Pub Date : 2025-02-01DOI: 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, 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 < 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.</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}
Pub Date : 2025-02-01DOI: 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 , Yicheng Liu , Xiaochen Sun, Jingwei Feng, Guanwen Ding, Bo Pan, 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 < 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).</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}
Pub Date : 2025-02-01DOI: 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.
{"title":"Indications for tracheostomy placement in pediatric patients with cerebral palsy","authors":"Elizabeth Fisher , 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}
Pub Date : 2025-01-31DOI: 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 , Jennifer M. Siu , Brittany N. Rosenbloom , Melanie Noel , Tanya Chen , 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}
Pub Date : 2025-01-26DOI: 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 , Chau Phung , Dominick Rich , Fengling Hu , Jana Bradley , Mark D. Rizzi , 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 < 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).</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}
Pub Date : 2025-01-01DOI: 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.
{"title":"Acute mastoiditis: 30 years review in a tertiary hospital","authors":"Aida Veiga-Alonso , Natalia Roldán-Pascual , Rosa María Pérez-Mora , Beatriz Jiménez-Montero , María Jesús Cabero-Pérez , 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}
Pub Date : 2025-01-01DOI: 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, Ergin Eroğlu, 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}
Pub Date : 2025-01-01DOI: 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.
{"title":"Long-term outcomes of pediatric temporal bone fractures with hearing loss: Results of a multinational database analysis","authors":"Jason L. Steele , Heather J. Smith , Samira Takkoush , Jumah G. Ahmad , Zachary D. Urdang , Neil S. Patel , Richard K. Gurgel , Mana Espahbodi","doi":"10.1016/j.ijporl.2024.112186","DOIUrl":"10.1016/j.ijporl.2024.112186","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>Using the multinational TriNetX database, a retrospective cohort study was performed of patients less than 18 years old with diagnostic codes for <em>other fracture of base of skull</em> and <em>hearing loss</em> 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"188 ","pages":"Article 112186"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894345","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}
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.
{"title":"Predicting most comfortable listening levels of ESRT from ECAP thresholds in paediatric cochlear implant users","authors":"Periannan Jawahar Antony , Palani Saravanan , Manjula Puttapasappa , Geetha Chinnaraj , Megha","doi":"10.1016/j.ijporl.2024.112194","DOIUrl":"10.1016/j.ijporl.2024.112194","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"188 ","pages":"Article 112194"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863250","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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