bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Otogenic Sinus Thrombosis and the Role of Anticoagulation
Authors: Chun Robert H. , Sitton Matthew 
Published: September 2011

Objective1) Discuss the presentation, work up, and treatment of a series of pediatric patients presenting with otomastoiditis with sigmoid sinus thrombosis (OSST). 2) Review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis.MethodRetrospective case series of 3 patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using Pubmed search terms “thrombosis and otitis media and anticoagulation” limited to English.ResultsThree patients were diagnosed with OSST. One patient presented with diplopia and otitic hydrocephalus. All patients were treated with anticoagulation following myringotomy with tubes and cortical mastoidectomy without thrombectomy. All patients were anticoagulated for 24 to 42 weeks with clinical recovery with resolution of thrombosis by MRI in less than 6 months. There were no major complications from anticoagulation use. Literature review of 50 patients with OSST showed that 60% had sigmoid aspiration or incision in addition to mastoidectomy, and only 64% of patients had anticoagulation. All patients had clinical recovery, with recanalization or resolution of clot in 16 patients.ConclusionThe treatment of OSST is controversial. All patients presented had clinical recovery but 66% had anticoagulation and clot resolution in 19 out of 32. Two patients had hematoma with anticoagulation. This series and literature review highlights the controversy of surgical and medical management of OSST and the need for further investigation.
Practice Trends among Otolaryngologists Treating Hemangiomas
Authors: Mascarinas Christopher A. , Stefanov Dimitre G. , Butts Sydney 
Published: September 2011

Objective1) Compare the approaches to the treatment of hemangiomas between pediatric otolaryngologists and facial plastic surgeons. 2) Understand practice trends among otolaryngologists in the context of evolving standards of care in the management of patients with hemangiomas. 3) Identify the variables that influence therapeutic choices in treatment of hemangiomas.MethodA 10‐question survey was sent to ASPO and AAFPRS members. Responses were collected between July and December 2010. All questions were based on a 5 point Likert scale from “Strongly Disagree” to “Strongly Agree” except 2 questions related to physician practice. Results were analyzed using t tests comparing mean scores.ResultsA total of 89 surveys from ASPO and 80 from AAFPRS were returned. Mean years in practice (15.4 AAFPRS and 19.7 ASPO) and patient volume (59.6% ASPO versus 29.49% AAFPRS treated at least 5 hemangioma patients yearly) differed significantly between both groups (P <. 01 and P <. 001, respectively). There was no association between years of experience and whether a physician agreed/strongly agreed with any question. There was a significant difference between percentage of ASPO and AAFPRS members agreeing/strongly agreeing with questions 2 to 7. These questions focused on the role of steroids, propanolol, laser therapy, and surgery.ConclusionSubspecialty affiliation was a significant factor in the majority of survey responses. There was greater use of steroids and lasers by facial plastic surgeons. More pediatric otolaryngologists reported using propanolol. Sources of differences in treatment philosophy should be elucidated. Standardized management approaches could potentially be generated across subspecialties in otolaryngology.
Preoperative Sleep Studies for Pediatric Adenotonsillectomy
Authors: Nayar Meenakshi , Fleming Jason , Wong Robynne 
Published: September 2011

ObjectiveIn 2008, an expert UK panel produced a consensus statement highlighting factors putting children at additional risk of having respiratory complications following adenotonsillectomy for sleep related breathing disorders. This audit, performed at a pediatric teaching hospital, assessed whether at‐risk children indicated by the guidelines were having appropriate preoperative investigations.MethodA retrospective study conducted in the Royal Alexandra Children’s Hospital in Brighton over a 6‐month period. A total of 49 children having elective day case adenotonsillectomy fulfilled inclusion criteria. Patient notes were analyzed for demographics and past medical history to see if they fit the consensus criteria to undergo sleep studies preoperatively.ResultsThe audit highlighted that the common indications putting children in the high risk group were weight (<15 kg), age (<2) and significant co‐morbidity. Despite 49% fulfilling criteria to have pre‐operative sleep studies, only 20% of this high risk group were investigated pre‐operatively. The most common complication was postoperative desaturations. Overall 10% of the audit population developed postop complications requiring enhanced level of care. 60% of these complications were in high risk patients who did not have pre‐op sleep studies and pre‐booked high dependency unit (HDU) provision. A total of 8 days of unplanned HDU care was needed.ConclusionStandards of preoperative respiratory investigations were not being met, with children being listed for adenotonsillectomy without appropriate risk stratification. Information bulletins were disseminated across relevant specialties and risk chart posters were introduced to ENT consultation rooms. A repeat audit cycle will be completed in 6 months.
Prevalence of Hearing Loss in Twins
Authors: Anicete Rosslyn Capuno , Lazaroo Derek , Omar Haryani , Posas Maria Lina , Balane Pia , Tan Henry K. 
Published: September 2011

