Head and Neck Medicine by Alexandros G.Sfakianakis: 03/06/17

Δευτέρα 6 Μαρτίου 2017

Medial Olivocochlear function in children with poor speech-in-noise performance and language disorder

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Caroline Nunes Rocha-Muniz, Renata Mamede Mota-Carvalo, Eliane Schochat
ObjectivesContralateral masking of transient-evoked otoacoustic emissions is a phenomenon that suggests an inhibitory effect of the olivocochlear efferent auditory pathway. Many studies have been inconclusive in demonstrating a clear connection between this system and a behavioral speech-in-noise listening skill. The purpose of this study was to investigate the activation of a medial olivocochlear (MOC) efferent in children with poor speech-in-noise (PSIN) performance and children with language impairment and PSIN (SLI+PSIN).MethodsTransient evoked otoacoustic emissions (TEOAEs) with and without contralateral white noise were tested in 58 children (between 6 and12 years). These children were arranged in three groups: typical development (TD) (n=25), PSIN (n=15) and SLI+PSI (n=13).ResultsPSIN and SLI+PSI groups presented reduced otoacoustic emission suppression in comparison with the TD group.ConclusionOur finding suggests differences in MOC function among children with typical development and children with poor SIN and language problems.

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Association of airway abnormalities with 22q11.2 deletion syndrome

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Rosalba Sacca, Karen B. Zur, T. Blaine Crowley, Elaine H. Zackai, Kathleen D. Valverde, Donna M. McDonald-McGinn
Introduction22q11.2 deletion syndrome (22q11.2DS) presents with complex but variable symptoms, including cardiac, immune, palatal, endocrine, cognitive, and psychiatric issues. However, an association of 22q11.2DS with structural airway abnormalities has not been formally described. The aim of this study was to document the frequency of this association.MethodsWe retrospectively reviewed medical records of patients with 22q11.2DS evaluated in the 22q and You Center at the Children's Hospital of Philadelphia between 1999 and 2015 referred to otolaryngology for an airway assessment. Type of airway abnormality and presence of comorbidities, such as congenital heart disease, tracheostomy, and association with prenatal symptomatology such as polyhydramnios, were noted.ResultsOf the 104 patients who underwent an otolaryngology procedure (microlaryngoscopy or bronchoscopy), 71% (n = 74) had airway abnormalities. Patients with airway abnormalities ranged in age from 5 months to 37 years, with similar prevalence among males and females. Observed airway abnormalities included tracheomalacia (36%), subglottic stenosis (28%), laryngomalacia (26%), glottic web (21%), and bronchomalacia (16%). Most patients with airway abnormalities (91%) had an associated congenital heart defect, with ventricular septal defect and Tetralogy of Fallot being the most prevalent. Importantly, 30% of patients required a tracheostomy, and overall polyhydramnios was noted in 16% of pregnancies.ConclusionAirway abnormalities are a common feature of 22q11.2DS, leading to substantial morbidity, particularly when combined with complex cardiac disease. Polyhydramnios may be an important prenatal clue to both the diagnosis of 22q11.2DS and airway anomalies. Postnatal assessment of airway structure and function among patients with 22q11.2DS is an important component of overall evaluation and will help guide long-term management.

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Reliability and validity of the Dutch pediatric Voice Handicap Index

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Laura Veder, Bas Pullens, Marieke Timmerman, Hans Hoeve, Koen Joosten, Marieke Hakkesteegt
IntroductionThe pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score.MethodsAll items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point.ResultsWe obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%.ConclusionsThe Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia.

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Management of orbital cellulitis and subperiosteal orbital abscess in pediatric patients: A ten-year review

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Vittorio Sciarretta, Marco Demattè, Paolo Farneti, Martina Fornaciari, Ilaria Corsini, Ottavio Piccin, Domenico Saggese, Ignacio Javier Fernandez
ObjectivePediatric periorbital cellulitis represents a common disease complicating a nasal infection.MethodsA ten–year retrospective review of fifty-seven children admitted to our institution with the diagnosis of periorbital cellulitis as a complication of sinus infections was carried out.ResultsThe age varied from one month to eleven years (mean 3.9 years). Thirty-five were males (62%), while twenty-two were females (38%). Nine out of fifty-seven (15.8%) presented exophthalmos associated with eyelid erythema and edema, while the rest suffered mainly from eyelid erythema and edema. Twenty-two patients complaining of exophthalmos or not responding to medical therapy within 48 hours were assessed with a computed tomography scan (38.6%). A subperiosteal orbital abscess was detected in nine cases and these patients underwent surgical drainage (15,8%). Recurrence of orbital infection occurred in three cases (5.3%).ConclusionsMedical management is the main treatment for both preseptal and postseptal orbital cellulitis. Nevertheless, there is no universally accepted guideline for the treatment of subperiosteal abscesses and each case should be treated accordingly. Urgent surgical drainage should be considered in cases not responding to adequate medical management, or those cases presenting visual deterioration.

