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Objectives/Hypothesis: To analyze the microbiological origins of deep neck space infections requiring surgical intervention in a pediatric population. Study Design: Retrospective cohort study. Methods: The study population (N = 136) included all pediatric patients surgically treated for deep neck space abscesses in a metropolitan tertiary care children's hospital over the course of 5 years (September 2004–August 2009). Demographic and clinical information was compared with microbiological isolate data. Results: Microbiological analysis of 118 bacterial isolates demonstrated 49 (42%) methicillin-resistant Staphylococcus aureus (MRSA), 35 (30%) methicillin-sensitive S. aureus, and 34 (28%) non-S. aureus (N-SA) isolates. The median age was 16 months (range, 1 month–13years). Patients

To determine if degree of lingual tonsil hypertrophy (LTH) correlates with pharyngeal reflux.Prospective.Patients with flexible laryngoscopic evidence of LTH were included. Degree of LTH was graded mild, moderate, or severe by two otolaryngologists blinded to pH study results. Three-sensor pH study results were correlated to LTH grade.Nineteen patients were included (five with mild LTH, eight with moderate LTH, and six with severe LTH). Nasopharyngeal reflux (NPR) eventspH4 were found in four of six severe LTH patients but no mild or moderate LTH patients (P = 0.006). All severe LTH patients had NPR eventspH5, compared with only 4 of 11 mild or moderate LTH patients (P = 0.017). At the UES, 4 of 6 severe LTH patients had pathologic reflux, compared with 4 of 13 mild or moderate (P = 0.025). Interobserver reliability calculated by Cohen's kappa was excellent (0.92).Our study shows a continuum of increasing pharyngeal reflux with higher LTH severity. Severe LTH may be a reliable physical sign of pharyngeal reflux, especially NPR.

Objectives:Analyze the frequency of and techniques used in performing tracheostomies. Understand the prevailing contraindications used in the decision between open versus percutaneous method. Evaluate outcomes among the 2 modes of tracheostomy procedures.Methods:Case-series review of all patients who underwent a tracheostomy spanning 4 years within a tertiary metropolitan hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related emergency department (ED) visits, and other complications.Results:A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open versus 881 (66%) via the percutaneous dilatational technique (PDT). There was no difference in short-term complications between the 2 groups. The primary long-term complication, tracheal stenosis, occurred most commonly in the PDT group. The contraindications practiced in decision for open versus PDT are not uniform among the various services per...

Objectives:(1) Assess the effectiveness of multilevel surgery in the treatment of obstructive sleep apnea (OSA). (2) Analyze outcomes based on reduction of apnea hypopnea index (AHI) and positive airway treatment pressures.Methods:Case-series review in a tertiary referral center. A total of 44 patients underwent multilevel OSA surgery between November 2009 and September 2013. Depending on the preoperative examination and OSA severity based on sleep study, patients underwent multilevel surgery including nasal, oropharyngeal, transoral robotic, tongue base, hyoid, and/or orthognathic surgery. Follow-up sleep studies at 4 months were obtained and compared with preoperative data.Results:Overall AHI was significantly reduced from a mean of 44.5 to 19.9 (P = .0008), 78.9 to 35.8 (P = .0001) in the severe OSA group, 21.4 to 7.0 (P = .0001) in the moderate group, and 8.7 to 4.5 (P = .0004) in the mild group. AHI reduced from mean of 98.1 to 31.7 (P = .0013) in those who underwent orthognathic surgery and 36.1 to ...

Objectives:A majority of anterior skull base meningoceles are often managed via the endoscopic endonasal approach (EEA) for the excision and repair of the cerebrospinal fluid (CSF) leak, in addition to the reconstruction of the skull base defect. The aim of the study was evaluation of an institutional case series to identify specific risks and strategies for successful management of anterior skull base meningoceles.Methods:Case series review of all surgical cases involving repair of any anterior skull base meningocele spanning 3 years.Results:A total of 18 patients were managed surgically for repair of meningocele with or without CSF rhinorrhea. All patients had postoperative follow-up to one year. EEA was used in 17 patients, and one had a combined transcranial with endoscopic approach. Four patients had meningoceles with a larger than 1.0-cm bony skull base defect. Large spontaneous meningoceles along the ethmoid were likely to include cerebrovascular structures within their intranasal component. Nasal ...

Objective: 1) Identify acute and chronic indications for orbital and/or optic nerve decompression. 2) Review known techniques for endoscopic orbital decompression. 3) Evaluate the necessity to include inferior orbital wall/orbital floor. 4) Compare and contrast the endoscopic technique in comparison to various open methods.Method: Retrospective review of all patients that underwent endoscopic orbital decompression procedures between 2009 and 2011. Data analysis included review of perioperative clinical findings, operative technical details, radiology data, and outcomes.Results: A total of 15 orbital decompressions were performed. All patients underwent endoscopic medial orbital wall decompression, 2 included the orbital floor. The majority of the patients had allergic fungal sinusitis as their primary diagnosis for surgical indication (n = 7, 47%). Neoplasms (n = 5, 33%) and Graves disease (n = 3, 20%) were the remaining diagnoses. Restricted ocular motility, proptosis, and diplopia were the most common p...

Objective: 1) Evaluate the indications for performing a tracheostomy across the spectrum of all trauma and pulmonary critical care patients. 2) Understand the existing contraindications used in the decision against performing a percutaneous dilatational tracheostomy. 3) Examine outcomes among the 2 modes of tracheotomy procedures.Method: A retrospective review identifying all patients who underwent open surgical or percutaneous dilatational tracheostomy procedure spanning 3 years (from 2008) within a tertiary hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related ER visits, and other complications.Results: A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open surgical versus 881 (66%) percutaneous dilatational techniques. There was no significant difference in age between the 2 groups (53 years). The average length of hospital stay was 21 days, indifferent among the 2 groups. The major...