Elizabeth O. Shay, Madhuri Kesani, Michael G. Moore, Avinash V. Mantravadi, Michael W. Sim, Jessica Yesensky, Janice L. Farlow, David Campbell, Diane W. Chen
Publication date 17-11-2024
Microvascular free tissue transfer (MVFTT) for head and neck reconstruction is infrequently performed in pediatric patients. There is a paucity of data on perioperative airway management in pediatric MVFTT, such as the need for tracheostomy, which can pose higher morbidity to young patients due to potential long-term effects on the softer, more pliable laryngotracheal cartilage. Our objective was to report airway outcomes on pediatric patients undergoing MVFTT after segmental mandibulectomy with or without tracheostomy. Retrospective chart review of pediatric patients who underwent MVFTT reconstruction after segmental mandibulectomy at a tertiary care center from 2014 to 2023. Demographic variables, surgical characteristics, and hospital clinical outcomes were recorded. Statistical analyses were performed with JMP Pro, Version 16.0.0 (2021) SAS Institute Inc., Cary, NC, 1989-2021. Ten patients (median age 11.5 years old, IQR: 9.0-13.3) underwent fibular free flap reconstruction. Mandibular pathologies included 3 ameloblastoma, 2 mesenchymal chondrosarcoma, 2 desmoplastic fibroma, 1 Ewing sarcoma, 1 chondroblastic osteosarcoma, and 1 desmoid tumor. Two patients received upfront tracheostomy at time of initial surgery for a subtotal mandibulectomy and a sub-hemimandibulectomy, respectively. Both patients were decannulated within 1 week after surgery and prior to discharge. The median ICU and hospital length of stay for patients who underwent tracheostomy was 3.5 days [IQR: 3.0-4.0] and 8.5 days [IQR: 8.0-9.0] respectively. Of the remaining 8 patients without tracheostomy, surgical defects were hemimandibulectomy and anterior subtotal mandibulectomy. Median intubation duration was 1.0 day [IQR: 1.0-2.5]. The median ICU and hospital length of stay for these patients were 3.0 days [IQR: 2.0-6.3] and 8.5 days [IQR: 7.3-13.0], respectively. No patient had to be reintubated for respiratory failure following extubation or had long-term airway complications during the follow-up period. Fibular free flap reconstruction without tracheostomy can be feasible in pediatric patients with mandibular defects, which can potentially reduce hospital resources required for fresh tracheostomy care needs and avoid additional surgical morbidity. Further studies in larger populations and prospective approaches are warranted.
Pubmed PDF WebZhengjun Zhong, Xu Guo, Desheng Jia, Hongying Zheng, Zebin Wu, Xuansheng Wang
Publication date 16-11-2024
In order to promote the use of AI technology as the auxiliary tool in pediatric otitis media diagnosis, we use the convolutional neural networks and deep learning for image classification and disease diagnosis. We also designed a Pediatric Otitis Media Classifier to analyze and classify the images for physicians. A pediatric otitis media classifier was designed for junior physicians (doctors who have been engaged in clinical practice for a short time) as an auxiliary diagnostic tool. To design this classifier for children with otitis media, we used a large number of images of acute otitis media (AOM), secretory otitis media (OME), and normal otoscope images to obtain the optimal convolutional neural network model. The average recognition accuracies of the ZFNet and the TSL16 for classification were 97.87 % and 97.62 %, far exceeding the accuracy of human diagnosis. The results of using the Pediatric Otitis Media Classifier show that we can use the classifier to correctly identify the image types of child middle ear infections. We developed the Pediatric Otitis Media Classifier for the successful automated classification of AOM and OME in children using otoscopic images. In contrast to the traditional diagnosis of pediatric otitis media, which relies heavily on the experience of doctors, the diagnostic accuracy of even experienced physicians is only approximately 80 %. With AI technology, we can improve the accuracy rate to over 98 %, which can effectively assist doctors in auxiliary diagnosis. It also reduces delayed treatment, antibiotic misuse, and unnecessary surgery caused by misdiagnosis.
Pubmed PDF WebHarrison M. Thompson, Mikayla G. Hubbard, Sarah A. Ackah, Alden Dewey, Erika Zevin, Erik A. Imel, Boaz Kamazyn, Monali Lipman, Adeyinka O. Akinsanya, L. Daniel Wurtz, Diane W. Chen
Publication date 03-10-2024
Nezar Hamed, Mohamad-Hani Temsah, Yasser Sabr, Yassin Abdelsamad, Mohammed A. Alghamdi, Nouf Saleem Yaqoub, Muataz H. Alhashem, Abdullah Fahad Alnuwaybit, Raghad AlKhashan, Abduallah Mawkili, Abdulrahman Hagr
Publication date 13-11-2024
Congenital cytomegalovirus (CMV) infection, resulting from maternal-fetal transmission of CMV, poses a substantial risk to maternal and child health. It is the most prevalent congenital viral infection, and the prevention and management of this condition rely heavily on the knowledge and awareness of healthcare professionals. This cross-sectional survey was conducted between March 1, 2023, and August 31, 2023, across multiple tertiary centers in various Saudi Arabian cities. It assessed the understanding and awareness of congenital CMV infection among 400 healthcare professionals from diverse specialties. The study utilized a structured questionnaire to evaluate knowledge levels, obtain demographic data, and identify factors influencing awareness. The study revealed significant disparities in knowledge levels, with around 84 % of participants categorized as having "low" knowledge. Obstetricians and gynecologists exhibited better knowledge. Factors like specialization, age, and professional experience significantly affected knowledge levels. Additionally, many healthcare professionals perceived a lack of information and awareness regarding CMV among their peers. Congenital CMV infection is a major public health concern with potential severe consequences. The study identified knowledge disparities, particularly among non-specialist healthcare practitioners, emphasizing the need for targeted educational programs and focused awareness initiatives. Key factors, such as expertise, age, and experience, underscore the importance of addressing ongoing knowledge gaps, highlighting the need for continuous efforts to mitigate challenges associated with CMV infection.
Pubmed PDF WebHerrmann BW, Choi MH, Vance ME, Pickett-Nairne K, Cooper EH, Friedman NR
Publication date 04-11-2024
Aerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room.
Utilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5-10 μm in diameter were measured.
Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations.
SES was effective compared to controls, but inferior to intraoral mitigation strategies (p < 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p < 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles.
Intraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.
Anna Nyman, Marion Lieberman, Madelen Snickars, Anna Persson
Publication date 03-11-2024
Children born with moderate hearing loss present with speech and language outcomes at both ends of the spectrum. To explore reasons for this, the objective of this study was to follow up a group of children born with moderate sensorineural hearing loss at 6 years of age (n = 7) by investigating their outcomes in hearing, speech, and language development from time point of hearing aid fitting at 6 months. Another objective was to investigate the relationship between earlier outcomes on precursing variables to the current status in auditory, speech and language development. Earlier data from a project with the same participants of auditory variables, speech, and language development were compared to the current study outcomes at 6 years of age. Children in this study performed standardized tests of phonology (SVANTE), expressive vocabulary (BNT), and speech-in-noise test (Hagerman's sentences). Parents reported on their child's functional auditory performance in everyday life (PEACH), and demographics and general development (questionnaire). Etiology and frequency of speech and language-directed intervention from time point of diagnosis to 6 years of age were collected through medical journals. Hearing levels were stable over time in all children but one, who had received bilateral cochlear implants. Performance on speech-in-noise testing varied in aided condition (-0.8 to 8, mean 2.65, SD 3.09) and unaided condition (7.2 dB-21.2 dB, mean 12.06, SD 4.82). Scores on the PEACH indicated further review in four of the seven children. Mean group score on consonant proficiency had increased from 3 to 6 years of age and were within age norms. Vocabulary scores were below the norms of children with typical hearing. Outcomes on vocabulary measures at 2.5 years showed strong correlations that were significant to scores on the BNT at 6 years of age (r = 0.87, p = 0.05). Correlations between hours of hearing aid use and vocabulary was not significant at 6 years of age. The frequency of intervention sessions in the first 6 years varied between participants (4-55, mean 19.1, SD 17.1). Despite homogeneous hearing and other background variables in the participants from birth, large individual variations in speech and language outcomes at 6 years of age were found. Considering the many factors involved that impact the development of children with moderate hearing loss, the results suggest that monitoring early precursors in auditory, speech and language development may be helpful in setting commensurate goals for each child. Detecting additional conditions that may pose challenges in future speech and language as early as possible is important. There is ample room for improvement in terms of increasing the frequency of intervention for children with moderate hearing loss and their families.
Pubmed PDF WebTze Ling Loh, Pei Toh, Telvinderjit Singh Harbhajan Singh, Shane Anderson, Kelvin Kong, Mithma Ekanayake, John-Charles Hodge, Megan Hobson, Graeme van der Meer, Hannah Burns, Shyan Vijayasekaran, Niall Jefferson
Publication date 03-11-2024
To investigate the incidence and timing of postoperative haemorrhage between intracapsular (ICT) and extracapsular tonsillectomy (ECT) techniques and evaluate factors influencing haemorrhage risk and severity. A retrospective review of patients undergoing tonsillectomy over 5 years across otolaryngology services in Australia and New Zealand. Primary outcomes were rate and timing of post-tonsillectomy haemorrhage. A total of 12,275 patients were included in this study. The overall post-tonsillectomy bleed rate was 3.3 %, with 0.65 % requiring return to theatre. ICT had a significantly lower bleed rate of 1.7 % compared to 4.1 % for ECT (p < 0.001). The rate of return to theatre was markedly lower for ICT (0.08 %) compared to ECT (0.93 %, p < 0.001). Median day of bleeding was not different between the techniques. Patients undergoing surgery for recurrent tonsillitis had the highest rate of postoperative haemorrhage (15 %), while those with sleep-disordered breathing alone had the lowest (3 %, p < 0.001). ICT results in significantly lower rates of postoperative haemorrhage and need for surgical intervention compared to ECT. This was most pronounced in paediatric patients with sleep-disordered breathing. ICT may be considered a preferable option for certain patient groups, especially younger children with sleep-disordered breathing, though more evidence is needed to confirm its efficacy and safety in patients with recurrent tonsillitis.
