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Andrew LM, Sandler CB, Long CA, Bauman NM, Mudd PA. Exploring Mental Health in a Pediatric Paradoxical Vocal Fold Motion Sample Using Patient-Reported Outcomes. Otolaryngol Head Neck Surg 2024; 170:1167-1172. [PMID: 38193359 DOI: 10.1002/ohn.641] [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: 08/31/2022] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Paradoxical vocal fold motion (PVFM) is characterized by inappropriate adduction of vocal folds during inspiration causing dyspnea. While anxiety is suspected to be a predisposing factor, incidence has been understudied. STUDY DESIGNS Retrospective review. SETTING Multidisciplinary PVFM hospital clinic. METHODS We used patient-reported outcome measures to examine anxiety and depression in consecutive patients aged 10 to 17 years using Pediatric SFv1.1 Anxiety 8b and Level 2-Depression inventories (parents completed proxy forms). T-scores were classified as normal (none to slight <55) or elevated (mild 55-59.9, moderate 60-69.9, severe >70). RESULTS Twenty-three pediatric patients and 20 parents completed surveys. Mean age was 13.74 years. For anxiety, 69.6% of patients and 40% of parents identified elevated levels. For depression, 30.4% of patients and 15% of parents identified elevated levels. Therapy need for the sample was 65.2% (34.8% active in services and 30.4% referred). Child anxiety scores were significantly higher in the therapy need group, U = 17, P = .004. CONCLUSION This study of adolescents with PVFM confirmed elevated anxiety and depression scores in 2/3 of the participants. Anxiety likely precedes diagnosis and is a predisposing factor. Referral for individualized intervention targeting anxiety and depression is indicated.
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Affiliation(s)
- Lilia Mucka Andrew
- Psychology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Claire B Sandler
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Courtney A Long
- Hearing and Speech, Children's National Hospital, Washington, DC, USA
| | - Nancy M Bauman
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Pamela A Mudd
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
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Schonman I, Mudd PA, Ivancic R, Ryan MA, Ongkasuwan J, Prager J, Smith ME, Goudy SL, Rana MS, Wiet GJ, Bauman NM. Multi-Institutional Study of Patient-Reported Outcomes of Paradoxical Vocal Fold Motion. Laryngoscope 2023; 133:970-976. [PMID: 35730686 DOI: 10.1002/lary.30256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multi-institutional study of geographically diverse United States medical facilities to assess long-term management and outcomes. METHODS Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives. RESULTS 65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis. CONCLUSIONS Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care. LEVEL OF EVIDENCE 4 Laryngoscope, 133:970-976, 2023.
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Affiliation(s)
- Ian Schonman
- GW School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Pamela A Mudd
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Ryan Ivancic
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marisa A Ryan
- Department of Otolaryngology, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Jeremy Prager
- Department of Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Marshall E Smith
- Department of Otolaryngology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Steven L Goudy
- Department of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Md Sohel Rana
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
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Leonard JA, Blumenthal DL, Bauman NM, Rana MS, Peña MT, Espinel AG. Surgically treated pediatric tongue masses: A 20 Year review. Int J Pediatr Otorhinolaryngol 2023; 166:111486. [PMID: 36805845 DOI: 10.1016/j.ijporl.2023.111486] [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: 11/15/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Pediatric tongue lesions represent a rare, diverse group of pathologies related to congenital malformations, inflammatory changes, and neoplastic masses. We present the largest-to-date series of pediatric tongue lesions managed surgically. SETTING Charts of all pediatric patients with a tongue lesion surgically treated at a regional children's hospital from February 1st, 1997 to August 30th, 2019 were reviewed. METHODS After obtaining institutional review board approval, a retrospective review was completed of all pediatric patients with a tongue lesion surgically treated at a regional children's hospital from February 1st, 1997 through August 30th, 2019. Charts were evaluated for patient demographics as well as symptoms at presentation, surgical details, pathologic evaluation of the lesion, and rates of recurrence. Categorical variables were compared between various groups using Chi-square and/or Fisher's exact tests. Univariate and multivariable logistic regression analysis was performed unadjusted and adjusted to further explore these relationships. RESULTS 159 patients were included in the study with ages distributed relatively even across infants (27.7%), children 1-5 years (27.7%), 6-10 years (23.3%), and greater than 10 years of age (21.4%). Patient/family reported race/ethnic background was most commonly Caucasian (34.8%) or Hispanic/Latino/Spanish Origin (34.0%) followed by Black or African American (21.3%). The most commonly reported symptoms were pain (23.3%), difficulty with oral intake (12.6%), bleeding (11.3%), and respiratory distress (11%). Patients with lesions of the base of tongue were significantly more likely to present with respiratory distress or difficulty with oral intake (p < 0.001). The likelihood of recurrence was observed to be higher with lesions managed in infancy (OR 3.85, CI 1.47-10.0, p = 0.005), those greater than 2 cm (OR 3.45, CI 1.34-8.71, p = 0.009), or with laser (OR 4.52, CI 1.25-15.00), p = 0.015). CONCLUSION Pediatric patients with tongue lesions may present with a wide array of symptoms. Base of tongue lesions should be managed carefully as they are most likely to create barriers to the airway and oral intake. Larger lesions and those managed in infancy are at increased risk for recurrence.
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Affiliation(s)
- James A Leonard
- MedStar Georgetown University Hospital, Department of Otolaryngology-Head & Neck Surgery, Washington, DC, USA.
| | - Daniel L Blumenthal
- MedStar Georgetown University Hospital, Department of Otolaryngology-Head & Neck Surgery, Washington, DC, USA
| | - Nancy M Bauman
- Children's National Health System, George Washington University, Department of Otolaryngology, Washington, DC, USA
| | - M Sohel Rana
- Children's National Health System, George Washington University, Department of Otolaryngology, Washington, DC, USA
| | - Maria T Peña
- Children's National Health System, George Washington University, Department of Otolaryngology, Washington, DC, USA
| | - Alexandra G Espinel
- Children's National Health System, George Washington University, Department of Otolaryngology, Washington, DC, USA
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Martin CN, Barnawi Z, Chorvinsky E, Pillai D, Gatti M, Collins ME, Krakovsky GM, Bauman NM, Sehgal S, Pillai DK. Positive bronchoalveolar lavage pepsin assay associated with viral and fungal respiratory infections in children with chronic cough. Pediatr Pulmonol 2021; 56:2686-2694. [PMID: 33930245 PMCID: PMC8327477 DOI: 10.1002/ppul.25450] [Citation(s) in RCA: 3] [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: 12/26/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough. STUDY DESIGN We performed a retrospective chart review of 72 children with a BAL pepsin obtained through our Aerodigestive Center over an 18-month period. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid-laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophils, neutrophils, and lymphocytes; spirometry; FeNO; and IgE. RESULTS Seventy-two patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication. There was an association between positive BAL pepsin assay and positive viral panel (p = .002) or fungal culture (p = .027). No significant association found between positive BAL bacterial culture; BAL cytology; the presence of BAL lipid-laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology. CONCLUSIONS BAL pepsin is associated with a positive BAL viral PCR or fungal culture. Lack of correlation between pepsin-positivity and pH-impedance parameters or EGD pathology suggests microaspiration may be due to an acute event (such as a respiratory infection) rather than chronic gastroesophageal reflux disease. This may be especially true in the presence of a positive viral panel or fungal culture when a BAL pepsin is obtained.
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Affiliation(s)
- Corey N Martin
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Zhour Barnawi
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Dhruv Pillai
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Meagan Gatti
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Maura E Collins
- Department of Hearing and Speech, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gina M Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sona Sehgal
- Division of Pediatric Gastroenterology, Children's National Hospital, Washington, DC, USA
| | - Dinesh K Pillai
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA.,Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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5
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Schonman IA, Sehgal S, Javia LR, Bauman NM. Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD. Ann Otol Rhinol Laryngol 2021; 130:1202-1206. [PMID: 33657845 DOI: 10.1177/0003489421998214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We report obstructing laryngeal manifestations of Crohn's disease in a toddler with very early onset-IBD (VEO-IBD) who required tracheotomy tube placement at 27 months of age for relief of recalcitrant airway obstruction unresponsive to maximal medical therapy. We review the literature for the frequency of extra-intestinal laryngeal manifestations of Crohn's disease in adults and children. METHODS Case report and literature review of laryngeal manifestations of Crohn's disease. RESULTS Laryngeal involvement of Crohn's disease is very rare with only 14 other cases reported. Most cases appear in adults, with the supraglottis most commonly affected. This case marks the youngest report and only the second report of a patient requiring a tracheotomy for supraglottic obstruction when intensive medical management, including use of steroids and biologics, failed to relieve obstructing laryngeal inflammation. Despite ongoing Crohn's disease, laryngeal manifestations improved permitting decannulation the following year. CONCLUSIONS Laryngeal manifestations of Crohn's disease are rare and usually affect adults. Most cases are managed with medical therapy, however surgical excision of obstructing lesions or tracheotomy placement is sometimes required for temporary relief of airway obstruction.
