1
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Barbour A, Penman D, Kubba H. Prevalence of thyroid gland tissue in midline neck dermoid cysts in children and a proposed new 'thyroglossal entrainment' hypothesis for their formation. J Laryngol Otol 2024; 138:448-450. [PMID: 37795741 DOI: 10.1017/s0022215123001792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Thyroglossal duct cysts and dermoid cysts both commonly present as midline neck lumps in children. They are treated as separate entities with different embryological origins. There are isolated reports of thyroid gland tissue in a dermoid cyst, concurrent thyroglossal and dermoid cysts, and cysts with mixed histology. It is not known if these are rare or common. METHODS All children undergoing excision of a congenital midline neck cyst between January 2017 and December 2022 were identified. Histopathology slides were reviewed in detail. RESULTS In 53 children, there were 26 thyroglossal duct cysts, 24 dermoids, 1 lymph node and 2 with no diagnostic material identified. Five dermoids (28 per cent) had associated thyroid gland tissue, and 1 (4 per cent) had hybrid histology with keratinising and respiratory epithelium. Infection occurred in 17 per cent of dermoids prior to excision and 8 per cent of dermoids recurred after excision. CONCLUSION Hybrid histology, infection and recurrence are all common in midline neck dermoids. A new theory for their embryological origin is proposed, with the suggestion that some may need more extensive surgery.
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Affiliation(s)
- Amy Barbour
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Dawn Penman
- Department of Pathology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
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2
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Drake I, Fountain H, Kubba H. Managing recurrent nosebleeds in children: a retrospective review of 718 children attending a nurse-led epistaxis clinic. J Laryngol Otol 2024; 138:431-435. [PMID: 38224038 DOI: 10.1017/s0022215124000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE This review assessed the effectiveness of the nurse-led children's epistaxis clinic in streamlining patient care and avoiding unnecessary general anaesthesia. METHODS A retrospective case note review was conducted of children attending the nurse-led epistaxis clinic between 2019 and 2021. RESULTS A total of 718 children were seen over three years. Twelve (1.7 per cent) had a known coagulopathy. Of the children, 590 (82 per cent) had visible vessels and 29 (4 per cent) had mucosal crusting. Silver nitrate cautery was attempted under topical anaesthesia in 481 children, with 463 (96 per cent) successful cauterisations. Fifteen (3 per cent) were cauterised under general anaesthesia. Of the children, 706 (99 per cent) were prescribed nasal antiseptic preparations; this was the sole treatment for 58 (8 per cent). Blood investigations were requested for eight children (1 per cent) and haematology referral for three (0.4 per cent). CONCLUSION This is the largest published series of children's nosebleeds. Given the short-lived benefit from cautery, it is suggested that general anaesthesia should not be offered routinely. However, improved haematology referral criteria are required to increase underlying diagnosis.
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Affiliation(s)
- Ivy Drake
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Hazel Fountain
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
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Wescott RA, Downie LS, Kubba H. Retrospective observational study analysing the trends in ventilation tube insertion in children in Scotland between 2001 and 2018. Clin Otolaryngol 2024; 49:199-206. [PMID: 37964492 DOI: 10.1111/coa.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/06/2023] [Accepted: 09/21/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Otitis media with effusion (OME) is common, affecting up to 90% of children. Around 25% will have a persistent effusion with conductive hearing loss which can impact their development. Ventilation tubes (VTs) can improve their hearing in the short term. This study aims to analyse the trends in VT insertion rates across Scotland. DESIGN Retrospective observational study. SETTING All mainland Scottish health boards. PARTICIPANTS All children aged 0-16 who underwent a VT insertion procedure from 2001 to 2018 were included. MAIN OUTCOME MEASURES Data were provided by the Scottish Public Health Observatory, using Scottish Morbidity Records. Mid-year population estimates were obtained from the National Records Office of Scotland. Socioeconomic deprivation was estimated based on area of residence using the Scottish Index of Multiple Deprivation. VT insertion rates were calculated and trends analysed. RESULTS A total of 35 878 VT procedures were performed in total with a mean rate of 2.02 per 1000 children per year. The highest insertion rates were observed in children aged 4-6. VT insertion rates reduced during the study period (R = -0.729, p = .001). Variability in VT insertion rates between health boards reduced. There was a significant association between socioeconomic deprivation and VT insertion rate, with the most deprived children having the highest rate (p < .001). CONCLUSIONS VT insertion rates and the variability between Scottish health boards have reduced over the past two decades, suggesting a more equitable system. Our data intimates that the decision to perform VT insertion is based upon disease prevalence rather than clinician preference.
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Affiliation(s)
- Robert A Wescott
- Department of Otolaryngology, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | | | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, Scotland
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Davis SE, Davis C, Patel N, Kubba H, Clement WA. Long-term Airway Outcomes and Interventions in Children With Oesophageal Atresia With Tracheoesophageal Fistula: A 20-year Single Centre Observational Study. J Pediatr Surg 2024:S0022-3468(24)00087-3. [PMID: 38429129 DOI: 10.1016/j.jpedsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Airway anomalies, symptoms and interventions are commonly reported in children with oesophageal atresia with tracheoesophageal fistula (OA/TOF). The purpose of this study was to assess the incidence of these airway pathologies and those requiring interventions in the long-term. METHODS A retrospective case note review of all patients admitted to the Neonatal Unit at the Royal Hospital for Children, Glasgow between January 2000 and December 2015 diagnosed with OA/TOF. Included patients had a minimum of 5 years follow-up. RESULTS 121 patients were identified. 118 proceeded to OA/TOF repair. 115 patients had long-term follow-up data. Ninety-five (83%) children had one or more airway symptom recorded. Thirty-six (31%) neonates underwent airway endoscopy at the time of their initial OA/TOF repair. Forty-six (40%) children underwent airway endoscopy at a later date due to airway symptoms. Airway pathologies identified included airway malacia, thirty-two (28%), subglottic stenosis, eleven (10%), tracheal pouch, twenty-five (22%), laryngeal cleft, seven (6%) and recurrent fistula, five (4%). Airway interventions included endoscopic division of tracheal pouch, ten (9%), tracheostomy, seven (6%), aortopexy, six (5%), repair of recurrent fistula, five (4%), endoscopic repair of laryngeal cleft, three (3%) and four (3%) required open airway reconstruction for subglottic stenosis. One child (1%) remains tracheostomy dependent. CONCLUSIONS Long-term airway pathologies are common in children with OA/TOF. Many of these are remediable with surgical intervention. Clinicians should be cognisant of this and refer to Airway Services appropriately.
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Affiliation(s)
- Sandra E Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom.
| | - Carl Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - W Andrew Clement
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
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Drake I, Wilkinson S, Kubba H. Spontaneous abscess of the nasal septum in children: a 10-year series. J Laryngol Otol 2024:1-3. [PMID: 38311333 DOI: 10.1017/s0022215124000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND This paper reports a 10-year series of spontaneous nasal septal abscesses in immune-competent children, with suggestions for optimal management. METHODS A retrospective case note review was conducted of children undergoing an operation for incision and drainage of nasal septal abscesses between 2013 and 2023. RESULTS Six children were identified via electronic hospital records during the 10-year review period, five with a spontaneous abscess. The children were aged 10-14 years. All were immunocompetent and none had active sinus infection. The most common presenting features were nasal swelling, facial swelling, headache, nasal congestion and fever. The most common bacterial isolate was Staphylococcus aureus. All children received prompt surgical drainage and intravenous antibiotic therapy. Complications were seen in three children, with one child developing significant intracranial complications. CONCLUSION To our knowledge, this is the first series of spontaneous nasal septal abscesses in immunocompetent children. The high prevalence of Staphylococcus aureus suggests spread from the nasal mucosa or vestibule. Early recognition, computed tomography scanning, surgical drainage and antibiotic therapy are the mainstays of treatment, to prevent potentially life-threatening complications.
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Affiliation(s)
- Ivy Drake
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Sophie Wilkinson
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
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Kawar L, Clark E, Kubba H. External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm. Int J Pediatr Otorhinolaryngol 2024; 176:111821. [PMID: 38147731 DOI: 10.1016/j.ijporl.2023.111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. METHODS A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. RESULTS A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. CONCLUSION Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
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Affiliation(s)
- Luai Kawar
- University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.
| | - Emma Clark
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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Barbour AE, Penman D, Kubba H. What is the annual risk of infection in congenital midline neck cysts in children? Thyroglossal duct cysts versus dermoid cysts. Int J Pediatr Otorhinolaryngol 2024; 176:111842. [PMID: 38168651 DOI: 10.1016/j.ijporl.2023.111842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Midline neck lumps in children are mostly found to be thyroglossal duct cysts or dermoid cysts. Thyroglossal duct cysts often have an associated sinus tract which may connect all the way to the foramen caecum on the tongue, while dermoids have no such connection. This study aims to estimate the annual infection risk for midline neck cysts based on our patient series, and to see if this differs between thyroglossal duct cysts and dermoid cysts. METHODS All children seen at the Royal Hospital for Children, Glasgow who underwent surgical excision of a midline neck cyst between 1st January 2017 and 31st December 2021 were identified. In those whose cyst had been infected prior to surgical excision, the age at which the first episode of infection occurred was recorded and used to calculate a survival curve. RESULTS We identified 53 children (29 male, 24 female) aged 1-16 years (median 4) at the time of surgical excision. There were 26 thyroglossal and 24 dermoid cysts, plus 2 with indeterminate histology and 1 lymph node. Of the 24 dermoids, 4 suffered infection prior to surgery (17%), and 2 of these recurred after surgery (8%). Of the 26 thyroglossal cysts, 16 suffered infection prior to surgery (62%) and 5 of these recurred (19%). 78% of thyroglossal and dermoid cysts had at least 1 episode of infection by age 10 years. DISCUSSION In a child with a congenital midline neck cyst that has never been infected, deferring surgery for a year comes with a 7.8% risk that the cyst will get infected.
