bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Central Sleep Apnea Index Following Pediatric Adenotonsillectomy
Authors: Baldassari Cristina , Bryant Lucas , Kepchar Jessica J. , Choi Sukgi S. 
Published: September 2011

ObjectiveDetermine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA).MethodRetrospective review conducted at 2 tertiary children’s hospitals over 10 years. Children 1 to 18 years old who underwent adenotonsillectomy for OSA and had both pre‐ and postoperative full‐night polysomnography (PSG), with central sleep apnea (CSA) on preoperative PSG, were eligible. Criteria for diagnosis of CSA was CAI greater than 1.ResultsA total of 101 children with OSA had pre‐ and postoperative PSG. Fifteen of these patients had preoperative CSA. Ten of the children (66.7%) were male, and the mean age was 67.7 months (SD, 62.7). The mean preoperative CAI was 3.9 (SD, 2.9), while the postoperative CAI was 1.9 (SD, 4.8). The CAI ranged from 1.1 to 11.1. There was significant improvement (P =. 008) of the CAI following adenotonsillectomy. There was also significant improvement (P =. 004) of the obstructive apnea hypopnea index (OAHI), with the mean preoperative OAHI of 22.8 (SD 19.8) decreasing to an OAHI of 5.5 (SD 6.5) postoperatively.ConclusionChildren with OSA and mild central sleep apnea on preoperative PSG showed significant improvement in the CAI following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of central sleep apnea in children with OSA.
Clinical Indications for Modified Radical Mastoidectomy
Authors: Osborn Alexander J. , James Adrian L. , Papsin Blake C. 
Published: September 2011

ObjectiveTo establish clinically derived indications for modified radical mastoidectomy in the setting of cholesteatoma.MethodWe performed a retrospective review of 223 patients who underwent 265 operations for cholesteatoma in a single tertiary pediatric otolaryngology practice. Clinical characteristics of patients who underwent modified radical mastoidectomy were compared to those who underwent simple mastoidectomy or atticotomy.ResultsOf the 265 procedures, 10% were modified radical mastoidectomy. Congenital cholesteatoma was more common in the the canal‐wall‐up group, while recurrent cholesteatoma was more common in those who had a canal‐wall‐down procedure. The Mills score for those who had a modified radical mastoidectomy was significantly higher than those who underwent canal‐wall‐up procedures (4.9 vs 3.2, P <. 05). Furthermore, extremely poorly pneumatized mastoids and facial nerve dehiscence were both more common in the group who underwent modified radical mastoidectomy.ConclusionPosterior wall preservation or reconstruction is possible in the large majority of cases. Severity of Mills score correlated well with the need for a canal‐wall‐down procedure. This was further reflected by the fact that this group had a higher incidence of facial nerve dehiscence due to cholesteatoma.
Cochlear Implants under 6 Months
Authors: Colletti Liliana , Mandalà Marco , Colletti Vittorio 
Published: September 2011

ObjectiveCompare the influence of cochlear implantation (CI) in infants under 6 months vs older infants and children with bilateral profound sensorineural hearing loss on auditory‐based outcomes.MethodTwelve infants aged 2 to 6 months, 9 infants aged 7 to 12 months, and 34 children aged 13 to 48 months, bilaterally profoundly deaf, fitted with CI without associated disabilities, were evaluated longitudinally with the Category of Auditory Performance, the Infant‐Toddler Meaningful Auditory Integration, the Fanzago test, the PFLI test of Bortolini, and video analysis.ResultsThe age at fitting CI ranged from 2 to 48 months, and the degree of hearing loss was bilateral and profound in all children. Age at CI implantation was a significant factor in outcome measures of speech production and spoken language skills. The 2 to 6 months group showed significantly better results at the Fanzago and PFLI test of Bortolini than the older children even after 5 years of CI use (P >. 05).ConclusionFor the first time the decisive importance of fitting CIs before 6 months of age on communication outcomes becomes evident. Further studies on larger numbers of infants implanted under 6 months are necessary to validate the present findings.
Free Flap Reconstruction of Lateral Mandibular Defects: Indications and Outcomes
Authors: Dean Nichole R. , Rosenthal Eben L. , Virgin Frank , Magnuson J. Scott , Wax Mark K. , Carroll William R. 
Published: September 2011