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Affiliation(s)
- Ian A Schonman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sona Sehgal
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Departments of Gastroenterology, Hepatology and Nutrition (SS) and Otolaryngology Head and Neck Surgery (NMB), Children's National Hospital, Washington, DC, USA
| | - Luv R Javia
- Children's Hospital of Philadelphia, Department of Pediatric Otolaryngology and University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy M Bauman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Departments of Gastroenterology, Hepatology and Nutrition (SS) and Otolaryngology Head and Neck Surgery (NMB), Children's National Hospital, Washington, DC, USA
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6
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Faucett EA, Wolter NE, Balakrishnan K, Ishman SL, Mehta D, Parikh S, Nguyen LHP, Preciado D, Rutter MJ, Prager JD, Green GE, Pransky SM, Elluru R, Husein M, Roy S, Johnson KE, Friedberg J, Johnson RF, Bauman NM, Myer CM, Deutsch ES, Gantwerker EA, Willging JP, Hart CK, Chun RH, Lam DJ, Ida JB, Manoukian JJ, White DR, Sidell DR, Wootten CT, Inglis AF, Derkay CS, Zalzal G, Molter DW, Ludemann JP, Choi S, Schraff S, Myer CM, Cotton RT, Vijayasekaran S, Zdanski CJ, El-Hakim H, Shah UK, Soma MA, Smith ME, Thompson DM, Javia LR, Zur KB, Sobol SE, Hartnick CJ, Rahbar R, Vaccani JP, Hartley B, Daniel SJ, Jacobs IN, Richter GT, de Alarcon A, Bromwich MA, Propst EJ. Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus. Laryngoscope 2020; 131:1168-1174. [PMID: 33034397 DOI: 10.1002/lary.29126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/16/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN Blinded modified Delphi consensus process. SETTING Tertiary care center. METHODS A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE 5. Laryngoscope, 131:1168-1174, 2021.
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Affiliation(s)
- Erynne A Faucett
- Division of Otolaryngology, Head and Neck Surgery, Phoenix Children's Hospital, Department of Child Health, University of Arizona, Tucson, Arizona, U.S.A.,College of Medicine, Department of Otolaryngology, Mayo College of Medicine and Science, Phoenix, Arizona, U.S.A
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sanjay Parikh
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Michael J Rutter
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Glenn E Green
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Ravi Elluru
- Division of Otolaryngology, Dayton Children's Hospital, Dayton, Ohio, U.S.A
| | - Murad Husein
- Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Kaalan E Johnson
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jacob Friedberg
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - J Paul Willging
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Derek J Lam
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Christopher T Wootten
- Division of Otolaryngology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A
| | - Andrew F Inglis
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology - Head and Neck Surgery Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - David W Molter
- Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robin T Cotton
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Hamdy El-Hakim
- Division of Pediatric Surgery and Otolaryngology - Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - Marlene A Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Marshall E Smith
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Dana M Thompson
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Luv Ram Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, Boston, Massachusetts, U.S.A
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hartley
- Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
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7
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Straughan AJ, Mulcahy CF, Sandler AD, Bauman NM, Steinhorn D, Gitman L. Tracheal Agenesis: Vertical Division of the Native Esophagus - A Novel Surgical Approach and Review of the Literature. Ann Otol Rhinol Laryngol 2020; 130:547-562. [PMID: 33030043 DOI: 10.1177/0003489420962124] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. METHODS Case report and literature review. RESULTS A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. CONCLUSION We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.
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Affiliation(s)
- Alexander J Straughan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | - Lyuba Gitman
- Children's National Health System, Washington, DC, USA
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8
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Yibrehu B, Georgakopoulos B, Mudd PA, Rana MS, Bauman NM. Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood. Ann Otol Rhinol Laryngol 2020; 129:1195-1209. [PMID: 32527140 DOI: 10.1177/0003489420931894] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life. METHODS All children >8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives. RESULTS 21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in >50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001). CONCLUSIONS This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition.
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Affiliation(s)
- Betel Yibrehu
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bianca Georgakopoulos
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Pamela A Mudd
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
| | | | - Nancy M Bauman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
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9
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Yibrehu BA, Krakovsky GM, Rana MS, Pillai DK, Sehgal S, Collins ME, Gatti ML, Bauman NM. Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough. Ann Otol Rhinol Laryngol 2020; 129:1088-1094. [PMID: 32486883 DOI: 10.1177/0003489420931558] [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: 11/17/2022]
Abstract
OBJECTIVES Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27). METHODS The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months. RESULTS Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT's 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9).Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores (P = .009) regardless of age, gender, ethnicity, history of endoscopy and season. CONCLUSIONS The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.
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Affiliation(s)
- Betel A Yibrehu
- George Washington University School of Medicine, Washington, DC, USA
| | | | - Md Sohel Rana
- Children's National Health System, Washington, DC, USA
| | - Dinesh K Pillai
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | - Sona Sehgal
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | | | | | - Nancy M Bauman
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
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10
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Preciado D, Nolan RM, Joshi R, Krakovsky GM, Zhang A, Pudik NA, Kumar NK, Shelton RL, Boppart SA, Bauman NM. Otitis Media Middle Ear Effusion Identification and Characterization Using an Optical Coherence Tomography Otoscope. Otolaryngol Head Neck Surg 2020; 162:367-374. [PMID: 31959053 DOI: 10.1177/0194599819900762] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the feasibility of detecting and differentiating middle ear effusions (MEEs) using an optical coherence tomography (OCT) otoscope. STUDY DESIGN Cross-sectional study. SETTING US tertiary care children's hospital. SUBJECTS AND METHODS Seventy pediatric patients undergoing tympanostomy tube placement were preoperatively imaged using an OCT otoscope. A blinded reader quiz was conducted using 24 readers from 4 groups of tiered medical expertise. The primary outcome assessed was reader ability to detect presence/absence of MEE. A secondary outcome assessed was reader ability to differentiate serous vs nonserous MEE. RESULTS OCT image data sets were analyzed from 45 of 70 total subjects. Blinded reader analysis of an OCT data subset for detection of MEE resulted in 90.6% accuracy, 90.9% sensitivity, 90.2% specificity, and intra/interreader agreement of 92.9% and 87.1%, respectively. Differentiating MEE type, reader identification of nonserous MEE had 70.8% accuracy, 53.6% sensitivity, 80.1% specificity, and intra/interreader agreement of 82.9% and 75.1%, respectively. Multivariate analysis revealed that age was the strongest predictor of OCT quality. The mean age of subjects with quality OCT was 5.01 years (n = 45), compared to 2.54 years (n = 25) in the remaining subjects imaged (P = .0028). The ability to capture quality images improved over time, from 50% to 69.4% over the study period. CONCLUSION OCT otoscopy shows promise for facilitating accurate MEE detection. The imageability with the prototype device was affected by age, with older children being easier to image, similar to current ear diagnostic technologies.
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Affiliation(s)
- Diego Preciado
- Division of Pediatric Otolaryngology, Children's National Health System (CNHS), Washington, DC, USA.,Sheikh Zayed Institute, CNHS, Washington, DC, USA
| | | | - Radhika Joshi
- Division of Pediatric Otolaryngology, Children's National Health System (CNHS), Washington, DC, USA.,Sheikh Zayed Institute, CNHS, Washington, DC, USA
| | - Gina M Krakovsky
- Division of Pediatric Otolaryngology, Children's National Health System (CNHS), Washington, DC, USA
| | | | | | | | | | | | - Nancy M Bauman
- Division of Pediatric Otolaryngology, Children's National Health System (CNHS), Washington, DC, USA
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11
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Propst EJ, Wolter NE, Ishman SL, Balakrishnan K, Deonarain AR, Mehta D, Zalzal G, Pransky SM, Roy S, Myer CM, Torre M, Johnson RF, Ludemann JP, Derkay CS, Chun RH, Hong P, Molter DW, Prager JD, Nguyen LHP, Rutter MJ, Myer CM, Zur KB, Sidell DR, Johnson LB, Cotton RT, Hart CK, Willging JP, Zdanski CJ, Manoukian JJ, Lam DJ, Bauman NM, Gantwerker EA, Husein M, Inglis AF, Green GE, Javia LR, Schraff S, Soma MA, Deutsch ES, Sobol SE, Ida JB, Choi S, Uwiera TC, Shah UK, White DR, Wootten CT, El-Hakim H, Bromwich MA, Richter GT, Vijayasekaran S, Smith ME, Vaccani JP, Hartnick CJ, Faucett EA. Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus. Laryngoscope 2019; 130:2700-2707. [PMID: 31821571 DOI: 10.1002/lary.28461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric tracheotomy. STUDY DESIGN Blinded, modified, Delphi consensus process. METHODS Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items. RESULTS The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus. CONCLUSIONS It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure. LEVEL OF EVIDENCE 5 Laryngoscope, 130:2700-2707, 2020.
