International Journal of Pediatric Otorhinolaryngology

“How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigos syndrome”

18-02-2020 – John McLaren, Michael S. Cohen, Chadi M. El Saleeby

Journal Article, Review

Gradenigos Syndrome is a rare complication of otitis media and/or mastoiditis resulting in inflammation of the petrous apex of the temporal bone. Here, we highlight an interesting case from our institution, summarize available pediatric cases from the past fifty years to provide an updated diagnostic categorization for this rare condition with confusing nomenclature, and suggest guidance for diagnosis and management.

Benign tumoral melanosis of a cervical lymph node in a child

09-02-2020 – Elizabeth F. Boscoe, Mohammad K. Hararah, Mark Lovell, Peggy Kelley

Case Reports

We present a pediatric case of benign tumoral melanosis in a cervical lymph node arising from congenital pigmented lesions of the anterior neck. This is the first reported pediatric case not associated with regressed melanoma or trauma. Tumoral melanosis is a rare phenomenon which describes a pigmented lesion like melanoma; however, histology demonstrates melanin-laden macrophages without malignant cells. In the few reported cases, tumoral melanosis has arisen in the skin or lymph node and associated with a regressed melanoma, pigmented basal cell carcinoma or mycosis fungoides. We discuss the pathology of this disease process, and the work up in a pediatric patient.

Retropharyngeal abscess and mediastinitis as an uncommon complication of varicella infection

06-02-2020 – Marta Menéndez del Castro, Andrés Coca-Pelaz, Sergio Menéndez, Ana Vivanco-Allende, Daniel Pedregal-Mallo, Patricia García-Cabo, Laura Fernández-Vañes, José Luis Llorente

Case Reports

Varicella infection is one of the most common and contagious infection in children and could course with severe complications. We report the case of a 4-year-old patient derived to our hospital for suspicion of suppurative complication in the context of a varicella infection. A computerized tomographic scanning was performed, showing a large retropharyngeal abscess with mediastinitis.

Complications of varicella are up to 2% of patients, but this is the first report of a retropharyngeal and mediastinal abscess in this context. In the face of clinical suspicion, early intervention is important through imaging, intravenous antibiotics and surgical drainage in necessary cases.

Cochlear implantation and mastoid obliteration in a patient with Alström Syndrome

06-02-2020 – Robert G. Hill, Kelley Dwyer, Jennifer Tirino, Matthew Whitley

Case Reports

Objectives

To describe the outcomes of cochlear implantation with mastoid obliteration in a patient with Alström Syndrome and chronic otorrhea.

Methods

This is a single case discussion of a patient with Alström Syndrome and chronic otorrhea who underwent unilateral cochlear implantation and mastoid obliteration in January 2019. Subsequent contralateral procedure was performed 4 months later. Implantation was pursued due to the progressive sensorineural hearing-loss that is characteristic of Alström Syndrome. Serial Audiograms were obtained before and after procedure.

Results

Following implantation, audiological reports improved to near normal thresholds from the previous 60–85 d
B sloping hearing loss. The patients language skills rapidly improved as well as the ability to express her personality. Mastoid obliteration effectively resolved the chronic otorrhea that further complicated this case.

Conclusion

Cochlear implantation with mastoid obliteration was successful in improving hearing thresholds and resolving chronic otorrhea in a patient with Alström Syndrome.

Preventing recurrent acute otitis media with Streptococcus salivarius 24SMB and Streptococcus oralis 89a five months intermittent treatment: An observational prospective cohort study

18-02-2020 – Anna Cantarutti, Federico Rea, Daniele Donà, Luigi Cantarutti, Andrea Passarella, Antonio Scamarcia, Rebecca Lundin, Valerio Damiani, Carlo Giaquinto, Giovanni Corrao

Journal Article

Introduction

Acute otitis media (AOM) is the most common childhood disease leading to antibiotic use. More than 80% of children under three years of age experience at least one episode, and about one-third of these report significant recurrence of episodes. In recent years, several studies reported that normal nasopharyngeal flora inhibits growth of common otopathogens, suggesting that maintenance of an “adequate” nasopharyngeal flora might prevent occurrence of upper respiratory tract infections, including AOM. This study aims to determine whether five-month treatment with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray prevents recurrence of AOM and prescription of antibiotics in children with diagnosis of recurrent AOM.

Methods

Observational prospective cohort study including children aged 1–6 years with diagnosis of recurrent AOM registered with 31 Italian family pediatricians. 81 children were enrolled in the study from September 2016 to the end of the five therapeutic cycles of the Streptococcus salivarius 24SMB and Streptococcus oralis 89a supplied 7 days each month for 5 consecutive months. For each treated child, one untreated control was randomly selected, 1:1 matched for gender, age, and follow-up.

Results

158 children (79 treated and 70 untreated) were included into the analysis (mean age, 3.9 years; 47% female). Univariate analysis showed a statistically significant 34% (95% CI 1%–56%) reduction in number of AOM episodes in treated children compared with those not treated. Significantly fewer antibiotics were dispensed among treated children (24%, 95% CI 1%–41%).

Conclusions

Our findings suggest that intermittent treatment of children with diagnosis of recurrent AOM with nasal spray containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a for a period of five months might be effective in preventing antibiotic use associated with recurrent episodes of AOM. Additional larger studies to address this important clinical problem are recommended.

Long-term treatment outcomes in children with auditory neuropathy spectrum disorder (ANSD)

18-02-2020 – Désirée Ehrmann-Müller, Daniela Back, Heike Kühn, Rudolf Hagen, Wafaa Shehata-Dieler

Journal Article

Introduction

The present article shows long-term results in the hearing and speech development of children with auditory neuropathy spectrum disorder (ANSD). Some children were followed up for nearly 20 years, monitoring their progress through childhood into adulthood.

Methods

This retrospective study examined data from 10 children who were diagnosed and treated at our tertiary referral center. All children were provided with hearing aids and/or cochlear implants. The childrens hearing and speech development and their social and educational development were evaluated.

Results

Seven children were provided with cochlear implants on both sides; three children, one of which had single-sided deafness, received hearing aids. All children with cochlear implants on both sides used their devices full-time. Speech perception ranged between 100% and 0% on one side. Five children attended a school for the hearing impaired; four children attended a regular school. Four children attended vocational training.

Conclusions

At present, there is a lack of literature on the long-term outcomes of treatment in children with ANSD. The data presented show that the hearing and speech development in children with ANSD are significantly heterogeneous. Regular school education and social integration of children with ANSD can be achieved with intensive and supportive rehabilitative methods.

Posterior scalp pressure injury among pediatric head and neck surgical patients

18-02-2020 – Emily Pascal, Andrew R. Scott

Journal Article

Congenital midnasal stenosis: Conservative management

18-02-2020 – Serap Sahin Onder, Asli Sahin-Yilmaz, Ozgul Gergin Tinay, Busra Unsal

Journal Article

Introduction

Congenital midnasal stenosis (MNS) is an extremely rare disease which may be life threatening, and shows difficulty in diagnosis and management. This case series summarizes superiority of using intranasal mometasone furoate spray (IMS) and continuous positive airway pressure (CPAP) to treat nasal obstruction in neonates with MNS.

Methods

This study reviewed six consecutive cases of MNS.

Results

Three patients were treated with IMS and CPAP. Two patients were treated with endoscopic balloon dilatation without stenting, followed by IMS and CPAP due to persisting nasal obstruction after the operation. One patient was treated with endoscopic balloon dilatation without stenting alone.

Conclusion

This study is the first to review the use of CPAP and IMS as an effective therapy for some patients with MNS. It suggests that conservative management with CPAP and IMS may be an alternative therapeutic option to surgery.

