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• Minimal access and standard cochlear implantation: A comparative study.

  Authors: Jeremy D Prager, Marci J Neidich, Jonathan N Perkins, Jareen Meinzen-Derr, John H Greinwald

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To compare the operative times and complications between patients who underwent minimal access cochlear implantation and standard technique cochlear implantation. METHODS: Patients whoOBJECTIVE: To compare the operative times and complications between patients who underwent minimal access cochlear implantation and standard technique cochlear implantation. METHODS: Patients who underwent unilateral cochlear implantation by a single surgeon from 2001 to 2010. The minimal access technique of an approximately 2.5-3cm post-auricular incision with creation of subperiosteal pocket for the device was compared to the longer standard "S" incision into the scalp (∼8-10cm) with bone well creation and suture fixation. Outcomes include operative times and complications. RESULTS: There were 122 unilateral implants, 73 (59.8%) in the minimal access group and 49 (40.2%) in the standard group. Mean total time in the operating room was lower in the minimal access group compared to the standard group (200±31 vs. 255±49min, p<.0001) as well as mean operative time (149.5±28 vs. 200±45min, p<.0001 respectively). There were 17 complications in the entire cohort with 8 and 9 complications in the minimal and standard groups respectively. Of the 17 complications, 12 were surgical technique-specific. Although it appeared that there were higher rates of major, technique-specific, and overall complications in the standard access group, these differences did not reach statistical significance. CONCLUSIONS: Patients undergoing minimal access cochlear implantation require shorter operative times when compared to the standard access cochlear implantation. In addition, low complication rates are observed for major, technique-specific, and overall complications. Minimal access cochlear implantation may be considered an equivalent and potentially superior technique.

• Pediatric septoplasy: A review of the literature.

  Authors: Rachael Lawrence

  International journal of pediatric otorhinolaryngology.

  OBJECTIVES: Controversy has surrounded the procedure of pediatric septoplasty since the 1950s due to concerns over an adverse effect on nasal and facial growth. However, more recent evidence hasOBJECTIVES: Controversy has surrounded the procedure of pediatric septoplasty since the 1950s due to concerns over an adverse effect on nasal and facial growth. However, more recent evidence has demonstrated that septoplasty can be safely performed without affecting nasal and facial development in the appropriately selected pediatric patient. The purpose of this article is to establish the impact of pediatric septoplasty on nasal and facial growth and review the clinical indications and evidence for timing of surgery according to the most recent literature. METHODS: A structured review of the PubMed, Ovid Medline and Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the terms: pediatric, childhood, septoplasty, nasal septum, indications, nasal growth and facial growth. RESULTS: Three long term follow up studies using anthropometric measurements were identified which concluded that pediatric septoplasty does not interfere with normal nasal or facial development. A further similar study concluded that external septoplasty does not affect most aspects of nasal and facial growth, but may negatively influence growth of the nasal dorsum. Furthermore, one study demonstrated that a group of children with symptomatic uncorrected deviated nasal septum had a statistically significant increased occurrence of facial and dental anomalies compared with age and sex matched controls, therefore supporting a role for septoplasty. CONCLUSIONS: Evidence exists to support that pediatric septoplasty can be performed without affecting most aspects of nasal and facial growth. Furthermore, not performing or delaying septoplasty when indicated may adversely affect nasal and facial growth with compounding adverse effects in terms of deformity and asymmetry. Despite the majority advocating the timing of septal surgery to be 6 years and older, more clinical studies are required that may provide further evidence for correction of septal deviations in younger children, perhaps even at birth.

• The effect of paracetamol, metamizole sodium and ibuprofen on postoperative hemorrhage following pediatric tonsillectomy.

  Authors: Mahmut Ozkiriş, Zeliha Kapusuz, Yavuz Selim Yildirim, Levent Saydam

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To determine the risk of postoperative hemorrhage associated with the use of analgesic drugs including paracetamol, metamizole sodium and ibuprofen after pediatric tonsillectomy. PATIENTSOBJECTIVE: To determine the risk of postoperative hemorrhage associated with the use of analgesic drugs including paracetamol, metamizole sodium and ibuprofen after pediatric tonsillectomy. PATIENTS AND METHODS: Three hundred and forty consecutive children with recurrent tonsillitis and/or obstructive symptoms were included in the study. Children were divided into three groups based on the drugs used for postoperative pain relief. Each group received paracetamol, metamizole sodium and ibuprofen following the surgery. The study of population was compared respect to postoperative bleeding. Chi-square test was used for statistical analysis. RESULTS: A total of 115 patients received ibuprofen, 115 patients were given metamizole sodium and 110 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in fourteen (4.11%) children, consisting of primary hemorrhage in two patients and secondary hemorrhage in twelve patients. While 6 of 115 children (5.21%) who were given ibuprofen had postoperative hemorrhage, 4 of 115 children (3.47%) in metamizole sodium group and 4 of 110 patients (3.63%) in paracetamol group had hemorrhage. There was no significant difference with respect to hemorrhage rates between these three groups (p<0.05). CONCLUSION: In our study we could not show significant risk of hemorrhage after using of ibuprofen, metamizole sodium and paracetamol administration and they can be used safely for posttonsillectomy pain.

