Pediatric Otolaryngology

Stahl ear deformity associated with Finlay-Marks syndrome

May 31, 2010     Young S. Paik, MD and C.W. David Chang, MD
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Nasopharyngeal glioma causing respiratory distress in a neonate: Transoral endoscopic excision

April 30, 2010     Young Hak Park, MD, Sung Won Kim, MD, PhD, Seung Ho Cho, MD, and Yong Woo Choi, MD
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Abstract

Nasal gliomas are rare, benign, congenital midline tumors made up of heterotopic neuroglial tissue. They have the potential for intracranial extension. They are commonly seen in newborns and children, and rarely in adults. Preoperative diagnostic imaging is essential to delineate the exact location, limits, and extensions of the tumor and thus to determine the appropriate surgical approach. Endoscopic surgery is considered appropriate for the removal of an intranasal glioma without intracranial extension. We describe a rare case of nasopharyngeal glioma in a newborn who presented with early respiratory distress, and we include a review of the literature.

Ectopic thymic tissue presenting as a neck mass in children: A report of 3 cases

April 30, 2010     Estie Meyer, MBChB, FCORL(SA), Wakisa Mulwafu, MBChB, FCORL(SA), Johannes J. Fagan, MBChB, FCS(SA), MMed(Otol), Robin A. Brown, MBChB, DCH(SA), FRCS(Edin), and Kathryn Taylor, MBChB, DCH(SA), MMed(Anat Path)
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Abstract

The presentation of ectopic cervical thymic tissue as an anterior neck mass is rare. We report 3 similar cases in 3 boys-2 who had a thymic cyst and 1 who had an ectopic cervical thymus. We discuss the radiographic presentation on ultrasound and magnetic resonance imaging in these cases. We also review the typical histologic picture; histology is the only way of diagnosing this condition.

Neurilemmoma presenting as a midline nasal mass in a pediatric patient

April 30, 2010     Gary D. Josephson, MD, Sapna A. Patel, MD, Laurie Duckworth, PhD, Melissa Kress, DO, and Jeffrey Goldstein, MD
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Abstract

We report a case of a neurilemmoma presenting as a midline nasal mass in a 13-year-old girl. To the best of our knowledge, this is the first report of a nasal neurilemmoma in a pediatric patient. Although this neoplasm is benign in nature, surgical resection is warranted to prevent recurrence, and it is the sole means of treatment. The overall prognosis is excellent, as was the case for our patient. We discuss the diagnosis and management of neurilemmomas and urge physicians not to exclude nasal neurilemmoma from the differential diagnosis in a pediatric patient who presents with a nasal mass.

Dermoid of the nasopharynx: An unusual finding in an older child

March 31, 2010     Eyal Russo, MD, Hananya Vaknine, MD, and Yehudah Roth, MD
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Successful treatment of cutaneous hemangioma of infancy with topical imiquimod 5%: A report of 3 cases

March 1, 2010     Andrew J. Senchak, DO, Michael Dann, MD, Benjamin Cable, MD, and Glenn Bessinger, MD, PhD
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Abstract

Hemangioma of infancy is the most common benign tumor of childhood. Most of these tumors spontaneously regress over several years. However, many parents seek treatment for children with cutaneous hemangiomas because of the potential for disfigurement and the attendant psychosocial effects. We report our use of the nightly application of topical imiquimod 5% cream as an alternative to traditional management in 3 infants who presented with rapidly growing facial hemangiomas. After approximately 3 to 5 months of treatment, all 3 patients had experienced a near-complete resolution of their lesions without significant side effects. Based on our experience, we believe that topical imiquimod may be an important tool for the otolaryngologist who treats cutaneous hemangiomas.

Esophageal hamartoma as an unusual cause of neonatal apnea and bradycardia

March 1, 2010     Jeffrey Coury, DO, Jonathan Steinfeld, MD, David Zwillenberg, MD, and Seth Zwillenberg, MD
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Abstract

Esophageal hamartoma is a rare entity, as only 7 cases have been previously reported in the English-language literature. Common symptoms include dysphagia, weight loss, and vomiting. Life-threatening airway obstruction can also occur. Because of the nonspecific nature of the symptoms, patients with these dangerous polyps are often misdiagnosed as having more common entities such as gastroesophageal reflux, peptic ulcer disease, or achalasia. Most of these tumors are missed on esophagoscopy and radiologic studies, and they can go undiagnosed for years. We diagnosed an esophageal hamartoma in an infant girl who had first presented when she was 8 days old with symptoms of apnea and cyanosis. The patient had undergone a multitude of tests since her birth, and she was eventually diagnosed with episodic bradycardia. When the patient was 6 weeks old, we discovered a polyp on nasopharyngolaryngoscopy, and we removed it by microdirect laryngoscopy and esophagoscopy. This patient was the youngest of the 8 who have now been reported to have been diagnosed with a hamartomatous polyp, and she was the only one to have presented with apnea (secondary to airway obstruction) and bradycardia. We recommend microdirect laryngoscopy and esophagoscopy to remove these pedunculated cervical esophageal lesions. A transcervical approach is warranted for sessile distal esophageal polyps. Esophageal polyps are an interesting entity in view of their rarity and intriguing presentations. Because esophageal obstructions can be life-threatening, further evaluation by laryngoscopy, bronchoscopy, and esophagoscopy is warranted when symptoms of dysphagia, vomiting, intermittent apnea, bradycardia, and weight loss persist despite conventional treatment.

