Predictive Value of Laryngeal Penetration to Aspiration in a Cohort of Pediatric Patients.

Videofluoroscopic swallow studies (VFSS) provide dynamic assessment of the phases of swallowing under fluoroscopic visualization and allow for identification of abnormalities in the process, such as laryngeal penetration and aspiration. While penetration and aspiration both reflect degrees of swallowing dysfunction, the predictive potential of penetration for subsequent aspiration is not fully elucidated in the pediatric population. As a result, management strategies for penetration vary widely.

Evaluating the biomechanical characteristics of cuffed-tracheostomy tubes using finite element analysis.

The objective of this study was to perform finite element analysis (FEA) of cuff inflation within an anatomically accurate model of an adult trachea in four different cuffed-tracheostomy tube designs. The leakage quantified by the distance between the cuff and trachea was largest for the Tracoe cuff and smallest for the Portex cuff. The smooth muscle stresses were greatest for the Portex and least for the Distal cuff, respectively.

Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

Objectives/hypothesis: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal.

Study Design: Blinded modified Delphi consensus process.

Setting: Tertiary care center.

The use of videos in preparation for pediatric otolaryngology cases-a national survey.

Objective: 1) Review surgical preparation methods for pediatric otolaryngology fellows and fellowship directors, focusing on surgical video usage.

Study Design: Cross sectional survey.

Methods: Structured survey querying preparation methods for surgical cases was distributed to current pediatric otolaryngology fellows and fellowship program directors (FD's).

Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children.

Background: Postadenotonsillectomy unexpected admission remains an important challenge. Unexpected admissions can be quite frightening, increase health care burden, and cause unnecessary suffering in children and families. Identifying factors associated with postadenotonsillectomy unexpected admissions using a pragmatic approach could lead to a shift in the assessment and management of children presenting for adenotonsillectomy.

How design characteristics of tracheostomy tubes affect the cannula and tracheal flows.

Objectives: The aim of this study was to perform computational simulations of airflow within an anatomically accurate model of an adult trachea in different tracheostomy tube designs. We hypothesized that tracheal airflow in patients is significantly influenced by the geometry and size of these devices.

Methods: The three-dimensional (3D) geometry of the trachea was reconstructed using computed tomography scans for an adult with no history of lung disease.

Can overnight stenting be safely eliminated following a pharyngeal flap? A matched comparison study.

Objective: Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients METHODS: This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1.

Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report.

A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing.

A Systematic Review of Patient- or Proxy-Reported Validated Instruments Assessing Pediatric Dysphagia.

Objective: Pediatric dysphagia occurs in 500,000 children each year; however, there is not a common tool to assess these children. Our aim was to identify validated patient- or parent-reported outcome assessment tools evaluating pediatric dysphagia.

Data Sources: Scopus, EMBASE, PubMed, Cochrane Library, and CINAHL electronic databases (all indexed years through August 2014).

Obstructive sleep apnea.

This chapter outlines the surgical management of children who experience symptoms of airway obstruction after undergoing pharyngeal flap surgery or sphincter pharyngoplasty for the correction of velopharyngeal insufficiency. It also describes the management of children with hyponasality following these corrective surgical interventions.

Persistent velopharyngeal insufficiency.

This chapter outlines the management of patients who have failed initial surgical correction of velopharyngeal insufficiency. Clinical judgment is required to determine the most appropriate revision option for each patient.

Growth after adenotonsillectomy for obstructive sleep apnea: an RCT.

Background And Objectives: Adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) may lead to weight gain, which can have deleterious health effects when leading to obesity. However, previous data have been from nonrandomized uncontrolled studies, limiting inferences. This study examined the anthropometric changes over a 7-month interval in a randomized controlled trial of adenotonsillectomy for OSAS, the Childhood Adenotonsillectomy Trial.

Pediatric Exercise Stress Laryngoscopy following Laryngotracheoplasty: A Comparative Review.

Objective: Exercise-induced airway obstruction in pediatric patients is a unique phenomenon with multiple potential etiologies. An accurate diagnosis can be challenging to establish in pediatric patients because they are frequently asymptomatic at rest. Exercise stress laryngoscopy (ESL) is a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms.

Compensatory laryngeal function and airway protection in children following airway reconstruction.

Objectives: Laryngotracheal reconstruction (LTR) procedures for repair of complex congenital or acquired airway stenosis of the larynx and/or trachea in pediatric patients have advanced over recent decades. The aim of the present project was to investigate the relationships among diagnoses, type of surgical intervention, and laryngeal findings in a post-LTR patient cohort to identify factors associated with adequate airway protection and swallowing outcomes.

Methods: A retrospective review of 30 airway patients undergoing simultaneous or close interval functional laryngeal and swallowing examinations was completed.

A randomized trial of adenotonsillectomy for childhood sleep apnea.

Background: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.

Methods: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting.

Experience Corps: a dual trial to promote the health of older adults and children's academic success.

Background: As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs.

Future of pediatric tonsillectomy and perioperative outcomes.

Objective: Although commonly performed, pediatric tonsillectomy is not necessarily a low risk procedure due to potentially life threatening perioperative complications. There is paucity of literature on lethal anesthesia and surgical complications of tonsillectomy. In this article, we have reviewed both minor and serious complications following tonsillectomy.

Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation.

Background: The purpose of this study was to evaluate the incidence of vocal cord (VC) and swallowing dysfunction in infants after the Norwood operation and to examine the relationship between laryngopharyngeal dysfunction and postoperative outcomes.

Methods: We conducted a retrospective review of 63 infants who underwent routine postoperative fiberoptic endoscopic evaluation of swallowing function and vocal cords after a Norwood operation at our institution during a recent 6-year period (2003-2009).

Results: The overall incidence of VC dysfunction after the Norwood operation was 58.

Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication.

Background: Children with feeding disorders requiring Nissen fundoplication may develop gagging and retching following gastrostomy feedings. We developed a "pureed by gastrostomy tube" (PBGT) diet in an attempt to treat these symptoms and provide adequate nutrition and hydration.

Methods: Children post- fundoplication surgery with symptoms of gagging and retching with gastrostomy feedings were selected from our interdisciplinary feeding team.

Automated high-level disinfection of nonchanneled flexible endoscopes: duty cycles and endoscope repair.

Purpose: Guidelines issued by the Association of Operating Room Nurses and the Association of Professionals in Infection Control and Epidemiology recommend high-level disinfection (HLD) for semicritical instruments, such as flexible endoscopes. We aim to examine the durability of endoscopes to continued use and automated HLD. We report the number of duty cycles a flexible endoscope can withstand before repairs should be anticipated.

A preliminary investigation of four-dimensional ultrasound for evaluation of middle ear ossicles: an in vitro study.

Objective: Temporal bone imaging in children has several inherent limitations. Computed tomography has the disadvantage of ionizing radiation, possible sedation, cost and accessibility. Magnetic resonance imaging has most of these disadvantages, with the exception of radiation, and provides bone images of limited resolution.

Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.

Background: Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g.

The significance of post-operative fever following airway reconstruction.

Objective: Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction.