1
|
Hazan I, Ziv O, Marom T, Zloczower E, Pitaro J, Warman M. Has COVID-19 Changed Pediatric Acute Rhinosinusitis Epidemiology During the First 2 Pandemic Years? Pediatr Infect Dis J 2023; 42:412-417. [PMID: 36795587 PMCID: PMC10097472 DOI: 10.1097/inf.0000000000003856] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To study national pediatric acute rhinosinusitis (ARS) burden fluctuations before and during the first 2 coronavirus-19 (COVID) years, characterized by alternating lockdown and relaxation periods, the introduction of COVID vaccines, and the emergence of nonalpha COVID variants. METHODS This was a cross-sectional, population-based study covering the 3 pre-COVID years and the first 2 COVID years from a big database of the largest Israeli Health Maintenance Organization. For comparison purposes, we explored ARS burden trends with those of urinary tract infection (UTI), which is unrelated to viral diseases. We identified children <15 years presenting with ARS and UTI episodes and categorized them according to their age and presentation date. The average ARS and UTI episodes of the 3 pre-COVID years were used to calculate the incidence rate ratios (IRRs) of the 2 COVID years, analyzed separately. Seasonal variations were explored. RESULTS We identified 44,483 ARS and 121,263 UTI episodes. There was a substantial reduction in ARS episodes during the COVID years (IRR 0.36, 95% CI: 0.24-0.56, P < 0.001). Although UTI episode rates also decreased during COVID (IRR 0.79, 95% CI: 0.72-0.86, P < 0.001), the reduction in ARS burden was 3-fold higher. The dominant pediatric ARS age group was between 5 and 15 years. The largest decrease in ARS burden was during the first COVID year. ARS episode distribution showed a seasonal fluctuation, with a peak during the summer months during the COVID years. CONCLUSIONS Pediatric ARS burden decreased during the first 2 COVID years. Episode distribution was noted to be year-round.
Collapse
Affiliation(s)
- Itai Hazan
- From the Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Oren Ziv
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Tal Marom
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Clalit Health Services, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Elchanan Zloczower
- Clalit Health Services, Tel Aviv, Israel
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Pitaro
- Clalit Health Services, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (formerly Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler School Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Warman
- Clalit Health Services, Tel Aviv, Israel
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
2
|
Rothman S, Zabarqa S, Pitaro J, Gavriel H, Marom T, Muallem Kalmovich L. Head and neck cancer surgery in elderly patients: the role of frailty assessment. Eur Arch Otorhinolaryngol 2023; 280:1447-1453. [PMID: 36269365 DOI: 10.1007/s00405-022-07712-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/20/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To study whether any risk model, frailty index, patients' comorbidities, or demographic characteristics correlate with postoperative morbidity in elderly patients who underwent surgery for head and neck cancer (HNC). A secondary objective was to compare between frailty indexes that are used at our medical center. METHODS A retrospective analysis of head and neck cancer patients operated between 2007 and 2021 was performed. RESULTS One hundred and fifteen patients were included and divided into three age groups: 50-69 years, 70-79 years and ≥ 80 years. Although most elderly patients had a significantly higher rate of comorbidities and lower Norton scores, no statistically significant difference was found between the groups in postoperative morbidity rates, intensive care unit (ICU) or internal medicine department admissions, re-hospitalization in 1-3 months, and in falling risk (MFS-Morse Fall Scale). On multivariate analysis there was a positive correlation between preoperative cerebrovascular accident (CVA), dementia, and cardiac arrhythmias, and the probability for developing postoperative complication. The latter findings were not related to the patients' age. CONCLUSIONS In this study, we did not find higher postoperative morbidity rates among elderly population in comparison to younger age groups, and therefore, our current evaluation system could not assist in identifying elderly at risk. However, prediction of operative risk based on physiologic reserve or frailty is an important tool in the evaluation of elderly head and neck cancer patients. Future studies are needed to assess the role of frailty index in the elderly head and neck cancer population.
Collapse
Affiliation(s)
- S Rothman
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel. .,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - S Zabarqa
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Marom
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Health Sciences, Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - L Muallem Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Taha A, Pitaro J, Lazarovitch T, Muallem-Kalmovich L, Garti Y, Gavriel H. The association between Helicobacter pylori and chronic otitis media with effusion. Eur Arch Otorhinolaryngol 2023; 280:891-896. [PMID: 36178529 DOI: 10.1007/s00405-022-07677-0] [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: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Chronic otitis media with effusion (COME) is a common condition in children and a leading cause for hearing loss and ventilation tubes (VT) insertion. Among other risk factors, it is suggested that Helicobacter pylori (H. pylori) infection may have a role in the pathogenesis of COME. Previous studies have reached different results, and therefore, there is a need for further data on the relationship between H. pylori infection and COME development in children. Our objective is to investigate the presence of H. pylori in the middle-ear fluid (MEF) from children with COME. METHODS A Comparative cross-sectional study. Children ≤ 18 years were included. The study group included children diagnosed with COME and required VT insertion. The control group included children with acute otitis media (AOM) who required myringotomy in the emergency room. Middle-ear fluid samples were sent for both culture and bacterial identification using polymerase chain reaction (PCR) testing. RESULTS A total of 43 children were included. Eighteen with COME (median age 4 years, IQR 3-6), and 25 with AOM (median age 1 year, IQR 1-2). All samples were cultured for H. pylori. Twenty-two samples underwent H. pylori PCR testing of them, 12 samples from children with COME, and 10 from children with AOM. All cultures and PCR tests results were negative for H. pylori. CONCLUSIONS Our results suggest that H. pylori does not have a role in the pathogenesis of COME. Future larger studies are needed to investigate whether H. pylori has a role in the pathogenesis of COME.
Collapse
Affiliation(s)
- Ahmed Taha
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel.
