Ping Hsueh Sun, Shui-Ching Hsu, Huan-Rong Chen, Hsiao-Hsiuan Chou, Hsiao-Yun Lin, Kai-Chieh Chan
Publicatie 30-12-2024
Despite the reported auditory deficits and developmental challenges in children with unilateral microtia and aural atresia (UMAA), there remains a lack of consensus on early intervention with bone conduction hearing aids (BCHAs) to restore binaural hearing due to the uncertain clinical benefits and intolerability of the conventional devices. Previous studies investigating the auditory benefits under binaural hearing condition were limited and demonstrated controversial opinions in heterogenous patient groups with various devices. Our study aimed to evaluate the audiological performance, including monoaural and binaural hearing, and subjective satisfaction of the ADHEAR system, a novel adhesive BCHA, in experienced pediatric users with UMAA. Twelve children, with a mean age of 9.08 years and previous experience using the ADHEAR system averaging 2.76 years, were included in our final analysis. Auditory performance of monoaural hearing with the affected ears was assessed by sound-field audiometry, speech recognition threshold (SRT), word recognition score (WRS) in quiet and noise. Auditory performance of binaural hearing was assessed by SRT in quiet and noise, along with a virtual sound localization test. Subjective satisfaction was measured with questionnaires. Monoaural hearing of the affected ears improved in sound-field audiometry (by 18.44 dB HL), SRT (by 17.08 dB HL) and WRS (by 27.00 % in quiet and 30.50 % in noise). Binaural hearing improved in SRT in quiet (by 1.17 dB HL), remained no significant difference in noise and enhanced in sound localization test (reduction of RMS error by 5.96°). The questionnaires indicate satisfying experiences despite skin reactions encountered. In children with UMAA under long-term and routine use of the ADHEAR system reveals not only enhancement of audiological performance in the affected ears but also demonstrates potential benefits in speech recognition and sound localization under binaural hearing condition. Users generally expressed satisfaction with the device, while skin reaction is more noticeable in humid subtropical climate.
Pubmed PDF WebGamze Atay, Burçay Tellioğlu, Hilal Toprak Tellioğlu, Nizamettin Burak Avcı, Betül Çiçek Çınar, Hande Taylan Şekeroğlu
Publicatie 29-12-2024
This study aimed to investigate the presence, type, and severity of hearing losses in individuals with Duane Retraction Syndrome (DRS), and to ascertain if there are anomalies in the auditory pathways at the brainstem level in DRS, believed to arise from aberrant interaction between cranial nerves and brainstem nuclei. Cross-sectional observational study. Tertiary referral centre. The study group comprised 20 patients diagnosed with DRS, aged between 5 and 18 years, who underwent ophthalmological, otological and audiological follow-up at our clinic. The control group was established using data obtained from the previous work of Sanfins M.D., et al., 2022. Participants underwent tympanometry and pure tone audiometry after ophthalmological and otological examination. Patients with hearing loss underwent auditory brainstem response (ABR) testing, while patients with normal hearing underwent temporal CT and MRI to detect possible aetiology. Tympanograms, air and bone conduction pure tone averages, latencies of wave I, III and V and interwave latencies as well as radiological findings on CT and MRI were noted. Profound sensorineural hearing loss was detected in two of the 20 patients. One of the patients with hearing loss had left-sided exo-Duane, cochlear aplasia with dilated vestibule (CADV) anomaly in the right ear and profound sensorineural hearing loss in the right ear. The other patient had bilateral exo-Duane, incomplete partition type I (IP-I) malformation in the right ear and profound sensorineural hearing loss in the right ear. There was no significant difference observed in the ABR latencies of wave I, III, and V, as well as the inter-wave latencies, between the control group and the individuals diagnosed with DRS who had normal hearing. No statistically significant difference was found in auditory brainstem responses between the control group and patients with DRS without hearing loss. It can be speculated that Duane retraction syndrome and hearing loss do not share a common pathogenesis at the level of the brainstem. However, it should be noted that hearing loss may be associated with inner ear malformations in DRS patients.
Pubmed PDF WebJessie Marcet-Gonzalez, Ritu Sampige, Jennifer N. Brown, Janai Buxton, Morgan McCarver, Julina Ongkasuwan, Elton M. Lambert
Publicatie 29-12-2024
To describe the effects of scoliosis severity on the trachea in patients with a tracheostomy tube. A retrospective chart review of patients 21 years and younger with a tracheostomy and scoliosis between 2001 and 2019 was conducted at a single tertiary pediatric hospital. Patients with spine curvature from C6 - T3 (tracheal limits) were divided into two groups based on curvatures that were either greater than or equal to 30° (Group A) or less than 30° (Group B). Among the 59 patients who met the inclusion criteria, median age at tracheostomy tube placement was 1.45 years, median tracheostomy duration was 10.26 years, and 75 % were ventilator dependent. Group A encompassed 22 patients, and Group B included 37 patients. There were no significant differences in the following outcomes between Groups A and B: obstructed carina view (p = 0.095), tracheal irritation (p = 0.270), tracheal curvature (p = 0.113), inadequate tracheostomy tube fit (p = 0.323), tracheomalacia (p = 0.765), custom tracheostomy tube use (p = 0.113), or ventilator dependence (p = 0.109). Most tracheostomy patients with scoliosis were ventilator dependent. Spine curvatures of 30° or greater from C6 to T3 did not significantly influence view of the carina, tracheal irritation, tracheal curvature, and tracheostomy tube fit. Further work is needed to analyze the effects of scoliosis on tracheal abnormalities with greater power and to determine the best tracheostomy tube fit via in-office tracheoscopy evaluations.
Pubmed PDF WebEbrahim Barzegar Bafrooei, Morteza Farazi, Saman Maroufizadeh, Akbar Darouie
Publicatie 28-12-2024
This study aimed to develop and evaluate the effectiveness of a combined Fluency Rules Program (FRP) with parent-child interaction training for preschool children with stuttering. A randomized controlled trial was conducted with 49 preschool children who stuttered. Participants were randomly assigned to either the experimental group, which received the combined FRP with parent-child interaction training, or the control group, which received only the FRP. Both groups attended 45-min therapy sessions twice weekly for three months. According to the change score analysis, at posttest measurement, there were significant decreases in the stuttering severity scores in both groups, but intervention group had a greater decrease than control group (mean differences = 4.50, 95 % CI [3.55 to 5.45], P < 0.001). The improvement (i.e., increase) in the "Severity of Stuttering and Impact on the Parents" scores in the intervention group was 1.49 (95 % CI [1.10 to 1.89], P < 0.001) points higher than the control group. The similar result was obtained for "Parent's Knowledge and Confidence in Managing it" factor. There was no statistically significant difference in the "Impact of Stuttering on the Child" scores between control and intervention groups (P = 0.163). The combined FRP with parent-child interaction training was more effective than the FRP alone in reducing the severity of stuttering and improving parental confidence.
