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Artificial intelligence as an auxiliary tool in pediatric otitis media diagnosis 人工智能作为小儿中耳炎诊断的辅助工具。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-08 DOI: 10.1016/j.ijporl.2024.112154
Zhengjun Zhong , Xu Guo , Desheng Jia , Hongying Zheng , Zebin Wu , Xuansheng Wang

Objectives

In order to promote the use of AI technology as the auxiliary tool in pediatric otitis media diagnosis, we use the convolutional neural networks and deep learning for image classification and disease diagnosis. We also designed a Pediatric Otitis Media Classifier to analyze and classify the images for physicians.

Methods

A pediatric otitis media classifier was designed for junior physicians (doctors who have been engaged in clinical practice for a short time) as an auxiliary diagnostic tool. To design this classifier for children with otitis media, we used a large number of images of acute otitis media (AOM), secretory otitis media (OME), and normal otoscope images to obtain the optimal convolutional neural network model.

Results

The average recognition accuracies of the ZFNet and the TSL16 for classification were 97.87 % and 97.62 %, far exceeding the accuracy of human diagnosis. The results of using the Pediatric Otitis Media Classifier show that we can use the classifier to correctly identify the image types of child middle ear infections.

Conclusions

We developed the Pediatric Otitis Media Classifier for the successful automated classification of AOM and OME in children using otoscopic images. In contrast to the traditional diagnosis of pediatric otitis media, which relies heavily on the experience of doctors, the diagnostic accuracy of even experienced physicians is only approximately 80 %. With AI technology, we can improve the accuracy rate to over 98 %, which can effectively assist doctors in auxiliary diagnosis. It also reduces delayed treatment, antibiotic misuse, and unnecessary surgery caused by misdiagnosis.
目的:为了促进人工智能技术在小儿中耳炎诊断中作为辅助工具的应用,我们利用卷积神经网络和深度学习进行图像分类和疾病诊断。我们还设计了一个小儿中耳炎分类器,为医生分析和分类图像:我们为初级医生(短期从事临床工作的医生)设计了一个小儿中耳炎分类器,作为辅助诊断工具。为了设计这种儿童中耳炎分类器,我们使用了大量急性中耳炎(AOM)、分泌性中耳炎(OME)和正常耳镜图像,以获得最佳卷积神经网络模型:ZFNet 和 TSL16 的平均识别准确率分别为 97.87 % 和 97.62 %,远远超过了人工诊断的准确率。小儿中耳炎分类器的使用结果表明,我们可以使用该分类器正确识别儿童中耳炎的图像类型:我们开发了小儿中耳炎分类器,利用耳镜图像成功实现了儿童中耳炎和中耳积液的自动分类。传统的小儿中耳炎诊断主要依赖医生的经验,相比之下,即使是经验丰富的医生,其诊断准确率也只有约 80%。借助人工智能技术,我们可以将准确率提高到 98% 以上,有效辅助医生进行辅助诊断。同时,还能减少因误诊导致的延误治疗、抗生素滥用和不必要的手术。
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引用次数: 0
Lipid-laden macrophage index as a marker of aspiration in children, is it reliable? A scoping review 作为儿童吸入标志物的载脂巨噬细胞指数可靠吗?范围综述
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112151
Ostap Orishchak , Alexander Moise , Faisal Al-Osamey , Kimberley Kaspy , Sam J. Daniel

Introduction

A diagnostic pathway to detect aspiration is challenging and usually requires a multidisciplinary approach and a variety of tests. Lipid-laden macrophage index (LLMI) was first described in 1985 by Corwin and Irwin as a promising tool to detect aspiration. Information in the literature as well as physicians’ opinions about the clinical value of the LLMI remains controversial.

Objectives

To assess the clinical value and possible limitations of LLMI as a diagnostic marker for detecting aspiration in children.

Methods

Based on the available literature we thought to answer the following questions: 1. Is there a reliable cutoff value of LLMI to detect aspiration? 2. What are the limitations of LLMI? We queried 8 electronic databases: Medline, Embase, CINAHL, Cochrane, Global Health, Web of Science, Africa Wide Information, and Global Index Medicus. Studies were selected based on established study criteria. Search was limited to publications in English language including human and animal studies. Authors reviewed 2900 articles and identified 21 relevant to the studied subject.