Pubmed PDF WebJunnan Chen, Shaoping Wu, Shouxing Duan, Yongfa Zhang
Publication date 01-11-2024
To determine the predictive value of chest X-ray for the depth of tracheal intubation in infants. Basic data of 161 infants under 3 years old was collected. Tracheal length was measured on preoperative chest radiographs to guide intubation depth. Correlation analysis was performed to examine relationships between tracheal length, age, and body weight. 161 cases (male/female = 142/19, no significant difference in sex, p = 0.09) were included, aged from 1 month to 28 months, weight from 2.5 kg to 18.0 kg. The endotracheal intubation depth reached the standard rate was 100 %, with 0 cases of over-deep or over-shallow intubation. Correlation analysis showed that tracheal length was positively correlated with both age and body weight, with stronger correlations observed in infants aged 1-12 months (r = 0.751 for age, r = 0.672 for weight, p < 0.01) compared to those aged 13-28 months (r = 0.672 for age, r = 0.408 for weight, p < 0.01). Direct measurement of tracheal length on routinely performed chest X-rays is simple, feasible and safe, and may be another choice for guiding the depth of tracheal intubation in children.
Pubmed PDF WebLin Wang, Ke Ji, Jingjing Tu
Publication date 31-10-2024
We aimed to compare the effects of microdebrider adenoidectomy, curettage adenoidectomy through oral cavity under 70°endoscope, and endoscopic transoral low-temperature ablation on adenoid hypertrophy. A total of 180 children suffering from adenoid hypertrophy hospitalized during November 2019 and November 2023 were allocated to group A (microdebrider adenoidectomy, n = 65), group B (curettage adenoidectomy through oral cavity under 70° nasal endoscope, n = 54), and group C (nasal endoscopic transoral low-temperature adenoid ablation, n = 61). The operation data (operation time and bleeding amount), pain score, postoperative recovery, and complications were compared. The operation time of group A was significantly shorter than those of other two groups, while group C had a significantly smaller bleeding amount than those of other two groups (P < 0.05). An incidence rate of secondary bleeding at 6.15 % was detected in group A, without other complications. Group B had an adenoid residual rate of 35.19 % and a recurrence rate of 14.81 %, significantly exceeding those of other two groups (P < 0.05). The soft palate injury rate was 24.59 % in group C, which was raised significantly compared with those of other two groups (P < 0.05). In comparison to other two groups, significant increases in postoperative pain score and pain duration were detected in Group C (P < 0.05). There is no significant difference in the effective rate among the three methods. Nasal endoscopic transoral low-temperature adenoid ablation is recommended as the first choice because of small bleeding amount, few postoperative residuals, and low recurrence rate, but it poses high requirements on the operation of doctors.
Pubmed PDF WebBrett A. Campbell, Gabrielle French, Tieqi Sun, Farrukh Virani, Michael J. Cunningham, Eelam Adil, A. Eliot Shearer
Publication date 30-10-2024
Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin lymphoma with the sporadic subtype being predominant in North America. The clinical presentations and outcomes of pediatric BL within the head and neck were assessed using both an institutional case series and the Surveillance, Epidemiology, and End Results (SEER) Cancer database. The electronic medical record at our quaternary children's hospital was queried over a 22-year period (2000-2022) for BL patients with head and neck manifestations. Demographics, clinical presentation, staging, treatment, and outcomes data were collected and analyzed. A corresponding review of the SEER database from 1975 to 2022 was also performed. Our institutional case series identified 48 sporadic BL patients with a mean age of 8.7 years, the majority of whom were male (79 %) and white (74 %). The most common primary sites were the cervical lymph nodes (38 %) and (or) palatine tonsils (23 %). Thirty-five patients (73 %) were treated initially for a presumed inflammatory or infectious process before undergoing malignancy work-up, which did not significantly delay time to diagnosis (31.5 vs. 38.8 days, p = 0.27). The SEER database analysis identified 78 cases, 43.5 % of whom were 5-9 years of age, with a similar male (66 %) and Caucasian (76.9 %) predominance. Cervical lymph nodes were also the most common subsite (67 %), followed by the palatine tonsils (13 %). Remission rates were similar, 93.7 % and 94.8 %, respectively, in both the institutional and SEER database cohorts. Unilateral cervical lymphadenopathy and asymmetric tonsillar hypertrophy are the most common presentations in sporadic BL in the head and neck. Clinical presentation in patients with BL is often similar to common, insidious pediatric otolaryngology symptoms and a majority of patients initially undergo treatment for presumed infectious or inflammatory disease. Although overall BL disease-free survival is high even for disseminated BL, the prognosis is better for local/regional disease, and minimizing time to diagnosis and treatment should remain a priority.
Pubmed PDF WebMichelle A. Pokorny, Wiremu MacFater, Inbal Meshulam-Weiss, Zahoor Ahmad
Publication date 23-10-2024
To assess hearing levels and functional health outcomes of children two years after routine grommet surgery with standard care follow-up (discharge to General Practitioner (GP) care or Ear Nose and Throat (ENT) clinic appointment at 4-8 weeks). Prospective cohort study of 89 children (average age of 7.98 years) recalled for audiological assessment 2 years after grommet surgery in a large ENT outpatient service in South Auckland, New Zealand. Functional health was assessed using parent-reported responses to the OMQ20 questionnaire. 46 (51.7 %) children had hearing loss in at least one ear with 28 (31.5 %) children having bilateral hearing loss. Māori children had statistically higher odds compared to non-Māori children (odds ratio 5.491, p = .003) to have bilateral hearing loss after controlling for age, household deprivation, gender, season, and mode of follow-up. Most parents reported concerns with their child's hearing, speech, attention-seeking behaviours, and nasal symptoms, but not ear problems. Bilateral hearing loss (p < .001) was found to significantly predict functional health status (total OMQ20 score). The high prevalence of hearing loss and functional health concerns suggest that the standard follow-up care is not adequately managing children after routine grommet insertion. Māori children are disproportionately impacted, and post-grommet follow-up schedules must consider individualised approaches to address these inequities in outcomes.
Pubmed PDF WebMonica S. Trent, Brooke M. Su-Velez, Gurpreet Ahuja, Kevin Huoh
Publication date 23-10-2024
The Delphian lymph node (DLN) is the first lymph node receiving drainage from the thyroid. We aim to determine whether routine DLN sampling with frozen section analysis during pediatric thyroidectomy can alter intraoperative surgical decision making. Additionally, we aim to measure whether DLNs can predict a requirement for central neck dissection (CND) in the clinically node negative (CNN) pediatric population.
Retrospective chart review for pediatric patients who underwent thyroidectomy between 2014 and 2022.
Patients were included if they had prior FNA with a result of: benign nodule, atypia or follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC). All patients had intraoperative DLN analysis via frozen section histopathology.
27 patients were included, 9 males (33 %) and 18 females (67 %). On final pathology 19 patients (70.4 %) had PTC. The DLN was negative for carcinoma in all (n = 8, 100 %) patients with benign pathology. In 10 patients (100 %) with positive DLN on frozen section, postoperative pathology demonstrated central neck metastasis. Nine (90 %) of these patients were CNN and had alterations in the surgical plan based on the DLN. The tenth patient's surgical plan did not change given preoperative clinical disease. Three patients with negative DLNs had central neck metastasis.
The DLN serves a role in guiding treatment for the pediatric population. Positive DLN altered surgical plans in 60 % of CNN PTC patients, allowing for CND to be performed and reducing need for additional surgical resection. The positive predictive value for DLN status was 100 % in this study, and the negative predictive value was 62.5 %. However, negative DLNs do not rule out central neck disease.
Sara E. Bressler, Adele K. Evans
Publication date 23-10-2024
Despite its prevalence in adults, head and neck squamous cell carcinoma (HNSCC) is considered a rare entity in pediatrics where lymphomas, neural tumors, and soft tissue sarcomas predominate in the head and neck. Given the association of squamous cell carcinoma with the human papillomavirus, a risk factor that may be present from birth, and the difficulties in staging this disease for prognostication in children, it is important to revisit nationally collected data for prevalence and outcomes assessments. To examine a publicly available national database to describe the incidence, pathology, treatment, and survival of pediatric HNSCC. To review the available literature regarding management, outcomes, and risk factors for this disease process. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor database was queried to identify pediatric subjects ages 0 to 19 diagnosed HNSCC between 1973 and 2019. Two-hundred ninety-two cases were identified. Subjects were 62.7 % male (n = 183) and the average age was 15.4 years (range 2-19, median 16). Subjects were 65.8 % white (n = 192), 22.9 % black (n = 67), 8.9 % Asian/Pacific Islander (n = 26), 1 % American Indian (n = 3), and 1.4 % unknown (n = 4). The most common primary sites were nasopharynx (45.9 %), oral cavity (30.5 %), larynx (8.6 %), salivary gland (4.1 %), nasal cavity & paranasal sinus (3.4 %), and lip (2.7 %). There was no statistically significant difference between primary subsite and age, race, histologic grade, or extent of disease. The 5-year overall survival was 83.6 %. Head and neck squamous cell carcinoma is more likely to present in older children and is more prevalent in White populations. The nasopharynx is the most common subsite involved, which differs from adult populations in which non-nasopharyngeal subsites including the larynx, oral cavity, and oropharynx are most frequently affected. Head and neck squamous cell carcinoma is rare in pediatric patients but should not be overlooked by physicians in the differential diagnosis, particularly in teenagers. Further study is needed to determine whether this represents a unique entity or can be staged and treated according to adult guidelines.
