Index of pediatric voice handicap: Translation, transculturalization and validation to Argentinian Spanish.

OBJECTIVE: Voice disorders are very common in the pediatric population, with 6% and 23% of all children presenting with some form of dysphonia [1,2]. For many years, these patients have been underdiagnosed. There has been increasing awareness and interest in the study of voice alterations in children, and, most importantly, their impact in their quality of life. To do this, an instrument capable of measuring the quality of life in pediatric patients with vocal pathology is required, which can be used extensively in the scientific community. The objective of our study is to carry out the translation, transculturalization and validation of pVHI (Pediatric Voice Handicap Index) to Argentinian Spanish-speakers. MATERIAL AND METHODS: A study was carried out in the Hospital de Pediatria Dr. JP Garrahan in the city of Buenos Aires, Argentina. It included patients between 3 and 18 years old. The pVHI was translated and transculturalized for said population and for its validation, a survey was carried out in two groups of patients: one group being children with a background of both reconstructive larynx surgery, and dysphonia (n = 35) and the other group being control patients, without any voice pathology (n = 35). The survey was conducted among either parents or caregivers of the children in question. RESULTS: A significant difference was found between both groups, for both overall pVHI score and survey subgroups score (p < 0.001) with an optimal internal confidence and a good Alpha Cronbach for each of the subgroups (functional 0,92; organic 0,87 and emotional 0,88). Test-retest for reliability revealed "p-values" without any significant difference (p > 0.05) for each of all subgroups (functional 0,68; organic 0,32 and emotional 0,72). CONCLUSION: The validation and transculturalization of the rate of pediatric vocal impairment to Argentinian Spanish population presented an adequate validity and reliability. The rate of pediatric vocal impairment was identified through this simple and practical survey, offering additional information on the child's own vocal perception by part of the caregiver. We recommend this survey being included as a valuable tool in the evaluation of pediatric dysphonia in Spanish-speaking families.

Changes in biofilm in chronic cholesteatomatous otitis media in children following the application of sodium 2-mercaptoethanesulfonate (MESNA).

BACKGROUND: Pediatric cholesteatoma is a clinically challenging disease entity. Its biological behavior in the pediatric population differs from its behavior in adult population in terms of aggressiveness and recurrence. Several studies have shown the presence of biofilms associated with cholesteatoma that hinder the management and eradication of the infection. This led is to study the use of non-antimicrobial treatments impacting on the structure or composition of biofilms. OBJECTIVE: To evaluate the changes that occur in the biofilm of cholesteatoma in pediatric patients after the application of sodium 2-mercaptoethanesulfonate (MESNA). METHODS: A pilot study of 10 pediatric patients, with a median age of 10 years and a diagnosis of cholesteatomatous chronic otitis media, who underwent surgery for primary or revision mastoidectomy in the Otorhinolaryngology Service of the Hospital Infantil de México Federico Gómez between January 2016 and May 2017. During the surgery, basal samples of cholesteatoma and tissue were taken after topical application of 4% MESNA for 10 min. The samples were then processed for confocal laser microscopy. RESULTS: In all samples structures compatible with bacterial biofilms were identified. The most relevant finding was the changes in the structure of the biofilm after the application of MESNA, such as disintegration and separation of the underlying tissue. CONCLUSIONS: This is the first study that showing changes associated with cholesteatoma in the structure of the bacterial biofilm after the application of MESNA. The observed disintegration of cholesteatoma biofilm ultrastructure could aid in the management of the chronic infection associated with cholesteatoma.

Extended cricotracheal resection with posterior costochondral grafting for complex pediatric subglottic stenosis.

BACKGROUND AND OBJECTIVE: Severe laryngotracheal stenosis in childhood poses a complex surgical challenge for specialists in airway surgery. Patients with severe subglottic stenosis with vocal cord involvement are particularly difficult to manage successfully. The goal of this work was to review our experience with extended CTR in a cohort of young children with severe SGS and determine which clinical parameters would be associated with surgical success. METHODS: Retrospective analysis of the outcome of consecutive patients with severe glottic-subglottic stenosis submitted to an extended double-stage CTR between 2004 and 2014 at a large tertiary referral center. RESULTS: Twenty-five patients met inclusion criteria, with a mean age of 58.7 months at the time of repair. Overall decannulation rate was 80% (20/25), with a median time to deannulation of 120 days. Seven patients developed post-operative sequelae (4 arytenoid dislocations, 2 re-stenosis, and 1 anterior commissure adhesion). Patients with these sequelae had lower overall specific decannulation (42.8%) compared to those without any sequelae (94.4%) (Chi-square, p = 0.0123) with a longer time to decannulate (logrank, p = 0.0004). Notably, patients presenting with these sequelae on average had undergone a longer duration of post-operative stenting (27.14 days) compared to those presenting without any sequelae (14.8 days) (p = 0.0282). CONCLUSIONS: Extended CTR is an effective method for resolving a majority of severe glottic-subglottic stenosis cases in children. Duration of post-operative stenting may adversely impact overall outcome in these patients.