Pediatric Otolaryngology

Airway characteristics of infants with Pierre Robin sequence who undergo mandibular distraction osteogenesis

August 26, 2015     Paul Hong, MD, FRCSC; Donald Kearns, MD, FAAP
article

Abstract

Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be managed with conservative and surgical interventions. Mandibular distraction osteogenesis has been used to relieve micrognathia associated with severe airway obstruction. We conducted a retrospective chart review to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis during a 2-year period. Our study group was made up of 16 infants-11 boys and 5 girls, aged 21 to 112 days (mean: 55.9). In addition to demographic data, we compiled data on their baseline characteristics, airway characteristics, pre- and perioperative findings, and postoperative airway outcomes. Although most patients experienced documented improvements in Cormack-Lehane laryngoscopy grades postoperatively, the severity of micrognathia and airway obstruction did not always correlate with the higher grades. As well, the degree of improvement on laryngoscopic findings was not always evident, even though patients experienced a clinical benefit. All patients who had undergone a preoperative tracheostomy were decannulated successfully. We found that mandibular distraction osteogenesis was a safe and effective intervention for newborns with severe micrognathia and airway obstruction in our study population. It is interesting that the degree of micrognathia was not always correlated with the degree of airway compromise and laryngoscopy grades.

The incidence of postoperative aspiration among children undergoing supraglottoplasty for laryngomalacia

August 26, 2015     Lauren C. Anderson de Moreno, MD; Sarah J. Burgin, MD; Bruce H. Matt, MD, MS
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Abstract

We conducted a retrospective study to determine the incidence of aspiration after supraglottoplasty at Riley Hospital for Children in Indianapolis. We reviewed the charts of 468 patients-281 males and 187 females, aged 2 days to 20 years-who had undergone supraglottoplasty for the treatment of laryngomalacia; most patients (69.9%) were aged 28 days to 2 years. A total of 47 patients (10.0%) experienced aspiration after supraglottoplasty; the overall association between supraglottoplasty and aspiration was not statistically significant (p = 0.25). Aspiration was positively correlated with age younger than 18 months, the performance of a revision procedure, the presence of an underlying neuromuscular disorder (n = 20), and the need for a postoperative gastrostomy tube (p < 0.001 for all). When the 20 patients with a neuromuscular disorder were excluded from our data analysis, the incidence of aspiration after supraglottoplasty fell to only 5.8% (27/468). We conclude that supraglottoplasty is a safe and effective procedure for the treatment of laryngomalacia. It does not significantly increase the overall incidence of aspiration in children, and thus the risk of aspiration should not be considered a deterrent to surgery, even in children with neuromuscular problems.

Fetal rhabdomyoma of the tongue in a newborn

July 20, 2015     Nicole L. Aaronson, MD; Julia C.D. Toman, MD; Michael Z. Lerner, MD; Eric D. Baum, MD
article

Most extra-cardiac rhabdomyomas in the oral cavity arise in the floor of mouth,

Sleep problems of adolescents: A detailed survey

June 4, 2015     Nuray Bayar Muluk, MD; Selda Fatma Bulbul, MD; Mahmut Turgut, MD; Gulsah Agirtas, MD
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Abstract

We investigated the sleep problems and sleep habits of adolescents at three public primary schools and two high schools. Our study included 428 Turkish school children (244 girls and 184 boys). We used a questionnaire to determine the time they went to sleep at night; waking time in the morning; incidence of nightmares, snoring, daytime sleepiness, and intrafamilial physical trauma; concentration difficulty in class; and school success. The students were divided into age-related groups (group 1 = 11 to 13 years of age; group 2 = 14 to 15 years; group 3 = 16 to 18 years). The time they went to sleep was mostly between 10 and 11 p.m. in groups 1 and 2, and 11 to 12 p.m. in group 3. Difficulty in falling asleep was reported by 16.8 to 19.6% of the students in the three groups. Difficulty in waking up in the morning was reported by 12.7% of group 1, 16.0% of group 2, and 16.8% of group 3. Snoring was present in 12.1% of females and 22.0% of males. The occurrence of one nightmare in the preceding 3 months was reported by 11.3% of the students; 17.9% of the students reported having nightmares several times. Daytime sleepiness was present in 65.1%, and concentration difficulty was present in 56.8% of the students. We conclude that difficulty in falling asleep, snoring, and daytime sleepiness may be seen in adolescents who are in both primary and high schools. Watching inappropriate programs and movies on television and intrafamilial physical trauma may cause nightmares and sleeping problems in these adolescents. Students and families should be educated about the importance of sleep in academic performance. Countries' public health policies should address sleep problems and related educational activities.

