Tonsillectomy is one of the most common procedures performed in children. A well-known complication of tonsillectomy is post-tonsillectomy hemorrhage (PTH). PTH is a very serious complication due to the potential for airway compromise and severe bleeding. Most hospital protocols call for observation in scenarios where there is no active bleeding and return to operating room in situations where bleeding is not controlled. In recent years, the use of tranexamic acid (TXA), an antifibrinolytic agent, has been incorporated into the management of post-tonsillectomy bleeds, through nebulization and/or intravenously (IV). The goal of this study is to systematically review publicly available hospital protocols for the management of pediatric PTH, with particular focus on the incorporation of nebulized and/or IV TXA, and to introduce a universally applicable protocol for PTH management. A systematic review of publicly available hospital protocols for pediatric PTH was conducted in accordance with PRISMA guidelines. The Children's Hospital Association (CHA) database was used to identify protocols that were publicly available, written in English, and specific to pediatric PTH management. The protocols were analyzed for key management domains including specialist consultation and use and dosing of nebulized and IV TXA. Through this systematic review, we identified 12 publicly available hospital PTH protocols, all developed at quaternary or near-quaternary centers. Of these protocols, 83% of protocols outline when to use nebulized TXA, whereas 67% of protocols outline when to use IV TXA and in total 67% include the use of both IV and nebulized TXA. Nebulized TXA was most consistently recommended for active bleeding, with IV TXA reserved for active or higher-volume bleeding. Our guideline recommends nebulized TXA for all PTH patients, with IV TXA for all active bleeding and on a case by case basis for controlled bleeding. This study reveals 12 publicly available pediatric PTH hospital protocols, 67% of which included the use of nebulized and IV TXA. Our guideline combines key practical management guidelines for PTH, including when to consult services like Interventional Radiology and PICU, and is designed for applicability beyond tertiary referral centers, providing a practical framework for frontline providers across a range of clinical settings.
This study aimed to determine the frequency of epileptic etiology in pediatric patients presenting with dizziness, to correlate EEG findings with clinical data, and to evaluate the response to antiseizure treatment. The medical records of 736 pediatric patients who presented with dizziness to the Pediatric Neurology Outpatient Clinic of Medipol Mega University Hospital between September 2013 and January 2025 were retrospectively reviewed. Patients' sex, age, physical examination findings, EEG results, seizure history, and use of antiseizure medication were evaluated. Of the patients, 61.7% (n = 454) were female and 38.3% (n = 282) were male. The median age was 11 ± 4.3 years (range: 2-18). Pathological findings were detected in 17 patients (2.3%) during physical examination. EEG was performed in 413 patients (56.1%). Among them, 87.7% had normal EEG findings, 11.6% showed epileptiform activity, and 0.7% had age-inappropriate background rhythm. Among the 48 patients with epileptiform discharges, 70.8% had focal and 29.2% had generalized activity. In terms of regional distribution, focal epileptiform activity most commonly involved the centrotemporal (n = 5), temporal (n = 5), occipital (n = 5), frontotemporal (n = 4), frontocentral (n = 4), and frontal (n = 4) regions. Less frequently observed foci included central (n = 3), centrotemporo-parietal (n = 2), centroparietal (n = 1), parietal (n = 1), and temporo-occipital (n = 1) areas. A clinical history of seizures was present in 20.8% of the patients with epileptiform activity. During follow-up, complete resolution of dizziness was observed in 87.4% of these patients. While the prevalence of epilepsy in the general population is approximately 1%, the rate of epileptiform activity among children presenting with dizziness was found to be 11.6% in this study. This suggests that dizziness may be a manifestation of underlying epileptic activity in certain cases. Therefore, EEG may provide significant diagnostic and therapeutic value in the evaluation of pediatric patients with dizziness.
