Anita Jeyakumar

Choanal Atresia: Embryologic Analysis and Evolution of Treatment, a 30-Year Experience†‡

Objectives: Choanal atresia (CA) is a congenital obstruction of the posterior nasal apertures. Multiple surgical techniques have been proposed to repair the atresia. The purpose of this study is to review the basic science and embryology of CA with emphasis on the senior authors extensive experience, and refinement of the treatment of CA. In addition, we will review the outcomes after surgical correction of pediatric patients with CA.

Nonsteroidal Anti-inflammatory Drugs and Postoperative Bleeding Following Adenotonsillectomy in Pediatric Patients

OBJECTIVE To assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on bleeding for pediatric adenotonsillectomy in a retrospective study, based on the common practices at 2 different tertiary care facilities. DESIGN A retrospective study. SETTING Two different tertiary care facilities. PATIENTS Children up to 16 years of age, who underwent elective adenotonsillectomy or tonsillectomy, were included in the study. All indications for adenotonsillectomy, and all surgical techniques were included. Children with a bleeding tendency, and those with contraindications to the use of NSAIDs (eg, because of allergy), were excluded from the study. INTERVENTIONS Nonsteroidal anti-inflammatory drugs. MAIN OUTCOME MEASURE Postoperative bleeding in patients. RESULTS A total of 1160 patients were selected who met the criteria: 673 patients underwent an adenotonsillectomy or tonsillectomy and did not receive any preoperative and postoperative ibuprofen, and 487 patients underwent routine adenotonsillectomy or tonsillectomy and were given postoperative ibuprofen. We noted a 0.7% postoperative bleeding rate in patients who were not allowed to take ibuprofen perioperatively. There was a 1.0% postoperative bleeding rate in patients who were allowed to take ibuprofen perioperatively (P = .75). CONCLUSION Ibuprofen is not a contraindication to adenotonsillectomy or tonsillectomy and should be used in the control of postoperative pain if it is indicated in the patient.

Complications in pediatric cochlear implants

OBJECTIVE The purpose of this study is to retrospectively review the complications of pediatric patients undergoing cochlear implantation at a tertiary referral center. METHOD Institutional review board permission was obtained. A retrospective analysis of all pediatric patients (younger than 18 years) who underwent primary cochlear implantation was performed from January 2001 to December 2005. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications including implant failure, meningitis, hematoma, implant extrusion, cerebrospinal fluid leak, facial palsy, and wound infection. RESULTS One hundred sixty-five patient records were reviewed. Twenty-nine patients were lost to follow-up or were revision cases; therefore, 136 records were analyzed. Of the patients, 53.5% were male. The most common etiology of hearing loss was nonsyndromic, nongenetic, congenital sensorineural hearing loss (60.6%). Other less common etiology of hearing loss included TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus) (8.3%), connexin mutation (5.8%), and enlarged vestibular aqueduct (6.5%). All patients had a follow-up of 3 years. There were no intraoperative complications. The most common complications were flap infections (2.6%) and immediate postoperative hematomas (1.9%). Flap problems mostly occurred within 2 weeks of implantation. Within the study period, there was only one device failure (0.7%). CONCLUSIONS Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications. The patients should have a lifetime follow-up.

The association between sleep-disordered breathing and enuresis in children.

To evaluate the prevalence of nocturnal enuresis in children diagnosed with sleep disordered breathing (SDB) and the effect of adenotonsillectomy (T&A) on nocturnal enuresis.

A Systematic Review of Adenotonsillectomy as a Risk Factor for Childhood Obesity

Objective. Tonsillectomy is the most common major surgical procedure performed in children. There is evidence that tonsillectomy is associated with weight increase and may contribute to pediatric obesity. The study aimed to review the evidence that tonsillectomy with or without adenoidectomy is a risk factor for future obesity. Data Sources. Systematic literature search was performed using PubMed and Ovid. Review Methods. Systematic analysis of the literature from 1970 to 2009 on patients who underwent adenotonsillectomy (T&A) with preoperative and postoperative weight-based measurements. Results. Nine studies satisfied inclusion criteria. A total of 795 children were included. Preoperative weight ranged from normal to morbid obesity. In total, 656 children had demographic information recorded, and 53.35% of the children were male. Indication for surgery was not recorded in 336 patients. In 47.7% patients, the indication recorded was sleep-disordered breathing. The first group included 3 studies involving 127 children, and body mass index (BMI) increased by 5.5% to 8.2%. The second group included 3 studies involving 419 patients; the standardized weight scores increased in 46% to 100% of patients. The third group included 3 studies with 249 patients; the corrected weight increased postoperatively in 50% to 75% of patients. Morbidly obese patients (weight 130%-260% vs peers) remained unchanged postoperatively. Limitations. Each study was designed with different definitions of overweight and a range of follow-up periods. Demographic information was limited. Conclusions. A large population of normal and overweight children undergoing T&A gained a greater than expected amount of weight postoperatively, which suggests an association between T&A and weight gain. A significant need exists for a large study with consistent outcomes measured.