• Surgical treatment of paediatric cholesteatoma: Long-term follow up in comparison with adults.

  Authors: Lennart Edfeldt, Anders Kinnefors, Karin Strömbäck, Susanne Köbler, Helge Rask-Andersen

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: This study was designed to analyse long-term results after surgery of acquired (ACH) and congenital cholesteatoma (CCH) of the middle ear in children and compare these with adults.OBJECTIVE: This study was designed to analyse long-term results after surgery of acquired (ACH) and congenital cholesteatoma (CCH) of the middle ear in children and compare these with adults. METHODS: Computer-based analysis of consecutively operated paediatric patients for ACH and CCH in a tertiary referral centre was made in 57 cases under the age of 12 operated 1983-2004 by three surgeons using identical technique. A canal wall down and total reconstruction procedure (TRP) with obliteration of the mastoid cavity, canal wall reconstruction, ossiculoplasty with consistent use of autologous bone and an "aeration enhancement procedure" (AEP) with silicon sheet in selected cases were used. Pre- and post-operative PTA (0.5-3kHz) and pure-tone average air-bone gap (PTA-ABG) together with surgical parameters were assessed 1, 3 and 6 years following surgery. RESULTS: Results showed stable hearing over 6 years with low incidence of persistent and recurrent disease comparable with results from adult patients. In nearly half of the cases, silastic sheeting was used. In 21 cases, stapes was eroded. Bone conduction thresholds levels remained unaffected 6 years after surgery. No deaf ears, postoperative facial dysfunction or other lesions related to surgery were observed. Six years after surgery every evaluated ear was found to be water-resistant and infection -free. CONCLUSION: Our results suggest that one-stage eradication of ACH and CCH in children using total reconstruction procedure (TRP) provide long-term improvement or preservation of hearing, with a low incidence of persistent or recurrent disease. No difference in surgical outcome between children and adults was found.

• Mandibular distraction osteogenesis in children with Pierre Robin sequence: Impact on health-related quality of life.

  Authors: Paul Hong, Michael McNeil, Donald B Kearns, Anthony E Magit

  International journal of pediatric otorhinolaryngology.

  BACKGROUND: Upper airway obstruction in children with Pierre Robin sequence (PRS) may be severe enough to require surgical intervention. Although many studies have demonstrated the effectiveness ofBACKGROUND: Upper airway obstruction in children with Pierre Robin sequence (PRS) may be severe enough to require surgical intervention. Although many studies have demonstrated the effectiveness of mandibular distraction osteogenesis (MDO) in relieving airway obstruction, no study has reported health-related quality of life (QOL) outcomes. The objective of the present study was to conduct the first health-related QOL assessment post-MDO. METHODS: The Glasgow Children's Benefit Inventory (GCBI) questionnaire was distributed in a retrospective manner to the caregivers of all children who had undergone MDO at the authors' institutions between January 2007 and December 2010. Patients who had other major surgical procedures were excluded. RESULTS: The response rate was 84% (21 of 25 questionnaires completed). The total mean GCBI score was +54 (SD, 19.5), which demonstrated a subjective overall benefit in health-related QOL post-MDO. All of the domains within the GCBI also scored in the positive range, indicating domain specific improvements in health-related QOL. There were no significant differences in the GCBI scores between syndromic-PRS patients and isolated PRS patients; similar results were observed between tracheostomy patients and no tracheostomy patients. SUMMARY: In treating children with PRS and severe upper airway obstruction, MDO resulted in a subjective overall benefit in health-related QOL in our study population.

• The conceptions of hearing impairment, causes and its management: A train survey.