Pubmed PDF WebAza Bahadeen Taha
Publicatie 26-12-2024
Chronic suppurative otitis media is predominantly caused by aerobic bacterial infections, complicated by antibiotic-resistant strains and biofilm formation. This study aims to identify the aerobic bacterial pathogens in chronic suppurative otitis media among children and assess their antibiotic susceptibility patterns. The potential link between biofilm formation and antibiotic resistance is also evaluated. A cross-sectional study was conducted on 457 children with chronic suppurative otitis media. Middle ear discharge samples were collected and aerobic bacteria were isolated and identified using standard microbiological methods. Antibiotic susceptibility was determined by the agar dilution method, and biofilm formation was assessed using the microtiter plate assay. Of the 457 cases, 89.72 % were monomicrobial infections. The most prevalent Gram-negative bacterium was Pseudomonas aeruginosa (35.71 %), while Staphylococcus aureus (26.27 %) was the leading Gram-positive pathogen. Pseudomonas aeruginosa demonstrated high resistance, with 96.77 % resistant to cefuroxime and 92.26 % to amoxicillin/clavulanic acid. Similarly, Staphylococcus aureus showed significant resistance to ampicillin (83.33 %) and amoxicillin (78.07 %). A strong correlation (p < 0.001) was observed between biofilm formation and antibiotic resistance, with Gram-negative bacteria resisting an average of 4.24 ± 1.769 antibiotics and Gram-positive bacteria resisting 5.13 ± 1.535 antibiotics. A high prevalence of antibiotic-resistant pathogens has been observed in children with chronic suppurative otitis media, with a significant association between biofilm formation and antibiotic resistance.
Pubmed PDF WebJason L. Steele, Heather J. Smith, Samira Takkoush, Jumah G. Ahmad, Zachary D. Urdang, Neil S. Patel, Richard K. Gurgel, Mana Espahbodi
Publicatie 26-12-2024
Pediatric temporal bone fractures (TBFs) can result in adverse outcomes including meningitis, significant sensorineural hearing loss requiring cochlear implantation (CI), facial nerve weakness, cerebrospinal fluid (CSF) leak, and labyrinthitis. The objective of this study is to determine the risks of these outcomes for TBFs with hearing loss. Using the multinational TriNetX database, a retrospective cohort study was performed of patients less than 18 years old with diagnostic codes for other fracture of base of skull and hearing loss to serve as an approximation of TBF. This classification excluded all TBFs without hearing loss. An age- and sex-matched control cohort was selected without the above-mentioned diagnostic codes. More than 95 % of patient data used is from 2006-present, with an average of 12-14 years of data per health care organization. Measured outcomes included meningitis, CI, facial nerve disorders (including facial nerve weakness, lagophthalmos, and eyelid weight placement for lagophthalmos), CSF leak and labyrinthitis after TBF. Risk ratios were calculated after 1:1 propensity-score matching (PSM) for age and sex. TriNetX identified 2739 pediatric patients (mean age of 7.61 ± 4.39 years) with TBF and an age- and sex-matched cohort of 2739 pediatric patients without TBF (mean age of 7.58 ± 4.37 years). Those with TBF had a greater risk of developing meningitis (RR: 2.90, 95 % CI: 1.42-5.94) and facial nerve disorders (RR: 13.44, 95 % CI: 8.83-20.45) at any time than those without TBF. Matched results were not available for labyrinthitis, CI or CSF leak, as there were multiple instances in the Pediatric TBF cohort versus zero instances in the Control cohort. Results prior to PSM demonstrated an increased risk for labyrinthitis (RR: 43.12, 95 % CI: 23.17-80.27), CI (RR: 21.61, 95 % CI: 13.03-35.84) and CSF leak (89.08, 95 % CI: 67.71-117.20) in the pediatric TBF cohort compared with the cohort without TBF. Pediatric patients who sustain TBF with hearing loss are at increased risk of subsequent meningitis and facial nerve disorders and may also be at increased risk of labyrinthitis, CSF leak, and undergoing CI.
Pubmed PDF WebNayiere Mansouri, Mohanna Javanbakht, Ali Jahan, Enayatollah Bakhshi, Moslem Shaabani
Publicatie 23-12-2024
Auditory attention is an important cognitive factor that significantly affects speech perception in noisy environments. Hearing loss can impact attention, and it can impair speech perception in noise. Auditory attention training improves speech perception in noise in children with hearing loss. Could the combination of transcranial electrical current stimulation (tES) and auditory attention training enhance the speed and effectiveness of stability potentiation improvements? This investigation explores whether applying electrical stimulation alongside targeted auditory tasks can lead to more pronounced and rapid enhancements in cognitive function. In this study, 24 children with moderate to severe S.N hearing loss were examined. The monaural-selective-auditory-attention test (mSAAT) and the test of everyday-attention-for-children (TEA-CH) were used to investigate auditory attention. The words-in-noise tests evaluated speech perception in noise. A go/no-go task was conducted to record auditory P300 evoked potential. Children were divided into three groups. Group A received auditory attention training. Group B received tDCS. Group C received combined method. The tests were repeated immediately and one month after training. Attention and speech perception improvement was significantly higher for the group that received the combined method compared to the groups that received auditory attention training with sham or tDCS alone (P < 0.001). All three groups showed significant changes one month after the training ended. However, the group that received only tDCS demonstrated a significant decrease in improvement. The study showed that combining auditory attention training with tDCS can improve speech perception in noise for children with hearing loss. Combining behavioral training with tDCS has a more significant impact than using behavioral training alone, and combined method leads to more stability improvements than using tDCS alone.
Pubmed PDF WebAida Veiga-Alonso, Natalia Roldán-Pascual, Rosa María Pérez-Mora, Beatriz Jiménez-Montero, María Jesús Cabero-Pérez, Carmelo Morales-Angulo
Publicatie 21-12-2024
Acute mastoiditis, the most common complication of acute otitis media, is approached in our study, focused on children from the Autonomous Community of Cantabria, Spain. The aim is to analyze its clinical-epidemiological characteristics and propose diagnostic and treatment recommendations. We conducted a 30-year retrospective study on patients under 18 years of age diagnosed with acute mastoiditis in Cantabria. We analysed epidemiological data, clinical presentation, causes, treatment, and follow-up. We included 111 patients, 60.4 % of which were under 2 years old. The average incidence was 3.9/100,000 children per year. Streptococcus pneumoniae was the most common microorganism. Third-generation cephalosporins and amoxicillin-clavulanic acid were the most frequently used antibiotics. 19 % of patients underwent temporal bone CT scans. Twenty-nine children required surgical intervention, primarily myringotomy and mastoidectomy. Only 5.4 % developed retroauricular abscesses. During follow-up, 32 % experienced new acute otitis media cases. The incidence of acute mastoiditis in Cantabria is similar to that of other developed countries. Imaging studies are reserved for cases with poor progression. Conservative management with antibiotics is suitable for many patients, with surgery reserved for poor responders. Complications are rare in our setting.
