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Objectives/Hypothesis Lingual tonsil hypertrophy is a common cause of persistent airway obstruction in patients with Down syndrome (DS) following adenotonsillectomy (TA however, little is known about the effect of lingual tonsillectomy (LT) on polysomnographic outcomes in these patients. Our objective was to describe changes in sleep-related respiratory outcomes following LT in children with DS and persistent obstructive sleep apnea (OSA) following T&A. Study Design Retrospective case series. Methods We included all children with DS who underwent polysomnography before and after LT at a tertiary care center from 2003 to 2013. Nonparametric analysis of variables was performed. Results Forty patients with DS underwent LT; 21 met inclusion criteria. The mean age at surgery was 9.3 ± 4.3 years and 47.6% were female. The median apnea-hypopnea index (AHI) was 9.1 events/hour (range, 3.8 to 43.8 events/hour) before surgery and 3.7 events/hour (range, 0.5 to 24.4 events/hour) after surgery. The median improvement in overall AHI and the obstructive AHI (oAHI) were 5.1 events/hour (range, −2.9 to 41) and 5.3 events/hour (range, −2.9 to 41), respectively (P 50 mm Hg, central index, and percentage of rapid eye movement sleep were not significantly different. After surgery, the oAHI was

Aim Premature infants and those with brain injury often suffer from feeding intolerance and vomiting in the first several years of life. Cyproheptadine is a medication with antihistaminergic, antiserotonergic and anticholinergic effects, thought to increase gastric accommodation. We aimed to retrospectively review our experience using cyproheptadine for feeding intolerance and/or vomiting in children under the age of three. Methods This is a retrospective chart review of 39 patients less than three years of age who were prescribed cyproheptadine for feeding intolerance or vomiting and had follow-up information available. Results Starting dose ranged widely (from 0.069 to 0.825 mg/kg/day). Side effects such as sleepiness and constipation were rare. The medication had a significant positive effect, defined as resolution of vomiting, improved feeding tolerance or improved comfort with feeds, in 67% of children. An additional 28% showed possible improvement, defined as some improvement in vomiting or improvement in vomiting or feeding tolerance in conjunction with other changes in addition to cyproheptadine. Conclusion In our experience, cyproheptadine appears to be safe and effective in decreasing vomiting and feeding intolerance in children less than three years of age. A trial of cyproheptadine could be considered before invasive testing in infants with feeding issues.

BACKGROUND AND PURPOSE: Infants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities. Our study aimed to identify perinatal clinical factors in infants with congenital diaphragmatic hernia that are associated with evidence of brain injury on MR imaging performed before hospital discharge. MATERIALS AND METHODS: MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings. RESULTS: Fifty-three infants with congenital diaphragmatic hernia (31 boys) were included. At least 1 abnormality was seen on MR imaging in 32 infants (60%). The most common MR imaging findings were enlarged extra-axial spaces (36%), intraventricular hemorrhage (23%), ventriculomegaly (19%), white matter injury (17%), and cerebellar hemorrhage (17%). The MR imaging brain injury score was associated with extracorporeal membrane oxygenation ( P = .0001), lack of oral feeding at discharge ( P = .012), use of inotropes ( P = .027), and gastrostomy tube placement before hospital discharge ( P = .024). The MR imaging brain injury score was also associated with a large diaphragmatic defect size ( P = .011). CONCLUSIONS: Most infants with congenital diaphragmatic hernia have at least 1 abnormality identified on MR imaging of the brain performed before discharge. The main predictors of brain injury in this population are a requirement for extracorporeal membrane oxygenation, large diaphragmatic defect size, and lack of oral feeding at discharge.

Objectives/Hypothesis To establish the prevalence of abnormal vestibular test findings in children with enlarged vestibular aqueduct (EVA) and determine if these findings correlate with clinical symptoms, radiographic findings (EVA size and laterality), audiometric findings, and genetic testing in these patients. Study Design Prospective cohort. Methods Patients 3 to 12 years of age with hearing loss and imaging findings consistent with EVA treated at our tertiary care institution were sequentially enrolled from 2009 to 2011. The following six outcome measurements were analyzed: audiometric findings, EVA laterality, temporal bone measurements, genetic testing, vestibular testing (cervical-evoked myogenic potentials, posturography, rotational chair, and calorics), and vestibular symptoms. Results Twenty-seven patients with EVA (mean age 9.2 years, 48% female) were enrolled in and completed the study. Vertigo was reported in six patients. Twenty-four of 27 (89%) had at least one abnormal vestibular test result. Midpoint and operculum size correlated with directional preponderance (P = .042 and P = .032, respectively). Also, high-frequency pure tone average (HFPTA) correlated with unilateral weakness (P = .002). Walking at a later age correlated with abnormal posturography results. There was no correlation between EVA laterality and vestibular test findings. Conclusion We found a high rate of vestibular pathology in children with EVA; however, the prevalence of abnormal vestibular test findings in this patient population was not correlated with vestibular symptoms. Enlarged vestibular aqueduct size, HFPTA, and walking at a later age were correlated with abnormal vestibular test findings. In view of these results, it may be prudent to consider vestibular testing in children with these clinical characteristics. Level of Evidence 2b. Laryngoscope, 126:2344–2350, 2016

Objective The abnormality of intrinsic brain activity in autism spectrum disorders (ASDs) is still inconclusive. Contradictory results have been found pointing towards hyper-activity or hypo-activity in various brain regions. The present research aims to investigate the spatial and spectral signatures of aberrant brain activity in an unprecedented frequency range of 1–2884 Hz at source levels in ASD using newly developed methods. Materials and methods Seven ASD subjects and age- and gender-matched controls were studied using a high-sampling rate magnetoencephalography (MEG) system. Brain activity in delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), low gamma (30–55 Hz), high gamma (65–90 Hz), ripples (90–200 Hz), high-frequency oscillations (HFOs, 200–1000 Hz), and very high-frequency oscillations (VHFOs, 1000–2884 Hz) was volumetrically localized and measured using wavelet and beamforming. Results In comparison to controls, ASD subjects had significantly higher odds of alpha activity (8–12 Hz) in the sensorimotor cortex (mu rhythm), and generally high-frequency activity (90–2884 Hz) in the frontal cortex. The source power of HFOs (200–1000 Hz) in the frontal cortex in ASD was significantly elevated as compared with controls. Conclusion The results suggest that ASD has significantly altered intrinsic brain activity in both low- and high-frequency ranges. Increased intrinsic high-frequency activity in the frontal cortex may play a key role in ASD.

