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Objective: Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden. Methods: A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars. Results: Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology—Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7–1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (P =.001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), P =.02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1–1.8)]. Conclusion: EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible. [ABSTRACT FROM AUTHOR]

Background: Tympanostomy tube insertion is a standard surgical procedure in children to address middle ear infections and effusion-related hearing and speech development issues. Perioperative treatments like ear drops containing antibiotics, steroids, and tube irrigation with saline aim to prevent complications, yet no universal gold standard treatment exists. Despite guidelines, practice preferences among ENT specialists vary, motivating this study to investigate perioperative management practices in Israel. Method: A survey was distributed among ENT surgeons, collecting data on their main workplace, sub-specialty, preoperative hearing test requirements, tube irrigation practices, tube selection criteria, and timing of tube removal. Distribution and association with main workplaces were examined. Results: The survey achieved a response rate of 27.33%. Most participants routinely required preoperative hearing tests, with a preference for conducting them within three months prior to surgery (62.2%). Tube irrigation during the procedure was less common among surgeons in the public system (p = 0.007). In response to the COVID-19 pandemic, the majority of respondents maintained their established practices (96.3%), while a small proportion (3.7%) adapted by replacing two in-person meetings with one virtual session. Variations in tube removal timing based on the main workplace were noted, with private practitioners opting for earlier removal (p = 0.002) and were less permissive in water deprivation practices (p = 0.053). Conclusion: This study provides insights into the practices and preferences of ENT surgeons in tympanostomy tube insertion procedures in Israel. Adherence to standardized practices was observed, with variations influenced by the primary workplace. Despite the COVID-19 pandemic, minimal changes were made to established practices. Further research and consensus are necessary to optimize patient outcomes and develop tailored guidelines in this field. [ABSTRACT FROM AUTHOR]

Objective: Vocal fold immobility (VFI) is a cause of significant morbidity and mortality in the paediatric population. Laryngoscopy is the current first‐line investigation for patients with suspected VFI. Laryngeal ultrasound (LUS) has recently emerged as an alternative method of identifying VFI. Compared to laryngoscopy, LUS is less invasive, does not require anaesthesia, and can be performed by non‐otolaryngologists. The objectives of this study are to evaluate LUS as a diagnostic method for the identification of VFI in a cohort of paediatric patients in Aotearoa New Zealand (NZ) and to estimate the frequency of use of LUS in the paediatric population by clinicians around the world. Methods: A retrospective, single‐centre cohort study was performed on all paediatric patients who had undergone laryngoscopy and LUS at Starship Children's Health in Auckland, NZ, between 2020 and 2023. An eight‐question survey was also developed and distributed to better understand clinicians' use of LUS in their clinical practice to diagnose paediatric VFI globally. Results: Twenty‐nine paediatric patients met the inclusion criteria. LUS demonstrated good sensitivity (80.95%) for detecting VFI and increased to 93.33% for the detection of unilateral VFI. Of the 87 respondents to the survey, 41.38% utilise LUS in their clinical practice in the paediatric population. The main barriers to implementation of LUS as identified by non‐users were lack of equipment, expertise, and training. Conclusions: These findings support the use of LUS as an accurate diagnostic tool for the detection of unilateral VFI. Further studies in non‐surgical populations and in patients with bilateral VFI, as well as standardised guidelines for LUS technique and reporting, are required. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology. Study Design: A qualitative study. Setting: Semistructured interviews of pediatric otolaryngologists. Methods: The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM‐B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM‐B domains were performed by 2 separate reviewers. Results: A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult "agenda" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret. Conclusion: Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors. [ABSTRACT FROM AUTHOR]

Introduction: Central venous thrombosis (CVT) represents a well-documented complication of acute otitis media (AOM) and acute mastoiditis (AM). Despite widespread antibiotic utilization, which has significantly reduced the incidence of severe AOM/AM complications, recent years have witnessed an increasing frequency of thrombotic complications in pediatric patients, not invariably presenting with classical neurological manifestations. Aim: This study aimed to investigate the potential correlation between COVID-19 infection and increased CVT incidence, while sharing therapeutic experiences, given the absence of standardized treatment protocols for otogenic CVT in pediatric populations. Materials and methods: A retrospective observational analysis was conducted on patients admitted to the Department of Pediatric Otolaryngology at the Medical University of Warsaw for otogenic CVT between 2018 and 2023, with treatment completion by January 2024. The investigation encompassed the extent of thrombotic changes, concurrent complications, anticoagulation therapy modalities and duration, and therapeutic monitoring protocols. Results: The study cohort comprised 13 patients, with complete follow-up data available for 11 subjects. Low-molecular-weight heparin (LMWH) monotherapy achieved a 60% success rate (defined as complete recanalization), while combination anticoagulation therapy demonstrated a 16.67% success rate. Notably, all cases exhibited regression of active thrombosis, constituting a satisfactory therapeutic outcome. Conclusions: Anticoagulation therapy demonstrated both efficacy and safety, with no significant hemorrhagic complications observed. These findings underscore the necessity for multicenter analysis to establish evidence-based clinical guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric Relapsing Polychondritis (RP) is a rare autoimmune disorder that causes inflammation and damage to cartilage in children. Common symptoms include pain, swelling and deformities in the ears, nose, trachea, joints, and eyes. The lack of research on the pediatric population necessitates further evaluation of the literature on pediatric RP to summarize existing patterns in presentation, management, and treatment. Methods: A systematic review was conducted on PubMed and Embase from 1947 to April 2023 on RP in patients under 21 years old abiding by the 2020 PRISMA checklist. Only patient presentations meeting McAdam criteria for RP and including information on management were included. Results: From the 304 initial studies, 54 studies were included for final analysis with a total of 68 patients, who were predominantly female (65%). With a median diagnostic delay of 1 year, the mean age of onset was 12 years old. The most common symptoms on presentation included bilateral auricular chondritis (69%), nasal cartilage inflammation (62%), and respiratory tract chondritis (63%). The most commonly reported information in the literature for the initial workup usually included CT/MRI (72%), bronchoscopy (57%), biopsy (51%), and labs (88%), which most commonly displayed elevated ESR (59%). The most common medications were corticosteroids (91%) and methotrexate (35%) and the most common procedural treatment was tracheostomy (38%). The most efficacious treatment options were monoclonal antibodies (87%, n = 15) and corticosteroids (66%, n = 62) used in 22% and 91% of patients, respectively. The most commonly used monoclonal antibody therapy was infliximab (13%, n = 9). Conclusion: The most common presentation for pediatric RP includes chondritis of the ear, nose, and respiratory tract. The most effective treatment options include corticosteroids and monoclonal antibody therapy, such as infliximab. Our findings highlight increasing remission achieved with anti-rheumatic drugs and monoclonal antibody treatment, especially alongside corticosteroids. [ABSTRACT FROM AUTHOR]

