Comparison of high-versus low-dose corticosteroid administration on post-tonsillectomy outcomes.

OBJECTIVE: Intraoperative steroids have been shown to decrease post-tonsillectomy morbidity; however, optimal dosing of corticosteroids is unknown. This study evaluates the effects of high-versus low-dose dexemethasone administration (0.5 mg/kg vs. 0.1 mg/kg) on post-tonsillectomy outcomes. STUDY DESIGN: Nonrandomized controlled study. SETTING: Academic Medical Center. METHODS: Pediatric patients undergoing tonsillectomy at the University of Michigan between 2017 and 2018 were identified. Uncomplicated patients between 1 and 18 years who received dexamethasone during their operation were included. Patients were categorized by high- or low-dose dexamethasone administration and outcomes assessed included revisits within 30 days for pain, vomiting/dehydration, and post-operative bleeding. The number of postoperative phone calls was also assessed. RESULTS: A total of 1641 patients were included in the study. No significant differences in steroid group outcomes were observed regarding vomiting (1.65% vs 1.7%, p = 0.618), bleeding (1.09% vs 1.3%, p = 0.579), pain (1.64% vs 0.62%, p = 0.141), other morbidities (3.83% vs 3.57%, p = 0.493) or post-operative phone calls (10.6% vs 9.9%, p = 0.81). Post-tonsillectomy bleeding was higher for infectious etiology versus sleep disordered breathing (p = 0.005); however, no rate differences for vomiting or pain were noted. Controlling for indication, no differences in hospital return rates were seen between steroid groups. CONCLUSIONS: No statistically significant differences in post-tonsillectomy outcome measures were observed based on administration of either high- or low-dose dexamethasone. With no observed outcome differences related to steroid dosing, we transitioned to routine use of low-dose dexamethasone for tonsillectomy and adenoidectomy.

Pediatric Unilateral Vocal Fold Immobility.

Vocal fold immobility in children can affect breathing, swallowing, and speech function. Although sometimes idiopathic, it is often caused by injury to the recurrent laryngeal nerve during cardiac surgery. A detailed history and physical examination can identify risk factors, which affect the rate of resolution and overall prognosis. Fiberoptic laryngoscopy can be used to confirm the diagnosis and evaluate laryngeal anatomy. Many treatment options exist to improve function and quality of life, including vocal fold injection and laryngeal innervation. [Pediatr Ann. 2021;50(7):e286-e291.].

Development of video otoscopy quiz using a smartphone adaptable otoscope.

BACKGROUND: Otoscopy examination can be challenging. Traditional teaching uses still image illustrations. Newer attempts use video samples to simulate the otoscopy exam which is a dynamic process.Aims/Objective: To assess whether recorded otoscopy videos from a smartphone adaptable otoscope can be used to develop a video-based otoscopy quiz which may be used for instructing and familiarizing participants to normal anatomy and pathologic ear conditions. To use this quiz to assess current pediatric residents' competency of common otoscopy diagnosis. METHOD AND MATERIALS: This study was conducted in 2018. Video samples of ear pathology were collected at the Albany Medical Center using a smartphone adaptable otoscope- Cellscope. The videos were used to create a video otoscopy quiz (VOQ) without clinical vignettes. 45 pediatric residents from 3 academic institutions were evaluated with the quiz. RESULTS: The weighted mean for the VOQ was 66.90% (95%CI 58.89%-68.42%). The breakdown by questions are: myringosclerosis 72.88%, retraction pocket 80.65%, cholesteatoma 42.22%, hemotympanum 75.04%, tympanic membrane perforation 79.62%, cerumen impaction 95.46%, otitis externa 52.54%, otitis media with effusion 63.30%, acute otitis media 75.55%, normal ear 36.39%. CONCLUSION: We found that videos of otoscopy exams can be obtained with a smartphone adaptable otoscope and validated to develop a video-based quiz, which may be used to supplement otoscopic instruction. Following our testing process, we found pediatric residents are relatively well equipped to identify ear pathology on VOQ.

Adoption of Telemedicine for Multidisciplinary Care in Pediatric Otolaryngology.

OBJECTIVE: The COVID-19 pandemic has introduced a period of social isolation that has challenged the ability of providers to uphold in-person patient care. Although commonplace in pediatric otolaryngology, multidisciplinary clinics pose a unique challenge during this time due to increased infection risk from multiple patient-provider interactions. Guidance on the application of telemedicine for multidisciplinary clinics in pediatric otolaryngology is limited. METHODS: We provide comprehensive guidance on best practices for conducting telemedicine visits for a number of multidisciplinary otolaryngology clinics using our experiences at a single tertiary care children's hospital. A review of literature to support the adoption of telemedicine in multidisciplinary pediatric otolaryngology is also incorporated. RESULTS: Telemedicine was successfully adopted for 7 multidisciplinary pediatric clinics with a variety of specialists: aerodigestive disorders, congenital hearing loss, microtia/aural atresia, orofacial clefting, sleep disorders, tracheostomy care, and velopharyngeal dysfunction. CONCLUSIONS: Telemedicine is feasible for a variety of multidisciplinary clinics and its optimization is critical for providing care to complex pediatric otolaryngology patients during the COVID-19 pandemic and beyond.