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Affiliation(s)
- Amy Edith Barbour
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Dawn Penman
- Department of Paediatric, Pathology Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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Aldriweesh B, Alkhateeb A, Boudewyns A, Chan CY, Chun RH, El-Hakim HG, Fayoux P, Gerber ME, Kanotra S, Kaspy K, Kubba H, Lambert EM, Luscan R, Parikh SR, Rahbar R, Rickert SM, Russell J, Rutter M, Schroeder JW, Schwarz Y, Sobol SE, Thevasagayam R, Thierry B, Thompson DM, Valika T, Watters K, Wei JL, Wyatt M, Zur KB, Daniel SJ. International pediatric otolaryngology group (IPOG) consensus on approach to aspiration. Int J Pediatr Otorhinolaryngol 2024; 176:111810. [PMID: 38147730 DOI: 10.1016/j.ijporl.2023.111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To provide recommendations for a comprehensive management approach for infants and children presenting with symptoms or signs of aspiration. METHODS Three rounds of surveys were sent to authors from 23 institutions worldwide. The threshold for the critical level of agreement among respondents was set at 80 %. To develop the definition of "intractable aspiration," each author was first asked to define the condition. Second, each author was asked to complete a 5-point Likert scale to specify the level of agreement with the definition derived in the first step. RESULTS Recommendations by the authors regarding the clinical presentation, diagnostic considerations, and medical and surgical management options for aspiration in children. CONCLUSION Approach to pediatric aspiration is best achieved by implementing a multidisciplinary approach with a comprehensive investigation strategy and different treatment options.
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Affiliation(s)
- Bshair Aldriweesh
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology-Head & Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ahmed Alkhateeb
- Department of Otolaryngology-Head & Neck Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - An Boudewyns
- Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp Faculty of Medicine and Translational Neurosciences, Antwerp, Belgium
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | - Robert H Chun
- Department of Otolaryngology, Medical College of Wisconsin, United States
| | - Hamdy G El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada; Division of Pediatric Surgery, Department of Pediatrics, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital, CHU Lille, Université de Lille, Lille, France
| | - Mark E Gerber
- Division of Otolaryngology, Head & Neck Surgery, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Sohit Kanotra
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, United States
| | - Kimberley Kaspy
- Division of Respiratory Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, United Kingdom
| | - Elton M Lambert
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, 6701 Fannin Street, D.640, Houston, TX, 77030, United States
| | - Romain Luscan
- Department of Pediatric ENT, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris University, 149, rue de Sèvres, 75015, Paris, France
| | - Sanjay R Parikh
- Department of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Scott M Rickert
- Department of Otolaryngology, New York University Langone Medical Center, New York, NY, 10016, United States
| | - John Russell
- Department of Pediatric Otolaryngology Children's Health Ireland (Crumlin), Dublin, Ireland
| | - Mike Rutter
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - James W Schroeder
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Yehuda Schwarz
- Department of Otolaryngology- Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Steven E Sobol
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, United States
| | - Ravi Thevasagayam
- Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire, S10 2TH, United Kingdom
| | - Briac Thierry
- Department of Pediatric ENT, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris University, 149, rue de Sèvres, 75015, Paris, France
| | - Dana M Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Taher Valika
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Karen Watters
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Julie L Wei
- Chair, Otolaryngology Education, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, United States
| | - Michelle Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Karen B Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, United States
| | - Sam J Daniel
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
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Daniel SJ, Fayoux P, Bateman N, Boudewyns A, Brigger M, Chan CY, Chan K, Cheng A, Conley S, Kubba H, Lambert EM, Muntz H, Nuss R, Russell J, Rutter M, Schwarz Y, Spratley J, Thevasagayam R, Thompson D, Valika T, Wyatt M. Comprehensive management of anterior drooling: An International Pediatric Otolaryngology Group (IPOG) consensus statement. Int J Pediatr Otorhinolaryngol 2023; 168:111500. [PMID: 36990032 DOI: 10.1016/j.ijporl.2023.111500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To provide guidance for the comprehensive management of children referred for anterior drooling. The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. METHODS Survey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The recommendations are derived from current expert consensus and critical review of the literature. RESULTS Consensus recommendations include initial care and approach recommendations for health care providers who commonly evaluate children with drooling. This includes evaluation and treatment considerations for commonly debated issues in drooling management, initial work-up of children referred for anterior drooling, treatment recommendations, indications and contra-indications for rehabilitation, medical, and surgical management, as well as pros and cons of different surgical procedures in the hands of drooling management experts. CONCLUSION Anterior drooling consensus recommendations are aimed at improving patient-centered care in children referred for sialorrhea.
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Affiliation(s)
- Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, McGill University Health Center, Montreal Children's Hospital, McGill University, Quebec, Canada.
| | - Pierre Fayoux
- Department of Otolaryngology - Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
| | - Neil Bateman
- Department of Pediatric Otolaryngology, The University of Manchester, Royal Manchester Children's Hospital, England, UK.
| | - An Boudewyns
- Department of Otolaryngology - Head and Neck Surgery, University of Antwerp, Antwerp University Hospital, Belgium.
| | - Matthew Brigger
- Department of Otolaryngology - Head and Neck Surgery, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, USA.
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore.
| | - Kenny Chan
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, USA.
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The University of Sydney, The Sydney Children's Hospital Network- Westmead Campus, Sydney, Australia.
| | - Stephen Conley
- Department of Otolarynology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Haytham Kubba
- Department of Otolaryngology, University of Glasgow, Glasgow Children's Hospital, Glasgow, Scotland, UK.
| | - Elton M Lambert
- Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, Texas, USA.
| | - Harlan Muntz
- Department of Otolaryngology, UC Davis Children's Hospital, Sacramento, CA, USA.
| | - Roger Nuss
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - John Russell
- Department of Otolaryngology, Children's Health Ireland(CHI) at Crumlin, Dublin, Ireland.
| | - Mike Rutter
- Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Yehuda Schwarz
- Department of Otolaryngology- Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal.
| | - Ravi Thevasagayam
- Department of Paediatric Otolaryngology, Sheffield Children's Hospital, UK.
| | - Dana Thompson
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Taher Valika
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Michelle Wyatt
- Paediatric Otolaryngologist, Great Ormond Street Hospital, London, England, UK.
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Owusu-Ayim M, Locke R, Clement WA, Kubba H. Quantifying the annual risk of infection in congenital midline nasal dermoid cysts in children. Clin Otolaryngol 2023; 48:254-258. [PMID: 36536994 DOI: 10.1111/coa.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/29/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Richard Locke
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, UK
| | | | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, UK
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11
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Baker A, Grobler A, Davies K, Griffiths A, Hiscock H, Kubba H, Peters RL, Ranganathan S, Rimmer J, Rose E, Rowe K, Simpson CM, Davidson A, Nixon G, Perrett KP. Effectiveness of Intranasal Mometasone Furoate vs Saline for Sleep-Disordered Breathing in Children: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:240-247. [PMID: 36648937 PMCID: PMC9857783 DOI: 10.1001/jamapediatrics.2022.5258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023]
Abstract
Importance Obstructive sleep-disordered breathing (SDB) in children is characterized by snoring and difficulty breathing during sleep. SDB affects at least 12% of otherwise healthy children and is associated with significant morbidity. Evidence from small clinical trials suggests that intranasal corticosteroids improve SDB as measured by polysomnography; however, the effect on symptoms and quality of life is unclear. Objective To determine whether intranasal mometasone furoate is more effective than intranasal saline for improving symptoms and quality of life in children with SDB. Design, Setting, and Participants The MIST trial was a multicenter, randomized, double-blind, placebo-controlled trial, recruiting participants from June 8, 2018, to February 13, 2020. Children aged 3 to 12 years who were referred to a specialist for significant SDB symptoms were included; exclusions were previous adenotonsillectomy, body mass index greater than the 97th percentile, and severe SDB. Randomization was stratified by site, and data were analyzed on an intention-to-treat basis from October 28, 2020, to September 25, 2022. Interventions Participants were randomly assigned to receive mometasone furoate, 50 μg, or sodium chloride (saline), 0.9%, 1 spray per nostril daily, dispensed in identical bottles. Main Outcomes and Measures The primary outcome was resolution of significant SDB symptoms (ie, reduction to a level no longer requiring referral to a specialist as per the American Academy of Pediatrics guidelines) at 6 weeks, measured by parental report of symptoms using the SDB Score. Results A total of 276 participants (mean [SD] age, 6.1 [2.3] years; 146 male individuals [53%]) were recruited, 138 in each treatment arm. Resolution of significant SDB symptoms occurred in 56 of 127 participants (44%) in the mometasone group and 50 of 123 participants (41%) in the saline group (risk difference, 4%; 95% CI, -8% to 16%; P = .51) with 26 participants lost to follow-up and missing values managed by multiple imputation. The main adverse effects were epistaxis, affecting 12 of 124 participants (9.7%) in the mometasone group and 18 of 120 participants (15%) in the saline group, and nasal itch/irritation, affecting 12 of 124 participants (9.7%) in the mometasone group and 22 of 120 participants (18%) in the saline group. Conclusions and Relevance Results of this randomized clinical trial suggest that there was no difference in treatment effect between intranasal mometasone and saline for the management of SDB symptoms. The results suggest that almost one-half of children with SDB could be initially managed in the primary care setting and may not require referral to specialist services, as is currently recommended. Trial Registration Australian New Zealand Clinical Trials Registry: ANZCTRN12618000448246.
