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Genotypes and clinical phenotypes of pediatric patients with NOG variants: Middle ear surgical outcomes from a Tertiary Center in South Korea NOG变异患儿的基因型和临床表型:来自韩国某三级中心的中耳手术结果。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ijporl.2025.112230
Sang-Yoon Han , Sung Ho Cho , Sung Ho Jung , Myeongsin Kang , Myung-Whan Suh , Moo Kyun Park , Jun Ho Lee , Sang-Yeon Lee

Objective

Although NOG variants are linked to congenital stapes fixation and conductive hearing loss (CHL), little is known about middle ear surgery outcomes and the characteristics of accompanying inner ear anomalies. We explored auditory phenotypes in patients with NOG variants, with a focus on the outcomes of middle ear surgery.

Methods

This study included 11 patients from five unrelated Korean families harboring NOG variants. Genomic investigations were conducted using whole-exome sequencing and whole-genome sequencing. The clinical phenotypes, including pre- and postoperative audiological profiles, radiological abnormalities, and other comorbidities, were analyzed.

Results

The average age at genetic testing was 8.2 years (range, 0–13 years). Two previously reported NOG variants (c.509C > T:p.Pro170Leu and c.252dup:p.Glu85ArgfsTer97) and three novel NOG variants, including the c.187G > T: p.Glu63Ter and two cryptic large deletion within the 17q22.2 region, were identified. All patients exhibited non-progressive CHL. Inner ear anomalies were documented in two patients, with variations such as cochlea and vestibular dysplasia. In this study, seven ears of four patients underwent stapedotomy, resulting in a significantly reduced air-bone gap of 10.18 ± 1.48 dB (P = 0.016), with sustained improvement. Conversely, patients carrying p.Pro170Leu variant, which is associated with poor outcomes for middle ear surgery, were excluded from surgical consideration.

Conclusion

We expanded the spectrum of genotypes and auditory phenotypes associated with NOG variants. Surgical intervention for CHL underlying NOG variants elicits favorable outcomes. However, clinicians should consider the potential for poor prognosis in certain NOG variants. Collectively, identifying NOG variants could guide the treatment strategies to improve CHL.
目的:虽然NOG变异与先天性镫骨固定和传导性听力损失(CHL)有关,但对中耳手术结果和伴随的内耳异常的特征知之甚少。我们探讨了NOG变异患者的听觉表型,重点关注中耳手术的结果。方法:本研究纳入了来自5个无亲缘关系的韩国NOG变异家族的11例患者。基因组研究采用全外显子组测序和全基因组测序。分析了临床表型,包括术前和术后听力学特征、放射学异常和其他合并症。结果:基因检测的平均年龄为8.2岁(范围0-13岁)。两个先前报道的NOG变体(c.509C . > . T:p。发现了Pro170Leu和c.252dup:p.Glu85ArgfsTer97)以及三个新的NOG变体,包括c.187G > T: p.Glu63Ter和两个位于17q22.2区域的隐性大缺失。所有患者均表现为非进展性CHL。内耳异常记录在两个病人,变异如耳蜗和前庭发育不良。本研究中,4例患者7耳行镫骨切开术,气骨间隙明显减小,为10.18±1.48 dB (P = 0.016),且持续改善。相反,携带与中耳手术预后不良相关的p.Pro170Leu变异的患者被排除在手术考虑之外。结论:我们扩大了与NOG变异相关的基因型和听觉表型谱。手术干预CHL潜在的NOG变异可获得良好的结果。然而,临床医生应该考虑到某些NOG变异的潜在预后不良。总的来说,识别NOG变异可以指导改善CHL的治疗策略。
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引用次数: 0
Aspirated foreign bodies in children: 10-Years experience in a single tertiary centre in New Zealand 儿童吸入异物:新西兰单一高等教育中心10年经验。
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ijporl.2025.112234
Jae Hyun Jeong , Jeyasakthy Saniasiaya , Craig McCaffer

Objective

Aspirated foreign bodies (FB) are potentially life-threatening conditions which can be challenging to diagnose in children. The previous similar study from our hospital, published in 2014, created a guideline suggesting when to proceed to laryngobronchoscopy (LB) in suspected FB aspiration with over 99 % sensitivity. The grading system included the presence or absence of acute history, positive examination, and/or radiological findings, including witnessed choking, dysphonia, stridor, wheezing, or reduced air entry on examination or abnormal radiological findings. The current study reviewed a further 10 years and 5 months of data to re-evaluate the ongoing diagnostic usefulness of the three positive findings in children with suspicion of aspirated FB.

Methods

We undertook a retrospective review of all LB performed at our institution for suspected acute FB aspiration from August 2013 to January 2023. We analysed patient characteristics, clinical examination, radiological findings, and outcomes.