Pubmed PDF WebErim Pamuk, Ergin Eroğlu, Levent Sennaroğlu
Publicatie 21-12-2024
We aimed to evaluate the clinical findings of our cochlear implant (CI) patients with otitis media with effusion (OME) and CI patients treated with ventilation tube (VT) for OME. The medical records of patients who underwent CI surgery at Hacettepe University, Department of Otorhinolaryngology, between November 1997 and March 2023 were reviewed. Patients who had OME or VT in the implanted ear at the time of surgery were included in the study. Perioperative findings, complication status, revision status, and reasons for revision were recorded. A total of 2945 ears were operated for cochlear implantation during this period. Of these cases, 169 (5.7 %) had OME and 55 (1.86 %) had VT at time of surgery (180 patients). There were no significant differences between the two groups regarding demographic parameters and follow-up time. None of the investigated parameters showed any significant differences between the two groups, except for revision status. The revision rate was significantly higher in the OME group than that in the VT group (10.65 % vs. null, p = 0.008). The total non-OME and non-VT patient cohort had a significantly lower revision rates than the OME group (5.29 % vs. 10.65 %, p = 0.003). There is no significant difference in surgical difficulty and perioperative complications after CI between patients with VT and those with OME. The relationship between a higher rate of revision and OME in CI patients, and the optimal timing and necessity of VT insertion prior to CI surgery, should be further investigated.
Pubmed PDF WebSaad Elzayat, Hussein A. El-Shirbeny, Ahmed Morshedy, Islam Soltan, Maurizio Barbara, Edoardo Covelli, Mona A. Abdel-Kareem, Ashraf Fayed, Fathi Baki, Tawfiq Khurayzi, Haitham H. Elfarargy
Publicatie 20-12-2024
This study aimed to assess the ability of preoperative computed tomography (CT) to predict the crista fenestra (CF) type during cochlear implantation and correlate these types with intraoperative findings. This may allow for precise preoperative planning with better surgical outcomes. A prospective observational study. The study was done in multiple tertiary centers between September 2021 and March 2024. ology: We correlated the preoperative radiological type of the CF with the intraoperative CF type to evaluate the accuracy and sensitivity of the HRCT to predict the CF type. We also assessed the need for CF drilling in each case. Our study included 154 patients who underwent CI. They were 90 (58.4 %) males and 64 (41.5 %) females with ages ranging from 2.1 to 7.6 years, with a mean of 4.69 ± 1.19. The intra-class correlation coefficient between both radiological evaluators was 0.985, which indicated a high agreement between them. The intraoperative surgical types of CF were significantly related to the radiological types as the Spearman correlation coefficient was 0.976, and the P-value was <0.001. Our study revealed that preoperative CT is a precise tool for predicting the intraoperative type of CF during cochlear implantation type with a sensitivity of 96.67 % and an accuracy of 94.17 %. Moreover, drilling of the CF is recommended in type A3 and type B2 CF.
Pubmed PDF WebPeriannan Jawahar Antony, Palani Saravanan, Manjula Puttapasappa, Geetha Chinnaraj, Megha
Publicatie 20-12-2024
Studies have reported a varied correlation strength between the electrically evoked compound action potential (ECAP) and electrically evoked stapedial reflex thresholds (ESRT) in cochlear implant recipients. However, there is a lack of information on the relationship between the two measures in paediatric cochlear implant users. This study was aimed to compare the ESRT and ECAP measures and determine where ECAP thresholds fall within the dynamic range of ESRT-based Maps in paediatric cochlear implant users. The study involved 40 children aged between 3 and 6 years and were implanted with MedEL cochlear implant device unilaterally. ESRT and ECAP thresholds were measured for all twelve electrodes during the same mapping session, three months after cochlear implant activation. The results revealed significant differences between ECAP and ESRT thresholds across all electrodes. A significant moderate correlation between ESRT and ECAP thresholds was observed on all electrodes. The ECAP thresholds could predict the ESRT based Most comfortable levels (MCLs) significantly. Notably, ECAP thresholds fell by 17-34 % from the upper stimulation levels of ESRT-based maps across the electrodes. This study's findings have significant implications for programming cochlear implants in paediatric patients. For children who are unable to cooperate during ESRT measurements, or in cases where ESRT cannot be elicited, ECAP measurements offer a viable alternative. ECAP-based estimates can be used to set MCL levels that closely approximate those derived from ESRT, ensuring appropriate stimulation levels for these young children using cochlear implants.
Pubmed PDF WebRoee Noy, Jacob T. Cohen, Arie Gordin
Publicatie 19-12-2024
The vomer is an essential component of the nasopharynx. Although variations in vomer width(VW) and nasopharyngeal width(NW) can be observed, their clinical significance on post-adenoidectomy outcomes in children with sleep-disordered breathing and obstructive sleep apnea(SDB-OSA) remains uncertain. The primary outcome was to investigate the association between VW and post-adenoidectomy clinical improvement. Secondary outcomes were to investigate the variability and interplay between VW and NW. This prospective, blinded cohort study was conducted at a tertiary hospital between 6/2022 and 7/2023. Children who underwent adenoidectomy for SDB-OSA were included. VW and NW were measured using a transoral endoscope. A calibrated ruler was positioned at the inferior aspect of the vomer for direct visualization, and the NW was calculated as the distance between the medial edges of the torus tubarius. Clinical improvement was collected using the OSA-18 survey. Of the 29 children (mean age:3.5 years, IQR: 2-4, 16[55 %] males), 26(89.6 %) showed a clinical improvement 1-month post-adenoidectomy (ΔOSA-18 score: 24.6,95 % confidence interval: 31-(-14),p = 0.001). The mean VW was 3.88 mm (IQR: 3-4), and the mean NW was 13.76 mm (IQR:13-14). In the univariable analysis, clinical improvement was associated with age <3 years(p = 0.05), non-obese children(p = 0.01), large adenoids(p = 0.01), preoperative OSA-18 score>60(p = 0.05), and lower VW/NW(p = 0.013). The odds ratio for clinical improvement was decreased by 1.08 for each 0.01 increase in VW/NW (95%CI:1.05-1.11,p = 0.01). Lower VW/NW were associated with better clinical outcome 1-month post-adenoidectomy. Further randomized, prospective studies are needed to validate these findings and and explore whether interventions in this area could serve as a potential therapeutic target.
Pubmed PDF WebBigyan Raj Gyawali, Ashutosh Kashyap, Sanju Thapa, Darshan Chaulagain, Suyogya Shakya, Niraj Kumar Kushwaha
Publicatie 19-12-2024
Intranasal steroids are effective in managing adenoid hypertrophy in children, but the evidence regarding technique of use for optimal results is lacking. CFD analysis, with discrete phase modelling was done to simulate nasal spray in nasal cavity and drug delivery in the region of adenoids. The findings were validated using a 3D model designed from CT scan of the same region. Our study shows that the maximum spray deposition in the adenoid region is with injection angle of 30° with the concentration value of 14 kg/m Nasal steroids have been found to be quite effective in symptoms reduction in children with adenoid hypertrophy. The current guidelines for technique of application are similar to that which has been validated for nasal pathologies. But the studies analyzing optimum drug delivery to the adenoids with variations in technique of application are lacking. This is the research gap we have tried to fill with our study. The application of nasal steroids with nozzle inclined at 30° with respect to the floor of nose ensures maximum drug delivery to the adenoids and is likely to improve the efficacy of this treatment.
