Immunodeficiency in pediatric otolaryngology

The relationship between the individual's aerodigestive tract and the external environment is a delicate balance maintained by a competent immune system. An understanding of the immune system and the various immune defects thus enables the practitioner to diagnose and treat an otherwise unrecognized cause of recurrent respiratory and ear infections. In this article a review of the immune system is presented. The structure and function of cell mediated and humoral immunity as well as the corresponding deficiency states are discussed. Specific emphasis is placed on immunity as it relates to the air and food passages and the ear. All charts of patients with immune deficiency seen at the Children's Hospital of Philadelphia were reviewed. Thirty patients were found to be immunodeficient. Hypogammaglobulinemias accounted for 50.0 per cent, IgA deficiency accounted for 33.3 per cent, and chemotactic defects occurred in 13.3 per cent. All patients exhibited some type of otolaryngologic disease, characterized by frequent infections of the middle ear, upper respiratory tract, paranasal sinuses, or lungs. Because of this pattern of presentation, the otolaryngologist should be aware of these disorders and participate in their diagnosis and treatment.     

Outcomes research in pediatric otolaryngology

There are several validated outcomes instruments available for use in the pediatric otolaryngology population. These include instruments for otitis media, rhinosinusitis, tonsil and adenoid disease; sleep-disordered breathing, voice disorders and tracheotomy. In addition, several prospective outcomes studies have been performed on common pediatric otolaryngology conditions. These studies have typically indicated that the quality of life impact of diseases such as otitis media and recurrent tonsillitis is quite high, and that surgical treatments (such as tympanostomy tube placement and adenotonsillectomy) result in significant improvements in quality of life and disease-specific health status. In addition, cost-effectiveness studies of cochlear implantation have indicated that implantation is a very cost-effective intervention when performed in children.     

Augmentative communication considerations in pediatric otolaryngology

The authors review the alternative or augmentative communication approaches that are traditionally coordinated by the otolaryngologist. They also introduce the otolaryngologist to recent developments in services for the individual who is nonspeaking.     

The residency experience in pediatric otolaryngology

OBJECTIVES: To assess the residency experience in pediatric otolaryngology, determine the impact of pediatric fellowship programs on residency training, and evaluate the need for fellowship training in pediatric otolaryngology. DESIGN: An anonymous, web-based survey of chief residents in otolaryngology. METHODS: Respondents described their experience in pediatric otolaryngology using a 5-point Likert scale and reported their comfort levels (yes/no) with various medical and surgical issues in pediatric otolaryngology. RESULTS: The survey was successfully completed by 70 respondents, representing a response rate of 26%. The majority of the respondents reported positive experiences with regard to the following aspects of pediatric otolaryngology training: didactics (81%), clinical research opportunities (78%), positive faculty role models (87%), career mentorship (74%), independent medical (84%) and surgical (81%) decision-making, and overall comprehensive residency experience (87%). Basic science research opportunities (50%) were reported as less available than clinical research opportunities (78%) (P = .002). Compared with other surveyed issues, a lower comfort level was reported for management of craniofacial anomalies (P < .001), excision of large lymphatic malformations (P < .001), cochlear implantation (P < .001), laryngotracheal reconstruction (P < .001), and surgical correction of velopharyngeal insufficiency (P < .001). No statistically significant difference was noted in responses based on the presence of a fellowship program at the institution. CONCLUSIONS: The residency experience in pediatric otolaryngology is perceived as comprehensive by graduating chief residents participating in this survey. The presence of a fellowship program does not appear to negatively impact the residency experience. Based on the reported comfort levels, the management of complex issues in pediatric otolaryngology may require additional training.     