Theory of mind refers to the ability to attribute mental states to oneself and others and is foundational for effective social interaction. Children with hearing impairments often experience delays in theory of mind development, potentially due to limited access to language-based communication. While cochlear implants (CIs) and hearing aids (HAs) improve auditory access, the extent to which theory of mind skills can be enhanced through targeted intervention remains underexplored-particularly in Persian-speaking populations. To evaluate the effectiveness of a structured theory of mind intervention in improving theory of mind skills, comprehension of mental verbs, and mean length of utterance in Persian-speaking children aged 5-7 years with hearing impairments using CIs or HAs. A randomized controlled trial was conducted with 60 children (n = 15 per group), stratified into four groups: CI-Intervention, CI-Control, HA-Intervention, and HA-Control. The 8-week intervention (16 sessions) was adapted from existing theory of mind training programs and delivered by trained facilitators in rehabilitation centers across Kerman, Iran. Primary outcomes were theory of mind skills assessed using a validated Persian version of the theory of mind. Secondary outcomes included comprehension of mental verbs and mean length of utterance. Assessments were conducted at baseline, mid-intervention, post-intervention, and one-month follow-up. Repeated-measures ANOVA and post hoc tests were used for data analysis. Both intervention groups demonstrated significant improvements in theory of mind performance across all three levels (p < 0.001), with moderate to large effect sizes (0.58-0.75). Comprehension of mental verbs significantly improved in the CI-intervention group post-intervention (p = 0.03). While mean length of utterance increased over time in both intervention groups, no statistically significant difference was observed between groups post-intervention. Children with cochlear implants consistently outperformed those using hearing aids across multiple outcome measures. Gains in theory of mind and mental verb comprehension were maintained at one-month follow-up, though some attenuation was observed. Structured theory of mind intervention is effective in enhancing theory of mind skills and mental verb comprehension in Persian-speaking children with hearing impairments, particularly those using cochlear implants. However, the limited impact on MLU and the partial maintenance of gains at follow-up suggest that sustained and linguistically enriched interventions may be necessary to consolidate and generalize improvements. IRCT20230827059274N1.
Pediatric septoplasty and functional septorhinoplasty remain controversial due to concerns for the effect of surgery on the developing nose. We aimed to assess practice patterns among pediatric otolaryngologists who perform pediatric septoplasty and septorhinoplasty. A cross-sectional survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO). Descriptive statistics were employed to summarize the typical indications and the most common techniques used in pediatric septoplasty and septorhinoplasty. Eighteen percent (105/577) of ASPO members completed the survey. Of respondents, 91 (87.0%) performed septoplasty, while 29 (27.9%) performed septorhinoplasty. Those who did not perform septorhinoplasty most commonly referred to Facial Plastics and Reconstructive Surgery (74.7%). Impacts on patient-reported quality of life were the most common criterion for both septoplasty and septorhinoplasty (82.2% and 76.4%, respectively). The NOSE was the most common patient-reported outcome instrument utilized. Among respondents, 38.9% did not use a strict age cutoff to perform septoplasty and 24.1% for septorhinoplasty. The most common techniques reported were columellar strut grafts for caudal septal deviation (66.7%), spreader grafts for internal nasal valve collapse (86.7%), alar batten grafts for external nasal valve collapse (55.2%), and lateral osteotomies for external bony deviations (85.2%). Spreader grafts only are used more than spreader flaps only to treat internal nasal valve collapse (62.1% vs 3.4%), while lateral osteotomies are used more than transverse osteotomies for bony deformity (85.7 vs 0%). Diminished patient-reported quality of life was the most common indication for pediatric septoplasty and functional septorhinoplasty among respondents. Columellar strut grafts, spreader grafts, alar batten grafts, and lateral osteotomies were common techniques used. Further work is needed to develop guidelines on septoplasty and functional septorhinoplasty in children and adolescents.
