Pub Date : 2026-01-14DOI: 10.1016/j.ijporl.2026.112728
Joseph E. Kerschner , Roger A. Daley Jr. , Roxanne Link , Rachel M. Jones , Katherine J. Peterson , Robert H. Chun , Valerie A. Flanary , Michael Gorelik , Kristina L. Keppel , Matthew Maksimoski , Marsha Malloy , Timothy J. Martin , Michael E. McCormick , Thomas C. Robey , Sadia Ansari , Grace M. Matoska , Caroline A. Rupcich , Marineta L. Saunderson , Sophie G. Shay , Cecille Sulman , Stephen A. Boppart
Objective
To identify the ability of optical coherence tomography (OCT) to assist in the diagnosis and treatment of patients presenting to a primary care provider with signs and symptoms suggesting acute otitis media (AOM).
Design-Setting-Participants
An NIH-funded clinical trial was conducted and enrolled 75 children between 1 and under 7 years of age. Children presented with complaints of ear pain or suspected ear infection from their caregiver history to primary care clinics associated with an academic children's hospital. These patients upon presentation were eligible to enroll in the trial. Following a complete history and physical exam, including pneumatic otoscopy (PO), patients were provided with a diagnosis and treatment plan. Diagnoses included: AOM, middle ear effusion without AOM, or no evidence of otitis media with a clear middle ear space. Following this, OCT was performed, and the diagnosis and treatment plan was reassessed using this data.
Results
The diagnosis and/or treatment plan changed for 15.3 % of patients following the use of OCT compared with the initial use of PO. The greatest influence was seen in the patient group with MEE without AOM, with 36 % (5/14) of these patients having their diagnosis and/or treatment plan changed after OCT was employed.
Conclusions
OCT provides an additional adjunct for primary care providers to enhance visualization of the tympanic membrane and middle ear space. This data, in our clinical trial, resulted in enhanced clinical decision making, in particular for patients with MEE who were not diagnosed with AOM on PO.
Trial registration information
Coherent Optical Detection of Middle Ear Disease (OCTII). Clinicaltrials.gov ID number: NCT05353569.
{"title":"Clinical trial assessing the use of optical coherence tomography in decision making for children presenting with acute otitis media","authors":"Joseph E. Kerschner , Roger A. Daley Jr. , Roxanne Link , Rachel M. Jones , Katherine J. Peterson , Robert H. Chun , Valerie A. Flanary , Michael Gorelik , Kristina L. Keppel , Matthew Maksimoski , Marsha Malloy , Timothy J. Martin , Michael E. McCormick , Thomas C. Robey , Sadia Ansari , Grace M. Matoska , Caroline A. Rupcich , Marineta L. Saunderson , Sophie G. Shay , Cecille Sulman , Stephen A. Boppart","doi":"10.1016/j.ijporl.2026.112728","DOIUrl":"10.1016/j.ijporl.2026.112728","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the ability of optical coherence tomography (OCT) to assist in the diagnosis and treatment of patients presenting to a primary care provider with signs and symptoms suggesting acute otitis media (AOM).</div></div><div><h3>Design-Setting-Participants</h3><div>An NIH-funded clinical trial was conducted and enrolled 75 children between 1 and under 7 years of age. Children presented with complaints of ear pain or suspected ear infection from their caregiver history to primary care clinics associated with an academic children's hospital. These patients upon presentation were eligible to enroll in the trial. Following a complete history and physical exam, including pneumatic otoscopy (PO), patients were provided with a diagnosis and treatment plan. Diagnoses included: AOM, middle ear effusion without AOM, or no evidence of otitis media with a clear middle ear space. Following this, OCT was performed, and the diagnosis and treatment plan was reassessed using this data.