Faculty Bibliography

BACKGROUND:Otologic symptoms consistent with Eustachian tube dysfunction (ETD) are common in patients with chronic rhinosinusitis (CRS), but can also occur independently of CRS as primary ETD. It is unclear if CRS+ETD is similar to primary ETD or how treatment outcomes compare. METHODS:A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Any study describing ETD in CRS was included. Primary ETD studies were limited to those with preoperative and postoperative Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores in ETD treated only with Eustachian tube balloon dilation (ETBD). RESULTS:Sixteen studies were included: nine studies with 1336 consecutive patients with CRS and seven studies with 161 patients with primary ETD. In studies with specific data, 225 (47.2%) patients with CRS had a score >14.5, consistent with ETD. In CRS+ETD, baseline mean ± standard deviation (SD) ETDQ-7 score was 20.7 ± 8.4 and did not differ by polyp status. In primary ETD, mean ETDQ-7 score was significantly higher than CRS+ETD (29.5 ± 8.1, p < 0.0001). Regarding treatment outcomes, CRS+ETD treated with endoscopic sinus surgery (ESS) alone resulted in mean ETDQ-7 in the normal range (13.2 ± 5.3), with a mean change of -7.4 (95% confidence interval [CI], -10.82 to -3.99) (p < 0.00001). Patients with primary ETD treated with ETBD had postoperative ETDQ7 scores of 14.9 ± 7.5 with mean change of -13.9 (95% CI, -18.01 to -9.88), p < 0.00001. CONCLUSION:ETD is noted in approximately half of patients with CRS. Outcomes of CRS+ETD treated with ESS alone are similar to those of patients with primary ETD treated with ETBD.

OBJECTIVES/UNASSIGNED:To evaluate videofluoroscopic swallow study (VFSS) findings in infants with dysphagia and without prior diagnoses, and to characterize the outcomes and any diagnoses that follow. METHODS/UNASSIGNED:A chart review of all pediatric patients who received a VFSS at a tertiary children's hospital from November 2008 to March 2017 was performed. RESULTS/UNASSIGNED:There were 106 infants (57 males and 49 females) with 108 VFSS. VFSS was normal in 18 (16.98%) infants. Regarding airway protection, 50 (47.17%) infants had laryngeal penetration, and 8 (7.55%) had tracheal aspiration; 3 (2.83%, 37.5% of all aspirators) exhibited silent aspiration. Of the 75 infants with minimum 2-year follow-up, 35 (46.67%) had no sequelae of disease and received no diagnoses. The most common diagnoses and pathologic sequelae were gastroesophageal reflux (n = 18, 24.00%), asthma (n = 8, 10.67%), laryngomalacia (n = 6, 8.00%), and tracheomalacia (n = 4, 5.33%), all consistent with United States pediatric data on prevalence. All infants (n = 51) with follow-up for dysphagia had resolution of symptoms within 9 months from VFSS order date. CONCLUSIONS/UNASSIGNED:Otherwise healthy infants may show signs of dysphagia and not develop later illness. Parents can thus be counseled on the implications of dysphagia in a previously healthy infant. Our findings provide comparative statistics for future research in pediatric dysphagia.

OBJECTIVES/HYPOTHESIS:To further clinically characterize lingual hamartomas, and to consolidate literature by analyzing clinical presentation, diagnostic evaluation, treatment, and outcomes. STUDY DESIGN:Retrospective chart review and literature review. METHODS:Case series from 1989 to 2020 at a tertiary pediatric center; follow-up ranging from 2 months to 12 years. Patient demographics, clinical presentations, physical examination findings, surgical pathology, operative methods, pre-operative imaging, and follow-up. A review of English-language literature from 1945 to 2020 was conducted. RESULTS:Seven patients (four male, three female) with nine lingual hamartomas were identified. Average age at surgical excision was 7.9 months (SD 3.5 months, range 3 to 14 months). Follow-up ranged from 2 months to 12 years, with all patients having no recurrence. Physical examination identified five pedunculated hamartomas and two sessile hamartomas. One patient had a neck CT, one had neck ultrasound, and two had facial MRIs. CT and ultrasounds confirmed presence of cervical thyroid. MRI suggested no muscular invasion for one patient, whereas motion artifact obscured findings for the other patient. Most patients who presented with dysphagia or poor weight gain achieved post-surgical improvement. The present cases combined with the literature review identified 57 patients with 63 lingual hamartomas. CONCLUSIONS:Lingual hamartomas appear as hypovascular pedunculated masses near the foramen cecum. There is no demographic predisposition, and most are identified during infancy. Imaging is not necessary, unless there is concern for lingual thyroid, in which case thyroid ultrasound should be performed. Surgical excision is curative, with dysphagia resolution and low likelihood for recurrence. LEVEL OF EVIDENCE:4 Laryngoscope, 131:E2080-E2088, 2021.

