International Journal of Pediatric Otorhinolaryngology

International Journal of Pediatric Otorhinolaryngology

“Avoiding blindness in managing epistaxis for a child with Duanes Retraction Syndrome”

16-08-2019 – Navid Ahmadi, June Huang, Hannah JD. North, David Lord, Alan T. Cheng

Journal Article

Duanes Retraction Syndrome (DRS), a congenital cranial dysinnervation disorder, accounts for 5% of all strabismus. A vascular anomaly in DRS, which became clinically relevant in the context of significant epistaxis, is presented.

A 15-year-old girl with DRS underwent a rhinological procedure for traumatic nasal deformity and suffered large volume epistaxis. Using angiography, an anatomical variation was identified, noting the ophthalmic artery was supplied by branches from the sphenopalatine artery, facial artery, and middle meningeal artery; not from the internal carotid artery. Hence epistaxis control was achieved via alternative methods, and unilateral blindness was avoided.

G130V de novo mutation in an Iranian pedigree with nonsyndromic hearing loss without palmoplantar keratoderma

17-08-2019 – Mojgan Babanejad, Masoud Motasaddi Zarandy, Nooshin Nikzat, Niloofar Bazazzadegan, Sanaz Arzhangi, Marzieh Mohseni, Kimia Kahrizi, Hossein Najmabadi

Journal Article

Mutations in the GJB2 gene encoding connexin 26 (Cx26) cause autosomal recessive and rarely dominant nonsyndromic sensorineural hearing loss as well as asyndromic hearing impairment with skin problems. A dominant GJB2 mutation, c.389G > T (p.
G130V), has been reported previously in association with hearing impairment and palmoplantar keratoderm. Here we report the first de novo G130V mutation of GJB2 gene in a sporadic case of hearing loss in a consanguineous Iranian family which is not associated with skin disorder.

Proposal for the surgical management of children with laryngeal saccular Cysts: A case series

02-08-2019 – Ana Rosas, Hilary C. McCrary, Jeremy D. Meier, Harlan R. Muntz, Albert H. Park

Journal Article

This case series aims to determine the optimal surgical approach for pediatric laryngeal saccular cysts. A retrospective chart review of patients who underwent surgical treatment for laryngeal saccular cysts was completed; 5 patients were diagnosed and surgically treated. Treatment approaches included aspiration, supraglottoplasty, injection of bleomycin, endoscopic subtotal resection (marsupialization with the laser or endoscopic instrumentation of the cyst), endoscopic extended subtotal excision (subtotal resection plus removal of false vocal fold with lasering or coblation of the inner cyst wall), and transcervical approaches for resection. Based on our outcomes, an endoscopic extended subtotal resection of the cyst will achieve the best outcomes for cysts confined to the larynx or for Type 1 cysts. A transcervical approach for resection of the cyst will achieve the best outcomes for Type 2 cysts that extend into the neck or are extralaryngeal.

Atypical juvenile histiocytosis with novel KIF5B-ALK gene fusion mimicking subglottic hemangioma

28-07-2019 – Nikolaus E. Wolter, Bo Ngan, James A. Whitlock, Brendan C. Dickson, Evan J. Propst

Journal Article

Juvenile Xanthograuloma (JXG) is part of a diverse set of rare histiocytic disorders marked by infiltration of tissues with neoplastic myelomonocytic-derived cells. Molecular analysis has yielded new insights into the classification and management of histiocytic diseases. A three-year-old presented with atypical croup due to a localized subglottic histiocytic lesion mimicking subglottic hemangioma. The lesion was removed via tracheofissure. Pathology revealed a JXG-like histopathology with a rare KIF5B-ALK fusion gene. This is the first isolated ALK-positive lesion to be reported in this location. The discovery of the new ALK-positive subclass of histiocytosis has opened the door for targeted monoclonal ALK inhibition.

Parent-perceived challenges related to the pediatric cochlear implantation process and support services received in South Africa

20-08-2019 – Aaqilah Bhamjee, Talita le Roux, Kurt Schlemmer, Jenny Perold, Nicolize Cass, Kelly Schroeder, Dani Schlesinger, Deon Ceronio, Bart Vinck

Journal Article

Objective

To determine and describe parent-perceived challenges related to the pediatric cochlear implantation process and support services received.

Method

A multicenter survey study across six cochlear implant (CI) programs in South Africa (SA) was conducted. The study sample included 82 parents of pediatric (≤18 years) CI recipients with at least 12 months CI experience. A self-administered questionnaire was developed for the purpose of this study, exploring parental challenges regarding the CI process, education of their implanted children and the support services received.

Results

The financial implications of cochlear implantation, including CI device maintenance, were identified by parents as the most prominent challenge. Financing issues were the highest scoring reason that attributed to the delay between diagnosis of hearing loss and cochlear implantation, as well as the greatest barrier to bilateral implantation. Parent-perceived educational challenges included finding adequate educational settings specific to the individual needs of their child and a shortage of trained teachers equipped to support children with CIs. The presence of one/more additional developmental conditions and grade repetition were associated with more pronounced parent-perceived educational challenges. Parents considered speech-language therapy as the most critical support service for their implanted children to achieve optimal outcomes, while parent guidance was indicated to be the most critical support service required for parents of pediatric CI recipients.

Conclusion

A greater understanding of parent-perceived challenges will guide CI professionals to promote optimal outcomes, evidence-based service delivery and on-going support to pediatric CI recipients and their families. Study results imply a call for action regarding financial and educational support for pediatric CI recipients in SA.

Echocardiographic screening in children with very severe obstructive sleep apnea

20-08-2019 – Taylor B. Teplitzky, Kevin D. Pereira, Amal Isaiah

Journal Article

Objective

(i) To determine the prevalence of echocardiographic abnormalities in children with very severe OSA defined by an apnea hypopnea index (AHI) ≥ 30 events/hour. (ii) To test the hypothesis that polysomnographic parameters predict echocardiographic variables in this population.

Methods

Children aged 1–17 years presenting with polysomnography demonstrating an AHI ≥30 and referred for pre-operative echocardiography performed within the 6 months prior to tonsillectomy and adenoidectomy (T&A), over a two-year period (January 1, 2016 to December 31, 2018) were evaluated. The exclusion criteria were the presence of (i) unrepaired congenital cardiac disease, (ii) tracheostomy, (iii) poorly controlled asthma, or (iv) neuromuscular disorder. The prevalence of echocardiographic abnormalities was determined for the study population. The impact of the severity of OSA on echocardiographic parameters was evaluated using Students t-test. The relationships between polysomnographic variables and biventricular function as well as pulmonary hemodynamics were measured. A penalized regression model was used to identify the contributions of polysomnographic variables to each echocardiographic parameter by mitigating inter-variable relationships. P < .05 was considered significant.