ObjectiveDetermine the prevalence of hearing loss in the twin population. Compare the degree of hearing loss between first‐ and second‐born twins.MethodA retrospective review of twins born with hearing loss at KK Women’s and Children’s Hospital from 2005 to 2009 was done. Birth, medical history, and hearing test results were reviewed and recorded. Categorical and continuous data were analyzed using chi‐square tests and student’s t‐test respectively.ResultsA total of 1826 twins (913 sets) were born from 2005 to 2009. Twenty‐four out of 1826 (1.31%) twins have hearing loss. Mean gestational age was 32.15 (SD, ±4.36), and mean birth weight was 1.67 (SD, ±0.76). There is no difference in the degree of hearing loss between the first‐ and second‐born twins.ConclusionHearing loss occurs in 1.3 per 1000 twins. The birth order of twins does not influence the degree of hearing loss.
Residual Obstructive Sleep Apnea in Children Less Than 3 Years of Age after Undergoing an Adenotonsillectomy
Authors: Nath Andrea , Suskind Dana L. , Baroody Fuad M. , Emani Janaki 
Published: September 2011

ObjectiveObstructive sleep apnea (OSA) is the leading reason for adenotonsillectomy in children. We aimed to evaluate polysomnographic characteristics of OSA in children under 3 years of age and, in a subset of these children who had pre‐ and postoperative sleep studies, potential persistence of OSA after adenotonsillectomy.MethodWe performed a retrospective chart review of children.ResultsA total of 283 children underwent a preoperative polysomnogram, and 70 had both pre‐ and postoperative polysomnograms. Their average age was 20.3 + 0.8 months. Adenotonsillectomy resulted in a significant reduction in apnea hypopnea index (AHI) from 34.8 + 4.8 to 5.7 + 1.6 events/hr (p + 1% to 89 + 0.8%) (p1 and 21% had an AHI>5). The only predictor of persistent OSA was the preoperative AHI, which was higher for the group with residual OSA (55+50) compared to the group without it (29 + 36) (P =. 02).ConclusionAdenotonsillectomy results in a significant improvement in OSA in children.
An Anatomic Model for Use in Surgical Skills Training of Tracheotomy
Authors: Ingram Amy , Bartlett Jennifer A. , Malone James P. 
Published: September 2011

ObjectiveThe objective would be to design a low cost, reproducible anatomic model to simulate tracheotomy in the surgical skills training laboratory. The model was adapted from a base model used previously for verification of proficiency (VOP) assessment of cricothyrotomy by general surgery residents.MethodThe following materials were used: ventilator tubing, vessel loops, a 2x4x9‐inch block of wood, red and white felt fabric, automotive ceiling headliner, cardboard, foam tape, adhesive spray, and foam. All materials were found easily at a local craft store or in medical discard.ResultsThe model was assembled by securing ventilator tubing to a block of wood to represent the trachea. Thyroid and cricoid cartilages were fashioned and secured to ensure palpable landmarks. An anterior section of ventilator tubing was removed and replaced with foam tape to allow for a recyclable base. Finally, the thyroid and superficial tissue (including vessels and strap muscles) were assembled using headliner, felt, and vessel loops. After assembly was completed, four junior residents were able to successfully palpate each landmark, “ligate” vessels, identify and retract the thyroid isthmus, and perform a tracheostomy.ConclusionThe model developed is a practical and reproducible anatomic model for simulation training of tracheotomy for otolaryngology residents and can be created utilizing inexpensive, readily available materials. In conjunction with a skills lab training session, this useful tool could play an important role in the overall evaluation of surgical competence.
Rigid Laryngoscopy Is Necessary to Diagnose Laryngeal Cleft
Authors: Neubauer Paul D. , Rosenthal Laura Swibel , Drake Amelia F. , Zdanski Carlton J. , Shah Rupali N. 
Published: September 2011

