Greg R. Licameli

Effect of Adenotonsillectomy in PFAPA Syndrome

OBJECTIVE To assess the benefits of adenotonsillectomy in the treatment of pediatric patients with PFAPA (periodic fever, aphthous ulcers, pharyngitis, and adenitis) syndrome. DESIGN Prospective case series. SETTING Tertiary care pediatric hospital. PATIENTS Pediatric patients meeting criteria for PFAPA syndrome. INTERVENTION Tonsillectomy with or without adenoidectomy. MAIN OUTCOME MEASURE Resolution of PFAPA symptoms. RESULTS Twenty-seven (14 female, 13 male) children with PFAPA syndrome underwent tonsillectomy with or without adenoidectomy from 2004 through 2006. The length of follow-up for all patients ranged from 8 to 41 months. A total of 26 patients experienced a complete resolution of their symptoms. The 1 child who continued to have febrile episodes had fever cycles that were not regular in duration or interval and in hindsight was not likely a patient with PFAPA syndrome. CONCLUSIONS Our findings showed complete resolution of symptoms in 26 of 27 patients with PFAPA syndrome treated surgically. Patients who meet clinical criteria for PFAPA syndrome should be considered for tonsillectomy and adenoidectomy if they do not respond to medical management.

Disturbance of vestibular function attributable to cochlear implantation in children

To investigate the prevalence and severity of vestibular impairment in children with cochlear implant (CI) and raise the awareness of vestibular disturbance following cochlear implantation.

Assessment of Saccular Function in Children With Sensorineural Hearing Loss

OBJECTIVE To investigate saccular function using vestibular evoked myogenic potentials in children with congenital or early acquired sensorineural hearing loss. DESIGN Retrospective cohort study. SETTING Pediatric tertiary referral center. PATIENTS Twenty-three children with bilateral sensorineural hearing loss (severe to profound in 22 cases, moderate in 1 case) underwent evaluation of saccular function. Twelve pediatric subjects with normal hearing were included in the study as the control group. INTERVENTIONS Otologic examination, computed tomography of the temporal bone, audiometry, tympanometry, and vestibular evoked myogenic potential testing. MAIN OUTCOME MEASURE Differences in threshold, amplitude, and P1 and N1 latencies of vestibular evoked myogenic potentials between children with normal-hearing and hearing-impaired children. RESULTS Abnormal vestibular evoked myogenic potentials were found in 21 of 23 children (91%) with sensorineural hearing loss. The thresholds of vestibular evoked myogenic potential were significantly higher (P <.001) and the amplitudes were lower in children with sensorineural hearing loss than those in children with normal hearing. There were no differences in the P1 and N1 latencies between the 2 groups. CONCLUSIONS The impairment of saccular function, indicated by the abnormal findings in the vestibular evoked myogenic potential, is often associated with sensorineural hearing loss in the pediatric population. Although saccular dysfunction may create a vestibular deficit, its manifestations can vary and be easily overlooked in children. Considering the high percentage of abnormal findings in our study, we recommend that deaf and hard-of-hearing children undergo vestibular evaluation. Vestibular evoked myogenic potential testing is an easy and reliable procedure to evaluate saccular function in children.

The eustachian tube: Update on anatomy, development, and function

Central to many pathologic conditions affecting the middle ear is the failure of the ET to perform its functions of regulation of middle ear pressure, clearance of middle ear secretions, and protection of the middle ear space. Recent advances in radiologic imaging and fiberoptic endoscopes have allowed a more detailed description of the structure and function of this area. Hopefully, with the knowledge gained from advances in this area, more effective medical treatment options for common otologic problems, such as otitis media, will become available.

Long-term Surgical Outcomes of Adenotonsillectomy for PFAPA Syndrome

OBJECTIVE To evaluate the long-term efficacy of adenotonsillectomy in the treatment of pediatric patients with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome. DESIGN Prospective case series. SETTING Tertiary care pediatric hospital. PATIENTS Pediatric patients meeting the criteria for PFAPA syndrome. INTERVENTIONS Tonsillectomy with adenoidectomy. MAIN OUTCOME MEASURES Resolution of PFAPA symptoms. RESULTS A total of 124 patients (75 boys and 49 girls) underwent adenotonsillectomy from 2004 to 2011 for relief of cyclical fevers due to PFAPA syndrome. Of the 124 patients, 22 did not meet criteria for inclusion in this study because (1) they had less than 6 months of follow-up after surgery or (2) they were unavailable for follow-up; therefore, 102 patients were included in the study. The mean age at the time of surgery was 58 months (range, 18-179 months). The average duration of follow-up after adenotonsillectomy was 43 months (range, 6-98 months). Of 102 patients, 99 had complete resolution of their symptoms immediately after surgery. CONCLUSIONS Our findings showed complete resolution of symptoms in 99 of 102 patients with PFAPA syndrome who were treated surgically. Patients who meet the clinical criteria for PFAPA syndrome should be offered tonsillectomy and adenoidectomy as part of their treatment options.

