International Journal of Pediatric Otorhinolaryngology 2020-09-14

Continued development of auditory ability in autism spectrum disorder children: A clinical study on click-evoked auditory brainstem response

Aifeng Li, Guoqiang Gao, Tao Fu, Wenhui Pang, Xiaoheng Zhang, Zuorong Qin, Ruifeng Ge

Publicatie 25-08-2020


The study aimed to analyze the developmental mode of auditory at the level of brainstem in preschool autistic children using click-evoked auditory brainstem response (click-ABR). Twenty children with autism spectrum disorder (ASD) and 20 age matched typical development children (TD) were recruited. The detail data recorded from click-ABR were collected at two time periods (T1 and T2). There was no significant change in TD group at two time periods. In ASD group, wave V latency was significantly shortened at T2 compared to that recorded at T1. The interpeak latency of I-V was short at T2 versus at T1 in the autistic children. Compared to the TD group, ASD was associated with longer latencies for waves V and longer interpeak latencies of I-III, I-V at T1. In addition, ASD group also indicated longer latencies of wave III and wave V, longer interpeak latencies of I-III and I-V at T2 compared to the TD group. ASD group had immature and dysfunction developmental mode in auditory stimuli perception at the level of brainstem. The performance of auditory ability in children with ASD improved gradually with ages. However, there are still differences compared with TD children.

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Human papilloma virus induced oropharyngeal inverted papilloma as a precursor to laryngeal papillomatosis in A 1 year old child

Habie Thomas Samuel, Lalee Varghese, Regi Kurien, Meera Thomas

Publicatie 09-09-2020


Inverted papillomas are rare tumors in the pediatric population and have not been reported in children less than two years. These tumors may produce respiratory distress in patients, particularly if they ectopically occur in the airway. Human papilloma virus is one of the known etiologies for many head and neck neoplasms including inverted papillomas and squamous papillomas. We report a child who was surgically treated at fifteen months of age for inverted papilloma of the pharynx who subsequently developed squamous papilloma of the larynx which persisted as a recurrent respiratory papillomatosis. This is the first such reported case to our knowledge.

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"Zygomatic air cells in connection with Lucs abscess"

Steven Engebretsen, Tyler Patrick, Cecelia Helwig, Mallory ONiel

Publicatie 31-08-2020


An uncommon complication of Acute Otitis Media (AOM) is a subperiosteal temporal infection known as Luc's abscess. Zygomatic air cells (ZACs) are an uncommon anatomic variant. Two otherwise healthy male patients, aged six- and thirteen years-old presented with unilateral otalgia, swelling, trismus, and fever. Imaging revealed Luc's abscess near ZACs. Antibiotics, drainage and myringotomy tubes resulted in a full recovery. In addition to the spread of soft tissue infection through the Notch of Rivinus, the presence of ZACs may provide a pathway for suppurative effusion and development into Luc's abscess.

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Parotid gland atrophy after conservative treatment of a post-traumatic parotid fistula in a two-year-old boy

Hiroshi Fukumasa, Masayoshi Tsuda, Ryo Ninomiya, Masashi Kobayashi, Kazutaka Nishiyama, Ayami Ito, Yukihiro Tasaki, Masano Amamoto

Publicatie 30-08-2020


A parotid fistula is a rare complication following parotid gland and duct injury. A two-year-old boy with a previous parotid fistula after parotid injury due to a dog bite was successfully treated with pressure-dressing therapy, which is generally non-invasive and tolerable by young children. During follow-up, ultrasonography revealed atrophy of the parotid gland. This finding is consistent with the healing mechanism previously assumed in adult patients with a parotid fistula. Consideration should be paid to the possibility of oral environmental changes associated with reduced saliva secretion from parotid gland atrophy after conservative treatment of parotid fistula.

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Tracheal cartilaginous sleeve diagnosed on ultrasound in a child with Pfeiffer syndrome

Kelsey A. Loy, Austin S. Lam, Jeffrey P. Otjen, John P. Dahl

Publicatie 03-09-2020


The tracheal cartilaginous sleeve (TCS) is a rare, difficult to diagnose airway malformation in which segmented tracheal rings are replaced by a solid sheath of cartilage. TCS is a significant cause of morbidity and mortality in patients with syndromic craniosynostosis, and early diagnosis is essential. We report a case in which ultrasound (US) was used to diagnose TCS in a patient with Pfeiffer syndrome. This is the first case demonstrating the use of US as the initial tool to diagnose TCS. The case supports ongoing research investigating the use of US as a screening and diagnostic imaging modality for TCS.

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Minimally invasive transoral image-guided drainage of a retropharyngeal abscess with mediastinal extension

Christina Stevens, Patricia Ladd, Saied Ghadersohi, Sarah A. Gitomer

Publicatie 25-08-2020


Retropharyngeal abscess (RPA) in children is a serious deep neck space infection that rarely is complicated by extension into the mediastinum. RPA with mediastinal abscess requires prompt surgical management, generally via external or transoral approach. We present the case of a 3-year-old boy with RPA with mediastinal extension who was managed with a unique multidisciplinary surgical approach with otolaryngology and interventional radiology. A transoral approach was utilized to pass a transnasal drain with image guidance into the mediastinal fluid collection. This report reviews the presentation and surgical management of RPA with mediastinal extension and describes a unique minimally invasive approach to drainage.

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Benign postcricoid hypertrophy: Case report and review of the literature

Kevin J. Contrera, Tarik M. Elsheikh, Brandon Hopkins, Stephen Hadford, Samantha Anne

Publicatie 28-08-2020


This is a case of a premature infant with stridor, supplemental oxygen requirement, and dysphagia refractory to anti-reflux and anti-inflammatory medications. Endoscopy revealed postcricoid fullness with MRI showing submucosal lobulations. Microscopic resection of an obstructive postcricoid mass resulted in immediate resolution of stridor and oxygen requirement with mild improvement in dysphagia. Pathology demonstrated submucosal fibrosis, edema, and vascularity with no evidence of malignancy, fibromatosis, or cystic/polypoid components. Review of the literature shows that lesions in postcricoid region include amyloidosis, lymphatic malformation, and normal-variant hypertrophy. Surgery should be considered for atypical postcricoid lesions with symptoms refractory to medical management.

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Benign adenoidal hypertrophy caused by adenovirus presenting as a nasopharyngeal mass concerning for malignancy

J. Nicodemo, E. Hamersley, P. Baker, S. Reed

Publicatie 22-08-2020


Benign adenoidal hypertrophy is the most common cause of nasopharyngeal obstruction. However, depending on size and location, masses may cause nasopharyngeal obstruction. We present our experiences with a ten-year-old female who presented with what appeared to be a large nasopharyngeal mass that was initially favored to be malignant and was ultimately found to be adenoid hypertrophy related to acute infection with adenovirus.

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Heterotopic gastric mucosa of the proximal esophageal (HGMPE) and its potential role in pediatric dysphonia and dysphagia

Michael S. Weinstock, Jeffrey P. Simons, Joseph E. Dohar

Publicatie 18-08-2020


Despite a reported incidence of HGMPE of 10%, proof of acid production, and an increased incidence of respiratory symptoms, the pediatric otolaryngology, swallowing and voice care literature is silent on this entity. This case series describes pediatric patients confirmed to have HGMPE with dysphonia and/or dysphagia. Retrospective case series of Pediatric Voice, Resonance, and Swallowing Center patients at a tertiary Children's Hospital in 2019. Tertiary academic medical center. Three patients who underwent triple endoscopy for dysphonia or dysphagia were histologically diagnosed with HGMPE. Esophageal biopsies were otherwise normal. Two of the three patients resolved their primary aerodigestive symptoms following treatment with acid suppression and a protectant (sucralfate). The third patient reported significant improvement in symptoms by phone. The significance of this case series cannot be understated: 1) A need for increased awareness among pediatric otolaryngologists, voice care and swallowing professionals of this entity given its relatively common incidence of 10% offset by a dearth of presentations & scientific publications in our literature clearly exists. 2) Otolaryngologists have abandoned operative upper aerodigestive tract endoscopy in lieu of office-based less comprehensive videolaryngostroboscopy and fiberoptic endoscopic evaluation of swallowing. HGMPE & other esophageal disorders (i.e. eosinophilic esophagitis) support revisiting triple endoscopy in select patients where office endoscopy has failed to diagnose and successfully treat such patients. 3) Both acid suppression therapy and a protectant (sucralfate) may be useful in these patients. 4) Modification of rigid esophagoscopy technique to carefully assess the introitus and superior esophageal segment is paramount 5) Otolaryngologists over-diagnose & over-treat laryngopharyngeal reflux. The pediatric & adult literature is replete with significant safety warnings associated with acid suppression therapy and guidelines admonish their indiscriminate use, raising the liability bar of empiric treatment. Large scale prospective, randomized and controlled studies are needed to confirm the pathophysiologic role of this entity in pediatric aerodigestive disorders. HGMPE is a clinical entity that can be easily missed upon swift entry into the esophagus with rigid endoscopy. Careful scrutiny and visualization of the proximal esophagus is critical in order to identify HGMPE, as there is a higher rate of laryngospasm, stricture, and potentially neoplasm in this population.

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Fiber optic CO2-laser induced emphysema of the supraglottis

Lauren Arnold, Christopher Kennel, Eliav Gov-Ari

Publicatie 19-08-2020


Subcutaneous emphysema is a rare but well-defined surgical complication. However, emphysema of the supraglottic mucosa has not been described in the literature. We present a case of a 2-year-old male who suffered supraglottic emphysema secondary to fiber optic CO

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Surgical management of an infantile elliptical cricoid: Endoscopic posterior laryngotracheoplasty utilizing a resorbable plate

Andre M. Wineland

Publicatie 17-08-2020


The cricoid is a circular "ring" of cartilage in the airway. When the lateral walls of the cricoid approximate, it takes the shape of an ellipse. In severe cases, this also reduces the glottic aperture and causes respiratory distress, stridor, and failure to thrive. The elliptical cricoid has limited surgical options outside of open laryngotracheal procedures and tracheostomy. Recently, alternatives to autologous grafts have been utilized in airway reconstruction to reduce harvest site morbidity and increase operating room efficiency. Herein a case is presented that demonstrates the successful use of a resorbable plate in augmenting the posterior larynx in an infant with a severely elliptical cricoid to avoid a tracheostomy.

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Head and neck infections in children due to Eikenella corrodens: Report of three cases and review of literature

Manuel Penton, Silvia Schibeci Oraa, Ashraf Abdelhemid, Caitlin Otto, Margaret R. Hammerschlag

Publicatie 18-08-2020


Eikenella corrodens is a small, nonmotile Gram-negative rod that is part of the normal flora in the mouth, upper respiratory, gastrointestinal, and genitourinary tracts. It is classically found in human bite (fist to mouth) infections but is also seen in respiratory tract and head and neck infections. We describe three cases of E. corrodens causing head and neck infections in children seen in our institution between 2013 and 2019. We also reviewed the available literature on pediatric head and neck infections caused by E. corrodens. All 3 children recovered and fit the trends identified in the 58 patients published in the literature from 1976 to 2019. E. corrodens is responsible for a range of head and neck infections in pediatric patients. It is a not infrequent cause of head and neck infections in children and should be considered when selecting presumptive antibiotic therapy.

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Pediatric necrotizing soft tissue infection after elective surgery: A case report and literature review

Lisa Gheuens, Quinten Roggeman, Koen Cortebeeck, Paul Leyman, Anja Bernaerts, Bert De Foer, Jan Van Leemput, Joost van Dinther

Publicatie 25-07-2020


Necrotizing soft tissue infections (NSTIs) are rare but often lethal. Early diagnosis and aggressive surgical debridement are essential to achieve the best possible outcome. A 12-year old boy was diagnosed with a necrotizing soft tissue infection following elective revision surgery for functional impairment resulting from scar tissue of the neck. Fever and inflammation of the surgical wound manifested 24-36 hours postoperatively. Antibiotic therapy with amoxicillin-clavulanic acid was initiated, but the patient was unresponsive. Ultrasonography, a wound culture and surgical exploration confirmed the diagnosis. The culture was positive for a Streptococcus pyogenes infection and antibiotic treatment was switched to penicillin and clindamycin. Following the diagnosis, surgical debridement was performed subcutaneously, and only necrotic tissue was removed to preserve as much skin tissue as possible. After eradication of the infection, vacuum-assisted closure of the wound was used to close the subcutaneous space. The patient was discharged after 40 days. In this patient, we treated a necrotizing soft tissue infection with antibiotics, skin sparing surgeries and negative pressure wound therapy (NPWT). We used ultrasonography as imaging technique to help with the diagnosis. The extensiveness of surgical debridement was rather limited. We focused on opening all affected fascial layers. The surgical debridement was subcutaneous, and only necrotic tissue was removed. Because of the location in the neck, we tried to avoid an aggressive skin debridement to preserve as much skin tissue as possible. Negative pressure wound therapy is not frequently used in this context but it contributed to an enhanced wound healing. Ultrasonography for diagnosing NSTIs is useful, but the clinical findings and an explorative surgery will remain most important.

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Two rare cases of sinonasal vascular malformation in the pediatric population

Beatrice Go, Seerat K. Poonia, Conor Devine, Luv Javia, Adva Buzi, Mark D. Rizzi

Publicatie 25-07-2020


Vascular malformations presenting in the nasal cavity and paranasal sinuses are rare. Differentiating benign vascular malformations of the sinonasal cavity from other pathologic entities can be challenging and the role of preoperative angiography and embolization is not well defined. We present two unique cases of large pediatric sinonasal vascular malformations and describe their presentation, diagnosis and subsequent management. Both patients underwent embolization of the ipsilateral arterial supply followed by successful and complete endonasal surgical excision. This report provides description of management of the very rare occurrence of sinonasal vascular malformation in two adolescents.

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Personal protective equipment availability and usage amongst pediatric otorhinolaryngologists during the COVID-19 pandemic: An international survey

Dong Hyun Kim, Neil. K. Chadha, Lily. HP Nguyen, Murad Husein

Publicatie 13-09-2020


To survey a group of global pediatric otolaryngology specialists to assess their usage and access to personal protective equipment during the COVID-19 pandemic. A survey of 13 questions was created collecting information on: basic demographics of practice, types of PPE used for procedures of varying aerosolization risk, access to positive air-purifying respirator (PAPR) and patient testing for SARS-CoV-2. Pediatric otolaryngologists were invited to complete the survey via Whatsapp™. 96 responses were collected from 17 different countries. N95 was the most commonly utilized PPE when dealing with COVID-19 patients (64.2%-81.9% depending on aerosolization risk of the procedure). Significantly higher use of PAPR was noted in high-risk aerosolization generating medical procedures, when compared to other risks. Face covering was used consistently (91.6%). Most respondents (78.1%, n = 75) had access to PAPR or had at least requested it. The majority of patients (56.2%, n = 54) was being tested for SARS-CoV-2 prior to procedures performed in operating rooms (OR); whereas, only 1.1% (n = 1) of clinic patients were tested for SARS-CoV-2 irrespective of the history or symptomatology. Most pediatric otolaryngologists used N95 and some form of face covering (eg. goggles, face shields) when dealing with patients with COVID-19 positive status. PAPR was used in situations of high aerosolization risk. Majority of respondents were screening all patients prior to procedures in the operating room.

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Biofilm distribution on tympanostomy tubes: An ex vivo descriptive study

Nadeem Habashi, Tal Marom, Doron Steinberg, Batya Zacks, Sharon Ovnat Tamir

Publicatie 11-09-2020


Tympanostomy tube (TT) insertion is a common procedure in children with otitis media with effusion. Post-TT otorrhea (PTTO) is a frequent post-operative complication. Biofilms are involved in chronic PTTO cases. To describe and qualitatively analyze the geometry and sites prone to biofilms on removed TTs, relatively to their position in the ear, past medical/surgical history and PTTO presence. Biofilms presence and topographic distribution on TTs were ex vivo evaluated by using scanning electron microscope, confocal microscope and stereo-microscope. Forty-eight TTs from 30 children were analyzed. Indications for removal were: 71% due to retained TTs (average time from insertion: 24.4 ± 15.1 months), 23% due to chronic PTTO, and 6% due to TT obstruction/dysfunction. Different types of bacterial biofilms were detected on all TTs, regardless the time from their insertion nor their types. Biofilms were observed more on the perpendicular junction and on the internal lumen, and more biofilm colonies were detected on the medial part, facing the middle ear mucosa. TTs removed from children with PTTO exhibited more biofilm colonies when compared to their peers. Of the 16 children who underwent adenoidectomy concomitantly with TT insertion, 10 (62%) children were sent for TT removal due to retained TTs, and 6 (38%) children due to chronic PTTO (p = 0.03). Descriptive analysis of biofilm topographic distribution demonstrated adhesions on specific TT areas: perpendicular junctions and the internal lumen. Such "prone zones" may be the future target areas for changes in TT geometry or can be specifically coated with anti-biofilm materials.

