International Journal of Pediatric Otorhinolaryngology

Editorial Board

2012-05-01

Transnasal endoscopic repair of choanal atresia in a tertiary care centre: A review of outcomes

Vincent Uzomefuna, Fergal Glynn, Basil Al-Omari, Stephen Hone, John Russell — 2012-05-01

Abstract: Introduction/aim: Choanal atresia (CA) is an obliteration, in newborns, of the airway at the level of posterior nasal aperture resulting in absence of connection between the nasal cavity and the aerodigestive tract. It is rare, with incidence of 1 in 7000 live births. This review is aimed at assessing the factors influencing the outcome of transnasal endoscopic repair of CA in a tertiary referral children's hospital.Material/method: A retrospective study was carried out between 2002 and 2009. 31 children; 14 boys and 17 girls, age range 1 day to 15 years, mean 23.4 months were included. Unilateral presentation was 19 (11 right, 8 left) and bilateral was 12. All patients had transnasal endoscopic repair under direct vision. Nasal stents were placed for varying duration (range 4–12 weeks) or nasopharyngeal airways (removed within 24h) were inserted at time of surgery. Patients were monitored for re-stenosis and revisions carried out as necessary, with a mean follow-up of 11.9 months.Results: 54.7% (n=17) of patients had re-stenosis requiring revision surgery. Of these, 41.1% (n=7) had success after the 1st revision, 20% had success after the 2nd revision while 12.3% had success after the 3rd revision. One patient required more than four revisions. 80% of re-stenosis requiring revisions occurred in children who had surgery under 10 months of age and of these, approx. 42% were 1-week-old or younger. 57% of those who had stents for 4–6 weeks (n=15) had re-stenosis requiring revision while only 33.3% of those who either had no stents or had NP airways removed within 24h (n=16) had re-stenosis (P=0.019). The re-stenosis rate was comparable for those who had mitomycin (53%) versus those who did not (60%).Conclusion: Transnasal endoscopic repair of CA is effective and safe and provides the benefit of surgery under direct vision. Age 1 week or less was a predictive factor for re-stenosis. Intranasal stents was also associated with increased incidence of re-stenosis and the use of mitomycin C does not seem to have any significant effect on re-stenosis.

Bone anchored hearing aids in children: An update

Jayesh Doshi, Patrick Sheehan, Ann Louise McDermott — 2012-05-01

Abstract: Objective: Over recent years, there have been a significant number of publications reporting evolving bone anchored hearing device (BAHD) indications and modifications in surgical techniques. We aim to present a review of recent trends in paediatric BAHD surgery and also discuss alternative treatment options available.Methods: All papers referring to paediatric BAHD surgery (English language) were identified from Medline, Pubmed, Cochrane library and Embase search in May 2011. Abstracts were read and relevant papers were obtained.Results: BAHDs have evolved over recent years as technology has advanced. New bone conduction hearing devices have recently been launched such as the Ponto system [Oticon™], Alpha 1 (M) hearing system [Sophono™], Soundbite system [Sonitus™] and the Vibrant Soundbridge system [Medel™]. Modifications to existing implant systems have significantly altered BAHD practice with earlier loading of the sound processor now a positive step forward.Conclusions: The latest generation of percutanous devices have been designed to reduce skin complications, promote better osseointegration and earlier loading of the sound processor. Alternative devices without a skin-penetrating abutment are now available and have shown promising results in the paediatric population.

A review of the burden of disease due to otitis media in the Asia-Pacific

2012-05-01

Abstract: Objective: The burden of disease due to otitis media (OM) in Asia Pacific countries was reviewed to increase awareness and raise understanding within the region.Methods: Published literature and unpublished studies were reviewed.Results: In school-age children, OM prevalence varied between 3.25% (Thailand) and 12.23% (Philippines) being highest (42%) in Aboriginal Australian children. OME prevalence at school age varied between 1.14% (Thailand) and 13.8% (Malaysia). Higher prevalence was reported in children with hearing impairment, HIV, pneumonia and rhinitis. CSOM prevalence was 5.4% in Indonesia (all ages), 15% in Aboriginal Australian children and 2–4% in Thailand, Philippines, Malaysia and Vietnam (WHO estimate). OM prevalence/incidence and service utilisation were highest in children 2–5 years of age. The disease burden was substantially higher in Pacific Island children living in New Zealand (25.4% with OME), and was highest in indigenous Australians (>90% with any OM). Streptococcus pneumoniae and Haemophilus influenzae dominated as primary causes of AOM in all studies. Few studies examined pneumococcal serotype distribution. Health-related cost estimates for OM, when available, were substantial. In developing countries, significant investment is needed to provide facilities for detection and treatment of ear disease in children, if long term hearing deficits and other sequelae are to be prevented.Conclusion: The available evidence suggests an important burden of disease and economic cost associated with OM in most Asia Pacific countries and a potential benefit of prevention through vaccination. Large, prospective community-based studies are needed to better define the prevalence of ear disease in children, and to predict and track pneumococcal conjugate vaccine impacts. AOM prevention through vaccination may also provide a means of reducing antibiotic use and controlling antibiotic-resistant disease in children. This review highlights the need for additional research, and provides a basis on which to build and develop regional guidelines for OM management.

