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Comparative analysis of small-incision and traditional techniques in costal cartilage harvesting: Outcomes on thoracic deformities and scar appearance
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ijporl.2025.112235
Jiajun Zhi , Yicheng Liu , Xiaochen Sun, Jingwei Feng, Guanwen Ding, Bo Pan, Chuan Li

Objective

This study aims to compare the postoperative thoracic deformity and scar aesthetic outcomes of auricular reconstruction between the conventional large-incision technique and small-incision technique with perichondrium preservation for costal cartilage harvesting.

Methods

A retrospective analysis was performed on 134 patients who underwent auricular reconstruction using tissue expanders and autologous costal cartilage harvested from the right chest wall between January 2021 and September 2023. Patients were divided into two groups according to the harvesting technique: the traditional large-incision group (n = 64) and the small-incision group with perichondrium preservation (n = 70). Preoperative and postoperative chest CT scans were reviewed for thoracic deformities by measurements of the modified Haller Index (mHI) and modified correction index (mCI). Thoracic scar dimensions were measured in postoperative follow-up.

Results

In the conventional group, significant difference were observed between the left and right hemithorax in anterior-posterior diameter, maximum transverse diameter, cross-sectional area, and mHI values (p < 0.05), showing thoracic deformities. In contrast, within the small-incision group, there were no significant differences between hemithoraces. Additionally, postoperative thoracic scars were significantly smaller in the small-incision group, with shorter scar length (5.63 ± 1.33 cm vs. 11.44 ± 1.31 cm) and width (1.41 ± 0.55 cm vs. 3.75 ± 1.54 cm; p < 0.001).

Conclusion

The small-incision technique with perichondrium preservation significantly reduces postoperative thoracic deformities and results in smaller, less conspicuous scars compared to the traditional large-incision method. This approach minimizes disruption to the chest wall structure and reduces donor-site morbidity, offering improved patient outcomes.
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引用次数: 0
Indications for tracheostomy placement in pediatric patients with cerebral palsy 小儿脑瘫患者气管切开术的适应症。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ijporl.2025.112226
Elizabeth Fisher , Taher Valika

Background

Cerebral palsy (CP) is the most common neuromuscular disorder in children, and children with CP are at increased risk of respiratory distress potentially requiring tracheostomy placement. Previous studies have characterized indications for tracheostomy in neurologically compromised children, however no studies focus specifically on children with CP. The purpose of this study was to identify the indications for tracheostomy placement, sites of airway obstruction, and rate of decannulation in children with CP.

Methods

We conducted a single-center retrospective chart review of all patients who presented with cerebral palsy and required tracheostomy at our center between 2005 and 2023. Patients were categorized according to primary indication for tracheostomy placement. The most common sites of airway obstruction in the cohort were recorded. The date of decannulation was recorded for those patients who had undergone decannulation.

Results

933 patients with tracheostomies were identified, of whom 169 (18 %) had CP and 122 met inclusion criteria. The median age at tracheostomy placement was 1.69 (IQR 0.539–6.609) years. The most common indications for tracheostomy placement were: prolonged intubation or BiPAP dependence (81 %), airway obstruction/hypotonia (13 %), and aspiration/recurrent respiratory infection (6 %). At the time of tracheostomy placement: 38 % of patients had a single site of upper airway obstruction, while 27 % had multi-level obstruction. The most common sites of upper airway obstruction were the supraglottis (23.0 %), tongue base (12 %), and the tonsils/pharyngeal wall (8 %). 24 % of patients had tracheobronchomalacia, and 16 % had subglottic stenosis. Among all patients, 4 of 122 (3 %) were ultimately decannulated.