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Outcomes of OSA in surgically naïve young children with and without DISE identified laryngomalacia

Harrison Love, James E. Slaven, Ryan M. Mitchell, Anuja Bandyopadhyay

Publicatie 12-09-2020


Obstructive sleep apnea (OSA) in young children is caused by upper airway obstruction and is associated with changes in cognitive development, temperament and behavior. Adenotonsillectomy (AT) is often utilized as first line therapy for pediatric OSA. Children with laryngomalacia (LM) have a high chance of residual OSA after AT. There is paucity of literature regarding surgically naïve young children with OSA and laryngomalacia. Our study aimed to compare demographics, comorbidities and outcomes associated with OSA in surgically naïve young children with and without laryngomalacia. Retrospective chart review of surgically naïve young children (<2-year-old) with polysomnogram (PSG) diagnosed OSA. All young children underwent pre-operative PSG followed by drug-induced sleep endoscopy (DISE) directed intervention. Variables documented included demographics, comorbidities, history of adenotonsillectomy, DISE directed surgical interventions and pre and post PSG findings. Laryngomalacia was defined as presence of obstruction (Chan Parikh score ≥ 2) at the supraglottic level on DISE evaluation. Demographics and prevalence of comorbidities of those with and without LM were compared using t-test (continuous) and Chi Square (categorical). P value is significant for <0.05. 79 surgically naïve young children with PSG diagnosed OSA performed between 2015 and 2019 were included in the study. Children with LM were younger in age (11 months) and had a higher OSA-18 score (35) compared to children without LM (17 months) (OSA-18 score: 5). No significant difference was noted in the pre-DISE PSG parameters in the 2 groups. 56.1% of children with OSA and laryngomalacia did not need AT. Both children with and without laryngomalacia showed improvement in AHI on post-DISE PSG. Higher baseline AHI was associated with greater improvement in AHI. Surgically naïve young children with OSA and LM present earlier than those without LM and report a significantly worse quality of life Young children with a higher baseline AHI were found to have greater improvement in severity of OSA post-DISE and surgical intervention. Majority of children with OSA and laryngomalacia did not need adenotonsillectomy after a preprocedural DISE assessment yet showed similar improvement in AHI. More studies are needed to determine which patients with OSA and laryngomalacia will need multilevel interventions.

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Using 3D-reconstruction to analyse typical growth trends of the maxillary sinus in children

Sophie Lee, Justin Wade Fernandez, Murali Mahadevan, Gregory Tarr, Ali Mirjalili

Publicatie 13-09-2020


There remains a lack of consistent evidence surrounding the developmental anatomy of the maxillary sinus (MS), despite its clinical significance in radiological interpretation and surgical intervention. Our aim was to analyse the typical growth trends of the MS throughout development, to better understand its morphological transformation from birth until late adolescence. Computed Tomography (CT) scans of individuals aged 0-18 years within the Auckland District Health Board region in New Zealand were examined retrospectively. Sixty-five patients were selected for the study after careful review of criteria. Manual 3D-reconstruction was utilised to replicate the MS from CT images and the mean changes in size, volume and shape with increasing age were analysed. Principal component analysis (PCA) was performed to statistically calculate the mean 3D shapes of the MS in each age group and analyse the independent modes of variation evident in sinus morphology between individuals of each age category. At 0-1 years of age, mean MS size was 1.03 × 1.82 × 1.27 cm (width, length, height) with a mean volume of 0.81 cm The results of this study can be used as a reference for typical MS growth in healthy children and as a basis to study how disease or surgical intervention may influence sinus development in children.

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Diagnostic considerations prior to pediatric tracheocutaneous fistula closure

Stephen R. Chorney, Solomon Husain, Steven E. Sobol

Publicatie 11-09-2020


An airway assessment often occurs prior to tracheocutaneous fistula (TCF) closure in children. Bronchoscopy (MLB) with or without fistula-occluded polysomnography (PSG) helps determine candidacy and localize potential obstruction. To date, little has been published on MLB or PSG findings in children before surgically closing a TCF. A case series with chart review of children between 2017 and 2020 who underwent repair of a TCF after tracheostomy decannulation. Thirty-six children were included for review. Mean age was 5.9 years (95% CI: 4.5-7.3), 58.3% were male, and 50% had chronic lung disease. Surgery occurred 13.3 months (95% CI: 11.9-14.8) after decannulation, with 80.6% by primary closure and 19.4% by secondary intention. There was one unsuccessful closure and two patients (5.6%) presented with a postoperative complication. An MLB was performed in 97.2% of children, where 22.9% identified supraglottic pathology, 11.4% had grade 2 subglottic stenosis, and 11.4% had difficult exposure of the larynx. Further, one child had a non-obstructing subglottic cyst, one had a supraglottoplasty for redundant arytenoid mucosa, and two children had suprastomal granulomas requiring removal. A PSG was obtained in 36.1%, with a mean Apnea-Hypopnea Index of 2.4 events/hour (95% CI: 0.9-3.9), nadir Oxygen saturation of 90.5% (95% CI: 87.9-93.0), and peak end-tidal CO The selection of candidates for pediatric TCF closure requires careful evaluation of the airway. Surgeons should be familiar with the potential findings on MLB and PSG prior to closure.

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Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children

David Ulanovski, Sagit Stern Shavit, Oded Scheuerman, Meirav Sokolov, Ohad Hilly, Eyal Raveh

Publicatie 11-09-2020


To evaluate and compare characteristics of Fusobacterium necrophorum mastoiditis (FnM) to characteristics of acute mastoiditis (AM) caused by other bacteria in tertiary children hospital Methods : Children with FnM (N=43) and non FnM (N=88). Assess medical, microbiologic and imaging characteristics, surgical findings and postoperative recovery. Children with FnM had a positive history of otitis media, ear discharge and sub-periosteal abscess (p=0.0004, 0.09, 0.0003, respectively) at presentation. Their temperature, WBC and CRP were significantly higher (39.8 vs. 37.9, 19.4K vs. 16.1K, 21 vs. 8.7, p=0.0001). Positive culture was found in 46% of patients; 64% were diagnosed by PCR. CT scan was indicated in 95% and surgical intervention in 93% of children with FnM, compared to 15% and 9.7% of children in the non-FnM group (p=0.0001). Complex post-operative course was frequent for the FnM group: 88% of children had persistent fever, 46% had additional imaging and 14% additional surgical intervention. Children with FnM were treated with IV antibiotics for an average of 22 compared to seven days for non-FnM children (p=0.0001). Fusobacterium should be suspect in a child presenting with AM, a septic appearance, high fever and increased inflammation markers. A regimen of two antibiotics should be empirically started, then proceed to imaging and early surgical intervention. A relatively slow post-operative recovery process should be expected; however, prognosis is good.

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Pre-extubation ultrasonographic measurement of intracricoid peritubal free space: A pilot study to predict post-extubation airway obstruction in children

Madhusudan Samprathi, Arun Kumar Baranwal, Pramod Kumar Gupta, Muralidharan Jayashree

Publicatie 10-09-2020


Post-extubation airway obstruction (PEAO) is common and difficult to predict in children. We hypothesized that Intracricoid Peritubal Free Space (IPFS) obtained by deducting the outer diameter of the endotracheal tube in situ (OD This study was conducted in a Pediatric Intensive Care Unit of a tertiary care teaching hospital in a low-middle income economy. Laryngotracheal ultrasound was performed just prior to the first elective extubation in 93 patients (3mo-12yrs) intubated for ≥ 48 h, to calculate the IPFS. Patients with pre-existent upper airway conditions, chronic respiratory diseases and poor airway reflexes were excluded. Patients with Westley's Croup Score (WCS) ≥4 were classified as PEAO, and those with WCS ≥7, as extubation failure (EF). Thirty-two (34%) patients developed PEAO, while seventeen (18%) developed EF. Baseline clinical characteristics were similar in patients with and without PEAO. IPFS was lesser in patients who developed PEAO (4.16 ± 1.18 mm vs. 5.28 ± 1.51 mm, p < 0.001) and EF (4.13 ± 1.44 mm vs. 5.07 ± 1.46 mm, p = 0.019) compared to those who did not. IPFS <5.16 mm predicted PEAO [sensitivity, 84%; positive predictive value (PPV), 87%; AUC, 0.714), while IPFS <3.77 mm predicted EF (specificity, 80%; PPV, 88%; AUC, 0.679). Combining clinical risk factors (presence of clinical edema, prolonged ventilation and younger age) and lesser IPFS helped develop a clinico-sonographic prediction model with improved predictability for PEAO and EF (AUC, 0.820 for both). Lesser IPFS is reasonably sensitive and specific to predict PEAO and EF respectively with high PPV. Combining clinical risk factors and IPFS improved the PPV further. Further studies with larger samples stratified for different age groups in different clinical settings are required to confirm these observations.

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Predicting complications of pediatric temporal bone fractures

Raj D. Dedhia, Oliver Y. Chin, Matthew Kaufman, Tsung-Yen Hsieh, Rodney C. Diaz, Hilary A. Brodie, Jamie L. Funamura

Publicatie 10-09-2020


Our aim is to characterize complications of pediatric temporal bone fractures and identify predictive risk factors associated with fracture complications. A retrospective review was conducted of all temporal bone fractures diagnosed in children (age less than or equal to 18 years) from a single academic institution between 2003 and 2017. Demographics, mechanism of injury, fracture characteristics, computed tomography evaluation and follow-up duration were recorded on each patient. Outcomes measured include facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL). One-hundred-seventeen patients with 129 temporal bone fractures were included in the study. Most fractures were otic capsule sparing (OCS) (96%, n = 124) and longitudinal (71%, n = 91). Otic capsule violating (OCV) fractures were associated with higher CSF leak rates (20% versus 2%, p = 0.14) and FNI rates (60% versus 5%, p = 0.002) compared to OCS fractures. Audiograms were available in 37 patients (34%). Patients with Glasgow coma scale (GCS) consistent with a mild traumatic brain injury (TBI) (GCS > 13) had significantly fewer complications (FNI and CSF leaks) compared to the group with moderate and severe TBI (GCS < 13), 5% versus 23% (p = 0.03). Higher complication rates are seen with OCV fractures and transverse fractures. Moderate and severe TBI as measured by GCS is predictive of FNI and CSF complications in pediatric temporal bone fractures.

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The effectiveness of a preoperative multi-component non-pharmacologic preparation on post-tonsillectomy pain: A randomized controlled clinical trial

Mohammad Faramarzi, Sareh Roosta, Ali Faramarzi, Alireza Salehi, Nasim Matani

Publicatie 11-09-2020


Tonsillectomy is a painful operation and some studies have suggested that preoperative non-pharmacologic preparations may decrease postoperative pain. In this randomized clinical trial study, we decided to determine which is more effective in the post-tonsillectomy pain; an informative booklet or a costly, time consuming, sophisticated, and multi-component preparation program. Patients were randomly assigned into two groups. In the booklet group, children and their parents only received an informative booklet as routine information preparation. On the other hand, in the multi-component group; in addition to receiving the same booklet, children and their parents received our multi-component pre-operative preparation program. The following items were included in the package: preoperative tour in the ward, an educational DVD, and therapeutic play intervention. All patients were observed at least for 8 h as a day case or ambulatory tonsillectomy. The pain score was recorded according to the visual analog scale for seven days. Finally, the post-tonsillectomy pain scores were compared in the two groups. The multi-component group included 121 children and booklet group 120. Minimum and maximum age was 9 and 12 years. Regarding post-tonsillectomy pain, we found no significant difference between the multi-component group and the booklet group. Our data revealed that a new concept which is more cost-effective and concise booklet is as effective as costly and sophisticated methods in post-tonsillectomy pain among 9-12 years old children.

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Management of obstructive sleep apnea in children with achondroplasia: Outcomes of surgical interventions

Kayce L. Booth, Dylan A. Levy, David R. White, Jeremy D. Meier, Phayvanh P. Pecha

Publicatie 09-09-2020


Children with achondroplasia are predisposed to obstructive sleep apnea (OSA), however little is known regarding surgical interventions and outcomes for this condition. The aim of this study was to evaluate the severity of OSA in children with achondroplasia and report outcomes of surgical interventions using polysomnography (PSG) parameters. Retrospective chart review of children with achondroplasia with documented OSA from 2002 to 2018 that had pre- and post-operative PSG results. Additional data extracted included age, gender, and type of surgical interventions. The primary outcome was change in postoperative obstructive apnea hypopnea index (OAHI). Twenty-two children with achondroplasia were identified that underwent formal PSG before and after confirmed OSA. The median age was 12 months (range 4 days-15.3 years, IQR 2 years) at time of initial PSG evaluation. The majority (72.7%) of patients had severe OSA with a median preoperative OAHI of 14.25 (IQR 9.4). The most common surgical intervention was adenotonsillectomy (n = 15). Multilevel surgical intervention was required in 9 (41.0%) patients. Post-operatively, 16 (72.7%) children experienced a reduction in OAHI, of which four (18.2%) had complete OSA resolution. OAHI scores increased in six (27.3%) children. Patients with the most severe OSA at baseline had greater improvements in post-operative OAHI (P < 0.01). Neither type nor number of surgical interventions was associated with improved outcomes (P = 0.51, P = 0.89 respectively). Treatment of OSA in children with achondroplasia remains challenging. Although reduction of OAHI is possible, caregivers should be counseled about the likelihood of persistent OSA and the potential for multilevel airway surgery.

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Routine vocal cord mobility assessment post cardiac surgery via median sternotomy approach

Anthony Lambert, David S. Winlaw, Victoria Deacon, Karen A. Waters, Jane Pettigrew, Glenda Fleming, Yishay Orr, Eugene H. Wong, Alan T. Cheng

Publicatie 11-09-2020


Surgery of the aortic arch carries a risk of injury to the vagus and recurrent laryngeal nerves, particularly in a young child, as these structures lie in close proximity to aortic arch. This study aimed to determine the incidence, symptomatology and natural history of vocal cord dysfunction (VCD) following aortic arch reconstructive surgery through a median sternotomy approach. Prospective assessment was performed of all consecutive newborns who underwent cardiac surgery for aortic arch surgery via median sternotomy between January 2016 and May 2017 at a tertiary paediatric hospital. All patients underwent post-operative flexible fibreoptic nasolaryngoscopy (FNL) after extubation to assess for the presence of vocal cord dysfunction (VCD). Those with VCD were re-examined at followup. A feeding assessment performed by speech pathologists (SPs) and a video fluoroscopic swallow study (VFSS) were also performed in those with VCD or feeding difficulties. A total of 35 newborns were included in the study. At initial review, left sided VCD was demonstrated in 65.7% of patients (n=23). Significant associations with VCD were younger age (3.0 versus 6.5 days, p=0.041) and a weak or absent cry (Relative Risk=16.4, 95%CI 3.8-47.8, p<0.001). 52.5% (n=11) of patients with VCD had evidence of aspiration on VFSS. There was no significant difference in intensive care unit stay or overall hospital stay between patients with VCD compared to those without (33.0 days vs 28.8 days, p=0.73; 52.5 vs 45.9, p=0.72.) Infants with either proven VCD or a weak cry were more likely to be discharged home with a nasogastric (NG) tube (RR=4.67, p= 0.048; RR=7.00 p=0.022 respectively). At followup after 106 days, complete resolution was seen in 100% patients with partial VCD and 61.5% with complete VCD. VCD is a common complication following neonatal aortic arch surgery, although most experience resolution of symptoms over time. The authors recommend post-operative laryngoscopy in all patients should be routine, and particularly those with a weak cry.

