International pediatric otolaryngology group (IPOG) consensus on approach to aspiration.

OBJECTIVE: To provide recommendations for a comprehensive management approach for infants and children presenting with symptoms or signs of aspiration. METHODS: Three rounds of surveys were sent to authors from 23 institutions worldwide. The threshold for the critical level of agreement among respondents was set at 80 %. To develop the definition of "intractable aspiration," each author was first asked to define the condition. Second, each author was asked to complete a 5-point Likert scale to specify the level of agreement with the definition derived in the first step. RESULTS: Recommendations by the authors regarding the clinical presentation, diagnostic considerations, and medical and surgical management options for aspiration in children. CONCLUSION: Approach to pediatric aspiration is best achieved by implementing a multidisciplinary approach with a comprehensive investigation strategy and different treatment options.

Physician experiences of workplace racial and gender microaggressions.

OBJECTIVES: To investigate racial and gender-specific microaggressions that are experienced by pediatric otolaryngologists at work. METHODS: An anonymous web-based survey consisting of 18 questions was sent to American Society of Pediatric Otolaryngology (ASPO) members via an email link. The survey included questions from the Workplace and School Microaggressions component of the Racial and Ethnic Microaggressions (REM) Scale. RESULTS: 125 out of 610 ASPO members completed the survey for a response rate of 20.5%. 28% of respondents reported experiencing a racial/ethnic microaggression in the last six months. Respondents who identified as Asian American Pacific Islander had significantly higher REM scores when compared with Caucasian respondents (p < 0.05). There was no significant difference in scores when comparing the other Race categories. Female respondents reported significantly higher gendered-microaggression scores compared to those identifying as male (p < 0.001). 66% of female respondents experienced some form of gender-based microaggression in the last six months. CONCLUSION: By providing evidence that pediatric otolaryngologists continue to report experiences of discrimination in the form of microaggressions, this study aims to increase awareness and inspire a more inclusive work environment.

Effusion Prevalence at Tympanostomy During COVID-19: Follow-Up.

OBJECTIVE: We previously reported pandemic year (2020) intraoperative middle ear effusion (MEE) rate at time of bilateral myringotomy tube (BMT) placement was 18% lower compared to pre-pandemic year (2019). After mandatory stay at home orders (MSHO) and pandemic social distancing precautions were relaxed, we aimed to assess the impact of a persistent pandemic with new COVID-19 variants on MEE presence during BMT. METHODS: This study is a retrospective chart summary exempted by Nemours institutional review board at a single tertiary children's hospital. Children < 18 years who underwent BMT during March 1, 2019-June 31, 2019 (pre-COVID), March 1, 2020-June 31, 2020 (PY1), and March 1, 2021-June 31, 2021 (PY2) were included. Statistical analysis included chi-squared and KruskalWallis. RESULTS: A total of 1069 BMTs were reviewed: 551 (52%) during pre-COVID, 227 (21%) during PY1, and 291 (27%) during PY2. There were no significant differences in age, sex, or BMI across comparison groups. Intraoperative MEE was significantly higher pre-COVID (83%) compared to PY1 (65%) and PY2 (69%) (P < .001) despite a small rebound in PY2. CONCLUSION: Intraoperative MEE remains lower in subsequent pandemic years despite relaxed public health measures and may be impacted by persistent public health measures like masking, lower return to daycare, variable social distancing, and/or change to access to health care.

The Physician as Leader: Navigating the Breadth of Opportunity and Finding Your Best Fit.

Leadership is important in all aspects of a physician's professional life. Leadership skills can be developed with experience, training, coaching, and mentorship. Physicians have an obligation to learn as much as possible about effective leadership so that when an opportunity to lead comes, they will make optimal use of it and feel empowered to contribute to solutions and improvements at all levels of health care.

Balance Versus Integration: Work-Life Considerations.

The term work-life balance may cause physicians to feel inadequate in pursuing a reality in which work and life each have equal importance. Furthermore, the term implies competition between these 2 realms. Instead, work-life integration is a more constructive and realistic term. Achieving harmonious integration requires self-reflection on the current state, goals, and resources and strategies needed to achieve and maintain such a state. Prioritizing aspects of both, and aligning them with individual requirements, while incorporating consistent and intentional investment of time and efforts in both professional and personal arenas is crucial to cultivate and sustain longitudinal well-being.

Middle ear effusion prevalence at time of tympanostomy before and during COVID-19 pandemic.