Objective: Representation of women and minority groups is traditionally low in Otolaryngology–Head & Neck Surgery (OHNS). This cross‐sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS. Study Design: Cross‐sectional study of North American pediatric OHNS faculty websites. Setting: North America. Methods: Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs. Results: North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h‐indices, less publications, and less citations than men (P <.001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P <.001), gender‐differences in h‐index persisted when controlling for years in practice (P <.05). Men surgeons had higher academic titles (P <.001), but there was no gender difference in leadership roles while accounting for years in practice (P =.559). White surgeons had higher academic titles than non‐White surgeons (P =.018). There was no racial/ethnic difference in leadership roles (P =.392). Conclusion: Most pediatric OHNS surgeons are men and/or White. Significant gender‐differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts. [ABSTRACT FROM AUTHOR]

Objective: While management protocols of pediatric esophageal foreign bodies (EFBs) are well‐delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury. Methods: A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary‐care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs. Results: 203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88–38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66–38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02–5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09–181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73–28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49–17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46–19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42–27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636–$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage. Conclusions: Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same‐day outpatient basis to improve the value of care. Level of Evidence: 3 Laryngoscope, 134:4774–4782, 2024 [ABSTRACT FROM AUTHOR]

Objective: Intracranial complications of pediatric sinusitis are uncommon but are often associated with significant morbidity, especially when appropriate care is delayed. The present study aimed to identify commonalities for the development and progression of these complications in the pediatric population. Data Sources: CENTRAL, CINAHL, Citation searching, ClinicalTrials.gov, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, Scopus, Web of Science, and World Health Organization. Review Methods: A comprehensive literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta‐analyses scoping review guidelines. Studies describing intracranial infections secondary to sinusitis in the pediatric population (age <18 years) were included. Studies in which adult and pediatric data were not separated and studies in which the pediatric cohort was fewer than 10 cases were excluded. Ultimately, 33 studies describing 1149 unique patient cases were included for data collection and analysis. Results: Our analysis revealed intracranial complications were more common in adolescent males. Most children presented with over 1 week of vague symptoms, such as headache and fever. The majority of complications were diagnosed radiographically with computed tomography. Subdural empyema and epidural abscess were the most common intracranial complications reported. On average, patients were admitted for over 2 weeks. Most children were treated with a combination of antibiotics and surgical intervention. Complications were rare, but when present, were often associated with significant morbidity. Conclusion: This scoping review of the available literature has provided insight into commonalities among pediatric patients who develop intracranial complications of sinusitis, providing a foundation for further study to inform medical and surgical decision‐making in this population. [ABSTRACT FROM AUTHOR]

Objective: Operating room (OR) sounds may surpass noise exposure thresholds and induce hearing loss. Noise intensity emitted by various surgical instruments during common pediatric otolaryngologic procedures were compared at the ear‐level of the surgeon and patient to evaluate the need for quality improvement measures. Study Design: Cross‐sectional study. Setting: Single tertiary care center. Methods: Noise levels were measured using the RISEPRO Sound Level Meter and SoundMeter X 10.0.4 at the ear level of surgeon and patient every 5 minutes. Operative procedure and instrument type were recorded. Measured noise levels were compared against ambient noise levels and the Apple Watch Noise application. Results: Two hundred forty‐two total occasions of noise were recorded across 62 surgical cases. Cochlear implantation surgery produces the loudest case at the ear‐level of the patient (91.8 Lq Peak dB; P <.001). The otologic drill was the loudest instrument for the patient (92.1 Lq Peak dB; P <.001), while the powered microdebrider was the loudest instrument for the surgeon (90.7 Lq Peak dB; P =.036). Noise measurements between surgeon and patient were similar (P <.05). Overall agreement between the Noise application and Sound Level Meter was excellent (intraclass correlation coefficient of 0.8, with a 95% confidence interval ranging from 0.32 to 0.92). Conclusion: Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise‐related hearing loss. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long‐term hearing conservation. Discussion: Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise‐related hearing loss. The duration, frequency of exposure, and volume levels of noise should be studied further. Implications for Practice: Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long‐term hearing conservation. [ABSTRACT FROM AUTHOR]