Pubmed PDF WebDemet Tekcan, Ilknur Kulhas Celik, Merih Önal, Hasibe Artac
Publicatie 16-12-2024
Maya Guhan, Yiressy Pina, Elton Lambert, Maria Pereira, Marietta De Guzman
Publicatie 16-12-2024
Semih Guler, Ayse Sanem Sahli, Murat Dogan
Publicatie 16-12-2024
The aim of this study is to examine the effect of type of delivery and anesthesia method on the screening ABR test results of newborns within the scope of the Newborn Hearing Screening Program (NHCP) and to investigate the relationship between the test results and the relevant variables. 441 newborns were included in the study. Of these newborns, 221 constituted the control group (normal (vaginal) delivery), and 220 constituted the study group (cesarean section, delivery). In the study, all newborns whose hearing was evaluated within the scope of the Newborn Screening Program were screened twice. Screening ABR test results applied were compared considering the type of delivery (normal (vaginal) or cesarean section) and anesthesia method (spinal or general). The effects of variables such as the duration of the baby's separation (dissection) from the mother's womb, the duration of exposure to the anesthetic agent and the total duration of the surgical procedure were examined. As a result of the study, a statistically significant relationship was found between delivery type (normal (vaginal) or cesarean section) and anesthesia method (spinal or general) and first screening ABR test results (p < 0.001). While there was a statistically significant difference (p < 0.001) in terms of separation time from the mother's womb (p < 0.001) and exposure to an anesthetic agent among the first test screening ABR results of newborns born under general anesthesia, there was no statistically significant difference (p < 0.001) in terms of total surgical procedure time (p = 0.106) no difference was detected. There was no statistically significant difference between ABR test results and these three variables in newborns born under spinal anesthesia (p > 0.05). The type of delivery newborns and the anesthesia method used at delivery may affect the results of screening ABR applied within the scope of a newborn hearing screening protocol. For this reason, it is very important to perform screening tests at the most appropriate and correct time.
Pubmed PDF WebJane Sheehan, Alison Jagger, Kate L. Francis, S. Ghazaleh Dashti, Patrick Gornall, Melinda Barker, Valerie Sung, Sergio Ruiz-Carmona, Susan Baohm, Zeffie Poulakis
Publicatie 15-12-2024
Infections during pregnancy can increase the risk of congenital hearing loss. This population-based study investigated the effect of birthing parent COVID-19 infection during pregnancy on risk of congenital hearing loss in infants. Records of infants born in 2022 were reviewed via a retrospective clinical audit of a universal state-wide newborn hearing screening program in Victoria, Australia. The number and timing of COVID-19 infections during pregnancy were collected via self-report at the time of the hearing screen. Infant records (n = 75,330) were divided into birthing parent infection group (n = 25,547, 33.9 %), and non-infection group (n = 49,783, 66.1 %). Group differences in screen and diagnostic audiology results were estimated by general linear regression models with a binomial distribution. Birthing parent and infant characteristics were similar across groups. Comparable proportions of infants obtained a refer result on their newborn hearing screen, requiring referral to diagnostic audiology (infection group: 1.4 %, 95%CI 1.2-1.5 versus non-infection group: 1.3 %, 95%CI 1.2-1.4). The proportion of infants diagnosed with any type and degree of hearing loss was also similar (infection group: 0.6 %, 95%CI 0.5-0.7 versus non-infection group: 0.6 %, 95%CI 0.6-0.7). This epidemiological study is the largest to date and demonstrates that infants whose birthing parent reported COVID-19 infection during pregnancy were not at increased risk of obtaining a refer result on their newborn hearing screen, nor at increased risk of congenital hearing loss. Specific protocols or guidelines to manage the newborn hearing screening pathway of infants born to a parent with COVID-19 during pregnancy are not supported by this study's findings.
Pubmed PDF WebZainab Balogun, Tracy Cheng, Amber D. Shaffer, David Chi, Dennis Kitsko
Publicatie 14-12-2024
Tinnitus is a common otologic complaint which can range from bothersome to debilitating. Imaging is frequently utilized to rule out tumors, fractures, and other causes but can also cause significant medical and economic burden for patients. Furthermore, the pediatric population may require sedation for imaging. This study explored how commonly imaging was performed in pediatric patients with isolated tinnitus and whether imaging results affected clinical care. A retrospective case series of 266 patients aged 0-22 years diagnosed with tinnitus at a tertiary children's hospital was performed. Patients with otologic complaints other than tinnitus were excluded. Logistic regression, Wilcoxon rank-sum tests, and log-rank survival analysis were used for statistical analysis. The mean age of tinnitus diagnosis was 13.4 years (IQR 10.8-16.7), 221/266 (83.1 %) of patients were white, and 139/266 (52.3 %) were male. In the 108 with details available, 29 (26.9 %) had pulsatile tinnitus. Twenty-one of two-hundred and sixty-six (7.9 %) had a history of migraines and 24/266 (9.0 %) had a history of psychiatric diagnosis. Seventy-four out of two-hundred and sixty-six (27.8 %) of patients completed CT and/or MRI imaging. Eleven out of forty-four (14.9 %) of those who underwent imaging had abnormal findings, and only 1 MRI and 1 CT showed new abnormal findings. Of note, the abnormal MRI and CT were of the same patient, and the CT was obtained as part of a trauma survey. Of the 64 patients with follow-up, 47 % of patients noted resolution of tinnitus. Patients with pulsatile tinnitus and a history of migraines were more likely to obtain imaging (OR = 8.14, 6.17; p < 0.001, <0.001, respectively). History of sinusitis, head/ear trauma, psychiatric diagnosis, and pulsatile tinnitus was not correlated with new abnormal imaging. In pediatric patients with isolated tinnitus, imaging very rarely reveals new abnormalities which can impact clinical care. Additional research is needed to optimize resource utilization and identify cohorts of pediatric patients with tinnitus in whom imaging can be deferred.
Pubmed PDF WebKaitlyn A. Brooks, Anastasia Kolousek, Erin K. Holman, Sean S. Evans, Nandini Govil, Kristan P. Alfonso
Publicatie 14-12-2024
To present our experience with off-label MED-EL Bonebridge implantation in pediatric patients younger than 12 years of age and compare outcomes to pediatric patients 12 years and older.
Pediatric patients who underwent Bonebridge implantation were included in a retrospective cohort study and were categorized by off-label use (<12 years) and ≥12 years at time of bone conduction implantation (BCI). Hearing outcomes were collected after implant activation, which was typically 4-8 weeks post-implantation. Mann-Whitney U tests were performed to assess for differences between audiometric outcomes. Significance was set at p < 0.05.
Twenty patients (25 implants) < 12 years of age and 17 patients (23 implants) ≥12 years of age underwent BCI. Pre-BCI speech recognition threshold (SRT) was better for the older patient group (median 50 dB) than the younger patient group (median 60 dB). Post-BCI SRT, however, was significantly lower in the younger patient group (median 22.5 dB) as compared to the older patient group (median 35 dB), (p < 0.001, Z = 3.1). The two groups performed similarly on age-appropriate wordlists presented at 50 dB HL in aided conditions (p > 0.05, -1 Peter Kfoury, Jordan C. Stout, Stephanie Browning McVicar, Max Sidesinger, Eun Kyung Jeon, Kathryn Tonkovich, Chelsea M. Allen, Matthew A. Firpo, Albert H. Park Publicatie 11-12-2024 This study investigates the pandemic's impact on newborn hearing screening (NBHS) and access to hearing services for children in Utah. Specifically, it explores the differences in NBHS rates, diagnostic hearing testing, early intervention enrollment, and congenital cytomegalovirus (cCMV) screening before and during the pandemic.