Results

Research reveals different proposed cutoff values for aspirators ranging from 85 to 200 macrophages. LLMI reliability has several limitations including: inter- and intraobserver variability among pathologists scores, inability to differentiate between exogenous and endogenous lipid content, inconsistencies in the definition of the term “aspiration” in various publications. Also, studies in animal models have shown that the nature of the disease, frequency of aspiration, and the time frame when bronchoalveolar lavage (BAL) is performed, could all contribute to the overlap in LLMI in aspirators versus non-aspirators.

Discussion

Our research demonstrates the limitations of LLMI in distinguishing between aspirators and non-aspirators. We believe based on these findings that airway teams should audit their local data as to the value of BAL in detecting aspiration in their patient population.
导言:检测抽吸的诊断途径具有挑战性,通常需要多学科方法和各种检测。1985年,Corwin和Irwin首次将脂质巨噬细胞指数(LLMI)描述为检测吸入的一种有前途的工具。目的 评估 LLMI 作为检测儿童吸入的诊断指标的临床价值和可能存在的局限性。方法 根据现有文献,我们试图回答以下问题:1.是否有可靠的 LLMI 临界值来检测吸入?2.LLMI 有哪些局限性?我们查询了 8 个电子数据库:Medline、Embase、CINAHL、Cochrane、Global Health、Web of Science、Africa Wide Information 和 Global Index Medicus。我们根据既定的研究标准对研究进行了筛选。搜索仅限于包括人类和动物研究在内的英文出版物。作者查阅了 2900 篇文章,确定了 21 篇与研究主题相关的文章。研究结果表明,针对吸痰器提出了不同的临界值,从 85 到 200 个巨噬细胞不等。LLMI 的可靠性有几个局限性,包括:病理学家评分的观察者之间和观察者内部的差异性、无法区分外源性和内源性脂质含量、各种出版物对 "抽吸 "一词的定义不一致。此外,对动物模型的研究表明,疾病的性质、吸入的频率以及进行支气管肺泡灌洗(BAL)的时间框架都可能导致吸入者与非吸入者的 LLMI 有所重叠。我们认为,基于这些研究结果,气道团队应该对其本地数据进行审核,以确定 BAL 在检测患者吸入方面的价值。
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引用次数: 0
National survey on Congenital Cytomegalovirus Awareness and Screening Practices among Healthcare Professionals 关于医疗保健专业人员对先天性巨细胞病毒的认识和筛查做法的全国调查。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112150
Nezar Hamed , Mohamad-Hani Temsah , Yasser Sabr , Yassin Abdelsamad , Mohammed A. Alghamdi , Nouf Saleem Yaqoub , Muataz H. Alhashem , Abdullah Fahad Alnuwaybit , Raghad AlKhashan , Abduallah Mawkili , Abdulrahman Hagr

Objectives

Congenital cytomegalovirus (CMV) infection, resulting from maternal-fetal transmission of CMV, poses a substantial risk to maternal and child health. It is the most prevalent congenital viral infection, and the prevention and management of this condition rely heavily on the knowledge and awareness of healthcare professionals.

Methods

This cross-sectional survey was conducted between March 1, 2023, and August 31, 2023, across multiple tertiary centers in various Saudi Arabian cities. It assessed the understanding and awareness of congenital CMV infection among 400 healthcare professionals from diverse specialties. The study utilized a structured questionnaire to evaluate knowledge levels, obtain demographic data, and identify factors influencing awareness.

Results

The study revealed significant disparities in knowledge levels, with around 84 % of participants categorized as having “low" knowledge. Obstetricians and gynecologists exhibited better knowledge. Factors like specialization, age, and professional experience significantly affected knowledge levels. Additionally, many healthcare professionals perceived a lack of information and awareness regarding CMV among their peers.

