Dana L. Suskind

Clinical Study of Botulinum‐A Toxin in the Treatment of Sialorrhea in Children With Cerebral Palsy

Objective To assess the safety and efficacy of intraglandular (parotid and submandibular) botulinum‐A toxin (BTX‐A) in the treatment of sialorrhea in children with cerebral palsy (CP).

A Comparison of Polysomnography and a Portable Home Sleep Study in the Diagnosis of Obstructive Sleep Apnea Syndrome

OBJECTIVE: To validate the role of a portable sleep monitor device (SNAP) in the diagnosis of obstructive sleep apnea syndrome (OSAS). Inter-reader variability was also assessed for both PSG and SNAP. STUDY DESIGN AND SETTING: Sixty consecutive adults referred for PSG at The University of Chicago Sleep Disorder Clinic were prospectively enrolled. RESULTS: There was no significant difference between total number of apnea and hypopnea, respiratory disturbance index (RDI), and minimum oxygen obtained by PSG and SNAP, but there was a significant difference between sleep time and mean oxygen. Pearsons correlation coefficient for RDI ≥ 15 was 0.92. CONCLUSION: There was a significant correlation of RDIs between SNAP and PSG. SNAP has good sensitivity, specificity, positive and negative predictive values. Differences between SNAP and PSG could be attributed to inter-reader variability and not necessarily due to technical limitations of SNAP. SNAP is an excellent tool for the diagnosis of OSAS in the laboratory setting. Future studies should be performed to evaluate SNAPs accuracy in the home setting in the diagnosis of OSAS. EBM rating: B-2. (Otolaryngol Head Neck Surg 2004;131:844–50.)

An Exploratory Study of “Quantitative Linguistic Feedback” Effect of LENA Feedback on Adult Language Production

A child’s early language environment is critical to his or her life-course trajectory. Quantitative linguistic feedback utilizes the Language ENvironment Analysis (LENA) technology as a tool to analyze verbal interactions and reinforce behavior change. This exploratory pilot study evaluates the feasibility and efficacy of a novel behavior-change strategy, quantitative linguistic feedback, to influence adult linguistic behavior and, as a result, a child’s early language environment. Baseline LENA outcome measures (i.e., adult word count [AWC] and conversational turn count [CTC]) were obtained from a diverse sample of 17 nonparental caregivers and their typically developing children (charges) ages 10 to 40 months. Caregivers participated in a one-time educational intervention focusing on enriching a child’s home language environment, interpreting feedback from the baseline LENA recordings, and setting language goals for the following session. Post-intervention, six additional LENA recordings were obtained weekly to measure linguistic behavior. Caregivers showed a significant and prolonged increase from mean baseline to mean postintervention AWC and CTC as measured by LENA–AWC: mean difference = 395 words per hour, 31.6% increase, t = 3.29, p < .01; CTC: mean difference = 14 turns per hour, 24.9% increase, t = 3.54, p < .01. Preliminary results indicate that a one-time educational intervention combined with quantitative linguistic feedback may have a positive effect on caregiver language output, thus enhancing the child’s language environment. This study represents an initial step in the development and evaluation of a novel behavior-change strategy. We propose that quantitative linguistic feedback will add significantly to the arsenal of clinical and research tools used to evaluate and enrich a child’s early language environment.

Parent-Directed Approaches to Enrich the Early Language Environments of Children Living in Poverty

Childrens early language environments are critical for their cognitive development, school readiness, and ultimate educational attainment. Significant disparities exist in these environments, with profound and lasting impacts upon childrens ultimate outcomes. Children from backgrounds of low socioeconomic status experience diminished language inputs and enter school at a disadvantage, with disparities persisting throughout their educational careers. Parents are positioned as powerful agents of change in their childrens lives, however, and evidence indicates that parent-directed intervention is effective in improving child outcomes. This article explores the efficacy of parent-directed interventions and their potential applicability to the wider educational achievement gap seen in typically developing populations of low socioeconomic status and then describes efforts to develop such interventions with the Thirty Million Words Project and Project ASPIRE (Achieving Superior Parental Involvement for Rehabilitative Excellence) curricula.

Improved infant swallowing after gastroesophageal reflux disease treatment: A function of improved laryngeal sensation?

