Nira A. Goldstein

Intratemporal complications of acute otitis media in infants and children

We reviewed our experience with 100 children admitted to Childrens Hospital of Pittsburgh between 1980 and 1995 with an intratemporal complication of acute otitis media. Seventy-two patients were treated for acute mastoiditis. Of these 72 children, 54 (75.0%) were treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. Eighteen (25.0%) required mastoidectomy for treatment of a subperiosteal or Bezolds abscess or cholesteatoma, or because of poor response to conservative therapy. Twenty-two children presented with facial paralysis, complete in 5 (22.7%) and incomplete in 17 (77.3%). Eighteen (81.8%) were treated conservatively, but four required mastoid surgery. Nineteen patients had adequate follow-up; of these, 15 recovered normal facial function but 4 were left with partial paralysis. Three patients presented with serous labyrinthitis and recovered completely with conservative therapy. Of the two patients who presented with suppurative labyrinthitis, one was treated conservatively, but the other required tympanomastoidectomy with cochleotomy; both patients had permanent, profound sensorineural hearing loss in the affected ear. Four patients presented with acute petrositis, and in all four it resolved with mastoidectomy. In the antibiotic era, intratemporal complications of acute otitis media still occur in otherwise healthy children, often after inadequate treatment of acute otitis media.

Clinical Diagnosis of Pediatric Obstructive Sleep Apnea Validated by Polysomnography

The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clinical basis without formal polysomnography. To examine the accuracy of the clinical diagnosis of pediatric obstructive sleep apnea syndrome, we prospectively evaluated 30 children with obstructive symptoms by a standardized history, physical examination, and review of a tape recording of breathing during sleep. On the basis of this clinical evaluation, patients were divided into three predictive groups: (1) definite obstructive sleep apnea syndrome, (2) possible obstructive sleep apnea syndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Nocturnal polysomnography was used to determine the presence or absence of true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have possible obstructive sleep apnea syndrome had positive nocturnal polysomnographies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnography. Six nocturnal polysomnographies negative by conventional criteria were suspicious for apnea, but considering these positive for obstructive sleep apnea syndrome did not improve the specificity of the clinical prediction. Our results show that clinical assessment of obstructive sleep apnea syndrome in children is sensitive (92.3%) but not specific (29.4%) for making the diagnosis of obstructive sleep apnea syndrome as compared with nocturnal polysomnography and may contribute to the decision to obtain nocturnal polysomnography in specific circumstances.

Quality of life after tonsillectomy in children with recurrent tonsillitis

OBJECTIVE To describe changes in disease-specific and global quality of life (QOL) for children with recurrent or chronic tonsillitis at 6 months and 1 year after tonsillectomy using two validated instruments, the Tonsil and Adenoid Health Status Instrument (TAHSI) and the Child Health Questionaire-PF28 (CHQ-PF28). STUDY DESIGN AND SETTING A multicenter, prospective observational outcomes study. RESULTS Ninety-two children, mean age (SD) 10.6 (3.4) years, enrolled with follow-up available for 58 children at 6 months and 38 children at 1 year. The children showed significant improvements in all subscales of the TAHSI including airway and breathing, infection, health care utilization, cost of care, eating and swallowing (all P < 0.001), and behavior (P = 0.01). Significant improvements were also found on several subscales of the CHQ-PF28, such as general health perceptions, physical functioning, parental impact, and family activities (all P < 0.001). CONCLUSION/SIGNIFICANCE This uncontrolled study provides prospective evidence of improved disease-specific and global QOL in children after tonsillectomy.

Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology Patient

Context: Post‐obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II).

Water Precautions and Tympanostomy Tubes: A Randomized, Controlled Trial†

Objectives/Hypothesis: The objective was to determine whether there is an increased incidence of otorrhea in young children with tympanostomy tubes who swim and bathe without water precautions as compared with children who use water precautions in the form of ear plugs.

