Thresholds In Children Research Articles

The effect of bolus size on masticatory parameters at swallowing threshold in children using a hard, solid, artificial test food.

The effect of different bolus sizes on food breakdown has been studied in adults, but not in children. The objective of this study was to study median particle size (MPS) and other parameters of masticatory function at swallowing threshold (ST) in 8–10‐year‐old‐children with two different bolus sizes. A randomized crossover trial was undertaken in 89 eight to ten‐year‐old children. The study was performed with informed consent and ethical approval. The artificial test food used was made of a condensation silicone (Optosil Comfort) following a standardized protocol. Two bolus sizes (three or four quarters of a 20‐mm diameter, 5‐mm thick tablet) were randomized to avoid an order effect and tested in different sessions. Variables were: MPS (X 50) at ST, number of cycles until ST, sequence and cycle duration as well as cycles/g. Comparisons were performed with paired t and Wilcoxon tests, regressions and correlations were run. Cutoff for statistical significance was .05. Statistically significant differences were found for all variables; X 50 (2.5 ± 0.8 vs. 2.8 ± 0.7 mm, p < .001), cycles until ST (38 vs. 40, p = .022), sequence (25 vs. 27 s, p = .003), and cycle duration (650 vs. 683 ms, p = .015) and cycles/g (27 vs. 21 cycles/g, p < .001), three or four quarters, respectively. In conclusion, in children, as in adults, chewing on a bigger bolus size leads to a larger MPS (X 50) at ST. When chewing on a larger bolus the number of cycles increases, but not enough to swallow the same particle size since the number of cycles/g is less with a bigger bolus size.

Children track probabilistic distributions of facial cues across individuals.

Children face a difficult task in learning how to reason about other people's emotions. How intensely facial configurations are displayed can vary not only according to what and how much emotion people are experiencing, but also across individuals based on differences in personality, gender, and culture. To navigate these sources of variability, children may use statistical information about other's facial cues to make interpretations about perceived emotions in others. We examined this possibility by testing children's ability to adjust to differences in the intensity of facial cues across different individuals. In the present study, children (6- to 10-year-olds) categorized the information communicated by facial configurations of emotion varying continuously from "calm" to "upset," with differences in the intensity of each actor's facial movements. We found that children's threshold for categorizing a facial configuration as "upset" shifted depending on the statistical information encountered about each of the different individuals. These results suggest that children are able to track individual differences in facial behavior and use these differences to flexibly update their interpretations of facial cues associated with emotion. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Abstract 11584: Prevalence of Isolated Nocturnal Hypertension in Adolescents with Use of Adult Hypertension Criteria

Introduction: The 2017 Blood Pressure Guidelines aligned clinic hypertensive thresholds for children ≥13 years of age with adult BP criteria, increasing the predictive value for adverse cardiovascular outcomes. However, thresholds for adolescents have not been updated for ambulatory blood pressure monitoring (ABPM), a confirmatory test in the diagnosis of hypertension. We examined the impact of using adult ABPM criteria in adolescents, including the contribution of daytime (DH) and isolated nocturnal hypertension (INH), and associations with left ventricular hypertrophy (LVH). Methods: This retrospective study included all ABPMs obtained in 13–16-year-olds at Boston Children’s Hospital (2015-2020). ABPMs were interpreted using both pediatric and adult thresholds. For studies newly classified as hypertensive using adult criteria, available echocardiograms were reviewed for LVH. Independent T-test and Chi-square were used to compare age, gender, BMI, left ventricular mass (LVM), indexed LVM &gt;95 th percentile, and LVM z-score &gt;2 in individuals with INH vs. DH. Results: 347 ABPMs were included in this study; 92 studies (87 unique patients) were reclassified as hypertensive using adult thresholds; 96.7% of these studies were obtained in males. Of the 92 studies, 31 (33.7%) studies had INH and 58 (63.0%) had DH (54/58 had day &amp; night hypertension). There was no difference in age or BMI between INH and DH groups; more studies in the INH group were from females (p=0.05). We reviewed 14 and 42 echocardiograms for the INH and DH groups, respectively. There were no differences in indexed LVM or LVM z-score between the 2 groups. Though a small sample size, we found that 3/14 (21.4%) and 12/42 (28.6%) in the INH and DH groups respectively had an indexed LVM &gt;95 th percentile; there was no significant difference between groups (p=0.601). An LV mass z-score &gt; 2 was not seen in the INH group and was in 4/42 (9.5%) of the DH group. Conclusions: With use of adult ABPM criteria, INH significantly contributed to ABPMs reclassified as hypertensive. Prevalence of LVH was similar in INH and DH groups. Further study is needed to investigate the appropriateness of using adult thresholds for nocturnal hypertension in adolescents, whose sleep patterns may differ from adult counterparts.

