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Barron KA, Haimowitz SZ, Shah VP, Cowan P, Raia N, Ying YLM. A review of bilateral sudden sensorineural hearing loss in pediatric patients. Int J Pediatr Otorhinolaryngol 2023; 165:111459. [PMID: 36696710 DOI: 10.1016/j.ijporl.2023.111459] [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: 06/10/2022] [Revised: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition. METHODS PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected. RESULTS Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n = 3), meningitis (n = 13), mumps (n = 5), ototoxin exposure (n = 13), and enlarged vestibular aqueduct (n = 9). Tinnitus (n = 30) was the most reported concurrent symptom, followed by vertigo (n = 21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing. CONCLUSIONS This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.
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Affiliation(s)
- Kendyl A Barron
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07101, USA.
| | - Sean Z Haimowitz
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07101, USA
| | - Vraj P Shah
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07101, USA
| | - Paul Cowan
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07101, USA
| | - Nicole Raia
- Audiology Service, University Hospital, Newark, NJ, 07101, USA
| | - Yu-Lan Mary Ying
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07101, USA
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Omar M, Qatanani AM, Douglas NO, Nawash BS, Ibrahim T, Kaleem SZ, McKinnon BJ. Sociodemographic disparities in pediatric cochlear implantation outcomes: A systematic review. Am J Otolaryngol 2022; 43:103608. [PMID: 35988363 DOI: 10.1016/j.amjoto.2022.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the impact of sociodemographic factors on post-operative performance outcomes among PCI recipients across the world. METHODS A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase was undertaken for studies analyzing the association of sociodemographic factors with measures of PCI outcomes published before July 18, 2021. Study quality assessment tools from the National Institutes of Health (NIH) were used to assess for risk of bias. RESULTS Out of 887 unique abstracts initially retrieved, 45 papers were included in the final qualitative systematic review. Sociodemographic disparities in PCI outcomes from 4702 PCI recipients were studied in 19 countries, with 14 studies conducted in the United States of America, published within the years of 1999 to 2021. Parental education and socioeconomic status (e.g. income) were the most investigated disparities in PCI outcomes with 24 and 17 identified studies, respectively. CONCLUSION Socioeconomic status was a consistently reported determinant of PCI outcomes in the USA and elsewhere, and parental education, the most reported disparity, consistently impacted outcomes in countries outside the USA. This study is limited by our inability to perform a meta-analysis given the lack of standardization across measures of sociodemographic variables and assessment measures for PCI outcomes. Future studies should address the literature gap on racial and ethnic disparities among PCI outcomes and use standardized measures for sociodemographic variables and PCI outcomes to facilitate meta-analyses on the topic. Targeting the mechanisms of these disparities may mitigate the impact of the sociodemographic factors on PCI outcomes.
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Dev AN, Nahas G, Pappas A, Ambrose T, Craun P, Fustos E, Reilly BK, Preciado D. Underinsurance in children is associated with worsened quality of life after cochlear implantation. Int J Pediatr Otorhinolaryngol 2022; 157:111119. [PMID: 35398748 DOI: 10.1016/j.ijporl.2022.111119] [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: 07/29/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Research has suggested that early cochlear implantation is associated with improved language outcomes. Select studies demonstrate that this translates into a higher quality of life following implantation. Previous work from our group has shown that underinsurance represents a risk factor for worsened auditory and language outcomes for implantees. However, to our knowledge, the effect of insurance status on quality of life outcomes following cochlear implantation has not been evaluated. OBJECTIVE To assess quality of life outcomes for children receiving cochlear implants, accounting for age at implantation, insurance status, gender, surgeon, number of implants and duration of follow-up since implantation. DESIGN A retrospective study using the Glasgow Children's Benefit Inventory (GCBI), a validated questionnaire measuring quality of life across four domains: learning, emotion, vitality and physical heath. Multivariate linear regression was used to examine the effects of age at implantation, insurance status, number of implants, sex, surgeon, and duration of follow-up on GCBI scores. Age at implantation was assessed as both a continuous and dichotomous variable, comparing children implanted by 12 months of age with those implanted after 12 months. SETTING Children's National Health System in Washington, DC, a tertiary academic referral center. PARTICIPANTS The GCBI was administered telephonically to parents/guardians of prelingually deaf children aged 2-16 years who received cochlear implants at the center between January 1, 2008 and December 31, 2018. RESULTS Of 169 prelingually deafened implantee children who met inclusion criteria, parents/guardians of 64 (37.9%) responded to the questionnaire. After excluding children with late implantation (≥7 years age at CI) and missing GCBI responses, the final analytic sample consisted of 57 children. The mean age (SD) of the children at the time of the study was 3.3 (1.9) years, 63.2% were publicly insured, and 73.7% were implanted after 12 months of age. Average duration of follow-up was 3.9 (2.8) years. On a scale of -100 to +100, GCBI scores ranged from 41.7 to 95.8 (mean (SD), 64.0 (10.3)). Public health insurance (β, -5.8 [95% CI, -10.6 to -0.01]), and older age at the time of implantation (β, -0.1 [95% CI, -0.3 to 0.0]), particularly implantation following 12 months of age (p < 0.05), were significantly associated with lower GCBI scores after implantation. CONCLUSION Publicly insured recipients of cochlear implants and children implanted at an older age, particularly after 12 months of age, experienced significantly lower quality of life measures.
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Affiliation(s)
- Apurva Nidgundi Dev
- Division of Pediatric Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Gabriel Nahas
- Division of Pediatric Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Alyson Pappas
- Division of Hearing and Speech, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Tracey Ambrose
- Division of Hearing and Speech, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Patricia Craun
- Division of Hearing and Speech, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Emily Fustos
- Division of Hearing and Speech, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Brian K Reilly
- Division of Pediatric Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
| | - Diego Preciado
- Division of Pediatric Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
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Housley DM, Irani D, Housley GD, Ten Cate WJF. Audiological and Surgical Correlates of Myringoplasty Associated with Ethnography in the Bay of Plenty, New Zealand. Audiol Neurootol 2022; 27:406-417. [PMID: 35477110 DOI: 10.1159/000524312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This retrospective cohort study of myringoplasty performed at Tauranga Hospital, Bay of Plenty, New Zealand from 2010 to 2020 sought to identify predictive factors for successful myringoplasty with particular consideration given to the known high prevalence of middle ear conditions in New Zealand Māori. METHODS Outcomes were surgical success (perforation closure at 1 month) and hearing improvement, which were correlated against demographic, pathological, and surgical variables. RESULTS 174 patients underwent 221 procedures (139 in children under 18 years old), with 66.1% of patients being New Zealand Māori and 24.7% New Zealand European ethnicity. Normalized by population demographics, New Zealand Māori were 2.3 times overrepresented, whereas New Zealand Europeans were underrepresented by 0.34 times (a 6.8 times relative treatment differential). The rate of surgical success was 84.6%, independent of patient age, gender, and ethnicity. A postauricular approach and the use of temporalis fascia grafts were both correlated with optimal success rates, whereas early postoperative infection (<1 month) was correlated with ∼3 times increased failure. Myringoplasty improved hearing in 83.1% of patients (average air-bone gap reduction of 10.7 dB). New Zealand Māori patients had ∼4 times greater preoperative conductive hearing loss compared to New Zealand Europeans, but benefited the most from myringoplasty. DISCUSSION/CONCLUSION New Zealand Māori and pediatric populations required greater access to myringoplasty, achieving good surgical and audiological outcomes. Myringoplasty is highly effective and significantly improves hearing, particularly for New Zealand Māori. Pediatric success rates were equivalent to adults, supporting timely myringoplasty to minimize morbidity from untreated perforations.
