Christopher R. Grindle

Development of a Test to Evaluate Olfactory Function in a Pediatric Population

This study evaluated two versions of a test for olfactory function to determine suitability for use in a pediatric population.

Incidence of revision adenoidectomy in children

Adenoidectomy is a frequently performed procedure in the pediatric population. Revision rates and indications for a second procedure in children are scarce.

Inadvertent insertion of nasogastric tube into the brain stem and spinal cord after endoscopic skull base surgery

A significant number of neurosurgical patients require feeding tube placement via a nasogastric route. It is used as a temporary access for enteral feeding until patients are able to swallow or receive permanent access. Despite how commonly feeding tubes are used, they are not without potential complications. We report a case of inadvertent placement of small-bore feeding tube into the brain stem and spinal cord in a patient with a history of previous endoscopic transnasal resection of clival chordoma. We discuss the management of this complication and the strategies that have been developed to avoid this complication in the future.

Preoperative magnetic resonance imaging protocol for endoscopic cranial base image-guided surgery

OBJECTIVE Despite the increasing utilization of image-guided surgery, no radiology protocols for obtaining magnetic resonance (MR) imaging of adequate quality are available in the current literature. At our institution, more than 300 endonasal cranial base procedures including pituitary, extended pituitary, and other anterior skullbase procedures have been performed in the past 3 years. To facilitate and optimize preoperative evaluation and assessment, there was a need to develop a magnetic resonance protocol. METHODS Retrospective Technical Assessment was performed. DISCUSSION Through a collaborative effort between the otolaryngology, neurosurgery, and neuroradiology departments at our institution, a skull base MR image-guided (IGS) protocol was developed with several ends in mind. First, it was necessary to generate diagnostic images useful for the more frequently seen pathologies to improve work flow and limit the expense and inefficiency of case specific MR studies. Second, it was necessary to generate sequences useful for IGS, preferably using sequences that best highlight that lesion. Currently, at our institution, all MR images used for IGS are obtained using this protocol as part of preoperative planning. The protocol that has been developed allows for thin cut precontrast and postcontrast axial cuts that can be used to plan intraoperative image guidance. It also obtains a thin cut T2 axial series that can be compiled separately for intraoperative imaging, or may be fused with computed tomographic images for combined modality. The outlined protocol obtains image sequences effective for diagnostic and operative purposes for image-guided surgery using both T1 and T2 sequences.

Lymphosonographic Sentinel node Biopsy of the Supraglottis in a Swine Model

Objective To test the feasibility of a novel contrast-enhanced ultrasound (CEUS) technique, or lymphosonography, for sentinel node biopsy (SNB) of the supraglottis in a porcine model. Study Design and Setting In this prospective, non-randomized animal study, blue dye and ultrasound contrast agent were injected into the supraglottis in seven 50-kg Yorkshire swine. Transcutaneous CEUS was used to identify real-time lymphatic flow of contrast through lymph channels (LC) to the sentinel lymph node (SLN). SNB was carried out, visually identifying a blue node, with the assistance of intraoperative CEUS. Bilateral modified radical neck dissections were performed to search for any residual contrast-positive or blue SLNs. Results In each case, at least one SLN was identified by preoperative CEUS. A total of 12 nodes were identified on preoperative CEUS, and 11 of 12 nodes were stained with blue dye (91.7%). No residual blue or contrast-positive nodes were identified on neck dissection. Conclusions Lymphosonographic SNB of the supraglottis in a porcine model is technically feasible, and yields results comparable to traditional blue dye–guided techniques. No “shine-through” effect or nonsequential nodal enhancement occurred. This technique holds promise for sentinel node biopsy and allows a novel method for in vivo investigation of the lymphatic system.

