Preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns

HDR syndrome: Large cohort and systematic review

HDR syndrome is a rare disease characterized by hypoparathyroidism, deafness, and renal dysplasia. An autosomal dominant disease caused by heterozygous pathogenic GATA3 variants, the penetrance of each associated condition is variable. Literature reviews have provided some answers, but many questions remain, in particular what the relationship is between genotype and phenotype. The current study examines 28 patients with HDR syndrome combined with an exhaustive review of the literature. Some conditions such as hearing loss are almost always present, while others described as rare initially, do not seem to be so rare after all (genital malformations and basal ganglia calcifications). By modeling pathogenic GATA3 variants found in HDR syndrome, we found that missense variations appear to always be located in the same area (close to the two Zinc Finger domain). We describe new pathogenic GATA3 variants, of which some seem to always be associated with certain conditions. Many audiograms were studied to establish a typical audiometric profile associated with a phenotype in HDR. As mentioned in the literature, hearing function should always be assessed as early as possible and follow up of patients with HDR syndrome should include monitoring of parathyroid function and vesicoureteral reflux in order to prevent complications.

Cervical Chondrocutaneous Branchial Remnants: A Rare Congenital Anomaly of the Neck. A Case Series, Literature Review, and Associated Anomalies

Cervical chondrocutaneous branchial remnants (CCBRs) are rare anomalies found in the neck. These remnants can be easily misdiagnosed due to their low incidence, and they are often associated with other anomalies. Previous studies have reported an association with other anomalies in up to 76% of cases. In this article, the authors present a case series of two patients with bilateral CCBRs and investigate the associated anomalies through a literature review. Patients diagnosed with CCBRs who presented with cervical masses were included. Records were reviewed to investigate factors such as sex, location of the CCBRs, associated anomalies, timing of operations, and cartilage pathology. A surgical excision technique was employed, and the study also included a literature review focusing on reports related to CCBRs and associated anomalies. Two patients, a 3-year-old boy and a 17-year-old adolescent girl, with bilateral CCBRs underwent surgical excision. Patient demographics, prevalence, and characteristics of associated anomalies in CCBR cases were documented in the literature review. This case series presented two successful surgical excisions of CCBRs without complications or recurrence at 1 year of follow-up. The study emphasized the importance of thorough evaluation and assessment for associated anomalies in various body systems due to the potential co-occurrence of CCBRs with other anomalies.

Incidence of audiologic or otolaryngologic evaluation in patients with external ear anomalies

PURPOSE

The relationship between specific external ear anomalies (EEA) and hearing loss has been previously described. However, there is no literature regarding the appropriate evaluation of patients with EEA by audiology or otolaryngology. The objective of this study was to determine the incidence of audiologic or otolaryngologic evaluation of patients with EEA.

MATERIALS AND METHODS

A retrospective review of charts was conducted following approval from the institutional review board at Boston Medical Center. Charts of patients younger than 18 years old with EEA, identified using International Classification of Diseases (ICD)-9 codes 380-380.99, 744, and 744.4 and ICD-10 codes H61.90-92, Q16.0-16.9, Q17.0-17.9, Q18.0-18.2, from January 2012 to January 2019 were reviewed. Primary variables included incidence of audiologic and otolaryngologic evaluation, newborn hearing screen and audiometry results, and completion of surgical intervention. Binary logistic regressions were conducted for each group for diagnostic, procedural, and demographic characteristics.

RESULTS

A total of 723 patients were diagnosed with EEA from January 2012 to January 2019. Of these patients, 327 (45.2 %) were evaluated by audiology and 327 (45.2 %) were evaluated by otolaryngology. Of the 364 patients who obtained audiograms, 63 (17.3 %) demonstrated hearing loss. Surgical procedures were performed on 119 (16.5 %) patients, with the most common procedure being excision of the EEA (n = 79, 66.4 %). A total of 468 patients had a documented newborn hearing screen. Failure of newborn hearing screen and presence of microtia were associated with increased otolaryngologic and audiologic evaluation.

CONCLUSIONS

A majority of patients with EEAs do not obtain audiologic or otolaryngologic evaluation.

Ectopic Unilateral Ear Pit in an Otherwise Well-Appearing Child: A Case Report and Literature Review

Ear pits are a common congenital abnormality that is incidentally found on routine examinations. However, it is not well documented how many are found outside of their classical location or if these ectopic locations put patients at increased risk of having a hearing impairment, renal anomalies, genetic syndromes, or infection. Clinicians should be aware of the current guidelines for recognizing, screening, and evaluating for these risks in patients with ear pits, regardless of location.

