Pediatric Otolaryngology Department Research Articles

Isolated Incudostapedial Cholesteatomas: Unique Radiologic and Surgical Features

Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery, otorrhea, or tympanic membrane perforation. They are diagnosed by a pearl-like lesion on otoscopy and computed tomography (CT) scan showing an expansile soft-tissue mass. We describe a series of patients with no prior otologic history presenting with progressive unilateral conductive hearing loss and normal otoscopy. The CT scans showed ossicular erosion without obvious soft-tissue mass. Surgery confirmed incudostapedial erosion found to be cholesteatoma. In this study, we characterize the clinical course of patients diagnosed with isolated incudostapedial cholesteatoma (IIC) and review possible pathologic mechanisms. Retrospective review of IIC cases treated by the Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, 2014 to 2020. Data included patient demographics, clinical features, imaging, surgical findings, and audiologic data. Five patients were diagnosed with IIC (3 [60%] female; mean age at presentation 10.7 years [range 5.5-16.0]). All patients presented with postlingual unilateral conductive hearing loss and normal otoscopy without any past otologic history; delay in diagnosis ranged from 4 months to several years. The CT scans showed ossicular chain erosion with an absent long process of the incus and/or stapes superstructure. All patients underwent middle ear exploration, revealing a thin layer of cholesteatoma in the incudostapedial region, confirmed by histopathology. Mean preoperative speech reception threshold was 55 dB and improved to a mean of 31 dB in the 4 patients who underwent ossicular chain reconstruction. Isolated incudostapedial cholesteatoma should be included as a possible etiology in pediatric patients with insidious onset of unilateral conductive hearing loss with normal otoscopy, unremarkable otologic history, and a CT scan showing ossicular abnormality/disruption without notable middle ear mass. These patients should be counseled preoperatively regarding the possibility of cholesteatoma and should undergo middle ear exploration with possible ossiculoplasty.

The “Frankentower:” A clinician-driven approach to enhancing endoscopic data technology

ObjectiveTo develop a more efficient endoscopy tower and evaluate its capability to improve retrieval and storage of videos across 6 clinical sites. MethodsDescriptive study that took place at tertiary care Pediatric Otolaryngology Department over a 2 year period. In collaboration with our Information Services Department and Otolaryngology endoscopy vendors, we assembled our “Frankentower” endoscopy cart using components from 3 medical device manufacturers. ResultsIt is feasible to create a functional composite endoscopic tower. Implementation of “Frankentower” improved overall management and retrieval of endoscopy video and images in our department which lead to better patient care and facilitated education for medical students, residents and faculty. ConclusionsThe “Frankentower” is a feasible, cost-effective solution to streamline the capture, access and storage of patient endoscopy exams across our operating rooms, inpatient consult service, Emergency Department and outpatient clinics.

Acute Onset Neck Swelling in a Full Term Infant

1. Ashley Colberg Sabo, MD, FAAP* 2. Jonathan Marino Sherman, MD† 1. *Department of General Pediatrics and Academic Medicine, Advocate Children’s Hospital, Oak Lawn, IL 2. †Department of Pediatric Otolaryngology, Advocate Children’s Hospital, Oak Lawn, IL A 9-day-old boy born following a 39-week gestation via spontaneous vaginal delivery with no complications is transferred from an outside hospital emergency department after 1 day of increasing swelling of the left neck and cheek. The patient’s mother initially noticed the swelling on the morning of the day of admission. She reports that the infant had increased irritability the night prior. Over the course of the day, the swelling increased without overlying skin changes. The infant had no problems feeding, changes in urine output, emesis or diarrhea, cough, dyspnea, stridor, or fever at home. There were no recent sick contacts. The patient’s only medical history is ankyloglossia, which was recognized at birth when the patient struggled with breastfeeding. This led to outpatient otolaryngology evaluation and lingual frenulotomy on day 3 of life. The patient is brought to the outside emergency department where he is found to have no fever, age appropriate vital signs, and a white blood …

Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations.

The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations. We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology. We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear. Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days. We did evaluate our technics with the recurrence of CSF leak. Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases. Our "minimally invasive" technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.

