bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacologic Manipulation of Emergence after Adenotonsillectomy for Pediatric Obstructive Sleep Apnea: A Prospective Controlled Study
Authors: Isaiah Amal , Stein Rebecca , Shapiro Scott , Bellefleur Monique , Pereira Kevin D. 
Published: August 2013

Objectives:1) Elucidate the factors affecting emergence from anesthesia after adenotonsillectomy for obstructive sleep apnea (OSA) in children. 2) Highlight the advantages of a standardized anesthetic protocol in controlling peri‐operative events.Methods:A non‐randomized, prospective, observational study (n = 64) was designed to examine the relationship between the severity of OSA, as determined by apnea‐hypopnea index (AHI) and oxygen saturation (SpO2) nadir, and indices of recovery, including time to 1) emergence after surgery, 2) extubation following emergence, and 3) discharge from the post‐anesthesia care unit. A standardized anesthetic protocol was used in all patients using doses of opioids that inversely correlated with OSA severity.Results:A paradoxical yet significant reduction in recovery time was observed among patients with severe OSA following surgery; this reflected in quicker emergence, accelerated extubation, and shortened postanesthesia care unit discharge times (analysis of variance, Tukey‐Kramer post‐hoc tests, P < 0.001) besides a reduction in adverse events. In addition, the relationship between polysomnography (PSG)‐derived AHI and SpO2 nadir varied inversely with each of the recovery indices, as determined by a linear regression analysis (t‐tests, P <0.001).Conclusions:Emergence from anesthesia after adenotonsillectomy can be controlled by a standardized anesthesia protocol using different combinations of sedation and analgesia. The severity of sleep apnea and hypoxemia do not independently appear to play a significant role in recovery from anesthesia. By using a standardized anesthetic protocol with diminishing doses of opioids with increasing severity of OSA, our results indicate a striking departure from previously observed findings relating to post‐procedural respiratory complications following adenotonsillectomy.
Posterior Pharyngeal Wall Augmentation with Acellular Dermis Implant for Velopharyngeal Insufficiency
Authors: Johnson Kirsten , Meier Jeremy D. , Muntz Harlan R. 
Published: August 2013

Objectives:Review outcomes for children with velopharyngeal insufficiency (VPI) after posterior pharyngeal wall augmentation with an acellular dermis implant.Methods:Retrospective case series of children with VPI who underwent augmentation pharyngoplasty from 2002‐2011 at a tertiary care children's hospital. The posterior pharyngeal wall was augmented with rolled acellular dermis inserted in the subfascial plane. Pre‐ and postoperative nasometry, speech nasal endoscopy, and caretaker and clinician perceptual evaluation were reviewed.Results:Twenty‐four children with VPI (average age 8.8 ± 4.0 yrs) who underwent augmentation pharyngoplasty were identified. The majority of these children had a small gap noticed on speech nasal endoscopy. Of the 24 children, 5 were lost to follow‐up and were not assessed in the postoperative period. Average follow‐up for the remaining 19 patients was 17.6±20.9 months. Fifteen of the 19 patients (79%) had some improvement in VPI symptoms as determined by clinical perceptual evaluation, but only 8 children (42%) demonstrated complete resolution after the operation. One implant extruded. No major complications related to the surgical procedure were identified.Conclusions:We present a novel technique to treat VPI using an acellular dermis implant to augment the pharyngeal wall. Although this approach does not successfully treat all children with VPI, no major complications were seen in this series. Vital tissue that may be used for future speech surgery is preserved if this treatment option fails.
Prospective Quality‐of‐Life Assessment in Congenital Laryngomalacia and Its Treatment
Authors: Kilpatrick Lauren A. , Boyette Jennings R. , Hartzell Larry , Bower Charles M. , Richter Gresham T. 
Published: August 2013

