Paediatric ENT Research Articles

Inspiratory stridor of newborns and infants admitted to a paediatric ENT outpatient clinic: diagnostic approach and therapeutic outcome.

The main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (n = 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (n = 24) underwent concomitant endoscopic surgery. A 65.8% (n = 125) of the patients were diagnosed with laryngomalacia, 21.1% (n = 40) with isolated posterior excess of mucosa, 9.5% (n = 18) with another diagnosis and 3.7% (n = 7) with a normal examination. The presence of comorbidity was associated (p < 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery.Conclusion: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia. What is Known: • Previous research has established that laryngomalacia is the main aetiology of stridor. • Comorbidities are linked with a poor tolerance of stridor. What is new: • About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery). • Laryngomalacia and isolated posterior excess of mucosa account for 85-90% of the patients seen in consultation for stridor.

Telemedicine in paediatric otorhinolaryngology: Lessons learnt from remote encounters during the Covid19 pandemic and implications for future practice

IntroductionCovid19 has necessitated new methods of conducting outpatient consultations. At our institute, patient-facing paediatric ENT appointments were replaced with telemedical consultations. MethodWe performed a prospective analysis of the outcomes following telephone consultations with parents and describe our experience of remote consulting during a pandemic, and the possibilities for future applications of telemedicine in paediatric ENT. Results215 patients were appropriately referred to the paediatric ENT clinic, 65% of these patients were deemed suitable for remote telephone consultation. Following a telephone call, 50% did not need further ENT clinic management, most commonly due to being listed for surgery (20%) or discharged (18%). The treating consultant assessed 81% of phone consultations as being effective. When given the choice, patients reported that 29% would choose a telephone consultation whilst 43% preferred a face to face consultation. ConclusionOur experience has shown that there are areas of paediatric ENT that can be streamlined effectively by substituting face to face consultations with telephone consultations. However, prospective evaluation of these remote contacts suggest that telephone consultations are not a panacea and cannot be indiscriminately applied to all. Instead, the strategies to take forwards into a post Covid19 practice are vetting of referrals, individualised treatment plans, and giving patients a choice.

The burden of laryngomalacia and its effects on caregivers: A support group survey evaluation

ObjectiveTo evaluate which factors may affect anxiety and child's health perception of parents with children that have laryngomalacia. Study designSurvey Study. Setting“Coping with Laryngomalacia” – largest online laryngomalacia support group for parents with children who have laryngomalacia. Subjectsand Methods: A survey was sent to support group member that gathered information regarding the patient's diagnosis and associated course of treatment and evaluated for parental anxiety and perceived health of their child. Analysis was performed to evaluate which variables are associated with increased parental anxiety and worsened perceived child's health. ResultsData was gathered on 434 patients. All caregivers reported some level of anxiety due to the diagnosis and 64% felt completely anxious. Parents who saw an increased number of physicians prior to a pediatric ENT rated their child with poorer health (p < .05). Those that felt their concerns were brushed off initially reported increased anxiety (p < .05). If the child was admitted to the hospital, ICU, required intubation, had feeding troubles, required a feeding tube, or underwent pH monitoring, the patient was rated to have poorer health per the parents (p < .05). ConclusionLaryngomalacia causes a significant burden on patients and their families due to the eating problems, feeding problems, hospital stay, and other various conditions associated with the disease. Caregivers should take a more modern and compassionate approach to management and diagnosis.

