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Objective: Recurrent croup (RC) is a common problem in the pediatric population. We theorize that reduced rhinorrhea and post-nasal drip as well as suppressed cough receptor activity by the anticholinergic, intranasal ipratropium bromide (IB), may lead to reduced inflammation and edema of the subglottis, decreasing RC symptoms. The aim of this study is to determine the effectiveness of IB in improving symptoms of RC and in reducing the need for alternative forms of management., Method: A retrospective chart review combined with survey data of patients with RC was conducted to assess demographic data, comorbidities, and treatment outcomes. Pediatric patients less than 10 years of age diagnosed with RC through the department of pediatric otolaryngology between 2018 and 2020 were included. Results were compared between one group treated with IB for RC and a second group treated with medications other than IB., Results: Among the 67 patients treated for RC, 34 completed survey data and were included in the study. Overall, patients who were treated with IB for RC had 1.83 less croup episodes per year (p = 0.046), a 0.5-point improvement in child symptoms (p = 0.017) and 1.3 fewer doses of steroids per year than the patients not treated with IB (p = 0.018). Patients treated with IB were significantly more likely to answer "yes," that the use of medication helped improve symptoms (p < 0.01)., Conclusion: Intranasal IB is a novel therapeutic option that may reduce RC events, improve patient symptoms and reduce steroid use. Further prospective studies are needed to definitively characterize the benefits of IB in the treatment of RC., (Copyright © 2022. Published by Elsevier B.V.)

Objective: To determine the pediatric incidence and association of superior semicircular canal dehiscence (SSCD) with inner ear (IE) anomalies., Study Design: Retrospective chart review., Setting: Two tertiary referral centers., Patients: Children less than 18 years who received a 0.5 mm or less collimated computed tomography study including the temporal bones between 2010 and 2013 for reasons including, but not limited to, hearing loss, trauma, and infection., Interventions: Images were reformatted into Pöschl and Stenver planes. Five hundred three computed tomography studies (1,006 temporal bones) were reviewed by experienced, blinded neuroradiologists., Main Outcome Measures: Incidence of SSCD and IE anomalies. Patient age, sex, and diagnosis were recorded. Statistical analysis was performed to compare outcome measures among patient demographics., Results: The incidence of SSCD was 6.2% (31/503) and an IE anomaly was 15.1% (76/503) of individuals. The incidence of SSCD with an IE anomaly was not significantly correlated (1.1%, 40/1,006; p = 0.23; LR = +1.29). The mean age of children with SSCD was lower (5.9 versus 9.8 yr; p = 0.002). SSCD incidence decreased with age (ages <2, 2-8, and 9-18 yr were 36.7%, 5.6%, and 3.2%; p<0.001) and SSC bone thickness nonsignificantly increased with age. Children with SSCD were commonly male (74.2%, p = 0.041)., Conclusion: SSCD and IE anomalies are unlikely related. SSCD incidence is highest in children <2 years, with SSC bone increasing until 2 to 8 years of age. This supports the theory of a congenital precedent to SSCD, with overlying bone maturation occurring during early childhood. Age <2 years was a significant predictor of SSCD.