BACKGROUND: Children who are deaf or hard of hearing (D/HH) have improved language outcomes when enrolled in early intervention (EI) before the age of 6 months. Little is understood about the long-term impact of EI on outcomes of kindergarten readiness (K-readiness). The study objective was to evaluate the impact of EI before the age of 6 months (early) versus after 6 months (later) on K-readiness in children who are D/HH. METHODS: In this study, we leveraged data from the Ohio Early Hearing Detection and Intervention Data Linkage Project, which linked records of 1746 infants identified with permanent hearing loss born from 2008 to 2014 across 3 Ohio state agencies; 417 had kindergarten records. The Kindergarten Readiness Assessment was used to identify children as ready for kindergarten; 385 had Kindergarten Readiness Assessment scores available. Multiple logistic regression was used to investigate the relationship between K-readiness and early EI entry while controlling for confounders (eg, hearing loss severity and disability status). RESULTS: Children who were D/HH and entered EI early (n = 222; 57.7% of the cohort) were more likely to demonstrate K-readiness compared with children who entered EI later (33.8% vs 20.9%; P = .005). Children who entered early had similar levels of K-readiness as all Ohio students (39.9%). After controlling for confounders, children who entered EI early were more likely to be ready for kindergarten compared with children who entered later (odds ratio: 2.02; 95% confidence interval 1.18–3.45). CONCLUSIONS: These findings support the sustained effects of early EI services on early educational outcomes among children who are D/HH. EI entry before the age of 6 months may establish healthy trajectories of early childhood development, reducing the risk for later academic struggles.

To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites.Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As.Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions.Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.

To add to the limited body of literature on ocular vestibular evoked myogenic potential (oVEMP) responses in children and to assess a different montage for oVEMP recording.To evaluate the characteristics of the oVEMP response in children and compare the results with that of a group of healthy adults.Prospective descriptive study from a tertiary referral center.Twenty-two children (mean age = 6.3 yr, standard deviation = ±1.5, range = 3.5–8.9 yr) were recruited from families whose parent(s) were employed by the Cincinnati Children’s Hospital Medical Center (CCHMC). Pediatric participants were categorized by age into three groups for data analysis. The comparison adult group of ten participants were members of the employee staff at CCHMC.Audiometric assessment was completed in all participants. The latency, amplitude, and threshold of the oVEMP responses were recorded using a modified electrode montage with reference at the chin and compared between the pediatric and adult participants.All participants completed testing and had bilateral measurable oVEMP responses using a 105-dB nHL, 500-Hz tone burst stimulus. Comparison between right and left ears across all participants for each oVEMP characteristic found no statistically significant difference. oVEMP testing showed no significant differences with respect to latency, amplitude, interaural amplitude asymmetry, and threshold of response as a function of age.oVEMP responses for ages ≥3 did not differ from responses in adults.

(1) To examine language performance in the context of cognitive abilities in young children who are deaf or hard-of-hearing and (2) to identify factors associated with having a language underperformance, defined as a gap between the language standard score and the nonverbal IQ (NVIQ) standard score.Children 6 to 82 months of age with bilateral hearing loss were enrolled. Language performance was defined as a ratio of language skills relative to cognitive abilities with language underperformance defined as a ratio of language scores to NVIQ0.85.Among 149 children, approximately half had hearing loss that was clinically classified as mild or moderate, and over one-third received a cochlear implant. Participants had a mean NVIQ in the average range (95.4 [20.3]). Receptive language scores were significantly lower than their NVIQ by 10.6 points (p.0001). Among children with NVIQs 80 to 100, 62.5% had receptive scores85 and 50% had a language underperformance (ratio0.85). Among children with NIVQs100, 21.1% had receptive scores85 with 42% having a language underperformance. Children with language underperformance (n = 61, 41.5%) were more likely to have more severe levels of hearing loss, lower socioeconomic status, and be nonwhite.Many children early identified with hearing loss continue to demonstrate language underperformance, defined using their cognitive potential. Language deficits have a cascading effect on social functioning in children who are deaf or hard-of-hearing. This study highlights the need to understand a child's cognitive potential to adequately address language needs in existing intervention models.

Objectives/Hypothesis Determine the prevalence of high-frequency sensorineural hearing loss (HFSNHL) in our hearing loss population and a diagnostic algorithm for these patients. Study Design Retrospective case series. Methods We identified patients diagnosed with sensorineural hearing loss (SNHL) at our pediatric tertiary care institution from 1981 to 2010. Based on audiometric profiles, these patients were subdivided into those with a flat SNHL configuration and those with HFSNHL. Imaging and genetic testing data and data regarding age at diagnosis, laterality, and risk factors were obtained for both groups. Comparisons were then made between the two groups. Results Of 2,867 patients included in the study, 7.6% had HFSNHL. Age at diagnosis was significantly higher in HFSNHL patients (8.3 years vs. 6.1 years; P

Objectives/Hypothesis With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital. Study Design Retrospective chart review. Methods Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005–2006) and after (group 2, 2008–2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared. Results Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5–16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35–27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant. Conclusion Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach. Level of Evidence 4. Laryngoscope, 2015

Objectives/Hypothesis Although adenotonsillectomy is accepted as a first-line therapy for pediatric obstructive sleep apnea (OSA), there is currently no consensus regarding optimal methods for identifying the sites of obstruction or treatment of children with persistent disease after surgery. With this in mind, our aim was to systematically review the English-language literature pertaining to these issues. Study Design Systematic review. Methods We searched all indexed years of Pubmed, Cochrane CENTRAL, DynaMed, UpToDate, CINAHL, and Scopus for English-language articles containing original human data, with ≥ 7 participants, all