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The use of videos in preparation for pediatric otolaryngology cases—a national survey

Andrew J. Redmann, J. Paul Willging, Brianne B. Roby

Publicatie 10-09-2020


1) Review surgical preparation methods for pediatric otolaryngology fellows and fellowship directors, focusing on surgical video usage. Cross sectional survey. Structured survey querying preparation methods for surgical cases was distributed to current pediatric otolaryngology fellows and fellowship program directors (FD's). 84 surveys were distributed (47 fellows, 37 FD). Overall response rate was 44% (37/84); fellow response rate was 55% (26/47) and FD response rate was 30% (11/37). Most respondents used videos (84%) and textbooks (95%) to prepare for surgery; fellows were more likely than FD's to use videos (96% vs. 55%, p < 0.01). 89% of respondents used YouTube to prepare; C-videos was the next most common platform used (27%). Fellows were more likely to have used YouTube than FD's (100% vs 63%, p < 0.01). 45% of FD's did not know or did not think their fellows use videos to prepare for cases. Mean helpfulness of surgical videos on a 5 point scale was 3.41 (95% CI 3.0-3.8). Videos were considered most helpful for illustrating technical portions of cases (51%), visualizing the case (27%) and reviewing anatomy (24%). Survey respondents mentioned poor quality (59%) and irrelevance to a particular institutions approach (19%) as weaknesses of available surgical videos. Surgical videos are commonly used by pediatric otolaryngology fellows to prepare for cases, and can assist in building anatomic knowledge and illustrating technical details of complex cases. YouTube is the most commonly utilized platform accessed by fellows, but poor quality and limited generalizability may restrict the usefulness of current video resources. 4.

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Exploring the utility of fibreoptic endoscopic evaluation of swallowing in young children- A comparison with videofluoroscopy

Jayanthy Pavithran, Indu Vadakke Puthiyottil, Madhumita Kumar, Anju Viswambharan Nikitha, Sivakumar Vidyadharan, Renjitha Bhaskaran, Arya Chandrababu Jaya, Krishnakumar Thankappan, Iyer Subramania, K.R. Sundaram

Publicatie 11-09-2020


In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. Prospective, observational. Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.

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Supraglottoplasty for severe laryngomalacia. Can we predict success?

Ohad Cohen, Elie Picard, Leon Joseph, Yehuda Schwartz, Jean-Yves Sichel, Pierre Attal

Publicatie 07-09-2020


Laryngomalacia is the dynamic collapse of supraglottic structures during inspiration, leading to a variable degree of airway obstruction. Clinical symptoms appear in the first months of life and are usually mild and resolve by the age of 12-18 months. In severe cases, surgical intervention may be considered. The goal of the study was to review the clinical outcome of pediatric patients who underwent supraglottoplasty for laryngomalacia. Clinical and demographic data were retrieved from medical records of children diagnosed with laryngomalacia by laryngo-bronchoscopy between 2013 and 2019. Indications, outcome and long-term follow-up were collected from children undergoing surgery. During the study period, 115 children were diagnosed with laryngomalacia. The median age at diagnosis was 3 months. Synchronous airway lesions were diagnosed in 20% of patients. Ten (8.7%) children underwent surgical treatment because of significant respiratory symptoms and/or failure to thrive. Three of them had comorbidities. All otherwise healthy children had significant respiratory and nutritional improvement after surgery while those with comorbidities had less successful outcomes. We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.

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Surgical treatment of preauricular sinus in children: Temporalis muscle fascia anchoring suture

Min Sik Kim, Seong Wook Choi, Sang Hyo Lee, Jae Woo Lee, Il Woo Lee, Hyun Min Lee

Publicatie 09-09-2020


The aim of this study was to find an effective treatment method for preauricular sinus (PAS) in the pediatric population. We also investigated if the prognosis of treatment differed according to the location of the PAS. From May 2015 to April 2020, a retrospective chart review was conducted on pediatric patients who underwent surgical excision of PAS at a tertiary referral medical center. Patients were divided into classical and variant groups according to the location of the PAS. The recurrence and postoperative complications, along with the preoperative history, were confirmed through medical chart review. A total of 88 patients (112 ears) were included in the study (n = 77 in the classical group and n = 11 in the variant group). The mean age of the patient was 6.5 years, and there were 48 males and 40 females. To reduce recurrence after surgical treatment, a temporalis muscle fascia anchoring suture was used in combination with preoperative pit dye staining, probe use, and surgical microscopy. The overall recurrence rate was 2.4% (2 cases), and postoperative minor complications were chronic pain (4.5%, n = 4), minor skin inflammation (10.2%, n = 9), and subcutaneous suture knot discomfort (13.6%, n = 12). Between the classical and variant groups, no clinical differences such as recurrence rate or complication rate were found, except for the long hospitalization period in the variant group (p = 0.043). The use of a temporalis muscle fascia anchoring suture in combination with pit dye staining, probe use, and surgical microscopy in pediatric patients with PAS showed relatively low recurrence and complication rates compared to what has been previously reported in the literature. PAS in the variant position did not affect prognosis.

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Interstate variation within a five-state health system: Polysomnography prior to tonsillectomy in trisomy 21 patients

Caroline M. Kolb, Udayan Shah, Nicole L. Aaronson

Publicatie 07-09-2020


Since 2011, the American Academy of Otolaryngology - Head and Neck Surgery Clinical Practice Guidelines have recommended polysomnography (PSG) prior to tonsillectomy in children with Down syndrome (DS). The purpose of this study was to determine adherence to guidelines recommending polysomnography before tonsillectomy for children with DS and sleep-disordered breathing among pediatric otolaryngologists. A one-year quality assurance retrospective review was conducted at four hospitals within one pediatric health system to identify children with a diagnosis of DS who underwent a tonsillectomy with or without adenoidectomy from January 1, 2018, to December 31, 2018. De-identified data related to age, sex, BMI, procedure type, and preoperative PSG were collected and examined. The rate of PSG prior to tonsillectomy was 90.4% (66 of 73) among patients with DS. 51.6% of PSG studies were performed within 90 days before surgery, and 92.2% (59 of 64) of PSG studies were performed within one year before surgery. 33% of patients who did not undergo PSG also were obese or under age two years. The most common reason for not obtaining a PSG prior to tonsillectomy was that either the provider or parent felt the patient would not tolerate it. There was no variance from guidelines by age, sex, and procedure type. Polysomnography for children with DS prior to tonsillectomy is achieved greater than 90% of the time in a multistate pediatric health system. Broader assessment across the nation and future studies regarding the timing of PSG before tonsillectomy are warranted.

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Intraoperative ketorolac for pediatric tonsillectomy: Effect on post-tonsillectomy hemorrhage and perioperative analgesia

Cyrus C. Rabbani, Zachary E. Pflum, Michael J. Ye, John D. Gettelfinger, Senthil Sadhasivam, Bruce H. Matt, John P. Dahl

Publicatie 07-09-2020


Determine the impact of ketorolac on post-tonsillectomy hemorrhage (PTH) and narcotic administration in children undergoing tonsillectomy. Retrospective case series from 2013 to 2017. Patients younger than 18 years undergoing tonsillectomy were included. PTH was the primary outcome measured. Secondary measures include percentage of patients requiring surgical intervention for PTH, average time to PTH, the number of post-operative opioid doses, and average post-operative opioid dose. Statistical methods include Chi-square, Wilcoxon rank sum, and binary logistic regression analyses. During the study period, 669 patients received a single intraoperative dose of ketorolac (K+) and 653 patients did not receive ketorolac (K-). No differences were found in the rate of PTH (K- 6.5% vs. K+ 5.3%, RR = 0.82, 95% CI = 0.53 to 1.29, p = 0.40), surgical control of PTH (K- 4.0% vs. K+ 3.5%, RR = 0.87, CI = 0.51 to 1.51, p = 0.62), or average time [SD] to PTH (K- 6.0 [4.2] vs. K+ 5.2 [4.9] days; difference = 0.8 days; 95% CI, -1.3 to 2.9; p = 0.45). K+ patients had fewer post-operative opioid doses [SD] (K- 1.86 [1.14] vs. K+ 1.59 [1.23]; difference = -0.27; 95% CI, -0.053 to -0.49, Cohen d = 0.23) and a lower average opioid dose [SD] (K- 0.041 [0.032] vs. K+ 0.035 [0.030] mg/kg; difference = -0.006 mg/kg; 95% CI, -0.0003 to -0.012; Cohen d = 0.19). Ketorolac did not increase risk of hemorrhage following tonsillectomy and decreased narcotic use.

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Magnetic resonance angiography (MRA) in preoperative planning for patients with 22q11.2 deletion syndrome undergoing craniofacial and otorhinolaryngologic procedures

Rotem Kimia, Lisa Elden, Julia Dailey, Mallika Kodavatiganti, T. Blaine Crowley, Daniel E. McGinn, Alice Bailey, Elaine H. Zackai, Donna M. McDonald-McGinn, Oksana A. Jackson

Publicatie 06-09-2020


Patients with 22q11.2 deletion syndrome (22q11.2DS) have a variety of anatomic anomalies. For surgeons operating in proximity to the retropharynx, the most pertinent is medial displacement of the internal carotid arteries. The purpose of this study is to describe the preoperative use of magnetic resonance angiography (MRA) in surgical planning and update the incidence rate of medial carotid displacement in patients with 22q11.2DS. This is a retrospective cohort study of patients with a confirmed diagnosis of 22q11.2 deletion and preoperative MRA <18 years old who underwent tonsillectomy, adenoidectomy, Furlow palatoplasty (FPP), posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), or submucosal cleft palate (SMCP) repair between January 1st, 2008 and December 31st, 2019. Ninety patients who met the inclusion criteria underwent 133 procedures. The majority identified as Caucasian (84.4%); 52.2% were female. Cervical MRA was more likely to be ordered before a PPF (80.9%) and tonsillectomy (72.7%) over a FPP (47.6%) or adenoidectomy (11.1%). Carotid medialization was visualized in 23 patients (25.6%) and was mild in 11 cases, moderate in 7 cases, and significant in 5 cases. There was no association between sex, race/ethnicity, or genetic diagnosis with carotid medialization. Flap shortening was necessary in 20% of PPF cases to avoid injuring the medialized vessel. Patients with 22q11.2DS may have higher rates of medialization of the carotid arteries than previously thought. Given the risk for complications in these patients during pharyngeal operations, there may be a critical place for MRA in surgical planning for patients with 22q11.2DS.

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Endoscopic anterior-posterior cricoid split to avoid tracheostomy in infants with bilateral vocal fold paralysis

Alanna M. Windsor, Ian Jacobs

Publicatie 07-09-2020


Infants with bilateral vocal fold paralysis (BVFP) can present with stridor and respiratory distress necessitating tracheostomy. The endoscopic anterior-posterior cricoid split (APCS) with balloon dilation procedure has been described as an alternative to tracheostomy in these patients. Here, we report our institution's preliminary experience with APCS and evaluate patient factors that may predispose to the success or failure of this procedure in infants with BVFP. Electronic charts of patients who underwent APCS with balloon dilation at a single institution were reviewed for the following variables: patient demographics, comorbidities, etiology of vocal fold paralysis, symptoms at presentation, need for respiratory support, intra-operative findings, duration of intubation, perioperative medical treatments, subsequent airway management, and findings of follow-up evaluations. APCS was considered successful if the patient did not undergo tracheostomy. Six patients underwent APCS with balloon dilation between August 2014 and October 2019. Four patients (66.7%) were male, and 5 of 6 (83.3%) were born full term. The etiology of vocal fold paralysis was idiopathic in four patients (66.7%) and associated with a neuromuscular disorder and hydrocephalus in the remaining two patients. Mean age at the time of the procedure was 10.3 weeks. Three infants (50%) avoided tracheostomy and had marked alleviation of airway symptoms. Three patients who required tracheostomy had more severe respiratory symptoms pre-operatively, requiring either intubation or positive pressure support. Among all patients, there were no mortalities in our series. APCS is safe and may be effective at the elimination of airway symptoms in select infants with BVFP, avoiding the need for tracheostomy, however more investigation is needed to establish its precise role in this patient population.

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An extended release ciprofloxacin/dexamethasone hydrogel for otitis media

Matthew Ku, Shirley Cheung, William Slattery, Erik Pierstorff

Publicatie 07-09-2020


Otitis media and associated otorrhea are frequent complications following tympanostomy tube insertion; the most common otologic procedure performed in children in the United States. Current treatments include the administration of antibiotic or antibiotic/anti-inflammatory combination drops to the affected ear. Several studies have demonstrated that using an antibiotic/anti-inflammatory combination product is more effective than the use of antibiotics alone. However, administration of any drops through the tympanostomy tube is very difficult in children, and patient compliance can be an issue. Our group has developed a novel combination drug/hydrogel formulation for the treatment of otitis media/otorrhea that releases both ciprofloxacin and dexamethasone over a 2-3 week period. This has the potential to offer significant advantages over current treatments in use in the clinic. The release of drugs from the combination hydrogel was validated in vitro over the desired time frame and the activity of the released drugs was monitored via assays to confirm retention of full activity throughout the dissolution period. The safety of the ciprofloxacin/dexamethasone hydrogel and its inactive excipients was evaluated through in vivo otic toxicity studies in guinea pigs, including hearing tests, gross microscopy, and cytocochleogram analysis. Extended release of both drugs was demonstrated in vitro and antibiotic/anti-inflammatory activities were retained. The hydrogel components and its excipients did not cause adverse reactions in animals, demonstrating safety of the hydrogel combination in vivo. The studies presented lay the groundwork for extended release middle ear hydrogel formulations that are capable of safely releasing combinations of active pharmaceutical agents over a desired period of time. This would be more advantageous than therapeutics that are currently used in the clinic for the treatment of otitis media/otorrhea associated with tympanostomy tube insertion.

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One and half coblation supraglottoplasty: A novel technique for management of type II laryngomalacia

Ahmed AbdelFattah ElSobki, Menna Ibrahim Hashish, Noha Ahmed El-Kholy

Publicatie 06-09-2020


Endoscopic supraglottoplasty is the mainstay surgical procedure in treatment of laryngomalacia. Various instruments have been used with coblation recently gaining widespread attention. Regarding the technique used, cutting the aryepiglottic folds is associated with rapid improvement but carries risk of restenosis while outer scar contracture method has delayed but established result. Therefore, this study was conducted to introduce a modified coblation supraglottoplasty technique gathering both benefits and evaluate its results and effectiveness. Retrospective study included patients diagnosed with type II laryngomalacia was conducted. Supraglottoplasty was done by "one and half coblation supraglottoplasty" technique which involves cutting of one aryepiglottic fold while the other one is laterally coagulated. Patients' basic and clinical data were assessed. Outcome measures included assessment of inspiratory stridor, failure to thrive, choking, cyanosis, lowest oxygen saturation levels and weight gain. Seventeen patients were included in this study with a mean age of 3.71 ± 1.1 months. Significant statistical improvement was reached regarding stridor, failure to thrive and cyanosis. Also, minimal oxygen saturation and weight gain were significantly improved. None of the cases needed tracheostomy and no major postoperative complications occurred. We conclude that "one and half coblation supraglottoplasty" is an effective and safe treatment for type II laryngomalacia with satisfactory outcomes. IV.

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The association between pre-tonsillectomy education and postoperative emergency department returns: A retrospective cohort pilot study

Chandni Jain, Marc Levin, Heather Hardy, Forough Farrokhyar, Diane Reid

Publicatie 04-09-2020


Tonsillectomy is the most common pediatric surgery in Canada. Post-tonsillectomy 30-day Emergency Department (ED) visit rates are higher than other pediatric day surgeries. To date, there have been no studies assessing whether additional preoperative education directed by Child Life Specialists impacts preventable ED visits. The primary aim of this study was to evaluate whether additional preoperative tonsillectomy education is feasible and is associated with fewer ED visits and admissions in the immediate postoperative period compared to standard care. The secondary aim of this study was to assess whether this education was associated with a lower ED visit rate for preventable causes. This is a retrospective chart review conducted in an academic tertiary pediatric hospital. Patients undergoing tonsillectomy surgery (from 2014 to 2019) were divided into three groups: consultation with a Child Life Specialist plus educational Booklet plus traditional surgeon-led education (CLS), educational Booklet plus surgeon-led education (Booklet), and traditional surgeon-led education (Traditional). The feasibility of the CLS education was assessed and the 30-day ED visit and admission rates were compared between groups. Visits included patients who returned to ED post-tonsillectomy and were not admitted, whereas admission included those who returned to ED and were admitted. 2081 patients undergoing tonsillectomy were included. 329 (15.8%) presented to the ED (within a median of 5 days), and 92 (4.4%) were admitted. ED visit/admission rates by group were: 14.7%/4.4% (CLS), 15.8%/4.1% (Booklet), and 16.2%/4.7% (Traditional) (p = 0.81/p = 0.84). The most common reason for return to ED was Hemorrhage (4.9%). Patients also returned to the ED for preventable reasons such as dehydration, pain, nausea/vomitting and fevers. Additional preoperative tonsillectomy education is feasible but is not associated with fewer ED visits and admissions, or fewer ED visits for preventable causes. Further research is needed to identify the optimal intervention to address the high post-tonsillectomy ED visit rate.

