Pediatric Otolaryngology Research Articles

Медико-социальные проблемы распространенности ЛОР- заболеваний и доступности оториноларингологической помощи населению, в том числе детскому (обзор зарубежной литературы)

An analysis of foreign scientific sources suggests that the prevalence of otorhinolaryngological diseases in the world is high and affects the increase in disability and mortality rates. The most common pediatric otorhinolaryngological disease worldwide is otitis media. Low availability of specialized otorhinolaryngologist care and socioeconomic disadvantage are associated with earlier, more frequent and severe ENT disease in children. The most vulnerable to otitis media leading to hearing loss are children of low socioeconomic status (even in developed countries) and indigenous children in all countries of the world. In low- and middle-income countries, pediatric otorhinolaryngology faces challenges associated with a lack of infrastructure and equipment, a relatively small health care budget, a shortage of medical staff, and a lack of political will. In multicultural developed countries, the lack of understanding in medical institutions of the need to take into account ethno-cultural characteristics, as well as a decrease in confidence in medical institutions, creates constant barriers to access to medical services.

Bilateral Vocal Fold Paralysis in a Patient With Congenital MYOD1 Myopathy.

Congenital bilateral vocal fold paralysis (BVFP) is a rare but significant cause of morbidity in pediatric otolaryngology. The differential diagnosis is expansive, with common etiologies including birth trauma, brainstem neoplasms, and neurologic disorders. There are few known genetic causes of the condition. This report details the first known case of BVFP secondary to a genetic deficiency in MYOD1, a master transcriptional regulator of skeletal muscle cell specification. Genetics consultation and testing may be a useful adjunct in the workup of congenital BVFP and may help guide prognostication, additional workup, counseling, and clinical decision-making.

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy.

Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy. A retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management. University of California, San Francisco Pediatric Otolaryngology Department. Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management. The majority of pediatric PACLis benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow-up with neck ultrasound can be used to safely monitor patients.

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study.

The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended.

Prophylactic inhaled corticosteroids for the management of recurrent croup

Croup is characterized by a barky cough, inspiratory stridor, hoarseness and varying degrees of respiratory distress. Acute croup episodes are often treated with oral, inhaled, or intravenous corticosteroids. Recurrent croup, defined as more than 2-3 episodes of acute croup in the same patient, can mimic asthma. We hypothesized that inhaled corticosteroids (ICS) given at the first sign of a respiratory viral prodrome can be a safe treatment to reduce the frequency of recurrent croup episodes in children without fixed airway lesions.A retrospective chart review of patients being treated over an 18-month period was performed at a large tertiary care pediatric hospital following Institutional Review Board (IRB) approval. Patients under 21 years old referred to Pediatric Pulmonology, Otolaryngology, or Gastroenterology for recurrent croup were analyzed for their demographics, medical history, evaluation, treatment and clinical improvement. A Fisher's two-tailed exact test was used to compare the number of croup episodes before and after interventions.124 patients were included in our analysis: 87 male and 34 female with a mean age of 54 months. Of these, 78 had >5 episodes of croup, 45 had 3-5, and 3 had 2 episodes prior to their first visit for recurrent croup. Operative direct laryngoscopy/bronchoscopy was performed in 35 patients (27.8%), with 60% showing a normal exam without fixed lesions. Ninety-two patients (74.2%) were treated with ICS, 24 were lost to follow up. Of the remaining 68 treated patients, 59 (86.7%) saw improvement with reduced severity and overall number of episodes of croup. Additionally, patients with >5 episodes of croup (47) as compared to <5 (12) were more likely to improve with ICS, (p = 0.003). There were no adverse reactions reported with ICS treatment.The novel initiation of ICS at the earliest sign of a viral upper respiratory infection shows promise as a safe preventative treatment to mitigate the frequency of recurrent croup episodes.

Maxillary Frenulum and "Lip Tie": What Parents Understand.