Pubmed PDF WebReem Badghaish, Dalal Alrushaydan, Mada Aljabr, Mariam Al-Amro, Hassan Yalcouy
Publication date 23-10-2024
This study evaluates the feasibility of reducing in-person appointments by utilizing Remote Check (RC) in pediatric cochlear implant (CI) recipients and investigates the most suitable age range for implementing RC. Fifty-eight pediatric CI recipients, aged 1-17 years, were evaluated using a web-based RC application by audiologists. Most (84.5 %) used verbal communication. Inclusion criteria required stable map status, caregiver tech proficiency, and a compatible phone. Remote assessments were beneficial, with 89.7 % of participants successfully completing RC. Aided threshold tests (ATT) were completed in 73.2 % of participants, while speech-in-noise tests (Digit Triplet Test, DTT) were completed in 47.3 %. Children as young as 4 successfully completed ATT, while a minimum age of 7 was required for DTT. A significant relationship between age and test success was demonstrated. Verbally communicative children had higher completion success rates. Parental education was significantly correlated with DTT success, with higher success rates in children whose parents had undergraduate degrees. With RC use, 69 % of children did not need clinic visits, emphasizing the need for personalized and remote support for optimal cochlear implant performance. In-person appointments were primarily required due to concerns about the duration of device usage. The study confirms the effectiveness and feasibility of using RC in pediatric CI users, even as young as one year old with stable aided hearing. The findings advocate for the integration of RC into routine follow-up protocols, offering a more accessible option for enhanced patient care.
Pubmed PDF WebGabriela Sara Freixo Lima, Daniel Yafit, Benyamin Meir Kaminer, Ronit Harris, Oded Cohen, Oren Ziv
Publication date 23-10-2024
The purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. Retrospective cohort study. A single tertiary medical center. All patients ≤18 years with a diagnosis of DNI, between the years 2010-2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). A total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period). In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). In conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes.
Pubmed PDF WebTamara Veselinović, Justin C. Kickett, Helen L. Kickett, Glenys K. Yarran, Chantal T. Yarran, Valerie M. Swift, Natasha R. Morrison, Kerryn J. Gidgup, Robyn S.M. Choi, Wilhelmina H.A.M. Mulders, Helen Goulios, Vincent O. Mancini, Christopher G. Brennan-Jones
Publication date 21-10-2024
Jareen Meinzen-Derr, Deborah Mood, Rose Sheldon, Mekibib Altaye, Lindsay Mays, Susan Wiley
Publication date 19-10-2024
To explore potential differences in the relationship between executive function (EF) skills and language development when integrating augmentative and alternative communication technology into speech-language therapy for deaf/hard of hearing (DHH) children. Randomized trial data were analysed to investigate this relationship among children who participated in a Technology-Assisted Language Intervention (TALI) compared to treatment as usual (TAU). Language samples were assessed for pre-post-intervention changes, including mean length of utterance in morphemes (MLU), mean turn length (MTL), and number of different words spoken (NDW). EF skills were measured with standardized parent-report assessment. Thirty-seven DHH children were included (TALI n = 19 and TAU n = 18). Results of regression models indicated that higher EF skills were significantly (p < 0.05) associated with improvements in MLU, MTL, and NDW among children who received TAU. No significant associations between EF skills and any of the measures (MLU, MTL, NDW) were seen in children who received TALI. These results suggest that TALI may offer language learning support, particularly for DHH children with EF difficulties. Future research should investigate the direct relationship between EF measurements and language outcomes in TALI recipients. Establishing baseline EF measurements in DHH children could inform personalized strategies within language interventions and therapy.
Pubmed PDF WebTalal Al-Khatib, Leenah Turkistani, Shahad Hani Abdu, Rana A. Alahmadi, Muhnnad A. AlGhamdi, Nadeem Butt
Publication date 19-10-2024
This systematic review and meta-analysis evaluated the efficacy of various glottic widening procedures (GWPs) in avoiding tracheostomy in infants with bilateral vocal cord paralysis (BVCP). A systematic literature search was conducted in Pub Med, Scopus, Web of Science, and Cochrane Library from inception to July 2023, without any timeframe limitations. Studies reporting GWPs (Endoscopic anterior-posterior cricoid split, Botox injection, suture lateralization, and other procedures including laser posterior cordotomy/arytenoidectomy) in infants with BVCP were included. Meta-analysis was performed to assess tracheostomy avoidance and secondary outcomes including voice, swallowing, and resolution of airway symptoms. Thirteen studies with 100 patients were included. The mean age was 51.6 days. The etiology of BVCP was idiopathic (83 %), neurologic (10 %), and acquired (7 %). The GWP interventions were successful in 88 % of patients, with only 12 % requiring tracheostomy after surgery. The pooled proportion for avoiding tracheostomy was 0.88 (95 % CI 0.82-0.94) across interventions, with no significant differences between techniques. Among patients who avoided tracheostomy, 64 % had normal voice, 86 % tolerated oral feeding, 77 % had airway symptom resolution, and 70 % had recovery of vocal cord mobility. GWPs prevent a majority of infants with BVCP from undergoing tracheostomy, without permanent alterations to laryngeal function. All interventions were comparable in efficacy. Further research with larger sample sizes is warranted.
Pubmed PDF WebEileen C. Howard, Jonathan M. Carnino, Nicholas Y.K. Chong, Jessica R. Levi
Publication date 19-10-2024
This study aimed to evaluate the potential integration of artificial intelligence (AI), specifically ChatGPT, into healthcare decision-making, focusing on its alignment with expert consensus statements regarding the management of persistent pediatric obstructive sleep apnea. We analyzed ChatGPT's responses to 52 statements from the 2024 expert consensus statement (ECS) on the management of pediatric persistent OSA after adenotonsillectomy. Each statement was input into ChatGPT using a 9-point Likert scale format, with each statement entered three times to calculate mean scores and standard deviations. Statistical analysis was performed using Excel. ChatGPT's responses were within 1.0 of the consensus statement mean score for 63 % (33/52) of the statements. 13 % (7/52) were statements in which the ChatGPT mean response was different from the ECS mean by 2.0 or greater, the majority of which were in the categories of surgical and medical management. Statements with ChatGPT mean scores differing by more than 2.0 from the consensus mean highlighted the risk of disseminating incorrect information on established medical topics, with a notable variation in responses suggesting inconsistencies in ChatGPT's reliability. While ChatGPT demonstrated a promising ability to align with expert medical opinions in many cases, its inconsistencies and potential to propagate inaccuracies in contested areas raise important considerations for its application in clinical settings. The findings underscore the need for ongoing evaluation and refinement of AI tools in healthcare, emphasizing collaboration between AI developers, healthcare professionals, and regulatory bodies to ensure AI's safe and effective integration into medical decision-making processes.
Pubmed PDF WebIsha Dhondekar, C.S. Vanaja
Publication date 17-10-2024
Children with visual challenges rely on their hearing ability to accomplish daily tasks more efficiently. Many investigations show changes in the auditory pathway in children and adults with early blindness. It can be hypothesized that the auditory processing abilities of children with congenital blindness will be superior to those of typically developing children without any visual challenges. The current study was designed to compare some of the auditory processing abilities of children with congenital blindness and typically developing children who do not have any visual challenges. Specifically, the study compared the perception of speech in noise, temporal patterning ability, binaural integration ability as well as auditory memory and sequencing abilities of children in two groups. It was a prospective cross-sectional study comparing two groups. A total of 160 children, 80 typically developing children without any visual challenges (reference group) and 80 children with congenital blindness, in the age range of 7-11 years, participated in the study. Pitch pattern test (PPT), perception of speech perception in noise test in Marathi (PSIN-M), dichotic digit test in Marathi (DDT-M), and auditory memory and sequencing test in Marathi (AMST-M) were administered. Independent sample T test and Mann Whitney U test were used to compare the performance of the two groups on these tests. Children with congenital blindness showed significantly better scores on PPT, PSIN-M, and DDT-M as compared to children in the reference group in all the age groups. A clear trend was not observed on DDT-M. It can be concluded that children with congenital blindness have better auditory processing, auditory memory, and sequencing abilities compared to typically developing children without any visual challenges.
Pubmed PDF WebA.A. Aygun, B.C. Cinar, L. Sennaroglu
Publication date 16-10-2024
The changes in the inner ear affect both the cochlea and the vestibule and these effects are observed after cochlear implantation surgery. The aim of the current study is to evaluate the effect of unilateral cochlear implant use on vestibulo-ocular reflex (VOR) in children.
In the current study, 29 cochlear implanted children, aged 7-18 years, were include as the study group and 32 children, in the same age range, were included with normal-hearing as the control group. vHIT was used to evaluate VOR and the results of unilateral CI users were compared with the control group.
The study group was evaluated in two different situations: cochlear implant sound processor on (CI-ON) and cochlear implant sound processor off (CI-OFF). The data obtained in the evaluations were compared between the implanted ear and the non-implanted ear between the CI-ON and CI-OFF states within the study group and between the study group and the control group.
When the CI-ON and CI-OFF conditions in the study group were compared, no significant difference was found (p > 0.05). Similarly, no significant difference was found between the implanted ear and the non-implanted ear (p > 0.05). Also, there was no significant difference in the comparisons between the study group and the control group (p > 0.05).
vHIT is a functional test method that can be used in children to test vestibular function after cochlear implant. vHIT is a comfortable test to use after cochlear implantation to demonstrate the functionality of the vestibular system. And it provides consistent results regardless of whether the speech processor is on or off.
