Search

Endoscopic drainage of orbital subperiostial abscess has become a reasonable alternative and in most cases a preferred method of drainage to an external approach for abscesses that result from chronic or acute ethmoid sinusitis. Several published reports indicate the success of endoscopic drainage in preschool and school age children. However, endoscopic procedures in the middle meatus in the very young child have been reported rarely. We report the successful endoscopic drainage of orbital subperiostial abscesses in three children less than a year of age (ages 7 weeks, 5 months and 11.5 months). The anatomy of the middle meatus and lateral nasal wall was adequately large enough to place both adult and pediatric telescopes for visualization. Pediatric instruments were utilized for drainage. All children had computed tomography identification of subperiostial abscess, an ophthamological exam and preoperative and postoperative intravenous antibiotics. All patients resolved their infection without morbidity, recurrence or need for further sinus procedures. We conclude that the anatomy of the nasal cavity, lateral nasal wall, and middle meatus in an infant is adequate to consider endoscopic drainage for treatment of an orbital subperiostial abscess., John E. McClay, MD; Michael J. Biavati, MD; UTSMCD, Dallas, [...]

In Response to Letter to the Editor Regarding In-Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery Thank you for your comments regarding our article "In-Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery."1 We appreciate the opportunity to provide additional information and clarification in response to your Letter to the Editor. Verbal and physical responses to the anesthesia assessment were evaluated to determine anesthesia effectiveness. [Extracted from the article]

Importance: Congenital pyriform fossa sinus tracts predispose to neck masses and neck abscesses in pediatric and occasionally adult patients. Traditional management involves open excision with substantial potential morbidity. Endoscopic management allows an alternative, less morbid treatment approach., Objective: To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts., Design, Setting, and Patients: Retrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital., Intervention: Endoscopic electrocauterization of pyriform fossa sinus tract opening., Main Outcomes and Measures: Recurrence of symptoms after endoscopic treatment., Results: Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was reported., Conclusions and Relevance: Endoscopic cauterization seems to be an effective and potentially permanent treatment for congenital pyriform fossa sinus tracts.

Objective: To compare the postoperative course, complication rate, and decannulation rate in children who underwent either sutureless or sutured posterior costal cartilage grafting during laryngotracheal reconstruction (LTR)., Design: Retrospective chart review., Setting: Tertiary care children's medical center., Patients: The study included children who required posterior costal cartilage grafting when undergoing LTR for subglottic stenosis between the years of 2000 and 2009 by the senior author (J.E.M.) and who had adequate records for review., Main Outcome Measures: Postoperative complications, including the incidence of graft prolapse, restenosis or reobstruction requiring surgical intervention, and decannulation rate., Results: Forty-nine children who underwent 52 procedures met the inclusion criteria for this study. All patients had grade III acquired subglottic stenosis and underwent double-staged LTR. Twenty procedures were performed with a sutureless posterior graft, and 32 were performed with suture placement. None of the 20 procedures that were performed with a sutureless graft had prolapse of the graft into the airway compared with 2 of 32 prolapsed posterior grafts (6%) that were sutured (P = .52). Eleven of 20 children (55%) with sutureless posterior grafts compared with 24 of 32 children (75%) who underwent sutured posterior grafts required endoscopic surgical intervention for restenosis or reobstruction (P = .22). Decannulation was achieved in 19 of 20 sutureless cases (95%) and in 28 of 30 cases (93%) in which sutures were placed (P = .56) after a single LTR and necessary endoscopic interventions occurring at 6.3 months and 4.9 months, respectfully (P = .42)., Conclusion: Sutureless posterior costal cartilage grafting in children with acquired grade III subglottic stenosis is an equally effective and secure technique compared with sutured posterior grafting during double-staged LTR.

Objective: To evaluate the incidence and type of intracranial and inner ear abnormalities in children with sensorineural hearing loss (SNHL) identified with magnetic resonance imaging (MRI) and stratified by the degree and type of SNHL., Design: Retrospective review of medical records and MRIs., Setting: Tertiary care children's hospital., Patients: A total of 227 children aged 1 month to 17 years (mean age, 5.3 years; male to female ratio, 1:1) with a diagnosis of SNHL underwent MRI from June 1,1996, to June 1, 2002. Of these children, 170 had clinical information available and technically adequate MRIs and were included in the study., Intervention: Magnetic resonance imaging., Main Outcome Measure: Identification of an abnormality of the intracranial contents, inner ear, and cochlear nerve., Results: Of the 170 children, 101 (59%) had bilateral SNHL and 69 (41%) had unilateral SNHL, comprising 271 ears with SNHL. Abnormalities of the inner ear were found in 108 ears (40%) with 87 (32%) having abnormalities of the cochlea, which were considered mild in 63 (23%) and moderate to severe in 24 (9%). Forty-nine of 271 ears (18%) with SNHL demonstrated an either absent (26/49 [53%]) or deficient (23/49 [47%]) cochlear nerve. Ears with severe and profound SNHL had more abnormalities than ears with mild and moderate SNHL (66/138 [48%] vs 23/80 [29%]; P = .006), and children having ears with unilateral moderate, severe, or profound SNHL had more inner ear abnormalities than children with bilateral moderate, severe, or profound SNHL (28/45 [62%] vs 54/144 [38%]; P = .004)., Conclusions: The overall incidence of inner ear abnormalities in ears of children with SNHL evaluated by MRI is 40%. The most common abnormalities seen were an abnormal cochlea and abnormal cochlear nerve. Children with severe and profound SNHL have a greater percentage of inner ear anomalies than children with mild or moderate SNHL. Children with unilateral hearing loss have a greater percentage of inner ear anomalies than children with bilateral SNHL.