Predicting a difficult airway in pediatric patients remains challenging due to unique anatomical and physiological characteristics. Traditional bedside predictors show inconsistent accuracy in children, and ultrasonography has emerged as a promising, objective tool for airway evaluation. This study aimed to assess the diagnostic performance of anatomical and ultrasonographic parameters in predicting difficult intubation in pediatric patients. In this prospective, double-blind observational study, children aged 1-12 years undergoing elective surgery with endotracheal intubation were evaluated. Clinical assessments included anthropometric measurements and airway tests (Mallampati, thyromental distance (TMD), sternomental distance (SMD), hyomental distance (HMD)). Sonographic measurements-skin-epiglottis distance (S-ED) and skin-hyoid distance (S-HD)-were obtained preoperatively. Difficult intubation was defined as Intubation Difficulty Score (IDS) > 5. ROC curve analyses were used to evaluate diagnostic performance; logistic regression identified independent predictors. A total of 240 children were included, with a difficult-intubation incidence of 20%. S-ED demonstrated the highest predictive accuracy (AUC 0.941), followed by S-HD (AUC 0.912), HMD (AUC 0.898), and Mallampati classification (AUC 0.860). TMD and SMD showed moderate predictive ability. Combining significant clinical and sonographic parameters improved diagnostic performance, with S-ED + S-HD yielding an AUC of 0.961. Multivariable regression identified S-ED (OR 4.61), S-HD (OR 1.76), Mallampati ≥ III, and facial anomalies as independent predictors of difficult intubation. The final model correctly classified 95.4% of cases. Ultrasonographic parameters, particularly S-ED and S-HD, are highly accurate predictors of difficult intubation in children and outperform traditional clinical tests. Combining sonographic with anatomical assessments significantly enhances diagnostic performance. Airway ultrasound provides an objective, reproducible, and non-cooperation-dependent tool that can improve preoperative risk stratification in pediatric anesthesia.
Pediatric patients with tracheostomy tubes often require Magnetic Resonance Imaging (MRI); however, not all tracheostomy tubes are MRI-safe. Many are MRI-conditional. There is no unified protocol for obtaining MRIs for patients with MRI-conditional tracheostomy tubes. This lack of standardization puts patients at risk of unnecessary tracheostomy changes. The goal of this case series and proposed protocol is to describe the MRI characteristics of commonly available tracheostomy tubes and describe one institution's protocol for MRIs for pediatric patients with tracheostomy tubes. The Otolaryngology and Neuroradiology Departments developed a new protocol for performing MRIs for children with tracheostomy tubes. The development of the protocol began by categorizing and determining MRI compatibility of the most commonly available tracheostomy tubes. The new protocol was then developed and implemented in 3 cases. Tracheostomy tubes are commonly composed of polyvinyl chloride (PVC) or silicone with reinforced wire. There are 3 widely available brands: Bivona, Shiley, and Tracoe. PVC tubes (all Shiley models, some Tracoe models) are MR-safe, whereas silicone with reinforced wire tubes (all Bivona models, some Tracoe models) are MR-conditional. We propose a 3-step protocol. Step 1, pediatrics identifies the current tracheostomy tube. Step 2, depending on the type of tracheostomy tube, it is classified as MRI-safe or MRI-conditional. If MRI-safe, proceed with MRI without restrictions. If MRI-conditional, proceed to Step 3, where the pediatrics team determines if the patient is high-risk. If not high risk, proceed with tracheostomy tube change. If high-risk, proceed with MRI under restricted conditions. We also describe 3 cases in which this protocol was developed and utilized. This MRI tracheostomy protocol provides guidance for evaluation of a patient with a tracheostomy tube prior to performing an MRI and sets clear criteria for when a tracheostomy tube change is indicated. This protocol improves standardization of care, resource utilization, and patient experience. It provides a foundation for developing evidence-based guidelines that can improve safety and quality of care while simultaneously reducing unnecessary procedures.
To determine the prevalence of high risk for obstructive sleep apnea (OSA) in children with overweight and obesity and evaluate its impact on quality of life. We conducted a cross-sectional study of children aged 2-12 years diagnosed with overweight or obesity according to World Health Organization body mass index-for-age z-scores (BMIz). OSA risk and quality of life were assessed using the Thai version of the Pediatric Obstructive Sleep Apnea Screening Tool (POSAST) and the OSA-18 questionnaire, respectively. Physical examination included standardized tonsillar assessment using the Brodsky grading scale. Logistic regression models adjusted for potential confounders were applied in the data analyses. Among 68 children with overweight and obesity, the prevalence of high OSA risk was 41.2% based on POSAST criteria. Tonsillar hypertrophy was the strongest predictor of high OSA risk (adjusted OR: 10.92, 95% CI: 3.04-39.15, p < 0.001). Twenty-one percent of children experienced moderate to severe quality-of-life impairment. High OSA risk (adjusted OR: 14.59, 95% CI: 1.94-109.86, p = 0.009) and attention-deficit hyperactivity disorder (adjusted OR: 11.84, 95% CI: 1.52-92.14, p = 0.02) were independently associated with diminished quality of life after controlling for age, sex, and obesity severity. High OSA risk is prevalent among Thai children with overweight and obesity and significantly impairs their quality of life. Tonsillar hypertrophy represents a major treatable risk factor. These findings underscore the need for systematic OSA screening in pediatric obesity clinics and integration of quality-of-life assessments into routine clinical practice.
