Performance of portable objective wound assessment tools: a systematic review.

OBJECTIVE: Accurate wound assessment is crucial for determining the progression of healing and guides treatment strategies. Portable wound assessment devices can be useful in providing an accurate evaluation in the community where most cases are treated. The objective of this review was to compare the performance of various portable wound assessment techniques used for wound healing assessment described in the literature. METHOD: In April 2020, electronic databases were searched, using appropriate search terms, for all available publications on the use of portable wound assessment devices on human and artificial wounds. The primary outcome was the reliability and reproducibility of measurement while the secondary outcome was the feasibility of the instrument. All studies underwent quality assessment of diagnostic accuracy studies (QUADAS) to examine the quality of data. RESULTS: A total of 129 articles were identified and 24 were included in the final review; 17 articles discussed two-dimensional (2D) devices; three articles discussed three-dimensional (3D) devices; and four articles discussed application-based devices. Most studies (n=8) reported on a 2D device that had an ICC of 0.92-0.99 for area measurement and a coefficient of variance of 3.1% with an error of 2.3% in human wounds and 1.55-3.7% in artificial wounds. The inter/intra observer reliability was 0.998 and 0.985, respectively with a scan time of two minutes per wound. The median QUADAS score was 12. CONCLUSION: Based on the presented evidence, 2D-based portable wound assessment devices were the most studied and demonstrated good performance. Further studies are required for 3D and application-based measurement instruments.

Translation and Validation of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for Children and Adolescents in Arabic.

Background There are numerous quality-of-life (QoL) assessment tools available; however, only a few are designed specifically for children with chronic conditions. Among these assessment tools are the Hearing Environments and Reflection on QoL questionnaires for children (HEAR-QL26, HEAR-Q28) developed by Washington University. Unfortunately, there are no other tools that assess hearing loss, and none of them are in Arabic. This paper aims to adapt the HEAR-QL to Arabic and provide an accessible method of measuring the QoL of children with hearing loss in our Arabic-speaking populations. Methodology An independent medical translator translated the HEAR-QL26 and HEAR-QL28 into Arabic. The translations were then examined by two bilingual, native Arabic-speaking otolaryngologists who modified the inadequate questions. Back-translation of the Arabic version into English was subsequently performed by an independent translator. Intra-rater reliability was tested for each of HEAR-QL26 and HEAR-QL28 using 10 participants for each survey, where the participants answered the surveys twice with a period of two weeks between them. A pilot study was conducted which had a total of 40 participants divided equally between the two surveys where each group had an equal number of hearing participants and participants with hearing loss. Results Both HEAR-QL26 and HEAR-QL28 were validated with an overall intra-rater reliability of 88.85% and 87.86% respectively. In the pilot study, the HEAR-QL26 participants with normal hearing scored a median of 2437.5, while the participants with hearing loss scored a median of 1837.5 (p = 0.001). Moreover, HEAR-QL28 participants had a median score of 2725 among participants with normal hearing and 1725 for participants with hearing loss (p = 0.001). Conclusion HEAR-QL is a well-established QoL in children with hearing loss. The validated Arabic adaptation can now be used to measure deafness in Arabic-speaking children.

Systematic Review of Endoscopic Ear Surgery Outcomes for Pediatric Cholesteatoma.

OBJECTIVE: Endoscopic ear surgery (EES) has been increasingly adopted to enhance visualization during otologic surgery including pediatric cholesteatoma resection. The purpose of this study is to systematically review the current literature reporting rates of residual cholesteatoma to evaluate outcomes of EES in the pediatric population. DATA SOURCES: PubMed, Embase, Cochrane. STUDY SELECTION: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA), we systematically reviewed studies that reported outcomes for cholesteatoma surgery in children using the endoscope. Studies were included if they described the use of the endoscope for middle ear surgery and measured outcomes following cholesteatoma resection in pediatric patients. DATA EXTRACTION: Identified articles were assessed for study design, sample size, inclusion of pediatric population, the presence of a comparison group, outcomes measured such as: residual disease rate, recurrent cholesteatoma, audiologic outcome, quality of life measures, and complications. DATA SYNTHESIS: Fourteen articles in the literature discussed cholesteatoma outcomes in children when the endoscope was employed. Residual disease rate ranged from 0 to 22% when endoscope was used for dissection compared with 11 to 55% when endoscope was used for inspection or not at all. A meta-analysis was conducted on 11 studies. There was a significant risk reduction in residual disease rates for endoscopic dissection when compared with microscope (RR = 0.48, 95% CI = 0.37-0.63, p < 0.001). CONCLUSION: Among the studies included in this review, EES was associated with lower rates of residual cholesteatoma compared with traditional microscopic techniques. Additional prospective studies are needed to further assess these findings.

Audiologic testing in children with Down Syndrome: Are current guidelines optimal?

