Endoscopic balloon dilatation for pediatric subglottic stenosis: a meta-analysis of successful outcomes

OBJECTIVES

The primary goal of this study was to systematically identify all relevant published articles on the use of primary endoscopic balloon dilation for the management of pediatric patients with subglottic stenosis, critically assess the technique's success, and determine which patients are the best candidates for the procedure.

METHODOLOGY

This was a systematic review and meta-analysis that aimed to investigate the use and success rate of EBD for treating pediatric SGS. An electronic systematic literature search of three major databases, PubMed, EBSCO, and Web of Science&MEDLINE through Clarivate, was conducted to include the eligible articles.

RESULTS

A total of 14 unique studies were included in the final analysis, with 473 cases of pediatric SGS. The pooled success rate of EBD in treatment of pediatric SGS was 76% (k = 14 studies, 95% confidence interval [CI] = 0.65-0.86, P < 0.001, Q test for heterogeneity = 0.03, P < .001, I2 = 91%).

CONCLUSIONS

We reported a high success rate of EBD in treating pediatric SGS. The reported complications were uncommon, although they can be serious and life threatening. The intensity of SGS may be related to the likelihood of therapy failure.

Factors influencing quality of life in children with tracheostomy with emphasis on home care visits: a multi-centre investigation

OBJECTIVE

Only a few studies have assessed the quality of life in children with tracheostomies. This study aimed to evaluate the quality of life and the factors influencing it in these children.

METHOD

This cross-sectional, two-centre study was conducted on paediatric patients living in the community with a tracheostomy by using the Pediatric Quality of Life Inventory. Clinical and demographic information of patients, as well as parents' socioeconomic factors, were obtained.

RESULTS

A total of 53 patients met our inclusion criteria, and their parents agreed to participate. The mean age of patients was 6.85 years, and 21 patients were ventilator-dependent. The total paediatric health-related quality of life score was 59.28, and the family impact score was 68.49. In non-ventilator-dependent patients, multivariate analyses indicated that social functioning and health-related quality of life were negatively affected by the duration of tracheostomy. The Quality of Life of ventilator-dependent patients was influenced by care visits and the presence of pulmonary co-morbidities.

CONCLUSION

Children with tracheostomies have a lower quality of life than healthy children do. Routine care visits by a respiratory therapist and nurses yielded significantly improved quality of life in ventilator-dependent children.

Implications of Rigid Bronchoscopy: An Eight-Year Review in a Pediatric Intensive Care Unit

Introduction

Rigid bronchoscopy is an endoscopic technique used to visualize the airway, and rigid bronchoscopy is performed for both diagnostic and therapeutic indications. We defined the clinical characteristics of pediatric intensive care unit (PICU) patients undergoing bronchoscopy to establish a predictive model for early discharge from the PICU. Prediction can provide tangible aid in managing PICU patients.

Objectives

The primary objectives of this research are to evaluate the impact of different bronchoscopic procedures on the duration of PICU stay and to determine the Predictors of PICU discharge.

Methods

We retrospectively reviewed records of 451 PICU admissions from 2012 to 2019 at our institution. In total, 36 pediatric patients under 12 years of age undergoing interventional rigid bronchoscopy during their PICU stay were studied. This study examined the impact of bronchoscopic procedures on the duration of PICU stays. Patients were categorized into three groups according to the number of bronchoscopic interventions used to evaluate the implications of different bronchoscopic procedures on the duration of PICU stay.

Results

Multiple linear regression analysis was used to test the predictors of PICU discharge. Tracheostomy and gender were significant predictors (p = 0.072 and 0.060, respectively), but first bronchoscopy showed strong significance (p = 0.002).

Conclusion s

Our findings have shown that early bronchoscopic interventions assisted in early critical care unit discharge, and most patients who did not benefit from the first bronchoscopy were complicated cases that could explain the long stay in the PICU.