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Prevalence and risk factors for delayed-onset hearing loss in early childhood: A population-based observational study in Okayama Prefecture, Japan

Yuko Kataoka, Yukihide Maeda, Kunihiro Fukushima, Akiko Sugaya, Akiko Shigehara, Shin Kariya, Kazunori Nishizaki

Publicatie 03-09-2020


The aim of this study was to retrospectively document prevalence rates of delayed-onset hearing loss (DOHL) under 7 years old after passing the newborn hearing screening (NHS) program using its database in Okayama Prefecture, as well as records from Okayama Kanariya Gakuen (OKG, Auditory Center for Hearing Impaired Children, Okayama Prefecture, Japan). We explored the percentage of children with DOHL among all children who underwent the NHS and surveyed risk factors abstracted from their clinical records. We collected data of 1171 children, who first visited OKG from April 2006 to March 2018. DOHL children were defined as bilaterally hearing-impaired children who were diagnosed under 7 years old after passing the NHS at birth. Based on the medical records, we investigated age at diagnosis, hearing levels, and risk factors. As population-based data of 168,104 children, the percentage of DOHL subjects was retrospectively calculated among the total number of children who underwent the NHS in Okayama Prefecture from April 2005 to March 2017. During the period, we identified 96 children with bilateral DOHL, of which 34 children had failed the NHS unilaterally and 62 had passed the NHS bilaterally. Among all children who underwent the NHS in Okayama Prefecture, the prevalence rate of DOHL in unilaterally referred infants was 5.2%, and 0.037% in bilaterally passed children. The prevalence of bilateral DOHL was 0.057% overall. Unilaterally referred children with DOHL were diagnosed at an average of 13.9 months, while bilaterally passed children with DOHL were diagnosed at an average of 42.3 months. Approximately 59.4% of children with DOHL had risk factors, among which family history of hearing loss was the most frequent. We propose the first English report of DOHL prevalence in the prefecture population in Japann, which is among the largest community-based population ever reported. The NHS is not a perfect strategy to detect all early-childhood hearing loss; therefore, careful assessment of hearing throughout childhood is recommended, especially in children with risk factors of hearing loss. Further interventional strategies must be established, such as regular hearing screening in high-risk children and assessments of hearing and speech/language development in public communities and nursery schools.

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Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic

María del Carmen Pamplona, Pablo Antonio Ysunza

Publicatie 02-09-2020


To study whether providing Speech and Language Pathology (SLP) interventions by telepractice (TP) could effectively improve speech performance in children with cleft palate (CCP). Forty-three CCP were treated with TP intervention in 45 min sessions, 2 times per week for a period of one month. Children ages ranged 4-12 years (X = 7.04; SD = 2.59). All children presented with velopharyngeal insufficiency (VPI) and compensatory articulation (CA) after palatal repair. TP was provided in small groups (5-6 children) following the principles of the Whole Language Model (WLM). Severity of CA was evaluated by a standardized scale at the onset and at the end of the TP period. At the onset of the TP intervention period, 84% of the patients demonstrated severe CA. At the end of the TP period there was a significant improvement in severity of CA (p < 0.001). The results of this study suggests that TP can be a safe and reliable tool for improving CA. Considering that the COVID-19 pandemic will radically modify the delivery of Health Care services in the long term, alternate modes of service delivery should be studied and implemented.

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Comparing autologous versus allogenic rib grafting in pediatric cleft rhinoplasty

Louis F. Insalaco, Emily Karp, Hanan Zavala, Sivakumar Chinnadurai, Robert Tibesar, Brianne Barnett Roby

Publicatie 02-09-2020


Patients with cleft lip with or without cleft palate suffer from varying degrees of nasal deformity, often requiring nasal reconstruction to provide improved form and function. Rib cartilage is an excellent source of grafting material for nasal reconstruction and is available either as an autologous or allogenic graft. There is a paucity of literature comparing outcomes of autologous and allogenic rib grafts in pediatric cleft rhinoplasty. A retrospective chart review was performed on patients who underwent cleft rhinoplasty with autologous or allogenic rib grafting at a tertiary pediatric hospital between January 1, 2003 and December 31, 2017. Outcome data were gathered over a 6-month postoperative period. There were 23 cleft rhinoplasties performed with rib graft, 12 with autologous rib and 11 with allogenic rib. Those in the autologous group tended to be older than those in the allogeneic group (15.6 ± 4.4 v 12.4 ± 5.2 years, p = 0.13). The most common types of grafts used were columellar strut (20/23), shield graft (9/23), and unilateral or bilateral batten grafts (7/23). Length of stay was significantly longer for patients who underwent autologous rib grafting compared with those with allogenic rib grafting (25.8 ± 4.7 v 11.9 ± 7.2 h, p < 0.05). Each group reported one complication. Autologous and allogenic rib grafts are safe and effective in pediatric rhinoplasty. The most common grafts used in this sample were columellar strut, batten, and shield grafts. Autologous rib grafts were more likely to be used in older patients and require longer hospital stay compared to allogenic grafts.

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Continuous oximetry recordings on the first post-operative night after pediatric adenotonsillectomy-a case-control study

Katharine Jamieson, Han Jie Soh, Margot J. Davey, Joanne Rimmer, Rosemary SC. Horne, Gillian M. Nixon

Publicatie 06-09-2020


Children with obstructive sleep apnea (OSA) with recurrent dips in oxygen saturation (SpO Prospective sequential recruitment of 57 children who had overnight oximetry performed on the first night after adenotonsillectomy was undertaken, including 28 with a McGill Oximetry Score (MOS) of 2-4 pre-operatively (high risk group) and 29 with a normal/inconclusive pre-operative MOS (low risk group). Oximetry parameters (mean SpO In the high risk group, the MOS improved in 23/28 children, but remained abnormal in 82%. Conversely, in the low risk group 26/29 (90%) had a normal post-operative oximetry. The remaining 3, all of whom had severe OSA on pre-operative polysomnography, had a lowered baseline SpO Most children with an abnormal oximetry pre-operatively continued to have an abnormal oximetry on the first night after AT, albeit somewhat improved. While adverse events were more frequent in children with an abnormal post-operative oximetry, half (54%) did not suffer a clinical respiratory adverse event despite having repetitive desaturations on downloadable oximetry. These findings support close clinical observation of children at high risk of complications post-operatively, especially those with abnormal oximetry pre-operatively, rather than focusing on recurrent dips in SpO

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Challenges facing otolaryngologists in low- and middle-income countries during the COVID-19 pandemic

Maxwell P. Kligerman, Shaina Lamour, Samuel Okerosi, Blake Alkire, Mary Xu, Rolvix Patterson, Johan Fagan, Mahmood Bhutta, Mark Shrime, Patrick Jean Gilles, Titus Ibekwe, Ncogoza Isaie, Travis Tollefson, David Shaye, Josephine Czechowitz, James Saunders, Mark Zafereo, Doreen Nakku, Theodore Klug, Aveline Kahinga

Publicatie 31-08-2020


The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future.

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Quantitative video-fluoroscopic analysis of swallowing in infants

Isuru Dharmarathna, Anna Miles, Laura Fuller, Jacqui Allen

Publicatie 31-08-2020


To utilize objective, quantitative videofluoroscopic swallow measures to profile swallowing in infants and to determine the likelihood of objective swallow measures to predict risk of swallow impairments such as airway violation, reflux and post swallow residue. Our single center retrospective observational study used a cohort of 146 bottle-fed infants (0-9 months) referred for VFSS with any kind of feeding related concern. Frame-by-frame analysis of 20-s video loops of mid-feed sucking was completed to obtain quantitative timing, displacement and coordination measures as well as presence of other findings including aspiration, residue and naso-pharyngeal reflux (NPR) and esophago-pharyngeal reflux (EPR). Spearman correlation, Mann-Whitney U test and binomial logistic regression were conducted to determine statistical associations between swallow measures and binary reporting of swallow impairments. Videofluoroscopic data of 146 infants were reviewed and analyzed. 49% of infants demonstrated at least one penetration or aspiration event. Total pharyngeal transit time (TPT) and suck-swallow ratio were associated with aspiration (p < .05). Infants with >3 sucks per swallow had significantly longer TPT and their risk of aspiration was greater than those with <3 sucks per swallow (RR 1.23, 95% CI 0.43-8.507, p = .03). Pharyngeal constriction ratio (PCR) and bolus clearance ratio (BCR) were associated with residue, NPR and EPR (p < .05). Objective measures provide clinicians with reliable timing and displacement data even in the very young. These measures correlate with swallowing safety and may help to identify enhanced risk in some infants, which may influence management recommendations.

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International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

Michael D. Puricelli, Reza Rahbar, Gregory C. Allen, Karthik Balakrishnan, Matthew T. Brigger, Sam J. Daniel, Pierre Fayoux, Steven Goudy, Richard Hewitt, Wei-Chung Hsu, Jonathan B. Ida, Romaine Johnson, Nicolas Leboulanger, Scott M. Rickert, Soham Roy, John Russell, Michael Rutter, Douglas Sidell, Marlene Soma, Briac Thierry

Publicatie 07-09-2020


To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

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COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children

M. Gelardi, R. Giancaspro, V. Fiore, F. Fortunato, M. Cassano

Publicatie 31-08-2020


In response to the coronavirus pandemic 2019 (COVID-19), Italy established the national school closings from March 5, 2020. It has been shown that during school closures, there are significant decreases in the diagnoses of the respiratory infections. This has brought as well to a reduction in all those symptoms related to adenotonsillar hypertrophy. The study included 162 children, aged between 3 and 13 years, waiting for adenoidectomy and/or tonsillectomy, eventually combined with tympanocentesis or tube insertion. Parents have been called to answer a telephone interview aimed at detecting how the symptoms related to adenotonsillar hypertrophy were changing during lockdown. There was an improvement in the overall symptomatology of children during the lockdown period. The value attributed by parents to the children's general assessment during the lockdown period decreased significatively during the quarantine (p = 0,0000). The present study demonstrates that lockdown can have a positive impact on those specific diseases derived from precocious socialization and that it results to be particularly effective for the most vulnerable children. Indeed, lockdown has resulted to be so efficient that it has caused a modification in a medical and surgical therapeutic indication.

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The assessment of quality of life in children with tracheostomies and their families in a low to middle income country (LMIC)

Taseer F Din, Jessica McGuire, Jane Booth, Andrew Lytwynchuk, Johannes J Fagan, Shazia Peer

Publicatie 04-09-2020


The Breatheasy© Tracheostomy Program based at the Red Cross War Memorial Children's Hospital, Cape Town, manages children mostly from poor socio-economic backgrounds. In our resource-limited setting, it is unclear how these families cope with the demands of a tracheostomised child. We aim to assess the quality of life (QOL) of tracheostomised children and their families as the first study of its kind in a low-resource setting. A descriptive, observational study was done to assess the QOL of tracheostomised children managed by the Breatheasy© Program over 10 months. Children with tracheostomies for longer than 6 months, complex syndromic children, and home ventilated children were included. The validated Paediatric Tracheotomy Health Status Instrument (PTHSI) was utilised, where a higher score implied a better outcome. A total of 68 families were recruited. In 57 (85.1%) of the carers, the highest level of education achieved was primary or high school. Twenty-seven (42%) families reported having an annual household income of less than $675 US Dollars ( Pubmed PDF Web


Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea

Kathrine Nordblad Fenger, Ida Gillberg Andersen, Louise Aas Holm, Jens-Christian Holm, Preben Homøe

Publicatie 06-09-2020


To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.

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Ecuadorian Spanish translation and validation of the VELO quality of life instrument

Lucille Ridgell, Christina T. Roth, Mikaela Bow, Rayyan Hares-Helou, Karina Mayorga Arias, Sarah Hatch Pollard, Usama Hamdan, Travis T. Tollefson, Jonathan R. Skirko

Publicatie 04-09-2020


Adapt the Spanish translation of VPI Effects on Life Outcome (VELO) instrument into Ecuadorian Spanish; test the resulting instrument for reliability and validity. A cross-sectional, prospective design, set at a humanitarian mission within a community hospital. Linguistic validation: native Ecuadorian-Spanish speakers modified the Spanish VELO to Ecuadorian Spanish. Cognitive interviews were conducted with children with cleft palate (CP) and their parents (n = 50), guiding instrument modifications. An expert panel reviewed changes, resulting in the VELO-Ecuadorian dialect (VELO-Ec). 88 participants with CP (88 parents, 46 children) and 33 non-cleft controls (33 adult, 11 children) completed the VELO-Ec, Spanish-Pediatric Voice Handicap Index (pVHI), and Spanish-Intelligibility in Context Scale (ICS). Internal consistency was assessed with Cronbach's alpha; test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC); standard error of measurement (SEM) was calculated. Concurrent validity was assessed with Pearson correlations of VELO-Ec with pVHI and ICS. Discriminant validity assessment used an established ICS cutoff. Construct validity was assessed by grouping patients by parent report of hypernasality and early vs. late cleft repair (>24 months) using the Wilcoxon Rank-Sum test. VELO-Ec showed excellent internal consistency (alpha 0.96) and test-retest reliability (ICC = 0.85, 95% CI 0.68-0.93, SEM 5.71). It had strong concurrent validity, correlating with ICS (r = 0.75, p < 0.001) and pVHI (r = -0.79, p < 0.001). Discriminant validity was strong with better VELO-Ec scores among subjects with normal vs. abnormal ICS score (median 95 & 61, p < 0.001). Strong construct validity was identified: those with parent-reported hypernasality had worse VELO-Ec scores than those without (median 59 & 75, p < 0.001). Those with repair before or after 24 months had similar VELO-Ec scores (p = 0.882). The VELO-Ec is a valid and reliable measure of VPI-related quality of life, useful to clinicians and researchers treating Ecuadorian CP patients, especially in areas with limited resources such as on humanitarian missions.

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Factors impacting participation in flexible endoscopic evaluation of swallowing in children

Leonard Haller, Beth Osterbauer, Kayla Maldonado, Vrinda Bhardwaj, Manvi Bansal, Katy Peck, Christian Hochstim

Publicatie 30-08-2020


Flexible endoscopic evaluation of swallowing (FEES) is a common and useful tool for assessment of dysphagia and swallowing safety in children, however an important problem is limited participation in some children. We examine the factors associated with adequate participation in children undergoing FEES, including the completion rate, whether a clear diagnosis or feeding plan was made, and the incidence of adverse events (AEs). We conducted a retrospective review of children undergoing FEES at an urban children's hospital. Data collected included age, gender, race, comorbidities, AEs and outcomes of FEES. Of the 130 patients, 46 (35%) were female with a median age of 2.6 years. 113 (87%) patients cooperated and obtained a result, while 15 (12%) patients did not cooperate and no result was obtained; there was no significant difference in gender, comorbidities, or race between those groups. The age distribution of FEES subjects in this study was skewed with nearly 75% below age 5. Patients who cooperated had a higher median age (3 years) than those who did not (1.2 years) and 47% of non-cooperators were less than 1 year of age. There were no significant AEs, the most common mild AE was excessive crying (34 subjects, 26%). In a multivariate model controlling for age and gender, excessive crying was associated with a decreased odds of cooperation (OR: 0.16, p = 0.004, 95% CI: 0.04, 0.54). Children who undergo FEES have an overall favorable completion rate and no serious adverse events, however its utility is limited in cases where children refuse to participate. Understanding the factors associated with failure to cooperate with FEES is important in developing strategies to improve participation. Excessive crying is identified as such a factor in this study.