Lifestyle-related factors differentiating the prevalence of otorhinolaryngological diseases among 6–17-year-olds from Wrocław, Poland

15-02-2020 – Katarzyna Pazdro-Zastawny, Mateusz Kolator, Joanna Krajewska, Alicja Basiak-Rasała, Sara Górna, Patrycja Paluszkiewicz, Michał Zatoński, Tomasz Zatoński

Journal Article

An increased prevalence of sedentary behavior (SB) and a decrease in physical activity (PA) has been noted in recent decades. The aim of the study was to determine the association between the development of otorhinolaryngological diseases, PA and SB. Study draws on data collected from “Lets Get the Kids Moving” study (“Uruchamiamy dzieciaki”), a school-based survey study examining lifestyle factors among a population of elementary- and junior-high-school children in the city of Wrocław, Poland. The respondents were asked about SB, PA and the prevalence of conditions or groups of otorhinolaryngological conditions: adenoid hypertrophy (AH), rhinosinusitis (RS) and allergic rhinitis (AR).

There was a statistically significant association between the frequency of cleaning/vacuuming and the prevalence of AH. There was a statistically significant correlation between the prevalence of RS and screen-based activities on weekdays. AR was more prevalent in children who run less often, are less often engaged in team sports, spend less time outdoors on school days and weekends and spend more time in front of the computer on school days.

Our study provides support for the linkage between PA, SB and an increased prevalence of otorhinolaryngological diseases.

Auditory temporal processing assessment in children with developmental stuttering

15-02-2020 – Yones Lotfi, Zahra Hosseini Dastgerdi, Morteza Farazi, Abdollah Moossavi, Enayatollah Bakhshi

Journal Article

Objective

Stuttering is a developmental disorder of speech production with a dynamic and multifactorial nature. Scientific theories mentioned the role of auditory processing disorder in stuttering. Investigating the auditory processing in stuttering would provide insights into the mechanisms of stuttering. The details of basic auditory processing in children with stuttering (CWS) continue to remain uncertain. This study aimed to investigate the auditory temporal processing (ATP) in CWS and also its relationship with the stuttering severity.

Methods

The participants of this comparative cross-sectional study were 54 CWS and 63 children without stuttering (CWOS). All children were between 7 and 12 years old. ATP ability of the participants was measured using the Backward Masking (BM), Duration Pattern (DP), and Gap in Noise (GIN) tests. Then, the groups were compared in terms of ATP results. The correlation between the scores of these tests and stuttering severity was assessed.

Results

According to the results, CWS showed poorer performance on DP, BM and GIN tests when compared with CWOS. Moreover, the stuttering severity had a significant negative correlation with the DP scores and percentage of correct identification scores in GIN; whereas it had a significant positive correlation with the BM thresholds.

Conclusions

The results showed that some CWS have ATP disorder, which could exacerbate their stuttering. These findings highlighted the role of ATP disorder in stuttering.

The aural foreign body space: A review of pediatric ear foreign bodies and a management paradigm

13-02-2020 – Navin Prasad, Earl Harley

Journal Article

Purpose

We aim to describe and review the management of pediatric aural foreign bodies (FBs).

Methods

We performed an observational study and retrospective chart review with statistical analysis of management for patients presenting with aural FBs to the Emergency Department (ED) with or without ENT consultation, or presenting directly to the ENT clinic.

Results

There were 166 objects in the ears of 155 children. Paper and beads were the most common objects. Micro-alligator forceps and small right-angle hooks were the most commonly used instruments for removal. 60% of patients had attempted removal prior to referral to Otolaryngology, who removed 72% of the FBs in the outpatient setting, 23% in the operating room, and 2.5% in the ED.

Conclusion

Taking into account certain characteristics of the object reflects an efficient manner in which to determine referral of difficult removals to Otolaryngology. Providers should determine if the FB is very hard or very soft and spherical or cylindrical with secondary consideration of cost to the patient and hospital in order to properly navigate treatment. Soft and irregular objects may be extracted without need for referral to Otolaryngology. Patients with aural FBs that are hard or round, in instances which previous attempts have failed, and/or where there is trauma to the ear should be referred to Otolaryngology to avoid worsening the position of the FB and increasing the chances of requiring removal in the operating room.

Limitations and drawbacks of the hospital-based universal neonatal hearing screening program: First report from the Arabian Peninsula and insights

10-02-2020 – Arif Ali Kolethekkat, Rashid Al Abri, Omar Hlaiwah, Zeyad Al Harasi, Ahmed Al Omrani, Adil Ali Sulaiman, Hana Al Bahlani, Manal Al Jaradi, John Mathew

Journal Article

Objectives

To assess the efficacy of the current universal neonatal hearing screening program in a tertiary medical institution in Oman, identify its limitations and drawbacks, and explore their causative factors.

Methods

A retrospective review was carried out to analyse the hearing screening of 12,743 live babies born between January 2016 and December 2018. Screen coverage, drop outs, follow up rate, and age at completion of screening, diagnosis, and intervention were analysed. The results were compared with the Joint Committee on Infant Hearing (JCIH) performance quality indices. Prospective questionnaire-based telephonic interviews were then conducted with the parents or caregivers of neonates with hearing loss. Finally, the causes of loss to follow up or delays in hearing screenings, diagnosis, and/or early intervention were studied.

Results

The true prevalence of hearing loss was 4.0 in 1000. The coverage of first-stage screening was 90% whereas the compliance with the second stage was 88.04%. 22.8% of the patients eventually obtained final diagnostic confirmation. The overall compliance with amplification was 30.2%. The completion ages of primary screening and final confirmation were 7.98 and 17.3 weeks respectively. The importance of hearing screening is well received by parents, but problems related to communication, delays in the appointment system, and inefficient follow up tracking were identified as the main limitations and drawbacks of the program.

Conclusion

The coverage of the neonatal hearing screening program had not yet reached the required goal of 95%. The performance indicators also fell below the international benchmark. There is a need to address the identified causative factors. Effective communication and well-maintained tracking systems need to be implemented.

High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region

09-02-2020 – Alasdair P.S. Munro, Robert B. Dorey, Daniel R. Owens, Duncan J. Steed, Christina Petridou, Trent Herdman, Christine E. Jones, Sanjay V. Patel, Kate Pryde, Saul N. Faust

Journal Article

Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease.

Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st, 2010 and December 31st, 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management.

Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6–12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%.

Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.

Effect of probiotics in experimental otitis media with effusion

10-02-2020 – Selda Kargin Kaytez, Ramazan Ocal, Nihat Yumusak, Hatiçe Celi̇k, Necmi Arslan, Mustafa Ibas

Journal Article

Objectives

The articles aim was to investigate the effects of probiotics in the experimental otitis media with effusion.

Materials and methods

Twenty-four male Wistar albino rats were used. They were divided into four groups. Experimental otitis media with effusion was created by intratympanic histamine injection. The effusion was confirmed by otomicroscopic examination 24 h after injection. Group 1; did not receive any treatment, group 2; received probiotics for 7 days after the detection of effusion, group 3; received probiotics for 7 days prior to injection of histamine, group 4; received probiotics for 7 days before injection of histamine and 7 days after detection of effusion. After detection of effusion, animals were sacrificed. Otomicroscopic evaluation was done to determine the effusion. In histopathological examination neutrophil leukocyte counts were determined in 25 areas of the sub-mucosa of the temporal bulla.

Results

The otomicroscopic ear effusions’ healing rate in group 1 was 10%, in group 2 was 25%, in group 3 was 50%, and in group 4 was 100% (p < 0,013). The mean counts of submucosal neutrophil leukocyte from 25 areas of the temporal bulla of group 1 was 86,8 ± 24, group 2 was 66,5 ± 21, group 3 was 66,2 ± 16, and group 4 was 26,3 ± 6,5 (p < 0,001).

Conclusion

Probiotics have a curative effect on the prevention and treatment of otitis media with effusion. This result may be related to their anti-inflammatory effects. Therefore, probiotics can be widely used in the age group at risk for otitis media with effusion as a complementary therapy by dietary supplements.

