International Journal of Pediatric Otorhinolaryngology

International Journal of Pediatric Otorhinolaryngology

Incidental mastoid opacification on computed tomography in the pediatric population

09-10-2019 – David J. Lafferty, Jason E. Cohn, Brian J. McKinnon

Journal Article

Objectives

Incidental mastoid opacification (IMO) is a common radiologic finding and source of referral to otolaryngologists. Our objectives were to: 1) determine the rate of IMO in our pediatric population; 2) identify those with clinical mastoiditis; and 3) identify factors necessitating an otolaryngology consultation.

Methods

This was a retrospective chart review at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients with the keyword ‘mastoid’ on a computed tomography (CT) scan report were reviewed. The effect of age, gender, season and the use of contrast media on the rate of IMO was also analyzed. Chi-square analysis was used to compare the significance of categorical frequencies.

Results

The rate of IMO in our cohort was 14.2% (164/1157). In children <8 years of age, the IMO rate was 22.0% compared to 5.6% in children 8–17 years of age (p < .001). The IMO rate in male children was 16.6% compared to 11.0% in female children (p = .007). There was no statistically significant higher rate of IMO during winter (15.1%) compared to summer (9.0%) and in CT scans with contrast (16.0%) compared to without contrast (14.0%). Our department of otolaryngology was formally consulted in 3% (5/164) of IMO cases. None of those patients had clinical mastoiditis.

Conclusions

This is the largest study identifying IMO on CT and in children to date. Although the overall rate of IMO in the pediatric population is 14.2%, it is rarely clinically significant.

Systemic bevacizumab for end-stage juvenile recurrent respiratory papillomas: A case report

15-10-2019 – Osama Hamdi, Jeff Dome, George Zalzal, Diego Preciado

Journal Article

We report on two cases of severe recurrent respiratory papillomatosis (RRP) involvement where the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab IV has been administered for treatment. Notably, there have not been any episodes of urgent transfer to the hospital for obstructive events since the bevacizumab was started. It is important to note however, that the disease has not been eliminated. While some pulmonary nodules continue to grow, they have become cavitated. Overall, the number and size of pulmonary lesions has decreased. Therefore, VEGF-targeted therapies, Bevacizumab, could prove to be a promising novel approach for long-term treatment of severe RRP.

Intra-capsular complete tonsillectomy, a modification of surgical technique to eliminate delayed post-operative bleeding

16-10-2019 – James T. Albright, Newton O. Duncan, Abel M. Smerica, Joseph L. Edmonds

Journal Article

Pediatric tonsillectomy is a frequently performed procedure using a variety of surgical techniques. Despite decades of modern surgical experience and advances in tools and techniques, a consensus on which technique is superior for minimizing complications has not been established. In a 2014 study, the authors examined differing surgical techniques and devices to determine if there was a significant difference in the bleed rates based on technique and device 1. In that study 7024 children were evaluated, of which a total of 1.4% (n = 99) of children experienced a postoperative hemorrhage that required a second surgery. There was no significant difference found between the four different techniques that were evaluated. Although the combined rates of post-operative hemorrhage requiring a second surgery was lower compared to many other published reports, we hypothesized that continued improvement in surgical techniques could eliminate post-operative hemorrhage completely. As follow up to that study, we decided on a collective change in technique, and subsequent analysis of our post-operative results with respect to only one outcome, post-operative hemorrhage requiring a second surgery. With a new standardized technique in place, we retrospectively evaluated one year of surgical outcomes. These procedures were performed using the technique of a modified and complete, intra-capsular Coblator tonsillectomy. Of the 783 tonsillectomies done in 12 months, we found there were 0 patients that had experienced a postoperative hemorrhage requiring a second surgery. Based on our previous study with a rate of 1.4% post-operative hemorrhage we would have expected to have 11 episodes of post-operative hemorrhage requiring a second surgery.

Keratinocyte growth factor (KGF) induces stem/progenitor cell growth in middle ear mucosa

16-10-2019 – Tomomi Yamamoto-Fukuda, Naotaro Akiyama, Hiromi Kojima

Journal Article

Objective

The middle ear epithelium is derived from the neural crest and endoderm, which line distinct regions of the middle ear cavity. In this study, we investigated the localization of stem/progenitor cells in the middle ear mucosa of adult mice and the effects of keratinocyte growth factor (KGF) on the cell kinetics of stem/progenitor cells in vivo.

Methods

In this study, after KGF-expression vector was transfected in the ear, two kinds of thymidine analogues, Brd
U and Ed
U, were transferred at different time points. Brd
U was detected by immunohistochemistry and Ed
U was detected by click chemistry. We also performed immunohistochemistry using anti-Keratin14 (K14) antibody (an undifferentiated epithelial cell marker), anti-p63 antibody (a stem/progenitor cell marker) and anti-acetylated α-tubulin antibody (a ciliated epithelial cell marker).

Results

A large number of Ed
U-positive cells were detected in the thickened mucosal epithelium of the pars flaccida and attic region at Day 1 after KGF transfection. Interestingly, in the mucosal epithelium overlying the promontory of the cochlea, many Ed
U-positive cells were detected. These cells were also positive for K14 and p63. The acetylated α-tubulin positive cells were reduced in the attic region at Day 1 after KGF transfection.

Conclusion

These findings indicate that KGF over-expression may increase stem/progenitor cell proliferation in the mucosal epithelium not only within the attic which is typical in middle ear cholesteatoma, but also overlying the promontory of the cochlea.

Selected cytokines in hypertrophic adenoids in children suffering from otitis media with effusion

14-10-2019 – Beata Zelazowska-Rutkowska, Bozena Skotnicka, Elzbieta Hassmann-Poznanska, Bogdan Cylwik

Journal Article

Objectives

The aim of the current study was to assess the levels of MMP-8, MMP-9 and TIMP-1 in the group of children with adenoids who suffered from exudative otitis media.

Methods

The study included 20 patients (10 females and 10 males) with adenoid hypertrophy coexisting with otitis media with effusion. The reference group included 24 patients (10 females and 14 males) with adenoid hypertrophy without otitis media. The levels of MMP-8, MMP-9 and TIMP-1 were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated cell cultures of the tonsils, using commercial enzyme-linked immunosorbent assay kits (R@D Systems, USA).

Results

The median MMP-8, MMP-9 and TIMP-1 concentrations (220.8 ng/m
L, 311.1 ng/m
L, 53.5 ng/m
L, respectively) in the study group were significantly higher (p = 0.000, p = 0.000, p = 0.048, respectively) than those in the reference group (93.5 ng/m
L, 112.5 ng/m
L, 36.95 ng/m
L, respectively). ROC analysis revealed that the area under a curve (AUC) for both metalloproteinases MMP-8 and MMP-9 was 1 with a diagnostic sensitivity of 100% and diagnostic specificity of 95.8%, as compared to 0.690 for TIMP-1. Significant differences were found between the AUC for MMP-8 and TIMP-1 and MMP-9 and TIMP-1 (p < 0.001 for both comparisons).

Conclusions

The changes in the concentrations of MMP-8, MMP-9 and TIMP-1 may indicate an increased remodeling of the extracellular matrix in children with adenoid hypertrophy and otitis media with effusion. The findings can have clinical as well as diagnostic utility. Determination of MMP-8 and MMP-9 may help qualify a child for adenoidectomy and differentiate pediatric patients affected by adenoid hypertrophy with and without otitis media.

Predicting hearing loss in children according to the referrer and referral cause

15-10-2019 – Slovik Y, Gorali R, Dizitzer Y, Joshua Bz, Kordeliuk S, Novack V, Kraus M

Journal Article

Background

Hearing assessment in children is considered necessary in all cases involving a doubt regarding hearing acuity. Due to the fact that the number of referrals may be much greater than the actual capacity of a hearing institute, it would be desirable to have a filtering tool in order to detect the cases with higher suspicion of hearing loss.

Objective

To evaluate whether anamnesis details can be used as a sorting tool for detection of highly suspicious cases of hearing loss in preschool children. The anamnesis details may be one or more of the following: the reason for performing hearing test, which caregiver indicated the need for hearing evaluation, the parents comprehension of their child hearing, and the medical history.

Methods

the parents of preschool children, who were referred to the hearing institute at Soroka university medical center, were asked to fill a questionnaire containing 18 questions. The questions referred to details such as: the reason for performing the hearing test; who suggested the existence of hearing impairment; medical history issues and questions regarding details that may indicate a risk of hearing loss. Details such as Otoscopy results were taken from the medical record of the patient.

Results

317 preschool and school patients were recruited to the study. Hearing loss was found in 42% of the cases. The most common reason for performing the hearing test was speech disturbance (33%). In cases which the parents were those who raised the suspicion of hearing loss – hearing impairment was found in 61% of the cases, compared to 36% when the speech therapist was the one raising the doubts and to only 18% when the kindergarten teacher was the one raising the doubt. The positive predictive value of patient that their parents suspected the hearing loss combined with pathologic otoscopy result was 82.6% when the reason for the test was hearing impairment suspicion, and 91.3% when the reason for the hearing test was speech disturbance.

Conclusions

Parents are the best in assessing their childs hearing followed by the speech therapist and the least sensitive is the school teacher.

Quality of life of children with hearing loss in special and mainstream education: A longitudinal study

14-10-2019 – Tirza F.K. van der Straaten, Carolien Rieffe, Wim Soede, Anouk P. Netten, Evelien Dirks, Anne Marie Oudesluys-Murphy, Friedo W. Dekker, Stefan Böhringer, Johan H.M. Frijns, DECIBEL Collaborative study group

Journal Article

Objectives

To compare the quality of life (QoL) of children with hearing loss (HL) and children with normal hearing (NH) and to examine how the QoL of children with HL changes over time, considering language skills, type of hearing device, degree of HL, and type of education.

Methods and materials

This longitudinal study included 62 children with HL and their parents. Developmental outcome data were collected at two time points, when the mean ages of the children were 4 and 11 years. The Pediatric Quality of Life (Peds
QL™) questionnaire, which includes assessments of Physical, Emotional, Social, and School functioning, was completed by parents at both time points and by the children with HL at the second time point. Receptive and expressive language skills at 4 years were assessed by the Reynell Developmental Language Scale. Results were compared with a Dutch normative sample.

Results

The QoL of children with HL was similar to that of children with NH at both time points on two of the four QoL scales, Emotional and Physical functioning. On the other two scales, Social and School functioning, children with HL who attended special education and children who switched to mainstream education showed lower scores than children with HL who were consistently in mainstream education and lower scores than children with NH. The School QoL of children with HL decreased over time, as did the School QoL of children with NH. Social QoL of children with cochlear implants decreased over time, but this was not the case in children with hearing aids. Language skills and the degree of HL did not clinically improve the QoL over time of preschool children with HL.

Conclusions

The QoL of children with HL in mainstream education and the Physical and Emotional QoL of all children with HL were satisfactory. It is essential to develop specific guidance regarding school activities for children with HL in special education and for children with HL who switch to mainstream education in order to increase their social QoL.

Binaural processing and phonological awareness in Australian Indigenous children from the Northern Territory: A community based study

14-10-2019 – Mridula Sharma, Gillian Wigglesworth, Gemma Savage, Katherine Demuth

Journal Article

Objective

Research has found that otitis media (OM) is highly prevalent in Australian Indigenous children, and repeated bouts of OM is often associated with minimal-to-moderate hearing loss. However, what is not yet clear is the extent to which OM with hearing loss impacts auditory signal processing specifically, but also binaural listening, listening in noise, and the potential impact on phonological awareness (PA) – an important, emergent literacy skill. The goal of this study was to determine whether auditory abilities, especially binaural processing, were associated with PA in children from populations with a high incidence of OM, living in a remote Australian Indigenous community in the Northern Territory (NT).

Methods

Forty-seven 5-12-year-olds from a bilingual school participated in the study. All were tested to determine hearing sensitivity (pure tone audiometry and tympanometry), with PA measured on a test specifically developed in the first language of the children. OM often results in a hearing loss that can affect binaural processing: the Dichotic Digit difference Test (DDd
T) was used to evaluate the childrens dichotic listening and the Listening in Spatialized Noise-sentences test (Li
SN-S) was used to evaluate their abilities to listen to speech-in-noise.

Results

Seventeen (36%) and 16 (34%) had compromised middle ear compliance (combined Type-B and –C) in the right and left ear respectively. Six children demonstrated a bilateral mild hearing loss, and another five children demonstrated a unilateral mild hearing loss. Thirty-one children were able to complete the DDd
T listening task, whereas only 24 completed the speech in noise task (Li
SN-S). Forty-four children (94%) were able to complete the letter identification subtask, comprising part of the PA task. The findings revealed that age was significantly correlated with all tasks such that the older children performed better across the board. Once hearing thresholds were controlled for, PA also correlated significantly with both binaural processing tasks of dichotic listening (r = 0.59, p < 0.001) and listening to speech in noise (r = −0.56, p = 0.005); indicating a potential association between early, emergent literacy and listening skills.