[Antenatal ear examination: When, how and why?]

Antenatal ear examination is an integral part of the thorough examination of the fetal face. The discovery of an anomaly, whether it is made by chance or during a complementary in-depth examination, leads the practitioner to determine its isolated or associated character, in order to characterise its possible belonging to a syndromic entity. In this context, the realization of genetic analysis more precise and wider allowing a return of the results in a time compatible with an evolutive pregnancy, gives to the geneticist a central role in the management of these couples. The main challenge lies in obtaining a set of concordant clinical and biological clues, enabling the genetic results identified to be interpreted correctly, the optimised functioning of the ultrasound practitioner - geneticist duo is therefore fundamental. This results in a complex information to deliver, in the fact that the clinical translation of an ear anomaly in antenatal can go from an isolated aesthetic anomaly to a genetic syndrome with neurodevelopmental disorder. The objective of this work is to describe, from a methodological analysis of antenatal ears, the accessible malformative entities, isolated or associated, and to discuss the problems in the need or not to propose their screening.

Genodermatoses with hearing impairment

Hearing loss is a prominent feature in multiple genodermatoses. Underappreciation of auditory deficits can misdirect proper diagnosis by the treating dermatologist. This review reviews the anatomic, developmental, and embryologic aspects that characterize the ear and summarizes genodermatoses that have aberrant auditory findings. The latter are classified into neural crest, metabolic, pigmentary, craniofacial, and a miscellaneous category of disorders lacking specific cutaneous findings. The algorithms provided in this review enable treating dermatologists to better recognize and manage genodermatoses with ear involvement.

A Review of Benign Congenital Anomalies

Benign congenital anomalies are common in neonates. Some of these common benign congenital anomalies include preauricular pits, sacral dimples, supernumerary digits, accessory nipple, and natal teeth. It is important for health care providers who take care of newborns to recognize these benign anomalies so that unnecessary evaluations and investigations are not performed. However, some of these anomalies may be associated with clinically significant conditions. In this article, we discuss when further evaluation should be performed in babies presenting with these common benign congenital anomalies. [Pediatr Ann. 2020;49(2):e66-e70.].

Coccygeal Polypoid Eccrine Nevus

Skin tags are fairly common lesions usually seen in adults on the neck and in body folds. The sacrococcygeal region is an unusual location for skin tags in children and may represent a congenital malformation of the spine or an isolated skin lesion. In this review, we summarize the clinical presentation, histopathologic changes, and differential diagnosis of coccygeal polypoid eccrine nevus as a rare cause of sacrococcygeal papules in children.

Pregnancy outcomes after maternal use of thiocolchicoside: A case series

OBJECTIVE

The 2014 report by European Medicines Agency (EMA) restricted the use of thiocolchicoside for all reproductive-age women. In this study, we aim to expand the systematically-collected human data and discuss it within the frame provided by this report.

METHODS

We identified and evaluated the outcomes of 48 prospectively recorded pregnancies referred to Terafar (Teratology Information Service, Izmir, Turkey).

RESULTS

Of 42 pregnancies with first-trimester exposure and known outcomes, 31 resulted in live births, four in miscarriage and seven ended with elective terminations. There were 26 normal outcomes, two major and three minor congenital malformations among the live births.

CONCLUSIONS

Despite a number of limitations, our results and previous case series collectively strengthen the view that thiocolchicoside is unlikely to be a major teratogen. EMA's 2014 report should be revised to reflect this finding, while current restrictions on use should continue until more detailed safety information is available.

The results of newborn hearing screening by means of transient otoacoustic emissions - has anything changed over 10 years?

OBJECTIVES

Universal newborn hearing screening (UNHS) has become the standard of care in many countries. The aim of this study was to evaluate the results of UNHS after ten years of the program in Poland and to compare them with the results of 2003.

METHODS

In the study, we analyze the results of UNHS in the University Hospital in Poznan, Poland. Between 01.01.2013 and 31.12.2013, 6827 children were examined by means of otoacoustic emissions.