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Affiliation(s)
- David M Housley
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Dinaz Irani
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Gary D Housley
- Translational Neuroscience Facility & Department of Physiology, School of Medical Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wouter-J F Ten Cate
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Crowder HR, Bestourous DE, Reilly BK. Adverse events associated with Bonebridge and Osia bone conduction implant devices. Am J Otolaryngol 2021; 42:102968. [PMID: 33676070 DOI: 10.1016/j.amjoto.2021.102968] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/27/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Active transcutaneous Bone Conduction Implants (BCIs) are relatively new to the market and may offer improved outcomes while reducing skin-related complications associated with previous models. The purpose of this study is to examine medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events with the active, transcutaneous BCIs, Bonebridge and Osia. METHODS A search of the FDA MAUDE database was conducted using product code "PFO" (for Active Implantable Bone Conduction Hearing System), brand names "Bonebridge" and "Osia." Data was collected on device malfunction, patient injury, inciting events, and subsequent interventions between July 1, 2018 and November 1, 2020. RESULTS The search query yielded 83 reports that met inclusion criteria, 56 regarding Bonebridge and 27 regarding Osia. A total of 91 adverse events were reported, including 45 device malfunctions and 46 patient injuries. Of all adverse events reported for Bonebridge, 15 (26.3%, 15/57) documented patient injuries, while the majority (73.7%, 42/57) documented device malfunctions. Of all adverse events reported for Osia, 3 (8.8%, 3/34) were reported concerning malfunctions, while 31 (91.2%, 31/34) were reported for patient injuries. The most commonly reported adverse events included lack of conduction or hearing (n = 26, 28.6%), infection (n = 14, 15.4%), and intermittent or reduced conduction or hearing (n = 12, 13.2%). From the MAUDE database reported adverse events and the total number of Osia implants given to us from Cochlear over this 28 month period, we estimate patient injuries to occur in roughly 2.1% of patients. CONCLUSION There are limitations to the database which make systemic analysis challenging. This study suggests that patients with transcutaneous, active BCIs may be experiencing fewer soft tissue injuries, but similar device malfunctions as those with previous models.
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Omar M, Qatanani A, Kaleem SZ, McKinnon BJ. Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review. Laryngoscope 2021; 132:670-686. [PMID: 34191304 DOI: 10.1002/lary.29716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country. STUDY DESIGN Systematic review. METHODS A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate. RESULTS Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020. CONCLUSION Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data. Laryngoscope, 2021.
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Affiliation(s)
- Mahmoud Omar
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Anas Qatanani
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Syed Z Kaleem
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas, U.S.A
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Jimenez JE, Govil N, Shaffer AD, Ledonne JC, Chi DH. Hearing preservation with a slim modiolar cochlear implant in a pediatric cohort. Int J Pediatr Otorhinolaryngol 2021; 140:110479. [PMID: 33190921 DOI: 10.1016/j.ijporl.2020.110479] [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: 07/26/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Recent cochlear implant (CI) electrodes are designed to be atraumatic to inner ear structures. Studies in adults have demonstrated improved hearing preservation rates with the CI532/632 electrode, but none have examined this in children. Our objective is to describe the hearing preservation rate with CI532/632 in pediatric patients and determine factors that influence hearing preservation. METHODS We conducted a retrospective cohort study of children undergoing CI over a three-year period. Inclusion criteria were: CI with the 532/632 electrode, presence of pre-operative low frequency hearing defined by pure tone average (PTA) of ≤80 dB at 250 Hz or at the average of 250 and 500 Hz, and post-operative unaided audiometry. Other data collected included demographics, otologic history, imaging, and surgical details. RESULTS A total of 13 patients and 15 ears were included. Hearing was preserved in 10/15 (66%) ears at an average follow-up of 6 months, similar to that reported in the adult literature. Patients with preserved hearing post-operatively were more likely to have a positive family history of hearing loss. There was a trend towards patients with anatomic inner ear abnormalities being more likely to lose hearing after CI, but this was not statistically significant. Pre-operative thresholds were not predictive of hearing preservation. Patients with preserved hearing had a significantly smaller shift in thresholds after cochlear implantation. Therefore, hearing preserved and non-preserved groups differed more by the magnitude of change in threshold, rather than their preoperative threshold. Other factors such as age, sex, surgeon, and surgery duration were not associated with hearing preservation. CONCLUSION This study describes low frequency hearing preservation after pediatric CI532/632 implantation. The hearing preservation rate in our cohort was consistent with that reported in the adult literature. Our data suggest that preoperative thresholds do not solely determine which patients will go on to experience hearing preservation. We believe this will aid surgeons with patient-specific device selection and counseling potential pediatric CI recipients with preserved hearing.
