Search

This article discusses a case study of a 15-year-old male with a recurrent tracheoesophageal fistula (TEF) who underwent suspension microesophagoscopy for endoscopic suture closure. Traditional endoscopic repair methods for wide, short TEFs have been challenging, often requiring a thoracoscopic or open approach. However, this patient's medical history and narrow trachea made those options less feasible. Suspension microesophagoscopy allowed for improved exposure and the placement of sutures from the esophageal side, resulting in a successful closure of the TEF. This technique shows promise as an alternative for endoscopic closure of difficult-to-treat TEFs. [Extracted from the article]

Objective: Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies. Methods: We developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated. Results: Fifty‐one patients (38 pre‐ZP, 13 post‐ZP) were included. Median age was 2.3 years (IQR 1.3–3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9–6.5) to 0.4 h (IQR 0.3–0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x‐ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%. Conclusion: Implementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications. Level of Evidence: 3, Case‐series Laryngoscope, 134:5170–5177, 2024 [ABSTRACT FROM AUTHOR]

Introduction: Flexible nasolaryngoscopy (FNL) is a common, uncomfortable procedure performed to assess the upper airway in infants. Oral sucrose is used during various painful procedures in infants but has not been used during FNL. Our objective was to understand the impact of oral sucrose on discomfort in infants undergoing FNL. Methods: Infants (<12‐months‐old) undergoing FNL in the otolaryngology clinic were randomized to treatment (0.5 mL 24% oral sucrose) or standard management (no sucrose). Sucrose was administered <2 min prior to FNL performed by a single endoscopist. Outcome measures included: EVENDOL pain scale and cry duration and visit duration. Infant discomfort was measured by a second observer who was blinded to treatment group. Results: Forty‐seven infants were included, 23 were treated with sucrose and 24 with standard management. The median (IQR) age was 3.0 (2–5.7) months. There were no significant differences in age, weight, or sex across groups. The median (IQR) duration of FNL was 35.2 (26.5–58.4) and 36.4 (28.9–51.8) seconds for treatment and standard management groups, respectively. Mean (SD) EVENDOL scores were significantly lower in the sucrose group [4.9 (2.0)] than standard group (6.7 [2.1]) (p = 0.003). Mean cry duration after FNL was significantly shorter in the sucrose group (29.9 [20.4] seconds) than the standard group (52.7.0 [40.6] seconds) (p = 0.02). Median (IQR) visit duration did not differ across groups (1.1 [0.9–1.3] vs. 1.1 [0.7–1.4] h [p = 0.15]). Conclusion: Oral sucrose given before FNL reduced EVENDOL scores and cry duration after FNL and did not prolong clinic visits in this randomized pilot study. Level of Evidence: 2 Laryngoscope, 134:3826–3831, 2024 [ABSTRACT FROM AUTHOR]

Objective: Pediatric esophageal foreign bodies (EFBs) are common and can result in serious complications. Little is known about the influence of socioeconomic status (SES) on EFB ingestion in children. The goal was to study SES as a risk factor for dangerous foreign body ingestion and in‐hospital complications in children. Methods: This was a retrospective cohort study of children presenting to a tertiary care pediatric hospital with an esophageal foreign body from 2010 to 2021. SES was assessed for each patient by linking their postal code to the Ontario Marginalization Index to determine a quintile score across four dimensions of deprivation: residential instability, material deprivation, dependency, and ethnic concentration. Dangerous EFBs were defined as magnets, batteries, sharp objects, or bones. In‐hospital complications included: intensive care unit admission, prolonged length of stay, and postoperative sequelae. Results: A total of 680 patients were included. Dangerous EFB ingestion was higher for children with increased residential instability (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2–3.6) and increased material deprivation (OR, 2.2; CI, 1.9–2.8), which was similarly true for odds of complications. Odds of dangerous EFB ingestion were higher in older children (OR, 1.1; CI, 1.0–1.1) and odds of complications were higher in children with comorbidities (OR, 1.1; CI, 1.0–1.3). Conclusion: Higher levels of housing instability and material deprivation are associated with dangerous EFB ingestion and complications related to EFB ingestion. These findings emphasize the role that SES plays on child health outcomes and the need for initiatives to mitigate these disparities. Level of Evidence: 3 Laryngoscope, 134:2945–2953, 2024 [ABSTRACT FROM AUTHOR]

The current study trains, tests, and evaluates a deep learning algorithm to detect subglottic stenosis (SGS) on endoscopy. A retrospective review of patients undergoing microlaryngoscopy‐bronchoscopy was performed. A pretrained image classifier (Resnet50) was retrained and tested on 159 images of airways taken at the glottis, 106 normal‐sized airways, and 122 with SGS. Data augmentation was performed given the small sample size to prevent overfitting. Overall model accuracy was 73.3% (SD: 3.8). Precision and recall for stenosis were 77.3% (SD: 4.0) and 72.7 (SD: 4.0). F1 score for the detection of stenosis was 0.75 (SD: 0.04). Precision and recall for normal‐sized images were lower at 69% (SD: 4.35) and 74% (SD: 4), with an F1 score of 0.71 (SD: 0.04). This study demonstrates that an image classification algorithm can identify SGS on endoscopic images. Work is needed to improve diagnostic accuracy for eventual deployment of the algorithm into clinical care. [ABSTRACT FROM AUTHOR]

Objectives: Determine percentage of subglottic stenosis using current endotracheal tube (ETT) cross‐sectional areas as actual, compared with previously published ETT cross‐sectional areas as expected, and determine if style of ETT could result in a change in percentage of stenosis or Myer‐Cotton grade. Study Type: Cross‐sectional study. Design: Prospective analysis. Methods: Eight styles of uncuffed pediatric ETT from four manufacturers ranging from 2.0 to 6.0 inner diameter (ID) were evaluated. ID and outer diameter (OD) measurements were obtained from each company's specification sheets. Cross‐sectional area was calculated for each ETT using the formula (Area = πr2). The cross‐sectional areas of each current ETT (actual) were compared with those of previously published ETTs (expected) based on age, and the degree of stenosis was calculated using the formula [1‐ (Area actual/Area expected)] × 100%. Ranges of percentage for each style of ETT were calculated. Results: There was an increase in range of OD and area with increasing size of ETT ID, with the largest range in OD being 0.8 mm, and the largest range in area being 10.55 mm2. The median interquartile range (IQR), range of percentage stenoses was 11 (5%), ranging from 0% to 21%. Seven of 28 (25%) ranges were found to span two Myer‐Cotton grades. Conclusions: The Myer‐Cotton grade of subglottic stenosis depends on the style of ETT used. Using updated values from currently available ETTs aims to keep this grading system valid with respect to surgical approach and outcomes following surgery. Level of Evidence: NA Laryngoscope, 133:2808–2812, 2023 [ABSTRACT FROM AUTHOR]