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Introduction: Chronic rhinosinusitis (CRS) and asthma frequently coexhist in children leading to the unified airway theory. Although obesity has been associated with CRS and asthma in adults, studies exploring that association in children are limited. The goal of this study was to evaluate the association between obesity and the unified airway in children. Methods: A retrospective case-control study was performed in children aged 2 to 18 years presenting to our clinic between July 2020 and February 2024. Patient's demographics and comorbidities were reviewed. Children's obesity was classified based on their percentile body mass index of 95% and more. Asthma and CRS diagnoses were determined based on published guidelines. Results: A total of 406 pediatric patients met criteria, with 130 children (32%) with obesity. Children with CRS had a mean computed tomography (CT) Lund-Mackay score of 7.2 (SD of 6.3) and a mean endoscopy modified Lund-Kennedy score of 2.7 (SD of 2.9). Children with obesity were older (11.3 years vs 10.2 years, P = .039) and more likely to have asthma (28.5% vs 15.2%, P = .002) and obstructive sleep apnea (26.2% vs 13%, P = .001). Multivariate logistic regression showed an association between obesity and asthma (OR = 1.84, P = .029), but not with CRS (OR = 1.08, P = .856) or allergic rhinitis (OR = 1.05, P = .856). Conclusion: This study suggests an association between obesity and asthma but not with CRS in children. Further studies should explore whether there is any role for obesity in the treatment of CRS., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Key Points: Social determinants of health link to worse quality of life in pediatric chronic rhinosinusitis. The area deprivation index (ADI) may serve to predict health disparities in these patients., (© 2024 ARS‐AAOA, LLC.)

Objectives: To identify the differences in the impact of chronic rhinosinusitis (CRS) between female and male adolescent patients at presentation., Study Design: Cross sectional study., Methods: Adolescent patients, age 12 to 18 years old, presenting to our Otolaryngology clinic between August 2020 and April 2023 for CRS were asked to fill both the SNOT-22 and the SN5 forms. Female and male cohorts were compared regarding their demographics, comorbidities, subjective and objective disease measurements, and choice of treatment., Results: Sixty-six patients were included, 30 female and 36 male patients. There were no differences in age, allergic rhinitis, asthma, obstructive sleep apnea, presence of nasal septal deviation, and objective disease severity ( P  > .05 for all). At presentation, mean overall SNOT-22, ear/facial, sleep, and psychological domains were all higher in female patients (43vs 30.9, P  = .02; 9.1vs 6, P  = .03; 11.8vs 8.3, P  = .07; 14.1vs 8.8, P  = .02 respectively). SN5 scores and overall QoL visual analog scale were similar in females and males., Conclusion: Female patients with CRS show higher subjective disease burden. Incorporating data on gender-specific differences may be important to personalize treatment decision making., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Periorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children., Study Design: Retrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS., Setting: Patients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022., Methods: Patients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients' characteristics, treatment, hospital length of stay, and readmission were collected., Results: The sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups., Conclusion: Children presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Rhinosinusitis is a common diagnosis encountered by providers of all disciplines. Pediatric acute and chronic rhinosinusitis account for up to 2% of the total annual visits to the outpatient clinics and emergency departments. Once correct diagnosis is made, appropriate treatment measures can be initiated. It is important to recognize rhinosinusitis in children due to the potential serious complications and the impact it may have on quality of life of those children. Medical management is the mainstay of treatment, and, fortunately, it is successful in most of those children. When medical management fails, or a complication occurs, surgery may be required., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the frequency and types of humoral immunodeficiencies (HID) in pediatric and adult patients with recurrent (RARS). Patients with HID commonly present with upper respiratory tract infections. Their pathophysiology in children is different than adult counterparts. It is unknown how HID affects those two age groups., Materials and Methods: We performed a retrospective chart review of pediatric (<18 years old) and adult (18 years and older) patients who were evaluated in our pediatric and adult rhinology clinic between July 2010 and December 2020 and had the diagnosis of recurrent (>3 times/year) rhinosinusitis. Patients with cystic fibrosis, Aspirin Exacerbated Respiratory Disease (AERD), and ciliary dyskinesia were excluded. Demographic data and associated conditions were reviewed. Immunologic evaluation included complete blood cell count (CBC) with differential, serum immunoglobulin G, A, and M levels, and baseline and post-vaccination pneumococcal antibody titers., Results: There were 135 patients who met the inclusion criteria. 86 patients (63.7%) were children, 49 patients (36.3%) were adults. 46.5% of the pediatric patients and 45% of the adult patients were female. 17.4% of children had abnormal immunologic findings: 8 had hypogammaglobulinemia (p < 0.0001), 2 had specific antibody deficiency (SAD), and 5 had selective IgA deficiency. 32.7% of adults (p < 0.0001) had abnormal immunologic findings: 4 had hypogammaglobulinemia, 11 had SAD (p < 0.0001), and 1 patient had both IgA deficiency and SAD., Conclusion: Humoral immunodeficiency, specifically SAD, seems to be more common in adult versus pediatric RARS that is refractory to treatment., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: This case report describes a method of restoring function and aesthetics in a 9-year-old girl with ectodermal dysplasia with 15 years follow-up. Ectodermal dysplasia is both physically and emotionally devastating to patients. It is important that they are treated at an early age to help their social interaction. With proper dental intervention, the quality of life can be improved for patients with ectodermal dysplasia.

