Jamie L. Funamura

Pediatric tracheotomy: Indications and decannulation outcomes

The objective of this study was to determine if there are differences in decannulation rates and duration of cannulation between pediatric patients undergoing tracheotomy for different indications.

Otogenic lateral sinus thrombosis: Case series and controversies

OBJECTIVES The aim of this study is to (1) report the clinical presentation, treatment, and sequelae in a series of pediatric patients with otogenic lateral sinus thrombosis and (2) to review the most controversial aspects of management of this rare intracranial complication of otitis media. METHODS Retrospective chart review of inpatients treated for central venous thrombosis at a tertiary care facility between 1996 and 2012. RESULTS Five pediatric patients (four male, one female) were identified with otogenic lateral sinus thrombosis. Age at presentation ranged from 13 months to 15 years. All underwent a surgical procedure, ranging from a simple myringotomy with tympanostomy tube placement to tympanomastoidectomy and internal jugular vein ligation or craniotomy. Three were anticoagulated with unfractionated heparin with subsequent transition to low molecular weight heparin of variable duration. One patient developed a non-life-threatening intracranial hemorrhage while on long-term anticoagulation. Follow-up imaging, when available, did not directly correlate complete thrombus resolution with use of anticoagulation or with persistent symptoms. CONCLUSIONS Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media with significantly reduced morbidity and mortality in the modern era of antibiotic treatment, surgical intervention, and anticoagulation therapy. Due to the rarity of this condition today, the recommended extent of surgical intervention and need for routine anticoagulation are unclear, and requires further data to determine definitively.

Characterizing mortality in pediatric tracheostomy patients

To assess the longitudinal risk of death following tracheostomy in the pediatric age group.

Congenital Anomalies of the Nose.

Congenital anomalies of the nose range from complete aplasia of the nose to duplications and nasal masses. Nasal development is the result of a complex embryologic patterning and fusion of multiple primordial structures. Loss of signaling proteins or failure of migration or proliferation can result in structural anomalies with significant cosmetic and functional consequences. Congenital anomalies of the nose can be categorized into four broad categories: (1) aplastic or hypoplastic, (2) hyperplastic or duplications, (3) clefts, and (4) nasal masses. Our knowledge of the embryologic origin of these anomalies helps dictate subsequent work-up for associated conditions, and the appropriate treatment or surgical approach to manage newborns and children with these anomalies.

Complications of turbinate reduction surgery in combination with tonsillectomy in pediatric patients

To examine whether the addition of turbinoplasty to tonsillectomy and adenoidectomy (T&A) increases the risk of postoperative complications.

Evaluation and management of nonsyndromic congenital hearing loss

Purpose of review Nonsyndromic congenital hearing loss represents the largest proportion of paediatric sensorineural hearing loss. The optimal evaluation and management of affected patients remains clinically challenging. Current controversies in the diagnostic work-up of nonsyndromic congenital hearing loss are presented in this review. Recent findings The improved diagnostic yield of comprehensive genetic testing due to new sequencing technologies is changing the diagnostic for congenital hearing loss. Concerns for both ionizing radiation and general anaesthetic exposure are also driving shifts in imaging modality preferences for infants and toddlers. Summary A thoughtful systematic, targeted approach taking into consideration the audiologic phenotype of the patient is recommended for the work-up of nonsyndromic congenital hearing loss.

Surgical Management of Cysts and Papillomas of the Nose and Sinuses

Nasal dermoid cysts, encephaloceles, and gliomas are thought to be developmentally related errors in the closure of the anterior neuropore through a persistent anterior cranial and dural defect. Dermoid cysts are the most common congenital midline nasal lesion and contain dermal appendages. Intracranial extension of dermoid cysts may be suggested by a bifid crista galli and enlargement of the foramen cecum on CT but should be confirmed with MRI. The ideal surgical approach for a dermoid cyst is debatable but should allow for repair of CSF leak and cribriform defects as well as acceptable scar formation and nasal reconstruction if necessary. Nasal gliomas are comprised of normal brain tissue that has persisted through an anterior cranial defect. Sinonasal encephaloceles can be further divided into nasofrontal, nasoethmoidal, and naso-orbital types depending on their site of herniation. A combined intracranial/extracranial approach is necessary to address an encephalocele, and this can be done as a single-staged procedure. Congenital nasolacrimal duct cysts can often be treated with conservative management, but respiratory distress or infection may require urgent probing and marsupialization.

