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Chen T, Gudipudi R, Nguyen SA, Carroll W, Clemmens C. Should Propranolol Remain the Gold Standard for Treatment of Infantile Hemangioma? A Systematic Review and Meta-Analysis of Propranolol Versus Atenolol. Ann Otol Rhinol Laryngol 2023; 132:332-340. [PMID: 35466712 DOI: 10.1177/00034894221089758] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although propranolol has been established as the gold standard when treatment is sought for infantile hemangioma, concerns over its side effect profile have led to increasing usage of atenolol, a beta-1 selective blocker. METHODS A systematic review of PubMed, Scopus, CINAHL, Google Scholar, and Cochrane was conducted following PRISMA guidelines using MeSH terms and keywords for the terms propranolol, atenolol, and infantile hemangioma, including alternative spellings. All randomized control trials (RCTs) or cohort studies directly comparing outcomes of hemangioma treatment with atenolol and propranolol were included. A meta-analysis with pooled mean differences, pooled odds ratios, and analysis of proportions was performed. RESULTS A total of 669 participants in 7 studies (3 RCTs and 4 cohort) were included. Propranolol showed a significantly higher rate of complete response compared to atenolol (73.3% vs 85.4%, P = .0004). The pooled mean difference of 0.07 (95% CI -0.12, 0.27) in Hemangioma Activity Score (HAS) was not statistically significant. In terms of side effects, there were significantly more agitation and bronchial hyperreactivity events in the propranolol group (P = .0245 and P < .0001, respectively). Overall, there was a significantly greater number of adverse events in the propranolol group compared to the atenolol group (185 vs 117, P < .00001). The overall pooled odds ratio was 2.70 (95% CI 1.90, 3.84), indicating that there is 2.7 times higher odds of adverse events in the propranolol group. CONCLUSION Propranolol treatment leads to a significantly higher rate of complete response than atenolol. However, its use must be weighed against its greater side effect profile.
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Affiliation(s)
- Tiffany Chen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rachana Gudipudi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - William Carroll
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Clarice Clemmens
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Abstract
Congenital aplasia of the epiglottis is a rare condition with variable presentation ranging from respiratory distress requiring surgical airway to an asymptomatic finding. Epiglottic aplasia is presumed to be caused by arrest of development of laryngeal structures and is most commonly associated with syndromic conditions, though isolated episodes of aplasia of the epiglottis do exist. In this report, we present a term infant with multiple congenital anomalies who was noted to have a hoarse cry prompting laryngoscopy. This showed complete absence of the epiglottis. Subsequent genetic testing showed mutations in the CPLANE1 gene that is associated with Joubert syndrome. Our patient was able to be discharged home on a thickened formula diet and is eating and gaining weight appropriately. Here, we present a review of the currently available literature of other cases of congenital epiglottic aplasia or hypoplasia discussing the presentation, management and outcomes in these cases.
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Affiliation(s)
- Lindsey Shehee
- Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jaye Downs
- Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Clarice Clemmens
- Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
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Patel T, Clemmens C, Bradburn K, Beckstrand M, McGhee H, McKelvey K, Simmons C, Hill J, McGrattan KE. Effect of a standardized fluoroscopic procedural approach on fluoroscopy time during infant modified barium swallow studies. Int J Pediatr Otorhinolaryngol 2020; 138:110396. [PMID: 33152985 DOI: 10.1016/j.ijporl.2020.110396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pediatric dysphagia is a term used to describe dysfunctional feeding and swallowing in infants and children. It is estimated that about 1% of children in the United States are affected by these swallowing problems annually. The modified barium swallow study (MBSS) is considered by many as the gold standard in oropharyngeal swallowing assessment. Despite its diagnostic benefits, MBSS exposes infants to ionizing radiation, which carries potentially deleterious long-term effects for the pediatric population. OBJECTIVES Test the effect of a standardized MBSS procedural protocol on fluoroscopy time when compared to a non-standardized procedural approach. MATERIALS AND METHODS A retrospective review of infants ≤12 months who underwent a MBSS between 2011 and 2017 was conducted. Charts were reviewed for fluoroscopy time, age, primary diagnosis, MBSS indication, and severity of swallowing deficits. Infants were categorized as non-protocol or standardized protocol based on the utilized method of videofluoroscopic swallow study execution. RESULTS A total of 1378 MBSS' were included in the analysis. Swallow studies conducted using the standardized procedural protocol had significantly shorter fluoroscopy times (1.5 min) when compared to non-protocol group (2.0 min) (p < 0.001). Patients who aspirated had significantly longer fluoroscopy times when compared to patients who did not aspirate across both groups (p < 0.001). CONCLUSION Fluoroscopy time is influenced by both procedural and patient factors. Use of a standardized fluoroscopic procedural protocol appears to reduce fluoroscopy time and variability across patients.
