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Objectives: Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of solid organ transplantation and commonly affects upper airway lymphoid tissue. Tracheal and laryngeal involvement in patients with PTLD, however, is rare. We present one such case., Methods: We report the case of a patient with recurrent PTLD involving the larynx and trachea and describe the presentation, evaluation, management, and outcome., Results: An 11-year-old boy who underwent bilateral nephrectomy and renal transplantation as an infant was admitted to the hospital with chronic cough, fever, stridor, and dyspnea. His post-transplantation course was complicated by PTLD in cervical lymph nodes at 9 years of age that was successfully treated with chemotherapy. A computed tomographic scan during his present admission revealed supraglottic swelling, a distal tracheal mass, and paratracheal lymph node enlargement. The patient underwent laryngoscopy and bronchoscopy with biopsy specimens taken from the right laryngeal ventricle and distal trachea. Pathologic examination yielded a diagnosis of Epstein-Barr virus-positive PTLD. The patient was treated with chemotherapy, which resulted in resolution of the airway lesions, as seen on repeat bronchoscopy., Conclusions: This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.

Objective: Environmental tobacco smoke exposure in children increases the incidence of upper respiratory infections, chronic sinusitis, and chronic otitis media. This study investigated the effects of ex vivo and in vitro smoke exposure on dynamic ciliary beat frequency (CBF) in pediatric adenoid explants., Study Design: Blinded and controlled prospective study., Setting: Tertiary care pediatric hospital., Subjects and Methods: Fifty-five children undergoing adenoidectomy for obstructive sleep apnea and adenotonsillar hypertrophy were enrolled in this study. Adenoids were surgically removed using currettage. Hair was collected for nicotine analysis. Tissue was sectioned into 1-mm strips and allowed to equilibrate in DMEM/F12 with 2% fetal bovine serum for 24 hours. Cilia-bearing explant tissues were treated with either DMEM/F12 media, 5% cigarette smoke extract (CSE), or 10% CSE for 24 hours. Cilia were then stimulated using either isoproterenol (10(-9) M) or methacholine (10(-6)M), and CBF was serially recorded using the Sisson-Ammons Video Analysis (SAVA) software., Results: Children with hair nicotine levels ≥ 1 ng/mg consistent with secondhand smoke exposure display blunted dynamic CBF response ex vivo. Explants incubated with CSE in vitro demonstrate significant impairment of isoproterenol and methacholine-induced CBF., Conclusion: CBF of adenoid explants increases when stimulated with isoproterenol and methacholine. Ex vivo and in vitro smoke exposure blunted ciliostimulation of CBF in adenoid explants. Smoke exposure impairs ciliary function in the pediatric airway and could potentially contribute to disorders such as chronic rhinosinusitis and chronic otitis media.

Objective: To review outcomes after supraglottoplasty for laryngomalacia and identify risk factors for supraglottoplasty failure., Study Design: Case series with chart review., Setting: Tertiary care children's hospital., Subjects and Methods: Retrospective case series evaluating patient outcomes after supraglottoplasty at an academic medical center between 2004 and 2010. Surgical failure was defined as need for revision surgery, tracheostomy tube placement, or gastrostomy tube insertion. Multivariable logistic regression was performed to identify risk factors for failure., Results: The authors identified 95 children who underwent supraglottoplasty. After excluding patients with inadequate follow-up data, 74 patients were included. On the basis of chart review, 12 (16%) of those patients were defined as failures according to the criteria above. Age, history of prematurity (<34 weeks' gestational age), weight, growth curve percentile, neurologic/developmental problems, genetic syndrome, cardiac abnormality, synchronous airway lesions, and surgical technique were considered in risk factor analysis. Multivariable logistic regression was performed, revealing history of prematurity to be the only independent risk factor for failure (odds ratio = 4.85; 95% confidence interval, 1.07-22.1; P = .041)., Conclusions: Outcomes after supraglottoplasty were comparable to previous reports in the literature. History of prematurity should be considered a risk factor for surgical failure.