BACKGROUND: Management of pediatric otitis media with effusion (OME) and recurrent otitis media typically includes observation up to 3 months. Bilateral myringotomy and tube (BMT) placement is performed due to persistent effusion with associated symptoms such as decreased hearing. With the COVID-19 pandemic and mandatory stay at home orders (MSHO), children were quarantined at home and many remained home after MSHO. We reviewed the prevalence of middle ear effusion (MEE) at the time of BMT during similar time periods in the year before, during and after MSHO in this pandemic year. STUDY DESIGN: Retrospective summary of BMT cases at a single tertiary children's hospital. METHODS: All children <18 years who underwent BMT between March 1, 2020 and July 1, 2020 and between March 1, 2019 and July 1, 2019 were included. Statistical analysis included chi-squared and Mann-Whitney U tests. RESULTS: A total of 778 cases were reviewed; 551 (71%) were performed pre-pandemic and 227 (29%) during onset of pandemic (N = 778). There were no significant differences in gender, age, and BMI between groups, but significantly fewer Caucasians (58% vs. 45%, p < 0.05) and more Hispanics (20% vs. 33%, p < 0.05) during-COVID. The prevalence of intraoperative effusion during-COVID was significantly lower compared to pre-COVID (65% vs. 83%, p < 0.001). CONCLUSION: Pandemic and COVID-19 MSHO were associated with significantly lower intraoperative OME prevalence. Further research may elucidate the impact of face covering, social distancing, and virtual schooling on the incidence of pediatric ROM, OME, and ENT symptoms.

Prevalence of prescription medication use in preschool-age children seen in pediatric otolaryngology.

OBJECTIVE: To examine the prevalence of daily medication use and prescribing patterns in preschool aged children presenting to otolaryngology clinics. STUDY DESIGN: Retrospective summary of prescription-related data from PEDSnet database of two tertiary care children's hospitals within single health system. METHODS: All new patients between birth and 5 years of age seen in otolaryngology clinics from October 1, 2016 through September 30, 2017 were included. Existing diagnoses, active prescriptions at time of visit, prescription dates, and demographics were abstracted. Summary analysis was performed on medication prevalence, quantity and duration of use, comparing all variables between age, gender, and geographical regions. RESULTS: Of 7532 patient encounters, 20% presented with active daily medication use. Eustachian tube dysfunction and otitis media were the most common diagnoses regardless of daily medication usage. Corticosteroids, specifically hydrocortisone (Delaware) and Flovent (Florida), were the most common medication prescribed. The number of medications strongly correlated with the number of encounter diagnoses. Overall, patients in Delaware were 4.5 times more likely to have at least one prescription prior to encounter (p < 0.05, 95% CI 3.2-4.8). This pattern was preserved across age and gender. Patients with medication in Delaware and Florida had a median of 2 (IQR 3.0-1.0) and 1 prescriptions (IQR 2.0-1.0), respectively (p < 0.001). There were no differences based on insurance type and no correlations between medication count and age or gender. CONCLUSION: Children in Delaware presented to otolaryngology clinics with significantly more prescribed medications than in Florida. Regional differences were consistent across age and gender. Most children were on these medications for a significant duration.

Advanced practice providers and children's hospital-based pediatric otolarynology practices.

INTRODUCTION: Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting. METHODS: Pediatric otolaryngology chiefs of all academic children's hospitals in the US were electronically surveyed about the ways APPs intersected clinically and financially in their respective practice. RESULTS: A total of 29 of 36 children's hospital-based pediatric otolaryngology practices completed the survey, of which 26 practices (90%) utilized APP. There were large variances within the APP practice cohort in faculty size (mean/median/range = 9.4/8.5/3-29); annual patient visits (mean/median = 18,373/17,600); number of practice site (mean/median/range = 4.3/4/2-9) and number of outpatient APP (mean/median/range = 6.3/5/1-30). No factors (faculty size, annual visits and number of practice sites) differentiated between the APP and non-APP practices. Among APP practices, significant correlation (p<.00001) was observed between size of APP cohort to faculty size and annual visits. 69% of the practices did not differentiate job functions of nurse practitioners and physician assistants. 85% of the practices utilized APPs in all practice sites and 19% utilized APPs in the operating room. 77% of APPs billed independently and 46% had on-site supervision. The most prevalent APP salary bracket based on 0-5, 6-10 and > 11 years of tenure were $76-100K (65%), $100-150K (77%) and $100-150K (86%), respectively. In 46% of the practices, APPs were able to generate enough revenue to cover more than 75% of their salary and 23% of practices generated a profit. 81% of the chiefs ranked the effectiveness of APPs as high (4 and 5) on a 5-point Likert scale. DISCUSSION: The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.

A Survival Analysis of Pediatric Tonsillar Malignancies and Review of a Rare Case.