Vestibular function of pediatric patients with sudden sensorineural hearing loss: based on vertigo symptom and vestibular function testing.

This study aimed to evaluate the relationship between vestibular and auditory functions in pediatric patients with sudden sensorineural hearing loss (SSHL). A total of 30 pediatric patients experiencing unilateral SSHL between 5.9 and 13.0years of age were enrolled in this study. Pure tone audiometry was evaluated prior to treatment initiation and again after one month of treatment. Prior to treatment initiation, vertigo symptoms were noted; then several vestibular function tests were conducted including caloric testing, ocular vestibular evoked myogenic potentials (o-VEMPs) and cervical vestibular evoked myogenic potentials (c-VEMPs). Associations between pre and post-treatment vestibular function and hearing threshold levels were analyzed. Initial hearing thresholds of children with vertigo were higher than thresholds of children without vertigo (92dB vs 79dB, P = 0.033), while initial hearing thresholds of children with abnormal caloric test findings were higher than thresholds of children with normal caloric test findings (93dB vs 67dB, P = 0.014). Cutoff values of hearing thresholds for those with vertigo symptoms and abnormal vestibular test results were 86.000- and 89.583-dB HL, respectively. Regarding prognosis, children with vertigo exhibited lower recovery rates than children without vertigo (33% vs 75%, P = 0.025); recovery rates of children with abnormal caloric test results were lower than the overall recovery rate (25% vs 73%, respectively, P = 0.039). Assessments of vertigo symptoms and vestibular function are useful tools in predicting pediatric SSHL patient disease severity and prognosis.

Use of an autoinflation device does not lead to a clinically meaningful change in hearing thresholds in children with otitis media with effusion.

The objective of this study was to establish whether autoinflation was an effective intervention in a paediatric audiology service. This was a pragmatic retrospective study with historical controls using a paired availability design. The study took place at a single paediatric audiology service in England. All children seen in the clinic over a two-year period who were aged between 3 and 11 years and who had a type B tympanogram in at least one ear were included. The Otovent autoinflation device was available as a treatment option over the second year (Cohort B) but not the first (Cohort A). There were 976 children included in the study: Cohort A comprised 513 children, Cohort B comprised 463 children. The aims were to evaluate whether there was improvement in hearing thresholds following introduction of an autoinflation device, and whether there was a reduction in further audiology follow-ups, and in referrals to an ear, nose and throat specialist for consideration of ventilation tube insertion. There was a statistically significant improvement in hearing thresholds in Cohort B compared to Cohort A, however the improvements were clinically minimal with small effect sizes. There was no significant difference in improvement of tympanometry results between the two cohorts. Significantly more children in Cohort B (autoinflation group) were referred to an ear, nose and throat specialist after their second appointment compared to Cohort A. It was feasible to introduce autoinflation into the care pathway, however there was no evidence of clinically meaningful improved outcomes for patients.

Diagnosis of hypertension: Ambulatory pediatric American Heart Association/European Society of Hypertension versus blood pressure load thresholds.

