International journal of pediatric otorhinolaryngology最新文献_第3页

Preventing unnecessary tympanostomy tube placement in children: A 5-year Update

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-19 DOI: 10.1016/j.ijporl.2025.112250

Sofia Piperno , Zachary S. Burgess , Jason F. Ohlstein , Yusif Hajiyev , Charles A. Hughes , Harold S. Pine

Objective

In 2022 the American Academy of Otolaryngology (AAO) published updated clinical guidelines for pediatric tympanostomy tube placement. Statement 6 recommended that clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (rAOM) who do not have middle ear effusion (MEE) at the time of evaluation. We performed a 5-year update on a study evaluating this recommendation in our pediatric patient population.

Study design

Retrospective cohort study.

Setting

University of Texas Medical Branch.

Methods

Retrospective chart review was performed on children aged 6 months to 12 years diagnosed with rAOM without MEE at the time of assessment. The watchful waiting group (WW) consisted of children who did not receive tympanostomy tubes, while the watchful waiting failure group (BMT) ultimately underwent myringotomy with tube placement. Common rAOM risk factors were assessed between groups.

Results

285 children met inclusion criteria. There was a significant difference in age between groups (WW = 2.62 ± 1.87 years, BMT = 1.79 ± 1.19 years; p < 0.001). There was a 64.2 % success rate for watchful waiting. There was no significant difference in risk factors associated with rAOM between the groups.

Conclusion

As a 5-year update from a previous study, this study again assesses Statement 6 of the 2022 AAO tympanostomy tube guidelines. The 64.2 % watchful waiting success rate following these guidelines is consistent with the 66 % success rate found at the same institution 5 years prior. Contrary to the previous study, older children were significantly more likely to be successfully observed.

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引用次数: 0

Socioeconomic disparities in reconstructive pediatric microtia surgery

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-19 DOI: 10.1016/j.ijporl.2025.112278

Kalena Liu , Alex J. Gordon , Danielle F. Eytan , Zahrah Taufique

Objective

To assess the association of race/ethnicity and education status on time to intervention and the total number of interventions in pediatric patients with microtia undergoing hearing intervention and external ear reconstruction.

Methods

A retrospective chart review was performed in pediatric patients diagnosed with congenital ear deformities evaluated by an otolaryngologist or audiologist from January 1, 2013 to December 1, 2021 at a large surgical institution. Variables analyzed included demographics, patient conditions, time to surgery, and number of surgeries. Statistical analysis included analysis of variance, chi-squared tests, and multivariate regression.

Results

Disparities were identified in reconstructive microtia repair, with non-White patients having an increased number of external ear reconstructive surgeries (p = 0.004), with Black patients average 2 external ear reconstructive surgeries, Hispanic patients 1.74 surgeries, while White patients averaged 0.812 surgeries. All non-White patients also demonstrated increased total number of surgeries (1.94 Asian, 2.57 Black, 2.11 Hispanic, 3.29 Other/Unknown, vs 1.23 White, p = 0.007) and total number of interventions (2.17 Asian, 2.71 Black, 2.37 Hispanic 3.43 Other/Unknown, vs 1.56 White, p = 0.02) as compared to White patients. In multivariate regression analysis, race was a significant factor influencing the number of reconstructive and overall surgeries, while the presence of aural atresia was the strongest predictor for requiring additional hearing surgery.

Conclusion

An increased number of interventions and surgeries were seen amongst non-White patients with microtia. Further investigation is warranted to understand the socioeconomic factors associated with pediatric microtia surgery.

