bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Stuck”: Removal of Embedded Distal Airway Foreign Bodies
Authors: Hoff Stephen 
Published: February 2015

Objective1) Describe a novel technique for removal of embedded distal airway foreign bodies. 2) Apply the proximal endoscopic balloon dilation technique for removal of embedded distal airway foreign bodies in 2 patients. 3) Discuss the evolution, operative considerations, and future applications of the techniqueMethodReport of 2 cases in 2011. Condition studied: Embedded, symptomatic distal airway foreign bodies. Subjects studied: Pediatric airway patients. Setting: Tertiary care pediatric hospital. Intervention: Rigid bronchoscopy with endoscopic balloon dilation of the proximal bronchial segment to facilitate access to the foreign body. Outcomes: Successful foreign body removal.ResultsCase 1: A 23‐month‐old patient with recurrent pneumonia. Rigid bronchoscopy showed a cashew piece in the distal airway with proximal edema preventing removal. Dilation of the proximal bronchial segment with a Fogarty catheter allowed for access and removal with optical forceps. Case 2: Two‐year‐old unrestrained passenger in a motor vehicle accident with tooth aspiration causing intermittent respiratory distress. At bronchoscopy, the tooth was in the distal airway and embedded in granulation tissue which prevented removal. A Fogarty catheter was used to dilate the bronchial segment proximal to the foreign body which was then removed with optical forceps.ConclusionEmbedded airway foreign bodies are associated with edema and granulation tissue which may prevent removal due to proximal airway narrowing. We present a novel technique using a Fogarty balloon catheter to dilate the airway proximal to the foreign body. This allows for removal of otherwise stuck distal airway foreign bodies.
Accuracy of Preoperative Diagnosis of Pediatric Neck Masses
Authors: Hopewell Bridget , Schneider Rebecca , Gov‐Ari Eliav 
Published: February 2015

ObjectiveDiagnosing pediatric neck masses is challenging, often requiring open biopsy. Epidemiology and diagnostic tests utility have been described, but accuracy of clinicians’ judgment has not. We will describe/analyze preoperative diagnostic accuracy and identify the relative contributions from clinical, radiological, and pathological data.MethodRetrospective review of pediatric patients’ charts with an undiagnosed neck mass who underwent open biopsy from January 1986 to December 2011. 248 charts were reviewed, with approximately 30 more to review prior to presentation. Data collection identified preoperative accuracy and relative contributions of clinical clues, imaging studies, and FNA.ResultsPreoperative accuracy varied for each category of diagnoses. Congenital masses were diagnosed with 76% (n = 98) accuracy. Nodal inflammatory masses were correct in 55% (n = 85) of cases, whereas non‐nodal inflammatory were correct in only 13% (n = 8). Benign tumors were diagnosed in 71% (n = 17), yet only 64% (n = 14) in malignant cases. For miscellaneous diagnoses, accuracy was 35% (n = 26). Chi‐squared test indicates accuracy of diagnosis is significantly different between categories. Thirty‐eight percent of patients underwent preoperative CT scan, 11% had ultrasound, and 12% had an FNA of the suspicious mass. Sixteen percent of patients had no ancillary tests and all had correct diagnoses.ConclusionClinical and radiographic clues often establish accurate diagnoses in pediatric neck masses. Most inaccuracies occurred in masses with nonspecific clinical clues as in inflammatory lymphadenopathy and malignancies. Delaying diagnosis of malignancies is unacceptable; therefore, a certain percentage of unnecessary open biopsies should be accepted despite the most judicious preoperative workup.
Branchial Cleft Cysts in a Pediatric Asian Population
Authors: Teo Neville , Ibrahim Shahrul I. , Tan Kun Kiaang 
Published: February 2015

