International Pediatric Otolaryngology Group Research Articles

International pediatric otolaryngology group (IPOG) consensus on approach to aspiration

ObjectiveTo provide recommendations for a comprehensive management approach for infants and children presenting with symptoms or signs of aspiration. MethodsThree rounds of surveys were sent to authors from 23 institutions worldwide. The threshold for the critical level of agreement among respondents was set at 80 %. To develop the definition of “intractable aspiration,” each author was first asked to define the condition. Second, each author was asked to complete a 5-point Likert scale to specify the level of agreement with the definition derived in the first step. ResultsRecommendations by the authors regarding the clinical presentation, diagnostic considerations, and medical and surgical management options for aspiration in children. ConclusionApproach to pediatric aspiration is best achieved by implementing a multidisciplinary approach with a comprehensive investigation strategy and different treatment options.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis

ObjectivesTo outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis. MethodsExpert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature. ResultsForty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis. ConclusionThese recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.

International Pediatric Otolaryngology Group (IPOG) survey: Efforts to avoid complications in home tracheostomy care

ObjectiveTo provide guidance for home care tracheostomy management in the pediatric population. The mission of the IPOG is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. MethodsSurvey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). ResultsSurvey results provide guidance for caregiver teaching, the reuse of tracheostomies and suction catheters while inpatient and following discharge, acceptable sterilization practices for tracheostomies, tracheitis workup and management, and outpatient follow-up practices. ConclusionThis presentation of common home tracheostomy care practices are aimed at improving patient-centered care in the pediatric population.

International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation

ObjectivesTo provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients. MethodsAn iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group. ResultsTwenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation. ConclusionTracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Management of suprastomal collapse in the pediatric population

IntroductionSuprastomal Collapse (SuStCo) is a common complication of prolonged tracheostomy in children. There is a paucity of literature on this subject, especially regarding how to manage significant suprastomal collapse that prevents safe decannulation. ObjectiveProvide a definition, classification system, and recommend management options for significant suprastomal collapse in children with tracheostomy. MethodsMembers of the International Pediatric Otolaryngology Group (IPOG) who are experts in pediatric airway conditions were surveyed and results were refined using a modified Delphi method. ResultsConsensus was defined as > 70% agreement on a subject. The experts achieved consensus:•on a standard definition of Suprastomal Collapse•that there is clinical importance between significant and insignificant collapse•that the gold standard diagnostic modality is endoscopic examination under anesthesia•that the severity of collapse is a major determinant in the surgical approach•that surgical intervention is the first line management in combined anterior and lateral Suprastomal Collapse. ConclusionThis consensus statement provides recommendations for medical specialists who manage infants and children with tracheostomies with significant Suprastomal Collapse. It provides a classification system to facilitate diagnosis and treatment options for this condition.

International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

ObjectiveTo make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. MethodsRecommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. “Consensus” was defined by >80% respondent affirmative responses, “agreement” by 51–80% affirmative responses, and “no agreement” by 50% or less affirmative responses. ResultsRecommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. ConclusionsThorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA)

ObjectiveTo develop an expert-based consensus of recommendations for the diagnosis and management of pediatric obstructive sleep apnea. MethodsA two-iterative Delphi method questionnaire was used to formulate expert recommendations by the members of the International Pediatric Otolaryngology Group (IPOG). ResultsTwenty-six members completed the survey. Consensus recommendations (>90% agreement) are formulated for 15 different items related to the clinical evaluation, diagnosis, treatment, postoperative management and follow-up of children with OSA. ConclusionThe recommendations formulated in this IPOG consensus statement may be used along with existing clinical practice guidelines to improve the quality of care and to reduce variation in care for children with OSA.

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

International Pediatric Otolaryngology Group (IPOG) Consensus Recommendations: Congenital Cholesteatoma.