INTRODUCTION: Down Syndrome (DS) is a Tier 1 risk factor for hearing loss. Guidelines exist to ensure close monitoring of children with DS for hearing loss. It is important to consider the timing of testing in order to obtain meaningful audiologic data in this high-risk population. The purpose of this study is to present hearing outcomes for children with DS during the first 8 years of life and to assess these outcomes in the context of current screening guidelines. METHODS: Retrospective review of audiometric outcomes was conducted for children with DS age 8 or younger who presented to a multidisciplinary DS clinic between January 2014 to June 2017. Age at the time of testing, as well as test success rate and hearing loss type and severity were noted. RESULTS: 131 patients were included in the study, 52% of which were male. 36% of the patients failed their newborn hearing screening and only 9% of those subjects had normal hearing on subsequent testing. Most hearing loss identified was mild and conductive in nature. Inconclusive results were most likely to be obtained at 6-10 months of age. CONCLUSION: Hearing loss is common among children with DS. To optimize the quality of testing and avoid the need for sedation in followup testing, routine follow-up hearing screening should be performed either before 6 months of age or after 10 months of age.

Quality of Life in Children with Sensorineural Hearing Loss.

OBJECTIVE: To assess quality of life (QOL) in pediatric patients with sensorineural hearing loss (SNHL) with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) and the Hearing Environments and Reflection on Quality of Life 26 (HEAR-QL-26) and HEAR-QL-28 surveys. STUDY DESIGN: Prospective longitudinal study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Surveys were administered to patients with SNHL (ages 2-18 years) from July 2016 to December 2018 at a multidisciplinary hearing loss clinic. Patients aged >7 years completed the HEAR-QL-26, HEAR-QL-28, and PedsQL 4.0 self-report tool, while parents completed the PedsQL 4.0 parent proxy report for children aged ≤7 years. Previously published data from children with normal hearing were used for controls. The independent t test was used for analysis. RESULTS: In our cohort of 100 patients, the mean age was 7.7 years (SD, 4.5): 62 participants had bilateral SNHL; 63 had mild to moderate SNHL; and 37 had severe to profound SNHL. Sixty-eight patients used a hearing device. Mean (SD) total survey scores for the PedsQL 4.0 (ages 2-7 and 8-18 years), HEAR-QL-26 (ages 7-12 years), and HEAR-QL-28 (ages 13-18 years) were 83.9 (14.0), 79.2 (11.1), 81.2 (9.8), and 77.5 (11.3), respectively. Mean QOL scores for patients with SNHL were significantly lower than those for controls on the basis of previously published normative data (P < .0001). There was no significant difference in QOL between children with unilateral and bilateral SNHL or between children with SNHL who did and did not require a hearing device. Low statistical power due to small subgroup sizes limited our analysis. CONCLUSION: It is feasible to collect QOL data from children with SNHL in a hearing loss clinic. Children with SNHL had significantly lower scores on validated QOL instruments when compared with peers with normal hearing.

Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review.

OBJECTIVE: Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients. DATA SOURCES: PubMed, Embase and Cochrane Library. STUDY SELECTION: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated. DATA EXTRACTION: Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported. MAIN FINDINGS: Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia. CONCLUSION: Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.

Pediatric Endoscopic Ossiculoplasty Following Surgery for Chronic Ear Disease.

OBJECTIVE: Rigid endoscopes can improve visualization of the tympanic space compared to traditional microscopic techniques. This study investigates whether use of transcanal endoscopic ossiculoplasty influences audiologic outcomes compared to microscopic ossiculoplasty following chronic ear surgery in children. STUDY DESIGN: Comparative cohort study at two tertiary care centers. METHODS: Retrospective review of pediatric chronic ear cases where ossiculoplasty was performed from February 2009 to March 2018. RESULTS: We identified 100 ears that underwent endoscopic ossiculoplasty and 100 ears that underwent microscopic ossiculoplasty. The mean age was 11 years (range, 4-18 years) with 63% males. There were no significant differences in these parameters between the two groups. Subjects underwent either primary ossiculoplasty or ossiculoplasty during second-look procedures. There was no significant difference in air conduction pure tone average (PTA) after microscopic cases compared to endoscopic cases (-12.5 dB vs. -10.5 dB, P = .40). These results were independent of prosthesis type. Microscopic ossiculoplasty was significantly more likely to use a post-auricular approach (P = .0001). There was no difference in complication rate between the two groups. The malleus was more likely to be absent or removed prior to endoscopic ossiculoplasty (P = .0004) with no significant difference in the change in PTA between groups. CONCLUSIONS: Transcanal endoscopic ossiculoplasty was found to have equivalent audiometric outcomes with significantly fewer post-auricular approaches and no increase in complications compared to microscopic ossiculoplasty. While the malleus was more likely to be absent in endoscopic cases, this did not appear to influence the change in PTA. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

Development and validation of an endoscopic ear surgery classification system.