Objectives To study normative thresholds and latencies for click and tone-burst auditory brainstem response (TB-ABR) for air and bone conduction in normal infants and those discharged from neonatal intensive care units, who passed newborn hearing screening and follow-up distortion product otoacoustic emission. An evoked potential system (Vivosonic Integrity) that incorporates Bluetooth electrical isolation and Kalman-weighted adaptive processing to improve signal to noise ratios was employed for this study. Results were compared with other published data. Design One hundred forty-five infants who passed two-stage hearing screening with transient-evoked otoacoustic emission or automated auditory brainstem response were assessed with clicks at 70 dB nHL and threshold TB-ABR. Tone bursts at frequencies between 500 and 4000 Hz were used for air and bone conduction auditory brainstem response testing using a specified staircase threshold search to establish threshold levels and wave V peak latencies. Results Median air conduction hearing thresholds using TB-ABR ranged from 0 to 20 dB nHL, depending on stimulus frequency. Median bone conduction thresholds were 10 dB nHL across all frequencies, and median air-bone gaps were 0 dB across all frequencies. There was no significant threshold difference between left and right ears and no significant relationship between thresholds and hearing loss risk factors, ethnicity, or gender. Older age was related to decreased latency for air conduction. Compared with previous studies, mean air conduction thresholds were found at slightly lower (better) levels, while bone conduction levels were better at 2000 Hz and higher at 500 Hz. Latency values were longer at 500 Hz than previous studies using other instrumentation. Sleep state did not affect air or bone conduction thresholds. Conclusions This study demonstrated slightly better wave V thresholds for air conduction than previous infant studies. The differences found in the present study, while statistically significant, were within the test step size of 10 dB. This suggests that threshold responses obtained using the Kalman weighting software were within the range of other published studies using traditional signal averaging, given step-size limitations. Thresholds were not adversely affected by variable sleep states.

Objectives: In a video-based study of rapid sequence intubation (RSI) in a pediatric emergency department (PED), 33% of children experienced oxyhemoglobin desaturation (SpO2 < 90%). To inform targeted improvement interventions, we planned multivariable analyses to identify patient and process variables (including time-based data around performance of key RSI process elements uniquely available from video review) associated with desaturation during pediatric RSI. Methods: These were planned analyses of data collected during a retrospective, video-based study of RSI in a high-volume, academic PED. For variables with plausible associations with desaturation, multiple logistic regression and generalized estimating equations were used to identify those characteristics independently associated with desaturation at both the patient and the attempt levels. Results: The authors analyzed video data from 114 patients undergoing RSI over 12 months. Desaturation was more common in patients 24 months of age and younger (59%) than in patients older than 24 months of age (10%). Variables associated with desaturation in patients 24 months of age and younger were duration of attempts (both individual and cumulative), the occurrence of esophageal intubation, a respiratory indication for intubation, and young age. The receiver operating characteristics curve for the model had an area under the curve of 0.80 (95% confidence interval [CI] = 0.67 to 0.92). Forty-six percent of desaturations occurred after 45 seconds of laryngoscopy, and 82% after 30 seconds. The odds ratio for desaturation on individual attempts lasting longer than 30 seconds (vs. those 30 seconds or less) was 5.7 (95% CI = 2.26 to 14.36). Conclusions: For children 24 months of age or younger undergoing RSI in a PED, respiratory indication for intubation, esophageal intubation, and duration of laryngoscopy (both individual and cumulative) were associated with desaturation; the number of attempts was not. Interventions to limit attempt duration in the youngest children may improve the safety of RSI. ACADEMIC EMERGENCY MEDICINE 2015;22:431–440 © 2015 by the Society for Academic Emergency Medicine

With a high rate of additional learning needs in children with permanent hearing loss, this study sought to understand their educational and support needs. School information on 62 children with varying degrees of hearing loss attending an urban public school during a 5-year period was analysed to understand types and amounts of services over time. Individualized Education Programs and Multifactored Evaluation Plans reported the number of minutes provided by various providers, the types of services provided, and the goals set for each student. Although all students had a documented hearing loss, the services and intensity of services varied widely based on primary educational label. This is characterized by changes in goals, services, and intensity (minutes provided) from one year to the next if a child experienced an educational label change. Implications are far reaching for educators and administrators regarding determination of educational label for students with comorbid conditions.

Objectives/Hypothesis To examine the ability of the OSA−18 to predict Obstructive Sleep Apnea (OSA) in a racially diverse population when compared to overnight polysomnography (PSG). Study Design Cross-sectional retrospective. Methods Children 2 to 12 years of age diagnosed with OSA who were treated at a tertiary care institution between 2008 and 2013 and had complete PSG and OSA-18 data were included. We performed logistic regression with OSA as the dependent variable and the OSA-18 total symptom score (TSS), age, gender, race, asthma, and body mass index (BMI) as independent variables. Results Seventy-nine children (32 females) were included (mean age 5.2 ± 2.4 years). The positive predictive value (PPV) was greater than 90 for an obstructive apnea–hypopnea index (oAHI) ≥ 1. The PPV and specificity were higher for white than for nonwhite children; however, sensitivity and negative predictive value (NPV) of OSA-18 TSS were low for mild, moderate, and severe OSA regardless of race. Age, race, and BMI were not significantly associated with oAHI. Conclusions This study, conducted in a racially diverse cohort, examined the ability of the OSA-18 to predict OSA when compared to PSG—the gold standard—and found that sensitivity and NPV were extremely low for both white and nonwhite children. This suggests that the OSA-18 is not sufficiently sensitive to detect OSA nor sufficiently specific to determine the absence of OSA. The OSA-18 should be used as a quality-of-life indicator and is not a reliable substitute for PSG. Level of Evidence 4. Laryngoscope, 125:1491–1495, 2015

Few studies have addressed the benefits of cochlear implantation for the small group of patients with bilateral, end-stage Meniere's disease, or unilateral disease with contralateral hearing loss from another cause. Our retrospective study evaluates the effectiveness and post-operative performance in these Meniere's disease patients and discusses these findings relative to other post-lingually deafened adults.Among 456 adults who received cochlear implants, we identified eight (1.7%) patients with Meniere's disease who met clinical indications for implantation and a control group of seven non-Meniere's patients of comparable age and deafness. Data gathered included demographics, auditory and vestibular symptoms pre-implantation, and clinical course after implantation, including audiometric scores (consonant-nucleus-consonant (CNC), hearing-in-noise testing (HINT), and AzBio score) and audiologic evaluations.Comparing the Meniere's and non-Meniere's patients, pre- to post-implant scores averaged 15 and 16%-57 and 76% for CNC; and 4.5 and 40.5%-78 and 81% for AzBio and/or HINT tests, respectively; scores between groups did not statistically differ. Of note, five of eight patients had 0% word recognition scores pre-operatively. Fluctuations in CI performance were seen in five patients with Meniere's disease but not for those without the disease.Audiologic testing found a strong likelihood that CIs did benefit our subset of Meniere's patients with severe to profound sensorineural hearing loss. Fluctuations in hearing sensitivity (perhaps owing to physical changes relative to the implant array with the spiral ganglion neurons during an acute attack or changes in spiral ganglion neurons because of the hydropic state) can often be resolved by subsequent reprogramming.

