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Objective: Validation of a contemporary International Classification of Diseases, 10th Revision, Clinical Modification (ICD‐10‐CM) congenital esophageal atresia/tracheoesophageal atresia (EA/TEF) cohort in the Pediatric Health Information System (PHIS) database. Study Design: Database study, validation. Setting: Tertiary care center. Methods: Search methods used to validate an ICD‐9‐CM EA/TEF cohort in PHIS were modified for ICD‐10‐CM. A retrospectively and prospectively maintained clinical database at a single high‐volume EA/TEF center was used for comparison. Patients treated between October 1, 2015 and July 31, 2022 were included. Searches progressively narrowed the cohort by ICD‐10‐CM diagnosis codes, expansion to include incorrectly coded as 'iatrogenic, age less than 30 days, and use of at least 1 ICD‐10‐CM procedure code. Results of PHIS data and institution data were compared for accuracy. Results: The most refined search of PHIS and the EA/TEF clinical database yielded 93 and 84 patients, respectively. The sensitivity was 99% and positive predictive value was 94%. A PHIS search using these methods and encompassing 49 children's hospitals yielded an EA/TEF cohort of 2479 patients. Conclusion: We present a validated search method in the PHIS database to identify a high‐fidelity cohort of EA/TEF patients for multi‐institutional study. We have demonstrated that a carefully maintained clinical database may be used to validate cohorts in PHIS. This cohort allows for improved practice variability and outcomes study of EA/TEF patients. Similar methods may be employed to generate other rare disease cohorts in PHIS. Level of Evidence: Level 4. [ABSTRACT FROM AUTHOR]

Objective: To discuss the presentation, evaluation, and management of pediatric laryngeal web.Study Design: Retrospective case series.Setting: Single tertiary care center.Subjects: All patients with laryngeal web at Boston Children's Hospital in the past 22 years.Methods: No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes.Results: Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications.Conclusions: Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child's presentation. [ABSTRACT FROM AUTHOR]

Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ2, and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement. [ABSTRACT FROM AUTHOR]

Objectives: Fine-needle aspiration biopsy (FNAB) has a well-established role in the evaluation of an adult head and neck mass (HNM) but remains underused in children. The objectives of this study were to assess the diagnostic accuracy, safety profile, use of anesthesia, and influence on surgical decision making of FNAB of HNM in the pediatric population.Study Design: Case series with chart review.Setting: Tertiary care children's hospital.Subjects and Methods: In total, 257 consecutive patients with HNM who underwent 338 FNABs from July 2007 to July 2014 were reviewed. Patients ranged in age from 0 to 21 years (mean, 9.3 years); lesions ranged in size from 0.3 to 12.5 cm (mean, 2.4cm). Fine-needle aspiration biopsies were performed in the interventional radiology suite, operating room, clinic, or ward.Results: The most common patient final diagnoses included reactive lymphadenopathy (n = 99, 38.5%), benign thyroid colloid nodule (n = 31, 12.1%), malignancies (n = 21, 8.2%), and atypical mycobacterial infection (n = 15, 5.8%). On surgical histopathologic and clinical follow-up, overall sensitivity of FNAB was 94.6% and specificity was 97.7%. The complication rate was 2.1%, and general anesthesia or sedation was used for 73% of FNAB. Surgery occurred only 9 times following the 191 patients with negative FNAB results, indicating that 95.3% of unnecessary surgeries were avoided with the assistance of the FNAB result.Conclusions: Fine-needle aspiration biopsy is an accurate and safe diagnostic tool for guiding management of persistent lymphadenopathy, thyroid nodules, and other HNM in pediatric patients. Negative FNABs can often obviate the need for surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of vocal nodule size on voice in pediatric patients. Study Design: Vocal nodules were graded according to a validated grading scale by three pediatric otolaryngologists. Subjects and Methods: Patients evaluated from 2003 to 2007 with a diagnosis of vocal nodules were included. Results: Forty patients (21 female) with a mean age of 7.5 years were identified. Vocal nodules were rated as grade 1 (17 patients), grade 2 (15 patients), and grade 3 (8 patients). Pitch range was reduced in patients with larger nodules (P = 0.001). There was no statistical association between nodule grade and fundamental frequency abnormality, perturbation, shimmer, decreased respiratory support, air loss, or significant muscle tension. Conclusions: Voice characteristics in patients with vocal nodules were evaluated. Other than pitch reduction, objective and subjective voice measurements are not statistically different in varying vocal nodule sizes; however, many of the measures did show a trend towards significance. Vocal rehabilitation is complex in children with nodules and may not directly correlate with vocal nodule size. [Copyright &y& Elsevier]

