INTRODUCTION:Children with cleft palate face a high risk of otitis media with effusion (OME) and conductive hearing loss. This survey evaluated contemporary global practice patterns in hearing surveillance and management within this cohort. METHODS:A 43-item cross-sectional survey was electronically distributed to international pediatric otolaryngologists between January and March 2026. The questionnaire evaluated surveillance protocols, OME interventions, tympanostomy tube (TT) preferences, alternative hearing rehabilitation, and institutional resource barriers. RESULTS:Sixty-seven clinicians participated, primarily from university or tertiary healthcare settings (85.1%). 72.7% of the participants were from high-income countries, while 27.3% were from low- and middle-income countries. For OME management, TT insertion was the preferred first-line choice for 50.7%, though responses showed marked variation regarding timing of insertion. If surgery was unfeasible, 53.7% utilized hearing amplification as a first-line alternative. Most clinicians (85.1%) avoided Eustachian tube balloon dilatation. Intensive surveillance was adopted by 50.7% for syndromic cleft cases. Principal barriers to optimal care included prolonged appointment wait times (25.4%) and low family awareness (22.4%), despite 77.6% of respondents practicing in high-resource centers. CONCLUSION:Although otolaryngology and audiology surveillance is widely embedded in international cleft pathways, substantial variation across participating countries and regions persists regarding surgical indications, timing of TT insertion, and follow-up. These findings highlight a need for international consensus and evidence-based guidelines to standardize cleft-related hearing management and optimize long-term outcomes.
BACKGROUND:Research on pediatric salivary gland diseases and autoimmune disease is limited. This study examines juvenile recurrent parotitis (JRP) and autoimmune diseases. OBJECTIVE:To examine associations between JRP and autoimmune diseases, and modification by sex and age. RESEARCH DESIGN AND METHODS:Danish nationwide cohort study of children with JRP identified through hospital contacts, 1994-2024, matching ten controls per case. We investigated ten autoimmune groups within Gastrointestinal disease, Vasculitis, Skin disease, Nervous system disease, Metabolic disease, Type I diabetes, Joint disease, Sjögrens disease, Hematologic disease, and Connective tissue disease. Cumulative risks were estimated using the Aalen-Johansen estimator and hazard ratios (HRs) using Cox proportional hazards regression. RESULTS:We identified 2915 cases and 29,140 controls. Among cases, 55.8% were male; median age was 8 years. The cumulative risk of autoimmune disease was 4.73% (95% CI 3.71-5.74) in JRP, and 3.02% (2.76-3.28) in controls. JRP was associated with autoimmune diseases (HR 1.71, 95% CI 1.37; 2.13), including Sjögrens disease (HR 28.16, 95% CI 10.14; 78.18), connective tissue diseases (HR 3.69, 95% CI 1.85; 7.36), and gastrointestinal diseases (HR 1.55,95% CI 1.07; 2.25). Associations were stronger in females (HR 1.86, 95% CI 1.40; 2.46) than males (HR 1.53, 95% CI 1.07; 2.18), significant among age 10-17 years (HR 2.22, 95% CI 1.65; 2.99). CONCLUSIONS:Nonspecific salivary gland disease, likely JRP, was associated with autoimmune diseases, including Sjögren's disease, connective tissue diseases, and gastrointestinal diseases. Associations were strongest in females and adolescents and may represent both increased risk and an early indicator of autoimmune disease.
Background Bilateral vocal fold paralysis (BVFP) is a rare but potentially life-threatening cause of respiratory distress in newborns and infants. Although tracheotomy has traditionally been the standard treatment for severe airway obstruction, less invasive surgical alternatives have been developed to avoid associated morbidity. Endoscopic vocal fold lateralization (EVFLA) represents one such approach. Objective To evaluate the safety and efficacy of EVFLA using the Lichtenberger needle holder as an alternative to tracheotomy in neonates and infants with respiratory distress caused by BVFP. Methods This retrospective, single-center study included 8 infants younger than 6 months who underwent EVFLA between January 2017 and January 2025 at a tertiary pediatric airway center. All patients presented with significant respiratory distress requiring non-invasive ventilation (NIV). Preoperative, perioperative, and postoperative data were collected, with a minimum follow-up of 12 months. Primary outcome was the need for tracheotomy following surgery. Secondary outcomes included ventilatory status, feeding outcomes, complications, reinterventions, and dysphonia. Results Tracheotomy avoidance rate was 100%. Median duration of postoperative intubation was 1 day, median duration of continuous postoperative NIV was 1.5 days. At final follow-up, 6 patients achieved exclusive oral feeding, while persistent clinical aspiration was observed in only 1 patient. Three patients required revision surgery because of minor complications, including laryngeal edema, suture loosened, mild glottic synechia. Dysphonia was reported in 3 patients. No patient experienced structural damage to the vocal folds. Conclusions EVFLA using the Lichtenberger needle holder may represent a safe, effective, minimally invasive alternative to tracheotomy in newborns with BVFP-related airway obstruction.