{"title":"Socioeconomic disparities in reconstructive pediatric microtia surgery","authors":"Kalena Liu , Alex J. Gordon , Danielle F. Eytan , Zahrah Taufique","doi":"10.1016/j.ijporl.2025.112278","DOIUrl":"10.1016/j.ijporl.2025.112278","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association of race/ethnicity and education status on time to intervention and the total number of interventions in pediatric patients with microtia undergoing hearing intervention and external ear reconstruction.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed in pediatric patients diagnosed with congenital ear deformities evaluated by an otolaryngologist or audiologist from January 1, 2013 to December 1, 2021 at a large surgical institution. Variables analyzed included demographics, patient conditions, time to surgery, and number of surgeries. Statistical analysis included analysis of variance, chi-squared tests, and multivariate regression.</div></div><div><h3>Results</h3><div>Disparities were identified in reconstructive microtia repair, with non-White patients having an increased number of external ear reconstructive surgeries (p = 0.004), with Black patients average 2 external ear reconstructive surgeries, Hispanic patients 1.74 surgeries, while White patients averaged 0.812 surgeries. All non-White patients also demonstrated increased total number of surgeries (1.94 Asian, 2.57 Black, 2.11 Hispanic, 3.29 Other/Unknown, vs 1.23 White, p = 0.007) and total number of interventions (2.17 Asian, 2.71 Black, 2.37 Hispanic 3.43 Other/Unknown, vs 1.56 White, p = 0.02) as compared to White patients. In multivariate regression analysis, race was a significant factor influencing the number of reconstructive and overall surgeries, while the presence of aural atresia was the strongest predictor for requiring additional hearing surgery.</div></div><div><h3>Conclusion</h3><div>An increased number of interventions and surgeries were seen amongst non-White patients with microtia. Further investigation is warranted to understand the socioeconomic factors associated with pediatric microtia surgery.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"191 ","pages":"Article 112278"},"PeriodicalIF":1.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464229","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

Surgical and audiometric outcomes of active osseointegrated bone-conduction hearing device (Cochlear™ Osia® 2 system) placement from a tertiary paediatric centre

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-13 DOI: 10.1016/j.ijporl.2025.112272

Mona Mozaffari, Nicola Guderley, Anita Wong, Sevasti Konstantinidou, Nikul Amin, Robert Nash

Objective

To assess the audiometric and surgical outcomes of implanted Osia® 2 bone conduction devices in a large paediatric population.

Methods

We conducted a retrospective electronic patient record review of patients implanted with the Cochlear™ Osia® 2 system, over a two-year period. Pre-operative clinical details, audiometric data, operative details and post-operative surgical and audiological outcomes were recorded.

Results

66 Osia® 2 devices were implanted in 49 patients between September 2021 and September 2023 (median age: 9, range: 5–18). Patients were followed up in the ENT clinic for an average of 8.7 months. The majority of cases were primary surgery with patients using a BCHD on softband prior to surgery. Post-op pure tone audiometry and speech in noise testing showed a notable improvement post Osia (vs aided pre Osia) which was significant at 4 KHz and 0 dB speech-noise-ratio. There was one case of infection requiring explant and re-implantation with no further issues. Other post-operative complications included abnormal scarring and neuropathic pain. Subjective reports from the device users reflected high daily compliance and overall satisfaction with the device.

Conclusion

The Cochlear™ Osia® 2 is a relatively new active, transcutaneous osseointegrated implant, which has been available to our paediatric practice since September 2021. Our experience demonstrates the device is an increasingly popular choice amongst paediatric patients and can be safely implanted in children. We advocate simultaneous bilateral implantation in children with bilateral hearing loss. We have seen limited surgical complications and overall excellent audiometric outcomes.

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引用次数: 0

Hearing loss in newborns with prenatal cytomegalovirus record: Analysis of the nation-based data in Türkiye 有产前巨细胞病毒记录的新生儿听力损失：土耳其全国数据分析

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-11 DOI: 10.1016/j.ijporl.2025.112274

Rahşan Çinar , Başak Tezel , Bekir Keskinkiliç , Fatih Kara , Yusuf Kemal Kemaloğlu

Purpose

Primary and non-primary prenatal maternal cytomegalovirus (CMV) infections are a common risk factor for congenital CMV (cCMV) infection, leading to sensorineural hearing loss (SNHL). In this study, we looked for the rate of SNHL in newborns with prenatal maternal CMV records in the National Newborn Hearing Screening Program (NNHSP).

Methods

The database between 2016 and 2019 was retrospectively analyzed for those with prenatal maternal CMV record. The controls were composed of the sex-matched newborns without prenatal maternal CMV record. In addition to hearing status at the end of NNHSP, other risk factors related to congenital hearing loss (CHL) were also analyzed in both groups.