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Affiliation(s)
- Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology and Mayo Children's Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A
| | - Ashley R Deonarain
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michele Torre
- Airway Unit, Scientific Institute for Research and Healthcare, Giannina Gaslini Institute, Genoa, Italy
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Paul Hong
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - David W Molter
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karen B Zur
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Liane B Johnson
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Robin T Cotton
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - J Paul Willging
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - John J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew F Inglis
- Division of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Luv Ram Javia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Marlene A Soma
- Department of Pediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Trina C Uwiera
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Hamdy El-Hakim
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Nedlands, Western Australia, Australia
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Erynne A Faucett
- Department of Pediatric Otolaryngology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
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Abstract
INTRODUCTION Horner syndrome is described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital or acquired from neoplastic, infectious or traumatic conditions, including birth trauma. Most cases of pediatric Horner syndrome present first to a pediatric ophthalmologist however since the neural pathways involve the cervical sympathetic chain otolaryngologists should understand the pathophysiology to avoid delay in management of potentially malignant cases. OBJECTIVES To aid otolaryngologists in recognizing and managing pediatric Horner syndrome by describing 3 unique cases from malignant, traumatic and/or congenital causes. METHODS Case report of 3 pediatric patients with Horner syndrome presenting to our pediatric otolaryngology department. RESULTS Case #1 is 5-month-old female with ptosis and a left level II 1.5 cm neck mass. Magnetic resonance imaging showed the mass displacing the common carotid artery and excisional biopsy revealed a poorly differentiated neuroblastoma. Case #2 is a 9-year-old female with anisocoria appearing after suffering a severe playground injury. Case #3 is a 3-year-old-male who developed ptosis and anisocoria following re-excision of a recurrent cervical lymphatic malformation. CONCLUSION Pediatric Horner syndrome may be a benign finding that is easily overlooked but may reflect a serious underlying condition. Otolaryngologists should be aware of the pathophysiology and differential diagnosis, including malignant causes, to appropriately manage patients.
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Affiliation(s)
- Kyra N Folkert
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Heather de Beaufort
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Ophthalmology, Children's National Health System, Washington, DC, USA
| | - Nancy M Bauman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Otolaryngology, Children's National Health System, Washington, DC, USA
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13
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Straughan AJ, Mudd PA, Silva AL, Callicott SS, Krakovsky G, Bauman NM. Cost Analysis of a Multidisciplinary Vascular Anomaly Clinic. Ann Otol Rhinol Laryngol 2019; 128:401-405. [DOI: 10.1177/0003489419826135] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution’s VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. Method: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. Results: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. Conclusion: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.
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Affiliation(s)
| | - Pamela A. Mudd
- Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | | | | | | | - Nancy M. Bauman
- Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
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14
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Naime S, Batra SK, Fiorillo C, Collins ME, Gatti M, Krakovsky GM, Sehgal S, Bauman NM, Pillai DK. Aerodigestive Approach to Chronic Cough in Children. ACTA ACUST UNITED AC 2018; 4:467-479. [PMID: 30859056 DOI: 10.1007/s40746-018-0145-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of review Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.
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Affiliation(s)
- Samira Naime
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Suruchi K Batra
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Caitlin Fiorillo
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Maura E Collins
- Department of Hearing and Speech, Children's National Health System, Washington, DC, USA.
| | - Meagan Gatti
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Gina M Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Dinesh K Pillai
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
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15
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Balakrishnan K, Sidell DR, Bauman NM, Bellia-Munzon GF, Boesch RP, Bromwich M, Cofer SA, Daines C, de Alarcon A, Garabedian N, Hart CK, Ida JB, Leboulanger N, Manning PB, Mehta DK, Monnier P, Myer CM, Prager JD, Preciado D, Propst EJ, Rahbar R, Russell J, Rutter MJ, Thierry B, Thompson DM, Torre M, Varela P, Vijayasekaran S, White DR, Wineland AM, Wood RE, Wootten CT, Zur K, Cotton RT. Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement. Laryngoscope 2018; 129:244-255. [DOI: 10.1002/lary.27445] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karthik Balakrishnan
- Department of Otorhinolaryngology and Mayo Clinic Children's Center; Rochester Minnesota
| | - Douglas R. Sidell
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Palo Alto California
| | - Nancy M. Bauman
- Division of Otolaryngology, Children's National Health System; Washington DC
| | - Gaston F. Bellia-Munzon
- Department of Pediatric Surgery; General Hospital of Children Pedro de Elizalde; Buenos Aires Argentina
| | - R. Paul Boesch
- Department of Pediatric and Adolescent Medicine and Mayo Clinic Children's Center; Mayo Clinic; Rochester Minnesota
| | | | - Shelagh A. Cofer
- Department of Otorhinolaryngology and Mayo Clinic Children's Center; Rochester Minnesota
| | - Cori Daines
- Department of Pediatrics; University of Arizona Health Sciences; Tucson Arizona
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Nöel Garabedian
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Jonathan B. Ida
- Department of Otolaryngology, Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Nicolas Leboulanger
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Peter B. Manning
- Section of Pediatric Cardiothoracic Surgery; St. Louis Children's Hospital and Washington University School of Medicine; St. Louis Missouri
| | - Deepak K. Mehta
- Department of Pediatric Otolaryngology; Texas Children's Hospital; Houston Texas
| | - Philippe Monnier
- Department of Otolaryngology, Head and Neck Surgery; University Hospital of Lausanne (CHUV); Lausanne Switzerland
| | - Charles M. Myer
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Jeremy D. Prager
- Department of Otolaryngology; University of Colorado; Aurora Colorado
| | - Diego Preciado
- Division of Otolaryngology, Children's National Health System; Washington DC
| | - Evan J. Propst
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Reza Rahbar
- Department of Otolaryngology; Boston Children's Hospital, Harvard Medical School; Boston Massachusetts
| | - John Russell
- Department of Paediatric Otolaryngology; Our Lady's Hospital for Sick Children; Dublin Ireland
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Briac Thierry
- Department of Otorhinolaryngology; Hôpital Universitaire Necker-Enfants Malades; Paris France
| | - Dana M. Thompson
- Department of Otolaryngology, Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Michele Torre
- Airway Team and Surgical Department; Instituto Giannina Gaslini; Genoa Italy
| | - Patricio Varela
- Pediatric Surgery Department; University of Chile, Clinical Las Condes Medical Center; Santiago Chile
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head and Neck Surgery; Princess Margaret Hospital for Children; Perth Australia
| | - David R. White
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
| | - Andre M. Wineland
- University of Arkansas School for Medical Sciences; Department of Otolaryngology-Head & Neck Surgery, Arkansas Children's Hospital; Little Rock Arkansas
| | - Robert E. Wood
- Division of Pulmonary Medicine, Cincinnati Children's Hospital; Cincinnati Ohio
| | | | - Karen Zur
- Center for Pediatric Airway Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Robin T. Cotton
- Division of Pediatric Otolaryngology and Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Cincinnati Ohio
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Brown CL, Graham SM, Griffin MC, Smith RJH, Carter KD, Nerad JA, Bauman NM. Pediatric Medial Subperiosteal Orbital Abscess: Medical Management Where Possible. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800511] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Controversy exists about the optimal management of subperiosteal orbital abscesses (SPOAs) in pediatric patients. Some otolaryngologists advocate immediate surgical drainage while others recommend medical management initially and reserve surgery for nonresponders. We hypothesized that patients who can be managed without surgery have identifiable features on presentation that may aid in predicting their response to medical therapy. Methods A retrospective chart review was performed on all patients ≤18 years of age who were admitted to the University of Iowa between 1984 and 2001 with findings consistent with an SPOA on computed tomography imaging. Patients were divided into two groups: group I received medical treatment only while group II underwent surgical drainage of the abscess. Presenting features were compared between the two groups. Results Forty-two patients were identified with 17 group I patients and 25 group II patients. All patients had resolution of their SPOA and favorable outcomes. The following variables attained significance: group I patients were younger than group II patients (5.1 years versus 11 years; p < 0.0001), had less restriction of ocular motility (—1.0 versus —2.3), and were hospitalized for fewer days (6.5 days versus 9.6 days; p = 0.011). The following clinical variables did not vary significantly between the groups: gender, side of abscess, temperature, total white blood cell count, neutrophil count, chemosis, visual acuity, and proptosis. Culture results predominantly showed growth of anaerobic organisms (7/23). With increasing age, there was an increase in the number of organisms cultured (p = 0.005). Conclusion A subset of patients with SPOAs can be managed medically. These patients tend to be younger and present with minimal restriction of ocular motility. (American Journal of Rhinology 18, 321–327, 2004)
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Affiliation(s)
| | - Scott M. Graham
- Department of Otolaryngology—Head and Neck Surgery Iowa City, Iowa
| | - Mark C. Griffin
- Department of Otolaryngology—Head and Neck Surgery Iowa City, Iowa
| | | | - Keith D. Carter
- Department of Otolaryngology—Head and Neck Surgery Iowa City, Iowa
- Oculoplastics and Orbital Service, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Jeffrey A. Nerad
- Department of Otolaryngology—Head and Neck Surgery Iowa City, Iowa
- Oculoplastics and Orbital Service, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Nancy M. Bauman
- Department of Otolaryngology—Head and Neck Surgery Iowa City, Iowa
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Gu A, Bauman NM. Bipolar Radiofrequency Ablation (Coblation) of External Auditory Canal Lymphatic Malformation and Other Soft Stenoses. Ann Otol Rhinol Laryngol 2017; 126:835-838. [PMID: 29078703 DOI: 10.1177/0003489417739011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Soft tissue occlusion of the external auditory canal (EAC) can cause intense pruritis, recurrent foul smelling otorrhea, recurrent otitis externa, and conductive hearing loss. Occlusion of the EAC can be challenging to treat as the area is prone to circumferential scarring. METHODS We describe the novel use of serial bipolar radiofrequency ablation (coblation) to treat 3 children with complete EAC occlusion from congenital and acquired conditions including lymphedema (1), microcystic lymphatic malformation (1), and venolymphatic malformation (1). RESULTS Patients underwent a mean of 3 procedures with postoperative EAC stenting (7 days) and antibiotic and steroid aural preparations (10 days). Otologic symptoms resolved in all patients, and their EACs remained patent 14 months after last procedure (range, 4-32 months). One patient experienced a pinpoint tympanic membrane perforation that healed spontaneously 2 weeks later. CONCLUSIONS Coblation of soft tissue stenosis of the EAC can be an effective treatment for this problematic condition.
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Affiliation(s)
- Alex Gu
- 1 The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nancy M Bauman
- 1 The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,2 Division of Otolaryngology, Children's National Health System, Washington, DC, USA
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Rotsides JM, Krakovsky GM, Pillai DK, Sehgal S, Collins ME, Noelke CE, Bauman NM. Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist? Ann Otol Rhinol Laryngol 2017; 126:537-543. [DOI: 10.1177/0003489417708579] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To determine the utility of a pediatric multidisciplinary aerodigestive clinic (ADC) in treating recalcitrant aerodigestive conditions. Methods: Longitudinal observational study of presenting complaints, evaluation, management, and outcome of patients seen during 12 monthly ADCs beginning August 2013. Results: Fifty-five patients were seen by the ADC team (otolaryngology/gastroenterology/pulmonology/speech pathology/nurse practitioner) and followed for a mean 17.6 months (range, 12-26 months). Mean age was 4.3 years (range, 0.5-19 years). All were seen by at least 1 specialist before ADC referral but without significant improvement. Chronic cough was the most common primary symptom (44%). Clinic evaluation included flexible nasopharyngolaryngoscopy (FFL, 53%) and pulmonary function testing (36%.) FFL influenced management in 79%. An operative procedure usually combined endoscopy was warranted in 58%. Endoscopy provided high diagnostic yield, detecting laryngeal cleft (8), adenoid hypertrophy (8), vocal cord dysfunction (4), pulmonary infection (4), reflux disease (3), laryngomalacia (3), tracheomalacia (2), cilia abnormality (2), celiac disease (1), Helicobacter pylori (1), duodenal web (1), and eosinophilic esophagitis (1). Outcome was available for 48 of 55 patients, with 73% reporting resolved to markedly improved symptoms and 27% minimal to no improvement. Conclusions: The ADC team approach resulted in resolved to markedly improved symptoms in 73% of patients whose symptoms persisted despite seeing a single specialist prior to referral.
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Affiliation(s)
- Janine M. Rotsides
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gina M. Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
| | - Dinesh K. Pillai
- Department of Pulmonary and Sleep Medicine, Children’s National Health Services, Washington, DC, USA
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children’s National Health System, Washington, DC, USA
| | - Maura E. Collins
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Carolyn E. Noelke
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Nancy M. Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
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Mudd PA, Silva AL, Callicott SS, Bauman NM. Cost Analysis of a Multidisciplinary Aerodigestive Clinic: Are Such Clinics Financially Feasible? Ann Otol Rhinol Laryngol 2017; 126:401-406. [DOI: 10.1177/0003489417699420] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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]
Abstract
Objective: Multidisciplinary clinics offer important value to pediatric patients with complex conditions that overlap specialties; however, such labor-intensive clinics are difficult to facilitate. We performed a cost analysis of our pediatric multidisciplinary aerodigestive clinic (MADC) to assess its financial feasibility at our tertiary care institution. Method: Revenue was based on net collections for clinic, professional, and hospital setting charges generated during 12 consecutive monthly MADCs beginning August 2013. Clinic charges included facility and speech pathologist fees. Professional charges included clinic and operative fees generated by providers and anesthesiologist. Hospital setting fees included facility and material charges for technical procedures. Direct expense calculations included all providers and staff salaries, benefits, and supply costs. Results: Charge capture for 54 consecutive patients seen during the study time included new visits 99203-99205 (n = 63), consults 99243-99245 (n = 60), and follow-up visits 99212-99215 (n = 196). Sixty percent of patients underwent a clinic nasopharyngeal or laryngeal endoscopy (92511 or 31575), and 60% underwent subsequent intraoperative procedures with 1 (n = 8) or 2 to 3 services (n = 24). Program net revenue totaled $828 136 and direct costs $518 867, accounting for a net positive margin of $309 269. Conclusions: When including direct downstream revenue, our MADC operates on a net positive margin, making it financially feasible.
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Affiliation(s)
- Pamela A. Mudd
- Department of Otolaryngology, Head and Neck Surgery, Children’s National Health Services, Washington, DC, USA
| | - Allison L. Silva
- Joseph E. Roberts, Jr. Center for Surgical Care, Children’s National Health Services, Washington, DC, USA
| | - Susan S. Callicott
- Joseph E. Roberts, Jr. Center for Surgical Care, Children’s National Health Services, Washington, DC, USA
| | - Nancy M. Bauman
- Department of Otolaryngology, Head and Neck Surgery, Children’s National Health Services, Washington, DC, USA
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Bauman NM, Wang D. Laryngeal Electromyographic, Cardiovascular, and Respiratory Effects of Neuropeptide Injections into the Nucleus Tractus Solitarius of Rats. Ann Otol Rhinol Laryngol 2016; 113:809-20. [PMID: 15535144 DOI: 10.1177/000348940411301007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Identifying central neurotransmitters that mediate laryngeal adductor activity may aid in managing pathological laryngeal adduction as occurs in laryngospasm or apparent life-threatening events in infants. We studied the effect on cricothyroid (CT) and thyroarytenoid (TA) electromyography (EMG) and on cardiovascular parameters of neurotransmitter injections into the rat nucleus tractus solitarius (NTS), the primary sensory relay center of the larynx. Twenty nanoliters of vasoactive intestinal peptide (VIP; 2.5 pmol), neurokinin B (NKB, 16 pmol), calcitonin gene-related peptide (3.0 pmol), neurokinin A (NKA; 35 pmol), or artificial cerebrospinal fluid (control solution) was stereotactically injected into the region of the NTS and the control nucleus gracilis in 119 studies performed in 24 mature, anesthetized Sprague-Dawley rats. Changes in diaphragm, CT, and TA EMG activity and blood pressure (BP) were compared. Injection sites were verified histologically. Injections of both VIP and NKB into the region of the NTS, but not the nucleus gracilis, induced life-threatening changes, including apnea, a marked decline in BP (p < .05), and increases in EMG activity of the CT and TA adductor muscles ranging from sustained contraction to mild phasic increases during inspiration. Calcitonin gene-related peptide injection also decreased BP (p < .05), but caused only mild increases in CT and TA EMG activity. NKA and control injections into the NTS did not alter respiration, BP, or CT or TA EMG activity. VIP and NKB may play important roles in modulating EMG activity of the CT and TA muscles. This information may prove useful in evaluating pharmacological targets of central reflex activity to manage life-threatening laryngeal adduction.
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Affiliation(s)
- Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Division, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
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Cable BB, Brenner P, Bauman NM, Mair EA. Image-Guided Surgical Drainage of Medial Parapharyngeal Abscesses in Children: A Novel Adjuvant to a Difficult Approach. Ann Otol Rhinol Laryngol 2016; 113:115-20. [PMID: 14994765 DOI: 10.1177/000348940411300206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/15/2022]
Abstract
Surgical drainage of localized infections in deep neck spaces in children is often completed without a high degree of technical difficulty. However, abscess drainage within the superior parapharyngeal space medial to the great vessels is particularly challenging for otolaryngologists. Drawbacks to both the intraoral and external approaches to this area have led us to develop a new adjunctive technique that utilizes intraoperative image-guided technology to augment the intraoral approach. Here we present a case series of 12 children in whom this technique was successfully used.
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Affiliation(s)
- Benjamin B Cable
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Yang GS, Bishop WP, Smith BJ, Goudy SL, Sato Y, Bauman NM. Radiographic and Endoscopic Measurements of Esophageal Length in Pediatric Patients. Ann Otol Rhinol Laryngol 2016; 114:587-92. [PMID: 16190090 DOI: 10.1177/000348940511400802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 11/17/2022]
Abstract
Objectives: Knowledge of the length between the upper esophageal sphincter (UES) and the lower esophageal sphincter (LES) in pediatric patients is essential for intraluminal impedance and dual pH probe recordings. Methods: We measured the vertical distance between the true vocal cords (TVCs) and the LES in chest x-rays (CXRs) of 118 children (ages, 6 weeks to 13 years) and measured the vertical distance between the UES and the LES during endoscopy in 31 patients (ages, 14 months to 17 years) and correlated the measurements to height, weight, and age. Results: Esophageal length correlated best with patient height (R = 0.96 by CXR, R = 0.88 by endoscopy) and less well with weight (R = 0.87, R = 0.67) and age (R = 0.94, R = 0.86). Linear regression analyses using radiographic measurements revealed that esophageal length (TVC to LES) can be estimated from a patient's height by the following equation: 1.048 + 0.167 × height (in centimeters). With the upper pH probe placed in the hypopharynx at the TVC level and the inferior probe placed in the esophagus 3 to 6 cm above the LES, the patients were divided into 6 groups corresponding to the currently available number of sizes of dual pH-impedance probes. With the patients' heights between 71.5 and 161.3 cm, 64.7% to 100% of patients were within 1 cm of the desired location with preselected probes. Confirmation of placement was performed with CXR. Conclusions: A pediatric patient's height can be used to estimate the esophageal length (TVC to LES) and facilitate the selection of dual pH—impedance probes. Our method decreases the risk of morbidity while increasing the accuracy of the study of extraesophageal reflux disease.
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Affiliation(s)
- Grace S Yang
- Department of Otolaryngology-Head and Neck Surgery University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
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Cable BB, Manaligod JM, Bauman NM, Smith RJH. Pediatric Airway Reconstruction: Principles, Decision-Making, and Outcomes at the University of Iowa Hospitals and Clinics. Ann Otol Rhinol Laryngol 2016; 113:289-93. [PMID: 15112971 DOI: 10.1177/000348940411300406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
Pediatric airway stenosis challenges the treating surgeon, from the initial evaluation and decision-making process to the final postoperative care and follow-up setting. As our approach to these cases evolves, we must critically evaluate our outcomes in reference to our stated goals. We describe our process in treating this population and critically examine our outcome data from 1990 to the present. Emphasis is placed on selection of procedure and postoperative management.
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Affiliation(s)
- Benjamin B Cable
- Department of Otolaryngology, University of Iowa, Iowa City, Iowa 52242, USA
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Costa VA, Haimowitz R, Cheng YI, Wang J, Silverman RA, Bauman NM. Social Impact of Facial Infantile Hemangiomas in Preteen Children. JAMA Otolaryngol Head Neck Surg 2016; 142:13-9. [PMID: 26583696 DOI: 10.1001/jamaoto.2015.2597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Involuted infantile facial hemangiomas (IHs) may adversely affect the social skills of children. OBJECTIVE To assess the social impact of involuted facial IHs, with or without prior treatment, in preteen children. DESIGN, SETTING, AND PARTICIPANTS An observational, cross-sectional study of social anxiety and skills in preteen children with facial IHs diagnosed during infancy. The study took place in an academic institution and a community dermatology practice between January 1, 2013, and July 30, 2014. Records on 236 children with IHs located in a cosmetically sensitive area were identified; of those, 144 potential participants (parents) were reached by telephone and mailed study packets. Thirty completed questionnaires were returned. Data analysis was performed from August 1, 2014, to September 7, 2015. INTERVENTIONS The questionnaires included the following psychiatric scales: (1) Social Anxiety Scale for Children-Revised (SASC-R), completed by parents and children, including the domains of Fear of Negative Evaluation and Social Avoidance/Distress in New Situations (SAD-New) (higher scores indicate greater social anxiety), and (2) Social Competency Inventory (SCI), completed by parents, including the domains of Prosocial Behavior and Social Initiative (lower scores indicate poorer social competency). MAIN OUTCOMES AND MEASURES Demographics, clinical details, and survey responses were collected. Analysis was conducted using t tests to compare scores for each survey domain with established normative data and between sex as well as between treatment vs nontreatment groups. RESULTS Of the 144 potential participants, 30 (21%) responded. The mean age of the preteen subjects was 10.0 years (range, 5.4-12.9 years) with a 2:1 female to male ratio. Twenty-five children (83%) had a single IH, and the remaining 5 participants (17%) had multiple IHs, with at least 1 IH in a cosmetically sensitive area. The periocular region was the most common site of the IH (10 [33%]), followed by the nose (6 [20%]), cheek (5 [17%]), forehead (4 [13%]), lip or perioral region (4 [13%]), and ear (1 [3%]). Eighteen children (60%) had received treatment for their IH. With results reported as mean (SD), the SASC-R test showed that social anxiety of the children was not increased over normative data; however, those who did not receive IH treatment had significantly greater anxiety for new situations compared with those who received treatment (SAD-New: 15.5 [5.1] vs 11.5 [3.8]; P = .02). Results of the SCI scale indicated that the Prosocial Orientation domain score for the children was similar to normative data (3.96 [0.48] vs 3.89 [0.55], P = .50). Social Initiative domain scores were significantly poorer in children who did not receive treatment vs those who received treatment (3.45 [0.43] vs 4.03 [0.55]; P = .006). CONCLUSIONS AND RELEVANCE Preteen children with involuted, untreated facial IHs have higher Social Anxiety domain scores in new situations and decreased Social Initiative domain scores compared with children who receive treatment for facial IH. Although this study is limited by a small sample size, it raises important considerations for whether early treatment of facial IHs in cosmetically sensitive areas has a beneficial effect on social skills in preteens.
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Affiliation(s)
- Victoria A Costa
- Currently a medical student, School of Medicine, George Washington University, Washington, DC
| | - Rachel Haimowitz
- Currently a medical student, School of Medicine, George Washington University, Washington, DC
| | - Yao I Cheng
- Children's National Health System, Center for Translational Sciences, School of Medicine, George Washington University, Washington, DC
| | - Jichuan Wang
- Children's National Health System, Center for Translational Sciences, School of Medicine, George Washington University, Washington, DC
| | | | - Nancy M Bauman
- Children's National Health System, Department of Otolaryngology, Head, and Neck Surgery, School of Medicine, George Washington University, Washington, DC
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Sioshansi PC, Vezina G, Yaun AL, Miller MM, Bauman NM. Considering the Ectopic Pituitary Gland in Evaluation of the Nasopharyngeal Mass. JAMA Otolaryngol Head Neck Surg 2015; 141:649-53. [PMID: 25974707 DOI: 10.1001/jamaoto.2015.0706] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Extracranial pituitary ectopia is an uncommon finding characterized by all or a portion of the pituitary gland situated in an aberrant location. Often these lesions come to clinical attention only once they begin to function abnormally or increase in size significantly. OBSERVATIONS We describe an incidentally noted, asymptomatic pedunculated nasopharyngeal lesion in a 13-month-old girl that may be an extracranial pituitary gland. Consideration of this rare anomaly cautioned against performing a biopsy and may have prevented inadvertent removal of functional pituitary tissue. We describe the embryologic origins of ectopic pituitary tissue, discuss the differential diagnosis for nasopharyngeal lesions in children, and emphasize physical and radiologic findings suggestive of ectopic pituitary tissue to prevent potential inadvertent removal of this rare anomaly. CONCLUSIONS AND RELEVANCE We report this unusual case to review embryologic origins of ectopic pituitary tissue and to alert otolaryngologists of the need to consider ectopic pituitary tissue in the diagnosis of nasopharyngeal lesions in children.