Conclusion

Congenital CMV infection is a major public health concern with potential severe consequences. The study identified knowledge disparities, particularly among non-specialist healthcare practitioners, emphasizing the need for targeted educational programs and focused awareness initiatives. Key factors, such as expertise, age, and experience, underscore the importance of addressing ongoing knowledge gaps, highlighting the need for continuous efforts to mitigate challenges associated with CMV infection.
目的:先天性巨细胞病毒(CMV)感染是由母婴传播造成的,对母婴健康构成巨大威胁。先天性巨细胞病毒感染是最常见的先天性病毒感染,其预防和管理在很大程度上依赖于医护人员的知识和意识:这项横断面调查于 2023 年 3 月 1 日至 2023 年 8 月 31 日在沙特阿拉伯多个城市的多个三级医疗中心进行。调查评估了 400 名来自不同专业的医护人员对先天性巨细胞病毒感染的理解和认识。研究采用结构化问卷评估知识水平、获取人口统计学数据并确定影响认知的因素:结果:研究显示,知识水平存在显著差异,约 84% 的参与者被归类为 "低 "知识水平。妇产科医生的知识水平较高。专业、年龄和职业经验等因素对知识水平的影响很大。此外,许多医护人员认为他们的同行缺乏有关 CMV 的信息和意识:先天性巨细胞病毒感染是一个重大的公共卫生问题,可能造成严重后果。研究发现了知识差异,尤其是非专业医护人员之间的知识差异,强调了有针对性的教育计划和集中宣传活动的必要性。专业知识、年龄和经验等关键因素强调了解决当前知识差距的重要性,突出了持续努力减轻与 CMV 感染相关的挑战的必要性。
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引用次数: 0
Aerosol mitigation in upper airway surgery 上气道手术中的气溶胶缓解。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112153
Herrmann BW , Choi MH , Vance ME , Pickett-Nairne K , Cooper EH , Friedman NR

Background

Aerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room.

Methods

Utilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5–10 μm in diameter were measured. Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations.

Results

SES was effective compared to controls, but inferior to intraoral mitigation strategies (p < 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p < 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles.

Conclusions

Intraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.
背景:产生气溶胶的手术有传播 SARS-CoV-2 的风险,在耳鼻喉科手术中占很大比例。目前还没有减轻这种危害的最佳方法。本研究探讨了减少手术室手术气溶胶的方法:方法:利用插管人体模型(Nasco Healthcare)和粒子计数器(Sensirion SPS30),测量了一系列电灼诱发的气溶胶,其中含有直径为 0.5-10 μm 的粒子。测试了三种不同的缓解策略:口内(Yankauer、吸入式博维笔(SBP))、口外(排烟系统(SES))以及它们的组合:结果:与对照组相比,SES 是有效的,但不如口内缓解策略(p 结论:建议使用口内吸痰技术:建议使用口内抽吸技术缓解烟雾。单独使用口外 SES 不足以缓解气溶胶,与口内吸引技术一起使用可能会适得其反。要确定术中手术气溶胶的最佳缓解策略,还需要进一步的研究。
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引用次数: 0
Intracapsular versus extracapsular tonsil surgery: Comparison of postoperative haemorrhage outcomes in the Australasian setting 扁桃体囊内手术与囊外手术:澳大拉西亚地区术后出血结果比较。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112147
Tze Ling Loh , Pei Toh , Telvinderjit Singh Harbhajan Singh , Shane Anderson , Kelvin Kong , Mithma Ekanayake , John-Charles Hodge , Megan Hobson , Graeme van der Meer , Hannah Burns , Shyan Vijayasekaran , Niall Jefferson

Objective

To investigate the incidence and timing of postoperative haemorrhage between intracapsular (ICT) and extracapsular tonsillectomy (ECT) techniques and evaluate factors influencing haemorrhage risk and severity.

Methods

A retrospective review of patients undergoing tonsillectomy over 5 years across otolaryngology services in Australia and New Zealand. Primary outcomes were rate and timing of post-tonsillectomy haemorrhage.

Results

A total of 12,275 patients were included in this study. The overall post-tonsillectomy bleed rate was 3.3 %, with 0.65 % requiring return to theatre. ICT had a significantly lower bleed rate of 1.7 % compared to 4.1 % for ECT (p < 0.001). The rate of return to theatre was markedly lower for ICT (0.08 %) compared to ECT (0.93 %, p < 0.001). Median day of bleeding was not different between the techniques. Patients undergoing surgery for recurrent tonsillitis had the highest rate of postoperative haemorrhage (15 %), while those with sleep-disordered breathing alone had the lowest (3 %, p < 0.001).