To determine the proportion of parents that have some knowledge of abnormal maxillary frenulum, or "lip tie,"and their sources of this information. Cross-sectional study. Otolaryngology clinic. Consecutive parents of children ≤12 years of age presenting at a pediatric otolaryngology clinic were surveyed to discover their understanding of "lip tie" in children. The survey included questions on the effects of "lip tie,"where they learned about "lip tie,"whether they thought their child had "lip tie,"whether they had a child undergo "lip tie" division, and how concerned they would be if they thought their child had "lip tie."Information on participant demographics and social media was collected. Overall, 59.8% (193) of the 323 parents surveyed had heard of "lip tie"; of those, 17.1% (33) had a child that had undergone "lip tie" surgery. Most parents (91.2%, 176) thought "lip tie" caused breastfeeding problems. Roughly one-quarter of parents (51 of 197 responses) rated their concern about "lip tie" as >8 of 10 on a Likert scale (mean, 5.7). The reported sources of "lip tie" information included lactation consultants (36.8%, 71), nurses (22.8%, 44), and pediatricians (31.6%, 61) as well as nonmedical sources, such as social media, family, and friends (68.4%, 132). Overall, 87% (282) of the 323 participants reported daily use of social media. Although many parents are concerned about "lip tie,"much of their information on this condition comes from nonmedical sources. Social media would be a valuable platform to provide accurate information on "lip tie."

Consensus recommendations on the evaluation and treatment of congenital laryngeal clefts

Congenital laryngeal cleft is a rare airway malformation, mainly manifested as choking, feeding difficulties, which affects the growth and development of children. Patients with a severe laryngeal cleft may have recurrent aspiration, leading to cyanotic spells, or even death. Advances in development of endoscopic techniques have made early diagnosis possible. Depending on the degree of cleft, management may involve a variety of approaches ranging from medical management alone to open repair. Therefore, it is important for pediatric ENT doctors to diagnose and evaluate in clinical practice. This consensus statement, developed by the Pediatric otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance on diagnosis and management of laryngeal cleft, based on symptomatology, physical examinations, and laboratory tests.

HYPERTROPHY OF THE LOWER CORNEA OF THE NOSE: COMPARISON OF SURGICAL TECHNIQUES BY ASSESSMENT OF POSTOPERATIVE COMPLICATIONS

Background. Nasal congestion is one of the most commonly reported symptoms in clinical practice. The second most common cause of nasal congestion is hypertrophy of the lower concha, a pathology of the nose that often requires surgical treatment. The purpose of this study is to determine the most effective surgical method in patients with hypertrophy of the inferior turbinate.&#x0D; Materials and methods. The study was conducted from November 2019 to January 2023 at the Pediatric Otolaryngology Department of the Emilian Cotaga Republican Children's Clinical Hospital in Chisinau, Republic of Moldova. The study population included 205 patients who underwent surgery and were under observation in the hospital. Radiofrequency ablation was the method used in 73 patients, 68 patients were treated with microdebrider turbinoplasty, and the remaining 64 patients were treated with electrocautery. After surgery, postoperative complications were assessed and quantified.&#x0D; Results. A total of 205 patients were operated on. The first group (n=73) underwent radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, including 16 patients with bleeding and 6 with postnasal drip. The second group (n=68) was treated by the microdebrider method. The complication rate was 26.5%, with 50 patients having no postoperative symptoms and 18 having symptoms. In particular, postnasal drip was more common with this method, as all 18 patients experienced postnasal drip as a complication. The third group (n=64) received electrocautery. Patients in this group had the most complications (n=24), with 16 associated with postnasal drip and eight with infections that were treated promptly with oral antibiotics. The frequency of complications with this method was 37.5%.&#x0D; Conclusion. In our study, microdebrider turbinoplasty provided the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods were successful in relieving nasal congestion and treating inferior turbinate hypertrophy. More research is needed, as there is still no consensus on the optimal surgical technique for inferior turbinate hypertrophy.