Results

Eighty-nine children were screened, of whom 47 were included for analysis. The mean age was 68.8 months 95% confidence interval, 56.0 to 81.6. Thirty-three (70.2%) were boys. Twenty (42.6%) were obese. All children had normal echocardiograms. The differences in echocardiographic variables between children grouped by the severity of OSA were not statistically significant (P: 0.18-0.98). Polysomnographic variables predicted only 4 out of 13 studied echocardiographic parameters.

Conclusions

Pre-operative echocardiography did not identify significant abnormalities in children with very severe OSA. Majority of the echocardiographic variables were not predicted by polysomnographic parameters. This study demonstrates the limited benefit associated with routine echocardiographic screening of children with very severe OSA solely based on polysomnographic indices.

Pediatric hearing screening in low-resource settings: Incorporation of video-otoscopy and an electronic medical record

20-08-2019 – Kristen L. Yancey, Loyce J. Cheromei, Jackie Muhando, Jim Reppart, James L. Netterville, Asitha D.L. Jayawardena

Journal Article

Objective

To develop a sustainable, comprehensive, intervention-based approach to pediatric hearing care in low- and middle income countries (LMICs) where global hearing loss is most heavily concentrated.

Methods

Community health workers (CHWs) in Kilifi county, Kenya were trained to conduct hearing screening and video-otoscopy via a unified, smartphone-based platform using mobile electronic medical record (EMR) generation for children diagnosed with hearing loss or other pathology. Among at-risk students pre-selected by their teachers, the frequency of hearing loss and pathology in children with and without hearing loss was measured.

Results

Of the 155 screened, 16 (10%) children were found to have hearing loss. 12 (5.9%) children with normal hearing had the following pathology: perforation (N = 5 ears), effusion (N = 9), retraction (N = 6), and infections (N = 7). CHWs were also adept at EMR creation without significant delay in workflow. Out of all those screened, 28 (18%) children were found to have hearing loss or other pathology and were referred to follow up. All 28 of 28 children referred were successfully entered into the EMR.

Conclusions

CHWs with little to no prior medical experience can provide a much needed public health service – hearing screening in LMICs where access to health care is limited. The incorporation of video-otoscopy provides a more comprehensive approach to hearing care by not only helping identify etiologies of existing hearing disability but also conditions that predispose to future hearing loss. It can easily be performed in conjunction with hearing screenings via the use of a unified, mobile platform. The addition of EMR supports follow-up and allows remote consultation.

Pediatric partial gelfoam myringoplasty with ventilation tube placement

17-08-2019 – Michael A. Belsky, Noel Jabbour

Journal Article

Objective

For children with a history of persistent Eustachian tube dysfunction (ETD) or otitis media with effusion presenting with recurring tympanic membrane (TM) perforation, surgeons must often balance the treatment goals of correcting the perforation and maintaining ventilation to the middle ear to prevent future perforation formation. A partial gelfoam myringoplasty with ventilation tube placement is a previously unreported procedural option for addressing these goals. The objective of this study is to describe the partial myringoplasty technique and report preliminary outcome data for the procedure.

Methods

Retrospective cohort study of 29 children <18 years old undergoing partial myringoplasty at a tertiary care childrens hospital or satellite location. Size and course of initial perforation, time to tube extrusion, audiogram findings, and need for future otological procedures were studied.

Results

During a partial myringoplasty, a tympanostomy tube is placed in a TM perforation larger than the tube itself. The edges of the perforation are freshened, a tube is placed, and a piece of gelfoam is inserted to support the tube and to cover any remaining perforation. Out of 32 ears in 29 patients, 23 procedures were completed to correct existing perforations. The remainder were indicated in placement (n = 7) or replacement (n = 2) where the myringotomy or existing perforation was deemed too large to retain the tympanostomy tube without further support due to atelectatic or monomeric tympanic membranes. Thirteen tubes extruded within 1 year, of which 12 were Armstrong tubes and 1 was a T-tube. Out of 25 TM perforations corrected, 4 shrank in size and 2 did not close. For patients who underwent pre-surgical audiograms with findings indicating conductive hearing loss and had post-operative audiograms at follow-up, 8/10 showed improvement and 2/10 showed no change in hearing.

Conclusion

A partial myringoplasty is a simple procedure to close existing TM perforations while maintaining ventilation to the middle ear that can potentially improve hearing, provide ongoing ventilation, and eventually result in TM closure without the need for more complex repair. It may serve as a reasonable first line treatment for repair of perforations, reserving tympanoplasty for patients who fail this procedure.

The bacteriome of otitis media with effusion: Does it originate from the adenoid?

14-08-2019 – Oguz Ari, Sema Karabudak, M. Tayyar Kalcioglu, A. Yasemin Gunduz, Riza Durmaz

Journal Article

Objective

The aim of this study was to evaluate the composition and the diversity of bacteriome in middle ear effusion (MEE) and adenoid specimens of pediatric patients having otitis media with effusion (OME).

Materials and methods

Sample collection from children with OME followed by next generation sequencing. Seventeen adenoid and 43 middle ear effusion specimens from 25 children having OME were evaluated. Microbiome analysis was performed via Ion 16S r
RNA metagenomics kit.

Results

Twenty-two different bacterial species were identified from all of the samples analyzed. There were variations in the prevalence and relative abundance of the bacteriome observed between adenoid and MEE samples. MEE microbiome was significantly dominated by Alloicoccus otitis (44%), Turicella otitidis (6%), and Staphylococcus auricularis (3%). Whereas, Rothia mucilaginosa (39%), R. dentocariosa (11%), S. aureus (5%), Veillonella rogosae (2%), Granulicatella elegans (2%), Granulicatella adiacens (2%), Eikenella corrodens (1%), and Prevotella nanceiensis (1%) had significantly higher relative abundance in adenoid samples. Overall, there was no statistically significant difference in alpha diversity of MEE and adenoid samples, whereas adenoid samples constituted a cluster in the beta diversity graph.

Conclusion

Bacteriome of MEE is mostly dominated by A. otitis yet accompanied by other bacteria with lower relative abundances suggests that OME is likely to be a polymicrobial process. Despite similarities, significant differences in relative abundances of several predominant species between bacteriome in the MEE and adenoid put the theory that OME in children is originated from the adenoids under question.