ObjectiveBranchial cleft anomalies present fairly commonly in children as lateral neck masses. However, the diagnosis of such anomalies may not always be straightforward. This study seeks to review the distribution of branchial cleft anomalies in an Asian pediatric population, and highlight the challenges involved in diagnosis.MethodA retrospective chart review was performed of all pediatric patients who underwent surgery for branchial cleft anomalies between 2007 to 2011 in a tertiary pediatric hospital. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings, and histology. Classification of the branchial cleft anomalies was attempted from the results.ResultsTwenty‐six children underwent surgery for 27 branchial cleft anomalies in the 4‐year period; 1 child had excision of bilateral fourth branchial cleft sinuses. There were 7 patients (25.9%) with first, 5 patients (18.5%) with second, 2 patients (7.4%) with third, and 3 patients with 4 (14.8%) fourth branchial cleft anomalies. Six patients (22.2%) had branchial anomalies that were thought to be originating from the pyriform sinus, but we were unable to tell if these were from the third or fourth branchial clefts. The remaining 3 patients (11.1%) did not have adequate information for us to classify the level of anomaly.ConclusionThe incidence of second branchial cleft anomalies appears to be lower in our Asian pediatric population, with a higher incidence of third and fourth branchial cleft anomalies. Knowledge of the embryology and related anatomy of branchial clefts is crucial in helping to identify the type of branchial cleft anomaly present.
Consistency of Voice Frequency and Perturbation in Children
Authors: Hill Courtney A. , Ojha Shilpa , Bunting Glenn W. , Maurer Rie , Hartnick Christopher J. 
Published: February 2015

Objective1) Evaluate normal pediatric voice frequency and perturbation measures with Voice Evaluation Suite (VES) and the Multi Dimensional Voice Program (MDVP). 2) Determine consistency of these measures over time. 3) Understand which measures might be most useful for evaluating children with voice disorders.MethodProspective, longitudinal study of normal voices of 50 children aged 4 to 17 years. Two tests of sustained utterances from each child were evaluated by 2 computerized voice analysis programs for frequency and perturbation. Intraclass correlation coefficient (ICC) assessed the reliability between the samples.ResultsChildren (M:F 1.08:1) with a mean age of 8.34 years were tested on an average of 54.2 minutes apart. Each test included 4 utterances; 1 was analyzed by MDVP and 3 grouped utterances were averaged and evaluated by VES. Fundamental frequency had excellent reliability (ICC > 0.75) in both VES and MDVP. Jitter, shimmer, and noise to harmonic ratio were poorly reliable (ICC ≤ 0.4) in MDVP but had good reliability (ICC 0.4‐0.75) in VES.ConclusionConsistent measures of frequency can be derived from single, sustained utterances in children. Averaging multiple samples improves consistency of perturbation. Future work is needed to evaluate whether evaluating acoustic measure stability in spontaneous speech and in sustained utterances cued by tuning frequencies may provide further insight on pediatric voice consistency.
EGFR Inhibitor Therapy for Laryngeal Papillomatosis
Authors: Moldan Matthew , Bostrom Bruce , Liu Meixia , Tibesar Robert , Lander Timothy , Sidman James D. 
Published: February 2015

Objective1) Study efficacy of epidermal growth factor receptor (EGFR) inhibitor adjuvant therapies in recurrent respiratory papillomatosis by comparing surgical treatment intervals and modified Derkay score prior to and following initiation of medical therapy. 2) Understand factors which affect patient responses to EGFR inhibitor adjuvant therapy.MethodWe performed a retrospective case series of 4 pediatric patients with life threatening recurrent respiratory papillomatosis. Patient charts were reviewed to determine time between surgical procedures and Derkay severity score during operative procedures prior to and following initiation of EGFR inhibitors.ResultsPrior to therapy many of the patients’ median Derkay scores were worsening. Following initiation of EGFR inhibitor therapy, the median Derkay score decreased for all 4 patients. In one patient, in whom a limited response was observed, there was no significant change in the time interval between surgical procedures. In 2 patients there was a greater than 25% increase and in the remaining case the interval between procedures more than doubled the original time.ConclusionEGFR inhibitors appear to be a potential effective adjunct therapy for the treatment of recurrent respiratory papillomatosis. Beneficial results were observed in 3 patients as evidenced by Derkay score and interval between operative interventions. One patient exhibited no response to the EGFR inhibitors for reasons which are being investigated.
Evaluation of 2‐Stage Hearing Screening Model in Children
Authors: Arora Vipin , Singh P. P. 
Published: February 2015

