Post-tonsillectomy outcomes in children with mucopolysaccharidosis and obstructive sleep apnea.

OBJECTIVE: To describe the incidence of respiratory complications, postoperative hemorrhage, length of stay, and cost of care in children with mucopolysaccharidosis (MPS) undergoing adenotonsillectomy (AT). METHODS: Analysis of the 2009, 2012, and 2016 editions of the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) identified 24,700 children who underwent AT (40 children with MPS). Demographics, respiratory complications, postoperative hemorrhage, length of stay, and total cost were compared across children with and without MPS. RESULTS: Children with MPS had a higher likelihood of being male (P < 0.017). There was a higher rate of respiratory complications in children with MPS compared with children without MPS [6/40 (15%) vs. 586/24,660 (2.4%), P < 0.001], which remained significant after adjusting for sex [adjusted odds ratio 6.88 (95% CI 2.87-16.46)]. There was also a higher risk of postoperative hemorrhage [4/40 (10%) vs. 444/24,660 (1.8%), P < 0.001), with sex-adjusted odds ratio of 5.97 (95% CI 2.12-16.86). Median (IQR) length of stay was increased in children with MPS (3 days, 1-4) compared with children without MPS (1 day, 1-2, P < 0.001). There was an increase in median (IQR) charges for hospital stay in children with MPS compared with their peers [$33,016 ($23,208.50-$72,280.50 vs. $15,383 ($9937-$24,462), P < 0.001]. CONCLUSIONS: Children with MPS undergoing AT had an increased risk of respiratory complications, postoperative hemorrhage, longer length of stay, and a higher cost of treatment when compared with children without MPS. This information may help inform interventional, perioperative, and postoperative decision making.

Unilateral Cysticercosis of the Parotid Gland: Case Report, Diagnosis, and Clinical Management.

Cysticercosis is a systemic parasitic infection caused by the establishment of the larval form of the parasitic cestode, Taenia solium. Cysticercosis is acquired via the fecal-oral route and is prevalent in low- and middle-income countries (LMICs). Patients typically manifest with skeletal muscle, subcutaneous, or central nervous system involvement. Though there are reports of oral mucosa involvement, solitary involvement of the parotid gland is rare. This is a rare case of a 57-year-old man diagnosed with parotid cysticercosis by imaging and FNA. He was successfully treated by anthelminthic therapy and needle aspiration. The patient has been seen back several times. The cyst is not palpable, and he is satisfied. Parotid cysticercosis should be considered in the differential of a parotid mass in patients who have traveled to endemic regions. Though prior reports have indicated the importance of surgical excision, this patient was treated medically.

Gender-specific analysis of outcomes from endoscopic sinus surgery for chronic rhinosinusitis.

BACKGROUND: Women electing endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) report higher symptom burden but have lower computed tomography (CT) scores. Gender-specific analysis of outcomes from ESS therefore merits further study. The objective of this work was to study gender-specific differences in outcomes from ESS for CRS by analyzing preoperative and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores. METHODS: Data from adult CRS patients electing ESS (2011-2013) were retrospectively collected. SNOT-22 total, rhinologic/nonrhinologic subdomain, and individual item scores were analyzed for gender-specific differences. RESULTS: Two hundred and forty-eight patients met study criteria (mean age 55.4 years; 49.6% female). Preoperatively, mean Lund-Mackay CT score was 11.1; average total SNOT-22 score was 41.9. Compared to men, women had lower CT score (10.2 vs 12.0; p = 0.004) but higher total SNOT-22 score (44.7 vs 39.1; p = 0.02). Both genders showed significant improvement in total SNOT-22 scores at 3, 6, 12, and 24 months following ESS (p < 0.001), with largely similar slopes of improvement. The greatest improvement occurred at 3 months (SNOT-22 decreased by 25.4 points), with stable improvement after 12 months (SNOT-22 decreased by 21.3 points). Higher total SNOT-22 scores in females were noted preoperatively and until 6 months post-ESS; these were driven by rhinologic and nonrhinologic-otolaryngic subdomain items. No gender differences in anxiety/depression prevalence or psychological subdomain scores were noted preoperatively or postoperatively. CONCLUSION: Both male and female CRS patients showed significant and durable symptom relief following ESS. Women reported higher symptom burden prior to surgery, and in the early postoperative period. However, after 1-year post-ESS, both genders showed similar symptom scores. The trend and magnitude of improvement were similar in both genders.