Level of evidence

NA.

Normative data and construct validity of a cross-linguistic functional speech outcome, the Intelligibility in Context Scale: Italian (ICS–I)

10-02-2020 – Silvia Piazzalunga, Nicoletta Salerni, Federico Ambrogi, Sofia Limarzi, Giulia Visconti, Antonio Schindler

Journal Article

Objectives

The Intelligibility in Context Scale (ICS) is a parent-report scale, world-wide translated and widely validated, by which parents can rate their childs functional speech intelligibility according to seven different communicative partners.

The study aimed to report and discuss the normative data of the Italian version of ICS (ICS–I) in Italian-speaking preschool children, and to investigate whether the age influences the ICS-I scores (construct validity). Socio-economic status (SES) of the family were investigated and compared to parents ratings on childs speech intelligibility.

Methods

A cross-sectional observational study was conducted. Italian-speaking children aged 3–6 years (n = 355; mean age = 56.06 months; SD = 9.8 months), without major developmental impairment, were recruited in kindergartens throughout a convenience sampling. Parents completed a self-report form on their family SES (educational level and employment status of fathers and mothers). Children were independently rated by their mothers (ICS-Im) and fathers (ICS-If).

Results

Results show that ICS normative data for the Italian preschool population (ICS-Im = 4.52; SD = 0.46; ICS-If = 4.47; SD = 0.49) are consistent with previous evidence found in other languages, suggesting that ICS could be a potential cross-linguistic tool to assess functional intelligibility.

A statistically significant (p < 0.001) improvement in ICS-I score was found with increase of age (construct validity). No evidence of association (p > 0.05) with ICS-I was found for SES family.

Conclusion

The study provides normative data of the functional intelligibility assessed by a subjective parental scale. As for other previous international studies, ICS-I normative data suggest that a preschool child without major impairment shows a high degree of speech intelligibility, even if minimal differences of intelligibility are reported for different communicative partners.

The current findings support clinicians and researchers in implementing ICS-I in typical and also in atypical population with different SES background and promoting its application as a potential outcome measure in children with Speech Sound Disorders.

The role of 3D printing in pediatric airway obstruction: A systematic review

09-02-2020 – Joshua A. Stramiello, Robert Saddawi-Konefka, Justin Ryan, Matthew T. Brigger

Journal Article

Background

Tracheomalacia and tracheal stenosis are complicated, patient-specific diseases that require a multidisciplinary approach to diagnose and treat. Surgical interventions such as aortopexy, slide tracheoplasty, and stents potentially have high rates of morbidity. Given the emergence of three-dimensional (3D) printing as a versatile adjunct in managing complex pathology, there is a growing body of evidence that there is a strong role for 3D printing in both surgical planning and implant creation for pediatric airway obstruction.

Methods

A structured PubMed.gov literature search was utilized, and a two-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((3D printing) OR three-dimensional printing) OR 3D printed) OR three-dimensional printed) AND trachea) OR airway.

Results

Over 23,000 publications were screened. Eight literature reviews and thirty-seven original papers met inclusion criteria. Of the thirty-seven original papers, eleven discussed 3D printing for surgical planning and twenty-six discussed 3D printing implants for interventions.

Conclusion

The reported application of 3D printing for management of pediatric airway obstruction is emerging with positive and broad applications. 3D printing for surgical planning not only improves pre-operative assessment of surgical approach and stent customization, but also helps facilitate patient/family education. 3D printing for custom implantable interventions is focused on bioresorbable external airway splints and biological grafts, with both animal studies and human case reports showing good results in improving symptoms.

Clinical and imaging evaluation of Congenital Midnasal Stenosis

09-02-2020 – Lirit Levi, Liora Kornreich, Ohad Hilly, Eyal Raveh, Dror Gilony

Journal Article

Objectives

To illustrate the clinical and radiological presentation of a rare etiology of nasal obstruction in neonates, midnasal stenosis (MNS), including a comparison of nasal dimensions with those of normal infants.

Methods

We retrospectively reviewed medical charts and computerized tomography (CT) imaging of neonates with nasal obstruction diagnosed as stenosis in the midnasal area in a tertiary pediatric medical center. MNS was defined clinically by inability to visualize the middle turbinate with an endoscope despite the absence of stenosis of the anterior aperture or any gross septal deviation. CT measurements of the midnasal width were taken by an experienced neuroradiologist. We compared widths between the bony inferior turbinate to the bony septum in the narrowest area of symptomatic patients, to widths in a control group of asymptomatic children.

Results

Nine neonates from birth to three months old presenting with nasal obstruction, severe stertor, and blocked nasal passage at the midnasal level in endoscopic examination, were diagnosed with MNS. 6/9 had CT scans. Four had isolated unilateral stenosis, two unilateral MNS and contralateral choanal atresia, and three bilateral MNS. All patients were managed conservatively, initially with nasal saline irrigation and local steroids and topical antibiotics; Median time to resolution of symptoms was 14 days.

When comparing the dimensions at the midnasal narrowest area of the stenotic group with a control group of 139 healthy children, the median bony width was 1.7 mm vs. 3.2 mm, respectively (p < 0.00001). Average dimensions according to age groups until the age of 12 months are given.

Conclusion

In neonates with nasal obstruction, when choanal atresia and pyriform aperture stenosis are excluded, stenosis of the midnasal area should be considered. Most of these neonates can be managed conservatively.

Level of evidence

4.

Hearing outcomes in children of diabetic pregnancies

09-02-2020 – Joshua A. Lee, Charmee H. Mehta, Shaun A. Nguyen, Ted A. Meyer

Journal Article

Objective

Children of diabetic pregnancies (CDPs) face numerous risk factors for hearing loss (HL). The objective of this study was to investigate the hearing outcomes of CDPs on a population scale.

Methods

Using the Audiological and Genetic Database, the prevalence, severity, and progression of HL in CDPs was compared against children of non-diabetic pregnancies (CNDPs) who served as controls.

Results

Among 311 CDPs, 71.1% demonstrated evidence of HL compared to 45.5% in CNDPs (p < 0.001). The mean age at which CDPs received audiograms was 3.6 years compared to 5.4 years for CNDPs (p < 0.001). Compared to CNDPs, CDPs were similarly affected by common otologic conditions such as acute otitis media (25.7%), chronic otitis media (38.3%), and Eustachian tube dysfunction (41.8%) (all p > 0.05). CDPs were more likely to have bilateral HL (81%) and sensorineural hearing loss (SNHL) (8%) relative to CNDPs (p < 0.001 and p = 0.004, respectively). Rates of conductive HL and mixed HL were not significantly different between groups (p = 0.952 and p = 0.058, respectively). CDPs were at significant risk for the development of HL (a
OR 1.66 1.28–2.17, SNHL (a
OR 1.63 1.01–2.52, and high-frequency HL (a
OR 1.32 1.03–1.68). Of the comorbidities evaluated, CDPs with hyperbilirubinemia (a
OR 1.85 1.18–2.84), perinatal asphyxia (a
OR 1.90 1.06–3.16), or congenital heart disease (a
OR 1.21 1.07–1.37) demonstrated higher risk of SNHL.

Conclusion

Children of diabetic pregnancies face increased risks of developing HL, particularly bilateral and sensorineural hearing loss. Given these findings, we recommend close audiologic follow-up for these children, especially those with complicated birth histories or additional medical problems.

Craniofacial proportions in children with adenoid or adenotonsillar hypertrophy are related to disease duration and nasopharyngeal obstruction

08-02-2020 – Katarzyna Pawłowska-Seredyńska, Wioleta Umławska, Katarzyna Resler, Monika Morawska-Kochman, Katarzyna Pazdro-Zastawny, Tomasz Kręcicki

Journal Article

The effects of ondansetron versus dexamethasone on electrocardiographic markers of ventricular repolarization in children undergoing cochlear implant

08-02-2020 – Reza Safaeian, Valiollah Hassani, Alimohamad Asghari, Masood Mohseni, Haleh Ashraf, Zahra Sadat Koleini

Journal Article

Introduction

Congenital hearing loss is associated with cardiac rhythm disturbances namely long Q-T syndrome. This study was designed to investigate the effect of anti-emetic doses of ondansetron and dexamethasone on ECG recordings in children undergoing cochlear implant surgery.