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Tsilia Lazarovitch
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Limor Muallem-Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Yael Garti
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| |
Collapse
|
4
|
Marom T, Pitaro J. AAP otitis-media watchful-waiting recommendations not followed. J Pediatr 2022; 251:220-224. [PMID: 36464407 DOI: 10.1016/j.jpeds.2022.08.056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Tal Marom
- Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | | |
Collapse
|
5
|
Shcherbaeva T, Muallem Kalmovich L, Shalem T, Broide E, Gavriel H, Pitaro J. Caustic Ingestion in Children: The Otolaryngologist Perspective. Pediatr Emerg Care 2022; 38:e1541-e1544. [PMID: 35580175 DOI: 10.1097/pec.0000000000002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Caustic ingestion in children is a significant cause of morbidity despite preventive measures. Upon arrival to the emergency department, these children are often initially seen by the otolaryngologist and later on by the gastroenterologist. This study aimed to determine which otolaryngological and gastrointestinal signs and symptoms can better predict abnormal findings on imaging, esophagogastroduodenoscopy (EGD), and complications development. METHODS We performed a retrospective chart review of children 18 years or younger admitted because of caustic ingestion between January 2007 and November 2019. RESULTS Forty-one children with a median age of 4.2 years (interquartile range, 1.7-16.7 years) were included; of them, 22 (53.6%) were males. Nineteen children (46.3%) underwent EGD, which revealed no pathology in 13 cases (68.4%). Most ingested substances were in the form of liquid (82.9%), accidentally ingested (82.9%), and with an alkaline pH (57.5%). Stridor, dyspnea, drooling, abnormal oral cavity findings, dysphagia, and vomiting were significantly associated with pathological findings on imaging and/or EGD and/or complications development ( P = 0.028, P = 0.028, P = 0.022, P = 0.02, P < 0.001, and P = 0.01 respectively). Laryngopharyngeal group of findings (dyspnea, stridor, hoarseness, sore throat, and/or drooling) predicted a higher risk for complications development than the gastrointestinal group (dysphagia, abdominal pain, vomiting, or abdominal swelling and/or tenderness) ( P = 0.011, P = 0.31 respectively). CONCLUSIONS In children, after caustics ingestion, laryngopharyngeal signs and symptoms may predict a higher risk for complications development in comparison with gastrointestinal signs and symptoms. We therefore stress the importance of otolaryngological examination upon arrival to the emergency department.
Collapse
Affiliation(s)
| | | | - Tzippora Shalem
- Pediatric Gastroenterology Unit, Shamir Medical Center (formerly Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Broide
- Pediatric Gastroenterology Unit, Shamir Medical Center (formerly Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Gavriel
- From the Department of Otolaryngology-Head and Neck Surgery
| | - Jacob Pitaro
- From the Department of Otolaryngology-Head and Neck Surgery
| |
Collapse
|
6
|
Marom T, Pitaro J, Shah UK, Torretta S, Marchisio P, Kumar AT, Barth PC, Tamir SO. Otitis Media Practice During the COVID-19 Pandemic. Front Cell Infect Microbiol 2022; 11:749911. [PMID: 35071032 PMCID: PMC8777025 DOI: 10.3389/fcimb.2021.749911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.
Collapse
Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udayan K Shah
- Pediatric Otolaryngology, Delaware Valley, and Enterprise Chief of Credentialing, Nemours Children's Health System, Wilmington, DE, United States.,Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ayan T Kumar
- Department of Otolaryngology-Head & Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Patrick C Barth
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Pediatric Otolaryngology, Delaware Valley Nemours Children's Health System, Wilmington, DE, United States
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| |
Collapse
|
7
|
Marom T, Shefer G, Tshori S, Mingelgrin S, Pitaro J. Antibiotic prescription policy for acute otitis media: do we follow the guidelines? J Antimicrob Chemother 2021; 76:2717-2724. [PMID: 34278423 DOI: 10.1093/jac/dkab250] [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] [Received: 03/12/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common cause for antibiotic prescription. Most guidelines endorse abstaining from immediate antibiotic treatment ('watchful waiting', WW) in mild-moderate episodes. We studied adherence rates to the latest AOM guidelines (2013), in terms of antibiotic type and prescription options. METHODS In this population-based study, AOM episodes were identified in Clalit Health Services-insured children aged 0-10 years between 2011 and 2018, using a data-sharing platform. After identifying the index, prescription and issuing dates for antibiotics for each AOM episode, treatment was categorized as immediate (≤2 days after diagnosis) or WW (antibiotic not prescribed/issued; prescribed ≤2 days after diagnosis but issued on Days 2-7; or prescribed/issued on Days 2-7). Guideline adherence was measured according to age. RESULTS Of the 491 106 episodes, 361 518 (73.6%) were treated with antibiotics. Following the 2013 guidelines, the ratio of episodes in children aged ≤6 months that were adherent (immediate treatment) was higher (OR = 1.22; 95% CI 1.15-1.29; P < 0.001), whereas the adherent episode ratio for children aged 6-24 months and 2-10 years (WW) was lower (OR = 0.87; 95% CI 0.85-0.88 and OR = 0.94; 95% CI 0.92-0.96, respectively; P < 0.001). Antibiotic prescription rates after 2013 for children aged ≤6 months were not different (OR = 1.03; 95% CI 0.96-1.1; P = 0.4), but were higher in children aged 6-24 months and 2-10 years (OR = 1.07; 95% CI 1.05-1.09; P < 0.001 and OR = 1.02; 95% CI 1.01-1.04; P = 0.015, respectively). Amoxicillin was the most common antibiotic, administered in 75.6% of episodes. Azithromycin was most commonly associated with treatment failure (6.6%). CONCLUSIONS Improved adherence to the 2013 guidelines was observed only in children aged ≤6 months and over-treatment with antibiotics was still high.
Collapse
Affiliation(s)
- Tal Marom
- Central District, Clalit Health Services, Tel Aviv-Yafo, Israel.,Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Galit Shefer
- Research Authority, Kaplan Medical Center, Rehovot, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Rehovot, Israel.,Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada, The Hebrew University, Jerusalem, Israel
| | | | - Jacob Pitaro
- Central District, Clalit Health Services, Tel Aviv-Yafo, Israel.,Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| |
Collapse
|
8
|
Abu-Eta R, Gavriel H, Pitaro J. Extended High Frequency Audiometry for Revealing Sudden Sensory Neural Hearing Loss in Acute Tinnitus Patients. Int Arch Otorhinolaryngol 2020; 25:e413-e415. [PMID: 34377177 PMCID: PMC8321644 DOI: 10.1055/s-0040-1713921] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction
The measurement of extended high-frequency (EHF) audiometry has become more popular recently, mainly in connection with ototoxicity and noiseinduced hearing loss. New-onset tinnitus evaluation includes a standard hearing test that shows no pathology.