OBJECTIVES:To characterize the clinical presentation, management, and outcomes of pediatric epistaxis in a tertiary care center and to identify factors associated with emergency department (ED) length of stay, otolaryngology consultation, bleeding severity, and recurrence. METHODS:A retrospective chart review was performed for patients younger than 18 years presenting to the ED with epistaxis between July 2009 and December 2023. Data collected included demographic characteristics, clinical features, comorbidities, environmental factors, investigations, management approaches, and outcomes including resolution and recurrence. Multivariable regression analyses were conducted to determine independent predictors of consultation, length of stay, severity, and recurrence. RESULTS:A total of 521 patients were included (mean age 8.76 ± 4.97 years; 62.4% male). The majority of cases (61.4%) were idiopathic. Among cases that were not idiopathic (38.6%), trauma was the most common identifiable cause (16.5%). Otolaryngology consultation was required in 51.3% of visits. Median ED length of stay was 64 min and was independently associated with cancer history, otolaryngology consultation, and increased bleeding severity (all p < 0.01). Greater bleeding severity was independently associated with weekend/holiday presentation, recent intranasal surgery, and coagulopathy (all p < 0.05). Recurrence occurred in 9.6% of patients and was independently predicted by male sex and medication use at presentation. CONCLUSIONS:Though epistaxis was predominantly anterior and self-limited, several patients required specialist consultation. Risk-stratified management approaches may improve care delivery and resource allocation, particularly in resource-limited settings, though this warrants further investigation.
Background Tracheomalacia is the most common congenital tracheal anomaly in children, yet evidence remains fragmented. The sole prior systematic review, a 2012 Cochrane review restricted to randomized trials, identified only 1 eligible study; the observational evidence that informs nearly all clinical decision-making in this population has never been systematically synthesized. Objective To identify, appraise, and synthesize evidence on interventions for primary tracheomalacia in pediatric patients. Methods MEDLINE, Embase, and Scopus were searched through June 2025 per PRISMA 2020 guidelines. Studies reporting outcomes of any intervention for primary pediatric tracheomalacia/tracheobronchomalacia were eligible. Methodological quality was assessed using MINORS, ROBINS-I, Cochrane RoB 2, and JBI tools. GRADE ratings were applied to comparative studies. Narrative synthesis followed the Synthesis Without Meta-analysis (SWiM) guideline. Results Twenty-two studies (764 participants) were included: 20 across 4 groups (surgical pexy [13], airway stenting [4], external stabilization [2], medical management [2]; 1 in 2 groups) and 2 supplementary analyses. Eighteen studies (82%) were retrospective. All 13 pexy studies reported favorable outcomes, with clinician-defined resolution rates of 73-100% and study-level follow-up ranging from a median of 12 months to a mean of 101.5 months. All 4 stenting studies achieved immediate airway patency but were uniformly unfavorable on long-term durability. Conclusions Surgical pexy is the most studied intervention and the only one demonstrating sustained benefit, but all pexy evidence was derived from uncontrolled observational studies with no comparison against conservative management. Prospective registries with standardized outcomes, comparative studies with non-surgical controls, and routine patient-reported outcome measures are needed.
