bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Tympanoplasty in Children following Tympanostomy Tube Placement
Authors: Alrwisan Adel , Antonelli Patrick J. , Winterstein Almut G. 
Published: September 2014

Objectives:Quantify the incidence rate of tympanoplasty after tympanostomy tube (TT) insertion in children.Methods:This was a retrospective cohort study of healthy children <18 years old using Medicaid Extract Files from 1999 to 2004. All subjects received TTs and had at least 6 months continuous Medicaid eligibility prior to TTs. We followed patients for 2 years after TTs. The Kaplan‐Meier procedure was used to estimate time to tympanoplasty.Results:There were 270,408 children with billing records for TTs, and 141,243 met inclusion criteria with a follow‐up time of 217,431 patient‐years. Median age at TTs was 1.62 year, with 58.5% placed at <2 years. Subsequent tympanoplasty was performed in 963 (0.68%), with 324 at age 2‐4 years. The median age at tympanoplasty was 5.1 years. Median time from TTs to tympanoplasty was 450 days. The incidence rate of tympanoplasty was 44 cases per 10,000 patient‐years (95% confidence interval 41 to 47).Conclusions:Tympanoplasty following TTs is not uncommon. These repairs are commonly performed in preschool children and often within 2 years of TT placement.
Guinea Pig Model to Establish the Safety of Middle Ear Pellets
Authors: Hoskison Emma E. , Daniel Matija , Qureishi Ali , Lee Y. S. , Mulheran Mike , Bayston Roger , Birchall John P. 
Published: September 2014

Objectives:Effective treatments for otitis media with effusion (OME) remain elusive as many patients have recurrence. Direct drug delivery to the middle ear has the potential to maximize efficacy, minimize side effects, and provide a sustained release treatment, which is particularly important in the treatment of biofilms. Polymer‐based pellets are delivery vehicles for antibiotics and pellet placement in the middle ear is a potential future OME treatment. In vivo testing of these pellets in animal models is necessary prior to human application.Methods:Twenty‐four adult guinea pigs were divided into 3 (n = 8) treatment groups: biological controls, surgical controls, polylactic glycolic acid (PLGA) pellets inserted in middle ear. The surgical approach involved submandibular incision, dissection, and following digastric up to the middle ear bulla. Perforating the bulla wall facilitated a 2.5‐mm diameter pellet insertion. Auditory brainstem responses (ABRs) were recorded at 0, 1, 2, 4, and 16 weeks at 6 frequencies over 8 to 30 kHz. Analysis was performed using a paired t test with significance set at P <. 05 (Bonferroni correction).Results:Mean ABR thresholds across the 3 groups ranged between 42 and 49 dB SPL over 4 weeks. There were statistically significant threshold elevations between 4‐10db SPL in the surgical control and pellet groups although these were not considered physiologically significant.Conclusions:Using a guinea pig model, PLGA pellet insertion into the middle ear caused ABR threshold elevation of only 4‐10 dB SPL, supporting their use as a potential vehicle for middle ear drug delivery.
Management and Outcome of Airway Infantile Hemangiomas
Authors: Akyol Mehmet U. , Unal Omer F. , Gunaydin Riza O. , Senirli Rezarta T. , Kuscu Oguz 
Published: September 2014

Objectives:(1) Analyze the data of our series of cases of infantile hemangiomas (IH). (2) Describe the clinical characteristics and contemporary treatment modalities of the disease to general and pediatric otorhinolaryngologists.Methods:The medical records of children diagnosed with airway hemangiomas at Hacettepe University Hospital, Department of Otolaryngology between 2005 and 2013 were reviewed retrospectively. The study included 17 patients with IH of the airway. Four patients (23.5%) were male and 13 (76.5%) were female. All of the patients received medical treatment. Six patients (35%) did not respond to medical treatment and surgical intervention was needed. Five in the surgical group required tracheotomy.Results:All patients with tracheotomies were decanulated and stridor in all of them either disappeared or significantly improved. Endoscopic examinations of all of the patients revealed an open and safe lumen. After beginning propranalol as the medical agent, only one patient needed surgical intervention. None of the patients had any major complications.Conclusions:Medical treatment with propranalol of subglottic hemangioma is the first line choice. If medical treatment options fail, surgical intervention should be considered. Overall purpose should be the patient's airway safety.
Mandibular Distraction Osteogenesis in Patients with Pierre Robin Sequence: Preoperative Assessment Determines Success
Authors: Bodily Nathan , Lypka Michael , Teichgraeber John F. , Yuksel Sancak , Oy Soham 
Published: September 2014