Objective: The objective of this study was to describe improvements in pediatric swallowing after gastroesophageal reflux treatment.

Nontuberculous Mycobacterial Cervical Adenitis

Granulomatous inflammation is a common finding in pathologic evaluation of surgically excised chronic lymphadenopathy in children. Confusion exists regarding diagnosis and management of these lesions. Over a 10-year period at The Childrens Hospital of Philadelphia, a total of 81 children were identified with biopsy-confirmed granulomatous lesions of the head and neck, with nontuberculous mycobacteria (NTM) accounting for 67 of the cases. The typical presentation was that of a nontender mass in the cervicofacial area present for weeks to months, unresponsive to antimicrobials. All underwent surgical excision, which was curative in 54 patients; 13 children required additional procedures. This paper reviews NTM, its typical clinical presentation, difficulty in diagnosis, and the methods of treatment.

Management of the carotid artery following penetrating injuries of the soft palate

Penetrating injuries of the soft palate are not uncommon in the pediatric population. The majority are minor, requiring only conservative treatment. Despite the close proximity of the carotid artery to lateral soft palate and tonsillar fossa, the incidence of carotid injury is low. When carotid injury does occur, it is usually secondary to blunt trauma to the carotid with a resultant thrombosis. A concomitant neurologic deterioration often follows occurring from 3 h to 3 days after the initial injury (Hengerer et al. (1984). Laryngoscope 94, 1571-1575). The potential neurologic sequelae of such an injury make these seemingly innocuous wounds a diagnostic and management dilemma for the clinician. We present an unusual case of an internal carotid artery pseudoaneurysm in a neurologically intact child following soft palate impalement. We review the diagnostic evaluation including angiography and magnetic resonance angiography, the surgical approach, and postoperative issues including anticoagulation. The literature is reviewed and a discussion regarding the approach to penetrating injuries of the soft palate is presented.

Doxycycline sclerotherapy of benign lymphoepithelial cysts of the parotid: a minimally invasive treatment☆

Benign lymphoepithelial cysts (BLCs) of the parotid gland are associated with human immunodeficiency virus infections in both children and adults. These cysts may become painful and unsightly, often initiating a request for therapeutic intervention. There are several treatment options described in the literature. We report the use of doxycycline sclerotherapy in the treatment of a child with BLCs of the parotid.

Autosomal dominant familial frontonasal dermoid cysts: a mother and her identical twin daughters

A dermoid cyst is an ectodermal cyst that contains an epithelial lining as well as adnexal structures, and may occur in numerous areas of the body. The nasal dermoid accounts for 1% of all dermoid cysts and 3-12% of head and neck dermoid cysts. While there have been familial cases reported, a genetic inheritance for nasal dermoids has not been suggested. We present the first reported case of a mother and her identical twin daughters who were all found to have evidence of frontonasal dermoid cysts. Our case and a review of literature seem to implicate an autosomal dominant inheritance in certain instances of nasal dermoids.

Maturation of the Pediatric Tracheostomy Stoma: Effect on Complications

The pediatric tracheostomy stoma can be matured via a technique that places 4-quadrant sutures from the tracheal cartilage to the dermis. This has the potential of decreasing the risk of accidental decannulation and the formation of granulation tissue. A retrospective analysis of 149 tracheostomies performed between January 1989 and December 1996 was done for the following factors: age, underlying diagnosis, indication for tracheostomy, type of tracheal incision, maturation of stoma, duration of tracheostomy, and early and late (>7 days) complications. Maturation of the stoma was performed in 88 (59.1%) of the 149 tracheostomies. There was an overall complication rate of 21.5% (32/149, not including granulation tissue formation). There were 9 (6.0%) early complications and 23 (15.4%) late complications. The overall incidence of tracheocutaneous fistulas occurred in 11 (11.2%) of the 98 decannulated patients: 6 (10.2%) of the 59 matured stomas and 5 (12.8%) of the 39 nonmatured stomas. Granulation tissue was found on subsequent laryngoscopy in 24 (27.3%) of the 88 matured stomas versus 23 (37.7%) of the 61 nonmatured stomas. There were no tracheostomy-related mortalities. Maturing the tracheostomy stoma resulted in a decreased morbidity from accidental decannulations and did not increase the incidence of tracheocutaneous fistulas or granulation tissue formation.