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Affiliation(s)
- Alice Baker
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Karen Davies
- Department of Otolaryngology, Royal Children’s Hospital, Melbourne, Australia
| | - Amanda Griffiths
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Health Services Research Unit, Royal Children’s Hospital, Melbourne, Australia
- Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia
| | - Haytham Kubba
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland
| | - Rachel L. Peters
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Joanne Rimmer
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Elizabeth Rose
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Otolaryngology, Royal Children’s Hospital, Melbourne, Australia
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia
| | - Katherine Rowe
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Catherine M. Simpson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia
| | - Andrew Davidson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children’s Trial Centre, Melbourne Children’s, Melbourne, Australia
| | - Gillian Nixon
- Melbourne Children's Sleep Centre, Monash Children’s Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Kirsten P. Perrett
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children’s Trial Centre, Melbourne Children’s, Melbourne, Australia
- Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia
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Wong T, Macpherson O, Docherty S, Gray J, Clement WA, Kubba H. Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood. Int J Pediatr Otorhinolaryngol 2023; 164:111427. [PMID: 36577200 DOI: 10.1016/j.ijporl.2022.111427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/24/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Up to half of all children who have a tracheostomy will develop a persistent tracheo-cutaneous fistula (TCF) after decannulation. Surgical closure of the TCF is technically easy but post-operative complications can be immediate and life-threatening. These include air leak from the tracheal repair leading to massive surgical emphysema or pneumothorax. We reviewed our experience of TCF closure to try to identify potential risk factors for complications. METHOD Retrospective case record review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following development of a persistent TCF after decannulation of a tracheostomy. RESULTS We identified 67 children. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%). Life-threatening air leak occurred in the immediate post-operative period in 2 children (3%). Respiratory distress occurred in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications. DISCUSSION Complications for TCF closure are unfortunately common and it is unclear from the available evidence how best to prevent them. Further research is required.
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Affiliation(s)
- Tiffany Wong
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Orla Macpherson
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Sophie Docherty
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Joyce Gray
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - W Andrew Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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13
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Kubba H, Whitmer WM, Browning GG. Measuring benefit from non-surgical interventions in otolaryngology for different conditions, using the revised 5-factor Glasgow Benefit Inventory. Clin Otolaryngol 2023; 48:25-31. [PMID: 36240049 PMCID: PMC10092363 DOI: 10.1111/coa.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The Glasgow Benefit Inventory (GBI) has been extensively used to report the benefit from otolaryngological surgery. Benefit from non-surgical management has not been reported, despite this being the outcome of most otolaryngology and audiology consultations. DESIGN GBI responses from 4543 adults from the Scottish ENT Outcome Study were categorised by diagnosis. Benefit scores for different interventions within diagnostic categories for which surgery was not a potential management are reported using the revised 5-factor Glasgow Benefit Inventory (GBI-5F; 15 questions and 5 factors). SETTING Adult otolaryngology outpatient clinics in six university hospitals. PARTICIPANTS Adults seen with conditions that had no surgical option and given non-surgical management. RESULTS Overall, 80% of participants managed in Scottish Ear Nose and Throat Outcome Study (SENTOS) did not have surgery. A total of 1373 (30%) participants with various diagnoses were given reassurance and advice with no active intervention. There was no change in their GBI-5F total or factor scores, suggesting that they did not come to harm from their lack of active intervention. Hearing aids for bilateral sensorineural hearing loss gave greater benefit than reassurance in all factors, though individuals with a conductive impairment reported greater benefit in the Quality of life factor than those with a sensorineural impairment. Hearing aids and maskers produced benefit in the Support factor for patients with tinnitus. Epley's manoeuvre for benign paroxysmal positional vertigo gave benefit in the total score and the Quality of life factor compared with reassurance. Systemic medication for laryngo-pharyngeal reflux and topical medication for otitis externa gave no greater benefit in any factor or the total score compared with reassurance. CONCLUSION The GBI-5F and its five factors give useful information for reporting the benefit of non-surgical interventions in adult otolaryngology and audiology clinics.
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Affiliation(s)
- Haytham Kubba
- Hearing Sciences - Scottish Section, University of Nottingham, Glasgow Royal Infirmary, Glasgow, UK
| | - William M Whitmer
- Hearing Sciences - Scottish Section, University of Nottingham, Glasgow Royal Infirmary, Glasgow, UK
| | - George G Browning
- Hearing Sciences - Scottish Section, University of Nottingham, Glasgow Royal Infirmary, Glasgow, UK
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Kawar L, Deshpande A, Kubba H. 573 The Changing Microbiology of Paediatric Neck Abscesses: Implications for Antibiotic Therapy. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns of drained superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution. Analysis of the microbiology and epidemiological trends of paediatric neck abscesses is helpful for both antimicrobial stewardship purposes as well as to enhance the literature, given that paediatric-related conditions tend to be less well characterised when compared with adults.
Method
A retrospective case series of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, 2018–2021. Patients were only included if they had culture and sensitivity testing performed on a sample obtained intra-operatively, were prescribed antibiotics, and were aged 16 years or younger.
Results
Thirty-nine abscesses were identified. Methicillin-susceptible Staphylococcus aureus remains the commonest organism (28%), followed by Streptococcus pyogenes (13%). Their prevalence is significantly lower in comparison to historical data. This was met by a shift towards a variety of rarer micro-organisms. 82% of patients were administered a drug regimen containing co-amoxiclav. Only 3 children required a change in their antibiotics.
Conclusion
Our case series highlights a fall in the yearly rate of drained neck abscesses. There was a significant change in causative micro-organisms, including a decrease in Staphylococcus aureus and an increase in the Streptococcus anginosus group. We recommend the use of co-amoxiclav empirically. In abscesses showing no clinical improvement, second-line options such as clindamycin, cefotaxime and vancomycin should be considered.
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Affiliation(s)
- L Kawar
- School of Medicine, University of Glasgow , Glasgow , United Kingdom
| | - A Deshpande
- Department of Paediatric Microbiology, Royal Hospital for Children , Glasgow , United Kingdom
| | - H Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children , Glasgow , United Kingdom
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15
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Moen C, Kubba H, Downie LS. Complication rates for paediatric tonsillectomy based on Scottish national data 2000-2018. Clin Otolaryngol 2022; 47:500-503. [PMID: 35271764 DOI: 10.1111/coa.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/27/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Christy Moen
- Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF
| | - Haytham Kubba
- Paediatric Otolaryngologist, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF
| | - Laura S Downie
- Scottish Public Health Observatory, Public Health Scotland, 5 Cadogan Street, Glasgow, G2 6QE
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16
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Downie LS, Kubba H. Why is there such variation in nasal cautery rates for childhood epistaxis: deprivation or clinician behaviour? National data from Scotland 2000-2019. Rhinology 2021; 0:2937. [PMID: 34708837 DOI: 10.4193/rhin21.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L S Downie
- Scottish Public Health Observatory, Public Health Scotland, Glasgow, United Kingdom
| | - H Kubba
- Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
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17
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Kubba H, Whitmer WM. Exploring the Factor Structure of the Glasgow Children's Benefit Inventory: New Recommendations for Reporting Results. Ann Otol Rhinol Laryngol 2020; 130:614-622. [PMID: 33063521 DOI: 10.1177/0003489420965634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patient-reported outcomes can be useful for reporting benefit from non-life-saving interventions, but often they report a single overall score, which means that much information on the specific areas of benefit is lost. Our aim was to perform a new factor analysis on the Glasgow Children's Benefit Inventory (GCBI) to create subscales reflecting domains of benefit. Further aims were to assess the internal consistency of the GCBI, and to develop guidelines for reporting both a total score and sub-scales in future studies. METHODS We collected 4 existing datasets of GCBI data from children who have undergone tonsillectomy, ventilation tube insertion, pinnaplasty, and submucous diathermy to the inferior turbinates. We performed exploratory factor analysis with principal axis factoring with varimax rotation, we sought redundancy in question items, and we measured internal consistency. RESULTS Using the combined dataset of 772 cases, we found 4 factors which accounted for 64% of the variance and which we have labeled "Psycho-social," "Physical health," "Behavior," and "Vitality." Subscale results varied in predictable ways depending on the nature of the intervention. Cronbach's alpha was 0.928. Item-total correlations were high, and no item could be deleted to improve alpha. Floor effects were apparent for various questions but were not consistent between different interventions. CONCLUSIONS The GCBI contains a range of questions which each add value in different clinical interventions. We can now make recommendations for reporting the results of the GCBI and its 4 new subscales.
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Affiliation(s)
- Haytham Kubba
- Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland
| | - William M Whitmer
- Hearing Sciences (Scottish Section), University of Nottingham, Glasgow Royal Infirmary, Glasgow, Scotland
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Lim D, Hassani S, Lupton K, Gault EJ, Wynne D, Clement W, Kubba H, Mason A, Donaldson M. Prevalence, risk factors and management strategies for otological problems in girls with Turner syndrome. Acta Paediatr 2020; 109:2075-2083. [PMID: 31811789 DOI: 10.1111/apa.15128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/07/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
AIM To determine the prevalence and risk factors of ear disease in Turner syndrome (TS), propose an algorithm for future surveillance and recommend preventative strategies. METHODS Review of TS patients seen in the West of Scotland between 1989 and 2015, with questionnaire follow-up in 2015. RESULTS Of 168 girls, median age 27.3 (3.8-47.2) years, ear problems occurred more frequently with 45,X and 45,X/46,XiXq than other karyotypes: 71/103 (69%) versus 23/65 (35%). Recurrent acute otitis media (AOM) first developed at 0-5 years in 23 (40%) girls, persisting in 16 (10%) at 5-10 years; and first developing at 5-10 years in 11 (7%). Persistent otitis media with effusion (OME) first developed at 0-5 and 5-10 years in 23 (40%) and 14 (8%) girls. Recurrent AOM was significantly linked with cholesteatoma in 8 (4.9%) girls (7 aged >10 years). Permanent hearing loss was documented in 28 girls (16.7%), with 16 (9.5%) receiving hearing aids (bone-anchored in 3). CONCLUSION Acute otitis media and OME occur commonly in preschool TS girls and may persist or newly develop in later childhood. Recurrent AOM predisposes to cholesteatoma. Strategies to reduce otological morbidity include: intensive patient education, annual audiology, vaccinations and a randomised trial of antibiotic prophylaxis in high-risk groups.
