Gopi Shah

The role of routine hearing screening in children with cystic fibrosis on aminoglycosides: A systematic review.

To review the role of routine hearing screening for sensorineural hearing loss (SNHL) in children with cystic fibrosis (CF) who have been on aminoglycoside therapy.

Laryngotracheal reconstruction in infants and children: Are single-stage anterior and posterior grafts a reliable intervention at all pediatric hospitals?☆

OBJECTIVE To review outcomes of pediatric laryngotracheal stenosis treated by single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts and compare decannulation rate for single-stage laryngotracheal reconstruction with rates published at larger (>200 beds) pediatric tertiary care hospitals. METHODS A 4-year retrospective chart review (2004-2008) of all patients undergoing procedures coded with 2008 CPT codes 31582 (laryngoplasty for laryngeal stenosis with graft or core mold, including tracheotomy) and 31587 (laryngoplasty, cricoid split) for a pediatric, tertiary-care hospital. Interventions were single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts, and the main outcome measure was the decannulation rate after single-stage laryngotracheal reconstruction. RESULTS We identified 44 patients with subglottic stenosis, of whom 13 underwent single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts. The mean age at surgery was 2.2 years (range, 5 months to 4 years). Twelve of 13 children had Cotton-Myer grade III stenosis. Ninety-two percent (12 of 13) of children remain decannulated. The mean follow up was 52 months. CONCLUSIONS Single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts appears to be a safe and effective technique for managing patients with high-grade subglottic stenosis at intermediate size childrens hospitals. Our overall decannulation rate of 92% compares favorably to that reported in the literature (84-96%).

Resource analysis of tonsillectomy in children.

To analyze variables that affect time and cost parameters of pediatric adenotonsillectomy.

Intracranial complications of acute sinusitis in children: The role of endoscopic sinus surgery

OBJECTIVE To study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis METHODS: Retrospective chart review at a tertiary care pediatric hospital MAIN OUTCOMES: Demographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures RESULTS: Twenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n=10), epidural abscess (n=10), meningitis (n=5), intraparenchymal abscess (n=5), and cavernous sinus thrombosis (n= 2). Neurologic symptoms included headache (n=12), hemiparesis (n=5) and aphasia (n=3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. DISCUSSION Early ESS may be associated with less need for neurosurgical procedures.

Tongue entrapment in aluminum water bottle: Discussion of removal and airway management

Tongue entrapment in a bottle neck is rare, with few cases reported in the literature. Reported here is the case of a child who presented to the Emergency Department with her tongue entrapped in an aluminum bottle. This case is unique in that the patient had a delayed presentation resulting in significant tongue edema, requiring advanced methods for removal and airway management. These include sedated mechanical removal of the strangulating object and transnasal fiberoptic intubation. We review published cases and the options for removal of an entrapped tongue from a bottle neck, and we discuss the importance of airway management.

Concomitant Transsphenoidal Approach to the Anterior Skull Base and Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

Objectives To describe outcomes of endoscopic resection of sellar tumors with concomitant endoscopic sinus surgery for patients with chronic rhinosinusitis (CRS). Design Retrospective chart review. Setting Tertiary care medical center. Participants Patients who underwent endoscopic transsphenoidal surgery for excision of anterior skull base lesions and simultaneous functional endoscopic sinus surgery (FESS) for CRS between January 2006 and January 2011 by senior authors (MRR and JJE). Main Outcomes Measured Short- and long-term postoperative complications. Results Fourteen patients were identified. Average follow-up was 27 months. All patients had preoperative symptoms consistent with CRS. No patients were treated with preoperative antibiotics. Surgical pathology revealed chronic sinusitis in all specimens. Pathology of the intracranial lesions included 11 pituitary macroadenomas, one craniopharyngioma, one chondrosarcoma, and one cholesterol granuloma. Short-term postoperative morbidities included a sphenoid polyp, one adhesion, and one case of pharyngitis. Long-term outcomes included one frontoethmoidal mucocele, one recurrence of nasal polyps, and three cases of acute sinusitis. There were no intracranial complications for the entire follow-up period. Conclusions Transsphenoidal surgery can safely be performed in the setting of CRS without increased risk of intracranial complications.

Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review: Dornase alfa for CRS CF patients

A major component of sputum in cystic fibrosis (CF) patients is polymerized DNA, a byproduct of degraded neutrophils. Dornase alfa (dornase) selectively cleaves extracellular DNA and reduces the viscosity of sputum. It improves mucociliary clearance and pulmonary function. The benefit of dornase on CF‐associated sinusitis is less clear. Therefore, the objective of this study was to systematically review the use of dornase on chronic rhinosinusitis (CRS) in CF patients.

Pulmonary paraganglioma in a 10-year-old: a case report and review of the literature

Abstract Paraganglioma is a rare extra-adrenal tumor of the paraganglia often found in association with sympathetic and parasympathetic nerves. The case presented is of a 10-year-old boy with hemoptysis who was found to have an obstructive bronchial mass. He underwent surgical resection and biopsy confirmed primary pulmonary paraganglioma. He was subsequently found to have an associated genetic syndrome. This is the first case report describing a primary pulmonary paraganglioma in a child.

Rapid Development of a Simple Ranula in a Child

Objective: A simple ranula is a gradually progressive, benign condition of the salivary gland. The report here describes a very rare case of a simple ranula enlarging in an acute fashion, resulting in airway obstruction. Case Report: A 7-year-old girl presented with swelling in the floor of the mouth, pushing the tongue upward and backward, requiring immediate nasotracheal intubation. Magnetic resonance imaging suggested a simple ranula requiring urgent surgery. The patient was followed up 4 weeks after discharge, at which time she was doing well. Conclusion: To the best of the authors’ knowledge, this is the first case reported of a simple ranula presenting in an acute fashion, leading to airway compromise in a pediatric patient. The literature is reviewed and features of diagnosis and treatment are presented.