The Association Between Vitamin D Level and PFAPA Syndrome: A Systematic Review

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome's etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

A Case-Control Study of Titanium and Fluoroplastic Ventilation Tubes

Background Tympanostomy ventilation tube (VT) insertion is one of the most common procedures performed in otorhinolaryngology. VTs have been proven to effectively manage otitis media (OM) with effusion (OME) and to improve the quality of life of children postoperatively. Although there are multiple types of VT shapes, materials, and sizes, few studies have investigated and compared the effects of titanium VT with those of VTs made of other materials. This study aimed to compare titanium VTs and the more commonly used fluoroplastic VTs in a retrospective, age-matched, case-control study. We studied the postoperative outcomes and rates of extrusion, infection, otorrhea, tube obstruction, and residual perforation. Methodology Medical records of patients who underwent myringotomy with VT insertion from January 2018 to December 2020 were reviewed. A total of 34 patients met the inclusion criteria, of whom 17 had undergone titanium VT insertion bilaterally (titanium group) and 17 had undergone fluoroplastic VT insertion bilaterally (control group). Both groups were followed up with regular postoperative examinations for 18 months. Results Postoperative complications were categorized as early and late complications. The most common early postoperative complication was early extrusion of VT (six months or less after insertion) (67.6%); this was documented most often in the titanium group. Other early postoperative complications included transient otorrhea (14.7%), tube blockage (8.8%), and recurrent acute otitis media (AOM) (occurring within one month from completion of therapy of AOM episode) (5.9%); these rates were similar in both groups. Late complications were not significantly variable between groups. Tympanic membrane retraction was the most common late complication (8.8%). Conclusions VT insertion is associated with the risk of complications with varying degrees. Although factors affecting the VT complication rates are multiple and various, these rates were not different between groups in this study. However, further studies including larger population samples are needed to statistically confirm these results and their generalizability.

Treatment of Childhood High-Grade Subglottic Stenosis (SGS) Through Laryngotracheoplasty (LTP) in a Tertiary Pediatric Center from 2013 to 2020

Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013-2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively.

Prophylactic Central Neck Dissection for Clinically Node-Negative Papillary Thyroid Carcinoma

OBJECTIVE

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients.

METHODS

We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI).

RESULTS

Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups.

CONCLUSION

For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events.

LEVEL OF EVIDENCE

1 Laryngoscope, 2021.

Supraglottoplasty in the management of laryngomalacia in children with down syndrome: A systematic review

INTRODUCTION

Children with Down syndrome (DS) who have Laryngomalacia represent a specific management challenge due to their inherent multiple levels of airway obstruction and hypotonia. Therefore, the purpose of this study is to determine the outcome of supraglottoplasty (SGP) in children with DS.

DATA SOURCE

A systematic review was performed following the PRISMA guideline. Data were collected from online medical databases- CINAHL, Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid MEDLINE in process, PubMed, and Scopus.

REVIEW METHODS

all publications that address the outcome of supraglottoplasty in children who are less than 18 years old with Down syndrome prior to December 2018 were collected. The data were collected on different phases: Screening review using search words and controlled vocabularies during the period of November-December 2018, followed by a detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

RESULTS

Nine articles were included in the qualitative analysis. These articles included 231 subjects, out of which 32 children with DS met the inclusion criteria. Twenty patients (62.5%) were considered successfully treated and 12/32 failed including 1/32 (3.1%) mortality in the postoperative period. The duration of follow-up was 12-102 days. All of the patients whose treatment failed had significant comorbidities.

CONCLUSION

Although the success of SPG in children with DS is less than in otherwise healthy children, it remains an option especially in patients without comorbidities. Preoperative counseling of the families and thorough assessment are necessary to determine candidacy for SPG in children with DS.

The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis

OBJECTIVES

The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature.

DATA SOURCE

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials).

REVIEW METHODS

All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

RESULTS

Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31; P = .01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78-6.88; P < .001).

CONCLUSION

Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.

Endoscopic anatomy of the lacrimal sac for dacryocystorhinostomy. A cadaveric study

Objectives:

To assist the endoscopic localization of the lacrimal sac (LS) relative to nearby landmarks.

Methods:

This is a descriptive prospective anatomical study. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the LS between October and November 2015. Multiple measurements were obtained from the NS to the anterior and posterior walls of the LS, as well as to the middle turbinate axilla (MTA) and from the MTA to the LS borders.

Results:

The average distance from the NS to the anterior border of the LS was 42.0 mm and the posterior border was 48.5 mm. The average widths of the LS were 7.55 mm superiorly, and 6.6 mm inferiorly representing a mathematical proof that the LS is a trapezoid shape. The mean distance from the NS to the MTA was 47.3 mm. Nine of the 16 lacrimal sacs (56.3%) were found to be partially overlapped by the MTA. The LS was only totally overlapped and lying posterior to the MTA in one side (6.3%), while in 6 sides (37.5%) the LS lay anterior to the MTA.