Conclusions

The significant correlations between phonological awareness and dichotic listening as well as phonological awareness with listening to speech-in-noise skills suggests auditory processing, rather than hearing thresholds per se, are associated to phonological awareness abilities of this cohort of children. This suggests that the ability to process the auditory signal is critical.

Prevalence and clinical aspects of hearing loss among the South Korean adolescent: Data from a population-based study

14-10-2019 – Shin Hye Kim, Eun Shil Cha, Heung Eog Cha, Jae-Jun Song, Sung-Won Chae

Journal Article

Objectives

Slight/mild hearing loss is detrimental to communication and academic achievements. This study aimed to describe the prevalence of hearing loss, and to investigate the factors related to noise-induced hearing loss among South Korean adolescent.

Methods

As a population-based retrospective study, 1845 South Korean adolescents aged from 12 to 19 years were analyzed using the data from Korea National Health and Nutrition Examination Survey V (KNHANES V, 2010–2012). The prevalence of hearing loss according to the side, severity, and frequency was calculated. For assessing the noise-induced hearing loss in adolescent, the prevalence of hearing loss only in high-frequency (only
HFHL, defined as 1) thresholds at 0.5 and 1 k
Hz of ≤15 d
B HL, and 2) maximal thresholds at 3, 4, or 6 k
Hz ≥ 15 d
B HL higher than the highest threshold for 0.5 and 1 k
Hz) was analyzed. Moreover, the relevance of only
HFHL in context of sociodemographic factors and noise exposure history was evaluated.

Results

The prevalence of unilateral and bilateral hearing loss based on the average of six frequencies (0.5, 1, 2, 3, 4, and 6 k
Hz) in South Korean adolescents were 8.56% and 1.03%, respectively, and most cases were hearing loss with slight/mild degree. The prevalence of unilateral and bilateral only
HFHL were 32.74% and 5.53%, respectively. Factors found to be associated with only
HFHL were sex (female) and household income (high).

Conclusions

According to this population-based study, the prevalence of slight/mild hearing loss and only
HFHL in the South Korean adolescents were considerably high. With knowledge of the factors related with only
HFHL, paying more attention to slight/mild hearing loss will be helpful in preventing hearing loss in adolescents.

Radiologic, genetic, and endocrine findings in isolated congenital nasal pyriform aperture stenosis patients

14-10-2019 – James Ruda, Jonathan Grischkan, Zahir Allarakhia

Journal Article

Background

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in neonates. It can occur either associated with a solitary median maxillary central incisor (SMMCI) in 40–75% of cases or as an isolated morphogenic variant. Brain MRI is routinely performed in patients with CNPAS with a SCMMI due to the concomitant risks of intracranial midline defects of the hypothalamic-pituitary axis (HPA), holoprosencephaly, or associated endocrine dysfunction. However, the role of routine brain imaging and endocrinologic evaluation in patients with isolated CNPAS is not frequently studied given the assumption that isolated CNPAS is unlikely to be associated with any intracranial findings.

Objectives

To evaluate intracranial findings on dual brain MRI imaging in isolated CNPAS patients and to determine if any radiologic, endocrinologic, or genetic abnormalities existed in these patients.

Methods

We performed a single-institution retrospective review and case series of patients with isolated CNPAS from 2006 to 2019. Findings from dual brain MRI imaging, cytogenetic and karyotype testing, and formal endocrinologic testing were analyzed for each patient and compared to reported findings in isolated CNPAS patients within the literature.

Results

From 2006 to 2019, 16/29 patients were identified at our institution with isolated CNPAS. Inpatient otolaryngologic consultation, CT, and brain MRI imaging was obtained after a mean postnatal age of 3.21 days, 13.5 days, and 35.91 days, respectively. Dual brain MRI imaging was obtained in 12/16 (75%) patients. In our patients, abnormal MRI findings included hypothalamic hamartoma, pars intermedius cyst, and grades 1 and 4 germinal matrix hemorrhages. No holoprosencephaly was found in any patient. Genetic testing was performed on 10/16 (62.5%) patients. Karyotyping was normal in all patients and microarray testing was abnormal in 2/10 patients that represented a 2p16.3 deletion in one patient and a 7q36 deletion causing an unbalanced translocation mutation of the Sonic Hedgehog gene in the second patient. In the latter patient, a hypothalamic hamartoma and panhypopituitarism was found. Endocrine evaluation was performed in 5 patients and was normal in 3/5 patients.

Conclusions

Our case series of isolated CNPAS patients identified multiple abnormalities on radiologic, genetic, and endocrine testing; one of which that involved a defect of the HPA with panhypopituitarism resulting from a hypothalamic hamartoma. Based upon our findings, dedicated brain MRI imaging, endocrinologic, and genetic testing, should likely be considered for any newly diagnosed, isolated CNPAS patient given the uncommon but potential risk for associated intracranial abnormalities.

Determining concordance and cost impact of otoacoustic emission and automated auditory brainstem response in newborn hearing screening in a tertiary hospital

14-10-2019 – Kimberly Mae C. Ong, Adovich S. Rivera, Abner L. Chan, Charlotte M. Chiong

Journal Article

Objective

This study compared otoacoustic emission (OAE) and automated auditory brainstem response (AABR) in terms of concordance and cost impact for newborn hearing screening (NBHS) in the Philippine setting.

Methods

This was a prospective observational study to assess concordance between OAE and AABR involving 253 infants. Each infant underwent OAE and AABR testing. Infants who passed both tests were not required to follow up for additional testing. Infants who failed in any test were scheduled for repeat screening and diagnostic ABR after 1 month. Concordance was computed using B-statistic.

For cost analysis

4 scenarios were compared to 1-step both tests scenario: (1) OAE alone, (2) AABR alone, (3) 2-step OAE, and (4) 2-step AABR in terms of number of infants with hearing loss (HL) detected, cost of diagnosis, and economic loss from lack of treatment.

Results

There was high concordance between OAE and AABR (B-statistic = 0.8). AABR had a higher refer rate (18.58%) than OAE (10.27%) but higher number of detected babies with HL. Cost analysis favored an AABR alone scenario while the 2-step OAE protocol fared poorly.

Conclusion

A change from 2-step OAE to AABR alone is worth considering in our institution.

Hospital utilization for orbital and intracranial complications of pediatric acute rhinosinusitis

05-10-2019 – Dylan A. Levy, Shaun A. Nguyen, Richard Harvey, Claire Hopkins, Rodney J. Schlosser

Journal Article

Background

Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost.

Methodology

Analysis of Kids’ Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median IQR.

Results

A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 8 v 4 3days, p < 0.001). Daily cost for IC was greater than OC ($2861 4044 v $1683 1187, p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 41,976 v $32,299 18,235, p < 0.001) but similar LOS (12 10 v 11 9 days, p = 0.783).

Conclusions

Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.

Trends in complications of pediatric rhinosinusitis in the United States from 2006 to 2016

01-10-2019 – Dylan A. Levy, Phayvanh P. Pecha, Shaun A. Nguyen, Rodney J. Schlosser

Journal Article

Objectives

1) Evaluate the changing prevalence of complications from pediatric acute bacterial rhinosinusitis and 2) elucidate factors associated with the development of complicated acute rhinosinusitis in this population.

Study Design/Setting

Cross-sectional analyses of the Kids’ Inpatient Database.

Subjects and methods

Children <20 years with a diagnosis of acute rhinosinusitis were included. Diagnosis codes pertaining to acute rhinosinusitis-related complications were then queried for each subject. All patients were ultimately categorized into one of four groups: uncomplicated acute rhinosinusitis, orbital complications, intracranial complications, or both orbital and intracranial complications. Weighted measures were applied to provide national estimates.

Results

Over the decade studied, national estimates for children admitted with acute rhinosinusitis decreased from 8,312 cases in 2006 to 5,592 in 2016. There was an increase in the rate of orbital complications from 8.9% to 19.3% and intracranial complications from 2.2% to 4.3%. Children with both complications increased from 0.5% to 1.0% of cases. Children with orbital complications were significantly younger (8.6 years) compared to those with intracranial complications (12.4 years) and both complication types (12.2 years) (p < 0.001).

Conclusion

Despite an overall decrease in cases of acute rhinosinusitis, rates of orbital and intracranial complications continued to increase over a ten-year period. Antibiotic prescribing patterns, vaccination effects, and evolving practice patterns may help explain these observations. Further studies warrant investigation into the cause of these trends.

Level of evidence

4.

Evaluating pediatric intensive care unit utilization after tonsillectomy

01-10-2019 – Nathan D. Vandjelovic, Jenna W. Briddell, Meghan M. Crippen, Richard J. Schmidt

Journal Article

Objectives

To identify patients at risk for a pediatric intensive care unit (PICU) level intervention after adenotonsillectomy.

Study design

Retrospective cross-sectional study.

Setting

Tertiary Childrens Hospital.

Subjects and methods

Ninety-four patients who were admitted to the PICU after adenotonsillectomy were included. The need for PICU level intervention, defined as high flow oxygen by nasal cannula, positive airway pressure (PAP), heliox, and intubation, was documented. The age, gender, BMI percentile, polysomnography (PSG) data, home PAP use, and accompanying comorbidities of patients who required a PICU level intervention were compared to those who did not.

Results

Of the 94 patients admitted post-adenotonsillectomy to the PICU, most had at least one comorbidity, with obesity being the most common. PICU admission was unplanned in 29 (30.9%) patients. Postoperatively, 25 (26.5%) patients required a PICU level intervention, with PAP being the most common intervention. On chi-square analysis, there was no significant difference in the age, BMI percentile, or PSG parameters of children who required PICU intervention. Significantly more children who used preoperative PAP were started on PAP in PICU (p = 0.018). Only the comorbidity of neuromuscular disorder was associated with PICU intervention (p = 0.04). Using binary logistic regression, the use of home PAP and an oxygen nadir <80% on preoperative PSG were found to be independent predictors of PICU intervention (p = 0.04 and 0.025, respectively).

Conclusion

Home PAP use, the presence of a neuromuscular disorder, and an oxygen nadir <80% on preoperative PSG is related to a PICU level intervention.

Prevalence of hearing loss among polish school-age children from rural areas – Results of hearing screening program in the sample of 67 416 children

30-09-2019 – Henryk Skarżyński, Elżbieta Gos, Weronika Świerniak, Piotr Henryk Skarżyński

Journal Article

Background

Hearing loss in children is a relevant health issue, both for its prevalence and for its physical, emotional and social consequences. Our aim was to estimate the national prevalence of hearing loss in school-age children from rural areas in Poland.

Methods

The study was conducted in the general, pediatric, nonclinical population of school-age children from rural areas in Poland. It was a population-based, epidemiological study. The participants were 67416 children (32630 girls and 34786 boys) aged from 6 to 13 years old (M = 8.65; SD = 2.54). Pure-tone air-conduction hearing threshold were obtained at 0.5–8 k
Hz. Hearing loss was defined as a pure-tone average higher than 20 d
B in one or both ears in at least one of the following pure-tone average: four-frequency pure-tone average (FFPTA), high-frequency pure-tone average (HFPTA) and low-frequency pure-tone average (LFPTA).

Results

The rate of positive results of hearing screening was 16.4% and it was significantly higher in younger children than in older children. Mild hearing loss was more frequently than moderate or worse hearing loss. The children more often experienced unilateral than bilateral hearing loss.

Conclusions

This study reveals that hearing problems are common in this population, especially among younger children. It shows a strong need for systematic monitoring of hearing status among children and increasing awareness of parents and educators of the significance of hearing loss, including unilateral and mild hearing loss. Further studies conducted among children in urban areas are needed to compare the prevalence of hearing loss in children from various environments.

“The Professionals experience with causes of delay in the diagnosis and management of children with a congenital hearing loss in Libya”

30-09-2019 – Ibtihal Sambah, Fei Zhao, Rashad El-Lishani

Journal Article

The aim of this study was to collect and interpret narrative and observational data from Audiologists and ENT doctors experiences of delays in the identification and management of congenital hearing loss (CHL) in Libya. This qualitative study sought to explore and understand the reasons behind the delay. Participants were three Audiological Physicians and five Otolarngologists (ENT) working in public hospitals in four large cities in Libya. They were interviewed to explore the causes of such delays and themes were generated from their experiences. All participants revealed that the main causes might be associated with limited facilities and availability of audiology services, lack of awareness and knowledge of the magnitude of the issue and the importance of early detection and intervention for CHL in Libya. In contrast to other developing countries, the financial situation and poverty were not considered to be the main cause in Libya. Furthermore, socioeconomic status of the childrens families appears relevant.