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Affiliation(s)
- David Lim
- Department of Neonatology Ashford and St. Peter's NHS Foundation Trust St. Peter's Hospital Chertsey UK
| | | | - Kenneth Lupton
- Department of Radiology Queen Elizabeth University Hospital NHS Greater Glasgow and Clyde Glasgow UK
| | - Emma Jane Gault
- College of Medical, Veterinary & Life Sciences University of Glasgow Glasgow UK
| | - David Wynne
- Department of Ear, Nose & Throat Surgery Royal Hospital for Children Glasgow NHS Greater Glasgow and Clyde Glasgow UK
| | - William Clement
- Department of Ear, Nose & Throat Surgery Royal Hospital for Children Glasgow NHS Greater Glasgow and Clyde Glasgow UK
| | - Haytham Kubba
- Department of Ear, Nose & Throat Surgery Royal Hospital for Children Glasgow NHS Greater Glasgow and Clyde Glasgow UK
| | - Avril Mason
- Department of Endocrinology Royal Hospital for Children Glasgow NHS Greater Glasgow and Clyde Glasgow UK
| | - Malcolm Donaldson
- Section of Child Health School of Medicine University of Glasgow Glasgow UK
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Browning GG, Kubba H, Whitmer WM. Revised 15-item Glasgow Benefit Inventory with five factors based on analysis of a large population study of medical and surgical otorhinolaryngological interventions. Clin Otolaryngol 2020; 46:213-221. [PMID: 32949108 DOI: 10.1111/coa.13649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/21/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To review, using confirmatory factor analysis, the widely used 18-question Glasgow Benefit Inventory [GBI] that has three factors. Thereafter to develop, using exploratory factor analysis, a more coherent, revised version of the GBI. DESIGN Confirmatory and exploratory factor analysis of a large national GBI data set of ORL interventions. SETTING Adult otorhinolaryngology outpatient clinics in six University Hospital departments. PARTICIPANTS One thousand nine hundred eighty adult patients who had complete GBI data and who underwent an active (medical or surgical) intervention, out of the total data set of 9005 patients from the original Scottish ENT Outcome Study [SENTOS]. RESULTS One of the 18 questions was discarded from the data base because it was not answered by 8% of respondents. Two of the original factors remained (Physical Health, renamed General Health, and Social Support, renamed Support). The General factor was split into three new factors (Quality of Life, Self-Confidence and Social Involvement). The three new factors were found to give additional information regarding the area of benefit. This reduced number of questions does not make any material difference to the results of the >196 existing GBI papers in the literature. CONCLUSION A 15-question GBI with five factors is provided that is more explanatory of the areas of benefit.
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Affiliation(s)
- George G Browning
- Hearing Sciences - Scottish Section, Glasgow Royal Infirmary, University of Nottingham, Glasgow, UK
| | - Haytham Kubba
- Hearing Sciences - Scottish Section, Glasgow Royal Infirmary, University of Nottingham, Glasgow, UK
| | - William M Whitmer
- Hearing Sciences - Scottish Section, Glasgow Royal Infirmary, University of Nottingham, Glasgow, UK
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Kubba H, Downie LS. Trends in tonsillectomy surgery in children in Scotland 2000-2018. Clin Otolaryngol 2020; 46:146-153. [PMID: 32737926 DOI: 10.1111/coa.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/27/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tonsillectomy is one of the most common surgical procedures in children but indications and surgical practice change over time. OBJECTIVES We aimed to identify trends in tonsillectomy procedures in children, in particular the number of procedures performed, the age of child undergoing tonsillectomy and the type of hospital in which the surgery was performed. DESIGN Review of Scottish Morbidity Records data (SMR01) which are routinely collected after everyday case procedure or overnight stay in all Scottish NHS hospitals. SETTING All NHS hospitals in all 14 Scottish health boards. PARTICIPANTS All children (0-16 years) undergoing tonsillectomy, 2000-2018. MAIN OUTCOME MEASURES Number of tonsillectomy procedures; rate of tonsillectomy per 1000 children in the population; number of children aged 0-2 years and 3-4 years undergoing tonsillectomy; health board in which the surgery occurred; diagnostic coding for these episodes; length of stay and readmission within 30 days of surgery. RESULTS During 2000-2018, there were 50,208 tonsillectomies performed in children in Scotland (mean 2642/year). The number of tonsillectomies per year remained constant (R = 0.322, P = .178) but tonsillectomies performed in children 0-2 years rose from 0.41 to 1.56 per 1000 (R = 0.912, P < .001), and 3-4 years from 3.06 to 6.93 per 1000 (R = 0.864, P < .001). The proportion of all children's tonsillectomies performed up to age 4 rose from 20.6% to 35.9% and up to age 2 from 2.4% to 8.1%. All specialist children's hospitals showed a significant increase in surgery in very young children. CONCLUSIONS Tonsillectomy rates remained static between 2000 and 2018, despite a falling population. More tonsillectomies are now performed for obstructive sleep apnoea, at a young age and in regional children's hospitals. This has important implications for the workload of these specialist hospitals.
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Affiliation(s)
- Haytham Kubba
- Consultant Paediatric Otolaryngologist, Royal Hospital for Children, Glasgow, UK
| | - Laura S Downie
- Scottish Public Health Observatory, Public Health Scotland, Glasgow, UK
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Kubba H, Rowe K, Pinczower G, Sloane R, Waterham M, Weiss E, Harwood R. Our experience of a paediatrician‐led clinic for the medical management of children with obstructive sleep‐disordered breathing. Clin Otolaryngol 2019; 45:190-196. [DOI: 10.1111/coa.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/08/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Haytham Kubba
- Department of Otolaryngology Royal Children's Hospital Parkville Vic. Australia
| | - Katherine Rowe
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Gideon Pinczower
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Robert Sloane
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Michelle Waterham
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Emma Weiss
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Rachel Harwood
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
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Kubba H, McAllister K, Hunter K, Mason A. Annual hearing screening in girls with Turner Syndrome: Results from the first three years in Glasgow. Int J Pediatr Otorhinolaryngol 2019; 120:152-156. [PMID: 30798112 DOI: 10.1016/j.ijporl.2019.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hearing loss is prevalent in girls with Turner Syndrome (TS). A number of cross-sectional studies have confirmed that conductive hearing loss due to middle ear disease and permanent, progressive sensorineural hearing loss are both very common and often unrecognised in TS. Hearing screening has been suggested by many authors and is recommended in some recent national audiology guidelines (every 3-5 years in an international consensus statement, every 1-2 years in the USA and every year in the UK). The effectiveness of such regular hearing screening has not been assessed before. STUDY AIMS AND METHODS In January 2016 we began a programme of annual hearing screening for all girls attending the West of Scotland TS clinic. We have collected data on age, karyotype, ear and hearing symptoms, otoscopy findings, audiometric test results and subsequent outcomes for the first three years of our programme. Our aim is to assess whether this screening programme is an effective use of resources, with a worthwhile rate of detecting new otological problems and without an excessive additional workload for the audiology department. RESULTS Twenty-six girls participated in the screening programme and 8 of these had no hearing issues or ear abnormalities at any time over the 3 years. Two girls had cholesteatoma, 4 had tympanic membrane retractions and/or perforations, and 9 had OME (of which 6 were transient and 3 persistent, with 2 of these requiring treatment). One cholesteatoma, one perforation and one persistent OME were already known about but all other diagnoses were new as a result of the screening programme. Five girls have persistent conductive hearing loss (plus another 6 who had a transient episode of conductive loss due to middle ear fluid) and 6 have some degree of sensorineural hearing loss (3 purely sensorineural, 3 mixed). At the time that a hearing loss was diagnosed, the parents had concerns about the hearing in 4 cases and no concerns in 12. Six girls have been fitted with hearing aids since we started the screening programme, each for different indications (sensorineural hearing loss in two cases, and one case each of persistent OME, post cholesteatoma surgery, tympanic membrane perforation and unilateral tympanic membrane retraction respectively). Two girls have had ear surgery as a result of referral from the programme (one for ventilation tubes, one for cholesteatoma). CONCLUSIONS The screening programme has picked up ear disease in 69% of girls with TS with only a small additional workload for the audiology department. The ongoing detection of new problems in the second and third years of the programme attests to the value of continued regular hearing screening for girls with TS.
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Affiliation(s)
- Haytham Kubba
- Department of Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, Scotland, G51 4TF, United Kingdom.
| | - Kerrie McAllister
- Department of Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, Scotland, G51 4TF, United Kingdom
| | - Karen Hunter
- Department of Audiology, Royal Hospital for Children, 1345 Govan Road, Glasgow, Scotland, G51 4TF, United Kingdom
| | - Avril Mason
- Department of Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, Scotland, G51 4TF, United Kingdom
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Annamalai S, Kumar NA, Madkour MB, Sivakumar S, Kubba H. An Association between Acquired Epiphora and the Signs and Symptoms of Chronic Rhinosinusitis: A Prospective Case–Control Study. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700209] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It has been suggested that chronic rhinosinusitis may lead to epiphora because of inflammatory edema at the nasal end of the nasolacrimal duct and that treatment of the underlying nasal disease may obviate the need for dacryocys-torhinostomy. The aim of this study was to establish whether or not there is an association between the signs and symptoms of chronic rhinosinusitis and a complaint of epiphora in a blinded, prospective case-control study. Methods A consecutive series of 15 adult patients presenting to the ophthalmology department with acquired epiphora were compared with 29 patients presenting with chronic open-angle glaucoma over the same study period. Nasal symptoms and the findings on nasal endoscopy were recorded by a single otolaryngologist blinded to the diagnosis and using a standardized staging system. Results The age and sex distributions of the two groups were similar. Scores for headache and altered smell were significantly higher in the epiphora cases than in controls (p = 0.05 and 0.03, respectively). Trends for higher scores for congestion and discharge were not statistically significant (p = 0.06 and 0.07, respectively). Mucosal edema and discharge were significantly more common on endoscopy in the epiphora cases than in the control cases (p < 0.02). Conclusion We have shown an association between rhinosinusitis and acquired epiphora, and this would be consistent with chronic rhinosinusitis being the cause of the epiphora in some cases.
