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Objectives/Hypothesis: Internal auditory diverticula in adults have been found to exist independent of otosclerosis, and in the presence of otosclerosis. We sought to determine the prevalence of internal auditory canal (IAC) diverticula in a pediatric cohort, to assess whether IAC diverticula are a risk factor for hearing loss, and the co‐occurrence of otic capsule hypoattenuation. Study Design: Retrospective review. Methods: A single‐site retrospective review of high‐resolution temporal bones computed tomography (CT) scans including the presence and size of diverticula and hypoattenuation of the otic capsule. Demographic, imaging, and audiometric data were collected and descriptively analyzed. Bivariate analysis of collected variables was conducted. Comparisons between sides in unilateral cases were also performed. Results: 16/600 (2.7%; 95% CI [2.0%, 3.4%]) were found to have IAC diverticula. Six were bilateral. Thirty‐one patients (5.2%) were found to have hypoattenuation of the otic capsule. There were no coincident cases of IAC diverticulum and hypoattenuation of the otic capsule. There was no association between the presence of IAC diverticula and age (P =.13). In six patients with unilateral diverticula, pure tone average (P =.42), and word recognition (P =.27) scores were not significantly different when compared to the normal, contralateral side. Conclusions: The prevalence of IAC diverticula in children is lower than the prevalence in adults. IAC diverticula in children likely represent congenital variants of temporal bone anatomy. Similar to adult populations, there is evidence that IAC diverticula in children are likely not an independent risk factor for hearing loss. Level of Evidence: 4 Laryngoscope, 131:E1683–E1687, 2021 [ABSTRACT FROM AUTHOR]

Objective: Create and validate an objective structured assessment of technical skills (OSATS) for otolaryngology residents learning how to perform a tonsillectomy.Study Design: Multicenter prospective longitudinal validation study.Methods: A multi-institutional study at six tertiary academic otolaryngology residency programs from July 2009 to May 2012. Using the modified Delphi technique, a panel of pediatric otolaryngologists created a tonsillectomy task-based checklist (TBC) for a tonsil OSATS using a 5-point Likert-type scale. Residents were assessed by pediatric otolaryngology staff at the time of surgery with the TBC and a global rating scale. Procedure time, patient age, number of previously performed tonsillectomies, and surgical technique were also collected.Results: One hundred sixty-seven tonsil OSATS were completed for 38 residents, and competency was recorded for 99 (59.2%). Residents scored as competent had performed significantly more previous tonsillectomies than those deemed noncompetent, 44.4 ± 35.6 and 13.5 ± 11.6, respectively (P < .001). The mean overall score on the tonsil TBC was 4.0 ± 0.8 and 2.6 ± 1.0 for competent and noncompetent, respectively (P < .001). Higher number of tonsillectomies performed and mean tonsil TBC score significantly increased the likelihood of competency (P < .001). Each additional tonsillectomy performed increased the likelihood of achieving competency by 6.3% (P = .006, 95% confidence interval (CI): 1.330-1.110), and each 1.0 point increase in mean tonsil TBC score increased the likelihood of competency by a factor of 2.71 (P = .006, 95% CI:1.330-5.513). There is a 95% likelihood of competency at 48 tonsillectomies or a tonsil TBC score of 4.91.Conclusion: The tonsil OSATS is a valid and feasible instrument to assess resident competency with tonsillectomy and provides timely objective feedback.Level Of Evidence: 4. Laryngoscope, 131:E359-E366, 2021. [ABSTRACT FROM AUTHOR]

Objective: Determine attitudes within a state otolaryngologic society regarding indications for tonsillectomy and adenoidectomy and preoperative patient work-up when a diagnosis of sleep disordered breathing (SDB) is made. Design: Survey mailed in May 1998 Setting: Academic health care system Participants: A total of 199 surveys were sent out to all registered members of the participating state otolaryngologic society. The questionnaire pertained to the evaluations of 5 to 12 year-old patients who underwent Tonsillectomy, Adenoidectomy, or both (hereafter AT) during the 12 months prior to the study. Main Outcome Measures: Prevalence of 1) obstructive AT indications; 2) objective sleep data obtained prior to surgery when SDB was diagnosed; 3) successful treatment of AT indications. Results: 65 responses were adequate for analysis. The number of tonsillectomies and/or adenoidectomies performed per surgeon ranged from 6 to 310 (mean 111.47). 1) Of the AT performed, important indications for surgery were: recurrent throat infections 54.03%, obstructed breathing of any type 36.44%, obstructive sleep apnea (suspected or confirmed) 23.99%. Behavioral, cognitive or emotional problems were surgical indications in 2.75%. 2) Physicians reported obtaining sleep data 3.50% of the time prior to AT. Behavioral and/or cognitive issues were measured objectively in 1.71% prior to surgery. 3) AT significantly improved the patients&apos; symptoms when the primary indication was recurrent throat infections (90.46%), obstructive breathing of any type (87.67%), or obstructive sleep apnea (84.92%). Conclusions: Responding otolaryngologists rarely decided to obtain objective sleep studies prior to performing AT, even when SDB was a primary indication for surgery, contrasting with reports that OSA cannot be diagnosed reliably based on clinical signs and symptoms alone. A better understanding of the prevalence and magnitude of SDB in children selected for AT, particularly as they relate to behavioral, cognitive or emotional factors, may be of great benefit in treatment planning., Robert A. Weatherly, MD; Mary Grace Bock, MD; Ronald D. Chervin, MD, MPH; Ann Arbor, [...]

OBJECTIVES. Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. METHODS. We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. RESULTS. Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. CONCLUSIONS. Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms. KEY WORDS. polysomnography, sleep apnea, obstructive, tonsillectomy, child, attention-deficit disorder with hyperactivity.