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Factors associated with retained tympanostomy tubes a case-controlled study

Mikayla J. Huestis, Jennifer N. Shehan, Jessica R. Levi

Publicatie 28-08-2020


To determine factors associated with retained tympanostomy tubes in order to improve parent counseling on procedure risks and outcomes. This is a case-control study; we conducted a retrospective chart review from 2012 to 2019 of cases of retained tympanostomy tubes compared to controls with confirmed tympanostomy tube extrusion. The study was conducted at a single tertiary care center, Boston Medical Center. A retained tympanostomy tube was defined as in place for more than two years requiring removal in the operating room. Cases were matched to two controls and assessed for the following factors: indication for tympanostomy tube insertion, frequency of otitis media and otorrhea after tympanostomy tube insertion, duration tympanostomy tubes were in place, numbered set of tympanostomy tubes, sinopulmonary conditions, and adenoidectomy status prior to tympanostomy tube removal or extrusion. 46 cases were identified and matched to 92 controls. Cases had a significantly longer tympanostomy tube duration (3.273, IQR 1.099 vs 1.611, IQR 0.894 years, p < 0.001). The indication for tympanostomy tube placement for cases compared to controls was significantly more likely to be recurrent otitis media only (odds ratio 2.36, CI 1.121 to 5.003). A multiple logistic regression model was performed with the indication for tympanostomy tube placement (chronic or recurrent otitis media) and a history of more than two sets of tympanostomy tubes. The model had a low sensitivity, 9.09%, and high specificity, 98.91%. Patients whose only indication for surgery is recurrent otitis media are possibly at higher risk for retained tympanostomy tubes that require removal in the operating room.

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Cochlear implantation in children without preoperative computed tomography diagnostics. Analysis of procedure and rate of complications

Desiree Ehrmann-Müller, Wafaa Shehata-Dieler, Stefan Kaulitz, Daniela Back, Anja Kurz, Heike Kühn, Rudolf Hagen, Kristen Rak

Publicatie 01-09-2020


To evaluate the safety in cochlear implantation without preoperative computed tomography diagnostics, which was implemented into the protocol of cochlear implantation in 2013, since in the year before, new evidence concerning the risks of ionizing radiation especially in children arose. In this retrospective data analysis 89 children under 36 months, which were cochlear implanted from 2008 until 2018 at a tertiary referral centre with a large cochlear implant program were analysed. Fortyfour of the children were implanted before the date of change in 2013 and 45 in the following years up to now. The data about the operative procedures, the postoperative care and the complication rate before and after implementation of the new protocol were compared. Before the date of change in 2013, 100% of patients received preoperative CT diagnostics, in the following years 13.3%. No difference in the duration of surgery, the procedure related and the late complications between the two groups was identified. Cochlear implantation in very young children under the age of 36 months without preoperative radiological diagnostics by CT scan of the temporal bone is a safe procedure without additional risks for the patients.

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Otological outcome in cleft lip and palate children with middle ear effusion

Ali Azman, Anura Michelle Manuel

Publicatie 25-08-2020


To evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion. A prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1-18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome. 68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p < 0.05), however there was no significant difference in children more than 4 years old. Early surgical repair of cleft palate prior to the age of one year resulted in favourable results in both age groups (p < 0.05). There was a higher prevalence of chronic otitis media with repeated grommet insertion (3 or more) (p < 0.05). Speech and language milestones were achieved in 94% of all children above the age of four. Treatment with early ventilation tube insertion prior to the age of one year provides a hearing benefit in children less than 4 years of age, but no significant difference after 4 years of age. Factors significantly affecting the outcome after 4 years of age was the timing of palatal closure and total number of tube insertions. We recommend a conservative approach especially when considering repeated tube insertions. A long-term follow-up paired with interval hearing assessment is advocated until early adulthood.

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Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy

Marcin Dziekiewicz, Renata Cudejko, Marcin Banasiuk, Łukasz Dembiński, Henryk Skarżyński, Andrzej Radzikowski, Aleksandra Banaszkiewicz

Publicatie 23-08-2020


Recent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. This was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. 38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. It is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

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Diagnosis and treatment of speech disorders in children with Moebius syndrome

Maria del Carmen Pamplona, Pablo Antonio Ysunza, Jose Telich-Tarriba, Enrique Chávez-Serna, Pamela Villate-Escobar, Mariana Sterling, Alexander Cardenas-Mejia

Publicatie 24-08-2020


Moebius syndrome (MS) is characterized by congenital bilateral paralysis of the facial and abducens nerves. Clinical features include feeding problems, dysarthria, dysphagia, sialorrhea, strabismus, and lack of facial expression. Patients with MS frequently present with dysphagia during infancy. Further on during childhood a severe speech disorder is a common feature. However, articulation deficits in patients with MS are scarcely reported in the related scientific literature. The aim of this study is to describe speech deviations, intelligibility and sialorrhea in patients with MS. Eighty-seven patients with MS were prospectively studied. Age ranged from 4 to 18 years. A complete Speech and Language Pathology (SLP) evaluation was performed in all cases. The evaluation focused on articulation placement, sialorrhea and intelligibility of speech. Sialorrhea was detected in 23% of the patients. Abnormal articulation placement of bilabial phonemes was observed in 68% of the patients. Another 50% of the patients presented with articulation placement errors in other phonemes. Intelligibility was classified as adequate in 18% of the cases. Mildly affected intelligibility was found in 51% of the patients. Speech was considered moderately unintelligible in 20% of the cases. Unintelligible speech was found in 11% of the patients. From the results of this prospective study it can be concluded that a high percentage of patients with MS are at high risk of presenting with moderate to severe speech disorders. Thus, an early SLP intervention should be provided for this population in order to enhance speech development and reducing the risk of severe oral communication impairments.

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Surgical versus non-surgical treatment in the Obstructive Sleep Apnea-Hypopnea Syndrome

Paula Martínez-Ruiz de Apodaca, Marina Carrasco-Llatas, Eduard Esteller-Moré

Publicatie 25-08-2020


The treatment of choice for pediatric OSAHS is surgical. However, its etiopathogenesis is multifactorial and surgery does not always solve it. Therefore, other modalities of treatment are used. The main objective of this study is to shed light on the efficacy of surgery compared to other treatments. Prospective cohort study with 317 children ages 1-13 years and apnea-hypopnea index (AHI) ≥3/h with no previous treatment. The treatment was organised into 3 categories: surgical (n = 201), medical (n = 75) and observation (n = 41). Quality of life and sleep was assessed by two validated questionnaires (PSQ & Esteller et al.) The upper airway was explored, and nocturnal polysomnography (PSG) performed in every patient. After 12 ± 3 months of treatment was completed, a new PSG and questionnaires were evaluated. The surgical group improved significantly both subjectively and objectively. Mean AHI decreased from 7.95/h to 2.57/h and T 90 (time spent with arterial oxygen saturation <90%) from 0.49 to 0. AHI of the medical group decreased only from 5.09/h to 4.9/h. Subjective parameters improved less than in the surgical group. Persistence after surgery was 31%, 50% following medical treatment, and after observation 75%. There were no differences in age and BMI between groups. Age or obesity showed no relationship with treatment success or failure. The best results were achieved in surgically treated children. However, 31% of those operated had OSAHS persistence, which means a combination of treatments may be the most appropriate strategy.

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Drug-induced sleep endoscopy findings in surgically-naïve obese vs non-obese children

Sarah Lookabaugh, Margo McKenna, Sveta Karelsky, Michael Davis, Amanda Didas, Paul Allen, John Faria

Publicatie 20-08-2020


To determine if drug-induced sleep endoscopy (DISE) findings are different in obese versus non-obese pediatric patients with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). Prospective, observational cohort study from June 2017 to June 2018 at a tertiary academic pediatric medical center that included surgically-naïve children ages 2-12 with diagnoses of OSA or sleep-disordered breathing. Subjects with a known diagnosis of craniofacial syndromes, genetic disorders, prior adenoidectomy or tonsillectomy, or chronic tonsillitis as the indication for surgery were excluded. Two groups were assessed for patterns of obstruction based on DISE videos at each anatomic airway level using a previously published DISE scoring system. The groups included obese subjects (BMI ≥ 95th percentile) and non-obese controls (BMI <85th percentile). Each video was graded by two blinded, fellowship-trained Pediatric Otolaryngologists. Fifty-one patients were included, 26 non-obese and 25 obese. Based on anatomic airway level, there was no statistically significant difference in airway obstruction at the velum (p = 0.134), adenoid (p = 0.592), lateral pharyngeal walls (p = 0.867), tongue base (p = 0.977), or supraglottis (p = 0.428) between obese and non-obese children. Our prospective study did not associate severity of obstruction with obesity status based on anatomic airway levels. Further studies are needed to elucidate the etiology of the high rate of persistent obstructive sleep apnea in obese children.

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Systemic bevacizumab for recurrent respiratory papillomatosis

Yiressy Izaguirre Baday, Julina Ongkasuwan, Rajkumar Venkatramani

Publicatie 10-09-2020


Recurrent respiratory papillomatosis (RRP) is a benign tumor of the respiratory tract associated with human papillomavirus 6 and 11. Patients undergo multiple surgical debridements for management of growing papilloma. Adjuvant treatment options for RRP in children are often ineffective and do not decrease the need for repeated surgical debridement. We report on three patients with severe disease refractory to surgery who were treated with 10 mg/kg systemic bevacizumab every 4 weeks. All patients had improvement in voice and reduced need for surgical debridement. Interval between bevacizumab doses was gradually increased to every 8-12 weeks. Adverse events included mild proteinuria and self-resolving epistaxis.

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Endoscopic marsupialization of nasolacrimal duct cysts under topical anaesthesia: 5 years of a single institute experience

Ameen Biadsee, Or Dagan, Firas Kassem, Tom Ben-Dov, Yaniv Ebner

Publicatie 18-08-2020


To present the outcomes of neonatal nasolacrimal duct cysts treated through endoscopic intranasal marsupialization under topical anaesthesia. A retrospective study of 19 infants diagnosed with congenital nasolacrimal duct cyst, with or without dacryocystocele, diagnosed and treated between March 2015 through March 2020. Data were extracted for descriptive purposes and included: birth weight, main presenting symptom, stertor or dyspnoea, unilateral or bilateral occurrence. Follow-up one month after intervention included recurrence of symptoms, physical examination and fibreoptic naso-endoscopy. Nineteen infants with intranasal cyst were presented to our department at the age of 1 day. Four-teen infants had unilateral and 5 infants had bilateral intranasal cysts. There were 8 boys and 11 girls. Mean gestational age at birth was 39 weeks, mean birth weight was 3351 g. 42.1% of infants presented with dacryocystocele, 31.5% with stertor, and 26.3% with dyspnoea. 80% of infants with bilateral cysts presented with dyspnoea. Follow up ranged from 6 to 48 months, no recurrence of symptoms was reported. Intranasal endoscopic marsupialization under topical anaesthesia is a successful, safe, low cost procedure for treating neonatal nasolacrimal duct cysts while avoiding general anaesthesia for infants.

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Does the involvement of first-year residents have a negative impact on the performance of a newborn hearing screening program?

Roberto Gallus, Davide Rizzo, Laura Maria De Luca, Andrea Melis, Caterina Kihlgren, Paolo Parente, Roberta Anzivino, Simonetta Frezza, Francesca Priolo, Francesco Bussu, Guido Conti

Publicatie 18-08-2020


We aimed to evaluate the efficiency of our hearing screening program, prior to hospital discharge, together with the consistency of our teamwork including first year residents by assessing a learning curve for the operators involved. We evaluated all the data collected during the first stage of the screening program of all non-NICU neonates from March 2009 to July 2013, analyzing by means of a linear regression model, the monthly referral rate for the whole period of activity of each group of residents. performances of each group of screeners were statistically different (chi square test p < 0.005). The nptrend test showed that group 2 (p = 0.01) and group 4 (p = 0.01) reached a statistical significance in higher and lower referral rates respectively. No statistical differences were found in other groups (Group 1 p = 0.161; Group 3 p = 0.853). Despite a statistically significant difference in the performances between the groups of residents, the referral rates for each group (range 6.18%-9.29%) and the overall referral rate for the whole period (7.84%) agree with the values commonly reported for TEOAEs in the literature. It means that our screening program is reasonably effective despite a yearly turnover of operators.

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Polish version of the pediatric Voice Handicap Index (pVHI)

P. Krasnodębska, A. Szkiełkowska, A. Rosińska, H. Skarżynski

Publicatie 18-08-2020


The modern standard of voice diagnostics in both the adult and pediatric populations is based on perceptual, acoustic and videolaryngoscopic assessment, as well as self-assessment of voice quality. Currently, only two tools for assessing the voice in the pediatric population were translated into Polish: pVHI and its abbreviated version - cVHI (Children Voice Handicap Index). Thanks to the use of pVHI, the therapist and the patient, as well as his family and relatives, become aware of what functional zones are disturbed as a result of voice problems. The aim of the study was to analyze various methods of assessing children's voice, including the pVHI voice disability questionnaire in children with various voice disorders. In addition, the authors wanted to develop a classification of the degree of disability of children's voice expressed by the sum of points obtained in pVHI. The study included a group of 89 children aged 5-12. Each child underwent a standard otolaryngological and phoniatric examination procedure with hearing assessment and fiberoscopic laryngeal evaluation. The voice of the dysphonic children was assessed with a spectrogram and the GRBAS scale. The children's guardians completed the Pediatric Voice Handicap Index (pVHI). Polish children without voice disorders obtained an average of 1.9 points as a total result of the pVHI questionnaire. The results of the questionnaire obtained from children with voice disorders were on average 24.7 (SD 13.9). Total and individual domain scores were significantly higher in children with dysphonia than in asymptomatic children. Children with voice disorders were rated an average of 1.95 (SD 0.6) degree of hoarseness in Yanagihara's scale, and obtained an average overall score of 4.8 on the GRBAS scale (SD 2). A common upward trend in all types of evaluation is evident, along with an increase in the handicap expressed in pVHI score. Statistical analysis showed significant dependence between the overall pVHI score and other voice rating indicators. The result correlated to a moderate degree with the sum of points obtained from GRBAS and the severity of hoarseness assessed subjectively (G) and objectively according to Yanagihara's scale. In addition, weak correlations of the functional part of the questionnaire with the presence of learning problems, and the emotional part with the presence of problems with socialization were noticed. Analyzing the results of the questionnaire depending on the GRBAS results and the Yanagihara scale, a better fit of the exponential trend line than the linear one was observed. The point of inflection of the exponential curve, and thus a significant deterioration in voice assessment indicators, was observed in children who obtained over 32 points, which is 33% of the maximum value that can be obtained from the questionnaire. A new voice assessment tool for the pediatric population has been developed that complements the diagnostic facilities of the otolaryngologist, phoniatrician and speech therapist. Adaptation of the Polish version of the Voice Handicap Index (pVHI) allows the introduction of a new diagnostic indicator into medical and speech therapy practice. The pVHI questionnaire result differentiates children with voice and speech disorders from healthy children. The analysis of children's voice using various methods allows the clinician to further characterize the disturbance of voice quality. It is possible to assess the scale of the severity and type of problem, as well as the spheres of life it concerns most. There is a correlation between the severity of voice disorders and the severity of voice disability expressed in the pVHI question.

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A novel approach in managing challenging tracheoesophageal fistulae

Mark E. Quick, Neil Giblett, Trina C. Uwiera, Hayley Herbert, Shyan Vijayasekaran

Publicatie 18-08-2020


To analyze the outcomes of an open anterior cervical approach and tospecifically describe a novel extended tracheotomy incision ("Key-hole technique") torepair H-type and other challenging tracheoesophageal fistulae (TOF) at a singletertiary pediatric center. A retrospective chart analysis of pediatric patients (0-18 years old) who had undergone repair of TOF's between January 2006 and March 2020 were reviewed. A case series of patients who had undergone open cervical utilizing three different techniques were included. Patient demographics, surgical management and post-operative surgical outcomes including complications were evaluated. During the study period, 117 pediatric patients were diagnosed and anaged with TOFs with or without oesophageal atresia. Within this group, 12 patients (10%) had anterior open cervical repair of congenital or persisting TOFs (6 males and 6 females). Eight cases (7%) had congenital Type E (known as H-type), two had type D, one type B and one type C TOF. Median gestational age was 37 weeks (range 28-41 weeks), age of presentation ranged from 1 day old to 3 years old with 67% being diagnosed within the first month of life. At the time of definitive surgery all patients had a bronchoscopy and oesophagoscopy to confirm the diagnosis, identify the level of the fistula and place a catheter through the fistula. This cases series of open anterior cervical repair of TOFs comprised of seven (58%) patients who had primary extraluminal tracheal approach, four (33%) with extended tracheotomy incision ('Key-hole' technique) and one (9%) patient with slide tracheoplasty for recurrent type C TOF in the presence of subglottic stenosis. Eleven of the twelve patients had successful open anterior cervical repair of TOF. One patient who had primary open anterior cervical repair with the 'Key-hole' technique had recurrence managed successfully with slide tracheoplasty. There were no cases of recurrent laryngeal nerve injury. This series demonstrates that open anterior cervical approach to correct TOFs is an effective and safe method in the majority of cases of congenital and acquired fistulae where there is no oesophageal atresia or the atresia is corrected (in the case of recurrent or second fistulae). We also present the outcomes of a novel surgical "Keyhole" technique to manage TOF fistulas via an extended-tracheotomy incision. We also found that slide tracheoplasty is an effective salvage operation in the case of complex recurrent fistulae.