Pilot study of the potential of 3D ultrasound to measure tonsillar volume and hypertrophy

14-08-2019 – Daniel Chung, Anjum Bandarkar, Md Sohel Rana, Pooneh R. Tabrizi, Diego Preciado, James Jago, Marius George Linguraru, Brian K. Reilly

Journal Article

Objective

Obstructive sleep apnea (OSA), results in approximately 4–5 million outpatient visits per year in the United States. In pediatric patients, OSA is primarily caused by adenotonsillar hypertrophy, and therefore, adenotonsillectomy remains an effective surgical treatment. We investigate whether 3D ultrasound (3DUS) imaging can accurately and objectively assess tonsillar hypertrophy for the potential identification and stratification of candidates for adenotonsillectomy.

Methods

A prospective study was performed evaluating pediatric patients (N = 17) between the ages of 4–14 years who were undergoing adenotonsillectomy for OSA symptoms. On the day of surgery, tonsillar ultrasound was performed by a single attending radiologist. Tonsillectomy was performed and each tonsils principal axes and physical volume by water submergence were measured. The findings were compared using paired T-test, Pearson correlation coefficient and Bland-Altman analysis.

Results

The average tonsillar physical measurements of length, width and height were 1.54 ± 0.28, 2.0 ± 0.31 cm and 2.72 ± 0.41 cm, and 1.73 ± 0.17, 1.61 ± 0.21 mm and 2.98 ± 0.28 mm from physical and 3DUS estimations, respectively (P < 0.001 for all measurements). The average tonsillar volume was 3.84 ± 1.23 ml and 4.30 ± 1.15 ml from physical and 3DUS measurements, respectively (p = 0.04). The Bland-Altman mean difference ± 95% limit of agreement between length, width, height, and volume results from the two measurements were −0.186 ± 2.01 cm, −0.393 ± 6.33 cm, 0.25 ± 7.71 cm, and 0.45 ± 2.32 ml, respectively.

Conclusion

While 3DUS is feasible, it may not be an accurate estimate of tonsillar volume for assessing hypertrophy. A larger study will be required to establish the accuracy of 3DUS measurements of tonsillar volume.

Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis

14-08-2019 – Rachel Whelan, Amber Shaffer, Joseph E. Dohar

Journal Article

Objectives

Given the potential for devastating complications associated with esophageal impaction of a button battery, there is a need to distinguish between a button battery and look-alike stacked coins at the time of presentation. Given there have been no studies analyzing differences in radiographic density between these two entities, the study objective was to determine if a difference exists between esophageal coin and button battery radiographic density on plain radiograph and to describe the operative and treatment course following these two distinct entities of ingestion.

Methods

Retrospective case series following button battery or stacked coin ingestion in a tertiary care pediatric hospital from 2003 to present. Radiographic density of each button battery and stacked coin was calculated by dividing the foreign body radiographic density by the mean density of two background radiographic sections. Radiographic density of coins versus batteries was compared using t-tests.

Results

There were 22 patients identified with button battery ingestion and 47 with stacked coins. Median (range) radiographic density of button batteries on anteroposterior view was 1.16 (0.37–2.19) x background compared to 1.13 (0.09–2.65) x background of stacked coins, p = 0.198. There was similarly no statistically significant difference in lateral views, p = 0.622.

Conclusion

Our study suggests that radiographic density measured on diagnostic x-ray does not prove a reliable adjunctive measure to distinguish an innocuous stacked coin ingestion from the far more ominous button battery and highlights the need for prompt operative evaluation for any suspected button battery ingestion.

In vitro inhibitory activity of N-acetylcysteine on tympanostomy tube biofilms from methicillin-resistant Staphylococcus aureus and quinolone-resistant Pseudomonas aeruginosa

14-08-2019 – Yonghyun Jun, Cha Kyung Youn, Eu-Ri Jo, Sung Il Cho

Journal Article

Objectives

Biofilm formation in tympanostomy tubes causes persistent and refractory otorrhea. In the present study, we investigated the in vitro antibiofilm activity of N-acetylcysteine (NAC) against biofilm formation by methicillin-resistant Staphylococcus aureus (MRSA) and quinolone-resistant Pseudomonas aeruginosa (QRPA).

Methods

We examined the antibiofilm activity of NAC against biofilms produced by MRSA and QRPA strains using in vitro biofilm formation assay, adhesion assay, and biofilm eradication assay. Additionally, the antibiofilm activity of different concentrations of NAC against tympanostomy-tube biofilms from MRSA and QRPA strains was compared using a scanning electron microscope.

Results

The adhesion of MRSA and QRPA strains decreased significantly in a concentration-dependent manner after treatment with varying amounts of NAC. Treatment with NAC inhibited biofilm formation of both MRSA and QRPA strains and increased eradication of preformed mature biofilm produced by MRSA and QRPA. Besides, NAC exhibited significant eradication-activity against tympanostomy-tube biofilms produced by MRSA and QRPA strains.

Conclusions

Our results show potent inhibition of MRSA and QRPA biofilm after treatment with NAC. NAC shows potential for the treatment of biofilms and refractory post-tympanostomy tube otorrhea resulting from MRSA and QRPA infection.

Parents’ reports of barriers to care for pediatric otolaryngology patients

10-08-2019 – Reena Razdan, Levi D. Stevens, Michelle Ritchie, Travis Kennedy, Stephanie Saldivar, Michele M. Carr

Journal Article

Objective

To understand parent perceptions of types and severity of barriers to care within the pediatric otolaryngology patient population in WV.

Study design

Descriptive survey.

Setting

University pediatric otolaryngology clinic, Morgantown, WV.

Subjects and methods

Subjects were caretakers of pediatric patients in clinic. Subjects were asked to complete the modified validated Barriers to Care Questionnaire (BCQ) and to provide some demographic details.
Each BCQ question response was reported as a Mean Total Score (MTS), ranging from 0 (complete barrier) to 100 (no barrier) and they were grouped into 5 BTC subscales. Demographic question responses were used to establish subgroups. Data for subscale groups was compared across the demographic subgroups using non-parametric methods.

Results

301 parents provided responses. The overall mean BTC was 91.59 (95% CI 90.12–93.05). The Expectations and Pragmatics subscales were the two greatest barriers at 88.56 and 90.80, respectively. 26.7% reported no barriers to care. No statistically significant association was found among subscale scores and demographic subgroups.