Results

The study included 243 and 235 newborns with and without prenatal maternal CMV records, respectively, and of them, 222 and 213 newborns completed the whole NNHSP. While the control newborns without any risk factors disclosed no SNHL, 1.96 % of those with only prenatal maternal CMV record had SNHL. Rates of SNHL in those with risk factors were 3.33 % and 3.88 % in the prenatal maternal CMV and control groups, respectively.

Conclusion

With the results of this study, we can say that the CHL rate in those with prenatal maternal CMV history (1.96 %) was much higher than previously published CHL data in general population in Türkiye (0.2–0.3 %). Presence of other risk factors along with prenatal maternal CMV increased the rate of SNHL. Maternal CMV infection should be taken account during management of pregnancies as important a risk factor as other risk factors of CHL even in the societies with high maternal CMV seropositivity.

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引用次数: 0

Implementation of Child Life Specialists to improve outcomes in flexible endoscopic evaluation of swallowing in children

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-11 DOI: 10.1016/j.ijporl.2025.112266

Beth Osterbauer , Yvonne Adigwu , Sheng Zhou , Katy Peck , Avital Abraham , Christian Hochstim

Background

Dysphagia and feeding difficulties are common problems in children, and Flexible Endoscopic Evaluation of Swallowing (FEES) is a modality for evaluating pharyngeal swallow function through a transnasal flexible fiberoptic laryngoscopy.

Objective

Due to the concerns around participation and its impact on successfully completing FEES in children, we began utilizing Child Life Specialists (CLS) for FEES procedures and a concurrent implementation research study was launched to measure the impact CLS interventions had on participation rates of children undergoing FEES.

Methods

A retrospective chart review was conducted, collecting patient demographics, participation rates and presence of CLS for all FEES conducted in the study period. To compare children undergoing FEES with the benefit of CLS and those without a CLS present, two by two comparisons were conducted using Student's T-test and Pearson's Chi Squared test.

Results

During the study period 196 children had a FEES with a median age of 2 years (range 2 weeks–17.8 years). Overall, 89 % of children cooperated with the procedure, and in children over the age of 5 years, 99 % of children cooperated. Presence of CLS did not seem to affect cooperation rates in our study.

Conclusion

The addition of CLS services to the FEES team did not appear to improve participation rates in the current study, however more subtle potential impacts on procedural satisfaction/comfort were not assessed. Our results point to the need for additional work to standardize protocols in pediatric FEES to ensure not only improved participation, but a comfortable patient/family experience.

背景吞咽困难和进食困难是儿童的常见问题，而灵活内窥镜吞咽评估（FEES）是一种通过经鼻灵活纤维喉镜评估咽部吞咽功能的方法。目标由于对儿童参与度及其对成功完成 FEES 的影响的关注，我们开始在 FEES 过程中使用儿童生活专家（CLS），并同时启动了一项实施研究，以衡量 CLS 干预对接受 FEES 的儿童参与率的影响。方法我们进行了回顾性病历审查，收集了研究期间进行的所有 FEES 的患者人口统计数据、参与率和 CLS 存在情况。结果在研究期间，196 名儿童接受了 FEES，年龄中位数为 2 岁（范围为 2 周-17.8 岁）。总体而言，89%的儿童配合了手术，在 5 岁以上的儿童中，99%的儿童配合了手术。在我们的研究中，CLS 的存在似乎并不影响合作率。结论在目前的研究中，在 FEES 团队中增加 CLS 服务似乎并没有提高参与率，但对程序满意度/舒适度的更微妙的潜在影响却没有进行评估。我们的研究结果表明，有必要进一步规范儿科 FEES 程序，以确保不仅能提高参与率，还能为患者/家属带来舒适的体验。

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引用次数: 0

Effect of ice cream intake on post-tonsillectomy pain in children

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-11 DOI: 10.1016/j.ijporl.2025.112254

Faiza Grati , Mohamed Omrane , Imen Zouche , Sirine Ayadi , Wassim Guermazi , Hichem Cheikhrouhou

Aims

We aim to evaluate the effect of ice cream intake on post tonsillectomy pain in children.