Results

We found a total of 100 children under the age of 16 years who underwent LB for suspected FB aspiration. The mean age of our study population was 2.6 years. The population demographics were similar to the results from the previous study from our institution, with Māori and Pasifika children having the highest probability of finding a FB on LB. Male children presenting for suspected FB aspiration are 1.39 times more likely than female children to have a foreign body at LB (p = 0.04). Overall, having two or more positive findings had a sensitivity of 100 %. History or examination alone are more sensitive (both 95.6 %) but less specific (12.5 % and 31.3 %, respectively). Abnormal radiology alone was more specific (75.0) but less sensitive (77.9 %). The most common site of FB was the right bronchial tree (45.6 %), followed by the left (39.7 %). 95 % of FB were organic, and 54 % were nuts. The negative bronchoscopy rate was 32 %.

Conclusion

Two or more positive indicators in history, examination and radiological findings continue to be highly sensitive predictors for the presence of an aspirated foreign body in our paediatric population. We recommend a future large-scale multicentre study to confirm how applicable these findings would be to a broader cohort of patients.
目的:儿童吸入性异物(FB)是一种潜在的危及生命的疾病,其诊断具有挑战性。我院此前发表于2014年的一项类似研究创建了一个指南,建议在疑似FB吸入时何时进行喉支气管镜检查(LB),敏感性超过99%。分级系统包括有无急性病史、阳性检查和/或放射学表现,包括亲眼所见的窒息、发音困难、喘鸣、呼吸减少或检查时的异常放射学表现。目前的研究进一步回顾了10年零5个月的数据,以重新评估三种阳性结果对怀疑吸入性FB的儿童的诊断有用性。方法:我们对2013年8月至2023年1月期间在我院因疑似急性FB误吸而行LB手术的所有患者进行回顾性分析。我们分析了患者的特征、临床检查、放射学表现和结果。结果:我们共发现100名16岁以下儿童因怀疑FB误吸而行LB。我们研究人群的平均年龄为2.6岁。人口统计数据与我们机构之前的研究结果相似,Māori和Pasifika儿童在LB上发现FB的可能性最高。以疑似FB吸入性表现的男性儿童在LB上发现异物的可能性是女性儿童的1.39倍(p = 0.04)。总的来说,有两个或两个以上阳性结果的敏感性为100%。病史或单独检查更敏感(均为95.6%),但特异性较低(分别为12.5%和31.3%)。单独的异常放射学特异性更高(75.0),但敏感性较低(77.9%)。最常见的部位是右支气管树(45.6%),其次是左支气管树(39.7%)。95%的FB是有机的,54%是坚果。支气管镜检查阴性率为32%。结论:在我们的儿科人群中,病史、检查和放射学结果中的两个或两个以上阳性指标仍然是吸入性异物存在的高度敏感的预测因素。我们建议将来进行大规模的多中心研究,以确认这些发现在更广泛的患者队列中是否适用。
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引用次数: 0
Analysis of the therapeutic effect of EarWell ear orthotics on elderly children with congenital ear deformities within 98 days
IF 1.2 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ijporl.2025.112236
Jie OuYang, Xiaoqin Wang

Objective

To observe the efficacy of EarWell ear orthotics in treating congenital ear deformities in older children (≥7 weeks) within 98 days.

Method

A retrospective study was conducted on 58 infants (69 ears) aged 7–14 weeks after birth. Divided into three groups: A (7–9 weeks old, 26 ears), B (10–12 weeks old, 23 ears), and C (13–14 weeks old, 20 ears). Analyze the differences in treatment time, effective rate, six-month recurrence rate, and incidence of complications among three age groups.

Result

Age group A had the shortest treatment time (25.13 ± 3.28d) and the highest effective rate (84.61 %), while age group C had the longest treatment time (48.35 ± 7.64d) and the lowest effective rate (60.00 %), with statistically significant differences (p < 0.05); The six-month recurrence rate and incidence of complications in the A age group were lower than the other two groups, and the difference was statistically significant (p < 0.05); The recurrence cases in the three age groups are mainly concentrated in the cup ear and the prominent ear.