Methods

Sixty-three pediatric patients scheduled for elective cochlear implantation were enrolled in the study. Two patients were excluded as their baseline ECG showed long QT syndrome. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with propofol. Dexamethasone 0.1 mg.kg−1or ondansetron 0.2 mg.kg−1was randomly administered for the participants approximately 30 min before the end of surgery. ECG recording was performed 15 min after induction of anesthesia and 15 min after dexamethasone/ondansetron administration. RR interval, QRS duration, QT interval, and Tp-e interval were measured by a blinded cardiologist.

Results

Ondansetron resulted in no significant changes in RR, JTc and QTc intervals; while prolonged
Tp-e interval. Multivariable logistic regression analysis showed that use of ondansetron was an independent predictor of QTc prolongation after adjustment for age, gender and baseline QTc (OR = 17.94, CI 95% 1.97–168.70, p = 0.011). The incidence of postoperative retching/vomiting in ondansetron group was significantly lower than dexamethasone group. (3.2% vs. 26.7%, p = 0.011).

Conclusion

The risk of arrhythmias with the use of ondansetron in otherwise healthy candidates of cochlear implant is very low. However, the drug may induce significant changes in ECG parameters. The clinical significance of these changes in patients with cardiac conduction abnormalities should be investigated in further studies.

Systematic analysis of button batteries’, euro coins’, and disk magnets’ radiographic characteristics and the implications for the differential diagnosis of round radiopaque foreign bodies in the esophagus

08-02-2020 – Till Jasper Meyer, Jan-Peter Grunz, Johannes Taeger, Kristen Rak, Rudolf Hagen, Stephan Hackenberg, Johannes Völker, Agmal Scherzad

Journal Article

Objectives

Button battery (BB) ingestion can cause life-threatening complications such as esophageal perforation, and mediastinitis. Chest radiography is the method of choice to diagnose BB ingestion. Therefore, an adequate interpretation of X-ray imaging by physicians is mandatory. The study aimed to analyze relevant diagnostic aspects of BB X-ray imaging, and retrospective analysis of the imaging of radiopaque foreign bodies.

Methods

All commercially available BBs and different foreign bodies such as euro coins (EC) and disk magnets (DM) were listed according to their sizes and compositions. Furthermore, an X-ray analysis of a test set of BBs, ECs and DMs was performed at angles of 0°, 45°, and 90°.

Retrospective assessment of radiological characteristics was performed for patients with a round and radiopaque foreign body in the esophagus

Results

Only BBs with a diameter of at least 20 mm had a reliable positive double rim sign at scan angles of 90°, and 45°. The step-off effect was visible in all BBs regardless of the diameter. DMs and ECs presented a homogeneous X-ray weakening at all investigated scan angles. In the retrospective analysis all five cases of BB ingestion showed a double rim sign, all fifteen cases of coin ingestion a homogeneous X-ray weakening. A corrugated margin was detected for 10 cent, 20 cent and 50 cent coins.

Conclusions

BBs with a diameter of at least 20 mm showed, depending on the battery model, a more or less pronounced double rim sign and step-off effect in conventional X-ray imaging. However the double rim sign can be simulated by for example a pot magnet.

Correlation of air-bone gap and size of Enlarged Vestibular Aqueduct in children

08-02-2020 – Jenna Van Beck, Sivakumar Chinnadurai, Alison Kemph Morrison, M. Geraldine Zuniga, Bridget Smith, Christine M. Lohse, Devin McCaslin

Journal Article

Objective

Enlarged vestibular aqueduct (EVA) is an inner ear malformation that represents an important cause of pediatric hearing loss. While certain elements in the history or audiogram may suggest EVA, it is most often diagnosed using computed tomography (CT). The present investigation was conducted to determine if the size of the audiometric air-bone gap (ABG) is correlated with the size of the vestibular aqueduct in the pediatric population using three vestibular aqueduct measurements. These included the fundus, midpoint, and porous widths of the vestibular aqueduct.

Study design

This is a retrospective cohort study.

Setting

This study took place at a tertiary care referral center.

Patients

Fifty-five children (33 female; 22 male) with a confirmed diagnosis of unilateral or bilateral EVA as determined by prior imaging of the inner ear were included in the study.

Main outcome measures

Associations of EVA measurements with ABGs at 0.5 and 1 k
Hz were evaluated using Pearson correlation coefficients.

Results

All of the correlation coefficients were positive, indicating that as EVA measurements increased so did the ABG. Only the correlation between fundus width and ABG at 1 k
Hz was not statistically significant.

Conclusions

ABGs measured during audiometric testing correlate with the size of the EVA and ABGs can be clinical predictors of the severity of the bony abnormality. These data support the third window theory of conductive hearing loss in pediatric EVA.

Contralateral suppression of otoacoustic emissions in pre-school children

07-02-2020 – W. Wiktor Jedrzejczak, Edyta Pilka, Piotr Henryk Skarzynski, Henryk Skarzynski

Journal Article

Background

Contralateral suppression of otoacoustic emissions (OAEs) may serve as an index of the medial olivocochlear (MOC) reflex. To date, this index has been studied in various populations but never in pre-school children. The purpose of this study was to fill this gap and describe how the MOC reflex affects the properties of transiently evoked OAEs (TEOAEs) in this age group. In addition, the influence of the presence of spontaneous OAEs (SOAEs) in the studied ear on the suppression of TEOAEs was also investigated.

Methods

TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured in 126 normally hearing pre-school children aged 3–6 years. The values of response levels, suppression by CAS, and signal-to-noise ratios (SNRs) of TEOAEs were investigated for the whole signal (global) and for half-octave frequency bands from 1 to 4 k
Hz. Only ears with SNR >6 d
B were used in the analyses. SOAEs were acquired using the so-called synchronized SOAEs (SSOAEs) technique.

Results

Ears with SSOAEs had higher response levels and SNRs than ears without SSOAEs, and suppression was lower (0.58 d
B compared to 0.85 d
B). Only 22% of all studied ears had an SNR >20 d
B, a level recommended in some studies for measuring suppression. There were no significant effects of age or gender on TEOAE suppression.

Conclusions

Suppression levels for pre-school children did not differ appreciably from those of adults measured under similar conditions in other studies. Taken together with no effect of age in the data studied here, it seems that there is no effect of age on TEOAE suppression. However, we did find that the presence of SSOAEs had an effect on TEOAE suppression, a finding which has not been reported in earlier studies on different populations. We suggest that the presence of SSOAEs might be a crucial factor related to MOC function.

Minimization of skin incision at preauricular sinusectomy using a trans pit approach

06-02-2020 – Kang Hyun Lee, Sung Min Lee, Sang Wook Kim, Ki Joon Park, Jun Ho Lee

Journal Article

Background

We introduced a surgical procedure which includes a simple sinusectomy without opening the sinus whilst attempting to minimize the skin incision.

Methods

A total of 34 patients with preauricular sinus were treated. In six patients, this technique was performed bilaterally, so a total of 40 ears were enrolled and analyzed for recurrence rate and surgical outcome in retrospective observational study. A database was created which included patient age, the preoperative and postoperative incision size, suture materials used, and complications. Incisional size according to the previous infection condition and incision and drainage (I & D) history were analyzed.

Results

The mean initial skin incision length was 0.75 ± 0.40 cm and mean incision length after skin suture was 0.81 ± 0.42 cm. The young group under 10 years of age had a mean initial skin incision length of 0.56 ± 0.06 cm, and mean incision length after skin suture was 0.58 ± 0.08 cm. Suture materials were Nylon 6-0 for 14 ears, Nylon 7-0 for 20 ears, and Nylon 8-0 for 6 ears. The incidence of minor complications (immediate wound dehiscence, wound opening at a previous I & D region, keloid formation) was 7.5%.