Objective
The aim of the present study was to evaluate the possibility that acute tinnitus is essentially connected to sudden sensory neural hearing loss (SSNHL), by utilizing EHF audiometry in cases in which standard audiometry for frequencies between 250 Hz to 8 kHz is within normal limits.
Methods
A retrospective study was conducted between January 2009 and May 2014 that included all patients presenting with acute tinnitus and normal standard audiometry. All patients underwent EHF audiometry and were treated accordingly.
Results
Thirty-two patients with acute tinnitus and asymmetric sensorineural hearing loss on EHF audiometry were identified. The average deltas between the ears were between 9.2 and 33dB (worse in the affected ear).
Conclusion
Extended high-frequency audiometry up to 20,000 Hz should be performed in all patients with acute tinnitus and standard audiometry within normal limits.
Collapse
Affiliation(s)
- Rani Abu-Eta
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Previously Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Previously Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Previously Assaf Harofeh) Medical Center, Zerifin, Israel
| |
Collapse
|
9
|
Fellner A, Gavriel H, Pitaro J, Muallem Kalmovich L. Clinical parameters predicting tonsillar malignancy. Eur Arch Otorhinolaryngol 2020; 277:1779-1783. [PMID: 32130510 DOI: 10.1007/s00405-020-05873-4] [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: 12/28/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Tonsillectomy is indicated in unilateral tonsillar enlargement (UTE) to rule out malignancy, which eventually is found in about 1.4% of the patients. The aim of this study was to evaluate the presenting symptoms of patients who underwent tonsillectomy for UTE and identify parameters that are associated with an increased risk for malignancy, for better assessment and refinement of current management protocols. METHODS A retrospective chart review of adult patients with UTE who underwent tonsillectomy between 1/1/2006 and 31/12/2016 was conducted. RESULTS Forty-one patients with a median age of 53 years were included. There were 20 (49%) females and 21 (51%) males. Sixteen (39%) patients were diagnosed as having tonsillar malignancy. Patients with malignancy were older than those in the benign group (p = 0.001), had a previous malignancy (p = 0.006), and were less likely to present as an incidental finding (p < 0.001). Lymphadenopathy, throat pain, suspicious appearance of tonsillar mucosa, and hard consistency were also found to be statistically significant findings in the malignancy group (p = 0.017, p = 0.001, p = 0.01 and p = 0.018, respectively). Multivariable regression showed age, appearance and adjacent tissue involvement to be independently with malignancy. CONCLUSIONS UTE alone, as an incidental finding, should not be regarded as an indication for tonsillectomy, as the risk for malignancy is low and the morbidity is significant. We suggest integrating the above-mentioned clinical parameters in the decision-making process, which were found to be significantly more frequent in the malignant group.
Collapse
Affiliation(s)
- Avital Fellner
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel.
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Limor Muallem Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| |
Collapse
|
10
|
Marom T, Fellner A, Hirschfeld Z, Lazarovitch T, Gavriel H, Muallem-Kalmovich L, Pitaro J. The yield of respiratory viruses detection testing is age-dependent in children with acute otitis media. Ther Adv Infect Dis 2019; 6:2049936119871127. [PMID: 31798867 PMCID: PMC6868570 DOI: 10.1177/2049936119871127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Studies of nasopharyngeal secretions serve as reliable surrogate to evaluate the involvement of viruses in acute otitis media (AOM) and upper/lower respiratory tract infections (URIs/LRIs). We explored nasopharyngeal viral studies from children with uncomplicated AOM and examined their cost-effectiveness in relation to their age. Methods: We identified children aged 0–6 years admitted to our pediatrics department in a university-affiliated, secondary hospital with uncomplicated AOM and concurrent URI/LRI between 2012 and 2017, during October–April, when viral studies are performed. Studies were performed either using antigen detection tests, for respiratory syncytial virus (RSV) and influenza A/B (2012–2016) and for a variety of other common respiratory viruses, utilizing multiplex polymerase chain reaction assays (2017). Results: A total of 249 children were included (median age: 15 months). In 88 (35%) children, viral studies were positive, most of them in children ⩽24 months (78, 89%). RSV was positive in 52 (59%) children, followed by influenza A and B, in 11 (13%) and 5 (6%) children, respectively. First year switch to a molecular assay, 4.5-fold more expensive, resulted in a statistically significant higher yield: 69% positive results in ⩽24 months, and 66% in those aged ⩽12 months (p < 0.05). In those ⩽24 months, US$23 and US$95 were spent for one positive test in the antigen detection years and the polymerase chain reaction year, respectively, whereas in those >24 months, US$83 and US$878 were invested for one positive test in the same year, respectively. Conclusion: In cost-effectiveness terms, the greatest benefit of nasopharyngeal studies was highest in children ⩽24 months.
Collapse
Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, 70300, Israel
| | - Avital Fellner
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| | - Ze'ev Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| | - Tzilia Lazarovitch
- Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| | - Limor Muallem-Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, Zerifin, Israel
| |
Collapse
|
11
|
Jabarin B, Marom T, Gavriel H, Eviatar E, Pitaro J. Orbital complications secondary to acute rhinosinusitis in toddlers: A unique age group. Int J Pediatr Otorhinolaryngol 2019; 121:46-49. [PMID: 30861427 DOI: 10.1016/j.ijporl.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/27/2018] [Revised: 03/02/2019] [Accepted: 03/02/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To present the clinical course and management of pediatric orbital complications (OC) secondary to acute rhinosinusitis (ARS), focusing on subperiosteal orbital abscess (SPOA) in toddlers (<2 years). A secondary aim was to identify and evaluate unique variables in toddlers which distinguish them from the older age group. METHODS A retrospective cohort study of all children with OC secondary to ARS admitted to a secondary medical center between 2005 and 2014 was conducted. Variables analyzed included age, gender, symptoms duration, previous antibiotic therapy, highest recorded temperature, physical and ophthalmologist's examination results, laboratory results and imaging findings. RESULTS Of the 123 children with OC, 52 (42%) were toddlers. Of them, 30(58%) were boys, with a mean age of 1.4 years. Toddlers presented with higher fever measurements and leukocyte/lymphocyte counts than older children. 69% had Chandler's 1 stage vs 45% in older children (p = 0.015). Ophthalmoplegia was less common in toddlers, who were also less likely to develop late ophthalmoplegia, an important indicator for good treatment response. Eighteen (35%) toddlers underwent computerized tomography (CT) scans, compared to 50 (70%) in the older aged group. Of them, 16/18 (89%) had SPOA. Five (10%) toddlers underwent drainage (31% of Chandler's 3 in this age group) compared to 19 (27%) older patients who underwent surgical treatment (53% of Chandler's 3 in this age group). CONCLUSION Toddlers with OC have a milder disease and better outcomes, measured in lower rates of delayed ophthalmoplegia, number of CT scans and SPOA rates, and with fewer surgical interventions.