A positive wave at 8ms (P8) and modified auditory brainstem responses measurement in auditory neuropathy spectrum disorder

2012-05-01

Abstract: Objective: Auditory neuropathy spectrum disorder (ANSD) is characterized by absent or atypical auditory brainstem responses (ABR), recordable otoacoustic emissions and/or cochlear microphonics. Modification of ABR stimuli is discussed to improve wave V synchronization in ANSD patients.Design: Ten ANSD children (seven unilateral) underwent ABR measurement with an alternating stimulus (40.5s−1), constant rarefaction and condensation stimuli, a reduced click-rate (11.1s−1) and a chirp-stimulus.Results: The results showed no remarkably better synchronization with modified stimuli. Whereas higher levels showed no synchronization, reproducible positive waves at 8ms (P8) at intensities of 65–85dB were found in six patients with all stimuli.Conclusions: We suggest an ipsilateral auditory origin of the positive potentials at 8ms. They could be characteristic of synchronization abnormalities in some cases of ANSD.

First branchial cleft fistula presenting with internal opening on the Eustachian tube: Illustrated cases and literature review

Yuhe Liu, Tiancheng Li, Junfang Xue, Jun Jia, Shuifang Xiao, Enmin Zhao — 2012-05-01

Abstract: Objective: Two cases of first branchial cleft fistula with internal opening on the Eustachian tube are reported and the diagnosis, management and embryological hypothesis are discussed.Design: Retrospective study and review of the literature.Results: Both patients were young boys with first branchial cleft anomaly clearly identified by computed tomography fistulography scan and direct Methylene Blue dye injection. In both cases, surgical removal revealed a fistula with internal opening located on the Eustachian tube near the nasopharynx.Discussion: The main embryological theories and classification are reviewed. A connection between the theories of first branchial apparatus development and the classification by Work might explain the reported clinical association.

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria

2012-05-01

Abstract: Background/Aim: Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance.Materials and methods: This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010.Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected.The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software.Results: 1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16years (mean±SD, 8.3±4.8years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3–6years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3–6years, 121(38.9%) and above 6years of age 101(32.7%) and below 3years were 89(28%).Conclusion: Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.

Intra- and postoperative electrically evoked stapedius reflex thresholds in children with cochlear implants

2012-05-01

Abstract: Objectives: The aim of this study was to investigate whether there is a significant correlation between intra- and postoperative electrically evoked stapedius reflex thresholds (eSRTs) in children with cochlear implants.Methods: Sixty-five pediatric cochlear implant users were included in this study. All patients had congenital prelingual hearing loss. The round window approach was used in all patients. The eSRTs were intraoperatively measured using the 1st, 3rd, 6th and 12th electrodes of the cochlear implant. The measurements taken during the first fitting of the device were taken again one month after surgery. We used paired-sample t-tests to determine the correlation between intra- and postoperative eSRTs.Results: The eSRT analysis revealed a statistically significant difference between the intra- and postoperative thresholds. A correlation analysis did not reveal any correlation between intra- and postoperative eSRTs.Conclusion: Intraoperative eSRT measurements were unable to predict early postoperative eSRTs.

Comparison of pre-emptive tonsillar lodge infiltration with ropivacaine versus intravenous tramadol in pediatric tonsillectomies: A randomized placebo-controlled study

L. Pirbudak Cocelli, B. Kaya Ugur, C. Durucu, S. Kul, H. Arik, S. Mumbuc — 2012-05-01

Abstract: Objective: To investigate the placebo controlled effect of pre-emptive local infiltration of ropivacaine and intravenous tramadol in postoperative pain and nausea-vomiting in pediatric tonsillectomy cases.Methods: 90 children at ASA I-II physical status, who are between 2 and 9 years old, underwent tonsillectomy were included to the study. Patients were randomized into one of three study groups. Group I was i.v. saline group (placebo group), Group II was preemptive 1.5ml 0.75% ropivakain to the tonsil lodge and Group III was preemptive 1mg/kg i.v. tramadol. Hemodynamic parameters and synchronized Maunuksela pain scores were evaluated in the post anesthetic care unit.Results: There was no difference in age, weight, sex and hemodynamic parameters of children included to the study groups. Postoperative nausea vomiting was significantly lower in Group II and pain scores at resting and swallowing are significantly lower than the other study groups. Maunuksela pain scores at 2nd, 3rd, 6th and 9th hours while resting were significantly lower in Group II compared with Groups I and III (p<0.001). The comparison of scores between groups I and III were similar. Maunuksela pain scores during swallowing were significantly lower in Group II compared with Group I and III at 2nd, 3rd, 6th, 9th, 12th, 21st and 24th hours postoperatively (p<0.001). While comparing Maunuksela pain scores of Groups I and III, significantly lower scores are determined at 2nd and 24th hours in Group III (p<0.001). Analgesic needs were significantly low in Group II at postoperative period (150±30mg paracetamol) (p<0.05). It was similar in Groups I and III (Group I: 400±40mg, Group III: 360±40mg paracetamol).Conclusion: This study showed that peritonsillar ropivacaine infiltration might produce an effective postoperative analgesia probably due to a preventing effect on sensitization of the pain pathways.

Direct measurement of ear canal volume in a pediatric population: Can we explain its individual variation in terms of age and body weight?

