Exploring Factors Responsible for Delay in Pediatric Cochlear Implantation.

OBJECTIVE: To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children. STUDY DESIGN: Retrospective. SETTING: Tertiary pediatric CI referral center. PATIENTS: All patients under 18 years of age receiving CI between March 2018 and February 2020. INTERVENTIONS: CI. MAIN OUTCOME MEASURES: Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI. RESULTS: Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 ±â€Š0.8 yr versus 3.1 ±â€Š0.7 yr, p = 0.007) and those from low-income areas (8.6 ±â€Š7.6 yr versus 2.4 ±â€Š3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 ±â€Š0.6 yr versus 2.2 ±â€Š0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 ±â€Š107d versus 291 ±â€Š64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 ±â€Š0.2 versus 1.0 ±â€Š0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 ±â€Š132 d versus 197 ±â€Š67 d, p = 0.007), developmental evaluation (517 ±â€Š106 d versus 150 ±â€Š56 d, p = 0.003), speech evaluation (482 ±â€Š107 d versus 163 ±â€Š65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 ±â€Š107d versus 184 ±â€Š59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 × 10-4) and children with public insurance (p = 0.016; p = 0.002). CONCLUSIONS: Disparities in access to CI continue to affect timing of pediatric cochlear implantation.

Scirrhous carcinoma: A previously undescribed tumor of the oral cavity.

This patient was found to have a scirrhous carcinoma with extensive perineural invasion and without any evidence of minor salivary gland carcinoma. To our knowledge, this is the first report of isolated scirrhous carcinoma of the oral cavity. Treatment was surgery and adjuvant chemoradiation, and there was complete disease response.

Multidisciplinary clinic for care of children with complex obstructive sleep apnea.

OBJECTIVE: While adenotonsillectomy (AT) remains first line therapy for pediatric obstructive sleep apnea (OSA), management of children who are not candidates for AT or who have residual OSA post AT varies and spans across multiple specialties. We aim to report our experience in managing this population through a multidisciplinary sleep clinic composed of specialists in pediatric dentistry, otolaryngology, plastic surgery, and pulmonary/sleep medicine. STUDY DESIGN: Retrospective chart review. METHOD: The medical records of children attending our complex sleep apnea clinic were reviewed. Data pertaining to demographics, underlying diagnoses, prior evaluation and treatment, recommendations, and initial therapy were collected. RESULT: Two-hundred and thirty patients (mean age 10.7 ± 5.1 years, 62.2% male) were assessed. Underlying conditions included Trisomy 21 (n = 65, 28.2%), other genetic syndromes (n = 37, 16.1%), obesity in an otherwise typically developing child (n = 36, 15.2%), cerebral palsy (n = 27, 11.7%), and craniofacial syndromes (n = 7, 3.0%). Mean obstructive apnea hypopnea index (OAHI) was 14.2 events/hour at first clinic visit, and the majority of children had previously undergone at least one upper airway surgery (n = 168, 73.0%), primarily adenotonsillectomy. Recommended initial treatment plans included positive airway pressure (PAP) therapy (n = 108, 47.0%), surgery (n = 75, 32.6%), allergy management (n = 52, 22.6%), and/or weight loss (n = 34, 14.8%). Patients prescribed PAP therapy with follow up data were found to be adherent 43.9% of the time. Surgical patients with post-operative polysomnography had pre-operative OAHI 15.6 ± SD13.4 decrease to 10.7 ± 14.2 events/hour (p = 0.61). CONCLUSION: Genetic conditions and obesity were the most common underlying diagnoses cared for in the complex sleep apnea clinic. Patients presented with severe OSA, most having already had upper airway surgery. Management plans were frequently adjusted, and we observed improvement in SDB in a sub-segment of patients, suggesting benefit to a coordinated, multi-disciplinary approach.