RESULTS

Risk factors (RF) were identified in 772 (11.3%) newborns, which is significantly less than 10 years ago (p < 0.05). The most frequent RF were: ototoxic medications, treatment in neonatal intensive care unit (NICU) and prematurity < 33 weeks of gestation. In 2003, the most frequent were ototoxic medications and prematurity, less frequent was treatment in NICU and more common was low Apgar score. In 51 (6.6%) newborns with RF, the result of OAE was positive either unilaterally or bilaterally. In infants without RF the result was positive unilaterally in 22 (0.4%) and bilaterally in 14 (0.2%) patients. These results are significantly lower than in our former study. The relative risk of positive result was the highest in infants with complex congenital anomalies (RR = 44.99), craniofacial anomalies (RR = 17.46) and mechanical ventilation for > 5 days (RR = 10.69). In our previous study, the highest RR of positive test results was in infants with family history, congenital malformations and low Apgar score. We found that most predictive as to the final diagnosis was bilaterally positive OAE test. In most patients, the second check confirmed the diagnosis, independently of RF. The number of false positive tests at the 1st level of screening is significantly lower now than 10 years ago, probably due to better staff training.

CONCLUSIONS

Long term monitoring and the appropriate management of hearing deficit in children is essential. UNHS seems to be the most efficient way of finding children who require treatment of hearing impairment. The prevalence of most risk factors of hearing deficit has significantly changed over the years. The number of false positive results has significantly decreased over the years thanks to better staff training.

The Association of Accessory Auricular Tissue With Solid Organ Abnormalities and Its Effect on Auditory and Vestibular Function

BACKGROUND

Accessory auricular tissue is a common congenital anomaly ranging from an accessory skin appendage to a separate pinna. The association between auditory or vestibular dysfunction and accessory auricular tissue is debated, and little is known about related solid organ abnormalities. We examine the prevalence of accessory auricular tissue, its association between solid organ abnormalities and auditory/vestibular dysfunction, and its management.

METHODS

A retrospective cohort study was performed using the 2000 to 2012 HCUP kids' inpatient database. Live newborns with a diagnosis of accessory auricle were included.

RESULTS

Of the 19,638,453 births recorded between 2000 and 2012, 0.13% had accessory auricular tissue (n = 25,802); 11.8% underwent excision or destruction of the tissue during birth admission. Newborns with this diagnosis were more likely to receive auditory and vestibular testing (5% vs 4.2%, P < 0.001; 5.5% vs 5%, P < 0.001) and to be diagnosed with abnormal auditory function (1.2% vs 0.5%, P < 0.001) and hearing loss (0.09% vs 0.02%, P < 0.001). Diagnosis of auditory impairment had a 3-fold higher odds of surgical management during birth stay (odds ratio, 3.12; 95% confidence interval, 1.826-5.339). Although none were diagnosed with vestibular dysfunction, patients with accessory auricular tissue were 1.5-fold to 3-fold more likely to have cardiac malformations and 4-fold more likely to have renal anomalies.

CONCLUSIONS

Newborns with accessory auricular tissue more frequently undergo auditory and vestibular testing during birth stay. Auditory dysfunction, cardiac malformations, and renal anomalies are more frequently diagnosed in patients with accessory auricular tissue. However, none were diagnosed with vestibular impairment, bringing into question the necessity of vestibular testing.

Cervical Chondrocutaneous Branchial Remnants

Objective

Cervical chondrocutaneous branchial remnants are rare malformations usually found in the lower neck. As high as 76% of patients have been reported to have associated anomalies. We review the literature and report a case series of seven patients with cervical cartilaginous remnants.

Design

A retrospective case series of seven patients identified from the electronic hospital records.

Results

Seven patients with cervical chondrocutaneous branchial remnants were identified (six boys and one girl). Only one of the patients had associated anomalies.

Conclusions

A review of the literature revealed no evidence for sinuses or cysts related to cervical chondrocutaneous branchial remnants. Operative treatment can be postponed to a suitable and safe age. There is marked variation in the reported prevalence of associated anomalies, ranging from 11% to 76%.

Is routine audiometric testing necessary for children with isolated preauricular lesions?

INTRODUCTION

Preauricular lesions, including tags, pits, sinuses, and cysts are commonly seen. Some studies have shown increased incidence of hearing loss in these patients but other studies have failed to corroborate this finding. The purpose of this study is to evaluate the incidence of hearing loss in patients with isolated preauricular lesions.

METHODS

Retrospective chart review of all pediatric otolaryngology patients seen at a tertiary academic center between 2008 and 2014. All patients with the diagnosis code of 744.1 or 701.9 (preauricular skin tag) or 744.46, 744.47, or 744.89 (preauricular pit/fistula/cyst) were included in this study. Medical records were reviewed for clinical, demographic, and audiologic data.