INTRODUCTION:Improved survival in congenital high airway obstruction syndrome (CHAOS) has shifted management toward definitive airway reconstruction and functional airway independence. However, severe cartilaginous laryngeal atresia may distort normal laryngotracheal anatomy and limit conventional reconstructive approaches. We describe an anatomy-specific reconstruction using obstructing dysplastic cricoid cartilage as an autologous posterior graft. CLINICAL FINDINGS:A male infant with CHAOS underwent EXIT-to-tracheostomy at 32 weeks' gestation. At age three, airway evaluation demonstrated complete Grade IV transglottic laryngeal atresia with fused vocal folds, severe cricoid dysplasia, megatrachea, tracheobronchomalacia, and active lower-airway inflammation. Definitive reconstruction was delayed for pulmonary optimization. THERAPEUTIC INTERVENTION AND OUTCOMES:Double-stage laryngotracheoplasty with anterior and posterior costal cartilage grafting was initially planned. Intraoperative exposure revealed a profoundly abnormal cricoid framework with a fixed obstructing anterior cartilaginous segment and deficient posterior airway. The anterior cricoid was resected during extended partial cricotracheal resection and repurposed as a 10 × 4 × 3-mm keystone-shaped posterior autologous graft in conjunction with laryngofissure, glottic recreation, and prolonged suprastomal stenting. The graft demonstrated complete incorporation after 6.5 months. Following one postoperative balloon dilation, the patient was successfully decannulated 13 months after reconstruction. Surveillance bronchoscopy demonstrated durable airway patency without restenosis. CONCLUSION:Complex congenital laryngotracheal anatomy may require individualized adaptation of established reconstructive techniques. Repurposing obstructing dysplastic cricoid cartilage for posterior airway augmentation provided simultaneous relief of anterior obstruction and posterior expansion, with durable airway patency and successful decannulation validating this anatomy-specific approach.
BACKGROUND:Children with cochlear implants (CIs) may continue to experience auditory-cognitive difficulties that affect everyday listening. Telerehabilitation may increase access to auditory training, but evidence combining behavioral and electrophysiological outcomes remains limited. This study characterized pre-to-post behavioral and neural changes over an eight-week auditory-cognitive telerehabilitation period in children with CIs and normal-hearing (NH) peers. METHODS:Thirty children aged 7-12 years participated in this quasi-experimental pre-post study: 15 bilateral CI users and 15 age-matched normal-hearing peers. All participants completed an 8-week auditory-cognitive telerehabilitation program (İŞİTGEL). Behavioral outcomes included simple auditory reaction time and Test of Attention in Listening measures, including attend-frequency and attend-location reaction times, involuntary orienting, and conflict resolution. Electrophysiological outcomes were assessed using auditory P300 latency and amplitude. Cognitive and language measures were used to characterize baseline performance and support sensitivity analyses. RESULTS:Significant main effects of time were found for simple reaction time, attend-frequency reaction time, and attend-location reaction time, reflecting faster behavioral responses over the study period.P300 latency also decreased significantly, whereas P300 amplitude did not change. Sensitivity analyses adjusting for baseline nonverbal intelligence and processing speed supported the robustness of the main behavioral and electrophysiological findings. CONCLUSIONS:Across the eight-week study period, both CI and NH groups showed faster behavioral responses and shorter P300 latency These findings support the feasibility of multimodal outcome assessment in pediatric auditory rehabilitation. Because no untreated control group was included, the observed changes cannot be attributed specifically to İŞİTGEL. Larger randomized controlled trials are needed to determine treatment-specific effects.
OBJECTIVE:To evaluate whether pillar suturing or pharyngoplasty added to tonsillectomy with or without adenoidectomy provides additional benefit in children with obstructive sleep apnea (OSA). DATA SOURCES:PubMed, Embase, and the Cochrane Library were systematically searched from database inception to October 2025. REVIEW METHODS:Randomized controlled trials and nonrandomized comparative studies comparing tonsillectomy with adjunctive pharyngoplasty or pillar suturing versus tonsillectomy alone in pediatric OSA were included. Primary outcomes were polysomnography-derived parameters, including apnea-hypopnea index (AHI), oxygen desaturation index, respiratory disturbance index, and minimum oxygen saturation. Secondary outcomes included OSA-18 scores, clinical efficacy, and postoperative complications. Pooled analyses were performed using random-effects models. RESULTS:Eleven studies were included. Meta-analysis showed no significant difference in postoperative AHI between groups (mean difference, 2.22 events/hour; 95% CI, -4.36 to 8.80). No significant differences were observed in postoperative AHI <1 event/hour (odds ratio [OR], 0.75; 95% CI, 0.33 to 1.72), surgical success, or OSA-18 scores. Postoperative hemorrhage risk was also comparable (OR, 0.50; 95% CI, 0.13 to 1.89). Sensitivity analyses excluding studies enrolling children with Down syndrome yielded consistent findings. CONCLUSION:Current evidence does not demonstrate a consistent additional benefit of adjunctive pharyngoplasty or pillar suturing in pediatric OSA surgery. These findings do not support routine adjunctive pharyngeal suturing and underscore the importance of individualized surgical decision-making.