Analysis of tracheotomy indications in children treated in the Department of Pediatric Otolaryngology of Medical University of Warsaw between 2015-2020

Introduction. Tracheostomy is the opening enabling breathing without the larynx, throat and mouth, which aims to restore and sustain airway patency. Indications of this intervention have changed over the years. The selection of patients for this procedure, as well as the moment, when it has to be performed are still not clearly defined. Those require a multidisciplinary approach and a standardized protocol. More analyses are necessary to create widely available guidelines. Aim. Analysis of tracheotomy indications in children performed between 2015-2020 in the Department of Pediatric Otolaryngology, Medical University of Warsaw. Material and methods. During the 5-year period (2015-beginning of 2020) 64 children with tracheostomy were treated in the Department of Pediatric Otolaryngology. Groups of tracheotomy indications were separated after a retrospective overview of the 64 cases from our clinic and after manual and electronic search through medical databases for indications for tracheotomy in previous years. Then patient’s data (age at the time of surgery, concomitant diseases and/or disabilities) was collated, which allowed to present the characteristics of children and compare the tracheotomy indications in previous years with the results of this research. Results. Tracheotomy was performed among 64 children. The median patients’ age was 0.5 year and the average age was 4.26 years. Our patients were affected by many various conditions. We divided them into 8 main groups: congenital malformation syndromes, trauma, vocal folds palsy, perinatal complications, infection, autoimmune diseases, oncological and post-intubation subglottic stenosis. Currently, congenital malformation syndromes turned out to be the most common indication for tracheotomy. Conclusions. 1. Tracheotomy indications in children have changed over the years. 2. There is increasing number of tracheotomies due to various congenital defects. 3. New groups of tracheotomy indications among children are autoimmune diseases and injuries; those groups have the highest average of age. 4. The result of effective pharmacological treatment of laryngeal hemangiomas is the lack of tracheotomy performed in this indication. 5. The number of tracheotomies performed due to post-intubation stenosis has decreased. 6. Vocal cords palsy as an indication for tracheotomy in children is most often a complication of cardiac surgery due to congenital heart defect; this group of patient’s is the youngest among all. 7. Viral infections are still the tracheotomy indication among children.

Pediatric Microlaryngoscopy and Bronchoscopy in the COVID-19 Era

As an aerosol-generating procedure, traditional pediatric microlaryngoscopy and bronchoscopy techniques must be adapted in order to reduce the risk of transmission of severe acute respiratory syndrome coronavirus 2. To describe a modified technique for pediatric microlaryngoscopy and bronchoscopy for use in the COVID-19 era and present a case series of patients for whom the technique has been used. Observational case series of pediatric patients undergoing emergency or urgent airway procedures performed at a tertiary pediatric otolaryngology department in Australia. Procedures were completed between March 23 and April 9, 2020, with a median (range) follow-up of 24.5 (11-28) days. Modified technique for microlaryngoscopy and bronchoscopy, minimizing aerosolization of respiratory tract secretions. The main outcome was the feasibility of technique, which was measured by ability to perform microlaryngoscopy and bronchoscopy with comparable success to the usual technique (ie, adequate examination of the patient for diagnostic procedures and ability to perform interventional procedures). The technique was used successfully in 8 patients (median [range] age, 160 days [27 days to 2 years 6 months]); 5 patients were male, and 3 were female. Intervention was performed on 6 patients; 2 balloon dilations for subglottic stenosis, 2 injections of hyaluronic acid for type 1 clefts, and 2 cold-steel supraglottoplasties. No adverse events occurred. In this case series, feasibility of a modified technique for pediatric microlaryngoscopy and bronchoscopy was demonstrated. By reconsidering the surgical approach in light of specific COVID-19 infection risks, this technique may be associated with reduced spread of aerosolized respiratory secretions perioperatively and intraoperatively, but the technique and patient outcomes require further study.

The foreign bodies in lower respiratory tract in pediatric patients treated in referral academic department of pediatric otolaryngology