Objective: The purpose of this study was to determine resource utilization in managing subglottic stenosis. Study Design: The Kids’ Inpatient Database (KID) 2003 was analyzed. Subjects and Methods: International Classification of Diseases, Ninth Revision code 478.74 was the inclusion criteria. Results: Two thousand forty-six admissions with subglottic stenosis were sampled; there were 10 deaths (0.49%). States with the most admissions were Ohio, California, and Illinois; these did not have the highest spending per admission. Two hundred eighteen (10.7%) underwent a laryngeal graft procedure; states with the most were Ohio (35.8%), Texas, California, and Florida. Indicators of increased resource utilization include length of stay, nonelective admission, race, primary payer, hospital location, and type. Conclusions: For subglottic stenosis, three states account for 37% of admissions, and four states account for 56% of laryngeal graft procedures in 2003. The mean total charges were $53,787; 90% of admissions had total charges less than $139,253. Patients who underwent surgical procedures had total charges of $76,409. [Copyright &y& Elsevier]

Objective: Investigations that seek to generalize findings or to understand uncommon diseases must be conducted at multiple centers. This study describes the process of obtaining regulatory approval for a minimal risk genetic study in a multi-center setting as undertaken by the Recurrent Respiratory Papillomatosis (RRP) Task Force. Study design and setting: Sequential cohort of American children’s hospitals. A single protocol was submitted to each Institutional Review Board (IRB). Results: Documentation was prepared for 14 IRBs over 2.5 years. The median time between enlistment and approval at the first 8 sites was 15 months. Institutions varied considerably in their requirements and in the issues that were raised. Protocols were submitted sequentially and accumulated experience was used in the preparation of applications to subsequent IRBs. Nevertheless, there was no correlation between the accumulated experience and the number of issues that were raised. Conclusion: Despite uniform federal standards, all local IRBs required unique and individualized submissions. For multicenter studies, investigators should seriously consider the establishment of cooperative authorization agreements. On a simpler level, a standardized format for applications needs to be adopted nationwide. EBM rating: B-3b [Copyright &y& Elsevier]

Objectives: To compare postoperative complication rates of coblation and electrocautery adenotonsillectomies. Study design: Retrospective chart review. Results: From January 2000 to June 2004, 1997 pediatric patients underwent adenotonsillectomy. 745 coblation, and 1252 electrocautery tonsillectomies were performed. Primary bleed, secondary bleed, and dehydration were seen in 3, 35, and 23 coblation, and 9, 41, and 64 electrocautery tonsillectomies, respectively. Data analysis revealed no significant difference in primary and secondary hemorrhage rate, but a higher dehydration rate in the electrocautery group (P = 0.0423). A total of 602 coblation, 763 curette/cautery, and 632 electrocautery adenoidectomies were performed. Neck pain was seen in 0, 17, and 3 patients, respectively. Data analysis showed a higher incidence of neck pain with the curette/cautery technique compared with coblator and cautery techniques (P = 0.0006 and P = 0.0119, respectively). Conclusions: Coblation tonsillectomy had similar rates of primary and secondary hemorrhage when compared with electrocautery tonsillectomy but a lower incidence of postoperative dehydration. Coblation adenoidectomy caused less postoperative neck pain than curette/cautery adenoidectomy without significant advantage over cautery adenoidectomy. EBM rating: B-3b [Copyright &y& Elsevier]

OBJECTIVES: Two unusual cases of pediatric aerodigestive tract trauma postintubation with subsequent complications are described. Pediatric retropharyngeal dissection from trauma has not been reported previously. METHODS: We conducted a retrospective chart review in a pediatric tertiary care center. RESULTS: A 6‐year‐old girl underwent attempted nasotracheal intubation. She sustained retropharyngeal dissection, receiving positive pressure ventilation before this injury was noted. She developed subcutaneous emphysema. The child was managed conservatively and did well. An 8‐year‐old boy sustained a 4‐cm laceration of his posterior trachea, developing pneumomediastinum after intubation. On transfer to our institution, he underwent direct laryngobronchoscopy and was reintubated with the tip of the endotracheal tube distal to the laceration. Postoperatively, the child accidentally pulled his tube and coughed, resulting in severe subcutaneous emphysema with increased pneumomediastinum. An emergent tracheotomy was performed. The patient subsequently did well. CONCLUSION: A higher index of suspicion with more careful surveillance may prevent further morbidity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe mediastinitis in infants. Study Design: Case series. Setting: Tertiary-care, academic, pediatric hospital. Subjects: Four infants managed during eight months. Results: Patients were eight months (two patients), nine months, and 18 months old. They had retropharyngeal phlegmons and were started on clindamycin/cephalosporin. Interval imaging scans revealed abscess formation with mediastinal extension. All retropharyngeal abscesses were drained; three patients required video-assisted thoracoscopic debridement. Methicillin-resistant Staphylococcus aureus (two patients) and methicillin-sensitive Staphylococcus aureus (two patients) were cultured. Peak white blood cell counts were 15,000, 18,400, 30,200, and 44,900. The patients survived without long-term morbidity. Conclusions: In infants with pediatric deep neck space infections, increased vigilance should be maintained for progression to mediastinal extension. Optimal management includes imaging of the neck and chest as indicated, broad-spectrum antibiotic coverage, and aggressive surgery as warranted to clear the neck space infections with appropriate surgical consultants to manage the mediastinal process. Despite high morbidity and mortality in adult mediastinitis, infant mediastinitis may be a different disease process as all patients survived without sequelae. [Copyright &y& Elsevier]