Yasmine Madan, Jennifer M. Siu, Meghan E. Tepsich, Nicole K. McKinnon, Jackie Chiang, Evan J. Propst, Nikolaus E. Wolter
Publication date 16-10-2024
False passage (FP) after tracheostomy is an infrequent but potentially life-threatening complication. The practice of tracheal stomal maturation at the time of tracheostomy is variable amongst surgeons in pediatric patients, and it remains unknown whether or not maturation sutures decrease the risk of FP. Our objective was to evaluate the impact of maturation sutures on the incidence of FP after pediatric tracheostomy. A retrospective review of children who underwent tracheostomy (2001-2024) was performed. Records were reviewed for demographics and procedural details including use of maturation sutures. Outcomes included incidence of FP, time to FP and associated complications resulting from FP. One-hundred and twenty-five children met study criteria [median (IQR) age 0.5 (0.2-3.2) years]. Fifty-five children (44.0 %) received maturation sutures, with 31 (56.4 %) of these being four-point sutures, 10 (18.2 %) being two-point sutures (70 % of which were placed inferiorly), and 14 (25.5 %) being unrecorded. Four out of 125 (3.2 %) patients developed FP at a median (IQR) of 12.8 (4.6-13.5) days following tracheostomy insertion, and they all occurred within the first two tracheostomy changes. None of the patients who developed FP had maturation sutures. Of the four children who developed FP, three (75 %) had no further complications, and one (25 %) developed subcutaneous emphysema and pneumomediastinum. No deaths associated with FP were identified. This large single institution study evaluating the relationship between maturation sutures and FP in children undergoing tracheostomy suggests that maturation sutures may help prevent FP; however, ongoing work is required to validate these findings and guide clinical practice.
Pubmed PDF WebSeth C. Eckhardt, Clare M. Richardson, Klane K. White, Sanjay R. Parikh, Juliana Bonilla-Velez, John P. Dahl
Publication date 16-10-2024
Respiratory failure secondary to multilevel airway compromise may present complex airway challenges in patients with specific skeletal dysplasia diagnoses. This study sought to identify and characterize subgroups of skeletal dysplasia diagnoses that more frequently undergo operative airway evaluations and tracheostomy placement. Retrospective electronic medical record review of pediatric patients with an ICD-10 associated skeletal dysplasia diagnosis and CPT-specified airway intervention at a tertiary pediatric hospital from 1990 to 2022. Patients without a defined skeletal dysplasia diagnosis, subjects with craniosynostosis syndromes, and those with limited clinical data were excluded. Collected variables included demographics, age at diagnosis, comorbidities, operative procedures, and airway interventions. Descriptive statistical analysis was utilized to evaluate data distribution. From the initial population of 313 patients, 41 subjects were confirmed to have clinical features and/or genetic testing consistent with a skeletal dysplasia diagnosis. A tracheostomy was placed in 19/41 subjects and these patients' records were further analyzed. Skeletal dysplasia groups with more frequent tracheostomy placement included Filamins and related disorders, Sulfation disorders, and Chondrodysplasia punctata. In the patients with a tracheostomy, skeletal dysplasia was diagnosed at a median age of 0.3 years (IQR 4.8 years), and tracheostomy was initiated at a median age of 1.8 years (IQR 2.2 years). Only four of these patients were successfully decannulated, and two subjects are deceased. Over 32 years, nearly half of the skeletal dysplasia patients who underwent airway interventions eventually had a tracheostomy placed. Respiratory insufficiency and complex airway management challenges are common manifestations of skeletal dysplasia.
Pubmed PDF WebDaniel Peñaranda, Riley Hue Vo, Tania Sih, Graciela Gonzalez Franco, Tulio A. Valdez
Publication date 12-10-2024
To assess the real-world application of legislative measures and regulations governing newborn hearing testing in Latin America. An online survey was sent to the Interamerican Association of Pediatric Otorhinolaryngology (IAPO) network to investigate neonatal hearing screening practices. Twelve questions were asked about legislation, implementation, and barriers to neonatal hearing screening. A total of 89 pediatric otolaryngologists representing 20 Latin American nations participated in this survey. The majority of respondents (64 %) indicated the existence of neonatal hearing laws within their respective countries and correctly named the specific legislation. However, it is noteworthy that over half (58 %) of pediatric ear, nose, and throat specialists reported that these laws are not consistently put into practice in their daily clinical routines. Respondents from five countries disclosed that neonatal hearing screening is not conducted within the first month of an infant's life. While the majority of Latin American nations have established legislation concerning neonatal hearing screening, its application in clinical practice is lacking due to economic obstacles. Marked disparities across Latin America persist for neonatal hearing screening. Our study provides key insights and recommendations aimed at addressing these issues, including the need for stronger legislative enforcement, increased funding, improved infrastructure, targeted professional training, and expanded public education to strengthen this vital aspect of healthcare in Latin America.
Pubmed PDF WebTayebeh Kazemi, Sara S. Nabavizadeh, Reza Kaboodkhani, Ali Faramarzi, Erfan Sadeghi, Akram Rahmanipour
Publication date 16-10-2024
The objective of this study is to evaluate and compare the impacts of inferior turbinate monopolar submucosal cauterization and microdebrider-assisted inferior turbinoplasty on the sinonasal quality of life in pediatric patients with chronic nasal obstruction. A pilot randomized controlled trial. Tertiary hospital. This pilot clinical trial enrolled pediatric patients, all of whom had persistent inferior nasal turbinate hypertrophy. They were assigned to undergo either inferior turbinate monopolar submucosal cauterization or microdebrider-assisted turbinoplasty. The procedures were conducted under general anesthesia for both groups. Patient-reported sinonasal symptoms were assessed using the SNOT-22 questionnaire at baseline and during follow-ups. The study enrolled 52 pediatric participants aged 4-14 years for turbinate reduction, ending with 40 after follow-up losses. Nineteen underwent cauterization, and 21 had turbinoplasty. Both groups showed significant SNOT-22 score improvements at 1, 3, and 6 months post-surgery, though the turbinoplasty group had initially greater improvements. No significant differences were found in postoperative complications, except a higher malodor sensation incidence at one week in the cauterization group. In conclusion, both monopolar submucosal cautery and microdebrider-assisted turbinoplasty improved sinonasal quality of life in pediatric patients. Monopolar cautery was associated with more early postoperative malodor but may offer potential cost-effectiveness and simplicity. Further research is needed to validate these findings and refine surgical approaches.
Pubmed PDF WebZofnat Asulin, Ohad Cohen, Boaz Forer, Jean-Yves Sichel, Pierre Attal, Chanan Shaul
Publication date 11-10-2024
Tonsillar surgery is a common intervention for pediatric obstructive sleep apnea and recurrent tonsillitis. This study compared postoperative bleeding incidence and severity following tonsillotomy and tonsillectomy at a single medical center. A retrospective cohort study on 1984 pediatric patients (1-18 years old) who underwent surgery during 2004-2011 and 2019-2022. Tonsillectomy was performed during 2004-2011, while tonsillotomy was preferred for obstructive sleep apnea during 2019-2022. Tonsillectomy was performed using cold steel technique with complete removal of tonsillar tissue, while tonsillotomy was conducted using mono- or bipolar diathermy, preserving minimal tissue on the tonsillar capsule. Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University. Outcome measures included postoperative bleeding incidence and severity, surgery duration, hospitalization length, and readmission. Tonsillotomy was conducted on 958 (48.3 %) patients, and tonsillectomy was performed on 1026 (51.7 %) patients. Obstructive sleep apnea was the only indication in 1553 (78.3 %) patients. Overall bleeding rate was lower following tonsillotomy (3.9 %) than tonsillectomy (9.5 %) (p < 0.001). Significantly more patients required surgical bleeding control post-tonsillectomy than post-tonsillotomy: 39 (3.7 %) vs. 5 (0.5 %), respectively (p < 0.001). Tonsillectomy resulted in higher readmission rates (11.8 % vs 6.1 %, p < 0.001), more blood transfusions (3 vs. 0), and higher postoperative hemoglobin diminution (1.57 ± 2 vs. 0.94 ± 1 g/dL, p = 0.035). The duration of the surgery was shorter for tonsillotomy (24.7 vs 26.5 min, p = 0.012). Tonsillectomy sustained higher bleeding rates for obstructive sleep apnea patients (7.0 % vs 3.9 %, p = 0.006). For recurrent tonsillitis patients, bleeding rates did not vary between year groups. Older age and tonsillectomy were the most significant risk factors for postoperative bleeding. Among children undergoing tonsillar surgery for obstructive sleep apnea, tonsillotomy was associated with a safer postoperative bleeding profile, reduced bleeding severity, and fewer readmissions compared to tonsillectomy.
Pubmed PDF WebTaylor Loth, Rebecca Compton, Zahrah Taufique, Andrew Redmann, Brianne Barnett Roby
Publication date 06-10-2024
To analyze the language of letters of recommendation for pediatric otolaryngology fellowship for possible gender and/or racial bias. To refine methodology for future investigation of gender and language within letters of recommendation for pediatric otolaryngology fellowship. Practicing pediatric otolaryngologists were recruited as survey participants. A total of 10 letters of recommendation were screened to represent an equal number of applicants who identify as male and female and an equal number of applicants who identify as White and applicants who identify as Black, Indigenous, or a Person of Color. Names, pronouns, location, and other identifying information were removed from the letters. Survey participants were asked to read each letter and categorize the applicant's gender and race as well as that of the letter writer. The letters were also subject to analysis by Word Stat linguistic software. A total of 35 pediatric otolaryngologists participated in the survey. Participants assigned gender of the applicant correctly in 43 % of letters and gender of the letter writer correctly in 53 % of letters. Race of the applicant was judged correctly in 65 % of letters. Participants indicated words such as caring, hard-working, and prepared led them to assume the applicant was female, which was corroborated by linguistic analysis. No such words were identified as predictive of race. This pilot study suggests that while there are certain linguistic associations with gender among applications to pediatric otolaryngology fellowship, they may not impact biases held by the reader. This is relevant given a recent rise in the number of female applicants to this subspecialty and ongoing unfilled fellowship positions. Future studies are needed to determine if such associations exist and ultimately affect match potential and success within the field. These studies will require analysis of more letters and with more survey respondents, along with a higher in-depth linguistic analysis. This pilot study aims to evaluate letters of recommendation for pediatric otolaryngology fellowship applications for gender bias with the goal of outlining future studies. There were certain words associated with a given gender, which could impact applicants' potential to match. NA.