  Authors: Suman Kumar, Nachiketa Rout, Punam Kumari, Bhaskar Dey

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To identify the perception of the train passengers about the cause and the management of hearing loss. METHODOLOGY: A total of 115 passengers, 90 males and 25 females, in the age range ofOBJECTIVE: To identify the perception of the train passengers about the cause and the management of hearing loss. METHODOLOGY: A total of 115 passengers, 90 males and 25 females, in the age range of 13-80 years (mean: 39.19, standard deviation: 15.4) years. RESULTS: From the survey, it is found that most of the participants (82.6%) had seen a person with hearing loss. Among them, 10 reported to have relatives who have hearing loss but did not know where they should be taken for remedy. Seventeen individuals (all geriatric) were suspected to be having reduced hearing acuity during the survey. However, none of them admitted to be having a significant disability due to hearing loss. Also 48% of the participants correctly attribute hearing loss to biological and environmental causes (genetic, congenital and noise induced causes) and three percent of them attributed it to myth revealing that most of the participants had awareness about what could cause hearing impairment. Regarding management, most of the participants (25.2%) agreed to medical treatment as the best, followed by hearing aids (23.5%). There were no myths related to management. Five of the participants interviewed, were already undergoing medical treatments from various medical institutions for their hearing impairment, but reported to have no benefit from the treatment. Among the participants who answered yes to question 4, most of them recognized Speech Language Pathologists as professionals who could manage speech difficulties but mostly attributed management of hearing impairment to an Ear Nose and Throat (ENT) specialist. CONCLUSIONS: An awareness pamphlet targeting the myths can be distributed on train, role of an audiologist as a hearing professional can also be targeted in the pamphlets, language used in the advertisements and pamphlets should be culture and region specific, pictorial representation could be a better idea, the need for a healthy and comfortable communication has to be explained especially to the adults and geriatric population and the elderly persons must have both, the skills and the motivation to communicate in the external environment which must be conducive for communication [22].

• Monolateral suppurative parotitis in a neonate and review of literature.

  Authors: Lidia Decembrino, Giulia Ruffinazzi, Fabio Russo, Paolo Manzoni, Mauro Stronati

  International journal of pediatric otorhinolaryngology.

  OBJECTIVES: Neonatal suppurative parotitis is a rare condition characterized by swelling, pain, and erythema over the affected gland. Antimicrobials and adequate hydration are an essential part ofOBJECTIVES: Neonatal suppurative parotitis is a rare condition characterized by swelling, pain, and erythema over the affected gland. Antimicrobials and adequate hydration are an essential part of treatment. Surgical intervention is reserved for organized abscesses and for infections not responding to medical management. METHODS: A case report and review of the literature. RESULTS: Only few case reports and case series are reported in literature on neonatal parotitis. Transmission of bacteria seems to occur mainly by ascending spread through Stensen's duct, or by hematogenous spread from a distant focus. Dehydration, low birth weight, immune suppression, ductal obstruction, oral trauma and structural abnormalities of the parotid gland are recognised as risk factors. The most common pathogen is Staphylococcus aureus. Other less frequent agents are other Gram-positive cocci, Gram-negative bacilli and rarely anaerobic bacteria. Advances in antimicrobial therapy have improved both outcome and prognosis. CONCLUSIONS: Thanks to the prompt antibiotic treatment complications are now drastically reduced. Ultrasound examination may help in the diagnosis and monitoring of clinical course.

• Doxycycline sclerotherapy for pediatric head and neck macrocystic lymphatic malformations: A case series and review of the literature.

  Authors: Nausheen Jamal, Sameer Ahmed, Todd Miller, John Bent, Allan Brook, Sanjay Parikh, Ashish Ankola

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: (a) To evaluate the efficacy of doxycycline as a percutaneous sclerotherapy agent in pediatric head and neck macrocystic lymphatic malformations (LM) and (b) to review the literature withOBJECTIVE: (a) To evaluate the efficacy of doxycycline as a percutaneous sclerotherapy agent in pediatric head and neck macrocystic lymphatic malformations (LM) and (b) to review the literature with regard to recent developments in the treatment of lymphatic malformations using sclerotherapy. METHODS: We reviewed the medical records and imaging studies of all patients who underwent percutaneous sclerotherapy of macrocystic LM of the head and neck at our institution between June 2005 and May 2010. All studies were reviewed and procedures performed by a single interventional neuroradiologist using computed tomography (CT) guidance. LM were individually cannulated, the contents aspirated, and then injected with doxycycline at concentrations of 10-20mg/ml. Response to sclerotherapy was determined clinically. RESULTS: Seven patients underwent a total of eight sclerotherapy treatments during the study period. Of the six patients with appropriate follow-up, 67% have experienced complete or near-complete clinical resolution of their LM (1243 days mean follow-up), while 33% have developed recurrent swelling after an initial response following a single doxycycline injection (53 days mean follow-up). CONCLUSIONS: Our institutional results, in combination with recently published findings, support the moderate efficacy and excellent safety profile of percutaneous doxycycline sclerotherapy for macrocystic lymphatic malformations.

• Who should manage acute periorbital cellulitis in children?

  Authors: Navdeep S Upile, Nazia Munir, Samuel C Leong, Andrew C Swift

  International journal of pediatric otorhinolaryngology.

  INTRODUCTION: Periorbital cellulitis is inflammation of the eye anterior to the palpebral ligament. The sequeale may be life or vision threatening. There is no consensus on the optimal managementINTRODUCTION: Periorbital cellulitis is inflammation of the eye anterior to the palpebral ligament. The sequeale may be life or vision threatening. There is no consensus on the optimal management strategies. METHODS: A two year retrospective case note analysis was performed on all hospital admissions to a tertiary children's hospital with the diagnosis. RESULTS: 226 notes were retrieved, 13 were excluded. The incidence of periorbital cellulitis was nearly 9 cases per month (8.875): the median length of stay was 2 days: all were treated with antibiotics. Only 7 children (3%) underwent surgical intervention. DISCUSSION: Due to potentially serious intracranial and orbital complications, authors have previously argued that all patients with periorbital cellulitis need daily otorhinolaryngology assessment. This current review showed a much larger incidence than in the published literature, with the majority being managed by the paediatricians and ophthalmologists. Escalation to otorhinolaryngology when first line treatment has failed is a more appropriate use of resources.