Practice Patterns in the Operative Management of Pediatric Thyroid Disease Across Surgical Specializations

BackgroundMultiple surgical specializations are involved in the operative management of pediatric thyroid disease, but current practice patterns remain unknown. The objective of this study was to examine current practice patterns in the operative management of pediatric thyroid disease, specifically comparing practices across different surgical specializations including pediatric surgery, pediatric otolaryngology, general surgery, adult otolaryngology, and endocrine-focused general surgery. MethodsChildren 0-18 years-old undergoing thyroid surgery from 2015 to 2019 were identified using the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery and Services Databases across 6 states. Surgeon specialization was determined for all included surgeons. Patient and hospital characteristics were compared across surgical specializations. Clinical outcomes including hypocalcemia/hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, and wound infection were assessed. ResultsA total of 1241 pediatric thyroidectomies performed by 363 surgeons were included. Procedures were most frequently performed by pediatric surgeons (34.9%). Only 7.2% of procedures were performed by adult general surgeons. There were statistically significant differences in patient age, sociodemographics, surgical indications, and type of procedure performed between specializations (p < 0.05). Endocrine-focused general surgeons had the highest average annual thyroid procedure volume with 78.2 cases/year, and pediatric surgeons and pediatric otolaryngologists had the lowest volumes with 0.7 and 0.6 cases/year, respectively. Overall complication rates were low. ConclusionsOperative management of pediatric thyroid disease was most frequently performed by pediatric surgery. Pediatric specializations are more likely to operate on low-income, minority children with public insurance and patients with Graves’ disease. Overall complications were low. Level of EvidenceIII.

A case of malignant transformation of recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a rare, difficult to treat benign tumor disease of the respira­tory tract with a progressive course caused by human papillomavirus and most often occurs in the larynx in the form of papillomas. They may be present at any age, but most often between the ages of 1 and 4. They can recur after treatment, undergo malignant transformation, and spread to the vocal cords, trachea, or lungs.&#x0D; Objective — to present our own observation of the malignant transformation of RRP in a young man of 23 years old, who was diagnosed and treated at the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine».&#x0D; Materials and methods. Prior to this non-systematic review, information was searched in MEDLINE/PubMed for systematic reviews, meta-analyses, and randomized controlled trials published in the past 5 years using such terms as human papillomavirus, recurrent respiratory papillomatosis, and malignant transfor­mation.&#x0D; Results and discussion. Patient H. 23 years old. From the anamnesis, it is known that the diagnosis of RRP was made at the age of 4, since then he regularly noticed the appearance of dry wheezing, shortness of breath, hoarseness, and sometimes its disappearance. Since childhood, the patient has been under the supervision of a pediatric otolaryngologist. The papillomas were localized on the vocal cords. It is known that more than 100 procedures were performed to remove papillomas using electrocoagulation under general anesthesia. For morphological verification of the diagnosis, it was decided to perform a video-assisted thoracoscopic surgery of the right lung.Pathological examination findings: «Respiratory papillomatosis with a tendency to malignant transforma­tion». The biopsy material was sent for the immunohistochemical examination. Findings: «G2 Non-keratinizing squamous cell lung carcinoma. There are signs of lymphovascular, perineural invasion, there are signs of pleural invasion, the immunohistochemical study shows that tumor cells are positive for p40, which allows to confirm the diagnosis». After that, the patient was consulted by an oncologist and an immunologist. A 2-component chemotherapy with Carboplatin and Paclitaxel was prescribed.&#x0D; Conclusions. RRP is a rare disease that can become malignant in case of untimely diagnosis and inadequate screening. Great attention should be paid to complementing of the surgical treatment with vaccination and immunotherapy.

Women Surgeons Who Contributed to the Development of Pediatric Otolaryngology in the United States.

Our goal was to identify the early pioneering women surgeons in the United States who devoted their career or the majority of their practice to the care of otolaryngologic disorders in children. We sought to share their stories, recognize their contributions to the surgical subspecialty now known as pediatric otolaryngology, and acknowledge their vision and leadership. Primary sources include books, published articles in the medical literature, newspaper articles, memorials/obituaries in both the medical literature and lay press, web logs, the John Q Adams Center for the History of Otolaryngology to include the Women in Otolaryngology, a number of otolaryngology departments, and children's hospitals nationwide. Interviews were conducted with former colleagues and senior pediatric otolaryngologists. Following review of all available information, women surgeons were included in this study if there was documentation of a clinical practice involving the otolaryngologic care of children in the United States before 1985 with demonstration of the education of others in this discipline. Six women surgeons were identified: Drs. Alice G Bryant, Margaret F. Butler, Ellen James Patterson, Emily Lois Van Loon, LaVonne Bernadene Bergstrom, and Joyce A. Schild. Six pioneering women surgeons in the United States have been identified who devoted their practice to the care of otolaryngologic disorders in children and mentored or trained other health care providers. The stories of their lives, their contributions to the care of otolaryngologic disorders in children, and their work as mentors or educators have been described. Laryngoscope, 134:40-46, 2024.

