yo vs 5yo, P < 0.001). Median total charges increased (for RPA $12217 to $14453, P <0.01, for PPA $13184 to $19177, P < 0.01) with no cost difference between them (P = 0.055). Median length of stay (LOS) remained constant (3 d). Surgical drainage occurred more often for PPA (43% vs 37%, P < 0.01); however, LOS increased when an RPA was surgically drained (4 vs 3 days, P < 0.01).

Conclusions:

These national population‐based estimates show a similar demographic stratification for RPA and PPA. Incidence has increased slightly with RPA occurring more often and at a younger age. Costs per hospitalization increased, but lengths of stay were constant. Surgery occurred more often for PPA but increased LOS for RPA. Surgery increased overall costs; however, cost and resource use were similar for both infections.
AMPK Inhibits TGF‐β1–Induced Extra Cellular Matrix Production in Nasal Polyp‐Derived Fibroblast
Authors: Lee Heung M. , Park Il‐Ho , Cho Jung‐Sun , Um Ji‐Young
Published: August 2013

Objectives:

Adenosine monophosphate‐activated protein kinase (AMPK) is known to inhibit fibrogenic responses in many cells by targeting TGF‐Î21‐Smad signaling. The purpose of this study was to investigate the effect of AMPK on TGF‐Î21‐induced myofibroblast differentiation and ECM production and to determine the underlying mechanism for the action of AMPK in nasal polyp‐derived fibroblasts (NPDFs).

Methods:

NPDFs were incubated with TGF‐β1 and treated with the activator of AMPK (metformin) or inhibitor of AMPK (compound C). To determine the proliferation rate of nasal fibroblasts, MTT assay was performed. The expression levels of α‐smooth muscle actin and fibronectin were determined by reverse transcription polymerase chain reaction (RT‐PCR), Western blotting and immunofluorescent staining. Phosphorylation of AMPK and phosphorylation of Smad2/3 were evaluated by Western blot analysis.

Results:

In TGF‐β1‐induced NPDFs, metformin inhibited the expression of α‐SMA and fibronectin, as confirmed by both RT‐PCR and Western blotting analysis. Metformin increased the phosphorylation of AMPK and expression levels of α‐SMA and fibronectin, and compound C reversed these effects. Metformin inhibited TGF‐β1‐induced phosphorylation of Smad2/3.

Conclusions:

This study showed that AMPK inhibited TGF‐β1‐induced ECM production in NPDFs via the Smad2/3 pathway. AMPK can be a therapeutic target for the prevention of ECM remodeling in nasal polyps.
Baseline Characteristics of the Sinonasal Tract in Wild‐Type and Innate Immunity Knockout Mice
Authors: Rassouli Alipasha , Desrosiers Martin Y. , Ryan Allen F. , Hamid Qutayba , Tewfik Marc A.
Published: August 2013

Objectives:

1)I Investigate the baseline histological characteristics of sinonasal tissue in wild‐type mice. 2) Observe the effects of knocking out various genes involved in innate immunity on the inflammatory cell infiltrates and mucosal architecture of murine sinonasal epithelium.

Methods:

Unchallenged wild‐type C57‐BL6 mice, as well as knockouts for the innate immunity genes NOD‐1, NOD‐2, RIP‐2, TLR‐2 and MYD88, were sacrificed at age of maturity. The heads were decalcified and sinuses serially cut at 5 micrometer thickness. Three sections of the nasal cavity (anterior, mid, and posterior) were selected and examined under H&E and immunohistochemical staining conditions. Goblet cells, basement membrane thickness, neutrophil, macrophages, and eosinophils were evaluated and counted under high‐power field and compared using one‐way analysis of variance multiple comparison (SPSS 20).

Results:

Average cell counts per mm2 for wild‐type mice were 16.3 +‐ 1.5 macrophages, 2.0 +‐ 0.5 neutrophils, 0 eosinophils, and 2152.4 +‐ 572.4 goblet cells; basement membrane thickness was 3.1 +‐ 1.5 micro meter. There were no significant differences between the wild‐type and the knockout groups.

