Lyndsay Fraser

Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review.

OBJECTIVE: We review the management of 31 cases of atypical mycobacterial lymphadenitis presenting to a tertiary referral pediatric otolaryngology department between February 2002 and February 2007. STUDY DESIGN: Retrospective case review. SUBJECTS AND METHODS: Cases were identified by using the hospitals correspondence and pathology databases. Demographic and clinical information was collected. Descriptive and nonparametric inferential statistics (SPSS; SPSS Inc, Chicago, IL) were calculated. RESULTS: Four patients were treated conservatively with triple-therapy antibiotics. Twenty-seven underwent surgical excision plus 3 months of clarithromycin postoperatively. Thirteen percent developed nodal recurrence; this appeared to be unrelated to the operation performed (χ8 2 = 5.8, P = 0.69) or the management modality used (P = 0.35). Patients with previous surgery were more likely to have recurrent infection (χ2 2 = 9.3, P = 0.01). CONCLUSIONS: In our experience, nodal excision plus postoperative clarithromycin remains the best treatment option for most children, although those with limited disease may benefit from combination antibiotic therapy. Previous incision and drainage leads to high recurrence rates after later excision and therefore, heightened awareness of these infections is essential to ensure appropriate early management.

Childhood epistaxis and nasal colonization with Staphylococcus aureus

OBJECTIVE: Epistaxis is very common in children but its cause remains unknown. We postulate that nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and ultimately new vessel formation. STUDY DESIGN: A prospective case-control study. SUBJECTS AND METHODS: Sixty-seven children were recruited, 42 with epistaxis (22 had crusting in the nasal vestibule; 20 did not) and 25 control subjects. A microbiology swab was taken from the anterior nasal cavity of each child. RESULTS: All groups were equally likely to have a positive culture. S aureus was more common in the epistaxis group (P = 0.008) compared with the control group. There was no difference in the prevalence of S aureus between crust and noncrust groups. Epistaxis patients were much less likely to have isolates of respiratory pathogens or a skin commensal. CONCLUSION: Children with epistaxis are more likely to have nasal colonization with S aureus than controls. Our data would support the hypothesis that S aureus replaces existing nasal flora and causes inflammation and new vessel formation.

A double-blind randomized controlled trial of management of recurrent nosebleeds in children

Background: To establish whether a treatment regimen of silver nitrate cautery and 4 weeks of antiseptic nasal cream is superior to antiseptic cream treatment alone in the management of pediatric epistaxis. Study Design: Double-blind randomized controlled trial. Subjects and Methods: Children with epistaxis and visible anterior septal vessels were invited to participate. Patients were randomized to receive treatment or control. Treatment patients received silver nitrate cautery, followed by antiseptic cream for 4 weeks. Control patients received sham cautery followed by antiseptic cream for 4 weeks. Results: A total of 109 patients were randomized and results were available for 93 (85%). Of those receiving cautery, 21 (45.7%) of 46 had no bleeding in the 4 weeks before follow-up. Of those receiving only antiseptic cream 14 (29.8%) of 47 had no bleeding. (χ2 = 2.49; P = 0.114). More children in the active treatment group had an improvement in their symptoms compared with controls (42 of 46; 91.3%) in the treatment group vs 33 of 47 (70.2%) controls (χ2 = 6.626; P = 0.01; relative risk reduction = 71 percent, number needed to treat = 4.7). Conclusion: When using subjective improvement in symptoms as the outcome measure, silver nitrate cautery with antiseptic cream twice daily for 4 weeks appears to give a small but statistically significant benefit when compared to antiseptic cream alone.

Validation of a family-centred outcome questionnaire for pinnaplasty: a cross-sectional pilot study

Comparison of pinnaplasty techniques is difficult due to variation in the reporting of outcomes. We aimed to develop a family‐centred outcome questionnaire for use after pinnaplasty and assess it for reliability and validity.