Material and methods

This study is a prospective, randomized, simple blinded clinical trial. Patients were randomized into two groups: no ice-cream group which received a standard analgesic protocol and the ice cream group which received the same analgesic protocol associated with an ice cream offered for the child before leaving the post anesthesia care unit (PACU). Pain was evaluated by the FLACC scale.

Objectives

The main objective was to compare the FLACC scales between the 2 groups at H6 post-operatively. Accessory objectives included evaluating the time to the first analgesic request and to the first oral intake as well as the occurrence of post operative complications.

Results

Forty-eight children were included. Better pain control was noted in the ice-cream group with significant difference in FLACC scales compared to the no ice-cream group at H6 (p = 0,031), H12 (p = 0,04), H18 (p = 0,024).

The time to first analgesic request was significantly longer in the ice-cream group (p < 0,001).

The time to first oral fluid intake was significantly shorter in the ice-cream group (p = 0,043). Post operative complications were comparable between the 2 groups.

Conclusion

Ice cream intake proved to reduce post tonsillectomy pain and to improve the time to first oral fluid intake without increasing the incidence of post operative complications.

目的我们旨在评估摄入冰淇淋对儿童扁桃体切除术后疼痛的影响。患者被随机分为两组：无冰淇淋组接受标准镇痛方案，冰淇淋组接受相同的镇痛方案，并在离开麻醉后护理病房（PACU）前为患儿提供冰淇淋。主要目的是比较两组在术后 H6 时的 FLACC 量表。辅助目标包括评估首次要求镇痛和首次口服镇痛药的时间以及术后并发症的发生率。在 H6 (p = 0.031)、H12 (p = 0.04)、H18 (p = 0.024)，冰激凌组的疼痛控制较好，FLACC 量表与无冰激凌组相比差异显著。结论事实证明，摄入冰激凌可减轻扁桃体切除术后的疼痛，缩短首次口服流体的时间，但不会增加术后并发症的发生率。

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引用次数: 0

Decision aid for pediatric sleep disordered breathing: A randomized trial

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-11 DOI: 10.1016/j.ijporl.2025.112269

Purcell Chad , Corsten Gerard , Hong Paul

Objective

The objective of this study was to assess whether a decision aid (DA) can increase parental perceptions of shared decision making and reduce decisional conflict.

Study design

Prospective randomized controlled trial.

Setting

January 2017–June 2018 Single-Center Tertiary Pediatric Otolaryngology Practice in Halifax Nova Scotia, Canada.

Methods

English-speaking parents of children younger than 6 years with mild to moderate SDB were included. Parents were randomized to the intervention, with in-person consultation using the DA or the control group, without the DA. Outcomes measured were the decisional conflict scale (DCS), shared decision-making questionnaire (SDM-Q-9) and the OPTION instrument. Descriptive, parametric and non-parametric analyses were performed where appropriate. Spearman's r correlations were used to examine the relation between outcome measures.

Results

101 parents were included (n = 50 DA/51 control). Parents who used the DA reported lower median DCS scores (6.50 vs. 19.25; p = 0.005) and higher SDM-Q-9 scores (93.59 vs. 80.74; p = 0.035). The DCS scores were significantly negatively correlated to SDM-Q-9 scores (Spearman's r = −0.680; p < 0.001). No significant differences were found in mean OPTION scores between groups. SDM-Q-9 and OPTION scores were positively correlated (Spearman's r = 0.590; p < 0.010).

Conclusion

Parents using our DA reported lower levels of decisional conflict and greater perceived involvement in the decision-making process for their children with SDB.