Tracheotomy after laryngotracheopasty: Risk factors over 10 years

Background Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP).BACKGROUND Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP). METHODS Retrospective case series with chart review of patients undergoing single-stage LTP for SGS over a 10-year period (2001-2010) in a tertiary-care pediatric hospital. RESULTS Twenty-two children (15 boys, 7 girls), with a mean gestational age of 32.5weeks, underwent LTP with and without interpositional grafting, at a median age of 89days. Ten patients (43%) required postoperative tracheotomy. Of patients weighing <2.5kg, 7 of 8 eventually required tracheotomy, while none weighing >5kg needed tracheotomy (p=0.003). The average length of stay for patients with a tracheotomy was 125days, while those without tracheotomy required only 58days (p=0.011). The grade of SGS (p=0.809), gender (p=0.968), age at surgery (p=0.178), and gestational age (p=0.117) were not significantly associated with the need for tracheotomy. Weight at surgery was significantly correlated with the likelihood of needing tracheotomy (p=0.003). CONCLUSIONS Patients who weighed less than 2.5kg at the time of LTP procedures were more likely to require a postoperative tracheotomy. Children who required tracheotomy had longer lengths of hospital stay.

Central auditory processing deficiency with anatomic deficit in left superior temporal lobe

Describe the clinical presentation and treatment of a patient with central auditory processing deficiency associated with an anatomic deficit in the left superior temporal lobe.

Original ArticleTracheotomy after laryngotracheopasty: Risk factors over 10 years☆

Background Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP).BACKGROUND Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP). METHODS Retrospective case series with chart review of patients undergoing single-stage LTP for SGS over a 10-year period (2001-2010) in a tertiary-care pediatric hospital. RESULTS Twenty-two children (15 boys, 7 girls), with a mean gestational age of 32.5weeks, underwent LTP with and without interpositional grafting, at a median age of 89days. Ten patients (43%) required postoperative tracheotomy. Of patients weighing <2.5kg, 7 of 8 eventually required tracheotomy, while none weighing >5kg needed tracheotomy (p=0.003). The average length of stay for patients with a tracheotomy was 125days, while those without tracheotomy required only 58days (p=0.011). The grade of SGS (p=0.809), gender (p=0.968), age at surgery (p=0.178), and gestational age (p=0.117) were not significantly associated with the need for tracheotomy. Weight at surgery was significantly correlated with the likelihood of needing tracheotomy (p=0.003). CONCLUSIONS Patients who weighed less than 2.5kg at the time of LTP procedures were more likely to require a postoperative tracheotomy. Children who required tracheotomy had longer lengths of hospital stay.

iPhone otoscopes: Currently available, but reliable for tele-otoscopy in the hands of parents?

OBJECTIVES Tele-otoscopy has been validated for tympanostomy surveillance and remote diagnosis when images are recorded by trained professionals. The CellScope iPhone Otoscope is a device that may be used for tele-otoscopy and it enables parents to record their childrens ear examinations and send the films for remote physician diagnosis. This study aims to determine the ability to diagnose, and the reliability of the diagnosis when utilizing video exams obtained by a parent versus video exams obtained by an otolaryngologist. METHODS Parents of children ages 17 years or younger attempted recordings of the tympanic membrane of their children with the CellScope after a video tutorial; a physician subsequently used the device to record the same ear. Recordings occurred prior to standard pediatric otolaryngology office evaluation. Later, a remote pediatric otolaryngologist attempted diagnosis solely based on the videos, blinded to whether the examination was filmed by a parent or physician. Interrater reliability between video diagnosis and original diagnosis on pneumatic otoscopy was measured, and objective tympanic membrane landmarks visualized on the films were recorded. RESULTS Eighty ears were enrolled and recorded. There was low interrater agreement (k = 0.42) between diagnosis based on parent videos as compared with pneumatic otoscopy. There was high agreement (k = 0.71) between diagnosis based on physician videos and pneumatic otoscopy. Physician videos and parent videos had only slight agreement on objective landmarks identified (k = 0.087). CONCLUSIONS iPhone otoscopy provides reliable tele-otoscopy images in when used by trained professionals but, currently, images obtained by parents are not suitable for use in diagnosis.