Allergic rhinitis facts from an Irish pediatric population.

Assessing the main allergens in the pediatric population from the largest urban area in the country. Clinical letters of patients referred with possible allergic rhinitis (AR) were retrospectively reviewed over the past 5 years. Five hundred and fifty-five patients were included. Males suffer twice as often with AR than females and have high titers of allergens. House dust mites (44.7%) and grass pollen (29%) were the main allergens in our area, with 48% of patients sensitized to both allergens. Half of the patients had the diagnosis of AR confirmed with positive allergen-specific tests. For the other half, the diagnosis was based on a clinical assessment performed by a pediatric otolaryngologist. Half of suspected AR children have environmental allergen sensitivity confirmed by testing, and a large number had a clinical diagnosis of AR after an otolaryngology consultation. Our findings can help clinicians to initiate AR treatment considering the most problematic allergens in the area.

Outcomes and Management of Infants Who Refer Newborn Hearing Screening.

With the implementation of Universal Newborn Hearing Screening, early diagnosis and referral has been expedited. Many patients who refer screening pass subsequent testing with otoacoustic emissions (OAE) or auditory brainstem response (ABR). The objective of our study was to identify the incidence and etiology of hearing loss in infants who refer initial testing in an urban, tertiary care pediatric otolaryngology practice. We performed a chart review of infants who were evaluated after referring newborn hearing screening from 2017 to 2021. Data collected included birth history, hospital screening results, subsequent audiology and otolaryngology visit findings, final hearing diagnoses, interventions, and outcomes. Of the 450 patients, 83.8% (n = 377) had normal hearing bilaterally after repeat testing (OAE and/or ABR). Thirty five patients were diagnosed with otitis media with effusion (OME) (7.8%) and 17 patients (3.8%) were diagnosed with sensorineural hearing loss. Twenty seven patients (6.0%) were diagnosed with obstructing cerumen/vernix, many times in addition to another diagnosis. Of the 17 patients with sensorineural hearing loss, 2 had genetic syndromes and 2 had congenital cytomegalovirus. Sensorineural hearing loss was significantly associated with the presence of a deafness syndrome (P = .004) and in-utero infections (P = .04). About 11 (2.4%) underwent myringotomy with tube placement, 5 (1.1%) were fitted with hearing aids, 2 (0.4%) were referred for hearing aids, 4 (0.9%) had both myringotomy with tube placement and hearing aids, 1 child had a soft band/Bone Anchored Hearing Aid (BAHA) (0.2%), and 1 child (0.2%) had a cochlear implant. Our incidence of sensorineural hearing loss was 3.8% (95% CI 2.0, 5.5), compared to rates of 0.44 to 68% in the published literature. Most patients had normal hearing, usually identified after only 1 repeat test. OME requiring myringotomy tube insertion was the most common pathology requiring intervention. Close observation for resolution and intervention, if warranted, is critical to prevent sequelae.

Effect of adenoid size on the post-adenoidectomy hypernasality in children with a normal palate

PurposeAdenoidectomy, either alone or with tonsillectomy, is a common surgical procedure in the field of pediatric otorhinolaryngology. Resonance function may be altered postoperatively in the form of hypernasality, which is usually transient. This study aimed to investigate the effect of adenoid size on post-adenoidectomy hypernasality in children with a normal palate.MethodsSeventy-one children with different degrees of adenoid hypertrophy were included in this prospective observational study. Endoscopic assessment of the adenoid size and preoperative and postoperative evaluation of speech (at 1 and 3 months) with auditory perceptual assessment (APA) and nasometry were performed.ResultsAPA showed preoperative hyponasality in 59.1% of children and was found to be significantly related to the adenoid size, with more hyponasality in grades 3 and 4. One month postoperatively, hypernasality was detected in 26.7% of patients and was found to be related to the preoperative adenoid size with higher hypernasality in grades 3 and 4. Three months postoperatively, all patients had gained normal nasality except one (1.4%) who was subjected to a longer follow-up period. Nasometric assessment showed significant differences at the three visits (pre, 1, and 3 months postoperatively), with a negative correlation between the grade of adenoid size and nasalance scores preoperatively and a significant positive correlation between them at 1 month postoperatively. However, no significant correlation was detected at 3 months postoperatively.ConclusionTransient hypernasality may develop in some patients after adenoidectomy, especially in children with a larger preoperative adenoid size. However, transient hypernasality generally resolves spontaneously within 3 months.