The agreement between the traditionally‐used ambulatory blood pressure (ABP)‐load thresholds in children and recently‐recommended pediatric American Heart Association (AHA)/European Society of Hypertension (ESH) ABP thresholds for diagnosing ambulatory hypertension (AH), white coat hypertension (WCH), and masked hypertension (MH) has not been evaluated. In this cross‐sectional study on 450 outpatient participants, the authors evaluated the agreement between previously used ABP‐load 25%, 30%, 40%, 50% thresholds and the AHA/ESH thresholds for diagnosing AH, WCH, and MH. The American Academy of Pediatrics thresholds were used to diagnose office hypertension. The AHA threshold diagnosed ambulatory normotension/hypertension closest to ABP load 50% in 88% (95% CI 0.79, 0.96) participants (k 0.67, 95% CI 0.59, 0.75) and the ESH threshold diagnosed ambulatory normotension/hypertension closest to ABP load 40% in 86% (95% CI 0.77, 0.94) participants (k 0.66, 95% CI 0.59, 0.74). In contrast, the AHA/ESH thresholds had a relatively weaker agreement with ABP load 25%/30%. Therefore, the diagnosis of AH was closest between the AHA threshold and ABP load 50% (difference 3%, 95% CI ‐2.6%, 8.6%, p = .29) and between the ESH threshold and ABP load 40% (difference 4%, 95% CI ‐2.1%, 10.1%, p = .19) than between the AHA/ESH and ABP load 25%/30% thresholds. A similar agreement pattern persisted between the AHA/ESH and various ABP load thresholds for diagnosing WCH and MH. The AHA and ESH thresholds diagnosed AH, WCH, and MH closest to ABP load 40%/50% than ABP load 25%/30%. Future outcome‐based studies are needed to guide the optimal use of these ABP thresholds in clinical practice.

Los potenciales evocados auditivos de estado estable a múltiples frecuencias y su valor en la evaluación objetiva de la audición

Uno de los principales objetivos en la realización de un examen electroaudiométrico es la obtención de una evaluación frecuencia específico de los umbrales de audibilidad. En las últimas décadas han sido propuestas múltiples técnicas basadas en el registro de los Potenciales Evocados Auditivos (PEA). Los mismos no son afectados por la sedación ni el sueño y pueden ser detectados a intensidades de estimulación muy cercanas al umbral de audibilidad. Las ventajas antes mencionadas lo han convertido en una útil herramienta para la evaluación objetiva de la audición. No obstante, esta técnica tiene ciertas limitaciones desde el punto de vista electroaudiométrico, debido principalmente a la falta de frecuencia especificada de dicha respuesta.&#x0D; Los Potenciales Evocados Auditivos de Estado Estable (PEAee) por estímulos tonales aislados y a frecuencias de estimulación entre 75 y 110 Hz han sido propuestos como una alternativa valida para la realización de una audiometría frecuencia especifica. Este tipo de respuesta representa la descarga sincrónica de las neuronas del tronco cerebral, las cuales siguen la frecuencia de modulación del estimulo que les da origen.&#x0D; Múltiples han sido los autores que en los últimos años y usando este tipo de respuesta han obtenido estimaciones confiables del umbral de audibilidad tonal, tanto en niños y adultos sanos como en sujetos hipoacúsicos. Esta técnica tiene múltiples ventajas sobre los PEA transitorios en la determinación de umbrales específicos en frecuencia: 1) Dado la periodicidad de la respuesta esta puede ser representada en el dominio de la frecuencia, minimizando por ende la complejidad de su medición, 2) El estimulo acústico empleado es mas especifico en frecuencia, 3) Debido a las propiedades de rectificación de la coclea la respuesta provocada por un tono modulado en amplitud es representada como un pico espectral a la frecuencia de modulación, 4) Estos picos espectrales pueden ser detectados usando diferentes estadígrafos en el dominio de la frecuencia.&#x0D; A pesar de las ventajas anteriormente descritas, la obtención de un audiograma completo mediante el uso de los PEAee provocados por estímulos tonales aislados puede requerir un gran consumo de tiempo. Más recientemente ha sido propuesta una variante optimizada de los PEAee entre 75 y 110 Hz con el empleo simultaneo de múltiples tonos modulados en amplitud. Dado el hecho que cada tono portador es modulado con una frecuencia diferente, múltiples tonos pueden ser entonces sumados, formando un tono complejo compuesto por múltiples tonos modulados en amplitud. Usando entonces como estimulo, una mezcla compuesta por tonos de 500, 1000, 2000 y 4000 Hz podemos activar y evaluar simultáneamente estas cuatro regiones de frecuencia de la cóclea. Por otra parte, estos estímulos complejos pueden ser presentados binauralmente, evaluando ambos oídos simultáneamente.&#x0D; Los PEAee provocados por múltiples tonos modulados en amplitud han sido empleados con alentadores resultados en la determinación objetiva de los umbrales de audibilidad en niños y adultos, pacientes hipoacúsicos y en la detección temprana de defectos auditivos. El presente artículo resume algunos conceptos básicos, así como sus aplicaciones clínicas.

