Incidence and predictors of readmission following tonsillectomy in pediatric population.

BACKGROUND: Tonsillectomy is one of the most common surgical procedures performed in the pediatric population. This study aims to estimate the incidence rate of readmission post tonsillectomy in pediatrics and identify the causes and predictors contributing to the readmission post-surgery. METHODS: A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at a tertiary hospital in 2019 and 2020. The study sample was divided into two groups based on readmission and were compared using the appropriate statistical tests. Significant variables (p-value≤0.05) were included in the logistic regression model to determine the predictors of readmission following tonsillectomy in these patients. RESULTS: The readmission rate following tonsillectomy was 6.3 % (95 % confidence interval 5.1-7.9). The causes of readmission included poor oral intake followed by bleeding and vomiting, 55.6 %,49.4 %, and 13.6 %, respectively. In the multivariable logistic regression model, the only significant predictor of post-tonsillectomy readmission was the use of a single postoperative analgesia (OR: 57.27, P = 0.000). CONCLUSION: The readmission rate following tonsillectomy in this study was relatively high. The most common causes contributing to readmission post tonsillectomy were poor oral intake and hemorrhage. The study also revealed a significant association between the utilization of single postoperative analgesia and an increased likelihood of readmission.

TSH level as a risk factor of thyroid malignancy for nodules in euthyroid patients.

Objective: With the increased prevalence of incidental thyroid cancer, determining the predictors of thyroid malignancy has become a source of debate. This study aimed to determine the impact of thyroid stimulating hormone (TSH) levels on rates of thyroid cancer in euthyroid patients. Methods: A retrospective study included 421 patients who underwent thyroidectomy at a tertiary hospital between 2016 and 2020. Patients' demographics, history of cancer, pre-operative workup and final histology reports were obtained. The study sample was divided into two groups based on the final histopathology (benign vs malignant). The two groups were compared using the appropriate statistical tests to determine the predictors of thyroid cancer in euthyroid patients. Results: TSH levels were significantly higher in patients with malignant nodules compared to those with benign nodules (1.94 vs 1.62, p = 0.002). It was 1.54 times more likely for thyroid nodules to be malignant when TSH levels were higher (p = 0.038). Meanwhile, larger nodules (> 4 cm) were significantly more prevalent in benign nodules (43.1%) than in malignant nodules (21.1%). Larger nodules decreased the possibility of thyroid cancer by 24% (OR = 0.760, p-value = 0.004). Conclusions: High TSH levels in euthyroid patients were significantly correlated with the risk of thyroid malignancy. In addition, as Bethesda category proceeded toward malignancy, TSH levels increased. High TSH levels and small nodule diameters can be used as additional parameters in predicting thyroid cancer in euthyroid patients.

Predictors and Time Interval of Chronic Rhinosinusitis Recurrence After Endoscopic Sinus Surgery.

Objective: Chronic rhinosinusitis (CRS) is a common inflammatory disease that significantly impacts the quality of life. Endoscopic sinus surgery (ESS) is indicated for refractory CRS. This study aims to estimate the predictors of CRS recurrence, and the rates with time intervals of recurrent CRS and revision ESS. Methods: A retrospective cohort study included 516 patients who underwent ESS for CRS at King Abdulaziz Medical City in Riyadh between January 2017 and May 2020. Patients were followed up for 12-48 months postoperatively. The study sample was divided into two groups based on the recurrence status and compared using the appropriate statistical tests. Significant variables were included in the logistic regression model to determine the predictors of CRS recurrence. Results: The recurrence rate of CRS following ESS was 14.5%, with a time interval of 28.31 months, and standard deviation (SD) =18.76. On the other hand, the rate of revision ESS for recurrent CRS was 6.8%, with a time interval of 34.18 months, SD =16. In the multivariable logistic regression model, the significant predictors of recurrent CRS were a high Lund-Mackay (LM) score [odds ratio (OR): 1.055, p=0.04] and a high eosinophil count (OR: 3.619, p=0.03). Almost half of the patients who developed recurrent CRS underwent revision surgery (46.7%). Conclusion: CRS has a considerable recurrence rate despite the high success rate of ESS, and nearly half of the recurrent CRS patients need revision surgery. A high LM score and eosinophilic count significantly increase the likelihood of CRS recurrence.