Aims: To investigate 3 cases of chronic parotitis secondary to an acute bend in Stensen's duct caused by an enlargement of the masseteric space., Results: Three female patients presented with symptoms consistent with obstructive parotitis including glandular swelling and tenderness during meals. A 10-year-old patient had unilateral facial swelling with enlargement of the masseter muscle and mandible later diagnosed as fibrous dysplasia. Salivary endoscopy showed an acute bend in Stensen's duct secondary to a mass effect. The patient's parotid swelling resolved following debulking of the mandibular mass and sialendoscopy with irrigation. Two adult patients with bilateral parotid involvement presented with bilateral masseteric hypertrophy and dental wear facets consistent with bruxism. Salivary endoscopy revealed bilateral kinking of Stensen's duct with jaw closure. Both patients improved symptomatically following nightly bite guard use and ultrasound-guided Botox injections of the masseter muscle and parotid., Conclusion: Obstructive parotitis is rarely caused by an acute masseteric bend. Diagnosis of a kinking Stensen's duct is aided with salivary endoscopy and imaging to determine the precipitating pathology. In the case of masseteric hypertrophy, symptomatic improvement can be achieved with Botox-induced atrophy of masseteric hypertrophy or with surgical reduction for associated fibrous dysplasia., (Copyright © 2011 S. Karger AG, Basel.)

Objective: Although rarely encountered in the clinical setting, massive tongue edema is a known phenomenon that can occur in craniosynostotic children in the postoperative period. In 1998, Kunhert described an encounter with an adolescent patient with Crouzon syndrome who required craniectomy for complications associated with Chairi malformation [1]. Following her procedure she had rapid tongue edema which was felt to be secondary to obstruction of the venous drainage of the tongue. Despite extensive workup and unsuccessful medical attempts to reduce the swelling, she was extubated with rapid resolution of the tongue edema [1]., Methods and Results: In our facility, two children with underlying craniofacial diagnoses underwent elective surgical procedures. During their postoperative course, they encountered postoperative massive tongue swelling which ultimately required tracheotomy to relieve the compression and upper airway obstruction., Conclusion: We describe the clinical manifestations, treatment, and postoperative outcomes identified in these two cases., (Published by Elsevier Ireland Ltd.)