Pubmed PDF WebAlexandra E. Tunkel, Anisa Benbourenane, Hengameh K. Behzadpour, Md Sohel Rana, Tracey Ambrose, Eve Kronzek, Diego A. Preciado, Brian K. Reilly
Publication date 06-10-2024
Auditory brainstem response (ABR) testing is the gold standard for diagnosis of hearing loss in children who cannot complete behavioral audiometry. Testing under general anesthesia is often recommended when natural sleep ABR and/or behavioral audiometry are unsuccessful. This study aims to determine which demographic and patient factors serve as barriers to receiving this diagnostic testing.
A retrospective chart review from an internal database of patients who underwent ABR testing under anesthesia from 2017 to 2023 was completed. Patient demographics, clinical diagnoses, dates of initial recommendation, and dates of testing were recorded.
A total of 395 patients met inclusion criteria, with a median time from initial evaluation to successful ABR under anesthesia of 5.1 months (range 0.1-209 months).
This time was significantly higher in patients with public insurance compared to private insurance and in patients with the following medical complexities: cardiac disease, developmental delay, neurologic disease, eye disease, and genetic syndromes not associated with hearing loss. The interval was significantly shorter in patients with abnormal ear anatomy.
Patient factors, such as insurance type and certain medical diagnoses, may lead to delayed ABR testing under anesthesia and thus delayed diagnosis and management of hearing loss. This has implications for the timely care and treatment of children with hearing loss.
Laura Jelušić, Hrvoje Vidić, Andrijana Včeva, Željko Zubčić, Hrvoje Mihalj, Zlatko Kljajić, Ivan Abičić, Kristina Kralik, Tihana Mendeš
Publication date 03-10-2024
The aim of this study was to measure tonsils and adenoid vegetations, investigate the modified Mallampati score, determine BMI according to body mass and corresponding percentile, and compare these data with the results of the Pediatric Sleep Questionnaire (PSQ). The subjects were children aged 2 to 18 who were indicated for adenotonsillectomy at the Clinic for Otorhinolaryngology and Head and Neck Surgery. A doctor specialist conducted the clinical examinations. According to the PSQ, 75 subjects were divided into two groups: those at high risk and those at low risk for developing obstructive sleep apnea (OSA). The PSQ results showed that 45 subjects (60 %) were at high risk for OSA, and these subjects had significantly lower weight and BMI. Although a higher number of subjects had grade 4 tonsils and grade 3 and 4 adenoids, this distribution was not statistically significant. There was no statistically significant difference in the distribution of the modified Mallampati score when compared with the PSQ results. Lower body mass and BMI were statistically significant risk factors for OSA, while the size of the tonsils and adenoids, as well as the modified Mallampati score, did not show any statistically significant difference in comparison with the PSQ results.
Pubmed PDF WebMichael D. Puricelli
Publication date 02-10-2024
To characterize medical complexity and advanced interventions necessary to treat pediatric patients with chronic ear disease. A retrospective case review of children who received surgery for chronic otitis media, cholesteatoma, or tympanic membrane perforation at a tertiary children's hospital from 2020 to 2024 was performed. The frequency and type of medical complexities as well as distribution and success of advanced otologic interventions were recorded. Operations were performed on 80 ears. Forty-five percent were in medically complex patients. Twenty-five percent had a syndrome, 13 % had American Society for Anesthesiologists Severity Class 3 or more, and 38 % attended multi-disciplinary programs. Advanced audiology testing protocols were utilized in 53 % of patients, and multiple children received complex sleep and airway operations. Advanced surgical techniques were required in 58 %. Post-operatively, an intact tympanic membrane was achieved in 95 % of operated ears (p < 0.01). Residual and recurrent cholesteatoma were each present in 5 % of cases, with mean follow-up of 11.6 months. Otorrhea reduced from 64 % of patients pre-operatively to 2 % post-operatively (p < 0.01), including cessation in all individuals who reported social/bullying issues related to ear drainage/odor. Unrestricted water exposure was achieved in 99 % of individuals (p < 0.01). Patients showed a mean improvement after surgery of 7.6 dB, as measured by the change in air-bone gap (p < 0.05). Comprehensive treatment of otologic conditions included care that was holistic of all medical needs, integrated with other services, developmentally appropriate, encompassing of non-otologic procedures, technically advanced, effective, and functionally-focused. Surgical teams should endeavor together to provide this combination of services.
Pubmed PDF WebTimothy Davies, Anne Markey, Noor Janjua, Jacquline Chan, Kate Stephenson, Heather Newport, Thushita Kunanandam, Christine English, Jaya Nichani, Kade Harbert, Eishaan Bhargava, Miran Pankhania, Ayla Tabaksert, Steven Powell, Emily Davis, Richard Brown, Rhodri Costello, Jack Sandeman, Sarah ODonnell, Mary Consunji
Publication date 03-10-2024
In winter of 2022/3 paediatric ENT surgeons across the UK observed that the incidence of severe abscesses in the head and neck and associated complications was higher than seen in previous years. We aimed to collate and evaluate data from across the UK to establish if this was a true rise in cases, and to describe the factors associated. A multicentre retrospective data collection was undertaken from 13 units across the UK. Patients admitted between September 2022-February 2023 with a head and neck abscess including sinogenic, otogenic, deep and superficial neck abscesses were included. Demographic, disease specific, management and outcome data were collected. Hospital episode statistic data were also requested and analysed to allow for comparison with previous 10 years of head and neck abscesses. 262 patients with abscesses of the head and neck were admitted during the study period, 100 between September and November and 163 between December and February. Mastoid abscesses were the most common abscess across both groups. The rate of group A streptococcus + culture results rose significantly from 12 % in autumn group to 30 % in winter (p = 0.02). The rate of intracranial complications rose from 10 % to 18 % (p = 0.11) and the rate of venous thrombosis rose over the same timeframe from 3 % to 14 % (p = 0.01). This study demonstrated a statistically significant rise in the rate of group A streptococcus associated abscesses when comparing Autumn and Winter 2022/2023. Over the same timeframe a statistically significant rise in the proportion of patients with venous thromboses associated with H&N abscesses was noted. Interestingly, despite perceived national consensus regarding a spike in abscess incidence, the number of abscesses seen in winter 2022/2023 was in keeping with expected rates of paediatric H&N abscesses, based on pre covid year-on-year rise in incidence.
Pubmed PDF WebZhenyu Yang, Ziyi Liu, Jie Zhang, Xiaoxiao Li, Daxiong Zeng, Chuanyong Mu, Junhong Jiang
Publication date 29-09-2024
To observe the complications and inflammatory responses caused by the different types of metal stents in the trachea of rabbits. 79 rabbits were randomly divided into 4 groups and were implanted with the customized nickel-titanium alloy metal stents(fully covered metal stent: group A, bare metal stent: group B, segmented covered metal stent: group C and control group: group D). The complications (tracheal deformation, granulation tissue hyperplasia, scar hyperplasia and secretion retention) of different types of metal stents were compared by observing the anatomical and pathological specimens of dead rabbits; And the expression of inflammatory factors of different types of metal stents were compared by detecting the tissue of tracheas of dead rabbits. (1)There were significant differences in the above four complications among groups A, B and C(p < 0.01). The incidences of tracheal deformation, scar hyperplasia and secretion retention in group A were significantly higher than that in group B(p < 0.0167), however, the incidence of granulation tissue hyperplasia in group A was significantly lower than that in group B(p < 0.0167). The incidence of scar hyperplasia in group A was significantly lower than that in group C(p < 0.0167) and there were no significant differences in other complications between these two groups(p > 0.0167). The incidences of tracheal deformation, scar hyperplasia and secretion retention in group B were significantly lower than that in group C(p < 0.0167), however, the incidence of granulation tissue hyperplasia in group B was significantly higher than that in group C(p < 0.0167). (2)The concentration of IL-1β in group A was higher than that in group B (p < 0.05 and foldchange>1.2). (1)There are significant differences in complications between the fully covered metal stent, bare metal stent and segmented covered metal stent; the incidences of complications between the segmented covered metal stent and fully covered metal stent are similar. (2)Changes in different inflammatory factors can be observed between the fully covered and bare metal stent.
Pubmed PDF WebAnsar Ahmmed, Sabarinath Vijayakumar
Publication date 29-09-2024
Decreased sound tolerance (DST) is common in children with auditory processing disorder (APD). This study aimed to differentiate between hyperacusis and misophonia in children with APD. A retrospective study evaluating outcomes of structured history and co-morbidity following Research Domain Criteria (RDoC) frame-work. Misophonia was considered as oversensitivity to eating/chewing sounds and hyperacusis as oversensitivity to other sounds. Two hundred and seventy-nine children (160 males; 119 females), 6-16 year-olds with NVIQ ≥80, diagnosed with APD between January 2021 and December 2022. One hundred and forty-three out of 279 children with APD had DST, of which 107 had hyperacusis (without misophonia) and 36 had misophonia. Misophonia co-existed with hyperacusis in 35 children (97 %), and in one child misophonia occurred without hyperacusis. Misophonia was prevalent in older children, in females, and those with tinnitus. Fear and being upset were predominant emotional responses in hyperacusis (without misophonia) while disgust and verbal abuse were prevalent in misophonia (with or without hyperacusis). Compared to children without DST, the hyperacusis (without misophonia) and misophonia (with or without hyperacusis) groups had significant higher prevalence of ADHD, anxiety, and language impairment. Educational difficulties were similar in APD irrespective of the presence or absence of DST. Despite higher tinnitus prevalence in misophonia (with or without hyperacusis) along with similar co-morbidities and educational difficulties in both hyperacusis (without misophonia) and misophonia (with or without hyperacusis), the misophonia (with or without hyperacusis) group surprisingly had less support at school which was reflected in fewer Education, Health and Care Plan (EHCP). In APD misophonia mostly co-exists with hyperacusis, with differences in emotional responses, tinnitus prevalence, and gender distribution when compared to hyperacusis (without misophonia). Increase in awareness about misophonia is needed, as children with misophonia may have unidentified needs. Larger scale prospective study is required to clarify if misophonia evolves from hyperacusis, and to explore the factors underlying 'misophonia with hyperacusis' and 'misophonia without hyperacusis'. For clarity, DST studies need to specify if hyperacusis or misophonia co-existed when referring to hyperacusis or misophonia.