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Tympanometric interaural asymmetry in African-American school-aged children

Andrew Stuart, Baylee M. Engelhardt, Emma K. Tomaszewski

Publicatie 18-08-2020


The purpose of this study was to investigate the tympanometric asymmetry in children. The determination of ear differences would be useful clinically in determining what qualifies as a significant asymmetry in tympanometric indices and hence middle ear dysfunction. Fifty-five otologically normal school-aged African American children participated. Middle ear indices of peak compensated static acoustic admittance, equivalent ear canal volume, tympanometric peak pressure, and tympanometric width were examined. No significant differences between right and left tympanometric indices were found (p > .05). Correlations between right and left tympanometric indices were positive and statistically significant (p < .05). Critical differences, for deciding if two tympanometry indices are different between ears, were computed from the standard deviations of the right-left ear difference for confidence levels of 85%-99%. Critical differences for tympanometric indices can be used by clinicians to assess if ear asymmetries are statistically significant.

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Longitudinal study of use of the pressure free, adhesive bone conducting hearing system in children at a tertiary centre

Max Sallis Osborne, Anne Child-Hymas, Ann Louise McDermott

Publicatie 19-08-2020


To assess the long-term compliance and usability of the non-implantable, adhesive bone conduction hearing aid system in children. Review of patient demographics, compliance and continued use. Identification of factors that impact on future patient selection. Retrospective case series review of all children aged 5 and above fitted with the adhesive bone conduction hearing aid at a paediatric tertiary centre in the UK between 2015 and 2019. Data collected from medical and audiological records. Patient demographics, skin complications, patient feedback and changes in hearing aid provision were recorded. 82 children (40 female, 42 male) were provided with 89 adhesive hearing devices. To date 72 (87.8%) of the fitted patients, continue to use the device daily with minimal reported skin complications. Of the 10 patients that no longer use the adhesive aid, 5 no longer use any hearing device at all and the remaining 5 patients use an alternative hearing system. These include spectacle aids (n = 2) and bone anchored hearing implant (n = 3). Adhesive aid products are reported to provide comparable audiological results to the commercial softband hearing aids. They provide an excellent alternative in the treatment of conductive hearing loss without the costs and possible complications of a surgical intervention. A compliance rate of 87.8% of all patients fitted with the adhesive system demonstrates a high level of patient satisfaction. The device may also provide an appropriate stepping stone to implanted device once a child reaches the age in which an autonomous decision can be made. Limitations of the device have been the variability in the longevity of the adhesive adaptor and interference with headscarves, hats and glasses with a low frequency of transient minor skin reactions reported.

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Cochlear implantation outcomes with round window electrode insertion versus cochleostomy insertion

Haytham Elafandi, Mohamed Adel Khalifa, Ahmed S. Elguindy

Publicatie 18-08-2020


assessment of two techniques for electrode insertion during cochlear implantation which are the round window and the traditional cochleostomy insertions, the comparison utilized cochlear implantation outcomes. STUDY DEIGN: a prospective cohort study. children (n = 200) between 2 and 8 years old who had bilateral severe to profound SNHL and received a unilateral cochlear implant, 100 children had a round window insertion and were labeled the RW group while the other 100 children had a cochleostomy insertion and were labeled the C group which was taken as a control group. all the participants in this study were followed up and tested twice for their cochlear implant outcomes, the first time when the duration of using their implants was no less than 24 months and no more than 30 months. The second time between 31 and 36 months post implantation. For speech perception; The Consonant-Nucleus-Consonant test (CNC) and The Bamford-Kowal-Bench sentence lists (BKB). For language acquisition; The Preschool Language Scale-fourth edition (PLS-4) and The Peabody Picture Vocabulary Test, Fourth edition (PPVT-4) had been utilized. For speech production; the Diagnostic Evaluation of Articulation and Phonology (DEAP). for speech perception: The mean CNC scores for the RW group and the C group between 24 and 30 months post-implantation and at 31-36 months post-implantation were better for the round window group. Also, the mean BKB scores for the RW group were higher than the C group between 24 and 30 months post-implantation (p < 0.0013) and at 31-36 months post-implantation (p < 0.0011). for language acquisition; the PLS-4 mean scores for the RW group and the C group between 24 and 30 months post-implantation and at 31-36 months post-implantation were better for the round window group (p < 0.001). The PPVT-4 mean scores for the RW group were also higher than the C group at both durations. for speech production; The mean word intelligibility scores of the DEAP for the RW group were better at 24 to 30 and 31-36 months post-implantation. Round window insertion is associated with superior cochlear implantation outcomes regarding speech perception, language acquisition and speech production rather than the standard cochleostomy insertion.

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The direct laryngoscopy and rigid bronchoscopy findings and the subsequent management of infants with failed extubations

Mana Espahbodi, Samantha L. Kallenbach, Abigail A. Thorgerson, Chiang-Ching Huang, Sophie G. Shay, Michael E. McCormick, Robert H. Chun

Publicatie 18-08-2020


There is limited data regarding the role of direct laryngoscopy and rigid bronchoscopy (DLRB) in infants with failed extubations. Pediatric otolaryngologists are frequently consulted to perform DLRB in infants with failed extubations. To determine the DLRB findings in infants with failed extubations and the interventions performed based on these findings. A retrospective chart review was performed on infants less than 12 months old undergoing DLRB for failed extubations from January 2013-June 2017 at a tertiary care children's hospital. Data was collected on age, birth weight, perinatal complications, comorbid conditions, number of failed extubations, length of most recent intubation, operative findings, and subsequent interventions, including tracheostomy. Descriptive and comparative analyses were performed. Of the 62 subjects who met study criteria, median age at DLRB was 3.0 months, corrected age was 1.0 months, gestational age was 27.1 weeks, birth weight was 0.97 kg, and number of failed extubations was 2.0. About 80% had respiratory distress at birth requiring intubation, and 76% carried a diagnosis of bronchopulmonary dysplasia (BPD). The median number of days intubated prior to DLRB was 27. Twenty-seven percent of subjects had no significant abnormal findings on DLRB, and 26% had subglottic stenosis. The majority (74%) underwent tracheostomy. Eighteen percent of subjects had an initial intervention for abnormal DLRB finding(s) other than tracheostomy and were able to avoid tracheostomy as a future intervention. Tracheostomy placement was associated with a diagnosis of BPD (RR 1.78, 95% CI 1.02, 3.10), having a birth weight less than 0.71 kg (RR 1.45, CI 1.01, 2.10), and being intubated for 48 or more days prior to DLRB (RR 1.57, 95% CI 1.05, 2.36); it was not associated with the number of failed extubations prior to DLRB. Infants with failed extubations commonly had abnormal findings on airway evaluation by DLRB. Most children in this population still required tracheostomy placement, but about 20% were able to have an alternate intervention and avoid tracheostomy.

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Role of cochlear synaptopathy in cytomegalovirus infected mice and in children

Ali Almishaal, Pranav Dinesh Mathur, Lesley Franklin, Kevin Shi, Travis Haller, Aleksandra Martinovic, Kayla Hirschmugl, Brian R. Earl, Chong Zhang, Jun Yang, Michael R. Deans, Matthew A. Firpo, Albert H. Park

Publicatie 23-08-2020


Determine whether a murine model of cytomegalovirus (CMV) and CMV- infected children show evidence of synaptopathy. Murine model of CMV infection and case series. C57 BL/6 mice were inoculated with murine-CMV (mCMV). Auditory function was assessed using Auditory Brainstem Response (ABR) and distortion product otoacoustic emission (DPOAE) testing. Temporal bones from mCMV-infected mice were used for both ribbon synapse and hair cell quantification. Four groups of children (non-CMV normal hearing, non-CMV hearing impaired, CMV normal hearing and CMV hearing impaired) underwent ABRs between 2014 and 2018. The outcomes included raw amplitude, wave I:V amplitude ratio, absolute latency, and interpeak latency. Mice at 8 weeks post mCMV infection had higher ABR and DPOAE (P < 0.05) thresholds and increased outer hair cell loss compared to uninfected mice and mCMV-infected mice at 4 and 6 weeks post infection, indicating progressive hearing loss. A reduction in the wave I amplitude and synaptic counts were noted earlier at 4 weeks in CMV-infected mice (P < 0.05). The human data indicated that the wave I:V amplitude ratio was lower on average in CMV-infected groups when compared to the uninfected cohorts. The wave I:V amplitude ratio for the click and 4k stimuli were not significantly different between the congenital CMV-infected and uninfected children with normal or with hearing loss. This study suggests mCMV infection results in a synaptopathy before hair cell damage. Additional studies need to be performed to determine whether this effect is also observed in CMV-infected children. Animal studies and basic science- NA; human studies: level 4.

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International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA)

Pálma Benedek, Karthik Balakrishnan, Michael J. Cunningham, Norman R. Friedman, Steven L. Goudy, Stacey L. Ishman, Gábor Katona, Erin M. Kirkham, Derek J. Lam, Nicolas Leboulanger, Gi Soo Lee, Claire Le Treut, Ron B. Mitchell, Harlan R. Muntz, Mary Fances Musso, Sanjay R. Parikh, Reza Rahbar, Soham Roy, John Russell, Douglas R. Sidell

Publicatie 19-08-2020


To develop an expert-based consensus of recommendations for the diagnosis and management of pediatric obstructive sleep apnea. A two-iterative Delphi method questionnaire was used to formulate expert recommendations by the members of the International Pediatric Otolaryngology Group (IPOG). Twenty-six members completed the survey. Consensus recommendations (>90% agreement) are formulated for 15 different items related to the clinical evaluation, diagnosis, treatment, postoperative management and follow-up of children with OSA. The recommendations formulated in this IPOG consensus statement may be used along with existing clinical practice guidelines to improve the quality of care and to reduce variation in care for children with OSA.

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Mitochondrial mutations in non-syndromic hearing loss at UAE

Walaa Kamal Eldin Mohamed, Marc Arnoux, Thyago H.S. Cardoso, Abdullah Almutery, Abdelaziz Tlili

Publicatie 02-09-2020


Hearing loss (HL) is a common sensory disorder over the world, and it has been estimated that genetic etiology is involved in more than 50% of the cases in developed countries. Both nuclear and mitochondrial genes were reported as responsible for hereditary HL. Mitochondrial mutations leading to HL have so far been reported in the MT-RNR1 gene, mitochondrially encoded 12S rRNA. To study the molecular contribution of mitochondrial 12S rRNA gene mutations in UAE-HL, a cohort of 74 unrelated UAE patients with no gap junction protein beta 2 (GJB2) mutations were selected for mitochondrial 12S rRNA gene mutational screening using Sanger sequencing and whole-exome sequencing. Detected DNA variants were analyzed by bioinformatics tools to predict their pathogenic effects. Our analysis revealed the presence of two known deafness mutations; m.669T > C and m.827A > G in two different deaf individuals. Furthermore, whole-exome sequencing was done for these two patients and showed the absence of any nuclear mutations. Our study supports the pathogenic effect of the m.669T > C and m.827A > G mutations and showed that mitochondrial mutations have a contribution of 2.7% in our cohort. This is the first report of mtDNA mutations in the UAE which revealed that both variants m.669T > C and m.827A > G should be included in the molecular diagnosis of patients with maternally inherited HL in UAE.

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Non-research industry payments to pediatric otolaryngologists in 2018

Tam Ramsey, Divya B. Dasani, Jake Altshuler, Kent Curran, Jason Mouzakes

Publicatie 17-08-2020


To characterize non-research industry payments to pediatric otolaryngologists in 2018. Centers for Medicare and Medicaid Services Open Payments program was used to obtain all non-research industry payments to pediatric otolaryngology in 2018. Total payment amount information was obtained for years 2014-2017 for trend analysis. Descriptive statistics were used to analyze the data. There were 1704 payments to pediatric otolaryngologists in 2018, totaling $163,716 with a median of $17.79. Of the total payments, 74.77% (1274 out of 1704) were under $50. Payments to 299 physicians were reported for 175 different products, the majority of which were associated with otitis media and sinus disease. The nature of the payments included 1579 ($57,120) towards food and beverage, 64 ($46,251) for travel and lodging, 29 ($39,688) for consulting services, 23 ($1075) for education, 4 ($7898) for royalty or license, and 5 ($11,684) for compensation for services such as serving as faculty or a speaker. Our study is the first to investigate industry payments to pediatric otolaryngologists in 2018. Most of the payments were under $50 and mainly for food and beverage. The majority of payments were associated with otitis media and sinus disease.

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Italian primary care paediatricians’ adherence to the 2019 National Guideline for the management of acute otitis media in children: A cross-sectional study

Elena Chiappini, Marco Antonio Motisi, Paolo Becherucci, Monica Pierattelli, Luisa Galli, Paola Marchisio

Publicatie 25-08-2020


The Italian Guideline for the management of acute otitis media (AOM) in children has been recently updated. We conducted a cross-sectional survey to investigate the adherence of Italian primary care paediatricians to the guideline recommendations. A questionnaire including 13 closed-ended questions was administered to the paediatricians participating in the 24th National Congress of Practical Pediatrics, held in Florence in November 2019. The answers were collected and analyzed. Eight hundred fifty-four out of 1000 questionnaires were collected (85.4%). Most of the participants declared that they did not remove the cerumen (63.9%). Pneumatic otoscope and tympanometry were routinely used by a minority of paediatricians (9.6% and 3.9%, respectively); all the participants declared to routinely prescribe oral analgesic drugs and 97.6% of them considered amoxicillin or amoxicillin/clavulanic acid as the first-choice antibiotic. In an uncomplicated unilateral AOM case, the preferred strategy was immediate antibiotic therapy in children under two years of age (83.1%) and watchful waiting in those >2 years (77.3%). Oral amoxicillin was most commonly prescribed at the 80-100 mg/kg/day (56.6%), in 3 daily doses (87.7%), while amoxicillin/clavulanic acid was equally prescribed at 80-100 or 50 mg/kg/day (47.1%-48.5%), mainly in 2 doses (58.6%). However, both drugs are recommended at a dosage of 80-90 mg/kg/day (calculated on amoxicillin), in 3 daily doses. Although the Guideline recommends ten days of therapy, both drugs were most commonly prescribed for 7-8 days (55.5%-57.7%). Pneumococcal and flu vaccines were recommended only by 41.6% and 31.6% of participants, respectively. Our data suggest adequate adherence of the guideline recommendations considering the preferred antibiotic drug, pain management and the choice between immediate antibiotic therapy and watchful waiting. Conversely, targeted training programs are needed to improve adherence to recommendations on cerumen removal, use of pneumatic otoscopy, correct use of antibiotics in terms of optimal dosage, duration and number of daily administrations, and to implement proper AOM prevention strategies.

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Novel use of lip balm under tracheostomy ties to prevent skin irritation in the pediatric patient

Joel W. Jones, Zachariah G. Whiting, Elyse M. Gabay, Md Sohel Rana, Michael J. Rutter, Brian K. Reilly

Publicatie 18-08-2020


To study the effectiveness of lip balm in reducing skin irritation and preventing pressure induced injury in tracheostomy dependent children. The skin of tracheostomy patients presenting to a pediatric otolaryngology clinic over a 12 month period from 2018 to 2019 was assessed and categorized as hyperemic blanchable (abnormal pre-pressure injury), hyperemic non-blanchable, partial thickness skin loss, or full thickness skin loss. Caregivers were instructed to apply lip balm to the skin under soft ties three times per day and with tracheostomy tie changes. Patients were followed prospectively by a tracheostomy care nurse. 24 patients enrolled and reported daily adherence with lip balm use. Median age was 7.3 years (interquartile range, IQR, = 1.3-12.4) with 10 females and 14 males. The majority of patients (n = 20) were identified as having hyperemic blanchable skin. 96% (23/24) of caregivers reported a subjective benefit. 79.2% (95% CI: 57.8%-92.9%) of patients with hyperemic skin (n = 24) demonstrated complete resolution with continued application, and was found to be significant: all patients had skin hyperemia before application, while 20.8% (5/24) continued to have hyperemia after application (P < .001). Infants and ventilation dependent patients demonstrated recovery rates of 88.9% and 75% respectively. Median duration of follow-up was 6.3 months (IQR = 3.4-11.3). There were no documented allergic reactions, accidental decannulations, or skin deterioration in the cohort. Lip balm appears to be a low cost, hydrophobic, and friction-reducing agent that is potentially useful in preventing at risk pressure injuries in tracheostomy dependent pediatric patients.