Objective: To identify associations between cochleovestibular anatomy findings and hearing outcomes found in children with imaging evidence of an absent or hypoplastic cochlear nerve treated with cochlear implantation (CI). Study Design: retrospective review. Setting: Cochlear implant program at tertiary care center. Methods: A retrospective review was performed to identify children with imaging evidence of cochlear nerve absence or deficiency who underwent CI evaluation. High‐resolution 3‐dimensional T2‐weighted magnetic resonance imaging in the oblique sagittal and axial planes were reviewed by a neuroradiologist to identify cochleovestibular anatomy. Hearing was assessed pre and postoperatively with Speech Perception Category scores. Results: Seven CI recipients were identified (n = 10 ears) who had bilateral severe to profound sensorineural hearing loss with lack of auditory development with binaural hearing aid trial and imaging evidence of cochlear nerve aplasia/hypoplasia. All ears had 2 nerves in the cerebellopontine angle (100%, n = 10), half of the ears had evidence of 2 or less nerves in the internal auditory canal (IAC). All children showed large improvement in speech perception after CI. Conclusion: Our experience with CIs for children with absent or hypoplastic cochlear nerves demonstrates that CI can be a viable option in select patients who satisfy preoperative audiological criteria. Radiological identification of a hypoplastic or aplastic cochlear nerve does not preclude auditory innervation of the cochlea. CI recipients in this subgroup must be counseled on difficulty in predicting postimplantation language and speech outcomes, and cautioned about facial nerve stimulation. [ABSTRACT FROM AUTHOR]

Background: Vocal cord avulsion is a rare and potentially devastating injury which may result from blunt laryngotracheal trauma. While there are cases of unilateral vocal cord avulsion, we present a pediatric patient with bilateral vocal cord avulsion from blunt trauma to the anterior neck following a trampoline accident. Case report: This 10-year-old female presented with dysphonia and dysphagia and was found to have bilateral vocal cord avulsion effecting the superior vocal fold with a noticeable height mismatch and exposed cartilage seen only on diagnostic direct laryngoscopy, corresponding to a Schaeffer Grade 3 laryngeal injury. Distal chip laryngoscopy was not as useful in providing a comprehensive examination of the patient due to muscle tension with arytenoid prolapse. Primary endoscopic repair was performed with subsequent improved vocal cord position, voice quality, and tolerance of oral intake. Why should an emergency physician be aware of this?: Laryngeal trauma in children is rare, and early detection is critical to optimize long term outcomes. To date, no universal protocol for diagnosis and management of these injuries in the pediatric population exists. A low index of suspicion of endolaryngeal injury must be maintained for children with these injuries given their smaller airway diameter and increased propensity to develop acute airway compromise in the absence of obvious warning signs or symptoms. We highlight our endoscopic repair technique and excellent postoperative course with improvements in voice, swallow, and overall quality of life.

Aim: To examine the validity of lateral neck x ray (LNXR) for the diagnosis of retropharyngeal infection (RPI) in emergency room (ER) settings. Effectiveness of conservative treatment with IV antibiotics for RPI was also examined. Methods: A retrospective analysis of patients diagnosed with RPI at a university-affiliated primary care center, between the years 2012–2022. Pre-vertebral space diameter at C2 level on LNXR was compared to a control group as well as before and after treatment. A sensitivity analysis was performed. Results: 44 and 20 patients were included in the study and control group, respectively. Median pre-vertebral thickness was significantly different between the groups (14.9 mm [IQR: 12.5, 18.4] vs. 4.1 mm [3.6, 5], p < 0.001). Sensitivity and specificity of LNXR combined with clinical presentation for RPI diagnosis were 87 % and 74 %, respectively. Median pre-vertebral space diameter before and after treatment declined significantly (14.3 mm [12.3, 18.1] vs. 7.2 mm [4.6, 9.6], p < 0.001). Conclusions: LNXR is a good and valid modality for the diagnosis of RPI, in conjunction with clinical presentation in ER setting. IV antibiotics are efficient for most children with RPI. Neck CT and surgical intervention should be reserved for select patients.

Objective: To compare patterns of obstruction in infants and toddlers with obstructive sleep apnea (OSA) by analyzing drug‐induced sleep endoscopy (DISE) examinations. Study Design: Retrospective chart review. Setting: An academic tertiary care pediatric hospital at a single institution. Methods: Children aged ≤3 years who underwent DISE with propofol titration from 2020 to 2022 were included in the study. Data extracted included age, body mass index, comorbidities, and polysomnography parameters. The sites of anatomic obstruction during DISE were recorded using a validated 10‐site scoring system. Results: A total of 86 children underwent DISE, including 15 infants (<1 year) and 71 toddlers (>1≤3 years). Sixty‐two percent were male and 37% were female. The mean age of the infant group was 9.6 months (95% confidence interval [CI]: 7.92, 11.28 months), and the mean age of the toddler group was 2.3 years (95% CI: 2.06, 2.50 years). The mean total number of sites of obstruction was not significantly different between infants (N = 2.5) and toddlers (N = 3.2, P =.086). The most common subsite of significant obstruction in both infants and toddlers was the aryepiglottic folds (46.7% and 36.8%, respectively; P =.578). The sites of obstruction and frequency of their occurrence were not significantly different between the 2 groups. Conclusion: Multisite airway obstruction is common among children with OSA, especially at the epiglottis, aryepiglottic folds, and tongue base. There is no difference in sites of obstruction and their frequency between toddlers and infants. [ABSTRACT FROM AUTHOR]

Objectives: Plagiocephaly is a flattening or asymmetry of the skull in infants that –while benign– can be distressing to parents. There are no standardized treatment recommendations, but helmeting therapy (HT) can be pursued. However, there is no strong evidence for the effectiveness of HT, leading to ambiguity for who should be offered this intervention. In this study, we aim to evaluate any differences in the proportion of patients being offered HT based on race/ethnicity, sex, or insurance type. Methods: A retrospective review from January 12th, 2017, to April 30th, 2022, of all patients with a plagiocephaly diagnosis under 18 months of age was conducted. A one-way analysis of variance was used to assess significance with differences <0.05 considered significant. Results: Of the 1667 patients identified with plagiocephaly, 807 (48.4%) patients were offered HT, and 501 (30.1%) subsequently received a helmet. Patients with public insurance represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (26.9% vs 31.8%, P =.01). Additionally, patients who identified as Black or African American represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (8.1% vs 10.6%, P =.04). Conclusion: Our study demonstrates that the proportions of patients with plagiocephaly who were offered HT compared to their overall proportion within all patients diagnosed with plagiocephaly were different for patients with public insurance and patients who identified as Black or African American. This highlights the need for standardized recommendations for HT. [ABSTRACT FROM AUTHOR]