Quantitative Sensory Testing in Children with Sickle Cell Disease

▪Background: Quantitative Sensory Testing (QST) is used in a variety of pain disorders such as arthritis and neuropathic pain syndromes, to characterize pain and predict prognosis and response to specific therapies. QST evaluates sensory function using a set of psychophysical procedures to measure subjective somatosensory responses to various physical stimuli. In Sickle Cell Disease (SCD) the painful vasoocclusive crisis is the most difficult management challenge and factors underlying the transition from acute to chronic pain and the wide interpatient variability in the pain experience are poorly understood. Optimal management for this complex pain syndrome remains unclear despite over three decades of basic and clinical research in the field.In this study, we aimed to duplicate results in the literature documenting altered QST thresholds in SCD and test the reproducibility of results over time to validate QST as a therapeutic endpoint for use in clinical trials evaluating novel preventative pain therapies.Objectives: Primary objectives were to test thermal thresholds in children with SCD versus African American controls and determine consistency over 6 months. Exploratory objectives were to correlate QST with clinical factors and select biomarkers and assess pressure pain thresholds (PPTs).Methods: Fifty-seven SCD and 60 control subjects aged 8-20 years underwent heat (wdt) and cold (cdt) detection and pain (hpt and cpt) threshold testing using a Medoc TSAII. A thermal composite score (TCS) was constructed by averaging the wdt, cdt, hpt, and cpt threshold responses from the testing instrument's starting temperature of 32°C. All participants were tested at baseline and 3 months; SCD subjects were additionally tested at 6 months and blood collected for future biomarker assessment. PPTs were performed using an SBMedic algometer. A single individual performed all QST. Descriptive statistics were computed and covariate-adjusted differences in thresholds within and between groups evaluated over time by mixed effects regression models with random intercepts and linear contrast tests. The intraclass correlation coefficient (ICC) from these models was used to assess within-subject consistency and Spearman's correlation was used to evaluate associations between thresholds and biomarkers. In addition, as a nested pseudo-intervention study, we analyzed a subset of “new” hydroxyurea (HU) users consisting of SCD subjects in whom HU was initiated within a few weeks prior to, or shortly after baseline testing. Significance was set at 0.05.Results: There were no significant differences in mean thermal or PPTs between SCD and control participants at baseline (Table 1) or month 3. QST measurements were consistent in SCD and control subjects for cpt, wdt, hpt and TCS (each ICC>0.55), but not necessarily for cdt (ICC = 0.37). Although generally internally consistent, there was some variability in mean thermal thresholds among SCD subjects over time, but the only significant difference between the 3 and 6 month means was for hpt (+0.67°C; 95% CI 1.15, 0.19). There was no association between mean thermal thresholds and chronic transfusion therapy. The group in whom HU was initiated shortly after baseline testing (n=6) demonstrated significant reductions in all thermal sensitivity and pain threshold measurements following HU initiation (Table 2).Conclusions: In contrast to Brandow's study (Brandow, American Journal Hematology, 2012), which documented thermal hypersensitivity in SCD, we have not demonstrated significant differences in thermal thresholds between SCD and control subjects. This could be due, in part, to differences in body sites used for testing. Results between second and third test sessions were highly consistent, indicating that reliability may improve once subjects have experience with QST. Subjects on whom HU was initiated shortly after baseline testing (new HU users) exhibited progressive and significant decreases in both cold and heat sensitivity from baseline to 6 months, suggesting that thermal testing is sensitive to effective therapy to prevent vasoocclusive pain. These findings are of critical importance to inform the planning of future SCD related clinical trials using QST as an endpoint in the evaluation of preventative pain therapies.Supported by National Institute of General Medical Sciences National Institutes of Health Award P20GM109021 and U54GM104941 [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Pain pressure thresholds in children and adolescents with idiopathic chest pain.

