Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years' Experience.

Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20 years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.

Impact of Chronic Adenoid Hypertrophy on Quality of Life Index in Children and Role of Adenoidectomy.

Objectives: To analyze the effects of chronic adenoid hypertrophy on quality of life (QOL) of children and caregivers and compare quality of life of child before and after adenoidectomy. Materials & Methods: Prospective, observational before and after questionnaire based assessment study at a pediatric otorhinolaryngology specialty center in a metropolitan quaternary care hospital. Children aged between 2 and 12 years undergoing adenoidectomy were included. Parents were asked to fill the Obstructive Sleep Apnea-18 (OSA-18) Quality of Life Index Questionnaire one day before surgery and after one month of surgery during their scheduled follow-up visit. The study was conducted over a period of 1 year and total of 40 children's assessment was done. Results were tabulated and analyzed. Results: The mean age of presentation was 6 years. Based on OSA-18 quality of life assessment scoring the total pre-operative mean score was 73.3 and post-operative was 40.5. There was significant change in OSA-18 total score and individual domain scores post-operatively indicating significant improvement in QOL post adenoidectomy. The domains most affected due to chronic adenoid hypertrophy were physical suffering, caregiver concerns and sleep disturbance (p value < 0.001).Conclusion: Chronic adenoid hypertrophy has major impact on quality of life of a child along with caregiver concern and they show significant improvement after adenoidectomy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04000-z.

Surgical Candidacy for Management of Laryngomalacia: A Proposed Scoring System.

Introduction: Identifying surgical candidacy for the management of laryngomalacia is a challenge. Objective: To develop a simple scoring system for surgical candidacy in laryngomalacia. Methods: Eighteen years retrospective observational study of children with laryngomalacia (LM) clinically categorized into mild, moderate and severe LM and were analyzed for surgical candidacy. Results: There were 113 children (age ranging from 5 days to 14 months), 44% being mild, 30% moderate and 26% severe LM. None in mild, 32% in moderate, and all in severe LM had surgical intervention. Presence of stridor on feeding or crying and isolated type 1 or type 2 LM on laryngoscopy were significant indicators for conservative treatment (p-< 0.0001). Moderate failure to thrive, retraction at rest/sleep, with low oxygen saturation while feeding/at rest were significantly higher in both moderate and severe groups with laryngoscopic evidence of combined type 1 and 2 in moderate LM (p < 00,001). Aspiration pneumonia, hospitalization, pectus and mean pulmonary arterial pressure of more than 25 mmHg with laryngoscopic findings of all three combined types were significantly higher in severe LM (p < 0.0001).A simple scoring system was then developed and it revealed that a score of 10 or more required surgical intervention. Conclusion and clinical significance: A clinical scoring system is being reported for the first time in medical literature to identify 'the difficult to treat' subset within moderate laryngomalacia category simplifying decision making in its management for otolaryngologists and pediatricians as well as a referral criterion for pediatric otolaryngologists' services.

Endoscopic Repair of Laryngeal Clefts: 8 Years' Experience.

To emphasize the need for high clinical suspicion in the diagnosis of Laryngeal cleft in paediatric population, to catalogue the pattern of presentation, time to treatment and the evolution of surgical techniques for Laryngeal cleft repair at our center. A retrospective review of laryngeal cleft cases which presented over a period of 8 years (May 2012-May 2020), from a tertiary care center, was done. Data includes-patient demographics, preliminary investigations, diagnostic methods, type of cleft, surgical steps and post-operative follow up. Extensive literature search was done and we could not find similar studies from South East Asia and the Indian subcontinents. Of the 10 patients 7 were managed surgically and 3 conservatively. There was an equal distribution of type 1 (n = 5) and 2 (n = 5) clefts. 80% cases were males and 9 out of 10 patients had associated congenital anomalies. 80% cases had symptom resolution (75% were managed surgically and 25% managed medically). Surgical intervention should be based on the extent of anatomical defect and the functional impairment caused by cleft such as respiratory problems, persistence of feeding issues despite maximal medical management and feeding therapy. Early surgical management of type I and II clefts have satisfactory outcomes.

The COVID TIDE Approach: A Protocol for Safe Tracheostomy Practice in COVID Patients.

We all are aware of COVID 19 pandemic. As the numbers are increasing, the critical care demand is also increasing. Tracheostomy is one of the commonest procedures which has been performed on COVID positive ventilated patients. It is important to understand and follow the utmost safe practices for the patient and the health care workers for such aerosol generating procedures. The aim of this study is to identify the lacunae in tracheostomy practices during this COVID times and suggest a systematic approach for the safe practices. An online questionnaire survey-based study was performed in September 2020. The target population was practicing otolaryngologists of India with various years of experience. The aim of the study was to evaluate the lacunae in tracheostomy safe practices and to create a systematic approach for the safety of health care workers. Data compilation and analysis was done by using Microsoft Excel. A systematic COVID TIDE tracheostomy safe practices approach was designed after reviewing various tracheostomy guidelines and recommendations. Total 114 otolaryngologists responded with a complete survey report. 72.2% responders were not up to date with their knowledge of tracheostomy safe practices. 79.8% were not performing this procedure in a negative pressure room. 15.8% were not aware of the personal protective equipment level they are using. Only 56.1% survey responders were holding the ventilation before tracheal incision. Overall, 94.7% responders were keen to know about the safe approach of tracheostomy in COVID positive patients. Tracheostomy is an aerosol generating procedure, lacunae in the knowledge can cause major risk to health care professionals. Finally, in such crises, consideration should be taken for simulation exercises, dedicated airway teams and a systematic COVID TIDE approach to improve the safety of the staff and patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-021-02370-w.

Pediatric Airway Surgeries in COVID 19 Era.

To outline a set of recommendations on the management of pediatric cases who requiring airway surgery in the context of COVID 19 pandemic. A set of recommendations have been prepared based on National and International published scientific literature and recent updates on COVID 19. These has been implemented in our tertiary care centre. Due to the evolving nature of COVID 19 and existing knowledge gaps, these recommendations may have to be revised periodically. The incidence of COVID 19 is very low (1-5%) in the pediatric age group with relatively good prognosis. Pediatric airway surgeries should be restricted to emergency cases only. The decision of postponement of the surgical cases should be taken by the team of senior pediatric airway surgeons. Flexible laryngoscopy should be avoided. Foreign body cases should undergo a computed tomography scan to avoid diagnostic bronchoscopies. All the measures should be taken to prevent direct contact of aerosol so powered instruments should not be used unless mandatory. Protective draping method should be adopted to prevent aerosol exposure. As paediatric airway surgeries are aerosol generating procedure where the risk of contracting COVID 19 by the surgeons and support staff is very high, we suggest recommendations to prevent the contact with infected aerosol. We assure these recommendations are easy to follow and can impact good quality outcome during this pandemic crisis.