Collapse
Affiliation(s)
- Basel Jabarin
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Sackler School of Medicine, 70300, Zerifin, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Sackler School of Medicine, 70300, Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Sackler School of Medicine, 70300, Zerifin, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Sackler School of Medicine, 70300, Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Sackler School of Medicine, 70300, Zerifin, Israel.
| |
Collapse
|
12
|
Pitaro J, Waissbluth S, Quintal MC, Abela A, Lapointe A. Characteristics of children with refractory acute otitis media treated at the pediatric emergency department. Int J Pediatr Otorhinolaryngol 2019; 116:173-176. [PMID: 30554692 DOI: 10.1016/j.ijporl.2018.10.045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/31/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Refractory acute otitis media (rAOM) is defined as the persistence of signs and symptoms of AOM for more than 48 to 72 hours after the initiation of antibiotic treatment. These patients are often referred to the pediatric emergency department (PED). We sought to study rAOM cases referred to our PED, and to evaluate their clinical characteristics and response to our local management guidelines. METHODS A retrospective chart review of all children treated for rAOM between 1/2012-3/2014 was performed. Data recorded included demographics, clinical presentation, antibiotic treatments, need for surgery, and culture results. RESULTS A total of 255 patients were included with a mean age of 19 months. Prior to admission, all the children had received at least one course of antibiotics. Amoxicillin was the most common first-line antibiotic prescribed while amoxicillin-clavulanic acid was the most common second and third-line antibiotic given. Intravenous ceftriaxone was the treatment administered at the PED. Myringotomy and pressure equalizing tube (PET) insertion were required in 60% of cases. Middle ear cultures (55 ears) were positive for Streptococcus pneumoniae in two, and Moraxella catarrhalis in only one culture. There were no differences between the mean age of children who had PET insertion and those who did not with regards to fever, rhinorrhea, and preschool or school attendance. Children presenting with otorrhea were less likely to undergo surgery (P = 0.013). CONCLUSIONS This is the first study evaluating the established local practice guideline with regards to clinical characteristics and need for surgical management. We showed that myringotomy and PET insertion due to antibiotic failure is commonly performed for cases of rAOM. The majority of the middle ear cultures were sterile.
Collapse
Affiliation(s)
- Jacob Pitaro
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
| | - Sofia Waissbluth
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Marie-Claude Quintal
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Anthony Abela
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Annie Lapointe
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| |
Collapse
|
13
|
Jabarin B, Pitaro J, Marom T, Muallem-Kalmovich L. Dysplastic Changes in Patients with Recurrent Laryngeal Leukoplakia: Importance of Long-Term Follow-Up. Isr Med Assoc J 2018; 20:623-626. [PMID: 30324779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Leukoplakia of the vocal cords may represent a pre-cancerous lesion of the larynx. The management of cases of recurrent leukoplakia with pathologically proven dysplasia is still controversial. OBJECTIVES To present a series of patients with recurrent vocal cord leukoplakia and to examine their malignant transformation rate in relation to the clinical characteristics, risk factors, and histological findings. METHODS A retrospective cohort study was conducted between 1999 and 2017. The study comprised 52 patients with recurrent leukoplakia of the vocal cords who required ≥ 2 direct laryngeal procedures within a minimum of 3 months between each procedure. Malignant transformation rate over follow-up period, risk factors for malignant transformation, and interval to develop laryngeal squamous cell carcinoma were investigated. RESULTS All patients presented with hoarseness. An average of three procedures per patient was performed (range 2-13). Ten male patients (19.2%) developed squamous cell carcinoma. Of these, four with severe dysplasia developed SCC within 19 months of the first direct laryngoscopy. In the six other patients, SCC developed within an average of 3.7 years. The follow-up period ranged from 9-253 months (mean 109 months). Heavy smoking and severe dysplasia in the first biopsy were found to be significant risk factors for developing squamous cell carcinoma, as was male gender. CONCLUSIONS We showed an increased malignant transformation rate in recurrent leukoplakia cases among heavy smokers and male patients. In addition, severe dysplasia at initial diagnosis was a risk factor for SCC development. Close follow-up of patients with recurrent leukoplakia is warranted.
Collapse
Affiliation(s)
- Basel Jabarin
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Muallem-Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Abu Eta R, Eviatar E, Pitaro J, Gavriel H. Post-turbinectomy nasal packing with Merocel versus glove finger Merocel: A prospective, randomized, controlled trial. Ear Nose Throat J 2018; 97:64-68. [PMID: 29554399 DOI: 10.1177/014556131809700320] [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: 11/15/2022] Open
Abstract
Nasal packs are widely used after septoplasty and turbinectomy. We conducted a prospective, randomized, controlled clinical trial including 100 patients who underwent septoplasty with/or without turbinectomy randomized into two groups. In the first group (the Merocel group), a standard tampon was inserted at the end of surgery. In the second group (the glove finger group), the tampon was first placed inside a glove finger. The main outcomes measured were pain and bleeding during the postoperative period and during tampon removal. Consumption of pain killers and tranexamic acid were also recorded. The mean visual analog scale score 12 hours after surgery and during tampon removal in the Merocel group were 6.78 and 8.92, respectively, compared to 4.06 and 5.27, respectively, in the glove finger group (p < 0.001). A statistically significant difference in the bleeding rate and tranexamic acid consumption during tampon removal in favor of the Merocel group was shown (p < 0.001). The use of Merocel in a glove finger is significantly less painful, although a higher chance of bleeding is reported. The influence of the surgeon's experience in using this technique needs further investigation.