Introduction. Foreign bodies in lower respiratory tract for many years are big challenge for otolaryngologists. These objects could present variability of clinical symptoms. Increase of infection and mortality due to delay of accurate diagnosis. Interview is the most important part of examination of patient with suspected foreign body in airways. Any suspicion of aspiration is qualification to diagnostic bronchoscopy. Aim. This paper refers occurrence assessment, clinical course, diagnostic process and treatment of the pediatric patients with suspected foreign body in lower respiratory tract hospitalized in referral Academic Department of Pediatric Otolaryngology. Material and methods. Retrospective analysis of 74 patients with suspected foreign body in lower respiratory tract, who were hospitalized in Clinical Department of Pediatric Otolaryngology in Warsaw Medical University in 2016-2018. Analysis includes demographic data, occurrence frequency, localization and the type of foreign body, diagnostic process and treatment. Results. This study includes 42 boys (57%) and 32 girls (43%) in age of 8 months to 16-year-old. The episode of choking occurs in interview in 71 patients (96%). Foreign bodies in lower respiratory tract were confirmed and evacuated in bronchoscopy procedure in 44 cases (59.5%). In 30 cases (40.5%) there were any foreign body in airways. The most common group of patients admitted to Clinic with suspected foreign body in airways was children in age between 1 to 3-year-old, which accounted for 22 cases (50%). Coughing was the most commonly reported symptom (54.5%), wheezing (27.5%) and dyspnea (15.9%). Twenty-three patients were presenting wheezing and whirring in physical examination. Air trap found in thorax x-ray were in 22 patients (45%). The right main bronchus was the most common place of foreign body retention – 22 patients (50%). The organic foreign bodies were in 32 cases (72.7%) and non-organic in 12 (27.3%). The nuts were the most common foreign body aspirated to airways. Conclusions. Foreign body aspiration should be suspected in every patient, not only those with choking episode but also with patients who presents ambiguous change in physical examination and x-ray scan. In pediatric patient with suspected foreign body in lower respiratory tract, in every time the bronchoscopy is needed to be done, even in patients with no abnormalities in physical examination and x-ray scan.

Эпидемиология экссудативного среднего отита у детей

Objectives. To determine the prevalence of exudative otitis media (OME) in children according to data from the pediatric otolaryngology department of state budgetary health care institution “Regional Clinical Hospital № 2”. Tyumen city. Materials and methods. A retrospective analysis of 20,000 medical records of children hospitalized in the pediatric otorhinolaryngology service for 12 years was conducted. Results and Discussion. The article presents a clinical and statistical analysis of the epidemiology of exudative otitis media in children. The number of children with otitis media was 33% (6509/20000), of which OME occupies a third of the ear pathology 33.02% (2149/6509), which represents 11% of all diseases treated in children (2149/20000), the children with the most prevalence of the disease are the youngest categories of children and those of preschool age constitute the main risk group (84.83%) for the development of OME. Conclusions. The practical equivalence of the quantitative distribution of the SSE by seasons of the year bears witness to the current problem that occurs throughout the year.

Nasal glial heterotopia – Clinical manifestation in 2.5 month-old boy

Nasal glial heterotopia is a rare congenital defect that is formed during embryological development. This lesion is part of a larger group of diseases, congenital midline nasal tumors, that occur with a frequency of once per 20,000-40,000 live births. Histologically, nasal glial heterotopia is a concentration of glial tissue which exhibits no malignant potential. We can differentiate three basic types of the disease based on the location of the lesion: 60% of nasal gliomas are extranasal, 30% are intranasal and only 10% combine extra- and intranasal components. Because of the rare occurrence correct diagnosis is quite difficult. We present a case of 2.5-month male who was admitted to the Department of Pediatric Otolaryngology for the diagnosis and treatment of a tumor deforming the bridge of his nose. Initial differential diagnosis included encephalocele, glial heterotopia (nasal glioma), angioma, nasal dorsal cyst, rhabdomyosarcoma, lacrimal duct cysts. We performed endoscopic examination, radiological imaging (CT, MRI) and histological assessment of lesion. The patient was diagnosed with nasal glial heterotopia (extra-and intranasal) based on diagnostic studies and clinical manifestation. The resection of the lesion was performed by means of dual access, external and endoscopic. The results of surgical treatment are satisfactory, control endoscopy showed no residual tumor presence.