Phosphorylcholine-coated antibiotic tympanostomy tubes: Are post-tube placement complications reduced?

OBJECTIVE To determine if a phosphorylcholine (PC) antibacterial coating on standard Armstrong beveled tympanostomy tubes (TT) reduced the incidence of post-tube placement complications. METHODS A prospective cohort aged 8-51 months received bilateral TTs for otitis media with effusion between July 2002 and February 2004 at a tertiary care pediatric hospital. Seventy children were randomized to receive a PC-coated TT in one ear and an uncoated TT in the other. Otologic examinations at prescribed intervals over two years post-operatively ascertained the status of sequelae. We analyzed the incidence of TT complications: otorrhea, premature extrusion, persistent tympanic membrane perforations, granulation tissue, and ventilation tube lumen obstruction. RESULTS There was no statistical difference in the incidence of any of these sequelae between standard and PC-coated tympanostomy tubes (p>0.05) during the 24-month-follow-up period. Results after 13 months of follow-up may have been affected by patients lost to follow-up and therefore a smaller sample size as the study continued. CONCLUSIONS This study found that there is no statistically significant difference in the incidence of complications between uncoated and PC-coated fluoroplastic Armstrong beveled TTs.

Sensorineural hearing loss in patients with cystic fibrosis

Objective: To determine the prevalence of sensorineural hearing loss (SNHL) in cystic fibrosis (CF) patients and its relationship to antibiotic use. Study Design: Case series with chart review. Setting: Tertiary care pediatric hospital. Subjects and Methods: We reviewed the medical records of CF patients seen in our childrens hospital between March 1994 and December 2007. Data collected included patient demographics, audiograms, tympanograms, genotype, and use of potentially ototoxic antibiotics. Results: Seven of 50 (14%) patients had SNHL. Three percent of patients who received ≤10 courses of intravenous aminoglycosides had SNHL versus 43 percent of those who received >10 courses (P < 0.01). No patients who received five or fewer courses of nasal irrigation with aminoglycosides had SNHL versus 23 percent of those who received more than five courses (P < 0.05). Nine percent of patients who received five or fewer courses of macrolides had SNHL versus 60 percent of those who received more than five courses (P = 0.079). Conclusion: CF patients receiving aminoglycosides are at high risk for developing SNHL.

Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy

Objective To determine the efficacy of a preoperative bleeding questionnaire (POBQ) and coagulation screening in predicting hemorrhage associated with adenotonsillectomy. Study Design Retrospective study. Subjects and Methods Between January 1998 and December 2003, 7730 tonsillectomy and adenotonsillectomy patients were administered the POBQ preoperatively. Further coagulation screening was based on POBQ responses. Results A total of 232 (3.0%) of 7730 had postoperative bleeding; 184 (3.2%) of 5782 patients who had negative questionnaires bled postoperatively compared with 48 (2.5%) of 1948 patients with positive questionnaires (P = 0.126). Of 1948 patients with positive questionnaires, 141 (7.2%) had abnormal preoperative coagulation screens and 9 (6.4%) of 141 bled; of the 1807 (92.8%) with negative coagulation screens, 39 (2.2%) bled (P = 0.005). Conclusion The POBQ is an effective tool for identifying patients who are at potential risk for post-tonsillectomy bleeding. Patients with both a positive POBQ and coagulation screen had a statistically higher likelihood of postoperative bleeding than other patients. The POBQ allowed the identification of individuals with bleeding disorders to be treated before surgery, likely decreasing the risk of bleeding in these patients.

Is computed tomography (CT) or magnetic resonance imaging (MRI) more useful in the evaluation of pediatric sensorineural hearing loss

BACKGROUND Computed tomography (CT) and magnetic resonance imaging (MRI) have become an essential part of the evaluation of pediatric sensorineural hearing loss (SNHL). Anomalies are found in 20% to 39% of patients, ranging from major anatomic abnormalities to subtle dysplasia. Although each aspect of the evaluation contributes to management and treatment options, disagreement persists with regard to the most cost-effective and clinically useful imaging studies in the evaluation of SNHL.

Congenital cervical teratoma: airway management and complications.

teratomas frequently present as large and deforming neoplasms; however, they are benign congenital entities. Expedient multidisciplinary management is critical for successful long-term management. The prognosis is good provided that the airway is stabilized and the neoplasm is removed in a timely fashion. Complications noted in the literature focus on the challenges of controlling the airway before tumor removal. Few reports of congenital cervical teratomas address subsequent airway findings and management. We present a case of congenital cervical teratoma in which the airway was compromised by the massive growth of the tumor. Initial and long-term airway management is discussed.