Objective1) To know the incidence of hearing impairment in children up to the age of 2 years in an apparently healthy urban population in India. 2) To evaluate the efficacy of 2‐stage hearing screening using repeat otoacoustic emissions (OAE) and brain stem evoked response audiometry (BERA).MethodA total of 2579 children up to the age of 2 years were screened in the pediatrics and ENT departments of a tertiary care university hospital for a duration of 1 year. TEOAE’s were used to screen hearing in response to an 80 dB SPL click, whereas DPOAE’s were measured in responses to stimulus condition with L1 = 65 dB SPL and L2 = 50 dB SPL. Those children who failed the initial OAE screening test were rescreened using OAE with similar parameters on a subsequent day. Children who failed the repeat testing by OAE were further subjected to BERA testing for confirmation of hearing loss.ResultsThe mean age of children undergoing screening was 4.2 months. A total of 6.14% children failed on the initial OAE screening test, and 32.4% of children who failed the repeat test with OAE were subjected to BERA test. This 2‐stage testing by OAEs and BERA was collectively able to pick 0.17% of hearing impaired children in an apparently healthy pediatric population.ConclusionThe present 2‐stage model using OAE and BERA is successful in mass screening for hearing loss. Repeated hearing screening by OAE used in this study is beneficial in decreasing the number of referrals for BERA and hence decrease the cost of screening programme.
H2O2 Irrigation in Children undergoing Adenoidectomy
Authors: Ugur Kadriye S. , Ark Nebil , Kurtaran Hanifi , Yuksel Alper , Gunduz Mehmet , Canbal Metin 
Published: February 2015

ObjectiveTo evaluate the effectiveness of 0.5% hydrogen peroxide (H2O2) irrigation in hemostasis after adenoidectomy.MethodA cross‐sectional study was conducted on 80 children undergoing adenoidectomy. Children were randomized into either 0.5% H2O2 or control (25 0C serum physiologic) irrigation groups after adenoidectomy. Adenoid volume, size, location were recorded. Hemostasis and operation times were measured. Bleeding and hemostasis visual analog scale (VAS) values were scored.ResultsThe ages ranged from 3 to 9 years (mean ± SD, 4.9 ± 1.8 years). There were 29 boys and 8 girls in the control group and 22 boys and 21 girls in the H2O2 group. The average hemostasis time for H2O2 group (4 minutes) was shorter than control group (5 minutes), but there was no correlation between control and H2O2 groups with respect to operation (P =. 854) or hemostasis time (P =. 065), or VAS values of subjective bleeding (P =. 961) and hemostasis (P =. 346). Significant positive correlation was found between adenoid volume and operation time (r = 0.269; P =. 016). But correlation between adenoid volume and hemostasis was not significant (r = 0.213; P =. 058).ConclusionWe may recommend to surgeons a higher concentration than 0.5% H2O2 in the hemostasis of post‐ adenoidectomy, especially for those confronted with significant bleeding following adenoidectomy.
Impact of ASA and Body Mass Index in Pediatric Tonsillectomy
Authors: Roehm Corrie , Marino Jeffrey , Weiss Jessica , Naples James , Valdez Tulio A. 
Published: February 2015

ObjectiveTo identify the impact of body mass index and ASA classification on complications, PICU stay and length of hospitalization following tonsillectomy.MethodRetrospective chart review of all tonsillectomies performed from July 2008 to December 2009 at a tertiary pediatric institution, including BMI, length of stay, length of intubation, ASA status, hemorrhage, and PICU stay.ResultsA total of 677 patients were identified, with complete data in 607, 4.4% underweight, 49% normal, 45% overweight or obese. No significance difference between BMI categories for hospitalization, length of intubation or postoperative hemorrhage, or between ASA for hemorrhage or length of intubation. BMI normal to obese (P =. 0006) and overweight to obese patients (P =. 0253) showed significant difference in PICU stay. ASA classification showed significant difference in length of hospitalization in ASA 1 and 2 (P <. 001), 2 and 3 (P =. 0002), and 1 and 3 (P =. 0002), and in PICU stay between ASA 1 and 3 (P <. 0001), 1 and 2 (P =. 0095) and 2 and 3 (P <. 0001).ConclusionOverweight and obese patients are a significant percentage of patients undergoing tonsillectomies in this country. Patients with higher ASA status (2 and 3) show higher use of PICU resources and longer hospitalizations, and patients of overweight and obese categories require PICU care more often than patients with normal weight.
Osteogenesis Imperfecta and Hearing Loss
Authors: Moran‐Hansen Jessica , Esposito Paul , Sewell Ryan K. 
Published: February 2015

