David W. Roberson

Can History and Physical Examination Reliably Diagnose Pediatric Obstructive Sleep Apnea/Hypopnea Syndrome? A Systematic Review of the Literature

OBJECTIVE: Using an evidence-based technique, systematically review the literature to evaluate the accuracy of routine clinical history and physical examination in the diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the pediatric patient. STUDY DESIGN AND SETTING: The biomedical literature was systematically reviewed. Articles comparing the results of clinical evaluation to polysomnography (PSG) were selected. The level of evidence was assessed using established evidence-based medicine (EBM) guidelines. RESULTS: Twelve articles were identified using the search criteria. Eleven of 12 articles concluded that clinical evaluation is inaccurate in the diagnosis of OSAHS. The level of evidence was good to very good (Grade B/B+). CONCLUSION/SIGNIFICANCE: Clinical history and physical examination are not reliable for diagnosing OSAHS compared with overnight PSG. Complicating the interpretation of this work is the lack of a validated PSG threshold of clinically significant disease. There is an urgent need for the development of adequate screening tests with validated clinical outcomes. EBM rating: B-3.

Surgical Management of Retropharyngeal Space Infections in Children

Objective To study the perioperative management strategies in a large group of pediatric patients undergoing surgical therapy for suppurative adenitis of the parapharyngeal and retropharyngeal spaces.

Using a virtual reality temporal bone simulator to assess otolaryngology trainees.

Objective: The objective of this study is to determine the feasibility of computerized evaluation of resident performance using hand motion analysis on a virtual reality temporal bone (VR TB) simulator. We hypothesized that both computerized analysis and expert ratings would discriminate the performance of novices from experienced trainees. We also hypothesized that performance on the virtual reality temporal bone simulator (VR TB) would differentiate based on previous drilling experience.

Classification and Consequences of Errors in Otolaryngology

Objective: To develop a preliminary classification system for errors in otolaryngology.

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

OBJECTIVES: The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use. PATIENTS AND METHODS: A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 childrens hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations. RESULTS: Forty-eight percent of children were ≤6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P ≤ .01), less decannulation (5.0% vs 11.0%; P ≤ .01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P ≤ .01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors. CONCLUSIONS: Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.

Epiglottitis in the Hemophilus influenzae Type B Vaccine Era: Changing Trends †

Objective To describe the epidemiology, natural history, and treatment of epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era.

Mortality and major morbidity after tonsillectomy

To report data on death or permanent disability after tonsillectomy.

New Evidence about an Old Drug — Risk with Codeine after Adenotonsillectomy

In response to reports of respiratory depression and death in young children who had received codeine after tonsillectomy, adenoidectomy, or both, the FDA initiated a safety evaluation. The result is a boxed warning on the labels of all codeine-containing products.

Phenotyping the Function of TRPV1-Expressing Sensory Neurons by Targeted Axonal Silencing

Specific somatosensations may be processed by different subsets of primary afferents. C-fibers expressing heat-sensitive TRPV1 channels are proposed, for example, to be heat but not mechanical pain detectors. To phenotype in rats the sensory function of TRPV1+ afferents, we rapidly and selectively silenced only their activity, by introducing the membrane-impermeant sodium channel blocker QX-314 into these axons via the TRPV1 channel pore. Using tandem mass spectrometry we show that upon activation with capsaicin, QX-314 selectively accumulates in the cytosol only of TRPV1-expressing cells, and not in control cells. Exposure to QX-314 and capsaicin induces in small DRG neurons a robust sodium current block within 30 s. In sciatic nerves, application of extracellular QX-314 with capsaicin persistently reduces C-fiber but not A-fiber compound action potentials and this effect does not occur in TRPV1−/− mice. Behavioral phenotyping after selectively silencing TRPV1+ sciatic nerve axons by perineural injections of QX-314 and capsaicin reveals deficits in heat and mechanical pressure but not pinprick or light touch perception. The response to intraplantar capsaicin is substantially reduced, as expected. During inflammation, silencing TRPV1+ axons abolishes heat, mechanical, and cold hyperalgesia but tactile and cold allodynia remain following peripheral nerve injury. These results indicate that TRPV1-expressing sensory neurons process particular thermal and mechanical somatosensations, and that the sensory channels activated by mechanical and cold stimuli to produce pain in naive/inflamed rats differ from those in animals after peripheral nerve injury.

Tracheotomy-related catastrophic events: Results of a national survey†‡

To gather qualitative and semiquantitative information about catastrophic complications during and following tracheotomy.