Impact of the COVID-19 epidemic on ENT surgical volume

PurposeThe purpose of this study was to assess the impact of the COVID-19 pandemic on the surgical volume of three ENT departments in Ile-de-France, a region severely affected by the epidemic. Materials and methodsThe number and nature of surgeries was collected from three university hospital ENT departments from 17/03/2020 to 17/04/2020 and from 18/03/2019 to 18/04/2019. Centre 1 is a general adult ENT department specialized in otology, centre 2 is a general adult ENT department specialized in cancer and centre 3 is a paediatric ENT department. Comparative analysis of the decreased surgical volume was conducted between 2019 and 2020. ObjectiveTo analyse the reduction of ENT surgical volume. ResultsThe three centres operated on 540 patients in 2019, versus 89 in 2020, i.e. an 84% decrease: 89% in Centre 1, 61% in Centre 2, and 95% in the paediatric centre. Otological surgery decreased by 97%, endonasal surgery decreased by 91%, head and neck surgery decreased by 54%, plastic surgery decreased by 82%, and transoral surgery decreased by 85%. The number of surgical operations for skin cancer decreased (24 vs. 9), while the total number of head and neck cancer surgeries remained stable (18 vs. 22). The number of planned tracheostomies increased from 8 to 22. ConclusionThe number of ENT surgeries decreased by 84% during the first month of the COVID-19 epidemic. This decreased surgical volume mainly concerned functional surgery, while the level of cancer surgery remained stable. Hospital units will need to absorb a marked excess surgical volume after the epidemic.

Prematurity and associated future paediatric airway pathology: experience from a single tertiary paediatric ENT centre.

Enhanced management of the pre-term patient has resulted in improved survival rates in increasingly premature patients. Although prematurity predisposes to congenital airway pathology, there is also increased risk of endotracheal intubation, and therefore acquired subglottic pathology. We sought to evaluate airway pathology in children outside the neonatal period with a history of prematurity to explore the relationship between prematurity and upper airway pathologies. Data for patients undergoing elective microlaryngobronchoscopy (MLB) at our centre were collected prospectively over a 5-year period. Patients identified as premature were sub-classified by the grade of prematurity. 339 patients over 1month of age underwent MLB, of which 56 (16.5%) were born prematurely. Of those with identified airway pathology, 49 (23.4%) were born prematurely, accounting for 32.6% of subglottic stenosis (n = 30), 24% of laryngomalacia (n = 13) and 19% of laryngeal cleft diagnoses (n = 16). 49 premature patients (87.5%) had one or more airway pathologies diagnosed. Multi-level airway pathology was seen in twelve premature infants (21.4%), demonstrating a statistically significant association (odds ratio 3.396; 95% CI 1.697-6.842; p value < 0.0016). Incidence of airway pathology, the severity of airway disease and multi-level airway pathology were not related to the grade of prematurity. Premature patients account for a significant proportion of the workload within our tertiary centre due to improving neonatal care and survival in pre-term infants. We suggest early paediatric ENT evaluation for ex-premature patients with symptoms of airway pathology, with a low threshold for MLB. Improving neonatal survival rates in ever-increasing prematurity will require the further provision of specialist paediatric ENT services to manage their ongoing care.

Pediatric sudden sensorineural hearing loss: Experience in a pediatric ENT emergency care center

ObjectivesSudden sensorineural hearing loss (SSNHL) is relatively rare and its physiopathology remains unclear, particularly in children. Our goal was to evaluate clinical characteristics, etiologies, management, treatment outcomes and prognostic factors in the pediatric population. MethodsWe performed a retrospective chart review of all children registered for SSNHL between August 2004 and September 2017 in a tertiary care pediatric hospital. We analysed data regarding clinical symptoms, audiological characteristics, diagnostic investigations and treatment outcomes. ResultsThirty-five patients were included. Mean age was 12 years (range 4–18 years). Male:female ratio was 15:20. Hearing loss was left-sided for 18 patients, right-sided for 12 patients and bilateral for 5 patients. Degree of hearing loss varied from mild to profound across frequencies in the 40 ears studied. Thirty-four patients had associated otologic symptoms: the most frequent was tinnitus (28 ears), followed by vertigo (23 ears), otalgia (5 ears) and sensation of blocked ear (5 ears). Twenty-nine patients received systemic steroids and 3 intra-tympanic steroids. In the treated group, 69% had improvement on the audiograms (14% total, 55% partial). Vestibular tests were performed in 16 patients and were abnormal in 10 patients. Radiological examination included computed tomography scan (n = 16) and/or magnetic resonance imaging (n = 33). They revealed 2 bilateral enlarged vestibular aqueducts, 1 labyrinthitis, 1 intra-cochlear haemorrhage. ConclusionSSNHL can affect speech and language development in children. There are differences among the pediatric population, including inner ear malformation and immune disease. Specific work up is proposed. Appropriate diagnosis and therapeutic management are discussed.