Objectives/hypothesis: To evaluate changes in growth curve measurements after supraglottoplasty and compare these patterns to patients with laryngomalacia treated conservatively., Study Design: Retrospective case-control study., Methods: Children treated surgically for laryngomalacia were compared to control groups of patients who underwent observation or medical treatment only. Body weight the day of surgery and on follow-up visits was plotted on a standardized growth curve and the z-score calculated., Results: A total of 15 patients were included that were observed (group 1), 71 patients that were treated with medical therapy only (group 2), and 29 patients that underwent surgery (group 3). The average z-score at the time of surgery was significantly worse in group 3 (-0.854 ± 1.080), compared to the z-score at the time of diagnosis in group 1 (-0.086 ± 0.834), and the time when antireflux therapy was initiated in group 2 (-0.120 ± 0.979). Within 3 months from surgery, significant improvement on the growth curve was seen in group 3 (P = .009). After 12 months, all three groups approached the mean on the growth curve., Conclusions: In this series, patients with severe laryngomalacia who warranted surgery presented with significantly lower percentile weight on a standardized growth curve than patients who required only medical or conservative treatment. Substantial improvement in growth curve percentile was seen in the immediate months following supraglottoplasty. Long-term follow-up after supraglottoplasty shows that infants return to a mean weight on the growth curve., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objective: To determine the influence of pediatric laryngotracheal reconstruction (LTR) on postoperative feeding status and longitudinal weight gain after surgery., Study Design: Case series with chart review., Setting: Tertiary care pediatric hospital., Subjects and Methods: We identified 30 consecutive pediatric patients undergoing LTR from November 2005 to October 2008. Demographics, stenosis grade, surgical procedure, decannulation status, preoperative feeding status and weight, discharge feeding status, and weights at follow-up were collected. Weights were plotted on standardized growth charts at surgery, during the early postoperative period (1-3 months), and during the late postoperative period (10-14 months). Growth percentiles were compared by the use of Wilcoxon signed rank test., Results: Twenty-eight patients (97%) maintained or advanced their feeding status after LTR. Twenty-one patients (72%) were oral feeders at surgery. All of these patients continued the same oral diet postoperatively. Five patients (17%) were dependent on gastrostomy before and after surgery. Three patients (10%) were fed via naso- or orogastric tubes at surgery. Two of these patients were discharged on an oral diet, and one required a gastrostomy tube. The median growth percentiles at the time of surgery, early postoperative, and late postoperative periods were nine, 18, and 32, respectively. Differences between percentiles at the time of surgery compared with early (P = 0.081) and late follow-up (P = 0.074) were not significant. In patients who were not dependent on gastrostomy, there was a significant increase in growth percentile at early follow-up (P = 0.026)., Conclusion: The performance of LTR does not influence feeding status. An early increase in median growth percentile is observed in oral feeders, but overall long-term median growth percentiles remain stable after LTR., (Copyright (c) 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: To evaluate postoperative airway-associated outcomes following sphincter pharyngoplasty., Study Design: Case series with chart review., Setting: Academic tertiary care medical center., Subjects and Methods: Postoperative management of sphincter pharyngoplasty (SP) conventionally includes overnight observation to monitor for upper airway obstruction. To evaluate for postoperative airway-related outcomes, 36 patients who underwent SP between April 2003 and January 2009 were evaluated retrospectively., Results: Mean patient age was 8.1 (SD 4.3) years. Mean follow-up was 6.5 (SD 10.7) months. Cleft palate (36.1%), velo-cardio-facial syndrome (22.2%), and post-adenoidectomy (16.7%) were the most common causes of velopharyngeal insufficiency. All patients underwent overnight observation postoperatively. Mean hospital stay was 1.2 (SD 0.5) days. Five patients remained inpatient two or three days owing to fever (2 patients), bleeding ear after concurrent otoplasty (1 patient), minimal oropharyngeal bleeding with spontaneous resolution (1 patient), and medication allergy (1 patient). No patient had a documented apneic event or desaturation below 95 percent. Although no desaturations were documented, four patients received supplemental oxygen: three for less than two hours, and one for 12 hours. All patients had adequate oral intake and pain control on oral medications prior to discharge; nine patients required one to three doses of intravenous narcotic medication for pain on postoperative day zero., Conclusion: Upper airway obstruction requiring overnight observation following SP is uncommon. In otherwise healthy patients, performing SP in an outpatient setting, given appropriate recovery room evaluation for airway concerns, oral intake, and pain control, should be considered., (Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.)

Background: Cystic fibrosis (CF) patients have a high incidence of multidrug-resistant infections, rendering CF patients a treatment challenge., Objective: To evaluate culture protocols for CF patients and develop a cost-effective culture regimen that identifies clinically relevant pathogens., Study Design: Retrospective review., Methods: At the time of endoscopic sinus surgery, CF patients underwent both sinus and bronchial lavage cultures. Medical records from 2002 to 2006 were reviewed., Results: Twenty-four cases were identified; 12 had complete sets of cultures. Seven of 12 had sinus aerobic bacteria that were also present in bronchial culture. Anaerobic cultures from both sites were all negative (42%) or nondiagnostic (58%). Thirty-three percent of sinus fungal cultures and 91.6% of bronchial fungal cultures were positive. Sinus acid fast bacillus cultures were all negative., Conclusion: CF culture protocols may be streamlined by eliminating all anaerobic cultures, as well as sinus acid fast bacillus and fungal cultures for a 52% reduction in cost.