Conclusions

Patients in our cohort most often received tracheostomy after failure of less invasive ventilation therapies. Tracheostomy placement occurred at a young age. Patients presented with a variety of sites of airway obstruction. Decannulation rate in this cohort was low. Further work is needed to confirm indications for tracheostomy placement and decannulation rate in this population.
背景:脑瘫(CP)是儿童中最常见的神经肌肉疾病,患有CP的儿童发生呼吸窘迫的风险增加,可能需要气管切开术。先前的研究已经明确了神经功能受损儿童的气管切开术指征,但没有研究专门针对CP儿童。本研究的目的是确定CP儿童气管切开术的指征、气道阻塞部位和脱管率。我们对2005年至2023年间在本中心就诊的所有脑瘫患者进行了单中心回顾性图表回顾。根据气管造口术的主要指征对患者进行分类。记录队列中最常见的气道阻塞部位。对已行脱管术的患者记录脱管日期。结果:933例气管切开术患者中,CP 169例(18%),符合纳入标准122例。气管造口术患者的中位年龄为1.69岁(IQR 0.539-6.609)。气管造口术最常见的适应症是:延长插管或BiPAP依赖(81%),气道阻塞/低张力(13%)和误吸/复发性呼吸道感染(6%)。气管造口置管时:38%的患者有单一部位的上气道阻塞,27%的患者有多级阻塞。上呼吸道梗阻最常见的部位是声门上(23.0%)、舌根(12%)和扁桃体/咽壁(8%)。24%的患者有气管支气管软化症,16%的患者有声门下狭窄。在所有患者中,122例患者中有4例(3%)最终切除了血管。结论:在我们的队列中,大多数患者在微创通气治疗失败后接受气管切开术。气管切开术发生在年轻时。患者表现为不同部位的气道阻塞。该队列的去管率较低。在这一人群中,需要进一步的工作来确定气管切开术的适应症和脱管率。
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引用次数: 0
Parental anxiety and catastrophizing in pediatric tonsillectomy pain control: A multivariate analysis
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-31 DOI: 10.1016/j.ijporl.2025.112244
Ben B. Levy , Jennifer M. Siu , Brittany N. Rosenbloom , Melanie Noel , Tanya Chen , Nikolaus E. Wolter

Objective

Parental anxiety and/or catastrophizing may bias the interpretation of children's pain and administration of analgesia post-tonsillectomy. We aimed to determine whether high levels of parental anxiety and/or catastrophizing impact child pain intensity interpretation and administration of analgesia.

Methods

Child-parent dyads were recruited from a tertiary care institution between July 2017–December 2019. Preoperative parental anxiety and catastrophizing were assessed using self-report measures. Postoperative data on child and parent pain intensity, as well as analgesia use, were collected up to 2 weeks post-surgery. Multivariable logistic regression models were created to assess predictors of postoperative child pain intensity and analgesia use.

Results

Our cohort included 234 child-parent dyads. Median child age was 5 years (IQR, 4–6), and 9.0 % of children (n = 21) had a medical comorbidity. Both child- and parent-reported pain intensity were highest on postoperative day 2 (3.65 [SD = 3.08] and 3.67 [SD = 2.51], respectively). Parental catastrophizing did not predict analgesia use at home, although a minimal significant decrease in the odds of analgesia administration was observed on postoperative day 7 (OR 0.932, p = 0.017). Maximal parental anxiety did not predict higher odds of increased child postoperative pain intensity on any postoperative day.

Conclusion

Parental catastrophizing prior to tonsillectomy has minimal predictive value for analgesia use postoperatively. Children may be successfully advocating for their own pain control as parental anxiety and catastrophizing do not appear to be unduly influencing analgesia administration. Future studies should explore the impact of parental anxiety on vulnerable pediatric populations who may be unable to self-advocate for pain management.
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引用次数: 0
Pneumococcal revaccination in pediatric patients with sinusitis
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-26 DOI: 10.1016/j.ijporl.2025.112242
William G. Cohen , Chau Phung , Dominick Rich , Fengling Hu , Jana Bradley , Mark D. Rizzi , Adva Buzi

Objectives

In pediatric patients with sinusitis and suspected low pneumococcal antibody titers, we aimed to determine the association between a pneumococcal polysaccharide vaccine booster dose (PPSV23) and healthcare utilization.