Features of innate immunity in children with hypertrophy of the palatine tonsils

Hypertrophy of pharyngeal lymphoid tissue is among the most common problems in pediatric otorhinolaryngology, in particular, hypertrophy of the palatine tonsils. This disorder is characterized by increased size of a single or both palatine tonsils combined with various clinical symptoms. The principles of treatment in children with this pathology remain debatable, since the long-term effects of bilateral tonsillotomy are still not fully understood. The aim of the study was to assess the expression levels of genes encoding the innate immunity molecules (TLR4, HBD1, HBD2, IL1β) in the mucous membranes of palatine tonsils in children with palatine tonsillitis before and after treatment.We conducted a study of 78 patients divided into three independent groups. The 1st group (comparison) included 20 somatically healthy children. The 2nd group included 28 children with grade 2 palatine tonsil hypertrophy who underwent local treatment. The 3rd group included 30 children with grade 3 hypertrophy of the palatine tonsils, who, by clinical indications, underwent bilateral tonsillotomy. Determination and evaluation of innate immunity indices was carried out both before starting the treatment, and one month later, using the real-time PCR method.In children with hypertrophy of palatine tonsils, the initial values of TLR4 gene expression and antimicrobial peptides differed from those of healthy children. A decreased expression of HBD1 and HBD2 genes, which provide immediate protection against pathogens, was revealed. The values of TLR4 gene expression differed in groups of children with varying degrees of palatine tonsillar hypertrophy. In patients with bilateral tonsillotomy, an increased expression of TLR4 gene and a decreased expression of antimicrobial peptide genes (HBD1, HBD2) were revealed, which may indicate a readiness for development of tonsillar inflammation in response to pathogens. One month after surgical treatment, the indices of innate immunity were comparable with those of healthy children thus confirming the validity of surgical treatment. In the 2nd group of patients, the TLR4 gene expression one month after conservative treatment remained reduced, the expression of β-defensin HBD1 gene increased and exceeded the indicators of the group of healthy children, the expression level of the IL-1β gene was reduced.The revealed imbalance between the TLR4, HBD1 and HBD2 expression levels confirms an important role of innate immunity mechanisms in pathogenesis of palatine tonsillitis. The assessment of innate immunity indices may be used as an additional criterion in administration of therapy for hypertrophy of palatine tonsils and evaluation of its efficiency.

Fatigue and Quality of Life in Children with Hearing Loss or Obstructive Sleep Apnea.

To investigate the fatigue levels of children with hearing loss (HL) and obstructive sleep apnea (OSA), hypothesizing that the fatigue experienced by children with HL is under-recognized. Cross-sectional survey. We identified children aged 2-18 with HL, OSA, sleep-disordered breathing (SDB), and controls from a pediatric otolaryngology clinic and sleep center. Children and/or parents completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS), Hearing Environments And Reflection on Quality of Life (HEAR-QL), and OSA-18. Responses of 50 children with HL, 79 with OSA, and 18 with SDB were compared with those of 49 recruited controls (RC) and literature controls (LC). Children with HL or OSA had higher fatigue than controls in the PedsQL MFS self-reported (HL 65.4, OSA 54.7, RC 71.8, LC 80.5, p < 0.001) and parent-reported (HL 64.6, OSA 59.3, RC 75.2, LC 89.6, p < 0.001). Children with HL had Cognitive Fatigue similar to that of children with OSA (self 60.4 vs. 49.5, p = 0.170; parent 56.0 vs. 56.7, p = 0.998), though with decreased Sleep/Rest Fatigue (self 67.8 vs. 56.3, p = 0.033; parent 69.8 vs. 57.5, p = 0.001). Children with HL or OSA had lower disease-related quality of life (QOL) than controls in the HEAR-QL and OSA-18, respectively. Stratification with disease severity revealed no differences in fatigue. Children with HL or OSA experience higher fatigue and lower QOL than controls. Similar Cognitive Fatigue in both groups suggests under-recognized fatigue in children with HL. 3 Laryngoscope, 134:443-451, 2024.