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Coblation of suprastomal granulomas in tracheostomy-dependent children

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): C. Scott Brown, Marisa A. Ryan, Vaibhav H. Ramprasad, Anatoli F. Karas, Eileen M. Raynor
ObjectiveSuprastomal granulomas pose a persistent challenge for tracheostomy-dependent children. They can limit phonation, cause difficulty with tracheostomy tube changes and prevent decannulation. We describe the use of the coblator for radiofrequency plasma ablation of suprastomal granulomas in five consecutive children from September 2012 to January 2016.MethodRetrospective case series at a tertiary medical center.ResultsThe suprastomal granuloma could be removed with the coblator in all 5 cases. Three were removed entirely endoscopically and 2 required additional external approach through the tracheal stoma for complete removal. There were no intraoperative or postoperative complications. One patient was subsequently decannulated and 2 patients have improved tolerance of their speaking valves. Two patients remain ventilator dependent, but their bleeding and difficulty with tracheostomy tube changes resolved. Three of the patients have had subsequent re-evaluation with bronchoscopy, demonstrating resolution or markedly decreased size of the granuloma. This technique is time efficient, simple and minimizes risks associated with other techniques. The relatively low temperature and use of continuous saline irrigation with the coblator device minimizes the risk of airway fires. Additionally, the risk of hypoxia from keeping a low fractional inspiratory oxygen level (FIO2) to prevent fire is avoided. The concurrent suction in the device decreases blood and tissue displacement into the distal airway.ConclusionCoblation can be used safely and effectively with an endoscopic or external approach to remove suprastomal granulomas in tracheostomy-dependent children. More studies that are larger and have longer follow-up are needed to evaluate the use of this technique.

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Five-years’ experience with outpatient thyroglossal duct cyst surgery

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Ana Coelho, Catarina Sousa, Ana Sofia Marinho, Joana Barbosa Sequeira, João Ribeiro Castro, Fátima Carvalho, João Moreira-Pinto
ObjectivesMany pediatric surgeons feel uncomfortable doing Sistrunk procedure without drain placement and in an outpatient setting. This study aimed to review our pediatric surgery department's experience in managing thyroglossal duct cyst surgery and to prove feasibility and safety of Sistrunk procedure without drain placement in an outpatient setting.MethodsA retrospective review was performed of all patients who underwent Sistrunk procedure, between January 2011 and December 2015, in our department.ResultsA total of 36 patients were included, with age ranging from 1 to 14 years (mean 6.3 years). Sixteen patients underwent day surgery, and 20 stayed overnight (with less than 24h postoperative discharge). The main reason to stay overnight was distance (greater than 60km or 1hour driving) between the hospital and patient's residence. All patients had histopathological confirmation of the diagnosis. None of the patients had a drain placed intraoperatively. There was only one readmission at 48h postoperative; a patient who underwent day surgery came back with cervical edema, which resolved with non-operative treatment. Short-term complications included post-operative local wound infection (11,4%) and hematoma (2,9%), none of which required surgical treatment.ConclusionsSistrunk procedure without drain placement is safe and can be performed in an outpatient setting.

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The Analysis of Reliability and Validity of the IT-MAIS, MAIS and MUSS

