Bas Pullens

Voice outcome and voice-related quality of life after surgery for pediatric laryngotracheal stenosis

To evaluate the long‐term outcome of voice quality and voice‐related quality of life after open airway surgery for pediatric laryngotracheal stenosis.

Long-term quality of life in children after open airway surgery for laryngotracheal stenosis

OBJECTIVES The purpose of this study is to evaluate the long-term health related quality of life (HRQoL) in a cohort of children surgically treated for laryngotracheal stenosis (LTS). STUDY DESIGN Prospective cohort study. METHODS Parents of children between 4 and 18 years at follow-up completed the Child Health Questionnaire Parent Form (CHQ-PF50). Children between 11 and 18 years at follow-up completed the Child Health Questionnaire Child Form (CHQ-CF87). Biographical and pre-operative data were extracted from the hospital records. Post-operative measurements consisted of the Bruce treadmill test and pulmonary function testing (PFT). RESULTS Fifty-four parents completed the CHQ-PF50; twenty-one children completed the CHQ-CF87. The CHQ-PF50 was significantly worse than the norm population on the subscales physical functioning, role functioning: emotional/behavior, general health perceptions, family activities, parental impact: emotional, and time. CHQ-CF87 was significantly worse than the norm population on physical functioning and better on mental health. After multivariate analysis, presence of co-morbidities and glottic stenosis are the most important pre-operative factors for worse scores on general health. As post-operative measurements, the Bruce treadmill test and peak expiratory flow (PEF) correlate well with HRQoL physical subscales. CONCLUSIONS At long-term follow-up after treatment for LTS, deficits in HRQoL may still exist. Presence of co-morbidities and glottic stenosis are important negative factors for long-term HRQoL. The Bruce treadmill test and peak expiratory flow on pulmonary function testing correlate well with physical subscales on HRQoL. A long-term multidisciplinary follow-up with assessment of HRQoL is advised in patients treated for LTS. LEVEL OF EVIDENCE 2B, individual prospective cohort study.

Characteristics and surgical outcome of 98 infants and children surgically treated for a laryngotracheal stenosis after endotracheal intubation: Excellent outcome for higher grades of stenosis after SS-LTR

INTRODUCTION To describe the characteristics and surgical outcome of 98 infants and children treated for an acquired laryngeal stenosis after intubation for respiratory support. MATERIAL AND METHODS We retrospectively reviewed our data from the last 18 years (1994-2013) concerning infants and children with an acquired laryngotracheal stenosis who were treated in our hospital with a laryngotracheal reconstruction or a cricotracheal resection. Outcome was defined by decannulation ratio. RESULTS Of the 98 infants and children who were studied, 54% were preterm, 18% neonates, 13% infants and 14% children. Ninety-one SS-LTRs, two DS-LTRs and five CTRs were performed as primary surgery; three revision operations were performed (DS-LTR). Seventy-seven children had a tracheostomy prior to surgery; decannulation ratio was 93% after primary surgery and 95% after inclusion of revision surgery. For SS-LTR, the decannulation ratio was 93%, including grade III stenosis with comorbidities. Male sex and glottic involvement of the stenosis are correlated to failure of decannulation. Intubation in the term neonatal period is correlated to complicated post-operative course after SS-LTR. CONCLUSIONS Excellent results of surgery for acquired laryngotracheal stenosis can be obtained with a high decannulation rate. Even for higher grades of stenosis with comorbidities and glottic involvement, an SS-LTR is an effective surgical treatment for acquired laryngeal stenosis.

Long-term functional airway assessment after open airway surgery for laryngotracheal stenosis

The purpose of this study was to evaluate our patient‐reported and objective long‐term outcomes of patients treated for laryngotracheal stenosis.

Case Report: Traumatic Displacement of a Cochlear Implant Magnet

Objectives: To date, over 200 000 cochlear implants (CIs) have been implanted worldwide and the incidence is still increasing. We present a case of traumatic displacement of CI magnet to raise awareness about this complication and to highlight the need for vigilance during surgery as well as for proper counseling. Methods: The clinical presentation of a 1.5-year-old boy with a traumatic displacement of a CI magnet was presented and the literature was reviewed for this rare complication. Results: After minor head injury, the sound processor could no longer connect to the CI. X-ray imaging demonstrated displacement of the CI magnet. During revision surgery, the magnet was replaced by a new magnet in the silicon holding cap. Intraoperative impedance measurements were normal and the CI was successfully activated 4 weeks postoperatively. Conclusions: Clinicians and patients should be aware of the risk of displacement of the CI magnet after (minor) head injury. Young boys tend to have a higher risk for this complication.