Endoscopic transcanal coblation excision of glomus tympanicum: a novel technique.

OBJECTIVE: To evaluate the feasibility of coblation in excision of glomus tympanicum tumors. PATIENTS AND METHODS: A retrospective study carried out over 28 patients with types I and II glomus tympanicum tumors according to GLASSCOCK-JACKSON classification. Preoperative radiological and endocrinal evaluation were performed. All patients underwent endoscopic transcanal excision of their glomus tympanicum tumors using coblation. RESULTS: None of the patients developed recurrence during the 1-year follow up period proved radiologically. None of the patients developed facial palsy postoperatively. Differences between preoperative and postoperative dizziness and taste disturbance were statistically non-significant. Tinnitus disappeared completely in 22 patients postoperatively. A statistically significant reduction in Tinnitus Handicap Inventory (THI) after surgery was found. Statistically significant reductions in postoperative air conduction (AC) threshold and air bone gap (ABG) were recorded while bone conduction (BC) threshold showed statistically non-significant change. CONCLUSION: Coblation is an effective and safe tool in excision of glomus tympanicum tumors. Further studies comparing coblation with laser and piezosurgery are strongly recommended.

Digital impression (intraoral scanners) and factors affecting its accuracy - an insight into knowledge and awareness amongst graduates, and clinical practitioners.

BACKGROUND: This study aimed to evaluate the knowledge, awareness, and practice of intraoral scanners (IOS) and the factors affecting their accuracy amongst dental interns and practitioners. METHODS: This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia, with the help of online questionnaires. The forms were distributed to 500 dental interns and practitioners and the questionnaire's validity and reliability were evaluated for vetting and remarks. The questionnaire consisted of three parts: the participants' demographic details, questions on the awareness and knowledge of participants regarding IOS, and the factors affecting the accuracy in clinical use of IOS. Questions were to be answered with 'yes', 'no' and 'I don't know'. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p < 0.05. RESULTS: Most of the participants (58%) knew about the IOS and its applications (47.5%), but the majority of the participants did not use IOS in their clinics (43.5%). The majority of males (57.39%) and females (50.86%) strongly agreed that cost was a barrier to purchasing an IOS. To better get more knowledge on IOS, the specialists 66 (16.5%) and interns 54 (13.5%) chose continuing dental education programs and workshops. There was a significant association (p < 0.05) of knowledge and awareness, perception, and factors affecting parameters with different categories and years of experience. CONCLUSION: Within the limitations of this study, most participants had a positive stance towards IOS but due to inadequate knowledge and understanding, its use and applications were minimal. IOS was well-received regardless of operator training and experience. There is a significant need to increase awareness of this concept, as it may increase treatment efficiency and effectiveness.

"Better start": promoting breastfeeding through demarketing.

BACKGROUND: This paper explores how demarketing strategies impact women's breastfeeding attitudes, intentions, and behaviors under the moderation of time pressure and breastfeeding knowledge. METHODS: A cross-sectional questionnaire-based survey among 369 respondents is used to test the proposed hypotheses. The study's population includes all breastfeeding women in Palestine. Snowball and convenience sampling were used to choose study participants through personal connections and social media. Every respondent was encouraged to share the survey with their social media contacts. RESULTS: The data results confirm the positive effects of promotion, place, price, and product demarketing, respectively, on women's attitudes, intentions, and behavior toward breastfeeding. These effects were reinforced by reduction in time pressure and breastfeeding knowledge. Furthermore, demarketing effects are stronger for younger, more educated, unemployed, and lower-income women. CONCLUSION: The study is a primer on promoting breastfeeding instead of formula by means of demarketing strategies.

Endoscopic transcanal management of incus long process defects: rebridging with bone cement versus incus interposition.