加强小儿耳鼻咽喉科学的学科建设

由于小儿的解剖、生理和病理特点明显不同于成人 ,所以儿科疾病的诊治绝不是处理成人疾病的简单缩小。这在耳鼻咽喉科领域更为突出。例如发生于成人的听力损失 ,不再影响其已形成的言语能力 ;但小儿的听力损失却会严重影响其言语和认知的发育。又如成人的急性喉炎主要表现为声音嘶哑 ,而婴幼儿急性喉炎却可能表现为严重的呼吸困难 ,危及生命。有些疾病如分泌性中耳炎 ,扁桃体和腺样体肥大 ,鼻腔、喉、气管 支气管异物等 ,儿童的患病率远高于成人。在综合性医院 ,小儿约占全部耳鼻咽喉科患者的 1/3。所以小儿耳鼻咽喉科学(pediatricotorhino…     

Research in pediatric otolaryngology: an overview

Pediatric otolaryngology research, most of the time, relies on basic research in animals. This is especially evident when looking at the neonatal period on which this paper is mainly focused. Most of perinatal hearing pathologies are related to the existence of sensitive periods during development. Major improvements of evoked potential techniques have permitted early recognition of hearing losses. This paper also deals with problems involving secretory otitis media, laryngeal stenosis and drooling in crippled children. Finally, there is brief mention of future research domains: immunology and vestibular pathology.     

加强小儿耳鼻咽喉科学的学科建设

由于小儿的解剖、生理和病理特点明显不同于成人，所以儿科疾病的诊治绝不是处理成人疾病的简单缩小。这在耳鼻咽喉科领域更为突出。例如发生于成人的听力损失，不再影响其已形成的言语能力；但小儿的听力损失却会严重影响其言语和认知的发育。又如成人的急性喉炎主要表现为声音嘶     

Assessment and management of pain in pediatric otolaryngology

IntroductionPain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction.ObjectivesThe aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services.MethodologyNarrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016.Results129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services.ConclusionsWe present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and pharmacological interventions in neonates, infants and children are very wide and it should be promoted ethical and safe research on pain control in this population.     

Improving outcomes in a high-output pediatric otolaryngology practice

ObjectivesTo identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.MethodsRetrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction.Results223 cases were performed over 20 operative days. The average turnover time was significantly longer in “major” surgeries (p = 0.03), cases with multispecialty involvement (p = 0.01), cases requiring intubation (p < 0.001), and in cases where a fellowship trained pediatric anesthesiologist (p = 0.01) or CRNA was present (p < 0.001). When comparing “fast” (<25 min average turnover) operative days vs. “slow” (>25 min average turnover) days, presence of a non-fellowship trained anesthesiologist (p < 0.001), and the presence of an anesthesiology resident (p = 0.03) were significantly associated with “fast” days, while the presence of a CRNA was associated with “slow” days (p < 0.001). A significantly greater proportion of patients required intubation on “slow” turnover days vs. “fast” days (p = 0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p = 0.047) and on days with turnover times of 25 min or less (p < 0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover.ConclusionsHigh-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.     

HIV protocol for the pediatric otolaryngology office

With the increasing awareness and concern over the transmission of human immunodeficiency virus (HIV) to health care providers, the development of a reasonable approach to patient care is necessary with those suspected of or documented as being HIV-positive. Children are all too frequently the innocent victims of this deadly disease and will often require the services of the otolaryngologist for evaluation, diagnosis, and treatment. In order to provide appropriate care for these children and reduce the risk of possible contamination of health care professionals or other patients a protocol was established for the Pediatric Otolaryngology Division of Children's Hospital at Washington University. This protocol is discussed in detail with explanation of rationale and alternatives.     

Estimation the effectiveness of cefuroxime therapy in pediatric otolaryngology

The authors present results of retrospective clinical analysis of usefulness the cefuroxime therapy of acute ENT diseases in children. The study group consist of 886 patients, aged 4 m. to 17 year, hospitalized at the Department of Paediatric Otolaryngology between 1997-2002. The efficacy of therapy was estimated on the ground of 4 degree scale. Particular attention was paid on measuring an average time of intravenous and oral administration of drug and on side effects of treatment. The results of the study shown that cefuroxime therapy is safe and effective. Beneficial therapeutic effect was obtained in 98.9% of patients.