As the body's largest organ and first line of defense against the environment, the skin plays a vital role in host immune defense. In addition to its function as a physical barrier, the skin contains an active immune surveillance network and can mount highly specific responses to eliminate invading organisms. In this review, we discuss the functions of adhesion molecules in regulating the recruitment of distinct cell populations to skin in both healthy and disease states, and the interaction between innate and adaptive immune mechanisms active in the skin. We also review how these systems underlie the pathogenesis of skin manifestations of pediatric rheumatologic diseases.

To evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2 (1535 mm2 on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

We reviewed our experience with 17 cases of posterior urethral disruption due to traumatic pelvic injuries. In all cases, a suprapubic cystostomy was performed at first. For blunt injuries, urethroplasty was delayed for 6 months in average. For most of the penetrating injuries (3/4), we performed immediate debridement and primary repair. Resulting bulbous or membranous strictures less than 3 cm long were treated with one-stage perineal excision-reanastomosis urethroplasty. Membranous strictures longer than 3 cm were managed with a combined transpubic-perineal repair, while bulbous defects longer than 3 cm were treated with a scrotal pedicled island flap. The overall restricture rate was 25%. Those having had initial repeated urethrotomies displayed a 100% restenosis rate. Incontinence rate was 12.5% Erectile dysfunction occurring in 42% of our patients is a sequela of the pelvic injury and was found to be directly related postoperatively to its presence at the time of surgery.

This study describes the results of 50 consecutive cases of varicocelectomy by the inguinal approach. The testicle is delivered through a small inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under optical magnification. The testicular artery, the lymphatics and the vas deferens are identified and preserved. All internal spermatic veins are ligated. 94 varicocelectomies were performed in 50 men. Follow-up period extended from 12 months to 24 months. No hydroceles, no clinical recurrences and no wound infection were found. One scrotal hematoma occurred and resolved progressively. Preoperative and postoperative semen analysis were obtained. The changes in sperm count mean value (million/cc) (20 to 28.6) (p < 0.005), per cent normal forms (42.9 to 52.1%) (p < 0.005) and per cent motility (31.5 to 39.2%) (p < 0.005) were significant. The pregnancy rate was 10 of 21 couples available for follow-up (47.6%). This technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele clinical recurrence.

An enterocystoplasty was done on 17 paraplegic adults patients (Beit Chahab Hospital for Handicapped) with hyperreflexic neurogenic bladder secondary to an accident of the supra-sacral medulla. These patients were incontinent, had urinary tract infections, vesico-renal reflux or autonomic dysreflexia. Detubularized ileum was used in 16 cases and sigmoid in one. Ureteral reimplantation was performed on one patient; implantation of an artificial urinary sphincter for one patient and an injection of a periurethral Teflon paste was also done for one patient. After 16 months of follow-up all patients are continent on self intermittent catheterization. The upper urinary tract is stable or improved. No autonomic dysreflexia. Thirteen patients have an asymptomatic untreated bacteriuria.