The pathophysiology of idiopathic chest pain remains unclear. Studies evaluating pain pressure thresholds in other idiopathic pain syndromes have revealed pain sensitivity in both affected and unaffected areas. The present study aimed to evaluate thoracic and extrathoracic pain pressure thresholds and their correlation with patients' pain characteristics and quality of life. This cross-sectional, single-blind, controlled study included children and adolescents with idiopathic chest pain. The patients' pain characteristics, including their symptom duration, type of pain, mean pain intensity, mean duration of painful periods, pain frequency, and Pediatric Quality of Life Inventory Child Version scores, were assessed by a paediatric cardiologist via a face-to-face interview. Pain pressure thresholds were measured using an algometer by an algologist who was blinded to the study groups. There was a statistically significant difference in pain pressure thresholds in the trapezius; supraspinatus; thoracic 2, 4, and 10 areas; deltoid; and tibia between the patient and healthy control groups. In the patient group, while there was a positive correlation between the mean all-region pain pressure thresholds and age (p = 0.047, r = 0.235), there was no correlation between pain pressure thresholds and symptom duration, pain intensity, and quality of life. The present study is the first step towards investigating probable pain sensitivity mechanisms in children and adolescents with idiopathic chest pain. We noted lower thoracic and extrathoracic pain pressure thresholds in children and adolescents with idiopathic chest pain than in healthy controls.

Psychophysical Tracking Method to Assess Taste Detection Thresholds in Children, Adolescents, and Adults: The Taste Detection Threshold (TDT) Test

This paper describes a two-alternative, forced-choice, staircase, tracking procedure, called the Taste Detection Threshold (TDT) test, that provides a reliable measure of sweet, salty, and umami taste detection thresholds from childhood to adulthood. Advantages of the method include procedures that are identical for children and adults, thus allowing the determination of age-related and individual differences in taste perception, if any, and tasks that can be completed in a relatively short time frame, do not rely on continuous attention or require memorization, control for subjective response biases, and minimize the impact of language development. After a 1 hour fast, participants are presented with pairs of solutions; in each pair, one solution is water, and the other solution contains varying concentrations of the tastant. Using a whole-mouth tasting method, participants taste each solution (without swallowing and with rinsing between tastings) and then point to the solution with a taste or that tastes different from water. The concentration of the stimulus in the subsequent pair increases after a single incorrect response and decreases after two consecutive correct responses. A reversal occurs when the concentration sequence changes direction. The task is deemed completed after the occurrence of four reversals, provided there are a maximum of two dilution steps between two successive reversals, and the series of reversals do not form an ascending pattern. These additional criteria ensure greater reliability in outcomes. The TDT is then calculated as the geometric mean of the concentrations of the four reversals. This method has real-world relevance as it provides information on a dimension of taste perception that is independent of hedonics, and that can change with aging and certain disease states, making it a valuable psychophysical test.

Psychophysical Tracking Method to Assess Taste Detection Thresholds in Children, Adolescents, and Adults: The Taste Detection Threshold (TDT) Test

This paper describes a two-alternative, forced-choice, staircase, tracking procedure, called the Taste Detection Threshold (TDT) test, that provides a reliable measure of sweet, salty, and umami taste detection thresholds from childhood to adulthood. Advantages of the method include procedures that are identical for children and adults, thus allowing the determination of age-related and individual differences in taste perception, if any, and tasks that can be completed in a relatively short time frame, do not rely on continuous attention or require memorization, control for subjective response biases, and minimize the impact of language development. After a 1 hour fast, participants are presented with pairs of solutions; in each pair, one solution is water, and the other solution contains varying concentrations of the tastant. Using a whole-mouth tasting method, participants taste each solution (without swallowing and with rinsing between tastings) and then point to the solution with a taste or that tastes different from water. The concentration of the stimulus in the subsequent pair increases after a single incorrect response and decreases after two consecutive correct responses. A reversal occurs when the concentration sequence changes direction. The task is deemed completed after the occurrence of four reversals, provided there are a maximum of two dilution steps between two successive reversals, and the series of reversals do not form an ascending pattern. These additional criteria ensure greater reliability in outcomes. The TDT is then calculated as the geometric mean of the concentrations of the four reversals. This method has real-world relevance as it provides information on a dimension of taste perception that is independent of hedonics, and that can change with aging and certain disease states, making it a valuable psychophysical test.