Conclusion

EarWell ear orthotics can still be chosen for morphological correction of congenital ear deformities in children aged 7–14 weeks. However, the effectiveness of treatment may be affected by the age of treatment and the type of malformation. The older the age of treatment, the lower the effectiveness of orthosis treatment, the longer the treatment time, and the higher the probability of complications. Cup ears and prominent ear over 7 weeks old have a higher recurrence rate after treatment, and it is recommended to correct them as soon as possible.
{"title":"Analysis of the therapeutic effect of EarWell ear orthotics on elderly children with congenital ear deformities within 98 days","authors":"Jie OuYang,&nbsp;Xiaoqin Wang","doi":"10.1016/j.ijporl.2025.112236","DOIUrl":"10.1016/j.ijporl.2025.112236","url":null,"abstract":"<div><h3>Objective</h3><div>To observe the efficacy of EarWell ear orthotics in treating congenital ear deformities in older children (≥7 weeks) within 98 days.</div></div><div><h3>Method</h3><div>A retrospective study was conducted on 58 infants (69 ears) aged 7–14 weeks after birth. Divided into three groups: A (7–9 weeks old, 26 ears), B (10–12 weeks old, 23 ears), and C (13–14 weeks old, 20 ears). Analyze the differences in treatment time, effective rate, six-month recurrence rate, and incidence of complications among three age groups.</div></div><div><h3>Result</h3><div>Age group A had the shortest treatment time (25.13 ± 3.28d) and the highest effective rate (84.61 %), while age group C had the longest treatment time (48.35 ± 7.64d) and the lowest effective rate (60.00 %), with statistically significant differences (p &lt; 0.05); The six-month recurrence rate and incidence of complications in the A age group were lower than the other two groups, and the difference was statistically significant (p &lt; 0.05); The recurrence cases in the three age groups are mainly concentrated in the cup ear and the prominent ear.</div></div><div><h3>Conclusion</h3><div>EarWell ear orthotics can still be chosen for morphological correction of congenital ear deformities in children aged 7–14 weeks. However, the effectiveness of treatment may be affected by the age of treatment and the type of malformation. The older the age of treatment, the lower the effectiveness of orthosis treatment, the longer the treatment time, and the higher the probability of complications. Cup ears and prominent ear over 7 weeks old have a higher recurrence rate after treatment, and it is recommended to correct them as soon as possible.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"189 ","pages":"Article 112236"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023401","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
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.
{"title":"Comparative analysis of small-incision and traditional techniques in costal cartilage harvesting: Outcomes on thoracic deformities and scar appearance","authors":"Jiajun Zhi ,&nbsp;Yicheng Liu ,&nbsp;Xiaochen Sun,&nbsp;Jingwei Feng,&nbsp;Guanwen Ding,&nbsp;Bo Pan,&nbsp;Chuan Li","doi":"10.1016/j.ijporl.2025.112235","DOIUrl":"10.1016/j.ijporl.2025.112235","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 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 &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"189 ","pages":"Article 112235"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028784","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
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。
{"title":"Indications for tracheostomy placement in pediatric patients with cerebral palsy","authors":"Elizabeth Fisher ,&nbsp;Taher Valika","doi":"10.1016/j.ijporl.2025.112226","DOIUrl":"10.1016/j.ijporl.2025.112226","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"189 ","pages":"Article 112226"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965037","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
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.
{"title":"Parental anxiety and catastrophizing in pediatric tonsillectomy pain control: A multivariate analysis","authors":"Ben B. Levy ,&nbsp;Jennifer M. Siu ,&nbsp;Brittany N. Rosenbloom ,&nbsp;Melanie Noel ,&nbsp;Tanya Chen ,&nbsp;Nikolaus E. Wolter","doi":"10.1016/j.ijporl.2025.112244","DOIUrl":"10.1016/j.ijporl.2025.112244","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>p</em> = 0.017). Maximal parental anxiety did not predict higher odds of increased child postoperative pain intensity on any postoperative day.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"190 ","pages":"Article 112244"},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255666","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
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.
{"title":"Pneumococcal revaccination in pediatric patients with sinusitis","authors":"William G. Cohen ,&nbsp;Chau Phung ,&nbsp;Dominick Rich ,&nbsp;Fengling Hu ,&nbsp;Jana Bradley ,&nbsp;Mark D. Rizzi ,&nbsp;Adva Buzi","doi":"10.1016/j.ijporl.2025.112242","DOIUrl":"10.1016/j.ijporl.2025.112242","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 0.001) and the number of antibiotic prescriptions decreased 51.3 % (95 % CI: [42.9 %, 58.6 %], p &lt; 0.001). Among immunocompromised patients, encounters were decreased by 46.9 % (95 % CI: [26.2 %, 62.1 %], p &lt; 0.001) and antibiotic prescriptions by 49.2 % (95 % CI: [28.5 %, 64.2 %], p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"190 ","pages":"Article 112242"},"PeriodicalIF":1.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255668","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
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。
{"title":"Acute mastoiditis: 30 years review in a tertiary hospital","authors":"Aida Veiga-Alonso ,&nbsp;Natalia Roldán-Pascual ,&nbsp;Rosa María Pérez-Mora ,&nbsp;Beatriz Jiménez-Montero ,&nbsp;María Jesús Cabero-Pérez ,&nbsp;Carmelo Morales-Angulo","doi":"10.1016/j.ijporl.2024.112204","DOIUrl":"10.1016/j.ijporl.2024.112204","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Study design/setting</h3><div>We conducted a 30-year retrospective study on patients under 18 years of age diagnosed with acute mastoiditis in Cantabria.</div></div><div><h3>Methods</h3><div>We analysed epidemiological data, clinical presentation, causes, treatment, and follow-up.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"188 ","pages":"Article 112204"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872028","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
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
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International journal of pediatric otorhinolaryngology
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