ObjectiveTo evaluate outcomes following lateral mandibular defect free flap reconstruction.MethodPatients undergoing lateral mandibular defect free flap reconstruction from 1999 to 2010 at 2 tertiary care centers were classified into 4 groups based on type of reconstruction: 1) radial forearm swing (n = 8), 2) radial forearm with bar (n = 5), 3) osteocutaneous radial forearm (n = 73) and 4) fibula free flap reconstruction (n = 51).ResultsThe majority of patients were male (67%) and presented with advanced T‐stage (59%) squamous cell carcinoma (93%) involving the alveolus (26%) retromolar trigone (21%) or oral tongue (25%). The recipient site complication rate approached 35% and included infection and mandibular malunion (n = 9), exposed bone or mandibular plates (n = 7), venous congestion (n = 2), and flap failure (n = 6). Most patients demonstrated little to no trismus following reconstruction (81%) and were able to resume a regular or soft diet (61%). No difference in complication rates, hospital stay or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P >. 05).ConclusionFree flap reconstruction of lateral mandibular defects results in acceptable functional outcomes for the majority of patients including those who undergo osteocutaneous radial forearm free tissue transfer.
Demographic Influences on Antibiotic Use for Otitis Media
Authors: Sidell Douglas R. , Bhattacharyya Neil , Shapiro Nina 
Published: September 2011

Objective1) Understand epidemiologic antibiotic treatment patterns for acute otitis media (AOM). 2) Understand the potential impact of race and insurance status on the medical management of acute otitis media.MethodCases of isolated AOM in children.ResultsA total of 15.8 ± 1.5 million cases of AOM were studied (mean age, 3.6 years; 55.1% male). 15.0 ± 2.8% of children were Hispanic, and 10.4 ± 3.1% were black. Medicaid/SCHIP and private insurance covered 30.6 ± 4.4% and 69.4 ± 4.4% of children, respectively. Overall, 83.1 ± 2.2% of children received an antibiotic prescription. The most commonly prescribed antibiotics were amoxicillin (6.5 ± 0.9 million), beta‐lactamase inhibitors (2.6 ± 0.4 million), and third‐generation cephalosporins (2.3 ± 0.4 million prescriptions). On multivariate analysis, insurance status, ethnicity, race, age, and sex did not influence the likelihood of an antibiotic prescription during the visit (P =. 884, P =. 909, P =. 849, P =. 931, and P =. 102, respectively).ConclusionThe vast majority of children with acute otitis media are covered by health insurance. Ethnicity, race, and insurance type do not significantly influence antibiotic prescribing rates for AOM.
Early Intervention with Mandibular Distraction Osteogenesis
Authors: Mudd Pamela , Allen Gregory C. 
Published: September 2011

ObjectiveDetermine benefits of early intervention in neonates with symptomatic retrognathia who underwent bilateral mandibular distraction osteogenesis (MDO) within the first 90 days of life as relates to growth, need for supportive care, and further invasive procedures.MethodRetrospective chart review of neonates who underwent bilateral MDO in the past 5 years. Inclusion criteria included MDO performed within the first 90 days of life. Outcome measures included length of hospital stay, growth, oral intake, supportive home care needs, and time to cleft repair.ResultsTwenty‐five patients were identified as meeting inclusion criteria. Mean age at distraction was 29 days and average discharge is POD#14. No patients required home oxygen on discharge, most patients were able to begin oral diet, and growth curves stabilized. No patients required tracheotomy. Early MDO intervention facilitates earlier and less complicated palate repair. A cost‐based analysis is included.ConclusionEarly intervention with MDO in neonates facilitates decreased length of hospital stay, less need for supportive care, fewer invasive procedures, and improved growth stabilization. In addition cleft repair is done earlier and with less likelihood of complication. MDO is a cost‐effective and beneficial intervention in neonates with symptomatic retrognathia.
Factors Associated with Revision Adenoidectomy
Authors: Dearking Amy C. , Orvidas Laura J. 
Published: September 2011