Hearing screening failure rate in newborn infants with hypoxic ischemic encephalopathy

29-09-2019 – Gülsüm Kadıoğlu Şimşek, H.Gözde Kanmaz Kutman, Fuat Emre Canpolat, Mehmet Büyüktiryaki, Yaprak Engin Üstün

Journal Article

Objective

The objective of this study was to establish the local incidence of hearing screening failure rate in newborns with all three stages of hypoxic ischemic encephalopathy (HIE).

Methods

This retrospective cohort study was undertaken in a tertiary neonatal intensive care unit. Medical records and hearing secreening test results were collected for two years.

Results

One hundred and ninety seven infants diagnosed with HIE, 20 of them died, 177 screened. Thirty five of 177 (19%) infants failed in screening test for hearing. Screening failure rate was 10/51 (19%), 20/105 (19%) and 5/21 (23%) in stage 1, 2 and 3, respectively and did not differ between HIE stages (p = 0.88). Furthermore failure rates were similar between infants who received therapeutic hypothermia or not (20% vs 19%, p = 0.84).

Conclusion

Hearing screening failure rate in HIE is quite high even in Stage 1 infants. Management and treatment of these infants should be made carefully concerning additional risks for hearing loss and long term follow-up even in Stage 1 HIE infants should be planned strictly.

Lipofilling in patients with a cleft lip (and palate) – a pilot study assessing functional outcomes and patients’ satisfaction with appearance

01-10-2019 – Cassandra Alighieri, Kim Bettens, Nathalie Roche, Laura Bruneel, Kristiane Van Lierde

Journal Article

Introduction

Lipofilling of the upper lip as secondary treatment in patients with a cleft lip (and palate) (CL ± P) has been proposed to improve projection and volume especially in profile view. The purpose of the present study was to document differences in functional (i.e. logopaedic) and self-reported aesthetic outcomes by comparing pre- and postoperative results after lipofilling of the upper lip in patients with CL ± P.

Methods

Eight Dutch-speaking youngsters and young adults (three women, five men) with CL ± P were included. The median age was 19 years (range: 14–24 years). Logopaedic outcomes (i.e. assessment of orofacial myofunctional behavior, articulation and lip strength) and self-reported aesthetic outcome (i.e. patients’ satisfaction using the Cleft Evaluation Profile) were determined.

Results

Neither for lip strength and orofacial myofunctional behavior nor for articulation statistically significant differences were found when comparing measurements before and after lipofilling. Regarding patients’ satisfaction, a statistically significant increased self-evaluation of appearance in profile was found after lipofilling.

Conclusion

Regarding functionality, the present study did not find any differences when comparing outcomes before and after lipofilling. Nevertheless, patients were more satisfied with appearance in profile after performance of this technique. As this is a small sample study, further research and long-term follow-up studies are necessary.

Auditory processing disorders in incarcerated youth: A call for early detection and treatment

01-10-2019 – Jonathan A. Berken, Elizabeth Miller, Deborah Moncrieff

Journal Article

Background

Numerous reports have linked language impairment, academic underachievement, and attention disorder to misbehavior in adolescence. Recent studies have found an association between deficits in hearing and auditory processing and involvement in the juvenile justice system. In fact, the existence of an auditory processing disorder (APD) is a risk factor for adolescent delinquency even in the presence of normal hearing. The nexus between APD, low academic achievement and offending behavior in teens has prompted recommendation for early screening of school children for abnormalities in auditory processing. Using a variety of diagnostic tools, investigators have found an increase in the frequency of APD in cohorts of confined youthful offenders. The present investigation evaluates the prevalence of APD in a group of incarcerated youth residing in a detention center.

Methods

A total of 52 incarcerated adolescents (8 females and 44 males; age range 13–20 (M = 16.0), residing at a juvenile detention center in Pittsburgh, Pennsylvania and determined to have normal auditory acuity were included in the study. All participants were screened for APD using two dichotic listening tests, the Randomized Dichotic Digits Test (RDDT) and the Dichotic Words Test (DWT), evaluative modalities to identify deficits in auditory processing. The prevalence of APD in the study group was compared to previously published normative data for non-offending age-matched youth.

Results

On the RDDT, 23.1% of participants demonstrated normal auditory processing, while 77% had abnormal test results. On the DWT, 75% of subjects exhibited normal auditory processing, while the scores were abnormal for 24.9%. When the results of the RDDT and the DWT were combined to establish a pattern for the purpose of interpreting a deficit, 21.1% of the participants produced results that were within normal limits, while 17.3% qualified for a diagnosis of APD, with abnormal results on both tests. Previous studies have estimated the prevalence of auditory processing disorder in the general adolescent population as being between 2% and 7%.

Conclusions

This study found a higher prevalence of auditory processing disorder in a cohort of incarcerated youth compared with age-matched controls. Diagnostic screening protocols that identify at-risk children have been developed, as have effective therapies to improve auditory processing function. Teachers, pediatricians and psychologists should consider APD in children and adolescents with behaviors that may increase their risk for juvenile justice involvement. Studies on optimal timing and strategies for assessing and treating APD in children and adolescents are needed, including youth caught up in the juvenile justice system.

Clinical outcomes of intracranial complications secondary to acute mastoiditis: The Alder Hey experience

30-09-2019 – Madhan Krishnan, Hussein Walijee, Anthony Jesurasa, Su De, Ajay Sinha, Ravi Sharma, Adam Donne

Journal Article

Objective

Acute mastoiditis is the most common intra-temporal complication of acute otitis media. Its management remains a challenge due to potential extracranial and intracranial complications. This study was designed to evaluate the recent experience with acute mastoiditis and its associated intracranial complications at a tertiary paediatric centre.

Methods

A retrospective case note review was carried out for patients admitted to Alder Hey Childrens Hospital between January 2006 and December 2016 with a diagnosis of acute mastoiditis. Patients were identified using ICD-10 codes H700, H701, H702, H708 and H709. A case note review was performed to identify patients with intracranial complications and data collected.

Results

30 patients were identified with intracranial complications of acute mastoiditis, with 18 males and 12 females. The average age was 4 years and 2 months (range 2 months–15 years). The most common presenting complaint was otalgia and vomiting (63%), with only 27% patients presenting with mastoid swelling. 83% of patients were investigated with a combination of CT and MRI scans, 6.7% with CT scans only and 6.7% with MRI scans only. 73% were diagnosed with sinus thrombosis, 40% cerebral abscess and 33% postauricular subperiosteal abscess. 78% of the patients required surgical intervention. 27 of the 30 patients recovered fully with no significant long term sequalae following an average of 50 months follow-up.

Conclusion

Intracranial complications of acute mastoiditis remain a significant challenge. Most patients tend to present without mastoid swelling, necessitating a high index of suspicion in patients with picket fence fever, vomiting, drowsiness, headaches, seizures or cranial nerve involvement. Most cases treated at our institution required acute surgical intervention in addition to adjuvant medical treatment with majority patients recovering fully.

New onset dysphagia and pulmonary aspiration following sclerotherapy for a complex cervical venolymphatic malformation in an infant: Case report and review of the literature

29-09-2019 – D.R. Johnston, J. Donaldson, A.M. Cahill

Journal Article

We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case.

Methods

Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed.

Results

A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy.

Conclusions

Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.

Three-layered repair with a collagen membrane and a mucosal rotational flap reinforced with fibrine for palatal fistula closure in children

20-09-2019 – Veronica Alonso, Alberto Sanchez- Abuin, Cristina Duran, Oscar Gomez, Lorena Miguez, Maria E. Molina

Journal Article

The incidence of postoperative fistula following primary cleft palate repair ranges from 0% to 58%. The reported recurrence rate is between 33% and 37%, and the prognosis of a successful closure declines with each reoperation.

Closure of palatal fistulas can be achieved by different techniques depending on its size and the experience of the surgeon. Local, regional and distant flaps are commonly used. Alternatively, or in addition to the previous ones, synthetic materials are becoming very popular nowadays. However, a scarcity of articles explains in detail a simple and effective method in children.

We present a case report and the procedure proposed by our pediatric surgery team consisting of a three-layered repair, with a collagen membrane placed over the reconstructed nasal mucosa, and a rotational palatal mucosa flap reinforced with a fibrine sealant.

This method is simple, easy to reproduce, effective and has a low rate of complications.

Injection bronchoplasty with carboxymethlycellulose with cystoscopy needle for neonatal persistent bronchopleural fistulae

31-08-2019 – Nicholas Beckmann, Jordan Luttrell, Brad Petty, Cecil Rhodes, Jerome Thompson

Journal Article

Objective

We describe the novel use of injectable carboxymethylcellulose to close a persistent bronchopleural fistula (BPF) in a neonate who underwent an ex utero intrapartum treatment (EXIT) after aborted fetoscopy.

Methods

In this case, a patient with laryngeal atresia underwent fetoscopy that was halted after concern for instruments within the mediastinum, and thus ultimately required an EXIT to establish an airway. Bilateral pneumothoraces and eventually multiple BPF were identified that continued to persist despite multiple attempts at removal of chest tubes over a four-week period. We look at the role of endoscopy and a substance often used in the larynx to help close a persistent BPF.

Results

At initial bronchoscopy, no BPF was identified, but at subsequent evaluation due to persistent pneumothorax, we used increased positive end expiratory pressure to help reveal the fistula. Given the bronchial location of the fistula, traditional laryngeal instruments could not be used, requiring the use of urologic cystoscopy needles to assist in accessing these challenging locations. At postoperative day 2 from the injection, the chest tube was removed and did not require replacement.

Conclusion

There are many methods to help treat BPF. The endoscopic injection of carboxymethylcellulose adds a technique to the pediatric otolaryngologists armamentarium.

The p.Gly130Val mutation in the GJB2 gene: A familiar case of autosomal dominant non-syndromic hearing loss

01-09-2019 – Adelaide Bussini, Rossana Righi, Chiara Pessina, Angelo Genoni, Eliana Cristofari, Annalisa Meli, Paola Granata, Emanuela Meroni, Francesco Broccolo, Rosario Casalone

Journal Article

Several forms of sensorineural hearing loss (SNHL) have been imputated to connexins mutations and prevalently to connexin 26 (Cx26), codified by the GJB2 gene (gap junction protein, beta 2). Here, we report the first familiar case (heterozygous p. G130V mutation) of non-syndromic (without any dermatological manifestation) dominant profound SNHL. Proband was a 6-years-old male with post-lingual bilateral profound SNHL, clinically identified at the age of 3 with diagnosis of severe SNHL. We confirm that the p. G130V variant of the GJB2 gene is causative of autosomal dominant form of SNHL, although it is not always associated with the presence of skin diseases.

Risk factors of post-surgery complications in children with thyroid cancer

24-09-2019 – Jozef Babala, Petra Zahradníková, Igor Béder, Lenka Fedorová, Martin Lindák, Ľudmila Košťálová, Zuzana Pribilincová, Juraj Staník, Róbert Králik

Journal Article

Introduction

Thyroid cancer in children is a hot topic because of the large clinical heterogeneity and the risk of severe complications. We aimed to study 1. The frequency, 2. Etiology, and 3. Risk factors of post-surgery complications of thyroid cancer.

Material and methods

A retrospective analysis including risk factors for post-surgery complications of patients treated for thyroid malignancies in years 2006–2018 was performed.

Results

Over a period of 12 years 22 patients with thyroid malignancy (68% female; 12.6 ± 4.0 years of age, median follow-up 6 years) were identified. Histologically, 12 (55%) patients had papillary carcinoma. Six patients (27.3%) had multiple endocrine neoplasia type 2 (MEN2) syndrome, 3 (13.7%) patients had medullary carcinoma and 1 patient had follicular carcinoma. Neck lymph node metastases were diagnosed in 8 (36.4%), distant metastases in 6 (27.3%), and both locations were involved in 4 (18.2%) patients. Six (27.3%) children had surgical complications: 1 child had unilateral vocal cord paralysis and transient hypoparathyroidism and 5 had transient hypoparathyroidism. The higher risk of surgery complications in forward stepwise logistic regression was associated in with distant metastases (R2 = 0.584, OR 52.63, p = 0.010).

Conclusions

Postoperative complications were significantly associated with presence of distant metastases. Favorable results were observed in with children with MEN2 syndrome.

Comprehensive management of infected preauricular sinuses/cysts

24-09-2019 – Glenn Isaacson

Journal Article

Objective

To review a single-surgeon, 16-year experience with the management of infected preauricular sinuses/cysts.

Methods

Computerized search of all office notes and operative reports during the years 2002–2018.