OBJECTIVE: To examine the survival of pediatric tonsillar cancer patients and review a rare case of pediatric tonsillar cancer. METHODS: Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of tonsillar malignancy using the ICD O-3 tonsil primary site codes of: C09.0, C09.1, C09.8, and C09.9. Patients were included from birth-18 years. Survival analysis was performed using Kaplan-Meier analysis. Additionally, a case of pediatric natural killer (NK) cell tonsillar lymphoma diagnosed and treated at the Nemours Children's hospital in Orlando, Florida is presented. RESULTS: One hundred forty-one cases of tonsil cancer were identified. The mean age at diagnosis was 9.9 years (SD: 5.1, range: 0.0 (months)-18.0). Ninety five (67.4%) patients were male and 116 (82.3%) had unilateral malignancies. Burkitt lymphoma (32.6%) followed by diffuse large B-cell lymphoma (DLBCL) (27.0%) were the two most common histological types of tonsillar cancers. 79.4% of patients received chemotherapy and 81.6% received surgery as a part of their care. The 5-year disease-specific survival rate was >90% for patient cohorts diagnosed from 1984 to 1993, 1994-2003, and 2004-2014 as compared to 64% for patients diagnosed from 1973 to 1983 (p = 0.01). CONCLUSIONS: Survival rates for pediatric patients with tonsillar cancer are excellent. Pediatric primary tonsil cancer occurred most commonly in adolescent males and usually presents as a unilateral mass. Lymphoma remains the predominant histological type of cancer. Most patients are likely to receive surgery and chemotherapy.

Pediatric head and neck fibrosarcomas: A demographical, treatment, and survival analysis and review of a rare case.

OBJECTIVE: To examine pediatric head and neck fibrosarcoma cases and review the demographics, management, and survival for these patients. METHODS: Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of a head and neck fibrosarcoma using ICD-O-3 head and neck primary sites and histology codes. Patients were included from birth-18 years of age. Additionally, a pediatric case of a head and neck infantile fibrosarcoma treated at the Nemours Children's hospital in Orlando, Florida is presented. RESULTS: One hundred-thirteen pediatric head and neck fibrosarcomas were identified within the SEER database over the study period. The mean age at diagnosis was 9.8 years (SD: 6.2, range: 0.0-18.0). The mean age at diagnosis for infantile fibrosarcomas was 1.7 years (SD: 3.2, range: 0.0-12.0). Fifty-one (45.1%) patients were female. A majority (N = 67, 59.3%) of patients had dermatofibrosarcoma followed by 18 (15.9%) who had infantile fibrosarcomas. Nearly all patients (N = 107, 94.7%) received surgical intervention. 27.8% of patients with an infantile fibrosarcoma received chemotherapy as a part of their care compared to 1.5% of patients with a dermatofibrosaroma (p = .004). The 5-year disease-specific survival was 97%. CONCLUSIONS: Pediatric patients with head and neck fibrosarcomas are most likely to present in Caucasian males or females during late childhood or early adolescence. Infantile fibrosarcomas present in pediatric patients at a much earlier age. Surgical management is common for pediatric head and neck fibrosarcomas. Additionally, chemotherapy may be used for infantile fibrosarcomas of the head and neck. Survival rates for pediatric patients with a head and neck fibrosarcoma are excellent.

Limiting Dietary Sugar Improves Pediatric Sinonasal Symptoms and Reduces Inflammation.

Excessive sugar consumption is associated with many chronic inflammatory diseases in adults. The effects of excessive sugar consumption in children have not been determined. In this study, we hypothesized that sinonasal symptoms and proinflammatory cytokine levels would be related and could be altered through reduction in sugar-sweetened beverage (SSB) consumption. To test this, we conducted a pilot study involving behavior modification and a 2-week follow-up. Seventeen children participants were recruited, and eleven completed the study. The experimental group presented with chronic nasal congestion or rhinorrhea defined by daily symptoms without acute illness for at least 3 months. The control group presented for non-nasal problems. Both groups received counseling to decrease SSB consumption. The Sinus and Nasal Quality of Life (SN-5) Survey was administered, and a blood sample was obtained by venipuncture at baseline and 2 weeks after counseling. Participants kept a 2-week food diary to document sugar intake. Serum lipid profile and inflammatory cytokines were measured. The experimental group reduced daily sugar intake, 46% versus 11% in the control. Baseline SN-5 scores were significantly worse in the experimental group and normalized to controls after intervention. Inflammatory cytokine levels were not different at baseline, but the experimental group significantly reduced in proinflammatory markers and increased the levels of anti-inflammatory markers after intervention. Our pilot data demonstrate higher sugar consumption may be associated with increased inflammatory stress and sinonasal symptoms. Reducing SSB and controlling inflammation in early childhood may have future health benefits.

Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion.

Importance: Chronic nasal congestion often persists in children despite empirical treatment using intranasal corticosteroids, systemic antihistamines, and/or leukotriene receptor antagonists. Symptoms are often reported even with negative results of skin or blood allergy testing. Inferior turbinoplasty has been effective in adults and children, but outfracture of inferior turbinates in children is rarely reported, as is use of validated quality-of-life measures to quantify improvements after intervention. Effective use of these 2 procedures for treating chronic nasal congestion may reduce the need for medication and improve sinonasal quality of life. Objective: To quantify changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion. Design, Setting, and Participants: A case series with planned data collection was conducted in an ambulatory pediatric otolaryngology clinic among 43 patients with chronic nasal congestion who underwent surgical intervention between January 1, 2014, and May 31, 2015. Exposures: Microdebrider submucous inferior turbinoplasty (without bony resection) and outfracture of inferior turbinates. Main Outcomes and Measures: Demographics and medication use before and after the procedure were reviewed. Scores on the Sinus and Nasal Quality of Life Survey (SN-5) and quality-of-life scores were collected at baseline, 4 to 6 weeks after the procedure, and more than 6 months after the procedure. Results: Among the 43 patients (14 girls and 29 boys; mean age, 11.2 years [range, 4.8-17.6 years]), every domain showed significant improvements in scores on the Sinus and Nasal Quality of Life Survey and quality-of-life scores 1 to 2 months after the proecdure: sinus infection (-2.55; 95% CI, 1.85-3.26), nasal obstruction (-3.51; 95% CI, 2.88-4.14), allergy symptoms (-2.14; 95% CI, 1.43-2.86), emotional distress (-2.37; 95% CI, 1.68-3.06), activity limitation (-1.70; 95% CI, 1.14-2.25), and overall quality of life (3.72; 95% CI, 2.95-4.48). At long-term follow-up, improvement was maintained in all categories. Significant improvements in SN-5 and quality-of-life scores correlated with proportional decreased reporting of snoring after the procedure (33 [77%] vs 1 [2%]; absolute reduction, 75%; 95% CI, 62%-88%), as well as nasal congestion (41 [95%] vs 1 [2%]; absolute reduction, 93% ; 95% CI, 85%-100%), and rhinorrhea (44 [41%] vs 1 [2%]; absolute reduction, 42%; 95% CI, 27%-57%). The proportion reporting use of intranasal corticosteroids (25 [58%] vs 2 [5%]; absolute reduction, 50%; 95% CI, 39%-71%), antihistamines (27 [63%] vs 1 [2%]; absolute reduction, 61%; 95% CI, 46%-75%), and leukotriene receptor antagonists (13 [30%] vs 0; absolute reduction, 30%; 95% CI, 16%-44%) also decreased. Conclusions and Relevance: Concomitant outfracture and submucous microdebrider inferior turbinoplasty improves quality of life in children with chronic nasal congestion and can reduce use of daily medication.

Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures.

BACKGROUND: Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated Pediatric Emergence Delirium (PAED) Scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat surgery. METHODS: Forty-six children aged 12 months-7 years were randomly assigned to receive either sevoflurane (N.=23) or desflurane (N.=23) for maintenance of general anesthesia. All patients were extubated awake in the OR, and upon arrival in the PACU, PAED scores were assessed every 15 minutes until discharged. In addition to PAED scores, time to tracheal extubation, emergence behavior, pain scores, and recovery complications were recorded. RESULTS: We found no significant difference in incidence of ED or peak PAED scores between sevoflurane and desflurane groups (12 [0-18] versus 12 [0-20]; P=0.79). There were no significant differences between desflurane and sevoflurane with respect to incidence of adverse events, such as nausea, vomiting, laryngospasm, or excessive secretions. CONCLUSIONS: In conclusion, the use of desflurane for maintenance of anesthesia did not significantly affect the incidence or duration of ED when compared to sevoflurane. However, desflurane did not demonstrate any increase in adverse events, which may support its routine use in this patient population.

Badly Behaving Noses in Children: Rhinitis, Sinusitis, or Neither?

Every pediatrician has likely experienced frustration with cases of chronic nasal symptoms that either do not seem to get better or do show improvement but then worsen again. Often, this leads to the diagnosis of allergic rhinitis or sinusitis and subsequent prescription of medication(s) that may or may not be warranted. This article discusses the various causes of rhinitis, both allergic and nonallergic. Recommendations for treatment place special focus on nasal irrigation and the role that a child's diet can have on chronic nasal symptoms, with the hope of reducing excessive and sometimes unnecessary medication use. [Pediatr Ann. 2016;45(11):e384-e387.].

