Jessica R. Levi

Readability of pediatric otolaryngology information by children's hospitals and academic institutions

Evaluate the readability of pediatric otolaryngology–related patient education materials from leading online sources.

Vestibular and balance testing in childhood migraine

INTRODUCTION The prevalence of benign recurrent vertigo of childhood (BRVC) and migraine in school-age children is estimated to range from 2% to 10.6%. Both conditions can have a significant impact on health, and in 10% of patients, migraine significantly hinders school attendance and activities of daily living. Seventy percent of children with BRVC experience peripheral vestibular disturbances; however, the pathophysiology of their vertiginous symptoms is unclear. Despite the importance of this clinical issue, documentation of comprehensive vestibular and balance testing in these patients is scant. The aim of this study was therefore to report the audiometric findings and both objective and subjective measures of vestibular and balance testing in pediatric patients diagnosed with migraine, BRVC, or other migraine equivalent.

Evaluating Tonsillectomy as a Risk Factor for Childhood Obesity

OBJECTIVE To investigate weight gain and any increased risk of obesity in children who have undergone tonsillectomy. DESIGN Retrospective chart review. SETTING Tertiary care pediatric hospital. PATIENTS The study included 200 children aged 2 to 12 years who were undergoing tonsillectomy and 200 age- and sex-matched controls. All children had a preoperative body mass index (BMI) and a postoperative BMI recorded 6 to 18 months after surgery. MAIN OUTCOME MEASURES The BMI percentile (BMI%) for age was analyzed between and within groups. A Wilcoxon matched-pairs test was used to analyze BMI% before and after tonsillectomy. A Mann-Whitney test was used to compare BMI% between the study and the control groups. An odds ratio (OR) was used to compare overweight (≥ 85%) and obese (≥ 95%) patients before and after surgery. A correlation analysis was used to examine the relationship between age and weight gain. RESULTS The BMI% did not differ significantly between the study and the control groups before surgery (P = .14). The BMI% in the study group increased significantly after tonsillectomy (P < .001). Although older children had a higher BMI% than matched controls before surgery, they had a smaller change in BMI% than younger children after tonsillectomy (P = .004). The odds of a child being overweight (OR, 1.23; P = .36) or obese (OR, 1.44; P = .12) were not significantly different before or after tonsillectomy. CONCLUSION Children, particularly younger ones, gained weight after tonsillectomy, but the odds of a child being overweight or obese after tonsillectomy were no different than they were before surgery.

Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction

IMPORTANCE Myringotomy and tympanostomy tube placement for chronic otitis media with effusion is the most common reason for a child to undergo anesthesia in the United States. Postoperative tube obstruction occurs in 1.4% to 36.0% of cases and remains a challenge in achieving middle ear ventilation. OBJECTIVE To identify risk factors associated with tube obstruction. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of 248 patients, mean age 2.54 years, seen between March 2007 and June 2011 in a tertiary care pediatric hospital. INTERVENTIONS Tympanostomy tube placement and postoperative otic drop therapy. MAIN OUTCOMES AND MEASURES Tube patency at postoperative visit, number of tube removals and revisions, age, sex, body mass index (BMI), middle ear fluid type at time of surgery, and time between surgery and first postoperative visit were examined. Type of surgery (tympanostomy tube placement alone, adenoidectomy + tympanostomy tube placement, tympanostomy tube placement + adenoidectomy + tonsillectomy) and its effect on tube patency were also reviewed. RESULTS At first follow-up, 10.6% of patients had occlusion of one or both tubes. No significant association was found between tube patency and a patients BMI percentile, sex, or procedure type. Patients with no middle ear fluid were more likely to have patent tubes than those who had serous fluid (odds ratio [OR], 3.5; 95% CI, 1.2-10.6; P = .02). A significant inverse correlation was found between patency and time between surgery and follow-up in that patients who had longer follow-up after surgery were less likely to have patent tubes (OR per day of follow-up delay, 0.990; 95% CI, 0.981-0.999; P = .01). CONCLUSIONS AND RELEVANCE Tympanostomy tube obstruction was seen in 10.6% of patients. Serous fluid and increased time to postoperative visit were statistically significant indicators for tube occlusion.

Complications Following Pediatric Tracheotomy

IMPORTANCE Pediatric tracheotomy is a complex procedure with significant postoperative complications. Wound-related complications are increasingly reported and can have considerable impact on clinical course and health care costs to tracheotomy-dependent children. OBJECTIVE The primary objective of this study was to identify the type and rate of complications arising from pediatric tracheotomy. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of medical records of 302 children who underwent tracheotomy between December 1, 2000, and February 28, 2014, at a tertiary care pediatric referral center. Records were reviewed for preoperative diagnoses, gestational age, age at tracheotomy, tracheotomy technique, and incidence of complication. MAIN OUTCOMES AND MEASURES Main outcome measures included incidence, type, and timing of complications. Secondary measures included medical diagnoses and surgical technique. RESULTS Of the 302 children who underwent tracheotomy, the median (SD) age at time of tracheotomy was 5 months (64 months) and the range was birth to 21 years. The most frequent diagnosis associated with performance of a tracheotomy was ventilator-associated respiratory failure (61.9%), followed by airway anomaly or underdevelopment (25.2%), such as subglottic or tracheal stenosis, laryngotracheomalacia, or bronchopulmonary dysplasia. The remaining indications for tracheotomy included airway obstruction (11.6% [35 of 302]) and vocal fold dysfunction (1.3% [4 of 302]). No statistical significance was found associated with diagnosis and incidence of complications. Sixty children (19.9%) had a tracheotomy-related complication. Major complications, such as accidental decannulation (1.0% [3 of 302]). There were no deaths associated with tracheotomy. Minor complications, such as peristomal wound breakdown or granuloma (12.9% [39 of 302]) and bleeding from stoma (1.7% [5 of 302]), were more common. Of all complications, 70% (42 of 60) occurred early (≤7 days postoperatively) and 20% (12 of 60) were late (>7 days postoperatively). CONCLUSIONS AND RELEVANCE Pediatric tracheotomy at our institution is associated with an overall 19.9% incidence of complications. Although the rate of major complications such as accidental decannulation or death is low, rates of peristomal skin breakdown and development of granuloma are more frequently reported and can occur at any point following tracheotomy. Further work is necessary to understand and mitigate wound care issues in post-tracheotomy care.