OBJECTIVES: to compare hearing outcomes between endoscopic transcanal rebridging with bone cement and endoscopic transcanal incus interposition in patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type). METHODS: This retrospective study was performed on 83 ears of 83 consecutive patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type). According to the extent of incus long process erosion and subsequent ossiculoplasty technique, patients were divided into 2 groups. Patients in group 1 had erosion involving up to two thirds of the length of the incus long process and underwent endoscopic transcanal rebridging with bone cement. Patients in group 2 had erosion involving more than two thirds of the length of the incus long process and underwent endoscopic transcanal incus interposition. RESULTS: Hearing gain (mean ± standard deviation) was 21.39 ± 2.15 dB in group 1 and 19.71 ± 6.12 dB in group 2. A significantly greater hearing gain was achieved in bone cement group than in incus interposition group (P value < 0.001). Successful hearing outcome (post-operative air bone gap closure within 20 dB) was achieved in 81.6% and 71.1% of patients of group 1 and group 2 respectively. CONCLUSION: Endoscopic transcanal rebridging with bone cement offers greater hearing gain than endoscopic transcanal incus interposition. The two techniques remain reliable and cost-effective techniques in management of patients with incus long process defects. The main limitation of this study was the short follow-up period. Further studies with relatively long-term follow-up are strongly recommended.

Assessment of the ability of the radiological incudo-stapedial angle to predict the stapedotomy technique type: a prospective case-series study.

PURPOSE: This study aimed to propose a radiological classification of the incudo-stapedial angle by preoperative high-resolution computed tomography (HRCT) images and to highlight its importance for predicting the use of reversal-steps stapedotomy (RSS) rather than the traditional non-reversal technique. METHODS: We included 83 candidates for stapedotomy operation. Two physicians measured the radiological incudo-stapedial joint angle in the preoperative HRCT. According to this measurement, the radiological incudo-stapedial joint was classified into three types: obtuse, right, and acute. In addition, this radiological classification was correlated with the intraoperative use of the stapedotomy technique, either reversal or non-reversal. RESULTS: The RSS technique was used in forty-two (97.7%) cases with an obtuse angle and twenty-six (89.7%) with a right angle. At the same time, the traditional non-reversal technique was used in all patients with an acute angle. The three groups differed significantly regarding the method used for stapedotomy (P value < 0.001). Moreover, Spearman's correlation coefficient revealed a significant correlation between the used technique and the radiological type of the incudo-stapedial angle (P value < 0.001). CONCLUSIONS: This prospective study proposed a preoperative radiological classification of the incudo-stapedial angle. This classification was significantly correlated with the type of stapedotomy technique. The RSS technique was feasible in most cases with an obtuse and right radiological incudo-stapedial angle. In contrast, the non-reversal method was used in all patients with an acute radiological incudo-stapedial angle. This radiological classification could predict the choice for the stapedotomy technique with an accuracy of 95.18%, a sensitivity of 73.33%, and a specificity of 100%.

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction.

PURPOSE: Pediatric laryngotracheal reconstruction (LTR) for laryngotracheal stenosis (LTS) mandates stenting in certain situations. This study presents a novel commercially available and cost-effective stent, a refashioned foley catheter. METHODS: This prospective clinical study was performed on pediatric cases with LTS up to 8 years. The study was performed in a tertiary referral center. The selection of the proper foley catheter size for age was explained. The atraumatic insertion maneuver of the stent was also shown in detail in different situations of LTS. The endoscopic removal of the stent was also described. The mean follow-up was 6.45 ± 1.3 months. RESULTS: The study included 31 cases using the refashioned foley catheter stents. The study included 17 males and 14 females with a mean age of 3.45 ± 1.09. Subglottic stenosis was the most common cause of LTR in the study (74.2%) cases. The mean duration of stenting was 40.5 ± 3.7 days. Decannulation was achieved in 96.8% of cases. No stent complications were encountered like stent migration, excess granulation tissue, intractable aspiration, or pressure necrosis. CONCLUSION: The refashioned foley catheter is a novel, available, and inexpensive stent that can be utilized for LTR cases for pediatric LTS. The newly described stent is soft, pliable with atraumatic insertion and easy endoscopic removal with minimal complications.

Clinical assessment of different implant-supported esthetic crown systems fabricated with semi-digital workflow: Two-year prospective study.