{"title":"Decision aid for pediatric sleep disordered breathing: A randomized trial","authors":"Purcell Chad , Corsten Gerard , Hong Paul","doi":"10.1016/j.ijporl.2025.112269","DOIUrl":"10.1016/j.ijporl.2025.112269","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess whether a decision aid (DA) can increase parental perceptions of shared decision making and reduce decisional conflict.</div></div><div><h3>Study design</h3><div>Prospective randomized controlled trial.</div></div><div><h3>Setting</h3><div>January 2017–June 2018 Single-Center Tertiary Pediatric Otolaryngology Practice in Halifax Nova Scotia, Canada.</div></div><div><h3>Methods</h3><div>English-speaking parents of children younger than 6 years with mild to moderate SDB were included. Parents were randomized to the intervention, with in-person consultation using the DA or the control group, without the DA. Outcomes measured were the decisional conflict scale (DCS), shared decision-making questionnaire (SDM-Q-9) and the OPTION instrument. Descriptive, parametric and non-parametric analyses were performed where appropriate. Spearman's r correlations were used to examine the relation between outcome measures.</div></div><div><h3>Results</h3><div>101 parents were included (n = 50 DA/51 control). Parents who used the DA reported lower median DCS scores (6.50 vs. 19.25; p = 0.005) and higher SDM-Q-9 scores (93.59 vs. 80.74; p = 0.035). The DCS scores were significantly negatively correlated to SDM-Q-9 scores (Spearman's r = −0.680; p < 0.001). No significant differences were found in mean OPTION scores between groups. SDM-Q-9 and OPTION scores were positively correlated (Spearman's r = 0.590; p < 0.010).</div></div><div><h3>Conclusion</h3><div>Parents using our DA reported lower levels of decisional conflict and greater perceived involvement in the decision-making process for their children with SDB.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"191 ","pages":"Article 112269"},"PeriodicalIF":1.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471405","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

Abbe-Estlander flap reconstruction in infants with extensive upper lip defects following oncosurgery: Two case reports

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-11 DOI: 10.1016/j.ijporl.2025.112252

Wei-Liang Chen , Dao-Wei Lin , Zi-Xian Huang , Bin Zhou , Rui Chen

Background

Surgical resection of malignant lip tumors and the reconstruction of extensive lip defects in infants pose significant challenges. We evaluated the effectiveness of the Abbe-Estlander (A-E) flap in repairing upper lip defects in infants following oncosurgery.

Case presentation

We present two cases of pediatric upper lip malignancies: an 18-month-old infant diagnosed with fibrosarcoma (FS) of the right upper lip (Case 1) and a 19-month-old infant diagnosed with rhabdomyosarcoma (RMS) of the left upper lip (Case 2). Both patients underwent surgical resection of the tumors followed by reconstruction of large upper lip defects using the A-E flap under general anesthesia via nasotracheal intubation. No complications were reported during the procedures. Postoperatively, neither patient received adjuvant chemotherapy. Both patients demonstrated acceptable aesthetic outcomes. Case 1 could use a straw, whereas Case 2 could breastfeed. At the 32- and 18-month follow-up, no recurrences were observed.

Conclusion

Surgical resection, followed by reconstruction with an A-E flap, is an effective and safe treatment for these tumors in infants. In addition, general anesthesia via nasotracheal intubation is a reliable anesthetic technique for these procedures.

{"title":"Abbe-Estlander flap reconstruction in infants with extensive upper lip defects following oncosurgery: Two case reports","authors":"Wei-Liang Chen , Dao-Wei Lin , Zi-Xian Huang , Bin Zhou , Rui Chen","doi":"10.1016/j.ijporl.2025.112252","DOIUrl":"10.1016/j.ijporl.2025.112252","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection of malignant lip tumors and the reconstruction of extensive lip defects in infants pose significant challenges. We evaluated the effectiveness of the Abbe-Estlander (A-E) flap in repairing upper lip defects in infants following oncosurgery.</div></div><div><h3>Case presentation</h3><div>We present two cases of pediatric upper lip malignancies: an 18-month-old infant diagnosed with fibrosarcoma (FS) of the right upper lip (Case 1) and a 19-month-old infant diagnosed with rhabdomyosarcoma (RMS) of the left upper lip (Case 2). Both patients underwent surgical resection of the tumors followed by reconstruction of large upper lip defects using the A-E flap under general anesthesia via nasotracheal intubation. No complications were reported during the procedures. Postoperatively, neither patient received adjuvant chemotherapy. Both patients demonstrated acceptable aesthetic outcomes. Case 1 could use a straw, whereas Case 2 could breastfeed. At the 32- and 18-month follow-up, no recurrences were observed.</div></div><div><h3>Conclusion</h3><div>Surgical resection, followed by reconstruction with an A-E flap, is an effective and safe treatment for these tumors in infants. In addition, general anesthesia via nasotracheal intubation is a reliable anesthetic technique for these procedures.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"190 ","pages":"Article 112252"},"PeriodicalIF":1.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420989","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