Objective: To determine the effectiveness of using intravenous antibiotics alone to treat clinically stable children with clearly defined deep neck abscesses diagnosed by contrast-enhanced computed tomography (CT)., Design: Retrospective chart and CT scan review., Setting: Tertiary care children's hospital., Patients: The study comprised clinically stable pediatric patients who presented with signs and symptoms of a deep neck infection and who had CT scans demonstrating an abscess in the parapharyngeal space, retropharyngeal space, or both that included (1) a well-formed ring enhancement around a nonenhancing density consistent with fluid and (2) a size greater than 1 cm in every dimension., Main Outcome Measures: Clinical resolution of the signs and symptoms of the deep neck abscess after treatment with intravenous antibiotics., Results: Over a 22-month period (May 1999 to March 2001), 11 children ranging in age from 4 months to 16(1/2) years who had contrast-enhanced CT evidence of deep neck abscess and no clinical evidence of severe symptoms or significant airway compromise were initially treated with intravenous antibiotics. Ten (91%) of the 11 children responded to intravenous antibiotic therapy as their only treatment. All 10 responders began to improve clinically by 48 hours. The symptoms resolved in 5 children by treatment day 3. Five to 8 days of treatment were required to completely resolve the symptoms in the other 5 patients. The 1 child who did not respond to intravenous antibiotic therapy underwent surgical drainage of her deep neck abscess within 12 hours of admission, with purulence discovered at the time of surgery., Conclusion: In a select number of clinically stable children, deep neck abscesses diagnosed on contrast-enhanced CT scans using strict radiographic criteria can be effectively treated with intravenous antibiotics alone.

Benign congenital laryngeal cysts are rare. Infants and children with these lesions can present with chronic or intermittent airway obstructive symptoms, hoarseness, aspiration, chronic cough, or failure to thrive. The most common congenital laryngeal cysts include saccular cysts, laryngoceles, and ductal cysts. Other more unusual laryngeal lesions, such as hamartomas, choristomas, and teratomas, can also present with these symptoms. We describe a unique congenital cyst that arose in continuity with the larynx in a child with hoarseness and intermittent stridor. The features of this lesion are similar to those of bronchogenic duplication cysts of the trachea, but with histopathological features of the larynx.

Objective: To determine the extent of correlation between sensorineural hearing loss (SNHL) and abnormal temporal bone anatomy in children., Design: Axial and coronal high-resolution computed tomographic scans of the temporal bones of 247 children (494 ears) aged 2 months to 15 years with and without SNHL were blindly reviewed. The presence or absence of mild or severe cochlear dysplasias, vestibular dysplasias, and an enlarged vestibular aqueduct (VA) were recorded. The width of the VA was measured. The height, width, and length of the internal auditory canal (IAC) were measured, and abnormalities were described as narrow, widened, or bulbous. Clinical information was then reviewed to determine the presence or absence of a congenital syndrome and/or SNHL, and historical factors that might be responsible for SNHL., Main Outcome Measure: The relationship between radiographic findings and SNHL., Results: One hundred thirteen patients (185 ears) had SNHL. Significant abnormal temporal bone anatomy in children with vs without SNHL included major cochlear and vestibular dysplasias (17% vs 0%; P<.001), enlarged VA (>2 mm) (5% vs 0%; P<.001), and narrow IAC (< or =2 mm) (4% vs 1%; P=.03). The average IAC width (4.85 vs 5.02 mm), height (4.39 vs 4.62 mm), and length (11.22 vs 11.44 mm) were not statistically different between children with vs without SNHL. In children with vs without SNHL, neither a widened (0.5% vs 3.6%) nor a bulbous (9% vs 8%) IAC was seen more often in children with SNHL. In ears with SNHL, the presence of a congenital syndrome significantly increased the risk of cochlear and vestibular abnormalities of the temporal bone (45% vs 14%; P<.001), including IAC abnormalities (30% vs 2%;P<.001), which overall were more commonly seen in children with (20%) vs without (3%) a congenital syndrome regardless of the presence of SNHL. No children with an enlarged VA had a congenital syndrome., Conclusions: Well-established temporal bone abnormalities such as cochlear and vestibular abnormalities and a grossly enlarged vestibular aqueduct are significantly found in children with SNHL. A narrow IAC is found more often in children with vs without SNHL. No significant correlation is found between SNHL and radiographic findings of a widened or bulbous IAC. In children with a congenital syndrome, more IAC abnormalities were seen, regardless of the presence of SNHL. In children with SNHL, the presence of a congenital syndrome increases the likelihood of a cochlear or vestibular abnormality.