This study aimed to clarify other diseases claimed simultaneously with acute upper respiratory infection (URI), antibiotic prescriptions, and examinations associated with infectious diseases in pediatric patients with acute URI insurance claims at otorhinolaryngology outpatient visits. Pediatric patients who visited an otolaryngology department between 2019 and 2021 and were definitively diagnosed with URI were selected using a large Japanese medical claims database. Patient backgrounds, antibiotic use, and examinations were descriptively evaluated. In total, 8010 patients were included in the analysis. The median number (interquartile range) of diseases claimed in the same month as acute URI was 4 (3–6). Only 519 (6.5 %) patients were claimed as acute URI alone. Regardless of the prescription of antibiotics, the most commonly redundantly claimed disease in these patients was allergic rhinitis, followed by acute bronchitis, acute sinusitis, and earwax impaction. The frequently prescribed antibiotics were third-generation cephalosporins, macrolides, and penicillins with extended-spectrum, including amoxicillin which was recommended by the Japanese manual; the proportion of patients with examinations was low (2.9–21.7 %). Among patients with acute URI, diagnoses requiring antibiotics were also claimed; therefore, when evaluating acute URI using the Japanese medical claims database, care must be taken in patient selection. Moreover, the implementation rate of examinations necessary for diagnosis was low, so there is an urgent need to develop an environment where examinations can be conducted in outpatient settings. [ABSTRACT FROM AUTHOR]

Purpose: To understand if high parental anxiety leads to increased post-tonsillectomy pain in children. Methods: Prospective study including parents of children aged 3–10 years old submitted to tonsillectomy with or without adenoidectomy. To evaluate anxiety, parents were asked to fill the State-Trait Anxiety Inventory form-Y, with postoperative pain being evaluated with the Wong-Baker FACES pain scale at postoperative days 1, 3 and 7. Parents were also asked to register the number of days during which children took analgesic and the number of analgesic intakes needed. Results: 41 parents were enrolled, of which 95.1% (n = 39) were female with a mean age of 35.64 years (SD 5.751), with 41 children also being enrolled, of which 85.4% of children (n = 35) underwent tonsillectomy and adenoidectomy. 43.9% (n = 18) of parents presented State anxiety scores above the cut-off level and 53.7% (n = 22) above the Trait anxiety scores above the cut-off. Children of parents with high State anxiety presented statistically higher pain scores in both the third (p = 0.035) and the seventh postoperative days (p = 0.006), with significantly longer use of analgesic medication (p = 0.043) being found, as well as a statistically higher number of analgesic intakes (p = 0.045) (Table 4). Conclusion: The present study establishes an association between preoperative parental anxiety, postoperative pain scores and the need for longer analgesic use in children undergoing tonsillectomy. This reinforces the importance of reducing parental anxiety and opens the door for further strategies to better post-tonsillectomy outcomes. [ABSTRACT FROM AUTHOR]

Objective: To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology. Study Design: Prospective randomized crossover design. Setting: Tertiary Academic Center. Methods: From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6‐question baseline test based on the information. They each watched a 2‐minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6‐questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed‐rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences. Results: Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed‐rank test indicated that postresource scores were statistically significantly higher (P <.001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process. Conclusion: The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure‐specific resources can supplement the consent process and ensure decision‐makers have adequate health literacy for informed decision‐making. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. Methods: Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. Results: There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. Conclusions: Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates. [ABSTRACT FROM AUTHOR]

Objective To systematically review the progress in the application of artificial intelligence in the field of pediatric otolaryngology-head and neck surgery at home and abroad, aiming to provide reference for the development and clinical practice in the future. Methods Literature related to the application of artificial intelligence in otolaryngology, head and neck surgery were searched from PubMed, Web of Science and Embase databases in June 2024, regardless of the research type, publication date and language restrictions. Subsequently, using the National Heart, Lung, and Blood Institute Study Quality Assessment Tools (NHI-SQAT) and the Oxford 2011 Levels of Evidence (LOE), tables were designed to assess the quality of the articles and select authentic and effective literature. Literature content was extracted, and a systematic review of current status and future prospects of artificial intelligence in this field was conducted. Results After preliminary screening of abstracts and titles, full-text reading, supplementary retrieval, and exclusion of literature that did not meet quality standards, a total of 38 articles were finally included. Artificial intelligence has been widely used in the diagnosis and treatment of pediatric otolaryngological diseases in various forms. Significant clinical effects have been achieved through methods such as machine learning and big data processing, enabling surgical assistance and the establishment of diagnostic and treatment models. In recent research, the diagnosis and treatment of pediatric otitis media, assessment of pediatric hearing loss, preoperative planning and postoperative guidance, and telemedicine are becoming the main directions of exploration and application of artificial intelligence. Conclusions Application of artificial intelligence in pediatric otolaryngology head and neck surgery at home and abroad has been gradually extended in recent years. As the use of artificial intelligence in assisted diagnosis and treatment has been gradually accepted by the medical community, the application platform for artificial intelligence will become diversified in the future. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the diagnostic and predictive factors for perennial allergic rhinitis (PAR) onset in children by analyzing the results of the Chiba High-risk Birth Cohort for Allergy study, which examined newborns with a family history of allergies. Overall, 306 pregnant women were recruited. Their newborns were examined by otolaryngologists and pediatric allergists at 1, 2, and 5 years of age. Participants with clinical and laboratory data available at all consultation points were considered eligible. Among 187 eligible participants, the prevalence rates of PAR were 2.1%, 4.3%, and 24.1% at 1, 2, and 5 years of age, respectively. AR-specific nasal local findings and eosinophils in nasal smear were observed in a substantial number of patients with PAR at 1 and 2 years of age. Factors present up to 2 years of age that were associated with PAR onset at 5 years of age, in descending order, were as follows: sensitization to house dust mites (HDM), nasal eosinophilia, and sensitization to cat dander. In 44 cases with HDM sensitization, nasal eosinophilia up to 2 years of age achieved a sensitivity of 76.0% and a specificity of 73.7% for predicting PAR onset at 5 years. Rhinitis findings and nasal eosinophilia are useful auxiliary diagnostic items for pediatric PAR. Sensitization to HDM and nasal eosinophilia were the most influential factors associated with future PAR onset. A combination of these factors may facilitate the prediction of PAR onset. [ABSTRACT FROM AUTHOR]