Auditory Steady-State Responses to Narrow-Band Chirps in Predicting Aided Behavioral Thresholds

Purpose: A review of the existing literature shows that auditory steady-state responses (ASSR) to narrow-band (NB) chirps analyzed using q sample averaging is more reliable and accurate than ASSR for modulated tones in predicting behavioral thresholds. Studies in this direction have been carried out to predict hearing sensitivity. However, there is a dearth of studies investigating ASSR for NB chirps in persons using hearing aids. The present study evaluated if ASSR for NB chirps analyzed using q sample averaging could be used to predict aided behavioral thresholds during the hearing aid selection. Specifically, the study investigated the agreement and differences between behavioral thresholds predicted from aided ASSR with aided behavioral thresholds. Materials and Methods: Retrospective analysis of clinical records of 24 ears with hearing loss were carried out. The age of the children ranged from 3 to 5 years. Aided behavioral thresholds and aided ASSR for NB chirps were recorded at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. Results: Wilcoxon signed-rank test revealed no significant difference between aided thresholds predicted through aided ASSR and measured behavioral thresholds for all four frequencies. The Bland–Altman analysis also showed that the results of the two tests are comparable for all four frequencies. Conclusions: Aided ASSR can predict aided behavioral thresholds in children who fail to provide voluntary responses to behavioral tests, but the results need to be crosschecked using other measures. ASSR can thus be added to the protocol used for hearing aid fitting and validation in young children.

Adenoid hypertrophy- Prevalence of otitis media with effusion and effect on hearing thresholds in children

Adenoid hypertrophy- Prevalence of otitis media with effusion and effect on hearing thresholds in children

Auditory brainstem response testing using intranasal dexmedetomidine sedation in children: a pilot study

Objective Auditory brainstem response (ABR) is used to determine hearing thresholds in children who cannot undergo behavioural testing. Children must remain still during testing, with general anaesthesia (GA) in theatre required for those who cannot. We developed a protocol whereby an ABR was undertaken in a ward environment using only intranasal dexmedetomidine for sedation. Design Prospective data were collected including the time of sedation onset, ABR duration and arrival to discharge time was recorded and feedback was requested using a questionnaire. Study sample Twenty-nine consecutive patients routinely undergoing an ABR. Results From this pilot study, we demonstrated that intranasal dexmedetomidine could be used successfully to administer safe sedation to all twenty-nine children undergoing an ABR in a ward environment as opposed to theatre. Conclusions This allowed for faster time to discharge compared to GA, produced what was felt to be a better quality ABR trace, better utilization of a theatre slot, negated the need for GA in a child and created a less stressful experience for both parent and child according to information from feedback questionnaires.

Critical Care Thresholds in Children with Bronchiolitis

Reduction in mortality from bronchiolitis in developed health is principally achieved from the availability of critical care. Different health care providers and countries demonstrate considerable variance in admission rates, but globally the use and cost of this resource are increasing. The reasons of this are multifold and include organizational, cultural, and clinical aspects. The organization of care has evolved differently in different health care settings at the threshold of critical need, with local priorities and resources determining the location of care (ward or critical care). Critical care areas adopting high-flow oxygen therapy (HFOT) (a ward-based therapy in some institutions) have seen significant increase in their occupancy, without change in rates of mechanical ventilation. Culturally, some countries appear to have a lower threshold for intubation and mechanical ventilation: United States (18%), Finland (4%), and even in countries with high rates of critical care admission (27% in Australia and New Zealand), intubation rates can decline with time (reducing from 27% to 11%). Baseline clinical characteristics of children admitted to critical care are remarkably similar, children are young (c30-60 days) and often born prematurely (21-46%). Clinical thresholds for admission as predefined by critical care units in online guidance focus on presence of apnea (observed in 7-42% of admissions), low pulse oxygen saturation and subjective measures (exhaustion and reduced consciousness). Clinical characteristics of children at the time of admission are commonly reported in relation to the modified Woods Clinical Asthma Score (mean = 3.8 to ≥7) and raised pCO2 (range = 8.0-8.8 kPa), with pCO2 the only significant parameter in a multivariate analysis of factors associated with intubation. KEY POINTS: · More children are being admitted to intensive care over time with increased costs.. · Cultural, organizational, and clinical variance exist between centers and countries.. · Comparing and aligning admissions is difficult as there are no standardized criteria..