Investigation of feasibility of early fitting after cochlear implantation and comparison with classical fitting method

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-10 DOI: 10.1016/j.ijporl.2025.112273

Ahmet Cansu , Muzaffer Kanlıkama , Hüseyin Deniz

Objectives

To investigate the feasibility of early activation of the sound processor (1 day postoperatively) after cochlear implant surgery and to compare the electrophysiological parameters with those of the classical method (activation 1 month postoperatively).

Method

This prospective study included 69 patients who underwent cochlear implant surgery between March 2019 and August 2022. Patients were divided into two groups: early fitting and classic fitting (control group). In the early fitting group, the sound processor was activated 1 day after surgery, whereas in the classic fitting group, it was activated 4 weeks after surgery. The study investigated whether early fitting had a negative effect on wound healing and compared electrophysiological parameters between the two groups.

Results

In both groups, the most common early side effects were pain, redness, and swelling. In both groups, 2 patients (5.7 %) required flap revision. The electrode impedance (EI) and most comfortable loudness level (MCL) values were lower in the early fitting group than in the classic fitting group at the initial measurements. However, no significant difference was observed in measurements after 1 month.

Conclusion

Early fitting of the sound processor after surgery did not adversely affect wound healing and is considered a viable approach. Although the electrode impedance and MCL values were lower in the early fitting group in the short term, similar results were obtained in the long term. Early fitting may reduce the procedure cost, particularly for patients who travel long distances to reach the treatment center.

{"title":"Investigation of feasibility of early fitting after cochlear implantation and comparison with classical fitting method","authors":"Ahmet Cansu , Muzaffer Kanlıkama , Hüseyin Deniz","doi":"10.1016/j.ijporl.2025.112273","DOIUrl":"10.1016/j.ijporl.2025.112273","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the feasibility of early activation of the sound processor (1 day postoperatively) after cochlear implant surgery and to compare the electrophysiological parameters with those of the classical method (activation 1 month postoperatively).</div></div><div><h3>Method</h3><div>This prospective study included 69 patients who underwent cochlear implant surgery between March 2019 and August 2022. Patients were divided into two groups: early fitting and classic fitting (control group). In the early fitting group, the sound processor was activated 1 day after surgery, whereas in the classic fitting group, it was activated 4 weeks after surgery. The study investigated whether early fitting had a negative effect on wound healing and compared electrophysiological parameters between the two groups.</div></div><div><h3>Results</h3><div>In both groups, the most common early side effects were pain, redness, and swelling. In both groups, 2 patients (5.7 %) required flap revision. The electrode impedance (EI) and most comfortable loudness level (MCL) values were lower in the early fitting group than in the classic fitting group at the initial measurements. However, no significant difference was observed in measurements after 1 month.</div></div><div><h3>Conclusion</h3><div>Early fitting of the sound processor after surgery did not adversely affect wound healing and is considered a viable approach. Although the electrode impedance and MCL values were lower in the early fitting group in the short term, similar results were obtained in the long term. Early fitting may reduce the procedure cost, particularly for patients who travel long distances to reach the treatment center.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"190 ","pages":"Article 112273"},"PeriodicalIF":1.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420988","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

Botox injections with and without general anesthesia for pediatric sialorrhea: A cost, efficacy, and safety analysis

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology

Pub Date : 2025-02-10 DOI: 10.1016/j.ijporl.2025.112270

Michael M. Lindeborg, Alyssa M. Civantos, Michelle Florentine, Anna K. Meyer, Kristina W. Rosbe

Objective

Ultrasound-guided salivary gland Botulinum toxin A (Botox) injections are often used in pediatric patients with refractory sialorrhea, performed with or without general anesthesia. This study aims to compare outcomes and costs between these methods.