A 10-year experience with pediatric asphyxiation secondary to near hanging

Background: Pediatric (especially preadolescent) asphyxiation secondary to near hanging is a seldom reported entity and tends to be predominantly accidental in nature.Objective: The objective of the study was to assess and report the course during the intensive care unit (ICU) stay and the unique problems that are pertinent to pediatric near-hanging injuries.Methodology: A 10-year retrospective analysis (2009–2019) was conducted after obtaining ethical approval.Results: Eleven patients presented to our pediatric ICU over the past 10 years, with pediatric asphyxiation secondary to near hanging. Among these children, most of them had saree swing as the mode of hanging; this subgroup had a higher morbidity and mortality. They tend to have higher markers of myocardial ischemia (high troponin T and creatine kinase). About half of the patients required fluid boluses, inotropic requirement, and ventilation at admission. Patients with pulmonary edema tended to have low oxygen saturation (SpO2), even without respiratory distress at admission, and higher ventilator and inotropic requirement. Only half of the patient population admitted were discharged with good neurological outcome (Glasgow Coma Scale: 15/15 at discharge).Conclusion: The nature of complications secondary to hanging necessitates ICU monitoring, with pediatric ENT and anesthesia backup. The presence of low SpO2at admission in this setting should alert the clinician to possibility of pulmonary edema. Parents should be made aware that saree swing can lead to accidental asphyxiation. It is important to raise awareness to prevent this entity as it is associated with poor outcome.

Allergic rhinitis in children: from diagnosis to therapy

Allergic rhinitis, according to modern data, affects up to a quarter of the population of developed countries. The disease affects not only the nasal mucosa, but also affects the receptors and mediators of inflammation in the bone marrow. A significant decrease in the quality of life of patients against the background of exacerbation of allergic rhinitis makes us look for new approaches to both the treatment of attacks and their prevention. Correction, including surgical, of concomitant pathology of the nasal cavity and paranasal sinuses significantly improves the quality of life of patients with allergic rhinitis. For a long time, surgical treatment of concomitant pathology of the nasal cavity in children was extremely limited due to the risk of damage to the growth zones and, as a consequence, a high probability of recurrence of deformation of the structures of the nose and paranasal sinuses. With the development of endoscopic methods of surgical treatment of the nasal cavity and paranasal sinuses, operations with minimal invasiveness and, as a consequence, safe at any age were introduced into practice. Surgical intervention on the structures of the lymphoid pharyngeal ring in children with allergic rhinitis is causing heated debate in the pediatric community to date. The article considers modern approaches to the diagnosis and treatment of allergic rhinitis in children. Topical problems of conservative and surgical treatment are discussed. Special attention is paid to the safety of various treatment regimens. The discussed practical issues of tactics of treatment of allergic rhinitis are relevant for both pediatric allergists and ENT pediatricians.

Integration of diagnostic and treatment methods of pediatric ENT diseases into the practice of a pediatrician

In his or her daily practice, a pediatrician often has to encounter various ENT diseases, since more than half of visits to children's clinics are associated with various conditions of ENT organs. This article highlights the issues of introducing diagnostic and treatment methods for acute and chronic diseases of ENT organs into the daily practice of pediatricians.

Laparoscopic-assisted management of paediatric intra-abdominal lymphatic malformations

Lymphatic malformations (LMs) are low-flow vascular anomalies with treatment modalities that include conservative, sclerotherapy, oral therapeutic agents and surgical excision. The use of laparoscopy combined with interventional radiology has not previously been described. We report our multidisciplinary (MDT) approach to the management of these lesions. All complex paediatric LM referrals are discussed at our vascular MDT that spans across general paediatric surgery, interventional radiology (IR), plastics, orthopaedics, ENT, and dermatology. Intra-abdominal LM’s undergo an initial USS followed by contrast-enhanced MRI to confirm diagnosis and delineate the nature of the lesion. Our first-line treatment has previously been US-guided sclerotherapy. More recently, we have changed our approach to perform an intra-operative assessment of these lesions combined with IR to confirm the diagnosis and assess their resectability. Four patients have undergone combined assessment with our IR team in the last 24 months ranging from 1 to 7 years of age. Two lesions were found to involve the distal ileum, one proximal jejunum and one greater omentum. In all cases, the lesions were excised following initial laparoscopic assessment combined with IR-guided drainage. There have been no complications encountered in these four patients and none have had a recurrence till date. Primary laparoscopic assessment of an intra-abdominal LM is feasible and enables the confirmation of the diagnosis and assessment of resectability. Morbidity from the use of sclerosant agents and the repeated use of general anaesthesia can also potentially be avoided using this technique.