Conclusion

ICT results in significantly lower rates of postoperative haemorrhage and need for surgical intervention compared to ECT. This was most pronounced in paediatric patients with sleep-disordered breathing. ICT may be considered a preferable option for certain patient groups, especially younger children with sleep-disordered breathing, though more evidence is needed to confirm its efficacy and safety in patients with recurrent tonsillitis.
目的研究囊内(ICT)和囊外扁桃体切除术(ECT)术后出血的发生率和时间,并评估影响出血风险和严重程度的因素:方法:对澳大利亚和新西兰耳鼻喉科5年来的扁桃体切除术患者进行回顾性研究。主要结果是扁桃体切除术后大出血的发生率和时间:本研究共纳入了 12,275 名患者。扁桃体切除术后总出血率为 3.3%,其中 0.65% 需要返回手术室。ICT 的出血率为 1.7%,明显低于 ECT 的 4.1%(P 结论:ICT 能明显降低扁桃体切除术后出血率:与 ECT 相比,ICT 术后出血率和手术干预需求明显降低。这在有睡眠呼吸障碍的儿科患者中最为明显。对于某些患者群体,尤其是患有睡眠呼吸障碍的年幼儿童,信息和通信技术可能被认为是一种更可取的选择,尽管还需要更多证据来证实其对复发性扁桃体炎患者的有效性和安全性。
{"title":"Intracapsular versus extracapsular tonsil surgery: Comparison of postoperative haemorrhage outcomes in the Australasian setting","authors":"Tze Ling Loh ,&nbsp;Pei Toh ,&nbsp;Telvinderjit Singh Harbhajan Singh ,&nbsp;Shane Anderson ,&nbsp;Kelvin Kong ,&nbsp;Mithma Ekanayake ,&nbsp;John-Charles Hodge ,&nbsp;Megan Hobson ,&nbsp;Graeme van der Meer ,&nbsp;Hannah Burns ,&nbsp;Shyan Vijayasekaran ,&nbsp;Niall Jefferson","doi":"10.1016/j.ijporl.2024.112147","DOIUrl":"10.1016/j.ijporl.2024.112147","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the incidence and timing of postoperative haemorrhage between intracapsular (ICT) and extracapsular tonsillectomy (ECT) techniques and evaluate factors influencing haemorrhage risk and severity.</div></div><div><h3>Methods</h3><div>A retrospective review of patients undergoing tonsillectomy over 5 years across otolaryngology services in Australia and New Zealand. Primary outcomes were rate and timing of post-tonsillectomy haemorrhage.</div></div><div><h3>Results</h3><div>A total of 12,275 patients were included in this study. The overall post-tonsillectomy bleed rate was 3.3 %, with 0.65 % requiring return to theatre. ICT had a significantly lower bleed rate of 1.7 % compared to 4.1 % for ECT (p &lt; 0.001). The rate of return to theatre was markedly lower for ICT (0.08 %) compared to ECT (0.93 %, p &lt; 0.001). Median day of bleeding was not different between the techniques. Patients undergoing surgery for recurrent tonsillitis had the highest rate of postoperative haemorrhage (15 %), while those with sleep-disordered breathing alone had the lowest (3 %, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>ICT results in significantly lower rates of postoperative haemorrhage and need for surgical intervention compared to ECT. This was most pronounced in paediatric patients with sleep-disordered breathing. ICT may be considered a preferable option for certain patient groups, especially younger children with sleep-disordered breathing, though more evidence is needed to confirm its efficacy and safety in patients with recurrent tonsillitis.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112147"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564202","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}
引用次数: 0
Longitudinal follow-up of hearing, speech, and language skills in 6-year-old children with congenital moderate hearing loss 对患有先天性中度听力损失的 6 岁儿童的听力、言语和语言能力进行纵向跟踪。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112148
Anna Nyman , Marion Lieberman , Madelen Snickars , Anna Persson

Objectives

Children born with moderate hearing loss present with speech and language outcomes at both ends of the spectrum. To explore reasons for this, the objective of this study was to follow up a group of children born with moderate sensorineural hearing loss at 6 years of age (n = 7) by investigating their outcomes in hearing, speech, and language development from time point of hearing aid fitting at 6 months. Another objective was to investigate the relationship between earlier outcomes on precursing variables to the current status in auditory, speech and language development.

Method

Earlier data from a project with the same participants of auditory variables, speech, and language development were compared to the current study outcomes at 6 years of age. Children in this study performed standardized tests of phonology (SVANTE), expressive vocabulary (BNT), and speech-in-noise test (Hagerman's sentences). Parents reported on their child's functional auditory performance in everyday life (PEACH), and demographics and general development (questionnaire). Etiology and frequency of speech and language-directed intervention from time point of diagnosis to 6 years of age were collected through medical journals.