Objective1) Determine the incidence and prevalence of hearing loss in the pediatric population with osteogenesis imperfecta. 2) Determine the average age of onset of hearing loss. 3) Determine the type and severity of hearing loss.MethodThis is a retrospective chart review of audiological data from 127 patients, 19 years or younger, with osteogenesis imperfecta who were seen in the orthopedic clinic at Childrens Hospital. Data in the form of pure tone audiometry, sound field audiometry, tympanometry, and otoacoustic emissions was collected and reviewed. The prevalence, incidence, age of onset, type, and severity of hearing loss were determined.ResultsThe prevalence of hearing loss was 24% and the incidence was 9%. The mean age of onset was 5.8 years. A conductive hearing (50‐56%) loss was more common than sensorineural (39‐44%) or mixed (11%) hearing loss. The majority of patients had a mild hearing loss (67%).ConclusionHearing loss was found in 24% of patients. The average age of onset was 5.8 years. Our data supports screening children with osteogenesis imperfecta for hearing loss starting at a young age.
Pediatric Parotidectomy: Postoperative Facial Nerve Function
Authors: Owusu James A. , Parker Noah P. , Rimell Frank 
Published: February 2015

ObjectiveThe purpose of this study was to analyze the incidence of postparotidectomy facial nerve dysfunction in pediatric patients and to evaluate the association between patient demographics or underlying pathology and functional outcomes.MethodWe retrospectively reviewed charts of patients under 18 years who underwent parotidectomy between 1999 and 2011 at a tertiary pediatric center by a pediatric otolaryngologist. Distribution of dysfunction and timing of recovery were noted. Chi‐square and t‐test analyses were conducted to determine association between demographics or pathology and functional outcomes.ResultsForty‐three patients met inclusion criteria. Forty‐one underwent superficial parotidectomy, and 2 underwent total parotidectomy. Leading indications for surgery were atypical mycobacterium (16/4 [37.2%]) and branchial cleft anomaly (8/43 [18.6%]). The incidence of immediate facial nerve paralysis was 2% (1/43).The incidence of facial nerve paresis was 21% (9/43), distributed in the marginal mandibular nerve (n = 7), buccal branch (n = 1), and marginal mandibular nerve and frontal branch (n = 1). Full recovery of nerve function in patients with paresis occurred by 1 month (n = 2), 2 months (n = 1), 6 months (n = 3), or 10 months (n = 2). No association was revealed between age, gender, or pathology and postoperative facial nerve function.ConclusionTransient postparotidectomy paresis of distal branches of the facial nerve is common in the pediatric population and should be discussed in the preoperative evaluation. The risk is comparable to that of the adult population. Although malignant disease would seem to portend greater risk of dysfunction, underlying pathology was not predictive.
Systematic Assessment of Noise Amplitude Generated by Toys
Authors: Mahboubi Hossein , Oliaei Sepehr , Badran Karam , Kiumehr Saman , Djalilian Hamid R. 
Published: February 2015

ObjectiveTo systematically quantify the amplitude of noise generated by toys intended for young children.MethodFrom 2008 to 2011, greater than 200 toys intended for children under 5 years were screened for loudness. The toys with sound output of >80 dB were retested in a sound‐proof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker.ResultsNinety different toys were analyzed. Mean noise amplitude peak at the speaker level was 99.5 dBA ± 8.1 SD (range, 80‐121 dBA) and at 30 cm away from the speaker was 79.7 dBA ± 11.1 SD (range, 60‐109 dBA). Eighty‐one (90%) had more than 90 dBA noise amplitude at speaker level while 16 (22%) had more than 90 dBA noise amplitude at 30 cm distance. The mean noise amplitude of the loudest toys significantly decreased during the studied period (P <. 001). There was no significant difference in mean noise amplitude of different toys specified for different ages.ConclusionOur findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise‐induced hearing loss in this age group. Parents should be warned about the consequences of purchasing loud toys.
Utility of MRI in Workup of Pediatric Central Sleep Apnea
Authors: Woughter Meghan , Baldassari Cristina 
Published: February 2015