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The pattern and progression of hearing loss in Marfan Syndrome: A study of children and young adults

Alexandra O. Hamberis, Charmee H. Mehta, Thomas A. Valente, James R. Dornhoffer, Shaun A. Nguyen, Ted A. Meyer

Publicatie 17-08-2020


(s): To describe the prevalence, type, severity, and progression of hearing loss (HL) in children and young adults with Marfan Syndrome (MFS), and to evaluate the influence of comorbidities on HL. Retrospective database analysis. Of 70 patients with MFS, 52.8% (N = 37) had HL. Within the HL group, 75.7% (N = 28) had bilateral HL, while 24.3% (N = 9) had unilateral HL. 21.4% (N = 15) had moderate or more severe HL. The overall prevalence of CHL was 40.5% (N = 15), SNHL 13.5% (N = 5), and mixed HL 37.8% (N = 14). The mean initial age of HL was 8.4 years (range 0.8-24.0). HL was more prevalent in patients with MFS who also experienced chronic otitis media (ES 1.00, 95% CI, 0.32-1.68) and skull anomalies (ES 0.75, 95% CI, 0.07-1.44) as well as for patients with hypertension (ES 2.17, 95% CI, -1.29-5.64). Children and young adults with Marfan syndrome have a high likelihood of hearing loss, with high rates of CHL, chronic otitis media, and Eustachian tube dysfunction. SNHL is also prevalent in this syndrome; hypertension increased the likelihood of SNHL. Early audiologic screening is needed to ascertain type of HL and to efficiently direct patient care in this population.

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Pediatric sublingual dermoid and epidermoid cysts: A 20-year institutional review

Emily Misch, Ryota Kashiwazaki, Mark A. Lovell, Brian W. Herrmann

Publicatie 17-08-2020


Pediatric cystic sublingual masses often present a diagnostic dilemma for practitioners. Though uncommon, dermoid or epidermoid cysts can present in the sublingual space at any age and are often misdiagnosed as an inflammatory pseudocyst (ranula) or lymphatic malformation. Imaging may not always identify the underlying etiology, requiring physicians to maintain a high index of suspicion for these relatively rare oral cysts. To describe the presentation and treatment of sublingual dermoid and epidermoid cysts presenting to a tertiary children's hospital over 20 years. A retrospective review of all pathology specimens identified as dermoid or epidermoid cysts within the sublingual space from 1999 to 2019. Patient charts were then reviewed for relevant clinical, imaging, and operative data. Twelve pediatric patients were identified (8 female, 4 male) with a mean age of 7.2 years (SD 5.6). Eighty six percent (6/7) of dermoid cysts were found in female patients, while 60% (3/5) of epidermoid cysts were in male patients. Multiple dermoid and epidermoid cysts were each found in one patient (8%). Two epidermoid cysts presented in the neonatal period. Preoperative diagnosis included nondiagnostic "cystic mass" (33%), ranula (25%), lymphatic malformation (LM) (17%), and dermoid/epidermoid cyst (17%). Two thirds of patients (8/12) underwent imaging, with all receiving either MRI or CT. Although MRI was the most likely to suggest the possibility of a dermoid/epidermoid cyst (2/4), ranula was the most common primary radiographic diagnosis (5/8). One patient underwent sclerotherapy for presumed LM one year prior to surgical excision of the cyst. Eleven patients (92%) underwent intraoral excision, one (8.3%) underwent a combined intraoral/extraoral approach. To our knowledge, this review represents the largest case series of pediatric sublingual dermoid and epidermoid cysts to date. This series contained higher levels of epidermoid cysts and female patients than previously reported in the literature. Identifying more dermoid cysts in females and epidermoid cysts in males is also a new finding. MRI was superior to CT and US regarding the presence of a dermoid/epidermoid cyst. Frequently misdiagnosed, it is important to consider these relatively rare pathologies when treating children presenting with sublingual masses in order to avoid delayed and/or inappropriate treatment.

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Familial and genetic factors in laryngeal cleft: Have we learned anything?

Natasha D. Dombrowski, Youjin Li, Cher X. Zhao, Pankaj B. Agrawal, Reza Rahbar

Publicatie 11-08-2020


Laryngeal clefts are rare congenital anomalies characterized by failed fusion of the posterior cricoid lamina or incomplete development of the tracheoesophageal septum. While most cases are sporadic, laryngeal cleft may be associated with other congenital anomalies or syndromes. Though not frequently reported, familial occurrence of laryngeal cleft has been noted in our clinical experience. The goal of this research is to describe the existing literature and our own experience surrounding familial occurrence of laryngeal cleft that may help elucidate its underlying genetic basis. Comprehensive literature search was conducted and retrospective chart review was performed on 8 sets of siblings diagnosed at our institution. Data assessed included demographics, type of cleft, and genetic findings. Laryngeal cleft appears to be mostly sporadic. We evaluated data at our institution over a 10-year period and identified 19 patients from 8 families demonstrating familial occurrence of laryngeal cleft. Six (75%) families had two affected siblings, one family (12.5%) had three affected siblings, and one family (12.5%) had four affected siblings. There was no evidence of sex predilection, with half the patients being male (10/19, 52.6%). Fourteen patients (73.7%) had Type 1 clefts and five (26.3%) had Type 2 clefts. Genetic findings were available for review in five patients from three families. Beyond a few known syndromes, laryngeal cleft has largely been thought to be sporadic. However, findings from the existing literature and our own experience with familial laryngeal cleft in eight families suggest additional genetic factors are yet to be elucidated.

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Reflections and perceptions of chronic tinnitus during childhood and adolescence

Susan Tegg-Quinn, Rebecca J. Bennett, Christopher G. Brennan-Jones, Syndon Barabash, Wilhelmina HAM. Mulders, Robert H. Eikelboom

Publicatie 22-08-2020


To enhance understanding of the lived experience of tinnitus during childhood/adolescence from the reflections of adults who experienced tinnitus during childhood/adolescence and the perceptions of primary carers and clinicians who care for children/adolescents who experience it. Secondly to develop a conceptual framework to better describe the experience of chronic tinnitus during childhood/adolescence and to guide approaches to assessment and management. Using a concept mapping approach, participants from two stakeholder groups generated statements describing what chronic tinnitus sounds and feels like to children/adolescents who experience it. Participants subsequently grouped and rated the statements to reveal key concepts. The first stakeholder group consisted of adults who had experienced chronic tinnitus as a child/adolescent and parents of children or adolescents who are experience chronic tinnitus. The second stakeholder group consisted of clinical professionals who provide care for children/adolescents experiencing chronic tinnitus. Participants identified 102 different descriptions of what chronic tinnitus sounds and feels like to children/adolescents, across five concepts: 1) Sounds of tinnitus; 2) Descriptions of tinnitus; 3) Perceptions of tinnitus; 4) Emotional responses to tinnitus and 5) Physical responses to tinnitus. The experience of chronic tinnitus during childhood/adolescence is heterogenous and multifaceted. It may involve the perception of sound, emotions and physiological sequalae. How a child/adolescent experiences their tinnitus will be influenced by the interplay between the sound they perceive, the number of accompanying senses involved and their interpretation of the sound. As well as the emotions and physical effects they experience.

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Validation and adaptation of the Arabic version of the Tonsil and Adenoid Health Status Instrument

Saad Elzayat, Haitham Elfarargy, Ibrahim A. Kabbash, Ihab Nada, Ahmed M. Mehanna, Hossam S. Elsherief

Publicatie 10-08-2020


Validation and cross-cultural adaptation of the Tonsil and Adenoid Health Status study tool, in Arabic while studying its psychometric properties. prospective -validation study. Multiple tertiary centers. 63 consecutive patients who underwent tonsillectomy or adenotonsillectomy operation (pre-operative and 6 months post-operative) and 65 asymptomatic controls. FOLLOWING: Guidelines for the cross-cultural adaptation process, to translate the original English language version into an Arabic language one. We assessed the psychometric properties of the Arabic version of the TAHSI (A-TAHSI) its feasibility, reproducibility, internal consistency, reliability, discriminatory validity and responsiveness to change. The Mann-Whitney test showed a statistically significant difference for the mean score between the patients and the control group denoting good clinical validity. The Cronbach's coefficient value for the A- TAHSI for 63 cases was 0.983, demonstrating good internal consistency. The Wilcoxon signed-rank test showed a marked improvement in the patients' scores 6 months post-operatively. Spearman's rank and Pearson's correlations were used to correlate the level of resemblance of the mean score of the A-TAHSI, which showed statistically significant results. The A-TAHSI is a valid instrument for evaluating the subjective effect of tonsillectomy on the health and quality of life and hence is recommended to be used in tonsillectomy research and daily practice. 3b.

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Grades of hearing loss affect the presence of acoustically evoked short latency negative responses in children with large vestibular aqueduct syndrome

Jianyong Chen, Yao Chen, Qing Zhang, Xiaobao Ma, Ling Mei, Wei Wang, Jiali Shen, Qin Zhang, Lu Wang, Min Shen, Kuan He, Xiangping Chen, Jun Yang

Publicatie 04-08-2020


We aimed to investigate the relationship between grades of hearing loss and the presence of acoustically evoked short latency negative response (ASNR) in children with large vestibular aqueduct syndrome (LVAS), so as to enhance the reference value of ASNR for the diagnosis of LVAS in children. Two hundred sixteen ears from 108 patients (aged 4-90 months) diagnosed with bilateral LVAS, with slight to profound hearing loss, were enrolled in the present study from January 2012 to December 2018. All of the cases were diagnosed with LVAS according to high-resolution computed tomography (HRCT) or magnetic resonance imaging (MRI) scans of the inner ears. The auditory brain stem response (ABR) tests were performed on these subjects with click stimulus (ck-ABR), and the ASNRs were detected based on the method recommended by previous studies. The degree of hearing loss for each ear was classified by the estimated pure-tone average (PTA) thresholds, which were calculated according to the ck-ABR thresholds. ASNRs were present in 40.7% (88/216) ears during ck-ABR tests. Both thresholds of ABR (Z = 2.977, p = 0.003) and estimated PTA (Z = 2.977, p = 0.003) were significantly higher in the ASNR absent group than in the ASNR present group. The frequency of not profound hearing impairment (≤80 dB HL) was much higher in the ASNR present group (44/88; 50%) than in the ASNR absent group (40/128; 31.3%) (χ Grades of hearing loss affect the presence of ASNR in children with LVAS, and manifesting as cases with not profound hearing impairment showed increased odds of recording ASNR in the ck-ABR test. Furthermore, more studies should be performed imperatively to determine the diagnosis value of ASNR in children with LVAS.

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Utility of polysomnography and video swallow studies in the management of pediatric patients with congenital idiopathic bilateral vocal fold dysfunction

James Ruda, Swaroop Pinto, Zahir Allarakhia

Publicatie 04-08-2020


Congenital idiopathic bilateral vocal fold dysfunction (BVFD) is an uncommon cause of neonatal stridor and respiratory distress postnatally. Approximately 50% of affected neonates or infants will historically require tracheostomy for this condition. Timing and candidacy for tracheostomy in BVFD patients is often subjective and poorly understood. Polysomnography (PSG) and video swallow studies (VSS) may be helpful in the management of patients with BVFD prior to tracheostomy by quantifying their degree of upper airway obstruction during sleep and feeding dysfunction while awake. We performed a single-institution retrospective case series of BVFD patients from 2000 to 2018 who had postnatal PSGs performed prior to tracheostomy. Demographics, gestational age, and VSS results prior to PSG were recorded for all patients. Findings from PSGs included non-REM AHI, REM AHI, oxygen nadir, % total sleep time (TST) O2<90%, peak end-tidal (ET) CO2, % TST ETCO2 >52 torr. Rates of post-PSG tracheostomy, gastrostomy tube (G-tube) placement, and home O2 supplementation were noted for all patients. From 2000 to 2018, 12/46 (26%) BVFD patients had postnatal PSGs performed prior to tracheostomy. Median patient age at BVFD diagnosis, VSS, and PSG was 5.5 days, 12.5 days, and 17.5 days, respectively. Mild, moderate, and severe obstructive sleep apnea (OSA) was found in 7/12, 3/12, and 4/12 patients, respectively. Hypercapnia (ETCO2 >52 torr) was found in 5/12 patients on PSG while hypoxemia (SpO2 <90% for >4% TST) was not found in any patient. VSS results demonstrated normal swallowing, inconsistent laryngeal penetration, and silent aspiration in 7/12, 2/12, and 3/12 patients, respectively. Tracheostomy and G-tube placement was performed in 3/12 and 2/12 patients, respectively. There was no association between the severity of OSA or any PSG abnormality, VSS findings, and the performance of tracheostomy in any BVFD patient. OSA was found in all BVFD patients undergoing postnatal PSG at our institution while feeding dysfunction was found in approximately 50% of patients. The presence of feeding dysfunction, severe OSA, or any PSG abnormality was not individually associated with the subsequent performance of a tracheostomy in our patients. PSG is likely useful in supporting but not supplanting one's clinical decision-making in the management of patients with congenital idiopathic BVFD.

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Oral literacy in pediatric otolaryngology surgical consultations amongst parents with high levels of decisional conflict

David Forner, Gilanders Ungar, Jeremy Meier, Paul Hong

Publicatie 04-08-2020


Oral literacy is an important aspect of physician and patient/family communication. Adequate communication is essential in the shared decision-making process and is inherently important in pediatric surgical consultations where parents must make decisions for their children. The aim of this study was to describe oral literacy in pediatric otolaryngology consultations and how it may relate to shared decision-making in a cohort of parents experiencing significant decisional conflict. Thirty-six parent/patient-physician interactions from two pediatric otolaryngology clinics were recorded. Parents completed the Decision Conflict Scale (DCS), and both parents and physicians completed the Shared Decision-making (SDM-Q-9/SDM-Q-Doc) questionnaires. Language complexity was assessed by the Flesch Reading Ease Scale (FRES), the Simple Measure of Gobbledygook (SMOG) Readability Formula, and a series of grammar statistics. The Pearson product-moment was used to examine the correlation between measures. The mean age of parents was 32.3 (mother) and 34.8 (father) years, with the majority having a college education or greater (77.8%). The mean DCS score was 85.8 (range 56-100), and all parents reported clinically significant conflict scores (DCS score > 25). Physicians spoke at a higher-grade level (mean difference SMOG 1.2 (95% CI: 0.8-1.6)), with more words per sentence (mean difference 3.7 (95% CI: 2.4-4.9)), and longer words (mean difference 0.1 (95% CI: 0.03-0.16)). Parents who had higher language complexity experienced less decisional conflict (SMOG vs DCS, r = -0.471, p = 0.004; words per sentence, r = -0.414, p = 0.012; word length, r = -0.419, p = 0.011), but there was no correlation between physician language complexity and DCS or SDM-Q-9 scores. Physicians demonstrated higher language complexity than that of parents in this study. Differences in language complexity between physicians and parents do not appear to play a substantial role in decisional conflict or the perception of shared decision-making in general. However, parents who use a more complex vocabulary may experience less conflict.

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Silencing long non-coding RNA H19 combined with paclitaxel inhibits nasopharyngeal carcinoma progression

Hongyu Zhu

Publicatie 01-08-2020


This study aimed to study the effect of long non-coding RNA (lncRNA) H19 on proliferation, apoptosis and chemosensitivity of nasopharyngeal carcinoma (NPC) cells. NP69 and HNE3, C666-1, SUNE1, 6-10B and 5-8F cell lines were selected to detect the expression of lncRNA H19 via RT-qPCR. LncRNA H19 was overexpressed or silenced for exploring the regulatory effect of lncRNA H19 in cell proliferation, clone formation, apoptosis and drug resistance through CCK-8, clone formation experiment and flow cytometry respectively. The tumorigenic effect of lncRNA H19 silencing was verified by xenograft tumor in nude mice. LncRNA H19 was significantly up-regulated in NPC cells. Silencing lncRNA H19 inhibited the proliferation of NPC C666-1 cells and promoted apoptosis, while overexpression of lncRNA H19 promoted the proliferation of NPC C666-1 cells and inhibited apoptosis. Knockdown of lncRNA H19 in drug-resistant cells remarkably reduced their drug resistance, and overexpression of lncRNA H19 in parental cells significantly reduced their drug sensitivity. Silencing lncRNA H19 inhibits tumor growth in vivo, and silencing lncRNA H19 combined with paclitaxel can enhance tumor inhibition in vivo. In NPC cells, lncRNA H19 was up-regulated, lncRNA H19 inhibited the proliferation and chemosensitivity of NPC cells, promoted apoptosis, and silencing lncRNA H19 combined with paclitaxel could enhance tumor inhibition in vivo.