• The second branchial cleft fistula.

  Authors: John Maddalozzo, Jeffrey C Rastatter, Heath F Dreyfuss, Reema Jaffar, Bharat Bhushan

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To review the surgical anatomy and histopathology of second branchial cleft fistulae. STUDY DESIGN: Retrospective study of patients treated for second branchial cleft fistulae at aOBJECTIVE: To review the surgical anatomy and histopathology of second branchial cleft fistulae. STUDY DESIGN: Retrospective study of patients treated for second branchial cleft fistulae at a tertiary care pediatric hospital. The senior author noted anatomic and histologic features of second branchial cleft fistulae, not previously described. SETTING: Tertiary care children's hospital. PATIENTS AND METHODS: Retrospective examination of 28 patients was conducted who were operated upon for second branchial cleft fistula. Data collected included age at surgery, initial presentation, imaging characteristics prior to surgery, laterality of the fistula tract, pathology results and follow-up data. RESULTS: Twenty-eight patients met the criteria for inclusion. Three patients (11%) had bilateral fistulae. 11 (39%) were male and 17 (61%) were female. 23 (74.2%) tracts were lined with ciliated columnar epithelium, 3 (9.7%) had cuboidal epithelium, and 5 (16.7%) had squamous epithelium. Nineteen (61.3%) tracts contained salivary tissue. Of the unilateral fistula tracts, 25 (100%) were on the right side. Of the 3 patients with bilateral lesions, 2 (66%) had associated branchio-oto-renal syndrome (BORS). CONCLUSIONS: Second branchial cleft fistulae are rare. They are usually right-sided. If bilateral fistulae are present, one should consider an underlying genetic disorder. The histology of the fistulae mostly demonstrates ciliated columnar epithelium with the majority of specimens showing salivary tissue. There is a clear association with the internal jugular vein (IJV). Dissection should continue until superior to the hyoid bone, ensuring near complete surgical dissection and less risk of recurrence.

• Endoscopic brow approach for frontal osteoma in a pediatric patient.

  Authors: Samuel L Oyer, Krishna G Patel

  International journal of pediatric otorhinolaryngology.

  Osteomas are benign bony growths that have been reported following trauma. Previous management of forehead osteomas has centered around direct excision, but there has been a recent interest inOsteomas are benign bony growths that have been reported following trauma. Previous management of forehead osteomas has centered around direct excision, but there has been a recent interest in endoscopic resection to improve cosmesis. Endoscopic resection has previously been described in adults, but not in children. We describe a case of a 15-year-old who developed a forehead osteoma following trauma that was resected entirely endoscopically, leaving no visible scar with resolution of edema and good cosmetic result as early as post-operative day 9. Our case lends evidence to support the safe and effective use of this technique in adolescents.

• Fat graft myringoplasty using umbilical fat.

  Authors: Kelvin M Kwong, Matthew M Smith, James M Coticchia

  International journal of pediatric otorhinolaryngology.

  BACKGROUND: Myringoplasty is a common procedure performed by otolaryngologists, particularly in the pediatric population. Tympanic membrane (TM) perforations can be caused by a variety of factorsBACKGROUND: Myringoplasty is a common procedure performed by otolaryngologists, particularly in the pediatric population. Tympanic membrane (TM) perforations can be caused by a variety of factors including retained tympanostomy tubes, infection and trauma. First described in 1878, myringoplasty has evolved to include many different materials for repair. Current materials used for myringoplasties include fascia, perichondrium, gelfoam, fat and paper. Multiple studies have looked at the success rates for these different materials. Fat graft myringoplasties in particular offer the advantage of a high success rate commonly reported in the range between 80% and 90%. Fat graft is classically harvested from ear lobe or post-auricular subcutaneous tissue. PURPOSE: In this study, we described the techniques and results of harvesting umbilical fat for the use in pediatric myringoplasty. METHOD: Twenty-eight cases of umbilical fat-graft myringoplasty performed between June 2008 and January 2011 was retrospectively reviewed and studied for rate of successful TM closure. RESULTS: Average length of follow up was 8 months ranging from 3 months to 26 months. Overall rate for successful TM closure of 100% was achieved. Literature review was performed to compare our results with those of studies using auricular fat graft. Furthermore, a review of existing literature on various properties of fat graft was done to explain the potential advantages of using umbilical fat for myringoplasty. CONCLUSION: Fat patch myringoplasty using umbilical fat is a safe and successful procedure for TM repair.