Perspectives on neonatal and infant tracheostomy.

Neonates and infants may need a tracheostomy for many different reasons, ranging from airway obstruction to a requirement for long term mechanical ventilator support. Here, we present the pathophysiology of the many congenital and acquired conditions that might be managed with a tracheostomy. Decisions about tracheostomy demand consideration of not only the benefits, but also the potential side-effects, which may differ in the short and long term and may be attributable to underlying conditions as well as the tracheostomy. Evaluation of potential advantages of tracheostomy will influence decisions about optimal timing. In many cases, an infant may 'graduate' from dependence on a tracheostomy and resume a natural airway, although some will require reconstructive airway surgery.

Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither?

PURPOSE OF REVIEW: To review challenges in the diagnosis, work-up, and management of healthy children who present to the otolaryngologist with nasal dysfunction. Common symptoms include chronic nasal congestion, with or without rhinorrhea, with or without previous empirically treated 'allergic rhinitis' and/or 'sinus' infection. Symptoms are often unresolved despite chronic use of intranasal steroid, antihistamine, and/or leukotriene receptor antagonists. RECENT FINDINGS: There are no published studies addressing nasal symptoms in children who test negative for allergies yet report persistent nasal obstruction, congestion, and/or rhinorrhea. Recent publications continue to address efficacy of medical and/or surgical treatment for allergic rhinitis or acute/chronic rhinosinusitis. Best practice for children who 'fail' medical therapy but have impaired quality of life because of nasal dysfunction remains unknown. SUMMARY: Chronic nasal symptoms are common in childhood despite daily treatment using intranasal steroid, antihistamines, and/or leukotriene receptor antagonist therapies. Diet and dietary habit history should be included during evaluation and differential diagnosis as excessive dairy and sugar may contribute to chronic symptoms. Children who fail medical therapy for persistent nasal symptoms, allergic or not, should be referred and considered for outfracture of inferior turbinates and inferior turbinoplasty. Turbinate reduction procedures have demonstrated significant improvement in all domains of SinoNasal Quality of Life as measured by 'SN-5' survey.

Vocal cord paralysis and Dysphagia after aortic arch reconstruction and Norwood procedure.

OBJECTIVES: To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure. SETTING: Tertiary children's hospital. STUDY DESIGN: Retrospective cohort. METHODS: Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed. RESULTS: One hundred fifty-one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7-13) for Norwood and 24 days (IQR, 12-49) for arch reconstruction (P < .001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion (P = .337), dysphagia (P = .987), and VC paralysis (P = .706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow-up after discharge from surgery. More than 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis. CONCLUSION: There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.

Pediatric oral burns: a ten-year review of patient characteristics, etiologies and treatment outcomes.

OBJECTIVE: To summarize etiologies and treatments of pediatric oropharyngeal burns. DESIGN: Retrospective summary of 75 patients treated from January 1999 to January 2009. SETTING: Tertiary Children's Hospital. METHODS: Data collected included demographics, etiology of burn, site of injury, medical and/or surgical treatments, need for endoscopy, duration of hospitalization, and complications. RESULTS: 75 patients were treated with 50 being males (66%). Mean age was 4.3 years (median 2.7 years). The five most common causes were chemical (34.6%), electrical (12.3%), hot liquids (12.3%), food (12.3%) and battery ingestion (9.9%). Ingestion of hair products made up nearly 1/3 of the chemical causes (9/28) and alone made up 12% of the burns in our study. Main sites of injury included buccal mucosa (77.3%), lips (56%), tongue (48%), and palate (22.7%). One-third of the patients' required PICU/Burn unit admissions, 1/3 were admitted to floor, and 1/3 were discharged home from the ED. Average duration of hospitalization was 5 days. Of those admitted, 30% received antibiotics and only 8% received systemic steroids. Patients were made NPO on the first day of admission in 33.3% of patients and allowed to resume normal diet after surgical consultation. Only 9/75 (12%) patients required intubation. Otolaryngology consultation was obtained in 10.7% of cases. Only 18% of all patients required surgical intervention with debridement being most common (>60%). In this group, 20% received esophagogastroduodenoscopies due to ingestion of alkali substance. Complications occurred in less than 6% of all cases. CONCLUSION: Ingestion of chemicals, including hair dye/relaxer products, as well as overheated liquids and foods, are leading causes of oropharyngeal burns treated at our Children's Hospital Emergency Department over the past decade.