Pediatric Otolaryngology Trends In Patient Care Volume During Covid-19: A Survey Study, William R Pellegrini, Anna H Messner, Jessica R Levi

Faculty, Staff and Students Publications

PURPOSE: To assess changes in outpatient clinic, inpatient consult, and operative volumes among pediatric otolaryngologists in response to the COVID-19 pandemic.

MATERIALS AND METHODS: An online questionnaire was distributed to 535 active members of the American Society of Pediatric Otolaryngology from April 21, 2020, to May 4, 2020. The questionnaire assessed operative and clinical volumes during a two-week period between April 6, 2020, to April 20, 2020, while restrictions on elective surgery were in place, as compared to an average two-week period before the start of the COVID-19 pandemic.

RESULTS: Both outpatient clinic and inpatient consult visit volume decreased significantly …

Labial Frenotomy For Symptomatic Isolated Upper Lip Tie, Cecilia G Freeman, Jason F Ohlstein, Nicholas A Rossi, John B Mcintire, Luis D Neve, Shiva Daram, Harold S Pine

Faculty, Staff and Student Publications

BACKGROUND: The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties.

MATERIALS AND METHODS: Seven infants with isolated upper lip tie and breastfeeding difficulty were taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers …

Tonsillectomy In Children With 22q11.2 Deletion Syndrome., Jill M. Arganbright, Paul Bryan Hankey, Meghan Tracy, Srivats Narayanan, Janelle R. Noel-Macdonnell Phd, David G. Ingram Md

Manuscripts, Articles, Book Chapters and Other Papers

Tonsillectomy is one of the most common procedures performed in children, however there are currently no published studies evaluating tonsillectomy in children with 22q11.2 deletion syndrome (22q11DS). With this study, our goal was to investigate the indications, efficacy, and complications of tonsillectomy in a pediatric cohort of patients with 22q11DS. This is a retrospective chart review of patients in our 22q Center's repository. Inclusion criteria were a diagnosis of 22q11DS and a history of tonsillectomy or adenotonsillectomy. Data collected included: indications for tonsillectomy, preoperative and postoperative polysomnography (PSG) results, and surgical complications. In total, 33 patients were included. Most common …

Complications Of Pediatric Cochlear Implant Surgery, Andrew Stefan, Sabrina Bernardo, William Azkoul Ii, Bianca Siegel

Medical Student Research Symposium

Background:

Cochlear implantation (CI) surgery is the standard of care treatment for pediatric patients diagnosed with severe to profound sensorineural hearing loss. While considered a relatively safe operation, any invasive procedure involving the cranium has risks. However, there are few recent studies in the United States that have analyzed complication rates among children who have received CI. Furthermore, existing studies fail to discuss specific risk factors that led to post-operative complications, nor offer solutions to reduce their incidence. This study aims to 1) determine the incidence of specific complications in pediatric CI patients and 2) identify evidence-based risk factors for …

Endoscopic Cricoid Split As A Treatment For Subglottic Stenosis: A Systematic Review, Silvia Aluia, Katherine Akers, Michael Chung Md

Medical Student Research Symposium

Introduction: Subglottic stenosis, a fibrotic narrowing of the airway below the vocal cords extending to the lower border of the cricoid cartilage, can be classified as congenital, idiopathic, or acquired in neonates from prolonged intubation. Treatment has more recently expanded from open surgical intervention to include endoscopic procedures. This systematic review aims to evaluate existing literature on anterior and posterior endoscopic cricoid split procedures as a treatment for congenital and acquired subglottic stenosis in order to explore the efficacy of these techniques.

Methods: Literature searches were conducted in PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google scholar, which produced …

Outcome Of Newborn Hearing Screening Program In A Tertiary Care Centre, South India., S. Sija, V. K. Gireeshan, V. T. Ajith Kumar Professor And Head Of The Department, T. V. Rajesh Additional Professor

Journal of Early Hearing Detection and Intervention

Objective

To determine the coverage and outcome of Universal Newborn Hearing Screening (UNHS) Program in Government Medical College Manjeri, South India. To study the prevalence of hearing loss (HL) among those children screened, to describe the characteristics of confirmed cases, and the status of speech and language development acquired by them at follow up.

Design

Hospital based retro prospective study.

Methods

Data were collected from all newborns who underwent Universal Newborn Hearing Screening (UNHS) over a four-year period (November 2014 to October 2018). Cases with confirmed hearing loss were studied by pre-structured questionnaire and telephonic interview. Speech and language …

Nasal Chondromesenchymal Hamartoma: A Case Report And Review Of The Literature, Jana Ghulmiyyah

Research Days

Background: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal cavity. It commonly presents in infancy, however there are reported cases of adult tumors. As of August 2021, there have been 56 reported cases in the literature. This is the first description of a solely endoscopically resected NCMH in a neonate in addition to a review of the literature.

Case Presentation: A 5-day old male patient born at term presented to our institution for stridor and cyanosis since birth. The patient was reported to have desaturations while feeding at the outside hospital. On bedside examination, the patient …

Use Of Mandibular Distraction Osteogenesis To Correct Micrognathia And Airway Obstruction In Newborn Female With Pierre Robin Sequence And Neonatal Abstinence Syndrome In Rural Appalachia, Seneca Williams, Adam Van Horn Md

Marshall Journal of Medicine

We present a case of Pierre Robin sequence and Neonatal Abstinence Syndrome (NAS) in a newborn female patient to highlight the surgical technique of mandibular distraction osteogenesis to correct airway obstruction due to micrognathia. The patient presented as a transport after delivery due to respiratory distress. She was noted to have a cleft palate and micrognathia. The absence of other dysmorphic features diagnosed her with non-syndromic Pierre Robin sequence. To solve her upper airway obstruction, mandibular distraction osteogenesis was performed. This procedure allowed the patient to be weaned from all respiratory support and nasogastric tube feeds by the end of …

Otosyphilis: A Rare Cause Of Reversible Hearing Loss In A Teenage Male, Shan He, Anna H Messner, Gayatri Mirani

Faculty, Staff and Students Publications

A high index of suspicion and a thorough neurotologic examination at the onset of presentation are imperative to generate the diagnosis of otosyphilis. Complete audiologic recovery is rare but possible in approximately 20%-25% of patients after appropriate treatment. We present a case of reversible hearing loss secondary to otosyphilis in a teenage male patient with a new diagnosis of human immunodeficiency virus (HIV). Audiology findings were consistent with mixed hearing loss. Lumbar puncture results were consistent with neurosyphilis. Prompt treatment with a 14-day course of intravenous penicillin led to the complete recovery of hearing. In this case report, the pathophysiology, …

Trending Tubes: A Social Media Analysis Of Tympanostomy Tubes In Children, Nicholas A Rossi, Katherine R French, Chad L Evans, Jason F Ohlstein, Luis D Neve, Shiva Daram, Dayton L Young, Brian J Mckinnon, Harold S Pine

Faculty, Staff and Student Publications

OBJECTIVE: To investigate the popular social media platforms Instagram and Facebook for public posts related to tympanostomy tubes in children, to discern attitudes and perceptions surrounding tympanostomy tubes, and to evaluate the content of social media posts related to tympanostomy tubes.

STUDY DESIGN: Qualitative study.

SETTING: Instagram and Facebook social media platforms.

METHODS: Instagram and Facebook were searched for public posts from 2018 and 2019 including the search terms "ear tubes,""ear tube surgery,""tympanostomy," and "myringotomy." Posts were excluded if they were unrelated to pediatric tympanostomy tubes or written in a non-English language. Relevant posts underwent subgroup analysis based on 6 …

The Impact Of The Covid-19 Pandemic On Newborn Hearing Screening Programs In Western States, Nathan A. Blaseg, Hannah M. Williams, Shelby Jepperson, Jessica J. Messersmith

Journal of Early Hearing Detection and Intervention

The primary objective of this study was to determine the impact of the COVID-19 pandemic on newborn hearing screening guideline adherence and the respective rates of screening, diagnosis, and intervention. This was a review of newborn hearing screening data compiled from the Departments of Health of six states for the time periods of March-September 2019 and March-September 2020. Endpoints included the numbers of live births as well as the numbers and timeframes of screening, diagnostic, and intervention events. Two-tailed paired t-tests were performed to determine statistical significance. 181,662 births in six states were assessed. Compared to March-September 2019, March-September 2020 …

Update On The Safety Of Anesthesia In Young Children Presenting For Adenotonsillectomy., Stephanie R. Mcguire, Nichole M. Doyle

Manuscripts, Articles, Book Chapters and Other Papers

Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is …

Anatomy And Physiology Of The Palatine Tonsils, Adenoids, And Lingual Tonsils., Alexandra Arambula, Jason R. Brown, Laura Neff

Manuscripts, Articles, Book Chapters and Other Papers

Objective: This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils, with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.

Methods: A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils, adenoids, anatomy, physiology, and adenotonsillectomy. Primary sources were excluded if they were abstracts only, non-English language, or non-human studies. Thirty-five sources were included in this review.