Setting

Academic medical center and suburban office practice.

Participants

Children from 0 to 18 years of age with symptomatic preauricular sinuses/cysts.

Intervention

Children with symptomatic preauricular sinuses/cysts underwent surgical excision. Those presenting with infected cysts were treated with oral antibiotics, needle-aspiration and/or incision and drainage to control infection prior to surgery. The chronic preauricular abscesses were curetted without resection of overlying skin or the abscess walls.

Main outcome measure

Control of infection without recurrence following surgery.

Results

415 patient encounters involved preauricular sinuses/cysts. These ultimately led to 56 surgical excisions. 28 of the sinuses/cysts were infected at presentation. All infected lesions were treated with oral antibiotics. 6 infected sinuses/cysts were needle aspirated. 2 infected sinuses/cysts required incision and drainage. 1 infected sinus/cyst could not be controlled by either drainage technique and was surgically excised while actively infected. Nine children presented with chronic preauricular abscesses. One the 28 infected sinuses/cysts (3.5%) recurred 10 years after surgery– it was cured with re-resection at the root of the helix.

Conclusion

Treatment of infected preauricular sinuses/cysts remains controversial. Control of infection prior to definitive surgery is desirable, but not mandatory. Chronic preauricular abscesses can be managed by sinus/cyst excision and subcutaneous abscess curettage without resection of the abscess wall or overlying skin. This leads to consistent control and favorable cosmesis.

Evaluating butterfly inlay tympanoplasty

27-09-2019 – James A. Leonard, Ryan S. Ference, Michael S. Weinstock, John P. Bent

Journal Article

Objective

To compare closure rate, reduction in air-bone-gap, and operative time of butterfly tympanoplasty (BT) to underlay tympanoplasty (UT).

Methods

Retrospective cohort study of children (age <18y) undergoing Type I tympanoplasty between 2009 and 2017. Patients were excluded if they had <6 months of follow up, mastoidectomy, fat graft or cholesteatoma.

Results

Twenty-one patients (mean age 13.4) underwent BT while forty-one patients (mean age 13.5) underwent UT. The mean size of perforation in 30.6% in BT patients and 43.6% in UT patients (p = 0.01). Preoperative audiogram showed a similar air-bone-gap between the two groups of 31.7, 22.7, and 17.9 d
B in BT vs 29.6, 24.8, and 17.6 d
B in UT at 500, 1000, and 2000 Hz, respectively (p = 0.65, 0.63, and 0.94). Operative time was reduced in BT as compared to UT (94.0 min vs. 150.9, p = 0.01). Closure rate was similar at 85.7% in BT vs 75.6% in UT patients (p = 0.40). Average reductions in air-bone gap were similar with 19.2, 11.7, and 13.2 d
B for BT vs 16.6, 12.1, and 10.3 d
B for UT at 500, 1000, and 2000 hz, respectively (p = 0.66, 0.93, 0.40).

Conclusion

BT has become a reliable tool for the pediatric otolaryngologist. This retrospective study shows that pediatric BT results in similar outcomes with reduced operative time.

Defining atypical croup: A case report and review of the literature

23-09-2019 – Raphael Hanna, Francisco Lee, Derek Drummond, Warren K. Yunker

Journal Article

Background

Croup is a common respiratory illness in children. It presents with a barky cough, stridor and hoarseness occurring secondary to inflammation of the subglottis and larynx. The clinical course of croup is well-described, however atypical presentations pose a diagnostic and management challenge.

Objectives

This case report and systematic review aims to synthesize the published literature on the definition, diagnosis and treatment of atypical croup.

Study selection

Peer-reviewed journal publications in Ovid MEDLINE® and EMBASE from inception to January 1, 2019 in English, focusing on pediatric patients (<18 years of age) with diagnoses of atypical croup.

Data extraction

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Twelve studies involving 670 patients ranging from 6 months to 11 years of age presenting with atypical croup were selected. A variety of definitions of atypical croup were identified based on recurrence, duration of symptoms, severity, and etiology. Data on the incidence of atypical croup, the overall rates of intubation and tracheostomy, and patient characteristics leading to definitive airway management were not clearly characterized.

Limitations

All studies were case series, case reports or retrospective chart reviews.

Conclusions

Atypical croup is a poorly defined clinical entity that is used to describe recurrent, refractory, or croup-like illness that follows an uncharacteristic natural history. Our case presentation and accompanying literature review highlights the variable, but limited, information available on the diagnosis of atypical croup. Given the commonality of its use in clinical practice, we propose some guidelines around the use of the term ‘atypical croup’ as well as a management algorithm.

Evaluation and therapy outcome in children with auditory neuropathy spectrum disorder (ANSD)

23-09-2019 – Désirée Ehrmann-Müller, Mario Cebulla, Kristen Rak, Matthias Scheich, Daniela Back, Rudolf Hagen, Wafaa Shehata-Dieler

Journal Article

Objectives

The aims of the present study are to: describe diagnostic findings in patients with auditory neuropathy spectrum disorder (ANSD); and demonstrate the outcomes of different therapies like hearing aids (HAs) or cochlear implantation.

Methods

32 children were diagnosed and treated at our tertiary referral center and provided with HAs or cochlear implants (CIs). All of them underwent free-field or pure-tone audiometry. Additionally, otoacoustic emissions (OAEs), impedance measurements, auditory brainstem responses (ABRs), auditory steady-state responses (ASSR), electrocochleography, and cranial magnetic resonance imaging (c
MRI) were all performed. Some patients also underwent genetic evaluation. Following suitable provision pediatric audiological tests, psychological developmental diagnostic and speech and language assessments were carried out at regular intervals in all the children.

Results

OAEs could initially be recorded in most of the children; 17 had no ABRs. The other eight children had a poor ABR morphology. Most of the children had typical, long-oscillating cochlear microphonics (CMs) in their ABRs, which was also observed in all of those who underwent electrocochleography. Eight children were provided with a HA and 17 received a CI. The functional gain was between 32 and 65 decibel (d
B) with HAs and between 32 and 50 d
B with CI. A speech discrimination level between 35 and 100% was achieved during open-set monosyllabic word tests in quiet with HA or CI. With the Hochmair-Schulz-Moser (HSM) sentence test at 65 d
B SPL (sound pressure level), 75% of the children with a CI achieved a speech discrimination in noise score of at least 60% at a signal to noise ratio (SNR) of 5, and four scored 80% or higher. Most of the children (72%) were full-time users of their devices. All the children with a CI used it on a regular basis.

Conclusion

Only a few case reports are available in the literature regarding the long-term outcomes of ANSD therapy. The present study reveals satisfactory outcomes with respect to hearing and speech discrimination in children with CIs or HAs. The nearly permanent use of the devices reflects a subjective benefit for the children. Provision with a suitable hearing device depends on audiological results, the speech and language development of an individual child, and any accompanying disorders. Repeated audiological evaluations, interdisciplinary diagnostics, and intensive hearing and speech therapy are essential for adequate rehabilitation of this group of children.

Use of non-invasive ventilation in children with congenital tracheal stenosis

21-09-2019 – G. Pellen, C. Pandit, C. Castro, P. Robinson, C. Seton, D.A. Fitzgerald, K. Waters, A.T. Cheng

Journal Article

Introduction

Congenital tracheal stenosis (CTS) is a rare airway condition characterized by complete tracheal rings. Most patients undergo a slide tracheoplasty, which greatly reduces mortality but significant morbidity remains. The assessment of sleep disordered breathing (SDB) and use of non-invasive ventilation (NIV) in these children has not been described.

Aim

To describe the presence of SDB and use of NIV in children diagnosed with CTS over a 10-year period (2005–2015).

Design

Retrospective case series at a tertiary childrens hospital.

Results

There were 16 patients identified with CTS with a median range age at diagnosis of 2.5 months (0–9 months). One child died in the immediate post-operative period following a slide tracheoplasty, leaving 15 survivors. There were no later deaths during follow-up while using NIV for up to 3 years after surgery. Slide tracheoplasty was undertaken in (12/15) with long-segment tracheal stenosis. 3/15 patients had a short-segment tracheal stenosis and were managed conservatively. The use of NIV occurred in 10/15 (66.67%) patients, all of whom had long-segment CTS. Pre-operative polysomnography (PSG) showed a median (±SD) obstructive apnoea/hypopnoea index (OAHI) of 14.6/hr (±6.2) which reduced to 7.2/hour (±4.2) on NIV prior to slide tracheoplasty. The median oxygen desaturation index (ODI) before NIV use was 15.3 (±19.4) episodes/hour, which reduced to 6.3 (±11) on NIV. The median period of NIV use was 5 1–24 months months.

Conclusion

Patients with CTS have obstructed sleep disordered breathing. Trials of NIV are well-tolerated and improve sleep disordered breathing.

Developing a functional assessment tool for the auditory performance of Arabic-speaking Egyptian hearing impaired children

20-09-2019 – Sara Elawady, Omayma Afsah, Wessam Elshawaf, Tamer Abou-Elsaad

Journal Article

Background

Auditory performance outcome of children with hearing impairment has been widely studied, and the related factors of the performance have been explored among different age groups for English speaking hearing impaired children.

Objectives

The objective of this study was to construct Arabic questionnaires for the evaluation of the auditory abilities of hearing impaired Egyptian Arabic-speaking children.

Methods

Three Arabic questionnaires targeting the auditory abilities were constructed by selecting items from different English-based questionnaires and translating them into Arabic and adapted to Egyptian culture. The questionnaires were administered to 210 Arabic-speaking Egyptian children in the age range 1–12 years who were divided into three age groups. They included 90 hearing impaired children fitted with hearing aids and 30 hearing impaired children with a cochlear implant and 90 children with normal hearing (as a control group). Participants responses were statistically analyzed to assess the validity and reliability of the questionnaires and to compare hearing impaired children with normal hearing children.

Results

There were non-significant differences between cochlear implanted children and children with hearing aids regarding auditory abilities performances. Language age and aided pure tone audiometry were considered the best predictors of auditory abilities of hearing impaired Egyptian children.

Conclusion

The constructed Arabic questionnaires proved to be reliable and valid functional assessment tools that provide information about auditory behaviors of hearing impaired Egyptian children in everyday life and would complement other objective test results in evaluating and monitoring the performance of these children.

Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management

19-09-2019 – Emma S. Campisi, Jane E. Schneiderman, Blythe Owen, Theo J. Moraes, Paolo Campisi

Journal Article

Introduction

Exercise-induced laryngeal obstruction (EILO) affects 2–3% of the general population and 5.1% of elite athletes. Symptoms arise during high-intensity exercise and resolve at rest. EILO is often misdiagnosed as exercise-induced asthma as both conditions can present with dyspnea, chest tightness and cough. The purpose of this quality initiative was to identify patient characteristics that predict a higher likelihood of EILO, streamline referrals for exercise-endoscopy testing and avoid unnecessary medications.

Methods

A retrospective chart review included patients referred to a pediatric tertiary center between 2013 and 2018 for suspected EILO requesting exercise endoscopy. Data was collected from the patient chart and referral letters included age, sex, physical activity, medications, symptoms, and results of pulmonary and cardiac function tests.

Results

Between 2013 and 2018, 35 patients (9 males and 26 females, aged 5–18 years) were referred. Only 18 patients developed symptoms during an exercise endoscopy test. The majority were female (15/18), older than 10 years (18/18) and were involved in competitive sports (16/18). Stridor was the most common complaint among all patients referred (24/35) and many reported anxiety and high stress (15/35). The majority (63%) were previously treated with asthma medication. Pulmonary and cardiac function testing was not predictive of EILO.

Conclusion

EILO is typically present in adolescent females involved in competitive sports. Anxiety and high stress was commonly noted. The majority were treated with asthma medication even though pulmonary function testing was normal. Recognition of this patient profile should improve timely access to appropriate diagnostic assessments, avoid unnecessary medical treatment, and promote a return to optimal athletic performance.

Evaluation of nasal obstruction in children by acoustic rhinometry: A prospective study

19-09-2019 – Léa Distinguin, Bruno Louis, Geneviève Baujat, Alessandro Amaddeo, Brigitte Fauroux, Vincent Couloigner, François Simon, Nicolas Leboulanger

Journal Article

Introduction

acoustic rhinometry (AR) is a non-invasive method measuring the nasal volume (NV) and the nasal minimal cross-sectional area (MCA), reflecting nasal obstruction. The first objective of this study was to measure and compare NV and MCA between 3 groups of children: “achondroplasia”, “Down syndrome” and “control”. The control group corresponded to children with suspicion of sleep disorder disease and without cranio-facial malformation. The second objective was to correlate AR measurements with the obstructive apnea-hypopnea index (OAHI).