Methods

Pediatric patients with a diagnosis of sinusitis, a PPSV23 booster dose, and pre-vaccine anti-pneumococcal antibody titers (age 2–16) were abstracted from the medical records system. Sinusitis-related healthcare encounters and antibiotic prescriptions were measured for 2 years before and after PPSV23 vaccination. A mixed effects negative binomial regression was utilized to compare pre and post-vaccine healthcare utilization while accounting for age and sex.

Results

A total of 233 patients were included in the study analysis. Mean age at pre-vaccination titer was 7.99 years (±3.83), 47 (20.2 %) were immunocompromised, and nearly all patients received the complete childhood pneumococcal vaccine series. When comparing pre and post-vaccination periods, encounters decreased from an average of 2.70 (95 % CI: [2.29, 3.10]) to 1.23 (95 % CI: [1.00, 1.46]). Antibiotic prescriptions decreased from 2.58 (95 % CI: [2.17, 2.98]) to 1.18 (95 % CI: [0.93, 1.42]). Mixed effects modeling demonstrated the number of encounters after vaccination decreased 51.1 % as compared to before vaccination (95 % CI: [42.9, 58.2], p < 0.001) and the number of antibiotic prescriptions decreased 51.3 % (95 % CI: [42.9 %, 58.6 %], p < 0.001). Among immunocompromised patients, encounters were decreased by 46.9 % (95 % CI: [26.2 %, 62.1 %], p < 0.001) and antibiotic prescriptions by 49.2 % (95 % CI: [28.5 %, 64.2 %], p < 0.001).

Conclusion

PPSV23 booster vaccination was associated with a significant decrease in sinusitis-related healthcare encounters and antibiotic use among pediatric patients, including those who are immunocompromised.
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引用次数: 0
Acute mastoiditis: 30 years review in a tertiary hospital 某三级医院急性乳突炎30年回顾。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112204
Aida Veiga-Alonso , Natalia Roldán-Pascual , Rosa María Pérez-Mora , Beatriz Jiménez-Montero , María Jesús Cabero-Pérez , Carmelo Morales-Angulo

Objective

Acute mastoiditis, the most common complication of acute otitis media, is approached in our study, focused on children from the Autonomous Community of Cantabria, Spain. The aim is to analyze its clinical-epidemiological characteristics and propose diagnostic and treatment recommendations.

Study design/setting

We conducted a 30-year retrospective study on patients under 18 years of age diagnosed with acute mastoiditis in Cantabria.

Methods

We analysed epidemiological data, clinical presentation, causes, treatment, and follow-up.

Results

We included 111 patients, 60.4 % of which were under 2 years old. The average incidence was 3.9/100,000 children per year. Streptococcus pneumoniae was the most common microorganism. Third-generation cephalosporins and amoxicillin-clavulanic acid were the most frequently used antibiotics. 19 % of patients underwent temporal bone CT scans. Twenty-nine children required surgical intervention, primarily myringotomy and mastoidectomy. Only 5.4 % developed retroauricular abscesses. During follow-up, 32 % experienced new acute otitis media cases.