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Affiliation(s)
- Pedrom C Sioshansi
- Georgetown University School of Medicine, Washington, DC2now with Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Gilbert Vezina
- Department of Radiology, Children's National Health System, George Washington University, Washington, DC
| | - Amanda L Yaun
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Marijean M Miller
- Division of Ophthalmology, Children's National Health System, George Washington University, Washington, DC
| | - Nancy M Bauman
- Division of Otolaryngology, Children's National Health System, George Washington University, Washington, DC
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Bauman NM, McCarter RJ, Guzzetta PC, Shin JJ, Oh AK, Preciado DA, He J, Greene EA, Puttgen KB. Propranolol vs prednisolone for symptomatic proliferating infantile hemangiomas: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2014; 140:323-30. [PMID: 24526257 DOI: 10.1001/jamaoto.2013.6723] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE While propranolol is touted as superior to prednisolone for treating infantile hemangiomas (IH), a randomized clinical trial (RCT) comparing the outcome and tolerability of these medications for symptomatic, proliferating IH has not been reported. OBJECTIVES To determine if oral propranolol is more efficacious and better tolerated than prednisolone in treating symptomatic, proliferating IH and to determine the feasibility of conducting a multi-institutional, RCT comparing efficacy and tolerability of both medications. DESIGN, SETTING, AND PARTICIPANTS Phase 2, investigator-blinded, multi-institutional RCT conducted in 3 academic vascular anomalies clinics on 19 of 44 eligible infants aged between 2 weeks and 6 months. All participating patients had symptomatic proliferating IH treated between September 1, 2010, and August 1, 2012. INTERVENTIONS Treatment with oral propranolol vs prednisolone (2.0 mg/kg/d) until halted owing to toxic effects or clinical response. MAIN OUTCOMES AND MEASURES Primary outcome was change in IH size after 4 months of therapy. Secondary outcomes were response rate and frequency and severity of adverse events (AEs). RESULTS The primary outcome showed no difference in lesion size or affected skin area after 4 months of therapy: 41% and 1.32 mm2 for prednisolone vs 64% and 0.55 mm2 for propranolol (P = .12 for lesion size, and P = .56 for affected skin area). Longitudinal analyses showed a faster response in total lesion outer dimension with prednisolone (P = .03), but this advantage over time was not noted when central clearing and outer dimension were included in the analysis (P = .91). The overall frequency of AEs was similar (44 for prednisolone vs 32 for propranolol) (P = .84), but prednisolone-treated participants had more grade 3 severe AEs (11 vs 1) (P = .01), particularly growth retardation resulting in size and weight below the fifth percentile. Early study withdrawal owing to AEs occurred in 6 (75%) of 8 patients in the prednisolone group but 0 of 11 propranolol-treated participants. The mean duration of therapy was shorter for prednisolone (141 vs 265 days), reflecting the higher rate of early withdrawals. CONCLUSIONS AND RELEVANCE Both medications show similar efficacy for reducing the area of symptomatic, proliferating IH. Although prednisolone showed a faster response rate, propranolol was better tolerated with significantly fewer severe AEs. Propranolol should be the first line of therapy for symptomatic IH unless contraindicated or unless future studies demonstrate severe AEs from propranolol. Recruiting participants for a phase 3 RCT would be difficult owing to safety profiles measured here and emerging trends favoring propranolol. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00967226.
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Affiliation(s)
- Nancy M Bauman
- Department of Otolaryngology, Children's National Medical Center, Washington, DC
| | - Robert J McCarter
- Department of Biostatistics, Children's National Medical Center, Washington, DC
| | - Philip C Guzzetta
- Department of General Surgery, Children's National Medical Center, Washington, DC
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Albert K Oh
- Department of Plastic Surgery, Children's National Medical Center, Washington, DC
| | - Diego A Preciado
- Department of Otolaryngology, Children's National Medical Center, Washington, DC
| | - Jianping He
- Department of Biostatistics, Children's National Medical Center, Washington, DC
| | | | - Katherine B Puttgen
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Motz KM, Nickley KB, Bedwell JR, Yadav B, Guzzetta PC, Oh AK, Bauman NM. OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations. Ann Otol Rhinol Laryngol 2014; 123:81-8. [DOI: 10.1177/0003489414523561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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
Objectives: A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. Methods: The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. Results: The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients. Conclusions: OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.
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Affiliation(s)
- Kevin M. Motz
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Katherine B. Nickley
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Joshua R. Bedwell
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Bhupender Yadav
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Philip C. Guzzetta
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Albert K. Oh
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Nancy M. Bauman
- Georgetown University School of Medicine (Motz, Nickley), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Otolaryngology (Bedwell, Bauman), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Radiology (Yadav), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Department of Pediatric Surgery (Guzzetta), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
- Division of Plastic Surgery (Oh), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC
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Patel NJ, Bauman NM. How should propranolol be initiated for infantile hemangiomas: Inpatient versus outpatient? Laryngoscope 2013; 124:1279-81. [DOI: 10.1002/lary.24363] [Citation(s) in RCA: 7] [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] [Revised: 06/26/2013] [Accepted: 07/25/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Nitin J. Patel
- Division of Otolaryngology; George Washington University; Washington DC U.S.A
| | - Nancy M. Bauman
- Division of Otolaryngology, Children's National Medical Center; George Washington University; Washington DC U.S.A
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Puttgen KB, Summerer B, Schneider J, Cohen BA, Boss EF, Bauman NM. Cardiovascular and blood glucose parameters in infants during propranolol initiation for treatment of symptomatic infantile hemangiomas. Ann Otol Rhinol Laryngol 2013; 122:550-4. [PMID: 24224397 DOI: 10.1177/000348941312200903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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
OBJECTIVES We sought to determine the effect of propranolol on cardiovascular and blood glucose parameters in infants with symptomatic infantile hemangiomas who were hospitalized for initiation of treatment, and to analyze adverse effects of propranolol throughout the course of inpatient and outpatient treatment. METHODS A retrospective cohort analysis was performed on 50 infants (age less than 12 months) with symptomatic infantile hemangiomas who were hospitalized for propranolol initiation between 2008 and 2012. Demographic data and disease characteristics were recorded. Systolic and diastolic blood pressures, heart rate, blood glucose values, and adverse events recorded during hospitalization were analyzed. An additional cohort of 200 consecutively treated children was also assessed for adverse events associated with outpatient propranolol use. RESULTS The median age among the inpatient cohort was 3.4 months (range, 0.8 to 12.0 months). Infants older than 6 months were more likely to exhibit bradycardia than were younger infants (p < 0.001). Hypotensive and/or bradycardic periods were infrequent and were not associated with observable clinical symptoms. The mean systolic and diastolic blood pressures and the mean heart rate decreased significantly from day 1 of hospitalization to day 2 (p = 0.004; p = 0.008; p < 0.001), but not from day 2 to day 3, when the propranolol dose was increased to target. Hypoglycemia was rare (0.3% incidence.) Among the 250 outpatients, 2 infants developed lethargy and hypoglycemia during a viral illness and recovered without sequelae. One infant experienced recurrent bronchospasm with viral illnesses and required concomitant bronchodilator therapy. CONCLUSIONS Frequent deviations from normal ranges of blood pressure and heart rate occur upon initiation of propranolol, but are clinically asymptomatic. These findings support that outpatient initiation of propranolol in healthy, normotensive infants appears to be a relatively safe alternative to inpatient initiation. Hypoglycemia is rare, but can occur throughout the treatment period; parent counseling is of paramount importance.