Conclusions

Parents of pediatric otolaryngology patients in WV demonstrate low expectations of the healthcare system. There are concerns about pragmatics that could create barriers. Our hope is to spur scientific interest in this understudied healthcare topic. Future studies should be conducted to identify association/causation and help establish a framework for addressing potential barriers to care in the pediatric population.

Differentiation of sublingual thyroglossal duct cyst from midline dermoid cyst with diffusion weighted imaging

11-08-2019 – Ahmed Abdel Khalek Abdel Razek, Fatma Mohamed Sherif

Journal Article

Purpose

to differentiate sublingual thyroglossal duct cyst (TGDC) from midline dermoid cyst (DC) with diffusion weighted imaging (DWI).

Materials and methods

Retrospective analysis of 22 consecutive patients (11 male and 11 female aged 5–15 years) with midline cystic lesion at floor of mouth. They underwent DWI of floor of mouth. Apparent diffusion coefficient (ADC) of the cystic lesions was calculated and correlated with surgical findings.

Results

The mean ADC value of TGDC of 1st observer was (2.20 ± 0.28 × 10−3 mm2/s) and of 2nd observer was (2.28 ± 0.27 × 10−3 mm2/s) was significantly higher than that of DC (P = 0.001) whose ADC of 1st observer was (1.55 ± 0.15 × 10−3 mm2/s) and of 2nd observer was (1.53 ± 0.11 × 10−3 mm2/s). There was excellent inter-observer agreement of both readings (r = 92%, P = 0.001). When ADC of 1.76 and 1.62 × 10−3 mm2/s was used as a threshold value for differentiating TGDC from DC, the best results were obtained with area under the curve of 0.94 and 0.96, accuracy of 90% and 86%, sensitivity of 91% and 91%%, specificity of 90% and 80%, negative predictive value of 90% and 88% and positive predictive value of 92% and 84% of both reviewers respectively.

Conclusion

DWI is reliable and reproducible imaging modality for differentiation sublingual TGDC from DC.

Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report

09-08-2019 – Monica Segura-Hernández, Víctor Manuel Valadez-Jiménez, Pablo Antonio Ysunza, Araceli Patricia Sánchez-Valerio, Emilio Arch-Tirado, Ana Luisa Lino-González, Xochiquetzal Hernández-López

Journal Article

Background

Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population.

Objective

To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice.

Material and methods

Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4–5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation.

Results

Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls.

Conclusion

SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.

Impact of reading and writing skills on academic achievement among school-aged hearing-impaired children

10-08-2019 – Akiko Sugaya, Kunihiro Fukushima, Soshi Takao, Norio Kasai, Yukihide Maeda, Akie Fujiyoshi, Yuko Kataoka, Shin Kariya, Kazunori Nishizaki

Journal Article

Objectives

Reading and writing skills are important for hearing-impaired children since these skills help them to develop their language skills, but the prevalence of reading/writing difficulties and its effects on language development aspects among them are unclear. In this study, we identified language development features and demographic factors of Japanese hearing-impaired children diagnosed as having reading/writing difficulties.

Methods

We analyzed data from a total of 546 sever-to-profound pre-school and elementary school hearing-impaired children for this study. Children with reading/writing difficulties (Group A) were defined as children obtaining low scores (−1.5 SD compared to others in the same grade) in the Screening Test of Reading and Writing for Japanese Primary School Children (STRAW), and we compared other language development features (communication ability, vocabulary, syntax and academic achievement) and demographic factors to those of hearing-impaired children with normal reading and writing skills (Group B). We assessed language development domains as outcomes using the Assessment of Language Development for Japanese Children (ALADJIN) package, and analyzed the results stratified by age groups (5–6, 7–8, 9–10, and 11–12 years) using multiple regression analyses.

Results

The prevalence of reading/writing difficulties was 20.1% among the participants. Almost all point estimates in each language development domain showed better odds ratios (OR) except Criterion Referenced Test -II (CRT-II) mathematics in 11- to 12-year-olds in fully-adjusted models. Among 9- to 10-year-olds, the ORs (95% confidence interval) for fair academic achievement measured by CRT-II were 2.60 (1.09–6.20) for Japanese and 3.02 (1.29–7.11) for mathematics in Group B, even after adjusting for possible confounding factors.

Conclusions

Reading and writing are important for language development of hearing-impaired children, especially for academic achievement during the middle phase of elementary school. Screening for reading/writing difficulties is important for appropriate intervention and to prevent language and academic delays among hearing-impaired children.

First experiences with a new adhesive bone conduction hearing device in children

05-08-2019 – Urík Milan, Hošnová Dagmar, Šlapák Ivo, Jančíková Jana, Odstrčilík Jan, Jarkovský Jiří, Baumgartner Wolf-Dieter

Journal Article

Objectives

To evaluate the hearing benefit, advantages, and disadvantages in a series of children using a new, nonimplantable, pressure-free, adhesive bone conduction hearing aid.

Methods

Seventeen children were included in the study. 5 children suffered from bilateral conductive hearing loss (CHL), 6 children with unilateral CHL and 6 children with unilateral sensorineural hearing loss. An audiological tests were provide. Additionally, sound quality (SSQ10) and quality of life (AQoL-6D) were assessed using questionnaires.

Results

The average value of speech audiometry with bubble noise in children with SNHL is 21.33 (±5.72) d
B HL with the device and 27.67 (±4.59) d
B HL without the device, which is a statistically significant gain (p = 0.027). The analysis showed the average value of hearing threshold in sound field in the group of children with CHL supported 20.23 (±16.84) d
B HL and not supported 33.52 (±27.27) by the hearing aid for bone conduction, which i a statistically significant gain (p = 0.008). The average value of speech audiometry is 23.45 (±14.45) d
B HL with the device and 37.27 (±26.65) d
B HL without the device, which is a statistically significant gain (p = 0.012). The average value of speech audiometry with bubble noise is 30.55 (±10.03) d
B HL with the device and 45.45 (±18.41) d
B HL without the device, which is a statistically significant gain (p = 0.008). No patient referred pain or irritation.

Conclusion

This new device for bone conduction show a hearing benefit for a paediatric patient, without any concomitant aesthetic and other complications.

Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis

06-08-2019 – Noor-E-Seher Ali, Jennifer C. Alyono, Peter J. Koltai

Journal Article

Objective

To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA).

Methods

Retrospective chart review was performed, and literature reviewed.

Results

We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species.

Conclusions

Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.

