Comparison of Ibuprofen vs Acetaminophen and Severe Bleeding Risk After Pediatric Tonsillectomy: A Noninferiority Randomized Clinical Trial.

Importance: Ibuprofen is an effective analgesic after tonsillectomy alone or tonsillectomy with adenoidectomy, but concerns remain about whether it increases postoperative hemorrhage.

Objective: To investigate the effect of ibuprofen compared with acetaminophen on posttonsillectomy bleeding (PTB) requiring surgical intervention in children.

Design, Setting, And Participants: A multicenter, randomized, double-blind noninferiority trial was conducted at 4 tertiary medical centers (Massachusetts Eye and Ear Infirmary, Boston; Naval Medical Center, San Diego, California; Naval Medical Center, Portsmouth, Virginia; Madigan Army Medical Center, Tacoma, Washington).

Trends in orbital complications of pediatric rhinosinusitis in the United States.

Importance: Several studies have documented the prevalence and treatment of orbital complications secondary to pediatric rhinosinusitis, but to our knowledge, none have investigated the national health care burden of this disease since the introduction of the heptavalent pneumococcal vaccine (PCV-7).

Objective: To identify the current public health burden of orbital complications of pediatric rhinosinusitis, and to determine if the introduction of the PCV-7 has resulted in a change in national practice patterns.

Design, Setting, And Participants: Population-based study using the 2000 and 2009 Kids' Inpatient Databases to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009.

Management of tracheal stenosis.

Purpose Of Review: The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway reconstruction has traditionally been the treatment of choice for this condition. Numerous recent publications now support the use of endoscopic techniques to both augment and sometimes replace open procedures.

Double-reversing z-plasty (Furlow palatoplasty).

Dr. Leonard Furlow first described the double-reversing z-plasty technique for cleft soft palate repair in 1978. This approach allows for repair of an overt or submucous cleft palate, but just as an importantly, provides additional length to the palate and also realigns the palatal musculature.

Multimedia approach to preoperative adenotonsillectomy counseling.

Objective: The primary objective was to compare retention of knowledge of surgical risks in parents of children having an adenotonsillectomy who received a preoperative handout or watched a video, in addition to standard counseling. A secondary objective was to determine whether time from counseling to day of surgery affects risk retention.

Study Design: Prospective randomized control study.

Enchondroma of the skull base secondary to generalized enchondromatosis: a case report and review of the literature.

Generalized enchondromatosis, of which Ollier disease is the most common type, is a rare bone dysplasia characterized by multiple intraosseous tumors near growth-plate cartilage. These cartilaginous tumors have a propensity to transform into chondrosarcomas. Enchondromas of the skull base are exceedingly rare.

Prospective comparison of handheld pneumatic otoscopy, binocular microscopy, and tympanometry in identifying middle ear effusions in children.

Objectives: To compare pneumatic otoscopy, binocular microscopy, and tympanometry in identifying middle ear effusions in children and to determine if a significant difference exists in sensitivity and specificity based on patient age and/or experience of the examiner.

Methods: A prospective study of 102 patients, or 201 ears, enrolled over a 1-year period in a tertiary medical center. Sensitivity, specificity, positive predictive value, and negative predictive value were determined for staff and resident-performed pneumatic otoscopy, staff and resident-performed binocular microscopy, and tympanometry.

Pacific Northwest survey: posttympanostomy tube water precautions.

Objectives: To determine what recommendations are given to patients or parents of patients with tympanostomy tubes regarding water exposure and to elucidate any recommendation differences between primary care and specialty care physicians.

Design: Clinical survey.

Setting: General community in the Pacific Northwest, including Washington, Oregon, and Idaho.

A useful algorithm for managing the difficult pediatric airway.

Management of the pediatric airway can be extremely challenging. A useful algorithm is presented that can be used when faced with even the most difficult of airways. A new adjuvant airway tool is also presented, as well as a list of equipment for the operating room.

Spasmodic dysphonia in an adolescent patient with an autoimmune neurologic disorder.

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) has been primarily described in the neurology and psychiatry literature. The symptoms of this syndrome typically are a range of obsessive compulsive disorders and neuromuscular tics. The otolaryngologist occasionally becomes involved with these children when it is deemed that chronic tonsil infections are the source.