Study design

Retrospective cohort study.

Setting

Tertiary children's hospital.

Methods

Patients with chronic sialorrhea refractory to medical therapy who underwent Botulinum toxin A injections between 2012 and 2023 under general anesthesia (n = 50; 126 injections) were compared to those performed without general anesthesia (n = 31; 116 injections). Sociodemographic factors, clinical history, and injection regimen were recorded. Available billing data from this time period was used to compare costs.

Results

Pediatric patients who underwent Botulinum toxin A injections without general anesthesia did not have statistically significant differences in post-injection cessation of anticholinergic medications (AOR = 0.980, [0.29, 3.29]), family-reported improvement in sialorrhea (AOR = 3.25, [0.58, 18.1]), admissions for aspiration pneumonia within the year (Coefficient = 0.260, [-0.22, 0.75]), or progression to sialorrhea surgery (AOR = 0.374, [0.07, 2.16]) compared to those performed under general anesthesia. Amongst patients who underwent repeat injections, there were no significant differences in the average number of injections (p = 0.41) or time between injections (p = 0.16). Botulinum toxin A injections performed in the outpatient setting ($1374.49) had significantly lower costs compared to injections performed under general anesthesia ($5077.13) (p < 0.001).

Conclusion

Pediatric patients undergoing Botulinum toxin A injections with and without general anesthesia have similar efficacy and quality outcomes. Exploring the advantages of Botulinum toxin A injections without general anesthesia could lead to improved access, reduced risks of general anesthesia, and reduced costs to the medical system.

{"title":"Botox injections with and without general anesthesia for pediatric sialorrhea: A cost, efficacy, and safety analysis","authors":"Michael M. Lindeborg, Alyssa M. Civantos, Michelle Florentine, Anna K. Meyer, Kristina W. Rosbe","doi":"10.1016/j.ijporl.2025.112270","DOIUrl":"10.1016/j.ijporl.2025.112270","url":null,"abstract":"<div><h3>Objective</h3><div>Ultrasound-guided salivary gland Botulinum toxin A (Botox) injections are often used in pediatric patients with refractory sialorrhea, performed with or without general anesthesia. This study aims to compare outcomes and costs between these methods.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary children's hospital.</div></div><div><h3>Methods</h3><div>Patients with chronic sialorrhea refractory to medical therapy who underwent Botulinum toxin A injections between 2012 and 2023 under general anesthesia (n = 50; 126 injections) were compared to those performed without general anesthesia (n = 31; 116 injections). Sociodemographic factors, clinical history, and injection regimen were recorded. Available billing data from this time period was used to compare costs.</div></div><div><h3>Results</h3><div>Pediatric patients who underwent Botulinum toxin A injections without general anesthesia did not have statistically significant differences in post-injection cessation of anticholinergic medications (AOR = 0.980, [0.29, 3.29]), family-reported improvement in sialorrhea (AOR = 3.25, [0.58, 18.1]), admissions for aspiration pneumonia within the year (Coefficient = 0.260, [-0.22, 0.75]), or progression to sialorrhea surgery (AOR = 0.374, [0.07, 2.16]) compared to those performed under general anesthesia. Amongst patients who underwent repeat injections, there were no significant differences in the average number of injections (p = 0.41) or time between injections (p = 0.16). Botulinum toxin A injections performed in the outpatient setting ($1374.49) had significantly lower costs compared to injections performed under general anesthesia ($5077.13) (p < 0.001).</div></div><div><h3>Conclusion</h3><div>Pediatric patients undergoing Botulinum toxin A injections with and without general anesthesia have similar efficacy and quality outcomes. Exploring the advantages of Botulinum toxin A injections without general anesthesia could lead to improved access, reduced risks of general anesthesia, and reduced costs to the medical system.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"190 ","pages":"Article 112270"},"PeriodicalIF":1.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420990","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