Objective: Families preferring to receive care in a language‐other‐than‐English have disparities in access to care. We studied the effect of implementing an ambulatory outbound scheduling team on the timeliness of scheduling referrals to pediatric otolaryngology. We hypothesized this intervention could increase access to care. Study Design: Retrospective cohort analysis. Setting: Tertiary care academic center. Methods: Data were abstracted from the hospital's enterprise database for patients referred to Otolaryngology over 3 years (October 2019‐August 2022; 7675 referrals). An outbound scheduling team was created April 2021 and tasked with calling out to schedule referrals within one business day of receipt. Referral lag was compared across patient cohorts before and after the scheduling intervention. Log‐transformed linear regression models were used to assess the impact of the scheduling intervention on referral lag for language cohorts. Results: The median preintervention referral lag was 6 days (interquartile range [IQR] 2‐18), which was reduced to 1 day postintervention (IQR 0‐5; P <.001). Preintervention language‐other‐than‐English families had a median referral lag of 8 days (IQR 2‐23), which was 1.27 times higher than for patients speaking English (P <.001). With implementation of the scheduling intervention, language‐other‐than‐English families were scheduled in a median of 1 day (IQR 0‐6), and the disparity in timeliness of scheduling was eliminated (P =.131). Postintervention, referral lag was reduced by 58% in the English and 64% in the language other than English cohorts. Conclusion: Implementation of an outbound ambulatory scheduling process reduces referral lag for all patients and eliminated a disparity in referral lag for language‐other‐than‐English families. [ABSTRACT FROM AUTHOR]

Abstract Objective To report a case of oral tongue entrapment due to a metal water bottle and review clinical considerations for managing this rare pathology. Study Design Case report and literature review. Setting Tertiary care hospital. Methods A 6‐year‐old female presented with her tongue trapped in a threaded aluminum water bottle. Upon admission, her tongue was edematous and actively bleeding, though she was spontaneously breathing. A systematic review was then performed to document similar case studies found in the literature. Results Emergency removal of the foreign body was performed in the operating room using drill cutting burrs and metal shears. The bottle was successfully removed with minimal injury to the oral tongue. The patient required nasal intubation for seven days to allow the tongue edema to subside. Subsequent literature review identified 14 similar cases, with the vast majority occurring with similar brand of aluminum water bottle. Conclusion The increasing use of reusable bottles may lead to a higher incidence of tongue entrapment cases. Awareness of this complication and appropriate management strategies are crucial to prevent severe outcomes in pediatric patients.

Purpose: Despite the robust expansion of research surrounding artificial intelligence (AI) and machine learning (ML) and their applications to medicine, these methodologies often remain opaque and inaccessible to many otolaryngologists. Especially, with the increasing ubiquity of large-language models (LLMs), such as ChatGPT and their potential implementation in clinical practice, clinicians may benefit from a baseline understanding of some aspects of AI. In this narrative review, we seek to clarify underlying concepts, illustrate applications to otolaryngology, and highlight future directions and limitations of these tools. Methods: Recent literature regarding AI principles and otolaryngologic applications of ML and LLMs was reviewed via search in PubMed and Google Scholar. Results: Significant recent strides have been made in otolaryngology research utilizing AI and ML, across all subspecialties, including neurotology, head and neck oncology, laryngology, rhinology, and sleep surgery. Potential applications suggested by recent publications include screening and diagnosis, predictive tools, clinical decision support, and clinical workflow improvement via LLMs. Ongoing concerns regarding AI in medicine include ethical concerns around bias and data sharing, as well as the "black box" problem and limitations in explainability. Conclusions: Potential implementations of AI in otolaryngology are rapidly expanding. While implementation in clinical practice remains theoretical for most of these tools, their potential power to influence the practice of otolaryngology is substantial. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Myofibromas are rare mesenchymal tumors with a predilection for the head, neck, and oral cavity. Primarily affecting infants and young children, these tumors typically manifest as superficial painless nodules. Diagnosis is confirmed through histopathological examination of a biopsy, revealing nodules characterized by spindle cell proliferation. To our knowledge, only two cases of pinna myofibroma have been previously reported in the literature. Case presentation: Here, we present the case of a three-year-old male who developed a myofibroma of the left auricle following trauma to the area one year earlier. The patient underwent surgical resection without any postoperative complications. The patient later returned with a lesion consistent with hypertrophic scar. Conclusions: This study aims to provide a comprehensive review of the clinical presentation, histopathologic and immunohistochemical features, and surgical management of this unique case of myofibroma of the pinna. [ABSTRACT FROM AUTHOR]