Objective1) Determine if patient factors, such as indication for initial surgery, medical comorbidities, and patient age, are associated with adenoid regrowth and revision adenoidectomy. 2) Determine if surgical factors, such as surgical technique or level of surgeon’s training, are associated with adenoid regrowth and need for revision adenoidectomy.MethodRetrospective review of children less than 18 years who underwent adenoidectomy or adenotonsillectomy between 1980 and May 2009. Charts of patients with revision adenoidectomies were reviewed for sex, age at surgery, indication for surgery, training level of surgeon, surgical technique, and history of allergies, asthma or GERD.ResultsOf 8472 surgical cases (54% male), 202 were revision adenoidectomies (2.4%). Children less than 2 years old at initial surgery had increased rate of revision (23.5% of revision cases compared with 4.7% of all surgical cases). Of patients with revision adenoidectomy, 31.1% had curettage and 68.9% had electrocautery or coblation adenoidectomy at initial surgery. Patients with revision adenoidectomy were 3 times more likely to have a PGY1 or 2 as surgeon in initial surgery. The revision patients were found to have a higher incidence of allergies (32%), asthma (23%), and/or GERD (16%) than the general population.ConclusionSeveral risk factors were associated with revision adenoidectomy. Children 3 years and under (especially under 2 years), at initial adenoidectomy have a higher incidence of revision surgery. Other factors identified with increased need for revision adenoidectomy include: medical history of allergies, asthma and/or GERD, and level of training of surgeon.
Food Hypersensitivity and Ear, Nose, and Throat Pathology in Children Less than 2 Years of Age
Authors: Paddack Angela Cogburn , Smith Chandra , Richter Gresham T. , Gibbons Troy 
Published: September 2011

ObjectiveExplore the relationship between food hypersensitivity associated with cows milk protein allergy (CMPA) and common gastrointestinal and upper aerodigestive disorders found in children less than two years of age.MethodTwo‐year retrospective chart review of a common cohort of children less than 2 years of age, managed in both a tertiary pediatric gastroenterology and otolaryngology clinic. Comparison with a control pediatric population was performed.ResultsOf 191 children reviewed with CMPA, 141 demonstrated upper gastrointestinal (GI) complaints. Twenty‐five (18%) of these children had otolaryngologic (ENT) conditions refractory to standard therapy with the majority being chronic otitis media (70%) and oropharyngeal dysphagia (80%). In contrast, only 2% of patients in a GI control group demonstrated ENT disease. Dairy elimination improved GI symptoms in 92 patients, and ENT disease improved in 60%. ENT conditions improved in the control group via standard therapy.ConclusionThis study suggests a relationship between CMPA and ENT concerns in children less than 2 years old, whereby food hypersensitivity can be associated with recalcitrant otits media and oropharyngeal dysphagia. Elimination diets can improve both GI and ENT conditions refractory to GERD therapy in patients with CMPA.
Impact of Endoscopic Sinus Surgery on Pulmonary Function in Children with Cystic Fibrosis
Authors: Rihani Jordan J. , McClay John E. 
Published: September 2011

ObjectiveDetermine the impact of endoscopic sinus surgery on pulmonary function in children with cystic fibrosis.MethodRetrospective chart review of cystic fibrosis patients at a tertiary children’s hospital who underwent endoscopic sinus surgery between 1995 and 2010. Main outcome measures include presurgical and 1‐ and 6‐month postsurgical pulmonary function tests (PFTs).ResultsSixty‐two children underwent 110 endoscopic sinus surgeries. Pre‐ and post‐PFT data (FEVI and FVC) were available for 66 surgeries. Postoperative, only 10 out of 66 children (15%) at 1 month and 11 out of 66 (16%) at 6 months showed improvement following surgery. A total of 41 out of 66 children (62%) at 1 month and 42 out of 66 (64%) at 6 months showed no difference, while 15 out of 66 (23%) at 1 month and 13 out of 66 (20%) at 6 months were worse following surgery. There was no difference in pulmonary function following primary (28/66 [42%]) or revision (38/66 [58%]) surgeries.ConclusionImprovement of sinonasal symptoms achieved with endoscopic sinus surgery does not correlate with improvement in pulmonary function as measured by pre‐ and postoperative pulmonary function testing in children with cystic fibrosis.
Incidence of Plagiocephaly in Teens Born after “Back to Sleep” Campaign
Authors: Roby Brianne Barnett , Sidman James D. , Tibesar Robert J. , Finkelstein Marsha 
Published: September 2011