Readability Trends of Online Information by the American Academy of Otolaryngology—Head and Neck Surgery Foundation

Objective Previous studies have shown that patient education materials published by the American Academy of Otolaryngology—Head and Neck Surgery Foundation may be too difficult for the average reader to understand. The purpose of this study was to determine if current educational materials show improvements in readability. Study Design Cross-sectional analysis. Setting The Patient Health Information section of the American Academy of Otolaryngology—Head and Neck Surgery Foundation website. Subjects and Methods All patient education articles were extracted in plain text. Webpage navigation, references, author information, appointment information, acknowledgments, and disclaimers were removed. Follow-up editing was also performed to remove paragraph breaks, colons, semicolons, numbers, percentages, and bullets. Readability grade was calculated with the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook. Intra- and interobserver reliability were assessed. Results A total of 126 articles from 7 topics were analyzed. Readability levels across all 6 tools showed that the difficulty of patient education materials exceeded the abilities of an average American. As compared with previous studies, current educational materials by the American Academy of Otolaryngology—Head and Neck Surgery Foundation have shown a decrease in difficulty. Intra- and interobserver reliability were both excellent, with intraclass coefficients of 0.99 and 0.96, respectively. Conclusion Improvements in readability is an encouraging finding and one that is consistent with recent trends toward improved health literacy. Nevertheless, online patient educational material is still too difficult for the average reader. Revisions may be necessary for current materials to benefit a larger readership.

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis: A Systematic Review

Importance Repairing the saddle nose deformity in the setting of granulomatosis with polyangiitis disease is a rare but challenging situation for any surgeon. Given that the available data in the literature is based on case reports and small case series, there is little evidence available to help delineate which reconstructive techniques are optimal. Objective To examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis. Evidence Review PubMed, MEDLINE, Cochrane Collaboration Databases, and Web of Science were searched using the terms Wegener’s granulomatosis or granulomatosis with polyangiitis cross-referenced with saddle nose deformity or acquired nasal deformity. These databases were supplemented with 2 cases from Boston Medical Center. Databases were queried from inception of article collection through December 14, 2015, to identify publications reporting the repair of a saddle nose deformity and granulomatosis with polyangiitis. Findings A total of 10 studies met inclusion criteria yielding a cohort of 44 patients. The overall success rate for rhinoplasty, both primary and secondary, was 84.1% (37 of 44 patients), with a complication rate of 20%. The use of a single L-shaped graft fared better than individually placed grafts. An increased risk of graft failure was noted as the number of overall grafts increased and if nonautologous tissue was used. Conclusions and Relevance Rhinoplasty for saddle nose deformity is a safe and effective procedure in the setting of granulomatosis with polyangiitis. In the face of this disease, reconstruction should focus on placing a robust, L-shaped strut graft with autologous tissue over individual grafts. Additionally, the use of split-calvarial bone appears to have a slightly lower complication rate over costal cartilage.

Assessing work-related musculoskeletal symptoms among otolaryngology residents

PURPOSE Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits, however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents. MATERIALS AND METHODS A cross-sectional survey incorporating the Nordic Musculoskeletal Questionnaire was sent to 30 Otolaryngology-Head and Neck Surgery residencies to examine musculoskeletal symptoms among residents. A two-sample test of proportions was performed to compare symptoms between male and female residents. RESULTS In total, 141 respondents (response rate=34.7%) completed the survey. Fifty-five percent of survey respondents were male and 45% were female. Musculoskeletal symptoms were most frequently reported in the neck (82.3%), followed by the lower back (56%), upper back (40.4%), and shoulders (40.4%). The most common symptoms were stiffness in the neck (71.6%), pain in the neck (61.7%), and pain in the lower back (48.2%). In total, 6.4% of residents missed work and 16.3% of residents stopped during an operation at some point due to their symptoms. Most residents (88.3%) believed their musculoskeletal symptoms were attributed to their surgical training. Female residents were significantly more likely to experience neck (p<0.0001) and wrist/hand (p=0.019) discomfort compared to male residents. CONCLUSIONS Musculoskeletal symptoms were common among residents, approaching rates similar to those previously identified in practicing otolaryngologists. Increased emphasis on surgical ergonomics is warranted to improve workplace safety and prevent future injury.

Stomal maturation does not increase the rate of tracheocutaneous fistulas

To determine the rate of persistent tracheocutaneous fistula (TCF) in pediatric patients managed with stomal maturation at the time of the tracheostomy.

Social media presence of otolaryngology journals: The past, present, and future

Evaluate the use of Twitter by otolaryngology journals and determine the relationship between social media altmetrics and measures of academic impact.