Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort.

OBJECTIVE: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. METHODS: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. RESULTS: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) (P = .56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa = .75), with 91.9% agreement. CONCLUSION: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. LEVEL OF EVIDENCE: 2b.

Treatment of an obstructive, recurrent, syncytial myoepithelioma of the trachea with tracheal resection and reconstruction.

Myoepithelioma is a rare occurrence in the trachea and respiratory tract with only 11 cases reported in the literature. We present a case report of a 10-year-old female who was found to have an anterior tracheal mass causing near total obstruction of the airway on bronchoscopy. Characteristics of the mass were consistent with syncytial myoepithelioma. The patient experienced multiple recurrences requiring tracheal resection with end-to-end reanastomosis. To date there have not been any reported cases of myoepithelioma of the trachea in a child and no reports of syncytial myoepithelioma in the trachea or respiratory tract.

Incidence of revision adenoidectomy in children.

OBJECTIVE/HYPOTHESIS: Adenoidectomy is a frequently performed procedure in the pediatric population. Revision rates and indications for a second procedure in children are scarce. STUDY DESIGN: Retrospective cohort study. METHODS: Patient records at a multistate pediatric healthcare system were searched for all CPT codes that included adenoidectomy in children less than 12 years of age for a 5-year period (2005-2010). A subset of patients was identified for whom the same CPT codes appeared more than once in this 5-year period. The indication, age, gender, adenoid size, and technique of adenoidectomy were recorded. RESULTS: A total of 23,612 occurrences of the CPT codes were identified. The subset of patients with multiple CPT codes, indicating revision adenoidectomy, included 304 records (1.3%). Mean age at first procedure was 2.8 years (SD = 1.7 years). Mean age at second procedure was 4.7 years (SD = 1.99 years). Mean interval between procedures was 1.8 years (SD = 1.1 years). CONCLUSIONS: Revision adenoidectomy occurs at a rate of 1.3%. Reasons for revision include persistence symptoms ranging from adenoiditis to recurrent otitis to obstructive sleep apnea.

Antibiotic eluting chitosan glycerophosphate implant in the setting of acute bacterial sinusitis: a rabbit model.

BACKGROUND: Topical therapy offers the potential for treatment of sinonasal disease with minimal systemic side effects. Chitosan glycerophosphate (CGP) is a mucoadhesive polymer that can be used as an antibiotic eluting sinonasal implant in the treatment of sinusitis. The purpose of this study was to assess the potential for CGP as an antibiotic impregnated implant in a rabbit model of acute bacterial sinusitis. METHODS: The Institutional Animal Care and Use Committee approved study of acute bacterial sinusitis in 12 New Zealand white rabbits using either Pseudomonas aeruginosa (n = 6) or Staphylococcus aureus (n = 6). CGP impregnated with 50 mg of either gentamicin or vancomycin was bilaterally implanted in two rabbits in each arm, respectively. The sinuses were irrigated with saline for 4 days and the lavage was collected for colony-forming unit (CFU) determination. Within each group, the CFU log reduction in the lavage was compared with that of rabbits receiving saline alone (n = 2) or a daily 80-microgram/mL gentamicin or vancomycin irrigation (n = 2) and analyzed using a Student's t-test. RESULTS: Within the S. aureus group, the CFU log reduction using CGP + vancomycin (-2.57 +/- 0.21) was greater than vancomycin irrigation (-1.66 +/- 0.5; p = NS) and significantly greater than saline alone (2.46 +/- 0.97; p = 0.018). Within the P. aeruginosa group, the CFU log reduction using the CGP + gentamicin (-4.62 +/- 0.74) was greater than gentamicin irrigation (-4.09 +/- 0.70) and saline alone (-1.90 +/- 0.90); however, the results were not significant. In all rabbits receiving the CGP + antibiotic implant, no viable bacteria were present in the lavage by day 4. CONCLUSION: Placement of a single antibiotic impregnated CGP implant in the setting of an acute Gram-positive or Gram-negative bacterial sinusitis resulted in a greater log reduction of CFU than daily antibiotic irrigation and led to complete sterilization of the lavage within 4 days.