Conclusions

The incidence of acute mastoiditis in Cantabria is similar to that of other developed countries. Imaging studies are reserved for cases with poor progression. Conservative management with antibiotics is suitable for many patients, with surgery reserved for poor responders. Complications are rare in our setting.
目的:探讨急性乳突炎是急性中耳炎最常见的并发症,研究对象为西班牙坎塔布里亚自治区的儿童。目的是分析其临床流行病学特征,提出诊断和治疗建议。研究设计/背景:我们对坎塔布里亚18岁以下诊断为急性乳突炎的患者进行了一项30年的回顾性研究。方法:分析流行病学资料、临床表现、病因、治疗及随访。结果:纳入111例患者,其中60.4%为2岁以下儿童。每年平均发病率为3.9/10万儿童。肺炎链球菌是最常见的微生物。第三代头孢菌素和阿莫西林-克拉维酸是最常用的抗生素。19%的患者接受颞骨CT扫描。29名儿童需要手术干预,主要是鼓膜切开术和乳突切除术。仅5.4%发生耳后脓肿。在随访期间,32%的患者出现了新的急性中耳炎病例。结论:坎塔布里亚的急性乳突炎发病率与其他发达国家相似。影像学检查保留给进展不良的病例。抗生素的保守管理适用于许多患者,手术保留对不良反应。并发症在我们这里很少见。
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引用次数: 0
Pediatric cochlear implantation in otitis media with effusion: Are ventilation tubes truly necessary? 积液性中耳炎儿童人工耳蜗植入术:是否真的需要通气管?
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112203
Erim Pamuk, Ergin Eroğlu, Levent Sennaroğlu

Objective

We aimed to evaluate the clinical findings of our cochlear implant (CI) patients with otitis media with effusion (OME) and CI patients treated with ventilation tube (VT) for OME.

Methods

The medical records of patients who underwent CI surgery at Hacettepe University, Department of Otorhinolaryngology, between November 1997 and March 2023 were reviewed. Patients who had OME or VT in the implanted ear at the time of surgery were included in the study. Perioperative findings, complication status, revision status, and reasons for revision were recorded.

Results

A total of 2945 ears were operated for cochlear implantation during this period. Of these cases, 169 (5.7 %) had OME and 55 (1.86 %) had VT at time of surgery (180 patients). There were no significant differences between the two groups regarding demographic parameters and follow-up time. None of the investigated parameters showed any significant differences between the two groups, except for revision status. The revision rate was significantly higher in the OME group than that in the VT group (10.65 % vs. null, p = 0.008). The total non-OME and non-VT patient cohort had a significantly lower revision rates than the OME group (5.29 % vs. 10.65 %, p = 0.003).

Conclusion

There is no significant difference in surgical difficulty and perioperative complications after CI between patients with VT and those with OME. The relationship between a higher rate of revision and OME in CI patients, and the optimal timing and necessity of VT insertion prior to CI surgery, should be further investigated.
目的:评价人工耳蜗(CI)合并渗出性中耳炎(OME)和人工耳蜗(CI)合并渗出性中耳炎(VT)的临床表现。方法:回顾性分析1997年11月至2023年3月在Hacettepe大学耳鼻咽喉科行CI手术患者的病历。在手术时植入耳中有OME或VT的患者被纳入研究。记录围手术期发现、并发症情况、翻修情况和翻修原因。结果:同期共行人工耳蜗植入术2945耳。在这些病例中,169例(5.7%)在手术时有OME, 55例(1.86%)有VT(180例)。两组在人口学参数和随访时间方面无显著差异。除修订状态外,两组间调查参数均无显著差异。OME组的修正率明显高于VT组(10.65% vs. null, p = 0.008)。非OME组和非vt组的翻修率明显低于OME组(5.29% vs. 10.65%, p = 0.003)。结论:VT患者与OME患者CI术后手术难度及围手术期并发症无显著差异。CI患者较高的翻修率与OME之间的关系,以及CI手术前VT插入的最佳时机和必要性,有待进一步研究。
{"title":"Pediatric cochlear implantation in otitis media with effusion: Are ventilation tubes truly necessary?","authors":"Erim Pamuk,&nbsp;Ergin Eroğlu,&nbsp;Levent Sennaroğlu","doi":"10.1016/j.ijporl.2024.112203","DOIUrl":"10.1016/j.ijporl.2024.112203","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate the clinical findings of our cochlear implant (CI) patients with otitis media with effusion (OME) and CI patients treated with ventilation tube (VT) for OME.</div></div><div><h3>Methods</h3><div>The medical records of patients who underwent CI surgery at Hacettepe University, Department of Otorhinolaryngology, between November 1997 and March 2023 were reviewed. Patients who had OME or VT in the implanted ear at the time of surgery were included in the study. Perioperative findings, complication status, revision status, and reasons for revision were recorded.</div></div><div><h3>Results</h3><div>A total of 2945 ears were operated for cochlear implantation during this period. Of these cases, 169 (5.7 %) had OME and 55 (1.86 %) had VT at time of surgery (180 patients). There were no significant differences between the two groups regarding demographic parameters and follow-up time. None of the investigated parameters showed any significant differences between the two groups, except for revision status. The revision rate was significantly higher in the OME group than that in the VT group (10.65 % vs. null, p = 0.008). The total non-OME and non-VT patient cohort had a significantly lower revision rates than the OME group (5.29 % vs. 10.65 %, p = 0.003).</div></div><div><h3>Conclusion</h3><div>There is no significant difference in surgical difficulty and perioperative complications after CI between patients with VT and those with OME. The relationship between a higher rate of revision and OME in CI patients, and the optimal timing and necessity of VT insertion prior to CI surgery, should be further investigated.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"188 ","pages":"Article 112203"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872030","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
Long-term outcomes of pediatric temporal bone fractures with hearing loss: Results of a multinational database analysis 儿童颞骨骨折伴听力损失的长期预后:多国数据库分析的结果。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112186
Jason L. Steele , Heather J. Smith , Samira Takkoush , Jumah G. Ahmad , Zachary D. Urdang , Neil S. Patel , Richard K. Gurgel , Mana Espahbodi