Heil Noh, Dong-Hee Lee — 2012-05-01

Abstract: Objective: The aim of this work was to measure the external auditory canal (EAC) volume in children directly and to analyze its variation according to age and body weight.Methods: This was a prospective study at a university-based, secondary referral hospital. Volumes of the bony and cartilaginous EACs were measured using a 1ml tuberculin syringe filled with 95% ethyl alcohol before inserting ventilation tube(s). Three hundred thirty-eight ears from 194 children (107 boys and 87 girls) were enrolled in this study (mean age=58.8±25.2months). They were between the 10th and 90th percentiles for age and gender based on the 2007 growth chart for Korean children.Results: EAC volume tended to increase with age. The volumes of cartilaginous and total EACs were significantly larger in boys than in girls. The volume of the bony EAC was significantly larger in right than in left ears. Under the assumption that EAC volume is a linear function of age as well as body weight, these factors explained less than one-third of overall variation. Preferably, the growth of EAC seemed to be not linear with aging in pediatric population.Conclusions: Our cubic model seemed to be more fit to the growth of EAC than simple linear model did and age and body weight alone were not clinically useful predictors of ear canal volume needed for the fitting of hearing aids in pediatric population. Because this variation can result in a large variation of real ear to coupler difference (RECD), this study supports that individual measurement of the RECD is crucial for fitting appropriate hearing aids in children.

Cartilage palisade tympanoplasty in children and adults: Long term results

Marko Velepic, Radan Starcevic, Robert Ticac, Milodar Kujundzic, Mitja Velepic — 2012-05-01

Abstract: Objective: To show long-term anatomic and functional results of full thickness cartilage palisade tympanoplasty in children and adults.Methods: In 51 patients (56 ears); 9 children (12 ears) and 42 adults (44 ears) full thickness cartilage palisade tympanoplasty and interposition with malleus head autograft was performed. On average 11 years after the tympanoplasty, an otomicroscopy and a tonal audiogram were done to assess anatomic and functional results.Results: Anatomic results of 56 ears: 40 (71.43%) tympanic membranes have no anatomic irregularities; 14 (25.00%) have cartilage resorption (11 of them minor and 3 major resorptions), 2 (3.57%) have secondary perforation. In the group of children all ears tympanic membrane were with no or minor resorption and no perforations.Functional results (51 audiograms performed: in children 12 and in adults 39): pre- and post-operative average pure tone average air-bone gaps were 27.29±10.26 and 10.73±7.90dB, respectively.In the group of children pre- and post-operative average pure tone average air-bone gaps were 29.44±10.30 and 6.81±3.47dB, respectively. In the group of adults pre- and post-operative pure tone average air-bone gaps were 26.63±10.30 and 11.93±8.50dB, respectively. The differences between the two groups preoperatively (z=0.733; p=0.463) and postoperatively are irrelevant (z=1.723; p=0.085). The hearing gain is bigger in children (F=4.788; p=0.033).Conclusion: The full thickness cartilage palisade tympanoplasty with malleus autograft interposition is also nowadays a successful method in solving of an advanced ear pathology also in children.

Radiofrequency ablation of laryngeal saccular cyst in infants: A series of six cases

Sunil Kumar, Sunil Garg, J.K. Sahni — 2012-05-01

Abstract: Saccular cysts of larynx are uncommon entity. These are infrequent causes of respiratory obstruction in neonates and infants. The saccular cysts are thought to arise in the saccule of the ventricle as a result of atresia of the ventricular orifice. The treatment options used in the management of saccular cysts are endoscopic needle aspiration, marsupialization and endoscopic extended ventriculotomy. We have found that removal of the saccular cyst can be achieved relatively safely and effectively by endoscopic radiofrequency ablation with improved surgical precision and better healing. We share our experience with a series of six cases, diagnosed under the sedation, thereafter radiofrequency ablation of laryngeal saccular cysts was done.

Post-traumatic morbidity is frequent in children with frontobasilar fractures

2012-05-01

Abstract: Objective: Frontobasilar fractures are potentially life-threatening injuries also in pediatric populations, often due to associated intracranial trauma. This retrospective study was performed at a tertiary care university hospital to evaluate the management and outcome of pediatric frontobasilar fractures. The secondary aim was to re-evaluate the computerized tomography images to reveal all the skull base fracture sites predicting morbidity.Methods: A retrospective analysis of all the 20 consecutive pediatric patients diagnosed with and treated for a frontobasilar fracture at the Turku University Hospital, Turku, Finland during 1995–2010 was performed. The referral area of this tertiary care university hospital covers 750,000 inhabitants of whom approximately 20% are 18 years or younger.Results: The mean annual incidence of frontobasilar fractures was 1.1 per 100,000 children aged 18 years and under. A road traffic accident was the most common etiological factor. Other factors included being hit by a heavy object, falling from a height, and falling to the ground. The mean Glasgow Coma Scale score was 10 and loss of consciousness was initially detected in 15 (75%) patients in the emergency unit. Twelve (60%) patients had an intracranial injury, 17 (85%) had facial bone fractures, and 15 (75%) had a fracture of the anterior cranial base. The middle cranial fossa and sella were affected in five (25%) of the patients. There seem to be no long-term neuroendocrine sequelae following brain injury, not even when the sella or the hypophyseal area was affected. Twelve (60%) patients were treated operatively. One patient died after one week of intensive care treatment. Only four (20%) patients had no post-traumatic implications, eight (40%) suffered from various long-term sequelae, and five (25%) had permanent neurological or neuropsychological sequelae.Conclusions: Frontobasilar fractures in childhood are rare and often associated with intracranial trauma and long-term morbidity. However, according to this study, 75% of the patients showed no permanent neurological or neuropsychological sequelae.