</div></div><div><h3>Results</h3><div>The diagnosis and/or treatment plan changed for 15.3 % of patients following the use of OCT compared with the initial use of PO. The greatest influence was seen in the patient group with MEE without AOM, with 36 % (5/14) of these patients having their diagnosis and/or treatment plan changed after OCT was employed.</div></div><div><h3>Conclusions</h3><div>OCT provides an additional adjunct for primary care providers to enhance visualization of the tympanic membrane and middle ear space. This data, in our clinical trial, resulted in enhanced clinical decision making, in particular for patients with MEE who were not diagnosed with AOM on PO.</div></div><div><h3>Trial registration information</h3><div>Coherent Optical Detection of Middle Ear Disease (OCTII). Clinicaltrials.gov ID number: NCT05353569.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"202 ","pages":"Article 112728"},"PeriodicalIF":1.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ijporl.2026.112719
Murilo de Santana Hager , Mary Youssef , Gaayathri Varavenkataraman , Nicole Favre , Michele M. Carr
{"title":"Postoperative complications following tonsillectomy in children with Ehlers-Danlos Syndrome","authors":"Murilo de Santana Hager , Mary Youssef , Gaayathri Varavenkataraman , Nicole Favre , Michele M. Carr","doi":"10.1016/j.ijporl.2026.112719","DOIUrl":"10.1016/j.ijporl.2026.112719","url":null,"abstract":"","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"201 ","pages":"Article 112719"},"PeriodicalIF":1.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Otitis media with effusion (OME) is a leading cause of acquired conductive hearing loss in children. When performing an adenoidectomy for OME, surgeons must decide whether to supplement the procedure with a simple myringotomy or a myringotomy with tympanostomy tube (TT) insertion. While TT offers extended middle ear ventilation, it carries a risk of long-term complications. This systematic review of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of these two approaches.
Methods
A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs up to August 2025. Eligible RCTs were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcomes were hearing improvement and resolution of effusion. Secondary outcomes included OME recurrence and postoperative complications.
Results
Eleven RCTs involving 955 pediatric patients were included. The addition of TT consistently resulted in superior short-term outcomes, with significantly better hearing levels and faster resolution of middle ear effusion within the first 3–6 months. However, these advantages were not sustained, and no significant differences in hearing or effusion rates were observed at 12-month follow-ups. In contrast, the TT group experienced a significantly higher incidence of long-term complications, including otorrhea, tympanosclerosis, and persistent tympanic membrane perforation.
Conclusion
Adding a TT to adenoidectomy provides a transient benefit in hearing and effusion resolution but significantly increases the risk of long-term tympanic membrane complications. Adenoidectomy with myringotomy alone appears to be a safer and equally effective long-term strategy for managing pediatric OME.
背景：渗出性中耳炎是儿童获得性传导性听力损失的主要原因。当对OME进行腺样体切除术时，外科医生必须决定是否辅以简单的鼓膜切开术或鼓膜切开术并插入鼓膜造瘘管（TT）。虽然TT提供了延长的中耳通气，但它有长期并发症的风险。本系统综述随机对照试验（rct）旨在比较这两种方法的疗效和安全性。方法对截至2025年8月的随机对照试验进行PubMed、Scopus、CENTRAL、Web of Science的综合检索。使用风险偏倚(RoB)-2工具评估符合条件的随机对照试验的质量。主要结果是听力改善和积液的消除。次要结果包括OME复发和术后并发症。结果纳入6项随机对照试验，共955例儿科患者。TT治疗的短期效果一直很好，在最初的3-6个月内，患者的听力水平明显提高，中耳积液的清除速度也更快。然而，这些优势并没有持续，在12个月的随访中没有观察到听力或积液率的显著差异。相比之下，TT组的长期并发症发生率明显更高，包括耳漏、鼓膜硬化和持续性鼓膜穿孔。结论在腺样体切除术中加入TT对听力和积液解决有短暂的好处，但明显增加了长期鼓膜并发症的风险。腺样体切除术联合鼓膜切开术似乎是治疗小儿OME的一种更安全、同样有效的长期策略。