ObjectiveDetermine the incidence of positional plagiocephaly in teenagers born after the “Back to Sleep” Campaign but before orthotic helmet treatment became widely available.MethodThis is a cross‐sectional analysis. Subjects were selected if they attended participating high schools and were born after 1992, which is when the “Back to Sleep” campaign began. Skull measurements, including transcranial diameter, circumference, length, and width, were taken. Cranial vault asymmetry and cephalic index were calculated for each participant.ResultsThere were 411 participants in this study ranging from age 14 to 18 years old, with the average age of 16.3 years. The diagnosis of plagiocephaly was made if cranial vault asymmetry was >1 centimeter. Brachycephaly was diagnosed if the cephalic index was >0.90. The incidence of plagiocephaly based on the above criteria was 1.3% in females and 2.7% of males. The incidence of brachycephaly was 0.9% in females and 1.6% in males. Of those noted to have abnormal facial characteristics (telecanthus, frontal prominence), 40% had plagiocephaly and 6.7% had brachycephaly.ConclusionThe incidence of plagiocephaly in teenagers is significantly lower than the 20% to 48% incidence found in infants in previous studies, suggesting a significant number of infants will outgrow it. Physicians must recognize plagiocephaly and gain insight into which patients might benefit from treatment and which will likely have resolution without intervention.
Infantile Hemangioma: Evolving Trends in Surgical Management
Authors: Daramola Opeyemi O. , Drolet Beth , North Paula E. , Kerschner Joseph E. , Chun Robert H. 
Published: September 2011

Objective1) Present outcomes of surgically treated infantile hemangioma, and describe changes in surgical management with the advent of changes in medical therapy. 2) Highlight the role of imaging in surgical planning. 3) Identify risk factors for surgical complications.MethodRetrospective chart review of patients in a multidisciplinary clinic diagnosed with infantile hemangioma involving soft tissue and skin between 2008 and 2010. Data relating to demographics, indications for surgery, histopathology analysis, postoperative care, and complications were collected.ResultsOf 1050 subjects, 109 patients (10%) underwent surgical intervention, and 78% of the lesions were in the head and neck. Ulceration, bleeding, and deformity were the major surgical indications. Seven patients underwent staged excision. Magnetic resonance imaging was utilized in diagnostic workup and preoperative planning in 15 cases. Adjunctive medical therapy was safely used in 26% of the surgical cohort. Head and neck lesions were more likely to receive adjunctive therapy (P =. 007) and had a higher complication rate. Overall complication rate was lower (6%) compared with our 2005‐2007 surgery cohort (1012 patients) with a complication rate of 17%.ConclusionSurgery continues to be a viable form of therapy for complicated infantile hemangiomas. Introduction of propanolol and vincrinstine for challenging lesions did not change the surgery rate but may partly explain the lower complication rate secondary to preoperative reduction of surgical bulk.
Injection Augmentation for Type I Laryngeal Clefts
Authors: El‐Hakim Hamdy , Mangat Harshdeep Singh 
Published: September 2011

ObjectiveDescribe a series of children diagnosed with type I congenital laryngeal clefts (LC‐I) and treated due to various presentations with endoscopic injection augmentation (IA).MethodThis is a retrospective study. The children were identified from a prospectively collected database. Only those who were treated with IA (using hyaluronic acid derivatives) and had a minimum follow‐up of 3‐months were included. We collected demographics, diagnoses, surgical procedures, number of IA, clinical outcomes, and complications.ResultsOver a period of 8 years, 32 patients were diagnosed with LC‐I. Fifteen had undergone IA over the past 3 years. Mean age at IA was 28.67 ± 17.54 months with a male‐to‐female ratio of 8:7. The indications were swallowing dysfunction (13) and atypical croup (2). Seven patients required repeated injections (mean of 2.57 injections). A total of 10 patients responded with resolution of symptoms in question. No record of complications was found.ConclusionIA is a brief, simple management option that succeeds in a number of children with LC‐I. It is minimally morbid and supplements other conservative approaches to treat the condition.
Jugular Bulb: Vestibular Aqueduct Dehiscence and Hearing Loss
Authors: Ann Kupfer Robbi , Hoesli Rebecca , Green Glenn E. , Thorne Marc C. 
Published: September 2011