Objectives:Disturbances in breathing or feeding may profoundly affect parental perceptions of an infant's health. Previous research into quality of life (QOL) for patients with laryngomalacia is limited to retrospective analysis. The purpose of this study is to prospectively evaluate the QOL of children with laryngomalacia and their parents and the impact of surgical and non‐surgical treatments.Methods:Pilot prospective analysis using the Laryngomalacia QOL Survey in patients with newly diagnosed laryngomalacia under age one year. A 29‐question survey regarding severity of symptoms related to overall health, airway, and swallowing is completed at initial and post‐treatment visits. Responses are quantified over a range from 1 to 5 (5 always or severe).Results:Twenty‐seven patients were enrolled in the study. Twelve were managed medically, and 15 underwent supraglottoplasty. The overall mean QOL score for patients treated medically was 2.57 (standard error SE 0.16) on initial visit and 1.67 (SE 0.16) post‐treatment (mean 3.9 months). Patients undergoing supraglottoplasty had an overall mean QOL score of 3.59 (SE 0.14) on initial visit and 2.22 (SE 0.22) post‐treatment (mean 3.5 months). Analysis of variance and post‐hoc testing revealed significant improvement between initial and follow‐up visits in both treatment groups (P < 0.01). Patients who underwent supraglottoplasty had significantly higher scores at initial visit (P < 0.01). No statistically significant difference was noted between patient groups post‐treatment (P > 0.05).Conclusions:Prospective QOL assessment of children with laryngomalacia and their families reveals a significant burden of disease. Quality of life improves in all patients but may improve more significantly in patients managed surgically.
Risk Factors for Hearing Loss in the Setting of Pressure Equalization Tube Placement in Children
Authors: Sidell Douglas R. , Hunter Lisa , Lin Li , Arjmand Ellis M. 
Published: August 2013

Objectives:Pressure equalization tube (PET) placement is the most common surgical procedure performed during childhood. Current Academy guidelines recommend more aggressive management of children with otitis media with effusion (OME) who are at greater risk for speech‐language and developmental problems. This study was designed to examine risk factors for continued hearing loss following PET placement in children with chronic OME. A large clinical sample ascertained through electronic medical records is used.Methods:All pediatric patients undergoing PET‐placement between January 2009 andOctober 2012 at a tertiary‐care children's hospital who had audiometric tests were included. Demographics and patient diagnoses (craniofacial anomalies, allergies, prematurity, developmental delay, and speech‐language delay) were extracted. A multivariate regression model was used to identify an association between patient‐specific characteristics and the presence of pre‐ or postoperative hearing loss.Results:4083 children with 4792 visits were included (2433 males and 1650 females; mean age of 3.4 years). 1007 preoperative and 2655 postoperative audiograms were performed. In addition to known risk factors and patient diagnoses, male gender, younger age, and lower acoustic admittance were associated with preoperative hearing loss (P = 0.03; P = 0.01; P < 0.001). Postoperative hearing loss was associated with patient age, preoperative hearing loss, and lower equivalent canal volumes (P < 0.0001; P = 0.0078; P = 0.0035). Race and ethnicity were not determined to be risk factors.Conclusions:The results of this study identify several demographic and patient‐specific risk factors for hearing loss surrounding PET placement. These data may have important preoperative counseling and postoperative management implications.
Severity of Voice Handicap in Children Diagnosed with Elevated Lesions
Authors: Mudd Pamela , Zur Karen B. , Carroll Linda M. 
Published: August 2013

Objectives:Determine the impact of voice disability on children with dysphonia. The Pediatric Voice Handicap Index (PVHI) was used to assess impact on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness and overall severity of dysphonia was also determined.Methods:Institutional Review Board approved study to examine severity of dysphonia in children evaluated at a voice clinic between 2007 and 2011. Setting: Tertiary specialized hospital. Medical records of 33 children (11 females, 22 males) diagnosed with an elevated laryngeal lesion by a pediatric laryngologist were reviewed for voice disability using the PVHI. The PVHI is a 23 statement instrument for perceived handicap in functional, physical, and emotional aspectsand includes a talkativeness rating scale (1‐7 scale) and Visual‐Analog Overall Severity Rating of Voice (100 mm line), all judged by the child's parent/caregiver. Data were examined for young children (age 2‐5), children (age 6‐10), and adolescents (age 11‐17).Results:There was no significant difference between age groups for overall PVHI (mean 29.3), but all groups had significantly higher functional disability (mean = 16) compared to physical (mean = 8.2) or emotional (5.1). Talkativeness averaged 5.1, and VAS averaged 40. Talkativeness was significantly greater for the child age group (5.6) compared to the young child and adolescent groups. Masses were more common in males.Conclusions:Children with elevated lesions have significant voice disability (PVHI = 29.3), greatest for functional aspects of voice, and present across all studied age groups. Mean severity was 47.1, and mean talkativeness was 5.1.
Socioeconomic Status and Otitis Media in a Universal Healthcare Model
Authors: Ambrosio Art A. , Brigger Matthew T. 
Published: August 2013