Introduction: Our study seeks to understand the profiles of otolaryngologists selected by Castle Connolly's Top Doctor list and how this compares to the entire field of otolaryngology. Methods: Top Doctor lists published in Castle Connolly affiliated magazines were analyzed for Otolaryngology, Otolaryngology/Facial Plastic Surgery, or Pediatric Otolaryngology physicians. Only lists published in 2021 or representing the 2021 Top Doctor lists were analyzed. Of the total 39 partnered magazines, 27 met our criteria. Information on the physician was analyzed from the Castle Connolly website and included: gender, education, faculty position, years as a Top Doctor, and certifications of each physician. Results: 879 doctors, 742 (84%) men and 137 women (16%), were included in our analysis. 509 physicians completed a fellowship, 85 (62%) women and 424 (57%) men. The fellowship type varied significantly between gender (p =.002). 122 (14%) Top Doctors completed facial and plastic reconstructive surgery and 111 (91%) were men. Of the women Top Doctors completing a fellowship, 29 (34%) completed a fellowship in pediatric otolaryngology. A logistic regression found that men have an increased odds of being on the Top Doctors list for more years than females (OR: 1.36, p <.001). Conclusion: The percentage of women named as Top Doctors was less than the proportion of women in otolaryngology. This may be attributed to gender differences we found in fellowship type and certification. Further research into the role of otolaryngology subspecialties in selection of Top Doctors is needed to better understand gender differences. [ABSTRACT FROM AUTHOR]

Objective: Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG. Study Design: Retrospective cohort. Setting: Referral center. Methods: This study included adults and children who received enPCCG for BVFMI (2010‐2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected. Results: Ten children and 11 adults underwent enPCCG for BVFMI. Eighty‐one percent of patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double‐staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensive care unit care (P = 0.004). Adults had mean 4.4 post‐enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare. Conclusion: EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double‐staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow‐up. [ABSTRACT FROM AUTHOR]

Endoscopy is the gold standard for characterizing pediatric airway disorders, however, it is limited for quantitative analysis due to lack of three‐dimensional (3D) vision and poor stereotactic depth perception. We utilize structure from motion (SfM) photogrammetry, to reconstruct 3D surfaces of pathologic and healthy pediatric larynges from monocular two‐dimensional (2D) endoscopy. Models of pediatric subglottic stenosis were 3D printed and airway endoscopies were simulated. 3D surfaces were successfully reconstructed from endoscopic videos of all models using an SfM analysis toolkit. Average subglottic surface error between SfM reconstructed surfaces and 3D printed models was 0.65 mm as measured by Modified Hausdorff Distance. Average volumetric similarity between SfM surfaces and printed models was 0.82 as measured by Jaccard Index. SfM can be used to accurately reconstruct 3D surface renderings of the larynx from 2D endoscopy video. This technique has immense potential for use in quantitative analysis of airway geometry and virtual surgical planning. [ABSTRACT FROM AUTHOR]

Objectives: Differences in management and outcomes of otolaryngologic diseases may reflect inequities driven by social determinants of health. This study aimed to investigate disparities in presentation and outcomes of retropharyngeal abscess (RPA) among 231 pediatric patients. Methods: Medical records were searched for pediatric patients with RPA from 2010 to 2021. Charts were reviewed for demographics, clinical features, and treatment decisions. Area deprivation index (ADI) scores for patient zip codes were determined. Chi‐square analysis independent samples t‐test, and regression analyses were used to investigate associations between variables. Results: Among patients presenting for RPA, Black patients were less likely to undergo surgical management than non‐Black patients (53.2% vs. 71.6%, p = 0.009). Black patients had a lower rate of treatment with antibiotics prior to hospital admission (19.4% vs. 54.4%, p < 0.001). Among patients who received surgery, Black patients had higher cross‐sectional abscess area on CT (6.4 ± 8.4 cm2 > vs. 3.8 ± 3.3 cm2, p = 0.014), longer length of stay (5.4 ± 3.3 days vs. 3.2 ± 1.5, p < 0.001), and longer time between admission and surgery (2.3 ± 2.1 vs. 0.83 ± 1.1, p < 0.001). Increased ADI was correlated with increased rate of trismus. Conclusions: Lower rates of pre‐admission antibiotics and larger abscess area on CT imaging among Black patients may suggest disparities in access to primary care, resulting in presentation to tertiary care at later stages of disease and higher rates of medical management trial prior to surgical intervention. Level of Evidence: 3 (retrospective cohort study) Laryngoscope, 134:1907–1912, 2024 [ABSTRACT FROM AUTHOR]

Objective: Geographic information systems (GIS) provide a unique set of tools to spatially analyze health care and identify patterns of health outcomes to help optimize delivery. Our goal is to create maps of pediatric tracheostomy patients using GIS to assess socioeconomic and other factors that impact postoperative care after discharge to home. Methods: A retrospective study was performed on patients (≤21 years old) who underwent tracheostomy at a tertiary care pediatric hospital from January 1, 2015 to December 31, 2020. Using GIS, we geocoded patient addresses and conducted spatial analyses of the relationship between patients and access to health care providers as well as vulnerable population factors including poverty, educational attainment, and single‐parent households. Results: A total of 156 patients were included. Patients initially discharged to transitional care (108/156, 69.2%) had significantly higher likelihood of presenting to the ED regardless of socioeconomic status (OR: 2.28, 95% CI: 1.03–5.05; p = 0.042). There was no relationship between ED visit rate and median household income, poverty level, and percentage of uneducated adults (p = 0.490; p = 0.424; p = 0.752). Median distance to the tertiary care pediatric hospital was significantly longer for patients with no ED visit (median = 61.28 miles; SD = 50.90) compared with those with an ED visit (median = 37.75 miles; SD = 35.92) (p = 0.002). Conclusion: The application of GIS could provide geo‐localized data to better understand the healthcare barriers to access for children with tracheostomies. This study uniquely integrates medical record data with socioeconomic factors and social determinants of health. Level of Evidence: 4 Laryngoscope, 134:1919–1925, 2024 [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to survey the knowledge and treatment management practices for single-sided deafness (SSD) among different subspecialties of otolaryngology. METHODS: A questionnaire was sent via Google Sheets to members of the Turkish and Egyptian Otorhinolaryngology Societies between December 2021 and February 2022. For the statistical analysis, the respondents were divided into 3 groups as otologists, non-otologists, and residents at the department of otolaryngology—head and neck department. RESULTS: There were no statistically significant differences between otologists and non-otologists in radiological imaging (child P = .469, adult P = .140) and preferred treatment method (child P = .546, adult P = .106). However, otolaryngologists showed significant differences in radiological evaluation (P < .001), vestibular evaluation (P = .000), and frequency of treatment options recommended for pediatric and adult SSD patients (P = .000). CONCLUSION: There were no significant differences in SSD diagnosis, treatment, and rehabilitation between otologists and non-otologists. However, when comparing pediatric and adult patients, there was a difference in the treatment management of SSD patients. [ABSTRACT FROM AUTHOR]