Results and conclusions: The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a …

Pharmacologic Management Of Post-Tonsillectomy Pain In Children., Daniel R. Jensen

Manuscripts, Articles, Book Chapters and Other Papers

Tonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review …

Pediatric Drug-Induced Sleep Endoscopy: An Updated Review Of The Literature., Jill M. Arganbright, Jason C. Lee, Robert A. Weatherly

Manuscripts, Articles, Book Chapters and Other Papers

The field of drug-induced sleep endoscopy (DISE) has grown considerably over the last 10∼15 years, to now include its use in pediatric patients. In this review article, we outline our approach to the use of this technology in Children with Airway Obstruction, most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.

Inferior Turbinate Hypertrophy Presenting As Bilateral Nasal Masses In A Paediatric Patient, Nicholas Armando Rossi, Megan L Swonke, Shiva Daram

Faculty, Staff and Student Publications

No abstract provided.

The Perception Of Prosody In English-Speaking Children With Cochlear Implants: A Systematic Review, Grace R. Smith

Dissertations, Theses, and Capstone Projects

Objective: The goal of this paper was to systematically review literature in order to investigate the perception of prosody in English-speaking children with cochlear implants.

Methods: A comprehensive search utilizing various peer-reviewed databases accessible through the City University of New York (CUNY) Graduate Center Library was conducted to identify relevant studies. Inclusion criteria included studies that examined prosody perception in pre-and post-lingually deafened children with cochlear implants. Children who utilized unilateral, bilateral, and bimodal configurations of cochlear implants were therefore included in this search.

Results: 9 studies met the inclusion criteria for this systematic review. The findings …

Sleep Patterns And Problems Among Children With 22q11 Deletion Syndrome., Jill M. Arganbright, Meghan Tracy, Susan Starling Hughes, David G. Ingram Md

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: To delineate sleep habits and problems in children with 22q11.2 deletion syndrome (22q11DS).

METHODS: Thirty children, age 1-15 (mean 6.8) years, participated in the study, which was an internet-based anonymous survey of parents of children with 22q11DS administered via the 22q11.2 Foundation. The main outcome was the Childhood Sleep Habits Questionnaire (CSHQ).

RESULTS: Scores on the CSHQ demonstrated clinically significant sleep problems in 29 of the 30 children. When compared with previously reported normative values for typically developing children of the same age, children with 22q11DS had significantly greater sleep problems. Only 30% of children had previously undergone sleep …

Neonatal Abstinence Syndrome And Infant Hearing Assessment: A Kids’ Inpatient Database Review, Liza Creel, Adam Van Horn, Alex Hines, Matthew L. Bush

Journal of Early Hearing Detection and Intervention

Objective: Neonatal abstinence syndrome (NAS) has become an epidemic. This study assesses documented rates of failed newborn hearing screening (NBHS) or hearing loss diagnosis (HL) in NAS infants, and sociodemographic factors associated with abnormal inpatient hearing results.

Methods: The 2016 HCUP/KID national database was used to identify a weighted sample of infants with failed NBHS/HL during birth hospitalization. Independent variables included diagnoses of NAS/in-utero opioid exposure, HL risk factor presence and sociodemographic data. Univariate analyses and multivariate logistic regression were used to determine associations between NAS and abnormal hearing assessment.

Results:NAS infants had lower odds ratio (OR) of documented …

A Comprehensive Examination Of The Immediate Recovery Of Children Following Tonsillectomy And Adenoidectomy, Bryan K. Lao, Zeev N. Kain, Dina Khoury, Brooke N. Jenkins, Jeremy Prager, Robert S. Stevenson, Brenda Golianu, Jeannie Zuk, Jeffrey I. Gold, Qiu Zhong, Michelle A. Fortier

Psychology Faculty Articles and Research

Objectives

Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery.

Study design

Observational, longitudinal study.

Setting

Four major pediatric hospitals in the U.S. consisting of Children's Hospital of Orange County, Children's Hospital of Los Angeles, Lucile Packard Children's Hospital, and Children's Hospital Colorado.

Subjects

and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Sustainability And Outcomes Of A Standardized Aminoglycoside Induced Ototoxicity Monitoring Algorithm, Claire Elson, Christopher M. Oermann, Michelle Weltman, Ellen Meier

Posters

No abstract provided.