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Affiliation(s)
| | - N. Ajith Kumar
- Departments of Ophthalmology, Ysbyty Gwyned, Bangor, Wales
| | - M. B. Madkour
- Departments of Otolaryngology, Ysbyty Gwyned, Bangor, Wales
| | | | - Haytham Kubba
- MRC Institute for Hearing Research (Scottish Section), Glasgow Royal Infirmary, Glasgow, Scotland
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Abstract
Background Scoring systems exist to standardize the recording of nasal endoscopy findings. The extent to which two surgeons will agree on the findings of nasal endoscopy in adults currently is unknown, although a study in children showed high rates of agreement between two observers. We studied the interobserver agreement of adult nasal endoscopy scored with the system proposed by Lund and Mackay. Method: A consecutive series of otolaryngology patients attending with a variety of nasal complaints were recruited. All were examined with a 0o 4-mm endoscope by two surgeons on the same clinic visit. Each independently recorded their findings using the Lund and Mackay scoring system. Neither surgeon was aware of the other's findings. Results Thirty patients were studied (16 women and 14 men). Because the endoscopic findings were recorded separately for each side of the nose, each surgeon made 60 observations. Interrater agreement was calculated as Cohen's κ, and suggested moderate agreement for edema (κ = 0.45), good agreement for crusting (κ = 0.62), and very good agreement for polyp (κ = 0.93) and discharge (κ = 0.84). Conclusions Two independent observers agree on the findings of nasal endoscopy in a high proportion of cases. Nasal endoscopy is a reliable tool, especially when a scoring system such as that of Lund and Mackay is used. (American Journal of Rhinology 18, 301–303, 2004)
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Affiliation(s)
- Sivakumar Annamalai
- Department of Otolaryngology, Medway Maritime Hospital, Kent, United Kingdom
| | - Jeremy Davis
- Department of Otolaryngology, Medway Maritime Hospital, Kent, United Kingdom
| | - Haytham Kubba
- Medical Research Council Institute of Hearing Research, Glasgow Royal Infirmary, United Kingdom
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McNeill EJ, Kubba H, Bearn MA, Robson AK. The Management of Rhinitis in Patients with Functional Epiphora: A Randomized Controlled Crossover Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Nasolacrimal duct obstruction, secondary to inflammation of the nasal mucosa, can result in epiphora. This can be treated successfully with topical corticosteroids, avoiding the need for surgery. This study tests the hypothesis that treating clinically significant rhinitis improves the symptoms of epiphora. Methods A randomized controlled crossover trial (pilot study) was performed at the Cumberland Infirmary, Carlisle. Patients were assessed in an epiphora clinic by a consultant ophthalmologist and were included in the trial if they had bilateral functional epiphora, i.e., the nasolacrimal duct was patent on syringing. Twenty-three patients were then referred to a consultant otolaryngologist, where the severity of rhinitis and epiphora were assessed using visual analogue scales, subjective scoring, and clinical assessment. The 11 patients suitable for the study were randomized into two groups. The treatment group received nasal corticosteroids and the control group received no treatment, both groups changing treatment arms at a specified point. Subjective and objective scores were assessed at the beginning, midpoint, and end of each treatment period. Results Seven of 11 patients showed an improvement in epiphora scores with topical therapy. Six patients documented a symptomatic improvement. Eight patients showed an improvement in symptoms and signs of rhinitis, with two patients continuing on nasal corticosteroids for nasal symptoms only. There was a statistically significant improvement in both epiphora symptom scores and clinical findings of rhinitis in patients treated with nasal steroids (p = 0.021 and 0.019, respectively). Conclusion Epiphora secondary to rhinitis can be treated successfully with intranasal steroids. Patients with epiphora should be asked about symptoms of rhinitis and should always have their nose examined for evidence of intranasal pathology.
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Affiliation(s)
- Emma J. McNeill
- Department of Otolaryngology, Cumberland Infirmary, Carlisle, United Kingdom
| | - Haytham Kubba
- Department of Great Ormond Street Hospital, London, United Kingdom
| | - Mike A. Bearn
- Department of Ophthalmology, Cumberland Infirmary, Carlisle, United Kingdom
| | - Andrew K. Robson
- Department of Otolaryngology, Cumberland Infirmary, Carlisle, United Kingdom
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Nixon GM, Kubba H, Perrett KP. Time to Open Our Eyes? A Challenge to the Role of Polysomnography for Trials in Pediatric Sleep-Disordered Breathing. J Clin Sleep Med 2018; 14:489-490. [PMID: 29510797 DOI: 10.5664/jcsm.7014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Haytham Kubba
- Department of Otolaryngology, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne
| | - Kirsten P Perrett
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Allergy and Immunology and General Medicine, Royal Children's Hospital, Melbourne, Australia
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Kubba H. The Role of Reflux in Childhood Otorhinolaryngological Disorders. Curr Otorhinolaryngol Rep 2018. [DOI: 10.1007/s40136-018-0179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Affiliation(s)
- H Kubba
- Consultant ENT Surgeon, Royal Hospital for Sick Children, Yorkhill, Glasgow
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Mortimer H, Kubba H. A retrospective case series of 318 tracheostomy-related adverse events over 6 years - a Scottish context. Clin Otolaryngol 2016; 42:936-940. [PMID: 27759914 DOI: 10.1111/coa.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - H Kubba
- Royal Hospital for Sick Children, Glasgow, UK
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Beaton F, Baird TA, Clement WA, Kubba H. Tracheostomy decannulation at the Royal Hospital for Sick Children in Glasgow: Predictors of success and failure. Int J Pediatr Otorhinolaryngol 2016; 90:204-209. [PMID: 27729134 DOI: 10.1016/j.ijporl.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tracheostomy techniques, indications and care are extensively covered in the literature. However, little is written about the process of removing the tracheostomy tube. At the Royal Hospital for Sick Children in Glasgow we use a stepwise ward-based protocol for safe tracheostomy decannulation. Our aim therefore was to review all the paediatric tracheostomy decannulations that we attempted over the last 3 years to evaluate our protocol, to determine our success rate and to see whether any modifications to the protocol are required. METHOD We reviewed all patients who had undergone ward decannulation between January 2012 and May 2015. We extracted data from clinical records including patient characteristics, indications for tracheostomy, timing of decannulation and success or failure of the process. RESULTS The 45 children in the study underwent 57 attempts at decannulation during the study period. 25 were male (56%) and 20 were female (44%), and they were aged between 1 day and 16 years 6 months at the time of the original tracheostomy operation. 33 attempts were successful (58%). 10 children had more than one attempt at decannulation. Children were found to fail at every stage of the protocol, with the commonest point of failure being day 2 when the tracheostomy tube was capped. DISCUSSION We have demonstrated that our current protocol for ward decannulation is effective and safe, and that all five days of the protocol are required.
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Affiliation(s)
- Fiona Beaton
- Medical School, University of Dundee, United Kingdom.
| | - Tracy-Anne Baird
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
| | - W Andrew Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
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31
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Kubba H, Smyth A, Wong S, Mason A. Ear health and hearing surveillance in girls and women with Turner's syndrome: recommendations from the Turner's Syndrome Support Society. Clin Otolaryngol 2016; 42:503-507. [DOI: 10.1111/coa.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. Kubba
- Department of Paediatric Otolaryngology; Royal Hospital for Children; Glasgow UK
| | - A. Smyth
- Turner's Syndrome Support Society; Glasgow UK
| | - S.C. Wong
- Developmental Endocrinology Research Group; Royal Hospital for Children; Glasgow UK
| | - A. Mason
- Developmental Endocrinology Research Group; Royal Hospital for Children; Glasgow UK
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Crosbie RA, Nairn J, Kubba H. Management of paediatric periorbital cellulitis: Our experience of 243 children managed according to a standardised protocol 2012-2015. Int J Pediatr Otorhinolaryngol 2016; 87:134-8. [PMID: 27368460 DOI: 10.1016/j.ijporl.2016.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Paediatric periorbital cellulitis is a common condition. Accurate assessment can be challenging and appropriate use of CT imaging is essential. We audited admissions to our unit over a four year period, with reference to CT scanning and adherence to our protocol. METHODS Retrospective audit of paediatric patients admitted with periorbital cellulitis, 2012-2015. RESULTS Total of 243 patients included, mean age 4.7 years with slight male predominance, the median length of admission was 2 days. 48/243 (20%) underwent CT during admission, 25 (52%) of these underwent surgical drainage. As per protocol, CT brain performed with all orbital scans; no positive intracranial findings on any initial scan. Three children developed intracranial complications subsequently; all treated with antibiotics. Our re-admission rate within 30 days was 2.5%. CONCLUSIONS Our audit demonstrates benefit of standardising practice and the low CT rate, with high percentage taken to theatre and no missed abscesses, supports the protocol. There may be an argument to avoid CT brain routinely in all initial imaging sequences in those children without neurological signs or symptoms.
