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Objective There is a lack of consensus and a paucity of data regarding how to best treat pediatric patients with mild obstructive sleep apnea. The objective of our study was to compare outcomes following adenotonsillectomy vs. observation in children with mild obstructive sleep apnea based on polysomnography results. Methods A retrospective chart review was performed on children ages 9 months to 9 years with 2 or more polysomnograms completed at a tertiary care academic center. Children diagnosed with mild obstructive sleep apnea (obstructive apnea–hypopnea index 1–5) on polysomnography performed from 1999 to 2013 were included. Patients underwent adenotonsillectomy or watchful waiting for obstructive sleep apnea. The primary outcome was the change in apnea–hypopnea index. Results There were 62 patients who met inclusion criteria for the study; 19 of the 62 patients were obese, while 15 had a craniofacial syndrome or hypotonia. Eighteen patients underwent adenotonsillectomy for mild obstructive sleep apnea while 44 were observed. The mean apnea–hypopnea index of patients after adenotonsillectomy improved from 3.50 (95% Confidence Interval [CI] 2.97–4.03) to 2.69 (95% CI 1.48–3.90), while the mean apnea–hypopnea index of the observation group worsened from 3.09 (95% CI 2.76–3.42) to 5.18 (95% CI 2.46–7.90). Between-group analysis showed significant improvement in the surgery group ( p = 0.03), with a persistent improvement on multivariate analysis adjusting for baseline apnea–hypopnea index ( p = 0.05). This difference was seen mostly in non-obese, non-syndromic children ( p = 0.04). There was no significant difference between groups amongst obese ( p = 0.25) and syndromic ( p = 0.36) patients. Conclusions Adenotonsillectomy leads to a significant improvement in apnea–hypopnea index on follow-up polysomnography over an observational approach, especially in non-obese, non-syndromic children. A prospective, randomized trial is necessary to help determine appropriate treatment strategies for pediatric mild obstructive sleep apnea.

Objectives To analyze what characteristics of patients and/or ear foreign bodies should prompt referral to otolaryngology with the goal to maximize successful removal and minimize complications. Methods This was a retrospective chart review of pediatric patients who presented for ear foreign body removal from January to December 2016 at a tertiary hospital center. Data collection included successful removal, major or minor complications, use of general or conscious sedation, use of otic or oral antibiotics, age of patient, comorbid behavioral disorders, and foreign body characteristics. Major complications included tympanic membrane perforation or ossicular damage. Minor complications included injury of the canal wall. Patients with retained or extruded tympanostomy tubes were excluded. Results Of 275 patients aged 1–18 years, 16% presented initially to otolaryngology (ENT), 48.4% presented to the emergency department (ED), 21.8% presented to a pediatrician, and 13.8% presented to ENT after prior attempts at removal. Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). Retrieval by ENT after prior failed attempts had the highest rate of minor complications (26.3% vs 2.3–6.0%). There were two tympanic membrane perforations that were noted by ENT after prior failed attempts. Rate of operative intervention was significantly higher in patients who presented to ENT after prior attempts compared to patients who presented initially to ENT (34.2 vs 4.6%, p = 0.001). Of the patients who presented to ENT after previous failed attempts, there was a higher rate of complications and operative intervention if the patient was age 5 or under or the foreign body was difficult to grasp. Conclusions Pediatric ear foreign body presentation is common. Repeated attempts at removal are associated with higher rates of minor complications and operative intervention. Early consultation to otolaryngology should be considered if the foreign body is deemed difficult to grasp such as a bead or stone, especially if the patient is age five or younger.

Oropharyngeal stenosis (OPS) is a narrowing of the oropharynx as a result of adhesions from the base of tongue to the anterior tonsillar pillars and inferior tonsillar fossa [1]. OPS is a rare complication of oropharyngeal surgery and can cause dysphagia, sleep disordered breathing, velopharyngeal incompetence due to tethering of the soft palate, and dyspnea. Whereas OPS occurred historically following oropharyngeal infection, the advent of antibiotic treatment for common infectious agents in the early 20th century has made OPS an extremely rare condition [1,2]. OPS has been associated with multilevel, single-stage upper airway surgery involving lingual tonsillectomy and in conjunction with nasopharyngeal stenosis [2]. OPS is mentioned historically anecdotally after simple adenotonsillectomy but to our knowledge this is the first case report of a patient who developed OPS following routine adenotonsillectomywith no other risk factors. She underwent successful surgical repair which included scar division and palatal scar lengthening with local advancement flap. This