Research suggests that intracapsular tonsillectomy (ICT) is less morbid than extracapsular tonsillectomy. It is underutilized, in part, because of concerns regarding its effectiveness and the possible need for repeat surgery in the future. We conducted long-term follow-up patient interviews to evaluate symptom control and incidence of revision tonsillectomy in children who had undergone ICT years earlier. A computerized collection of office notes and operative reports was queried to identify children undergoing ICT in the years 2010-2023 at an academic pediatric otolaryngology practice. We contacted these families and assessed persistence of recurrent sore throat, snoring, and upper airway obstruction and need for revision or completion tonsillectomy. 219/610 (35.9%) families of children and teenagers operated on during the study period were successfully contacted. 181/219 (82.6%) contacts elected to participate in the study. Median age at surgery was 7.6 years (range = 1.2, 21.4). Median follow-up time was 8.7 years (range = 1.9, 15.3). ICT controlled snoring/upper airway obstruction (95/104-91.3%) and severe recurrent sore throat (72/77-93.5%), with 167/181 (92.3%) respondents reporting symptom resolution. 10/181 (5.5%) respondents reported postoperative bleeding. 6/181 (3.3%) patients reported undergoing a second tonsillectomy, four of which were for upper airway obstruction. 1/181 (0.6%) child was treated for peritonsillar abscess after intracapsular tonsillectomy. Intracapsular tonsillectomy is effective both short- and long-term for the control of symptoms of upper airway obstruction and recurrent sore throat. This study provides a modest reinforcement of existing literature that suggests significant benefit from ICT as a treatment option.

Artificial intelligence in pediatric otorhinolaryngology: Assessing readability, understandability, and actionability of postoperative instructions.

Enhancing paediatric endoscopic airway training with a high-fidelity 3D-printed simulator.

Brazilian Academy of Paediatric Otorhinolaryngology Task Force - lingual frenulum disorders in childhood - evidence-based recommendations.

Early identification of hearing loss through screening, such as pure-tone audiometry, is a crucial aspect of preventive pediatric care that helps minimize negative developmental outcomes. However, non-native English-speaking (NNES) children, often immigrants or children of immigrant families, encounter systemic barriers in healthcare that limit their access to recommended screenings. This study is the first to investigate the differences in audiometric screening adherence and outcomes between NNES and native English-speaking (NES) children. Using a retrospective cohort analysis, demographic and audiometric screening data were collected from 176 patients (88 NNES and 88 NES) during well-child checks (WCC) at ages four, five, six, and eight at an academic outpatient pediatric clinic in the United States. Statistical analyses compared adherence to recommended hearing screenings between the two groups. Both NNES and NES groups had a mean age of 10.8 years (p = 0.83), shared similar insurance coverage, and had a balanced sex distribution. The non-English languages represented included Nepali (40%), Mai-Mai (11%), and Swahili (8%). Our findings showed that NNES children had lower audiometric screening rates at the four-year WCC (p = 0.04) and the six-year WCC (p = 0.04). No disparities were found in screening failure rates or referral rates to audiologists or pediatric otolaryngologists. Implementing targeted cultural competency interventions could help reduce implicit provider bias and improve hearing screening practices. The variability in adherence to hearing screening during attended WCC visits and test frequencies used underscores the necessity for more standardized and universally adopted guidelines for pediatric hearing screens at pediatric clinics.

A "Code Blue" is a term to activate an alarm for the resuscitation team for a patient who has a cardiopulmonary arrest. The role of a pediatric otolaryngologist in a tracheostomy-related code blue case is not clearly defined. We aim to describe the role of pediatric otolaryngologists in pediatric tracheostomy code blue (PTCB) cases. This retrospective study analyzed pediatric code blue cases in a tertiary care hospital from January 2019 to December 2022, before and after the implementation of a standardized PTCB that includes a pediatric otolaryngologist in the resuscitation team. Primary outcome variables included response time and survival-to-discharge of patients. The most common reason for code activation was reduced oxygen saturation. The leading cause for the otolaryngology consultation was tube blockage. Tracheostomy tube change was the most common intervention performed. The mean time of otolaryngology arrival was significantly decreased from 14.0 min pre-implementation to 4.0 min post-implementation (p < 0.001). While including all 48 PTCB events, pediatric otolaryngologist involvement was significantly associated with higher survival-to-discharge (94.4% vs. 66.7%, p = 0.028). While comparing post-PTCB protocol implementation versus pre-implementation, mortality declined from 23.8% to 3.7% with increased discharge rates, although this did not reach statistical significance (p = 0.073). Inclusion of a pediatric otolaryngologist in the resuscitation team reduces time-to-arrival of the pediatric otolaryngologist to the code blue activation site. Reduced time to pediatric otolaryngologist arrival and completion of interventions by pediatric otolaryngologist are associated with reduced mortality in PTCB events.