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Affiliation(s)
- Katherine B Puttgen
- Department of Dermatology, Johns Hopkins University School of Medicine, 200 N Wolfe St, Unit 2107, Baltimore, MD 21287, USA
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Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, Chun RH, Garzon MC, Holland KE, Liberman L, MacLellan-Tobert S, Mancini AJ, Metry D, Puttgen KB, Seefeldt M, Sidbury R, Ward KM, Blei F, Baselga E, Cassidy L, Darrow DH, Joachim S, Kwon EKM, Martin K, Perkins J, Siegel DH, Boucek RJ, Frieden IJ. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131:128-40. [PMID: 23266923 PMCID: PMC3529954 DOI: 10.1542/peds.2012-1691] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [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] [Indexed: 12/13/2022] Open
Abstract
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
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Affiliation(s)
| | | | - Sarah L. Chamlin
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Anita Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nancy M. Bauman
- Department of Otolaryngology, Children’s National Medical Center, Washington, District of Columbia
| | | | | | | | | | | | | | - Anthony J. Mancini
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | | | - Marcia Seefeldt
- Department of Dermatology, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Robert Sidbury
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Kendra M. Ward
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Francine Blei
- Departments of Hematology & Oncology, Vascular Birthmark Institute of New York, New York, New York
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Cassidy
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David H. Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | | | | | | | | | | | - Robert J. Boucek
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Ilona J. Frieden
- Departments of Dermatology & Pediatrics, University of California San Francisco, San Francisco, California
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Menezes MD, McCarter R, Greene EA, Bauman NM. Status of propranolol for treatment of infantile hemangioma and description of a randomized clinical trial. Ann Otol Rhinol Laryngol 2011; 120:686-95. [PMID: 22097156 DOI: 10.1177/000348941112001010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our primary objective was to review the current use of propranolol for treatment of infantile hemangioma (IH), specifically regarding 1) the age at initiation of therapy, 2) the method of initiation, 3) the use of other adjuvant therapy, 4) the duration of therapy and relapse rate, 5) the adverse events, and 6) the outcome. Our secondary objective was to describe a randomized, controlled, single-blinded trial comparing propranolol to prednisolone for treatment of IH. METHODS Ovid Medline and PubMed searches were completed for the MeSH keywords "propranolol" and "hemangioma." Forty-nine English-language articles were published between June 2008 and September 2010, and 28 of these reported data from a total of 213 patients. Only 6 studies treated more than 10 patients, and these were selected for review in detail (154 patients). RESULTS The treatment was initiated during infancy in 92.9% of patients (mean, 4.5 months). Sixty-five percent of patients were treated with 2 mg/kg per day, and 25.3% with 3 mg/kg per day. Patients were monitored overnight at initiation of treatment in 3 series (59 patients), for 4 to 6 hours as outpatients in 2 series (62 patients), and initially as inpatients but later as outpatients in 1 series (32 patients). Propranolol was used as sole therapy in about two thirds of patients (103 patients). Treatment was ongoing in 46% of patients at the time of publication. The average treatment duration in the remaining patients was 5.1 months. Rebound growth occurred in 21% of patients after a mean of 4.3 months of therapy. Adverse events occurred in 18.1% of patients and included hypotension in 6, somnolence in 6, wheezing in 4, insomnia, agitation, and/or nightmares in 6, cool hands or night sweats in 2, gastroesophageal reflux in 3, and psoriasis-like rash in 1. All authors reported a favorable outcome with propranolol, but the definition of efficacy was not standardized. CONCLUSIONS Propranolol is an attractive alternative to other treatments for IH. Despite apparent widespread use of this medication, the data are limited, and prospective studies are lacking for this indication. The relatively high rate of adverse effects supports the need for careful monitoring of patients on this therapy. Fastidious reporting of adverse events and objective evaluation of early and late outcomes are necessary to improve our understanding of the use of propranolol for this indication.
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Provenzano MJ, Hulstein SL, Solomon DH, Bauman NM, Manaligod JM, Kacmarynski DSF, Smith RJH. Pediatric endoscopic airway management with posterior cricoid rib grafting. Laryngoscope 2011; 121:1062-6. [DOI: 10.1002/lary.21579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jaryszak EM, Shah RK, Bauman NM, Howell RJ, Rossi CT, Preciado DA. Unexpected pathologies in pediatric parotid lesions: management paradigms revisited. Int J Pediatr Otorhinolaryngol 2011; 75:558-63. [PMID: 21316113 DOI: 10.1016/j.ijporl.2011.01.019] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/13/2011] [Accepted: 01/15/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To present case vignettes of unusual pediatric parotid pathologies and discuss management paradigms in the context of these lesions. STUDY DESIGN Retrospective case series. SETTING Free-standing, academic tertiary care pediatric hospital. METHODS All patients over the past 18 months undergoing parotidectomy for a parotid mass were reviewed (N=5). RESULTS Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a persistent parotid mass for more than 3 months which was usually painless. Most (4/5 patients) had been treated with antibiotics prior to Otolaryngology consultation. Fine-needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision of the mass was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology showed metastatic neuroblastoma (17 months old), undifferentiated primitive sarcoma (22 months old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died from complications of bone marrow transplant. CONCLUSIONS The differential diagnosis for a persistent pediatric parotid mass is expansive and differs from that found in the adult population. As this series highlights, in many cases, it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Surgical excision remains the standard for management of these patients and is both diagnostic and therapeutic. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children.
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Affiliation(s)
- Eric M Jaryszak
- Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Av NW, Washington, DC 20010, USA
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Jaryszak EM, Shah RK, Howell RJ, Rossi CT, Bauman NM, Preciado DA. Unexpected pathologies in pediatric parotid lesions: Management paradigms revisited. Laryngoscope 2010. [DOI: 10.1002/lary.21305] [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: 11/08/2022]
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Smith MC, Zimmerman MB, Burke DK, Bauman NM, Sato Y, Smith RJH. Efficacy and safety of OK-432 immunotherapy of lymphatic malformations. Laryngoscope 2009; 119:107-15. [DOI: 10.1002/lary.20041] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Brookes JT, Smith MC, Smith RJH, Bauman NM, Manaligod JM, Sandler AD. H-type congenital tracheoesophageal fistula: University Of Iowa experience 1985 to 2005. Ann Otol Rhinol Laryngol 2007; 116:363-8. [PMID: 17561765 DOI: 10.1177/000348940711600508] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/17/2022]
Abstract
OBJECTIVES We review the diagnostic workup, associated disorders, surgical technique, and postoperative course of patients who underwent repair of H-type tracheoesophageal fistulas. METHODS We performed a retrospective chart review of patients who received a diagnosis of tracheoesophageal fistula at the University of Iowa. RESULTS Seven patients with an H-type tracheoesophageal fistula and a single patient with a missed proximal fistula associated with esophageal atresia were identified. Their symptoms included coughing with feeding, recurrent pneumonia, and episodic cyanosis. A delay in diagnosis was seen in 4 patients and ranged from 2.5 months to 5.9 years. In all patients, the diagnosis was made with an esophagogram. The level of the fistulas was between C5 and T3, and all were successfully repaired via a right cervical approach. CONCLUSIONS A high index of suspicion for an H-type tracheoesophageal fistula should be maintained in the presence of neonatal respiratory symptoms, as the condition can be associated with a delay in diagnosis. Repeat esophagograms and bronchoscopy may be required for diagnosis. In the postoperative period, airway obstruction is a potential risk; however, long-term difficulty with swallowing, respiration, and phonation was not observed.
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Affiliation(s)
- James T Brookes
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
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Khanna G, Sato Y, Smith RJH, Bauman NM, Nerad J. Causes of facial swelling in pediatric patients: correlation of clinical and radiologic findings. Radiographics 2006; 26:157-71. [PMID: 16418250 DOI: 10.1148/rg.261055050] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [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: 11/11/2022]
Abstract
Facial swelling is a common clinical problem in pediatric patients. The causes of swelling are diverse, and knowledge of the typical clinical and imaging manifestations and the most common sites of occurrence of these conditions is needed to formulate a differential diagnosis. The general clinical manifestations may be classified into the following four groups: (a) acute swelling with inflammation, (b) nonprogressive swelling, (c) slowly progressive swelling, and (d) rapidly progressive swelling. Conditions that may account for acute swelling accompanied by inflammation include lymphadenitis, sinusitis, odontogenic infection, and abscess. Contrast-enhanced computed tomography is the modality of choice for detection of abscesses requiring surgical drainage. Nonprogressive midfacial swelling is suggestive of a congenital anomaly (eg, a cephalocele, nasal glioma, or nasal dermoid or epidermoid cyst). Slowly progressive swelling may indicate the presence of a neurofibroma, hemangioma, lymphangioma, vascular malformation, or pseudocyst, or of fibrous dysplasia. The differential diagnosis for rapidly progressive facial swelling in association with cranial nerve deficits should include rhabdomyosarcoma, Langerhans cell histiocytosis, Ewing sarcoma, osteogenic sarcoma, and metastatic neuroblastoma.
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Affiliation(s)
- Geetika Khanna
- Department of Radiology, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA.
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Abstract
OBJECTIVES There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV). METHODS Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development. RESULTS Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional weeks of observation. There was no difference between the groups in papilloma size at the site of the injections, nor was there eradication of papillomas at remote sites in either group. No new papillomas developed in any of the 8 animals that were rechallenged. CONCLUSIONS We have reproduced an effective mammalian papilloma model for preclinical immunotherapeutic testing. Despite the potency of CpG in triggering host immunity, CpG oligodeoxynucleotide did not show a therapeutic effect against the large papilloma burdens tested in this study. The lack of effect suggests that either enhanced papilloma antigen presentation or targeting of immune-evasive mechanisms used by the papillomas is needed to treat bulky disease with an immunotherapeutic strategy.