Immune Dysregulation In Patients Persistently Infected With Human Papillomaviruses 6 And 11, A. V. Lucs, J. A. Devoti, L. Hatam, A. Afzal, A. L. Abramson, B. M. Steinberg, V. R. Bonagura

Journal Articles

Human Papillomaviruses (HPVs) 6 and 11 are part of a large family of small DNA viruses, some of which are commensal. Although much of the population can contain or clear infection with these viruses, there is a subset of individuals who develop persistent infection that can cause significant morbidity and on occasion mortality. Depending on the site of infection, patients chronically infected with these viruses develop either recurrent, and on occasion, severe genital warts or recurrent respiratory papillomas that can obstruct the upper airway. The HPV-induced diseases described are likely the result of a complex and localized immune suppressive milieu …

Presurgical Ct Evaluation Of Congenital Aural Atresia, V. T. Nguyen, G. Paek, J. Hu, L. P. Smith

Journal Articles

Congenital aural atresia occurs in approximately 1 in 10,000‐20,000 births and may be surgically repaired if the middle ear malformation is limited in character. External auditory canal atresia is difficult to repair surgically, with significant risks and complications. Surgical candidacy in congenital aural atresia is based on multiple factors, central to which are the anatomy of the temporal bone and audiometric findings. High-resolution multidetector CT is the imaging technique of choice for anatomy delineation, although there are some specific indications for MR imaging in presurgical assessment. Various CT grading systems have been developed to determine surgical candidacy and are described …

Poly(I:C) Induces Controlled Release Of Il-36gamma From Keratinocytes In The Absence Of Cell Death, A. A. Rana, A. V. Lucs, J. Devoti, L. Blanc, J. Papoin, R. Wu, C. J. Papayannakos, A. Abramson, V. R. Bonagura, B. M. Steinberg

Journal Articles

The epithelium is part of an integrated immune system where cytokines, toll-like receptors and their ligands, and extracellular vesicles play a crucial role in initiating an innate immune response. IL-36gamma is a pro-inflammatory member of the IL-1 family that is mainly expressed by epithelial cells, but regulation of its expression and release are only beginning to be understood. Previous studies reported that IL-36gamma is abundant in recurrent respiratory papillomatosis, a rare but devastating disease caused by human papillomaviruses (HPV) types 6 and 11, in which papillomas recurrently grow in and block the airway. Despite the overexpression of IL-36gamma, papilloma tissues …

Decreased Langerhans Cell Responses To Il-36 Gamma: Altered Innate Immunity In Patients With Recurrent Respiratory Papillomatosis, J. Devoti, L. Hatam, A. Lucs, A. Afzal, A. Abramson, B. M. Steinberg, V. Bonagura

Journal Articles

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomaviruses (HPVs) types 6 and 11 that is characterized by the polarization of adaptive immune responses that support persistent HPV infection. Respiratory papillomas express elevated mRNA levels of IL-36 gamma, a proinflammatory cytokine in comparison to autologous clinically normal laryngeal tissues; however there is no evidence of inflammation in these lesions. Consistent with this, respiratory papillomas do not contain T(H)1-like CD4(+) T-cells or cytotoxic CD8(+) T-cells, but instead contain a predominance of T(H)2-like and T regulatory cells (Tregs). In addition, papillomas also are infiltrated with immature Langerhans cells …

Congenital Bilateral Choanal Atresia, Ali Faisal Saleem, Shabina Arif, Nadeem Aslam, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Abstract: Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal …

Ethnicity And Gender Related Differences In Extended Intraesophageal Ph Monitoring Parameters In Infants: A Retrospective Study, Dena Nazer, Ronald Thomas, Vasundhara Tolia

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Gastroesophageal reflux disease (GERD) is believed to be more common in adult males as compared to females. It also has been shown in adults to be more common in Caucasians. We wanted to determine ethnicity and gender related differences for extended pH monitoring parameters in infancy.

Methods

Extended pH monitoring data (EPM) from infants <1 year of age were reviewed. Results were classified in two groups, as control and Gastroesophageal reflux disease (GERD) group based on the reflux index (RI). The GERD group had RI of equal to or more than 5% of total monitoring period. The parameters of RI, total number of episodes of pH < 4, and the number of episodes with pH < 4 lasting more than 5 minutes were compared by genders and by ethnic groups, Caucasians and African American (AA).

Results

There were 569 infants, 388 controls, 181 with GERD (320 males, 249 females; 165 Caucasians, 375 AA). No statistical difference in EPM parameters was detected between genders in both groups. However, Caucasian infants had a significantly higher incidence of GERD than AA infants …

Reversible Obstructive Sleep Apnea And Right Heart Failure Due To Massive Tonsillar Hypertrophy, Mehnaz Atiq, Fatima Masood, Mubasher Ikram, Raana Haqqee

Section of Otolaryngology, Head & Neck Surgery

Obstructive sleep apnea is a relatively common but under diagnosed clinical entity in children. Adenotonsillar hypertrophy is the most common cause for upper airway obstruction in pediatric patients. If the obstruction to upper airways is not relieved, then the child can develop obstructive sleep apnea and its consequences. Treatment is simply to remove the obstruction thereby restoring patency of upper airways