Objective1) Identify the signs and symptoms of a laryngeal cleft in children. 2) Compare diagnostic methods available for identifying laryngeal cleft and determine their utility.MethodThe charts of all patients diagnosed with laryngeal cleft in a tertiary care institution between 2009 and 2010 were evaluated retrospectively for age, gender, comorbidity, symptoms, bedside swallow evaluation, and results of imaging studies. Findings on flexible and direct laryngoscopy, both performed under general anesthesia, were compared.ResultsSix patients had a diagnosis of laryngeal cleft, confirmed by direct laryngoscopy, performed for cough and signs of aspiration. In 3 cases the pattern on a barium video swallow examination heightened suspicion of laryngeal cleft. Flexible laryngoscopy was performed on all patients by a pulmonologist. Laryngeal cleft was suspected in four cases but could not be confirmed. Direct laryngoscopy was performed by an otolaryngologist. Direct laryngoscopy, in which the arytenoids could be physically separated, allowed for definitive diagnosis of the cleft and identification of its type and severity in all 6 cases.ConclusionVideo swallow and flexible laryngoscopy can raise suspicion of a rare laryngeal cleft in patients with otherwise common symptoms. A laryngeal cleft and its type can be definitively diagnosed by a direct laryngoscopy in which the inter‐arytenoid space is palpated.
Second Step of LTP: A New Technique for Stoma Closure
Authors: Trozzi Marilena , Revol Magdalena Roques , Bottero Sergio 
Published: September 2011

ObjectiveTo present our protocol and propose a new surgical technique for the closure of the tracheocutaneous fistula in patients admitted for laryngotracheal reconstruction.MethodWe present a modified surgical technique to close the tracheocutaneous fistula performed on patients around 6 months after laryngotracheoplasty and decannulation. The procedure involves the closure of the stoma of the tracheal anterior wall by placing the suture along the longitudinal axis and approaching the tracheal margins in craniocaudal direction.ResultsEight closures were performed in accordance with this technique without complications in the short and long term. Max follow‐up was 3 years with no evidence of tracheal stenosis, tracheomalacia, tracheal pouch, or caliber irregularities on the site of the previous stoma. Although the modified closure technique slightly reduces the length of the trachea, it has proven to effectively enlarge the transverse diameter, reduce the risk of an extraluminal or intraluminal invagination of the flaps, and prevent secondary tracheal stenosis or pouch.ConclusionBased on our protocol for decannulation after LTP, we recommend postponing fistula treatment until the grafts have been well established, the stomal scar has reduced spontaneously, and the traumatic effect of intubation has been minimized. Our method for surgical closure has shown to reduce problems associated with these fragile tracheae.
Sharp Foreign Body Aspiration Patients: Are They Different?
Authors: AlRomaih Saud Romaih , Alrajhi Yaser , Nguyen Lily H. P. 
Published: September 2011

ObjectiveCompare and contrast patients with sharp foreign body aspiration (FBA) in the airways to other non‐sharp FBA in terms of age, social background, presentation, and nature of foreign body.MethodCase series of patients with FBA in airways and the upper digestive tract in multi‐centers, between Jan 2004 to Dec 2009.ResultsAround 10 percent of patients had sharp FBA in the airway. We noticed that they are overall older. They mostly have the same social background. Most of them gave clear history of sharp FBA. Imaging was useful in the majority of patients. Most sharp FBA happened with the same object.ConclusionPatients with sharp FBA are different in terms of age, social background, presentation, and nature of FBA when compared to other non‐sharp FBA.
The Effectiveness of Laryngotracheal Separation for Children
Authors: Hara Hirotaka , Nakamoto Tetsuya , Yamashita Hiroshi 
Published: September 2011