Conclusion

Our method overcomes potential problems with esthetics in addition to reducing the recurrence rates of preauricular sinusectomy. With our technique, minimization of skin incision length is possible without the risk of recurrence. The use of fine suture materials and not using drainage avoids additional skin trauma.

The effect of tracheotomy on ventilator-associated pneumonia rate in children

06-02-2020 – Sevgi Topal, Emine Demir, Gülhan Atakul, Mustafa Çolak, Ekin Soydan, Ünal Utku Karaarslan, Nevbahar Yaşar, Elif Kıymet, İlker Devrim, Hasan Ağın

Journal Article

Objectives

Data on the relationship between tracheotomy and ventilator-associated pneumonia (VAP) in children is very limited. We planned to evaluate the effect of tracheotomy on VAP rates in children.

Materials and methods

We evaluated patients who underwent tracheotomy during follow-up at the pediatric intensive care unit (PICU) of our hospital. Patients who were diagnosed as VAP at least once and followed by a mechanical ventilation (MV) for at least 30 days before and after tracheotomy were included in our study. The underlying diagnoses of the patients and the number of VAP diagnosis, VAP rates (VAP number x1000/day of MV) before and after tracheotomy were recorded. Logistic regression analysis was used to compare VAP rates before and following a tracheotomy.

Results

There were a total of 47 patients including 28 (59.6%) girls and 19 (40.4%) boys in our study. The duration of MV before tracheotomy was 74.9 ± 48.9 (31–295) days and after tracheotomy, it was 103.3 ± 102.8 (30–586) days. The number of VAP before tracheotomy was 0.9 ± 1.2 (0–8) and after tracheotomy, it was 0.6 ± 0.6 (0–3). The VAP rate before tracheotomy was 5.9 ± 6.3 (0–26.5) and the VAP rate after tracheotomy was 3.2 ± 3.8 (0–11.4). Ventilator-associated pneumonia rates were lower following tracheotomy (OR:0.91,95%CI:0.826–0.981,p = 0.017).

Conclusion

Tracheotomy decreased the VAP rate in children receiving long-term mechanical ventilatory support.

Airway protection & patterns of dysphagia in infants with down syndrome: Videofluoroscopic swallow study findings & correlations

06-02-2020 – Amit Narawane, James Eng, Christina Rappazzo, Jeanan Sfeir, Kimberly King, Mary Frances Musso, Julina Ongkasuwan

Journal Article

Introduction

Down syndrome is a genetic condition that affects 1:737 births. Along with cardiac, otolaryngologic, and developmental anomalies, infants with Down syndrome can have swallowing difficulties resulting in respiratory infections. This study aims to characterize the airway protection and dysphagia seen in infants with Down syndrome.

Methods

This is a retrospective chart review of infants with Down syndrome who underwent videofluoroscopic swallow studies (VFSS) from 2008 to 2018 at a tertiary childrens hospital. Demographic data and VFSS findings were collected.

Results

89.8% (114/127) of infants presented with at least one element of oral dysphagia, while 72.4% (92/127) had at least one element of pharyngeal dysphagia. Sucking skills were classified as abnormal in 63.7% of the patients and bolus formation-control was determined to be deficient (abnormal) in 62.2% of the patients. Oral residuals were present in 37.8% of the patients. With regard to pharyngeal phase, the swallow initiation was considered abnormal in 53.5% of the patients. Pharyngeal residue was present in 17.3% and pharyngo-nasal reflux was present in 27.5% of the patients.

Conclusions

Swallowing assessments in infants with Down syndrome suspected of dysphagia should be considered, especially in those with any alterations in pulmonary health.

The effects of gender and academic achievement on reading fluency among Year 2 Malaysian school children

06-02-2020 – Azlinda Abd Ghani, Nur Hazirah Muslim, Mohd Normani Zakaria

Journal Article

Objective

Language disorders can affect reading skills contributing to poor academic achievements. As such, it is vital for speech language pathologists to identify the potential language-based reading problems among children. To achieve this, specific reading assessments should be developed and studied. Thus, the present study aimed to determine the effects of gender and academic achievement on oral reading fluency (ORF) and silent reading fluency (SRF) among Year 2 Malaysian children.

Methods

In this study that employed a comparative design, fifty-nine typically developing Malaysian children (24 boys, aged from 8 years, 0 months to 8 years, 11 months) were enrolled. They were chosen from three different classrooms (consisting of high achieving, medium achieving and low achieving students, respectively) in a primary school. Their ORF and SRF skills were assessed according to the established methods.

Results

As revealed by two-way ANOVA results, both ORF and SRF scores were found to be comparable between boys and girls (p > 0.05). In contrast, ORF and SRF results between the three classrooms were significantly different from each other (p < 0.05).

Conclusion

The present study provides the first report on oral and silent reading fluency skills among Year 2 Malaysian school children. While the gender effect was insignificant, low achieving students showed poorer reading fluency skills. The preliminary normative data for ORF and SRF provided by the present study are beneficial for future research applications.

Modified external approach to the pediatric cricopharyngeal myotomy: A case series

02-02-2020 – Asitha D.L. Jayawardena, Lauren E. Miller, Lara Hirner, Jessica Sorbo, Claire Zar-Kessler, Corey Baker, Christopher J. Hartnick

Journal Article

Objective

To assess the success of a modified approach to external pediatric cricopharyngeal myotomy in children with inappropriate upper esophageal sphincter relaxation as determined by video fluoroscopic swallow study (VFSS) and pediatric manometry findings.

Methods

This is a case series in which hospital records of all patients who underwent a modified external approach to pediatric cricopharyngeal myotomy 2017 to 2019 were reviewed at a single institution. The primary outcome measure was post-operative diet and presence of aspiration/penetration on post-operative VFSS.

Results

A total of 7 patients underwent modified external approach to pediatric cricopharyngeal myotomy. The average age of the child at the time of surgery was 5.6 (±3.7) years. The average duration (SD) of surgery was 90 (±30) minutes and no complications were observed. 6 of 7 patients (86%) demonstrated an improvement in swallow function after the procedure. The single child who did not was suffering from a posterior fossa tumor which was resected and radiated, which likely made their dysphagia multi-factorial. Although no pediatric normative data exists for upper esophageal sphincter pressure, we observed an average decrease in UES residual pressure of 8.5 (±15.1) mm
Hg and an average decrease in mean UES pressure of 21.2 (±35.1) mm
Hg.

Conclusions

The modified external approach to the pediatric cricopharyngeal myotomy appears to be a safe and efficient procedure with no apparent complications to date. However, further longitudinal data is needed to formally evaluate the efficacy of this procedure when treating pediatric cricopharyngeal achalasia

Adaptation and validation of receptive expressive emergent Language Test-3: Evidence from Hindi speaking children with cochlear implant

02-02-2020 – Vijay Kumar, Rachna Mehta

Journal Article

Introduction

Selection of an effective tool for assessment of language learning outcomes in post cochlear implantation is always an important but challenging task. Receptive expressive emergent language test-3rd Eds. (REELT-3) is one of the comprehensive language assessment tools used in India. In case of administration of REELT-3, which is standardized in English speaking typically developing western population, to another language speaking population with post-cochlear implant condition, the test outcome may get compromised owing to linguistics and population variability. The objective of the study is to test and validate REELT-3 in Hindi speaking children with cochlear implantation.

Methods

Ninety six typically developing children (22.3 ± 6.9 months, 48 boys and 48 girls) and 96 children with cochlear implantation (25.8 ± 9.2 months, 57 boys and 39 girls) participated in this study. As per the eligibility criteria of REELT-3, infants and toddlers with cochlear implant of age below 36 months participated in this study. Criterion, content and construct validity were tested using correlation based statistical analysis.

