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Objective To characterize otitis media-associated structures affixed to the mucosal surface of the tympanic membrane (TM) in vivo and in surgically recovered in vitro samples. Study Design Prospective case series without comparison. Setting Outpatient surgical care center. Subjects and Methods Forty pediatric subjects scheduled for tympanostomy tube placement surgery were imaged intraoperatively under general anesthesia. Postmyringotomy, a portable optical coherence tomography (OCT) imaging system assessed for the presence of any biofilm affixed to the mucosal surface of the TM. Samples of suspected microbial infection-related structures were collected through the myringotomy incision. The sampled site was subsequently reimaged with OCT to confirm collection from the original image site on the TM. In vitro analysis based on confocal laser scanning microscope (CLSM) images of fluorescence in situ hybridization-tagged samples and polymerase chain reaction (PCR) provided microbiological characterization and verification of biofilm activity. Results OCT imaging was achieved for 38 of 40 subjects (95%). Images from 38 of 38 (100%) of subjects observed with OCT showed the presence of additional microbial infection-related structures. Thirty-four samples were collected from these 38 subjects. CLSM images provided evidence of clustered bacteria in 32 of 33 (97%) of samples. PCR detected the presence of active bacterial DNA signatures in 20 of 31 (65%) of samples. Conclusion PCR and CLSM analysis of fluorescence in situ hybridization-stained samples validates the presence of active bacteria that have formed into a middle ear biofilm that extends across the mucosal layer of the TM. OCT can rapidly and noninvasively identify middle ear biofilms in subjects with severe and persistent cases of otitis media. [ABSTRACT FROM AUTHOR]

Objective: To determine the rate of recovery of pediatric vocal fold paralysis (VFP) after cardiac surgery. Study Design and Setting: Retrospective case series from January 2000 to 2005 at 4 tertiary care pediatric hospitals. Results: A total of 109 children with VFP were identified. Of 80 patients with follow-up >3 months, 28 (35%) recovered vocal fold function with a median time to diagnosis of recovery of 6.6 months. Fifty-two (65%) patients had persistent vocal fold paralysis with a median follow-up time of 16.4 months. Twenty-five (45%) of 55 patients demonstrated aspiration or laryngeal penetration with modified barium swallow. Twenty-nine (27%) of the 109 patients underwent surgical intervention for their airway, feeding, or voice. Conclusions: Pediatric VFP is not an uncommon complication after cardiac surgery and can result in serious sequelae. This study demonstrates a 35% rate of recovery, 45% rate of aspiration, and 27% rate of complications that require surgical intervention. [Copyright &y& Elsevier]

: ObjectivesTo investigate the role of the inflammatory cytokine interleukin-1β (IL-1β) in the regulation of mucin secretion by middle ear epithelia.: Study design and settingPrimary chinchilla middle ear epithelial cultures were established and exposed to IL-1β in a dose- and time-dependent manner. Mucin secretion was characterized by exclusion chromatography and liquid scintillation.: ResultsEpithelial cultures exposed to increasing doses of IL-1β demonstrated greater amounts of mucin secretion (P = 0.007). Additionally, cultures exposed to IL-1β at 50 ng/mL showed increased secretion of mucin over control noticeable at 6 hours, but significant at the 15- and 24-hour time points (P < .0001 for each).: ConclusionsIL-1β upregulates mucin secretion from cultured middle ear epithelial cells in a dose- and time-dependent manner.: SignificanceElucidating the effect of specific cytokines on the regulation of mucin secretion is vital to understanding the pathophysiology of otitis media and the development of novel therapeutic strategies. [Copyright &y& Elsevier]

Objective: 1) Present outcomes of surgically treated infantile hemangioma, and describe changes in surgical management with the advent of changes in medical therapy. 2) Highlight the role of imaging in surgical planning. 3) Identify risk factors for surgical complications. Method: Retrospective chart review of patients in a multidisciplinary clinic diagnosed with infantile hemangioma involving soft tissue and skin between 2008 and 2010. Data relating to demographics, indications for surgery, histopathology analysis, postoperative care, and complications were collected. Results: Of 1050 subjects, 109 patients (10%) underwent surgical intervention, and 78% of the lesions were in the head and neck. Ulceration, bleeding, and deformity were the major surgical indications. Seven patients underwent staged excision. Magnetic resonance imaging was utilized in diagnostic workup and preoperative planning in 15 cases. Adjunctive medical therapy was safely used in 26% of the surgical cohort. Head and neck lesions were more likely to receive adjunctive therapy (P =. 007) and had a higher complication rate. Overall complication rate was lower (6%) compared with our 2005‐2007 surgery cohort (1012 patients) with a complication rate of 17%. Conclusion: Surgery continues to be a viable form of therapy for complicated infantile hemangiomas. Introduction of propanolol and vincrinstine for challenging lesions did not change the surgery rate but may partly explain the lower complication rate secondary to preoperative reduction of surgical bulk. [ABSTRACT FROM AUTHOR]

Objective: To compare practices of the American Broncho-Esophagological Association (ABEA) membership regarding the evaluation and management of unilateral vocal fold motion impairment (UVFMI) in adult versus pediatric populations. Study design and setting: An 18-item adult survey and 16-item pediatric survey were administered to ABEA members. Results: Seventy-six adult (31%) and 35 pediatric surveys (43%) were completed. Key differences are highlighted. With respect to etiology, the most common reported childhood cause is idiopathic; adults more often suffer iatrogenic paralysis. Children more commonly experience reflux disease, feeding difficulties, and choking. Preferred testing involves flexible laryngoscopy and chest x-ray; however, laboratory tests are carried out less often in children (51% vs 71%) and medical intervention is advocated by fewer pediatric practitioners (39% vs 57%). Conclusion: Significant disparities exist in the etiology, presenting symptoms, diagnostic testing, and medical treatment between children and adults with UVFMI. Significance: Clinicians’ perceptions regarding UVFMI may reflect the differing impact of vocal paralysis in the pediatric versus adult populations. [Copyright &y& Elsevier]