Objective: To compare the success rates of laryngotracheoplasty (LTP) with those of anterior cricoid split (ACS) performed over the same period in infants younger than 6 months., Design: Case-control study., Setting: Tertiary children's hospital., Participants: Thirty-two infants younger than 6 months., Interventions: Twenty-one infants younger than 6 months underwent single-stage LTP as an alternative to tracheotomy, and the outcomes were compared with those in 11 infants who underwent ACS as an alternative to tracheotomy., Main Outcome Measures: Operation-specific success was defined as extubation without subsequent tracheotomy or revision open-airway procedure., Results: Infants who underwent LTP had a greater percentage of grade 3 subglottic stenosis (71%-99% obstruction) (P = .02, Fisher exact test). Mean age of patients was similar (3.7 months in the LTP group vs 2.8 months in the ACS group) with no significant difference on t test (P = .12). The operation-specific success rate was 81% (17 of 21) in the LTP group and 27% (3 of 11) in the ACS group (P = .006, Fisher exact test)., Conclusions: Single-stage LTP should be considered the first alternative to tracheotomy when subglottic stenosis is the primary airway lesion. The operation-specific success rate of 81% is comparable to reported operation-specific success rates for LTP in older children.

Congenital elevation of the scapula (Sprengel deformity) is the most common congenital abnormality involving the scapula. In up to 50% of cases, there is an associated connection, which may be osseous, cartilaginous, or fibrous, between the scapula and the lower cervical spine. To date, there have been no reports of an osseous structure extending from the medial scapula to the clavicle and occipital region of the skull associated with Sprengel deformity.

Objectives: Treatment of type I laryngeal clefts (T1LCs) remains controversial. We present our experience with 16 endoscopic T1LC repairs to evaluate the effect of patient characteristics and surgical technique on outcomes., Methods: A retrospective study was performed. Diagnosis of T1LC was made by interarytenoid palpation during operative microlaryngoscopy. Two surgeons performed endoscopic repair using either microflap reconstruction or laser demucosalization and reapproximation. All patients received preoperative and postoperative modified barium swallow (MBS) studies. Improved MBS at 3-5 months determined success of repair. Factors contributing to success of repair were analyzed statistically., Results: No intraoperative complications occurred. One T1LC repair dehisced after 3 months. Overall, 11 of 16 repairs (68.8%) were successful. Mean age at repair was 23.3 months. Length of stay for microflap repair was significantly shorter than for laser reapproximation (0.89 days vs. 4.6 days, p<0.001, two-tail t-test). The difference in patient age between failures and successes (21.3 months vs. 24.2 months) was non-significant (p=0.661, two-tail t-test). Success for the nine patients receiving microflap reconstruction (77.8%) vs. the seven receiving laser reapproximation (57.1%) is comparable (p=0.596, Fisher's exact test). No correlation between comorbidities and failure was found (p>0.05, Fisher's exact test)., Conclusions: This series matches the largest reported series of endoscopic T1LC repairs. Success rates were lower than in previously reported studies, and comorbidities were higher. However, comorbidities did not contribute to surgical failure. No difference in outcome was seen between the two endoscopic techniques. Microflap repair may require a shorter hospital stay.

Blunt neck trauma is not common in children, but these injuries can be potentially life-threatening. Presenting symptoms and signs of laryngeal injuries are often subtle, and poor outcomes in regard to voice and airway function are associated with delayed diagnosis. The purpose of this report was to present a pediatric case that illustrates the subtle symptoms and signs of a laryngeal laceration. In this case, the appearance of the laryngeal laceration was similar to the glottis, highlighting the importance of developing airway management guidelines for blunt laryngeal injuries in children.