Methods

prospective study between February and July 2017, in a tertiary care center. The following data were collected: demographic characteristics, medical and surgical history, NV, MCA, and OAHI.

Results

83 children were included. The mean NV was lower in achondroplasia group compared to control group: 2.75 cm3 vs 3.60 cm3 (p = 0.02, 95% CI 0.0694, 0.7456). Negative correlation was found between the NV and the OAHI for children with achondroplasia (T = −0.37; p = 0.02).

Conclusions

AR is an effective tool for assessing nasal obstruction in children. Nasal obstruction was correlated to OAHI in achondroplasia. AR could become a routine tool in the management of nasal obstruction of children with cranio-facial malformations.

Analysis of phonological criteria in Egyptian Arabic speaking children using cochlear implant

19-09-2019 – A.S. Quriba, E.M. Hassan

Journal Article

Objectives

The purpose of this study is to assess the most common segmental and supra-segmental phonological criteria of the Egyptian Arabic speaking children using CI. This may lead to; better understanding of speech progress and planning individualized therapy programs for these children.

Methods

This study included 43 children using cochlear implant (23 males and 20 females), from the clients of the phoniatric unit of ORL Department Zagazig University, at the period from September 2017 to April 2019. The age ranged between 4 to 10 years old. All children had assessments of their language and speech features (phonological patterns, segmental and supra-segmental) and speech intelligibility, then the results were collected and statistically analyzed.

Results

The participants of the study exhibited many types of developmental patterns; e.g., Cluster reduction, final consonant deletions, assimilation and substitutions. There were also fewer incidences of non-developmental phonological patterns. The sequence of acquisition of segmental phonological development revealed the following sequence: Bilabial sounds acquired first (oral /b/ before nasal /m/), then lingu-alveolar, then fricatives, then velar and back sounds and lastly laterals and glides. All studied segmental, supra-segmental features and speech intelligibility were correlated with the CI usage period.

Conclusion

The speech of the Egyptian CI children shows many developmental phonological patterns as well as non-developmental ones. The sequence of phonemic development revealed that anterior sounds precede posterior ones, oral sounds precede nasal ones and stops precede fricatives. Glides and laterals showed very late acquisition. All segmental and supra-segmental disturbances improved gradually with regular use of CI and attending speech therapy plans.

Normative data on nasalance scores for Farsi speaking children: Influence of age, gender and phonetic context

20-09-2019 – Reihane Saber-Moghadam, Maryam Faham, Fatemeh-Sadat Ghavami, Zahra Ghayoumi-Anaraki

Journal Article

Background

Normative nasalance scores are essential for treatment and assessment purposes for clinicians. The purpose of the current study is to determine the normative data on nasalance scores for Farsi speaking children. Comparing to the obtained normative data, hypernasal or hyponasal speech (i.e. the higher or lower nasalance score) can be evaluated.

Methods

Ninety-six Farsi speakers ranging from 4 years to 11 years old with typically developing speech were included in this study. Mean nasalance scores were obtained using the Universal Parameters System sentences with nasometer II (model 6450). The nasalance data was also analyzed for any gender, age and phonetic context dependence.

Results

Normative nasalance values were determined, Nno differences were found for gender and age for the school-aged children. With an increasing in age, the nasalance score also increased in oral passages but not in nasal passages. Furthermore, amongst the nasalance scores there was a significant difference between these four categories of sentences: 7 sentences loaded with oral stop consonants, 5 sentences loaded with oral fricative consonants, 2 sentences loaded with oral affricatives and 3 sentences loaded with nasal consonants.

Conclusions

The absence of age and gender differences led to a computation of an overall mean nasalance score for different types of phonetic context (Nasal, oral and oronasal). These normative nasalance data for Farsi speaking children will provide important reference information during speech assessments of children with velopharyngeal insufficiency.

Index of pediatric voice handicap: Translation, transculturalization and validation to Argentinian Spanish

19-09-2019 – Sandra M. Carrera Fernández, Paula Gabaldon Massé, Fabiana Wilder, Diego Preciado, Hugo A. Rodriguez

Journal Article

Objective

Voice disorders are very common in the pediatric population, with 6% and 23% of all children presenting with some form of dysphonia 1,2. For many years, these patients have been underdiagnosed. There has been increasing awareness and interest in the study of voice alterations in children, and, most importantly, their impact in their quality of life. To do this, an instrument capable of measuring the quality of life in pediatric patients with vocal pathology is required, which can be used extensively in the scientific community. The objective of our study is to carry out the translation, transculturalization and validation of p
VHI (Pediatric Voice Handicap Index) to Argentinian Spanish-speakers.

Material and methods

A study was carried out in the Hospital de Pediatria Dr. JP Garrahan in the city of Buenos Aires, Argentina. It included patients between 3 and 18 years old. The p
VHI was translated and transculturalized for said population and for its validation, a survey was carried out in two groups of patients: one group being children with a background of both reconstructive larynx surgery, and dysphonia (n = 35) and the other group being control patients, without any voice pathology (n = 35). The survey was conducted among either parents or caregivers of the children in question.

Results

A significant difference was found between both groups, for both overall p
VHI score and survey subgroups score (p < 0.001) with an optimal internal confidence and a good Alpha Cronbach for each of the subgroups (functional 0,92; organic 0,87 and emotional 0,88). Test-retest for reliability revealed “p-values” without any significant difference (p > 0.05) for each of all subgroups (functional 0,68; organic 0,32 and emotional 0,72).

Conclusion

The validation and transculturalization of the rate of pediatric vocal impairment to Argentinian Spanish population presented an adequate validity and reliability. The rate of pediatric vocal impairment was identified through this simple and practical survey, offering additional information on the childs own vocal perception by part of the caregiver. We recommend this survey being included as a valuable tool in the evaluation of pediatric dysphonia in Spanish-speaking families.

Age-related causes of emergency department visits after pediatric adenotonsillectomy at a tertiary pediatric referral center

19-09-2019 – Nathan R. Lindquist, Zipei Feng, Ankita Patro, Shraddha S. Mukerji

Journal Article

Introduction

The complications of tonsillectomy and adenoidectomy (T&A) are well-described and include bleeding, dehydration, nausea, respiratory complications, and pain. After the immediate postoperative phase, the overall 30-day emergency department (ED) return rate is as high as 13.3%. However, few studies have examined the types and rates of late post-operative complications for children undergoing T&A stratified base on patient age. Herein, we aim to better characterize ED return visits for children of all ages, with special attention to those patients under three years of age.

Methods

This is a retrospective case series at a tertiary academic pediatric medical center. All patients 18 years of age or younger who underwent T&A over eighteen months were included. Data including ED return diagnosis, post-operative day of presentation, and need for surgical intervention was recorded for patients who presented to the ED within 30 days of their original surgery.

Results

5,225 patients were identified, with an overall late complication rate of 12.8%. There was no difference in the 30-day ED readmission rate for children under the age of three, although children under the age of two were more likely to present to the ED. There was a significantly higher risk of dehydration for children under the age of four years, and a significantly higher bleeding risk and need for reoperation for control of post-tonsillectomy hemorrhage (PTH) for children over the age of six.

Conclusions

The overall ED visit rate in this study is 12.8%, with no difference based on age. Patients younger than three years of age are more likely to return to ED for dehydration, while bleeding and need for control of oropharyngeal hemorrhage is more common in older children. Knowledge of the age-related late complications of T&A may direct appropriate anticipatory peri-operative counseling of risks and return precautions.

Referral rates for newborn hearing screening based on the test time

16-09-2019 – You Sun Chung, Seung-ha Oh, Su-Kyoung Park

Journal Article

Objectives

To suggest the optimal timing for newborn hearing screening to obtain an ideal and stable referral rate in well babies and in babies in neonatal intensive care units (NICU).

Methods

This study analyzed nationwide hearing screening data of 71,596 newborns in the low-income families who received support from the government in 2017. The referral rate for neonatal hearing screening, based on the period from birth to screening, was compared in well babies (n = 68,206) who were born healthy or hospitalized in the NICU for < 5 days and moved to a well-baby nursery and babies (n = 3,390) who were in the NICU for ≥ 5 days.

Results

In well babies, most screenings (73.1%) were performed in the first three days of life. Most babies (74%) in the NICU underwent screening within the first 20 days after birth. The referral rates for babies at 32–60 days after birth differed from those of other screening days, except for the rates at 21–31 days after birth. Referral rates for NHS at > 60 days after birth were significantly higher than those for other periods in babies overall. However, the incidence of hearing loss according to age did not differ significantly within or between groups.

Conclusions

Referral rates based on the period from birth to screening were significantly different between well babies and NICU babies. To reduce and ensure stable referral rates, we recommend that the hearing screening be performed between 2 and 20 days after birth for well babies and between 5 and 31 days after birth for NICU babies.

Identification of different clinical faces of obstructive sleep apnea in children

15-09-2019 – Yunxiao Wu, Guoshuang Feng, Zhifei Xu, Xiaodan Li, Li Zheng, Wentong Ge, Xin Ni

Journal Article

Objective

This study aimed to identify the heterogeneity of obstructive sleep apnea syndrome clinical presentation in children.

Participants

Children who were 3–14 years old and with obstructive sleep apnea syndrome after polysomnography monitoring (apnea and hypopnea index>5 or obstructive apnea index>1) in the sleep center of Beijing Childrens Hospital were included.

Methods

A sleep disorder questionnaire including different combinations of symptoms and co-morbidities of obstructive sleep apnea syndrome in children was used. A cluster analysis was used to classify the data.

Results

The apnea hypopnea index alone is not adequate to predict clinical phenotypes. Based on symptoms and co-morbidities of obstructive sleep apnea syndrome, three distinct clusters were identified. They were “nocturnal snoring and daytime sleepiness group” (cluster 1), “hyperactivity group” (cluster 2), and “minimally symptomatic group” (cluster 3). A prediction model was built according to eight variables which showed statistical significance by pairwise comparison among clusters. Overall accuracy of the prediction model could reach 86%. Both the sensitivity and specificity of cluster 2 and 3 prediction were around 90%.

Conclusion

Children with obstructive sleep apnea syndrome have different patterns of clinical presentation and the identification of the different clinical profiles of obstructive sleep apnea syndrome can provide clues for more personalised diagnoses and therapies.

Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings

14-09-2019 – Justin R. Shinn, M. Geraldine Zuniga, Ian Macharia, Jim Reppart, James L. Netterville, Asitha D.L. Jayawardena

Journal Article

Objective

To establish community health workers as reliable hearing screening operators in a technology-based pre-surgical hearing screening program in a low and middle-income country (LMIC).

Methods

This is a cross sectional study that evaluated community health worker driven hearing screening that took place in semi-rural Malindi, Kenya during an annual two-week otolaryngology surgical training mission in October 2017. At five separate locations (four schools) near Malindi, Kenya, children between the ages of 2–16 underwent hearing screening using screening audiometry (Android-based Hear
X Group). Children were screened by a community health worker who underwent a short training course, a senior otolaryngology resident, or both. Hearing screening results were compared to determine the reliability and concordance between independent, blinded community health worker and otolaryngology resident testing.

Results

One hundred and four participants (53% males) underwent hearing screening. Hearing screening pass rate was 93%. Community health workers obtained a similar result to otolaryngology residents 96% of the time (Mc
Nemar test: p = 0.16, OR 0.96, 95% CI 0.9–1.0).

Conclusion

Community health workers can obtain reliable results using a technology-based, pre-surgical hearing screening platform when compared to otolaryngology residents. This finding has profound implications in low-resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited and can ultimately improve the surgical yield of patients presenting to local otolaryngologists in these settings.

To drain or not to drain following a Sistrunk procedure: A dual institutional experience

09-09-2019 – Jennifer A. Brooks, Michael J. Cunningham, Jeffrey A. Koempel, Kosuke Kawai, Jonathan K. Huang, Rachel E. Weitzman, Beth Osterbauer, Amy L. Hughes

Journal Article

Introduction

A Sistrunk procedure is the standard operative management of patients with thyroglossal duct cysts. Drain placement is commonly employed with the goal of reducing postoperative complications. This study investigates the association between drain use and relevant postoperative complications following pediatric Sistrunk procedures.

Methods

Retrospective cohort study evaluating 295 pediatric patients treated between 2007 and 2016 at two tertiary care childrens hospitals.

Results

The mean age of the study population was 5.6 years (SD 4.0). A drain was utilized in 234 cases (79.3%). The mean procedural duration was 108 min (SD 48), and significantly longer in patients receiving a drain. Early postoperative complications included seroma (5.8%), secondary infection (3.4%), wound breakdown (2.0%) and hematoma (0.3%). The risk of such complications did not significantly differ between patients without drain placement (9.8%) versus those who underwent surgical drain placement (12.0%) after accounting for age and history of preoperative infection (adjusted RR = 0.86; 95% CI: 0.37, 1.98; p = 0.72). In the subgroup analysis, findings were consistent across institutions, age category, history of infection, and primary versus secondary procedure.