Standardising reporting of cervical lymphadenopathy in paediatric neck ultrasound: A pilot study using an evidence-based reporting protocol

OBJECTIVES Cervical lymphadenopathy is common in children and can arise from a wide range of aetiologies. Ultrasound can be a useful imaging tool for initial investigation but is known to be operator dependent. We aimed to compare the content of ultrasound reporting in this clinical scenario before and after the introduction of an evidence-based reporting protocol. METHODS We performed a prospective 8-month pilot study assessing the content of ultrasound reports generated from scans to investigate suspected cervical lymphadenopathy in children referred to our tertiary referral otolaryngology service. We found wide variation in report content and inconsistent reporting of certain radiological features. In response to this we performed a literature search to identify key, clinically relevant ultrasonographic features for cervical lymphadenopathy and then in consultation with our radiology colleagues, devised a protocol to facilitate the reporting of these key features. Content of reports was then prospectively re-audited over a further 8-month period. RESULTS 23 reports were assessed before and 26 after introduction of the reporting protocol. Fishers exact test was used to analyse the data. We found a statistically significant (p < 0.05) improvement in the frequency of reporting of various key features such as nodal distribution, shape, echogenicity, calcification, necrosis and vascular pattern. CONCLUSIONS The introduction of a standardised protocol has helped to streamline the reporting of ultrasounds to investigate cervical lymphadenopathy within our department. In the absence of any national guidelines on the reporting of paediatric neck ultrasound in this scenario, we propose that our protocol could be used by other departments to improve standardisation and as a teaching aid.

Development of a screening service for neonatal ear deformity using neonatal hearing screeners and an information leaflet

OBJECTIVES Early splinting of neonatal ear deformities has been proven to be successful but the opportunity to splint is frequently missed due to lack of awareness amongst healthcare personnel. We aimed to develop a regional screening service using neonatal hearing screeners and an information leaflet to allow for the early detection and treatment of such children. METHODS We created an information leaflet that was distributed by hearing screeners to all parents in Greater Glasgow at the time of the childs neonatal hearing assessment, with a contact number allowing parents to self refer. All neonates referred were seen at a dedicated clinic within a week and suitability for splints determined. We aimed to assess acceptability of the service, splinting result as rated by parents and otolaryngologist and also costs involved. RESULTS Over a 15 month period, 13,403 leaflets were distributed. 88 babies were referred (0.7%) and 54 were found suitable for splinting. 78% of parents rated the efficacy of splints as either excellent or very good and 96% said they would recommend the service to a friend. Median age at first review was 4 days. We found a weak but statistically significant correlation between age at first review and the surgeon rated outcome from splinting (Spearmans rho=-0.321, p=0.038), with those babies commencing treatment early generally having a better splinting result. We also found that age at first review correlated with duration of splinting required (Spearmans rho=0.357, p=0.008), with younger babies generally requiring shorter splinting times. Cost analysis revealed a saving of £482.76 per child when comparing splint treatment to potential later corrective ear surgery costs. CONCLUSIONS Our screening service is both acceptable to parents and efficient in allowing for early correction of ear deformity in the majority of cases. By detecting treatable children early, we propose that the introduction of routine screening and splinting on a wider basis will avoid the psychological burden of ear deformity in childhood and also avoid the need for later corrective surgery.

How reliable are ear measurements as a measure of outcome after pinnaplasty? A prospective study of inter‐rater reliability in 20 pinnaplasty patients

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09:10: The Microbiology of Childhood Epistaxis

missions were Ohio (15%), California (13%), and Illinois (7%); these three states did not have the highest spending per admission. Indicators for high resource utilization included length of stay (mean, 11.5 days; OR 1.09), number of procedures performed (mean, 3.4; OR 1.27), underlying diagnosis (OR 1.42), female gender (OR 1.42), and discharge quarter (OR 27.2). Median total charges for an admission were

08:44: Childhood Mycobacterial Neck Infections: A Five-Year Study

20,518; 90% of patients had total charges less than

Liquid detergent capsule ingestion in children: an increasing trend

139,253. CONCLUSIONS: Analysis of the KID allows for assessment of national trends and resource utilization in pediatric diseases. For SGS, median charges for an admission were