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Affiliation(s)
- Joaquin E Jimenez
- Department of Otolaryngology, University of Pittsburgh Medical Center, UPMC Eye & Ear Institute, 203 Lothrop Street, Suite 519, Pittsburgh, PA, 15213, United States.
| | - Nandini Govil
- Department of Otolaryngology-Head and Neck Surgery, Emory University & Children's Healthcare of Atlanta, 1400 Tullie Road NE, 1st Floor, Atlanta, GA, 30329, United States.
| | - Amber D Shaffer
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
| | - Jessica C Ledonne
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
| | - David H Chi
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
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Abstract
Congenital cholesteatoma is a rare, primarily pediatric disease that presents in otherwise healthy ears. Typically, this disease is found in a well-defined sac in the middle ear, making it particularly suited for removal through transcanal endoscopic ear surgery. This article reviews the ways in which endoscopy can be applied to the surgical management of congenital cholesteatoma and provides a guide based on congenital cholesteatoma stage and extent. Outcomes have shown similar rates of residual disease in total endoscopic ear surgery compared with operative microscopy.
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Affiliation(s)
- Rachel McCabe
- Department of Otolaryngology, University of Minnesota, 420 Delaware Street Southeast, MMC 396, Minneapolis, MN 55455, USA
| | - Daniel J Lee
- Pediatric Otology and Neurotology, Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Manuela Fina
- Department of Otolaryngology, University of Minnesota, HealthPartners Medical Group, 401 Phalen Blvd, St Paul, MN 55130, USA.
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Windsor AM, Ruiz R, O'Reilly RC. Congenital soft tissue stenosis of the external auditory canal with canal cholesteatoma: Case report and literature review. Int J Pediatr Otorhinolaryngol 2020; 134:110053. [PMID: 32344234 DOI: 10.1016/j.ijporl.2020.110053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Congenital external auditory canal stenosis (EACS) is a spectrum of abnormalities affecting the external and middle ear. We report a 6 year-old patient with EACS affecting the lateral fibrocartilaginous canal that was successfully repaired. This patient highlights a variant of EACS characterized by lateral soft tissue narrowing with normal osseous development. Most previous studies of CAA have described severe forms associated with complete atresia, bony stenosis, and middle ear malformations. Stenosis affecting only the fibrocartilaginous canal is a milder form resulting from premature arrest of the canalization process during embryologic development, and may predispose to cholesteatoma formation.
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Prasad N, Harley E. The aural foreign body space: A review of pediatric ear foreign bodies and a management paradigm. Int J Pediatr Otorhinolaryngol 2020; 132:109871. [PMID: 32050118 DOI: 10.1016/j.ijporl.2020.109871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE We aim to describe and review the management of pediatric aural foreign bodies (FBs). METHODS We performed an observational study and retrospective chart review with statistical analysis of management for patients presenting with aural FBs to the Emergency Department (ED) with or without ENT consultation, or presenting directly to the ENT clinic. RESULTS There were 166 objects in the ears of 155 children. Paper and beads were the most common objects. Micro-alligator forceps and small right-angle hooks were the most commonly used instruments for removal. 60% of patients had attempted removal prior to referral to Otolaryngology, who removed 72% of the FBs in the outpatient setting, 23% in the operating room, and 2.5% in the ED. CONCLUSION Taking into account certain characteristics of the object reflects an efficient manner in which to determine referral of difficult removals to Otolaryngology. Providers should determine if the FB is very hard or very soft and spherical or cylindrical with secondary consideration of cost to the patient and hospital in order to properly navigate treatment. Soft and irregular objects may be extracted without need for referral to Otolaryngology. Patients with aural FBs that are hard or round, in instances which previous attempts have failed, and/or where there is trauma to the ear should be referred to Otolaryngology to avoid worsening the position of the FB and increasing the chances of requiring removal in the operating room.