Results

High content validity was established by obtaining very low correlation coefficient r = 0.16 across two distinct population of typically developing children and children with cochlear implantation. Similarly, correlation coefficient of r = 0.84 revealed high criterion validity across REELT-3 in English and Hindi speaking conditions. Finally, correlation coefficient of r = 0.87was obtained between language raw score and chronological age to establish construct validity. Chronbach alpha coefficient (Chronbach α = 0.85) and interclass correlation coefficient 0.87was observed for REELT-3 which suggests good internal consistency and test-retest reliability, respectively. Receiver Operating Characteristics curve analysis of the REELT-3 suggested that area under curve 0.95 (95% CI = 0.89–0.99, p < 0.001) is excellent. The cut-off Language Ability Score (LAS) was determined as 74.5 with the sensitivity of 87.9% and specificity of 84.1% infer high sensitivity and specificity.

Conclusions

These results validate that REELT-3 can be used in assessment of language outcome in Hindi speaking children with post-cochlear implantation. Clinical assessment of receptive and expressive language will be beneficial in effective evaluation as well as in therapeutic planning.

Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes

02-02-2020 – Ahmad Daneshi, Mohammad Farhadi, Mohammad Ajalloueyan, Mohsen Rajati, Seyed Basir Hashemi, Mohammad Mahdi Ghasemi, Hesamaldin Emamdjomeh, Alimohamad Asghari, Mohammad Mohseni, Saleh Mohebbi, Farideh Hosseinzadeh, Marjan Mirsalehi

Journal Article

Objectives

This multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation.

Methods

Cochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively.

Results

Types of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values <0.001 and < 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively).

Conclusion

The median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4–6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3–4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.

Adherence to follow-up recommendations for babies at risk for pediatric hearing loss

02-02-2020 – Maryrose McInerney, Rachel Scheperle, Wendy Zeitlin, Kenneth Bodkin, Barbara Uhl

Journal Article

Objective

The purpose of this retrospective study was to evaluate the families’ compliance with recommendations for continued monitoring of babies with high-risk factors for hearing loss.

Methods

Hearing screening and follow-up results from 604 babies were tracked across a five-year period. Bivariate analysis, including chi-square analysis, t-tests, and one-way analyses of variance were conducted to test whether various factors predicted likelihood of follow up.

Results

Although 86% of the babies returned for the initial follow-up appointment, few completed the protocol or were diagnosed with hearing loss (10.3%). Excluding the babies who never returned, the average age for initial assessment was near the recommended 3-month target (3.5 months). However, babies were last seen at 9.4 months on average, which is earlier than recommended. Some factors positively predicted follow-up: receipt of ototoxic medication, hyperbilirubinemia requiring transfusion, ECMO, syndromes associated with hearing loss, craniofacial anomalies, and passing the newborn hearing screening. Others were negatively predictive: NICU stay >5 days, younger maternal age, and failing the newborn screening. There was no relationship between the results of the last test and whether the families continued with monitoring. Babies with risks categorized as more likely to be associated with delayed onset hearing loss were more often late to the initial follow up, but also followed up for a longer period of time.

Conclusions

These results demonstrate the need to focus on the barriers unique to babies with risk factors for late onset/progressive hearing loss in addition to those barriers that generally affect loss to follow up. Tools for parental engagement are recommended.

A survey of pediatric cochlear implant recipients as young adults

02-02-2020 – Hillary V. Ganek, Mary-Lynn Feness, Gina Goulding, Gillian M. Liberman, Morrison M. Steel, Leanne A. Ruderman, Blake C. Papsin, Sharon L. Cushing, Karen A. Gordon

Journal Article

Objectives

To identify the influence of pediatric cochlear implantation on long term communication modality, education, and income.

Methods

A telephone survey was conducted with 56 young adults who had received cochlear implants (CI) as children. The participants were, on average, 10.6 (SD = 64) when they received their CI and 21 (SD = 2.29) when they participated in this study. All of the participants used a unilateral CI at the time of the survey. Where applicable, survey results were compared to the general population of similar aged individuals in Ontario using chi-squared tests of proportionality.

Results

Participants (49/56, 88%) indicated that they used their CI all waking hours and 75% (42/56) reported using spoken language as their primary mode of communication. They attended post-secondary school at higher rates than the general population (χ2(1) = 14.35, p < .001); a wide range of study areas were identified with a greater proportion involved in fine arts than the general population (χ2(1) = 25.50, p < .001). The rates of employment in this group were below general rates (χ2(1) = 21.87, p < .001). However, those who were employed reported salaries similar to their hearing peers.

Conclusion

The findings from this study suggest that young adults who received a unilateral CI in childhood typically continue to use their CIs to support spoken language. Their increased rates of post-secondary education are encouraging and they may be choosing unique areas of study. Longer term studies are required to further investigate lower rates of employment in this cohort.

Endonasal endoscopic surgery for pediatric anterior cranial fossa encephaloceles: A systematic review

10-02-2020 – Joshua A. Lee, Young Jae Byun, Shaun A. Nguyen, Rodney J. Schlosser, David A. Gudis

Journal Article, Review

Background

Endoscopic endonasal skull base surgery (ESBS) is a well-established management strategy for anterior cranial fossa (ACF) encephaloceles in adults. However, its application to the pediatric population has not been evaluated in large-scale studies. This study systematically reviews the safety of ESBS for pediatric ACF encephaloceles.

Methods

Articles reporting on pediatric patients undergoing purely ESBS for encephaloceles were reviewed from three databases (PubMed, Scopus, and Cochrane Library). Main outcomes were post-operative cerebrospinal fluid (CSF) leak and other surgical complications.

Results

Twenty-three articles provided data on 110 eligible patients with a mean age of 4.3 years (range birth – 18 years). Intraoperative CSF leaks occurred in 18.5% of children while post-operative CSF leaks developed in 6.0% of cases. Rates of meningitis and hydrocephalus were each 3.7%. Other complications included alar collapse, nasal stenosis, transient diabetes insipidus, pneumonia, and neurologic injury, collectively occurring in 7.0% of cases. The rate of death was 4.8%. The average duration of follow-up was 25.3 months. Encephaloceles recurred in 5.2% of patients.

Conclusions

ESBS for pediatric ACF encephaloceles provides a relatively favorable risk-benefit profile, with a low rate of post-operative CSF leak, other surgical complications, and disease recurrence.

The efficacy of bone-anchored hearing implant surgery in children: A systematic review

07-02-2020 – I.J. Kruyt, K.H.E. Bakkum, C.J.I. Caspers, M.K.S. Hol

Journal Article, Review

Objective

To evaluate the efficacy of Bone-Anchored Hearing implants (BAHIs) in children and to elucidate the usage and outcomes of new surgical techniques and implants in this specific population.

Data sources

Embase and PubMed.

Study selection

We identified studies evaluating surgical outcomes of BAHIs in children. Retrieved articles were screened using predefined inclusion and exclusion criteria. Critical appraisal included directness of evidence and risk of bias. Studies that successfully passed critical appraisal were included.

Data extraction

Outcome measures included patient demographics, follow-up time, surgical technique (one-versus two-stage surgery), tissue handling technique (reduction versus preservation), type of implant used, and complications.

Data synthesis

We selected 20 articles published between 2000 and 2017 for data extraction, encompassing 952 implanted BAHIs. The overall mean age at implantation was 8.6 years (range, 2–21 years). Adverse soft-tissue reactions occurred in 251 of the 952 implants (26.4%; range 0%–89% across studies). Revision surgery was performed in 16.8% (142 of the 845) of the implants. The total rate of implant loss, i.e. caused by OIF (n = 61), trauma (n = 33), recurrent infection (n = 15), elective removal due to insufficient benefit (n = 1), cosmetic reasons (n = 1), or unknown reason (n = 16), was 13.3% of the implants (127 out of 952; range 0%–40% across studies). Differences are seen in the type of implants used; wide-diameter implants seem to be superior in terms of implant survival, and similar in terms of adverse skin reactions, while one-stage surgery and soft-tissue preservation do not seem to result in higher implant loss rates or increased adverse skin reactions based upon limited amounts of literature.