Objective: To evaluate the utility of therapy with the cyclic cogener of the anti-cytomegalovirus (CMV) agent cidofovir against CMV-induced hearing loss in a guinea pig model., Design: Thirty-six guinea pigs were randomly divided into 4 groups of 9. All groups underwent auditory brainstem response testing on days 0, 4, 7, 14, 21, and 28. Group 1 received no intervention. Group 2 underwent sham surgery consisting of unilateral round window injection of 25 microL of sterile viral media on day 0. Groups 3 and 4 underwent round window injection of 1.7 x 10(5) plaque-forming units of guinea pig CMV on day 0. Group 4 received antiviral treatment with intraperitoneal injection of cidofovir (20 mg/kg) on days 1 and 5 after inoculation., Setting: An animal research facility., Subjects: Thirty-six weanling Hartley guinea pigs., Results: Of the animals who received guinea pig CMV and no cidofovir treatment, 4 of 9 (day 4) and 5 of 9 (days 7 and 28) demonstrated a hearing loss of at least 30 dB. In contrast, none of the animals in the untreated, sham surgery, or cidofovir-treated groups had a hearing loss of greater than 20 dB. This difference was statistically significant for day 4 (P = .04, 1-tailed Fisher exact test), day 7 (P = .01), and day 28 (P = .01). Histologic evaluation of hearing-impaired animals revealed inflammatory infiltrates, particularly in the scala tympani. Fibrosis of the basal turn of the cochlea was observed in 7 of 9 untreated animals and 1 of 9 treated animals., Conclusion: Cidofovir therapy prevents CMV-induced hearing loss and associated histologic changes in guinea pigs.

Objective: To assess the efficacy of open excision as an alternative to tracheostomy in the management of subglottic hemangioma., Design: A retrospective review of patients undergoing open surgical excision of subglottic hemangiomas over a 10-year period., Setting: A tertiary pediatric center., Patients: The study included 22 children ranging in age from 2 to 42 months (median age, 5 months) who underwent open excision of subglottic hemangioma over a 10-year period., Results: Twenty-one patients were treated with single-stage procedures, with postoperative endotracheal intubation for an average of 5 days. One patient who had a preexisting tracheostomy was treated with a 2-stage procedure and underwent decannulation 2 months after excision. Seven other patients were tracheostomy dependent at the time of excision and underwent decannulation at the time of the procedure. Cartilage grafts were inserted in 10 patients. There were no problems with subglottic stenosis. Twenty-one patients reported good voice and no airway symptoms after a mean follow-up period of 42 months. Five patients had significant postoperative problems. Three patients required further endoscopic procedures for removal of granulation tissue, and 1 patient, who remains minimally symptomatic, developed an anterior glottic web. One patient required a 6-month course of steroids after surgery to treat residual glottic hemangioma., Conclusions: Open surgical excision of subglottic hemangiomas can be performed as a single procedure, avoiding a tracheostomy, when modern surgical techniques developed for laryngotracheal reconstruction are incorporated. This approach can avoid repeated endoscopic procedures, prolonged treatment with corticosteroids, and years spent with a tracheostomy waiting for spontaneous involution of the hemangioma.

Background: Stereotactic computer-aided surgery has provided the surgeon with a means to navigate more safely through diseased or surgically altered sinus anatomy. Accurate registration is vital to successful image-guided surgery. This study compared the accuracy and performance of three registration methods: fiducial, anatomic landmarks, and surface registration., Methods: Ten fixed cadaveric heads underwent endoscopic computed tomography scan followed by middle meatal antrostomy and sphenoidotomy. Each registration method was performed, and the time required and mean registration error were recorded. Five anatomic sites were then identified and compared with the preoperative computed tomography images. The true distances between the known anatomic sites and the crosshair locations on the images were measured., Results: Statistically significant differences were noted for mean registration error and time for registration. The mean +/-SEM time for registration for the fiducial, surface, and landmark methods were 5 minutes 24 seconds +/-27 seconds, 1 minute 1 second +/-5 seconds, and 11 minutes 46 seconds +/-45 seconds, respectively. The mean +/-SEM registration error for the fiducial, surface, and landmark methods were 0.48 +/- 0.21 mm, 1.05 +/- 0.06 mm, and 3.1 +/- 0.25 mm, respectively. When the true accuracy of the three registration methods were compared, no significant difference was found between fiducial and surface registration. However, fiducial registration was significantly more accurate than landmark registration at all points. When compared with landmark registration, surface registration was statistically more accurate at all anatomic sites except for the sella turcica and optic nerve., Conclusion: When the true accuracies of these methods were compared in fixed cadaveric specimens,fiducial and surface registration were statistically similar but were found to be significantly more accurate than landmark registration. Furthermore, when time of registration, accuracy, and ease of use were considered, surface registration was found superior.