• Letter to the Editor regarding 'Is local ointment or cauterization more effective in childhood recurrent epistaxis'

  Authors: Suay Ozmen, Omer Afsin Ozmen

  International journal of pediatric otorhinolaryngology.

• Targeted surveillance for postnatal hearing loss: A program evaluation.

  Authors: Rachael Beswick, Carlie Driscoll, Joseph Kei, Shirley Glennon

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: The importance of monitoring hearing throughout early childhood cannot be understated. However, there is a lack of evidence available regarding the most effective method of monitoringOBJECTIVE: The importance of monitoring hearing throughout early childhood cannot be understated. However, there is a lack of evidence available regarding the most effective method of monitoring hearing following the newborn screen. The goal of this study was to describe a targeted surveillance program using a risk factor registry to identify children with a postnatal hearing loss. METHODS: All children who were born in Queensland, Australia between September 2004 and December 2009, received a bilateral 'pass' on newborn hearing screening, and had at least one risk factor, were referred for targeted surveillance and were included in this study. The cohort was assessed throughout early childhood in accordance with Queensland's diagnostic assessment protocols. RESULTS: During the study period, 7320 (2.8% of 261,328) children were referred for targeted surveillance, of which 56 were identified with a postnatal hearing loss (0.77%). Of these, half (50.0%) were identified with a mild hearing loss, and 64.3% were identified with a sensorineural hearing loss. In regards to risk factors, syndrome, craniofacial anomalies, and severe asphyxia had the highest yield of positive cases of postnatal hearing loss for children referred for targeted surveillance, whereas, low birth weight, bacterial meningitis, and professional concern had a particularly low yield. Limitations of the targeted surveillance program were noted and include: (1) a lost contact rate of 32.4%; (2) delays in first surveillance assessment; (3) a large number of children who required on-going monitoring; and (4) extensive diagnostic assessments were completed on children with normal hearing. Examination of the lost contact rate revealed indigenous children were more likely to be documented as lost contact. In addition, children with one risk factor only were significantly more likely to not attend a surveillance appointment. CONCLUSIONS: Positive cases of postnatal hearing loss were detected through the targeted surveillance program. However, the limitations of the program question the usefulness of this service delivery model. For targeted surveillance to continue, time frames for assessment, assessments performed, and discharge criteria need to be revisited. The contribution of individual and combined risk factors in detecting postnatal hearing loss should also be examined in more detail.

• Can Helicobacter pylori cause inflammation in the middle ear?

  Authors: Abdullah Aycicek, Zafer Cetinkaya, Halil Kıyıcı, Aysegul Bukulmez, Fatih Yucedag

  International journal of pediatric otorhinolaryngology.

  OBJECTIVES: To investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion. METHODS: Sixteen adult New Zealand white rabbits were dividedOBJECTIVES: To investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion. METHODS: Sixteen adult New Zealand white rabbits were divided into two gropus equally. Group I was representing histamine-induced middle ear inflammation and Group II was representing normal middle ear. While H. pylori was inoculated in the right ears, physiologic saline was inoculated in the left ears of the rabbits in both groups. Results were evaluated clinically, histopathologically and microbiologically. Fisher's exact test was used for statistical analysis. RESULTS: In Group I, clinical scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Histopathological scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Also, H. pylori was isolated in 6 of the 8 right ears of the rabbits. In Group II, while clinical scores of the inflammation in the right ears scores were higher than the left ears scores at the 7th day, histopathological scores were not significantly different between both ears. Also, no H. pylori was isolated in right ears of the rabbits. CONCLUSIONS: Effusion in the middle ear induced by histamine is an appropriate medium for H. pylori reproduction and it also aggravates the inflammation process. In contrary, H. pylori did not cause inflammation in the normal middle ear. We suggest that H. pylori does not play a role in the etiology of otitis media with effusion alone, but it contributes to the inflammation process in the presence of an effusion.

• Nature and onset of communication disorder in pediatrics with HIV.

  Authors: Sujoy Kumar Makar, Sovon Dhara, Ashok Kumar Sinha, Indranil Chatterjee, Palash Dutta

  International journal of pediatric otorhinolaryngology.

  American Speech-Language Association (ASHA) and the International Association of Physicians in AIDS Care (IAPAC) reported that speech-language and hearing disorders that occur as a direct or indirectAmerican Speech-Language Association (ASHA) and the International Association of Physicians in AIDS Care (IAPAC) reported that speech-language and hearing disorders that occur as a direct or indirect consequence of HIV-infection are so common. However there has been little research into the nature and onset of such communication disorders in children living with HIV. Therefore the purpose of the study is to understand about the nature and onset of audiological and speech-language disorders of a group of children with HIV for the better management. In methodology 67 children (4-16 years, mean: 11.06) with HIV infection took part in the study. Otoscopic examination, Pure-tone and Impedance audiometry, REELS, SECS, PAT, FDA and BUFFALO-III was used to assess. In result, 22/67 individuals had hearing loss, 17/67 had swallowing disorder, 21/67 individuals had voice problems. Language development was delayed in 21/67 of the individuals at the pragmatic and syntactic level and 7/67 had the deviant language. There was negative correlation (r=-0.932) between the duration of HIV infection and degree of severity of communication disorders in the participants.

