bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.