Acute mastoiditis in children population

Aim: Aim of the study was retrospective analysis of the patients documentation treated for acute mastoiditis (AM) in Department of Pediatric Otolaryngology in Bialystok and available literature on this subject to determine the optimal rules of treatment in AM. Material and methods: A retrospective analysis of 40 patients treated for AM in 2001-2017. We have adopted Anthonsen et al. [15] AM diagnosis criteria to include patients to this study. Results: The mean age of the respondents was 46 months, 37% of children were less than 2 years old. 2/3 of the cases were not preceded by previous acute otitis media(AOM) episodes. 69% of patients received antibiotics before admission to the hospital. In laboratory studies, 95% of patients had elevated indices of inflammation (CRP, leukocytosis), and their value was higher among patients qualified for surgery. The indications for computed tomography (CT) were the lack of improvement after conservative treatment for 48 hours or symptoms of the presence of subperiosteal abscess. CT was performed in 35% of patients. 24 patients (60%) were treated only conservatively: myringotomy without / with the insertion of a ventilation tubes and intravenous antibiotic therapy. The most commonly used antibiotic was ceftriaxone - 75% of patients. 16 patients required mastoidectomy. The most common indication (30%) for mastoidectomy was the presence of subperiosteal abscess. Conclusion: In uncomplicated AM cases CT does not have to be routinely performed, a myringotomy should be performed with or without drains insertion and an empiric intravenous antibiotic therapy should be started. In presence of a subperiosteal abscess, it is recommended to perform CT with contrast and mastoidectomy. Deterioration of the patient's condition or lack of improvement after 48 hours of conservative treatment obliges us to make a CT and on the basis of the decision on mastoidectomy.

Ocular compications in ethmoiditis in children treated in a reference laryngological academic center

Introduction. One of the most commonly diagnosed upper respiratory diseases is sinusitis. A particular form of sinusitis in children is ethmoiditis. Due to the location of ethmoidal cells, their inflammation is associated with higher risk of complications compared with inflammation of other sinuses. Aim. The aim of the study was to assess the prevalence, severity and management of ocular complications of ethmoiditis in the retrospective material of the reference laryngological academic center. Material and Methods. The retrospective analysis included 41 patients with ocular complications of ethmoid sinusitis who were hospitalized in the Department of Pediatric Otolaryngology in the years 2012–2017. The analysis included the severity of complications on Chandler’s scale, management and results of culture of the material obtained during surgery. Results. The study included 25 boys (60%) and 16 girls (40%) aged from 3 months to 16 years. Mean age of the patients was 5.34 years (SD = 3.98). According to Chandler’s scale, retroseptal complications were diagnosed in 12 patients (29.27%), and anteroseptal complications – in 29 patients (70.73%). Surgical treatment was performed in 12 patients (29.27%), 8 of whom (66.7%) underwent external ethmoidectomy with orbital drainage, and 4 of whom (33.3%) underwent functional endoscopic sinus surgery (FESS). Consistent findings of CT scan with lesions found during surgical intervention were found in 10 patients (83.3%). Fifteen different pathogens were isolated from the material collected during the procedures. In more than half of the patients (53.3%), the pathogen was a staphylococcus. Al the patients with retroseptal ocular complications underwent combination therapy consisting of surgical management and two intravenous antibiotics targeted for the etiological factor. The most frequently used antibiotics included 3rd generation cephalosporins and clindamycin. Conclusions. In children with ethmoiditis treated in a reference laryngological academic center, anteroseptal complications occurred twice as often as retroseptal complications. Most cases did not require surgical intervention.

Retroauricular region involvement during otitis externa caused by P. aeruginosa

Introduction. Diffuse otitis externa is one of the causes of ear pain, especially in school-age children. Risk factors for the disease include skin damage during cleaning audito ry canal, moisture exposure, anatomical factors, and dermatological comorbidities. Aim. The aim of the study was to present clinical picture, differential diagnosis and method of treatment of diffuse otitis externa based on cases of patients hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw. Material and Methods. A retrospective analysis of the clinical presentation and diagnostic tests of 12 cases of children with diffuse otitis externa hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw from 1st March 2017 to 1st March 2018 was conducted. Results. The most common etiological factor of diffuse otitis externa was Pseudomonas aeruginosa. Over half of the patients presented an involvement of retroauricular region during otitis externa. All the patients were treated with local and intravenous antibiotics. Conclusions. Atypical course associated with the spread of inflammation to the retroauricular region may lead to an erroneous diagnosis of otitis externa as a complication of otitis media. Treatment is difficult due to severe pain and resistance of P. aeruginosa to most antibiotics.