Objectives:(1) Understand the importance of an interdisciplinary approach to the selection of patients with Pierre Robin sequence for mandibular distraction osteogenesis. (2) Recognize that unfavorable outcomes can be linked to inaccurate preoperative assessment.Methods:A retrospective review of 10 consecutive patients with Pierre Robin sequence who underwent mandibular distraction from July 2011 to July 2013 at Children's Memorial Hermann Hospital was performed. Age at distraction, associated syndromes and medical conditions, pre‐ and postoperative sleep studies, and complications were evaluated. Follow‐up ranged from 6 months to 2 years.Results:A total of 10 patients with Pierre Robin sequence underwent mandibular distraction. Two had defined syndromal diagnoses and two had undefined chromosomal abnormalities. Average pre and postoperative AHI were 31.5 and 4.5, respectively. Average distraction length was 24 mm. Eight of the 10 patients who underwent distraction had successful outcomes defined by relief of obstructive apnea, reduction in AHl, and improved feeding at 2 months. Two patients had unfavorable outcomes. One did not respond to the distraction procedure and had a delayed diagnosis of spinal muscular atrophy, ultimately resulting in death. The other patient had multiple congenital anomalies and failed to respond to the distraction. The patient had significant laryngomalacia on post distraction repeat L and B, required tracheostomy, and later died of cardiac shunt failure.Conclusions:In the properly selected patient, mandibular distraction in patients with Pierre Robin sequence can be successful. Preoperative assessment involves both art and science, but ultimately determines the success or failure of the distraction procedure.
Medical and Surgical Management of Congenital Laryngomalacia: A Retrospective Case‐Control Study
Authors: Faria John , Behar Philomena 
Published: September 2014

Objectives:Compare the growth of infants with moderate to severe laryngomalacia who underwent supraglottoplasty to the growth of those treated with medical therapy alone.Methods:Retrospective case‐control chart review of patients treated between 2008 and 2013 in a tertiary care pediatric otolaryngology practice. 51 infants newly diagnosed with moderate to severe congenital laryngomalacia were included. A total of 17 infants underwent supraglottoplasty and 34 matched controls had medical management, which included acid suppression therapy, speech and swallowing therapy, and/or high‐calorie formula. The primary outcome measure was weight percentile recorded at the second clinic visit and at the last available follow‐up. The secondary outcomes were the need for tracheostomy or gastrostromy, development or persistence of failure to thrive, surgical complications, and new onset developmental delay. The management strategy was considered a success if none of the secondary outcomes occurred.Results:There was no difference in the mean weight percentile between the surgical and nonsurgical groups at the time of last follow‐up (P =. 89). Twenty‐nine (85%) patients in the medical management group and 12 (71%) in the surgical group were managed successfully. There were no statistically significant differences in the success rate between groups (P =. 27).Conclusions:Medical management and close observation of infants with moderate to severe congenital laryngomalacia may be a viable alternative to supraglottoplasty.
Modification of the Laerdal MegaCode Kid Mannequin Head to Simulate Aspiration of Peritonsillar Abscess
Authors: Fox Daniel P. , Larrier Deidre R. 
Published: September 2014

Objectives:(1) Validate a low‐fidelity mannequin model engineered to teach drainage of peritonsillar abscesses. (2) Pilot this mannequin model in instructing incoming otolaryngology residents on drainage of peritonsillar abscesses.Methods:A peritonsillar abscess (PTA) simulator was constructed through modification of the Laerdal MegaCode Kid Mannequin head using inexpensive components. Tonsils were constructed from Dermasol, and the peritonsillar abscess was simulated by placing a balloon filled with a mixture of water and body lotion behind the appropriate soft palate region. A feedback electrode was placed behind this to create an audible buzz if the needle went too far, simulating entrance into the carotid artery. The model was validated by a panel of experts through survey, and subsequently used to teach PTA drainage to PGY2 otolaryngology residents.Results:The expert panel unanimously agreed that they would use the device to teach PTA drainage to trainees. The model was then used to instruct a novice group (N = 6). The majority of this novice group reported that the session was a vital part of their training experience, and it was important to practice drainage of a PTA on a mannequin.Conclusions:We validated a mannequin task trainer for drainage of peritonsillar abscesses and successfully implemented it into a teaching session. Given the frequency of presentation of PTA, the need to become competent in the procedure early in residency, and the success demonstrated using our model, we believe the model could be inexpensively replicated at other institutions for more safely and effectively teaching the procedure.
Nonsurgical Radiofrequency Volumetric Reduction of Adenoidal Hypertrophy
Authors: Naraghi Mohsen 
Published: September 2014