Foreign Body Ingestion and Aspiration in the Pediatric Population: Analysis of 315 Cases

Objectives: 1) Determine the patient characteristics, presentation, location, and rates of associated injury in pediatric foreign body ingestion and aspiration. 2) Analyze the types of intervention and rates of postoperative complications. Methods: Retrospective analysis of all patients under the age of 18 who were evaluated for foreign body (FB) ingestion and aspiration at a tertiary care center between January 1, 2003, and December 31, 2012. Results: We identified 315 patients. 61% were male and 39% female, with an average age of 3.9 years (SD 3.9). 55.6% of FBs were found to in the esophagus, 22.2% in the airway, and 22% in the oropharynx or GI tract. The most common signs and symptoms at presentation were emesis (30.9%), choking/gagging (27.4%), coughing (24.0%), drooling (23.4%), and dysphagia (23.4%) with an esophageal FB and increased work of breathing (50.0%), cough (48.6%), choking/gagging (44.3%), wheezing (40.0%), and stridor (20.0%) with an airway FB. The most common FBs were coins (88.6%) and nuts/seeds (42.9%) in the esophagus and airway, respectively. Patients with a proximal esophageal FB were younger than patients with a distal esophageal FB (2.53 vs. 8.29 years). There was a 44% rate of superficial mucosal injury in the esophageal FB group. Rigid bronchoscopy and esophagoscopy were the most common methods of FB retrieval. There were no pneumothoraces and pneumomediastinum noted postoperatively. Conclusions: Aerodigestive FB ingestion and aspiration represent common problems in children. History, physical exam, and imaging are all key aspects of timely diagnosis, with rigid endoscopy as the mainstay of management.

Salivary Duct Carcinoma of the Accessory Parotid Gland

Objective: 1) Present a rare case of salivary duct carcinoma of the accessory parotid gland (APG). 2) Understand the current prevalence, diagnosis, and management of benign and malignant tumors of the APG.Method: This study includes a case presentation and literature review. The literature review included articles from October 1966 to January 2010 and included all cases of accessory parotid gland tumors in adults.Results: One hundred and nineteen cases with 19 different tumor types were reported in the accessory parotid gland (APG). Pleomorphic adenoma and mucoepidermoid carcinoma represented 50% and 23%, respectively. There were no previously reported salivary duct carcinomas of the APG. Forty percent of APG neoplasms were malignant. This malignancy rate was comparable to previous studies reporting a higher rate of malignant tumors in the APG compared with 15% to 20% in parotid tumors. A standard parotidectomy remains the preferred approach with less risk to the facial nerve compared with direct cheek re...

Hyoid Movement as a Predictor of Aspiration in Patients with Dysphagia

Objective: 1) Quantify the differences in hyoid movement in elderly patients with and without aspiration. 2) Determine whether reduced hyoid displacement is a significant predictor of aspiration in patients with dysphagia. Method: Data on hyoid displacement and aspiration was collected from pre-existing modified barium swallow (MBS) studies at USC University Hospital from the past 5 years. Patient studies were selected on the basis of bolus volume (5 and 10 mL), age (>60 years), and dysphagia symptoms at the time of the study. Results: Studies were grouped by absence of aspiration on MBS, bolus volume, sex, and complaint of dysphagia as documented in their medical records at the time of the study. Preliminary results show that patients without aspiration or penetration (n = 2) achieved a mean hyoid displacement of 2.05 cm, whereas patients with aspiration or penetration (n = 5) achieved a hyoid displacement of only 1.53 cm. Conclusion: Based on preliminary results, it appears that hyoid movement may accurately predict patients who are at high risk of aspiration and may serve as a parameter for treatment goals in these patients. However, greater sample size and establishment of controls are needed to further validate these findings.