The impact of continuity of care on antibiotic prescribing in acute otitis media

04-08-2019 – Shelby C. Barrera, Ramon S. Cancino, Tyler W. Barreto

Journal Article

Background

The rate of antibiotic prescribing for acute otitis media (AOM) remains high despite efforts to decrease inappropriate use. Studies have aimed to understand the prescribing patterns of providers to increase antibiotic stewardship. Watch and wait (WAW) prescriptions are effective at decreasing the number of antibiotic prescriptions being filled by patients. Additionally, poor continuity of care has been associated with higher cost and lower quality health care.

Objective

To understand the antibiotic prescribing habits for AOM in a largely Hispanic population.

Methods

A retrospective review was performed from 2016 to 2018 of all patients under 25 years old with a diagnosis of AOM seen at multiple outpatient primary care clinics of a single institution. Charts were reviewed for factors including race, ethnicity, gender, insurance status, presence of fever, primary care physician visit, and treatment choice. Data were collected and analyzed using STATA software with t-tests, ANOVA, and Pearson chi squared analysis.

Results

Antibiotics were prescribed 95.6% of the time with 3.8% being WAW prescriptions. There was no significant difference in antibiotic prescribing by race (p = 0.66), ethnicity (p = 0.38), gender (p = 0.34) or insurance status (p = 0.24). There was a difference between physicians, nurse practitioners, and physicians assistants and antibiotic prescribing rate (p < 0.01). Additionally, seen by their primary care provider were less likely to be prescribed antibiotics (85.8% vs 94.4%, p = 0.01).

Conclusion

While a patients race, ethnicity, gender, and insurance status did not influence the prescribing rate of physicians, continuity of care may play an important role in decreasing inappropriate antibiotic prescribing.

Assessment of hair cell damage and developmental toxicity after fine particulate matter 2.5u202fμm (PM 2.5) exposure using zebrafish (Danio rerio) models

03-08-2019 – Jihye Rhee, Eunjung Han, Kuk Jin Nam, Kang Hyeon Lim, Yoon Chan Rah, Saemi Park, Soonil Koun, Hae-Chul Park, June Choi

Journal Article

Objectives

Particulate matter (PM) exposure has become one of the most serious problems. The aim of the present study was to evaluate the hair cell damage and possible developmental toxicity caused by PM2.5 exposure using a zebrafish model.

Methods

Zebrafish embryos were exposed to various concentrations of PM2.5. Developmental toxicity was evaluated based on general morphology score (GMS) system and Panzica-Kelly score, and by measurement of body length and heart rate. To evaluate hair cell damage, the average number of total hair cells within four neuromasts exposed to various concentrations of PM2.5 was compared with that of the control group.

Results

Morphological abnormalities evaluated by the GMS system and Panzica-Kelly score were rare and body length tended to be shorter in the PM2.5-exposed groups. Heart rate decreased significantly in the PM2.5-exposed group. Additionally, significant hair cell damage was observed after PM2.5 exposure. It was dose-dependent and more severe after a longer period exposure (10 dpf).

Conclusions

In zebrafish embryos, exposure of PM2.5 in the early stages of life decreased heart rate and caused significant hair cell damage in a dose-dependent manner.

Is there a role for computed tomography scanning in microtia with complete aural atresia to rule out cholesteatoma?

03-08-2019 – Lindy M.R. Moxham, Neil K. Chadha, Douglas J. Courtemanche

Journal Article

Objective

To determine if radiologic imaging is necessary to rule out cholesteatoma in patients with congenital aural atresia.

Methods

A retrospective chart review of patients attending the BC Childrens Hospital Microtia Clinic from January 1, 1990 through April 17, 2017 was undertaken. Patients with complete atresia of the external canal were included in the study. Available radiologic imaging and clinical records were examined for the presence or absence of cholesteatoma.

Results

Of the 125 charts reviewed, 102 met criteria for inclusion in the study and 79 had three-dimensional imaging completed. None of these 102 patients had radiologic or clinical evidence of cholesteatoma.

Conclusion

Computed tomography and/or magnetic resonance imaging remains an essential modality in the work-up of selected patients with microtia/atresia. It may be unnecessary in the follow-up of certain patients to rule out a congenital cholesteatoma. This imaging avoidance may reduce exposure to radiation, the potential need for general anaesthesia, and unnecessary financial cost.

Congenital nasal pyriform aperture stenosis: Analysis of twenty cases at a single institution

03-08-2019 – Gopi B. Shah, Allison Ordemann, Shiva Daram, Emily Roman, Tim Booth, Romaine Johnson, Yin Xi, Ron Mitchell

Journal Article

Objectives

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress that is difficult to treat. The primary objective of this study was to identify factors that predict the need for initial and revision surgery for CNAPS. The secondary objective is to identify risk factors in maternal history associated with the development of CNPAS.

Methods

Infants with CNPAS between 2010 and 2017 were identified by ICD- 9 and 10 codes. Demographics, maternal history, anatomic features on imaging and medical and/or surgical management were reviewed. Frequencies, means and standard deviations were calculated. A p-value <.05 was considered significant.

Results

Twenty infants were included. All underwent flexible nasal endoscopy with inability to pass the scope in either nostril in 65% of infants. Nineteen had a CT scan and 13 had a MRI with midline defects in 76.3% and 53.8%, respectively. Solitary central mega-incisor was present in 65%. Half underwent surgical intervention at a mean age of 74.8 days, with 90% requiring revision surgery. There was no difference in pyriform aperture distance in the surgical and non-surgical patient subgroups (5.4 mm and 5.2 mm, p = .6 respectively). No specific variables were predictive of need for initial or revision surgery. Maternal diabetes mellitus (MDM) was found in 55% of mothers of infants with CNPAS.

Conclusion

Pyriform aperture distance was not a predictor of surgical intervention. MRI should be considered in all infants with CNPAS as the rate of intracranial complications is high. MDM may be a risk factor for CNPAS.

Is there an association between age at first words and speech sound disorders among 4- to 5-year-old children? An epidemiological cross-sectional study based on parental reports

03-08-2019 – Pietro Salvago, Eleonora Gorgone, Silvia Giaimo, Epifanio Battaglia, Francesco Dispenza, Sergio Ferrara, Francesco Martines

Journal Article

Objective

To investigate the role of the period of emergence of the first words and its interactions with other risk factors in predicting the development of speech sound disorder (SSD) among 4- to 5-year-old children.