Objective1) Evaluate the effectiveness of laryngotracheal separation (LTS) for pediatric neurological impaired patients from a viewpoint of postoperative improvement of respiratory condition and swallowing function. 2) Evaluate the effectiveness of LTS from a viewpoint of postoperative improvement of the burden on the caregiver.MethodStudy design: prospective. From September 2004 to December 2010, nineteen children underwent LTS. The effectiveness of LTS and postoperative improvement of QOL on patients and caregivers were evaluated by the questionnaire for caregivers. The questionnaire included frequency of suction, frequency of aspiration pneumonia, methods of food intake, and postoperative complications.ResultsAfter the laryngotracheal separation, frequency of suction decreased significantly (Wilcoxon t‐test). The episodes of aspiration pneumonia and respiratory disorders were well controlled after operation. The burden on the caregiver was reduced. There were no significant complications of laryngotracheal separation. There were two episodes of laryngocutaneous fistules.ConclusionLaryngotracheal separation can prevent the neurologically impaired children from aspiration pneumonia and provide higher QOL. Also, laryngotracheal separation provides a higher QOL for the caregiver of the neurologically impaired child.
The Increased Risk of Post‐tonsillectomy Hemorrhage in Coagulopathic Children
Authors: Venkatesan Naren Natraj , Mukerji Shraddha S. , Rodman Regina E. 
Published: September 2011

ObjectiveTonsillectomy is a routine procedure performed in children with the main complication being postoperative hemorrhage. In coagulopathic patients, does their disease affect management of these children after a tonsillectomy? Whether these patients need more intricate management following a tonsillectomy is important to know to prevent and treat postoperative hemorrhage.MethodThis case series is done through a chart review searching for patients who have undergone a tonsillectomy and have a known coagulopathic disorder. This will include von Willebrand’s disease, Hemophilia A, Hemophilia B, and Factor 8 deficiency.ResultsThe results show that these children do not suffer posttonsillectomy hemorrhage at an increased rate over non‐coagulopathic patients. These patients should be managed by correction of the Protime and INR to normal ranges prior to procedure. If this is done, these patients are not at an increased risk of postoperative hemorrhage.ConclusionWhile coagulopathic patients are at an increased risk for prolonged hemorrhage, their risk of postoperative hemorrhage is not increased. Correction of INR and Protime decreases their risk of hemorrhage. If a hemorrhage does occur, these patients will require both surgical intervention and specific correction of their coagulopathy.
The Relationship between Vitamin D, Otitis Media, and Weight
Authors: Weinreich Heather , Daly Kathleen 
Published: September 2011

Objective1) Assess vitamin D levels as a predictor of history of recurrent otitis media (ROM), tube treatment, and weight‐for‐length (WFL). 2) Explore the relationship of vitamin D as a confounder in the relationship between OM and overweight status.MethodData were analyzed from a prospective cohort of mothers/children recruited between 1995 and 2002 from local HMO. ROM and tube status were obtained through physical exam and medical records, while WFL data was gathered from well‐child checks. Vitamin D levels were assayed from cord blood. Chi‐square and logistic regression were performed.ResultsA total of 47.9% of children had ROM, 13.2% received tubes. A total of 10.7% of children age 2 years had a WFL ≥ 95th percentile. A total of 56.7% of children had vitamin D levels below sufficient. Children with a sufficient vitamin D level were at greater risk of having a WFL ≥85th in multivariate analysis (OR 2.004, P =. 04); however, vitamin D status did not predict ROM or tube status. Children with history of tube treatment had a significantly increased risk of a WFL ≥95th percentile after controlling for family income, maternal prenatal smoking, maternal education, gender, birth season, breastfeeding status, daycare attendance, and vitamin D level (OR 3.69, P =. 01).ConclusionVitamin D is not a predictor of ROM or tube status; however, children with a vitamin D status that is sufficient are more likely to be ≥85th WFL percentile. Vitamin D status is not a confounder in the relationship between a history of tube treatment and overweight status.
The Use of Intranasal Corticosteroids in Children
Authors: Marianowski Remi , Lacroix Candice , Mornet Emmanuel , Potard Gael , Valette Gerald 
Published: September 2011

