Emily L. Jensen

Treatment of Juvenile Recurrent Parotitis of Childhood: An Analysis of Effectiveness

IMPORTANCE Juvenile recurrent parotitis (JRP) is characterized by recurrent painful swelling of the parotid gland that occurs in the pediatric population. Sialendoscopy with and without ductal corticosteroid infusion (DCI) has been found to be effective in the treatment of JRP and autoimmune parotitis. OBJECTIVE To determine the utility of instrumentation vs pharmacotherapy alone for juvenile recurrent parotitis. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of pediatric patients undergoing DCI without sialendoscopy at a tertiary pediatric hospital was conducted. The medical records were reviewed to determine the frequency of parotitis events before and after treatment. A multiquestion telephone survey of patients and their parents who underwent the procedure was then conducted to determine patient satisfaction. INTERVENTIONS Ductal corticosteroid infusion with hydrocortisone through catheter inserted in the parotid duct. MAIN OUTCOMES AND MEASURES Frequency of symptoms before and after treatment and parental satisfaction with the treatment. RESULTS Twelve patients with a mean age of 6.7 years were identified. The mean duration and frequency of symptoms before the procedure were 22 months and every 2 months, respectively. Five patients had a recurrence, on average 4 months after the procedure. Four patients underwent repeated surgical procedures. All had a longer duration between episodes compared with before DCI. Eight parents participated in the survey on satisfaction with the procedure, and 75% reported improvement in their childs life postprocedure. CONCLUSIONS AND RELEVANCE Current literature shows sialendoscopy with corticosteroid application is successful in treating JRP, but it is unclear whether corticosteroid application alone would treat JRP equally. This study shows that DCI alone has similar results as sialendoscopy with corticosteroid application, indicating that it is the corticosteroid application and not the sialendoscopy causing improvement in symptoms. Because JRP must be differentiated from sialolithiasis, we recommend ultrasonography of the involved parotid(s) prior to using DCI alone to ensure no stone is present. Sialendoscopy should be reserved to rule out other parotid ductal pathologic conditions.

Correlates of Pediatric CPAP Adherence.

STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. METHODS A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. RESULTS Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. CONCLUSIONS Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

Indications, Clinical Course, and Postoperative Outcomes of Urgent Adenotonsillectomy in Children

IMPORTANCE Children undergoing urgent adenotonsillectomy have been poorly described in literature. OBJECTIVE To characterize the clinical course and outcomes of patients who underwent urgent adenotonsillectomy. DESIGN, SETTING, AND PARTICIPANTS A 7-year retrospective medical record review of patients undergoing urgent adenotonsillectomy (study group) at a tertiary care pediatric hospital was undertaken. Comparisons were made between the study group and the control group consisting of children undergoing adenotonsillectomy following diagnostic polysomnography. INTERVENTIONS Retrospective medical record review with no study interventions. MAIN OUTCOMES AND MEASURES Demographics, hospital course, and clinical outcomes. RESULTS A total of 35 patients (21 boys [60%] and 14 girls [40%]; mean age, 3.8 years) were identified as having undergone urgent adenotonsillectomy defined as severe obstructive sleep apnea with associated hypoxemia unresponsive to oxygen. The control group included 301 patients who received a diagnostic polysomnogram prior to nonurgent adenotonsillectomy. Patients undergoing urgent adenotonsillectomy patients were more likely to be younger than 3 years (54%) than nonurgent patients (P < .001) and were characterized by elevated obstructive apnea-hypopnea indices (average, 39.4 events per hour). Persistent desaturation below 80% despite at least 0.5 L of supplemental oxygen was the most common admission indication (83%). Obesity was the most frequent comorbidity (9 patients [31%]). Two patients (6%) experienced a major postoperative complication requiring intervention. Fifteen patients (43%) were discharged with supplemental oxygen. Two patients (6%) were admitted to the hospital more than 72 hours after surgery. CONCLUSIONS AND RELEVANCE Patients requiring urgent adenotonsillectomy are marked by younger age, elevated obstructive apnea-hypopnea indices, and persistent desaturations below 80% unresponsive to supplemental oxygen. Following surgery, some children have a dramatic improvement in gas exchange and will no longer require supplemental oxygen.

Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants

To assess long‐term complication rate and parental satisfaction of osseointegrated bone conduction hearing implants (OBCHIs).

Presentation and management of nasal foreign bodies at a tertiary children's hospital in an American metro area.