Introduction

Pediatric temporal bone fractures (TBFs) can result in adverse outcomes including meningitis, significant sensorineural hearing loss requiring cochlear implantation (CI), facial nerve weakness, cerebrospinal fluid (CSF) leak, and labyrinthitis. The objective of this study is to determine the risks of these outcomes for TBFs with hearing loss.

Methods

Using the multinational TriNetX database, a retrospective cohort study was performed of patients less than 18 years old with diagnostic codes for other fracture of base of skull and hearing loss to serve as an approximation of TBF. This classification excluded all TBFs without hearing loss. An age- and sex-matched control cohort was selected without the above-mentioned diagnostic codes. More than 95 % of patient data used is from 2006-present, with an average of 12–14 years of data per health care organization. Measured outcomes included meningitis, CI, facial nerve disorders (including facial nerve weakness, lagophthalmos, and eyelid weight placement for lagophthalmos), CSF leak and labyrinthitis after TBF. Risk ratios were calculated after 1:1 propensity-score matching (PSM) for age and sex.

Results

TriNetX identified 2739 pediatric patients (mean age of 7.61 ± 4.39 years) with TBF and an age- and sex-matched cohort of 2739 pediatric patients without TBF (mean age of 7.58 ± 4.37 years). Those with TBF had a greater risk of developing meningitis (RR: 2.90, 95 % CI: 1.42–5.94) and facial nerve disorders (RR: 13.44, 95 % CI: 8.83–20.45) at any time than those without TBF. Matched results were not available for labyrinthitis, CI or CSF leak, as there were multiple instances in the Pediatric TBF cohort versus zero instances in the Control cohort. Results prior to PSM demonstrated an increased risk for labyrinthitis (RR: 43.12, 95 % CI: 23.17–80.27), CI (RR: 21.61, 95 % CI: 13.03–35.84) and CSF leak (89.08, 95 % CI: 67.71–117.20) in the pediatric TBF cohort compared with the cohort without TBF.