Comparison of middle ear function and hearing thresholds in children with adenoid hypertrophy after microdebrider and conventional adenoidectomy: a randomised controlled trial.

Microdebrider has superior efficacy in clearing the adenoids, compared to curettage. We compared the improvement in middle ear function and hearing thresholds after adenoidectomy, by both methods. 126 patients (median age-9years) were randomized into groups A and B, where adenoidectomy was done by microdebrider and curettage, respectively. Middle ear function parameters and hearing thresholds were measured serially. The mean improvement in middle ear pressure, compliance and hearing thresholds were 92.5 ± 67.6 and 84.2 ± 71.4 daPa; (p = 0.40), 0.19 ± 0.34 and 0.27 ± 0.27mL; (p = 0.07) and 3.20 ± 4.95 and 2.54 ± 3.98dB; (p = 0.27), in groups A and B, respectively. Reversal of type B tympanograms was noted in both groups. Middle ear function and hearing thresholds improved in both groups after adenoidectomy. More improvement was noted in the microdebrider group, which, however, was not significant.

Using ASSR with narrow-band chirps to evaluate hearing in children and adults.

All studies concerning the reliability and threshold prediction of auditory steady-state responses (ASSR) focused on a particular group of patients. The present article evaluates the use of narrow-band, chirp-evoked ASSR for testing hearing in adults and children of all ages and with different types of hearing loss, as well as normal hearing. The aims are: to determine whether there are possible influencing factors, mainly the degree of hearing loss; and to validate the clinical value of using ASSR with chirp-stimuli. This is a retrospective study of 667 patients who had been diagnosed with and treated for hearing loss at our tertiary referral center. The following results were compared: ASSR to pure tone audiometry (PTA); click-ABRs to PTA; and click-ABRs to ASSR. We then calculated mean, median and standard deviation. A regression analysis was used to examine the correlation between: ASSR and click-ABRs; "estimated" audiogram and PTA; click-ABRs and PTA; and ASSR and PTA. We found significant correlations at all frequencies when comparing ASSR to click-ABRs, click-ABRs to PTA, and ASSR to PTA. Concerning the degree of hearing loss, there were significant differences between the patients with normal hearing and those with moderate-to-profound hearing loss. ASSR with narrow-band chirps are a reliable tool for estimating hearing thresholds in children and adults with all kinds of hearing loss. We have demonstrated that threshold differences between PTA and ASSR are negligible in the clinical routine. The "estimated" ASSR audiogram is a good approach for communicating ASSR results to the average user.

Predicting polysomnographic severity thresholds in children using machine learning