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Affiliation(s)
- Robin A Crosbie
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland.
| | | | - Haytham Kubba
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland
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Kubba H, Swan IRC, Gatehouse S. The Glasgow Children's Benefit Inventory: A New Instrument for Assessing Health-Related Benefit after an Intervention. Ann Otol Rhinol Laryngol 2016; 113:980-6. [PMID: 15633901 DOI: 10.1177/000348940411301208] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most health-related quality-of-life measures make an assessment at a single point in time. Comparing results before and after an intervention is often difficult, because the difference measured is usually small compared with the variation between individuals. A retrospectively applied measure specifically worded to assess benefit would be very useful for clinical research. Such a measure exists for adults. We aimed to develop a similar measure for children. We chose potential items after reviewing existing health-related quality-of-life measures, published literature, and parental interviews. A draft questionnaire was given to a group of parents and modified. The resulting Glasgow Children's Benefit Inventory (GCBI) comprised 24 questions on the consequences of a specified intervention on various aspects of the child's day-to-day life, without reference to any specific symptoms, and was worded to apply to children of any age. The questionnaire was mailed to the parents of all 1,777 children who had undergone tonsillectomy or ventilation tube insertion at one hospital during the period January 1998 to December 2001. There were 670 questionnaires returned. The GCBI scores correlated well with parental satisfaction with surgery and with estimates of technical success (residual sore throats, reported hearing impairment, ear infections). The questionnaire had high internal consistency. Factor analysis showed 4 dimensions in the pattern of responses relating to emotion, physical health, learning, and vitality. The GCBI is a means to retrospectively assess benefit after an intervention in children, and we have shown initial evidence of reliability and validity. Although not restricted to any branch of pediatric medicine, it is eminently suitable for use in pediatric otolaryngology.
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Affiliation(s)
- Haytham Kubba
- Medical Research Council Institute for Hearing Research (Scottish Section), Glasgow Royal Infirmary, Glasgow, Scotland
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Abstract
This retrospective study was undertaken to document the epidemiology of permanent childhood hearing impairment (PCHI) in Glasgow and to make some assessment of the current practice to identify these children before universal neonatal hearing screening (UNHS) is implemented. Subjects were those with bilateral permanent hearing impairments of at least 40dB in the better hearing ear, born between 1985 and 1994, in Greater Glasgow. The subjects were identified and data extracted from the Educational Audiology database. The case records at the Royal Hospital for Sick Children were also reviewed to identify possible aetiology groups. The prevalence rate of all permanent hearing impairments was 1.23 per thousand live births. Eleven percent of all hearing impairments were acquired or progressive. There was no significant effect of sex on aetiology (X2 = 6.509, df=6, p, = 1), age at identification of hearing impairment and hearing aid provision (Kruskal Wallis, p=0.484. and 0.782 respectively). For those identified as congenitally hearing impaired, the median ages at diagnosis of hearing impairment and hearing aid provision were 18 months and 31 months respectively. Age at diagnosis of hearing impairment and hearing aid provision were unaffected by aetiology of hearing impairment (Kruskal Wallis, p = 0.782 and p = 0.484 respectively). The prevalence rate of PCHI and the ages at identification and intervention in Glasgow are typical of the rest of the UK. Audiological surveillance measures are falling well below the standard of care expected today and the introduction of UNHS is likely to improve outcomes as long as the additional health and educational resources are in place to deal with the earlier identification of these children.
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Affiliation(s)
- C MacAndie
- Royal Hospital for Sick Children, Yorkhill, Glasgow.
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Montgomery J, McCusker S, Lang K, Grosse S, Mace A, Lumley R, Kubba H. Managing children with sialorrhoea (drooling): Experience from the first 301 children in our saliva control clinic. Int J Pediatr Otorhinolaryngol 2016; 85:33-9. [PMID: 27240493 DOI: 10.1016/j.ijporl.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Sialorrhoea (drooling) is defined as the involuntary escape of saliva from the mouth. It is considered normal in young children but may cause social problems in older children. Sialorrhoea is frequently seen in children with cerebral palsy, with rates between 10% and 58% and in other neurodevelopmental diseases. Management of these children can be challenging and often requires an individual and stepwise approach. This is a large case series of children managed at the saliva control clinic in Glasgow, Scotland. METHODS A chart review of all children attending the saliva control clinic between 2006 and June 2012 was performed. This was to ensure that all children would have long term follow up (3 years minimum). Drooling severity was assessed on the child's first attendance at clinic, and at review following a treatment option, using the Teacher Drooling Scale (TDS). RESULTS The total number of children attending this clinic was 301, of which 274 had adequate records for inclusion in the study. 176 (64%) were male. The mean age was 7.3 (median 5) years. In terms of development 35 (13%) of children were developing normally and 50 (18%) had general developmental delay. There were 105 (38%) children with cerebral palsy. The final management of sialorrhoea in these children was simple reassurance and advice for 34 (12%), speech and language therapy for 62 (23%) anticholinergics in 90 patients (33%), botox for 30 (11%) and surgery for 71 (26%) children. The rate of non-tolerance of anticholinergics is 30%; 90 of the 298 children tried on anticholinergics had side effects leading to the treatment being stopped. The average teachers drooling score was 4.24 before clinic and 1.59 after clinic. Satisfactory results were achieved in 215 (78%) of children. CONCLUSION Our data illustrates that effective patient management requires all treatment options to be available, including speech therapy, medications, botulinum toxin and surgery. This is one of the larger case series of children attending a saliva control clinic.
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Affiliation(s)
- Jenny Montgomery
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
| | - Sarah McCusker
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Kerry Lang
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Susan Grosse
- Department of Speech & Language Therapy, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Alastair Mace
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Ruby Lumley
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
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Fraser L, Montgomery J, Murphy L, James H, Kubba H. How reliable are ear measurements as a measure of outcome after pinnaplasty? A prospective study of inter-rater reliability in 20 pinnaplasty patients. Clin Otolaryngol 2016; 42:743-748. [PMID: 27208460 DOI: 10.1111/coa.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L Fraser
- Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
| | - J Montgomery
- Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
| | - L Murphy
- Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - H James
- Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - H Kubba
- Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
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Kubba H, Swan IRC, Gatehouse S. Measuring Quality of Life in Preschool Children with Sore Throats and Otitis Media Using the Tapqol Questionnaire. Otolaryngol Head Neck Surg 2016; 132:647-52. [PMID: 15806062 DOI: 10.1016/j.otohns.2005.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES: TNO-AZL Preschool Quality of Life Questionnaire (TAPQOL) is one of the few instruments designed to assess health-related quality of life in preschool children but its applicability to otolaryngology is unknown. STUDY DESIGN AND SETTING: We studied a consecutive series of children aged 1 to 5 years referred to hospital with recurrent sore throats, recurrent acute otitis media, or otitis media with effusion. RESULTS: TAPQOL domain scores were not influenced by age, sex, or socio-economic class, but correlated with markers of disease severity (frequency of sore throat or pyrexia, time off school), ear-related handicap (assessed with the OM6 questionnaire), and other measures of health-related quality of life (visual analogue scale, 5-point rating scale and the Health Utilities Index mark III). Comparison with published data from healthy children suggests that these common otolaryngologic problems have a large impact on a child's quality of life. CONCLUSIONS: TAPQOL seems to be appropriate for use in this context. Marked ceiling effects in some domains, however, may limit their sensitivity.
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Affiliation(s)
- Haytham Kubba
- MRC Institute for Hearing Research (scottish section), Glasgow Royal Infirmary, Glasgow, Scotland.
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Yaneza MMC, Hunter K, Irwin S, Kubba H. Hearing in school-aged children with trisomy 21 - results of a longitudinal cohort study in children identified at birth. Clin Otolaryngol 2016; 41:711-717. [PMID: 26663508 DOI: 10.1111/coa.12606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report the prevalence of hearing problems and the hearing sequelae in school-aged children with trisomy 21 in a longitudinal study. DESIGN All children with trisomy 21 were identified via schools, community-based child development centres, general practitioners, or the universal newborn hearing screen. Audiological data and otorhinolaryngological problems were prospectively entered in to the Audiological Surveillance Programme database from each visit. SETTING Retrospective review of the Audiological Surveillance Programme database in the Glasgow area (United Kingdom) of all children reviewed between 2004 and 2012. PARTICIPANTS All pre-teenaged children with trisomy 21 of school age (aged 5-12 years old). MAIN OUTCOME MEASURES Hearing thresholds, aetiology of hearing loss and management of hearing loss was determined for the cohort of children. RESULTS A total of 102 children were included. Fifty-four had normal hearing. Twenty-six had fluctuating otitis media with effusion; five had hearing in normal limits, six were managed with hearing aids, fourteen were managed conservatively, and one had ventilation tube insertion. Fifteen had persistent otitis media with effusion; four had ventilation tube insertion; and nine were managed with hearing aids. Seven had mixed hearing loss with four required hearing aids. CONCLUSIONS Otitis media with effusion was the commonest cause of hearing impairment; effusions may fluctuate through the pre-teenaged years, and thus, hearing aids are beneficial. Ventilation tube insertion and bone-conducting hearing aids were useful when ear-level hearing aids were not tolerated. Mixed hearing loss occurred in later years as sensorineural hearing loss developed on a background of otitis media with effusion.