Pediatric rhabdomyosarcoma is not exclusive to the head and neck. However, the unique anatomy of the head and neck requires special consideration and treatment modifications. The low incidence of these tumors has prevented the development of rigorous treatment protocols. Treatment strategies must be individualized on the basis of histopathologic subtype, prognostic indicators, tumor location, tumor extent, available clinical trial data, and hospital resources. The primary treatment of these tumors typically involves a combination of surgery, radiation, and chemotherapy. Advancements in surgical and radiotherapy techniques have reduced patient morbidity, whereas new chemotherapeutic protocols have improved local disease control and overall survival. Because of the infrequency and complexity of these tumors, patients may benefit from referral to centers with a comprehensive multidisciplinary team that has experience treating these tumors in the pediatric population. If possible, patients should be enrolled and treated on the current Children's Oncology Group protocol.

Objective: To identify risk factors for operation-specific outcomes of pediatric cricotracheal resection (CTR)., Design: We identified the first 100 consecutive children undergoing CTR at our institution from January 1, 1993, to December 31, 2004. Retrospective review of medical records provided data on demographics, operation dates, decannulation dates, and proposed risk factors, including age, stenosis grade, vocal cord function, Down syndrome, history of distal tracheal surgery, history of open laryngotracheal surgery, presence of tracheotomy at the time of operation, use of suprahyoid release, extended CTR, and use of chin-to-chest sutures. Complete data sets were available for 93 patients. We performed multivariable logistic regression analysis to identify significant independent risk factors., Setting: A tertiary care children's hospital., Patients: All patients younger than 18 years who underwent CTR at our institution., Main Outcome Measures: Operation-specific and overall decannulation rates., Results: Results of the preoperative evaluation showed grade III or IV stenosis in 89 patients (96%). The overall decannulation rate included 87 patients (94%); the operation-specific decannulation rate, 66 patients (71%). The only significant risk factor for failure to decannulate after 1 operation was the presence of unilateral or bilateral vocal cord paralysis (P = .007)., Conclusions: Cricotraceal resection may be safely performed in patients with multiple airway lesions. Patients with a history of vocal cord paralysis who undergo CTR often require more than 1 open airway procedure for decannulation and should be counseled appropriately. This study represents the largest reported series of pediatric CTR.

Objective: Reconstruction of the laryngotracheal airway in pediatric burn victims has been described anecdotally as less successful than reconstruction performed in other populations. To evaluate this clinical impression, outcomes of laryngotracheal reconstruction (LTR) in pediatric burn victims were compared with a randomly selected, matched control population of children receiving LTR., Design: Retrospective case control study., Subjects: The records of 34 pediatric burn victims undergoing LTR were reviewed. A control group of 48 children undergoing LTR for acquired stenosis was randomly selected from a population matched for age and grade of stenosis., Results: Decannulation rate after 1st procedure, number of open airway procedures required, and length of time after 1st procedure until decannulation were not significantly different between the 2 groups. Two deaths (both tracheostomy tube related) occurred in the burn group; 1 occurred in the control group. Two patients in the burn group and 3 patients in the control group remain tracheostomy tube dependent at least 1 year after the initial reconstructive attempt., Conclusions: Long-term outcomes of LTR in burn patients are not significantly different from outcomes of LTR in the pediatric acquired airway stenosis population.