Collapse
Affiliation(s)
- Rani Abu Eta
- Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | | | | | | |
Collapse
|
15
|
Eta RA, Eviatar E, Pitaro J, Gavriel H. Post-turbinectomy Nasal Packing with Merocel versus Glove Finger Merocel: A Prospective, Randomized, Controlled Trial. Ear Nose Throat J 2018. [DOI: 10.1177/014556131809700307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nasal packs are widely used after septoplasty and turbinectomy. We conducted a prospective, randomized, controlled clinical trial including 100 patients who underwent septoplasty with/or without turbinectomy randomized into two groups. In the first group (the Merocel group), a standard tampon was inserted at the end of surgery. In the second group (the glove finger group), the tampon was first placed inside a glove finger. The main outcomes measured were pain and bleeding during the postoperative period and during tampon removal. Consumption of pain killers and tranexamic acid were also recorded. The mean visual analog scale score 12 hours after surgery and during tampon removal in the Merocel group were 6.78 and 8.92, respectively, compared to 4.06 and 5.27, respectively, in the glove finger group (p < 0.001). A statistically significant difference in the bleeding rate and tranexamic acid consumption during tampon removal in favor of the Merocel group was shown (p < 0.001). The use of Merocel in a glove finger is significantly less painful, although a higher chance of bleeding is reported. The influence of the surgeon's experience in using this technique needs further investigation.
Collapse
Affiliation(s)
- Rani Abu Eta
- Department of Otolaryngology Head and NeckSurgery,
Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology Head and NeckSurgery,
Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jacob Pitaro
- Department of Otolaryngology Head and NeckSurgery,
Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology Head and NeckSurgery,
Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Ramat Aviv, Israel
| |
Collapse
|
16
|
Fellner A, Marom T, Muallem-Kalmovich L, Shlamkovitch N, Eviatar E, Lazarovitch T, Pitaro J. Pediatric neck abscesses: No increase in methicillin-resistant Staphylococcus aureus. Int J Pediatr Otorhinolaryngol 2017; 101:112-116. [PMID: 28964280 DOI: 10.1016/j.ijporl.2017.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/27/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recent studies from Western countries showed an increased incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric neck abscesses cultures. We sought to examine the microbiology and antibiotic susceptibility of such samples over a 10-year period, and particularly of Staphylococcus aureus (SA), in order to determine whether a similar trend exists in our institution. METHODS A retrospective chart review of children ≤18 years that underwent needle aspiration or surgical drainage of neck abscesses, including suppurative lymphadenitis, retropharyngeal abscesses, and parapharyngeal abscesses was conducted between 1/1/06-31/12/15. RESULTS Sixty-two children were identified with a male predominance (34, 55%). The median age was 2 years. There were 37 (60%) suppurative lymphadenitis, 15 (24%) parapharyngeal abscess, and 10 (16%) retropharyngeal abscess cases. Twenty-nine (47%) children received antibiotic treatment prior to admission, most commonly β-lactam agents. Of them, 15 (52%) had positive cultures, including 7 (47%) with SA. On admission, 45 (73%) children had already received amoxicillin-clavulanate. Of those who did not improve, 16 (26%) received ceftriaxone and clindamycin. Twenty-one (38%) cultures were negative. The most common isolated bacteria were SA in 13 (24%), Streptococcus pyogenes in 7 (13%), and Streptococcus viridians group in 9 (16%). Of the SA isolates, there was only 1 (8%) case of MRSA; however, there were 4 (31%) clindamycin-resistant SA isolates. CONCLUSION Unlike previously published data, there was no increase in MRSA incidence at our institution. However, the high prevalence of clindamycin-resistant SA was in line with previous reports. These findings should be considered when starting empirical therapy in pediatric neck abscesses.
Collapse
Affiliation(s)
- Avital Fellner
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Limor Muallem-Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Nathan Shlamkovitch
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Tzilia Lazarovitch
- Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel.
| |
Collapse
|
17
|
Motallebzadeh H, Maftoon N, Pitaro J, Funnell WRJ, Daniel SJ. Fluid-Structure Finite-Element Modelling and Clinical Measurement of the Wideband Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear. J Assoc Res Otolaryngol 2017; 18:671-686. [PMID: 28721606 DOI: 10.1007/s10162-017-0630-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/19/2017] [Indexed: 11/26/2022] Open
Abstract
The anatomical differences between the newborn ear and the adult one result in different input admittance responses in newborns than those in adults. Taking into account fluid-structure interactions, we have developed a finite-element model to investigate the wideband admittance responses of the ear canal and middle ear in newborns for frequencies up to 10 kHz. We have also performed admittance measurements on a group of 23 infants with ages between 14 and 28 days, for frequencies from 250 to 8000 Hz with 1/12-octave resolution. Sensitivity analyses of the model were performed to investigate the contributions of the ear canal and middle ear to the overall admittance responses, as well as the effects of the material parameters, measurement location and geometrical variability. The model was validated by comparison with our new data and with data from the literature. The model provides a quantitative understanding of the canal and middle-ear resonances around 500 and 1800 Hz, respectively, and also predicts the effects of the first resonance mode of the middle-ear cavity (around 6 kHz) as well as the first and second standing-wave modes in the ear canal (around 7.2 and 9.6 kHz, respectively), which may explain features seen in our high-frequency-resolution clinical measurements.
Collapse
Affiliation(s)
- Hamid Motallebzadeh
- Department of BioMedical Engineering, McGill University, 3775 rue University, Montreal, QC, H3A 2B4, Canada
| | - Nima Maftoon
- Department of BioMedical Engineering, McGill University, 3775 rue University, Montreal, QC, H3A 2B4, Canada
| | - Jacob Pitaro
- Division of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - W Robert J Funnell
- Department of BioMedical Engineering, McGill University, 3775 rue University, Montreal, QC, H3A 2B4, Canada.
- Division of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, Montreal, QC, Canada.
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada.