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Affiliation(s)
- Terral Patel
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Clarice Clemmens
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Kathryn Bradburn
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Michael Beckstrand
- College of Liberal Arts Research Support, University of Minnesota, 101 Pleasant Street SE, Minneapolis, MN, 55455, USA.
| | - Heather McGhee
- Department of Speech Language Pathology, Medical University of Seouth Carolina, 131 Ashley Ave, Charleston, SC, 29425, USA.
| | - Keeley McKelvey
- Department of Speech Language Pathology, Medical University of Seouth Carolina, 131 Ashley Ave, Charleston, SC, 29425, USA.
| | - Cephus Simmons
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
| | - Jeanne Hill
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
| | - Katlyn Elizabeth McGrattan
- Department of Speech Language Hearing Science, University of Minnesota, 164 Pillsbury Drive, SE, Minneapolis, MN, 55455, USA.
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Abstract
A newborn girl was referred to the otolaryngology service after prenatal imaging showed a right mandibular mass. Physical examination revealed a 1-2 cm mass along the right mandible with the appearance of a vestigial oral cavity. Tissue resembling the vermillion and primitive tongue appeared innervated and moved in conjunction with oral movements. MRI and CT of the mandible after birth confirmed a partially ossified soft tissue mass of the right mandibular body, containing unerupted teeth. She was taken to the operating room at 6 months of age for mass excision and reconstruction. Postoperatively, she healed well and was feeding without difficulty. Craniofacial duplication, including duplication of stomatodeal structures or diprosopus, is a rare condition with a variety of phenotypes. In the case of suspected craniofacial duplication, associated syndromes should be ruled out and appropriate imaging employed to determine the extent of involvement of adjacent structures, which will ultimately guide surgical planning.
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Affiliation(s)
| | - David Macias
- Otolaryngology - Head & Neck Surgery, MUSC, Charleston, South Carolina, USA
| | - Clarice Clemmens
- Otolaryngology - Head & Neck Surgery, MUSC, Charleston, South Carolina, USA
| | - Krishna G Patel
- Otolaryngology - Head & Neck Surgery, MUSC, Charleston, South Carolina, USA
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Ni JS, Kompelli AR, Nguyen SA, Schlosser RJ, Clemmens C, Soler ZM. The Sinus and Nasal Quality of Life Survey (SN-5) in the Management of Pediatric Chronic Rhinosinusitis: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2018; 111:162-169. [PMID: 29958603 DOI: 10.1016/j.ijporl.2018.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/02/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Pediatric chronic rhinosinusitis (CRS) is a prevalent condition with quality of life (QoL) impacts that are seldom reported in the literature. We aimed to conduct a systematic review and meta-analysis on studies using the Sinus and Nasal Quality of Life Survey (SN-5), the only validated symptom questionnaire in pediatric CRS. METHODS A literature search was conducted to identify studies that used the SN-5 to measure QoL before and after medical or surgical interventions for pediatric CRS. Comparison of means and standard deviations was performed between pre- and post-intervention SN-5 scores. RESULTS A total of 10 studies, consisting of 13 separate treatment arms of either medical therapy, adenoidectomy, balloon catheter sinuplasty (BCS), or functional endoscopic sinus surgery (FESS) were identified. The vast majority (92.3%) of the treatment arms demonstrated minimal clinically important differences between baseline and post-intervention SN-5 scores. Rates of treatment success and minimal clinically important difference among all treatment arms ranged from 43.2% to 94.0%. Comparison of means showed an improvement in SN-5 score of 1.97 [95% CI, 1.18 to 2.76; p < 0.00001] for BCS, 1.83 [95% CI, 1.47 to 2.19; p < 0.00001] for FESS, and 1.15 [95% CI, 0.36 to 2.66; p = 0.13) for medical treatment. CONCLUSION There is a paucity of literature on QoL outcomes in pediatric CRS. More studies using the SN-5, particularly those controlling for baseline patient characteristics, are necessary to fully elucidate the impact of various interventions on QoL in pediatric CRS.