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Targeted next-generation sequencing identifies a novel frameshift EYA1 variant causing branchio-otic syndrome in a Chinese family

Zhan-Kui Xing, Su-Yang Wang, Xin Xia, Wen-Juan Ding, Lei Duan, Xiao Cui, Bai-Cheng Xu, Yi-Ming Zhu, Xiao-Wen Liu

Publicatie 28-07-2020


To evaluate the genotype-phenotype correlation of branchio-otic syndrome (BOS) in a Chinese family. The proband in this study was an 18-month-old boy with hearing loss, preauricular pit, and branchial fistula without a renal anomaly. We collected blood samples from 6 family members, including 4 who were affected by the syndrome. Targeted next-generation sequencing and Sanger sequencing were performed to identify pathogenic mutations in this family. Pedigree analysis indicated that the mode of inheritance in the family was consistent with the autosomal dominant pattern. Hearing loss was the most common manifestation, occurring in 4 patients. Other findings included preauricular pits (n=2), cervical fistulas (n=3) and abnormal pinnae (n=4). None of the patients had renal anomalies. Evaluation by pure-tone audiometry and temporal bone imaging demonstrated bilateral mixed hearing loss, as well as middle ear and inner ear deformities, in two patients. Mutational analysis of candidate genes in the selected patients led to the identification of a novel frameshift variant NM_000503.4: c.1075_1077delinsAT (p.Gly359Ilefs*7) in the EYA1 gene. The EYA1 c.1075_1077delinsAT mutation is the causative variant in the Chinese family with BOS, although the penetrance is variable within patients.

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Current status of universal newborn hearing screening program at 26 institutions in China

Cheng Wen, Xingming Li, Lihui Huang, Xianlei Wang, Xuelei Zhao, Xiaohua Cheng, Wenying Nie, Xiangrong Tang, Fang Ge, Dinghua He, Shujun Hu, Jin Zheng, Di Zhang, Chunxiu Wen, Jin Zhang, Chuan Wang, Lixia Ma, Ying Lin, Yaqiu Chen, Man Gao

Publicatie 28-07-2020


The present study aimed to determine the status of a universal newborn hearing screening (UNHS) program being conducted in parts of China, by comparing differences in the program findings between 2016 and 2017, as well as across regions in China. This study investigated a nationally representative sample of newborns from 26 provinces, autonomous regions, and municipalities in mainland China. A ''Newborn Hearing Screening Survey'' questionnaire was sent to 43 hearing screening institutions throughout China and the data were analyzed, with appropriate quality control throughout the study process. Twenty-six questionnaires, covering 55.88% (19/34) of the provincial administrative regions in China were appropriately completed. The overall sampling frame comprised 238,795 (year 2016) and 229,185 (year 2017) newborns, respectively. We found differences between two years, the initial screening coverage in 2017 (96.10%) was higher than that in 2016 (94.96%); the referral rate at initial screening in 2017 (9.21%) was lower than that in 2016 (10.26%); and the rescreening rate in 2017 (73.50%) was higher than that in 2016 (68.44%). We found differences across three regions, the rescreening rate were highest in West China, the referral rate at rescreening and the referral rate to diagnostic audiological assessment diagnosis were both highest, while the hearing-loss rate was lowest, in the East China in two years. Overall, 61.54% (n = 16) reported using otoacoustic emissions (OAEs), while 38.46% (n = 10) reported using OAEs in combination with automated auditory brainstem response (AABR) tests, for the initial screening. For rescreening, most sites (n = 19, 73.08%) reported using OAEs in combination with AABR, followed by OAEs only (n = 4, 15.38%) and AABR only (n = 3, 11.54%). Of the twenty-six institutions, 57.69% (n = 15) were equipped with a digital information management system for UNHS program, East China had the highest rate of it (81.82%, 9/11). This study indicated that implementation of a UNHS program had essentially been achieved in many regions of China under the guidance of technical specifications for newborn hearing screening. Compared with 2016, the overall quality of the UNHS program had improved in 2017 and that in East China was better than in the Midland and West China. However, national quality control of the UNHS program is still required to enhance the quality of the program and public education needs to be emphasized to improve the rescreening and reception rate.

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Pressure ulcers and skin infections after cochlear implantation: A delayed yet serious issue

Hui-Shan Hsieh, Chee-Yee Lee, Hung-Pin Wu, Ming-Ying Zhuo, Chung-Feng Hwang

Publicatie 25-07-2020


Skin flap infection is one of the most common complications of cochlear implantation (CI). We identified the causes of skin flap pressure ulcer over the antenna site and proposed wound management strategies. A total of 250 consecutive pediatric patients who underwent CI to treat profound hearing loss were retrospectively assessed. Data on demographic characteristics, the cause of skin infection, and the time of onset were obtained. Seventeen patients (17/250, 6.8%) had a total of 23 skin pressure injuries in the area covering the antenna. We used the National Pressure Ulcer Advisory Panel pressure injury staging system to grade injury severity. Twelve patients had 16 (16/23, 69.6.%) stage 1 pressure injuries; the skin reaction resolved after the patients stopped wearing the device for a brief period, loosened the magnet to relieve pressure on the coil, and received topical antibiotics. Five patients with six (6/23, 26.1%) stage 2 pressure injuries and one (1/23, 4.3%) stage 3 injury, were treated with oral antibiotics. The patient with the stage 3 injury was instructed not to wear the external device for 10-14 days. The incidence of skin reactions associated with the ESPrit speech processor (0/17, 0%) was significantly lower than that associated with the Freedom (2/17, 11.8%), N5 (8/17, 47.1%), and N6 (7/17, 41.1%; p < 0.05) processors. Pressure injuries were more common in younger children (≤7 years, 100%) than in older children (>7 years, 0%; p < 0.05) most likely due to their thinner scalps. Early detection and treatment can prevent implant-threatening infections, particularly in younger children. We believe that better antenna designs will reduce this complication.

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Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification

António Fontes Lima, Filipa Carvalho Moreira, Ana Sousa Menezes, Isabel Esteves Costa, Cátia Azevedo, Miguel Sá Breda, Luís Dias

Publicatie 25-07-2020


chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.

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Clinical features of hearing loss caused by STRC gene deletions/mutations in Russian population

T.G. Markova, N.N. Alekseeva, O.L. Mironovich, N.M. Galeeva, M.R. Lalayants, E.A. Bliznetz, S.S. Chibisova, A.V. Polyakov, G.A. Tavartkiladze

Publicatie 25-07-2020


Congenital sensorineural hearing loss is related to mutations in numerous genes encoding the structures of the inner ear in majority of the cases. Mutations in GJB2 gene are the most frequently identified causes of congenital nonsyndromal hearing loss. GJB2 gene testing became a routine clinical tool. For GJB2-negative patients new genetic approaches including methods based on new generation sequencing give a chance to identify mutations in other genes. The frequent reason of mild-to-moderate hearing loss such as the deletions/mutations of the gene STRC encoding stereocilin protein were recognized (OMIM: 606440). To evaluate the audiological features in hearing impaired patients with deletions and point mutations in the STRC gene. The group of 28 patients from 21 unrelated families with pathological mutations in the STRC gene underwent audiological examination. The description and analysis of the results of full audiological examination was provided. All patients initially had bilateral nonsyndromal sensorineural hearing loss. Among 11 homozygotes of large deletion harboring STRC to CATSPER2 genes were 7 male individuals indicating the presence of male infertility syndrome. In general, 7 children failed audiological screening and 4 children underwent audiological assessment in the age of 3 and 6 months. The most frequently hearing thresholds were registered between 35 and 55 dB that corresponds to mild-to-moderate hearing impairment. The average age of diagnostics was 7.9 years (ranged from 3 months to 45 years). In the majority of patients the audiological profiles were flat or descending with elevation of thresholds at middle and high frequencies and relatively preserved thresholds at low frequencies. Hearing thresholds are symmetric and stable with age. STRC-linked hearing loss is congenital, of mild and moderate severity. Special clinical and genetic approach for children who failed newborn hearing screening with mild-to-moderate hearing loss is necessary.

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Low vitamin D levels and frequencies of regulatory T cells (Tregs) are associated with adenotonsillar hypertrophy in children

Hailong Shen, Zhangying Lin, Jinjin Yuan, Changyu Yao, Yifan Li, Jing Wu, Yehai Liu

Publicatie 25-07-2020


To evaluate the levels of vitamin D and the frequencies of regulatory T cells (%Tregs) in children undergoing adenotonsillectomies (T&As) and their controls. We prospectively collected data from 130 children aged from 2 to 14 years old undergoing T&As and 60 undergoing unrelated elective procedures from November 1, 2015 to December 20, 2017 at the First Affiliated Hospital of Anhui Medical University. Demographic and disease specific data was obtained in addition to blood samples for the measurement of 25-hydroxy (OH)-vitamin D, interleukin-10 and %Tregs. Among the 130 patients undergoing T&As who had 25(OH) vitamin D levels measured, 40.8% were vitamin D deficient (25(OH) vitamin D < 20 ng/mL), 42.3% were insufficient (20 ng/mL < 25(OH) vitamin D < 30 ng/mL), only 16.9% were sufficient (25(OH) vitamin D > 30 ng/mL). Compared with the control group, children undergoing adenotonsillectomies exhibited a significant decrease in the level of serum 25(OH) vitamin D and %Tregs (p < 0.01, p < 0.01). The level of 25(OH) vitamin D and % Tregs did not correlate to parameters like BMI, age, sex in the children undergoing T&As. The lower Vitamin D levels were related to higher OSA-18 scores (Pearson correlation, r = -0.476, p < 0.01), tonsil size (Spearman rank correlation, r = -0.563)and adenoid size (Spearman rank correlation, r = -0.291). In the different vitamin D concentration groups, the mean values of %Tregs were not equal (ANOVA, F = 7.389, p = 0.001). Children undergoing T&As have a lower level of 25(OH) vitamin D and %Tregs. Low 25(OH) vitamin D levels were related to higher OSA-18 scores and greater lymphoid tissue size rather than sex, age, increased BMI. Vitamin D and Treg cells are associated with adenotonsillar hypertrophy.

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Factors associated with frenotomy after a multidisciplinary assessment of infants with breastfeeding difficulties

Gillian R. Diercks, Cheryl J. Hersh, Rebecca Baars, Sarah Sally, Christen Caloway, Christopher J. Hartnick

Publicatie 02-08-2020


Frenotomy for ankyloglossia has increased nearly 10-fold over the past few decades despite insufficient evidence that the procedure improves breastfeeding outcomes. There is no universally accepted method for identifying patients who may benefit from the procedure. The objective of this study is to determine if comprehensive feeding evaluations and targeted interventions can identify children who should undergo procedures, and to identify factors associated with lip or tongue frenotomy to treat breastfeeding difficulties. This observational quality improvement study followed infant-mother dyads between March 2018 and December 2019 referred to our tertiary care center for breastfeeding difficulties. Speech and language pathologists performed comprehensive feeding evaluations on infants prior to surgical consultation for frenotomy. Infants' oral anatomy and function and their ability to breast and bottle feed were assessed, and techniques for mothers to address feeding difficulties without a procedure were offered prior to surgical consultation. Infants either found success over a short observation period or underwent procedures (lip and/or tongue frenotomy). 153 patients (mean age 47.0 days (stdev 39.0 days, 56.2% male) were referred for surgical division of the lingual frenulum. Following development of a program utilizing pediatric speech language pathologists to perform feeding evaluations prior to surgical consultation, 69.9% of patients subsequently did not undergo surgical procedures. 11 (23.9%) underwent labial frenotomy alone and 30 (65.2%) underwent both labial and lingual frenotomies. Frenotomy was associated with significantly increased worry subscale of the Feeding Swallow Impact Survey (FSIS) and decreased mean Breastfeeding Self Efficacy Scale score (p = 0.0001, p = 0.006, respectively). Tongue appearance was significantly associated with having a procedure, while lip appearance was not. The Bristol Breastfeeding Assessment Tool (BBAT) was lower in children undergoing tongue and/or lip frenotomy (p = 0.0006), while the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) appearance and function scores were lower in children undergoing lingual frenotomy with or without lip frenotomy (p = 0.0008, p = 0.0009, respectively). The majority of patients referred for ankyloglossia may benefit from nonsurgical intervention strategies based on findings from comprehensive feeding evaluation. Frenotomy is associated with higher maternal feeding-related worry and reduced breastfeeding self-efficacy scores. While tongue appearance is associated with frenotomy, functional assessment is critical for identifying patients who may also benefit from lip frenotomy.

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The impact of COVID-19 on global disparities in surgical training in pediatric otolaryngology

Tina Munjal, Katherine R. Kavanagh, Rami M. Ezzibdeh, Tulio A. Valdez

Publicatie 25-07-2020


To assess global trends in otolaryngologic and non-otolaryngologic education in response to COVID-19, specifically with regard to surgical simulation and personnel reallocation needs in case of patient demand. Online survey. A multiple-choice survey regarding operative caseload and impact on resident education was sent to Otolaryngology residents and Pediatric Otolaryngology faculty globally. The survey was open for responses for ten days in March 2020. A total of 96 completed surveys were received across 22 countries. 87.5% of respondents reported that no supplementary operative education is being provided. Despite 71.43% of responses indicating that simulation was useful for all levels of residents, 20.95% of responses indicated that simulation is not possible at their institution, with the majority of these being skewed toward responses from South America. Despite the majority of respondents stating that simulation was helpful, there were disparities in access to simulation seen across countries. The results inform the need for a coordinated effort to expand educational efforts outside of the operating room and clinical environment. A major limitation of this study is the low domestic response rate.

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Facial nerve dehiscence and cholesteatoma: Pediatrics vs adults

Giampiero Gulotta, Irene Claudia Visconti, Annalisa Pace, Giannicola Iannella, Valeria Rossetti, Pierluigi Mastino, Claudio Vicini, Francesco Salzano, Marco Artico, Antonio Greco, Giuseppe Magliulo

Publicatie 25-07-2020


the aim of this paper is to study the incidence of facial canal dehiscence (FCD) in pediatric and non-pediatric patients, analyzing eventual differences in frequency, localization, primary or revision surgery and duration of the disease. 527 patients suffering from chronic otitis media with acquired cholesteatoma, divided into two groups, those aged 18 years or over (470 patients), and those aged below 18 years (57 patients). Total incidence of FCD in adult population was 25,7% (121/470) and 7% (4/57) in pediatric one. Globally higher values were found in revision surgery, 43,5% (40/92) in adults and 16,7% (1/7) in children. Diseases longer than 5 years have been correlated to higher incidence of FCD in adults, 29,9% (109/364), than in pediatrics, 7,3% (3/41). No statistical significant difference has been found in those with a disease shorter than 5 years: 11,3% in adults (12/106) and 6,2% in children (1/16). The majority of patients, both adults and pediatrics, had a dehiscence in the tympanic tract of facial nerve. No statistical correlation regarding concomitant semicircular canal fistula and FCD has been found due to the absence of data in children. Incidence of FCD is higher in adult population than in pediatric. Adults have a higher incidence in primary surgery than children. No statistical significant difference has been found in adults and pediatrics with a less than 5 years disease, while diseases longer than 5 years expose adults to higher risk of FCD. Middle tract of tympanic segment is the most involved site of dehiscence in both populations.

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Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions

Seyed Abolfazl Tohidast, Banafshe Mansuri, Rasool Bagheri, Hadi Azimi

Publicatie 25-07-2020


Recently, a novel virus has spread worldwide causing the disease called COVID-19. In addition to putting people's lives at risk and causing mortality, various problems have occurred due to the negative effects of the COVID-19 pandemic. Quarantine, social distancing, and the obligation to use protective tools have led to sometimes long term closing of various jobs and services, including rehabilitation services. For instance, the disease has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes. Therefore, here, we described the quality of providing SLP services during the COVID-19 pandemic and the negative effects of the disease on the provision of SLP services. In addition, we made an attempt to explain concerns and problems raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the outbreak of COVID-19.

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