ImportanceSingle-entry models (SEMs) may decrease wait times as they place patients in a common queue to see the first available physician. Accordingly, SEMs are a potential strategy for managing wait times in pediatric otolaryngology. No study has assessed SEMs in pediatric otolaryngology or evaluated the perspectives of patients and caregivers.ObjectiveTo evaluate the views of patients and their caregivers on the role of SEMs in managing surgical backlogs for high-volume procedures and to capture information regarding their suggestions for optimal SEM design and implementation.DesignA qualitative study using semi-structured interviews (according to COREQ and SRQR guidelines).SettingAcademic and community pediatric otolaryngology settings across Ontario, Canada.ParticipantsEight patients, along with their caregivers, were recruited through purposive sampling. Eligibility criteria included Ontario residents who are fluent in English and were scheduled for, or already had, a routine pediatric otolaryngology procedure.Intervention or ExposuresThis study investigated the perceptions of pediatric otolaryngology patients and their caregivers on the concept of implementing SEMs for pediatric otolaryngology.Main Outcome MeasuresPediatric otolaryngology patients and their caregivers' perceptions of SEMs as a method of managing wait times in pediatric otolaryngology.ResultsAcross the patient and caregiver stakeholder group, four thematic domains were established: (1) challenges of long wait times, (2) current perceptions and hesitations of SEM, (3) enablers and patient buy-in, and (4) additional wait time reduction strategies.ConclusionsPatients and caregivers agreed that implementing an SEM would effectively decrease wait times for routine procedures in pediatric otolaryngology. They felt that it would likely promote patient equity and accessibility and improve patient healthcare experiences.RelevanceEmphasizing communication, transparency, patient autonomy, and funding will be imperative to patient and caregiver satisfaction and SEM longevity.

Hearing Trajectories in Congenital Cytomegalovirus Infection: A 4-Year Follow-Up Study.

ImportanceAdenotonsillectomy is one of the most common pediatric surgeries, and postoperative pain management remains variable. Despite recommendations favoring non-opioid regimens, opioids continue to be prescribed, highlighting the need to better characterize current prescribing practices.ObjectiveTo evaluate self-reported opioid prescribing practices among Canadian otolaryngologists following pediatric adenotonsillectomy and to identify surgeon-level factors associated with opioid-sparing preferences.DesignNational cross-sectional survey.SettingMembers of the Canadian Society of Otolaryngology-Head & Neck Surgery.ParticipantsPracticing Canadian otolaryngologists involved in the perioperative care of pediatric patients undergoing adenotonsillectomy.Intervention or ExposuresSurgeon characteristics, including subspecialty training, practice setting, and surgical volume.Main Outcome MeasuresThe primary outcome was self-reported use of opioid-sparing postoperative analgesia following pediatric adenotonsillectomy. Secondary outcomes included opioid type prescribed and reported minimum age thresholds for opioid use.ResultsOf 517 eligible otolaryngologists, 100 responded (19.3%). Overall, 73% reported preferential use of opioid-sparing analgesia. Pediatric otolaryngologists showed strong evidence of opioid-sparing practice, with a 95% posterior probability of opioid avoidance, followed by academic (87%) and high-volume surgeons (91%). Morphine was the most-commonly-prescribed opioid (82%), whereas codeine was least preferred. Reported minimum age thresholds for opioid prescribing showed a bimodal distribution.ConclusionsMost Canadian otolaryngologists surveyed reported a theoretical preference for opioid-sparing analgesia following pediatric adenotonsillectomy.RelevanceObserved practice variation, including bimodal age thresholds, highlights opportunities for opioid stewardship initiatives and quality improvement efforts. Future studies evaluating real-world prescribing behavior are needed to inform standardized postoperative pain management strategies.