Hospitalization of children after ENT surgery in Germany

Morbidity following tonsil surgery is widely determined by pain, odynophagia, and bleeding. Detailed information about postoperative care in pediatric patients in Germany in the context of otolaryngologic interventions is currently lacking. Aquestionnaire including eight questions to clarify trends and traditions in hospitalization strategies for pediatric patients was sent via email on January14, 2019, to all heads of ENT departments who were also members of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO). The electronic survey was designed by the Pediatric Working Group of the DGHNO. The response rate was 72.9% (120/166), one response was excluded because it was not provided via the online tool. Children are currently transferred to pediatric clinics after surgery in 64 of 120 otorhinolaryngology departments, atradition in existence for at least 5years in 48 of the 64departments. In the remaining 56institutions, children remained in the otorhinolaryngology department despite 30 having specialized pediatric clinics or clinics for pediatric surgery. This strategy is expected to be discontinued in 5 of the 56hospitals in due course. Aseparate pediatric ENT clinic within the same institution is uncommon (27/120). The average travel time of on-call physicians in cases of postoperative bleeding is 3.4 min; transportation of the child to the emergency operation room takes 5.4 min on average. The nursing staff is predominantly responsible for transportation of pediatric emergency patients (109/120). The wards and operation rooms are commonly located in the same building, but on different floors (83/120). There is currently no uniform hospitalization strategy for postoperative care of children who undergo typical otorhinolaryngologic interventions in Germany.

Modified radical mastoidectomy in children: mastoid cavity problem and its management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Various factors are responsible for post MRM chronically discharging mastoid cavity which has to be identified and treated properly so as to avoid further complications. The aim of this study is to evaluate the causative factors responsible for persistent ear discharge in post mastoidectomy cases and their management in paediatric age group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a cross sectional study done from May 2013 to April 2017 in the Paediatric ENT unit of Department of ENT &amp;amp; HNS, TUTH, Kathmandu, Nepal. Children were evaluated for persistent ear discharge and managed for one year. Risk factors like high facial ridge, inadequate meatoplasty, unepithelize mastoid cavity, tympanic membrane perforation and residual or recurrent choleateatoma, infections, nasal or nasopharngeal pathology were evaluated and treated. Outcome of management was measured in terms of achieving dry mastoid cavity over one year period. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 92 post MRM children with persistent discharge were included in the study. 33/92 (35.8%) had anatomical defects. Four cases had recurrent or residual cholesteatoma. 22/92 (23.9%) of the cases had granulation and infection. 14 cases had nasophayngeal inflammation and 13 cases had recurrent accumulation of wax or debris. After the treatment of various factors, 43/75 (53.7%) ear became dry within 3 months, 22/75 (29%) ear became dry within 6 months, 6/75 had persistent discharge even 1 year after treatment. Whereas, in 5/75 (13.4%) had on and off discharge.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The chronically discharging mastoid cavity can be well managed by early identification of causative factors.&lt;/p&gt;

Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation.