{"title":"Adenoidectomy with tympanostomy or with myringotomy alone: A systematic review of pediatric randomized controlled trials","authors":"Ebraheem Albazee , Noof Albannai , Hajar Alismail , Yasmeen Alazemi , Munawer Alsaeed , Esraa Alhammadi , Abrar Awadh , Abdullah Alabdullah , Mariam AlRaish , Ahmad Alawadhi , Ghezlan Aldawas , Mohmmad Alkaak , Dhoha Ismaeel","doi":"10.1016/j.ijporl.2026.112718","DOIUrl":"10.1016/j.ijporl.2026.112718","url":null,"abstract":"<div><h3>Background</h3><div>Otitis media with effusion (OME) is a leading cause of acquired conductive hearing loss in children. When performing an adenoidectomy for OME, surgeons must decide whether to supplement the procedure with a simple myringotomy or a myringotomy with tympanostomy tube (TT) insertion. While TT offers extended middle ear ventilation, it carries a risk of long-term complications. This systematic review of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of these two approaches.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs up to August 2025. Eligible RCTs were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcomes were hearing improvement and resolution of effusion. Secondary outcomes included OME recurrence and postoperative complications.</div></div><div><h3>Results</h3><div>Eleven RCTs involving 955 pediatric patients were included. The addition of TT consistently resulted in superior short-term outcomes, with significantly better hearing levels and faster resolution of middle ear effusion within the first 3–6 months. However, these advantages were not sustained, and no significant differences in hearing or effusion rates were observed at 12-month follow-ups. In contrast, the TT group experienced a significantly higher incidence of long-term complications, including otorrhea, tympanosclerosis, and persistent tympanic membrane perforation.</div></div><div><h3>Conclusion</h3><div>Adding a TT to adenoidectomy provides a transient benefit in hearing and effusion resolution but significantly increases the risk of long-term tympanic membrane complications. Adenoidectomy with myringotomy alone appears to be a safer and equally effective long-term strategy for managing pediatric OME.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"202 ","pages":"Article 112718"},"PeriodicalIF":1.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ijporl.2026.112721
Mack J. Tempero , Peter Kfoury , Michael Seipp , Kelly Otsuka , Matthew A. Firpo , Sarah Al Nemer , Albert H. Park
Objective
This study aims to compare gene expression levels in pediatric versus adult cholesteatoma using bulk RNA sequencing.
Study design
Retrospective analysis of prospectively collected human tissue.
Setting
Tertiary medical center.
Methods
RNA sequencing was performed on 3 pediatric and 3 adult cholesteatoma tissue samples and differentially expressed genes were identified. Gene set enrichment analysis (GSEA) was performed to identify mechanistic pathways and differential cellular reprogramming.
Results
Bulk RNA sequencing of 3 pediatric and 3 adult cholesteatoma tissue samples identified 20,298 genes. Differential gene expression analysis revealed 14 genes: 6 downregulated in and 8 upregulated in pediatric cholesteatoma compared to adult tissue. The GSEA revealed 3 gene sets upregulated in pediatric samples compared to adults relevant in cholesteatoma literature: Tumor Necrosis Factor (TNF-α), Transforming Growth Factor Beta (TGF-β, and the Epithelial-Mesenchymal Transition (EMT).
Conclusion
Pediatric cholesteatoma has distinct gene expression and pathway enrichment compared to adult disease, involving inflammation and fibrosis. This study highlights the complex inflammatory process seen in pediatric cholesteatoma and suggests molecular markers that could serve as potential therapeutic targets for treatment.