Synchronous airway lesions in children with obstructive sleep apnea.

To identify the prevalence and polysomnography (PSG) features of obstructive sleep apnea (OSA) in subcategories of children with obesity. Children with obstructive sleep-disordered breathing evaluated in pediatric otolaryngology clinic and referred for PSG between January 2023 and December 2023 were included. Children with a history of tonsillectomy and/or adenoidectomy were excluded. Collected data included demographics, comorbidities, PSG parameters, and BMI categories including underweight, healthy weight, overweight, and obesity (Class I, II, and III). The prevalence of OSA and PSG parameters were compared using the χ2 test, logistic regression, multivariate analysis of variance, and linear regression models. p < 0.05 was considered significant. Out of 604 children (342 male, 262 female, age range: 2-18), 488 (81%) had OSA. Most children were healthy weight (46%) or had obesity (38%). Prevalence of OSA was significantly different across BMI categories (p < 0.001), with highest odds of OSA in children with Class III Obesity (OR = 5.01, 95% CI [1.77, 21.04], p = 0.008). Compared to patients with healthy weight and no OSA, patients with Class II (OR = 2.67, 95% CI [1.16, 6.16], p = 0.02) and Class III Obesity (OR = 8.31, 95% CI [2.40, 28.81], p < 0.001) were more likely to have severe OSA (apnea-hypopnea index > 10). PSG parameters including obstructive apnea-hypopnea index, minimum SpO2, and mean CO2 differed among BMI categories (p < 0.001, p < 0.001, p = 0.003, respectively). The prevalence of OSA varies among weight groups. The severity of obesity is associated with increased odds of OSA and OSA severity. Obesity has a significant effect on minimum SpO2 saturation and mean CO2 levels. The utility of these findings in decision-making for PSG referral and surgical planning merits further investigation.

Congenital pediatric hearing loss can be linked to a genetic cause in about 60% of cases. Genetic testing (GT) for this condition can be complicated by the availability of blood draw services and the patient's amenability to this procedure. The primary objective of this study was to assess whether GT sample collection method influences the percentage of completed tests in pediatric patients with congenital, non-syndromic sensorineural hearing loss. This was a retrospective chart review of patients at a tertiary pediatric otolaryngology clinic who had GT ordered through blood draw from May 2022-April 2023 and patients who had GT ordered through buccal swab from June 2023-May 2024. Patients were offered a testing method based on availability at our institution during the time period studied. The primary endpoint was completion of GT. Additional data collected included demographic patient characteristics, average turnaround time for GT completion, and GT results. Each cohort had a GT completion percentage of approximately 93%. Almost twice as many patients had GT ordered via buccal swab (148/227) than blood sample (79/227: p < 0.05). There was no difference in GT results between cohorts. The observed similarities in GT completion of the cohorts in this study suggests that barriers to GT completion may not be the sample type alone, but rather a more complex set of factors that may affect family decision-making.

First branchial cleft anomalies (FBCAs) are the result of misguided embryologic development of the external auditory canal, resulting in a partial duplication of the structure. A recent consensus statement by the International Pediatric Otolaryngology Group (IPOG) reclassified lesions based on anatomic location rather than the classic germ cell layer classification. Type I FBCAs are external and superficial to the parotid fascia, and type II FBCAs are juxtaposed to, or involving, the parotid gland. The consensus statement supports extensive resection to prevent recurrence. We hypothesized that type II FBCAs may be multicentric. The objective of this study was to search for histological evidence of this characteristic which, if present, supports the recommendation of the IPOG consensus for extended surgical resection. Archived histopathologic resections of type II FBCAs were evaluated for satellite lesions or filamentous tracts off the main lesion indicating respiratory epithelium and extension of pathology beyond the typical resection. Pathologic analysis identified 22 archived tissue specimens with adequate histology to evaluate for the presence of FBCA tissue in the parotid gland. 6/22 (27.3%) demonstrated FBCA tissue external to the main lesion or multiple epithelial rests of similar tissue outside the primary lesion consistent with pathology beyond the primary cyst itself. The results support the notion that type 2 FBCAs are extensive and can be multicentric. These findings also support the clinical experience and recommendation of the IPOG consensus statement for a more extensive dissection and removal of surrounding tissue in the effort to best prevent recurrence.