Over the past decade, thoracic slide tracheoplasty (TST) has become the principal operation in the management of congenital tracheal stenosis. The purpose of this report was to describe our experience with revision TST following unsuccessful prior tracheal reconstruction.Retrospective analysis at an academic children's hospital.Patients undergoing TST on cardiopulmonary bypass between January 2005 and May 2014 were reviewed. Patients with a history of prior airway surgery were extracted for further analysis. Preoperative patient variables and postoperative outcomes were evaluated and compared between patients undergoing revision slide tracheoplasty (RTST) and a control group of 26 matched patients undergoing primary surgery TST.Twenty-six revision patients (25 referrals, one primary patient) of 162 patients reviewed over the study period met inclusion criteria. Twenty-three patients had a history of complete tracheal rings, and three patients had cartilaginous deficiency. A total of 41 airway reconstruction procedures had been performed prior to RTST. When compared to primary TST, patients undergoing RTST required fewer cardiac procedures intraoperatively, and fewer mean ventilator hours (P = .01) postoperatively. There was no significant difference in the median length of stay, requirement of48 hours ventilation, or postoperative complications between groups. There was one nonsurgical postoperative mortality following RTST.Despite some differences in the postoperative management when compared to nonrevision cases, revision TST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.4. Laryngoscope, 128:2181-2186, 2018.

Objective:This study aimed to evaluate the role of 3 Tesla magnetic resonance imaging in predicting tongue tumour thickness via direct and reconstructed measures, and their correlations with corresponding histological measures, nodal metastasis and extracapsular spread.Methods:A prospective study was conducted of 25 patients with histologically proven squamous cell carcinoma of the tongue and pre-operative 3 Tesla magnetic resonance imaging from 2009 to 2012.Results:Correlations between 3 Tesla magnetic resonance imaging and histological measures of tongue tumour thickness were assessed using the Pearson correlation coefficient: r values were 0.84 (p < 0.0001) and 0.81 (p < 0.0001) for direct and reconstructed measurements, respectively. For magnetic resonance imaging, direct measures of tumour thickness (mean ± standard deviation, 18.2 ± 7.3 mm) did not significantly differ from the reconstructed measures (mean ± standard deviation, 17.9 ± 7.2 mm; r = 0.879). Moreover, 3 Tesla magnetic resonance imaging had 83 per cent sensitivity, 82 per cent specificity, 82 per cent accuracy and a 90 per cent negative predictive value for detecting cervical lymph node metastasis.Conclusion:In this cohort, 3 Tesla magnetic resonance imaging measures of tumour thickness correlated highly with the corresponding histological measures. Further, 3 Tesla magnetic resonance imaging was an effective method of detecting malignant adenopathy with extracapsular spread.

Objectives/Hypothesis The objective was to describe trends in the annual prevalence of hospitalization for pediatric acute mastoiditis since introduction of the 7-valent pneumococcal vaccine in 2000 and the 13-valent vaccine in 2010. Study Design Cross-sectional retrospective data analysis. Methods The Kids' Inpatient Database from years 2000 to 2012 was analyzed. To determine the annual prevalence of hospitalization for acute mastoiditis, nationally weighted frequencies of hospitalization for children

The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs).Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226 kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS).Children with DS (n = 40; mean age 6.4 years), and TD children (n = 48; mean age 5.1 years) were included.Wideband absorbance was significantly lower at 1-4 kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5 kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups.Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.

Supplemental material, AUT716606_Lay_Abstract for Preliminary efficacy of a daily living skills intervention for adolescents with high-functioning autism spectrum disorder by Amie Duncan, Lisa A Ruble, Jareen Meinzen-Derr, Carrie Thomas and Lori J Stark in Autism

Objective The aim of this study is to determine the validity and reliability of neutrophil CD64 in identifying infected infants and to evaluate the impact of this marker on clinical care. Study Design Neutrophil CD64 index was incorporated in 371 infection evaluations in 234 infants (ages 1–293 days) from 2005 to 2009 and the impact of this change on clinical care was evaluated. Results The sensitivity of the neutrophil CD64 assay was 87% in identifying 31 episodes of culture positive sepsis and 83% in identifying 12 infants with ventilator-associated pneumonia. There was no difference in the mean number of antibiotic days in infants with a normal CD64 versus those with a normal complete blood count (CBC) ( p = 0.89), but twofold more infants were identified as “not infected” by CD64 than by CBC. Conclusion CD64 had a high sensitivity for identifying infected infants while also decreasing the number of infants that were exposed to unnecessary antibiotic use.

Objective To examine the association of missed oral feeding opportunities among preterm infants with achievement of full oral feedings and length of hospitalization. Study Design A secondary analysis of clinical trial data was conducted. Study infants included in the analysis (N = 89) were randomized to one of four standardized feeding progression approaches; detailed records on all feedings were maintained. The proportion of oral feeding opportunities reported as missed due to factors unrelated to the infant's clinical condition was calculated for each infant. Results The proportion of missed oral feeding opportunities per infant ranged from 0 to 0.12; 30 infants experienced one or more missed oral feeding opportunity. Each 1% increase in the proportion of missed oral feeding opportunities extended the time to achieve full oral feeding by 1.45 days (p = 0.007) and time to discharge by 1.36 days (p = 0.047). Conclusion Preterm infants' missed oral feeding opportunities may adversely affect feeding outcomes and extend hospitalization.