{"title":"Molecular markers of pediatric cholesteatoma: A gene expression comparison with adult tissue","authors":"Mack J. Tempero , Peter Kfoury , Michael Seipp , Kelly Otsuka , Matthew A. Firpo , Sarah Al Nemer , Albert H. Park","doi":"10.1016/j.ijporl.2026.112721","DOIUrl":"10.1016/j.ijporl.2026.112721","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to compare gene expression levels in pediatric versus adult cholesteatoma using bulk RNA sequencing.</div></div><div><h3>Study design</h3><div>Retrospective analysis of prospectively collected human tissue.</div></div><div><h3>Setting</h3><div>Tertiary medical center.</div></div><div><h3>Methods</h3><div>RNA sequencing was performed on 3 pediatric and 3 adult cholesteatoma tissue samples and differentially expressed genes were identified. Gene set enrichment analysis (GSEA) was performed to identify mechanistic pathways and differential cellular reprogramming.</div></div><div><h3>Results</h3><div>Bulk RNA sequencing of 3 pediatric and 3 adult cholesteatoma tissue samples identified 20,298 genes. Differential gene expression analysis revealed 14 genes: 6 downregulated in and 8 upregulated in pediatric cholesteatoma compared to adult tissue. The GSEA revealed 3 gene sets upregulated in pediatric samples compared to adults relevant in cholesteatoma literature: Tumor Necrosis Factor (TNF-α), Transforming Growth Factor Beta (TGF-β, and the Epithelial-Mesenchymal Transition (EMT).</div></div><div><h3>Conclusion</h3><div>Pediatric cholesteatoma has distinct gene expression and pathway enrichment compared to adult disease, involving inflammation and fibrosis. This study highlights the complex inflammatory process seen in pediatric cholesteatoma and suggests molecular markers that could serve as potential therapeutic targets for treatment.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"202 ","pages":"Article 112721"},"PeriodicalIF":1.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.ijporl.2026.112722
Evette A. Ronner , Nicole Kim , Michael Cheung , Heidi Leonard , Julie Arenberg , Michael S. Cohen
{"title":"ADHEAR in infants with Down syndrome and minimal hearing loss","authors":"Evette A. Ronner , Nicole Kim , Michael Cheung , Heidi Leonard , Julie Arenberg , Michael S. Cohen","doi":"10.1016/j.ijporl.2026.112722","DOIUrl":"10.1016/j.ijporl.2026.112722","url":null,"abstract":"","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"201 ","pages":"Article 112722"},"PeriodicalIF":1.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.ijporl.2026.112716
Victoria Carswell , Wisha Gul , Thushitha Kunanandam
Objectives
To develop and validate a high-fidelity, low-cost paediatric airway simulation model for endoscopic procedures, replicating a range of laryngeal pathologies. The study assessed the model's face, content, and construct validity and evaluated its educational value for airway surgery training.
Methods
A prospective, multicentre validation study was conducted across three international paediatric otolaryngology courses. Eighty otolaryngologists of varying seniority completed a 19-item Likert questionnaire assessing face and content validity for laryngomalacia, subglottic stenosis and laryngeal cyst models. A subgroup of registrars undertook repeated supraglottoplasty practice to assess construct validity through performance scores and completion time.
Results
All 80 participants completed validation surveys. Mean face and content validity scores exceeded 4/5 across all models, indicating strong anatomical fidelity and educational value. The simulator was rated highly for improving endoscopic technique (mean content score 4.79 ± 0.41). In the construct validity subgroup, supraglottoplasty completion time improved by 7.54m (t = 3.55, p = 0.01) with skill scores increasing by +1.25 points (t = −3.56, p = 0.01). Junior trainees showed greater improvement than seniors. Participants provided favourable qualitative feedback on realism and instrument handling.
Conclusions
This modular, 3D-printed paediatric airway simulator demonstrates face, content and construct validity, with reproducible educational benefits across an international cohort. Its low cost, modularity and interchangeable inserts supports scalable adoption in training programmes. Future work should assess transferability of skills to clinical practice and optimise tissue fidelity for improved haptic realism.