ImportanceSingle-entry models (SEMs) can decrease wait times by placing patients in a common queue to see the first available physician. SEMs may be suitable to manage wait times in pediatric otolaryngology; however, understanding is lacking on stakeholder perceptions, and no previous studies have evaluated SEMs specifically for pediatric otolaryngology patients.ObjectiveTo evaluate the views of referring physicians and otolaryngologists on the role of SEMs in managing surgical backlogs for high-volume procedures, and to investigate their recommendations for optimal SEM design and implementation.DesignA qualitative study using semi-structured interviews (according to COREQ and SRQR guidelines).SettingPrimary care and referral settings across Ontario, Canada.ParticipantsTwelve referring physicians who refer to pediatric otolaryngologists and 11 otolaryngologists were recruited through purposive sampling. Eligibility criteria included physicians that work in Ontario.Intervention or ExposuresThis study investigated the perceptions of referring physicians and otolaryngologists on the concept of implementing SEMs for pediatric otolaryngology.Main Outcome MeasuresReferring physicians’ and otolaryngologists’ perceptions of SEMs as a method of managing wait times in pediatric otolaryngology.ResultsFour thematic domains, each with subdomains, were identified: (1) perceived value of SEMs; (2) operational design and digital integration; (3) evidence and resourcing; and (4) adoption, scope, and system pressures.ConclusionsSEMs are viewed as a viable option to address the surgical backlog in pediatric otolaryngology, from the perspective of referring physicians and otolaryngologists.RelevanceImplementation of an SEM should consider ease of use, adequate support resources, strong and regular communication with all stakeholders, long-term funding, and transparency.

ImportanceThe role of artificial intelligence (AI) within medicine has increased exponentially over the last decade. However, adoption across medical specialties remains variable, influenced by institutional support, availability of tools, and concerns about accuracy, privacy, and legal liability. Addressing these barriers is necessary to achieving the full clinical capacity of AI.ObjectivesThis study aimed to explore current AI usage patterns among pediatric otolaryngologists and highlight perceived benefits and barriers to adoption.DesignCross-sectional survey design.SettingAll aspects of the present study were conducted remotely, with the survey link being distributed within a private group chat.ParticipantsParticipants were recruited via an international pediatric otolaryngology WhatsApp group chat. Admission is through invitation only.Intervention or ExposuresThe survey sought to characterize a variety of themes regarding AI, including utilization patterns, attitudes, motivational factors and barriers to adoption, and extent of institutional support.Main Outcome MeasuresResponses were evaluated using chi-squared tests and descriptive statistics.ResultsSurvey responses were analyzed from 50 individuals, reflecting a response rate of 15.2%. More than half of survey respondents (60.9%, n = 28/46) use AI in practice, relying on tools like ChatGPT, iScribe, and Gemini to improve workplace efficiency (71.4%, n = 20/28) and address administrative burdens (64.2%, n = 18/28). Despite current adoption of AI, participants identified a lack of institutional guidelines (66.7%, n = 30/45) and support (54.3%, n = 25/47) as major barriers to widespread integration across the subspecialty. No statistically-significant association was found between age and likelihood of AI adoption (P = .095) nor was between geographic region and likelihood of AI adoption (P = .505).ConclusionsPediatric otolaryngologists are interested in and enthusiastic about AI tools. This study highlights prominent institutional and educational gaps, limiting widespread integration.RelevanceThe findings guide future efforts to support AI adoption in pediatric otolaryngology through tailored training, policy, and institutional support.

With the advancement of minimally invasive surgery and anesthesiology, ambulatory surgery has become a pivotal model for enhancing healthcare efficiency and optimizing resource allocation. This guideline seeks to establish a systematic, operable, and standardized framework for implementing ambulatory surgery in pediatric otorhinolaryngology and head and neck surgery across healthcare institutions in China. Formulated based on evidence-based medicine principles and integrating the latest literature and multidisciplinary expert consensus, it provides detailed recommendations pertaining to organizational structure, hardware configuration, information system development, multidisciplinary team building, patient and procedure selection criteria, perioperative process management, and quality control. The primary objectives are to ensure surgical safety and quality, and to promote the standardized and sustainable development of ambulatory surgery within this pediatric subspecialty.