Objectives:Adenoidal hypertrophy (AH) is the most common cause of pathologic mouth breathing in children. Medical treatment of adenoid hypertrophy includes treatment of allergies, nasal sprays, and antibiotics. However, in some cases AH continues to produce symptoms despite maximal medical therapy. Potential risks of anesthesia and complications of surgical procedures have led to the promotion of non‐surgical alternatives. During the past 3 years, advances in expertise and technology led to the new advent of using office based setting for nonsurgical procedures by the author as an innovative method for treatment of AH.Methods:Sixty five children who were definitive candidates for surgical adenoidectomy were managed with radiofrequency treatment under endoscopy control without any need of general anesthesia. The age range was between 4 and 15. All children underwent direct endoscopic examination of adenoid before and after procedure.Results:The period of follow‐up was from 2 to 32 months. Patients experienced different degrees of improvement after nonsurgical procedure, according to a researcher‐based questionnaire. The results were impressive for some parents because of marked improvement by very simple procedure as compared to surgery.Conclusions:Nonsurgical radiofrequency reduction of adenoid size has multiple advantages: excellent magnified view of adenoid area, accurate reduction of central obstructing part of adenoid, nonbleeding, evaluation and treatment of other nonadenoid obstructing problems, complete preservation of normal nasopharyngeal structures, no general anesthesia, no operating room stress, no hospitalization, high safety, no complications, and better patient tolerance using this fast and easy procedure.
OSA and Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital
Authors: Ibrahim Shahrul I. , Anicete Rosslyn C. , Ang Annette Hui‐Chi , Balakrishnan Abhilash , Tan Henry K. K. 
Published: September 2014

Objectives:Obstructive sleep apnea (OSA) has been hypothesized to be protective against postoperative tonsillectomy hemorrhage, presumably due to the upregulation of prothrombotic factors. This study investigates this possible correlation in patients at our institution.Methods:A 6‐year retrospective case control study of tonsillectomy only and adenotonsillectomy cases done on children up to 16 years of age, from the end of January 2007 through the end of January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis were recorded.Results:There were 2320 tonsillectomy cases. A total of 1581 were adenotonsillectomies and 730 were bilateral tonsillectomies only. Thirty‐four cases returned to the operating room for hemostasis. Overall postoperative hemostasis rate was 1.47%. A total of 450 cases were listed as recurrent tonsillitis, 383 listed as OSA (confirmed on polysomnography [PSG]), and 1487 listed as adenotonsillar hypertrophy (no PSG done, presumed OSA). Of the 34 cases that returned to theatre, 9 were OSA cases, 8 were recurrent tonsillitis, and 17 were for hypertrophied tonsils (presumed OSA), giving a postoperative hemostasis rate of 1.39% for the OSA patients and 1.78% for recurrent tonsillitis.Conclusions:Despite the possible upregulation of prothrombotic factors in OSA, we found no real difference in postoperative tonsillectomy hemostasis rate in our patients, contrary to findings in other studies.
Otolaryngological Manifestations in Mucopolysaccharidoses
Authors: Gomes Erika F. , Vasconcelos Francisco D. A. , Alcantara Patricia , Cabral Ticiana , Ribeiro Erlane M. 
Published: September 2014

Objectives:(1) Describe the most prevalent findings of anamnesis and physical otolaryngologic examination in patients with mucopolysaccharidoses (MPSs), which are a lysosomal storage disorder group caused by deficiency of enzymes involved in catabolism of glycosaminoglycans. (2) Evaluate the importance of a multidisciplinary approach for MPSs patients.Methods:A descriptive cross‐sectional (prevalence) study performed in January 2014. Thirty‐four MPSs patients followed at a tertiary teaching hospital were invited, from which 25 participated from the study, with agreement of their families. Questionnaires were answered by their parents and a physical examination was done. The analyzed variables were otologic, pharyngolaryngeal, and nasal and respiratory signs and symptoms.Results:Among the evaluated patients, 52% (13/25) were male and 48% (12/25) female. The average age was 12.44 years at examination and 5.14 years at MPS diagnosis. The most frequent subtype was MPS VI (12/25). Hearing complaints were present in 60% (15/25) of patients, snoring in 44% (11/25), with witnessed sleep breathing pauses in 24% (6/25). The number of pharyngotonsillitis and upper airway infections was 1.68 and 3.36 episodes in the past year, respectively. Important findings on physical examination were: hyperplastic gums (60%‐15/25), modified Mallampati score IV (64%‐16/25), tonsil size grade III (60%‐16/25), flattened nasal pyramid (80%‐20/25), and tympanic retraction (24%‐6/25).Conclusions:There is a high prevalence of ear, nose, and throat manifestations that requires further investigation and possibly intervention, such as suspected respiratory sleep disturbances and hearing loss. There was a similar prevalence of respiratory tract infections as expected for age. Results support recommendation for multidisciplinary approach.
Pediatric Laryngotracheal Stenosis Management: 10 Years’ Experience at the Hacettepe University Otorhinolaryngology Department
Authors: Akyol Mehmet U. , Gunaydin Riza O. , Unal Omer F. , Yilmaz Taner 
Published: September 2014

Objectives:Analyze surgical treatment modalities for pediatric laryngotracheal stenosis.Methods:We retrospectively reviewed patients that underwent laryngotracheal surgery for stenosis between 2002 and 2012. Age, sex, etiologic factors, stenosis grades, comorbidities, surgical techniques, decannulation rates, and complications were evaluated. There were subglottic stenosis (SGS), posterior glottis stenosis (PGS), and tracheal stenosis (TS). Surgical details and outcomes were examined for endolaryngeal procedures, laryngotracheal reconstruction (LTR), partial cricotracheal resection (PCTR), and tracheal resection (TR).Results:There were 44 patients. Prolonged intubation because of trauma was the leading primary cause of stenosis. Congenital stenosis and congenital heart disease operations were also present frequently. There were 20 LTRs, 13 endolaryngeal balloon dilatation, 7 PCTRs, and 4 TRs. Decannulation was successfully accomplished in 27 of 32 patients (84%). Overall success rate in airway management was 91% (40/44). Restenosis was observed after 8 LTRs and 2 PCTRs. Major complications were bilateral recurrent nerve paralysis, postoperative death due to sepsis, and accidental extubation with an overall rate of 6% (3/44).Conclusions:Pediatric airway surgery needs good multidisciplinary cooperation. Correct indication and precise surgical technique are important factors in determining the results. Endolaryngeal procedures should be performed only for membranous and/or low grade stenosis cases, otherwise they cause more tissue damage, leading to fibrosis that complicates the pathology. LTR with anterior and/or posterior grafting is suitable for grade II and III stenosis, while PCTR should be the first choice of treatment for grade IV stenosis. Open surgical procedures should be performed as a single stage surgery if possible.
Pediatric Parotidectomy: A 20‐Year Experience at a Single Institution
Authors: Britt Christopher J. , Kille Tony 
Published: September 2014

Objectives:Review a single institution's experience with parotidectomy in pediatric patients.Methods:A retrospective chart review was performed on children undergoing parotidectomy between 1994 and 2013. Data included presenting symptoms, tumor histology, postoperative complications, facial nerve weakness, and disease recurrence.Results:Forty‐two pediatric patients underwent parotidectomy. Preoperatively, 16 patients (38%) presented with an asymptomatic mass, 7 (17%) had pain, 18 (43%) had recurrent infection, and 6 (14%) had skin involvement. Surgical pathology revealed 20 (48%) infectious or inflammatory lesions, 15 (36%) benign lesions, and 7 (17%) malignant lesions. The infectious and inflammatory lesions included granulomatous infections (26%), hyperplastic lymphadenopathy (12%), and chronic sialadenitis (10%). Lymphangioma (14%) and pleomorphic adenoma (12%) were the most common benign lesions. Malignant lesions included one (2.4%) of each of the following: acinic cell carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, melanoma, scute lymphoblastic leukemia, Hodgkins lymphoma, and Langerhans histiocytosis. The patient with adenoid cystic carcinoma had recurrence of disease, and required a second extirpative surgery. Facial weakness occurred in 19 (45%) patients. Of these, 9 (47%) had infectious or inflammatory lesions. Permanent weakness occurred in 5 (12%) patients. The facial nerve was intentionally resected in one patient (recurrent adenoid cystic carcinoma); the other 4 had surgery for infectious or inflammatory lesions. Additional complications included facial pain (3 patients), wound infection, seroma, and Frey syndrome (one each).Conclusions:Short‐term facial paresis is common in pediatric parotidectomy, especially when surgery is for infectious or inflammatory disease. Parotid neoplasms are uncommon and malignancies are especially rare.
Perinatal Medical Risks Associated with Auditory Neuropathy Spectrum Disorder
Authors: Peng Kevin A. , Wu Edward C. , Haji Farnaz , West Alisha N. 
Published: September 2014

