Does resident involvement in tonsillectomy affect outcomes?

OBJECTIVE: Tonsillectomy is essentially a solo surgery with a well-described complication profile. It may serve as a good benchmark to evaluate the resident-as-surgeon. This study examined complications such as post-tonsillectomy bleeding in children undergoing tonsillectomy by attending surgeons (AS) or pediatric otolaryngologist-supervised residents. METHODS: Charts were reviewed of all children aged 12 and under who had tonsillectomy +/- adenoidectomy at a children's hospital between Jan 2019 and Dec 2020. Patient age, gender, BMI, indication for surgery, surgical technique, presence of a resident surgeon, primary bleeding, secondary bleeding, treatment of bleeding, other Emergency Room (ER) visits, and clinic phone calls were recorded. Binary logistic regression was performed. RESULTS: 2051 total children (1092 (53.2 %) males and 956 (46.6 %) females) with a mean age of 6.1 years (95 % CI 6.0-6.2) were included. 1910 (93.0 %) underwent surgery for tonsillar obstruction. 1557 (75.9 %) underwent monopolar cautery tonsillectomy. 661 (32.2 %) had a resident surgeon. 274 (13.4 %) had a related ER visit within 15 days. 18 (0.9 %) had a primary bleed and 155 (7.6 %) had a secondary bleed. Binary logistic regression showed that significant predictors of postoperative ER visits were patient age (OR = 1.101, 95 % CI = 1.050-1.154, p < .001) and resident involvement (OR = 0.585, 95 % CI = 0.429-,797, p < .001). Only age was associated with overall postoperative bleeding incidence (OR = 1.131, 95 % CI = 1.068-1.197, p < .001), as well as secondary bleeding (OR = 1.128, 95 % CI = 1.063-1.197, p < .001). There were no significant predictors of primary bleeding. CONCLUSION: Resident involvement in pediatric tonsillectomy is associated with decreased postoperative ER utilization and does not appear to increase common postoperative complications including bleeding and dehydration.

Do Children with Previous COVID Infection Have Hyposmia?

OBJECTIVE: Our goal was to see if children with a history of COVID infection had subclinical hyposmia. METHODS: Consecutive patients at a pediatric otolaryngology clinic aged 5-17 years were recruited. Demographics including gender, race, use of nasal topical medications (NTM), previous nasal surgery including adenoidectomy (NSA), and previous COVID-19 infection were collected. Each child performed a test of their sense of smell using the Pediatric Smell Wheel (PSW, Sensonics Intl, USA) under the direct supervision and scores were compared. RESULTS: 260 children were included; mean age 10.1 years (95% CI 9.7-10.5), 128 (49.2%) female and 132 (50.8%) male. 65 (25%) used steroid nasal sprays, 100 (38.5%) had undergone adenoidectomy, and 36 (13.8%) had other nasal surgery. 120 (46.2%) had a previous COVID-19 infection. The COVID+ and COVID- groups were the same for age, gender, race, use of NTMs, and previous NSA (p > 0.05). Mean PSW score was 7.8 (95% CI 7.6-8.0), median of 8, ranging from 2 to 11. The mean PSW score was 8.0 for the COVID- group and 7.6 for the COVID+ group (p = 0.005). There was no significant difference in total PSW scores based on gender, race, use of NTMs, previous NSA. Linear regression showed previous COVID infection was significantly negatively associated with total PSW score (Beta -0.636, p = 0.006) with age significantly positively associated (Beta 0.122, p < 0.001). CONCLUSION: Children with a history of COVID infection performed slightly worse when identifying odors than children without a COVID history. More study into the rates of pediatric anosmia related to COVID infection is needed. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:901-906, 2024.

Knowledge and Attitudes towards HIV and HCV among the Population Attending the Fast-Track Cities Mobile Unit in Brescia, Italy.