RESULTS

Ninety-nine patients, 46 males, 53 females, with preauricular lesions were identified. Twelve were found to have abnormal hearing. Five patients had conductive hearing loss due to underlying Eustachian tube dysfunction. Four patients had sensorineural hearing loss; three of these patients had an enlarged vestibular aqueduct and one patient did not have an identified cause. Three patients had sound field testing or abnormal otoacoustic emissions that suggested hearing loss with no further follow up.

CONCLUSION

Children with isolated preauricular lesions with no history of otologic surgery or risk factors for hearing loss may not need audiologic evaluation outside of regular hearing screening. However, there does appear to be a higher association with Eustachian tube dysfunction in these children. Further studies will need to be done to determine whether or not there is an embryological correlation for this finding.

Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors

Background

Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.

Methods

A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).

Results

Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.

Conclusions

We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.

Biochemical properties of tissue-engineered cartilage

OBJECTIVE

Microtia is treated with rib cartilage sculpting and staged procedures; though aesthetically pleasing, these constructs lack native ear flexibility. Tissue-engineered (TE) elastic cartilage may bridge this gap; however, TE cartilage implants lead to hypertrophic changes with calcification and loss of flexibility. Retaining flexibility in TE cartilage must focus on increased elastin, maintained collagen II, decreased collagen X, with prevention of calcification. This study compares biochemical properties of human cartilage to TE cartilage from umbilical cord mesenchymal stem cells (UCMSCs). Our goal is to establish a baseline for clinically useful TE cartilage.

METHODS

Discarded cartilage from conchal bowl, microtic ears, preauricular tags, rib, and TE cartilage were evaluated for collagen I, II, X, calcium, glycosaminoglycans, elastin, and fibrillin I and III. Human UCMSCs were chondroinduced on 2D surfaces and 3D D,L-lactide-co-glycolic acid (PLGA) fibers.

RESULTS

Cartilage samples demonstrated similar staining for collagens I, II, and X, elastin, and fibrillin I and III, but differed from rib. TE pellets and PLGA-supported cartilage were similar to auricular samples in elastin and fibrillin I staining. TE samples were exclusively stained for fibrillin III. Only microtic samples demonstrated calcium staining.

CONCLUSIONS

TE cartilage expressed similar levels of elastin, fibrillin I, and collagens I and X when compared to native cartilage. Microtic cartilage demonstrated elevated calcium, suggesting this abnormal tissue may not be a viable cell source for TE cartilage. TE cartilage appears to recapitulate the embryonic development of fibrillin III, which is not expressed in adult tissue, possibly providing a strategy to control TE elastic cartilage phenotype.

Cleft Lip and/or Palate and Auricular Malformations

Objective

To study the relationship between cleft lip and/or palate and auricular malformations in Finnish patients with cleft.

Design

Retrospective analysis of patients with an external ear malformation and either a cleft lip with or without a cleft palate (CL±P) or an isolated cleft palate (CP).

Setting

Tertiary referral clinic.

Patients

Review of hospital records of 100 patients from the register of 8200 patients with cleft in the Cleft and Craniofacial Centre at the Helsinki University Central Hospital.

Main Outcome Measures

Proportions of variable auricular malformations among CL±P and CP patients.

Results

Microtia is the most common auricular malformation among patients with cleft and is almost equally prevalent with both CL±P and CP. The prevalence of microtia increases as the severity of CL±P increases. The combination of microtia and CL±P or CP is frequently found with both oculo-auriculo-vertebral spectrum and Treacher Collins syndrome.

Conclusions

Microtia seems to be the most common auricular malformation among patients with cleft. The prevalence of microtia seems to increase as the severity of CL±P increases, whereas in isolated CP microtia seems to occur independently.

Analysis of incidence and genetic predisposition of preauricular sinus

OBJECTIVES

To evaluate the incidence of preauricular sinus, the association between preauricular sinus of a parent and their children, and the odds of hearing impairments in patients with preauricular sinus.

METHODS

A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. We evaluated data from 23,533 subjects who were interviewed between 2010 and 2012.

RESULTS

The incidence of unilateral preauricular sinus was 1.3% and that of bilateral preauricular sinus was 0.3%. Female gender was statistically associated with preauricular sinus (adjusted odd ratio, AOR=1.401). There was no statistical difference between right- and left-sided preauricular sinus. There was an association between parents and their children for bilateral preauricular sinus (AOR of father's bilateral preauricular sinus=35.711; AOR of mother's bilateral preauricular sinus=7.683), but there was no association found for unilateral preauricular sinus. There was no link found between hearing impairment and preauricular sinus.