Utilizing a comprehensive statewide Early Hearing Detection and Intervention (EHDI) database, we analyzed data from January 2017 to December 2021, excluding a 6-month period preceding March 16, 2020, to eliminate potential confounders related to pandemic onset. We assessed NBHS completion rates, time to diagnose hearing loss, early intervention referrals, and cCMV screening. Multivariable logistic regression analysis was employed to identify factors influencing timely completion of the EHDI milestones.
Our study included 192,161 newborns in Utah. Although over 99 % of newborns underwent NBHS, differences were noted among those born in small towns, rural locations, home births, and self-pay situations. Births in metropolitan areas witnessed an increased proportion of NBHS and timely diagnostic ABR during the pandemic. While home births increased from 3 % of births in 2017 to 5 % in 2021, the proportion of home births who received NBHS also increased from 89.4 % pre-COVID to 96.2 % during the pandemic (p < 0.0001). The rate of timely ABR testing and EI services increased during the pandemic.
The COVID-19 pandemic did not considerably alter NBHS rates, and overall, the rates of timely ABR diagnosis and timely EI services in the state of Utah increased during the pandemic. Laureline Kahn, Guillaume Poillon, Monique Elmaleh-Bergès, Luca Litman-Roventa, Emilien Chebib, Natacha Teissier, Audrey Maudoux Publicatie 07-12-2024 To describe the inner ear sectors after an inner ear MRI protocol and search for the presence of endolymphatic pressure anomaly in patients presenting with a congenital CMV infection and audio-vestibular dysfunction.
A 3D FLAIR MRI sequence, 4 h after gadolinium injection, was performed in patients with sensory-neural hearing loss secondary to a congenital CMV infection in order to analyse the morphology of the endolymphatic space.
Two patients presented with a unilateral SNHL and 4 patients a bilateral SNHL. Seven ears with SNHL demonstrated an endolymphatic hydrops on MRI images and 2 showed a membranous labyrinth atelectasis. All ears but two had a marked enhancement in the perilymph of the basal turn of the cochlea. One ear, with a normal hearing threshold but altered vestibular function, demonstrated cochlear and saccular hydrops. Two ears with normal or near normal hearing and normal vestibular function were radiologically normal on the MRI.
The compartmental endolymphatic study using delayed contrast-enhanced MRI sequences in children with cCMV infection suggests a relationship between inner ear involvement and endolymphatic pressure anomaly. Joseph Lee, Logan F. McColl, Molly O. Meeker, Tony Satroplus, Natalie Kelly, Kevin Liu, Amanda Onwuka, Tendy Chiang Publicatie 05-12-2024 Allergic rhinitis (AR) within the pediatric population affects more patients than any other chronic disease. Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction in children and is strongly associated with AR. Inferior turbinate reduction (ITR) surgery is used in patients with ITH who have failed medical management. While surgery is curative for most, there remains a subset of patients who continue to have symptoms of nasal obstruction despite ITR, which can cause discomfort and significant impacts on quality of life. Additionally, some patients with persistent disease go on to require revision surgery. The objectives in this study were to assess the impact of allergy testing results in patients undergoing ITR and evaluate if they predict long-term durability of surgical outcome.
A retrospective chart review of patients undergoing ITR between January and December of 2015 was performed. Data pertaining to demographics, allergy testing results, surgical technique, and medical management was collected. Patients who underwent concomitant procedures at the time of ITR were excluded. Data analysis included descriptive statistics, chi-squared tests, and t-test analyses.
297 patients who underwent ITR were included for data analysis. Overall, 20.9 % of patients had recurrent nasal obstruction after ITR and 5.4 % required revision surgery. Among all included patients, 37.7 % underwent allergy testing of which 53 (47.3 %) tested positive and 54 (48.2 %) tested negative; results were unknown for 5 (4.5 %) patients. In patients with positive allergy tests, 36 % had recurrent nasal obstruction and 11 % required revision surgery. In patients with negative allergy tests, 41 % had recurrent nasal obstruction and 13 % required revision surgery. There were no significant associations among those with positive and negative allergy tests and recurrence of nasal obstruction or need for revision surgery. Patients with a documented clinical diagnosis of AR were more likely to have recurrence of nasal obstruction after surgery than those without (28 % vs 12 %, p = 0.001) and were more likely to require revision surgery (9 % vs 1 %, p = 0.001).
ITR is a reasonable choice for the treatment of nasal obstruction in children. However, there remains a subset of patients who have recurrent nasal obstruction following initial surgery. Allergy testing results do not appear to impact the rate of recurrent nasal obstruction or the need for revision surgery. Therefore, the utility of allergy testing may have a limited benefit in the management of nasal obstruction in children. However, a clinical diagnosis of allergic rhinitis does appear to be a prognostic factor for experiencing post-operative recurrent nasal obstruction and requiring revision surgery. Alessandra Di Nora, Antonino Maniaci, Francesco Pizzo, Nicolien Van Der Poel, Pierluigi Smilari, Salvatore Cocuzza, Gloria Spadaro, Mario Lentini, Christian Calvo-Henriquez, Jerome R. Lechien, Paolo Campisi, Federica Maria Parisi, Giuseppe Sangiorgio, Piero Pavone Publicatie 30-12-2024 Acute suppurative thyroiditis (AST), a rare yet potentially life-threatening infection, comprises less than 1 % of neck pathologies and requires prompt treatment. Symptoms range from neck pain and fever to dysphagia and possible abscess formation. Broad-spectrum antibiotics are the primary treatment; however, surgical drainage may be necessary for abscesses to prevent systemic infection. Following acute management, identifying underlying anomalies such as branchial arch defects that predispose to recurrence is crucial. Diagnostic tools like barium swallow or transnasal fiberoptic laryngoscopy aid in this identification process. Recurrent AST or left-sided neck abscesses often prompt investigation for fourth branchial arch anomalies like pyriform sinus fistula, which may require surgical correction to prevent future infections. This paper presents the case of a 5-year-old with left torticollis, odynophagia, and fever, previously treated for a deep neck abscess with antibiotics. Ultrasound and CT scans revealed a left thyroid lobe abscess, confirmed by barium swallow to be associated with a pyriform sinus fistula. Supported by a literature review, this case highlights the importance of a systematic approach to AST management to guide clinicians in effectively treating this uncommon condition. Fabiane Zimmermann, Georgea Espindola Ribeiro, Josiane Hoffmann, Daniela Polo Camargo da Silva Publicatie 12-12-2024 to summarize the evidence on the electrophysiological findings in the auditory brainstem response (ABR) in infants with DS.
This is a systematic review study, whose protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023424139) and conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies were included: cross-sectional and cohort studies that performed ABR evaluation in infants with DS up to two years of age, which had their results compared with normal infants, of the same age group. The search for studies was performed in the following databases: PubMed, LILACS, Scopus, CINHAL, Web of Science, Scielo, Embase and LIVIVO, and in the gray literature: Google Scholar and Proquest. There were no restrictions on language or publication date. The methodological quality of the included studies was assessed using the JBI (Joanna Briggs Institute) checklist. Phases 1 (reading of titles and abstracts) and 2 (reading in full), data extraction, assessment of methodological quality and certainty of evidence were performed independently by the reviewers. Existing disagreements were resolved in a consensus meeting.