Conclusions:

The current study suggests that innate immunity gene knockouts had little effect on the sinonasal epithelium of unchallenged mice. Disruption of innate immune effector genes is not sufficient in and of itself to cause a rhinosinusitis phenotype in mice, but may still cause an inability to mount an appropriate host immune response to microbial pathogens.
Central Giant Cell Reparative Granuloma of the Maxillary Sinus: Endoscopic Resection and Intranasal Calcitonin Therapy
Authors: Vazquez Alejandro , Blake Danielle M. , Eloy Jean A. , Kalyoussef Evelyne
Published: August 2013

Objectives:

Central giant cell reparative granuloma (CGCRG) is an uncommon, nonneoplastic, osteolytic lesion that can display locally aggressive behavior. CGCRG most often involves the mandible. Lesions arising within the paranasal sinuses are far less common. Treatment has historically consisted of surgical excision, typically via open approaches. Recently, calcitonin has been proposed as therapy for CGCRG. We present the case of a young woman with an extensive, aggressive CGCRG of the maxillary sinus who underwent total endoscopic resection followed by adjuvant therapy with intranasal calcitonin.

Methods:

Case report.

Results:

A 19‐year‐old woman presented with a 3‐month history of progressively worsening left‐sided malar pain and hypesthesia. Physical exam revealed hyperglobus; loose maxillary dentition; a soft, compressible bulge in the left hard palate; and a large mass occupying the left nasal cavity. Computed tomography and magnetic resonance imaging showed a 4 x 4 x 4.8 cm mass within the left maxillary sinus which had eroded the hard palate and inferior orbital wall and displaced the orbital contents superiorly. Biopsy of the lesion was consistent with CGCRG. The patient underwent complete resection via a modified endoscopic, endonasal medial maxillectomy approach. Adjuvant therapy with intranasal calcitonin is underway, and the patient is doing well 3 months post‐excision.

Conclusions:

In this report, we demonstrate a safe, effective, entirely endoscopic resection of an extensive CGCRG. We advocate prompt surgical management of these lesions given their potential for local destruction. Although evidence regarding the use of calcitonin is limited, we suggest considering its use as adjuvant therapy.
Clinical Aspect of Concha Bullosa of Middle Turbinate and Nasal Septal Deviation
Authors: Cho Jin‐Hee , Kim Young‐Ha
Published: August 2013

Objectives:

Concha bullosa (CB) with nasal septal deviation (NSD) can be the cause of postoperative functional failure if not corrected during surgery.

Methods:

All the paranasal computed tomography scans (CTs) taken in a tertiary hospital from May 2011 to October 2012 were analyzed. Cases with history of nasal surgery and nasal trauma were excluded due to the possibilities of nasal anatomical changes.

Results:

520 CTs were included in this study, from 550 CTs analyzed. 331 males and 189 females were included, and the ages of patients ranged from 2 to 87. 444 patients (85.38%) had NSD. The age distributions of CB were as follows: in the age group of 0~15, 0%; 16~30,.70%; 31~45, 40%; 46~60, 33.14%; and over 60 years, 25%. In 444 patients with NSD, bilateral CBs were observed in 93, unilateral CBs in wide nasal cavity in 47, and narrow nasal cavity in 7. When 269 CBs were classified as true, lamella, or bullous type, the average measured pneumatization areas were statistically wider in true type (p=0.008). When comparing the maximum pneumatization areas of CB in coronal CT of patients with NSD, the CB area of wide side nasal cavity was statistically wider than that of narrow side nasal cavity (P = 0.000).

Conclusions:

CBs are clinically thought to be formed in those over 15 years old. CBs are formed mainly in wider nasal cavity, and especially larger in true type, so they should be removedin surgery.
Complications of Endoscopic and Conventional Dacryocystorhinostomy (External) in Chronic Dacryocystitis
Authors: Venegas Monica M. H. , Morante Juan C. C. , Cruzado‐Sanchez Deivy , Valdivia Victor , Chang Jorge H.
Published: August 2013

Objectives:

Describe the complications of endoscopic and conventional dacryocystorhinostomy (external) in chronic dacryocystitis (CDC) in a public hospital.

Methods:

Case series. We evaluated 39 patients who were treated surgically of CDC by endoscopic or conventional dacryocystorhinostomy between January 2006 and December 2011 at the Arzobispo Loayza National Hospital, Lima, Peru. We evaluated the complications associated with the treatment received.