Unlabelled: Patients with Coloboma, Heart defect, choanal Atresia, Retarded development, Genitorenal and Ear abnormalities (CHARGE) syndrome have been reported to be at high risk for aspiration and swallowing difficulties. Aspiration has been implicated as the most common cause of mortality in these patients. To date, however, aspiration and swallowing disorders in CHARGE patients have not been independently studied., Objective: To determine the prevalence of aspiration and swallowing dysfunction in children with CHARGE syndrome., Methods: A retrospective chart review of 30 children with CHARGE syndrome was performed., Results: Eighteen (60%) children had aspiration observed on video swallow study (VSS), flexible endoscopic evaluation of swallowing (FEES), and/or had otherwise unexplained bronchiectasis noted on CT scan of the chest. Twenty-four children (80%) had evidence of abnormal swallowing such as laryngeal penetration, dyscoordination, poor bolus mobility, or pooling of secretions., Conclusion: Aspiration and swallowing dysfunction are common in children with CHARGE syndrome. Formal evaluation of swallowing function should be part of the standard otolaryngologic examination for these patients.

Introduction: Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures., Study Design: Retrospective case control study., Methods: Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared., Results: Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced., Conclusions: Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing.

Prevention and early recognition remain critical factors in the treatment of foreign body inhalation in children. Accidental inhalation of both organic and nonorganic foreign body material continues to be a cause of childhood morbidity and mortality. The University of North Carolina Department of Otolaryngology has collected foreign bodies acquired from the airways of young children since its inception in 1954. The authors reviewed 26 foreign bodies removed bronchoscopically from the airways of children during the years 1955 to 1960, and compared these to 27 foreign bodies collected from 1999 to 2003. Findings showed remarkable similarities in the types of foreign bodies aspirated. Organic foreign bodies were most commonly found. Differences existed in the type of organic foreign body aspirated, with popcorn being retrieved in 15% of cases during the later time period. Also, an increase in bronchoscopically removed small toy parts was found in the later group.

Introduction: Cross-contamination of Venturi atomizers has been reported., Methods: In phase I, 16 atomizers were sterilized and refilled with either 1% lidocaine or 0.1% Tyzine (day 0). During phase II, atomizers were wiped with isopropyl alcohol wipes between uses. In both phases, on days 7, 14, 21, and 28, the contents of the atomizer were sprayed onto two culture media. If a culture was found positive, cultures from the nozzle, lumen, and solution were taken and cultured in depth., Results: Twelve lidocaine bottles and three Tyzine bottles were initially positive. There were more positive cultures from lidocaine bottles than Tyzine bottles at 2 weeks (p = 0.02). After wiping with isopropyl alcohol, contamination was significantly reduced in the lidocaine bottles at 2 weeks (p = 0.02)., Conclusion: Microbial contamination of questionable clinical significance may occur with nasal atomizers. Regardless of this significance, wiping the devices with isopropyl alcohol can eliminate microbial growth for a 2-week interval.

Objectives: Endoscopic repair of cerebrospinal fluid (CSF) leaks has proven to be effective and safe. CSF rhinorrhea is a well-known complication of neurosurgical procedures in the anterior cranial fossa. We present a series of endoscopic repairs of CSF rhinorrhea secondary to neurosurgical procedures., Study Design: Retrospective review of 13 cases., Methods: Thirteen patients are included in the study. Eleven had CSF leaks after hypophysectomy, one after clipping of an anterior circle of Willis aneurysm, and one after posttraumatic frontal lobe debridement. Leaks were identified intraoperatively during the neurosurgical procedure (n = 8) or with intrathecal fluorescein injection during a separate procedure (n = 5). Repair was performed by exposing the skull base defect, debriding the defect margins, and sealing the defect with a free mucosal graft or abdominal fat., Results: Leaks were identified in the sphenoid (n = 12) and posterior ethmoid (n = 1) sinuses. Nine patients had lumbar drains placed. One patient had recurrence of CSF rhinorrhea 2 months after initial repair requiring a revision procedure. No other recurrences were noted. One patient developed postoperative meningitis requiring intravenous antibiotics and a prolonged hospital stay. No other postoperative complications were observed., Conclusions: Endoscopic repair is a safe and effective treatment for CSF rhinorrhea encountered as a neurosurgical complication.