Conclusion

This dual institutional study found drain placement during a Sistrunk procedure may not reduce rates of common postoperative complications, even in longer duration cases in which a drain is more frequently placed. This data suggests a Sistrunk procedure may be safely performed without drain placement in select cases.

Pharyngeal dysfunction associated with early and late onset sleep disordered breathing in children

10-09-2019 – Marie Lyons, Timothy Cooper, Dominic Cave, Manisha Witmans, Hamdy El-Hakim

Journal Article

Objective

To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB).

Methods

This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared.

Results

73 patients with early onset SDB were identified (51 boys, mean age 2.25 ± 0.64 years, range 1.75–3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ± 2.40 years and 8.04 ± 3.34 years respectively (range 4–16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups.

Conclusion

Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.

The influence of cochlear implantation on aggression behaviors in children

09-09-2019 – Nader Saki, Arash Bayat, Somayeh Moniri, Nahid Khajeh Moogahi

Journal Article

Objective

It has been suggested that children with higher degree of hearing loss may show more severe externalizing (e.g., aggression) and internalizing (e.g., depression and anxiety) behavioral problems compared to that of their normally hearing peers. The purpose of this study was to investigate the influence of sound amplification through cochlear implants (CIs) on aggressive behaviors in Persian children.

Methods

During a prospective study design, 72 children (40 girls, 32 boys) who underwent unilateral implantation and 72 (40 girls, 32 boys) age-matched normally hearing children (control group) participated. All CI children had age of <4 years at the time of implantation. The Aggression Scale for Preschoolers (ASFP) was utilized to measure various types of aggression including verbal aggression, physical aggression, relational aggression, and impulsive anger. The speech performance of children was also evaluated using Speech Intelligibility Rating (SIR). The ASFP and SIR measurements were conducted at the pre-implantation phase and at 6, 12, and 18 months post-implantation period.

Results

A repeated measures analysis of variance showed significant reduction in ASFP scores from “pre-operation” to “post-operative” conditions in CI group. However, aggression level in CI recipients were significantly higher than children in control group. In the analyses of ASFP subscales, we found a reduction and a consequent improvement in verbal aggression, physical aggression and impulsive anger. However, no significant difference was found in relational aggression across various time intervals. Furthermore, children who received CI before 2 years old exhibited better aggression level than children who received their devices at later ages. The significantly negative correlation (r = −0.76, p < 0.001) was found between the SIR and ASFP scores, so that lower speech intelligibity ability scores were associated with more aggressive behavior problems.

Conclusion

This study suggests that young children with noticeable degree of hearing loss may experience higher level of aggression compared to normally hearing peers. However, when they undergo early implantation and attend at regular post-operative rehabilitation programs, their aggression status will improve seriously.

High-frequency otoacoustic emissions in universal newborn hearing screening

08-09-2019 – Olubunmi V. Akinpelu, W. Robert J. Funnell, Sam J. Daniel

Journal Article

Objective

Distortion-product otoacoustic emissions (DPOAEs) are currently used in many newborn hearing screening programs as the initial hearing test, typically testing frequencies between 1 and 4 or 6 k
Hz, but they have been associated with high false-positive rates. The objective was to investigate the possible benefit of high-frequency DPOAEs for reducing false-positive rates.

Methods

255 healthy newborns (138 males and 117 females) undergoing conventional hearing screening based on DPOAE and automated auditory brainstem response (AABR) testing were recruited. High-frequency DPOAE amplitudes, noise floors and signal-to-noise ratios (SNRs) were measured for f2 frequencies up to 12 k
Hz.

Results

Of the 255 newborns who participated in this study, 23 (9%) failed the conventional DPOAE test but passed the AABR test, and 8 (3%) failed both tests. For an SNR threshold of 6 d
B, high-frequency DPOAE tests at f2 = 4, 6, 8 and 10 k
Hz resulted in a reduction in the false-positive rate from 9% to 0.4%, or to zero if only three of the four frequencies were required to exceed the threshold. SNRs were lower in newborns with birth weights greater than 4000 g; lower at 2 k
Hz in newborns with a gestational age of 41 weeks; slightly higher in vaginally-delivered newborns; and higher at 2 k
Hz with increasing age in the group that failed the conventional DPOAE test but passed AABR.

Conclusion

High-frequency DPOAEs resulted in a reduction in the DPOAE failure rate and the false-positive rate. These findings may be helpful in universal newborn hearing screening programs.

Surgical management of midline cervical cleft

07-09-2019 – Jill N. DSouza, Taher Valika, John Maddalozzo

Journal Article

Introduction

Midline Cervical Cleft (MCC) is a midline cervical congenital anomaly that manifests as a vertical cutaneous/subcutaneous defect with abnormal dermal elements as well as an underlying fibrous cord that extends from the sternum to the mentum of the mandible, which can lead to “wry neck” and hypoplastic mandible. The goal of surgical correction of MCC is to provide adequate healthy tissue coverage, as well as restore contour of the anterior neck. The primary treatment modality for midline cervical cleft is surgical. We describe a technique involving complete excision of the fibrous cord, and use of double z-plasty flap in order to create a tension-free closure and restore contour to the anterior neck.

Methods

Using a database search method, children with the clinical diagnosis of midline cervical cleft treated between 2006 and 2016 were identified at a pediatric tertiary care center. Chart review was completed to assess for age at surgery, follow up, results, and complications.

Results

12 patients were identified in the Lurie Childrens Hospital (LCH) database. 8 patients underwent complete cord excision by the seniorauthor using the double z-plasty (DZ) technique for closure, with no recurrences. 4 patients underwent linear closure by another surgeon, had persistent contracture, and underwent revision using the DZ technique by the senior author, with no recurrence. Average age of surgery was 9.5 months. Most common post op complication was hypertrophic scar (3/12). Recurrence was only seen in the linear closure cases (4/12).

Conclusions

Midline Cervical Cleft is a rare entity with less than 200 cases in the literature. We believe the double z-plasty closure and complete excision of the fibrous cord results in reproducible restoration of neck contour and prevents cord recurrence, and should be considered the standard method for surgical excision of MCC.

Characterization of acute otitis media otopathogens before the introduction of the pneumococcal conjugated vaccine into the national immunization program in Poland

07-09-2019 – Aneta Górska–Kot, David Greenberg, Karolina Gastoł, Adam Zieliński, Noga Givon-Lavi

Journal Article

Background

Bacterial etiologic data for acute otitis media (AOM) otopathogens in Poland are scarce. The aim of this study was to determine the bacterial etiology and antibiotic susceptibility patterns of otopathogens in children prior to the introduction of the pneumococcal conjugated vaccine (PCV) into the national immunization program (NIP) in Poland.

Methods

Demographic and laboratory data of children < 5 years old who underwent tympanocentesis due to AOM in Nieklanska Hospital Warsaw between 2010 and 2016, were collected. All middle ear fluids (MEF) cultures were processed at the hospital according to conventional culture methods.

Results

Out of 940 MEF cultures, 407 (43.3%) were positive for 419 isolates. The most common etiologies of positive cultures were: S. pneumonaie, nontypeable H. infuenzae (NTHi), and S. pyogenes. Children aged 12–23 months had significantly more S. pneumoniae and NTHi positive cultures than children <12 months of age. S. pneumoniae isolates non-susceptible to penicillin, erythromycin, and clindamycin, declined over the study period (2010–2016).

Conclusions

This is the largest dataset of MEF isolates from AOM patients in Poland, collected during the pre-PCV period. These data can help determine the appropriate treatment for AOM patients and can serve as a baseline for the period before the introduction of PCV to the NIP in Poland.

Quality of life in paediatric tracheostomy patients and their caregivers – A cross-sectional study

09-09-2019 – Elizabeth L. Westwood, Jane V. Hutchins, Ravi Thevasagayam

Journal Article

Objectives

(1) To better outline quality of life outcomes in paediatric tracheostomy patients and their caregivers. (2) To establish whether quality of life outcomes for children are associated with those of their caregivers. (3) To establish whether quality of life outcomes were associated with the demographic and clinical variables of age, duration of time with a tracheostomy, number of comorbidities, and ventilator dependence.

Methods

Cross-sectional methodology was applied to gather quantitative data on quality of life outcomes, through Peds
QL written questionnaires. These questionnaires covered social, emotional, physical and role/cognitive functioning. Caregivers also provided information on communication, worries, daily activities and family relationships. All children with a tracheostomy in situ, or recently decannulated, attending Sheffield Childrens Hospital during the study period were eligible for inclusion.

Results

25 families wished to participate, with patients ranging from 0.5 to 16.5 years (median 6.25). Both patients and caregivers attained lower scores than many other chronic diseases studied. Mean patient HRQoL was 56.2, with a physical health score of 52.4, psychosocial health score of 61.7. Caregiver HRQoL was 63.8, family functioning score was 68.1 and total family impact score was 61.6. Relative deficits were seen in caregiver social functioning (54.9), communication (56.3), worries (49.1) and daily activities (48.9), whilst role/cognitive functioning (73.8) and family relationships (79.6) subsections produced higher scores. Child psychosocial health showed moderate positive correlation (r = 0.492, p = 0.015) with both caregiver HRQoL and total family impact score. No correlation was identified between quality of life outcomes and demographic or clinical variables.

Conclusions

Disease burden appears to be particularly high for children and families with tracheostomies, especially when compared to other serious childhood disease. Lack of time and energy to complete daily activities, social isolation, worries, as well as difficulty communicating and perceived lack of understanding of their childs health were instrumental in reduced quality of life of caregivers. Anxiety about the future affected the majority of caregivers. This psychosocial impact may be lost in the busyness of delivery of medical care. We recommend provision of psychosocial support for these families as is now also recommended in other chronic childhood illness.

Outcomes with non-sedated MRI for infants with sensorineural hearing loss

04-09-2019 – Evette Ronner, Rochelle Reid, Razan A. Basonbul, Christen Caloway, Julie Arruda, Amy Fan-Yee Juliano, Michael S. Cohen

Journal Article

Effects of type 1 diabetes mellitus on efferent auditory system in children and adolescents

06-09-2019 – Nadja Braite, Luciene da Cruz Fernandes, Mara Renata Rissatto Lago, Crésio de Aragão Dantas Alves

Journal Article

Aim

To investigate whether type 1 diabetes mellitus (T1DM) could affect the efferent auditory system by analyzing the relationship between the activation of the medial olivocochlear reflex with disease duration, metabolic control and age at time of diagnosis.

Method

A total of 101 children and adolescents were evaluated. They were divided into two groups: 50 with T1DM and 51 without the disease. The participants answered a structured questionnaire containing questions about auditory complaints and were evaluated for tonal audiometry, tympanometry, acoustic reflex, otoacoustic emission by distortion product to evaluate the inhibitory effect of medial olivocochlear reflex (MOC).

Results

The participants with T1DM presented changed AR (increased or absent) at all the frequencies in both ears (p < 0.05) when compared with the group without the disease. No differences were found between the DPOAE amplitudes of the individuals with and without T1DM, in both ears at all the frequencies. There were significant differences in the activation of the MOC reflex between the groups with and without T1DM, the participants with T1DM presented the absence of the inhibitory effect of the DPOAE in the right and left ears, in the frequencies of 4000 Hz (p = 0.035/0.002respectively) and 6000 Hz (p = 0.033/0.031 respectively) and 8000 Hz (p = 0.007/0.001 respectively) when compared to the healthy group. Significant differences were also observed between the groups with and without T1DM (p < 0.05) for self-reported complaints of tinitus, difficulties with the perception of speech when there was noise and distraction with noise. No association was found between the hearing complaints and the audiological measurements obtained and disease time, metabolic control and age at the time of diagnosis.

Conclusion

The findings suggest the presence of early auditory dysfunction of the efferent pathway in patients with T1DM.

Pediatric obstructive sleep apnea screening questionnaire and post-operative outcomes: A prospective observational study

03-09-2019 – Vidya T. Raman, Emily Geyer, Rebecca Miller, Dmitry Tumin, Mark Splaingard, Kris R. Jatana, Joseph D. Tobias

Journal Article

Introduction

Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing (SDB) in children tend to be a more complex and multifactorial disease than in adults. Although adult screening tools, such as the STOP-BANG questionnaire, their application limited in pediatrics. We used our previously described 6-point questionnaire to identify OSA in children and evaluated its use for predicting post-operative respiratory events.