The Infectious and Tropical Diseases Department of the University of Brescia organized free rapid screening tests for HIV and HCV as part of the Fast-Track City commitment. A cross-sectional study was conducted, consisting of an anonymous multiple-choice questionnaire that was administered to individuals who underwent the screening or consultation. The study aimed to compare knowledge and attitudes towards HIV and HCV between age groups (18-40 vs. >40) and sexual orientations (heterosexual vs. LGBTQ+). Overall, 333 questionnaires were completed. Overall, only 107 (32%) of respondents knew how HIV is transmitted. Major differences were shown between different age groups, where people under the age of 40 had a significantly higher correct response rate than people over 40 (n = 101; 39% versus n = 6; 7.8%, p < 0.00001). Similarly, almost half of LGBTQI+ people (n = 28; 44.4%) gave the correct answer, versus 30% (n = 79) of heterosexuals (p = 0.0359). Only 9.6% of the population demonstrated high levels of knowledge for both HIV and HCV. Our study highlights that misconceptions about HIV and HCV should be addressed in prevention and education programs, whose target should also be specific populations.

Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective.

OBJECTIVE: Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication. METHODS: Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges. RESULTS: A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001). CONCLUSION: Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study.

Background: Syphilis infection does not confer definitive and protective immunity against reinfection, and crucial aspects of repeated episodes of syphilis are far from being understood, especially among people living with HIV (PLWH). Methods: In order to explore the burden of syphilis in a large cohort of HIV-negative patients and PLWH, this retrospective study describes the demographics, clinical presentation and treatment outcome of patients with syphilis treated at our clinic from 2013 to 2021. Results: Within the study period, 1859 syphilis episodes (827, 44.5% first infections and 1032, 55.5% reinfections) were recorded. A total of 663 patients, of whom 347 (52%) had PLWH, were considered. Syphilis was mostly diagnosed in males (77%) and European (79%) patients. More than half of syphilis episodes were recorded during the late latent stage (64%) or during follow-up/screening visits for other diseases, while symptomatic stages led to a diagnosis in almost half of HIV-negative patients (p < 0.001). PLWH with syphilis infection were predominantly homo/bisexual (p < 0.001). A significantly higher rate of syphilis reinfection was observed in PLWH, who also demonstrated a higher range of subsequent episodes. The serofast state was found to be similar at the 6- and 12-month follow-up visits. The multivariate analysis carried out in the HIV-positive group showed that an RPR titre >1:16 was an independent predictor for serological non-response. Conclusions: Syphilis reinfections are predominantly diagnosed in HIV-positive MSM. The high rate of asymptomatic presentation among PLWH supports the role of periodical syphilis screening. In PLWH, the only baseline factor associated with an increased risk of non-response was an RPR titre >1:16, while assessment at 12 months after treatment increased the possibility of detecting a serological response, indicating that PLWH have a slower serological response to treatment.

Risk factors of adolescent exposure to violence in Burkina Faso.

BACKGROUND: Globally violence against children and adolescents is a significant public health problem. Since children rely on family for early learning and socialization, evidence of the factors associated with exposure to violence within households may inform the development of policies and measures to prevent violence and aid the victims of violence. This study examines the risk and protective factors associated with adolescents' exposure to violence at home and how these differ by gender and age in four regions of Burkina Faso. MATERIALS AND METHODS: We used data from the baseline survey of the Child-Sensitive Social Protection Programme (CSSPP) conducted in four regions of Burkina Faso. The CSSPP is a cash transfer programme accompanied by complimentary nutrition, and water and sanitation interventions to address multidimensional child poverty. We employed bivariate and multivariable regression analysis on a sample of 2222 adolescents aged 10-19 to explore the risk and protective factors associated with exposure to violence. RESULTS: Results show that exposure to psychological violence (22.7%) was more common within the households when compared to physical violence (9.1%). Adolescent girls reported more exposure to physical violence while boys reported more exposure to psychological violence. Significant risk factors associated with the likelihood of exposure to violence among girls are orphanhood, living in a household receiving safety nets and living in a Muslim-majority community. Among boys, age, school attendance, disability, a household receiving safety nets, sharing a household with a depressed individual, and living in a Muslim-majority community, were associated with exposure to violence. CONCLUSIONS: These gender-specific findings highlight the importance of family background characteristics and can be used to inform and strengthen the targeting of vulnerable children and adolescents in interventions aimed at reducing exposure to violence against children.

Pediatric Otolaryngology During COVID-19: Parental Concern About Elective Surgery.