Discussion

Pediatric patients who sustain TBF with hearing loss are at increased risk of subsequent meningitis and facial nerve disorders and may also be at increased risk of labyrinthitis, CSF leak, and undergoing CI.
儿童颞骨骨折(tbf)可导致不良后果,包括脑膜炎、需要人工耳蜗植入的严重感音神经性听力损失(CI)、面神经无力、脑脊液(CSF)泄漏和迷路炎。本研究的目的是确定伴有听力损失的tbf患者这些结果的风险。方法:使用多国TriNetX数据库,对年龄小于18岁的患有其他颅底骨折和听力损失诊断代码的患者进行回顾性队列研究,以作为TBF的近似值。该分类排除了所有无听力损失的tbf。选择年龄和性别匹配的对照队列,不使用上述诊断代码。95%以上的患者数据来自2006年至今,每个卫生保健组织平均有12-14年的数据。测量结果包括脑膜炎、CI、面神经紊乱(包括面神经无力、眼lagophthalmos和眼lagophthalmos的眼睑重量放置)、脑脊液漏和TBF后迷路炎。在1:1倾向评分匹配(PSM)后计算年龄和性别的风险比。结果:TriNetX确定了2739例有TBF的儿童患者(平均年龄7.61±4.39岁)和2739例年龄和性别匹配的无TBF的儿童患者(平均年龄7.58±4.37岁)。有TBF的患者在任何时候发生脑膜炎(RR: 2.90, 95% CI: 1.42-5.94)和面神经紊乱(RR: 13.44, 95% CI: 8.83-20.45)的风险都高于无TBF的患者。迷路炎、CI或脑脊液泄漏没有匹配的结果,因为在儿童TBF队列中有多个病例,而在对照队列中为零。结果在PSM之前,与没有TBF的队列相比,儿童TBF队列中迷路炎(RR: 43.12, 95% CI: 23.17-80.27)、CI (RR: 21.61, 95% CI: 13.03-35.84)和CSF泄漏(89.08,95% CI: 67.71-117.20)的风险增加。讨论:持续TBF并伴有听力损失的儿科患者随后发生脑膜炎和面神经疾病的风险增加,也可能增加迷路炎、脑脊液泄漏和接受CI的风险。
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引用次数: 0
Frequency of long-term nonsteroidal anti-inflammatory drug hypersensitivity after nasal polypectomy in childhood 儿童鼻息肉切除术后长期非甾体类抗炎药过敏的发生率。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112201
Demet Tekcan , Ilknur Kulhas Celik , Merih Önal , Hasibe Artac
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引用次数: 0
Predicting most comfortable listening levels of ESRT from ECAP thresholds in paediatric cochlear implant users 从 ECAP 阈值预测儿科人工耳蜗用户最舒适的 ESRT 聆听水平。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112194
Periannan Jawahar Antony , Palani Saravanan , Manjula Puttapasappa , Geetha Chinnaraj , Megha
Studies have reported a varied correlation strength between the electrically evoked compound action potential (ECAP) and electrically evoked stapedial reflex thresholds (ESRT) in cochlear implant recipients. However, there is a lack of information on the relationship between the two measures in paediatric cochlear implant users. This study was aimed to compare the ESRT and ECAP measures and determine where ECAP thresholds fall within the dynamic range of ESRT-based Maps in paediatric cochlear implant users. The study involved 40 children aged between 3 and 6 years and were implanted with MedEL cochlear implant device unilaterally. ESRT and ECAP thresholds were measured for all twelve electrodes during the same mapping session, three months after cochlear implant activation. The results revealed significant differences between ECAP and ESRT thresholds across all electrodes. A significant moderate correlation between ESRT and ECAP thresholds was observed on all electrodes. The ECAP thresholds could predict the ESRT based Most comfortable levels (MCLs) significantly. Notably, ECAP thresholds fell by 17–34 % from the upper stimulation levels of ESRT-based maps across the electrodes. This study's findings have significant implications for programming cochlear implants in paediatric patients. For children who are unable to cooperate during ESRT measurements, or in cases where ESRT cannot be elicited, ECAP measurements offer a viable alternative. ECAP-based estimates can be used to set MCL levels that closely approximate those derived from ESRT, ensuring appropriate stimulation levels for these young children using cochlear implants.
研究报道了人工耳蜗受者电诱发复合动作电位(ECAP)和电诱发镫骨反射阈值(ESRT)之间不同的相关强度。然而,在儿童人工耳蜗使用者中,缺乏关于这两种措施之间关系的信息。本研究旨在比较ESRT和ECAP测量,并确定ECAP阈值在儿童人工耳蜗使用者ESRT-based Maps的动态范围内的位置。研究对象为40例3 ~ 6岁儿童,均单侧植入MedEL人工耳蜗。在人工耳蜗激活3个月后,在相同的测绘过程中测量所有12个电极的ESRT和ECAP阈值。结果显示ECAP和ESRT在所有电极上的阈值存在显著差异。在所有电极上观察到ESRT和ECAP阈值之间存在显著的中度相关性。ECAP阈值可显著预测ESRT的最舒适水平(mcl)。值得注意的是,ECAP阈值比基于esrt的电极图的高刺激水平下降了17- 34%。本研究结果对小儿患者人工耳蜗植入程序设计具有重要意义。对于在ESRT测量过程中无法合作的儿童,或者在无法引发ESRT的情况下,ECAP测量提供了一个可行的替代方案。基于ecap的估计可用于设定MCL水平,该水平与ESRT得出的MCL水平非常接近,确保这些使用人工耳蜗的幼儿获得适当的刺激水平。
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引用次数: 0
Electrophysiological findings of brainstem auditory evoked potentials in infants with down syndrome: A systematic review and meta-analysis 唐氏综合征婴儿脑干听觉诱发电位的电生理结果:系统回顾和荟萃分析。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ijporl.2024.112188
Fabiane Zimmermann , Georgea Espindola Ribeiro , Josiane Hoffmann , Daniela Polo Camargo da Silva