Methods

Children from 3 to 18 years of age presenting for surgery were eligible. Exclusion criteria were emergency surgery or refusal to participate. A 6-question survey regarding symptoms of OSA/SDB was administered preoperatively. Neck circumference was measured. Height and weight were recorded from preoperative data and the body mass index (BMI) percentile obtained.

Results

749 patients were enrolled in the study. 707 patients were in the final analysis (359 boys and 348 girls, mean age 12 ± 4 years). The median 6-item questionnaire score was 1 (interquartile range: 0, 2) and 186 (26%) scored ≥ 2 of 6 points. Children with predicted OSA (yes on ≥ 2 questions) were more likely than without predicted OSA to require supplemental oxygen in the PACU (24% vs. 17%; 95% confidence interval CI of difference: −0.3%, 13%; p = 0.049). Amongst 681 patients with available data on Post Anesthesia Care Unit (PACU) length of stay (LOS), prolonged LOS (>1 h) was not more likely among children with predicted OSA (42%) compared to those without predicted OSA (39%; 95% CI of difference: −5%, 11%; p = 0.479). Outcomes assessed after PACU discharge noted no differences. Specifically, overnight hospital stay was required in 33% of patients with predicted OSA as compared to 29% of those without (95% CI of difference: −4%, 11%; p = 0.399). On POD 0, supplemental oxygen was used on the inpatient ward for 6% of patients with predicted OSA compared to 4% of patients without predicted OSA (95% CI of difference: −2%, 6%; p = 0.272).

Conclusion

The incidence of OSA/SDB is under-appreciated in children presenting for non-otolaryngological surgical procedures. Although patients judged to have OSA on the 6-item question may need for supplemental oxygen longer in the PACU, no other outcomes differences were noted.

Second primary cancers in pediatric head and neck cancer survivors in Denmark during 1980–2014: A nationwide study

01-09-2019 – Jakob Schmidt Jensen, Christian Grønhøj, Eva Kristine Ruud Kjær, Birgitte Wittenborg Charabi, Christian von Buchwald, Thomas Hjuler

Journal Article

Introduction

The survival among children with cancer has improved considerably the past decades. Consequently, more children are at risk of second primary cancers (SPC). This study aimed to investigate the incidence of SPC among pediatric head and neck cancer (HNC) patients.

Methods and materials

Data on children aged 0–17 years registered with a HNC in the Danish Registry of Childhood Cancer and the Danish National Patient Registry during the period 1980–2014 was obtained. SPC was defined as registration with any second malignancy that was not simultaneous with the first primary cancer (FPC) or a relapse hereof. All information was validated through review of medical charts. Standardized incidence rates (SIR) were calculated using the average incidence of all cancers in the general population of Denmark during the study period as reference.

Results

Among 234 pediatric HNC patients, six patients (four females) were registered with a SPC (2.6%), corresponding to an overall SIR of 4.8. No patients were diagnosed with more than one SPC. The median age at FPC and SPC was 15.2 years (range 9–16 years) and 35.0 years (range 19–41 years). The most common tumor histology and location among the patients with SPC was nasopharyngeal lymphoepithelial carcinoma for FPC and basal cell carcinoma of the skin for SPC.

Conclusion

During 1980–2014 we identified six cases of SPC among 234 pediatric head and neck cancer patients in Denmark, corresponding to an overall SIR of 4.8.

Early detection of neonatal hearing loss by otoacoustic emissions and auditory brainstem response over 10 years of experience

31-08-2019 – Fredy A. Escobar-Ipuz, Carmen Soria-Bretones, María A. García-Jiménez, Elisa M. Cueto, Ana M. Torres Aranda, Jorge Mateo Sotos

Journal Article

Objectives

A number of different screening protocols for detecting neonatal hearing loss currently exist. We present our 10 years of experience with using auditory brainstem response (ABR) complementary to otoacoustic emissions (OAEs) in the three phases hearing screening process in our hospital. Furthermore, we want to demonstrate the usefulness of these screening techniques used in combination, that remain valid to identify cases of neonatal hearing loss and meet the well-established program quality criteria for these screening protocols.

Methods

Data were collected retrospectively from patient record forms completed on 9698 newborns from 2007 to 2017. The screening protocol for neonatal hearing loss in our centre is carried out in three phases. First phase, prior to discharge from the hospital, consists of carrying out the OAE evaluation on the newborn. Second phase is carried out in the paediatric consultation department. There, the newborns who did not pass the first phase are again studied with OAE. If this phase is not passed either, the child is referred to a third phase for the realization of ABR, in the clinical neurophysiology service. Newborns with risk factors for hearing loss, identified in the first phase, also go on to this third phase. When this hearing threshold exceeds 30 d
B, it is considered abnormal. Cases with abnormal ABR, has a re-test conducted within the next six months from the initial ABR assessment.

Results

A total of 9390 (97.1%) OAEs were performed during first phase, with 8245 newborns (87.8%) passing the screening test, while 1145 children (12.1%) presented an abnormal OAE and were included in the second screening phase. Second phase involving a repeat OAE examination performed on 1077 newborns (94%). In this second phase, 941 newborns (87.3%) passed the test. Nevertheless, 136 newborns (12.6%) failing the retest and were referred to continue on to phase three. Furthermore, 181 newborns (1.8%) presented high-risk factors at birth and were also included in this third phase. However, in the registries of children referred to this phase, only 255 (80%) ABR evaluations were confirmed. In total, 227 newborns (2.3%) were missed from the first to third phases of the screening process. According to the database of the clinical neurophysiology service, ABRs evaluations were performed in 352 newborns referred between December 2007 and December 2017. Of this sample, 38.9% were boys and 61.1% were girls. From among cases underwent ABR, 34% of newborns did not pass the OAEs. The most common risk factor was prematurity (with admission to the neonatal intensive care unit for more than five days), affecting 28%. Abnormal ABRs waveforms were found in 43.9%, with 12.3% having a sensorineural hearing loss, 26.5% showing mixed hearing loss and, conductive hearing loss being present in 61.9%. Considering sensorineural hearing loss and other types of severe hearing loss, affected patients constituted only 1.7% of the total number of individuals studied. Finally, regarding quality control of the program participation in the first phase of care included 97.2% of all newborns, yielding a third phase referral rate of 2.9%, confirmation of a diagnosis before the fourth month of life in more than 90% of cases with an average of 3.4 months of age, and a hearing impairment detection rate as an outcome indicator of 4.5%.

Conclusions

Our data are similar to those of previous studies on screening for hearing loss in newborns. We have demonstrated the advantages of carrying out this protocol in three phases using the otoacoustic emissions together with auditory brainstem response, diagnostic tools that remain as a Gold Standard. Also, we want to highlight and demonstrate the importance of interdisciplinary coordination between the paediatric and clinical neurophysiology services in the implementation of this screening protocol. The foregoing has allowed us to comply with the proposed quality indicators, reaching coverage percentages of more than 95%, confirming the diagnosis of hearing loss within the first six months of life and making timely referrals to benefit the newborns with hearing impairment by way of treatment and follow-up in the early stages of development, avoiding future disabilities.

Lipopolysaccharide disrupts the cochlear blood-labyrinth barrier by activating perivascular resident macrophages and up-regulating MMP-9

31-08-2019 – Ying Jiang, Jie Zhang, Yufang Rao, Junhong Chen, Kai Chen, Yuedi Tang

Journal Article

Objective

To determine the distribution of perivascularresident macrophages (PVMs) in BLB and their relationship with capillaries, and to explore the possible mechanisms responsible for lipopolysaccharide (LPS)-induced activation of PVMs and the breakdown of BLB.

Methods

Adult Balb/c mice were either trans-tympanically injected with LPS, or mock-treated. Auditory brainstem response was tested before and 48 h after treatments. Distribution of pericytes, PVMs and capillaries was analyzed by immunohistochemical staining, and BLB permeability was estimated by FITC-dextran leakage assay. Ultrastructure of stria vascularis was examined by transmission electron microscope. Protein and m
RNA level of matrix metallopeptidase 9 (MMP-9), zona occludens-1 (ZO-1), interleukin-33 (IL-33) and its receptor suppression of tumorigenicity 2 (ST2) was measured by IHC and q
RT-PCR.

Results

Unlike pericytes that surround one capillary, PVMs branched to connect with more than one capillary. LPS caused hearing loss in mice. Following LPS challenge, cochleae showed vascular leakage in stria vascularis, and PVMs presented morphological changes including reduced contact with capillaries. TEM revealed a reduced number of tight junction contact points between endothelial cells and a wider space between PVMs, pericytes and endothelial cells. The m
RNA and protein levels of MMP-9 and ST2 in stria vascularis were up-regulated, while ZO-1 were down-regulated after exposure to LPS.

Conclusions

Our results suggest that PVMs may play a more significant role than pericytes in maintaining the integrity of BLB. Our findings also reveal a possible mechanism contributing to LPS-induced activation of PVMs, breakdown of BLB and hearing loss.

Unilateral acute cervical lymphadenitis in children: can we predict the need for surgery?

31-08-2019 – Ricardo Matos, Sónia Martins, Pedro Marques, Margarida Santos

Journal Article

Introduction

Paediatric acute cervical lymphadenitis is a frequent diagnosis in the emergency department. Traditionally, suppurative cervical lymphadenitis (SCL) is associated with a higher need of surgical drainage. However, a great variability in the management of this suppurative infections can be observed. Moreover, the clinical distinction between non-suppurative cervical lymphadenitis (NSCL) and SCL is not an easy task and there are, currently, no guidelines defining which patients are eligible for imaging study.

Objectives

To assess the determinants and benefits in the surgical management of SCL in children. As secondary outcome, to determine differences in epidemiological characteristics, clinical, biochemical and radiological features between NSCL and SCL.

Material and methods

A retrospective survey was carried out in a tertiary university hospital between January 2007 and December 2016. Forty-two children with a diagnosis of acute cervical lymphadenitis (ACL) were included and categorized according to the presence of suppuration, resulting in two groups: NSCL and SCL. The latter group was further categorized into surgical and non-surgical groups, according to the need of surgical drainage.

Results

No significant differences were found between SCL and NSCL groups in gender, age and previous antibiotics intake (p > 0.05). According to clinical presentation, odynophagia was significantly more frequent in NSCL patients (p = 0.01), with no differences found in other clinical parameters (p > 0.05). Patients presenting acute cervical lymphadenitis involving the submandibular region have 16 times the odds of a suppurative process (p = 0.029). In a SCL subgroup analysis, no association was observed between lymphadenitis size or location and the need for surgical drainage (p > 0.05). Children included in the SCL surgical group presented a trend to an increased in the hospitalization length (p = 0.01), when comparing to those in which treatment was limited to intravenous antibiotics. One death was observed in the SCL non-surgical group.

Conclusions

Predictive factors for the need of surgery were not found. Furthermore, surgical drainage was not associated with better outcomes. Surgery could be considered in selected stable patients, when alternative medical treatments do not seem to work, in a case-to-case basis.

Bacteriology and resistance patterns of otitis media with effusion

30-08-2019 – Hye Kyu Min, Seok Hyun Kim, Myung Jin Park, Sung Su Kim, Sang Hoon Kim, Seung Geun Yeo

Journal Article

Objectives

Following the increased use of antibiotics, the emergence of antibiotic-resistant species in pediatric patients with otitis media has become a problem in recent years. The aim of this study was to investigate change in bacterial species, antibiotic resistance, and detection rate of highly pathogenic species, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa according to the number of repeated ventilation tube insertion (VTI) procedures in pediatric patients diagnosed with otitis media with effusion (OME).

Materials & methods

From May 2010 to June 2018, 158 patients under 17 years of age who were admitted to the outpatient clinic of Kyung Hee Medical Center and diagnosed as OME and underwent unilateral or bilateral VTI were included in this study. Bacterial cultures were performed on aseptically collected middle ear effusion (MEF) at the time of VTI and antibiotic sensitivity tests were performed on the identified bacteria.

Results

Bacteria were not identified in 195 (70.1%) cultures and identified in 83 (29.9%) cultures. Coagulase-negative staphylococci (CNS) was the most frequently detected species in both the non-recurrent group and the recurrent group. MRSA detection rate was found to be significantly higher in the recurrent group than in the non-recurrent group (p = 0.029). The two groups showed no significant difference in antibiotic resistance against all antibiotics (p > 0.05).

Conclusion

Staphylococcus species were detected most frequently in the MEF of pediatric OME patients, and the MRSA detection rate was higher in the recurrent group than in the non-recurrent group. There was no difference in antibiotic sensitivity between the two groups against all antibiotics, but resistance to penicillin G and cefoxitin was newly appeared in patients with repeated detection of same bacterial isolates.