Conclusion

In general, BAHIs are a safe method for hearing rehabilitation in children, although large differences between studies are observed. The outcomes of new surgical techniques and implant designs in the pediatric population seem promising, but more research is needed before definitive conclusions can be drawn.

Pediatric thyroidectomies: A surgical subspecialty comparison

20-02-2020 – Emily Savoca, Sina J. Torabi, David Kasle, Elbert Mets, Michael Hajek, Erik H. Waldman

Journal Article

Objective

This study aims to establish the typical population, safety, and outcomes of pediatric thyroidectomies, specifically identifying surgical complication rates. Furthermore, the study compares management and complication differences between the two specialties that most often manage these patients – Pediatric General Surgery and Otolaryngology.

Methods

National Surgical Quality Improvement Program – Pediatrics (NSQIP-P) data between the years of 2012 and 2016 was reviewed and analyzed for patient characteristics, perioperative course and outcomes. Sub-group analysis was used to compare groups based on surgeon sub-specialty: Otolaryngology or Pediatric General Surgery.

Results

The study identified 516 cases pediatric patients operated on by Pediatric Otolaryngology (229; 44.4%) and Pediatric General Surgery (287; 55.6%). Overall, rates of surgical and medical adverse events were low (1.2% and 0.7%, respectively). Upon univariate analysis, there were no differences between specialties in surgical adverse events (p=1.000), medical adverse events (p=0.196), reoperation (p=0.505), or readmission (p=0.262). Indication for surgery differed between specialties, with benign neoplasm more common in the Pediatric Otolaryngology group (48.9% vs. 35.2%), and thyrotoxicosis more common in the Pediatric General Surgery group (43.9% vs. 23.1%) (p<0.001). Compared to cases done by Otolaryngology, Pediatric General Surgery was independently associated with a shorter operative time (B: -31.583 minutes 95% CI: -42.802 to -20.364; p<0.001).

Conclusion

Thyroidectomy in the pediatric population is a safe procedure with no differences in adverse outcomes noted when comparing Pediatric General Surgeons to Pediatric Otolaryngologists. Pediatric General Surgeons were observed to have a significantly shorter operative time.

Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries

15-02-2020 – Amanda Jane Leach, Preben Homøe, Clemence Chidziva, Hasantha Gunasekera, Kelvin Kong, Mahmood F Bhutta, Ramon Jensen, Sharon Ovnat Tamir, Sumon Kumar Das, Peter Morris

Journal Article

Panel 1: Biotechnology, biomedical engineering and new models of otitis media

07-01-2020 – Marie Gisselsson-Solén, Paula A. Tähtinen, Allen F. Ryan, Apoorva Mulay, Shin Kariya, Anne G.M. Schilder, Tulio A. Valdez, Steve Brown, Ryan M. Nolan, Ann Hermansson, Gijs van Ingen, Tal Marom

Journal Article

Objective

To summarize recently published key articles on the topics of biomedical engineering, biotechnology and new models in relation to otitis media (OM).

Data sources

Electronic databases: PubMed, Ovid Medline, Cochrane Library and Clinical Evidence (BMJ Publishing).

Review methods

Articles on biomedical engineering, biotechnology, material science, mechanical and animal models in OM published between May 2015 and May 2019 were identified and subjected to review. A total of 132 articles were ultimately included.

Results

New imaging technologies for the tympanic membrane (TM) and the middle ear cavity are being developed to assess TM thickness, identify biofilms and differentiate types of middle ear effusions. Artificial intelligence (AI) has been applied to train software programs to diagnose OM with a high degree of certainty. Genetically modified mice models for OM have further investigated what predisposes some individuals to OM and consequent hearing loss. New vaccine candidates protecting against major otopathogens are being explored and developed, especially combined vaccines, targeting more than one pathogen. Transcutaneous vaccination against non-typeable Haemophilus influenzae has been successfully tried in a chinchilla model. In terms of treatment, novel technologies for trans-tympanic drug delivery are entering the clinical domain. Various growth factors and grafting materials aimed at improving healing of TM perforations show promising results in animal models.

Conclusion

New technologies and AI applications to improve the diagnosis of OM have shown promise in pre-clinical models and are gradually entering the clinical domain. So are novel vaccines and drug delivery approaches that may allow local treatment of OM. IMPLICATIONS FOR PRACTICE: New diagnostic methods, potential vaccine candidates and the novel trans-tympanic drug delivery show promising results, but are not yet adapted to clinical use.

Panel 3: Genomics, precision medicine and targeted therapies

03-02-2020 – Regie Lyn P. Santos-Cortez, Mahmood F. Bhutta, Joshua P. Earl, Lena Hafrén, Michael Jennings, Joshua C. Mell, Michael E. Pichichero, Allen F. Ryan, Hilda Tateossian, Garth D. Ehrlich

Journal Article

Objective

To review the most recent advances in human and bacterial genomics as applied to pathogenesis and clinical management of otitis media.

Data sources

PubMed articles published since the last meeting in June 2015 up to June 2019.

Review methods

A panel of experts in human and bacterial genomics of otitis media was formed. Each panel member reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a merged draft was created. The panel met at the 20th International Symposium on Recent Advances in Otitis Media in June 2019, discussed the review and refined the content. A final draft was made, circulated, and approved by the panel members.

Conclusion

Trans-disciplinary approaches applying pan-omic technologies to identify human susceptibility to otitis media and to understand microbial population dynamics, patho-adaptation and virulence mechanisms are crucial to the development of novel, personalized therapeutics and prevention strategies for otitis media.

Implications for practice

In the future otitis media prevention strategies may be augmented by mucosal immunization, combination vaccines targeting multiple pathogens, and modulation of the middle ear microbiome. Both treatment and vaccination may be tailored to an individuals otitis media phenotype as defined by molecular profiles obtained by using rapidly developing techniques in microbial and host genomics.

Panel 5: Impact of otitis media on quality of life and development

31-12-2019 – Preben Homøe, Christian H. Heidemann, Roger AMJ. Damoiseaux, Susen Lailach, Judith E.C. Lieu, John S. Phillips, Roderick P. Venekamp

Journal Article

Objective

To summarize recent advances in knowledge on otitis media (OM) and quality of life (QoL) and development by synthesizing relevant research in this field published between June 1., 2015 until June 1., 2019.

Data sources

Systematic searches of PubMed, Embase and the Cochrane Library using predefined database-specific syntaxes.

Review methods

Articles selected were randomized controlled trials and observational studies with an adequate control group estimating treatment effects of OM including acute OM (AOM), recurrent AOM (RAOM), OM with effusion (OME), chronic OM (COM) and chronic suppurative OM (CSOM). Items included were Health Status, Health Status Indicators, Quality of Life, Functional Status, Specific Learning Disorder, Developmental Disabilities, Language Development Disorders, and Problem Behavior.

Results

The electronic database searches yielded a total of 699 records. After screening titles and abstracts, we identified 34 potentially eligible articles. Of these, 18 were excluded. This left 15 articles suitable for inclusion.

Conclusions

Although evidence is accumulating that OM may significantly impair childrens QoL and development as well as caregivers QoL, studies on this topic are relatively scarce and vary substantially in terms of methodological quality and outcome measurement instruments (OMI) used. In this review, studies have used 10 different OMIs capturing a wide range of OM symptoms as well as generic and disease-specific QoL outcomes. OM was associated with negative effects on auditory processing, language and speech development, school readiness, social competence, psychosocial wellbeing, and sleep. We found only four relevant randomized controlled trials, which mostly failed to demonstrate superiority of interventions in terms of QoL improvement and reports on reversibility are lacking. This underpins the urgent need for high quality studies in this field using validated and uniform OMIs. To facilitate interpretation and harmonization of study findings, we suggest and support the development of a core outcome set for the various OM entities that should include the most reliable and meaningful QoL and developmental OMIs.