Consensus recommendations on the evaluation and treatment of laryngotracheal anomalies in infants and young children

Infants with laryngotracheal anomalies are clinically manifested as stridor or noisy breathing, choking, hoarseness, feeding difficulties, and cyanotic spells, followed by developmental and growth retardation and other health issues; in severe cases, patients may present with severe dyspnea, which is associated with high mortality. A timely diagnosis as well as appropriate strategy for laryngotracheal anomalies is still challenging for pediatric otolaryngologists. This consensus statement, evolved from expert opinion by the members of the Pediatric Otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance for otolaryngologists who manage infants and young children with laryngotracheal anomalies in evaluation and treatment based on symptomatology, physical and laboratory examinations.

Parents' Opinions About Pediatric Otolaryngology on Social Media.

Social media is a novel tool that many parents turn to when looking for a new healthcare provider. The purpose of this study is to assess how parents of children attending a pediatric otolaryngology practice engage with social media. Survey. Two pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Parents of children aged <18 years were surveyed. The survey consisted of 25 questions divided into 5 categories: demographics, social media accounts, social media use, use of social media to interact with pediatric otolaryngologists, and perception of pediatric otolaryngologists' social media accounts. Frequencies were calculated. Three hundred five parent participants were included. 247 (81.0) were female and 57 (18.97) were male. 258 (84.6%) of the participants reported use of Facebook, which was the most popular social media platform. 238 (78.0%) of participants indicated that they would want to see medical posts and 98 (32.1%) participants indicated that they would want to see personal posts on the pediatric otolaryngologist's social media page. Younger parents were statistically more likely to check social media more often (P = .001) and seek a pediatric otolaryngologist's social media before seeing them (P = .018). Use of social media by pediatric otolaryngologists may positively impact the way a small percentage of their patients' parents perceive them. Social media accounts do not appear to be a vital part of pediatric otolaryngology practice in 2022.

Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP)

BackgroundOtorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers’ autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care.MethodsAn open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children’s distress before surgery and family preparation for hospitalisation.DiscussionThe results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management.Trial registrationTrial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023.

Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric tonsillectomy.

Tonsillectomy is a common pediatric surgery, and pain is an important consideration in recovery. Due to the opioid epidemic, individual states, medical societies, and institutions have all taken steps to limit postoperative opioids, yet few studies have examined the effect of these interventions on pediatric otolaryngology practices. The primary aim of this study was to characterize opioid prescribing practices following North Carolina state opioid legislation and targeted institutional changes. This single center retrospective cohort study included 1552 pediatric tonsillectomy patient records from 2014 to 2021. The primary outcome was number of oxycodone doses per prescription. This outcome was assessed over three time periods: (1) Before 2018 North Carolina opioid legislation. (2) Following legislation, before institutional changes. (3) After institutional opioid-specific protocols. The mean (± standard deviation) number of doses per prescription in Periods 1, 2, and 3 was: 58 ± 53, range 4-493; 28 ± 36, range 3-488; and 23 ± 17, range 1-139, respectively. In the adjusted model, Periods 2 and 3 had lower doses by -41% (95% CI -49%, -32%) and -40% (95% CI -55%, -19%) compared to Period 1. After 2018 North Carolina legislation, dosage decreased by -9% (95% CI -13%, -5%) per year. Despite interventions, ongoing variability in prescription regimens remained in all periods. Legislative and institution specific opioid interventions was associated with a 40% decrease in oxycodone doses per prescription following pediatric tonsillectomy. While variability in opioid practices decreased post-interventions, it was not eliminated. 3.