Seasonality in the incidence of deep neck space infections in children hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Introduction. Parapharyngeal abscesses are invariably a diagnostic and therapeutic challenge for pediatric otolaryngologists. The lack of consistency in the Polish nomenclature in relation to the English terms additionally complicates the problem. The wide spectrum of signs and symptoms, as well as an extremely heterogenous clinical presentation of the disease, also delay the implementation of appropriate treatment. Aim. The aim of the study was to analyze selected epidemiological and clinical characteristics of the parapharyngeal abscesses in children, such as the seasonality in the incidence, diagnostic difficulties, and available treatment methods. Material and Methods. A retrospective analysis was conducted on data obtained from medical histories of patients treated for deep neck space infections in the years 2013–2018 in the Department of Pediatric Otolaryngology of the Medical University of Warsaw. The study analyzed the age and sex of the children, as well as diagnostic methods and bacterial culture tests of the abscess. Particular attention was drawn to the seasonality in the incidence of the parapharyngeal abscesses in children. A statistical analysis was performed and seasonality index for the data was calculated, and a simulation of the prognosis of the occurrence of the factor for a moving average with a reference period of 2 months was performed. Next, the thesis on the discrete uniform data distribution was adopted, and Monte Carlo method was used for testing of the hypothesis. The significance level was α = 1%. The probability of 9 cases in one month was calculated based on the binomial distribution. Results. In the years 2013–2018, 23 children with parapharyngeal and retropharyngeal abscesses were admitted to the Department, 9 of which were admitted in December. In the analyzed group, a slight advantage in the number of boys was observed, with the male to female ratio being M:F = 1.3:1. Mean age of the patients was 3 years and 5 months. All the children had undergone an upper respiratory tract infection before being diagnosed with a deep neck space infection. All the patients had enlarged neck lymph nodes. The seasonality index for December was over 3 times higher than for March and accounted 4.696. The hypothesis on the discrete uniform data distribution was adopted (H0). The significance level was α = 1%. Based on monomial distribution, the probability of the occurrence of 9 cases in one month was calculated and amounted P(9) = 0.000141. Hence, the rejection of H0 occurs with an error of 0.17% < 1%. Conclusions. In Poland, the admission of a child diagnosed with a retropharyngeal or parapharyngeal abscess is most likely in late autumn – in November and December. Purulent deep neck space infections in children are a complication of upper respiratory tract infections. Deep neck space infections are difficult to diagnose due to the lack of pathognomonic signs and symptoms. The conservative treatment is an alternative to the surgical drainage in stable patients with small-size abscesses under the conditions of normalization of inflammatory marker levels and improvement of the general condition of the patient.

The efficacy of adenotomy and adenotonsillotomy in children under three years of age ? a retrospective analysis

Introduction. Adenoid and tonsillar hypertrophy is one of the most common indications for surgery in children. Symptomatic adenoid and tonsillar hypertrophy mostly affects pre-school children. Children under 3 years of age constitute a distinct group of patients suffering from this disease, as they are more prone to perioperative complications, as well as to the adenoid regrowth. Aim. The aim of the study was to assess the efficacy of surgery as seen by the parents of children under 3 years of age who had undergone adenotomy or adenotonsillotomy. Material and methods. A telephone survey with the parents of children who had undergone adenotomy or adenotomy under 3 years of age in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in the years 2015?2016 was conducted. Age, sex, time elapsed from the procedure, as well as symptoms reported by the parents before and after the procedure were analyzed. Results. Out of 50 children hospitalized in our Department, the parents of 42 patients (84%) took part in the survey. The median age of children at the time of the surgery was 2 years and 8 months, and the median follow-up from the procedure was 17 months. The procedure was assessed as infective by the parents of 2 patients (5%). Snoring occurred in 76% of children before the procedure, apnea ? in 52%, and hearing impairment ? in 57%. The parents reported the persistence of these symptoms in 12%, 2% and 21% of the children, respectively. At the time of the survey, the above-mentioned symptoms were present in 29%, 0% and 26% of the children, respectively. The parents’ satisfaction with the procedure was greater in cases of children who had less severe symptoms at the time of the survey (Spearman’s rank correlation coefficient = -0.515, p = 0.0005). There were no other significant correlations between the time elapsed from the surgery, sex, age of the child at the time of the procedure, and symptom severity before and after the surgery. Conclusions. Adenotomy and adenotonsillotomy are efficient as seen by the parents of children under 3 years of age. Other possible causes for symptoms typical for adenoid hypertrophy must be taken into account, especially in younger patients. A short and simple telephone survey enabled to achieve a high response rate.