Submandibular gland pleomorphic adenoma is rare in children, and data regarding the optimal surgical approach remain limited. This study evaluated the feasibility, perioperative outcomes, and postoperative complications of transoral submandibular gland excision for pediatric pleomorphic adenoma. A retrospective review was conducted of pediatric patients who underwent transoral excision of submandibular gland pleomorphic adenoma between January 2023 and December 2024. Patients aged 18 years or younger with histopathologically confirmed pleomorphic adenoma treated via a transoral approach were included. Demographic characteristics, tumor size, operative time, length of hospital stay, postoperative complications, cosmetic satisfaction, and recurrence were analyzed. Sixteen patients were included. The mean age was 11.6 ± 2.8 years, and the mean tumor diameter was 2.4 ± 0.6 cm. All patients underwent successful transoral excision without conversion to a transcervical approach. The mean operative time was 42.6 ± 11.6 min, and the mean length of hospital stay was 4.5 ± 1.2 days. The mean cosmetic satisfaction score was 9.1 ± 0.6 at 3 months postoperatively. Transient lingual nerve dysfunction occurred in five patients and resolved spontaneously in all cases. One patient developed a postoperative abscess, and one experienced transient limitation of tongue movement; both resolved without long-term sequelae. No permanent lingual, hypoglossal, or marginal mandibular nerve dysfunction, hematoma, residual gland tissue, or local recurrence was observed. Transoral submandibular gland excision may be a feasible, safe, and cosmetically favorable approach for carefully selected pediatric patients with pleomorphic adenoma. Careful patient selection, meticulous surgical technique, and long-term follow-up remain essential.
To systematically review and meta-analyze the efficacy and safety of balloon dilation of the Eustachian tube (BDET) in pediatric patients with Eustachian tube dysfunction (ETD). PubMed, Scopus, and Web of Science were searched from inception to October 25, 2025. Original studies of any design evaluating BDET in pediatric patients were included. Outcomes included air-bone gap (ABG), pure-tone average (PTA), Eustachian tube scores, tubomanometry, Valsalva maneuver, tympanometry, tympanic membrane findings, efficacy, and complications. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models. Twenty studies (18 retrospective, 2 prospective) involving 1175 children (1868 ears; mean age 9.1 years) were included. Within-cohort analyses showed significant ABG improvement at 6 months (MD -14.84 dB; 95% CI: -26.11 to -3.57) and 12 months (MD -10.60 dB; 95% CI: -18.29 to -2.90). Eustachian tube scores significantly improved (MD 3.78; 95% CI: 2.85-4.71), and negative Valsalva results were significantly reduced after BDET (OR 17.21; 95% CI: 6.87-43.12). However, comparative analyses versus controls showed no significant differences in ABG or efficacy/cure rates (OR 1.08; 95% CI: 0.31-3.73). PTA and tubomanometric resistance scores showed no significant changes. The pooled efficacy rate was 67%, and the pooled complication rate was 3% (95% CI, 2-4%). Heterogeneity was high, and most studies were of fair quality. BDET may improve functional and audiological outcomes in pediatric ETD, but current comparative evidence does not confirm superiority over standard management. Higher-quality prospective randomized studies are needed.