Methods

After 373 children underwent otolaryngology and speech pathology examinations, their parents answered a questionnaire about potential risk factors for speech impairment. The presence of SSD was identified by a speech pathologist who administered Fanzagos Articulation Test to each child. Multivariate logistic analysis was used to explore the relationships between variables and outcomes.

Results

Mean age at first words was 17.8 ± 6.5 months of life; 25.7% of patients suffered from SSD, and 3.7% from stuttering. A family history of language impairment was found in 12.9% of the sample, whereas a family history of reading difficulty was reported in only 5.4% of cases. No differences in terms of mean age (p = 0.3) or gestational age (p = 0.16) were found between children affected by SSD and those who were not. Multivariate logistic analysis revealed that male sex (p < 0.001), a family history of language impairment (p < 0.001) and stuttering (p = 0.001) were significantly associated to SSD. Age at first words did not result a predictor of speech impairment.

Conclusion

In contrast to male sex (p < 0.001), family history of language impairment (p < 0.001) and stuttering (p = 0.001) which resulted significantly associated to SSD, age at first words does not seem to be a predictor of SSD (p = 0.11); however, it remains a useful indicator of language delay and, when considered in association with other language milestones, can be a reason of concern for parents and caregivers about their childrens developmental and speech therapy needs.

Speech characteristics of childhood apraxia of speech: A survey research

03-08-2019 – Mersede Imani Shakibayi, Talieh Zarifian, Nasibeh Zanjari

Journal Article

Purpose

There has not been any valid method for the clinical diagnosis of Childhood Apraxia of Speech (CAS) up to now, and the golden standard for diagnosis is the experts opinion. The current research was conducted to obtain criteria used by the Iranian Speech-Language Pathologists (SLPs) to establish speech characteristics and co-occurring problems of CAS based on their knowledge and clinical experience.

Methods

This research used a questionnaire-based survey design for data collection. The questionnaire was filled out by 260 anonymous participants, both physically and online.

Results

The nine top speech characteristics reported with 75.6% agreement as the core symptoms of CAS included: inconsistency (86.9%), consonant sequencing problems (75%), low intelligibility (75%), groping (72.7%), slow diadochokinetic (DDK) (72.3%), articulatory configuration problems (66.2%), difficulty with multisyllabic words (62.7%), suprasegmental disturbances (56.2%) and metathesis (53.5%). The consent of the Iranian practicing SLPs was consistent with the American Speech–Language–Hearing Association (ASHA) diagnostic criteria, Strands 10-point checklist, and Ozannes cluster model. More than half of the respondents have been identified with fine motor deficit and language impairment as the most common co-occurring problems of CAS.

Conclusions

The results of this study are in accordance with the findings of previous practicing SLPs surveys in different languages. Carrying out researches on the speech characteristics of Persian-speaking children suspected of CAS and compare with the results of clinicians’ surveys will help us to find a reliable standard for differential diagnosis of Persian-speaking children in Iran.

Comparison of exhaled nitric oxide levels in pediatric patients with allergic rhinitis

02-08-2019 – Siwaporn Sapsaprang, Pattara Tanticharoenwiwat, Prapasri Kulalert, Orapan Poachanukoon, Dhave Setabutr

Journal Article

Objective

To determine whether the measurement of exhaled nitric oxide (e
NO) can help distinguish children with allergic rhinitis (AR) from healthy controls and whether e
NO in children with AR correlates with disease severity.

Methods

From August 2015 to 2016, children aged 5–15 years of age grouped into those with allergic rhinitis (n = 40) and those classified as healthy control subjects (n = 40) had exhaled nitric oxide (e
NO) levels measured. The e
NO level was additionally compared to the patients clinical disease severity according to the ARIA (Allergic Rhinitis and its Impact on Asthma) classification.

Results

Mean e
NO in children with AR (12.64 ± 14.67 ppb) was significantly higher than that in the healthy control group (7.00 ± 6.33 ppb) (p-value = 0.046). In the persistent AR group (17.11 ± 18.40 ppb), e
NO level was significantly higher than individuals in the intermittent AR group (8.59 ± 8.88 ppb, p-value = 0.024) and the healthy control group (7.00 ± 6.33 ppb, p-value = 0.008). Among children with AR, e
No was not significantly different with relationship to gender, age, weight and passive smoking exposure.

Conclusions

Exhaled nitric oxide may be elevated in children with AR that do not have concomitant asthma. This suggests exhaled nitric oxide may show utility as a parameter to monitor the severity of allergic rhinitis and to monitor the efficacy of the treatment. Physicians should consider comorbid AR when utilizing exhaled nitric oxide as a monitoring parameter in the treatment of asthma.

Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests

02-08-2019 – Violeta Necula, Mirela Cristina Stamate, Cristina Blebea, Sebastian Cozma

Journal Article

Objectives

Chloral hydrate is a sedative that has been used for many years in clinical practice and, under proper conditions, gives a deep and long enough sleep to allow performance of objective hearing tests in young children. The reluctance to use this substance stems from side effects reported over time that can vary, depending on dose, procedure settings and immediate life supporting intervention when needed. Our study adds to those that have appeared in recent years, showing that chloral hydrate is an effective and safe substance when is used in proper conditions.

Methods

The study included 322 children who needed sedation for objective hearing tests, from April 2014 to March 2018. Parents were instructed to bring the child tired and fasted for at least 2 h before sedation. The sedative was administered by trained staff in the hospital, and the child was monitored until awaking.

Results

In our study group, over half of the children were in the age 1–4 years group, and only 15% were older than 4 years. The dose of chloral hydrate ranged between 50 and 83 mg/kg body weight, with an average of 75 mg. Successful sedation occurred in 94.1% of children; 0.9% of children awoke during testing and required supplemental sedation or rescheduling of the testing. The most common side effects were vomiting, agitation, prolonged sleep, and failure to fall asleep.

Conclusions

Comparing the side effects of chloral hydrate in our study with those from other studies, ours were similar to those described in the literature. In our study chloral hydrate was effective and had only limited adverse effects. The use of chloral hydrate under hospital conditions with proper monitoring could be a practical and safe solution for outpatients or those with short-term hospitalisation.

Cochlear basal turn patency in unrecognized perilymph gushers

02-08-2019 – Varun V. Varadarajan, Orrin L. Dayton, Reordan O. De Jesus, Malisa Sarntinoranont, Patrick J. Antonelli

Journal Article

Objectives

Perilymph gusher (PLG), an uncommon complication of otologic surgery, has been attributed to communication between the cochlea and the internal auditory canal (IAC). Subtle osseous defects may be missed on routine review of computed tomography (CT). This study aimed to quantify cochlear basal turn patency not seen on axial CT in patients with PLG and compare those against patients without intraoperative PLG.