OBJECTIVE: To assess the clinical outcome of three esthetic implant-supported crown systems fabricated with semi-digital workflow and their influence on the clinical outcome of dental implants. MATERIAL AND METHODS: A total of 30 participants had received dental implants restoring missing maxillary first/second premolars. After 6 weeks, customized zirconia abutments were early loaded. Two months later, the definitive crowns were fabricated using semi-digital workflow and cemented. According to the crown material, 3 groups were randomly allocated; group (Z): ultrahigh-translucent monolithic zirconia, group (C): resin-matrix ceramic and group (P): polyetherketoneketone veneered with light-cured composite resin. Clinical outcomes including the survival and success rates were evaluated at baseline, 6, 12, 18, and 24 months. RESULTS: The survival rate for all studied groups was 100%, while their success rate was 100% for group (Z) and 90% for group (C) and group (P). Based on the functional implant prosthodontic score, a statistically significant difference was detected between group (Z) and group (P) (p < 0.001) as well as between group (C) and group (P) (p = 0.01). CONCLUSIONS: The zirconia group had the most favorable clinical behavior, while the polyetherketoneketone had the least. All crown systems had comparable success rates with similar values of the peri-implant marginal bone loss. CLINICAL SIGNIFICANCE: Using semi-digital workflow, ultrahigh-translucent monolithic zirconia, resin-matrix ceramic and polyetherketoneketone veneered with light-cured composite resin can be considered as favorable implant-supported crowns. The implant-supported crown system based on polyetherketoneketone veneered with light-cured composite resin is counted as a promising esthetic and restorative option.

Diagnostic performance of chest computed tomography for COVID-19 in children: a systematic review and meta-analysis of clinical and computed tomography features in 987 patients.

Purpose: The outbreak of a new coronavirus is still spreading worldwide, affecting children and adults. However, COVID-19 in children shows distinctive characteristics in clinical and radiological presentation. We aimed to assess the diagnostic performance of chest CT and clarify the clinicoradiological CT features of COVID-19 among children with COVID-19. Material and methods: Adhering to PRISMA-DTA guidelines, we searched databases (PubMed, Google Scholar, and Web of Science) to identify relevant articles. The search keywords were: "Chest CT" AND "COVID-19" OR "coronavirus" OR "SARS-COV-2" AND "Children" OR "Pediatric". Published reports providing clinical and imaging findings of paediatric COVID-19 were included. Results: Twenty-eight studies were included, with 987 patients. Most of the patients were symptomatic (76.9%; 95% CI: 69.2-84.7%), with fever being the most frequent manifestation (64%; 95% CI: 58.0-71.2%). Only 2.3% of the cases were critical, and mortality was reported in one case. The proportion of COVID-19 detected by chest CT among children is relatively high (658/987), with ground-glass opacity (GGO) being the most prevalent feature (52.5%; 95% CI: 40.5-64.7%). The pooled sensitivity of chest CT in all patients was 67%; however, it was different between symptomatic and asymptomatic patients (71% and 33%, respectively). The pooled specificity was (67%), which was calculated after considering the symptomatic PCR-positive patients as the gold standard. Conclusions: Chest CT showed moderate pooled sensitivity and specificity among symptomatic children with COVID-19 and low sensitivity among asymptomatic children. This means that CT is not to be used as a screening tool or for confirmation of the diagnosis in children and should be reserved for specific clinical situations.

Endoscopic single versus double flap tympanoplasty: a randomized clinical trial.

OBJECTIVE: This study aims to compare the results of endoscopic over-underlay tympanoplasty, single flap technique, with endoscopic over-underlay tympanoplasty combined with an anterior tab, double flap technique, in repair of the challenging total and subtotal tympanic membrane perforations with inadequate anterior remnant. This is to determine whether highly adequate visualization at the anterior meatal angle area offered by endoscopy can eliminate the need for anterior tab reinforcement. SUBJECTS AND METHODS: A prospective randomized single-blinded study involving 104 patients with total or subtotal tympanic membrane perforations was conducted. Patients were randomized into two groups: 52 with endoscopic single flap tympanoplasty, first group, and 52 with endoscopic double flap tympanoplasty, second group, between August 2017 and February 2019. The main outcome is graft take rate. Secondary outcomes include hearing results, pain score assessment, operative time and postoperative complications. RESULTS: Graft take rates were 94% and 98% for the first and second groups, respectively (P value = 0.307). Significant improvement was achieved in total air-bone gap from 21.45 ± 5.37 and 23.1 ± 4.47 preoperatively to 6.4 ± 5.46 and 6.15 ± 3.57 postoperatively for the first and second groups, respectively. Pain scores were not significantly different between the two groups. Mean operative time was significantly longer in the second group (P value = 0.010). There was no reported lateralization or anterior blunting in both groups. CONCLUSION: In repair of total and subtotal tympanic membrane perforations with inadequate anterior remnant, endoscopic enrollment provides excellent visualization and good manipulation at the anterior meatal angle area with favorable results, eliminating the need for adding an anterior tab and alleviating the burden of longer operative time. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov (NCT03922295) "retrospectively registered" at 18/4/2019.

