Sphenochoanal polyps.

Nasal polyps are a common aetiology for persistent nasal obstruction. While antrochoanal polyps predominate the literature, the lesser known sphenochoanal polyp is equally as bothersome. To our knowledge, no prior dedicated review exists that characterises the patient population affected by this disease. We present a case and associated literature review over the past 30 years on the patient demographics and treatment of sphenochoanal polyps. A total of 88 cases were identified. Of the published cases, 77 were included in our search as patient characteristics were available. The age ranged from 2 to 80 years old. There were 35 female and 42 male patients. Only 58 studies established laterality, with the polyps originating from the left in 32 cases, right in 25 and bilateral in 1 case. Sphenochoanal polyps occur in all ages, nearly even distribution across sex. Endoscopic removal is safe with favourable outcomes.

Asthma control in normal weight and overweight/obese asthmatic children following adenotonsillectomy.

OBJECTIVES: Childhood adenotonsillar hypertrophy (ATH) with sleep-disordered breathing (SDB) frequently occurs concomitant with asthma. Adenotonsillectomy and reduction in asthma severity association has been reported. We describe changes in asthma control in nonobese or normal weight and obese/overweight children undergoing adenotonsillectomy for SDB. METHODS: This prospective, nonrandomized cohort trial with 6-month follow-up at a tertiary children's hospital enrolled 41 children with persistent asthma undergoing adenotonsillectomy for SDB. Children with significant chronic medical conditions, premature birth (< 28 weeks), or recent respiratory infection were excluded. Patients were stratified by baseline BMI into nonobese or normal weight (BMI < 85 percentile) and obese/overweight (BMI > 85%). The primary outcome was change in Childhood Asthma Control Test (cACT) scores 3 and 6 months following adenotonsillectomy. Secondary outcome examined improvement in Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) 3 and 6 months following adenotonsillectomy. RESULTS: Baseline characteristics were similar except for anthropometric measures and mean PACQLQ (P = .03). Children with nonobese or normal weight (n = 26) had statistically significant improvement in change in cACT at 3 (22.80 ± 2.33 vs. 17.86 ± 3.53, P < .001) and 6 (20.71±3.29 vs. 18.24 ± 4.16, P = .044) months compared with baseline. PACQLQ scores also improved at 3 (6.20 ± 0.87 vs. 4.56 ± 1.12, P < .001) and 6 (6.36 ± 0.72 vs. 4.93 ± 0.96, P < .001) months. Obese/overweight children (n = 10) had significant improvement in cACT scores at 6 months (20.00 ± 3.90 vs. 15.00 ± 6.90, P = .048). Change of cACT scores at 3 months (17.86 ± 3.53 vs. 14.86 ± 6.31, P = .272) was not significantly different. PACQLQ scores improved at 3 (5.47 ± 1.09 vs. 3.70 ± 0.85, P < .001) and 6 (5.75 ± 2.19 vs. 3.67 ± 1.04, P = .016) months. CONCLUSION: Nonobese or normal-weight children undergoing adenotonsillectomy demonstrated significant improvement in asthma control scores at 3 and 6 and obese/overweight children at 6 months. Using the PACQLQ, caregiver quality of life improved for all children at 3 and 6 months. Surgical management of ATH in children with comorbid SBD and asthma is a good treatment option.

Physician impact on the patient and family experience in a pediatric otolaryngology practice.

OBJECTIVE: On the Press Ganey (PG) survey, the item "likelihood of recommending practice" is a proxy for patient satisfaction because only the most satisfied patients will recommend a practice to friends and family. The objective of this study is to determine which other items on the PG survey best correlate with "likelihood of recommending practice" as a measure of patient satisfaction in pediatric otolaryngology. STUDY DESIGN: Retrospective analysis of a survey database. METHODS: The PG survey, consisting of 24 questions scaled from 1 to 5 representing (1) very poor, (2) poor, (3) fair, (4) good, and (5) very good, was sent to 28 different pediatric otolaryngology practices. Using the Pearson correlation coefficient, the statistical relationship of each PG survey question was analyzed in its association to the PG question "likelihood of recommending practice." Factors with a correlation coefficient greater than 0.65 were considered significant. RESULTS: Ten of 24 questions on the PG survey correlated with a top "likelihood of recommending practice" score. Eight of these 10 items were from the Care Provider category and were related to the physician-patient/family interaction. CONCLUSION: Patient satisfaction surveys are utilized as a quality metric of the patient and family experience. These scores serve as one of several measures that affect reimbursement. The results demonstrate that most of the factors correlated with "likelihood of recommending practice" are provider-based. In conclusion, the physician-patient interaction strongly influences the potential for a practice to earn top box scores on the PG item "likelihood of recommending practice" and thereby achieve the highest patient satisfaction. LEVEL OF EVIDENCE: NA. Laryngoscope, 129:2610-2613, 2019.