CONCLUSION

This large population-based study provides reliable information about the incidence of preauricular sinus, the association between preauricular sinus in parents and their children, and the lack of an association with hearing impairment; these results can help clinicians in the management of their patients.

Co-occurrence of hemiscrotal agenesis with cutis marmorata telangiectatica congenita and hydronephrosis affecting the same side of the body

To our knowledge, there are nine previous reports of patients with congenital scrotal agenesis (CSA), seven of which were bilateral, and unilateral in two, also named as hemiscrotal agenesis (HSA). Here, we report a male infant with the previously undescribed co-occurrence of HSA with cutis marmorata telangiectatica congenita (CMTC), and hydronephrosis due to vesicoureteral reflux, all of them on the left side. CMTC is a segmental vascular malformation usually attributed to mosaicism of a postzygotic mutation, whereas the mechanisms in the CSA involve a failure on the labioscrotal fold (LSF) development due to a localized 5α-reductase deficiency and/or androgen insensitivity. Since the skin with HSA was affected also by CMTC and by the fact that it exhibited lack of response to the topical testosterone treatment, all this suggests to us an androgen insensitivity mosaicism in our patient restricted to the left LSF, because skin with intact androgen receptors normally shows some type of response. Since CSA and/or HSA have been also seen in patients with PHACES, popitleal pterygium syndrome, or as part of a recently proposed familial entity with CSA (or agenesis of labia majora as its female counterpart), developmental delay, visual impairment, and moderate hearing loss, further reports could confirm this manifest genetic heterogeneity, highly evocative of somatic mosaicism in our patient.

Developmental anomalies of the skin

This paper focuses on the diagnosis and management of developmental anomalies of the skin that may be seen early in life. Common locations include the head, nose, preauricular area of the face, neck, and spine. Those that occur in or near the midline can be more serious because of possible intracranial connections. Radiologic imaging of the areas of involvement is often important; computed tomography (CT) scans can delineate bony defects; whereas, magnetic resonance imaging (MRI) more clearly defines intracranial connections. Occult spinal dysraphism can be suspected when certain cutaneous signs are present.

Risk indicators for hearing loss in infants treated in different neonatal intensive care units

AIM

To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs).

METHODS

For 2002-2005, data from the NICU hearing screening database in the Netherlands were matched with the national neonatology database in which all NICU infants with their patient characteristics and specialized procedures are registered. Multivariate logistic regression analyses were performed to assess risk indicators for HL and to explain differences in prevalence rates between NICUs.

RESULTS

A total of 10 830 infants were available for analyses. The prevalence of HL was 1.8% and ranged from 0.7 to 3.7% between NICUs. Infants' characteristics that significantly increased the risk of HL were the presence of craniofacial anomalies, chomosomal/syndromal anomalies, central nervous system conditions, circulatory system conditions and intra-uterine infections. The specialized procedures involving > or =12 days of intensive care and high frequency oxygenation ventilation were independent risk indicators for HL. Approximately 20% of the variance can be explained by the studied risk indicators. Differences in prevalence rates between NICUs were slightly reduced after adjustment for these risk indicators. NICUs with the highest prevalence rates of HL were situated in the largest cities in the Netherlands with a mixed population because of immigration. Therefore, ethnicity may be a risk indicator.

CONCLUSIONS

Several independent risk indicators for HL were found, but they could not explain all differences in prevalence rates of HL between NICUs.

[What's new in pediatric dermatology?]

The main selected articles in pediatric dermatology covered the following topics: development and maturation of the epidermal barrier in the neonate, iatrogenic events in the neonatal ICU, diagnostic value of minor birthmarks, complications, risk factors and treatment of hemangiomas, coagulopathy in venous malformations, epidemiology and dermoscopy of congenital and acquired melanocytic nevi in childhood, growth of the body surface area, new pathogenic concepts and treatment in atopic dermatitis, the impact of filaggrin deficiency, hereditary factors in Kawasaki disease, severe and drug resistant cases, management of juvenile dermatomyositis, treatment of childhood psoriasis with biologics, the new classification of epidermolysis bullosa and therapeutic approach with cell therapy, neurological impairment in xeroderma pigmentosum, behavioural anomalies in X-linked ichthyosis, guidelines for neurofibromatosis type I, the genetics of an hereditary hypotrichosis, infantile acne, rosacea in childhood, mast cell disease management and, last but not least, treatment of hair lice with silicone.