Objectives. We identified individual and contextual factors associated with referral and enrollment in home visiting among at-risk, first-time mothers. Methods. We retrospectively studied referral and enrollment in a regional home visiting program from 2007 to 2009 in Hamilton County, Ohio. Using linked vital statistics and census tract data, we obtained individual and community measures on first-time mothers meeting eligibility criteria for home visiting (low income, unmarried, or age Results. Of 8187 first-time mothers eligible for home visiting, 2775 were referred and 1543 were enrolled. Among referred women, high school completion (RR = 1.10) and any college (RR = 1.17) compared with no high school completion were associated with increased enrollment, and enrollment was less likely for those living in communities with higher socioeconomic deprivation (RR = 0.71; P Conclusions. Barriers to enrollment in home visiting persisted at multiple ecological levels. Ongoing evaluation of enrollment in at-risk populations is critical as home visiting programs are implemented and expanded.

The primary goal of the current study is to evaluate the concurrent validity of the Leiter International Performance Scale-Revised (Leiter-R Brief IQ) and Differential Ability Scales – Second Edition (DAS-II Nonverbal Reasoning Index) in a group of children who are deaf or hard-of-hearing. Knowing the breadth of cognitive tools appropriate for use in children who are deaf or hard-of-hearing is highly beneficial, given that clinical and school psychologists are often challenged to reliably assess cognitive functions in the context of hearing loss. Participants included 54 children between three and six years of age with permanent bilateral hearing loss. As part of the study, neurocognitive assessments were conducted by a pediatric neuropsychologist or licensed clinical psychologist with extensive experience administering assessments to children with developmental disabilities, including children with hearing loss. The Leiter-R Brief IQ score was similar to the DAS-II nonverbal reasoning index, with no significant difference in the mean scores across the two assessments. The severity of hearing loss was not correlated to either the Leiter-R or the DAS-II nonverbal IQ. Nearly a quarter of the children evaluated had meaningful intra-individual differences between scores on the Leiter-R and DAS-II that were more than one standard deviation from one another. Conducting accurate intellectual assessments in children who are deaf and hard-of-hearing is fundamental in determining and designing interventions and educational services. More comprehensive neuropsychological test batteries utilizing several tasks to assess a single domain (such as nonverbal reasoning) may be warranted for children who are deaf or hard-of-hearing.

Objectives Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss. Methods Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected. Results The median age of diagnosis was 14 months (range 1–71) for hearing loss and 66.5 months (range 33–106) for ASD. Only 25% (n = 6) children were diagnosed with ASD ≤48 months of age and 46% by ≤6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators). Conclusions Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.

In the last two decades, online learning has transformed the field of higher education. Also during this time, institutions of higher education have seen increases in their adult learner populations. The flexibility and accessibility of an online education model is often particularly appealing to adult learners, who bring unique needs, expectations, and learning styles to their educational experiences. Using Kolb’s Learning Style Inventory and Knowles’ andragogy model as theoretical frameworks, this study evaluates an online graduate course in epidemiology in terms of the demographics, learning styles, satisfaction, and achievement of students. Comparing the online course to the same, land-based course that was offered concurrently, we found no differences between students’ learning styles, satisfaction, and overall achievement. However, students in the land-based class were more likely to be matriculated into a degree program (p

Background No clear consensus yet defines the endpoints for operative learning curves in the transition to minimally invasive endoscopic techniques. This retrospective review of our first 202 patients who underwent endoscopic pituitary resection examines the statistical learning curve related to operative times—a measure of our surgical team's efficiency and complication rate, a reflection of surgical skill and maturity. Methods Retrospective chart review included patient demographic data, tumor type, operative time, complications, and follow-up. During the 5-year study period, surgeries were performed by an otolaryngology-neurosurgery team. Statistical analysis by Pearson's correlation delineated a learning curve for operative time and complications. Results Our learning curve showed comparable plateaus: 120 cases (48% males, 52% females) for operative time (mean, 134 minutes; range, 62–307 minutes) and 100 cases for incidence of cerebrospinal fluid (CSF) leak. The risk of CSF leak declined significantly with the surgeon's increasing experience. Complication rates were as follows: temporary nasal obstruction, 9.9%; CSF leak, 8.4%; postoperative epistaxis, 7%; sinusitis, 4.5%; septal osteomyelitis, 2.4%; postoperative sellar hematoma, 1.5%; anosmia, 0.5%; and septal perforation, 0.5%. The overall CSF leak rate included 5.5% intraoperative and 2.9% postoperative; most cases resolved with a lumbar drain. Four patients (2%) underwent postoperative surgical repair and lumbar drainage. Conclusion Our learning curve–defined endpoints for 2 measures, operative time and complication rates, support improved outcomes for reduced CSF leaks, the most common complication, with increasing operative experience. We will continue to examine the implications related to safety, efficacy, and the need for subspecialization in this minimally invasive surgery.

The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.

To assess daily functional skills among young cochlear implant (CI) recipients with additional disabilities.Children with CI and developmental disabilities and a hearing control group containing similar ages and similar disabilities were enrolled in a cross-sectional study of language and functional skills. Daily functional skills were measured using the Pediatric Evaluation of Disability Inventory (PEDI), which provides standard and scaled scores in Self-Care, Mobility, and Social Functioning domains. Language was assessed using the Preschool Language Scales, 4th edition which provides standard scores and age equivalents.Fourteen children with CIs and seven hearing controls were included in this analysis. Most children in this study (90.5%) had cognitive disabilities and 57% had motor disabilities. Compared with the hearing controls, children with CIs were less likely to have functional independence in any PEDI domain. Children with CI had significantly lower median social functioning standard scores compared with controls (17.3 vs. 27.5, P = 0.009). After controlling for nonverbal cognitive abilities and language level, the difference was no longer significant (19.1 vs. 24, P = 0.3). Among children with CI, age at implant and duration with device were not associated (P0.4) with PEDI scores.Although children with CI and developmental disabilities had similar functional skills as hearing children with similar disabilities regarding the PEDI domains of Self-Care and Mobility, they had lower Social Function standard scores. This lower social functioning among children with implants may be related to lower language levels and possible language deficits seen in the CI group. Regular assessments of functional abilities coupled with language abilities are essential in providing every child with the opportunity for maximizing the potential for independence.