Objectives:1) Determine the association between socioeconomic status (SES) and other risk factors in surgically managed otitis media within a model of universal healthcare. 2) Determine quality of life (QOL) outcomes of surgically managed otitis media in the Tricare health system.Methods:A prospective cross‐sectional study was conducted between June 2011 and December 2012 with dependent children of military families. Tricare provides equal access to care among all beneficiaries despite a wide range of income and education across enrollment. Caretakers of children scheduled for bilateral myringotomy and tympanostomy tube (BMT) placement were administered a demographic survey that encompassed proxies for SES and risk factors for otitis media. The validated OM‐6 QOL instrument was administered upon enrollment and 6 weeks postoperatively. The survey and OM‐6 were administered to a comparison group who did not undergo BMT. Categorical variables associated with BMT were analyzed by logistic regression, and OM‐6 scores were compared by non‐parametric tests of hypotheses.Results:120 children undergoing BMT were enrolled. Logistic regression demonstrated age less than 2 years old (P < 0.001), daycare attendance (P < 0.001), and Caucasian ethnicity (P = 0.001) as associated with surgery. Surgical QOL outcomes demonstrated a significant improvement in OM‐6 scores after surgical management from 11.7 (95% confidence interval [CI]: 10.5,12.9) to 2.2 (95% CI: 1.4,2.9).Conclusions:In a universal healthcare model serving over 2 million children, previously reported proxies of low SES were not associated with surgically managed otitis media contrary to reported literature. Caucasian ethnicity, young age, and daycare attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.
Surgical Intervention for Severe Sleep Apnea: Experience from a Tertiary Care Children's Hospital
Authors: Shah Jay R. , Greenberg Laura , Mehta Deepak 
Published: August 2013

Objectives:Review a 5‐year, single‐institution experience with patients undergoing adenotonsillectomy or tonsillectomy with or without lateral pharyngoplasty (LP) or other upper airway surgeries for severe obstructive sleep apnea (OSA).Methods:Retrospective review of subjects who underwent airway surgery for severe OSA at a tertiary care academic children's hospital between January 2007 and June 2012. Subjects were diagnosed with OSA by polysomnography, with severe OSA being defined by a combined Apnea‐Hypopnea Index (AHI) of >10. Outcome measures included pre‐ and postoperative symptoms, polysomnography data, and immediate postoperative outcomes.Results:A total of 300 subjects, 158 male and 142 female, underwent surgery. Eighty‐eight were considered “unhealthy” based on comorbidities. Ages ranged from 6 months to 19 years. 253 subjects (84%) were seen for follow‐up, and 130 (43%) subjects had postoperative sleep studies. The mean obstructive AHI preoperatively was 21.2 (CI: 16.8‐21.0) and postoperatively was 4.1 (CI: 3.1‐5.3). This was statistically significant. The average total length of stay was 2.2 days (CI: 1.9‐2.6). Fifty‐one percent (n = 152) of subjects were discharged on postoperative day one. Ninety‐five percent (n = 240) of subjects had either a complete or partial resolution of subjective symptoms.Conclusions:Surgery in children with severe sleep apnea is generally accepted. Our study is one of the largest studies that focuses specifically on subjects with severe sleep apnea. While there was some persistent OSA, our results show that subjects’ OSA improved significantly. Improvement of OSA after airway intervention may be multifactorial; our data show that patients may strongly benefit from surgery.
Using Exercise Stress Laryngoscopy in the Pediatric Patient with Exercise Intolerance
Authors: Sidell Douglas R. , Balakrishnan Karthik , Willging J. Paul , de Alarcon Alessandro 
Published: August 2013