Adult Sinonasal Rhabdomyosarcoma With Spinal Metastasis: A Case Report and Review of the Literature.

Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor mainly seen in the pediatric population. Here, we describe a case of an aggressive sinonasal RMS with distant metastasis in an adult patient. A 51-year-old male presented to the otolaryngology clinic with a unilateral painless neck mass and nasal obstruction. A flexible transnasal endoscope showed a huge fungating mass obstructing more than 80% of the right nasal cavity. A contrasted computed tomography (CT) scan of the paranasal sinuses showed an enhancing soft-tissue density mass involving the right nasal cavity. A biopsy revealed RMS, an embryonal variant. The patient responded well to chemoradiotherapy but later developed spinal metastasis and cord compression. He was admitted for palliative care but died due to cardiopulmonary arrest 10 months after diagnosis. A high index of clinical suspicion for malignancy is required in adult patients with unilateral nasal symptoms.

Predictors of Otitis Media with Effusion Recurrence Following Myringotomy.

Otitis media with effusion (OME) is the most common cause of acquired pediatric hearing loss. The treatment of persistent OME includes myringotomy with or without tube insertion, with a reported recurrence rate of 19.9-40%. This study aims to investigate the recurrence rate of OME and its predictors following myringotomy. A retrospective study that included 345 ears that underwent myringotomy for persistent OME in 179 pediatric patients during 2016-2018. Patients were followed for 36-48 months post myringotomy procedure to detect the recurrence rate. The study sample was divided into two groups based on recurrence status, and the groups were compared using chi-square test and independent T-test. Significant variables (p-value ≤ 0.05) were included in the logistic regression model to determine the predictors of OME recurrence after myringotomy. OME recurrence was detected in 85 ears (24.64%). The OME recurrence rate is higher in patients who underwent myringotomy alone compared to myringotomy with tube insertion (44.1% vs. 22.8%). The insertion of a tympanostomy tube decreases the recurrence rate of OME by 59.9% (OR 0.401; 95% CI 0.162-0.933). The other socio-demographic and clinical characteristics such as age, siblings, daycare attendance, passive smoking, previous acute otitis media, atopy, and adenoidectomy did not significantly influence OME recurrence (p-value > 0.05). The recurrence rate of OME following myringotomy is high. Myringotomy with tube insertion significantly decreases the recurrence rate and the need for further surgeries compared to myringotomy alone. Adenoidectomy and the patient's age have no impact on the recurrence rate of OME.

Endoscopic transorbital management of frontal sinus mucocele: a case report and review of the literature.

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

Short bowel syndrome as an unusual complication of strangulated congenital diaphragmatic hernia: Case report.

INTRODUCTION: Strangulation is a rare complication of congenital diaphragmatic hernia (CDH). There are few cases in the literature describing strangulated CDH. However, none of them was a recurrence of a previously repaired defect nor resulted in short bowel syndrome. PRESENTATION OF CASE: We report an unusual case of newborn presenting with CDH that was repaired shortly after birth but developed recurrence with strangulation few months after, requiring a massive resection, resulting in short bowel syndrome (SBS). It was managed via total parenteral nutrition feeding for three months until the patient was able to tolerate orally. DISCUSSION: There were one familiar case in the reported literature by Woolley of an infant developing bowel infraction as a result of CDH where he later developed short bowel syndrome. CONCLUSION: Short bowel syndrome is an unlikely outcome of strangulated CDH. Early repair of the defect should be promoted to avoid the devastating consequences of an CDH similar to the ones encountered in our case. High index of suspicion should be kept during the follow-up of patients with CDH post repair to detect early signs of recurrences.