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Affiliation(s)
- Jonathan S Ni
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
| | - Anvesh R Kompelli
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
| | - Clarice Clemmens
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
| | - Zachary M Soler
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.
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Horton J, Atwood C, Gnagi S, Teufel R, Clemmens C. Temporal Trends of Pediatric Dysphagia in Hospitalized Patients. Dysphagia 2018; 33:655-661. [PMID: 29464395 DOI: 10.1007/s00455-018-9884-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to determine temporal trends of dysphagia diagnoses in hospitalized children. This is a retrospective observational study from the 1997-2012 Kids' Inpatient Database (KID) conducted in the setting of weighted hospitalizations in a KID participating center. More than 6 million pediatric admissions were captured in each triennial KID report. Main outcomes included triennial rates of dysphagia diagnosis in hospitalized pediatric patients, and secondary outcomes included rates of dysphagia in premature and low-birthweight infants. Dysphagia diagnoses were coded in 5107/6607653 (0.08%) of these admissions in 1997, rising to 27,464/6,675,222 (0.41%) in 2012 (p < 0.001). The portion of these diagnoses in premature neonates has been increasing over time from 162/9551 (1.7%) in 2003 to 1027/27,464 (3.7%) by 2012 (p < 0.001). Similarly, low-birthweight children constituted 40/5107 (0.8%) of dysphagia diagnoses in 1997, a number that increased to 762/27,464 (2.8%) in 2012. Rates of dysphagia are increasing nationally, particularly in premature and low-birthweight infants, which may represent an increase alongside other neuroanatomic abnormalities. This growing problem illustrates the need for better data on the comparative efficacy of diagnostic and treatment modalities.
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Affiliation(s)
- Joshua Horton
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South, 135 Rutledge Ave, MSC 550, Charleston, SC, 29425, USA.
| | - Carlyn Atwood
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South, 135 Rutledge Ave, MSC 550, Charleston, SC, 29425, USA
| | - Sharon Gnagi
- Division of Otolaryngology - Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Ronald Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Clarice Clemmens
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South, 135 Rutledge Ave, MSC 550, Charleston, SC, 29425, USA
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Wilson M, Clemmens C, Rizzi M. Clival Osteomyelitis with Retropharyngeal and Epidural Abscesses in a Child. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1580021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
A broad spectrum of congenital upper airway anomalies can occur as a result of errors during embryologic development. In this review, we will describe the clinical presentation, diagnosis, and management strategies for a few select, rare congenital malformations of this system. The diagnostic tools used in workup of these disorders range from prenatal tests to radiological imaging, swallowing evaluations, indirect or direct laryngoscopy, and rigid bronchoscopy. While these congenital defects can occur in isolation, they are often associated with disorders of other organ systems or may present as part of a syndrome. Therefore workup and treatment planning for patients with these disorders often involves a team of multiple specialists, including paediatricians, otolaryngologists, pulmonologists, speech pathologists, gastroenterologists, and geneticists.
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Affiliation(s)
- Alanna Windsor
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
| | - Clarice Clemmens
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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