Results

Hearing levels were stable over time in all children but one, who had received bilateral cochlear implants. Performance on speech-in-noise testing varied in aided condition (−0.8 to 8, mean 2.65, SD 3.09) and unaided condition (7.2 dB–21.2 dB, mean 12.06, SD 4.82). Scores on the PEACH indicated further review in four of the seven children. Mean group score on consonant proficiency had increased from 3 to 6 years of age and were within age norms. Vocabulary scores were below the norms of children with typical hearing. Outcomes on vocabulary measures at 2.5 years showed strong correlations that were significant to scores on the BNT at 6 years of age (r = 0.87, p = 0.05). Correlations between hours of hearing aid use and vocabulary was not significant at 6 years of age. The frequency of intervention sessions in the first 6 years varied between participants (4–55, mean 19.1, SD 17.1).

Conclusion

Despite homogeneous hearing and other background variables in the participants from birth, large individual variations in speech and language outcomes at 6 years of age were found. Considering the many factors involved that impact the development of children with moderate hearing loss, the results suggest that monitoring early precursors in auditory, speech and language development may be helpful in setting commensurate goals for each child. Detecting additional conditions that may pose challenges in future speech and language as early as possible is important. There is ample room for improvement in terms of increasing the frequency of intervention for children with moderate hearing loss and their families.
目标:先天性中度听力损失儿童的言语和语言表达能力两极分化。为了探究其中的原因,本研究的目的是对一组出生时患有中度感音神经性听力损失的儿童(n = 7)在 6 岁时进行随访,调查他们从 6 个月时佩戴助听器开始的听力、言语和语言发育情况。另一个目的是调查早期前兆变量结果与当前听觉、言语和语言发展状况之间的关系:方法:将一个由相同参与者参与的项目中关于听觉变量、言语和语言发展的早期数据与当前研究中 6 岁儿童的结果进行比较。参加本次研究的儿童进行了标准化的语音测试(SVANTE)、词汇表达测试(BNT)和噪音语言测试(哈格曼句子)。家长汇报了孩子在日常生活中的听觉功能表现(PEACH)、人口统计学和一般发展情况(问卷)。我们还通过医学期刊收集了从确诊到 6 岁期间的病因和语言干预频率:除一名接受过双侧人工耳蜗植入手术的儿童外,其他儿童的听力水平均保持稳定。噪声语言测试的成绩在有辅助条件(-0.8 至 8,平均 2.65,标差 3.09)和无辅助条件(7.2 分贝至 21.2 分贝,平均 12.06,标差 4.82)下有所不同。在 PEACH 测试中,7 名儿童中有 4 名的得分表明他们需要进一步复习。辅音熟练程度的小组平均得分在 3 到 6 岁期间有所提高,且符合年龄标准。词汇得分低于正常听力儿童的标准。2.5 岁时的词汇量测量结果与 6 岁时的 BNT 分数有显著的相关性(r = 0.87,p = 0.05)。助听器使用时长与 6 岁时的词汇量之间的相关性不显著。前 6 年的干预次数因人而异(4-55 次,平均 19.1 次,标准差 17.1 次):结论:尽管参与者从出生起就具有相同的听力和其他背景变量,但他们在 6 岁时的言语和语言成果却存在很大的个体差异。考虑到影响中度听力损失儿童发育的因素很多,研究结果表明,监测听觉、言语和语言发育的早期先兆可能有助于为每个儿童设定相应的目标。尽早发现可能对未来言语和语言发展构成挑战的其他情况非常重要。在增加对中度听力损失儿童及其家庭的干预频率方面,还有很大的改进空间。
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引用次数: 0
The predictive value of chest X-ray for the depth of tracheal intubation in infants 胸部 X 射线对婴儿气管插管深度的预测价值
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112149
Junnan Chen , Shaoping Wu , Shouxing Duan , Yongfa Zhang

Objective

To determine the predictive value of chest X-ray for the depth of tracheal intubation in infants.

Methods

Basic data of 161 infants under 3 years old was collected. Tracheal length was measured on preoperative chest radiographs to guide intubation depth. Correlation analysis was performed to examine relationships between tracheal length, age, and body weight.