Effect of caffeic acid phenethyl ester (CAPE) on H2O2 induced oxidative and inflammatory responses in human middle ear epithelial cells

2012-05-01

Abstract: Objective: Acute otitis media (OM) is a common pediatric disease. Recent research into the pathogenesis of OM has focused on oxidative damage, induced by oxygen free radicals, to the middle ear mucosa along with inflammation. Caffeic acid phenethyl ester (CAPE) is a biologically active ingredient of propolis honey bees, with antioxidative and anti-inflammatory activities. The effect of CAPE on hydrogen peroxide (H2O2)-induced inflammatory and oxidative reactions in the middle ear is still not known. The aim of this study was to evaluate the anti-inflammatory and antioxidative effects of CAPE on cultured human middle ear epithelial cells (HMEECs).Methods: The inflammatory injury of H2O2 and the anti-inflammatory effect of CAPE were determined by measuring levels of pro-inflammatory cytokines (tumor necrosis factor (TNF)-α and COX-2) with real-time reverse transcription polymerase chain reaction and Western blot analysis. Oxidative stress induced by H2O2 and antioxidative effects of CAPE were evaluated directly by reactive oxygen species (ROS) production using flow cytometric analysis of 5-(and-6)-chloromethyl-2′,7′-dichlorodihydrofluorescein diacetate, acetyl ester (CM-H2DCFDA), and indirectly by the expression of superoxide dismutase (SOD) using Western blot analysis. The effect of CAPE was compared with N-acetyl cysteine (NAC) which has well-known antioxidative and anti-inflammatory effects.Results: CAPE significantly inhibited H2O2-induced upregulation of TNF-α and COX-2 expression in a dose and time dependent manner. ROS accumulation induced by H2O2 stimulation was decreased by CAPE pretreatment. Induced SOD expression after H2O2 stimulation was diminished by CAPE pretreatment. The anti-inflammatory and antioxidative effects of CAPE were similar to those of NAC.Conclusions: These findings suggest that inflammation induced by H2O2 can be inhibited by CAPE via inhibition of the expression of pro-inflammatory cytokines such as TNF-α and COX-2. Furthermore, CAPE has antioxidative effects, which decreases the need for endogenous SOD expression.

Assessing toddlers’ speech-sound discrimination

Rachael Frush Holt, Kaylah Lalonde — 2012-05-01

Abstract: Objective: Valid and reliable methods for assessing speech perception in toddlers are lacking in the field, leading to conspicuous gaps in understanding how speech perception develops and limited clinical tools for assessing sensory aid benefit in toddlers. The objective of this investigation was to evaluate speech-sound discrimination in toddlers using modifications to the Change/No-Change procedure .Methods: Normal-hearing 2- and 3-year-olds’ discrimination of acoustically dissimilar (“easy”) and similar (“hard”) speech-sound contrasts were evaluated in a combined repeated measures and factorial design. Performance was measured in d′. Effects of contrast difficulty and age were examined, as was test-retest reliability, using repeated measures ANOVAs, planned post hoc tests, and correlation analyses.Results: The easy contrast (M=2.53) was discriminated better than the hard contrast (M=1.72) across all ages (p<.0001). The oldest group of children (M=3.13) discriminated the contrasts better than youngest (M=1.04; p<.0001) and the mid-age children (M=2.20; p=.037), who in turn discriminated the contrasts better than the youngest children (p=.010). Test-retest reliability was excellent (r=.886, p<.0001). Almost 90% of the children met the teaching criterion. The vast majority demonstrated the ability to be tested with the modified procedure and discriminated the contrasts. The few who did not were 2.5 years of age and younger.Conclusions: The modifications implemented resulted, at least preliminarily, in a procedure that is reliable and sensitive to contrast difficulty and age in this young group of children, suggesting that these modifications are appropriate for this age group. With further development, the procedure holds promise for use in clinical populations who are believed to have core deficits in rapid phonological encoding, such as children with hearing loss or specific language impairment, children who are struggling to read, and second-language learners.

Longitudinal functional performance among children with cochlear implants and disabilities: A prospective study using the Pediatric Evaluation of Disability Inventory

2012-05-01

Abstract: Objective: Functional outcomes are important in children with cochlear implants (CI) and additional disabilities as studies on auditory skill and speech/language development may not identify functional benefits from implantation. This study sought to measure functional performance skills of young children with developmental disabilities post-CI.Methods: Eight children with cognitive disabilities undergoing cochlear implantation were enrolled in a prospective study of language and functional abilities; 6 with 1year follow-up were included in the analysis. Functional performance was measured using Pediatric Evaluation of Disability Inventory (PEDI), providing standardized (mean: 50) and scaled scores (range: 0–100) of functional domains: Self-Care, Mobility and Social Function. The PEDI was administered pre-implant, 6 and 12months post-implantation along with language testing at the same intervals.Results: All children had cognitive disability; 5 also had motor delay. The ages at CI ranged from 13.8 to 134months. For functional abilities, children did not make significant changes in domain-specific standard scores over 1year. Children made progress in scaled scores by 1-year post-implant. The largest increase for all domains occurred in the first 6months (7–11.5 point increase). For language abilities, children made a median 5.5-month increase in receptive language age (p=0.06) and 5-month increase in expressive language age (p=0.03) in the first year post-CI with no change in language quotients. Receptive language level was significantly (p<0.05) associated with increasing scores in the domains of Self-Care and Social Function.Conclusions: This is the first study to measure daily functional abilities in children with implants and disabilities using a standardized tool. Although our small group of complex children did not have an increase in standard scores (gap-closing trajectories), they made progress in skill development on scaled scores. Receptive language appears to play a key role in social functioning in this population. Functional assessments are informative for treatment planning and identifying specific areas to target intervention.