Objectives:(1) Determine perinatal medical factors associated with auditory neuropathy spectrum disorder (ANSD). (2) Compare risk factors associated with ANSD to those in sensorineural hearing loss (SNHL).Methods:Retrospective case‐control study of children diagnosed with ANSD at an academic tertiary care center between July 2009 and January 2014. Inclusion criteria for the ANSD group were normal otoacoustic emissions, absent or elevated middle‐ear muscle reflexes, and severely abnormal or absent auditory brainstem response waveforms. The ANSD group was compared with 2 age‐ and sex‐matched control groups: (1) normal‐hearing children and (2) children with SNHL.Results:Twenty‐two patients (15 male, 7 female) met ANSD inclusion criteria, and were matched to 2 control groups as described above. Case and control groups were assessed for the following perinatal risk factors: prematurity, low birth weight, hyperbilirubinemia, mechanical ventilation, and administration of ototoxic antibiotics. On multivariate logistic regression between ANSD and normal‐hearing groups, hyperbilirubinemia (P =. 006) and administration of ototoxic antibiotics (P =. 004) were significantly associated with an increased odds ratio (OR) toward developing ANSD. Comparing ANSD and SNHL groups, the only significant risk factor for development of ANSD was hyperbilirubinemia (P =. 005, odds ratio = 12).Conclusions:ANSD, a clinical spectrum of disease united by normal cochlear function but abnormal auditory pathway transduction, remains an enigmatic entity. In the present study, matched comparisons between ANSD versus normal‐hearing and SNHL control groups identified perinatal hyperbilirubinemia and ototoxic antibiotics as significant risk factors. Diligent hearing evaluation to diagnose ANSD in infancy, particularly among patients with a perinatal history of hyperbilirubinemia, is critical.
Primary Molar Crown Height in Children with Recurrent Acute Otitis Media
Authors: Teixeira Miriam S. , Andrews Rebecca G. , Swarts J Douglas , El‐Wagaa Jenna A. , Martin Brian S. , Casselbrant Margaretha 
Published: September 2014

Methods:This cross‐sectional study compared dental occlusion in 56 children (29 males and 27 females) between 5 and 7 years of age (mean of 5.8 years) enrolled in an ongoing, longitudinal study designed to characterize the changes in Eustachian tube (ET) anatomy and function between 3 and 8 years of age. Subjects with cleft palate, other syndromes predisposing to otitis media (OM), cholesteatoma, or past/current orthodontic treatment were excluded. Dental casts were made between 5 and 7 years of age and selected measurements on the casts from 29 children with a confirmed history of recurrent acute otitis media (rAOM) that required placement of ventilation tubes were compared to those from 27 children with no past history of middle ear disease.Results:The measurements included overbite (%), overjet (mm) and mandibular second primary molar crown height (mm) made using a calibrated perioprobe and occlusal relationships referenced to the first molar were assigned. A discriminant function analysis identified average crown height (Avg CH) only as a predictor of group assignment and this was confirmed using a general linear model where Avg CH controlled for age was significantly higher in the control group (P =. 005) but not different between sexes or among races. While the sample population was relatively small, the enrolled subjects were prospectively followed for disease course and the group assignment is expected to be highly accurate.Conclusions:The results support those for a previously published study that reported a lesser vertical dimension of occlusion to characterize children with ET dysfunction and ME disease.