Objective To present a series of experiments: (1) to evaluate the impact of pre-annotation on the speed of manual annotation of clinical trial announcements; and (2) to test for potential bias, if pre-annotation is utilized. Methods To build the gold standard, 1400 clinical trial announcements from the clinicaltrials.gov website were randomly selected and double annotated for diagnoses, signs, symptoms, Unified Medical Language System (UMLS) Concept Unique Identifiers, and SNOMED CT codes. We used two dictionary-based methods to pre-annotate the text. We evaluated the annotation time and potential bias through F-measures and ANOVA tests and implemented Bonferroni correction. Results Time savings ranged from 13.85% to 21.5% per entity. Inter-annotator agreement (IAA) ranged from 93.4% to 95.5%. There was no statistically significant difference for IAA and annotator performance in pre-annotations. Conclusions On every experiment pair, the annotator with the pre-annotated text needed less time to annotate than the annotator with non-labeled text. The time savings were statistically significant. Moreover, the pre-annotation did not reduce the IAA or annotator performance. Dictionary-based pre-annotation is a feasible and practical method to reduce the cost of annotation of clinical named entity recognition in the eligibility sections of clinical trial announcements without introducing bias in the annotation process.

INTRODUCTION: Children with dual sensory impairments are receiving cochlear implants; however, little is known regarding their language outcomes. MATERIALS AND METHODS: Children between the ages of 6 months and 8 years with dual sensory impairment and cochlear implant(s) were recruited from across the United States to participate in an evaluation of language skills using the Reynell-Zinkin Developmental Scales, a tool validated on children with vision impairment and adapted for children with hearing loss. Basic demographic information was also collected from care givers. RESULTS: Ninety-one children completed assessments after implantation. For receptive language abilities, 32% of children obtained a level of sound detection, 15% obtained the ability to understand simple words, 21% could identify words, 5% could follow simple directions, and 22% could follow directions related to the functional use of objects. Four children had no response to sound after cochlear implantation. For expressive language abilities, 49% only had sound production skills, 9% could jargon, 18% could communicate with some words, 12% could communicate with simple sentences, and 12% could communicate with complex sentences. Children with lower developmental ages (or quotients) tended to obtain lower level expressive language skills such as sound production and jargoning. Developmental abilities, rather than age at implant, were the most robust predictor associated with outcomes. DISCUSSION: This information can guide cochlear implant centers when discussing outcomes with families in the cochlear implant candidacy process. There is great heterogeneity in outcomes and caution should be used in discussing possible language outcomes for children with dual sensory impairments.

Objective Quantify neonatal morbidity by week of gestation for twins compared with singletons. Study Design We performed a population-based retrospective cohort study of all Ohio births from 2006 to 2007. Composite neonatal morbidity consisting of Apgar score 6 hours, neonatal transport, or seizures was compared between singletons and twins from 34 to 41 weeks. Results Neonatal morbidity was the lowest in twins delivered at 37 completed weeks and 2 weeks later for singletons at 39 weeks. Twin morbidity rapidly increased after 37 weeks and reached 15.8% at 41 weeks versus the singleton morbidity rate of 3.4% at 41 weeks. Twins delivered at 39 weeks and beyond were more than twice as likely to incur neonatal morbidity compared with singletons. Conclusion The lowest rate of neonatal morbidity occurs at 37 weeks for twins versus 39 weeks for singleton births. The increased risk after 37 weeks for twins accelerates at a faster rate compared with that for singletons born past 39 weeks.

To determine acceptance of donor human milk (DM) for feeding preterm infants and whether offering DM, alters mothers' milk (MM) feeding.Infant feeding data were collected from medical records of 650 very preterm infants enrolled between 2006-2011 in two hospital level III neonatal intensive care units (NICUs) in Cincinnati, Ohio. The study was conducted during the implementation of a program offering 14 days of DM.From 2006-2011, any DM use increased from 8 to 77% of infants, largely replacing formula for the first 2 weeks of life; provision of MM did not change. DM was more likely to be given in the first 2 weeks of life, if infants never received MM or were1000 g birth weight, but DM use did not differ by sociodemographic factors.Offering DM dramatically increased human milk feeding and decreased formula use, but did not alter MM feeding in hospital.

Objective. To examine the association of intracranial radiographic abnormalities and developmental measures with outcomes in children with congenital symptomatic cytomegalovirus (CMV) and cochlear implants (CI). Design/Methods. It was a retrospective review of 15 children implanted from 2004 to 2010. Preimplant nonverbal intelligence quotient/developmental quotient (IQ/DQ) and head circumference (HC) were obtained. Computed tomography and magnetic resonance imaging of the brain and post-CI audiometry and language assessments were reviewed. Results. Eleven children (73%) had cognitive delay. Most had >1 developmental disability. Median IQ/DQ was 65 (23–90). All had imaging abnormalities. Most imaging abnormalities were in parietal (60%) and temporal (60%) lobes. Children with HC < 5th percentile had poorer median post-CI PTA (38 dB versus 27 dB, ). Periventricular calcifications were associated with lower receptive (, ) and expressive (, ) language. Because IQ/DQ was associated with periventricular calcifications (, ) and small HC (, ), their relationships with language appear partially driven by IQ/DQ. Conclusions. The location of brain abnormalities appears to correlate with worse outcomes after CI. These findings may allow for more accurate counseling of parents regarding anticipated postimplantation performance.