Objective

to summarize the evidence on the electrophysiological findings in the auditory brainstem response (ABR) in infants with DS.

Material and methods

This is a systematic review study, whose protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023424139) and conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies were included: cross-sectional and cohort studies that performed ABR evaluation in infants with DS up to two years of age, which had their results compared with normal infants, of the same age group. The search for studies was performed in the following databases: PubMed, LILACS, Scopus, CINHAL, Web of Science, Scielo, Embase and LIVIVO, and in the gray literature: Google Scholar and Proquest. There were no restrictions on language or publication date. The methodological quality of the included studies was assessed using the JBI (Joanna Briggs Institute) checklist. Phases 1 (reading of titles and abstracts) and 2 (reading in full), data extraction, assessment of methodological quality and certainty of evidence were performed independently by the reviewers. Existing disagreements were resolved in a consensus meeting.

Results

A total of 494 articles were obtained, which after removal of duplicates and independent analysis by the reviewers, ten studies were selected for qualitative synthesis and four studies were selected for meta-analysis. There was heterogeneity between the effects observed in the ABR parameters (I2 = 78 %) with an overall pooled effect size of −0.05 (95 % confidence interval of −0.13-0.03; p = 0.22) indicating no significant difference in ABR responses between groups. The certainty of the evidence assessed by GRADE was considered very low due to inconsistency and imprecision.