Horizontal Review on Video Surveillance for Smart Cities: Edge Devices, Applications, Datasets, and Future Trends.

The automation strategy of today's smart cities relies on large IoT (internet of Things) systems that collect big data analytics to gain insights. Although there have been recent reviews in this field, there is a remarkable gap that addresses four sides of the problem. Namely, the application of video surveillance in smart cities, algorithms, datasets, and embedded systems. In this paper, we discuss the latest datasets used, the algorithms used, and the recent advances in embedded systems to form edge vision computing are introduced. Moreover, future trends and challenges are addressed.

Liver Tumor Segmentation in CT Scans Using Modified SegNet.

The main cause of death related to cancer worldwide is from hepatic cancer. Detection of hepatic cancer early using computed tomography (CT) could prevent millions of patients' death every year. However, reading hundreds or even tens of those CT scans is an enormous burden for radiologists. Therefore, there is an immediate need is to read, detect, and evaluate CT scans automatically, quickly, and accurately. However, liver segmentation and extraction from the CT scans is a bottleneck for any system, and is still a challenging problem. In this work, a deep learning-based technique that was proposed for semantic pixel-wise classification of road scenes is adopted and modified to fit liver CT segmentation and classification. The architecture of the deep convolutional encoder-decoder is named SegNet, and consists of a hierarchical correspondence of encode-decoder layers. The proposed architecture was tested on a standard dataset for liver CT scans and achieved tumor accuracy of up to 99.9% in the training phase.

Seroprevalence and risk factors of Q-fever (C. burnetii infection) among ruminants reared in the eastern region of the Kingdom of Saudi Arabia.

Q-fever is a worldwide spread zoonotic disease associated with severe illness in humans and abortions and stillbirths in ruminants. Ruminants are major sources of human infection where subclinical carriers shed the bacteria in various secretions and excreta. The goal of the current study was to investigate the prevalence and risk factors of Coxiella burnetii infection among cattle, sheep, and goats in the eastern province of the Kingdom of Saudi Arabia (KSA). A total of 1310 serum samples were collected through a designed cross-sectional study from private farms and slaughterhouses in the study area and examined against antibodies of C. burnetii using ELISA. A multivariate logistic regression analysis was built to detect risk factors of C. burnetii infection among examined species. The prevalence of C. burnetii infection among examined animals was 9.2% (CI, 7.7-10.8)-15.6%, 9.1%, and 5.8% among goats, cattle, and sheep, respectively). The risk of getting C. burnetii infection among old animals (> 1 year old) was 23 times higher than the risk among young animals (< 1 year old) (95% CI, 10.04-53.01; P < 0.01). Goats were 2.27 (95% CI, 1.41-3.66; P < 0.01) and 3 times at higher risk than cattle and sheep, respectively, of getting C. burnetii infection. In conclusion, C. burnetii infection is widespread among different ruminant species of the eastern province of KSA which represents a high risk for environmental contamination and disseminating the infection to humans and animal species in that area. Also, our findings may reflect the disease status in other countries of the Arabian Gulf area.

Control of citrus molds using bioactive coatings incorporated with fungal chitosan/plant extracts composite.

BACKGROUND: The ongoing postharvest loss in citrus fruits, due to fungal infection, is a chronic economic and agricultural problem. Most of citrus damage is caused by Penicillium spp., e.g. green mold (P. digitatum) and blue mold (P. italicum). Fungal chitosan, from Mucor rouxii, and plant extracts from cress seeds, olive leaves, pomegranate peels and senna pods, were evaluated as antifungal agents against the phytopathogenic fungi, P. digitatum and P. italicum, using in vitro qualitative and quantitative assays. RESULTS: All natural agents tested exhibited potent antifungal activity; the most powerful agent was cress (Lepidium sativum) seed extract, followed by pomegranate (Punica granatum) peel extract. Fungal chitosan also had a remarkable fungicidal potentiality using both evaluation assays. Penicillium digitatum was generally more resistant than P. italicum toward all examined agents. The incorporation of each individual natural agent in coating material resulted in a great reduction in fungal growth and viability. The addition of chitosan combined with cress and pomegranate extracts, to the coating materials, prevented coated citrus fruit from decay by green and blue mold for a 2-week storage period. CONCLUSION: Natural derivatives could be recommended as powerful antifungal alternatives to protect citrus fruits from postharvest fungal decay.