Early cochlear implantation (CI) is considered a key determinant of auditory development in children with severe-to-profound sensorineural hearing loss. However, long-term outcomes remain highly variable and still incompletely understood. This study aimed to evaluate the long-term impact of age at implantation and other modifying variables in a large pediatric CI cohort. A retrospective longitudinal cohort study was conducted including 588 implanted ears from 494 children aged ≤10 years. Speech recognition scores (SRS) at 65 dB SPL were assessed longitudinally up to 10 years after implantation. Patients were stratified according to age at implantation (<12 months, 1-2 years, 3-5 years, 6-8 years, and 9-10 years). Earlier implantation was associated with significantly superior SRS at all follow-up intervals (p < 0.001). Children implanted before 12 months achieved the highest outcomes, with 100% reaching SRS >75% at 10 years, whereas those implanted at 9-10 years showed substantially lower performance. Prior hearing aid use was associated with better long-term outcomes, becoming significant from 6 years onward (p = 0.010). Perimodiolar electrodes demonstrated superior early performance and remained an independent predictor of higher 10-year SRS (p = 0.005). In multivariable analysis, only age at implantation (p = 0.004) and electrode array type (p = 0.005) remained independently associated with long-term results. Age at implantation is the strongest determinant of long-term speech recognition outcomes in pediatric CI recipients. Earlier implantation not only improves average performance but also reduces outcome variability. Electrode design and prior auditory stimulation further modulate outcomes, supporting a multifactorial model of auditory development.
Foreign body aspiration (FBA) is a serious and potentially life-threatening pediatric emergency. When promptly diagnosed and managed, outcomes are usually favorable, but delayed recognition can result in pneumonia, acute respiratory distress and even death. Prior studies show that language barriers and limited English proficiency (LEP) are associated with delayed diagnosis, increased risk of high-severity aspirations (e.g., nuts), and disparities in perioperative and emergency care. However, few investigations have directly examined the relationship between language barriers and clinical outcomes in pediatric FBA. This study sought to evaluate these associations in a large national cohort. We conducted a retrospective cohort study using the TriNetX research network. Pediatric patients (<18 years) with an index diagnosis of FBA were included. Exclusion criteria were age ≥18, prior history of FBA, asthma, or neuromuscular disorders. Two cohorts were created: children with FBA and a documented ICD code for acculturation difficulty (language barrier group) and children with FBA without such documentation (control group). Summary statistics were generated, and cohorts were propensity matched via multivariate linear regression based on age, age at index event, gender, race, and ethnicity. Outcomes compared included pneumonia, bronchoscopy, prolonged hospital stay, chest radiograph utilization, acute respiratory distress, dyspnea, and critical care services. After propensity score matching for age, age at index event, sex, race, and ethnicity, 880 pediatric patients with foreign body aspiration (FBA) and documented language barriers were compared with 880 matched controls. Patients with language barriers experienced significantly higher rates of pneumonia (39.0% vs 21.8%; OR 2.29, 95% CI 1.86-2.82; p < 0.0001) and prolonged hospital stay (6.93% vs 2.16%; OR 3.38, 95% CI 2.00-5.70; p < 0.0001). Respiratory complications were also more common, including acute respiratory distress (8.64% vs 1.93%; OR 4.80, 95% CI 2.81-8.19; p < 0.0001) and dyspnea (13.1% vs 3.86%; OR 3.74, 95% CI 2.52-5.55; p < 0.0001). Chest radiograph utilization (26.5% vs 14.0%; OR 2.22, 95% CI 1.74-2.82; p < 0.0001) and critical care use (6.93% vs 2.05%; OR 3.57, 95% CI 2.09-6.09; p < 0.0001) were higher among language barrier patients, while bronchoscopy rates were similar between groups (4.21% vs 3.30%; OR 1.29, 95% CI 0.79-2.11; p = 0.32). This national analysis demonstrates that pediatric patients with language barriers face significantly higher morbidity and resource utilization following FBA. These findings reinforce evidence that LEP contributes to delayed recognition, higher complication rates, and disparities in perioperative and emergency care. In the context of FBA, where timely diagnosis is critical, language barriers may affect survival and recovery. Standardized use of professional interpreters and culturally tailored caregiver education represent actionable strategies to reduce these inequities and potentially improve outcomes in this vulnerable population. To our knowledge, this is the first large-scale national study to directly examine language barriers and pediatric FBA outcomes.