A total of 494 articles were obtained, which after removal of duplicates and independent analysis by the reviewers, ten studies were selected for qualitative synthesis and four studies were selected for meta-analysis. There was heterogeneity between the effects observed in the ABR parameters (I2 = 78 %) with an overall pooled effect size of -0.05 (95 % confidence interval of -0.13-0.03; p = 0.22) indicating no significant difference in ABR responses between groups. The certainty of the evidence assessed by GRADE was considered very low due to inconsistency and imprecision.
The results of the meta-analysis indicate that there are no significant diferences in ABR parameters, including waves I, III, and V and the I - V interpeak interval, between infants with and without DS up to two years of age. However, the limitations found, such as methodological heterogeneity, small sample sizes and variability in the age range of the participants, generated uncertainty in the results. Therefore, the certainty of the evidence was classified as very low, according to the GRADE methodology. Tomoko Esaki, Tadao Yoshida, Masumi Kobayashi, Kyoko Morimoto, Chisa Shibata, Michihiko Sone Publicatie 26-12-2024 Bahareh Khavarghazalani, Zahra Hosseini Dastgerdi, Morteza Hamidi Nahrani, Maryam Emadi Publicatie 16-12-2024 Alexandra F. Corbin, Lauren A. DiNardo, Deepthi S. Akella, Alison C. Ma, Douglas P. Nanu, Francesca C. Viola, Michele M. Carr Publicatie 05-12-2024 To describe maxillary frenum Kotlow scores in a pediatric population.
A retrospective chart review was performed for children ages 0-19 years old seen at a pediatric otolaryngology clinic by one surgeon from March-December 2022. Inclusion criteria required a recorded maxillary frenum Kotlow score. Data collected included age, gender, race/ethnicity, Kotlow score, and history of maxillary frenotomy.
570 children were included, comprising 267 (46.8%) females, 302 (53.0%) males, and 1 (0.2%) transgender male. Mean age was 5.0 years (95% CI 4.6-5.4). 24 patients (4.2%) had a history of maxillary frenotomy, while 546 (95.8%) did not. Among those with no maxillary frenotomy history, 21 (3.8%) had a Kotlow 1, 127 (23.3%) Kotlow 2, 261 (47.8%) Kotlow 3, and 137 (25.1%) Kotlow 4. Kotlow scores decreased with age. For children with prior maxillary frenotomy, class 1 frenum mean age was 6.9 years, and class 4 was 0.6 years (P=.008). For those without a maxillary frenotomy history, class 1 frenum mean age was 8.7 years, and class 4 was 1.3 years (P<.001). No association was found between maxillary frenotomy history and lower Kotlow scores.
Nearly half of children have a Kotlow 3 maxillary frenum. Kotlow scores decrease as children age, reflecting elevated frenum insertion as the alveolar ridge develops. Otolaryngologists may find this data valuable when considering maxillary frenotomy in children. Jacob Heninger, Arkadeep Ghosh, Matthew Rowland, Inbal Hazkani, Taher Valika, Eric C. Cheon Publicatie 02-12-2024 Accidental tracheostomy decannulation (ATD) is a life-threatening event in pediatric patients. The factors associated with ATD in children are largely unknown. Utilizing the National Surgical Quality Improvement Pediatric (NSQIP-P) dataset, we sought to identify the incidence of ATD and associated factors.
Patients who underwent surgery at continuously enrolled American College of Surgeons NSQIP-P hospitals from January 1, 2012, to December 31, 2021, were included. Those who underwent a tracheostomy (CPT 31600 or 31601) as a primary or concurrent procedure were analyzed. ATD was defined by the NSQIP-P REINTUB variable. Multivariable logistic regression analysis and propensity score matching were performed to identify independent associations between demographic variables, relevant comorbidities, intraoperative factors, and ATD. Multivariable regression analyses were performed to identify any association between ATD and unplanned reoperation, pneumonia, extended length of stay, and death in 30 days in both pre-matched and matched cohorts.
A total of 5229 patients undergoing tracheostomy were included in the final analysis for the pre-matched cohort. ATD occurred in 93 (1.8 %) patients, with 42 % (n = 39) of these cases occurring within the first two postoperative days. In the matched cohort, female gender (P = 0.002) and structural pulmonary/airway abnormality (P = 0.016) were independently associated with ATD. Additionally, ATD was associated with unplanned reoperation (P < 0.001) and pneumonia (P = 0.024). The pre-matched cohort showed consistent results with the matched cohort.
Accidental decannulation is a serious complication following pediatric tracheostomy. By identifying patients at higher risk for ATD and the timing of its occurrence, providers can employ measures targeting these patients during their highest risk period. The sequelae associated with ATD further emphasize the importance of preventing this complication. Wenshan Xing, Jiao Zhang, Tun Liu, Yue Wang, Jin Qian, Bingqing Wang, Yongbiao Zhang, Qingguo Zhang Publicatie 02-12-2024 Microtia is a prevalent congenital malformation, the precise etiology and pathogenesis of which remain elusive. Mutations in the non-coding region of the HMX1 gene have been implicated in isolated cases of microtia, emerging as a significant focus of contemporary research. Several pathogenic copy number variations (CNVs) proximal to the HMX1 gene have been documented in wild animal populations, whereas only a single large segmental duplication in this region has been identified in humans. However, the absence of a gene-edited animal model has impeded the investigation of the unclear gene function associated with HMX1 mutations in human isolated microtia. In this study, we sought to precisely identify the pathogenic mutation by analyzing three pedigrees alongside population controls. Subsequently, our objective was to develop a CRISPR/Cas9 gene-edited mouse model to elucidate the functional implications of the identified mutation.
Genomic DNA was collected from 32 affected individuals across three pedigrees, as well as from 2000 control subjects. Comprehensive genomic analyses, including genome-wide linkage analysis, targeted capture, second-generation sequencing, and copy number analysis, were conducted to identify potential mutations associated with congenital auricle malformation. CRISPR/Cas9 gene-edited murine models were generated in response to the identified mutation. The auricular phenotypes of these gene-edited mice were systematically monitored. Small-animal Micro-CT scanning was employed to identify potential craniofacial or skeletal abnormalities. Furthermore, the expression of the HMX1 gene in the PA2 region of mouse embryos was quantified using RT-qPCR.
A co-segregated 600 base pair duplication located on chromosome 4 (chr4:8701900-8702500, hg19) was identified in affected individuals across three pedigrees, but was absent in healthy controls. Two types of CRISPR/Cas9 gene-edited mice were subsequently generated. The knock-in (KI) mouse model was engineered by inserting one copy of the duplicated sequence directly adjacent to the mutated site, whereas the knockout (KO) mouse model was created by excising the mutation sequence. The phenotypes of different group of CRISPR/Cas9 gene-edited mice demonstrated distinct auricular deformities. Furthermore, an increase in the copy number of the mutated sequence was associated with elevated expression levels of HMX1 in the gene-edited mouse model.