BACKGROUND:Unilateral vocal fold immobility (UVFI) after pediatric cardiac surgery is prevalent; however, the burden of swallowing symptoms is unclear. HYPOTHESIS:We hypothesize that swallowing dysfunction is more prevalent in UVFI patients compared to non-UVFI patients, and that perioperative factors may influence swallowing symptom burden. METHODS:This was a retrospective cohort study of pediatric patients who underwent aortic arch surgery between 2013 and 2024 at the Stollery Children's Hospital. Exclusion criteria included bilateral vocal fold paralysis, genetic, or neurological comorbidities that could affect nerve function. Swallowing data from clinical and instrumental swallowing assessments were collected via chart review. Abnormal findings were compared between UVFI and non-UVFI patients. Associations between variables and aspiration on instrumental swallow assessments in UVFI patients were calculated through univariate analysis using a significance level of p < 005. RESULTS:234 patients of 1047 included in the study were diagnosed with UVFI. The mean gestational age was 37.0 (±4.7) weeks. There were 623 males and 424 females. UVFI patients were significantly more likely to undergo clinical and instrumental swallowing assessments compared to non-UVFI patients (p < 0.001, p < 0.001). Univariate analysis showed aortic coarctation (p = 0.012, OR = 0.07, CI = 0.01-0.56) was negatively associated with penetration or aspiration on instrumental swallowing assessments. CONCLUSIONS:Swallowing dysfunction is more common in patients who develop UVFI after cardiac surgery than those who do not. Patients who underwent aortic coarctation repair were less likely to have penetration or aspiration post-operatively. However, there were no other clear predictors or perioperative factors associated with a higher likelihood of swallowing dysfunction.
OBJECTIVES:Respiratory and feeding symptoms in children with vascular rings and slings are nonspecific and may not be solely attributable to the vascular anomaly. We evaluated the impact of Aerodigestive Clinic (ADC) assessment on long-term postoperative outcomes and characterized its diagnostic yield. METHODS:We retrospectively studied children with vascular rings or slings at a tertiary pediatric center (2011-2024), comparing those who underwent primary ADC evaluation with those who did not. The primary outcome was residual respiratory or feeding symptoms ≥1-year after repair. Multivariable regression assessed factors associated with symptom persistence. RESULTS:Among 219 patients, 91 (41.6%) underwent primary ADC evaluation and 8 (3.7%) were evaluated post-repair. ADC assessment identified additional aerodigestive pathology prompting treatment modifications in 56.6% (56/99). Surgical repair was deferred in 57.1% (52/91) of patients undergoing primary ADC evaluation; 40.4% (21/52) had treatment modifications based on ADC findings. Overall, 118 patients (53.9%) underwent repair at a median age of 372 days (IQR 133-1030). Among 108 patients with ≥1-year follow-up, residual symptoms occurred in 30 (27.8%), including 21.9% of ADC patients and 30.3% of non-ADC patients. ADC involvement was not associated with reduced residual symptoms (adjusted OR 0.71; 95%CI 0.18-2.41; P = .6), whereas preoperative respiratory medication use predicted symptom persistence (adjusted OR 3.28; 95%CI 1.25-8.98; P = .02). CONCLUSIONS:Despite the lack of statistically significant reduction in residual symptoms, ADC involvement identifies alternative causes of respiratory or feeding symptoms, informs surgical decision-making, guides pre- and postoperative management, and may, in some cases, defer the need for major cardiovascular surgery.