Early detection of infant hearing loss in the private health care sector of South Africa

Miriam Elsa Meyer, De Wet Swanepoel, Talita le Roux, Mike van der Linde — 2012-05-01

Abstract: Objective: A national survey of early hearing detection services was undertaken to describe the demographics, protocols and performance of early hearing detection, referral, follow-up and data management practices in the private health care sector of South Africa.Methods: All private hospitals with obstetric units (n=166) in South Africa were surveyed telephonically. This data was incorporated with data collected from self-administered questionnaires subsequently distributed nationally to audiology private practices providing hearing screening at the respective hospitals reporting hearing screening services (n=87). Data was analyzed descriptively to yield national percentages and frequency distributions and possible statistical associations between variables were explored.Results: Newborn hearing screening was available in 53% of private health care obstetric units in South Africa of which only 14% provided universal screening. Most (81%) of the healthy baby screening programs used only otoacoustic emission screening. Auditory brainstem response screening was employed by 24% of neonatal intensive care unit screening programs with only 16% repeating auditory brainstem response screening during the follow-up screen. Consequently 84% of neonatal intensive care unit hearing screening programs will not identify auditory neuropathy. A referral rate of less than 5% for diagnostic assessments was reported by 80% of universal programs. Follow-up return rates were reported to exceed 70% by only 28% of programs. Using multiple methods of reminding parents did not significantly increase reported follow-up return rates. Data management was mainly paper based with only 10% of programs using an electronic database primarily to manage screening data.Conclusions: A shortage of programs and suboptimal and variable protocols for early hearing detection, follow-up and data management in existing programs mean the majority of babies with hearing loss in the South African private health care sector will not be identified early. Newborn hearing screening must be integrated with hospital-based birthing services, ideally with centralized data management and quality control.

Seizure activity following cochlear implantation: Is it the implant?

2012-05-01

Abstract: Objective: Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been associated with facial nerve and vestibular end-organ stimulation suggesting potential for extra-cochlear stimulation. The objectives of this study were to investigate the potential relationship between cochlear implantation and seizure activity in the pediatric implant population.Methods: Local Research Ethics Board approval was obtained. The Hospital for Sick Children's Cochlear Implant Database from 1998 to 2011 was retrospectively reviewed. Based on a multidisciplinary team, patients who received a diagnosis of seizure disorder or had been investigated for seizure-like activity were identified and reviewed.Results: Fifteen children from a group of 816 pediatric cochlear implant users were identified as having suspected seizure-like activity. Eventually 10 children were found to have seizures based on an evaluation by a pediatric neurologist and an electroencephalogram. Of these 10, only 3 children had new onset of seizures after cochlear implantation and 2 of these 3 suffered from global developmental delay and other medical comorbidities. No definite temporal connection was found between cochlear implant use and seizure activity.Conclusions: Cochlear implantation in the pediatric population continues to be a reliable and safe intervention for children. Overall the prevalence of post implantation seizure disorders in our population (0.37%) is lower than that of the overall population (0.5–1%). The presence of new-onset seizure activity following cochlear implantation is unusual and while there are theoretic possibilities of how a cochlear implant could be implicated in initiating seizures we were unable to find evidence to support this association.

Congenital cysts of the infant larynx

Simon Prowse, Lindsey Knight — 2012-05-01

Abstract: Objectives: Congenital laryngeal cysts are a rare cause of neonatal airway obstruction. Two varieties can be distinguished, ductal cysts and saccular cysts. Treatment remains controversial, particularly with regard to saccular cysts, with some believing that endoscopic procedures leave cysts more prone to recurrence. We reviewed our management of congenital laryngeal cysts to determine the most effective intervention.Methods: A review of all children treated by our unit for congenital laryngeal cysts between 2001 and 2011. Demographic data, age at and mode of presentation were noted. Operation notes were reviewed to determine the nature of each laryngeal cyst and treatment methodology.Results: Ten children were identified, six with a ductal cyst of the vallecula and four with a saccular cyst, giving an overall incidence of 3.49 cases per 100,000 live births. Children of Pakistani ancestry were disproportionately represented, accounting for 40% of cases. Saccular cysts presented earlier with symptoms of more severe airway compromise, whilst vallecular cysts tended to present later with feeding difficulties and failure to thrive. Two-thirds of children with vallecular cysts had co-existing laryngomalacia. Treatment by single-stage endoscopic marsupialisation was effective in all cases at a mean follow-up of thirteen months.Conclusions: Congenital laryngeal cysts are rare, although they appear to be more common in the British-Pakistani population. Presentation depends on cyst size and proximity to the glottis and can be associated with laryngomalacia. Endoscopic marsupialisation is an effective means of treatment for ductal cysts and saccular cysts confined to the larynx.