ObjectiveDetermine the prevalence of dehiscence of the jugular bulb and vestibular aqueduct (JBVAD) in pediatric patients undergoing temporal bone computed tomography (CT) scans and assess the correlation between JBVAD and hearing loss.MethodAll patients 18 years of age or younger who underwent temporal bone CT scans and audiometric testing between 2004 and 2009 were retrospectively reviewed. JBVAD was determined by blinded review of CT images. Hearing loss was determined by review of audiometric data and correlated with imaging findings.ResultsCT images and audiometric data were available for review in 927 patients (1854 ears). Overall prevalence of JBVAD was 8.6%, with a prevalence of 6.6% in right ears and 3.6% in left ears. JBVAD was present in 8.3% of patients with sensorineural or mixed hearing loss and 7.1% of patients without sensorineural or mixed hearing loss (P =. 51). Similarly, JBVAD was present in 5.5% of ears with and 4.6% of ears without sensorineural or mixed hearing loss (P =. 37).ConclusionThe prevalence of JBVAD is 8.6% in pediatric patients undergoing temporal bone CT scans, 65% of which occur in the right ear. We were unable to identify any correlation between JBVAD and hearing loss. A major contribution to pediatric sensorineural hearing loss from JBVAD is excluded.
Laryngomalacia and Acid Reflux: A Systematic Review
Authors: Hartl Trevor , Chadha Neil K. 
Published: September 2011

ObjectiveLaryngomalacia is widely described as having an association with acid reflux. Many otolaryngologists therefore employ empiric treatment with anti‐reflux medication in this setting. This study aims to identify and appraise the evidence for this association, and to explore the potential role for treatment of reflux in the management of laryngomalacia.MethodA predefined protocol was employed to search Medline, EMBASE, the Cochrane Library, and Google Scholar. Included studies were those that explored the potential for an association between laryngomalacia and gastro‐esophageal and/or laryngopharyngeal reflux. The Oxford Centre for Evidence Based Medicine (CEBM) guidelines were applied to assess study quality of evidence.ResultsA total of 26 studies, representing 1295 neonates with laryngomalacia, were included. Study quality varied from CEBM 2a (n = 3 to 4 (n = 20). No randomized controlled trials were identified. While reflux definitions were diverse, overall reflux prevalence in this group was 59%. Evidence supporting an association between reflux and laryngomalacia included: the near ubiquity of acid reflux in dual‐probe pH monitoring in children with laryngomalacia (3 studies); case series and reports of laryngomalacia improvement with anti‐reflux therapy (5 studies); histologic evidence of reflux‐related laryngeal inflammation in children with laryngomalacia (2 studies); and implication of reflux as a cofactor in laryngomalacia symptom severity (12 studies).ConclusionThe literature shows a co‐existence between acid reflux and laryngomalacia, but the evidence for causal association is limited. In view of the widespread use of anti‐reflux treatment in laryngomalacia, an RCT of anti‐reflux medication vs placebo appears well‐justified. This review provides a rational foundation for such an endeavor.
Long‐Term Quality of Life Outcomes in Children Undergoing Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Randhawa Premjit Singh , Chilvers Geoffrey , Cetto Raul , Narula Antony A. P. 
Published: September 2011

ObjectiveAssess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery for continued and long‐term improvement in quality of life using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a healthy United Kingdom population.MethodA telephone survey was carried out using the CHQ‐PF28 questionnaire and administered to the primary care giver of 37 patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years after initial surgery at our university hospital tertiary referral center.ResultsA total of 33 patients (89.1%) from our initial cohort were contacted. The mean age was 10.6 years (median, 11 years range, 5‐16 years). The mean scores from our follow‐up study show improvements in 5 subscales and were statistically significant in 2 subscales (role limitations P <. 00001; bodily pain P <. 002) when compared to values obtained 3 months postoperatively. The 4‐year follow‐up scores showed further improvement in 5 subscales when compared with a healthy population. All subscales of the CHQ‐PF28 improved in the long term when compared to scores preoperatively.ConclusionQuality of life data are an important measure when deciding on a particular intervention. In the short term quality of life measures have been shown to improve. Our study demonstrates that the benefits of surgery are still persistent, and the children continue to improve in the long term.