Pubmed PDF WebQiang Du, Zengjun Sun, Weijia Kong, Hao Wu, Yun Li, Chunfu Dai
Publication date 28-09-2024
This prospective multicenter clinical trial was to evaluate the safety and effectiveness of a novel cochlear implant (CI) system, the LISTENT LCI-20PI device in prelingually deafened children (<6 years old). The LCI-20PI CI system was implanted in 70 prelingually deafened children (<6 years old). The median age (interquartile range) at implantation was 3 years old (2-4 years old). The status of the LCI-20PI devices was evaluated through CI device testing and fitting including measurement of electrically evoked compound action potential (ECAP), electrode impedances, subjective thresholds (T levels), and subjective comfort levels (C levels). The safety and effectiveness of the devices were evaluated during 1-year follow-up. The clinical trial registration number is ChiCTR2200067092. ECAPs were successfully measured in 92.8% (64/70) recipients intraoperatively and in 94.3% (66/70) recipients during device activation. Most of the impedances (99.7%) were within normal limits of 0.7-20 k Ohm. The median (interquartile ranges) Meaningful Auditory Integration Scale/Infant-Toddler Meaningful Auditory Integration Scale (MAIS/IT-MAIS) was 95% (85%-97.5%) at 12-month post-activation testing. Median (interquartile range) close-set monosyllabic-word recognition score (MRS) and disyllabic-word recognition score (DRS) in children 3-6 years old at 12-month post-activation testing were 86% (77%-97%) and 90% (70%-100%), respectively. The new developed LCI-20PI CI device proved safe and effective in prelingually deafened children (<6 years old) in the clinical trial. This CI system could be a cost-effective alternative for prelingually deafened children.
Pubmed PDF WebMagdalena Beata Skarżyńska, Elżbieta Gos, Milaine Dominici Sanfins, Patryk Hartwich, Piotr Henryk Skarżyński, Agata Szkiełkowska
Publication date 27-09-2024
The AMSA® manosonic nebulizer uses acoustic vibration and a flow of air to create an aerosol from a solution or suspension of a drug. The aerosol created this way is claimed to have enhanced penetration and drug delivery. It is administered under short-term overpressure, meaning that the aerosol is able to penetrate into the middle ear through the Eustachian tube (ET).
of the study: The aim of this study is to identify the active substances used in AMSA® manosonic nebulization for treating common ENT diseases in children aged 2-17 years and to evaluate the overall effectiveness of AMSA® manosonic nebulization in this context.
Assessments were done by comparing conditions before and after nebulization using the following tests: (1) Eustachian tube function test, (2) tympanometry, and (3) otoscopy.
This study was a retrospective study with ethics committee consent. 129 children, comprising 56 girls and 73 boys. They were aged between 2 and 17 years, with a mean age of 6.9 years (SD = 3.0). There were 74 children up to 6 years and 55 children over 6 years of age.
Children had the following conditions: (1) chronic otitis media with effusion, OME (n = 86), (2) Eustachian tube dysfunction, ETD (n = 34) (3) Other conditions (e.g. cholesteatoma, retraction pocket), (n = 9).
Combination of medicines administered in this study was: Budesonide + ambroxol (with or without Na Cl), Budesonide (with or without Na Cl), Budesonide + N-acetylcysteine (with or without Na Cl), Budesonide + hyaluronic acid, Budesonide + ambroxol (with hyaluronic acid), Ambroxol (with or without Na Cl).
The number of nebulizations ordered was between 1 and 20 treatments, but most commonly, pa-tients were given a nebulization series of 10 treatments. This was the case for 80.6 % of the patients. Most patients with OME and ETD had 10 treatments ordered (79 % and 79.5 %, respectively), while all patients with other conditions had 10 treatments. Analysis of the tympanometry results was done in terms of the number of affected ears (not by individual). There were 210 ears with complete tympanometry (both pre and post), including 142 ears with OME, 54 with ETD, and 14 others. Statistically significant changes (improvements) after AMSA nebulizations were found for statistic compliance and middle ear pressure. Otoscopy assessments were done in all ears. The results were abnormal in 155 ears (73.8 %) and normal in 55 ears (26.2 %). After AMSA nebulizations, the number of abnormal results decreased to 117 ears (55.7 %) and normal results were found in 93 ears (44.7 %).
Use of the AMSA manosonic nebulizer appears to be an effective way of improving chronic medical conditions in children - such as chronic otitis media with effusion and Eustachian tube defect - but only if patient compliance can be achieved. The most frequently used active substance was budesonide, irrespective of whether additional secretolic/mucolytic agent was administered.
I.H. Marks, J. Ridgley Vaidya, O. Israel, P. Nixon, R. Sharma
Publication date 25-09-2024
Injection of botulinum toxin into salivary glands is a well-established treatment for sialorrhea in children, but the absolute need for radiological guidance has not been tested. Single-centre study in which clinicians of varying seniority attempted blind injection of salivary glands, after which their position within or outside the gland was confirmed by ultrasound guidance before the injection is administered. 117 patients underwent botulinum toxin of salivary glands between November 2008 and August 2023, with 459 glands injected in total. 24 (5 %) glands were injected by medical students, 32 (7 %) by junior trainees (foundation doctors or senior house officers), 343 (75 %) by registrars or senior fellows and 36 (8 %) by consultants. 160 (68 %) of injections to the parotid gland were on target, and 74 (32 %) submandibular gland were on target (P < 0.01). No differences were detected on likelihood of success depending on seniority of practitioner, age of patient or hand dominance. Ultrasound guidance ought to be recommended for injection of botulinum toxin into salivary glands regardless of the seniority of the practitioner.
Pubmed PDF WebAmy Callaghan, Hamdy El-Hakim, Amanda R. Adsett, Daniela M. Isaac, Andre Isaac
Publication date 21-09-2024
There is growing research on the association between swallowing dysfunction and laryngomalacia. Supraglottoplasty is the surgical intervention used to treat laryngomalacia, however a portion of patients who undergo this procedure will require a revision surgery. Predictive risk factors for revision supraglottoplasty in patients with laryngomalacia are not well understood, and previous studies failed to evaluate swallowing systematically. We predict a significant association between swallowing dysfunction and revision supraglottoplasty for patients with laryngomalacia. This was a retrospective cohort study of consecutive patients between 2013 and 2023 at a tertiary pediatric care centre (Stollery Children's Hospital). All patients had an endoscopic diagnosis of laryngomalacia by a staff otolaryngologist and at minimum a systematic clinical swallowing assessment by a speech language pathologist, with an instrumental assessment as needed. Patients with genetic or neurological comorbidities, lack of follow up information, or age of >3 years were excluded. Clinical and instrumental swallow data, demographic information, surgical outcomes and revision surgeries were documented and collected. Univariate analysis was done to determine associations between variables and revision supraglottoplasty. Binary logistic regression was done to determine independent predictors of revision supraglottoplasty. 214 patients met the inclusion criteria and were analyzed in the study. 24 patients (11 %) required revision supraglottoplasty. 118 out of the 214 patients (55 %) had an instrumental assessment completed (FEES or VFSS). Of those, 92 (78 %) had abnormal findings on instrumental assessments. Univariate analysis showed Type 2 laryngomalacia (P = 0.017), presence of aspiration (P=<0.001), presence of cyanosis (P = 0.002) and abnormal findings on an instrumental assessment (P = 0.013) to be significantly associated with the need for revision supraglottoplasty. Binary regression analysis showed aspiration (OR = 5.6 {2.087-14.889}, P=<0.001) and cyanosis (OR = 5.3 {1.852-15.181}, P = 0.002) to be the only independent predictors of revision supraglottoplasty. Presence of aspiration is a strong predictive factor for revision supraglottoplasty in patients with laryngomalacia, when swallowing is evaluated systematically. More prospective research is needed to understand the relationship between swallowing dysfunction, laryngomalacia and surgery.
Pubmed PDF WebJessie G. Jiang, Sarah A. Gitomer, Suhong Tong, Brian W. Herrmann, Ilana Neuberger, David M. Mirsky
Publication date 17-09-2024
Existing literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging. A retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19-20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate. In this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB. The prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.
Pubmed PDF WebAshley L. Heilingoetter, Goh Bee See, James Brookes, Paolo Campisi, Sergio Santino Cervantes, Neil K. Chadha, Daniel Chelius, Diane Chen, Bob Chun, Michael J. Cunningham, Jill N. DSouza, Taseer Din, Titus Dzongodza, Christian Francom, Thomas Q. Gallagher, Mark E. Gerber, Michael Gorelik, Steven Goudy, M. Elise Graham, Benjamin Hartley
Publication date 16-09-2024
First branchial cleft anomalies are rare congenital head and neck lesions. Literature pertaining to classification, work up and surgical treatment of these lesions is limited and, in some instances, contradictory. The goal of this work is to provide refinement of the classification system of these lesions and to provide guidance for clinicians to aid in the comprehensive management of children with first branchial cleft anomalies. Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature. Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions. The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management.
