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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.

Objective: To describe the common otolaryngologic manifestations in patients with achondroplasia., Design: Retrospective review., Setting: Tertiary care children's hospital., Patients: Twenty-two patients with achondroplasia, who were treated from 1994 to 2005, with a focus on otolaryngologic diagnoses., Main Outcome Measures: Descriptive statistics of common otolaryngologic diagnoses in patients with achondroplasia., Results: Of the 22 patients, 15 (68%) received an otologic diagnosis, including 6 with recurrent otitis media and 5 with otitis media with effusion, and 11 patients (50%) underwent an otologic procedure, with 10 undergoing tympanostomy tube insertion. Nine patients (41%) had adenotonsillar hypertrophy, 6 of whom had polysomnogram-documented obstructive sleep apnea. Seven patients underwent adenotonsillectomy (TA). Two patients had significant residual postoperative obstructive sleep apnea, and 1 patient died from acute respiratory distress syndrome following TA. All patients had preoperative neurosurgical evaluation for foramen magnum stenosis, with 11 (50%) requiring decompression. No other airway or laryngeal diagnoses were seen., Conclusion: Patients with achondroplasia often present with common diagnoses such as otitis media and adenotonsillar hypertrophy, and familiarity with the condition and its common otolaryngologic manifestations improves the likelihood of successful patient care.

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.

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.

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.

Background: Congenital cholesteatoma (CC) of middle ear is a rare entity that may go undiagnosed for years. Patients with CC who are diagnosed at a later stage of disease have poor outcome. There is controversy regarding the best way to delineate CC preoperatively. More specifically, the need to obtain preoperative computed tomography (CT) scan in all cases of CC is debated., Objectives: This study was conducted to determine factors that may influence the outcome of surgery in CC as well as the value of obtaining preoperative CT scan in CC., Method: A retrospective chart review of all patients with a diagnosis of middle ear cholesteatoma operated on between 1994 and 2000 was carried out. Patients with CC were identified using the criteria proposed by Levenson and Parisier., Results: Thirty-five patients with CC were identified. In 30 (86%) patients, the diagnosis was made during ear examination and the remaining five (14%) patients were diagnosed during myringotomies. Preoperative CT scans were available in 17 patients. The findings on CT scans were classified into four categories based on the ossicular chain and mastoid septae status as well as the presence or absence of middle ear and mastoid opacification. Intraoperatively, 22 (63%) patients were found to have extensive cholesteatomas with or without extension beyond the mesotympanum. Eleven of these 22 patients had ossicular chain erosion and five were later found to have recidivism. Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 14/17 (82%) and ossicular chain status in 15/17 (88%), while micro-otoscopy predicted the extent of the existing pathology in only 10/35 (29%). Intraoperative location and size of CC influenced the type of surgical approach, status of ossicular chain, postoperative hearing level and rate of recidivism., Conclusions: Children still present with late stage CC. Micro-otoscopy is insufficient to clearly delineate the extension of CC. Preoperative CT scan is essential in defining the extent of existing pathology. The intraoperative CC size and location influence the outcome of surgery. Early surgical intervention and long-term follow-up are essential.

Objectives: To assess the complications of ventilation tubes that were retained in children for 2 years or longer and the necessity of removal., Design: A retrospective chart review of all patients who underwent ventilation tube removal from 1997 to 2000, with the exclusion of patients with craniofacial anomalies., Setting: A tertiary children's hospital., Patients: One hundred twenty-six children with ventilation tubes that were retained for 2 years or longer., Interventions: Ventilation tube removal and tympanic membrane (TM) patching., Main Outcome Measures: Otorrhea, formation of granulation tissue, TM perforation, development of cholesteatomas, and tube reinsertion., Results: A total of 126 patients aged 2(1/2) to 14 years (59 girls and 67 boys) underwent removal of their ventilation tubes after 2 years or more. The patients were divided into 2 groups. Group 1 included 67 patients (29 girls and 38 boys) who were younger than 7 years at the time of tube removal. The tubes were retained for 2 to 5(1/2) years (mean retention time, 3.3 years). Group 2 included 59 patients (30 girls and 29 boys) aged 7 years and older at the time of tube removal. The tubes were retained for 2 to 10(1/2) years (mean retention time, 4.2 years). Complications such as otorrhea, formation of granulation tissue, and TM perforation were seen in 10.3%, 13.8%, and 5.2% of the patients with tube retention of 2 to 3 years, compared with 40.0%, 40.0%, and 46.7% of patients with tube retention of more than 5 years. In group 1, transient otorrhea, formation of granulation tissue, and TM perforation occurred in 13.4%, 7.4%, and 6.0% of the patients, respectively, after 2 years of tube retention. In group 2, similar complications occurred in 23.7%, 25.4%, and 27.1% of the patients, respectively. Forty-six patients in group 1 underwent TM patching (31 with paper and 15 with absorbable gelatin film, with a success rate of 91.3%; however, 8 patients (11.9%) required tube reinsertion. In group 2, patching of the TM was done in 40 patients (13 with paper, 24 with absorbable gelatin film, and 3 with fat), with a success rate of 67.5%. Tube reinsertion was necessary in 1.7% of the patients in group 2. No cholesteatoma was encountered., Conclusions: Higher complication rates are seen in children when ventilation tubes are retained longer than 2 years. Children 7 years and older have a higher incidence of complications from the tube retention than children younger than 7 years. Early removal of ventilation tubes in children younger than 7 years of age, when the risk for otitis media is still present, may result in the need for tube reinsertion.