Conclusion

The results of the meta-analysis indicate that there are no significant diferences in ABR parameters, including waves I, III, and V and the I – V interpeak interval, between infants with and without DS up to two years of age. However, the limitations found, such as methodological heterogeneity, small sample sizes and variability in the age range of the participants, generated uncertainty in the results. Therefore, the certainty of the evidence was classified as very low, according to the GRADE methodology.
目的:总结退行性椎体滑移婴儿听性脑干反应(ABR)的电生理表现。材料和方法:这是一项系统评价研究,其方案已在国际前瞻性系统评价登记册(PROSPERO CRD42023424139)注册,并按照系统评价和荟萃分析首选报告项目(PRISMA)的建议进行。观察性研究包括:横断面和队列研究,对两岁以下的DS婴儿进行ABR评估,并将其结果与同年龄组的正常婴儿进行比较。在以下数据库中进行研究检索:PubMed, LILACS, Scopus, CINHAL, Web of Science, Scielo, Embase和LIVIVO,以及灰色文献:谷歌Scholar和Proquest。对语言和出版日期没有限制。纳入研究的方法学质量采用JBI (Joanna Briggs Institute)检查表进行评估。阶段1(阅读标题和摘要)和阶段2(阅读全文)、数据提取、方法学质量评估和证据确定性由审稿人独立完成。现有的分歧在一次协商一致的会议上得到解决。结果:共获得494篇文献,经审稿人去除重复和独立分析后,选择10篇研究进行定性综合,选择4篇研究进行meta分析。ABR参数所观察到的效应之间存在异质性(I2 = 78%),总体合并效应大小为-0.05(95%置信区间为-0.13-0.03;p = 0.22),表明两组间ABR反应无显著差异。由于不一致和不精确,GRADE评估的证据的确定性被认为非常低。结论:meta分析结果显示,两岁前DS患儿与非DS患儿ABR参数(包括I波、III波、V波及I - V峰间间隔)无显著差异。然而,所发现的局限性,如方法的异质性、小样本量和参与者年龄范围的可变性,产生了结果的不确定性。因此,根据GRADE方法,证据的确定性被分类为非常低。
{"title":"Electrophysiological findings of brainstem auditory evoked potentials in infants with down syndrome: A systematic review and meta-analysis","authors":"Fabiane Zimmermann ,&nbsp;Georgea Espindola Ribeiro ,&nbsp;Josiane Hoffmann ,&nbsp;Daniela Polo Camargo da Silva","doi":"10.1016/j.ijporl.2024.112188","DOIUrl":"10.1016/j.ijporl.2024.112188","url":null,"abstract":"<div><h3>Objective</h3><div>to summarize the evidence on the electrophysiological findings in the auditory brainstem response (ABR) in infants with DS.</div></div><div><h3>Material and methods</h3><div>This is a systematic review study, whose protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023424139) and conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies were included: cross-sectional and cohort studies that performed ABR evaluation in infants with DS up to two years of age, which had their results compared with normal infants, of the same age group. The search for studies was performed in the following databases: PubMed, LILACS, Scopus, CINHAL, Web of Science, Scielo, Embase and LIVIVO, and in the gray literature: Google Scholar and Proquest. There were no restrictions on language or publication date. The methodological quality of the included studies was assessed using the JBI (Joanna Briggs Institute) checklist. Phases 1 (reading of titles and abstracts) and 2 (reading in full), data extraction, assessment of methodological quality and certainty of evidence were performed independently by the reviewers. Existing disagreements were resolved in a consensus meeting.</div></div><div><h3>Results</h3><div>A total of 494 articles were obtained, which after removal of duplicates and independent analysis by the reviewers, ten studies were selected for qualitative synthesis and four studies were selected for meta-analysis. There was heterogeneity between the effects observed in the ABR parameters (I2 = 78 %) with an overall pooled effect size of −0.05 (95 % confidence interval of −0.13-0.03; p = 0.22) indicating no significant difference in ABR responses between groups. The certainty of the evidence assessed by GRADE was considered very low due to inconsistency and imprecision.</div></div><div><h3>Conclusion</h3><div>The results of the meta-analysis indicate that there are no significant diferences in ABR parameters, including waves I, III, and V and the I – V interpeak interval, between infants with and without DS up to two years of age. However, the limitations found, such as methodological heterogeneity, small sample sizes and variability in the age range of the participants, generated uncertainty in the results. Therefore, the certainty of the evidence was classified as very low, according to the GRADE methodology.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"188 ","pages":"Article 112188"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813052","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}
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International journal of pediatric otorhinolaryngology
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