Results

161 cases (male/female = 142/19, no significant difference in sex, p = 0.09) were included, aged from 1 month to 28 months, weight from 2.5 kg to 18.0 kg. The endotracheal intubation depth reached the standard rate was 100 %, with 0 cases of over-deep or over-shallow intubation. Correlation analysis showed that tracheal length was positively correlated with both age and body weight, with stronger correlations observed in infants aged 1–12 months (r = 0.751 for age, r = 0.672 for weight, p < 0.01) compared to those aged 13–28 months (r = 0.672 for age, r = 0.408 for weight, p < 0.01).

Conclusion

Direct measurement of tracheal length on routinely performed chest X-rays is simple, feasible and safe, and may be another choice for guiding the depth of tracheal intubation in children.
方法 收集了 161 名 3 岁以下婴儿的基本数据。根据术前胸片测量气管长度,以指导插管深度。结果161例病例(男/女=142/19,性别无显著差异,P=0.09)年龄从1个月到28个月,体重从2.5公斤到18.0公斤。气管插管深度达标率为100%,0例插管过深或过浅。相关性分析表明,气管长度与年龄和体重均呈正相关,与 13-28 个月的婴儿相比,1-12 个月的婴儿相关性更强(年龄的相关性为 0.751,体重的相关性为 0.672,p <0.01)(年龄的相关性为 0.672,体重的相关性为 0.672,p <0.01)。结论在常规胸部 X 光片上直接测量气管长度简单、可行且安全,可能是指导儿童气管插管深度的另一种选择。
{"title":"The predictive value of chest X-ray for the depth of tracheal intubation in infants","authors":"Junnan Chen ,&nbsp;Shaoping Wu ,&nbsp;Shouxing Duan ,&nbsp;Yongfa Zhang","doi":"10.1016/j.ijporl.2024.112149","DOIUrl":"10.1016/j.ijporl.2024.112149","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the predictive value of chest X-ray for the depth of tracheal intubation in infants.</div></div><div><h3>Methods</h3><div>Basic data of 161 infants under 3 years old was collected. Tracheal length was measured on preoperative chest radiographs to guide intubation depth. Correlation analysis was performed to examine relationships between tracheal length, age, and body weight.</div></div><div><h3>Results</h3><div>161 cases (male/female = 142/19, no significant difference in sex, p = 0.09) were included, aged from 1 month to 28 months, weight from 2.5 kg to 18.0 kg. The endotracheal intubation depth reached the standard rate was 100 %, with 0 cases of over-deep or over-shallow intubation. Correlation analysis showed that tracheal length was positively correlated with both age and body weight, with stronger correlations observed in infants aged 1–12 months (r = 0.751 for age, r = 0.672 for weight, p &lt; 0.01) compared to those aged 13–28 months (r = 0.672 for age, r = 0.408 for weight, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Direct measurement of tracheal length on routinely performed chest X-rays is simple, feasible and safe, and may be another choice for guiding the depth of tracheal intubation in children.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112149"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Environmental factors and the incidence of pediatric epistaxis: A systematic review with meta-analysis 环境因素与小儿鼻衄的发病率:系统回顾与荟萃分析
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.ijporl.2024.112152
Alireza Sharifi , Peter H. Hwang , Mohaddeseh Zojaji , Sahar Ghaedsharaf , Samad Samadizadeh , Mohammad E. Ghaffari , Z. Jason Qian

Background

A growing body of literature explores environmental risk factors for pediatric epistaxis, yielding variable results. We aim to clarify these associations through a systematic review and meta-analysis.

Methods

PubMed, Scopus, Cochrane Central Register of Control Trials, Web of Science, Medline, Google Scholars, and Embase were systematically searched up to April 2024. Eligible articles were reviewed, and the quality was assessed. A systematic review and meta-analysis was conducted to clarify correlations between the incidence of epistaxis and multiple environmental factors according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Results

A total of 8 studies, comprising 55,176 participants, met the inclusion criteria. The incidence of epistaxis peaked during the summer months (Proportion = 12.73 %, CI: 9.629 %–16.201 %). Significant risk factors included environmental variables elevated in the summer, including higher monthly mean temperatures, increased sunlight exposure, elevated O3 levels, and lower atmospheric pressure. In contrast, factors like mean monthly humidity, wind speed, SO2, CO, NO2, and PM-10 levels were not associated with an increased risk of epistaxis.