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Affiliation(s)
- M M C Yaneza
- Department of Paediatric Otolaryngology, The Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Govan, Glasgow, UK.,Department of Otolaryngology, Monklands Hospital, Airdrie, UK
| | - K Hunter
- Department of Paediatric Audiology, The Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Govan, Glasgow, UK
| | - S Irwin
- Department of Paediatric Otolaryngology, The Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Govan, Glasgow, UK
| | - H Kubba
- Department of Paediatric Otolaryngology, The Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Govan, Glasgow, UK
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Fraser L, Montgomery J, James H, Wynne D, MacGregor F, Clement W, Morrissey M, Kubba H. Validation of a family-centred outcome questionnaire for pinnaplasty: a cross-sectional pilot study. Clin Otolaryngol 2016; 41:472-80. [DOI: 10.1111/coa.12553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- L. Fraser
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - J. Montgomery
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - H. James
- Faculty of Medicine; University of Glasgow; Glasgow UK
| | - D.M. Wynne
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - F.B. MacGregor
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - W.A. Clement
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - M.S.C. Morrissey
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
| | - H. Kubba
- Department of Otolaryngology; Royal Hospital for Sick Children; Glasgow UK
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40
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Hamilton J, Yaneza MMC, Clement WA, Kubba H. The prevalence of airway problems in children with Down's syndrome. Int J Pediatr Otorhinolaryngol 2016; 81:1-4. [PMID: 26810279 DOI: 10.1016/j.ijporl.2015.11.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 01/29/2023]
Abstract
AIM Airway disorders are common in children with Down's syndrome. We report the findings on airway endoscopy in a birth cohort of children from a well-defined geographical area, in order to estimate true population prevalence of airway problems in children with Down's syndrome. METHOD Retrospective case note review over a 20-year period between 1993 and 2013 for all children in Greater Glasgow born with Down's syndrome, identified through the hearing surveillance programme. All children undergoing airway endoscopy under general anaesthesia for investigation of potential airway symptoms (stridor, hoarseness, recurrent croup and difficulties with intubation/extubation) were studied in detail to identify the number with laryngeal, tracheal or bronchial pathology. RESULTS All 239 children (F:M=1.15:1) were reviewed. Of these, 39 (16.3%) underwent microlaryngoscopy-bronchoscopy under general anaesthesia for airway symptoms. The main presentations were stridor (9), extubation problems (12) and exacerbations of recurrent croup (7). Thirty-three were found to have at least one airway diagnosis (13.8%) including trachaeobronchomalacia (17), laryngeal cleft (2), laryngomalacia (2), tracheal compression (2), vocal cord paralysis (1), acquired tracheal stenosis (2) and symptomatic subglottic stenosis (14). CONCLUSION Laryngo-tracheo-bronchial pathology is much more common in children with Down's syndrome than in the general population, particularly subglottic stenosis and tracheal problems.
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Affiliation(s)
| | - May Maxime Corazon Yaneza
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, GlasgowG51 4TF, Scotland
| | - William Andrew Clement
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, GlasgowG51 4TF, Scotland
| | - Haytham Kubba
- Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Children, GlasgowG51 4TF, Scotland.
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Douglas CM, Poole-Cowley J, Morrissey S, Kubba H, Clement WA, Wynne D. Paediatric tracheostomy-An 11 year experience at a Scottish paediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol 2015; 79:1673-6. [PMID: 26255606 DOI: 10.1016/j.ijporl.2015.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this paper was to review the indications, complications and outcomes for tracheostomy at a Scottish paediatric tertiary referral hospital. METHODS All patients undergoing tracheostomy between January 2001 and September 2012 were identified. A retrospective case note analysis was performed. RESULTS 111 tracheostomies were done in the study period. The mean number per year was 11 (3-12). Full data was available for 95 patients. There were 56 (59%) males and 39 (41%) females. Age at time of tracheostomy ranged from one day to 15 years, the mean age of tracheostomy insertion was 69 weeks. The majority of patients, 75 (79%), were under one year old when they had their tracheostomy. The most common indication was long-term ventilation (20%), followed by craniofacial abnormality causing airway obstruction (18%), followed by subglottic stenosis (14%). 37% of patients were decannulated. CONCLUSIONS This series reflects current trends in the indications for paediatric tracheostomy, with chronic lung disease of prematurity being the most common indication.
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Affiliation(s)
- C M Douglas
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Dalnair St., Glasgow G3 8SJ, Scotland.
| | - J Poole-Cowley
- School of Medicine, University of Glasgow Medical School, Glasgow, Scotland
| | - S Morrissey
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Dalnair St., Glasgow G3 8SJ, Scotland
| | - H Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Dalnair St., Glasgow G3 8SJ, Scotland
| | - W A Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Dalnair St., Glasgow G3 8SJ, Scotland
| | - D Wynne
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Dalnair St., Glasgow G3 8SJ, Scotland
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Begbie F, Walker G, Kubba H, Sabharwal A. Acute colonic pseudo-obstruction in a child taking trihexyphenidyl for drooling: Prescribers beware. Int J Pediatr Otorhinolaryngol 2015; 79:932-934. [PMID: 25912627 DOI: 10.1016/j.ijporl.2015.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/25/2015] [Accepted: 03/28/2015] [Indexed: 11/17/2022]
Abstract
Colonic pseudo-obstruction (Ogilvie's Syndrome) in children is relatively uncommon. We report an unusual case of colonic pseudo-obstruction in an 8-year-old child with cerebral palsy and long-term hypomotility issues being treated for drooling with the anticholinergic medication trihexyphenidyl. He presented as an emergency with severe abdominal distension, abdominal tenderness and vomiting. An emergency laparotomy revealed colonic dilatation and a defunctioning ileostomy was created. To our knowledge, this is the first case reporting colonic pseudo-obstruction as a possible complication of treatment with trihexyphenidyl. We suggest prescribers should exercise caution when prescribing trihexyphenidyl in patients with long-term intestinal hypomotility issues.
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Affiliation(s)
- F Begbie
- Department of Paediatric Otolaryngology, Yorkhill Children's Hospital, Glasgow, United Kingdom.
| | - G Walker
- Department of Paediatric Surgery, Yorkhill Children's Hospital, Glasgow, United Kingdom
| | - H Kubba
- Department of Paediatric Otolaryngology, Yorkhill Children's Hospital, Glasgow, United Kingdom
| | - A Sabharwal
- Department of Paediatric Surgery, Yorkhill Children's Hospital, Glasgow, United Kingdom
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Abstract
Educational aimsTo understand the current challenges in the care of tracheostomy patientsTo understand principles of quality improvement collaboration and how this can improve the quality of care for tracheostomy patientsSummaryThe UK National Confidential Enquiry into Patient Outcomes and Death illustrates that there remains significant morbidity and mortality relating to patients with a tracheostomy, with much preventable harm. Challenges include the inherent complexity of the patient's underlying condition, wide variations in tracheostomy management, variable delivery of education for staff, patients and families, and difficult coordination of care between such a variety of individuals involved in performing, managing and ultimately removing tracheostomies.Quality-improvement collaboratives are groups of institutions with a common purpose who work together to drive positive change. They help support clinicians in developing skills and teams necessary to design and sustain quality-improvement cycles. They are a cost-effective way of rapidly disseminating improvement strategies and engaging in shared learning across institutions around the world. The Global Tracheostomy Collaborative aims to improve quality of care and outcomes through five interdependent key drivers: coordinated multidisciplinary team care, education, institution-wide protocols, family and patient-centred care, and metrics and outcomes using a specifically designed database.
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Hamilton J, Clement WA, Kubba H. Management of congenital cartilaginous sleeve trachea in children. Int J Pediatr Otorhinolaryngol 2014; 78:2011-4. [PMID: 25200602 DOI: 10.1016/j.ijporl.2014.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 11/30/2022]
Abstract
AIMS Children with congenital tracheal cartilaginous sleeve may present to otolaryngology services with airway problems. We wish to describe our overall management in a series of four children with this very rare anomaly. METHODS Retrospective case note review of children diagnosed with congenital tracheal cartilaginous sleeve presenting to our department between 2006 and 2014. RESULTS Four patients were seen. One had Opitz G syndrome, two had Pfeiffers syndrome and one had no associated anomalies. Two children were successfully managed with laryngeal reconstruction using an anterior costal cartilage graft, while the third and fourth required a short period of tracheostomy only. All four are well and currently asymptomatic from an airway point of view. CONCLUSION Congenital tracheal cartilaginous sleeve is a very rare and potentially challenging problem. Otolaryngologists should be aware that it can occur in children with syndromes other than craniosynostosis (and indeed, those with no syndrome) and that it can be successfully treated using established airway management techniques. ETHICAL APPROVAL Registered with Clinical Governance Committee.
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Affiliation(s)
| | - W Andrew Clement
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, United Kingdom
| | - Haytham Kubba
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, United Kingdom.
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Chiu S, Webster L, Kubba H. Can we predict which children will go home the same day after microlaryngoscopy-bronchoscopy? Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Montgomery J, McCusker S, Hendry J, Lumley E, Kubba H. Botulinum toxin A for children with salivary control problems. Int J Pediatr Otorhinolaryngol 2014; 78:1970-3. [PMID: 25242701 DOI: 10.1016/j.ijporl.2014.08.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to review the response of children who have received botulinum toxin A (BtA) injections for saliva control in our institution. METHODS Retrospective case series of children attending a saliva control clinic in a paediatric tertiary referral hospital. Children were identified from the saliva control database, which has been in place since its creation in 2006. Prior to receiving BtA all the children in the study had previously undertaken a 3-month trial of pharmacological therapy, with no effect. All BtA injections were performed freehand to the parotid and submandibular glands. The background diagnosis, comorbidities for the child, age at presentation, dose of BtA, the response, and any complications were recorded. RESULTS 97 children were identified and 175 BtA doses were given (median per child: 1, mean: 1.9). 59 (61%) were male. The age range was between 2 months and 18 years (mean 8.6 years, median 8.8 years). The dose injected varied between 0.52 units/kg and 21.28 unit/kg (mean 5 units/kg, median 4.2 units/kg). These were performed using local anaesthetic on 131 (75%) occasions. The remainder were performed under general anaesthetic. Responses to BtA were classed as effective 109 (62%), partially effective 14 (8%) or not effective 50 (29%). The response duration was between 0.25 and 18 months (mean 4 months). Complications were seen following 22 injections (10.9%). Data modelled using binary logistic regression found that male gender and children with cerebral palsy are statistically predicted to have a better response to BtA. CONCLUSION Botulinum A injected under local anaesthetic is a safe, effective treatment for children with sialorrhoea. Ultrasound guidance is not necessary as long as anatomical landmarks are used for placement. The main adverse effect that can result is dysphagia, which is of concern in children that can swallow independently prior to injection. Male sex and cerebral palsy are statistically independent positive predictive factors for successful outcome of BtA injections for sialorrhoea, however this does not preclude other children from receiving or benefitting from it. Children that respond well to BtA initially, are likely to respond well in the future.