Approximately 500,000 children undergo tonsillectomy and adenoidectomy (T&A) annually for treatment of obstructive sleep disordered breathing (oSDB). Although polysomnography is beneficial for preoperative risk stratification in these children, its expanded use is limited by the associated costs and resources needed. Therefore, we used machine learning and data from potentially wearable sensors to identify children needing postoperative overnight monitoring based on the polysomnographic severity of oSDB. Children aged 2-17 years undergoing polysomnography were included. Six machine learning models were created using (i) clinical parameters and (ii) nocturnal actigraphy and oxygen desaturation index. The prediction performance for polysomnography-derived severity of oSDB measured by apnea hypopnea index (AHI) >2 and >10 were evaluated. One hundred and ninety children were included. One hundred and eight were male (57%), mean age was 6.7 years [95% confidence interval; 6.1, 7.2], and mean AHI was 10.6 [7.8, 13.4]. Predictive performance utilizing clinical parameters was poor for both AHI > 2 (accuracy range: 48-56% for all models) and AHI > 10 (50-61%). Combining oximetry and actigraphy improved the accuracy to 87-89% for AHI > 2 and 95-96% for AHI > 10. Machine learning with oximetry and actigraphy identifies most children needing overnight monitoring as determined by polysomnographic severity of oSDB, supporting a potential resource-conscious screening pathway for children undergoing T&A. We provide proof of principle for the utility of machine learning, oximetry, and actigraphy to screen for severe obstructive sleep apnea syndrome (OSAS) in children. Clinical parameters perform poorly in predicting the severity of OSAS, which is confirmed in the current study. The predictive accuracy for severe OSAS wasimproved by a smaller subset of quantifiable physiologic parameters, such as oximetry. The results of this study support a lower cost, patient-friendly screening pathway to identify children in need of in-hospital observation after surgery.

Pressure pain thresholds in children before and after surgery: a prospective study.

Background and aims This prospective study aimed to assess pressure pain thresholds (PPTs) by pressure algometry and the correlation to postoperative pain in children undergoing orthopaedic surgery. We hypothesized, that the PPTs would decline immediately after elective orthopaedic surgery and return to baseline values at follow-up. Methods Thirty children aged 6-16 years were included. PPTs and intensity of pain (Numerical Rating Scale, NRS) were assessed 3-6 weeks before surgery (baseline), 1-2 h before surgery (Day 0), the first postoperative day (Day 1) and 6-12 weeks after surgery (Follow-up). Results A significant difference of PPTs between the four assessments was seen using the Friedman test for detecting differences across multiple tests and Wilcoxon signed-rank test with a Bonferroni adjustment. The changes in PPTs between baseline (PPTcrus = 248 kPa, PPTthenar = 195 kPa) and day 1 (PPTcrus = 146 kPa, PPTthenar = 161 kPa) showed a decline of PPTs as hypothesized (Zcrus = 2.373, p = 0.018; Zthenar = 0.55, p = 0.581). More surprisingly, a significant decrease in PPTs between baseline and day 0, just before surgery (PPTcrus = 171 kPa, PPTthenar = 179 kPa), was also measured (Zcrus = 2.475, p = 0.013; Zthenar = 2.414, p = 0.016). PPTs were positively correlated to higher age, weight and height; but not to NRS or opioid equivalent use. Conclusions Children undergoing orthopaedic surgery demonstrate significant changes in PPTs over time. The PPTs decrease significantly between baseline and day 0, further decreases the first day postoperatively and returns to baseline values at follow-up. This suggests that other factors than surgery modulate the threshold for pain. Implications Awareness of pressure pain thresholds may help identify children with affected pain perception and hence improve future pain management in children undergoing orthopaedic surgery. Factors as for example anticipatory anxiety, psychological habitus, expected pain, catastrophizing, distraction, physical activity, patient education and preoperative pain medication might play a role in the perception of pain and need further investigation.

Evaluation of Hearing Thresholds by Using a Mobile Application in Children with Otitis Media with Effusion

Objective: Otitis media with effusion (OME) is the most common cause of hearing loss in children. Early diagnosis is important as hearing loss affects speech and language development in children. The aim of this study was to compare conventional audiometry with the Android mobile operating system application Hearing Test^TM in the evaluation of hearing thresholds in children with OME and to determine the accuracy and reliability of the mobile application. Design and Study Sample: Fifty school-age children aged between 5 and 15 years with OME in at least 1 ear were included in the study. First, hearing thresholds were obtained by conventional audiometric methods and the degree of hearing loss was determined. Then, the hearing thresholds of the patients were measured using the smartphone-based Hearing Test^TM application. The data were compared using Cohen’s kappa analysis. Results: OME was detected in 88 ears. There was no statistically significant correlation between the hearing threshold results obtained with the mobile phone and conventional audiometry at 500, 1,000, 2,000, and 4,000 Hz. Conclusion: The Android mobile phone application Hearing Test^TM (version 1.1.3) is not an appropriate screening test to detect hearing loss in children with OME.