Objectives:Exercise induced airway obstruction in the pediatric patient is a unique phenomenon with multiple potential etiologies. Because patients are frequently asymptomatic at rest, establishing an accurate diagnosis can be challenging. Exercise Stress Laryngoscopy (ESL) presents a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study is to demonstrate the diagnostic utility of pediatric ESL and to guide the treatment of patients with exercise intolerance.Methods:All patients undergoing ESL for exercise intolerance and airway symptoms at a tertiary care children's hospital were reviewed. Data extracted included patient demographics, exam indications, exam findings, and management recommendations.Results:A total of 37 patients, average age 11.8 years (range 5‐19), were included. There were 14 male and 37 female patients. A specific airway abnormality became evident upon exertion in 56% of patients undergoing ESL. Of these, 24% had focal supraglottic collapse, 43% had paradoxical vocal fold motion, 24% had combined dysfunction, and 9% had distal airway abnormalities. A focal airway abnormality resulting in a change in management occurred in 71% of patients. 57% of patients in this review had a history of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 83% received a focal diagnosis following ESL that resulted in treatment.Conclusions:Determining the etiology of exercise intolerance is often a challenge in the pediatric patient. ESL is a contemporary modality by which complex patients with undiagnosed airway symptoms can be effectively evaluated, frequently leading to effective treatment.
Utility of Cardiology Referral in Children with EKG Abnormalities on Polysomnogram
Authors: Baldassari Cristina , Peak Jessica , Baydoun Hind 
Published: August 2013

Objectives:1) Determine the incidence of cardiac disease in children with electrocardiogram (EKG) abnormalities on polysomnogram (PSG). 2) To assess whether demographic factors such as family history of heart disease improve the yield of cardiology referral in these subjects.Methods:Study Design: Case series with chart review. Setting: Tertiary childrens hospital. Children between 6 months and 18 years of age with EKG abnormalities on PSG who were referred to cardiology for evaluation were included in the study. Children with a known history of cardiac disease were excluded.Results:Sixty‐four children had EKG abnormalities on PSG and underwent cardiology evaluation. The mean age was 6.83 years (SD 4.81), and 64% of subjects were African‐American. The mean obstructive apnea hypopnea index (OAHI) was 8.8 (SD 13.2), and 43 of the children had obstructive sleep apnea (OAHI >1). The most common EKG abnormality on PSG was premature ventricular contractions. The majority of children referred to cardiology underwent echocardiogram (48/64) and Holter monitoring (44/64). Seven children (11%) had cardiac pathology, including tuberous sclerosis, mitral and aortic valve insufficiency, and bradycardia, identified during cardiology evaluation. Factors such as family history of heart disease (P = 0.87), severity of sleep apnea (P = 0.48), and history of prematurity (P = 0.50) did not increase the likelihood of diagnosing cardiac disease.Conclusions:Cardiac pathology in children with abnormal EKGs on PSG is common. Cardiology referral in such patients is warranted. Further research is needed to determine whether there are factors that increase the likelihood of identifying cardiac pathology on referral.
Validation of Sleep Nasopharyngoscopy (SNP) in Children with Snoring/Sleep‐Disordered Breathing
Authors: El Hakim Hamdy , Ramji Maleka , Cote David , Biron Vincent L. , Xu Caroline 
Published: August 2013