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Affiliation(s)
- David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Affiliation(s)
- Ryan K Sewell
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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Abstract
OBJECTIVES To examine the prevalence of hearing loss (HL) in Union Army (UA) veterans by year, birth cohort, and occupation, and to compare Civil War pension and contemporary disability programs by examining monthly dollar awards. STUDY DESIGN A retrospective review of medical records for 17,722 UA veteran pension applicants, a subset of some 35,000 soldiers retrieved randomly from the Military Archives. METHODS The diagnosis of HL was based on review of medical records, which used gross measurements because of the unavailability of audiometric testing. RESULTS One third (5,891 or 33%) of pensioners sampled received compensation for HL. The veterans with HL suffered predominantly from left-sided HL (4,091 or 70%), which is consistent with noise-induced HL in a right-handed individual firing a rifle. Comparison of civilian occupations reveals minimal variation in prevalence of HL. Civil War pensions for unilateral HL averaged $134.04 per year, representing nearly one third of the average annual income in 1890. Bilateral HL received nearly twice that amount. Today, military veterans receive $1,248 annually for unilateral loss and $27,288 annually for bilateral loss. Social Security disability benefits are granted only for bilateral HL, with an average 60-year-old individual receiving $11,400 per year. CONCLUSION HL was a common disability among UA Civil War veterans, with noise exposure a likely etiology for the HL. The differing levels of compensation for HL may reflect differing perceptions on the incapacitating effects of HL.
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Affiliation(s)
- Ryan K Sewell
- Department of Otolaryngology/Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1113, USA
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Brown CL, Graham SM, Griffin MC, Smith RJH, Carter KD, Nerad JA, Bauman NM. Pediatric medial subperiosteal orbital abscess: medical management where possible. Am J Rhinol 2004; 18:321-7. [PMID: 15586805] [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: 05/01/2023]
Abstract
BACKGROUND Controversy exists about the optimal management of subperiosteal orbital abscesses (SPOAs) in pediatric patients. Some otolaryngologists advocate immediate surgical drainage while others recommend medical management initially and reserve surgery for nonresponders. We hypothesized that patients who can be managed without surgery have identifiable features on presentation that may aid in predicting their response to medical therapy. METHODS A retrospective chart review was performed on all patients < or =18 years of age who were admitted to the University of Iowa between 1984 and 2001 with findings consistent with an SPOA on computed tomography imaging. Patients were divided into two groups: group I received medical treatment only while group II underwent surgical drainage of the abscess. Presenting features were compared between the two groups. RESULTS Forty-two patients were identified with 17 group I patients and 25 group II patients. All patients had resolution of their SPOA and favorable outcomes. The following variables attained significance: group I patients were younger than group II patients (5.1 years versus 11 years; p < 0.0001), had less restriction of ocular motility (-1.0 versus -2.3), and were hospitalized for fewer days (6.5 days versus 9.6 days; p = 0.011). The following clinical variables did not vary significantly between the groups: gender, side of abscess, temperature, total white blood cell count, neutrophil count, chemosis, visual acuity, and proptosis. Culture results predominantly showed growth of anaerobic organisms (7/23). With increasing age, there was an increase in the number of organisms cultured (p = 0.005). CONCLUSION A subset of patients with SPOAs can be managed medically. These patients tend to be younger and present with minimal restriction of ocular motility.
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Affiliation(s)
- Christopher L Brown
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242, USA
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Abstract
OBJECTIVE To determine how frequently the use of -interferon (-IFN) is associated with the development of spastic diplegia. STUDY DESIGN AND METHODS Meta-analysis of 600 English manuscripts published January 1991 to June 2002 reporting -IFN use in infants/children. We identified 3,113 children 18 years of age or younger and an estimated 3,055 children 12 years of age or younger who received -IFN therapy. Sixty-nine percent were treated for chronic hepatitis and 14% for vascular neoplasms. OUTCOME MEASURE Neurologic examination to confirm spastic diplegia or a motor developmental disturbance other than spastic diplegia such as hyperactive deep tendon reflexes, gait disturbances, or impaired fine motor control. RESULTS Including our index case, 11 of 441 children with vascular lesions developed spastic diplegia and an additional 16 of 441 developed a motor developmental disturbance. All of these children were less than 1 year of age at initiation of therapy. Mean age of initiation and duration of -IFN therapy were not significantly different between groups (P >.05); however, motor developmental disturbances improved with cessation of therapy, whereas spastic diplegia did not. No child receiving treatment for chronic hepatitis developed neurologic complications; however, only 49 children were less than 1 year of age at initiation of therapy. CONCLUSION -IFN should not be used in infants under 1 year of age unless life-threatening conditions do not respond to any other form of treatment. If -IFN must be used, children should have monthly neurologic examinations. If a motor developmental disturbance is detected and -IFN therapy can be discontinued, it should be.
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Little JP, Bauman NM, Levy J, Loughlin GM, Rutter MJ. Pediatric Otolaryngology Committee: Pediatric Extraesophageal Reflux: Contemporary Diagnosis and Management. Otolaryngol Head Neck Surg 2004. [DOI: 10.1016/j.otohns.2004.06.474] [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: 12/01/2022]
Affiliation(s)
- John P Little
- Knoxville TN; Iowa City IA; New York NY; New York NY; Cincinnati OH
| | - Nancy M Bauman
- Knoxville TN; Iowa City IA; New York NY; New York NY; Cincinnati OH
| | - Joseph Levy
- Knoxville TN; Iowa City IA; New York NY; New York NY; Cincinnati OH
| | | | - Michael J Rutter
- Knoxville TN; Iowa City IA; New York NY; New York NY; Cincinnati OH
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Abstract
Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.
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Affiliation(s)
- Chantal M Giguère
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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48
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Abstract
Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.
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Affiliation(s)
- Chantal M Giguère
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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49
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Abstract
Recurrent respiratory papillomatosis (RRP), caused by the human papillomavirus, is characterized by unregulated growth of wartlike neoplasms on laryngeal mucosa. Apoptosis is important in normal cellular homeostasis, and dysregulation of this process is thought to govern the behavior of certain neoplasms. This study evaluates the expression of several pro-apoptotic and anti-apoptotic factors in papillomas of patients with RRP, with a specific interest in survivin, a cell cycle-regulated anti-apoptotic factor. Three anti-apoptotic and 6 pro-apoptotic messenger RNA (mRNA) species were quantified by ribonuclease protection assay in 11 RRP papilloma specimens and 5 normal laryngeal specimens. Anti-apoptotic and pro-apoptotic mRNA ratios were quantified by normalizing to the ribosomal protein L32 and compared between specimens. Protein expression of survivin in tissue samples was also evaluated. The mean (+/- SD) expression of survivin was almost fivefold greater in the RRP papillomas than in normal tissue (14.2% +/- 2.5% versus 3.0% +/- 0.8% of L32, p = .003). The RRP specimens also had greater expression of XIAP, Fas, and p53 than did the normal tissue. Survivin protein was differentially expressed in the papilloma specimens, and was greatest in a papilloma that underwent malignant transformation. Survivin was absent in all normal laryngeal tissue tested. Apoptotic factors in general appear to be upregulated in papillomatous tissue as compared to normal laryngeal tissue and may suggest a higher proliferation rate and cell turnover. Survivin is abundant in papillomas and absent in normal laryngeal tissue. Dysregulation of apoptosis as determined by abnormal expression of anti-apoptotic factors like survivin and XIAP probably favors papilloma growth and survival. Such factors may represent potential targets in the treatment of this disease.
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Affiliation(s)
- David M Poetker
- Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA
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50
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Giguère CM, Bauman NM, Sato Y, Burke DK, Greinwald JH, Pransky S, Kelley P, Georgeson K, Smith RJH. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial. Arch Otolaryngol Head Neck Surg 2002; 128:1137-44. [PMID: 12365884 DOI: 10.1001/archotol.128.10.1137] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe and to determine the robustness of our study evaluating the efficacy of OK-432 (Picibanil) as a therapeutic modality for lymphangiomas. DESIGN AND SETTING Prospective, randomized trial and parallel-case series at 13 US tertiary care referral centers. SUBJECTS Thirty patients diagnosed as having lymphangioma. Ages in 25 ranged from 6 months to 18 years. Twenty-nine had lesions located in the head-and-neck area. INTERVENTION Every patient received a 4-dose injection series of OK-432 scheduled 6 to 8 weeks apart unless a contraindication existed or a complete response was observed before completion of all injections. A control group was observed for 6 months. OUTCOME MEASURES Successful outcome of therapy was defined as a complete or a substantial (>60%) reduction in lymphangioma size as determined by calculated lesion volumes on computed tomographic or magnetic resonance imaging scans. RESULTS Overall, 19 (86%) of the 22 patients with predominantly macrocystic lymphangiomas had a successful outcome. CONCLUSIONS OK-432 should be efficacious in the treatment of lymphangiomas. Our study design is well structured to clearly define the role of this treatment agent.
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Affiliation(s)
- Chantal M Giguère
- Department of Otolaryngology, The University of Iowa, Iowa City 52242, USA
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