In this study, we further narrowed down and identified a 600 base pair copy number variation (CNV) located at chr4:8701900-8702500 (hg19), which is implicated in human bilateral, isolated microtia. Utilizing CRISPR/Cas9 technology, we developed novel mouse models harboring the identified mutation. These models serve as a robust platform for the comprehensive investigation of the underlying mechanisms of the disease. Arshad Zubair, Alison Flynn, Heather Todd, Grace Khong Publicatie 28-11-2024 Referrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times.
ENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022-February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times.
Forty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3-16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (p = 0.003, Wilcoxon rank sum test). Overall quality of care in NPEC was described as "very satisfactory" and "fairly satisfactory" by 92 % and 8 % parents respectively.
Nurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients. Chenxi Luo, Wenbo Chen, Qi Li Publicatie 25-11-2024 The aim of this study was to evaluate the variations in sleep architecture and types of sleep disturbances in preschool and school-age children diagnosed with obstructive sleep apnea (OSA).
Children who underwent polysomnography (PSG) were enrolled and divided into two groups based on age: a preschool group and a school-age group. We analyzed differences in sleep architecture and types of sleep disturbances between these groups.
Total sleep time was significantly higher in the preschool group compared to the school-age group (P < 0.05). The percentage of Stage N1 sleep (N1%) was also higher in the preschool group (p < 0.05). Conversely, the percentage of Stage N2 sleep (N2%) was lower in the preschool group (p < 0.05). Additionally, the average and minimum heart rates were higher in the preschool group, while the minimum oxygen saturation, including during non-rapid eye movement (NREM) and REM stages, was lower compared to the school-age group (P < 0.05). The prevalence of positional OSA (P-OSA) was lower, and the prevalence of REM OSA (R-OSA) was higher in the preschool group (P < 0.05).
The prevalence of P-OSA was lower, and R-OSA was higher in preschool children compared to school-age children. Furthermore, the types of sleep disturbances in preschool children with OSA showed significant differences from those in school-age children with OSA. Arifeen Rahman, Christopher Low, Alice Huang, Kara Meister, Karthik Balakrishnan Publicatie 23-11-2024 To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.
A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.
A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1-15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4-22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05-0.53, p < 0.01).
Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors. Soorya Todatry, Robert Newsom, James Wald, Manuela Fina Publicatie 24-11-2024 This study aims to assess the utility of the European Academy of Otology & Neurotology - Japanese Otologic Society (EAONO-JOS) and Potsic staging systems in predicting recidivism in pediatric patients with congenital (CC), primary acquired (PA), and secondary acquired (SA) cholesteatoma.
This is a retrospective study on 31 ears from 30 pediatric patients (≤18 years old) treated from 2015 to 2023 for CC, PA, and SA cholesteatoma. Surgical ears were classified according to EAONO-JOS and Potsic staging system. Surgery included transcanal endoscopic ear surgery (TEES), canal-wall up (CWU) or canal-wall down (CWD) mastoidectomy. Primary outcomes included the rate of residual disease at second-look surgery and the rate of recurrence at clinical observation. In addition, stapes erosion, incus erosion, labyrinthine fistula, and extension of disease in the mastoid at primary surgery were investigated for predictivity for recidivism. Descriptive statistics, Kaplan-Meier estimators (KM), and Fisher's Exact tests were used for statistical analysis.
Based on EAONO-JOS staging, the majority (87 %) of cholesteatoma were stage II (100 % for CC, 86.7 % for PA, and 60 % for SA). The rate of residual disease was 45 % for CC, 60 % for PA, and 40 % for SA cholesteatoma. The rate of recurrent disease among the entire cohort was 6.5 %. Univariate analysis on stapes or incus erosion or mastoid extension did not predict residual disease. Within the CC cohort, outcomes suggest a potential correlation between Potsic stage and the risk of residual disease. Insufficient variability in EAONO-JOS stages precluded statistical analysis of the system's ability to predict residual disease. Among the EAONO-JOS stage II cases, those presenting with all three variables (mastoid extension, incus erosion, and stapes erosion) at primary surgery had lower KM survivability (p = 0.010). The type of surgery was predictive of residual disease: CWU was associated with a lower KM survivability compared to TEES (p = .009). CWD was not predictive, given the insufficient sample size. Among all ears, 58 % were managed with TEES.
In this limited cohort of pediatric CC, PA, and SA cholesteatoma, the majority of cases were managed with TEES. Among EAONO-JOS stage II cases, the simultaneous presence of mastoid extension, incus erosion, and stapes erosion at primary surgery demonstrated statistically significant decreased residual-free survivability; TEES approach at primary surgery also has a statistically significant improved residual-free survivability compared to CWU approach. Yi Zhang, Yan Li, Rui Zhang, Lin Zhong, Lina Chen Publicatie 23-11-2024 To summarize the clinical characteristics and risk factors of occult foreign body aspiration (FBA) in children, which can help with early diagnosis and timely intervention, potentially preventing further exacerbations.
We retrospectively analyzed the clinical data of the children with a final diagnosis of FBA by flexible bronchoscopy in our hospital from 2017 to 2023. The patients were divided into occult and typical groups, and two groups were compared. Multivariate binary logistic regression analysis was employed to identify risk factors associated with the occurrence of occult FBA.
Among 1031 patients, the incidence of occult FBA was 4.3 % (44 cases). Compared to the typical group, children in the occult group had higher odds of ventilator management (P = .006) and longer postoperative hospitalization time (P < .001). Risk factors for predicting occult FBA were identified as age greater than 3 years old [OR: 6. 918; 95%CI (3.150-15.191)], fever [OR: 2.323; 95%CI (1.092-4.939)], inspiratory laryngeal stridor [OR: 6.514; 95%CI (1.863-22.781)], atelectasis [OR: 3.372; 95%CI (1.418-8.020)], and infiltration [OR: 2.749; 95%CI (1.195-6.323)].
Unlike typical FBA, the diagnosis of occult FBA is far more challenging, and occult foreign bodies are linked to a further exacerbation. This study identifies a few risk factors that have the potential to facilitate an early diagnosis of occult FBA in children. Further multicenter studies should be conducted to validate the findings. Anuj Kumar Neupane, C.S. Vanaja Publicatie 22-11-2024 Voice onset time (VOT) has been identified as a potential temporal cue for predicting children's performance in speech-in-noise tasks, yet the relationship between these two factors has never been explored among children using CI. Hence, the present study aimed to explore the performance of children using CI on temporal cue-based syllable categorization test and speech perception in noise and examine the relationship between the two.
Temporal cue-based syllable categorization test was developed with the manipulation of /ba/ sound in 10 steps continuum with VOT varied between -74 ms to 26 ms. The developed test and revised speech in noise for Marathi-speaking children (0 and 5 dB SNR) were administered to thirty children with unilateral cochlear implant and thirty children with normal hearing, aged between 5 to 7 years.
The Mann-Whitney U test showed significant differences between groups in temporal cue-based categorization and speech in noise tests at 0 dB and 5 dB SNR. Kendall Tau B revealed a moderate correlation between implant age and scores on the temporal cue-based categorization and speech in noise tests at 0 dB SNR, with a strong correlation at 5 dB SNR. Additionally, there was a significant moderate relationship between temporal cue-based categorization and speech in noise test scores at both 0 dB and 5 dB SNR.