Objectives:Propose and validate a scoring system of the findings of sleep nasopharyngoscopy (SNP) for children with sleep disordered breathing (SBD).Methods:We conducted an inter‐ and intra‐rater agreement study on video documentations of SNP performed on children (non‐syndromic or dysmorphic) presenting with SDB. Videos used represented different types of pharyngeal findings including normal, collapse, mixed picture, or obstruction. Three “non‐expert” raters at various stages in their otolaryngological career rated the videos twice and independently. One calculation assumed equal spacing between categories, the second assumed unequal spacing between the first and the second two based on need for surgical intervention.Results:Sixty‐three videos were rated by each observer (2 weeks apart). None were syndromic or dysmorphic patients. Intra‐observer agreement was 0.6442 ± 0.0835 (95%CI 0.4806‐0.8078), 0.7373 ± 0.0718 (95%CI 0.5965‐0.8781), 0.5853 ± 0.0789 (95%CI 0.4306‐0.74), for raters 1, 2, and 3. Weighted kappa was 0.593 ± 0.1864 (95%CI 0.2277‐0.9583), 0.85 ± 0.0884 (95%CI 0.6848‐1), 0.79 ± 0.0772 (95%CI 0.6458‐0.9506), respectively. Inter‐rater agreements between raters 1 and 2, 2 and 3, 3 and 4 were 0.8304 ± 0.0604 (95%CI 0.7119‐0.9489), 0.5168 ± 0.0827 (95%CI 0.3546‐0.697), and 0.5306 ± 0.0829 (95%CI 0.368‐0.693), respectively. Weighted kappa was 0.81 ± 0.1504 (95%CI 0.5231‐1), 0.72 ± 0.1147 (95%CI 0.5‐0.95), and 0.6658 ± 0.052 (95%CI 0.5253‐0.8), respectively.Conclusions:This is the first proposed scoring method for SNP in children. It is based on a generic interpretation of SNP into four types. Overall reproducibility among the three raters and their agreement was good.
Analysis of Headache Outcomes in Patients Treated with Endoscopic Sinus Surgery
Authors: Davis‐Malesevich Melinda , Rohayem Ziad , Catalano Peter J. , Wijewickrama Rohan C. 
Published: August 2013

Objectives:Assess the headache outcomes for patients treated with targeted endoscopic sinus surgery. Study Design: Prospective, non‐randomized.Methods:Consecutive patients (n=50) presenting to our clinic with headache as a feature of their presenting symptoms were recruited. Pre‐operative SNOT 20, HIT‐6 (Headache Impact Test) scores, and computed tomography (CT) analysis of multiple radiological parameters was calculated and compared to post‐operative measures.Results:Preliminary results for our cohort revealed an average pre‐operative HIT‐6 score of 61 and SNOT‐22 score of 49. Average post‐operative HIT‐6 score was 44 and SNOT‐22 score 19 (p<.0001). Patients had an average of 3 contact points identified on CT and average Lund‐Mackay score of 5. Median follow‐up was 3 months.Conclusions:Targeted endoscopic sinus surgery offers a reliable therapeutic modality in patients with headache as a feature of their presenting symptoms. Correlative CT findings and surgical technique are discussed.
Efficacy of Preoperative Itraconazole in Allergic Fungal Rhinosinusitis
Authors: Patro Sourabha K. , Verma Roshan , Panda Naresh K. , Singh Paramjeet , Chakrabarti Arunaloke 
Published: August 2013

Objectives:Gold standard treatment of allergic fungal rhinosinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals like itraconazole and steroids have shown varying success rates in delaying recurrences given postoperatively. Itraconazole decreases need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigates the efficacy of Itraconazole given preoperatively in AFS.Methods:A prospective study was carried out from July 2011 to December 2012 on twenty histologically proven patients of AFS, who were given Itraconazole preoperatively for 1 month, operated subsequently. They were compared with 20 matched controls of AFS cases, operated directly without preoperative itraconazole. Both groups were given oral steroids for 6 weeks postoperatively and followed for 3 months. Evaluations were done using symptomatic (SNOT score), radiologic (Lund Mackay scores) and endoscopic (Kupferberg Grades) parameters.Results:Symptomatology scores (SNOT20) decreased significantly (p=0.000) with Itraconazole. There was a significant decrease (p=0.005) in Lund Mackay scores reaching to 0 with complete resolution of disease in 15% cases with reduced hyper densities noted in all. Polyp sizes decreased and nasal endoscopic grades improved. Postoperative fungal cultures were positive in 45% compared to 79% cases among control group suggesting a decreased fungal burden. Total serum IgE decreased with itraconazole and had positive correlation (c.c=0.68) with postoperative fungal culture.Conclusions:We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative Itraconazole administration, decreasing the disease load significantly. It may prove to be a good preoperative adjunct needing further research.