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Affiliation(s)
- Navin Prasad
- Georgetown University School of Medicine, Washington, DC, United States.
| | - Earl Harley
- Department of Otolaryngology - Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, United States.
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Lafferty DJ, Cohn JE, McKinnon BJ. Incidental mastoid opacification on computed tomography in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 128:109688. [PMID: 31593875 DOI: 10.1016/j.ijporl.2019.109688] [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: 01/27/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Incidental mastoid opacification (IMO) is a common radiologic finding and source of referral to otolaryngologists. Our objectives were to: 1) determine the rate of IMO in our pediatric population; 2) identify those with clinical mastoiditis; and 3) identify factors necessitating an otolaryngology consultation. METHODS This was a retrospective chart review at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients with the keyword 'mastoid' on a computed tomography (CT) scan report were reviewed. The effect of age, gender, season and the use of contrast media on the rate of IMO was also analyzed. Chi-square analysis was used to compare the significance of categorical frequencies. RESULTS The rate of IMO in our cohort was 14.2% (164/1157). In children <8 years of age, the IMO rate was 22.0% compared to 5.6% in children 8-17 years of age (p < .001). The IMO rate in male children was 16.6% compared to 11.0% in female children (p = .007). There was no statistically significant higher rate of IMO during winter (15.1%) compared to summer (9.0%) and in CT scans with contrast (16.0%) compared to without contrast (14.0%). Our department of otolaryngology was formally consulted in 3% (5/164) of IMO cases. None of those patients had clinical mastoiditis. CONCLUSIONS This is the largest study identifying IMO on CT and in children to date. Although the overall rate of IMO in the pediatric population is 14.2%, it is rarely clinically significant.
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Affiliation(s)
- David J Lafferty
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; Department of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; Department of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brian J McKinnon
- Department of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
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McGuire JK, Fagan JJ, Wojno M, Manning K, Harris T. Radiological differences between HIV-positive and HIV-negative children with cholesteatoma. Int J Pediatr Otorhinolaryngol 2018; 110:6-11. [PMID: 29859589 DOI: 10.1016/j.ijporl.2018.04.011] [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: 05/31/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. OBJECTIVES Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. METHODS A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at our institute over a 6 year period. RESULTS Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to opacification of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. CONCLUSION HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.
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Affiliation(s)
- J K McGuire
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - J J Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - M Wojno
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - K Manning
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Harris
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
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Van Wyhe RD, Emery CV, Williamson RA. Cochlear implantation in pediatric patients with Cockayne Syndrome. Int J Pediatr Otorhinolaryngol 2018; 106:64-67. [PMID: 29447894 DOI: 10.1016/j.ijporl.2017.12.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
Cockayne Syndrome (CS) is a rare, autosomal recessive disorder characterized by a spectrum of phenotypic abnormalities, including progressive sensorineural hearing loss (SNHL) that involves both peripheral and central components. To date, a single series of CS patients undergoing cochlear implant (CI) placement has been reported; this study reports on additional previously unreported pediatric CI recipients. Subjective benefits were noted early after activation in both patients, and speech perception scores improved over time as well, varying from 42 to 70% (versus 0-12% previously). Thus, we report that cochlear implantation in pediatric patients with CS can be effective in the management of progressive SNHL.
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Affiliation(s)
- Renae D Van Wyhe
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Texas Children's Hospital, Department of Pediatric Otolaryngology, 5th Floor, 6621 Fannin Street, Houston, TX 77030, USA.
| | - Claudia V Emery
- Texas Children's Hospital, Department of Audiology, 6621 Fannin Street 5th Floor, Houston, TX 77030, USA.
| | - Robert A Williamson
- Dell Medical School at the University of Texas at Austin, Department of Otolaryngology/ENT, 6811 Austin Center Blvd Suite 300, Austin, TX 78731, USA.