Basic evidence for epidermal H2O2/ONOO(-)-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS.

Nonsegmental vitiligo (NSV) is characterized by loss of inherited skin color. The cause of the disease is still unknown despite accumulating in vivo and in vitro evidence of massive epidermal oxidative stress via H2O2 and peroxynitrite (ONOO(-)) in affected individuals. The most favored hypothesis is based on autoimmune mechanisms. Strictly segmental vitiligo (SSV) with dermatomal distribution is a rare entity, often associated with stable outcome. Recently, it was documented that this form can be associated with NSV (mixed vitiligo). We here asked the question whether ROS and possibly ONOO(-) could be players in the pathogenesis of SSV. Our in situ results demonstrate for the first time epidermal biopterin accumulation together with significantly decreased epidermal catalase, thioredoxin/thioreoxin reductase, and MSRA/MSRB expression. Moreover, we show epidermal ONOO(-) accumulation. In vivo FT-Raman spectroscopy reveals the presence of H2O2, methionine sulfoxide, and tryptophan metabolites; i.e., N-formylkynurenine and kynurenine, implying Fenton chemistry in the cascade (n=10). Validation of the basic data stems from successful repigmentation of skin and eyelashes in affected individuals, regardless of SSV or segmental vitiligo in association with NSV after reduction of epidermal H2O2 (n=5). Taken together, our contribution strongly supports H2O2/ONOO-mediated stress in the pathogenesis of SSV. Our findings offer new treatment intervention for lost skin and hair color.

An unusual presentation: temporomandibular tissue herniation through congenital foramen of Huschke.

BACKGROUND: The herniation of temporomandibular tissue through the foramen of Huschke into the external auditory canal is a rare clinical anomaly. This paper describes one such case and provides an overview of the relevant literature. This paper elaborates upon the aetiology, clinical assessment, management and associated complications. CASE REPORT: A 54-year-old woman presented with a 3-month history of right ear pain and a polypoid lesion in her right ear canal. This lesion expanded during a Valsalva manoeuvre, and imaging demonstrated a defect in the antero-superior aspect of the canal with herniation of soft tissue. The patient was managed conservatively as the symptoms resided. CONCLUSION: Ear canal lesions that protrude or change in size with a Valsalva manoeuvre could be due to a persistent foramen of Huschke. In symptomatic cases needing surgical intervention, a variety of materials may be used to close the defect. Titanium mesh, with or without cartilage overlay, appears to be the most popular choice.

Deep residual 2D convolutional neural network for cardiovascular disease classification.

Cardiovascular disease (CVD) continues to be a major global health concern, underscoring the need for advancements in medical care. The use of electrocardiograms (ECGs) is crucial for diagnosing cardiac conditions. However, the reliance on professional expertise for manual ECG interpretation poses challenges for expanding accessible healthcare, particularly in community hospitals. To address this, there is a growing interest in leveraging automated and AI-driven ECG analysis systems, which can enhance diagnostic accuracy and efficiency, making quality cardiac care more accessible to a broader population. In this study, we implemented a novel deep two-dimensional convolutional neural network (2D-CNN) on a dataset of PTB-XL for cardiac disorder detection. The studies were performed on 2, 5, and 23 classes of cardiovascular diseases. The our network in classifying healthy/sick patients achived an AUC of 95% and an average accuracy of 87.85%. In 5-classes classification, our model achieved an AUC of 93.46% with an average accuracy of 89.87%. In a more complex scenario involving classification into 23 different classes, the model achieved an AUC of 92.18% and an accuracy of 96.88%. According to the experimental results, our model obtained the best classification result compared to the other methods based on the same public dataset. This indicates that our method can aid healthcare professionals in the clinical analysis of ECGs, offering valuable assistance in diagnosing CVD and contributing to the advancement of computer-aided diagnosis technology.

Outlier detection for keystroke biometric user authentication.

