Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea.

Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed.

Long-Term Outcomes of Tracheostomy-Dependent Children.

Objective: To estimate the 1-, 5-, and 10-year survival and decannulation rates of children with a tracheostomy.

Study Design: Ambidirectional cohort.

Setting: Tertiary children's hospital.

Resting-State Cerebral Hemodynamics is Associated With Problem Behaviors in Pediatric Sleep-Disordered Breathing.

Objective: Untreated sleep-disordered breathing (SDB) is associated with problem behaviors in children. The neurological basis for this relationship is unknown. We used functional near-infrared spectroscopy (fNIRS) to assess the relationship between cerebral hemodynamics of the frontal lobe of the brain and problem behaviors in children with SDB.

Tracheostomy in the extremely premature neonate - Long term outcomes in a multi-institutional study.

Objectives: To describe the long-term outcomes related to breathing, feeding, and neurocognitive development in extremely premature infants requiring tracheostomy.

Study Design: Pooled cross-sectional survey.

Setting: Multi-institutional academic children's hospitals.

Pathogenic bacteria in bronchoalveolar lavage cultures and pediatric laryngotracheal reconstruction outcomes.

Objective: The primary objective was to determine if treating pathogenic bacteria in bronchoalveolar lavage (BAL) cultures improves outcomes after pediatric double stage laryngotracheal reconstruction (dsLTR).

Study Design: Case series with chart review.

Setting: Tertiary children's hospital.

Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy.

Objective: To determine factors associated with frequent emergency department (ED) visits and hospitalizations after pediatric tracheostomy.

Methods: A prospective cohort of children (<18 years) with a tracheostomy placed at a tertiary children's hospital between 2015 and 2019 were followed for 24 months after index discharge. ED visits and hospitalizations were recorded to identify risk factors for frequent utilization (≥4 visits).

Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation.

Objectives: To determine the incidence of tracheocutaneous fistula (TCF) and identify characteristics associated with persistence.

Study Design: Prospective cohort.

Methods: All successfully decannulated children (<18 years) between 2014 and 2020 at a tertiary children's hospital were included.

Mortality Among Children with a Tracheostomy.

Objectives: To characterize the cause of death among children with a tracheostomy.

Study Design: Prospective cohort.

Methods: All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included.

Tracheostomy on infants born in the periviable period: Outcomes at discharge from the neonatal intensive care unit (NICU).

Objectives: Advances in neonatal intensive care have allowed successful resuscitation of children born at the border of viability. However, there has been little change in the incidence of bronchopulmonary dysplasia (BPD) and anatomical upper airway obstruction which may require a tracheostomy in that group. The benefits of the procedure are accompanied by sequelae that impact outcomes.

Predictors of Tracheostomy Decannulation in Adult Laryngotracheal Stenosis.

Objective: Predictors of tracheostomy decannulation in patients with laryngotracheal stenosis are not fully known, making prognosis difficult. The aim was to identify predictors of tracheostomy decannulation in adult patients with acquired stenosis of the larynx and/or trachea who were tracheostomy dependent.

Study Design: Case series.

Adenochondroma of the Thyroid in a 3-Year-Old Female: A Case Report.

Follicular adenomas are the most common benign thyroid neoplasm but are unusual in children. However, other rare degenerative lesions and those of developmental origin can also present as thyroid masses. This article reports the first described pediatric thyroid adenochondroma.

Echocardiographic screening in children with very severe obstructive sleep apnea.

Objective: (i) To determine the prevalence of echocardiographic abnormalities in children with very severe OSA defined by an apnea hypopnea index (AHI) ≥ 30 events/hour. (ii) To test the hypothesis that polysomnographic parameters predict echocardiographic variables in this population.

Methods: Children aged 1-17 years presenting with polysomnography demonstrating an AHI ≥30 and referred for pre-operative echocardiography performed within the 6 months prior to tonsillectomy and adenoidectomy (T&A), over a two-year period (January 1, 2016 to December 31, 2018) were evaluated.

The Role of Cognitive Evaluation in Predicting Successful Audiometric Testing among Children.

Objective: To determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months.

Study Design: Prospective.

Setting: Tertiary care audiology clinic.

Surgical Treatment of Tinnitus.

Surgery for tinnitus can be divided into procedures directed specifically at elimination of tinnitus versus those directed at an independent primary otopathology whose symptoms include tinnitus. For the latter, although there may be an independent primary goal for which the surgery is undertaken, tinnitus may be expected to improve secondarily. This article will address both tinnitus-specific and tinnitus non-specific procedures for objective and subjective causes.

Clinical Evaluation of Tinnitus.

The clinical evaluation of patients with tinnitus differs based on whether the tinnitus is subjective or objective. Subjective tinnitus is usually associated with a hearing loss, and therefore, the clinical evaluation is focused on an otologic and audiologic evaluation with adjunct imaging/tests as necessary. Objective tinnitus is divided into perception of an abnormal somatosound or abnormal perception of a normal somatosound.

B cells in T follicular helper cell development and function: separable roles in delivery of ICOS ligand and antigen.

B cells are required for follicular Th (Tfh) cell development, as is the ICOS ligand (ICOS-L); however, the separable contributions of Ag and ICOS-L delivery by cognate B cells to Tfh cell development and function are unknown. We find that Tfh cell and germinal center differentiation are dependent on cognate B cell display of ICOS-L, but only when Ag presentation by the latter is limiting, with the requirement for B cell expression of ICOS-L overcome by robust Ag delivery. These findings demonstrate that Ag-specific B cells provide different, yet compensatory, signals for Tfh cell differentiation, while reconciling conflicting data indicating a requirement for ICOS-L expression on cognate B cells for Tfh cell development with those demonstrating that the latter requirement could be bypassed in lieu of that tendered by noncognate B cells.