目的：开发和验证一种高保真、低成本的儿科气道模拟模型，用于内镜手术，复制一系列喉部病变。本研究评估了模型的外观、内容和结构效度，并评价了其对气道外科培训的教育价值。方法在三个国际儿科耳鼻喉科课程中进行了一项前瞻性、多中心验证研究。80名不同资历的耳鼻喉科医生完成了一份19项李克特问卷，评估喉软化症、声门下狭窄和喉囊肿模型的面部和内容效度。一组注册者进行了重复的喉上成形术练习，通过表现分数和完成时间来评估结构的有效性。结果80名参与者均完成了验证性问卷调查。所有模型的平均面部和内容效度得分均超过4/5分，显示出较强的解剖逼真度和教育价值。该模拟器对内镜技术的改进评价较高（平均内容评分4.79±0.41）。在构念效度亚组，喉上成形术完成时间提高了7.54m (t = 3.55, p = 0.01)，技能得分提高了+1.25分（t = - 3.56, p = 0.01）。初级学员比高年级学员表现出更大的进步。与会者对现实主义和仪器处理提供了有利的定性反馈。这个模块化的3d打印儿科气道模拟器展示了面部、内容和结构的有效性，在国际队列中具有可重复的教育效益。它的低成本，模块化和可互换的插入支持可扩展的培训计划采用。未来的工作应评估技能转移到临床实践和优化组织保真度，以提高触觉真实感。
{"title":"Enhancing paediatric endoscopic airway training with a high-fidelity 3D-printed simulator","authors":"Victoria Carswell , Wisha Gul , Thushitha Kunanandam","doi":"10.1016/j.ijporl.2026.112716","DOIUrl":"10.1016/j.ijporl.2026.112716","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop and validate a high-fidelity, low-cost paediatric airway simulation model for endoscopic procedures, replicating a range of laryngeal pathologies. The study assessed the model's face, content, and construct validity and evaluated its educational value for airway surgery training.</div></div><div><h3>Methods</h3><div>A prospective, multicentre validation study was conducted across three international paediatric otolaryngology courses. Eighty otolaryngologists of varying seniority completed a 19-item Likert questionnaire assessing face and content validity for laryngomalacia, subglottic stenosis and laryngeal cyst models. A subgroup of registrars undertook repeated supraglottoplasty practice to assess construct validity through performance scores and completion time.</div></div><div><h3>Results</h3><div>All 80 participants completed validation surveys. Mean face and content validity scores exceeded 4/5 across all models, indicating strong anatomical fidelity and educational value. The simulator was rated highly for improving endoscopic technique (mean content score 4.79 ± 0.41). In the construct validity subgroup, supraglottoplasty completion time improved by 7.54m (t = 3.55, p = 0.01) with skill scores increasing by +1.25 points (t = −3.56, p = 0.01). Junior trainees showed greater improvement than seniors. Participants provided favourable qualitative feedback on realism and instrument handling.</div></div><div><h3>Conclusions</h3><div>This modular, 3D-printed paediatric airway simulator demonstrates face, content and construct validity, with reproducible educational benefits across an international cohort. Its low cost, modularity and interchangeable inserts supports scalable adoption in training programmes. Future work should assess transferability of skills to clinical practice and optimise tissue fidelity for improved haptic realism.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"202 ","pages":"Article 112716"},"PeriodicalIF":1.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.ijporl.2026.112720
Kathleen R. Billings , Sydney J. Sachse , Saied Ghadersohi , Achilles A. Kanaris , Rachel L. Schappacher , Rachel D. Yoon , Alexander J. Szymczak , Inbal Hazkani
Objective
Post-tonsillectomy hemorrhage is a common risk after tonsillectomy. The goal of this study is to analyze the rate of recurrent PTH (R-PTH), and to determine potential risk factors for recurrent bleeding.
Methods
Retrospective cohort study of patients <18 years of age evaluated at a tertiary care pediatric hospital for PTH. Risk factors for patients with R-PTH episodes were evaluated, when compared to patients with a single bleeding episode. An assessment of healthcare utilization in those with R-PTH was performed.
Results
Among 18,819 tonsillectomies performed in the study period, 382 (2.0 %) had a PTH. Of these, 42 patients (11.0 %) experienced R-PTH: 35 patients (9.2 %) with two bleeding episodes, and 7 patients (1.8 %) with three. Patients with R-PTH were male (n = 26, 61.9 %), Hispanic/Latino (n = 19, 45.2 %), and English-speaking (n = 33, 78.6 %). The overall risk of R-PTH following tonsillectomy was 0.2 %, and the relative risk of R-PTH after an initial PTH was 5.4 times. None of the factors analyzed were found to have a significant association with R-PTH, although a greater proportion of patients with R-PTH were found to have a history of chronic tonsillitis (21.4 % vs 14.4 %). Healthcare utilization, an aggregate measurement of primary care, otolaryngology, telemedicine, and emergency department visits unrelated to PTH, was significantly higher in R-PTH patients (2.5 vs. 1.8 occurrences, p = 0.023).