OBJECTIVES/HYPOTHESIS: To design and validate a classification system for endoscopic ear surgery. STUDY DESIGN: Validation study. METHODS: A classification system was devised that quantifies use of the endoscope during middle ear surgery. Otologic operative reports were reviewed by attending surgeons and trainees. A power analysis was performed to determine number of cases needed to review. The following categories were used: class 0 is defined by using the microscope only; class 1 describes the use of endoscope for inspection without dissection; and class 2 describes mixed use of the endoscope and the microscope. It is further subdivided into 2a and 2b, where the endoscope is used for less than 50% of dissection and more than 50% of dissection, respectively. Class 3 describes the use of the endoscope for the entire surgery. Fifty cases were reviewed by three attending otologic surgeons, one resident, and one medical student. RESULTS: Weighted Cohen's Kappa for inter-rater agreement between the two institutional surgeons was 0.79 (95% bias corrected [BC] confidence interval [CI]: 0.58-0.93). Agreement between the external surgeon and the two institutional surgeons was 0.77 (95% BC CI: 0.58-0.89) and 0.76 (95% BC CI: 0.57-0.88). Weighted Kappa between institutional surgeons and a resident was 0.73 (95% BC CI: 0.53-0.88) and 0.62 (95% BC CI: 0.38-0.80), and between institutional surgeons and a medical student was 0.75 (95% BC CI: 0.56-0.89) and 0.70 (95% BC CI: 0.49-0.85). CONCLUSIONS: There was substantial inter-rater agreement. This classification system can be used as a simple and reliable tool to describe the extent to which an endoscope was used during ear surgery. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:967-970, 2018.

Utilization of diagnostic testing for pediatric sensorineural hearing loss.

BACKGROUND/OBJECTIVE: Sensorineural hearing loss is a common diagnosis among children. The diagnostic workup varies widely among practitioners. This study's aim was to assess the utilization of diagnostic testing for SNHL and determine the yield of each test. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care center. SUBJECTS: 827 patients with a diagnosis of SNHL from January 1, 2011 to January 1, 2015. RESULTS: 746 patients met inclusion criteria. Temporal bone imaging was performed on 561 (75%) of patients with 224 (40%) having positive results that explained the etiology of the SNHL. Congenital SNHL was more likely to be associated with abnormal imaging than acquired SNHL (109/299 versus 106/316 respectively) (p = 0.001). Unilateral SNHL was more likely to be associated imaging abnormalities than bilateral SNHL (101/221 and 123/340 respectively) (p = 0.028). Genetic testing was performed on 244 (33%) patients, of which 94 (39%) had abnormalities. Positive genetics results were more common with bilateral than unilateral SNHL (82/191 and 12/53 respectively) (p = 0.007). There was no statistically significant difference in the utility of genetic testing for congenital and acquired SNHL (p = 0.0836). Cytomegalovirus (CMV) testing was available for 104 (14%) of patients with 13 (12.5%) being positive and consistent with congenital CMV. Electrocardiogram, urinalysis, and Lyme titers were less useful. CONCLUSIONS: Imaging and genetic testing had the highest yield in the evaluation of children with SNHL and were the most commonly performed. CMV testing was valuable in neonates who failed newborn hearing screening.

Use of porcine small intestinal submucosa for pediatric endoscopic tympanic membrane repair.

Tympanic membrane perforationsoccur frequently in children, and can result in hearing loss, otorrhea, pain, and cholesteatoma. Due to the narrower ear canal in children, a postauricular incision is often needed to access the tympanic membrane for surgical repair. Endoscopic approaches are increasingly being used for tympanic membrane repair, reducing the need for postauricular incisions. As the need for a postauricular incision decreases, the demand for non-autologous grafting material has increased. Acellular porcine small intestinal submucosa (SIS) has been described in the literature as an alternative to commonly used autologous grafts, and is well suited for use with transcanal endoscopic ear surgery as a minimally invasive approach. This paper describes techniques for use of SIS in endoscopic tympanic membrane repair in children.

Residual Cholesteatoma during Second-Look Procedures following Primary Pediatric Endoscopic Ear Surgery.

Objectives To determine the rate of residual cholesteatoma during planned second-look procedures in pediatric patients following primary cholesteatoma resection using endoscopic and microscopic operative approaches. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Outcomes from pediatric patients undergoing cholesteatoma surgery from January 2011 through August 2015 were analyzed. Cholesteatoma extent at initial resection was staged, and comparison among endoscopic dissection and microscopic or endoscopic inspection groups was made. Presence of disease at time of planned second look was quantified. Descriptive analysis was performed. Results Fifty-five patients (56 ears) with planned second-look procedures were included and underwent a total of 120 procedures. Median age was 11 years (6.7-13 years). Endoscopes were used for inspection in 25 (39%) primary resections and for dissection in 39 (61%) primary resections. Extent of disease at the time of primary resection was similar among groups (χ2, P = .72). Cases where the endoscope was used for inspection only or not at all during primary resection had a 24% rate of residual cholesteatoma at the time of second look compared with a 23% rate for cases with endoscopic dissection (χ2, P = .93). Rate of mastoidectomy significantly decreased from 63% to 33% over the study period ( P = .04) with similar disease extent ( P = .99). Conclusions Residual cholesteatoma rates during planned second-look procedures were similar between the study groups. Use of the endoscope led to a lower rate of mastoidectomy for cases with similar disease extent.