This study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches. A prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care. In total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively. Intracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

LittlEARS auditory questionnaire as an infant hearing screening in Germany after the newborn hearing screening

Objective: To investigate the feasibility of using the LittlEARS® Auditory Questionnaire (LEAQ®) as part of the infant hearing screening programme in Germany.Design: LEAQ®s were distributed to 47 paediatric practices and were completed by the parents/guardians of the infants (aged between 9-14 months) involved in the study (= LEAQ® screening). The infants who failed the LEAQ® screening were invited to a LEAQ rescreening. Infants who failed the LEAQ® rescreening were sent to a paediatric ENT specialist. After 3 years, a follow-up was performed on two groups: the first group comprised infants who failed the LEAQ screening; the second group (control group) comprised 200 infants who passed the LEAQ screening.Study Sample: 5316 questionnaires were returned.Results: Six infants with permanent hearing loss were identified using the LEAQ® as a screening tool.Conclusions: An infant hearing screening using the LEAQ® is easily implementable in paediatric practices and may be a good alternative in countries where no objective screening instruments are available. The LEAQ® was suitable for monitoring hearing development in infants in general and could help to identify a late-onset or progressive hearing loss in infants.

Total and partial ossiculoplasty in children: Audiological results and predictive factors

ObjectiveTo assess ossiculoplasty results in children and screen for predictive factors of efficacy. Patients and methodsSeventy five children undergoing ossiculoplasty between 2001 and 2014 in a pediatric ENT department were included. The following data were collected and analyzed: demographic data, surgical indication, history of tympanoplasty, contralateral ear status (healthy, affected), preoperative hearing thresholds, surgical technique, intraoperative findings, and ossicular chain status at eardrum opening. Audiological results were reported according to American Academy of Otolaryngology-Head and Neck Surgery guidelines. ResultsForty eight patients were included in the total ossicular reconstruction prosthesis (TORP) group. Mean age at surgery was 9.9years. Mean follow up was 2.7years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 40% of cases at medium term (12 to 18 months after surgery). Air conduction (AC) threshold ≤30dB was achieved in 68% of cases. AC threshold improved by 14.6dB and 8.7dB at medium and long-term follow-up, respectively. A significant correlation was found between success rate and absence of history of tympanoplasty. The success rate was higher for primary than for revision procedures. Twenty seven children were included in the partial ossicular reconstruction prosthesis (PORP) group. Mean age was 9.5years, and mean follow-up 2.6years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 75% of cases at medium term. AC threshold ≤30dB was achieved in 75% of cases AC threshold improved by 9.3dB and 5dB at medium and long-term follow-up, respectively. No predictive factors for success were found in the PORP group. ConclusionThe present study suggested that total ossiculoplasty leads to better results when performed in first-line. It also confirmed that functional outcome is better in partial than total ossicular reconstruction prosthesis.

Pattern of paediatric ear, nose and throat disorders in a district hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; ENT disorders such as otitis media, serous otitis media, sinusitis, and tonsillitis are among the commonest childhood disorders and important reasons for parents and children to visit the physicians/otolaryngologists. The pattern of ENT disorders also varies from community to community or hospital to hospital based on the availability of specialist personnel or facilities for the management. Present study was carried out with the objective of to study the pattern of paediatric ENT disorders in our Government district hospital.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The patients of both gender and age between 0 to 16 years and presenting with ENT problems were screened. The patients having END disorders diagnosed by ENT surgeon were enrolled into the study. All information to accomplish objectives was collected by studying the patients’ treatment record and by personal interview of each of the study participants/parents for 5 to 10 minutes using case record form. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Children from rural community were more affected than children from urban community. The maximum children were suffered from ear disorders (49.32%) followed by throat disorders (34.55%); and nose disorders (16.14%). CSOM found the commonest ENT disorder, OME, AOM, tonsillitis, adenoid hypertrophy, and acute pharyngitis. In 0-5 years-age-group, AOM and OME were the commonest; CSOM and OME in 5-10 years age group while acute pharyngitis and CSOM were the commonest in age-group of 10-16 years.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; These results of the present study clearly show the wide prevalence of ENT disorders, particularly in the rural communities. There is urgent need to establish better healthcare especially ENT services for the rural population of our country. The general physicians and paediatricians should be trained and taught enough recognize common ENT disorders promptly; therefore they are able to refer early and prevent complication.&lt;/p&gt;

THE IMPACT OF AN EDUCATIONAL PROGRAM FOR MOTHERS OF CHILDREN WITH OTITIS MEDIA ON THE PREVENTION OF ITS RECURRENCE AT ZAGAZIG UNIVERSITY HOSPITAL