Diagnostic difficulties in children with iatrogenic vocal cord paralysis in the material of the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Introduction. The causes of vocal cord paralysis in children include congenital malformations, nervous system disorders, and iatrogenic causes. The paralysis may affect one or both cords. The signs of bilateral vocal cord paralysis include respiratory stridor of varying severity, and even acute respiratory failure. The signs and symptoms of unilateral vocal cord paralysis include phonation and swallowing disorders, as well as respiratory stridor associated with partial stenosis of already physiologically narrow airways in children. Diagnosing the cause for vocal cord paralysis in children is difficult. Aim. The aim of the study was to analyze the causes of iatrogenic vocal cord paralysis, as well as to assess the usefulness of diagnostic methods used in children with iatrogenic vocal chords paralysis. Material and methods. A retrospective analysis of clinical data of 20 children with iatrogenic vocal cord paralysis under the care of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2017 was conducted. Results. The study group included 13 boys and 7 girls aged from 1 month of age to 10 years of age; median age at the diagnosis was 3 months. In 17 children, bilateral paralysis was diagnosed, and 3 children were diagnosed with unilateral paralysis. The cause of iatrogenic vocal cord paralysis in 7 children was cardiac surgery, in 1 ? thoracic surgery, in 7 ? prolonged intubation, in 3 ? perinatal hypoxia, and in 2 ? vincristine chemotherapy. Conclusions. The diagnosis of iatrogenic vocal cord paralysis is difficult. The applied diagnostic methods require an integrated interpretation. The larynx ultrasound (US) examination remains very useful in the assessment of the vocal cords mobility in children, however, it is not possible to perform this examination in intubated patients. Fiberoscopy, performed under local anesthesia, is widely available, however, performing it on a narrow larynx of a child may cause respiratory disorders. US and fiberoscopy in infants should be supplemented by direct laryngoscopy in order to exclude congenital airway defects that may have symptoms similar to them. In any case, neurological disorders and genetic defects causing vocal cord paralysis must be excluded.

A 10-year retrospective study of alterative aeroallergens sensitization spectrum in urban children with allergic rhinitis.

ObjectiveTo investigate the alterative spectrum and trends of aeroallergens sensitization in children with allergic rhinitis (AR) in Guangzhou, China in the past 10 years.Participants and methodsIn this retrospective study, 4,111 children with complaints of nasal hyper-reactivity who visited the Pediatric Department and/or Otolaryngology Department from January 2007 to November 2016 were enrolled. Serum specific immunoglobulin E was measured and positive detection was made in 3,328 patients, who were, therefore, diagnosed with AR. Positive rates and trends of different aeroallergens sensitization were assessed. The tendency of positive rates changing over the years, and the difference and trends in positive rate of aeroallergen sensitization that occurred in subgroups of gender, age, and season were determined and analyzed with logistic regression.ResultsThe percentage of detected common aeroallergens in AR children was (from high to low) 81.07%, 34.44%, 14.72%, 11.81%, 6.04%, and 3.70% for house dust mites (HDMs), cat–dog dander, cockroach, mold mixture, tree pollen mixture, and herb pollen mixture, respectively. An ascending trend of aeroallergens sensitization or AR (odds ratio [OR] =1.116, 95% CI: 1.086–1.146) was found. Interestingly, an increasing trend of cat–dog dander and mold sensitization was found in AR children (OR =1.164, 95% CI: 1.133–1.196; OR =1.169, 95% CI: 1.120–1.223) in this retrospective study, while HDMs sensitization held a steady trend (OR =0.983, 95% CI: 0.961–1.007).ConclusionIn the increasing trend of aeroallergens sensitization or AR, HDMs sensitization still held the majority. But emphasis should be made on pet allergy for young children with AR in the context of ascending trend of sensitization to cat–dog dander.

Prevalence of allergy in children with adenoid hypertrophy and otitis media with effusion admitted to the Department of Pediatric Otolaryngology in Poznan

Prevalence of allergy in children with adenoid hypertrophy and otitis media with effusion admitted to the Department of Pediatric Otolaryngology in Poznan

Parotitis in children hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in the years 2010-2017

Parotitis in children hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in the years 2010-2017

Clinical characteristics of antrochoanal polyps in patients treated in the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Clinical characteristics of antrochoanal polyps in patients treated in the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Utility of polysomnography in determination of laryngomalacia severity

ObjectiveTo examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients. MethodsProspective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score. Results25 pediatric patients (n = 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p = 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p = 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p = 0.81, r = 0.08, CI: −0.5197 to 0.6235). ConclusionIn our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.