Results:

Of the 39cases, 29 (74.4%) were women, and the average age was 54.9 years. The mean disease duration was 29.7 months. The affected side was the right in 59%, and the most common symptom was epiphora (84.6%), followed by secretion (7.7%) and tumor (5.1%). 56.4% of the surgeries were made by conventional technique. The most common complication was the post‐surgical removal of the probe in 4 patients, 3 (7.7%) by the conventional and 1 (2.5%) by the endoscopical technique. Other complications were reocclusion (5.2%), abscess (2.6%), and epistaxis (2.6%), all for the conventional technique. By the endoscopical technique, just the infection (5.2%) and synechiae (2.6%).

Conclusions:

Complications associated with the conventional technique were expulsion of the probe (7.7%), reocclusion (5.2%), abscess (2.6%), and epistaxis (2.6%), while complications with the endoscopic technique were removal of the probe (2.5 %), infection (5.2%), and synechiae (2.6%).
Confirmation of Tolosa‐Hunt Syndrome via Endoscopic Endonasal Biopsy of the Orbital Apex
Authors: Takashima Masayoshi , Richter Amy L.
Published: August 2013

Objectives:

1) Review the criteria for diagnosing Tolosa‐Hunt Syndrome (THS), a rare cause of painful ophthalmoplegia due to idiopathic granulomatous inflammation of the orbital apex or cavernous sinus. 2) Review the literature of THS and other surgical techniques used previously in the setting of THS.

Methods:

We present a literature review of THS, focusing on the surgical approaches to and findings in the cavernous sinus and orbital apex. We report a recent case of unilateral vision loss and painful ophthalmoplegia where endonasal endoscopic biopsy of the orbital apex was performed after initial evaluation failed to yield a diagnosis. We present the pre‐operative imaging, intra‐operative observations, and pathologic results of this patient with THS.

Results:

In our review of THS, there are no other documented reports of endonasal endoscopic biopsy of the orbital apex. There are few reports of variable neurosurgical approaches used previously in THS. In our case, endoscopic biopsy yielded pathologic evidence of granulomatous inflammation without evidence of infectious or neoplastic disease. The patient received intravenous steroids, and symptoms improved within 72 hours, confirming THS.

Conclusions:

THS is an extremely rare cause of painful ophthalmoplegia. Traditionally, THS is a diagnosis of exclusion without tissue confirmation, as biopsies are difficult to perform. This may delay diagnosis of a neoplasm. We present a single case of THS where endonasal endoscopic biopsy of the orbital apex confirmed granulomatous inflammation, suggesting that endoscopic techniques may be used as a safe, minimally invasive approach to the orbital apex in the setting of painful ophthalmoplegia.
Efficacy and Safety of Sublingual Immunotherapy in Children with Allergic Rhinitis: 2‐Year Follow‐up
Authors: Shin Jae‐Min , Park Il‐Ho , Lee Heung‐Man
Published: August 2013

Objectives:

Sublingual immunotherapy is currently accepted as a suitable alternative to subcutaneous immunotherapy because of its easy and painless administration and improved safety. Many clinical trials have demonstrated that sublingual immunotherapy is an effective and safe treatment for pollen or mite allergic rhinitis. However, there have been very few studies overall on children with allergic rhinitis who are sensitized to house‐dust mites in Asia. The purpose of the present study was to investigate the efficacy and safety of sublingual immunotherapy in children with allergic rhinitis to house‐dust mites.

Methods:

A total of 112 patients under the age of 15 who had allergic rhinitis to Dermatophagoides pteronyssinus and Dermatophagoides farinae were included. All patients were treated with sublingual immunotherapy (Staloral®). Symptom scores and quality of life were evaluated by questionnaires. The medication score was assessed monthly using a diary medication card, and serologic tests were evaluated before and 24 months after treatment. Adverse effects and compliance were also investigated.

Results:

All nasal and non‐nasal symptoms and quality of life were significantly improved after treatment. The total medication score was decreased significantly after sublingual immunotherapy. There was no significant change in serologic tests. Some minor adverse effects were reported; however, there were no systemic reactions. The drop‐out rate was 46%.

Conclusions:

Sublingual immunotherapy is a valuable therapy for the treatment of allergic rhinitis in Asian children sensitized to house‐dust mites.