Conclusion:

Endoscopic surgeons should be aware of the location of the LS relative to nearby landmarks, particularly the MTA. Representing a mathematical proof that the LS is wider at it upper part than lower part best presented as a trapezoid shape. We have provided additional measurements that may prove useful in cases of difficult exposure.

Outcomes of Saudi Arabian Patients With Nasopharyngeal Cancer Treated With Primarily Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiotherapy

Purpose

Nasopharyngeal cancer (NPC) is the most common head and neck cancer in Saudi Arabia. This study reports the locoregional disease control and survival outcomes in patients with NPC treated in King Abdulaziz University Hospital.

Methods

Patients treated for NPC between June 2007 and October 2014 were retrospectively reviewed. Demographic information, clinicopathologic variables, and chemotherapy data were collected and analyzed. Cumulative survival and disease control rates were calculated by Kaplan-Meier product-limit actuarial method.

Results

Thirty-nine patients with NPC were reviewed. Thirty-five (90%) patients received definitive radiotherapy (RT) and four (10%) had palliative RT. Mean prescribed dose for definitive RT was 68 Gy (range, 60 to 70.2 Gy), delivered with mean doses per fraction of 1.9 Gy (range, 1.8 to 2.1 Gy). After a median follow-up of 15 months (range, 1 to 84 months), 22 (63%) patients who underwent definitive RT were disease free and 13 (37%) were still with disease. During this period, seven (18%) patients died of the disease; five (13%) of them received definitive RT. After 2 years’ follow-up, the actuarial estimate rates were: 85.7% for local control, 91.4% for nodal control, and 85.7% for distant control.

Conclusion

Our study showed a disease with clinical behavior similar to what has been observed in East and Southeast Asia. Further it explored the neoadjuvant chemotherapy approach in treating NPC with results that are comparable to literature. However, little is known about the molecular pathogenesis of this disease in this region, and further research integrating clinical and molecular biomarkers is required.

Endoscopic Dacryocystorhinostomy (DCR): a comparative study between powered and non-powered technique

BACKGROUND

Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other.

METHODS

A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups.

RESULTS

A total of 66 endoscopic DCRs were performed on 59 patients. Procedure success rate among kerrison punch group was 87.88% vs. 90.9% in powered drill group (p = 0.827), while complications for both groups were statistical not significant (p = 0.91). The mean operating time among kerrison punch group was significantly lower than in powered drill group (75 min vs. 125 min, p = 0.0001).

CONCLUSION

Kerrison punch showed significant reduction in operating time when compared to powered drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures' success rate and complication.

Severe Vitamin D Deficiency

Objective

To assess the role of preoperative serum 25 hydroxyvitamin D as predictor of hypocalcemia after total thyroidectomy.

Study Design

Retrospective cohort study.

Setting

University teaching hospital.

Subjects and Methods

All consecutively performed total and completion thyroidectomies from February 2007 to December 2013 were reviewed through a hospital database and patient charts. The relationship between postthyroidectomy laboratory hypocalcemia (serum calcium ≤2 mmol/L), clinical hypocalcemia, and preoperative serum 25 hydroxyvitamin D level was evaluated.

Results

Two hundred thirteen patients were analyzed. The incidence of postoperative laboratory and clinical hypocalcemia was 19.7% and 17.8%, respectively. The incidence of laboratory and clinical hypocalcemia among severely deficient (<25 nmol/L), deficient (<50 nmol/L), insufficient (<75 nmol/L), and sufficient (≥75 nmol/L) serum 25 hydroxyvitamin D levels was 54% versus 33.9%, 10% versus 18%, 2.9% versus 11.6%, and 3.1% versus 0%, respectively. Multiple logistic regression analysis revealed preoperative severe vitamin D deficiency as a significant independent predictor of postoperative hypocalcemia (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.3-22.9; P = .001). Parathyroid hormone level was also found to be an independent predictor of postoperative hypocalcemia (OR, 0.6; 95% CI, 0.5-0.8; P = .002).

Conclusion

Postoperative clinical and laboratory hypocalcemia is significantly associated with low levels of serum 25 hydroxyvitamin D. Our findings identify severe vitamin D deficiency (<25 nmol/L) as an independent predictor of postoperative laboratory hypocalcemia. Early identification and management of patients at risk may reduce morbidity and costs.

The perception of otolaryngology-related diseases among parents of children with Down syndrome in Jeddah, Saudi Arabia

OBJECTIVE

To assess the perception of otolaryngology-related diseases among parents of children with Down syndrome (DS).