OBJECTIVE: To identify the concerns of parents whose children may need elective surgery during the COVID-19 pandemic. METHODS: In December 2020, parents of pediatric otolaryngology patients were recruited for a survey about concerns related to elective surgery during the COVID-19 pandemic. A Likert scale quantified concern. The 1 was anchored "Not at all important" and 5 was "Most important." Demographics included gender, age, race, education level, number of children in household, and whether their child had surgery since March 2020. RESULTS: About 253 participants were included. Medians ranged from 1 for concerns about emotional and family support to 4 for concerns about their child being exposed to COVID-19 in the Emergency Room. Black parents were more concerned about the risks of COVID than White parents; they were more concerned about their child contracting COVID-19 during surgery compared to White parents, median was 4 versus 3 (P = .027). Black parents had a median score of 3 for concern about medical expenses compared to a median of 2 (P = .001). Parents of children who had surgery since March 2020 had less concern about their child being exposed to COVID-19 during hospitalization (P = .045) and less concern about critique from others (P = .024). CONCLUSION: Parents were most concerned about the risk of seeking Emergency Room care. Black parents were generally more concerned about having their child undergo elective surgery. Whether this is translated into fewer Black children undergoing important but elective surgery requires more study.

Carcinosarcoma of the Nasal Septum: A Case Report and Review of the Literature.

We report a case of a 62-year-old man with epistaxis and right-sided nasal obstruction. Nasal endoscopy revealed an exophytic mass arising from the anterior septum that extended posteriorly to the osteo-meatal complex. Excision with endoscopic sinus surgery was performed. Carcinosarcoma was diagnosed based on histopathology and immunohistochemical studies. The patient declined surgery and opted for chemoradiation therapy for the residual tumor. Six weeks after completion of the treatment, clinical resolution of the right nasal mass was noted. Carcinosarcomas are rare and rapidly growing tumors that have a high recurrence rate and are associated with poor patient prognosis. This report emphasizes the need for patients with prolonged nasal obstruction and epistaxis to consult otolaryngologists and undergo nasal endoscopy for definitive diagnosis and appropriate treatment.

Unilateral Vocal Cord Paresis During Sleep Endoscopy.

Abnormalities of vocal cord motion in children with obstructive sleep apnea (OSA) who undergo drug-induced sleep endoscopy (DISE) are not frequently described. A 17-year-old female with a history of asthma, reflux, and bipolar disorder had a history of poor sleep. Polysomnography (PSG) showed apnea-hypopnea index (AHI) of 13.9/hr, obstructive AHI 10.3/hr, and oxygen saturation nadir 87%. Physical exam showed BMI 34 and 3+ tonsils. She underwent DISE with propofol infusion, which showed partial obstruction at the palatine and lingual tonsil levels, a posteriorly displaced epiglottis along with immobility of the left vocal cord. Tonsillectomy was performed as planned. At her post-op visit, laryngoscopy showed normal vocal cord motion bilaterally. Post-operative PSG was improved.

Thumb to spinous process is a false metric for glenohumeral internal rotation.

Background: The measurement of internal rotation by noting the maximal vertebral level reached by the patient's thumb behind their back is an established physical examination technique, as outlined in the American Shoulder and Elbow Surgeons Shoulder Assessment Form.7 The purpose of the present study is to correlate real-time glenohumeral internal rotation with thumb to spinous process movement to determine the accuracy of the technique. Methods: Healthy volunteers with no previous history of shoulder injury or symptoms were recruited from the local medical school population. Ultrasound probe was placed over the anterolateral shoulder, and relevant anatomy was identified. Internal rotation was evaluated by measuring displacement of the peak of the medial aspect of the bicipital groove relative to the anterior glenoid rim with the arm held in defined positions of progressively increasing internal rotation. The difference in displacement between arm positions was calculated and recorded. Results: A total of 20 participants (11 women/9 men, aged 22-42 years) were recruited for measurement. A mixed-model repeated-measures analysis of variance was used. The most significant differences in displacement, and therefore internal rotation, were observed between the neutral and anterior superior iliac spine (0.21 ± 0.39 mm, P= .0269) and between the anterior superior iliac spine and peak iliac crest (0.26 ± 0.44 mm, P= .0163). After the peak iliac crest, there was no further statistically significant change in rotation. Conclusion: The present study suggests that most glenohumeral internal rotation occurs before reaching the arm behind the back. Although not directly studied, this supports the notion that the maximal vertebral level reached involves an interplay of various joint motions. While the thumb to spinous process maneuver remains a functional evaluation, our results suggest a different examination technique be used to more accurately test glenohumeral internal rotation.