Methods

Ears that underwent cochlear implantation or stapedotomy with preoperative helical CT that was interpreted as “normal” at a tertiary referral center. An otologist and a radiologist independently and in a blinded fashion measured the dimensions of cochlear basal turn patency on CT images in oblique plane and parasagittal planes along the interface of the cochlea and IAC fundus.

Results

Sixty-one ears were reviewed, including 3 with surgically confirmed PLGs and 12 with apparent dehiscence without a PLG. Mean defect width with PLG was 0.83 mm (range 0.75–0.9 mm) and without PLG was 0.43 mm (range 0.3–0.65 mm, p = 0.011). A greater proportion of PLGs occurred in ears with defects (3 of 15) than in ears without (0 of 46, p = 0.013). Using a cutoff of 0.75 mm, a greater proportion of PLGs occurred with defect width >0.75 mm (3 of 3) than in defects <0.75 mm (0 of 12, p = 0.022).

Conclusions

CT dehiscence between the IAC and cochlear basal turn, particularly with a width > 0.75 mm, should be considered a risk for PLG with stapedotomy or cochlear implantation.

Treatment of post-adenotonsillectomy velopharyngeal stenosis with bivalved uvular flaps

06-08-2019 – Mosaad Abdel-Aziz, Abdel-Rahman El-Tahan, Mahmoud El-Fouly, Ahmed Kamel, Assem Abdel-Wahid

Journal Article

Objective

Velopharyngeal stenosis (VS) is a rare devastating complication of adenotonsillectomy that causes obstructive sleep apnea (OSA). Its treatment is challenging and has a high recurrence rate. The aim of this study was to assess the efficacy of a bivalved uvular flap technique with topical application of mitomycin C for treatment of this problem.

Study design

Case series.

Methods

Fourteen children with VS after adenotonsillectomy were treated with a bivalved uvular flap technique with application of mitomycin C after release of the adhesions and removal of scar tissue. Preoperative and postoperative evaluation of patients were performed. Flexible nasopharyngoscopy was used to assess the patency of the velopharynx, and apnea/hypopnea (A/H) index and minimum O2 saturation were measured before and after surgery.

Results

Adequate patent airway was obtained in all patients as seen by oropharyngeal examination and flexible nasopharyngoscopy. Additionally, significant improvement in A/H index and minimum O2 saturation were achieved postoperatively.

Conclusion

The bivalved uvular flap technique with topical application of mitomycin C after removal of scar tissue is an effective treatment for VS that may follow adenotonsillectomy in children.

Which coin is easier to pass esophagus spontaneously?

30-07-2019 – Xiao-fei Shen, Qi Li

Journal Article

Objective

To determine the factors associated with the spontaneous passage (SP) of coins lodged in the esophagus in children.

Subjects and Methods

A total of 351 pediatric patients with coin ingestion admitted to our hospital from March 2016 to March 2019 were included in the study. The patients underwent a period of overnight watch with a repeated chest x-ray within 24 h after the commencement of hospitalization. The influencing factors (sex, age, types of coin, time in the esophagus, and location) were analyzed.

Results

The repeated chest x-ray showed coins that had passed into the stomach or intestine in 68 patients. Sex, age, time in the esophagus, location in the esophagus or the types of coins were not associated with SP, but the distribution of the esophageal coins varied statistically significantly in the different ages.

Conclusion

Coins pass spontaneously through the esophagus (19.4%) within 24 h, unrelated to sex, age, time of esophagus lodging, coin location in the esophagus, or coin types. Children approximately two years old were more likely to ingest small coins (10 or 50 cents), whereas children approximately five years old were more likely to ingest a large coin (1 Yuan).

The impact of cleft lip and/or palate on parental quality of life: A pilot study

02-08-2019 – Elise De Cuyper, Frederick Dochy, Els De Leenheer, Helen Van Hoecke

Journal Article

Background

Cleft lip and/or palate (CL/CP/CLP) is one of the most common congenital anomalies. Children may suffer from a variety of health problems including difficulties with feeding and speech, middle ear problems, hearing loss and associated psychosocial concerns. The extent of impact of this disorder on the parents, however, has not yet been thoroughly evaluated. This pilot study was performed to evaluate the impact of having a child with CL/CP/CLP on the parents quality of life (QoL) and family functioning and to compare between cleft subgroups.

Methods

Forty-five parents with children aged 6 months to 6 years with CL/CP/CLP, followed by the multidisciplinary orofacial cleft team of Ghent University Hospital, completed following standardized questionnaires: Impact on Family Scale (IOFS), Family Impact Scale (FIS) and Care-Related Quality of Life Instrument (Carer
QoL). Subgroups were compared with diverse unpaired statistical tests.

Results

Younger children (6m-2y) with CL/CP/CLP entail more impact on parental QoL compared to children aged 2-4y old (p=0.04, ε²=0.15/p=0.02, ε²=0.17/p=0.02, ε²=0.17). Families from children with a syndromic cleft also encounter more impact (p=0.04, r=0.32 /p=0.01, r=0.37 /p=0.008, r=0.40/p=0.003, r=0.45). Prenatal orofacial cleft diagnosis is associated with a higher reporting of family conflicts (p=0.04, r=0.32). In case of non-syndromic clefts, families having children with CLP report more family conflicts compared to CL or CP (p=0.02, ε²=0.46). Parental education and number of children within the household showed no significant impact on parental QoL.

Conclusion

This cross-sectional study confirms that having a child with CL/CP/CLP impacts the parental QoL. This study was performed as a pilot-study for larger multicentre studies, future development of effective screening tools and identification of subgroups at risk. Long-term multidisciplinary follow-up should involve family-centred support.

The effect of rosmarinic acid on the prevention of myringosclerosis

28-07-2019 – Doğukan Özdemir, İbrahim Ağrı, Mustafa Bakirtaş, Arzu Ağrı, Dursun Mehmet Mehel, Mehmet Çelebi, Abdulkadir Özgür

Journal Article

Objectives

Myringosclerosis commonly occurs as a long-term complication of ventilation during the treatment of otitis media. We aimed to determine the effects of rosmarinic acid as an antioxidant on experimentally induced myringosclerosis.