Treatment of idiopathic sudden sensorineural hearing loss

Abstract Conclusion. The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden sensorineural hearing loss (SSNHL) has yet to be fully elucidated; however, in cases where deafness is profound and of recent onset, a therapeutic trial is indicated. Objectives. To investigate treatment regimens and their efficacies, as well as evaluating the potential prognostic correlates and allowing comparison between local and national standards of care for SSNHL. Patients and methods. A retrospective evidence-based case series of 143 patients seen at the University of Rochester, Department of Otolaryngology between 1999 and 2002 was investigated. Treatment modalities included (1) observation, (2) steroids, and (3) steroids with antivirals. Results. The study demonstrates that steroid treatment, alone or in combination with antivirals, results in a significant improvement rate compared with observation. Results indicate that the more expediently a patient with SSNHL is seen by an otolaryngologist, the better their prognosis.

3D Printed Pediatric Temporal Bone: A Novel Training Model.

Objective Temporal bone dissection is a fundamental element of otologic training. Cadaveric temporal bones (CTB) are the gold standard surgical training model; however, many institutions do not have ready access to them and their cost can be significant:

The relationship of age and radiographic incidence of superior semicircular canal dehiscence in pediatric patients.

300 to

Round window insertion of precurved electrodes is traumatic.

500. Furthermore, pediatric cadaveric temporal bones are not readily available. Our objective is to develop a pediatric temporal bone model. Study Design Temporal bone model. Setting Tertiary Children’s Hospital. Subjects Pediatric patient model. Methods We describe the novel use of a 3D printer for the generation of a plaster training model from a pediatric high- resolution CT temporal bone scan of a normal pediatric temporal bone. Results Three models were produced and were evaluated. The models utilized multiple colors (white for bone, yellow for the facial nerve) and were of high quality. Two models were drilled as a proof of concept and found to be an acceptable facsimile of the patient’s anatomy, rendering all necessary surgical landmarks accurately. The only negative comments pertaining to the 3D printed temporal bone as a training model were the lack of variation in hardness between cortical and cancellous bone, noting a tactile variation from cadaveric temporal bones. Conclusion Our novel pediatric 3D temporal bone training model is a viable, low-cost training option for previously inaccessible pediatric temporal bone training. Our hope is that, as 3D printers become commonplace, these models could be rapidly reproduced, allowing for trainees to print models of patients before performing surgery on the living patient.

Lithotripsy for refractory pediatric sialolithiasis

Objective To determine if age affects radiographic incidence of superior semicircular canal dehiscence (SSCD) in pediatric patients. Study Design Retrospective case review. Setting Tertiary children’s hospital. Patients Patients (0–18 yr) with high-resolution computed tomography (CT) temporal bone scans from April 2001 to February 2013. Interventions Diagnostic high-resolution CT temporal bone scans. Main Outcome Measures Findings of dehiscent, thin, or normal SSC on CT scans (including reconstructed Poschl views). Interobserver radiographic interpretation rate between neuroradiologist and otologist. Results Seven-hundred CT scans (1,400 ears) were reviewed, and 1,188 ears were acceptable for analysis. Twenty-three ears (1.9%) had dehiscent SSC, 185 ears (15.6%) had thin SSC, and 980 ears (82.5%) had normal SSC. Median ages of dehiscent, thin, and normal canals were 5, 7, and 9 years, respectively ( p < 0.05). As age increased, the incidence of dehiscent and thin SCC cases decreased; for example, dehiscent or thin canal existed in 51.4% of children less than 12 months, 17.5% of children between 1 and 2 years, 18.5% of children between 3 and 10 years, and 10.9% of children between 11 and 18 years. The &kgr; value of agreement between neuroradiologist and otologist was 0.814, demonstrating a high value of agreement (p < 0.05). Conclusion Radiographic SSCD, although uncommon, appears to be more prevalent in younger children, especially infants younger than 12 months. This suggests that the SSC may develop more bony covering with age.