Efficacy of treating children with anterior commissure and true vocal fold respiratory papilloma with the 585-nm pulsed-dye laser.

Objective: To report preliminary results regarding the safety and efficacy of the 585-nm pulsed-dye laser (PDL) for the treatment of juvenile-onset recurrent respiratory papillomatosis (JORRP) in the pediatric population.

Design: Prospective longitudinal cohort study.

Setting: Two pediatric otolaryngology referral centers.

Development of the human true vocal fold: depth of cell layers and quantifying cell types within the lamina propria.

Objectives: We sought to further describe the development of the 3-layered human vocal fold in children and to quantify macrophage and myofibroblast concentrations in each layer.

Methods: We used an optical analysis software package to examine 8 longitudinally sectioned human vocal folds that had been fixed in formalin (ages 2 days to 14 years).

Results: The 2-day-old vocal fold contained only a monolayer of cells.

The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review.

Study Objective: Acute cardiogenic pulmonary edema is a common cause of respiratory distress in emergency department (ED) patients. Noninvasive ventilation by noninvasive positive pressure ventilation or continuous positive airway pressure has been studied as a treatment strategy. We critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality and endotracheal intubation.

Pediatric partial cricotracheal resection: a new technique for the posterior cricoid anastomosis.

Objective: Partial cricotracheal resection has become a more popular procedure in the pediatric population as a treatment for severe subglottic stenosis. We describe a new technique for the posterior cricoid anastomosis.

Study Design And Setting: This is a case series of 4 pediatric patients with a Myer-Cotton grade III or IV subglottic stensosis.

Validation of the Pediatric Voice-Related Quality-of-Life survey.

Objective: To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to assess voice changes over time in the pediatric population.

Design: Prospective longitudinal study.

Setting: Outpatient pediatric otolaryngology office practice.

The utility of the fiberoptic endoscopic evaluation of swallowing (FEES) in diagnosing and treating children with Type I laryngeal clefts.

This case series of three young children with type I laryngeal clefts is presented to demonstrate the utility of fiberoptic endoscopic evaluation of swallowing (FEES) in managing these patients. FEES revealed laryngeal penetration in a posterior to anterior direction in two patients and penetration from lateral to medial in the third patient. The type of laryngeal penetration helped in making the diagnosis of a type I cleft in two children and helped establish a safe feeding regiment in the third child.

Charcot-Marie-Tooth Disease type 1 and pediatric true vocal fold paralysis.

A case study of a child with Charcot-Marie-Tooth type 1 (CMT1) that presented with bilateral vocal fold paralysis. This is the first case of bilateral vocal fold paralysis in a child with CMT1 and it is the first case to be managed endoscopically. The surgical decision making process is discussed, and in particular the role of fiberoptic endoscopic evaluation of swallowing (FEES) in determining what surgical options should be entertained.

Assessing the outcome of surgery to correct velopharyngeal insufficiency with the pediatric voice outcomes survey.

Objective: To assess the functional outcome of surgery for velopharyngeal insufficiency (VPI) by administering the pediatric voice outcomes survey (PVOS) to the parents of the affected children.

Design: Prospective longitudinal study.

Setting: Tertiary referral pediatric otolaryngology office.

Endoscopic management of anterior skull base encephaloceles.

Encephaloceles are relatively rare phenomena produced by the protrusion of brain and dura through an anterior skull base defect. Although they can occur as congenital defects, encephaloceles can also present after trauma. The diagnosis is usually made with nasal endoscopy and imaging studies.

The role of the Genial Bone Advancement Trephine system in conjunction with uvulopalatopharyngoplasty in the multilevel management of obstructive sleep apnea.

Objectives: The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA.

A case of paranasal sinus angiolipoma.

Objective: To present the first documented case of an angiolipoma of the maxillary sinus, our treatment of the patient, and the 1-year follow-up results. At the conclusion of the report, the reader should be able to discuss the incidence, treatment options, and long-term prognosis of angiolipomas of the paranasal sinuses.

Study Design: A case study reporting on a single patient with the diagnosis of maxillary sinus angiolipoma.