BACKGROUND:Nonsurgical ear molding is effective for congenital auricular deformities, but treatment response varies by patient- and ear-specific characteristics. This study developed and internally validated an ear-level prediction model for successful correction. METHODS:This single-center retrospective cohort included infants undergoing nonsurgical ear molding between September 2022 and December 2025. The individual ear was the analytical unit. Successful correction was defined as an excellent or good outcome based on blinded photographic assessment. Six prespecified pretreatment predictors were entered into a multivariable logistic generalized estimating equation model accounting for within-infant correlation between bilateral ears. Missing predictor data were handled using multilevel multiple imputation. Model performance was evaluated using discrimination, calibration, Brier score, decision curve analysis, and infant-level cluster bootstrap validation. An exploratory restricted cubic spline analysis assessed the association between treatment-initiation age and correction probability. RESULTS:The cohort included 328 infants and 482 eligible ears. Successful correction was achieved in 426 ears (88.4%). Older age at treatment initiation (OR, 0.94 per day; 95% CI, 0.91-0.97), greater baseline severity (OR, 0.26 per grade; 95% CI, 0.15-0.45), and mixed or other anomalies versus helical-folding deformities (OR, 0.32; 95% CI, 0.14-0.74) were associated with lower success. The apparent and optimism-corrected AUCs were 0.812 and 0.795, respectively. The optimism-corrected calibration slope was 0.965, calibration intercept -0.021, and Brier score 0.088. The age-success association remained significant in spline analysis (overall P < 0.001), with no evidence of nonlinearity (P = 0.41) and no distinct data-supported age threshold. CONCLUSIONS:Earlier treatment, lower severity, and less complex morphology were associated with successful correction. The internally validated model may support pretreatment counseling and follow-up planning, but external validation is required before routine clinical use.
BACKGROUND:Intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy has been increasingly adopted for pediatric obstructive sleep apnea (OSA) because it reduces postoperative pain, dysphagia, and hemorrhage while preserving respiratory efficacy. However, its role in severe pediatric OSA remains debated. OBJECTIVE:To evaluate the effectiveness and safety of intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy in children with severe OSA, focusing on polysomnographic (PSG) improvement, residual disease, need for additional treatment, revision/completion tonsillectomy, nocturnal ventilation, and postoperative complications. METHODS:A PRISMA 2020-compliant, PICO-based systematic review was conducted. Thirty-six records were identified through title and abstract screening. After the initial screening, 11 studies were excluded and 25 full-text articles were assessed for eligibility. Studies involving syndromic or cleft populations, procedures other than intracapsular tonsil surgery, or lacking PSG-based outcomes were excluded. Fourteen studies were included in the qualitative synthesis, and 11 provided extractable pre- and postoperative apnea-hypopnea index/obstructive apnea-hypopnea index (AHI/OAHI) data for quantitative analysis. RESULTS:Intracapsular or partial tonsil surgery consistently reduced respiratory event burden (p < 0.001). In children with severe OSA, the sample-size-weighted reduction in AHI/OAHI was 16.5 events/hour (95% confidence interval [CI], 14.2-18.8). The weighted mean preoperative AHI/OAHI was 19.6 events/hour (95% CI, 18.7-20.5), decreasing to 3.0 events/hour (95% CI, 2.6-3.4) postoperatively. Reported postoperative bleeding rates were very low in intracapsular cohorts. Rates of tonsillar regrowth and revision surgery ranged from approximately 2% to 15%, depending on follow-up duration and surgical technique. CONCLUSIONS:In appropriately selected children with severe OSA, intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy provides substantial PSG improvement while maintaining a favorable postoperative morbidity profile. The principal trade-off is the need for long-term surveillance for residual OSA and tonsillar regrowth. No intracapsular surgical technique or instrument has demonstrated clear superiority, although all commonly used approaches achieved clinically meaningful improvements.