Objective: At the conclusion of the report, the readers should be able to recognize the rare complication of adenotonsillectomy of Grisel syndrome, discuss its pathogenesis, and provide early, effective treatment., Study Design: Analysis of the clinical presentation, plain radiographs, computed tomography scans, and magnetic resonance imaging scans of a child with Grisel syndrome after adenotonsillectomy., Methods: Retrospective study of the case record and a review of the literature regarding the pathogenesis, treatment modalities, outcome, and prognosis after early and delayed treatment of Grisel syndrome., Results: Pathophysiology of atlantoaxial subluxation revolves around the periodontoid vascular plexus that drains the posterosuperior pharyngeal region. Infectious and inflammatory emboli cause synovial engorgement, weakening paraspinal ligaments. Radiological studies play an important role in diagnosis. Treatment consists of cervical immobilization, muscle relaxants, analgesics, and antibiotics. Full resolution is expected with early conservative management. Failure to recognize the syndrome can lead to catastrophic results., Conclusions: Recognition of Grisel syndrome in addition to other rare complications of adenotonsillectomy requires a high index of suspicion. Early intervention is the critical factor for a positive outcome. However, delayed diagnosis is common and can result in catastrophic consequences, including neurological deficits, cosmetic deformity and, in rare instances, paralysis and death in the short term.

Objectives: We investigated the role of soluble interleukin (IL)-4 receptors (sIL-4R) and IL-5 antibodies (IL-5Ab) in preventing allergic eustachian tube dysfunction (ETD) and middle ear effusion (MEE)., Study Design: Brown-Norway rats were sensitized to ovalbumin (OVA) and challenged transtympanically. Two groups of rats received either IL-4R or IL-5Ab transtympanically 1 hour before challenge. Three additional groups were used as controls. Following the second transtympanic challenge, the ventilatory and clearance functions of the eustachian tube (ET) were assessed at 0, 2, and 8 hours. Histology was prepared using cut paraffin sections stained with hematoxylin and eosin., Results: sIL-4R-pretreated rats showed no significant changes in ventilatory or clearance functions of the ET or inflammatory changes in ET mucosa, whereas IL-5Ab pretreatment showed significant late ventilatory and clearance dysfunction as well as inflammatory mucosal changes., Conclusion: These data demonstrate that the late-phase allergic inflammatory response that leads to subsequent formation of ETD and MEE is prevented by pretreatment with sIL-4R and, more modestly, with IL-5Ab.

Objective: To explore the possible relationship between gastroesophageal reflux and eustachian tube dysfunction in an animal model., Study Design: Randomized trial., Methods: Twenty Sprague-Dawley rats were randomly assigned into two groups, the control (phosphate-buffered saline, n = 10) and experimental (hydrochloric acid [HCl]/pepsin, n = 10) groups. All rats underwent an operation to implant a polyethylene tube into the posterior nasopharynx, through which phosphate-buffered solution or simulated gastric juice (0.5 mg/mL pepsin in 0.01 HCl) was infused at a rate of 0.1 mL/h for 2 0 minutes three times a day for 7 days. Passive opening pressure (POP), passive closing pressure (PCP), active clearance of positive pressure (ACPP) and active clearance of negative pressure (ACNP) were measured before catheter implantation, on postoperative day 5, and after days 1, 3, 5, and 7 of infusion. Mucociliary clearance time (MCCT) was measured after day 7 of infusion. Statistical analysis used a two-way analysis of variance (POP, PCP, ACPP, and ACNP) and Mann-Whitney rank sum test (MCCT)., Results: Significant increases in POP (P = .004), PCP (P <.001), ACPP (P <.001), ACNP (P <.001), and MCCT (P <.001) were demonstrated in the HCl/pepsin group compared with the control group. No significant difference was seen between preoperative and postoperative values., Conclusions: Nasopharyngeal exposure to simulated gastric juice causes eustachian tube dysfunction in rats. Specifically, middle ear pressure regulation and mucociliary clearance of middle ear contents were disabled. These results support recent reports in the literature linking nasopharyngeal reflux to eustachian tube dysfunction and secondary development of otitis media.