Unexpected cholesteatoma in a very young child with a congenital aural duplication anomaly

April 27, 2015     Moo Kyun Park, MD
article

Cholesteatoma can develop in very young children with congenital aural stenosis and a duplication anomaly, and physicians should consider this condition in affected children with otalgia and otorrhea.

Distortion-product otoacoustic emissions testing in neonates treated with an aminoglycoside in a neonatal intensive care unit

April 27, 2015     Iosif Vital, MD; George Psillas, MD; Nikolaos Nikolaides, MD; George Kekes, MD; Stavros Hatzopoulos, MD; John Constantinidis, MD
article

Abstract

We evaluated the ototoxic effect of aminoglycosides on the outer hair cells of newborns in a neonatal intensive care unit (NICU) by means of distortion-product otoacoustic emissions (DPOAE) testing. Our study population was made up of 164 newborns who were divided into three groups: group A consisted of 105 infants who were given aminoglycoside therapy (either gentamicin or amikacin, or a combination of the two) as treatment for suspected or proven bacterial infection and septic states; group B included 30 newborns who were not given an antibiotic or who were given an antibiotic other than an aminoglycoside; group C, a control group, was made up of 29 healthy neonates who were hospitalized in the well-baby nursery. All the neonates underwent DPOAE testing in both ears (the f2 primary tone was presented at 2.0, 2.5, 3.2, and 4.0 kHz). We found that 41 patients in group A (39.0%) and 13 in group B (43.3%) failed the DPOAE test in one or both ears; the difference between these two groups was not statistically significant (p = 0.673). In group C, the DPOAE fail rate was 13.8% (4 newborns). In group A, there was no statistically significant association between the pass/fail rate and the specific aminoglycoside that was administered, or in the duration of antibiotic treatment, the number of doses, and the size of the mean daily dose and the mean total dose. In clinical practice, DPOAE testing is a sensitive method of evaluating the integrity of the outer hair cells in the basal turn of the cochlea after exposure to ototoxic drugs such as aminoglycosides. However, our study did not demonstrate that the aminoglycosides had any ototoxic effect on the hearing of neonates in the NICU.

Unusual presentation of a midline neck mass

January 19, 2015     Yann-Fuu Kou, MD; Gopi Shah, MD, MPH; Ronald Mitchell, MD; Larry L. Myers, MD
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Venous malformations are usually visible at birth, although deeper lesions may have normal overlying skin or a bluish discoloration. They grow proportionately with the child and can expand in adulthood.

Cherubism

January 19, 2015     Lester D.R. Thompson, MD
article

When there is significant infraorbital maxillary involvement, the inferior rim of the sclera is more prominent, resulting in the classic “eyes to heaven” appearance.

Congenital airway anomaly of double aortic arch in a 2-day-old infant

October 17, 2014     Seo Moon, MD; Jessica Mayor, MD; Ramzi Younis, MD
article

Double aortic vascular ring is a complete vascular ring that is formed when the distal portion of the right dorsal aorta fails to regress and the ascending aorta bifurcates to surround and compress both trachea and esophagus and rejoins to form the descending aorta.

Lingual hamartoma associated with a cleft palate in a newborn

October 17, 2014     Opeyemi O. Daramola, MD; Mariko Suchi, MD, PhD; Robert H. Chun, MD
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Abstract

A hamartoma is a benign malformation of native tissue that may occur in any area of the body. Hamartoma of the tongue is a rare developmental lesion. We describe the case of a pendulant lingual hamartoma in a 2-day-old girl that had not been identified on prenatal ultrasonography. We also review the utility of prenatal imaging options, the role of preoperative imaging, the mechanical relationship between lingual hamartoma and cleft palate, the histopathology of this tumor, surgical treatment, and emergency airway management.

Evidence-based update on tympanostomy tube placement for otitis media in children

July 13, 2014     Jeffrey Cheng, MD; Lisa Elden, MD
article

Controversy has grown over the indications, timing, and efficacy of tympanostomy tube placement compared with watchful waiting.

Pediatric rhabdomyosarcoma

July 13, 2014     Rosemary Ojo, MD; Si Chen, MD; Liset Pelaez, MD; Ramzi Younis, MD
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All children with rhabdomyosarcoma require multimodality therapy to maximize local tumor control. This can involve different combinations of chemotherapy, surgery, and radiation therapy.

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