Purpose: To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following adenotonsillectomy., Methods: Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013., Results: There was a significant relationship between patients who visited the ED pre-operatively, 25% (N=96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit (χ(2)=53.6, df=1, p<0.001), female gender (female=56.9%; male=43.1%; χ(2)=4.2, df=1, p=0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST=18%; RST=17.5%; OSA=11.8%; χ(2)=12.8, p=0.002) and having a post-operative ED visit., Conclusion: Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives/hypothesis: To evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage, and associated healthcare cost for pediatric adenotonsillectomy., Study Design: Retrospective chart analysis., Methods: Chart data were collected from pediatric patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and χ(2) analysis was utilized to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed., Results: A total of 1,280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the three instrumentation groups. When examining the various instruments' effect on procedure time in minutes, univariate ANOVA demonstrated a significant difference overall among the three groups (F = 8.79; P < .001). Post-hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either PlasmaBlade (P = .03) or radiofrequency ablation (P < .001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ(2) = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated to be $30.04 for monopolar cautery, $246.95 for PlasmaBlade, and $244.32 for radiofrequency ablation., Conclusions: The ideal surgical instrumentation should be cost and time efficient with a low complication rate. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates, and lower operative costs when compared to radiofrequency ablation and PlasmaBlade., Level of Evidence: 4., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To evaluate the effect of intravenous (i.v.) access in children undergoing bilateral myringotomy with pressure-equalizing tube placement., Design: One hundred healthy children were enrolled in this randomized controlled study. One group received i.v. access; the other group did not. Anesthesia in both groups was induced through a mask and maintained with oxygen, nitrous oxide, and sevoflurane. Spontaneous ventilation was maintained. All children received fentanyl, 1 microg/kg intramuscularly. Children with i.v. access received 20 mL/kg of lactated Ringer's solution. Parents were telephoned the day after surgery to report on pain and vomiting, as well as their satisfaction with anesthesia., Setting: Tertiary care children's hospital with all procedures performed by attending pediatric otolaryngologists and otolaryngology residents. Anesthesia was administered by a pediatric anesthesiologist and a trainee., Results: The groups were similar in age, weight, and incidence of vomiting. Children with i.v. access spent more time than those without (mean +/- SD minutes) in the operating room (21 +/- 8 vs 17 +/- 7; P =.02), in phase 2 recovery (75 +/- 67 vs 51 +/- 24; P =.02), and in the hospital (119 +/- 67 vs 88 +/- 30; P =.005). These children also required more pain medication (31% vs 2%; P<.001) and had a lower parental satisfaction rate (28% vs 95%; P<.001)., Conclusions: Intravenous access in otherwise healthy children undergoing myringotomy provided no added benefit. Children without i.v. access had reduced pain requirement and spent less time in the operating room, in phase 2 recovery, and in the hospital. Parental satisfaction, a clinically relevant outcome, was significantly greater for parents of children without i.v. access.

Objective: Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES)., Study Design and Setting: Patients aged 3 to 12 years from 3 clinical sites were randomly assigned and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45)., Results: Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055)., Conclusion and Significance: Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.

Objective: To determine the efficacy of phenylephrine hydrochloride, a topical vasoconstrictor, in preventing tympanostomy tube obstruction., Design: Prospective, randomized, double-blind, controlled trial of patients undergoing myringotomy with tympanostomy tube insertion., Setting: Academic, tertiary referral medical center., Patients: Two hundred eight patients were enrolled in the study; 157 patients (310 ears) returned for postoperative evaluation., Interventions: Myringotomy with tympanostomy tube insertion was performed in all ears: 139 control ears received ototopical antibiotics and 171 treatment ears received ototopical antibiotics plus topical phenylephrine., Main Outcome Measure: Postoperative tympanostomy tube obstruction., Results: The overall incidence of tympanostomy tube obstruction was 5.2%: 8.6% in the control group and 2.3% in the treatment group. The treatment group demonstrated an odds ratio of 0.25 (95% confidence interval, 0.08-0.78; P= .02)., Conclusion: The use of phenylephrine following tympanostomy tube insertion greatly reduces the incidence of tube obstruction.

A high jugular bulb is not an uncommon otologic anomaly. It may be noted as an incidental finding on physical exam, middle ear surgery, or computed tomography of the temporal bones. Frequently the patient is asymptomatic, but a high jugular bulb can occasionally cause tinnitus or conductive hearing loss. The case of a seven-year-old black male with unilateral conductive hearing loss secondary to a high jugular bulb is presented. The diagnosis, differential diagnosis, and management of a conductive hearing loss associated with a high jugular bulb are discussed.

A case of a 62-year-old man with a large mediastinal mass who had undergone aortocoronary bypass grafting 17 years earlier is presented. Computed tomography showed a 13-cm extrinsic cystic mass believed to represent a pericardial cyst or teratoma. Intraoperatively, the patient was noted to have an aneurysm of his right coronary artery bypass graft. We were able to find 4 other cases seen in this manner.