To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of children who present with signs and symptoms of congenital cholesteatoma. A two-iterative Delphi method questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group, on the preoperative work-up, the perioperative considerations, and follow-up. Twenty-two members completed the survey, in 14 tertiary-care center departments representing 5 countries. The main consensual recommendations were: a precise otoscopic description of the quadrants involved, extensive audiological workup (bilateral tonal, vocal audiometry, and BERA), and a CT scan are required. Facial nerve monitoring and a combination of microscope and telescope are recommended for surgical removal. Clinical and audiological follow-up should be pursued yearly for at least 5 years. First MRI follow-up should be done at 18 months postoperatively if the removal violated the matrix. MRI follow-up duration depends on the initial extent of the cholesteatoma. The goal of preoperative and follow-up consensus from International Pediatric Otolaryngology Group participants is to help manage infants and children with congenital cholesteatoma. The operative techniques may vary, and experienced surgeons must perform these procedures.

International Pediatric ORL Group (IPOG) Robin Sequence consensus recommendations

ObjectiveTo provide recommendations for the comprehensive management of airway obstruction in patients with Robin Sequence. MethodsExpert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). ResultsThe consensus statement provides recommendations for medical specialists who manage infants with Robin Sequence including: evaluation and treatment considerations for commonly debated issues in post-natal airway obstruction, assessment of antenatal obstruction and perinatal airway management. ConclusionConsensus recommendations are aimed at improving management of airway obstruction in patients with Robin Sequence.

Laryngeal clefts: a review of current literature

Laryngeal clefts as exceptionally rare congenital anomalies have been reported more and more recently. The clinical symptoms and presentations base on degree of clefts and variety of comorbidities. Mild types of clefts may have minimal clinical impact, whereas severe types may be life-threatening and even lead to death before diagnosis. With more attention of these anomalies and advances in endoscopy, the diagnosis, evaluation and surgery of laryngeal clefts have acquired great improvement, especially International Pediatric Otolaryngology Group(IPOG)have reported consensus guidelines on the diagnosis and management of type Ⅰ laryngeal clefts in 2017. This review of laryngeal clefts may be beneficial to decrease missed diagnosis or misdiagnosis and to achieve individual-based treatment.

International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of type I laryngeal clefts

IntroductionThe diagnosis and management of type I laryngeal clefts can be controversial and varies across centers and surgeons. Using existing peer-reviewed literature to develop an expert-based consensus will help guide physicians in the treatment of these patients as well as develop research hypotheses to further study this condition. ObjectiveTo provide recommendations for the diagnosis and management of type I laryngeal clefts. MethodsDetermination of current expert- and literature-based recommendations, via a survey of the International Pediatric Otolaryngology Group, using a modified Delphi method. SettingMultinational, multi-institutional, tertiary pediatric hospitals. ResultsConsensus recommendations include diagnostic workup, medical management, pre-operative, intra-operative and post-operative considerations for type I laryngeal clefts. ConclusionsThis guide on the diagnosis and management of patients with type I laryngeal clefts is aimed at improving patient care and promoting future hypothesis generation and research to validate the recommendations made here.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Routine peri-operative pediatric tracheotomy care

ObjectivesTo develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. MethodsExpert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. ResultsConsensus recommendations including pre-operative, intra-operative, and post-operative considerations, as well as sedation and nutrition management are described. These recommendations are based on the collective opinion of the IPOG members and are targeted to (i) otolaryngologists who perform tracheotomies on pediatric patients, (ii) intensivists who are involved in the shared-care of these patients, and (iii) allied health professionals. ConclusionPediatric peri-operative tracheotomy care consensus recommendations are aimed at improving patient-centered care in this patient population.

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To provide recommendations for the comprehensive management of young infants who present with signs or symptoms concerning for laryngomalacia.Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG).Consensus recommendations include initial care and triage recommendations for health care providers who commonly evaluate young infants with noisy breathing. The consensus statement also provides comprehensive care recommendations for otolaryngologists who manage young infants with laryngomalacia including: evaluation and treatment considerations for commonly debated issues in laryngomalacia, initial work-up of infants presenting with inspiratory stridor, treatment recommendations based on disease severity, management of the infant with feeding difficulties, post-surgical treatment management recommendations, and suggestions for acid suppression therapy.Laryngomalacia care consensus recommendations are aimed at improving patient-centered care in infants with laryngomalacia.