Pubmed PDF WebCarmelo Morales-Angulo, Jaime Gallo-Terán, Rocío González-Aguado, Esther Onecha, Ignacio del Castillo
Publication date 13-09-2024
Genetic variants in the OTOF gene are responsible for non-syndromic hearing loss with an autosomal recessive inheritance pattern. The objective of our work was to evaluate the clinical characteristics of patients with biallelic pathogenic variants in OTOF and their evolution after treatment. A cohort of 124 patients with prelingual hearing loss, studied from 1996 to 2023, was included in this study. A genetic analysis was conducted to identify the type and frequency of variants in the OTOF gene and their relation to the clinical characteristics of the patients. The homozygous p. Gln829* variant in the OTOF gene was detected in 3 probands (2.4 %) of a group 124 individuals with prelingual hearing loss. Another 6 family members to a total of 9 individuals were finally included. All presented with severe/profound bilateral sensorineural hearing loss of congenital onset. Three of these individuals were diagnosed with auditory neuropathy spectrum disorder. One individual passed the OAE test during the screening program, and since he did not have risk factors for hearing loss that would warrant ABR testing, this led to a delay in his hearing loss diagnosis. Four individuals underwent cochlear implants (three bilateral) with good functional outcomes. In three of them. However, in 17 familial cases with heterozygous variants, either no hearing loss was observed or it was within the expected range for their age. Hearing loss secondary to the p. Gln829* variant of the OTOF gene is relatively rare in our medical area. Its presence in homozygosity is the cause of severe/profound bilateral prelingual sensorineural hearing loss, responsible for auditory neuropathy with a good response to cochlear implantation.
Pubmed PDF WebMarit J.B. van Stigt, Saskia Coenraad, Inge Stegeman, Robert J. Stokroos, Stefaan H.A.J. Tytgat, Maud Y.A. Lindeboom, Arnold J.N. Bittermann
Publication date 12-09-2024
Laryngeal Cleft (LC) is an anatomical defect that can cause swallowing difficulties and subsequent recurrent respiratory symptoms. LC can be treated surgically by performing suture repair or by Injection Laryngoplasty (IL). The indications and efficacy of IL are debated among pediatric otolaryngologists. The aim of this survey study was to review the international perspective on IL for LC. An online survey was conducted to assess international opinions on the indications and efficacy of IL for LC patients. An online survey was sent to 250 pediatric otolaryngologists worldwide. The survey included questions on the management of LC, the physicians' experience with IL, and their use of IL. Sixty two (25 %) pediatric otolaryngologists, from 47 medical centers, completed the survey. Of the respondents, 38 (62 %) perform IL. The most reported indication was as a diagnostic tool. For the respondents who did not perform IL, the reasons most reported were that the effect is temporary and that there is a need for a second surgery after IL. According to this survey, the perspectives on the use of IL for LC differ among pediatric otolaryngologists, and there is variation in peri-and postoperative standard of care. The respondents' opinions on IL were partly dependent on the intended outcome of its use, i.e., as a permanent treatment or for other indications.
Pubmed PDF WebFrancesca C. Viola, Beatrice R. Bacon, Jason C. DeGiovanni, Gaayathri Varavenkataraman, Michele M. Carr
Publication date 12-09-2024
Our objective was to describe non-concussion head and neck ice hockey injuries in children in the US. This is a retrospective cohort study using data from the NEISS database. The NEISS database was reviewed from 2010 to 2021 for injuries in the head, neck, mouth, eye, and ear related to ice hockey in children 1-18 years old. Records where the only injury was a concussion or internal head injury were removed. Frequencies were calculated and chi-squared tests were performed. 475 children were included, with mean age of 13.1 years old (95 % CI 12.7-13.4), and 426 (89.7 %) were male. Females were significantly younger with mean age 11.8 years versus 13.2 years for males (t = -2.4, df = 473, p = .018). 110 (23.2 %) injuries were related to hockey sticks, 92 (19.4 %) involved a fall, and 32 (6.7 %) were subsequent to body checking. 301 of the injuries (63.4 %) were lacerations, 71 (14.9 %) contusions or abrasions, and 26 (5.5 %) strains and sprains. The type of injury varied according to head and neck region (p < .001). 231 (82.8 %) of facial injuries, 16 (76.2 %) of ear injuries, and 33 (62.3 %) of oral injuries were lacerations. Eight (1.7 %) patients were admitted or observed overnight, while the rest were discharged home. Female ice hockey players sustain injuries at younger ages than males, which may reflect the loss of older girls from the sport. In older boys, injury rates may reflect the loss of mandated full face protective shields.
Pubmed PDF WebEmmett Lui, Owen Conlan, Karen Hunter, Avril Mason, Haytham Kubba
Publication date 11-09-2024
Hearing loss is common in people with osteogenesis imperfecta (OI), although exactly how common is unknown. The prevalence of hearing loss in children with OI has been reported to be anything from 0 to 77 %. Brittle Bone Society guidelines suggest that, unless there are ear symptoms, children with OI should have their hearing tested every three years starting at age three. There is limited evidence to support this recommendation. We postulate that annual hearing screening would be easier to manage and would have a worthwhile pick-up rate.
In March 2019 we began a programme of annual hearing screening for all children (ages 0-16) with OI. We collected data on age, genotype, otoscopy findings, tympanometry findings, audiometric test results and subsequent outcomes for the first five years of our programme (2019-2024).
Nineteen children with OI participated in the screening programme.
Only one abnormality was found: a unilateral mild hearing impairment with a type B tympanogram, suggesting middle ear effusion. This was present in year 2 of the programme but resolved by year 3.
The screening programme has a low pickup rate (5 %) for new otological problems in the paediatric population. However, we believe that the low cost and small workload associated with the screening programme justifies continuing it until further conclusions can be drawn.
Ostap Orishchak, Alexander Moise, Faisal Al-Osamey, Kimberley Kaspy, Sam J. Daniel
Publication date 07-11-2024
A diagnostic pathway to detect aspiration is challenging and usually requires a multidisciplinary approach and a variety of tests. Lipid-laden macrophage index (LLMI) was first described in 1985 by Corwin and Irwin as a promising tool to detect aspiration. Information in the literature as well as physicians' opinions about the clinical value of the LLMI remains controversial.
To assess the clinical value and possible limitations of LLMI as a diagnostic marker for detecting aspiration in children.
Based on the available literature we thought to answer the following questions: 1. Is there a reliable cutoff value of LLMI to detect aspiration? 2. What are the limitations of LLMI? We queried 8 electronic databases: Medline, Embase, CINAHL, Cochrane, Global Health, Web of Science, Africa Wide Information, and Global Index Medicus. Studies were selected based on established study criteria. Search was limited to publications in English language including human and animal studies. Authors reviewed 2900 articles and identified 21 relevant to the studied subject.
Research reveals different proposed cutoff values for aspirators ranging from 85 to 200 macrophages.
LLMI reliability has several limitations including: inter- and intraobserver variability among pathologists scores, inability to differentiate between exogenous and endogenous lipid content, inconsistencies in the definition of the term "aspiration" in various publications. Also, studies in animal models have shown that the nature of the disease, frequency of aspiration, and the time frame when bronchoalveolar lavage (BAL) is performed, could all contribute to the overlap in LLMI in aspirators versus non-aspirators.
Our research demonstrates the limitations of LLMI in distinguishing between aspirators and non-aspirators. We believe based on these findings that airway teams should audit their local data as to the value of BAL in detecting aspiration in their patient population.
Alireza Sharifi, Peter H. Hwang, Mohaddeseh Zojaji, Sahar Ghaedsharaf, Samad Samadizadeh, Mohammad E. Ghaffari, Z. Jason Qian
Publication date 05-11-2024
A growing body of literature explores environmental risk factors for pediatric epistaxis, yielding variable results. We aim to clarify these associations through a systematic review and meta-analysis. Pub Med, Scopus, Cochrane Central Register of Control Trials, Web of Science, Medline, Google Scholars, and Embase were systematically searched up to April 2024. Eligible articles were reviewed, and the quality was assessed. A systematic review and meta-analysis was conducted to clarify correlations between the incidence of epistaxis and multiple environmental factors according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 8 studies, comprising 55,176 participants, met the inclusion criteria. The incidence of epistaxis peaked during the summer months (Proportion = 12.73 %, CI: 9.629 %-16.201 %). Significant risk factors included environmental variables elevated in the summer, including higher monthly mean temperatures, increased sunlight exposure, elevated O3 levels, and lower atmospheric pressure. In contrast, factors like mean monthly humidity, wind speed, SO2, CO, NO2, and PM-10 levels were not associated with an increased risk of epistaxis. This meta-analysis underscores the significant impact of multiple environmental factors, particularly those more pronounced during the summer months, on the incidence of pediatric epistaxis.
Pubmed PDF WebOzlem Ertugrul, Osman Ilkay Ozdamar, Levent Naci Ozluoglu
Publication date 25-10-2024
(s): This study aims to evaluate the changes in temporal auditory processing skills in children who underwent bilateral ventilation tube insertion (VTI) due to Otitis Media with Effusion (OME) and the effect of these changes on speech comprehension in noisy environments. This is a case-control study. In total, 60 children were included in the study in two groups. The control group included 30 children aged 11 to 15, who had normal hearing thresholds and normal immitancemetric evaluation, and were not diagnosed with OME. The study group included 30 children, aged 11-15 who underwent bilateral VTI surgery after their diagnosis of OME during the ages of 3-10 and currently had normal hearing thresholds and normal immitancemetric values. Each group underwent the Turkish Matrix Test (TMT), Random Gap Detection Test (RGDT), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Cortical Auditory Evoked Potential Test (CAEP). When the temporal processing tests (FPT, DPT, RGDT) were compared, a significant difference was obtained between the study group and the control group (p < 0.05). With the TMT, significantly lower scores were obtained in the study group compared to the control group (p < 0.01). In addition, the latency values in the cortical auditory evoked potential test were longer in the study group compared to the control group, but these results were not statistically significant (p > 0.05). As a result of the study, it is concluded that the central auditory processing skills were affected in children with a history of bilateral VTI due to OME. Temporal processing tests, Turkish Matrix Test and Cortical Auditory Evoked Potential tests can be recommended as reliable and easily applicable tests, together with traditional hearing test methods in children with a history of OME, in order to evaluate comprehension skills in classroom noise.