Conclusions

This meta-analysis underscores the significant impact of multiple environmental factors, particularly those more pronounced during the summer months, on the incidence of pediatric epistaxis.
背景越来越多的文献探讨了小儿鼻衄的环境风险因素,但结果各不相同。我们旨在通过系统综述和荟萃分析澄清这些关联。方法系统检索了截至 2024 年 4 月的 PubMed、Scopus、Cochrane Central Register of Control Trials、Web of Science、Medline、Google Scholars 和 Embase。对符合条件的文章进行了审查和质量评估。根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-analyses,PRISMA)指南,进行了系统综述和荟萃分析,以明确鼻衄发病率与多种环境因素之间的相关性。鼻衄的发病率在夏季达到高峰(比例=12.73%,CI:9.629%-16.201%)。重要的风险因素包括夏季升高的环境变量,包括月平均气温升高、日照增加、臭氧浓度升高和气压降低。与此相反,月平均湿度、风速、二氧化硫、一氧化碳、二氧化氮和 PM-10 水平等因素与鼻衄发病风险增加无关。
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引用次数: 0
Implementation of a nurse-led paediatric epistaxis clinic at a tertiary hospital 在一家三级医院开设由护士主导的儿科鼻衄门诊
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-10-29 DOI: 10.1016/j.ijporl.2024.112146
Arshad Zubair , Alison Flynn , Heather Todd , Grace Khong

Introduction

Referrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times.

Methods

ENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022–February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times.

Results

Forty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3–16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (p = 0.003, Wilcoxon rank sum test). Overall quality of care in NPEC was described as "very satisfactory" and “fairly satisfactory” by 92 % and 8 % parents respectively.

Conclusion

Nurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients.
导言:因反复鼻衄而转诊的患者占儿科耳鼻喉科就诊人数的很大一部分。为了改善二级医疗服务,我院与耳鼻喉科专科护士合作开设了由护士主导的儿科鼻衄门诊(NPEC)。本研究旨在描述我院 NPEC 的结构,并评估其影响,包括安全性、家长满意度和转诊至门诊的时间。制定了标准操作程序,并在开始实施 NPEC 之前授予相关能力。对服务进行评估,以评估非营利性儿童疾病防治中心的影响,包括安全性、家长满意度和转诊时间。所有在 2022 年 3 月至 2023 年 2 月期间就诊的患者均被纳入无陪护儿童中心。前瞻性地收集了前 25 名连续就诊患者在门诊结束时填写的家长满意度问卷。对患者病历进行审查,以评估并发症、顾问复查需求和等待时间。结果在研究期间,47名患者参加了NPEC(77次门诊)。中位年龄为 10 岁(3-16 岁不等)。处理方法包括涂抹抗生素软膏(25/77)、硝酸银烧灼(28/77),另有 3 名患者在全身麻醉下接受了鼻腔烧灼。在接受硝酸银烧灼的病例中,有一例报告了轻微并发症。有 18 次门诊(23.3%)需要顾问复查,其中包括 5 名需要进行纤维鼻内窥镜检查的患者。在研究期间,新患者从转诊到出诊的中位时间为 77 天,而顾问门诊的中位时间为 229 天(P = 0.003,Wilcoxon 秩和检验)。92%的家长对 NPEC 的整体护理质量表示 "非常满意",8%的家长表示 "比较满意"。NPEC 成功的关键在于对患者的适当选择、培训和临床医生的支持。这些诊所为改善儿科鼻衄患者的二级护理提供了一种可持续的选择。
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引用次数: 0
The evaluation of auditory processing skills and late latencies in children with ventilation tube history 评估有通气管病史儿童的听觉处理能力和晚期潜伏期。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-10-20 DOI: 10.1016/j.ijporl.2024.112145
Ozlem Ertugrul , Osman Ilkay Ozdamar , Levent Naci Ozluoglu

Objective

(s): This study aims to evaluate the changes in temporal auditory processing skills in children who underwent bilateral ventilation tube insertion (VTI) due to Otitis Media with Effusion (OME) and the effect of these changes on speech comprehension in noisy environments.

Methods

This is a case-control study. In total, 60 children were included in the study in two groups. The control group included 30 children aged 11 to 15, who had normal hearing thresholds and normal immitancemetric evaluation, and were not diagnosed with OME. The study group included 30 children, aged 11–15 who underwent bilateral VTI surgery after their diagnosis of OME during the ages of 3–10 and currently had normal hearing thresholds and normal immitancemetric values. Each group underwent the Turkish Matrix Test (TMT), Random Gap Detection Test (RGDT), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Cortical Auditory Evoked Potential Test (CAEP).