Hearing thresholds in children with a congenital CMV infection: A prospective study

2012-05-01

Abstract: Objective: Hearing thresholds in children with a congenital cytomegalovirus (cCMV) infection are not always stable. Children can develop late onset hearing loss, fluctuations, progression (worsening) and improvement of hearing loss. Knowledge about these characteristics is important to understand why long term follow up in these children is mandatory.Methods: We prospectively follow a cohort of 154 children with cCMV infection, 68 of which met the inclusion criteria of at least 3 hearing evaluations over a period of at least 18 months in the absence of other risk factors for hearing loss. In those 68 children we evaluated the occurrence of unstable hearing thresholds: late onset hearing loss, fluctuations, progression and improvement of hearing loss.Results: Unstable hearing thresholds were observed in 29.4% of children with cCMV infection of which 19.2% were found in the group of children with ultimately normal hearing and in 62.5% of children with sensorineural hearing loss (SNHL) (p=0.0027). Fluctuations occurred in 16.2%. Late onset hearing loss occurred in 4.3% of children with a normal hearing at birth. In children with SNHL, progression or worsening of hearing thresholds occurred in 27.3% and improvement of thresholds in 40.9%. Important changes in thresholds only occurred in 13.2% of all children and predominantly in children who finally develop SNHL.Conclusions: Unstable hearing thresholds are frequently found in children with cCMV infection and occur not only in children who develop hearing losses but also in children who have a normal hearing at the last visit. Important changes in hearing thresholds of >30dB are more frequently seen in children who ultimately will develop SNHL.

Clinical outcomes of ventilation tube placement in children with cleft palate

Hitome Kobayashi, Takaaki Sakuma, Naohiro Yamada, Harumi Suzaki — 2012-05-01

Abstract: Objective: The purpose of this study was to investigate the long-term clinical outcomes in children with cleft palate.Methods: One hundred eight patients with cleft palate (CP) were investigated. Microscopic observation of the middle ears was performed periodically. If chronic otitis media with effusion (OME) was diagnosed at 1 year of age or later, ventilation tube (VT) placement was performed. The air-filled area of the mastoid air cells was checked on X-rays obtained at 1 and 5 years. The data from each measurement were tested statistically by the bootstrap method and Wilcoxon's rank-sum test. The clinical course from age 6 to the final examination (average 9.42 years) and the language development at 5 years were analyzed using data from the medical records of individual patients.Results: VT placements were performed at 5 years of age or younger in 41 CP patients (82 ears, 38%). About 30% of patients treated by VT placement at 5 years of age or younger required myringotomy and/or VT re-placement at 6 years of age or over. Ninety-five percent of patients who had not been treated by VT insertion at 5 years of age or younger showed a favorable subsequent clinical course. Patients treated by VT insertion at 5 years of age or younger had significantly smaller mastoid air cell areas as measured at 5 years of age and also at 1 year of age. No significant difference in language development was observed between the CP patients that underwent /did not undergo VT placement.Conclusions: VT placement should be positively undertaken in CP children who have small mastoid air cell areas as measured at 1 year of age, because an unfavorable prognosis of OME is expected in such patients. It is considered that patients treated by VT placement at 5 years of age or younger should be carefully followed up for the development of OME even after 6 years of age. Thus, measurement of the mastoid air cell area at the age of 1 year is useful for determining the therapeutic program.

Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea

Mai Thy Truong, Victoria G. Woo, Peter J. Koltai — 2012-05-01

Abstract: Objectives: Ten to twenty percent of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy (T&A). We hypothesize that sleep endoscopy, a flexible fiberoptic examination of the pharynx under anesthesia, is an effective tool for identifying sites of persistent obstruction.Methods: In this retrospective cohort study, we reviewed records of children who had symptoms consistent with OSA and a positive polysomnogram (PSG) who underwent sleep endoscopy followed by sleep endoscopy directed surgery. Data collection included age, BMI and co-morbidities. Apnea–hypopnea index (AHI) was compared to pre and post surgery for each child using a paired t-test.Results: Of the 80 children who underwent sleep endoscopy followed by directed surgery, 65% were male, mean age was 6years (SD 3.75years), average BMI was 19 (SD 0.43years) and 28% had co-morbidities. For the 51% of patients who had persistent OSA after T&A, the mean AHI after sleep endoscopy directed surgery was significantly lower then before surgery (7.9 vs. 15.7, p<.01). For the 49% of patients who had never undergone surgery for OSA, or who were surgically naïve, and underwent sleep endoscopy directed surgery, the mean AHI was significantly lower then before surgery (8.0 vs. 13.8, p<.01).Conclusions: Sleep endoscopy is a consistently reliable tool for identifying the sites of obstruction in both surgically naive children and those with persistent OSA after T&A.

Differential expression of Immunoglobulin A in the adenoids of children with and without exudative otitis media

Bing Wang, Xinye Tang, Jie Xu, Hongbing Yao — 2012-05-01

Abstract: Objective: To evaluate the variation of Immunoglobulin A (IgA) levels in the adenoids of children with otitis media with effusion (OME) and the correlation to age.Methods: A total of 129 children were enrolled in this study, including 60 children with OME and 69 children without OME. The children were divided into two groups according to age: aged ≤4 years (33 children with OME and 39 children without OME) and aged >4 years (27 children with OME and 30 children without OME). The samples were collected from hypertrophic adenoids, which could cause obstructive symptoms and/or OME. The IgA concentrations were analyzed by immunohistochemistry in the two groups.Results: The expression of IgA in the adenoids of children ≤4 years was significantly lower than in those aged >4 years. Among children >4 years, lower levels of IgA in the adenoids were observed in patients with OME than in patients without OME. However, no statistically significant differences in the IgA levels were found between patients aged ≤4 years with and without OME.Conclusions: The differential expression of IgA in the adenoids between patients with and without OME was correlated to age.