Background: Otitis media is a common pediatric condition that affects most children by their second birthday and untreated cases of otitis media can possibly cause long term complications. This study aimed to evaluate the impact of implementing educational program for mothers about preventing of the recurrent otitis media. Design: Quasi- experimental design was conducted at pediatric ENT outpatient clinic at Zagazig University Hospital on a sample of 118 mothers who had children suffering from otitis media and attending the previously mentioned setting to manage their children. Tools of data collection: Data were collected by using child assessment sheet and structured interview questionnaire for mothers. Results: About one quarter of the studied children had recurrent otitis media once or twice episode per year and less than two thirds their recurrence were four episodes or more per year before program. After implementation of the educational program the children improved as the majority of children had recurrent otitis media once or twice episode per year. Conclusion: There was a positive impact of the educational program in improving mothers' knowledge as well as their reported practices about otitis media as well as on the recurrence of otitis media. Recommendations: Regular and continuous health educational programs are essential for improving the mothers' knowledge and their reported practices regarding their children having otitis media

THE IMPACT OF AN EDUCATIONAL PROGRAM FOR MOTHERS OF CHILDREN WITH OTITIS MEDIA ON THE PREVENTION OF ITS RECURRENCE AT ZAGAZIG UNIVERSITY HOSPITAL

Background: Otitis media is a common pediatric condition that affects most children by their second birthday and untreated cases of otitis media can possibly cause long term complications. This study aimed to evaluate the impact of implementing educational program for mothers about preventing of the recurrent otitis media. Design: Quasi- experimental design was conducted at pediatric ENT outpatient clinic at Zagazig University Hospital on a sample of 118 mothers who had children suffering from otitis media and attending the previously mentioned setting to manage their children. Tools of data collection: Data were collected by using child assessment sheet and structured interview questionnaire for mothers. Results: About one quarter of the studied children had recurrent otitis media once or twice episode per year and less than two thirds their recurrence were four episodes or more per year before program. After implementation of the educational program the children improved as the majority of children had recurrent otitis media once or twice episode per year. Conclusion: There was a positive impact of the educational program in improving mothers' knowledge as well as their reported practices about otitis media as well as on the recurrence of otitis media. Recommendations: Regular and continuous health educational programs are essential for improving the mothers' knowledge and their reported practices regarding their children having otitis media

Analysis of Scientific Production in Otolaryngology in Spain in the Period 2011–2015

IntroductionPublishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011–2015 and to compare them to a previous period between 1998–2002. Material and methodsOriginal papers published by Otolaryngology Departments in Spain in PubMed within 2011–2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications. ResultsBetween 2011 and 2015, 49342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011–2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period. ConclusionsSpanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor.

BSPD guidelines for treatment of IH with propranolol

Infantile haemangiomas (IH) are common birthmarks in babies consisting of dilated blood vessels. They are also known as strawberry naevi. Most of them grow for a few months, then gradually shrink spontaneously over a period of months or years. However, in about 15% of cases they can cause serious functional problems when they involve important structures such as the eye, ear, mouth, nose and the peri‐anal area. In addition they can sometimes resolve, but leaving significant disfigurement. In 2008 it was reported that the beta‐blocker drug propranolol, given orally (by mouth), was very effective in causing these birthmarks to shrink rapidly. This paper is designed to provide guidance to doctors on how best to administer propranolol to children with IH. Developing the guidelines involved several stages: an international survey of current practice in eight European countries; a systematic review of the literature; collecting current local guidelines from 19 centres leading to the generation of 70 statements. These 70 statements were then scrutinised by 19 experts from relevant specialities (Dermatology, Paediatrics, Paediatric Cardiology and Paediatric ENT surgery). Using an established research protocol, agreement was reached by these experts on 47 statements covering eight categories. These categories include: indications for starting propranolol (i.e. it which situations it should be used); contraindications (i.e. in which situations it should not be used); pre‐treatment tests needed; initiation of treatment; monitoring during treatment and when to stop treatment. They also cover treatment of children with additional medical complications.Although these guidelines are UK‐based, the authors hope that they will be useful in other European countries also.