Objective1) To determine the incidence of central nervous system pathology on magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA). 2) To assess whether certain factors such as abnormalities on neurologic examination impact the yield of MRI in evaluation of CSA.MethodA retrospective chart review was conducted at a tertiary pediatric hospital over 10 years. Inclusion criteria were patients 6 months to 18 years of age who underwent both full‐night polysomnogram (PSG) and head MRI. Children with central apnea index (CAI) greater than 1 were considered to have CSA.ResultsThirty‐six children were included. Sixteen patients were boy (44.4%), and the mean age was 43.2 ± 52.2 months. Twenty children (55.6%) had CAI greater than 1. Fourteen children (38.9%) had evidence of pathology on MRI, with the most common finding (n = 5) being arachnoid cyst. When patients with CSA were compared to those without CSA, there was no significant difference (P =. 23) in rates of abnormal head MRI. The presence of OSA on PSG did not predict (P =. 54) pathologic findings on MRI. In CSA patients, the presence of either developmental delay or an abnormal neurologic exam improved the diagnostic yield of MRI.ConclusionCAI greater than 1 did not predict the presence of pathology on head MRI. Thus, the routine use of MRI in evaluation of CSA is not recommended. Further research is necessary to determine if there are other diagnostic tests that can be utilized in evaluation and management of pediatric CSA.
Use of Sound Devices by Teenagers
Authors: De Nobrega Manoel , Alcântara Everson F. , Moraes Gerson L. , Passos Maria Aparecida Z. , Vitalle Maria Sylvia D.S. , Cintra Isa D. P. 
Published: February 2015

ObjectiveTo verify the use of electronic device (iPods, MP3s, cell phones, and PCs) by teenagers who are students in public schools of São Paulo, Brazil.MethodCarried out in a school in São Paulo/Brazil in 2011 and involving students from 10 to 17 years. The sample answered a questionnaire containing questions which referred to electronic devices: type of phones (external, internal, and occlusive), times and places used, elevated volume. Chi‐square was done and considered P <. 05.ResultsAmong the 249 teenagers studied, 55.8% were girls, the average age was 12.6 years (±1.42 years). Use of phones: 89.9% girls and 73.6% boys (P =. 01). Type: 17% external, 18.9% internal, and 64.1% occlusive. Time of usage: cell phone, ‐ >1 h/d by 26.4% girls and 38.3% boys (P =. 03); iPod/MP3, ‐ >1 h/d by 26.4% girls and 18.5% boys (P =. 06). Related to the places: 50% streets, 87% home, 45% car, 31% subway, 47% bus, and 21% park. Elevated volume in cell phone: 28% by girls and 35.8% by boys (P =. 83); in iPod/MP3, 16.7% and 25.9% (P =. 06) for girls and boys, respectively.ConclusionThe elevated percentage of teenagers using electronic devices in an inadequate way points to the necessity of concerning the topic as a way to avoid risks and future auditory loss.
Weight Changes Immediately following Tonsillectomy
Authors: Patel Anju K. , Bababekov Yanik , Mader Nicholas S. , Vecchiotti Mark A. , Scott Andrew R. 
Published: February 2015

ObjectiveTo evaluate weight change in the pediatric population after tonsillectomy and identify associated risk factors for weight loss.MethodA retrospective medical record review of all patients 12 years of age and younger who underwent tonsillectomy at a tertiary care center from January 2008 to November 2011 was conducted. Patient characteristics, preoperative and postoperative weight, indication for surgery, surgical technique, and perioperative complications were recorded.ResultsIn total, 152 patients met inclusion criteria based on complete medical records and postoperative follow‐up. Weight was recorded preoperatively (mean of 30 days prior to surgery) and between 2 and 6 weeks postoperatively (mean of 24 days) using the same clinic scale. There was a total of 95 (62.5%) patients with ages ranging from 0 to 5 years (group A) and patients with ages ranging from 57 (37.5%) 6 to 12 years (group B). Regression analysis estimated the mean and distribution for weight change in each age group. At 21 days postoperatively, groups A and B experienced percentage weight changes of 1.7% and −1.2%, respectively (P <. 03).ConclusionImmediately following tonsillectomy, pediatric patients experience varying degrees of weight loss. This depends primarily upon age but may be mitigated by other factors. Patients age 6 years and above have predicted weight loss in the immediate postoperative setting, while younger children maintain or surpass their preoperative weight by the 21‐day interval.