Long-Term Cochlear Implant Sound Processor Usage in Children with Single-Sided Deafness.

OBJECTIVE: To assess cochlear implant (CI) sound processor usage over time in children with single-sided deafness (SSD) and identify factors influencing device use. STUDY DESIGN: Retrospective, chart review study. SETTING: Pediatric tertiary referral center. PATIENTS: Children with SSD who received CI between 2014 and 2020. OUTCOME MEASURE: Primary outcome was average daily CI sound processor usage over follow-up. RESULTS: Fifteen children with SSD who underwent CI surgery were categorized based on age of diagnosis and surgery timing. Over an average of 4.3-year follow-up, patients averaged 4.6 hours/day of CI usage. Declining usage trends were noted over time, with the first 2 years postactivation showing higher rates. No significant usage differences emerged based on age, surgery timing, or hearing loss etiology. CONCLUSIONS: Long-term usage decline necessitates further research into barriers and enablers for continued CI use in pediatric SSD cases.

Management of paediatric post-tonsillectomy bleeds - does everyone need observation?

AIM: The management of patients who present with a post-tonsillectomy bleed (PTB) who are not actively haemorrhaging is contentious. In our institution, those without an active bleed are admitted for a period of observation, due to the theoretical risk of further bleeding. This paper aims to review PTB admissions to ascertain the risk of rebleeding while under observation and to identify whether there is a low-risk group who can be safely discharged without observation. METHODS: Review of current literature. Retrospective chart review of all patients who presented to Perth Children's Hospital between February 2018 and February 2022 with a PTB. Exclusion criteria included primary PTB, known blood dyscrasias and patients >16 years of age. RESULTS: A total of 826 presentations of secondary PTB (sPTB) were reviewed, with 752 admitted for a period of observation. Twenty-two (2.9%) patients rebled while under observation, with 17 managed operatively. The average age of patients who rebled was 6.2 years and they presented at an average 7.14 post-operative days. The median time to rebleed was 4.4 h. Four patients with no oropharyngeal clot at presentation subsequently re-bled (0.53%) while under observation, with 2 (0.26%) managed surgically. In patients observed with an oropharyngeal clot at presentation 18 (3.1%) rebled, with 15 (2.6%) managed operatively. CONCLUSION: Patients presenting with a sPTB have a low risk of rebleeding while under observation. Patients with a normal oropharyngeal examination at presentation have a very low risk of rebleed and should be considered for early discharge if they meet other low risk criteria. Patients who present with an oropharyngeal clot can be safely observed with a low risk of further bleeding. Patients who rebleed while under observation should have a trial of conservative management if clinically appropriate.

Tamizaje auditivo universal neonatal en Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experiencia 2015-2021 / Universal newborn hearing screening at Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experience 2015-2021

Introducción: La hipoacusia congénita es una patología frecuente entre los recién nacidos con gran impacto en su calidad de vida si no es diagnosticada y tratada precozmente. Para su pesquisa, se recomienda, internacionalmente, el tamizaje auditivo universal neonatal (TAUN), que desde 2014 se aplica en el Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF). Objetivo: Describir la experiencia del programa de TAUN del Servicio de Otorrinolaringología HLF. Material y Método: Estudio descriptivo, retrospectivo. Se incluyó a todos los recién nacidos vivos (RNV) del establecimiento entre 2015 y 2021, evaluados de acuerdo con el protocolo del programa. Resultados: Fueron evaluados 17.804 RNV. Se obtuvo una cobertura de 97,1% y tasa de referencia de 0,98%. Se confirmaron a 21 pacientes con hipoacusia sensorioneural (HSN), obteniéndose una tasa de HSN de 1,5 cada 1.000 RNV. Conclusión: La tasa de incidencia de HSN congénita fue similar a la estimada a nivel mundial. El programa de TAUN HLF cumple con estándares internacionales en cuanto a cobertura, tiempo de evaluación del tamizaje y tasa de referencia. El trabajo multidisciplinario, mejoría de tecnología y registro adecuado de pacientes, son las principales fortalezas. La dificultad de seguimiento durante horario inhábil y presencia de sólo un profesional con dedicación exclusiva, son aspectos a perfeccionar.

Introduction: Congenital hearing loss is a frequent pathology among newborns with great impact on their quality of life if it is not diagnosed and treated early. The Joint Committee on Infant Hearing recommends universal newborn hearing screening (UNHS) and has been applied at the Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF) since 2014. Aim: To describe the experience of UNHS program at the Otolaryngology Service of the HLF. Material and Method: Descriptive, retrospective study, including all newborns of the HLF between 2015 and 2021. They were evaluated according to the protocol proposed in the program. Results: 17804 newborns were evaluated. Coverage of 97,1% and a referral rate of 0,98% were obtained. Twenty-one patients with sensorineural hearing loss (SNHL) were confirmed, obtaining a SNHL rate of 1.5 per 1000 live births. Conclusion: The incidence rate of congenital SNHL is similar to that estimated worldwide. The UNHS program in HLF complies with international standards in terms of coverage, timing and referral rates. Multidisciplinary work, improved technology and adequate patient registration are the main strengths of the program. The difficulty of follow-ups during the weekends and the presence of only one full-time professional are aspects that can be improved.

Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento / Simulation in Otolaryngology: a teaching and training tool

La simulación en los procesos educativos de la medicina constituye un método de enseñanza y de aprendizaje efectivo. Permite estandarizar los procesos de aprendizaje y enseñar sin poner en riesgo al paciente. En Otorrinolaringología existen diferentes tipos de simulación en las distintas áreas de la especialidad. Se han desarrollado modelos tipo fantoma, paciente-maniquí, modelos virtuales y también se utilizan modelos animales para poder enseñar y practicar diferentes habilidades. Cada modelo tiene sus ventajas y desventajas, donde la realidad virtual se posiciona como un modelo emergente y con un futuro prometedor. Sin embargo, aún falta mayor desarrollo de la simulación en el área de Otorrinolaringología (AU)

Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology (AU)

Simulation in Otolaryngology: A teaching and training tool. / Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento.

Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology.

Uso de desmopresina en niños con disfunción plaquetaria congénita sometidos a adeno y/o amigdalectomía / Use of desmopressin in children with inherited platelet dysfunctions undergoing adenotonsillar procedures

Introducción y objetivos: La cirugía de adenoides y/o amígdalas representa un desafío hemostático importante en pacientes pediátricos con disfunción plaquetaria congénita leve. Si bien existen recomendaciones para el manejo perioperatorio de la hemostasia en estos pacientes, no hay informes de resultados del manejo con las distintas recomendaciones en niños sometidos a cirugía adenoamigdalina. Nuestro objetivo es evaluar el uso de desmopresina para la prevención de la hemorragia perioperatoria en niños con disfunción plaquetaria congénita leve sometidos a adeno y/o amigdalectomía en nuestro centro. Métodos: Estudio retrospectivo descriptivo dirigido a determinar la tasa de hemorragia perioperatoria y complicaciones en niños con disfunción plaquetaria congénita leve en quienes se utilizó desmopresina cuando fueron sometidos a adeno y/o amigdalectomía. Resultados: Entre los años 2004 y 2010, 27 niños con disfunción plaquetaria congénita leve fueron sometidos a cirugía de adenoides y/o amígdalas y recibieron desmopresina. Un paciente (3,7%) desarrolló hemorragia perioperatoria. Se registró un caso (3,7%) de hipotensión transitoria como efecto adverso atribuible a la desmopresina. Conclusiones: El uso de desmopresina permitió un buen manejo preventivo de la hemorragia perioperatoria en pacientes con disfunción plaquetaria congénita leve sometidos a adenoamigdalectomía, sin presentar complicaciones graves(AU)

Introduction and goals: Adenotonsillar surgery represents a major haemostatic challenge in paediatric patients with mild inherited platelet dysfunction. While there are recommendations for perioperative haemostatic management, there are no reports of the outcomes with the different recommendations in these children when undergoing adenotonsillectomy. Our objective was to evaluate the management of perioperative bleeding with desmopressin in children with mild platelet dysfunctions who underwent adenotonsillar surgery in our hospital. Methods: We performed a retrospective study aimed at determining the perioperative bleeding and complication rate in children with mild inherited platelet dysfunction in whom desmopressin was used while undergoing adenotonsillar procedures. Results: Between 2004 and 2010, 27 children with mild inherited platelet dysfunction underwent adenotonsillar procedures in our hospital and were treated with desmopressin. One patient developed perioperative bleeding (3.7%) and there was 1 child (3.7%) who presented transitory hypotension as a side effect of desmopressin. Conclusions: The use of desmopressin allowed adequate perioperative bleeding prophylaxis management in children with mild inherited platelet dysfunction who underwent adenotonsillar procedures without presenting severe complications(AU)

[Use of desmopressin in children with inherited platelet dysfunctions undergoing adenotonsillar procedures]. / Uso de desmopresina en niños con disfunción plaquetaria congénita sometidos a adeno y/o amigdalectomía.

INTRODUCTION AND GOALS: Adenotonsillar surgery represents a major haemostatic challenge in paediatric patients with mild inherited platelet dysfunction. While there are recommendations for perioperative haemostatic management, there are no reports of the outcomes with the different recommendations in these children when undergoing adenotonsillectomy. Our objective was to evaluate the management of perioperative bleeding with desmopressin in children with mild platelet dysfunctions who underwent adenotonsillar surgery in our hospital. METHODS: We performed a retrospective study aimed at determining the perioperative bleeding and complication rate in children with mild inherited platelet dysfunction in whom desmopressin was used while undergoing adenotonsillar procedures. RESULTS: Between 2004 and 2010, 27 children with mild inherited platelet dysfunction underwent adenotonsillar procedures in our hospital and were treated with desmopressin. One patient developed perioperative bleeding (3.7%) and there was 1 child (3.7%) who presented transitory hypotension as a side effect of desmopressin. CONCLUSIONS: The use of desmopressin allowed adequate perioperative bleeding prophylaxis management in children with mild inherited platelet dysfunction who underwent adenotonsillar procedures without presenting severe complications.