Effect of Intracapsular Tonsillectomy on Quality of Life for Children With Obstructive Sleep-Disordered Breathing

OBJECTIVE To assess the change in disease-specific quality of life (QOL) in pediatric patients with obstructive sleep-disordered breathing (OSDB) secondary to adenotonsillar hypertrophy after powered intracapsular tonsillectomy and adenoidectomy. DESIGN Prospective outcomes study. SETTING Hospital-based pediatric otolaryngology practice. PATIENTS Fifty children with a mean age of 4.5 years who had a clinical diagnosis of OSDB. INTERVENTIONS A caregiver of qualifying patients completed a validated QOL survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18), preoperatively and 3 months and 1 year postoperatively. MAIN OUTCOME MEASURE The OSA-18 mean change scores. RESULTS The mean (SD) total OSA-18 change score at the 3-month follow-up visit was 2.3 (1.2) and at the 1 year follow-up visit was 2.2 (1.3). The total and individual domain change scores were significantly improved at both postoperative intervals (P<.001 for all). There were no significant changes in the total or domain change scores between the intervals. The total change score was not significantly associated with either tonsil size or tonsil position. CONCLUSION The OSDB-related QOL is significantly improved after powered intracapsular tonsillectomy and adenoidectomy, and this improvement remains stable even after 1 year.

Validation of a clinical assessment score for pediatric sleep-disordered breathing.

To validate a clinical assessment score for pediatric sleep‐disordered breathing.

Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis

OBJECTIVE To describe changes in disease-specific and global quality of life (QOL) for adults with recurrent or chronic tonsillitis at 6 months and 1 year after tonsillectomy using two instruments: the Tonsil and Adenoid Health Status Instrument (TAHSI) and the SF-12 Health Survey (12-item short form of SF-36 Health Survey). STUDY DESIGN AND SETTING Multicenter, prospective observational outcomes study. RESULTS Seventy-two adults, mean age 28.0 years (SD 7.2 years), were enrolled with follow-up available for 42 adults at 6 months and for 40 adults at 1 year. Patients showed significant improvements in all six subscales of the TAHSI: airway and breathing, infection, health care utilization, cost of care, eating and swallowing, and behavior (all P < 0.0001). Significant improvements were also found in the physical functioning subscale of the SF-12 at 1 year. CONCLUSION After tonsillectomy for recurrent and chronic tonsillitis, we found large improvements in disease-specific and global QOL. SIGNIFICANCE Most prior studies on tonsillectomy for recurrent tonsillitis have assessed only the frequency of infections as an outcome measure. This study describes the changes in QOL measured in our cohort of reporting adults after tonsillectomy for chronic or recurrent tonsillitis. This study provides prospective evidence of the effectiveness of tonsillectomy on adult QOL.

Angioedema: a review of 367 episodes presenting to three tertiary care hospitals.

Objectives: We evaluated the clinical characteristics of patients treated for angioedema, and determined the factors associated with the clinical course. Methods: We performed a chart review of 367 episodes presenting from 1997 through 2008. Results: The mean (±SD) age was 51.8 ± 20.1 years; 65.7% of the episodes occurred in female patients; 62.4% of the episodes were in African American patients. The patients were on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for 49.1% of the episodes, and an inciting factor (diet change, minor trauma, or exposure to fumes) was present for 21.5%. We found that 75.7% of the episodes were type 1 angioedema, 5.7% were type 2, 1.4% were type 3, and 17.2% involved multiple sites; 58% of the episodes required admission. For 3.3% of the episodes, the patients were intubated, and in 0.3% of the episodes, the patients required a tracheostomy. Logistic regression identified non–African American race, allergies, alcohol use, use of ACE inhibitors or ARBs, multiple sites, and age as associated with the need for admission. Bivariate analysis identified age, multiple affected sites, stridor, hoarseness, dysphagia, and drooling as associated with intubation or tracheostomy. Conclusions: The novel findings of this study are lower rates of airway intervention than reported previously and the fact that multiple affected sites were associated with admission and intubation or tracheostomy, particularly when the edema involved the larynx or hypopharynx.

The prevalence of sleep-disordered breathing in children with asthma and its behavioral effects.

To determine the prevalence of sleep‐disordered breathing (SDB) in children with asthma compared to non‐asthmatic children and to determine if behavior problems are associated with asthma and SDB.