Pubmed PDF WebHannah Walter, Mihiar Atfeh
Publication date 21-10-2024
Recurrent respiratory papillomatosis (RRP) represents a clinical challenge, often necessitating multiple interventions to help mitigate against disease recurrence or airway obstruction. Multiple management strategies have been advocated by specialists regarding the management of RRP. However, the success rates and disease progression still vary widely. One promising treatment is bevacizumab, a vascular endothelial growth factor (VEGF) monoclonal antibody, which had been initially introduced systemically. More recently, intralesional bevacizumab has become one of the newest arms in dealing with RRP. The aim of this study is to systematically review the literature on the effectiveness, applicability and usage of intralesional bevacizumab in the treatment of RRP. A systematic search was carried out on MEDLINE, Embase, Journals@Ovid and Pub Med. PRISMA guidelines were adhered to in the reporting of this study. Study quality and bias risk was assessed using the Newcastle-Ottawa Scale (NOS). 6 studies have met our inclusion and exclusion criteria, one randomised doubled blinded placebo-controlled pilot study, one case series, three prospective and one retrospective study, encompassing a total of 108 patients. Anatomical, functional and objective outcomes are presented and scrutinised. Where reported, complete remission or minimal recurrence was identified in 34/38 (89 %) patients following treatment with intralesional bevacizumab. However, outcome measures were not consistent across all studies making it difficult to draw direct comparisons. Of the 6 studies, 2 (33 %) were deemed poor quality and 4 (66 %) fair quality. No adverse effects of intralesional bevacizumab were reported. This study's findings suggest a potential role for intralesional bevacizumab in the management of RRP objectively and functionally. Further research is required to necessitate a stronger evidence base, paying close attention to dose optimisation, assessment of long-term side effects and management of less severe disease phenotypes.
Pubmed PDF WebBahareh Khavarghazalani, Zahra Hosseini Dastgerdi, Morteza Hamidi Nahrani, Maryam Emadi
Publication date 08-10-2024
Auditory perception process is a transient phenomenon, which enables the person to make the relationship between events and auditory factor by working memory and obtain the sequence of auditory features and be able differentiate the auditory sources by using these component. In auditory processing, the basis formed by bottom - up process (data - driven). This pathway is dependent on the central auditory integration and also on acoustic signal input and interpreting auditory information is involved top-down process (concept - driven), which this pathway is dependent on central higher resource such as perception, attention, working memory and its span. The purpose of this study was to address information about top-down processing and auditory processing disorder. A review of the latest literature on (central) auditory processing disorders and top-down processing was performed using PUBMED, EBSCO, SCIENCE DIRECT, ASHA, GOOGLE SCHOLAR, THIEME, PROQUEST data sources. Deficit in cognitive processing of auditory information in children cause difficulty in processing auditory information and outbreak auditory processing disorder symptoms. Cognitive evaluation (especially working memory) in this subject is important as bottom-up processing evaluation.
Pubmed PDF WebZhi Ling Wang, Yu Ling Shen, Ting Wu, Hui Ni, Ya Qin Zhou, Wen Juan Wang
Publication date 07-10-2024
This study aimed to investigate the effectiveness of applying a multiphase optimization strategy (MOST) to enhance recovery after surgery (ERAS) protocols within the nursing management of children undergoing day surgery for snoring disease.
While MOST has been applied to behavioral intervention research in smoking cessation, AIDS management, and weight loss by international scholars, its application in constructing nursing intervention projects remains relatively unexplored.
Using convenience sampling, randomised controlled trial.
A convenience sampling method was employed. The study recruited 200 preschool children diagnosed with snoring who underwent day surgery at a specific hospital between January 2023 and January 2024.
The participants were divided into two groups: a control group receiving standard nursing care and an experimental group receiving MOST-guided, integrated high-quality nursing plans specifically designed for children with snoring undergoing day surgery, adhering to established ERAS guidelines.
Children in the experimental group exhibited significantly lower anxiety levels compared to the control group, both in the preoperative waiting area and upon returning to the ward (p < 0.01). While the quality of discharge teaching scale (QDTS) scores did not reveal a statistically significant difference between the groups (p > 0.01), the content of discharge instructions and the perceived effectiveness and skill of nurse guidance differed significantly between the control and experimental groups(p < 0.01). Notably, the experimental group experienced a demonstrably lower incidence of thirst, hunger, crying, aspiration, pain, and conversion of day ward to routine hospitalization mode compared to the control group (all p < 0.01). There was no significant difference in the incidence of postoperative nausea and vomiting between the groups after rehydration (p > 0.01).
The implementation of ERAS protocols enhanced by MOST within the nursing management of children with snoring undergoing day surgery demonstrates significant efficacy. This approach can effectively reduce preoperative anxiety in children, improve the quality of discharge guidance provided to parents, and demonstrably decrease the occurrence of postoperative thirst, hunger, crying, aspiration, pain, and the need for unplanned hospitalization transitions within 6 h after surgery.
It is necessary to provide fast rehabilitation nursing for children with snoring during daytime operation. Nurses should adopt the theory of fast rehabilitation based on multi-stage optimization strategy to promote children's fast rehabilitation after operation.
Sepideh Mohajeri, Ghedak Ansari, Daniela M. Isaac, Amanda Rae Adsett, Han Zhang, Andre Isaac
Publication date 03-10-2024
Pediatric dysphagia is a commonly encountered clinical problem, with primary cricopharyngeal achalasia being a rare etiology. Management options for this condition include observation, medical and surgical management. The goal of this review paper was to summarize the current literature on the topic with respect to patient presentation, diagnosis and surgical management options.
The inclusion criteria were as follows: pediatric patients less than age 18 years, case series featuring equal to or greater than two patients, and any article that described surgical interventions pertaining to primary cricopharyngeal achalasia. Exclusion criteria included patients greater than 18 years of age, those with lower esophageal sphincter pathology (achalasia), non-English articles and case reports consisting of only one patient. A search was run on the Pub Med/Medline, OVID, EMBASE, Cochrane, and Web of Science databases on November 1, 2023. The validated bias tool from the Institute of Health Economics was used for bias screening. The results were synthesized using pooled analysis and descriptive statistics.
Ten case series were identified that met inclusion criteria. The most common symptoms at presentation were choking/regurgitation, aspiration and failure to thrive. The most utilized diagnostic test that identified cricopharyngeal achalasia abnormality was the video fluoroscopic swallow study. Management options are dictated by the patient's symptoms and include observation, treating concomitant co-morbidities, balloon dilation, botulinum injection, and endoscopic or open cricopharyngeal myotomies. While botulinum toxin injections are reported to be effective, they often need to be repeated and thus offer a temporizing strategy to allow the natural history of the condition to declare itself. Surgical myotomy represents a more definitive management strategy compared to balloon dilation but has associated risks.
There are limited studies available regarding the diagnosis and management of CPA in children. The studies that are available are mainly case series, with low sample sizes and heterogeneous data. This systematic review highlights the importance of keeping this diagnosis within the differential for infants and pediatric patients with dysphagia to minimize delays in diagnosis and provides updated data on the presentation and surgical management of this condition. There was a limitation of evidence in this systematic review, including the small number of articles that were identified, and limited sample size of patients within the articles themselves. Consequently, the analysis was not amenable to a meta-analysis.
Amy Hannigan, Paul Bumbak, Christopher G. Brennan-Jones, Justin Hintze
Publication date 29-09-2024
Tonsillectomy and adenoidectomy (AT) are two of the most commonly performed ENT procedures in children, with over 500,000 cases performed annually in the United States. Whilst generally considered a safe and well-tolerated operation, it is not without its risks and complications including pain, nausea, anorexia and most importantly bleeding and post-tonsillectomy haemorrhage (PTH). Whilst tranexamic acid (TXA) has a proven benefit in reducing bleeding and transfusion requirements in patients undergoing trauma, spinal and cardiac surgery; the effectiveness, timing and safety of its application in paediatric tonsillectomy has not yet been established. To date, there has been no published systematic review of the literature specifically looking at paediatric patients undergoing AT, despite a massive surge in popularity of the use of TXA perioperatively. The aim of this study is therefore to systematically review the current literature and collate evidence regarding the efficacy and safety of using TXA to reduce bleeding in children undergoing tonsillectomy and/or adenoidectomy. A structured search of bibliographic databases (MEDLINE, EMBASE, Pub Med, CINAHL, Cochrane CENTRAL) was undertaken to retrieve randomised controlled trials, non-randomised case-control studies and ongoing clinical trials that describe the use of TXA in paediatric patients undergoing AT. The following search terms (and their variations) were used as both medical subject headings (MeSH terms) and text words: tranexamic acid, bleeding, tonsillectomy, adenoidectomy, paediatrics. To ensure that all relevant data was captured, the search did not contain any restrictions on language or publication time. Data extraction and risk of bias assessment was performed independently and in duplicate. This review identified and included a total of eight studies (n = 1315). Five studies reported on the intravenous use of TXA (n = 531) whilst three studies reported on the topical use of TXA (n = 784), and these were analysed separately. The intravenous use of TXA did not reduce intraoperative blood loss significantly (95 % CI: -0.1 to 0.33 p = 0.28) and there was not enough information to analyse the effect on PTH in these studies. Topical TXA led to a significant reduction in both intraoperative blood loss (95 % CI 0.11 to 5.31, p = 0.04) and post operative bleeding rates (RR 0.04, 95 % CI 0.01 to 0.08, P = 0.02). The results of this systematic review and meta-analysis suggest that TXA administered via the intravenous route does not reduce perioperative bleeding associated with AT in paediatric patients. However, when topical TXA is used intraoperatively at the surgical site in paediatric patients undergoing adenoidectomy alone, there was a significant reduction in both intraoperative blood loss and post operative bleeding. TXA appears to be a safe and well-tolerated drug in the paediatric population with no adverse effects reported in this review. Nevertheless, further large and well-designed randomised controlled trials are needed to investigate the risks and benefits of TXA in paediatric AT with a particular focus on its use topically and in association with newly developed surgical equipment.
Pubmed PDF WebJoseph E. Kerschner
Publication date 19-09-2024
Jordan B. Luttrell, Chad A. Nieri, Madhu Mamidala, Anthony Sheyn
Publication date 21-02-2024