Objective: Review the clinical presentation, histological subtypes, staging, treatment modalities, and survival rates for non‐orbital pediatric head and neck rhabdomyosarcoma (RMS). Method: A retrospective chart review of patients treated from 1996 to 2011 for nonorbital primary head and neck RMS at a pediatric tertiary care center. Baseline demographics, clinical presentation, staging, histology, treatment modalities, and survival outcome were analyzed. Results: Sixteen patients (7 M) were diagnosed with primary head and neck RMS, median age of 6.9 years (range, <1‐19 years). The majority of tumors were of parameningeal location (11/16). Fifty‐six percent (9/16) were metastatic at presentation (stage at diagnosis: 1, n = 1; 2, n = 2; 3, n = 4; 4, n = 9). Nine had skull base erosion and/or cranial nerve deficits. Ten patients had embryonal and sihad alveolar histology. Upfront resection gross resection was feasible in 4 patients (3 of which were non‐parameningeal), all with positive margins. All patients received chemotherapy combined with radiotherapy. Second look surgery was performed in 2 patients. Conclusion: Most patients presented with advanced disease in our series. Majority were parameningeal, thus limiting the role to biopsy only. Primary excision for non‐paramenigeal RMS is ideal. The role of second look surgery after chemotherapy and radiation is still unknown; however, it was successful in 2 patients in our small review. [ABSTRACT FROM AUTHOR]

Objective: 1) Report outcomes of balloon dilation in the endoscopic management of pediatric SGS. 2) Determine the role of balloon dilation in both primary vs adjuvant therapy. Method: Retrospective review of treatment with noncompliant, high‐pressure balloons for SGS in the past 2 years at a tertiary pediatric hospital. Fifty‐one dilations in 28 children with SGS were performed. Mean age was 39.2 months. Mean SGS grade was 2.40. Results: Overall, 18 (64.2%) had successful balloon treatment. Fifteen children had primary and 13 had secondary balloon dilation. Those with primary, 10 (66.6%), were able to avoid open reconstruction/tracheotomy, and 5 were temporized (36 days average) until definitive open reconstruction. Those with secondary, 9 (69.2%), were able to decannulate. Eight of 10 failed balloon dilations had concomitant airway pathologies, compared with only 6 of 12 where treatment was successful (P =. 02). There was no statistical association in successful vs failed treatment by age (49.6 vs 29.3, P =. 43), degree of stenosis (2.39 vs 2.60, P =. 41), presence of lung disease (33.3% vs 70%, P =. 07) or soft nature of stenosis (61.1% vs 40%, P =. 28). Conclusion: Balloon dilation plays an important role in the primary or adjuvant management of pediatric SGS. Presence of concomitant airway lesions is significantly associated with balloon dilation treatment failure. Meticulous surveillance of the dilated airway is necessary given this failure rate. [ABSTRACT FROM AUTHOR]

Objective: Determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA). Method: Retrospective review conducted at 2 tertiary children's hospitals over 10 years. Children 1 to 18 years old who underwent adenotonsillectomy for OSA and had both pre‐ and postoperative full‐night polysomnography (PSG), with central sleep apnea (CSA) on preoperative PSG, were eligible. Criteria for diagnosis of CSA was CAI greater than 1. Results: A total of 101 children with OSA had pre‐ and postoperative PSG. Fifteen of these patients had preoperative CSA. Ten of the children (66.7%) were male, and the mean age was 67.7 months (SD, 62.7). The mean preoperative CAI was 3.9 (SD, 2.9), while the postoperative CAI was 1.9 (SD, 4.8). The CAI ranged from 1.1 to 11.1. There was significant improvement (P =. 008) of the CAI following adenotonsillectomy. There was also significant improvement (P =. 004) of the obstructive apnea hypopnea index (OAHI), with the mean preoperative OAHI of 22.8 (SD 19.8) decreasing to an OAHI of 5.5 (SD 6.5) postoperatively. Conclusion: Children with OSA and mild central sleep apnea on preoperative PSG showed significant improvement in the CAI following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of central sleep apnea in children with OSA. [ABSTRACT FROM AUTHOR]