David H. Chi

Pediatric myringoplasty: factors that affect success-a retrospective study.

Objective: To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Childrens Hospital of Pittsburgh from 2000 to 2005.

Injection Laryngoplasty for Type 1 Laryngeal Cleft in Children

Objective. To review the 2-year, single-institution experience with injection laryngoplasty for diagnosis and treatment of type 1 laryngeal clefts (LC-1). Study Design. Case series with chart review. Setting. Tertiary care academic children’s hospital. Subjects and Methods. Patients at our institution who underwent injection laryngoplasty for LC-1 from January 2008 to December 2009. Outcome measures included patient demographics, surgical and anesthetic technique, effect on swallowing, and complications. Preoperative and postoperative swallowing evaluations were compared, and quality and duration of effects were calculated. Results. Sixteen children, 9 male and 7 female, underwent injection laryngoplasty for LC-1. Mean gestational age was 36.4 weeks (SD, 4.0 weeks; range, 27-41 weeks). Six patients had a major congenital anomaly (37.5%). Mean age at injection was 11.8 months (SD, 8.9 months; range, 2.9-33.5 months). Nine patients (56%) demonstrated complete resolution of penetration and aspiration on postoperative modified barium swallow (MBS), 4 patients (25%) had some improvement, and 3 patients (19%) showed no change. There were no complications. Mean duration of symptom improvement was 3.3 months (SD, 3.0 months; range, 0-11 months). Five patients went on to have definitive surgical LC-1 repair. Conclusion. Injection laryngoplasty was found to have favorable results in this group of patients with LC-1. Most patients experienced complete resolution of aspiration on MBS, and no patients experienced complications. These findings support the further study of injection laryngoplasty for LC-1 as both a diagnostic and therapeutic technique. Longer follow-up intervals are necessary to elucidate the predictive value with regard to success of formal cleft repair.

Children With Sensorineural Hearing Loss After Passing the Newborn Hearing Screen

OBJECTIVES To identify and describe the findings of children who passed their newborn hearing screen (NHS) and were subsequently found to have childhood hearing loss. SETTING Academic tertiary care center. DESIGN Retrospective medical chart review. METHODS With approval of the institutional review board, hospital records were reviewed for children diagnosed as having hearing loss. We identified 923 children with hearing loss from 2001 to 2011. Patients who passed the NHS with subsequent hearing loss were included. RESULTS Seventy-eight patients were included in our study. The suspicion of hearing loss in patients who passed the NHS was most often from parental concerns (n = 28 [36%]) and failed school hearing screens (n = 25 [32%]). Speech and language delay and failed primary care physician screens accounted for 17% and 12%, respectively. Configuration of the audiogram was bilateral symmetric (n = 42 [54%]), bilateral asymmetric (n = 16 [21%]), and unilateral (n = 20 [26%]) loss. Thirty-seven patients (47%) had severe or profound hearing loss. The etiology was unknown in 42 patients (54%); the remaining was attributed to genetics (n = 13 [17%]), anatomic abnormality (n = 11 [14%]), acquired perinatal (n = 9 [12%]), and auditory neuropathy (n = 3 [4%]). CONCLUSIONS This is the largest study to characterize children with hearing loss who passed the NHS. In our review, parental concerns and school hearing screens were the most common method to diagnose hearing loss after passing the NHS. Families and primary care physicians may have a false sense of security when patients pass the NHS and overlook symptoms of hearing loss. This study raises the question whether further screens would identify hearing loss in children after passing the NHS.

Ophthalmologic findings in children with sensorineural hearing loss.

OBJECTIVES To determine the prevalence of refractive and nonrefractive ophthalmologic abnormalities in children with sensorineural hearing loss (SNHL) and to evaluate the overall utility of routine ophthalmological examination in children with SNHL. DESIGN An institutional review board-approved retrospective analysis of ophthalmologic findings in children (18 years and younger) with SNHL seen between November 6, 2000, and June 4, 2007. SETTING Tertiary care university childrens hospital. PATIENTS Children (18 years and younger) with SNHL. MAIN OUTCOME MEASURES Ophthalmologic findings and SNHL. RESULTS There were 226 patients with SNHL who underwent ophthalmologic examination. Of these patients, 49 (21.7%) had an ophthalmologic abnormality. Refractive errors were present in 23 patients (10.2%), whereas nonrefractive conditions were present in 29 patients (12.8%). The cause of SNHL was syndromic in 11 patients (4.9%), of whom 5 (2.2%) had syndromes with associated ophthalmologic abnormalities. No statistically significant differences were found in ophthalmologic findings based on severity or laterality of SNHL. The prevalence of ophthalmologic findings was not significantly different between patients whose conditions were diagnosed on the basis of newborn screening and other patients. Ophthalmologic abnormalities were found in 1 of 27 patients (3.7%) with biallelic GJB2 mutations and 22 of 106 patients (20.7%) without any GJB2 mutations (P = .04). CONCLUSIONS In this study, the overall prevalence of ophthalmologic findings in children with SNHL was 21.7%. Ophthalmologic anomalies were present in 3.7% of children with GJB2 mutations. Routine ophthalmologic examination can be beneficial in the evaluation of children with SNHL.