Objective: Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. Methods: A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. Results: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher‐evidence items such as randomized‐controlled trials, guidelines, and systematic reviews. A 34‐statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. Conclusions: Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. Level of Evidence: 5 Laryngoscope, 134:1437–1444, 2024 [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that affects almost one billion individuals worldwide. An estimated 16.8% of adults in Jordan have been diagnosed with OSA. Given the importance of management of OSA by otolaryngologists, we assessed the knowledge and attitudes of Jordanian otolaryngologists in managing OSA in adult and pediatric patients. A survey, conducted anonymously online, was sent present otolaryngology residents and specialist in Jordan, in the English language. The participants were given the OSA Knowledge and Attitude questionnaire (OSAKA, OSAKA-KIDS), which have been previously validated. Data were obtained and then analyzed via SPSS software. A total of 140 residents and specialist of otolaryngology were selected. A significant difference in OSAKA scores were found between otolaryngologists under 30 years of age and those above, with higher scores for the older age group. The proportion of specialists who 'agreed' or 'strongly agreed' they are confident in their ability to manage patients with OSA was significantly higher that junior residents (73.8% vs 33.3%; p = 0.008). More than 10 years at practice was associated with statistically significant higher levels of knowledge towards OSAKA scale (AOR = 0.09; p = 0.044). Additionally, being a senior resident was significantly associated with more knowledge towards OSAKA-KIDS scale (AOR = 0.19; p = 0.03). Otolaryngology residents and specialists' knowledge of OSA was very good. Further improving in the level of the knowledge toward OSA among the otolaryngology resident doctors should be implemented as possible by following the updated guidelines for the diagnosis and management OSA. [ABSTRACT FROM AUTHOR]

Objective: Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. Study Design: Survey. Setting: Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Methods: Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. Results: Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P <.001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P =.004). Conclusion: Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family. [ABSTRACT FROM AUTHOR]

Objective: Postoperative pain is the most common morbidity associated with tonsillectomy. Opioids are frequently used in multimodal posttonsillectomy analgesia regimens; however, concerns regarding respiratory depression, drug‐drug interactions, and medication misuse necessitate responsible opioid stewardship among prescribing surgeons. It is unclear if intentionally reducing opioid prescription doses negatively affects the patient experience. Methods: A quality improvement team reviewed all posttonsillectomy opioid prescriptions at a pediatric ambulatory surgery center between January and June 2021 (preintervention, 163 patients). Following this review, we performed an opioid education session for surgeons and studied opioid prescribing habits between July and December 2021 (Plan‐Do‐Study‐Act [PDSA] 1, 152 patients). We then implemented a standardized prescription protocol of 7 doses of oxycodone per patient and again reviewed prescriptions between January and June 2022 (PDSA 2, 178 patients). The following measures were evaluated: initial number of opioid doses prescribed, need for refills, 7‐day emergency department (ED) visits, and readmissions. Results: Each intervention reduced the average number of initial oxycodone doses per patient (12.2 vs 9.2 vs 6.9 doses, P <.001). There were no changes in the rate of refill requests, 7‐day ED visits, and readmissions, by descriptive or Statistical Process Control analyses. Discussion: In 2 PDSA cycles, we achieved a 43% reduction in the number of doses of oxycodone prescribed following tonsillectomy. We did not observe any increased rates in balancing measures, which are surrogates for unintentional effects of PDSA changes, including refills, ED presentations, and readmission rates. Implications for Practice: Directed provider education and standardized posttonsillectomy prescription protocols can safely decrease postoperative opioid prescribing. Further PDSA cycles are required to consider even fewer opioid prescription doses. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of neighborhood‐level social vulnerability on pediatric tonsillectomy outcomes. Methods: This single‐center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census‐tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two‐sided Pearson chi‐square tests were used, whereas for continuous variables, paired t‐tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post‐T&A complications and readmissions. Results: The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128–22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270–28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275–31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293–79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089–29.396). Conclusion: Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community‐based interventions. Because of the increased risk, it may have implications for preoperative decision‐making, treatment plans, and clinic follow‐ups. Level of Evidence: 3. Laryngoscope, 134:954–962, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To study the performance of ChatGPT in the management of laryngology and head and neck (LHN) cases. Methods: History and clinical examination of patients consulting at the Otolaryngology-Head and Neck Surgery department were presented to ChatGPT, which was interrogated for differential diagnosis, management, and treatment. The ChatGPT performance was assessed by two blinded board-certified otolaryngologists using the following items of a composite score and the Ottawa Clinic Assessment Tool: differential diagnosis; additional examination; and treatment options. The complexity of clinical cases was evaluated with the Amsterdam Clinical Challenge Scale test. Results: Forty clinical cases were submitted to ChatGPT, accounting for 14 (35%), 12 (30%), and 14 (35%) easy, moderate and difficult cases, respectively. ChatGPT indicated a significant higher number of additional examinations compared to practitioners (p = 0.001). There was a significant agreement between practitioners and ChatGPT for the indication of some common examinations (audiometry, ultrasonography, biopsy, gastrointestinal endoscopy or videofluoroscopy). ChatGPT never indicated some important additional examinations (PET–CT, voice quality assessment, or impedance-pH monitoring). ChatGPT reported highest performance in the proposition of the primary (90%) or the most plausible differential diagnoses (65%), and the therapeutic options (60–68%). The ChatGPT performance in the indication of additional examinations was lowest. Conclusions: ChatGPT is a promising adjunctive tool in LHN practice, providing extensive documentation about disease-related additional examinations, differential diagnoses, and treatments. The ChatGPT is more efficient in diagnosis and treatment, rather than in the selection of the most adequate additional examination. [ABSTRACT FROM AUTHOR]