METHODS

A cross-sectional survey design. A questionnaire was distributed to parents of children with DS. The parents were attending an event aiming to raise awareness that was organized on World Down Syndrome Day on the 21st of March 2013, organized by Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia. The complete dates of study were March to May 2013.

RESULTS

Questionnaires were completed and perceptions regarding 10 common otolaryngology-related diseases were obtained from 78 parents. The data shows that most of the parents were not familiar with these otolaryngology-related diseases.

CONCLUSION

Many parents were not aware of some of the otolaryngology related conditions affecting children with DS, and did not have regular follow-up. Perception was highly affected by the presence of the condition in the children. Awareness of otolaryngology-related diseases affecting children with DS should be raised.

Pneumatic video-otoscopy teaching improves the diagnostic accuracy of otitis media with effusion: results of a randomized controlled trial

BACKGROUND

the diagnostic accuracy of otitis media with effusion (OME) has been shown to be poor among medical students, residents, and practicing physicians.

OBJECTIVE

to determine if the use of pneumatic video-otoendoscopic examination (VOE) improves the diagnostic accuracy of OME among residents.

METHODS

pediatric residents were randomized into a "pneumatic" examination group (intervention) and a "still" examination group (control). The control group viewed a set of 25 still VOE images of the tympanic membranes of both normal and OME ears. The intervention group viewed the same still images but with the addition of pneumatic VOE assessments. Each resident documented each of his or her diagnoses as normal or OME. The accuracy of assessment for both the static and the pneumatic methods was compared.

RESULTS

twenty-nine pediatric residents participated in this study: 15 in the intervention group and 14 in the control group. The overall diagnostic accuracy was 91% for the intervention group versus 78% for the control group (p  =  .0003).

CONCLUSION

pneumatic video-otoscopy teaching improves the diagnostic accuracy of OME among residents.

Cisplatinum ototoxicity in children, long-term follow up

OBJECTIVE

To assess the long-term ototoxicity effect of platinum chemotherapy in a series of pediatric patients.

DESIGN

A prospective cohort study.

METHODS

Patients who received platinum chemotherapy were identified through review of the pharmacy records from 2000 to 2005. Audiograms pre- and post-treatment with cisplatin were noted. The patients were brought back long after treatment for a repeat audiogram and a questionnaire to assess the impact of ototoxicity on their quality of life.

RESULTS

Forty-nine patients received platinum chemotherapy. Patients' exclusion: two had no pre-chemo audiograms, one had retinoblastoma with congenital hearing loss, three were lost to follow up, five deceased, and seven refused participation. The total number of patients included was 31 with long-term follow up total of 21 patients. The follow up period ranged from 1.5 to 6.6 years (median of 3.4 years). Fourty-two percent (13/31) of the patients suffered from otoxicity (3 mild, 3 moderate, 7 severe-profound). Thirty-three (7/21) of audiograms worsened on long-term follow up. Questionnaire revealed 70% subjective hearing loss with 40% requiring hearing aids.

CONCLUSION

Ototoxicity after platinum chemotherapy can present or worsen years after completion of therapy. Therefore, we recommend long-term follow up.

Routine thyroidectomy in total laryngectomy: is it really indicated?

OBJECTIVE

To evaluate the incidence and nature of thyroid gland invasion (TGI) in laryngeal carcinoma at the head and neck centres at McGill University.

METHOD

A retrospective case series was undertaken of 74 total laryngectomies performed at both McGill head and neck centres from 2001 to 2006. Thirteen specimens were excluded because thyroidectomies were not performed or laryngectomies were performed for nonprimary laryngeal carcinoma. Tumour stage, subsite, anatomic characteristics, and thyroid gland involvement were analyzed based on pathologic specimens. Pre- and postoperative radiation therapy treatment and thyroid function were also noted.

RESULTS

Twenty supraglottic, 21 glottic, 15 transglottic, and 5 subglottic tumours were analyzed. Subglottic extension > 10 mm was noted in 22 specimens (36%). Cartilaginous invasion was noted in 37 of our specimens (61%), and lymph node metastasis was noted in 12 specimens (20%). One subglottic tumour demonstrated bilateral invasion of the thyroid gland and lymph node metastasis. Forty patients (54%) received preoperative radiation therapy and 34 patients (46%) received postoperative radiation therapy, with pre- and postoperative rates of hypothyroidism of 38.9% and 91%, respectively.

CONCLUSION

TGI is rare for laryngeal cancer. Tumours with subglottic involvement or very advanced tumours may show a greater tendency for TGI over other tumours.