In children who are deaf or hard of hearing (DHH), it is helpful to have meaningful early measures of development in order to provide effective interventions and offer benchmarks that help recognize varied developmental trajectories. The main objective of this study was to compare results of an early developmental assessment prior to 3 years of age to later nonverbal IQ assessed between 3 and 6 years of age in children who are DHH.This study included children 3-6 years of age with bilateral permanent hearing who were enrolled in a prospective cohort study on developmental outcomes. As part of the study, children received the Leiter International Performance Scale-Revised, which provided a nonverbal Brief IQ, as well as standardized language assessment and behavioral checklists. Children were included in this analysis if they had received an early developmental assessment with the Gesell Developmental Schedules-Revised as part of a clinical visit with a developmental pediatrician. Correlation coefficients and multiple regression analysis were used to associate the scores on the Gesell (using a developmental quotient) with scores on the Leiter-R Brief IQ.Forty-five participants who enrolled in the observational study had available evaluation results from the Gesell and complete Brief IQ results from the Leiter-R. The adaptive domain of the Gesell had good correlation (r = 0.61, p 0.0001) with the Brief IQ on the Leiter-R. Children who had stable developmental or intelligence classifications based on scores (70, 70 to85, 85 to100, ≥100) over time were older (24 months) at the early Gesell assessment. Degree of hearing loss or maternal education did not appear to confound the relationship between the Gesell and the Leiter-R.The adaptive domain of the Gesell Developmental Schedules - Revised administered in early childhood (under 3 years of age) has good correlation with the nonverbal Brief IQ on the Leiter International Performance Scale-R. Because children who are DHH have a higher likelihood of having a developmental disability compared to the general population, early developmental assessments are often important. Although early developmental assessments have their limitations, our results indicate that they are fairly robust indicators of later development. Such early indicators can be extremely useful in the clinical and educational management of children who are DHH.

Tracheotomy is a common procedure. A reliable method of securing the tracheotomy tube is essential to minimize accidental decannulation. However, skin breakdown has been reported in ∼30% of patients. We sought to evaluate rates of skin-related complications and accidental decannulation with the use of Velcro ties compared to twill ties.A nonblinded, randomized controlled trial comparing Velcro versus twill ties in patients undergoing tracheotomy between July 1, 2014 and January 31, 2016.Patients ≤21 years of age were recruited and randomized to receive either Velcro or twill ties. The primary outcome measure was skin-related complications. The secondary outcome measure was accidental decannulation. Outcome measures were followed through postoperative day 5.Ninety-three patients were eligible, and 63 were enrolled. No patients were withdrawn. Fifty-seven patients were included in the analysis. Twenty-seven (47.4%) received Velcro, and 30 (52.6%) received twill. Five enrolled patients did not undergo tracheotomy (one Velcro, four twill). One was diagnosed with a genetic skin condition after enrollment but prior to undergoing tracheotomy. Patient characteristics were similar between groups. No significant differences were found with respect to skin-related complications (P = .59). Six patients (20%) with twill ties required early tie change compared to two (7.4%) with Velcro ties (P = .5). Two accidental decannulations occurred in the twill group compared to one in the Velcro group (P = 1.0).Our study demonstrated no differences in skin-related complications or accidental decannulation between Velcro and twill tracheotomy ties in the immediate postoperative period following tracheotomy. Our study suggests that Velcro ties are a viable alternative to twill ties.1b Laryngoscope, 127:1996-2001, 2017.

This article was migrated. The article was marked as recommended. Background: The globalization of healthcare has contributed to a rapid increase in global health education (GHE) among residency programs. However the impact of GHE on pediatric residency selection and potential barriers to GHE have not been reported. Objective: Our objective was to identify associations between resident ranking preferences and, 1) past GHE experience, and 2) interest in GHE participation in future. Methods: Residents entering a large urban academic pediatric residency program from 2009 to 2014 were surveyed, to identify factors influencing pediatric residency program selection and the role of GHE in ranking and career decisions. Results: 86.5% (n=294) of the 340 entering residents responded (67.2% female; 74.6% white; mean age [SD] of 27 years [2.3]). About 50% (n=147) had prior GHE experience, and 90.4% endorsed interest in participating in GHE rotations. Availability of faculty mentorship, financial support, and personal safety were the most important factors influencing interest in participation. Non-white residents were more likely than white residents to have prior GHE experience (p=0.02). Residents with prior GHE experience were more familiar with the program's GHE opportunities prior to submitting their rank-lists (p=0.004). They gave greater importance to availability of GHE opportunities, in-country (p

Objectives: To compare clinicians’ ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation. Methods: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings. Results: Clinicians were more likely to rate regularity on HSV versus VLS videos ( P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location ( P = .002). Supraglottic phase symmetry ( P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions ( P < .0001). Conclusions: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

BACKGROUND: Newborn hearing screening has a high participation rate of ∼97% of infants nationally, but a high lost to follow-up of ∼32% limits the effectiveness of the program. This study tested an intervention of targeted outpatient rescreening of infants through collaboration with the Women, Infants, and Children (WIC) program to improve follow-up rates for newborn hearing screen referrals. METHODS: Controlled intervention study of WIC-eligible infants who referred on newborn hearing screens at target hospitals. Hearing rescreens were performed by using screening auditory brainstem response testing by trained research assistants, coordinated with the infant’s WIC appointment. Loss to follow-up rates and age at follow-up were compared with non-WIC infants tracked via the Ohio Department of Health during the same time periods at the same hospitals and at nonintervention hospitals. RESULTS: During a 2-year period, there were 1493 hearing screen referrals at 6 hospitals in the Cincinnati region recorded by the Ohio Department of Health. Of these, 260 WIC-eligible infants were referred to the study. Among WIC-eligible intervention infants, the lost to follow-up rate over 2 years was 9.6%, compared with 28.7% for nonintervention infants in the same hospitals and 18.1% for nonintervention hospitals. The average age of hearing confirmation for the WIC intervention group was 34.8 days, compared with 63.6 days in non-WIC infants. One-third of mothers reported barriers to follow-up. CONCLUSIONS: Collaborating with WIC to provide targeted follow-up for newborn hearing screening improved loss to follow-up rates, decreased the age at hearing confirmation by 1 month, and addressed reported care barriers.

Lingual tonsillar hypertrophy is recognized as a cause of persistent obstructive sleep apnea (OSA) after adenotonsillectomy in children. However, little has been reported regarding the complications, postoperative course and effectiveness of lingual tonsillectomy (LT). Our objective was to review the safety and effectiveness of LT in children.Retrospective review of children undergoing LT from January 2009 to December 2015 at a tertiary children's hospital. Complications, postoperative course and polysomnographic (PSG) outcomes were recorded for all patients.We identified 92 children (mean age = 8.6 years, 50% female) who underwent LT; 43.5% had a syndromic diagnosis. The most common complications were emergency department presentation for bleeding (4.4%) and poor oral intake (3.3%). The readmission rate was 4.4% including 2 children (2.2%) who required operative control of hemorrhage. No children required unplanned reintubation or ICU admission. In children with PSG data (n = 18), the median apnea-hypopnea index (AHI) decreased from 8.5 to 3.8 events/hour (p = 0.022) and the median obstructive AHI (oAHI) decreased from 8.3 to 3.1 events/hour (p = 0.021). In addition, the oxygen saturation nadir increased from 83.8% to 89.0% (p = 0.0007). After surgery the percentage of patients with oAHI5 events/hour increased from 27.8% to 61.1% (p = 0.08).Readmission and bleeding rates after lingual tonsillectomy in children were similar to that seen with tonsillectomy. Polysomnographic data showed that lingual tonsillectomy resulted in a significant reduction of both AHI and oAHI with a postoperative oAHI5 achieved in 61% of patients.