• Stentless endoscopic transnasal repair of bilateral choanal atresia starting with resection of vomer.

  Authors: Magdy Abdalla Sayed El-Ahl, Mohammad Waheed El-Anwar

  International journal of pediatric otorhinolaryngology.

  OBJECTIVES: To assess the results of a transnasal endoscopic repair of congenital choanal atresia beginning by resection of the posterior portion of the vomer and ending by no stent. METHODS: SevenOBJECTIVES: To assess the results of a transnasal endoscopic repair of congenital choanal atresia beginning by resection of the posterior portion of the vomer and ending by no stent. METHODS: Seven patients with bilateral congenital choanal atresia aged ranging from 3 to 15days were operated upon between June 2009 and September 2011. This transnasal endoscopic approach allowed resection of the posterior portion of the vomer first then the atretic plates and part of the medial pterygoid plate if needed leaving no stent. Postoperative control included office fiberoptic nasal endoscopy. RESULTS: Adequate functional nasal breathing was maintained in all patients during follow up of 11 to 23months. Apart from one case that complicated by palatal defect, no any other complications were detected. CONCLUSION: The described technique was proved to be very effective, allowing fast recovery, and one step surgery with early discharge from hospital using neither stents nor nasal packing. Good patency with no reduction in functional quality was also observed.

• Understanding obstructive sleep apnea in children with CHARGE syndrome.

  Authors: Carrie-Lee Trider, Gerard Corsten, Debra Morrison, Margaret Hefner, Sandra Davenport, Kim Blake

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: CHARGE syndrome occurs in approximately 1 in 8500 live births and is diagnosed clinically by combinations of major characteristics: choanal atresia, coloboma, characteristic ears, cranialOBJECTIVE: CHARGE syndrome occurs in approximately 1 in 8500 live births and is diagnosed clinically by combinations of major characteristics: choanal atresia, coloboma, characteristic ears, cranial nerve abnormalities and distinct temporal bone anomalies. More than 50% of children with CHARGE syndrome experience sleep disturbances, with obstructive sleep apnea being one diagnosis. Objectives of this study were to develop a better understanding of the prevalence, symptomatology and treatments of sleep apnea in CHARGE syndrome. Secondary aims were to determine the usefulness of questionnaires examining obstructive sleep apnea in a CHARGE syndrome population. METHODS: Parents of 51 children with CHARGE syndrome (aged 0-14years) were recruited between May 2010 and July 2011. Genetic testing and/or clinical criteria confirmed diagnosis of CHARGE syndrome. Questionnaires completed by parents included one covering CHARGE characteristics and three previously validated questionnaires: the Brouilette Score Questionnaire, the Pediatric Sleep Questionnaire and the OSA-18 Quality of Life Questionnaire. SPSS 19.0 was used for statistical calculations. RESULTS: Previous diagnosis of obstructive sleep apnea was present in 65% of the study population. Treatments included continuous positive airway pressure, tonsillectomy and/or adenoidectomy, and tracheostomy. Brouilette scores identified the presence of obstructive sleep apnea in the CHARGE syndrome population studied and indicated statistically significant (p=<0.001) improvements following treatment, which were comparable to the general population. Only the subscales of snoring and daytime sleepiness were useful in identifying obstructive sleep apnea using the Pediatric Sleep Questionnaire. The OSA-18 Questionnaire indicated that residual symptoms affecting quality of life may be present in the CHARGE syndrome population after treatment for obstructive sleep apnea. CONCLUSIONS: Obstructive sleep apnea appears to be prevalent in children with CHARGE syndrome. All conventional treatments for obstructive sleep apnea reduce symptomatology. Brouilette scores are useful in identifying obstructive sleep apnea in the CHARGE syndrome population. The Pediatric Sleep Questionnaire could be useful once modified. The OSA-18 Questionnaire would be most useful as a means to measure quality of life gains following treatment.

• Cricoid split for acute subglottic injury in the older child.

  Authors: M M C Yaneza, H Kubba, D M Wynne, W A Clement

  International journal of pediatric otorhinolaryngology.