EWSR1::CREM gene fusions are increasingly being recognized in a diverse number of soft tissue tumors, including well-defined entities such as angiomatoid fibrous histiocytoma or clear cell sarcoma, and other unclassifiable tumors. As a group, EWSR1::CREM fused tumors often demonstrate primitive spindle or epithelioid cells, myxoid stroma, and a broad immunophenotype. Herein we present an unusual case of a child diagnosed with an intranasal malignant myxoid tumor harboring an EWSR1::CREM gene fusion. To the best of our knowledge, this is the first case of intranasal myxoid tumor with this particular fusion. Diagnosis and management of the case is discussed. [ABSTRACT FROM AUTHOR]

Objective: The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low‐ and middle‐income country missions‐based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. Study Design: Retrospective cohort study. Setting: Guatemalan surgery center is called the Moore Center. Methods: Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. Results: A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty‐nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p <.001) and had a higher ASA classification (p <.001) than the 89% who did attend. Sixty‐nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p <.001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. Conclusion: This surgical center models effective surgical care in low‐resource areas. Complications and follow‐up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to identify the early pioneering women surgeons in the United States who devoted their career or the majority of their practice to the care of otolaryngologic disorders in children. We sought to share their stories, recognize their contributions to the surgical subspecialty now known as pediatric otolaryngology, and acknowledge their vision and leadership. Data Sources: Primary sources include books, published articles in the medical literature, newspaper articles, memorials/obituaries in both the medical literature and lay press, web logs, the John Q Adams Center for the History of Otolaryngology to include the Women in Otolaryngology, a number of otolaryngology departments, and children's hospitals nationwide. Interviews were conducted with former colleagues and senior pediatric otolaryngologists. Review Methods: Following review of all available information, women surgeons were included in this study if there was documentation of a clinical practice involving the otolaryngologic care of children in the United States before 1985 with demonstration of the education of others in this discipline. Results: Six women surgeons were identified: Drs. Alice G Bryant, Margaret F. Butler, Ellen James Patterson, Emily Lois Van Loon, LaVonne Bernadene Bergstrom, and Joyce A. Schild. Conclusion: Six pioneering women surgeons in the United States have been identified who devoted their practice to the care of otolaryngologic disorders in children and mentored or trained other health care providers. The stories of their lives, their contributions to the care of otolaryngologic disorders in children, and their work as mentors or educators have been described. Laryngoscope, 134:40–46, 2024 [ABSTRACT FROM AUTHOR]

The study analyzed gender disparities in authorship across top-ranked otolaryngology journals over the past decade, finding that while there has been an increase in female representation as first and last authors, females still lag behind males in these roles. Neurotology had the highest rate of females as first and last authors, while rhinology had the lowest. The study suggests the importance of addressing these disparities through measures such as mentorship programs and visible female leadership to encourage greater gender equity in the field. [Extracted from the article]

Objective: In recent years, the video sharing app TikTok has become a new venue for health care providers and medical educators. Research on health care information within the app has primarily focused on cosmetic and plastic surgery content. TikTok could potentially be a tool used to educate the public on otolaryngology‐related topics. This study is the first to analyze the quality and quantity of otolaryngology‐related TikTok content. Methods: A cross‐sectional study of TikTok accounts using otolaryngology‐related hashtags within the preceding 6 months was conducted on February 4, 2023. Deductive qualitative analysis was performed between two coders to identify themes of the accounts and their content. Results: A total of 47 accounts were selected for analysis. Facial plastic surgery was the most represented specialty (n = 20; 43%) and pediatric otolaryngology the least represented (n = 1; 2%). Content posted was primarily educational in nature (n = 30; 64%) and 66% (n = 31) of content creators advertised contact information in their account biography. The majority of accounts were in English (n = 30; 64%) and originated in the United States (n = 30; 64%). More accounts were run by male (n = 29; 62%) than female content creators. Conclusion: Otolaryngology is a broad specialty with unequal representation of the related subspecialties on TikTok, a popular social media platform. The majority of current content focuses on patient education in facial plastic surgery. Future studies are warranted to examine the potential growth and impact of otolaryngology content on this video‐based platform. Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Objective: Social media is a novel tool that many parents turn to when looking for a new healthcare provider. The purpose of this study is to assess how parents of children attending a pediatric otolaryngology practice engage with social media. Study Design: Survey Setting: Two pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Methods: Parents of children aged <18 years were surveyed. The survey consisted of 25 questions divided into 5 categories: demographics, social media accounts, social media use, use of social media to interact with pediatric otolaryngologists, and perception of pediatric otolaryngologists' social media accounts. Frequencies were calculated. Results: Three hundred five parent participants were included. 247 (81.0) were female and 57 (18.97) were male. 258 (84.6%) of the participants reported use of Facebook, which was the most popular social media platform. 238 (78.0%) of participants indicated that they would want to see medical posts and 98 (32.1%) participants indicated that they would want to see personal posts on the pediatric otolaryngologist's social media page. Younger parents were statistically more likely to check social media more often (P =.001) and seek a pediatric otolaryngologist's social media before seeing them (P =.018). Conclusion: Use of social media by pediatric otolaryngologists may positively impact the way a small percentage of their patients' parents perceive them. Social media accounts do not appear to be a vital part of pediatric otolaryngology practice in 2022. [ABSTRACT FROM AUTHOR]