Background Acute chorioamnionitis contributes to premature birth, and is associated with post-birth complications. How chorioamnionitis impacts neonate’s developing immune system has not been well defined. Methods Blood from extremely preterm infants (≤28 weeks gestation) was drawn at the 1st, 2nd, and 4th week of life. Blood was either left unstimulated or stimulated for 4 hours with PMA/ionomycin. mRNA expression of transcription factors in unstimulated cells (RORC, TBET, GATA3, FOXP3) and inflammatory cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-5, and IL-6) in unstimulated and stimulated cells were analyzed. Data were analyzed based on the diagnosis of chorioamnionitis, funisitis and bronchopulmonary dysplasia (BPD). Results At 1 week of life, exposure to funisitis, but not maternal chorioamnionitis was associated with an increased expression of RORC and RORC/FOXP3 ratio. These increases in RORC and RORC/FOXP3 ration were sustained over the 4 weeks of follow-up. Leukocytes from infants who developed BPD had increased stimulated and unstimulated IL-4 at the 1st week of life, but these increases were not sustained over time. In contrast, infants with mild BPD had a sustained decrease in stimulated IL-2. Conclusion Chorioamnionitis exposure, in particular to funisitis, lead to enhanced Th17-like responses that persist for 4 weeks after birth. Infants who later developed BPD did not exhibit a strikingly distinct immune profile.

Lingual tonsil hypertrophy is a common cause of persistent airway obstruction in patients with Down syndrome (DS) following adenotonsillectomy (TA); however, little is known about the effect of lingual tonsillectomy (LT) on polysomnographic outcomes in these patients. Our objective was to describe changes in sleep-related respiratory outcomes following LT in children with DS and persistent obstructive sleep apnea (OSA) following TA.Retrospective case series.We included all children with DS who underwent polysomnography before and after LT at a tertiary care center from 2003 to 2013. Nonparametric analysis of variables was performed.Forty patients with DS underwent LT; 21 met inclusion criteria. The mean age at surgery was 9.3 ± 4.3 years and 47.6% were female. The median apnea-hypopnea index (AHI) was 9.1 events/hour (range, 3.8 to 43.8 events/hour) before surgery and 3.7 events/hour (range, 0.5 to 24.4 events/hour) after surgery. The median improvement in overall AHI and the obstructive AHI (oAHI) were 5.1 events/hour (range, -2.9 to 41) and 5.3 events/hour (range, -2.9 to 41), respectively (P.0001). The mean oxygen saturation nadir improved from 84% to 89% (P =.004). The mean time with COIn children with DS, persistent OSA after TA and lingual tonsil hypertrophy, LT significantly improved AHI, oAHI, and O4 Laryngoscope, 2016 127:520-524, 2017.

Objectives/Hypothesis: Evaluate sexual dysfunction in patients after treatment for head and neck cancer. Study Design: Single-institution cross-sectional study. Methods: Our modified Sexual Adjustment Questionnaire was administered to 42 patients (mean age, 55.1 years) and included seven questions (total score, 7–35). Based on sexual satisfaction ratings, we categorized three groups as unsatisfied (7–16), satisfied (17–25), and very satisfied (26–35). Clinical information was obtained by reviewing medical records. Bivariate analysis tested associations between sexual satisfaction and patient-related factors (e.g., sex, age, site/cancer stage, treatment, time between treatment and survey, partner, alcohol/tobacco consumption). Pearson correlation was used to analyze two continuous variables, and multivariate logistic regression analysis was used to evaluate the independent impact of each factor. Results: All 42 patients rated that head and neck cancer negatively impacted their sexual relationships, including 21 (50%) rating effects as negative or extremely negative. Men reported higher satisfaction scores with sexual function (mean ± standard deviation) than women (19.9 ± 5.0 vs. 16.3 ± 6.5, respectively; P = .06). Respondents with partners reported higher scores than those without partners (19.9 ± 5.3 vs. 14.1 ± 4.4, respectively; P = .01). When the survey was administered (median, 12 months; range, 4–33 months) after the first treatment, mean score was 19; 57% of respondents were sexually satisfied, 31% were unsatisfied, and 12% were very satisfied. Instrument reliability was .82 (Cronbach alpha). Conclusions: Patients who are male and ≤60 years have a higher probability of sexual satisfaction during recovery. Our sexual dysfunction questionnaire will be administered in further prospective studies in patients with head and neck cancer. Laryngoscope, 2012

The objective of this study is to assess the opportunities afforded to and competence of pediatric residents in performing neonatal endotracheal intubations.The records of all intubations performed on neonates over a 3-year period at a university-based birthing hospital were reviewed to assess the relationships between outcomes, types of providers and the setting of intubations.A total of 785 attempts were made during 362 intubations. Pediatric residents were given the opportunity to intubate 38% of the cohort (n=137) and were successful on 21% of the attempts. Residents were more likely to perform intubation in the neonatal intensive care unit (vs delivery room; P0.001), in non-emergency situations (P0.001), and on older (P0.001) and larger (P=0.07) infants.Opportunities for residents to intubate neonates were few and their success rate was low. In the current care paradigm, it is doubtful if trainees can be sufficiently skilled in endotracheal intubation during residency. Residents that plan to pursue procedure-intensive subspecialties may benefit from other models for training.

Aims To determine whether extremely low birth weight (ELBW) infants with bilateral compared to unilateral intraventricular hemorrhage (IVH) have worse neurodevelopmental outcomes at 18–22 months.

We sought to determine the incidence of necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in surviving extremely low-birth-weight (ELBW