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| |
Collapse
|
18
|
Marom T, Israel O, Gavriel H, Pitaro J, Baker AA, Eviatar E. Comparison of first year of life acute otitis media admissions before and after the 13-valent pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2017; 97:251-256. [PMID: 28483246 DOI: 10.1016/j.ijporl.2017.04.023] [Citation(s) in RCA: 6] [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: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood infection, which is usually managed in the outpatient setting. Yet, the more severe cases are referred for inpatient treatment. We hypothesized that pneumococcal conjugate vaccines (PCVs), administered during the first year of life, would decrease AOM admissions rate in this age group. We studied the characteristics of infants admitted with AOM and acute mastoiditis (AM) in the PCV13 era, routinely given from November 2010 to all infants. METHODS Charts of infants ≤1 year that were hospitalized during 1/1/2010-31/12/2015 with AOM, with or without AM, were retrieved using hospitalization codes. We compared 2010-11 (transition years, from PCV7 to PCV13) to 2012-15 (post-PCV13 marketing years). RESULTS AOM was the primary/secondary discharge diagnosis in ∼4% of all admitted infants ≤1 year. Boys had more admissions than girls (62% vs 38%). Accuracy of AOM diagnoses substantially increased in the post-marketing years. The average hospitalization duration slightly shortened, from 3.21 (2010-11) to 2.99 days (2012-15) (p = 0.52). Despite considerably modest pre-admission antibiotic treatment rate (<30%), AM was infrequent (∼3.4% of AOM admissions). Amoxicillin was the most common antibiotic therapy given before admission and during hospitalization. The number of myringotomies, usually reserved for treatment failure cases, significantly declined, and there were almost no cases of resistant bacteria. Respiratory syncytial virus was detected in ∼20% of collected respiratory samples, and influenza A/B viruses in ∼8%. CONCLUSIONS AOM is still a major cause for hospitalization of infants in the PCV13 era. Yet, complications are infrequent, and AM rate is low.
Collapse
Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel.
| | - Ofer Israel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Ali Abo Baker
- Faculty of Medicine, Tel Aviv University Sackler School of Medicine, 69978 Tel Aviv, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| |
Collapse
|
19
|
Motallebzadeh H, Maftoon N, Pitaro J, Funnell WRJ, Daniel SJ. Finite-Element Modelling of the Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear. J Assoc Res Otolaryngol 2017; 18:25-48. [PMID: 27718037 PMCID: PMC5243259 DOI: 10.1007/s10162-016-0587-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/09/2016] [Indexed: 12/25/2022] Open
Abstract
Admittance measurement is a promising tool for evaluating the status of the middle ear in newborns. However, the newborn ear is anatomically very different from the adult one, and the acoustic input admittance is different than in adults. To aid in understanding the differences, a finite-element model of the newborn ear canal and middle ear was developed and its behaviour was studied for frequencies up to 2000 Hz. Material properties were taken from previous measurements and estimates. The simulation results were within the range of clinical admittance measurements made in newborns. Sensitivity analyses of the material properties show that in the canal model, the maximum admittance and the frequency at which that maximum admittance occurs are affected mainly by the stiffness parameter; in the middle-ear model, the damping is as important as the stiffness in influencing the maximum admittance magnitude but its effect on the corresponding frequency is negligible. Scaling up the geometries increases the admittance magnitude and shifts the resonances to lower frequencies. The results suggest that admittance measurements can provide more information about the condition of the middle ear when made at multiple frequencies around its resonance.
Collapse
Affiliation(s)
- Hamid Motallebzadeh
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montréal, QC, H3A 2B4, Canada
| | - Nima Maftoon
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montréal, QC, H3A 2B4, Canada
| | - Jacob Pitaro
- Division of Otolaryngology-Head and Neck Surgery, Montréal Children's Hospital, Montréal, Canada
| | - W Robert J Funnell
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montréal, QC, H3A 2B4, Canada.
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Canada.
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Canada
- Department of Pediatric Surgery, McGill University, Montréal, Canada
| |
Collapse
|
20
|
Hermann G, Jabarin B, Marom T, Barzilay B, Elizur A, Eviatar E, Pitaro J. Nasal Fibrolipomatous Hamartoma, an Idiosyncratic Connective Tissue Malformation in an Infant. Fetal Pediatr Pathol 2017; 36:76-81. [PMID: 27629571 DOI: 10.1080/15513815.2016.1223238] [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] [Indexed: 10/21/2022]
Abstract
We describe a congenital mass in the nasopharynx of an infant presenting with dyspnea and feeding difficulties. Magnetic resonance imaging demonstrated 2 separate polypoid nasal cavity masses that were endoscopically resected. Histologically, both lesions were composed of mature adipose tissue with broad fibrous bands and several foci of brown fat. PLAG-1 and HMGA-2 were negative by immunostains. The best diagnosis was a fibrolipomatous hamartoma.
Collapse
Affiliation(s)
| | - Basel Jabarin
- b Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center , Zerifin , Israel
| | - Tal Marom
- b Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center , Zerifin , Israel
| | - Bernard Barzilay
- c Neonatal Intensive Care Unit, Assaf Harofeh Medical Center , Zerifin , Israel
| | - Arnon Elizur
- d Pediatric Pulmonology Unit, Assaf Harofeh Medical Center , Zerifin , Israel
| | - Ephraim Eviatar
- b Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center , Zerifin , Israel
| | - Jacob Pitaro
- b Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center , Zerifin , Israel
| |
Collapse
|
21
|
Pitaro J, Al Masaoudi L, Motallebzadeh H, Funnell WRJ, Daniel SJ. Wideband reflectance measurements in newborns: Relationship to otoscopic findings. Int J Pediatr Otorhinolaryngol 2016; 86:156-60. [PMID: 27260599 DOI: 10.1016/j.ijporl.2016.04.036] [Citation(s) in RCA: 8] [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: 02/16/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Newborn hearing screening includes testing with otoacoustic emissions and the auditory brainstem response. Unfortunately, both tests are affected by the presence of material in the ear canal and middle ear such as vernix, meconium, and amniotic fluid. The objective of this study was to determine to what extent occlusion of the ear canal as seen on otoscopy affects wideband energy reflectance measurements in newborns. A secondary objective was to obtain additional normative wideband reflectance data in newborns. METHODS Newborns from a well-baby nursery were enrolled. Wideband energy reflectance measurements and otoscopy were done immediately after the hearing screening. Occlusion of the ear canal as seen on otoscopy was described on a scale of 0-100%. RESULTS A total of 156 babies were enrolled (mean age = 25 hours). A statistically significant difference in the reflectance at ambient pressure was found between the 0-70% and 80-100% occlusion groups. There was no significant difference in reflectance between the right and the left ears. The median reflectance pattern generally followed that of previous studies but in certain frequency regions the present reflectance values were higher. CONCLUSION A significant increase in reflectance occurs when 70%-80% of the ear-canal diameter is occluded. Taking otoscopy findings into account may improve the interpretation of reflectance measurements. However, further studies are required to better establish the relationship between canal occlusion and reflectance.