Neuromuscular electrical stimulation improves feeding and aspiration status in medically complex children undergoing feeding therapy

27-08-2019 – Steven M. Andreoli, Brooke L. Wilson, Catherine Swanson

Journal Article

Objectives

Neuromuscular electrical stimulation (NMES) therapy in the head and neck has been effectively used to rehabilitate swallowing in adult patients with acquired dysphagia. Limited data is available for the effectiveness of NMES in medically complex children with dysphagia and aspiration. This study intends to determine the efficacy of NMES as a therapeutic adjunct to improve aspiration and feeding status in medically complex children with severe dysphagia undergoing comprehensive speech and swallow therapy.

Study design

Case series.

Setting

Tertiary childrens hospital.

Subjects

and Methods: Medically complex children undergoing treatment for dysphagia using NMES during a three year period were included. Duration of treatment routinely ranged from 20 to 26 weeks. Demographic information, pre and post-NMES treatment aspiration status via modified barium swallow (MBS), and pre and post-NMES treatment feeding status were examined.

Results

15 medically complex children underwent NMES as a component of their feeding therapy. The mean age was 2.51 ± 3.20 years. Mean pre-treatment Functional Oral Intake Scale(FOIS) was 3.07 ± 1.94. Following NMES, FOIS improved to 4.47 ± 2.26 (p < 0.0001). Fourteen patients were evaluated with MBS prior to NMES. Pre-treatment aspiration and penetration were noted in 10 and 2 patients respectively. Two patients did not aspirate on pre-treatment MBS. Improvement was noted in 9 of 11 children with post-treatment MBS.

Conclusion

NMES was safely completed in all children without complication. Improvement in aspiration status was seen in 83.3% of patients with pre- and post-treatment MBS. Feeding status as measured by textures was advanced in all patients with a significant improvement in FOIS. Future prospective studies are required to investigate the specific role in children with acquired and congenital dysphagia.

Ex utero intrapartum treatment (EXIT) for fetal neck masses: A tertiary center experience and literature review

04-09-2019 – Sydney Jiang, Catherina Yang, John Bent, Christina J. Yang, Mona Gangar, Michel Nassar, Barrie Suskin, Peer Dar

Journal Article

Objective

Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery.

Methods

We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status.

Results

Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention.

Conclusion

With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.

Identification of a novel CDH23 gene variant associated with non-syndromic progressive hearing loss in a Chinese family: Individualized hearing rehabilitation guided by genetic diagnosis

25-08-2019 – Ying Chen, Yun Li, Yan Ren, Haifeng Li, Meiping Huang, Huan Jia, Tao Yang, Zhaoyan Wang, Zhiwu Huang, Hao Wu

Journal Article

Outcomes of primary myringoplasty in indigenous children from the Northern Territory of Australia

11-09-2019 – Stephen OLeary, Amelia Darke, Kathy Currie, Katie Ozdowska, Hemi Patel

Journal Article

Aim

To report the surgical and audiological outcomes of myringoplasty (Type I tympanoplasty) in Indigenous Australian children living in remote and regional communities in northern Australia.

Method

An observational cohort study, with prospective recording of the details of surgery. Audiological outcomes were collected independently, and these data were integrated in the present study. Children aged 5–18 year underwent myringoplasty in the Northern Territory during a program initiated by the Australian Government. Surgery was performed by surgeons drawn from across Australia.

Results

412 primary myringoplasties were performed. The mean age at surgery was 11 years. The tympanic membrane was closed in 64.2% of cases. Fascial grafting was associated with greater surgical success than cartilage. Dryness of the ear at surgery did not affect drum closure. Post-operative aural discharge was half that reported in historical literature. Surgical success was independent of the patients age at surgery. Post-operative audiograms were available on 216 cases. At last review, hearing had improved even when the operation was not a surgical success, with hearing aid candidacy falling from 84 to 34%. Hearing was similar irrespective of the size of the perforation at surgery or the graft used and did not change with the time between surgery and review. The best hearing was associated with drum closure and Types A or C tympanograms. A conductive hearing loss persisted after surgery that was greater when there was an immobile drum.

Conclusions

Indigenous children benefited from myringoplasty, even when the operation was not a “surgical success” as deemed by drum closure. There lower incidence of post-operative discharge from persistent perforations suggests an improvement in the ear health of the population. A persistent conductive loss persists, likely a consequence of the underlying disease but possibly from the surgery.

Quality of life outcomes following velopharyngeal insufficiency surgery

24-08-2019 – Lilun Li, David Strum, Stephen Larson, Diego Preciado

Journal Article

Objectives

Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life.

Methods

This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing childrens hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their childs quality of life post-VPI surgery.

Results

Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores.

Conclusion

Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.

Epidemiology of common otologic surgical procedures in pediatric patients: A population-based birth cohort study

24-08-2019 – Mao-Che Wang, Chia-Huei Chu, Ying-Piao Wang

Journal Article

Objective

It is generally recognized the most common pediatric otologic surgical procedure is ventilation tube insertion (VTI). Tympanoplasty and mastoidectomy are more frequently performed on adults. In this study we examined the incidence and age distribution of these procedures by use of a population-based birth cohort design, in order to provide an overall view of the role of these procedures in the pediatric population.

Materials and methods

We used the national health insurance research database in Taiwan. We retrieved data on all patients born in the years 2000 and 2001, subsequently underwent VTI, tympanoplasty or mastoidectomy from 2000 to 2013. The incidence and age distribution of these procedures were analyzed.

Results

The cumulative incidence of VTI, tympanoplasty, and mastoidectomy was 0.41%, 0.02% and 0.025%, respectively. VTI were more often performed on children 4 or 5 years of age. Tympanoplasties are frequently done on children older than 5, and 30.7% of them had earlier VTI. The time interval from VTI to tympanoplasty was 5.18 ± 2.27 years (mean ± SD). Mastoidectomies are more often performed on children from 2 to 9 years of age.

Conclusions

VTI was the most frequent otologic surgery for the pediatric population, and was more often performed on children 4–5 years old. Also, tympanoplasty is more frequently performed on children older than 5, and a third of them had prior VTI. Overall, the time interval from VTI to tympanoplasty was 5.18 years. Furthermore, children with cleft palate and congenital metabolic disorder were more prone to otologic surgical procedures.

Anti-IgE treatment in allergic rhinitis

19-09-2019 – Nuray Bayar Muluk, Sameer Ali Bafaqeeh, Cemal Cingi

Journal Article, Review

Objectives

To review the efficacy of anti-Ig
E therapy in allergic rhinitis (AR).

Methods

Literature search was performed using the PubMed and Proquest Central databases at Kırıkkale University Library.

Results

Although the skin prick testing in patients suffering from AR is positive (indicating that antigen-specific Immunoglobulin E has been produced), there is no association with overall circulating Ig
E levels. Correlation was lacking between circulating Ig
E level and either skin prick tests or laboratory testing for specific Ig
E. Omalizumab binds to uncomplexed Ig
E in man more avidly than does Fc-epsilon. The effect of omalizumab is to lower the level of Ig
E and downgrade production of Fce
RI receptors (which bind Ig
E) in mast cells and basophils, causing less mast cell recruitment and responsivity and thus diminishing eosinophilic infiltration and activation. Anti-Ig
E therapy through omalizumab may shorten the lifetime of mast cells and causes dendritic cells to downgrade their production of FcεRI. There are reports indicating benefit from omalizumab in managing food allergies, nasal polyp formation, essential anaphylaxis, AR, venom allergy and eczema. Omalizumab acts to lessen circulating Ig
E levels, whilst reducing production of Fce
RI by mast cells and basophils. The fact that omalizumab influences how eosinophils respond may be down to disruption of the antigen-Ig
E-mast cell interactions, with mast cells being recruited at lower levels and thus chemotactic eosinophilic recruitment via cytokines being greatly reduced. Omalizumab has the effect in cases of perennial AR of blocking the increased eosinophilic recruitment and tissue infiltration initiated by seasonal antigens. Likewise, in omalizumab-treated cases, circulating unbound Ig
E levels showed significant decreases. For patients with perennial AR, the average daily nasal severity score was significantly reduced where omalizumab was administered, compared to placebo.

Conclusion

Omalizumab has efficacy in ameliorating symptoms and reduces the necessity for additional medication in both seasonal and perennial allergic rhinitis

“Childrens and adolescents experiences of living with respiratory assistance: A systematic review of qualitative studies”

10-09-2019 – Jessica Crumpton, Jo Wray

Journal Article, Review

Objectives

To date, no review has focused exclusively on the childs reported experience of living with respiratory assistance. The objective of this study was to review empirical studies exploring childrens experiences and perceptions of living with respiratory assistance.

Methods

Literature searches (1980–2017) of databases (PubMed, Web of Science, Psyc
INFO and CINAHL) resulted in 1,750 references. Studies were included if they used qualitative methods to explore childrens (under 18 years) experiences of living with respiratory assistance, such as tracheostomies and/or those who were ventilator dependent. Studies that focused only on parents, carers or other family members perspectives, included only adults, used only quantitative methods or were not published in the English language were excluded. Reference lists of relevant studies were reviewed. Each study meeting criteria was reviewed and assessed and key themes were extracted and grouped.

Results

Seven studies were included in this review. Synthesis of the data identified four main themes: childrens understanding of respiratory assistance, identity, social experiences and service delivery. Most children recognised the important function of respiratory assistance on their physical health. They spoke of positive social experiences and some of the challenges they had experienced. Children discussed their experiences of healthcare providers in terms of what was helpful to them and provided suggestions, based on their experience, for future service provision.

Conclusion

This review identified the valuable contribution childrens perspectives make to the growing evidence-base in this area. Further in-depth explorations are needed to provide greater understanding about childrens experiences of living with respiratory assistance. Research exploring the journey of a young person with respiratory assistance is important in developing knowledge and service provision in this field.

Vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with sensorineural hearing loss: A systematic review

30-08-2019 – Renato S. Melo, Andrea Lemos, Giselle S. Paiva, Lucas Ithamar, Marília C. Lima, Sophie Helena Eickmann, Karla Mônica Ferraz, Rosalie Barreto Belian

Journal Article, Review

Background

Several studies have demonstrated that children with sensorineural hearing loss (SNHL) exhibit postural instabilities, as well as balance and gait disorders, due to the vestibular dysfunction that they are prone to display as a consequence of inner ear injury. Thus, some experiments have proposed vestibular rehabilitation exercises programs as a treatment to improve these motor skills in children with SNHL.

Objective

Assess the evidence quality of the trials that used vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.

Methods

This is a systematic review that surveyed articles in nine databases, published up to July 4, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants of both groups with clinical diagnosis of SNHL, aged up to 12 years old, with no physical problems, cognitive or neurological impairments, except the vestibular dysfunction. (3) Using vestibular rehabilitation exercises programs to improve the following outcomes: postural control, balance and/or gait.

Results

Six experiments, including 153 children, met the inclusion criteria of this systematic review. Two randomized controlled trials (45 children) on the postural control exhibited low evidence quality and four others; three randomized and controlled trials (90 children) on the balance and one quasi-randomized (18 children) on the gait demonstrated very low evidence quality, respectively.

Conclusion

There is promising evidence that vestibular rehabilitation exercises programs improve the postural control, balance and gait of children with SNHL. However, due to the methodological limitations of the trials and low quality of current evidence on this topic, the trials results analyzed by this systematic review should be interpreted with caution. Due to the low quality of evidence observed in this review, we suggest that new trials be proposed on this topic, with better methodological quality, to prove the effectiveness of vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.

Pediatric hard palate foreign bodies: Case report and Systematic review of the literature

27-08-2019 – M. Khalaf, H. Smaily, S. Rassi

Journal Article, Review

Introduction

Foreign body impaction in the pediatric hard palate is a rarely described otolaryngologic entity. It is often misdiagnosed as a neoplastic or an inflammatory lesion causing much stress to parents. The aim of this paper is to report a case managed in our department and to present a systematic review of the literature on pediatric hard palate foreign body impaction.

Case report

We present the case and the management of an impacted plastic screw cap in the hard palate of a 9 month-old boy.

Material and methods

Following the PRISMA guidelines, a systematic review was conducted in August 2019 using Medline and Embase databases. Included articles were reviewed for mean age at presentation, gender, presumptive diagnosis, time to removal, foreign body type, average size, anesthesia type and complications.

Results

32 reported cases were included. Foreign bodies were mistaken for other diagnoses in 24 cases. Mean duration from first presentation till removal was 56.9 days. Circular plastic covers were found in 20 cases. General anesthesia was used in 68% of the cases. No major complications were reported.

Conclusions

Foreign body impaction should be kept in the differential diagnosis of hard palate lesions in children. Up to date, this entity is still frequently misdiagnosed.

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