Results

When the temporal processing tests (FPT, DPT, RGDT) were compared, a significant difference was obtained between the study group and the control group (p < 0.05). With the TMT, significantly lower scores were obtained in the study group compared to the control group (p < 0.01). In addition, the latency values in the cortical auditory evoked potential test were longer in the study group compared to the control group, but these results were not statistically significant (p > 0.05).

Conclusion

As a result of the study, it is concluded that the central auditory processing skills were affected in children with a history of bilateral VTI due to OME. Temporal processing tests, Turkish Matrix Test and Cortical Auditory Evoked Potential tests can be recommended as reliable and easily applicable tests, together with traditional hearing test methods in children with a history of OME, in order to evaluate comprehension skills in classroom noise.
目的:(s):本研究旨在评估因患中耳炎并伴有流脓(OME)而接受双侧通气管插入术(VTI)的儿童的颞叶听觉处理能力的变化,以及这些变化对嘈杂环境下言语理解能力的影响:这是一项病例对照研究。本研究分为两组,共纳入 60 名儿童。对照组包括 30 名 11 至 15 岁的儿童,他们的听阈正常,听力评估正常,未被诊断为 OME。研究组包括30名11至15岁的儿童,他们在3至10岁期间被诊断为OME后接受了双侧VTI手术,目前听阈和听力测量值均正常。每组儿童都接受了土耳其矩阵测试(TMT)、随机间隙检测测试(RGDT)、频率模式测试(FPT)、持续时间模式测试(DPT)和皮层听觉诱发电位测试(CAEP):将时间处理测试(FPT、DPT、RGDT)进行比较,研究组与对照组之间存在显著差异(P 0.05):研究结果表明,因 OME 而有双侧 VTI 病史的儿童的中枢听觉处理能力受到了影响。时间处理测试、土耳其矩阵测试和皮层听觉诱发电位测试,与传统的听力测试方法一起,可作为可靠且易于应用的测试方法,推荐给有OME病史的儿童,以评估他们在课堂噪音中的理解能力。
{"title":"The evaluation of auditory processing skills and late latencies in children with ventilation tube history","authors":"Ozlem Ertugrul ,&nbsp;Osman Ilkay Ozdamar ,&nbsp;Levent Naci Ozluoglu","doi":"10.1016/j.ijporl.2024.112145","DOIUrl":"10.1016/j.ijporl.2024.112145","url":null,"abstract":"<div><h3>Objective</h3><div>(s): This study aims to evaluate the changes in temporal auditory processing skills in children who underwent bilateral ventilation tube insertion (VTI) due to Otitis Media with Effusion (OME) and the effect of these changes on speech comprehension in noisy environments.</div></div><div><h3>Methods</h3><div>This is a case-control study. In total, 60 children were included in the study in two groups. The control group included 30 children aged 11 to 15, who had normal hearing thresholds and normal immitancemetric evaluation, and were not diagnosed with OME. The study group included 30 children, aged 11–15 who underwent bilateral VTI surgery after their diagnosis of OME during the ages of 3–10 and currently had normal hearing thresholds and normal immitancemetric values. Each group underwent the Turkish Matrix Test (TMT), Random Gap Detection Test (RGDT), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Cortical Auditory Evoked Potential Test (CAEP).</div></div><div><h3>Results</h3><div>When the temporal processing tests (FPT, DPT, RGDT) were compared, a significant difference was obtained between the study group and the control group (p &lt; 0.05). With the TMT, significantly lower scores were obtained in the study group compared to the control group (p &lt; 0.01). In addition, the latency values in the cortical auditory evoked potential test were longer in the study group compared to the control group, but these results were not statistically significant (p &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>As a result of the study, it is concluded that the central auditory processing skills were affected in children with a history of bilateral VTI due to OME. Temporal processing tests, Turkish Matrix Test and Cortical Auditory Evoked Potential tests can be recommended as reliable and easily applicable tests, together with traditional hearing test methods in children with a history of OME, in order to evaluate comprehension skills in classroom noise.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112145"},"PeriodicalIF":1.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500551","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}
引用次数: 0
期刊
International journal of pediatric otorhinolaryngology
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