A Review Over the Past 15 Years of the Management of the Internal Piriform Apex Sinus Tract of a Branchial Pouch Anomaly and Case Description.

OBJECTIVES: Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description. REVIEW METHODS: Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained. RESULTS: One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful. CONCLUSIONS: Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO2laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report.

Orbital complications of acute sinusitis in infants: a systematic review and report of a case.

IMPORTANCE: Orbital infections from acute sinusitis are rare in neonates and infants and can lead to devastating complications. To our knowledge, no prior dedicated review exists for evaluation, treatment, and outcomes of orbital complications in this age group. OBJECTIVE: To perform a systematic review over the past 50 years on the diagnosis and treatment of orbital complications secondary to acute sinusitis in neonates and infants and report a case. EVIDENCE AND ACQUISITION: A systematic review of the literature was performed searching PubMed to collect all the pertinent case reports and series in the English language with subperiosteal orbital abscess (SPOA) or orbital abscess in neonates or infants (date range, 1959-2012). RESULTS: Eleven cases of SPOA in infants were identified, including our current case. Ages ranged from 10 to 74 days. There were 6 female and 5 male infants. The right eye was affected in 5 cases, the left in 5, and both in 1. There was 1 mortality in this series for which surgical drainage was not performed. Staphylococcus aureus was the most common organism isolated in 9 of 11 cases. Seven of the cases had open surgical drainage, 2 had endoscopic procedures (including our case), and 1 had spontaneous rupture of the abscess. CONCLUSIONS AND RELEVANCE: An orbital complication due to acute sinusitis is rare in infants and neonates. Drainage in this patient population appears to be paramount, since the only infant in this series who did not receive drainage had died. Modern telescopes and equipment have allowed endoscopic drainage to be a safe and effective surgical treatment in this age group.

Proposed definitive grading system tool for the assessment of adenoid hyperplasia.

OBJECTIVES/HYPOTHESIS: To propose a definitive standard grading scale in the assessment of adenoid tissue in relation to size, position, and proximity to surrounding anatomic structures. This will allow for better clinical communications among practitioners when treating this pathology, a better understanding of its relationship and how it effects neighboring structures (eustachian tube and choanae), and allow for a more precise description of this tissue for the purpose of research data collection and analysis. STUDY DESIGN: A prospective evaluation of adenoid tissue during adenoidectomy was obtained documenting its size and descriptive relationship to adjacent structures (eustachian tube and choanae). METHODS: A convenience sample of 150 children undergoing adenoidectomy alone or concurrently with tonsillectomy and/or myringotomy and tubes were prospectively evaluated. Mirror nasopharyngeal exam was performed in all cases. Size of the adenoid, as well as its relationship to the choanae and eustachian tube were recorded. A descriptive grading system tool was created accounting for these relationships. Statistical analysis was performed to offer a preliminary validation of the tool. RESULTS: Adenoid grading scores were assigned to 150 pediatric patients, 74 males and 76 females, who underwent surgery for adenoidectomy with or without tonsillectomy and/or myringotomy and tube placement. Seven patients were found to have no adenoid tissue in the nasopharynx as they had previous adenoidectomy and received a grade of 0A-. The mean age was 5.71 years (range, 1-17 years). Of the 150 scores, 107 patients had an associated diagnosis of chronic hypertrophic adenoids and/or tonsils (CHAT) accounting for 71.3% of the sample. There was a significant increasing trend of CHAT with an increasing size and increasing blocking of the choanae. However, there is no relationship of this morbidity with blocking of the eustachian tube (ET). There is a strong inverse relationship between blocking of the choanae and chronic and recurrent adenotonsillitis. The percentage of patients with this morbidity significantly decreases with increasing blocking of the choanae. A total of nine patients with chronic sinusitis were found to have no relationship between size, blocking of the choanae, and abutting of the eustachian tube. Eustachian tube dysfunction (ETD) was significantly related to blocking of the eustachian tube (ET) in this study, as 54.3% experienced ETD in the presence of blocked ET compared to only 15% in the absence of a blocked ET. Among the components of the adenoid score, the diagnosis given preoperatively, and the surgical treatments performed, there were strong correlations found giving merit to the descriptive nature of this grading tool proposed. CONCLUSIONS: This grading system is simple, reliable, and easily used. It offers standardization for clinicians and researchers in facilitating communications, and allowing interpretation of adenoid tissue observed with its relationship to and effect on adjacent anatomic structures. This will allow more detailed information of findings during adenoid surgery to assist in future clinical research studies and outcomes analysis.