OBJECTIVES:To compare the efficacy of aural foreign body (FB) extractions among medical care settings and determine if certain methods of extraction resulted in higher failure rates and procedural complications. STUDY DESIGN:Case series with chart review. SETTING:Emergency departments (EDs), urgent cares (UCs), pediatric primary care providers (PCPs), and otolaryngologists (ENTs). METHODS:A total of 366 pediatric patients with EAC foreign bodies at a tertiary children's hospital and associated satellite clinics. RESULTS:The ED/UCs (17.46%), PCPs (75.22%), and ENTs (94.54%) exhibited highly variable success rates for pediatric aural FB extractions. Complications were considerably higher for attempts by ED/UCs (22.22%) as compared with PCPs (2.61%) and those of unclear etiology (2.73% of all attempts). Use of balloon-tipped catheters and adhesive-tipped probes (eg, cyanoacrylate/superglue) for FB extraction exhibited 0% success rates with high severity of complications. CONCLUSION:Our statistics provide an example in which ED/UCs had higher failure rates at pediatric aural FB removals when compared with PCPs and ENTs. If a single provider (PCP or ED/UC) fails to retrieve an aural FB or if the provider is not comfortable conducting the procedure, then referral to an ENT is preferable to another PCP or ED/UC. Our evidence reveals that balloon-tipped catheters and adhesive-tipped probes for FB removal in the pediatric population are prone to failure and higher rates/severity of complications.

INTRODUCTION/BACKGROUND:For pediatric patients, bone-conduction hearing devices (BCHD) have demonstrated excellent outcomes. Unique to this population, BCHD implant surgeries can be technically challenging in children due to thinner, developing bone and syndromes with atypical anatomy. Image-guided surgical navigation (IGSN) clarifies underlying skull structure, potentially improving outcomes. IGSN is commonly used in otorhinolaryngologic surgeries, but current use in BCHD placement surgeries remains unprecedented. We report favorable results of IGSN in BCHD implantation for three children with complex otologic anatomy: two syndromic patients with variable temporal bone thickness, and one with prior mastoidectomies. The three patients each underwent a successful hearing implant surgery without significant intra- or post-surgical complications. All patients had good audiologic outcomes. METHODS AND MATERIALS/METHODS:We report using IGSN to assist in BAHA or BONEBRIDGE™ implant surgery for three medically complicated patients. For stereotactic imaging, the patients each received pre-operative high-resolution CT scans using the paranasal sinus fusion protocol without contrast. The first patient was a 6-year-old male with CHARGE-associated abnormal temporal bone anatomy, atretic left auditory nerve, and bilateral chronic tympanic membrane perforation and otorrhea resulting in bilateral mixed conductive and sensorineural hearing loss. The patient thus was unable to consistently tolerate hearing aids. The second patient was an 18-year-old male with Rosai-Dorfman disease, history of bilateral chronic mastoiditis and middle ear infections, bilateral mastoidectomies, and bilateral malleus and incus removal resulting in mixed conductive and sensorineural hearing loss. The third patient was an 11-year-old male with Treacher Collins Syndrome, bilateral microtia, and bilateral atresia of the external auditory canals resulting in bilateral conductive hearing loss. RESULTS:The patients each underwent a successful hearing implant surgery without significant intra- or post-surgical complications. All patients had good audiologic outcomes. CONCLUSION/CONCLUSIONS:Intraoperative IGSN can be a beneficial adjunct to BCHD implant placement surgeries for pediatric patients with abnormal temporal bone anatomy. IGSN can help identify the optimal surgical implantation sites, thereby reducing the risk for major morbidities associated with BCHD implantations. Furthermore, our findings expand application of IGSN use to placement of both BAHA and BONEBRIDGE™.

The innate immune components that modulate allergic contact hypersensitivity (CHS) responses are poorly defined. Using human skin from contact dermatitis patients and a mouse model of CHS, we find that hapten allergens disrupt the Arginase1 (Arg1) and inducible NO synthase (iNOS) dynamic in monocytes/macrophages (mono/MΦ), which renders those cells ineffectual in suppressing skin inflammation. Mice lacking Arg1 in MΦ develop increased CHS characterized by elevated ear thickening, mono/MΦ-dominated dermal inflammation, and increased iNOS and IL-6 expression compared with control mice. Treatment of Arg1^flox/flox; LysMCre^+/- mice with a selective NOS inhibitor or knockout of Nos2, encoding iNOS, significantly ameliorates CHS. Our findings suggest a critical role for Arg1 in mono/MΦ in suppressing CHS through dampening Nos2 expression. These results support that increasing Arg1 may be a potential therapeutic avenue in treating allergic contact dermatitis.