Postoperative hemorrhage is a significant complication of tonsillectomy with or without adenoidectomy. This retrospective cohort study evaluates whether COVID-19 or influenza infection within defined preoperative intervals increases hemorrhage risk in patients under 18 years of age. Using the TriNetX database, we identified pediatric patients who underwent tonsillectomy with or without adenoidectomy and had documented COVID-19 or influenza infection within six, three, or one month before surgery. Cohorts included patients with COVID-19 only, influenza only, and a control group with neither infection. Propensity score matching was performed. Risk ratios (RR) and 95% confidence intervals (CI) for postoperative hemorrhage were calculated for postoperative days 0-1, 2-5, and 6-10. Influenza infection within six, three, or one month before surgery was not associated with an increased risk of postoperative hemorrhage at any time point. COVID-19 infection was associated with a significantly increased risk of secondary hemorrhage (postoperative days 2-5 and 6-10) across all preoperative intervals. No increase in primary hemorrhage (postoperative days 0-1) was observed with COVID-19 at any interval. Pediatric patients with a COVID-19 infection within six, three, or one month prior to tonsillectomy with or without adenoidectomy are at increased risk of secondary postoperative hemorrhage. Recent influenza infection does not confer increased risk of either primary or secondary hemorrhage. Clinicians should counsel families regarding the elevated risk associated with recent COVID-19 and consider additional perioperative precautions in affected patients.
Cochlear implantation provides an opportunity for children with congenital severe to profound hearing loss to acquire spoken language. However, as multiple factors influence language outcomes after cochlear implantation, language development performance can vary between individuals. The study participants (n = 150) were divided into three groups according to age at cochlear implantation: Group 1, 12-24 months; Group 2, 25-36 months; and Group 3, 37-48 months. The effect of age at implantation on auditory perception and language development performance was compared between these groups. The participants were also classified into five groups according to duration of cochlear implant use: Group 1, ≤48 months; Group 2, 49-72 months; Group 3, 73-96 months; Group 4, 97-120 months; and Group 5, ≥120 months. The effect of cochlear implant use duration on auditory perception and language development performance was compared between these groups. A statistically significant weak negative correlation was found between age at cochlear implantation and scores on Glendonald Auditory Screening Procedure (GASP) and Preschool Language Scales Fifth (PLS-5; p < 0.05). A statistically significant weak negative correlation was observed between age at cochlear implantation and Speech Intelligibility Rating (SIR), speech discrimination tests, and pure-tone thresholds (p < 0.05). Scores obtained from the GASP, Categories of Auditory Performance (CAP) and SIR, and the PLS-5 tests differed significantly across groups defined by chronological age at implantation (p < 0.05). Scores on the GASP, CAP, SIR, PLS-5, speech recognition threshold, and speech discrimination tests differed significantly according to the classification by cochlear implant experience (p < 0.05). The timing of cochlear implantation, together with individual differences, appears to impact long-term language development in children. To increase the chance that children using cochlear implants will achieve language development comparable to their normal-hearing peers, early implantation is important. Additionally, bilateral cochlear implantation, increased number of auditory-verbal therapy sessions, and long-term language intervention are critical. Children who undergo delayed cochlear implantation in particular require more intensive auditory-verbal therapy services.
Acute mastoiditis is one of the most common complication of acute otitis media, and its clinical course may vary significantly among patients. To investigate the association between adenoid size and the severity of acute mastoiditis in children. This retrospective cohort study included children (<18 years) hospitalized with acute mastoiditis. The primary outcome was the association between disease severity-defined by the presence of intracranial complications or PICU admission - and the adenoid-to-nasopharyngeal ratio (ANR), measured on CT scans at three nasopharyngeal levels. Secondary outcomes included length of hospital stay, differences in bacterial profiles, and incidence of subsequent ear infections. A total of 106 children (64 males [60.3%], mean age 3.03 years [IQR: 1-3.9]) were included in the analysis, of whom 32 (30.2%) were classified as having severe disease. Patients with severe mastoiditis were younger, had higher CRP levels, a longer duration of fever before presentation, underwent mastoidectomy more frequently, and had longer hospital stays (all p < 0.05). The ANR was significantly higher in patients with severe disease (0.6 vs. 0.4, p = 0.01). In multivariable logistic regression, both younger age (aOR, 2.26; 95% CI, 1.90-4.70; p = 0.05) and higher ANR (aOR, 1.30; 95% CI, 1.10-1.60; p = 0.03) were independently associated with severe mastoiditis. Bacterial profiles did not differ significantly, but severe cases had more subsequent ear infections (42.5% vs. 21.3%, p = 0.019). Higher ANR was associated with increased severity of acute mastoiditis in children. Further studies should explore whether early detection and treatment of adenoid hypertrophy can improve outcomes.
Preauricular sinus is a common congenital malformation that can become infected. The traditional treatment paradigm has been to settle any infection followed by delayed second-stage excision. This has been thought to achieve better post-operative outcomes and lower risk of recurrence. More recently, however, there have been studies reporting similar outcomes with emergency single-stage 'hot' excision. There are also few microbiological studies; hence, there is need to elucidate the bacteriology in an Australian population. A 10-year retrospective review of preauricular sinuses treated with surgery by the Otolaryngology department at the Royal Children's Hospital, Melbourne. Seventy-six sinuses were treated with surgical excision. 70.7% of sinuses had been previously infected. Elective excision occurred in 85.5%, while the remaining 14.5% underwent single-stage excision. 36.8% of sinuses were actively infected at the time of excision even though they may have been elective cases. There were two cases of sinus recurrence in elective cases. There was no significant difference in recurrence rates with regards to previous infections, management of infections, active infection at the time of excision nor elective versus emergency single-stage excision. The most common microorganisms were anaerobes, staphylococcus aureus, and upper respiratory tract flora. Multiple organisms were implicated in 77.6% of cases. Traditionally, the treatment paradigm of infected preauricular sinuses has been to settle the infection followed by delayed second-stage excision. This study demonstrates that single-stage excision of actively infected sinuses is a safe and viable treatment option. We suggest the addition of anti-anaerobic antimicrobials in the treatment of infection.
Subtotal petrosectomy (STP) is a radical otologic procedure aimed at complete eradication of diseased temporal bone air cells and creation of a closed, sterile cavity. While well established in adult otology, its role in pediatric patients remains insufficiently described. To analyze current indications, outcomes and complication rates of subtotal petrosectomy in a pediatric population, with particular emphasis in age - related patterns of indications. A retrospective review was conducted of 20 children (<18 years) who underwent STP between 2010 and 2024 at two tertiary referral centers. Patients were analyzed according to age groups (≤6 years vs. >6 years) and etiology, categorized as congenital (including congenital malformations, CHARGE syndrome and congenital CSF leaks) or acquired (cholesteatoma, chronic otitis media, traumatic and oncological lesions). Major and minor complications were recorded and analyzed using non - parametric statistical methods. The cohort included 15 boys and 5 girls with a mean follow-up of 4.3 ± 1.2 years. Congenital indications predominated in children ≤6 years, whereas acquired pathologies were significantly more common in older children (>6 years) (Fisher's exact test, p = 0.018). Patients treated for congenital indications were significantly younger than those with acquired pathologies (p = 0.0095). Major complications occurred in 2 of 20 patients (10%, 95% confidence interval 1,2-31,7%), including cholesteatoma recurrence requiring revision surgery and conversion to an open technique. Minor complications were observed in one patient (5%) and consisted of an abdominal hematoma). No cases of implant loss, permanent facial nerve palsy or wound dehiscence were observed. STP is a safe and effective procedure in selected pediatric patients, with low rates of major complications. Indications differ significantly by age, with congenital pathology predominating in younger children and acquired in older patients. In children, STP should be regarded not as salvage procedure but as a reconstructive strategy providing a stable anatomical foundation for long term hearing rehabilitation and disease control.
The prevalence of childhood hearing loss doubles from newborn period to school age. Parental concern and developmental checklists are often used to flag potential hearing loss after newborn screening, but parental concern alone is a poor indicator. This study explored parental awareness of childhood hearing loss, communication milestones, and risk factors, and particularly whether this knowledge was gained during the newborn period. A digital survey was anonymously completed by parents of children under 2 years old living in Sweden. While 98% of parents were aware of the impact of hearing loss on language development, only 56% recalled receiving information about early detection during newborn screening. Most parents (70%) believed a child could still have hearing loss despite passing the screening. This belief was less common among parents with lower education or who did not speak Swedish at home. Parents often underestimated the age at which children reach communication milestones, and 74% reported not considering hearing loss when their child failed to respond to a direction. Parents demonstrated high overall awareness of childhood hearing loss. However, whether information was provided during newborn screening was inconsistent. The limited sensitivity of parental concern in detecting hearing loss may not stem from a lack of knowledge, but rather from the fact that parents often do not consider hearing loss as a possible explanation when their child does not respond in everyday situations.