  OBJECTIVES: To describe our experience of cricoid split in the older child for acquired subglottic stenosis secondary to chemical or thermal burns. METHODS: A retrospective case series. RESULTS: WeOBJECTIVES: To describe our experience of cricoid split in the older child for acquired subglottic stenosis secondary to chemical or thermal burns. METHODS: A retrospective case series. RESULTS: We describe two patients, both two years old, who benefitted from the procedure and had a return to a normal-sized airway. Neither child required a tracheostomy or further airway intervention after the cricoid split. CONCLUSIONS: Laryngotracheal reconstruction (LTR) is the standard treatment for subglottic injuries with associated subglottic stenosis in children, infants and (where possible) neonates. We have found the cricoid split a useful technique in carefully selected older children with acute subglottic injury and associated early subglottic stenosis, where LTR or ballooning is not feasible, where there is limited experience of ballooning, and/or ballooning has failed in the early stages of treatment. Cricoid split is a technique that is part of the airway surgeon's open operative repertoire and therefore should be remembered as a management option.

• Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study.

  Authors: Qing-Tao Meng, Zhong-Yuan Xia, Tao Luo, Yang Wu, Ling-Hua Tang, Bo Zhao, Jin-Hui Chen, Xiangdong Chen

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To evaluate the efficacy and safety of dexmedetomidine for emergence agitation after tonsillectomy in children. METHODS: 120 ASA physical status I and II children, aged 5-14 years,OBJECTIVE: To evaluate the efficacy and safety of dexmedetomidine for emergence agitation after tonsillectomy in children. METHODS: 120 ASA physical status I and II children, aged 5-14 years, undergoing anesthesia for tonsillectomy, were randomly divided into 3 groups: Placebo group, the low dexmedetomidine concentration group and the high dexmedetomidine concentration group. Before the entrance of the operating room (OR), all of the children received intravenous injection 40μgkg(-1) midazolam to reduce anxiety at first, and then dexmedetomidine was given intravenously at an initial loading dose of 0.5μgkg(-1) or 1μg/kg over a 10-min period via a computer controlled infusion pump followed by a maintenance infusion of 0.2μgkg(-1)h(-1) or 0.4μgkg(-1)h(-1)over the surgery. The heart rate, SpO(2) and mean arterial blood pressure were recorded for each patient in both operation room and PACU. The designated time points: at the start of the anesthetic induction, at the discontinuation of inhalational agents, at first opening of eyes, at time to remove endotracheal tube were recorded. After patient arrival at the PACU, VAS score, RSS, the occurrence of emergence agitation were recorded every 5min for the first 30min and every 10min for the next 30min after endotracheal tube was removed. RESULTS: There was significant difference in the incidence of emergence agitation between Placebo group and the high concentration group when endotracheal tube was removed (P<0.05). There was significant difference in the VAS pain scores and in the RSS between three groups at the time of extubation, as well as 5min and 10min after extubation (P<0.05). CONCLUSIONS: Dexmedetomidine appears to be safe and effective to reduce the incidence of early emergence agitation in children after tonsillectomy. Initial loading dose of 1.0μgkg(-1) followed by a maintenance infusion of 0.4μgkg(-1)h(-1) is better choice for children received tonsillectomy.

• Prevalence and risk factors of otitis media with effusion in school children in Eastern Anatolia.

  Authors: Muzaffer Kırıs, Togay Muderris, Tolga Kara, Sami Bercin, Hakan Cankaya, Ergün Sevil

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: To investigate the prevalence and demographic, environmental and child associated risk factors of OME in schoolchildren in Eastern Anatolia, Turkey, and analyze the results with referenceOBJECTIVE: To investigate the prevalence and demographic, environmental and child associated risk factors of OME in schoolchildren in Eastern Anatolia, Turkey, and analyze the results with reference to the review of the literature. METHODS: A total of 2355 children who were attending two different primary schools, one located in low, and the other located in a high socioeconomic district of city of Van were screened and 2320 children who met the inclusion criteria were enrolled to study. Standardized questionnaires that include nine questions for determination of risk factors were delivered to the parents to be filled before examination of each child. All of the children underwent both otoscopic examination and tympanometric evaluation to provide high accuracy on the diagnosis of OME. The association between children diagnosed as OME and the answers to the questionnaires were evaluated. Also, teachers of the children were asked to complete a questionnaire evaluating child's level of school success, and the success levels of children with or without OME were compared. RESULTS: The prevalence of OME was found to be 10.43%. Second-hand smoking (p<0.0001), low socioeconomic status (p<0.001), living in a crowded house (p<0.001), presence of atopy (p<0.01), lack of breast-feeding (p<0.05), presence of URTI (p<0.0001), young age (p<0.001) and snoring (p<0.0001) were found to be associated with prevalence of OME. No significance was found for duration of breast-feeding, gender, birth history and previous otolaryngological operations. Also, children with OME were tended to be less successful in terms of school success. CONCLUSIONS: The potential of OME to cause serious sequelae and complications that may affect children's life long-term, makes the disease an important health problem. Environmental, epidemiologic and familial factors play an important role in pathogenesis of OME. Caretakers must be informed about these highly modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

• Perinatal airway management of neonatal cervical teratomas.

