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To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy.Prospective cohort study (July 2018-April 2019).Pediatric otolaryngology service at a tertiary academic children's hospital.Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics.Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation (Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.

Autologous cartilage grafting during open airway reconstruction is a complex skill instrumental to the success of the operation. Most trainees lack the adequate opportunity to develop proficiency in this skill. We hypothesized three-dimensional (3D) printing and computer-aided design can be used to create a high-fidelity simulator for developing skills carving costal cartilage grafts for airway reconstruction. The rapid manufacturing and low cost of the simulator allow deployment in locations lacking expert instructors or cadaveric dissection, such as medical missions and third world countries. In this blinded, prospective observational study resident trainees completed a physical simulator exercise using a 3D-printed costal cartilage grafting tool. Participant assessment was performed using a Likert-scale questionnaire and airway grafts were assessed by a blinded expert surgeon. A majority of participants found this to be a very relevant training tool and highly rated the level of realism of the simulation tool.

To determine the potential of an integrated, image-based computer-aided design (CAD) and 3-dimensional (3D) printing approach to engineer scaffolds for head and neck cartilaginous reconstruction for auricular and nasal reconstruction.Proof of concept revealing novel methods for bioscaffold production with in vitro and in vivo animal data.Multidisciplinary effort encompassing 2 academic institutions.Digital Imaging and Communications in Medicine (DICOM) computed tomography scans were segmented and utilized in image-based CAD to create porous, anatomic structures. Bioresorbable polycaprolactone scaffolds with spherical and random porous architecture were produced using a laser-based 3D printing process. Subcutaneous in vivo implantation of auricular and nasal scaffolds was performed in a porcine model. Auricular scaffolds were seeded with chondrogenic growth factors in a hyaluronic acid/collagen hydrogel and cultured in vitro over 2 months' duration.Auricular and nasal constructs with several types of microporous architecture were rapidly manufactured with high fidelity to human patient anatomy. Subcutaneous in vivo implantation of auricular and nasal scaffolds resulted in an excellent appearance and complete soft tissue ingrowth. Histological analysis of in vitro scaffolds demonstrated native-appearing cartilaginous growth that respected the boundaries of the scaffold.Integrated, image-based CAD and 3D printing processes generated patient-specific nasal and auricular scaffolds that supported cartilage regeneration.

A B S T R A C T Objectives: Identify factors related to patient/family satisfaction in an academic pediatric otolaryngology clinic and suggest strategies to improve patient and family satisfaction. Methods: Patients and families were surveyed following clinic encounters between May, 2010 and April, 2011. Review of an ongoing continuous quality improvement (CQI) effort. Univariable and multivariable ordinal logistic regression analyses were used to evaluate the relationship between reception area and examination room wait times, assessment of the provider, and clinic volume with overall satisfaction. Results: 1415 clinical encounters in the pediatric otolaryngology clinic resulted in 962 responses for a response rate of 68%. Ordinal logistic regression showed a significant relationship between overall satisfaction and satisfaction with the provider (cumulative odds ratio [COR] = 51.0; 95% CI: 29.5, 88.2; P < 0.001), examination room wait time (COR = 23.0; 95% CI: 15.0, 35.1; P < 0.001), reception area wait time (COR = 13.6; 95% CI: 9.41, 19.8; P < 0.001), and increases in clinic volume below 22 patients per day (COR = 0.86; 95% CI: 0.75, 0.99; P = 0.033). Multivariable analysis showed that satisfaction with provider (COR = 32.2; 95% CI: 14.5, 71.8; P < 0.001), reception area wait time (COR = 3.8; 95% CI: 1.8, 7.6; P < 0.001), and examination room wait time (COR = 2.8; 95% CI: 1.3, 6.1; P = 0.005) were independently associated with overall satisfaction. Conclusions: Examination room wait times and reception area wait times are associated with overall satisfaction and should be minimized.