Conclusions
The rate of R-PTH was small (0.2 %), although those patients with an initial PTH had a relative risk of 5.4 for a R-PTH episode. No clear risk factors for R-PTH were identified. Increased healthcare utilization was noted in those with R-PTH.
{"title":"Recurrent post-tonsillectomy bleeding in pediatric patients","authors":"Kathleen R. Billings , Sydney J. Sachse , Saied Ghadersohi , Achilles A. Kanaris , Rachel L. Schappacher , Rachel D. Yoon , Alexander J. Szymczak , Inbal Hazkani","doi":"10.1016/j.ijporl.2026.112720","DOIUrl":"10.1016/j.ijporl.2026.112720","url":null,"abstract":"<div><h3>Objective</h3><div>Post-tonsillectomy hemorrhage is a common risk after tonsillectomy. The goal of this study is to analyze the rate of recurrent PTH (R-PTH), and to determine potential risk factors for recurrent bleeding.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients <18 years of age evaluated at a tertiary care pediatric hospital for PTH. Risk factors for patients with R-PTH episodes were evaluated, when compared to patients with a single bleeding episode. An assessment of healthcare utilization in those with R-PTH was performed.</div></div><div><h3>Results</h3><div>Among 18,819 tonsillectomies performed in the study period, 382 (2.0 %) had a PTH. Of these, 42 patients (11.0 %) experienced R-PTH: 35 patients (9.2 %) with two bleeding episodes, and 7 patients (1.8 %) with three. Patients with R-PTH were male (n = 26, 61.9 %), Hispanic/Latino (n = 19, 45.2 %), and English-speaking (n = 33, 78.6 %). The overall risk of R-PTH following tonsillectomy was 0.2 %, and the relative risk of R-PTH after an initial PTH was 5.4 times. None of the factors analyzed were found to have a significant association with R-PTH, although a greater proportion of patients with R-PTH were found to have a history of chronic tonsillitis (21.4 % vs 14.4 %). Healthcare utilization, an aggregate measurement of primary care, otolaryngology, telemedicine, and emergency department visits unrelated to PTH, was significantly higher in R-PTH patients (2.5 vs. 1.8 occurrences, <em>p</em> = 0.023).</div></div><div><h3>Conclusions</h3><div>The rate of R-PTH was small (0.2 %), although those patients with an initial PTH had a relative risk of 5.4 for a R-PTH episode. No clear risk factors for R-PTH were identified. Increased healthcare utilization was noted in those with R-PTH.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"201 ","pages":"Article 112720"},"PeriodicalIF":1.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.ijporl.2026.112724
Fabian Kraus, Wafaa Shehata-Dieler, Rudolf Hagen, Stephan Hackenberg
Pediatric dysphagia represents a complex and multifactorial clinical challenge with potentially profound implications for development, nutritional status, pulmonary health, and overall quality of life. In infants and children, the early identification of swallowing difficulties is critical due to their impact on growth trajectories, neurodevelopment, and the psychosocial well-being of both the child and caregivers. This comprehensive article examines the importance of a systematic, interdisciplinary diagnostic approach in evaluating pediatric dysphagia in a university hospital. Based on a ten-year retrospective cohort study involving 223 pediatric patients aged one month to sixteen years, we investigate how the integration of clinical history, physical examination, and state-of-the-art instrumental techniques - such as flexible endoscopic evaluation of swallowing (FEES) - within a collaborative, multi-specialist framework can enhance diagnostic precision. Findings underscore the necessity of individualized, developmentally sensitive diagnostic pathways involving phoniatricions, ENT specialists, pediatricians, speech-language pathologists, radiologists and nutrition experts.
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