Collapse
Affiliation(s)
- Jacob Pitaro
- McGill Auditory Sciences Laboratory, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada
| | - Laila Al Masaoudi
- McGill Auditory Sciences Laboratory, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada
| | - Hamid Motallebzadeh
- McGill Auditory Sciences Laboratory, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of BioMedical Engineering, McGill University, 3775, rue University, Montréal, QC H3A 2B4, Canada
| | - W Robert J Funnell
- McGill Auditory Sciences Laboratory, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of BioMedical Engineering, McGill University, 3775, rue University, Montréal, QC H3A 2B4, Canada
| | - Sam J Daniel
- McGill Auditory Sciences Laboratory, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1, Canada; Department of Pediatric Surgery, McGill University, The Montréal Children's Hospital, 1001 Boul. Décarie, Montréal, QC H4A 3J1Canada.
| |
Collapse
|
22
|
Schwarz Y, Pitaro J, Waissbluth S, Daniel SJ. Review of pediatric head and neck pilomatrixoma. Int J Pediatr Otorhinolaryngol 2016; 85:148-53. [PMID: 27240514 DOI: 10.1016/j.ijporl.2016.03.026] [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: 01/14/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pilomatrixoma is a benign skin tumor, which is commonly found in the head and neck region. It usually presents as an isolated lesion and rarely undergoes malignant transformation. It is not uncommon for these tumors to be misdiagnosed. OBJECTIVE To review the clinical characteristics of head and neck pilomatrixomas in the pediatric population. METHODS A systematic review was completed by searching ten databases to identify studies reporting findings on pilomatrixoma in the pediatric population. Eligible articles were independently assessed for quality by two authors. RESULTS A total of 17 studies met the inclusion criteria totaling 318 pediatric patients. The age of diagnosis ranged from 3 months to 17 years of age. The female to male ratio was 1.65:1. In 14 articles, in which pilomatrixoma was located in the head and neck region, 76 (25%) lesions were found in the neck while 229 (75%) were present in the head region. Three articles exclusively described ophthalmologic pilomatrixoma. Even though pilomatrixoma presents with classical features, the clinical diagnostic accuracy when confronting this lesion averaged 43%. The definitive treatment was surgical excision with a very low recurrence rate. CONCLUSION Head and neck pilomatrixoma in the pediatric population has a typical presentation with a low clinical diagnostic accuracy. Awareness of this lesion and its clinical appearance can improve its diagnosis. We hereby suggest a management algorithm for suspected pilomatrixoma.
Collapse
Affiliation(s)
- Yehuda Schwarz
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofia Waissbluth
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
23
|
Pitaro J, Bechor-Fellner A, Gavriel H, Marom T, Eviatar E. Sudden sensorineural hearing loss in children: Etiology, management, and outcome. Int J Pediatr Otorhinolaryngol 2016; 82:34-7. [PMID: 26857312 DOI: 10.1016/j.ijporl.2015.12.022] [Citation(s) in RCA: 26] [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: 09/21/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric sudden sensorineural hearing loss (SSNHL) is uncommon, and the current guidelines for its management refer to adults. Our objective was to review cases of SSNHL in children and examine their etiologies, management, and outcome. METHODS We performed a retrospective chart review of all children under the age of 18 years treated for SSNHL between January 2003 and September 2014. Data recorded included age, gender, symptoms, onset of hearing loss, audiometric results, diagnostic studies, treatment, and outcome. RESULTS Nineteen children were included. Mean age was 14 years (range 7-18 years). Male: female ratio was 9:10. Degree of hearing loss varied from mild to profound across the tested frequencies. Most common accompanying symptom was tinnitus. Serologic tests demonstrated recent Epstein-Barr virus infection in one patient and previous cytomegalovirus infection in six patients. Imaging studies included computed tomography scan (n=3) and/or magnetic resonance imaging (n=12). All imaging studies did not demonstrate any pathology. Treatment included systemic steroids in 19 (100%) children and intratympanic steroids in eight (42%). Hearing completely improved in three (16%) children, partially improved in nine (47%), and there was no improvement in six (32%). One child was lost to follow-up. CONCLUSIONS Viral infection was a common finding in children with SSNHL and no pathological changes were demonstrated on imaging studies. In most patients (63%), hearing improvement was observed. Intratympanic steroid injection can benefit these children. Further studies are required to investigate the etiologies and establish guidelines for the management of SSNHL in children.
Collapse
Affiliation(s)
- Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Tel-Aviv, Israel.
| | - Avital Bechor-Fellner
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Tel-Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Tel-Aviv, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Tel-Aviv, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Tel-Aviv, Israel
| |
Collapse
|
24
|
Varshney R, Pitaro J, Alghonaim Y, Lacroix Y. Hemorrhagic Hairy Polyp Causing Velopharyngeal Dysfunction in a Newborn. Cleft Palate Craniofac J 2014; 52:625-8. [PMID: 25137603 DOI: 10.1597/13-265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Velopharyngeal dysfunction (VPD) can be secondary to anatomic, neurologic, or functional maldevelopment in the pediatric population. We present a case of transient VPD after the removal of a voluminous oropharyngeal hairy polyp in a newborn with an intact palate. This report sensitizes physicians, speech-language pathologists, and occupational therapists not only to the repercussions of oropharyngeal congenital masses, such as hairy polyps, on the feeding mechanisms of a newborn but also to the possibility of conservative management.