  Authors: Kiarash Taghavi, Robert G Berkowitz, A Michelle Fink, Ross D Farhadieh, Anthony J Penington

  International journal of pediatric otorhinolaryngology.

  Cervical teratomas are rare but life-threatening neonatal tumors and management of the fetus with a cervical teratoma that threatens the airway remains a clinical challenge. This has beenCervical teratomas are rare but life-threatening neonatal tumors and management of the fetus with a cervical teratoma that threatens the airway remains a clinical challenge. This has been revolutionized by advances in fetal imaging and management of the airway at delivery including the use of Ex-utero Intrapartum Treatments (EXIT procedures). We present a retrospective case series of three neonates managed over a 12-month period. Following pre-natal fetal MRI and a multi-disciplinary management approach, two newborns were managed by prompt post-natal endotracheal intubation while an EXIT procedure was required in one. All three underwent surgical resection in the first few days of life. A decision regarding the best means by which to manage the airway in fetal cervical teratoma requires fetal MRI and a multi-disciplinary team approach to determine whether EXIT, or a safer approach from a maternal perspective can be employed. We also recommend routine endotracheal intubation at birth, due to the risk of spontaneous intra-tumoral hemorrhage. The need for surgery should be planned early, as rapid growth of the tumor can threaten the viability of the overlying skin and surrounding structures.

• Surgical site infections in paediatric otolaryngology operative procedures.

  Authors: S N Ifeacho, Y Bajaj, C G Jephson, D M Albert

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: An assessment of the rate of surgical site infections associated with elective paediatric otolaryngology surgical procedures. METHODS: Prospective data was collected for a 3-week periodOBJECTIVE: An assessment of the rate of surgical site infections associated with elective paediatric otolaryngology surgical procedures. METHODS: Prospective data was collected for a 3-week period for all children undergoing surgery where either mucosa or skin was breached. The parents of the children were requested to complete a questionnaire at 30 days after the operation. RESULTS: Data was collected on 80 consecutive cases. The majority of cases were admitted on the day of the procedure. The procedures included adenotonsillectomy (24), grommets (12), cochlear implantation (6), bone-anchored hearing aid (2), submandibular gland excision (1), branchial sinus excision (1), cystic hygroma excision (3), nasal glioma excision (1), microlaryngobronchoscopy (13), tracheostomy (3) and other procedures (14). Nearly half the cases had more than one operation done at the same time. 26/80 (32.5%) patients had a temporary or permanent implant inserted at the time of operation (grommet, bone-anchored hearing aid, cochlear implant). 25/80 (31%) operative fields were classed as clean and 55/80 (68.7%) as clean contaminated operations. The duration of the operation varied from 6min to 142min. Hospital antibiotic protocol was adhered to in 69/80 (86.3%) cases but not in 11/80 cases. In our series, 3/80 (3.7%) patients had an infection in the postoperative period. CONCLUSIONS: Surgical site infections do occur at an appreciable rate in paediatric otolaryngology. With the potential for serious consequences, reduction in the risk of surgical site infections is important.

• Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: A safe treatment option?

  Authors: Thorsten Ropposch, Ulrike Nemetz, Eva Maria Braun, Andreas Lackner, Christian Walch

  International journal of pediatric otorhinolaryngology.

  OBJECTIVE: Septic thrombosis of the sigmoid and lateral sinus is a rare complication of acute otitis media, mastoiditis and cholesteatoma. Hence, the aim of this chat review was to analyze theOBJECTIVE: Septic thrombosis of the sigmoid and lateral sinus is a rare complication of acute otitis media, mastoiditis and cholesteatoma. Hence, the aim of this chat review was to analyze the demographics, presenting symptoms, diagnosis, and therapeutic management of otogenic sigmoid sinus thrombosis. Especially the role of low molecular weight heparin in the therapy of septic intracranial sinus thrombosis in children should be illuminated. METHODS: A retrospective chart review was performed. RESULTS: Six patients were included in this trial. One patient was treated completely conservatively. All other patients underwent surgical treatment consisting of mastoidectomy (n=5), additional thrombectomy (n=3) and ligation of the internal jugular vein (n=2). All patients received intravenous antibiotics and anticoagulants. Unfractionated heparin was administered for three days after surgery followed by an anticoagulant therapy with low-molecular weight heparin for three months. The activated partial thromboplastin time (aPTT) and the anti-factor-Xa-plasma-levels were monitored during anticoagulation in short term intervals. There were no complications related to the anticoagulant therapy. Recanalization was found in all patients who were treated without thrombectomy or ligation of the internal jugular vein and in the case of complete conservative treatment. CONCLUSION: Simple mastoidectomy combined with broad spectrum antibiotics is the therapy of choice. Our results indicate that anticoagulants represent a safe treatment option if they are administered correctly.

• Local ointment versus cauterization in childhood recurrent epistaxis.

  Authors: Viroj Wiwanitkit

  International journal of pediatric otorhinolaryngology.

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