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Yan Zhong, Tianqiu Xu, Ruijuan Dong, Jing Lv, Bo Liu, Xueqing Chen
ObjectiveThe aim of this study was to investigate the reliability and validity of the Infant-toddler Meaningful Auditory Integration Scale (IT-MAIS), Meaningful Auditory Integration Scale (MAIS), and Meaningful Use of Speech Scale (MUSS).MethodsIT-MAIS, MAIS and MUSS were divided into 3 sub dimensions. 300 children with cochlear implants (CI) were included in the investigation. To assess test-retest reliability of these questionnaires, 30 children were selected randomly to be evaluated at a two-week interval indicated that there were no significant changes between test and retest. Furthermore random test analysis by different evaluators was also administered to 30 users.ResultsReliability test: Test-retest reliability of the three scales was proved to be satisfactory. All domains had correlation coefficients that exceeded 0.750(P<0.01). The Cronbach's α of the three scales and their three domains were greater than 0.700. Reliability between evaluators of the three scales were considered to be satisfactory. All domains had correlation coefficients that exceeded 0.750(P<0.01). Validity test: The evaluation of content validity by expert review showed the questionnaire had good content validity; The correlation coefficients between the overall scores of the three scales and their three domains were 0.699∼0.978(P<0.01). There were correlations among the three sub-domains but the strength of the correlations was relatively low. There was certain construct validity.ConclusionsIT-MAIS, MAIS, MUSS scales have good reliability and validity, and can be used to measure the outcome for children with cochlear implants hearing and speech evaluation.

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Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Ryan Chin Taw Cheong, Philippe Bowles, Andrew Moore, Simon Watts
IntroductionPeri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA).MethodsAn 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres.ResultsThe survey response rate was 60% (n=21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n=12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery.ConclusionIn the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency.

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MYO15A splicing mutations in hearing loss: A review literature and report of a novel mutation

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Mahsa Motavaf, Mahdieh Soveizi, Majid Maleki, Nejat Mahdieh
Sensorineural hearing loss (SNHL) is the most prevalent genetic sensory defect in humans, affecting about 1 in 1000 newborns around the world. Non-syndromic SNHL accounts for nearly 70% of hereditary hearing loss and 80% of SNHL cases show an autosomal recessive mode of inheritance (ARNSHL). In the present study, we applied targeted-exome sequencing to a family with a single proband affected by congenital sensorineural hearing loss. 127 known genes were sequenced to find the causative mutation. One novel homozygous donor splice site mutation, c.4596 + 1G > A (IVS12 + 1G> A) was found in MYO15A gene. Analysis of this mutation within the family showed that the mutation segregates with hearing loss. New DNA sequencing technologies could lead to identification of the disease causing variants especially in highly heterogeneous disorders such as hearing loss.

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The public health resource utilization impact of airway foreign bodies in children

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Jeffrey Cheng, Beiyu Liu, Alfredo E. Farjat, Jonathan Routh
ObjectiveQuantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time. Study type: Cross-sectional analysis of national inpatient database with weighted estimates.Data sourceThe KID database (2000-2009).MethodsICD-9-DM codes for foreign body aspiration were used to identify patients to be included for investigation. Admission rates and charges were aggregated and compared among geographic region, location, and teaching hospital status. These factors were then also trended over time.ResultsFrom 2000 to 2009, airway foreign body diagnoses in children accounted for an estimated 4,000 to 5,000 admissions, resulting in a mean admission rate of 6.6 per 10,000 pediatric patients annually. Charges related to airway foreign bodies in children rose from a total of $93 million to $486 million in the observed period. There is an increasing trend over time of total charges per patient. Charges appear to be higher in urban locations and teaching hospitals.ConclusionsThe public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.

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Theory of mind and language development in Japanese children with hearing loss

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Hiroshi Fujino, Kunihiro Fukushima, Akie Fujiyoshi
ObjectiveThis study investigates the development of theory of mind (ToM) in Japanese children with hearing loss (HL) and its relationship with language abilities using the data of a large sample size.MethodsParticipants were 369 children with HL, ranging from around 4 to 12 years of age. The mean hearing level of the better ear was 100.7 dB. A "change in location"-type false belief task similar to the "Sally-Anne test" was given to the participants.ResultsThe pass rates for the false belief task were in the 20% range for 4 to 6-year-olds, 35.6% for 7-year-olds, 47.6% for 8-year-olds, and 63.6% for 9-year-olds. However, no children, even 12-year-olds, achieved a pass rate of 70%. A logistic regression analysis showed that the significant independent predictors of the false belief task performance were vocabulary age and syntactic comprehension level, and chronological age, hearing level, syntactic production level, and nonverbal intelligence were excluded.ConclusionThe results demonstrate that there is a delay in the development of ToM in Japanese children with HL. This finding is consistent with findings in English-speaking countries. Additionally, it is suggested that language abilities play an important role in the acquisition of ToM for children with HL.

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Using sildenafil (viagra) to treat congenital lymphatic malformations of the head and neck, our experience

Publication date: Available online 6 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): John Rocke, Gavin Quail, Graeme Copley

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Δευτέρα 6 Μαρτίου 2017