Therapeutic use of the HPV vaccine in Recurrent Respiratory Papillomatosis: A case report.

Recurrent Respiratory Papillomatosis (RRP) is a condition characterized by recurring squamous papillomas in the aerodigestive tract due to Human Papilloma Virus (HPV) infection. Treatment includes surgical debridement of the lesions often with adjuvant therapy. A newer adjuvant agent being tested is the HPV vaccine. The case report includes a child with RRP who underwent 10 surgeries in a year with an average inter-surgical interval (ISI) of 46 days. The patient then received the scheduled regimen of 3 doses of 9 valent HPV vaccine. Since beginning the vaccination, her average ISI increased to 113 days and as of writing of this paper only 1 surgery in the last 340 days. It is theorized that the increase in humoral response to the virus can slow the course of the disease, lengthen the ISI, and decrease morbidity. The results of this case report lends evidence to the use of the HPV vaccine as a therapeutic adjuvant therapy for RRP.

A novel intraoral bone conduction hearing prosthesis: one-year safety and efficacy study.

OBJECTIVE: To assess the safety and efficacy of an intraoral bone conduction (IOBC) hearing prosthesis after 12 months of use. STUDY DESIGN: Prospective cohort study. SETTING: Multisite study including private practice, hospital-based practice, tertiary care, and academic medical centers. PATIENTS: Patients aged 18 years or older with single-sided deafness (SSD). MAIN OUTCOME MEASURE(S): At the end of 6 months and 12 months, patients were asked to complete the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and SSD questionnaire in addition to audiometric testing. RESULTS: Eighty-one patients completed the study. Hearing thresholds remained the same throughout the study. APHAB results showed a significant benefit (p < 0.001) in categories of ease of communication, reverberation, background noise, and global score. The SSD questionnaire showed a high satisfaction among participants, with 93.8% of patients likely to recommend the IOBC. Dissatisfaction was highest with regard to patient's ability to eat with device, with only 55.6% satisfied. No serious adverse events were reported during the study. CONCLUSION: The IOBC is a safe and effective alternative to percutaneous osseointegrated hearing implants for patients with SSD. Patient satisfaction and improved hearing benefit are observed after 1 year of using the device. The IOBC significantly benefitted patients in APHAB categories of ease of communication, reverberation, background noise, and the overall global hearing score. The in-the-mouth transducer is the least-liked feature for some patients, particularly with regard to eating; however, the majority of patients are willing to deal with the size of the device for the hearing benefit gained.

The effect of duty hour regulation on resident surgical case volume in otolaryngology.

OBJECTIVE: Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and analyze trends in surgical case volume for Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996 to 2011. STUDY DESIGN: Time-trend analysis of surgical case volume. SETTING: Nationwide sample of otolaryngology residency programs. SUBJECTS: Operative logs from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996 to 2011. METHODS: Key indicator volumes and grouped domain volumes before and after resident duty hour regulations (2003) were calculated and compared. Independent t test was performed to evaluate overall difference in operative volume. Wilcoxon rank sum test evaluated differences between procedures per time period. Linear regression evaluated trend. RESULTS: The average total number of key indicator cases per graduating resident was 440.8 in 1996-2003 compared to 500.4 cases in 2004-2011, and overall average per number of key indicators was 31.5 and 36.2, respectively (P = .067). Four key indicator cases showed statistically significant (P < .05) increases in volume after duty hour implementation. General/pediatrics was the only grouped domain to show a significant increase. In contrast, the rate of change in operative volume decreased post duty hour for only 2 key indicators (P < .05). The year-by-year trend in average operative volume showed significant increases for 5 key indicator cases (P < .05). CONCLUSION: Implementation of the 2003 duty hour regulations has not reduced total volume of key indicator cases for graduating otolaryngology residents. The overall trend in operative volume is increasing for several specific key indicators.

Operative agreement on lateral compression-1 pelvis fractures. a survey of 111 OTA members.