Methods

Twenty-four male Sprague-Dawley rats, weighing 250–300 g, were unilaterally myringotomized and randomly separated into three groups. Group 1 received no treatment (control group) (n = 8); Group 2 received topical rosmarinic acid (n = 8); Group 3 received oral rosmarinic acid (n = 8). On the twenty-first day, the right ears were examined by otomicroscope and findings of myringosclerosis were recorded. Finally, all of the rats were euthanized and the tympanic membrane (TM) thickness and the severity of middle ear mucosal inflammation were evaluated histopathologically.

Results

The myringosclerosis severity, TM thickness, and inflammation scores were found to be significantly higher in the control group than in the topical and systemic treatment groups (p < 0.05). There were no statistically significant differences in terms of TM thickness and inflammation scores between the topical and systemic treatment groups (p > 0.05). While moderate and severe myringosclerosis were higher in the control group, mild myringosclerosis was found to be higher in both treatment groups.

Conclusion

The local and oral administration of rosmarinic acid suppressed inflammation, reduced TM thickness, and prevented the development of myringosclerosis in myringotomized rats.

Ankyloglossia: Last three-years of outpatient care at a tertiary referral center

29-07-2019 – Vivian LeTran, Beth Osterbauer, Floyd Buen, Ronica Yalamanchili, Gabriel Gomez

Journal Article

Introduction

Ankyloglossia is an oral anomaly characterized by a shortened, thickened lingual frenulum that may cause reduced tongue mobility. However, the diagnosis and management of this condition has long been a debated topic. Given the paucity of high level evidence, management can be frustrating for both families and clinicians. Our study aims to examine differences in the management of ankyloglossia and investigate influencing factors at a single tertiary pediatric referral center.

Methods

A retrospective chart review was completed of children less than one year of age seen in the outpatient otolaryngology clinic. Billing records were searched for ICD-9 code 750.0 (ankyloglossia) between January 2, 2015 and October 9, 2017 and data extracted from the charts of those meeting inclusion criteria.

Results

A total of 266 charts were reviewed that met the inclusion criteria during the study period. 100 (38%) were female with a mean age of 2.9 months. In the final multivariate regression model, children seen by providers in Group 1 (providers with high rates of frenotomies) had 4.4 times the odds of having a frenotomy as those seen by a provider in Group 2 (providers with low rates of frenotomies) (p < 0.001, 95%CI: 2.2, 8.9), and male children had 2.5 times the odds of having a frenotomy as female children (p = 0.002, 95%CI: 1.4, 4.5).

Conclusion

In this study we identify additional variables that may influence the decision to perform a frenotomy in children with ankyloglossia. The significant impact of clinician biases in the management of ankyloglossia suggests arbitrary differences in the way these patients are managed, highlighting the lack of consensus amongst otolaryngologists and the need for clear indications and diagnostic criteria.

Pediatric nasopharyngeal airways expand when exposed to saline

28-07-2019 – Yael Bensoussan, Nikolaus E. Wolter, Shazia Peer, Robel Z. Alemu, Melissa Roy, Evan J. Propst

Journal Article

Purpose

Nasopharyngeal airways (NPA) are commonly used to relieve upper airway obstruction in children. They must be sized to extend posterior to the tongue base but remain above the epiglottis. To avoid obstruction from nasal secretions, frequent irrigation with saline is required. We hypothesized that NPAs would swell when exposed to saline irrigation.

Methods

Twenty-five green Rusch NPA size 12, 14, 16, 18 and 20 Fr were submerged in 2 L of normal saline for 15 days. Tube length, inner diameter, outer diameter and wall thickness were measured on days 1,2,3,4,5,10, and 15 and compared using two-way repeated measures ANOVA and paired t-tests with Bonferroni correction.

Results

All dimensions increased significantly with exposure to saline. Increases in length, inner diameter, outer diameter and wall thickness were dependent on original tube size (p < 0.05) and duration of exposure to saline (p < 0.001). The increase in tube length was greatest over the first five days.

Conclusion

NPAs expand significantly when exposed to saline with the greatest increase in length occurring in the first five days. This could lead to gagging or airway obstruction in small children. Patients with NPAs should be monitored closely for these signs and new materials should be sourced to prevent these issues.

Risk factors associated with congenital defects that alter hearing or vision in children born in the city of Bogotá between 2002 and 2016

26-07-2019 – M. Manotas, K. Sarmiento, A. Ibañez-Morantes, F. Suárez-Obando, N. Gelvez, G. López, P. Ayala-Ramírez, J. Angel, J. Prieto, N. Tamayo, S. Puentes, C. Rodríguez, M.L. Tamayo, I. Zarante

Journal Article

Introduction

Congenital defects affecting the auditory and visual capacity of newborns represent a public health problem as they result in substantial disability, directly impacting the quality of life of newborns and their families.

Objective

To evaluate risk factors associated with congenital defects that alter hearing or vision in newborns in the city of Bogotá between 2002 and 2016.

Method

Data from the Bogotá Birth Defects Surveillance and Follow-up Program was used, which consolidated data regarding 167 ECLAMC study (Estudio Colaborativo Latino Americano de Malformaciones Congénitas, in spanish) variables in a case-control design to identify risk factors for birth defects after parents provided signed informed consent. Cases were defined as any newborn (alive or stillborn) with a weight greater than 500 g with any visual or hearing abnormality. Controls were defined as newborn in the same hospital and month with no birth defects. Groups were formed according to the case presentation as follows: isolated eye anomaly, isolated ear anomaly, polymalformative, syndromic, and teratogenic.

Results

In total, 402,657 births were reviewed, of which 968 cases had some congenital defects that alter hearing or vision. An association was found between the presence of defects and prematurity, as well as between syndromic cases and increasing maternal age. When comparing cases and controls with the risk of having a birth defect, multiparity had an odds ratio (OR) of 1.47 (95% CI: 1.27–1.71), acute respiratory infection had an OR of 2.41 (95% CI: 1.04–5.58), low maternal education level had an OR of 1.34 (95% CI:1.10–1.62), low paternal education had an OR of 1.42, (95% CI:1.17–1.73), manual labor in the maternal occupation had an OR of 1.31 (95% CI:1.03–1.67), and a history of congenital anomalies in the family had an OR of 1.55 (95% CI:1.19–2.00).

Conclusion

This research allowed the identification of epidemiological data and significant risk factors for congenital defects that alter hearing or vision in the population of Bogotá.

Statistical analysis on “Early auditory skills development in Mandarin speaking children after bilateral cochlear implantation”

20-08-2019 – Mohammad Soleimani, Sepehr Eslami, Reza Amani-Beni, Sadra Ansaripour

Letter