ObjectiveInvestigate the use of intranasal corticosteroids (ICS) by otolaryngologists with a predominantly pediatric practice, a national inquiry has been conducted in a European country.MethodParticipants: 212 otolaryngologists, representing around 10% of the specialty, answered the survey (M/F ratio=179/33). The mean age of this population was 52 ± 8.4 years, with a mean time in practice of 20.7 ± 9 years.ResultsDisease treated by ICS were chronic rhinosinusitis in 39.2% for a mean duration of 30 days in 62.2% of the cases, aergic rhinitis in 69.2 %, nasal polyposis in 67.2%, and OME in 30.2%. Acute rhinosinusitis was considered for treatment by intranasal corticosteroids by only 8.5% of otolaryngologists. Adenoid hypertrophy was treated in 16% of cases by ICS. Symptoms considered for treatment by ICS were nasal obstruction (88.6%), rhinorrhea (67.6%), nasal itching (66.1%), ocular symptoms (41.2%), sneezing (63%), olfactory troubles (73.2%), dyspnea (76%), edema of nasal mucosa (76.2%). Fever was never an indication (75%).ConclusionAccording to this nationwide survey nasal polyposis and allergic rhinitis are the most frequent indications for ICS treatment in children.
The Use of Propranolol in Infantile Subglottic Hemangiomas
Authors: Hui‐Chi Ang Annette , Manuel Anura M. , Anicete Rosslyn , Tan Henry K. 
Published: September 2011

ObjectiveThe discovery of propanolol for treatment of hemangiomas is a breakthrough, as current modalities are hampered by unpredictable outcomes and complications. Currently, there is a lack of long‐term data. We aim to contribute with our series of 3 patients with subglottic hemangiomas causing airway compromise, treated successfully with propanolol.MethodA detailed retrospective review of 3 patients who had received oral propanolol for the treatment of their subglottic hemangiomas was conducted based on the patients’ records. We documented their clinical history, degree of airway compromise, and duration of treatment and outcome with oral propanolol.ResultsPatient 1 was a 23‐day‐old girl who had a 1‐week history of stridor complicated by spontaneous rib fractures. Patient 2 was a 3‐month‐old girl who had a 1‐month history of stridor associated with a beard distribution of cutaneous hemangiomas. Patient 3 was a 2‐month‐old girl who had intermittent stridor from third week of birth. All children required intubation for relief of respiratory distress. Microlaryngobronchoscopy was performed for diagnosis and follow‐up at regular intervals. Cardiac echography was done prior to oral propanolol commencement at 1mg/kg/d, which was gradually escalated to 2mg/kg/d. All patients demonstrated significant clinical improvement at one week.ConclusionWhile the patients demonstrated remarkable clinical improvement at one week, radiological response (magnetic resonance imaging) was muted in contrast. This remarkable clinical response was not found to be sustained at 6 months interval. Propanolol may have to be combined with another modality of treatment to achieve a long‐term positive outcome.
Ultrasound Imaging to Identify Occult Submucous Cleft Palate
Authors: Meier Jeremy D. , Banks Caroline A. , White David R. 
Published: September 2011

Objective1) Determine the feasibility of transoral ultrasound imaging in evaluating palatal anatomy using a human cadaver model. 2) Describe ultrasound findings in patients with a submucous cleft palate.MethodUltrasound imaging of the soft palate in twenty fresh human cadaver specimens was performed using the Sono Site M Turbo system. In two specimens, the soft palate was imaged ex vivo to better evaluate the anatomy. Ultrasound imaging was then performed in three living patients with a submucous cleft palate.ResultsThe uvularis and levator sling were identified by ultrasound in each cadaver specimen. In each of the three patients with a submucous cleft palate, absence of the central uvularis muscle and discontinuity of the levator sling was seen on ultrasound imaging. The abnormal anatomy was confirmed after surgical exploration during the palatoplasty.ConclusionUltrasound imaging of normal velopharyngeal muscle is possible in human cadaver specimens. These results suggest that ultrasound imaging has potential in identifying patients with an occult submucous cleft palate. Ultrasound could help determine the appropriate surgery when formulating treatment for patients with velopharyngeal insufficiency without an obvious cleft palate.