Infantile myofibroma of the nasal cavity; a case report and review of the literature.

Infantile myofibroma is the most common fibrous tumor of infancy. Although the etiology is unknown, some cases are associated with a genetic inheritance of variable penetrance. With a myriad of possible locations, the presenting symptoms and findings are highly variable making its diagnosis difficult. Worldwide, there have been close to three hundred reported cases. Approximately 90% of these cases presented before age 2 with over half present at birth. The incidence is likely to be greater as many asymptomatic or hidden lesions will regress prior to discovery. The following is a report on a 7 month old male diagnosed with an infantile myofibroma within his right nasal cavity originating from the anterior skull base. This case is unusual in both its symptom presentation as well as location of origin of this tumor.

Neurilemmoma presenting as a midline nasal mass in a pediatric patient.

We report a case of a neurilemmoma presenting as a midline nasal mass in a 13-year-old girl. To the best of our knowledge, this is the first report of a nasal neurilemmoma in a pediatric patient. Although this neoplasm is benign in nature, surgical resection is warranted to prevent recurrence, and it is the sole means of treatment. The overall prognosis is excellent, as was the case for our patient. We discuss the diagnosis and management of neurilemmomas and urge physicians not to exclude nasal neurilemmoma from the differential diagnosis in a pediatric patient who presents with a nasal mass.

High yield technique to diagnose immotile cilia syndrome: a suggested algorithm.

OBJECTIVES: To determine the efficacy of our nasal brush biopsy technique to diagnose primary ciliary dyskinesia. STUDY DESIGN: Retrospective chart review at an urban children's hospital. METHODS: We obtained medical records of all patients who underwent an endoscopic guided ciliary brush biopsy from January 2000 to June 2008. Data recorded included the procedure date, biopsy location, presence of motility on light microscopy, and whether specimen was sent for electron microscopy and those results. RESULTS: Sixty pediatric patients between the ages of 16 months and 17.3 years with chronic sinusitis (35 males, 25 females) were identified. Three were excluded because biopsies were taken from a non nasal location. Forty-seven specimens had light microscopy evaluation only, as normal motile cilia were identified. Ten had haphazard or absent motility and required further evaluation with electron microscopy. Electron microscopy ruled out defects for three samples, was non-diagnostic for five, and the remaining two reports could not be found. Overall, in 47/57 (82%) cases, light microscopy alone ruled out primary ciliary dyskinesia (PCD). Using both methods, there was a 91% success rate in ruling out PCD. CONCLUSIONS: Obtaining an endoscopic biopsy with a cytosoft cytology brush (Camarillo California) from the posterior portion of the inferior turbinate gave sufficient specimen to examine for PCD. Light microscopy alone or in concert with evaluation by electron microscopy confirmed normal cilia in 91% of specimens ruling out the diagnosis of PCD. The algorithm suggested is simple and has high success in allowing the clinician to exclude the diagnosis of PCD in the patient with chronic or recurrent upper respiratory infections.

Magnetic resonance imaging in the diagnosis of subglottic cysts of infancy: case report and review.

Subglottic cysts can cause stridor and respiratory distress in the infant. The diagnosis of subglottic cysts is often confirmed during direct laryngoscopy and bronchoscopy. We describe the case of a 6-month-old boy with bilateral subglottic cysts that were preoperatively diagnosed by magnetic resonance imaging (MRI). We also review the current literature on the diagnosis and treatment of subglottic cysts. Up until now, 63 cases of subglottic cysts were reported in the literature since 1966, and most were diagnosed by direct endoscopy. In this article, we describe a new case and we provide the first published report of the novel use of MRI in diagnosing this lesion.