OBJECTIVES: To better characterize operative agreement and disagreement among orthopaedic surgeons treating lateral compression type 1 (LC-1) pelvic fractures in an effort to improve communication between care providers and improve patient care. DESIGN: Decision analysis. SETTING: Level 1 trauma center. METHODS: Twenty-seven LC-1 cases were selected to represent a wide array of LC-1 injuries. Each case was presented with 3 plain pelvic radiographs (anteroposterior, inlet, and outlet) and a scrollable computed tomography at the OTA national meeting. Attendees were queried whether they would perform operative stabilization "yes/no." Years of surgical practice (0-5, 6-10, and >10), annual pelvic fracture case volume (0-20, 21-50, and >50), and completion of a trauma fellowship (yes/no) were also collected. Fleiss' kappa (K) was used to measure operative agreement among survey respondents, where K = 0.21-0.40 was fair and K = 0.41-0.60 was moderate agreement. RESULTS: One hundred eleven surgeons completed the survey where the average tendency to operate across surveys was 40%. Of the 27 cases presented, only 9 cases (33%) showed substantial agreement. There were 4 cases where nearly everyone chose operative stabilization (93.1%-94.4%) and 5 cases where nearly no one chose operative stabilization (0%-8.7%). The overall agreement was fair with K = 0.39 [95% confidence interval (CI), 0.34-0.44]. Although there was a trend for surgeons with more years of surgical practice to have a lower tendency to operate, it did not achieve statistical significance (odds ratio for >10 years vs. 0-5 years = 0.73; 95% CI, 0.48-1.11). Annual case volume and completion of a trauma fellowship were not statistically significant predictors of operative tendency. CONCLUSIONS: Our results show only fair operative agreement (K = 0.39; 95% CI, 0.34-0.44) in a radiographic survey representing a broad range of LC-1 fracture morphologies among OTA surgeons. Only 9 of the 27 cases (33%) had substantial agreement. There was no difference in the decision to operate based on surgical volume, completion of a trauma fellowship, or time in practice. These results highlight the differing practice decisions among surgeons currently treating LC-1 injuries, and there is need for further studies to more fully understand stability after this injury pattern.

Biomechanical evaluation of tibial eminence fractures using suture fixation.

This study evaluates the initial fixation strength of tibial eminence fracture repair using 1, 2, 3, and 4 sutures to determine the optimal number of sutures required to adequately secure the avulsed fragment to the tibia. Sixteen skeletally immature porcine knees were stripped of all soft tissues, isolating the femur-anterior cruciate ligament (ACL)-tibia complex. Type III tibial eminence fractures were simulated in the specimens, and each specimen was randomly assigned to a repair group using 1, 2, 3, or 4 #2 FiberWire sutures (Arthrex, Inc, Naples, Florida). Initial fixation strength of the repair was measured by single cycle pull to failure testing using a materials testing machine (Instron, Norwood, Massachusetts). The mean ultimate failure force during anterior tibial translation was 389±128, 627±66, 703±77, and 802±29 N for 1, 2, 3, and 4 sutures, respectively. The lower limit of the 95% confidence interval was >500 N (estimated force of native ACL during activities of daily living) for each group with ≥2 sutures. In this study, at least 2 high-strength sutures were needed for tibial eminence fracture repairs to withstand potential forces seen across the ACL in the postoperative period. Suture fixation of tibial eminence fractures is a reproducible method requiring a minimum of 2 high-strength polyester sutures to resist forces seen during early rehabilitation.

Recovery of DNA and fingerprints from touched documents.

This study investigated the various factors affecting DNA profiling from DNA recovered from fingerprints deposited on paper before and after fingerprint enhancement treatments. The DNeasy plant mini kit (QIAGEN) was found to improve DNA recovery from paper by over 150% compared with the QIAamp mini kit. A significant decrease in the amount of DNA recovered was observed following treatment with DFO and/or Ninhydrin. This decrease in yield did not have a comparably significant effect on the quality of the SGM Plus profiles. Furthermore, this study found that whilst certain paper types, such as newspaper, magazine and filter paper allowed for the good recovery of DNA, common office paper and white card, strongly interfered with the recovery of DNA resulting in poor quality profiles.

The recovery of latent fingermarks and DNA using a silicone-based casting material.

There are many techniques available for the recovery of fingermarks at scenes of crime including the possibility of taking casts of the marks. Casts can be advantageous in cases where other destructive recovery techniques might not be suitable, such as when recovering finger marks deposited on valued or immobile items. In this research, Isomark (a silicone-based casting material) was used to recover casts of finger marks placed on a variety of substrates. Casts were enhanced using cyanoacrylate fuming. Good quality marks were successfully recovered from a range of smooth, non-porous surfaces. Recovery from semi-porous surfaces was shown to be inefficient. DNA was subsequently extracted from the casts using QIAamp Mini extraction kits, amplified and profiled. Full DNA profiles were obtained 34% of samples extracted.