Differences between electrically evoked compound action potential (ECAP) and behavioral measures in children with cochlear implants operated in the school age vs. operated in the first years of life

Sanja Vlahović, Branka Šindija, Ivana Aras, Matko Glunčić, Robert Trotić — 2012-05-01

Abstract: Objective: The aim of this study was to identify the differences in the NRT measures, behavioral measures, and their relationship between the group of congenitally deaf children operated in the first years of life and the group of children operated in the school age.Methods: The study included 40 congenitally deaf children with cochlear implants divided into two groups. Group 1 was composed of 20 children (mean age at operation 2.3years, range 1.4–4.6years) and Group 2 was composed of 20 children (mean age at operation 11.3years, range 7.0–17.1years). The ECAP was recorded using the Nucleus 24 neural response telemetry (NRT) system. In each child, the responses were evoked by the apical, middle and basal electrodes. The analyzed parameters were: the ECAP threshold (T-NRT), N1P2 amplitude, N1 latency, slope of the amplitude growth function, response morphology, threshold (T-) level, maximum comfort (C-) level, dynamic range (DR), T-NRT as a percentage of the map DR, the correlation between the T-NRT and the T- and C-levels. The recordings of parameters were performed two years after implantations.Results: The T-NRT, DR, T-NRT as a percentage of the map DR and the correlation between T-NRT and C-levels were significantly different between both groups of children. There were no statistically significant differences between the groups with respect to the amplitude, latency, slope and morphology recorded using the same electrodes. However, intragroup differences regarding NRT measures and behavioral measures with respect to the position of stimulating electrode were more prominent in Group 2 than in the Group 1.Conclusions: Results of this study have also found a great variability of NRT and MAP measures within and across patients in both groups of children, but it was still more pronounced in the group of school children. NRT profile across electrodes follows MAP profiles better in the Group 1 then in the Group 2. Overall findings of NRT and MAP measures are not consistent and unambiguous as we expected, but still suggest potential differences between results in children operated in first years of life, and those operated in school age.

Acute bilateral blindness as a presenting symptom of Non-Hodgkin's lymphoma

Nader Emami, Sam J. Daniel — 2012-05-01

Abstract: NHL usually presents with lymphadenopathy or symptoms related to compression by the primary tumor of surrounding structures. While the head and neck region is a common site of involvement, blindness is rarely a presenting symptom. We report here the case of a child who presented to the emergency room with acute bilateral loss of vision and no other symptoms. Cranial imaging studies revealed a solid mass of the skull base with compression on optic nerves. Diagnosis of Burkitt's lymphoma was confirmed after biopsy. The patient had partial vision improvement two days after optic nerve decompression which was done immediately at the night of presentation.

Noma in an Afghani child: A case report

Jose Barrera, Matthew P. Connor — 2012-05-01

Abstract: We present a case of Cancrum Oris, also known as Noma, in a child treated by an Otorhinolaryngologist at a United States-led Joint Forces hospital in Afghanistan. Noma is a deadly, necrotizing infection of the face that is rarely seen in wealthy nations but can cause significant morbidity in third world countries. Through a literature review, we report the incidence, risk factors, clinical features, and proposed treatment for this disease.

A fatal presentation of dermatomyositis with facial swelling

2012-05-01

Abstract: Juvenile dermatomyositis (JDM) is the most common inflammatory autoimmune myopathy in children. Most common presentations consist of heliotrophic rash and/or gottron's papules in addition to proximal muscle weakness. A typical presentations have been reported. We present a 13-year-old African American male who presented with a two-week history of bilateral periorbital edema that was unresponsive to glucocorticoids. He had elevated transaminases but no detectable muscle weakness. A muscle biopsy was consistent with juvenile dermatomyositis. This case highlights the need to consider dermatomyositis in cases of facial swelling and the use of aggressive immunosuppressive therapies due to its associated vasculopathies.

Don’t hang your coat here

Jeffrey Cheng, Andrew Kleinberger, Brian Dunham, Peak Woo — 2012-05-01

Abstract: Report 2 cases of coat hanger floor of mouth injuries in children. We describe 2 cases of children who presented with coat hanger impalement injuries of the floor of mouth and their management. Removal under anesthesia is safe with a period of observation postoperatively. Impalement injury with coat hangers in the head and neck is a rarely encountered or described mechanism of trauma. We report the first case series of coat hanger impalement injuries in the floor of mouth in two children. Plain film radiographs may be useful to determine the depth of injury and trajectory of the foreign body. Careful removal under anesthesia is safe. Little if any floor of mouth edema was encountered postoperatively, but close observation for potential critical floor of mouth hematoma or edema should be considered.

Atypical presentation of laryngeal tuberculosis in a pediatric patient

Chelsea Obourn, Behrad Aynehchi, Boris Bentsianov — 2012-05-01

Abstract: Laryngeal tuberculosis is uncommon and most often associated with a primary lung infection in immunocompromised adults. We describe an atypical case in a pediatric patient with a relatively rapid onset and no history of travel or exposure to high-risk settings. Despite the unusual presentation and relative lack of familiarity with procedural guidelines in managing this uncommon and capricious disease by otolaryngologists in developed countries, reporting is mandated at multiple governmental health department levels. Consequently, this contagious entity must be considered in the interest of avoiding untoward outcomes for not only the patient, but the public as well.