Objectives: To report the management of cricopharyngeal achalasia and cricopharyngeal discoordination using botulinum toxin in children. As this treatment strategy in children has not been previously reported, appropriate diagnostic methods and indications for management are discussed.Methods: Retrospective chart review of patients who underwent cricopharyngeal botulinum toxin injection for dysphagia between January 2002 and October 2003 at a tertial care children’s hospital was performed. All patients underwent a preoperative esophageal monometry and a preoperative and postoperative video-swallow study.Results: Four children were identified during the study period. Age range was 2 years to 9 years. Etiology of the cricopharyngeal disorder was achalasia in 2 patients and discoordinated relaxation of the cricopharyngeus associated with a vagal or recurrent laryngeal nerve injury in the other 2 patients. The patients with achalasia had significantly elevated pressures across the cricopharyngeus on esophageal manometry testing. The other 2 patients did not have elevated pressures but did show a restricted flow across the cricopharyngeus. Follow-up swallow studies noted improved transit across the cricopharyngeus in all the patients. No complications were noted in these patients.Conclusions: Cricopharyngeal dysfunction with associated dysphagia in children is uncommon. The potential for developmental changes and neural recovery after injury in children make noninvasive therapeutic measures particularly attractive in this patient population. Botulinum toxin injection can be used as an alternative to a cricopharyngeal myotomy for the management of achalasia in children and can also be used safely in children with discoordinated relaxation of the cricopharyngeus for management of their dysphagia. [Copyright &y& Elsevier]

Objectives: To report the outcomes of augmentation laryngoplasty using micronized alloderm for the management unilateral vocal fold paralysis in children. Indications for acute management and the observed longevity of micronized alloderm is discussed.Methods: Retrospective chart review of patients with unilateral vocal fold paralysis surgically managed at a tertiay care hospital between July 2002 and December 2003.Results: Eight children with unilateral vocal fold paralysis were identified. Age range at the time of surgical management was 3 weeks to 17 years. Follow-up ranged from 6 months to 14 months. Etiologies included cardiac surgery, idiopathic, and brainstem ependymoma. Five of 8 (62.5%) patients were managed in the acute setting; 4 of 8 (50%) of the augmentation laryngoplasty procedures were performed for significant aspiration, and the other 4 patients were managed for dysphonia. The clinically observed longevity of the micronized alloderm was 3 to 6 months. All patients managed for aspiration had significant objective improvement, and 3/4 (75%) were discharged home feeding orally. Three of 5 (60%) of the children managed in the acute setting had recovery of vocal fold function. No airway complications were observed.Conclusions: Augmentation laryngoplasty using micronized alloderm is a safe option for the acute management of aspiration associated with a unilateral vocal fold paralysis in children. The clinically observed longevity of the collagen in children is 3 to 6 months. [Copyright &y& Elsevier]

Otolaryngologists are viewed as the experts in diagnosing and treating otitis media (OM) both medically and surgically. As experts, otolaryngologists are also often asked to comment on controversial clinical topics related to OM. The miniseminar’s format will be that of an interactive panel of experts who have contributed to the medical literature concerning current controversial topics as they relate to the selective use of antibiotics for acute otitis media, and the impact of OM on speech, language, and childhood development. A point-counter point debate will center on the topic of withholding antibiotics to allow for spontaneous resolution of acute OM and will focus on the aspects of complications, speed of recovery, accuracy of diagnosis, costs, antimicrobial resistance, and medical/legal issues. A second point-counter point debate will center on the topic of the impact that chronic OM with effusion has on childhood development, specifically related to speech and language outcomes. The moderator will provide additional points of interest regarding each of these topics and audience participation will be encouraged through an interactive format. We plan a pre- and postpresentation audience survey to assess the program’s educational impact. [Copyright &y& Elsevier]

Diagnostic strategies and treatment algorithms for pediatric dysphonia and dysphagia have undergone significant changes in recent years. With these new techniques, otolaryngologists play an increasing role in the diagnosis and management of children with these conditions, often in a multidisciplinary fashion.The miniseminar’s format will be that of a multidisciplinary interactive panel of experts from the fields of pediatric otolaryngology, pediatric speech pathology, and pediatric gastroenterology. New technology and new approaches to using existing technology in the evaluation of patients with pediatric dysphonia and dysphagia will be discussed. Discussions will focus on pediatric video-stroboscopy, voice analysis, fiberoptic endoscopic evaluation of swallowing and sensory testing, video-fluoroscopic evaluation of swallowing, and esophageal manometry.In addition, the panel will discuss use of these tools and their management of patients with pediatric voice disorders and pediatric swallowing dysfunction with an emphasis on paradoxical vocal fold dysfunction, vocal fold paralysis, children with neurologically impaired swallow, cricopharyngeal dysfunction, and esophageal dysmotility.The moderator will provide additional points of interest regarding each of these topics and audience participation will be encourage through an interactive format. We plan a pre- and postpresentation audience survey to assess the program’s educational impact. [Copyright &y& Elsevier]