The present study highlights the importance of temporal cues in speech perception and the need for temporal processing for children using cochlear implants. It reinforces the evidence that speech perception skills improve with implant age. Elizabeth O. Shay, Madhuri Kesani, Michael G. Moore, Avinash V. Mantravadi, Michael W. Sim, Jessica Yesensky, Janice L. Farlow, David Campbell, Diane W. Chen Publicatie 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. Zhengjun Zhong, Xu Guo, Desheng Jia, Hongying Zheng, Zebin Wu, Xuansheng Wang Publicatie 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. Elysia Grose, Jenny B. Xiao, Evan Fang, Brigitte Routhier-Chevrier, Jennifer M. Siu, Nikolaus E. Wolter Publicatie 29-11-2024 This review aims to elucidate the role of endoscopic sinus surgery (ESS) on the outcomes of pediatric patients with sinogenic intracranial infections.
MEDLINE, Embase, and the Cochrane library were searched for articles that described the outcomes in pediatric patients who had intracranial complications of acute rhinosinusitis (ARS) and underwent ESS with or without open neurosurgical approaches (ONA) or external sinus approaches (ESA). Primary outcomes of interest include mortality, revision surgery, length of stay and neurological sequelae. Random effects meta-analysis was performed.
Forty-eight articles met the final eligibility criteria, totaling 710 pediatric patients and 905 intracranial complications. The most common complications were subdural empyema (n = 261, 29 %), epidural abscess (n = 213, 24 %), and Pott's Puffy tumor (PPT) (n = 95, 10 %). When comparing patients who underwent ESS (alone or combined with ONA) to those who underwent ONA only, there was a decreased risk of revision surgery (RR = 0.66, 95 % CI = 0.38-1.12 and RR = 0.63, 95 % CI = 0.36-1.09, respectively) and decreased risk of neurological sequelae (RR = 0.65, 95 % CI = 0.15-2.74 and RR = 0.50, 95 % CI = 0.20-1.26, respectively), however these differences were not statistically significant. When patients who underwent combined intervention were compared to ESS only, the risk of revision surgery (RR = 1.04, 95 % CI = 0.62-1.72) and neurological sequelae (RR = 0.99, 95 % CI = 0.37-2.64) were similar. Risk of mortality was minimal and similar across all interventions.
The current study including primarily small retrospective studies found no statistically significant differences between children who received ESS alone, ESS with ONA or ONA alone, on mortality, revision surgery, length of stay and neurological sequelae. Although ESS may be beneficial for managing certain pediatric sinogenic intracranial infections, its true effectiveness is difficult to determine due to the variability in the types of intracranial complications and the inconsistent extent of ESS procedures reported in the literature. Drew C. Gottman, Michaele Francesco Corbisiero, Arman Saeedi, Samantha Bothwell, Ellie Svoboda, Andy Ai, Soham Roy Publicatie 29-11-2024 Robotic-assisted surgery is increasingly used in pediatric otolaryngology, offering potential benefits like improved cosmetic outcomes. However, challenges such as longer operative times, higher costs, and a steep learning curve remain.
This systematic review and meta-analysis assess whether robotic-assisted surgery offers advantages in operative time, complication rates, hospital stay, and cosmetic outcomes compared to traditional methods in pediatric patients.
A literature search identified 20 studies, with six focused on thyroidectomy. Data on operative time, complications, hospital stay, and cosmetic outcomes were extracted and analyzed.
No significant differences in operative time or complications were found for robotic-assisted thyroidectomy, but it showed superior cosmetic outcomes and, in some cases, shorter hospital stays. Additional analyses suggested feasibility and functional benefits of other robotic procedures.
Robotic-assisted surgery in pediatric otolaryngology is as safe and efficient as traditional methods, with added cosmetic and functional benefits. Further large-scale trials are needed. Francesca Galluzzi, Werner Garavello Publicatie 25-11-2024 Children with mucopolysaccharidosis (MPS) with difficult airways may require tracheostomy, and surgery can be challenging. This review aims to study the indications, surgical aspects, postoperative complications and outcomes of tracheostomy in MPS children.
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Pubmed and Embase were searched for studies on tracheostomy in children with MPS. The Joanna Briggs Institute was used for quality appraisal.
A total of 9 studies were included. Three were retrospectives, one was prospective, and five were case series. Overall, 34 subjects who underwent a tracheostomy were included. The mean age was 11 years and the male/female ratio was 1.7. MPS II was the most common type included (16/34). The percentage of tracheotomized MPS children was 10 % (ranging from 3.5 % to 15.5 %). Indications for tracheostomy were: progressive or urgent airway obstruction unresponsive to conservative treatments, before a planned surgical procedure, and in case of failed intubation/extubation. Characteristics clinical features make surgery difficult and predispose complications such as tracheal granulations, wound infection, stomal narrowing, persistent of abundant secretions and tracheitis. Considering tracheostomy outcome, two patients underwent decannulation, but one of them required reinsertion tracheostomy after one year. The duration of follow-up was 8.4 and 9.98 years.
Tracheostomy is an effective means of ensuring airway patency in children with MPS and is considered essentially permanent. Management can be challenging due to typical clinical features and progression of MPS. A planned multidisciplinary approach may prevent complications. Joseph E. Kerschner Publicatie 19-09-2024
Impact of COVID-19 on newborn hearing screening (NBHS) and early hearing detection and intervention (EHDI) services: A statewide analysis of differences and policy implications
Hearing loss and vestibular dysfunction in congenital CMV infection: Could it be due to endolymphatic pressure anomaly? A preliminary study
Evaluating utility of allergy testing in management of nasal obstruction following inferior turbinate reduction
Acute suppurative thyroiditis in a child secondary to pyriform sinus fistula: From single case to systematic review
Electrophysiological findings of brainstem auditory evoked potentials in infants with down syndrome: A systematic review and meta-analysis
Corrigendum to “Factors influencing auditory brainstem response changes in infants” Int. J. Pediatr. Otorhinolaryngol. Volume185/issue details, cover date, 112094
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Corrigendum to “A review of the importance of top-down processing assessment in auditory processing disorder” Int. J. Pediatr. Otorhinolaryngol. 186, (November 2024), 112128
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Age-dependent trends in pediatric maxillary frenum classification
Accidental tracheostomy decannulation: Risk factors and complications in pediatric patients using the NSQIP-P database
An innovative CRISPR/Cas9 mouse model of human isolated microtia indicates the potential contribution of CNVs near HMX1 gene
Implementation of a nurse-led paediatric epistaxis clinic at a tertiary hospital
Differential sleep subtypes in children with OSA of different ages
Impact of demographics and social vulnerability on outcomes in pediatric medullary thyroid cancer
Comparison of current staging systems for predicting pediatric cholesteatoma outcomes
The characteristics of occult foreign body aspiration and predicting factors in children
Temporal cue based categorization and speech perception in noise among pediatric cochlear implant users
Airway management in pediatric patients undergoing microvascular free tissue transfer reconstruction after mandibulectomy
Artificial intelligence as an auxiliary tool in pediatric otitis media diagnosis
The impact of endoscopic sinus surgery in pediatric patients with sinogenic intracranial infection: A systematic review and meta-analysis
Assessing robotic-assisted procedures in pediatric otolaryngology: A systematic review and meta-analysis
Tracheostomy in children with mucopolysaccharidosis: A systematic review
Holiday letter 2024
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