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Affiliation(s)
- Jenny Montgomery
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, United Kingdom.
| | - Sarah McCusker
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, United Kingdom
| | - Jane Hendry
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, United Kingdom
| | - Eleanor Lumley
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, United Kingdom
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Montgomery J, Sau C, Clement W, Danton M, Davis C, Haddock G, McLean A, Kubba H. Treatment of tracheomalacia with aortopexy in children in Glasgow. Eur J Pediatr Surg 2014; 24:389-93. [PMID: 23918669 DOI: 10.1055/s-0033-1351662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess outcomes of infants and children undergoing aortopexy and to try and establish which children would derive the greatest benefit from this complex intervention. Materials and METHODS This is a retrospective case series in a pediatric tertiary referral hospital between 1993 and 2012. A case sheet review was performed to collect demographic data and identify outcomes for each child. The effects of the subtype of tracheomalacia, weight at surgery, symptoms at presentation, surgical approach, and preoperative ventilation were considered. RESULTS There were 30 children who underwent aortopexy during the study period. Of the 30 children in the study, 21 children (70%) were male. The gestational age at birth ranged between 25 and 41 weeks (9 children [30%] were preterm). Age at surgery was between 2 and 140 weeks (mean; 31.5 weeks, median; 26 weeks). The onset of symptoms was between birth and 18 months (mean; 3.8 months, median; 3.5 months). The presenting symptoms were stridor (n = 9; 30%), failed extubation (n = 4; 13%), death attacks (n = 8; 27%), and cyanosis (n = 9; 30%). The underlying pathology was primary in 10 children (33%) and secondary in 18 children. The diagnosis was made by bronchoscopy in 26 children (93%). Imaging was performed in 25 children (83%). Aortopexy in our institution is performed by general pediatric surgeons (n = 8; 27%) and cardiothoracic surgeons (n = 22; 73%). In the immediately postoperative period, 25 children (83%) were thriving. Of the children that required another procedure; 1 child was reintubated (3%), 2 children had a tracheostomy (6%), 1 child had a stent (3%), and 2 children died (6%). Clinical follow-up of these children was between 1 month and 12 years. Long term, in 22 children (73%) were asymptomatic. CONCLUSION There were no clinical predictors of outcome identified, but aortopexy is a safe effective procedure for children with severe tracheomalacia.
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Affiliation(s)
- Jenny Montgomery
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Chung Sau
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - William Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Mark Danton
- Department of Paediatric Cardiothoracic Surgery, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Carl Davis
- Department of Surgical Paediatrics, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Graham Haddock
- Department of Surgical Paediatrics, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Andrew McLean
- Department of Paediatric Cardiothoracic Surgery, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, United Kingdom
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Hamilton J, Clement WA, Kubba H. Otolaryngological presentations of Cornelia de Lange syndrome. Int J Pediatr Otorhinolaryngol 2014; 78:1548-50. [PMID: 25060937 DOI: 10.1016/j.ijporl.2014.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/21/2014] [Accepted: 05/25/2014] [Indexed: 11/28/2022]
Abstract
AIM Children with Cornelia de Lange syndrome frequently present to otolaryngology services with hearing problems. Airway problems have not previously been reported. We wish to describe our experience of the overall management in a series of children with Cornelia de Lange syndrome. METHODS Retrospective case note review of children diagnosed with Cornelia de Lange syndrome presenting to our department between 2005 and 2014. RESULTS Six patients were seen. Airway problems consisted of laryngeal overspill with severe gastroesophageal dysmotility and reflux despite structurally normal airway (1 case), laryngomalacia requiring supraglottoplasty (2 cases), reflux laryngitis with secondary laryngomalacia and coincidental tracheal diverticulum (1 case) choanal atresia requiring stents (1 case) and obstructive sleep apnoea (1 case). Supraglottoplasty produced a dramatic improvement in feeding and breathing in both children who underwent the procedure. Two children had palatal anomalies and one underwent cochlear implantation for a profound sensorineural hearing loss. CONCLUSION Children with Cornelia de Lange syndrome have multifaceted ENT problems. Airway pathology has not previously been described in Cornelia de Lange syndrome but has been common in our experience. We wish to highlight that laryngomalacia in Cornelia de Lange syndrome responds well to supraglottoplasty.
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Affiliation(s)
| | - W Andrew Clement
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, United Kingdom
| | - Haytham Kubba
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, United Kingdom.
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Lim DBN, Gault EJ, Kubba H, Morrissey MSC, Wynne DM, Donaldson MDC. Cholesteatoma has a high prevalence in Turner syndrome, highlighting the need for earlier diagnosis and the potential benefits of otoscopy training for paediatricians. Acta Paediatr 2014; 103:e282-7. [PMID: 24606043 DOI: 10.1111/apa.12622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/08/2014] [Accepted: 03/03/2014] [Indexed: 11/26/2022]
Abstract
AIM Girls with Turner syndrome are prone to cholesteatoma, a serious suppurative middle ear disease. We aimed to confirm its high prevalence in Turner syndrome, identify risk factors and suggest possible strategies for earlier detection. METHODS We reviewed 179 girls with Turner syndrome between 1989 and 2012 to identify cases of cholesteatoma. RESULTS Seven girls (3.9%) had cholesteatoma (index girls) and each was compared with three age-matched girls without cholesteatoma (comparison girls). All the index girls had either the 45,X or 45,X/46X,i(Xq) karyotypes. Nine ears were initially affected, with three recurrences in two girls. Median age at first cholesteatoma presentation was 11.9 years (range: 7.5-15.2), with otorrhoea for three (range: one to seven) months in all 12 affected ears. Index girls had a significantly higher proportion of previous recurrent acute (p = 0.007) and chronic otitis media (p = 0.008), chronic perforation (p = 0.038) aural polyps (p < 0.0001) and tympanic membrane retraction (p = 0.0001) than comparison girls. CONCLUSION Cholesteatoma has a high prevalence in Turner syndrome. Risk factors include 45,X and 46,XiXq karyotypes; a history of chronic otitis media, tympanic membrane retraction and persistent otorrhoea; and older age. Earlier recognition of ear disease is needed and otoscopy training for paediatricians caring for Turner syndrome patients may be beneficial.
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Affiliation(s)
- DBN Lim
- Section of Child Health; School of Medicine; University of Glasgow; Glasgow UK
| | - EJ Gault
- Section of Child Health; School of Medicine; University of Glasgow; Glasgow UK
| | - H Kubba
- Department of Ear, Nose and Throat Surgery; Royal Hospital for Sick Children; Glasgow UK
| | - MSC Morrissey
- Department of Ear, Nose and Throat Surgery; Royal Hospital for Sick Children; Glasgow UK
| | - DM Wynne
- Department of Ear, Nose and Throat Surgery; Royal Hospital for Sick Children; Glasgow UK
| | - MDC Donaldson
- Section of Child Health; School of Medicine; University of Glasgow; Glasgow UK
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Locke R, Comfort R, Kubba H. When does an enlarged cervical lymph node in a child need excision? A systematic review. Int J Pediatr Otorhinolaryngol 2014; 78:393-401. [PMID: 24447684 DOI: 10.1016/j.ijporl.2013.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/08/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Palpable cervical lymphadenopathy is very common in children. The clinician's job is to exclude malignancy as a cause and reach a diagnosis. In children selected for open biopsy, reactive hyperplasia and other inflammatory causes are far more common as a final diagnosis than malignancy. Furthermore complications can occur after open biopsy. OBJECTIVE To assess the diagnostic utility of clinical examination and investigations to exclude malignancy and other serious causes of paediatric cervical lymphadenopathy and minimise open biopsy. TYPE OF REVIEW A systematic review of the literature with defined search strategy. SEARCH STRATEGY A structured search of Medline, Embase, CINAHL and Cochrane databases. The references within standard paediatric ENT and head and neck textbooks were also examined. RESULTS The quality of evidence regarding predictors of malignancy is poor. Large lymph nodes and supraclavicular nodes are potential indicators of serious pathology. Fever, weight loss and organomegaly may be indicators but duration of symptoms and consistency are not. Abnormalities on chest X-ray are associated with serious causes but the diagnostic utility of routine chest X-ray is unknown. Ultrasound assessment of nodal architecture, margins, and shape (and possibly vascularity) shows considerable promise as a means of differentiating reactive hyperplasia from malignancy but further studies in children are required. Abnormalities in the full blood count (FBC) seem to be uncommon but when present are associated with serious causes of cervical lymphadenopathy, again the diagnostic utility is unclear. Serological testing may identify a specific cause and therefore avoid excision biopsy in around 10% of cases. Cutting needle biopsy requires further evaluation before it can be recommended. Fine needle aspiration cytology (FNAC) is very specific, but sensitivity varies in different studies to the extent that it cannot yet be relied upon to exclude malignancy. CONCLUSIONS Large and supraclavicular nodes should be biopsied. Ultrasound is likely to be useful but further study is required. FNAC cannot be relied upon to exclude malignancy in children. The diagnostic utility of chest X-ray and FBC are unclear. Work is required on multivariate predictive models.
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Affiliation(s)
- Richard Locke
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom.
| | - Rachael Comfort
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom
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