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Appelbaum EN, Howell JB, Chapman D, Pandya A, Dodson KM. Analysis of risk factors associated with unilateral hearing loss in children who initially passed newborn hearing screening. Int J Pediatr Otorhinolaryngol 2018; 106:100-104. [PMID: 29447880 DOI: 10.1016/j.ijporl.2018.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze 2007 Joint Committee on Infant Hearing (JCIH) risk factors in children with confirmed unilateral hearing loss (UHL) who initially passed newborn hearing screening. METHODS Retrospective record review of 16,108 infants who passed newborn hearing screening but had one or more JCIH risk factors prompting subsequent follow-up through the universal newborn hearing screening (UNHS) program in Virginia from 2010 to 2012. The study was reviewed and qualified as exempt by the Virginia Commonwealth University Institutional Review Board (IRB) and the Virginia Department of Health. RESULTS Over the 2-year study period, 14896 (4.9% of total births) children passed UNHS but had the presence of one or more JCIH risk factor. Ultimately, we identified 121 babies from this group with confirmed hearing loss (0.7%), with 48 babies (0.2%) showing UHL. The most common risk factors associated with the development of confirmed UHL after passing the initial screen were neonatal indicators, craniofacial anomalies, family history, and stigmata of syndrome associated with hearing loss. CONCLUSION Neonatal indicators and craniofacial anomalies were the categories most often found in children with confirmed unilateral hearing loss who initially passed their newborn hearing screen. While neonatal indicators were also the most common associated risk factor in all hearing loss, craniofacial abnormalities are relatively more common in children with UHL who initially passed newborn hearing screening. Further studies assessing the etiology underlying the hearing loss and risk factor associations are warranted.
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Affiliation(s)
- Eric N Appelbaum
- Department of Otolaryngology-HNS, Virginia Commonwealth University, 401 North 11th Street, PO Box 980146, Richmond, VA, 23298, United States.
| | - Jessica B Howell
- Department of Otolaryngology-HNS, Virginia Commonwealth University, 401 North 11th Street, PO Box 980146, Richmond, VA, 23298, United States.
| | - Derek Chapman
- Department of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Arti Pandya
- Department of Pediatrics, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
| | - Kelley M Dodson
- Department of Otolaryngology-HNS, Virginia Commonwealth University, 401 North 11th Street, PO Box 980146, Richmond, VA, 23298, United States
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De Zinis LOR, Berlucchi M, Nassif N. Double-handed endoscopic myringoplasty with a holding system in children: Preliminary observations. Int J Pediatr Otorhinolaryngol 2017; 96:127-130. [PMID: 28390601 DOI: 10.1016/j.ijporl.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/17/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Endoscopic transcanal myringoplasty is a newly-introduced technique for reconstruction of tympanic membrane perforation that offers the advantage to obviate postauricular incision. The objective of this study was to evaluate the feasibility of a double-handed endoscope holder transcanal myringoplasty in children. This technique permits bimanual execution of the procedure and allows the surgeon to overcome the two significant issues of single-handed endoscope surgery, i.e. easy domination of a bloody field and smooth introduction of the graft. METHODS A prospective non-randomized study of 10 consecutive primary endoscope holder-aided myringoplasties was performed; 3 mm or 4 mm 0° rigid endoscopes were used. A xenograft, biologic soft tissue, was applied in all cases. RESULTS All procedures were performed successfully. Duration of surgery was faster than with a single-handed procedure and varied between 20 and 60 min. The tympanic membrane healed successfully in all patients. CONCLUSIONS In this preliminary experience in children, a bimanual endoscopic holder-aided myringoplasty technique offers the possibility to overcome the obstacles encountered in a single-handed technique, since it can replicate the same concept of a bimanual microscopic approach and allow for easy management of a bloody field and introduction of the graft in the middle ear.
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Affiliation(s)
| | - M Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - N Nassif
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy.
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Dedhia K, Choi S, Chi DH. Management of refractory tympanostomy tube otorrhea with ear wicks. Laryngoscope 2014; 125:751-3. [PMID: 25215630 DOI: 10.1002/lary.24905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Kavita Dedhia
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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