Post-tonsillectomy bleeding in children with von Willebrand disease: A single-institution experience

Objectives: 1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD. Study Design: Historical cohort study. Setting: Tertiary care, university-based pediatric hospital. Subjects and Methods: Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery. Results: Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of −0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid. Conclusion: Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.

Comparison of Pediatric Voice Outcome Survey, Reflux Symptom Index, Reflux Finding Score, and Esophageal Biopsy Results

OBJECTIVE To examine correlations between the Pediatric Voice Outcome Survey (PVOS) score, the Reflux Symptom Index (RSI) score, the Reflux Finding Score (RFS), and esophageal biopsy findings in children undergoing upper aerodigestive tract endoscopy. DESIGN Retrospective review of pediatric voice quality-of-life and laryngopharyngeal reflux surveys. Blinded assessment of endoscopic laryngeal images. SETTING Tertiary care childrens hospital. PATIENTS The study included 36 children with the primary problem of dysphonia (n = 28) or cough (n = 8) who underwent endoscopy. INTERVENTIONS The PVOS and the RSI were administered to the patients parents before surgery. The patients underwent laryngotracheobronchoscopy and esophageal biopsy. Four raters independently assigned an RFS to the laryngeal photographs. MAIN OUTCOME MEASURES The assessment included (1) PVOS scores, RSI scores, and RFSs; (2) internal consistency of PVOS and RSI scores; (3) RFS intrarater and interrater reliability; and (4) correlations between PVOS score, RSI score, RFS, and esophageal biopsy findings. RESULTS The mean (SD) age of the patients was 7.5 (2.6) years; the mean (SD) PVOS score, 71.9 (21.4); and the mean (SD) RSI score, 16.2 (9.1). The PVOS and the RSI scores demonstrated good internal consistency (Cronbach alpha = 0.79 and 0.78, respectively). The RFS exhibited good intrarater reliability (r = 0.66-0.98) and moderate interrater reliability (r = 0.32-0.70). The PVOS and RSI instruments displayed significant correlation (r = -0.30; P = .04). There were no other significant correlations between RFSs, esophageal biopsy results, PVOS scores, or RSI scores (P > .05). CONCLUSIONS The RSI may be a useful parent-proxy instrument in addition to the PVOS for pediatric voice patients. The RFS is reliable in children, but its validity could not be demonstrated in this patient population.

Pediatric temporal bone fractures: Current trends and comparison of classification schemes

1) Characterize the current presentation of pediatric temporal bone fractures, 2) compare two classification schemes for temporal bone fractures and illustrate complications in each fracture type.

Congenital Nasal Pyriform Aperture Stenosis Is There a Role for Nasal Dilation

IMPORTANCE Congenital nasal pyriform aperture stenosis (CNPAS) may require sublabial drill-out of the pyriform aperture when symptoms are severe or refractory to medical therapy. Less invasive nasal dilation decreases potential morbidity to neonates with severe CNPAS. OBJECTIVE To determine the outcome of patients with CNPAS who underwent nasal dilation alone without other surgical therapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series at a tertiary pediatric hospital involving neonates with CNPAS. INTERVENTIONS Nasal dilation using Hegar cervical dilators in neonates with severe CNPAS. MAIN OUTCOMES AND MEASURES Avoidance of sublabial pyriform aperture drill-out and length of stay in the hospital after treatment. RESULTS Four patients (median age, 15 days) had respiratory distress and feeding difficulties. Nasal stenosis was suspected, and maxillofacial computed tomography scans revealed a mean pyriform aperture width of 4.5 mm. Medical therapy was initiated, but symptoms persisted. Direct laryngoscopy, rigid bronchoscopy, and nasal endoscopy with nasal dilation to at least 4 mm were performed in 4 patients without postoperative stenting. Mean length of stay after treatment was 4 days. Two patients underwent repeat nasal dilation on postoperative days 18 and 23. All 4 patients remained free of nasal disease in a median follow-up of 4.5 months. CONCLUSIONS AND RELEVANCE Four patients with severe CNPAS were successfully treated with nasal dilation without pyriform aperture bone removal or nasal stenting. This series, while small, suggests that nasal dilation may be a therapeutic option for severe CNPAS that decreases the risks of open surgery and subsequent stent use.

Outcomes and predictors of surgical management in type 1 laryngeal cleft swallowing dysfunction.

To examine the effect of and predict the success of type 1 laryngeal cleft (LC‐1) augmentation through swallowing evaluations.

Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves.

OBJECTIVES 1) Demonstrate the surgical anatomy of a fourth branchial cleft sinus relative to the superior and recurrent laryngeal nerves. 2) Review the diagnosis and management of a fourth branchial cleft sinus. DESIGN Case Study. SETTING Tertiary Childrens Hospital. PATIENT Three year old female who presented with a fever and painful right neck mass. CT scan demonstrated a right neck abscess containing air adjacent to the thyroid. INTERVENTION Two months after initial drainage, the patient underwent enbloc excision of the sinus including the thyroid lobe with closure of the piriform sinus defect. MAIN OUTCOME MEASURE Intraoperative photo documentation of the anatomic relationship between the fourth branchial sinus and surrounding neural structures. RESULTS The sinus tract was shown to terminate in the piriform sinus inferior to the superior laryngeal nerve.