Collapse
|
25
|
Coppoolse JMS, Van Kooten TG, Heris HK, Mongeau L, Li NYK, Thibeault SL, Pitaro J, Akinpelu O, Daniel SJ. An in vivo study of composite microgels based on hyaluronic acid and gelatin for the reconstruction of surgically injured rat vocal folds. J Speech Lang Hear Res 2014; 57:S658-73. [PMID: 24687141 PMCID: PMC4917880 DOI: 10.1044/2014_jslhr-s-12-0292] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE The objective of this study was to investigate local injection with a hierarchically microstructured hyaluronic acid-gelatin (HA-Ge) hydrogel for the treatment of acute vocal fold injury using a rat model. METHOD Vocal fold stripping was performed unilaterally in 108 Sprague-Dawley rats. A volume of 25 μl saline (placebo controls), HA-bulk, or HA-Ge hydrogel was injected into the lamina propria (LP) 5 days after surgery. The vocal folds were harvested at 3, 14, and 28 days after injection and analyzed using hematoxylin and eosin staining and immunohistochemistry staining for macrophages, myofibroblasts, elastin, collagen type I, and collagen type III. RESULTS The macrophage count was statistically significantly lower in the HA-Ge group than in the saline group (p < .05) at Day 28. Results suggested that the HA-Ge injection did not induce inflammatory or rejection response. Myofibroblast counts and elastin were statistically insignificant across treatment groups at all time points. Increased elastin deposition was qualitatively observed in both HA groups from Day 3 to Day 28, and not in the saline group. Significantly more elastin was observed in the HA-bulk group than in the uninjured group at Day 28. Significantly more collagen type I was observed in the HA-bulk and HA-Ge groups than in the saline group (p < .05) at Day 28. The collagen type I concentration in the HA-Ge and saline groups was found to be comparable to that in the uninjured controls at Day 28. The concentration of collagen type III in all treatment groups was similar to that in uninjured controls at Day 28. CONCLUSION Local HA-Ge and HA-bulk injections for acute injured vocal folds were biocompatible and did not induce adverse response.
Collapse
|
26
|
Masaoudi LA, Pitaro J, Daniel SJ. Does the Mode of Delivery Affect Wideband Reflectance Measurements in Newborns? Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Determine whether wideband reflectance (WBR) measurements in babies who were born by vaginal delivery are different from those of babies born by C-section. Our working hypothesis is that babies delivered by Caesarian section have higher reflectance scores on WBR, as they have more fluid and debris in the outer and middle ear. This can have an impact on universal hearing screening passing rates. Methods: Following standard newborn hearing screening, WBR was measured in 225 healthy babies. Sixty-six babies were delivered by Caesarean section compared to 159 babies delivered vaginally. A total of 123 ears were included in the C-section group and were compared to a total of 288 ears in the second group. The results were obtained for 60 frequencies. Results: The mean screening age for babies in the C-section delivery group was 27.5 hours compared to 24.3 hours for babies in the vaginal delivery group. For both groups reflectance was high between 0.24 to 0.79 kHz and 2.50 to 4.80 kHz, with the highest at 4.5 kHz. Low reflectance was observed between 0.84 kHz and 2.50 kHz, with a second decrease in reflectance between 4.8 kHz and 8 kHz for both groups. In general, reflectance of the C-section group was slightly lower than the reflectance for babies in the vaginal delivery group. Conclusions: Further studies are needed to conclude whether the type of delivery may have an effect on hearing screening results and possibly on the optimal timing for screening babies delivered via C-section.
Collapse
|
27
|
Pitaro J, Mood ZA, Daniel SJ. Ototoxicity of aluminum acetate/benzethonium chloride otic solution in the chinchilla animal model. Laryngoscope 2013; 123:2521-5. [PMID: 23918745 DOI: 10.1002/lary.23904] [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] [Accepted: 10/31/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the ototoxic potential of aluminum acetate (0.5%)/benzethonium chloride (0.03%) otic solution in the chinchilla animal model. STUDY DESIGN A randomized, prospective, controlled study was conducted in the chinchilla animal model. METHODS Fourteen female chinchillas were used. After an incision was made in each tympanic membrane, baseline auditory brainstem response measurements were performed at 16, 20, and 25 kHz. One ear was randomized to receive aluminum acetate (0.5%)/benzethonium chloride (0.03%), whereas the other ear served as the control and received 0.9% NaCl. Solutions were applied transtympanically once a day for 3 consecutive days. Postapplication auditory brainstem response measurements were done at day 7 and day 30. In half of the animals, scanning electron microscopy was done following the last auditory brainstem response measurement. RESULTS A statistically significant difference was found between the mean threshold shifts in the experimental and control ears at all frequencies on both 7 and 30 days postapplication (P < .02). Increased ossification of the cochleae was seen in experimental ears (n = 12). Scanning electron microscopy study demonstrated outer hair cell damage and/or loss in the experimental ears. No significant morphological changes were detected on scanning electron microscopy obtained from the control ears. CONCLUSIONS Application of aluminum acetate (0.5%)/benzethonium chloride (0.03%) otic solution causes hearing loss in chinchillas when a tympanic membrane perforation exists. Further studies are needed to test the effect of this otic solution on hearing. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Jacob Pitaro
- McGill Auditory Sciences Laboratory, Division of Pediatric Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | | |
Collapse
|
28
|
Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell's palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol 2012; 76:921-6. [PMID: 22503409 DOI: 10.1016/j.ijporl.2012.02.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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] [Received: 10/21/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To conduct an updated systematic review on the outcome of Bell's palsy (BP) in children following steroid treatment. DATA SOURCES MEDLINE, EMBASE, Cochrane Library and BIOSIS Previews electronic databases were searched obtaining articles published between 2000 and 2010 without any language restriction. REVIEW METHODS Articles describing children aged 0-18 years with BP treated solely with corticosteroids were included. In studies including various etiologies for facial palsy; cases of BP treated with steroids were selected and when available, untreated patients as well for comparison. The outcome measure was facial movements following steroidal treatment based on different clinical scales. Controlled clinical trials, prospective and historical cohort studies, cross sectional studies and case series were included. RESULTS A total of 2293 papers were initially identified. Following review by two authors, 68 papers were analyzed in a hard-copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies included children with BP exclusively while the remaining studies described various etiologies of facial palsy. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House-Brackmann scale, Yanagihara grading system and clinical evaluation. Studies analyzed were retrospective cohorts or case-series and were categorized as level 4 of evidence. CONCLUSION There were no controlled trials and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.
Collapse
Affiliation(s)
- Jacob Pitaro
- Division of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | |
Collapse
|