Artificial intelligence classification of pediatric middle ear effusion using consumer-grade otoscopes.

To investigate the association between specific types of water exposure and the incidence of tympanostomy tube otorrhea (TTO) in pediatric patients following tympanostomy tube placement (TTP). Cross-sectional survey. Tertiary pediatric otolaryngology practice. Caregivers of children who had undergone TTP at least 6 months prior were surveyed regarding their child's water exposure habits and episodes of otorrhea since surgery. Survey data were corroborated with medical chart review. Multivariable logistic regression was used to evaluate associations between exposure to "dirty" water (ocean, lake, or untreated pool water) versus "clean" water (chlorinated or salt-treated pool water) and the risk of recurrent TTO. Caregivers of 137 eligible patients completed the survey, and 68 (49.6%) reported recurrent TTO. Adjusting for age, smoke exposure, and other potential confounders, patients exposed to dirty water had 3.18 times higher odds of developing recurrent TTO compared to patients not exposed to dirty water (95% confidence interval [CI] 1.33-7.62, P = .009), while no significant association was observed between clean water exposure and TTO. Similar findings were observed when comparing patients with 0 versus ≥1 episode of TTO and <2 versus ≥2 episodes of TTO. Exposure to untreated or natural water sources may be associated with an increased likelihood of recurrent otorrhea following TTP, while swimming in treated pools appears safe. These findings support individualized water precaution counseling rather than universal restrictions, and further research is warranted to clarify underlying biological mechanisms and modifiable risk factors.

Recurrent paediatric epistaxis is a common condition that is often distressing for children and their caregivers. Although treatments such as Naseptin or silver nitrate cautery are widely used, a recurrence of epistaxis after an initial symptom-free period is frequent. Yet, there is a lack of robust, long-term studies comparing treatment modalities and sustained success rates. This study aims to address that gap by evaluating long-term outcomes in a previously established paediatric cohort. We performed a follow-up analysis of a 2020 cohort at a tertiary paediatric otolaryngology centre. Patients were contacted by letter and SMS to schedule a telephone appointment. Anonymised data, including age, sex, healthcare attendances, interventions and epistaxis frequency, were collected using a standardised proforma. Statistical analysis was performed using R Statistical Software (v4.5.1; R Core Team 2025). Two hundred and ten patients were scheduled for a telephone appointment and 145 (69.0%) were successfully contacted. Mean age was 13.08 years, with 125 males and 85 females. Median follow-up was 48 months. Among the 75 patients (51.7%) who reported persistent epistaxis, 65.3% (n = 49) had not sought any further medical care. Persistent epistaxis was reported in 44.1% (n = 30) of patients treated with Naseptin alone, compared to 57.6% (n = 30) of those who also received silver nitrate cautery. There was no significant difference in the rate of recurrence between Naseptin and added cautery. Persistent epistaxis was common, with no significant difference between treatment with Naseptin alone and those who also received silver nitrate cautery. Patient/parent education is essential to explain the aetiology of recurrent paediatric epistaxis, its natural history and appropriate first aid.

Summary Congenital laryngeal anomalies present a heterogeneous group of conditions, most commonly manifesting as inspiratory or biphasic stridor and swallowing difficulties in neonates and infants. Their true prevalence is likely underestimated, particularly in milder forms. The aim of this article is to provide an overview of the most common congenital laryngeal anomalies and current diagnostic and therapeutic approaches in paediatric otolaryngology. The review summarizes literature-based knowledge on key congenital laryngeal pathologies, including laryngomalacia, bilateral vocal fold paresis, subglottic stenosis, subglottic haemangioma, laryngeal webs, and clefts. Both conservative and surgical strategies are presented, including pharmacological treatment (e. g., propranolol for subglottic haemangioma), as well as endoscopic and open surgical interventions. The article also highlights frequent associations with other congenital malformations and syndromes, underscoring the need for multidisciplinary management. Early diagnosis and timely intervention are essential to prevent complications such as respiratory failure or aspiration. A comprehensive and individualized approach is crucial for the effective management of congenital laryngeal anomalies in the paediatric population. Key words laryngomalacia – congenital subglottic stenosis – vocal fold paresis – subglottic haemangioma – paediatric otolaryngology