To assess the interaction between cesarean section (CS) and maternal history of allergic diseases (MHAD) in influencing the risk of allergic rhinitis in the offspring. A case-control study was conducted with a 1:1 frequency matching by sex. A total of 239 children diagnosed with AR were enrolled in the case group, and 239 children without a history of AR served as the control group. Logistic regression models were used to analyze the association between maternal CS, MHAD, and the risk of AR in offspring. Interaction effects were evaluated using both the multiplicative and additive models. The CS (50.7%) and MHAD (36.8%) rates in the case group were significantly higher than those in the control group (35.1% and 27.6%, respectively). Logistic regression analysis revealed that maternal CS (OR = 1.916, 95%CI:1.322-2.778, P < 0.001) and MHAD (OR = 1.585, 95%CI:1.071-2.344, P = 0.021) were independent risk factors for AR in offspring. Furthermore, a significant multiplicative interaction was observed between maternal CS and MHAD (OR = 3.472, 95% CI:1.497-8.053, P = 0.004), with the combined effect increasing the risk by 5.619 times. Maternal CS and MHAD synergistically increase the risk of AR in children. These findings underscore the importance of considering both maternal CS and MHAD when developing public health strategies and preventive interventions to reduce the incidence of AR in the offspring.
Middle fossa craniotomy (MFC) with exposure of the internal auditory canal and/or petrous apex (anterior petrosectomy) is an uncommon operation in the pediatric population. We report our institution's experience and surgical outcomes with pediatric MFC. Retrospective case series including all MFC with exposure of the internal auditory canal and/or petrous apex, performed between May 2018 and September 2024, in patients aged 18 years and younger. Primary outcome measures were pre-operative and postoperative facial nerve function and hearing status. Sixteen patients met inclusion criteria. Median age was 12 years (range 1-18), 10 (63%) were male and six (37%) were female. On preoperative MRI, median tumor size was 12.5 mm (range 3-63). Gross total resection was achieved in 11 (69%) cases, near total in 1 (6%), and subtotal in 4 (25%). Facial nerve outcomes were favorable: of 11 patients with preoperative House-Brackmann (HB) I, 10 (91%) maintained HBI postoperatively. All 9 patients with vestibular schwannoma (VS) had class A hearing preoperatively. At first postoperative follow-up (median 8 days), five (56%) maintained class A hearing and four (44%) were class D. MFC can be safely performed in children for appropriately selected skull base lesions. VS in NF2 is the most common indication, and MFC offers a valuable hearing-preserving option in these cases. Early intervention for small, growing tumors with associated hearing loss, coupled with modern intraoperative monitoring and multidisciplinary expertise, allow for facial nerve and hearing outcomes similar to the adult population.
Unilateral soft palate and faucial pillar dysplasia is a rare anomaly distinct from typical cleft palate. Among patients with these anatomic findings, this study aims to define the consistent diagnostic features, assess surgical techniques for repair and speech outcomes. A systematic review of PubMed and Embase was conducted using the PRISMA protocol. A descriptive synthesis on patient demographics, surgical interventions, and outcomes was performed. A select patient case treated at the authors' institution is presented. Fifteen studies comprising 32 patients were included. All patients had unilateral soft palate deficiency with either dysplastic or absent faucial pillars. Twenty-six patients underwent surgical correction at a mean age of 33 months. The most common technique included soft palate dissection plus the addition of an adjacent interpolated flap. Twenty patients experienced improved speech; however, outcome only 53% of patients had follow-up >12 months. Four of 26 (15%) required revision surgery. Unilateral soft palate and faucial pillar dysplasia demands surgical techniques distinct from traditional cleft palate repair methods. Due to the hypoplasia of the unilateral velum and faucial pillars, the use of adjacent flaps may represent an important feature of successful surgical treatment.