Myxoma of the temporal bone: An uncommon neoplasm

March 1, 2010     Deepika Sareen, MBBS, Ashwani Sethi, MS, Sumit Mrig, MBBS, Sonu Nigam, MD, and A.K. Agarwal, MS
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Abstract

We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature.

Nasal foreign body as the cause of a subperiosteal orbital abscess in a child

February 1, 2010     Benjamin D. Webb, MD, Kevin D. Pereira, MD, MS (ORL), and Samer Fakhri, MD, FACS, FRCS
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Abstract

We present what to the best of our knowledge is the first reported case of an orbital abscess as a result of acute rhinosinusitis caused by obstruction of the middle meatus secondary to the impaction of a nasal foreign body in a child. The patient, a 5-year-old Hispanic boy, had presented with left periorbital edema, eye pain, rhinorrhea, headache, and a fever. The presence of a nasal foreign body had been suggested by a finding of a low-density signal in the left anterior nasal cavity and middle meatus on computed tomography. Endoscopic drainage of the abscess through the involved sinuses revealed that the foreign body was a wad of cotton. The cotton was removed, and the patient recovered uneventfully.

Acute suppurative neonatal parotitis: Case report

February 1, 2010     Sardar U. Khan, DLO, FCPS, Peter G. O'Sullivan, BSc, MPhil, and John McKiernan, FRCPI
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Abstract

Neonatal suppurative parotitis is very rare. One review of the English-language literature spanning 35 years found only 32 cases. Most cases are managed conservatively with antibiotic therapy; early antibiotic treatment reduces the need for surgery. The predominant organism is Staphylococcus aureus. We report a new case of neonatal suppurative parotitis in a 3-week-old boy. The patient was diagnosed on the basis of parotid swelling, a purulent exudate from a Stensen duct, and the growth of pathogenic bacteria in culture. He responded well to 9 days of intravenous antibiotic therapy. We also discuss the microbiologic and clinical patterns of this disease.

Pediatric airway consultation survey in a tertiary care children's hospital: An interobserver analysis

December 1, 2009     Iman Naseri, MD, Frederick L. Durden, MD, and Steven E. Sobol, MD, MSc
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Abstract

We conducted a prospective analysis to independently observe the initial opinion of: (1) consulting pediatric residents (postgraduate year 2 [PGY-2]), (2) corresponding consulting attending physicians (general pediatric or pediatric emergency medicine), and (3) consulting otolaryngology PGY-2 residents when assessing patients for “noisy breathing.” Each was asked to define the type of noisy breathing present and to formulate a diagnosis based on a limited set of choices. The final diagnosis was determined by a single attending pediatric otolaryngologist (S.E.S.) at the completion of the diagnostic workup. The accuracy for characterization of breath sounds for the pediatric residents, attending pediatricians, and otolaryngology residents were 26.1%, 23.5%, and 98.6%, respectively. The positive predictive values for the determination of diagnosis were 71.6%, 69.4%, and 76.6%, respectively. These findings indicate that pediatric residents and attending pediatricians may be deficient in their ability to characterize the breath sounds commonly seen in patients with noisy breathing. Further education of pediatricians may lead to a more accurate diagnostic evaluation of a child with noisy breathing.

Validation of a pediatric cough questionnaire

October 31, 2009     Christopher J. Hartnick, MD, David Zurakowski, PhD, and Kenan Haver, MD
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Abstract

We conducted a study to determine if a five-item pediatric cough questionnaire (PCQ) is a valid and reliable means of measuring cough-specific quality of life in children. The five questions, which are answered by the child's parent or caregiver, cover cough frequency (Q1), sleep disturbance of the child (Q2), sleep disturbance of the parent (Q3), cough severity (Q4), and the degree of bothersomeness to the child (Q5). Each of the five items was scored on a 6-point Likert scale. The PCQ was administered three times. The first occurred when the parent telephoned to schedule an appointment for the child at a pediatric pulmonology outpatient clinic for a chief complaint of cough. The second PCQ was administered within 2 weeks of the first but before any treatment had been instituted so that test-retest reliability could be assessed. Each child was then diagnosed and treated in accordance with standard care practices. The third PCQ was administered 3 weeks after the second to determine if it would accurately reflect the parent's perception of how the child's cough had changed following treatment. Also, at the second and third encounters, parents were asked to provide their global assessment of whether their child's cough had improved, worsened, or stayed the same since the previous encounter. The parents of 120 children (70 boys and 50 girls; mean age: 6.8 yr) completed all three PCQs. Test-retest reliability was established (p < 0.001) for each of the five PCQ questions by Spearman correlation analysis (Q1: r = 0.5; Q2: r = 0.38; Q3: r = 0.42; Q4: r = 0.53; Q5: r = 0.5). Other statistical analyses confirmed the PCQ's internal consistency, discriminant validity, and convergent validity. Based on our findings, we conclude that the PCQ is a valid and reliable instrument with which to follow children with chronic cough longitudinally.

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