OBJECTIVES To examine rates of otolaryngology intervention in children presenting to our emergency department with nasal foreign bodies, factors associated with otolaryngology involvement, rates of complications, and details on nasal button battery exposure. METHODS All patients presenting with a nasal foreign body to Childrens Hospital Colorado from 2007 to 2012 were identified. Factors leading to referral to otolaryngology and operative intervention were examined, as well as complications. RESULTS 102 patients were included. 36 (35%) patients were referred to the otolaryngology clinic, of which 58.9% required operating room intervention. 66 (64.7%) children had their nasal foreign bodies removed in the emergency room, however 30 (45%) of these were removed by an otolaryngology resident or attending physician. Overall, 64.7% of nasal foreign bodies required removal by otolaryngology. Of the 15 objects removed in the operating room, six were button batteries. No septal perforations occurred as a result of nasal button battery exposure. Multivariable logistic regression showed two significant predictors of OR removal: age and disc shaped objects. CONCLUSION While emergency department providers are comfortable attempting removal of nasal foreign bodies, there was a high rate of otolaryngology intervention. Based on this data, there is a need to educate emergency room providers on nasal anatomy and techniques for nasal foreign body removal.

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic.

Pediatric tinnitus: A clinical perspective

To define the clinical features and natural history of pediatric tinnitus from a practicing otolaryngologists perspective and formulate hypotheses therein.

Multiple surgeries in pediatric otolaryngology patients and associated anesthesia risks

OBJECTIVES To determine the risk of healthy children undergoing tympanostomy tubes of an additional surgery prior to age three and associated risk factors. METHODS A retrospective chart review of pediatric patients at a tertiary metropolitan childrens hospital who underwent tympanostomy tube insertion procedure before age of three from January 2010 through March 2015. We determined patient demographics, indication for tympanostomy tube insertion, as well as information about additional procedures requiring general anesthesia before the age of three years. A prospective telephone interview was also performed on a portion of the study population to assess if there were additional surgeries before the age of three that did not occur at our institution. RESULTS In our institution there was a 13% risk of getting an additional surgery after tympanostomy tubes in children who are otherwise healthy. The most common second procedure was an otolaryngologic procedure in 77.8% of the cases. Children with a diagnosis of recurrent acute otitis media had a threefold greater chance of getting an additional surgery than those with a diagnosis of chronic otitis media with effusion. Patients that identified as Black or African American were 3.2 times more likely to have additional surgery. With every year increase at age of surgery, the odds of an additional surgery decreased by 77%. CONCLUSIONS In healthy children undergoing tympanostomy tube insertion at our institution, the incidence of additional procedures under general anesthesia (GA) is low at 13%. Although there is evidence of possible deleterious effects of anesthesia on the developing brain, it is generally accepted that one short (≤1 h) anesthetic exposure under the age of three has not been associated with adverse neurodevelopmental outcomes. As a specialty that regularly performs procedures on young children, we need to be aware of the possible effects of anesthetic agents on our patients. However, this study shows that the exposure risk is low and should help reassure patients families.

Pediatric anosmia: A case series

INTRODUCTION Little is known about the etiology of olfactory dysfunction in the pediatric population. The aim of this study is to characterize the etiology and clinical features of anosmia and to explore evaluation options in a pediatric population. METHODS Olfactory dysfunction was identified at a tertiary pediatric hospital between January 2003 and October 2014 using a text-based and ICD-9 search of the electronic health record system. Clinical information gathered included history, physical examination and imaging study. A phone questionnaire was completed to determine persistence and development of other rhinologic, endocrine, or neurologic symptoms. RESULTS 37 children (male/female = 17/20) with mean/median ages of 13.28/14. 19 years were identified. The distribution of etiology was: rhinologic disease (N = 16), congenital (N = 4), trauma (N = 1), neoplasm (N = 1) and unknown (N = 15). Rhinologic disease included chronic rhinosinusitis (N = 3) and other nasal anatomic lesions. None of the four subjects with congenital anosmia had classic Kallmann syndrome. The utility of imaging in confirming an etiology of anosmia was noted in 1 of 8 CT and 5 of 22 MRI. The most significant finding of the questionnaire was confirmation of normal puberty in the congenital group. CONCLUSION Similar to the adult population, rhinologic disease is the most common cause. Absence or hypoplasia of the olfactory bulbs without associated delayed puberty is the presentation of congenital anosmia in our cohort. MRI had a higher utility than CT in evaluating anosmia in general and congenital anosmia in specific. MRI to evaluate children with a history of congenital olfactory dysfunction is recommended.