User authentication is a fundamental aspect of information security, requiring robust measures against identity fraud and data breaches. In the domain of keystroke dynamics research, a significant challenge lies in the reliance on imposter datasets, particularly evident in real-world scenarios where obtaining authentic imposter data is exceedingly difficult. This article presents a novel approach to keystroke dynamics-based authentication, utilizing unsupervised outlier detection techniques, notably exemplified by the histogram-based outlier score (HBOS), eliminating the necessity for imposter samples. A comprehensive evaluation, comparing HBOS with 15 alternative outlier detection methods, highlights its superior performance. This departure from traditional dependence on imposter datasets signifies a substantial advancement in keystroke dynamics research. Key innovations include the introduction of an alternative outlier detection paradigm with HBOS, increased practical applicability by reducing reliance on extensive imposter data, resolution of real-world challenges in simulating fraudulent keystrokes, and addressing critical gaps in existing authentication methodologies. Rigorous testing on Carnegie Mellon University's (CMU) keystroke biometrics dataset validates the effectiveness of the proposed approach, yielding an impressive equal error rate (EER) of 5.97%, a notable area under the ROC curve of 97.79%, and a robust accuracy (ACC) of 89.23%. This article represents a significant advancement in keystroke dynamics-based authentication, offering a reliable and efficient solution characterized by substantial improvements in accuracy and practical applicability.

Unusual coexistence: A case of mixed small and large cell neuroendocrine tumor in a bladder previously affected by bilharzial cystitis.

Neuroendocrine tumors of the bladder are rare, accounting for less than 1% of all bladder tumors. Among these, large cell neuroendocrine carcinoma is an extremely uncommon subtype. We report on a histologically confirmed case of mixed both large and small cells neuroendocrine tumor of the bladder in a 64-year-old male with a history of bilharzial cystitis. The diagnosis was made after radical cystectomy with Immunohistochemical staining revealing positivity for synaptophysin, CD56, and AE1/3. While bilharzia is commonly linked to squamous cell carcinoma in the bladder, the potential relationship with neuroendocrine tumors is still relatively unexplored in this context. This case marks the first reported instance of the atypical coexistence of bilharzial cystitis and mixed large and small cell neuroendocrine carcinoma of the bladder. This unique case of coexisting highlights a rare phenomenon warranting further study. Similar associations have been documented in other organs, emphasizing the importance of exploring underlying mechanisms and clinical implications for improved patient care and outcomes.

Endoscopic ossiculoplasty in traumatic conductive hearing loss with intact tympanic membrane: a five-year experience.

BACKGROUND: Exploratory tympanotomy in cases of traumatic ossicular disruption with intact tympanic membrane is crucial for both diagnostic and therapeutic purposes. Performing this procedure using the endoscope is gaining popularity. Hence, this study aimed to demonstrate varieties of ossicular pathology and their management in our institution. METHODS: A retrospective evaluation was conducted of 136 ears in patients with traumatic ossicular disruption with an intact tympanic membrane, who underwent endoscopic exploratory tympanotomy. A proposed algorithm was followed, to incorporate different traumatic ossicular possibilities. Assessment of hearing outcomes and surgical complications was performed six months post-operatively. RESULTS: Incudostapedial dislocation was the most commonly encountered type of traumatic ossicular disruption (35.3 per cent). Air conduction threshold improved significantly following endoscopic ossiculoplasty, from 50.9 ± 6.35 dB pre-operatively to 22.35 ± 3.27 dB post-operatively, with successful air-bone gap closure. CONCLUSION: Endoscopic ear surgery is effective in the diagnosis and management of challenging cases of post-traumatic ossicular disruption with an intact tympanic membrane.

Does surgery affect the neurodevelopmental outcome of moderate laryngomalacia?

BACKGROUND: Moderate laryngomalacia lies in the grey zone where the parents and treating team might hesitate to decide the treatment plan for the child. Neurodevelopmental assessment of the child was neither assessed nor incorporated in surgical decision-making in the past. OBJECTIVES: To evaluate the neurodevelopmental outcome of moderate laryngomalacia treatment strategies (surgery versus conservative). METHODS: We conducted an observational multicentric cohort study. We compared two groups of patients according to their moderate laryngomalacia treatment strategy: surgical treatment and no treatment. The neurodevelopmental outcome was assessed by Griffiths-III developmental scales. RESULTS: A total of 150 children were diagnosed with moderate laryngomalacia of which 56 were successfully treated with surgery and 94 improved without intervention. The median Griffiths-III developmental quotients (DQs) of subscales A, B, C, E, and general development were significantly higher in the surgically treated group compared to conservatively treated ones. CONCLUSION: Untreated moderate laryngomalacia cases have worse neurodevelopmental outcomes than surgically treated cases.