Congenital cholesteatoma isolated to the mastoid presenting as stricture of the external auditory canal

Toshihiro Nagato, Ryuki Otaka, Tetsuji Wada, Naoki Kanai, Yasuaki Harabuchi — 2012-05-01

Abstract: Congenital cholesteatoma may originate at various sites in the temporal bone. Congenital cholesteatoma of the mastoid origin shows a variable clinical presentation, although the least common site is the mastoid process. We report an extremely rare case of congenital cholesteatoma isolated to the mastoid presenting as stricture of the external auditory canal. A 10-year-old boy presented with stricture of the left-sided external auditory canal caused by bulging of the posterior wall of the external auditory canal. Computed tomography showed destruction of the posterior wall of the external auditory canal by a lesion of soft tissue density in the left mastoid cells. At surgery, cholesteatoma was observed in the mastoid cavity. Although destruction of the posterior wall of the external auditory canal was identified, the external auditory canal skin and tympanic membrane were intact, and the aditus ad antrum mucosa was normal. Congenital cholesteatoma isolated to the mastoid was diagnosed. Diagnosis of congenital cholesteatoma isolated to the mastoid should be based on clinical examination, radiological evaluation, and surgical findings. In addition, the possibility of congenital cholesteatoma isolated to the mastoid should be considered in patients with stricture of the external auditory canal.

Tongue entrapment in aluminum water bottle: Discussion of removal and airway management

Gopi Shah, Joseph Sciarrino, Patrick Barth, Steve Cook, Robert O’Reilly — 2012-05-01

Abstract: Tongue entrapment in a bottle neck is rare, with few cases reported in the literature. Reported here is the case of a child who presented to the Emergency Department with her tongue entrapped in an aluminum bottle. This case is unique in that the patient had a delayed presentation resulting in significant tongue edema, requiring advanced methods for removal and airway management. These include sedated mechanical removal of the strangulating object and transnasal fiberoptic intubation. We review published cases and the options for removal of an entrapped tongue from a bottle neck, and we discuss the importance of airway management.

Report of cochlear implantation outcome in a case of Waardenburg syndrome

Bita Najafiyan, Amin Saburi, Susan Amirsalari — 2012-05-01

We read with interest Dr. Kaufmann et al.’s paper “Dysplasia of the cerebellum in Waardenburg syndrome: outcomes following cochlear implantation, Int J Ped Otorhinolaryngol (2010) 74, 93–96” . They skillfully reported an interesting case of Waardenburg syndrome (WS) with profound sensory neural hearing loss (SNHL) and cerebellar dysplasia which he was underwent bilateral sequential cochlear implantation successfully. Moreover, they asserted that they have reviewed the English literature and found only 7 studies for a total number of 41 patients. But, it seems that their review was not proper and they missed some studies. We reviewed the English literature exactly and found until July 2009 (when Kaufmann et al.’s manuscript has been submitted) 5 reports that were missed by authors .

Response to Letter to the Editor by Saburi et al., IJPORL-D-11-00699, entitled “Letter to the Editor regarding review of cochlear implantation outcome in a case of Waardenburg syndrome.”

Daniel J. Lee — 2012-05-01

We appreciate the comments by Saburi et al. (IJPORL-D-11-00699) regarding our 2010 IJPORL case report by Kaufmann et al. entitled “Dysplasia of the cerebellum in Waardenburg syndrome: outcomes following cochlear implantation .” The focus of this case report was to highlight the unusual finding of isolated cerebellar dysplasia in the setting of congenital deafness in an infant who underwent successful bilateral cochlear implant surgery. There were no prior descriptions of a WS patient with CNS dysplasia who underwent CI surgery and so prior to implantation we did not know how these abnormalities would impact on the neighboring central auditory pathways and therefore, the audiologic outcomes. Therefore, the focus of this report was to (1) highlight a rare association between Waardenburg syndrome (WS), deafness, and cerebellar underdevelopment in an otherwise healthy child and (2) demonstrate that cochlear implants are a reasonable habilitative option in this unusual clinical presentation not previously described. In our review of the literature at the time of the first submission in 2009 we identified 41 patients from 8 studies that described WS and CI outcomes. We regret that we did not find some of these reports using our own search criteria mentioned by Saburi et al. and others papers cited by Saburi that we did find were not included in our 2010 IJPORL publication for reasons mentioned below. Adding these several patients would not have changed the theme of our case report.

Letter to the Editor regarding ‘The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study’

Dong-Hee Lee — 2012-05-01

I read with great interest the recent publication titled “The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study” by Tatlıpınar et al. . Comparing pre- and postoperative levels of insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) and evaluating the correlation between them and A/N ratio, they concluded that adenotonsillectomy has a positive effect on the growth in children with related sleep-disordered breathing (SDB) by increasing IGF-I and IGFBP-3 but they failed to show any significant correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

Response to the letter to the editor regarding “The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study”

2012-05-01

Impaired nocturnal growth hormone (GH) secretion in accordance with abnormal sleep patterns has been proposed as the cause of growth delay in children with adenotonsillar hypertrophy (ATH) . However, the pathology that causes abnormal sleep patterns in children with ATH is upper airway obstruction. Adenotonsillectomy results in relief of obstruction and gives rise to improvement of sleep patterns and elevation of GH levels.