Panel 7 – Pathogenesis of otitis media – a review of the literature between 2015 and 2019

28-12-2019 – R.B. Thornton, A. Hakansson, D.W. Hood, J. Nokso-Koivisto, D. Preciado, K. Riesbeck, P.C. Richmond, Y.C. Su, W.E. Swords, K.L. Brockman

Journal Article

Objective

To perform a comprehensive review of the literature from July 2015 to June 2019 on the pathogenesis of otitis media. Bacteria, viruses and the role of the microbiome as well as the host response are discussed. Directions for future research are also suggested.

Data sources

PubMed database of the National Library of Medicine.

Review methods

PubMed was searched for any papers pertaining to OM pathogenesis between July 2015 and June 2019. If in English, abstracts were assessed individually for their relevance and included in the report. Members of the panel drafted the report based on these searches and on new data presented at the 20th International Symposium on Recent Advances in Otitis Media.

Conclusions

The main themes that arose in OM pathogenesis were around the need for symptomatic viral infections to develop disease. Different populations potentially having different mechanisms of pathogenesis. Novel bacterial otopathogens are emerging and need to be monitored. Animal models need to continue to be developed and used to understand disease pathogenesis.

Implications for Practice

The findings in the pathogenesis panel have several implications for both research and clinical practice. The most urgent areas appear to be to continue monitoring the emergence of novel otopathogens, and the need to develop prevention and preventative therapies that do not rely on antibiotics and protect against the development of the initial OM episode.

Panel 2- recent advance in otitis media bioinformatics

04-01-2020 – Diego Preciado, Jian-Dong Li, Kensei Komatsu, Arwa Kurabi, Gustavo Nino, Stephanie Val, Shyan Vijayasekaran, Oren Ziv, Ann Hermansson

Journal Article

Objectives

To update the medical literature on recent large-scale studies employing bioinformatics data analysis tools in otitis media (OM) disease models with a principal focus on developments in the past 5 years.

Data sources

Pubmed indexed peer-reviewed articles.

Review methods

Comprehensive review of the literature using the following search terms: ‘genomics, inflammasome, micro
RNA, proteomics, transcriptome, bioinformatics’ with the term ‘otitis media’, and ‘middle ear’. Included articles published in the English language from January 1, 2015–April 1, 2019.

Implications for practice

Large scale bioinformatics tools over the past five years lend credence to the paradigm of innate immune response playing a critical role in host defense against bacteria contributing to Otitis Media (OM) progression from acute to chronic. In total, genomic, mi
RNAomic, and proteomic analyses all point to the need for a tightly regulated innate immune and inflammatory response in the middle ear. Currently, there is an urgent need for developing novel therapeutic strategies to control immunopathology and tissue damage, improve hearing and enhance host defense for both acute and chronic OM based on full understanding of the basic molecular pathogenesis of OM.

Panel 8: Vaccines and immunology

18-01-2020 – Mark R. Alderson, Tim Murphy, Stephen I. Pelton, Laura A. Novotny, Laura L. Hammitt, Arwa Kurabi, Jian-Dong Li, Ruth B. Thornton, Lea-Ann S. Kirkham

Journal Article

Objective

To review and highlight significant advances made towards vaccine development and understanding of the immunology of otitis media (OM) since the 19th International Symposium on Recent Advances in Otitis Media (ISOM) in 2015, as well as identify future research directions and knowledge gaps.

Data sources

PubMed database, National Library of Medicine.

Review methods

Key topics were assigned to each panel member for detailed review. Draft reviews were collated, circulated, and thoroughly discussed when the panel met at the 20th ISOM in June 2019. The final manuscript was prepared with input from all panel members.

Conclusions

Since 2015 there have been a number of studies assessing the impact of licensed pneumococcal vaccines on OM. While these studies have confirmed that these vaccines are effective in preventing carriage and/or disease caused by vaccine serotypes, OM caused by non-vaccine serotype pneumococci and other otopathogens remains a significant health care burden globally. Development of multi-species vaccines is challenging but essential to reducing the global burden of OM. Influenza vaccination has been shown to prevent acute OM, and with novel vaccines against nontypeable Haemophilus influenzae (NTHi), Moraxella catarrhalis and Respiratory Syncytial Virus (RSV) in clinical trials, the potential to significantly prevent OM is within reach. Research into alternative vaccine delivery strategies has demonstrated the power of maternal and mucosal vaccination for OM prevention. Future OM vaccine trials must include molecular diagnostics of middle ear effusion, for detection of viruses and bacteria that are persisting in biofilms and to enable accurate assessment of vaccine impact on OM etiology. Understanding population differences in natural and vaccine-induced immune responses to otopathogens is also important for development of the most effective OM vaccines. Improved understanding of the interaction between otopathogens will also advance development of effective therapies and encourage the assessment of the indirect benefits of vaccination.

Implications for practice

While NTHi and M. catarrhalis are the predominant otopathogens, funding opportunities to drive vaccine development for these species are limited due to a focus on prevention of childhood mortality rather than morbidity. Delivery of a comprehensive report on the high financial and social costs of OM, including the potential for OM vaccines to reduce antibiotic use and subsequent development of antimicrobial resistance (AMR), would likely assist in engaging stakeholders to recognize the value of prevention of OM and increase support for efforts on OM vaccine development. Vaccine trials with OM prevention as a clinical end-point are challenging, however a focus on developing assays that measure functional correlates of protection would facilitate OM vaccine development.

Panel 4: Recent advances in understanding the natural history of the otitis media microbiome and its response to environmental pressures

28-12-2019 – Robyn L. Marsh, Celestine Aho, Jemima Beissbarth, Seweryn Bialasiewicz, Michael Binks, Anders Cervin, Lea-Ann S. Kirkham, Katherine P. Lemon, Mary P.E. Slack, Heidi C. Smith-Vaughan

Journal Article

Objective

To perform a comprehensive review of otitis media microbiome literature published between 1st July 2015 and 30th June 2019.

Data sources

PubMed database, National Library of Medicine.

Review methods

Key topics were assigned to each panel member for detailed review. Draft reviews were collated and circulated for discussion when the panel met at the 20th International Symposium on Recent Advances in Otitis Media in June 2019. The final draft was prepared with input from all panel members.

Conclusions

Much has been learned about the different types of bacteria (including commensals) present in the upper respiratory microbiome, but little is known about the virome and mycobiome. A small number of studies have investigated the middle ear microbiome; however, current data are often limited by small sample sizes and methodological heterogeneity between studies. Furthermore, limited reporting of sample collection methods mean that it is often difficult to determine whether bacteria detected in middle ear fluid specimens originated from the middle ear or the external auditory canal. Recent in vitro studies suggest that bacterial interactions in the nasal/nasopharyngeal microbiome may affect otitis media pathogenesis by modifying otopathogen behaviours. Impacts of environmental pressures (e.g. smoke, nutrition) and clinical interventions (e.g. vaccination, antibiotics) on the upper respiratory and middle ear microbiomes remain poorly understood as there are few data.

Implications for practice

Advances in understanding bacterial dynamics in the upper airway microbiome are driving development of microbiota-modifying therapies to prevent or treat disease (e.g. probiotics). Further advances in otitis media microbiomics will likely require technological improvements that overcome the current limitations of OMICs technologies when applied to low volume and low biomass specimens that potentially contain high numbers of host cells. Improved laboratory models are needed to elucidate mechanistic interactions among the upper respiratory and middle ear microbiomes. Minimum reporting standards are critically needed to improve inter-study comparisons and enable future meta-analyses.