BACKGROUND:Chronic otitis media with effusion (COME) is a leading indication for tympanostomy tube insertion (TTI) in young children. While long-term developmental effects of TTI appear limited, short-term outcomes are less well described. OBJECTIVES:To assess caregiver-reported outcomes of TTI in children aged 1-4 years with COME, including reasons for consultation, baseline quality of life (QoL), and perceived changes one month after surgery. METHODS:This prospective study included 60 children with COME recruited from two non-referral ENT clinics in Denmark. Participants were randomized 1:1 to TTI or one-month observation. Controls who still met guideline criteria after one month were offered TTI. Caregivers completed the OM-6 questionnaire and two global QoL numerical rating scales at baseline and one month after TTI. Paired t-tests and Spearman correlations were used. RESULTS:Fifty-four children completed follow-up; 52 underwent TTI. Sleep disturbance was the most frequent caregiver-reported complaint (74%). Mean baseline OM-6 score was 3.16 (SD 1.0); the lowest item score was activity limitation (2.5), the only OM-6 item reflecting sleep. At one month, child QoL improved from 6.2 to 8.5 (Δ2.6; p < 0.0005) and family QoL from 6.7 to 8.1 (Δ1.7; p < 0.0005). OM-6 correlated with child (ρ = -0.56) and family QoL (ρ = -0.55). Caregivers reported improvement in sleep (58%), hearing (60%), and language (72%); overall satisfaction was 96%. CONCLUSION:TTI was associated with significant short-term improvement in child and family QoL. The low OM-6 activity limitation score despite frequent caregiver-reported sleep disturbance suggests otitis media-specific QoL instruments may underrepresent sleep-related morbidity.
OBJECTIVES:To compare the clinical efficacy of oral montelukast versus intranasal fluticasone furoate in reducing the severity of sleep-disordered breathing (SDB) among children with adenotonsillar hypertrophy. METHODS:A prospective randomized clinical trial was conducted between 9/2022 and 4/2023, including children aged 2-15 years with SDB and adenotonsillar hypertrophy. At baseline, all participants underwent symptom assessment using the Pediatric Sleep Questionnaire (PSQ), followed by physical examination. Subjects were randomized to receive either oral montelukast or intranasal fluticasone furoate for two months. Following treatment, the children were re-evaluated, and if no clinical improvement was observed, surgery was scheduled. RESULTS:Sixty-seven children with a mean age of 5.25 years (45, 67% males) were included. The median PSQ score improved in the montelukast group from 0.45 to 0.28 (p = 0.003) and in the fluticasone furoate group from 0.43 to 0.36 (p = 0.006) with comparable efficacy (p = 0.292). The prevalence of moderate-to-severe sleep apnea decreased from 67% to 41% with montelukast (p = 0.035) and from 81% to 60% with fluticasone furoate (p = 0.016). While both medications significantly reduced adenoid size (p < 0.001 and p < 0.001, respectively), only montelukast significantly reduced tonsillar size (p = 0.008). CONCLUSIONS:Both montelukast and fluticasone furoate reduced the pediatric SDB severity. While both medications significantly decreased adenoid size, only montelukast significantly decreased tonsillar size. Therefore, fluticasone furoate may be appropriate for adenoid hypertrophy, while montelukast is favored for concurrent tonsillar hypertrophy. These treatments may serve as alternatives to surgery in selected cases. Further studies are needed to evaluate their long-term efficacy.
BACKGROUND:Sensorineural hearing loss (SNHL) has been associated with cardiac channelopathies due to shared ion channel mechanisms. However, data regarding ventricular repolarization parameters and the index of cardiac electrophysiological balance (iCEB) in children with SNHL are limited. OBJECTIVE:To evaluate ventricular repolarization parameters and cardiac electrophysiological balance indices in children with SNHL and to investigate their potential association with arrhythmia risk. METHODS:This cross-sectional study included 106 children with bilateral SNHL and 101 age- and sex-matched healthy controls. Electrocardiographic parameters including heart rate, QRS duration, QT interval, corrected QT (QTc), frontal QRS-T angle, iCEB (QT/QRS), and corrected iCEB (iCEBc; QTc/QRS) were analyzed. Group comparisons and multivariable linear regression analyses were performed. RESULTS:Children with SNHL had significantly higher heart rates and shorter QRS, QT, and QTc intervals in unadjusted analyses (all p < 0.001). There were no significant differences in iCEB or iCEBc between groups in unadjusted analyses. However, in multivariable analysis, SNHL was independently associated with increased QTc duration (B = 25.7, p < 0.001) and lower iCEB values (B = -0.16, p = 0.011), whereas no independent association was observed for iCEBc (p = 0.676). CONCLUSION:Children with SNHL exhibit significant alterations in ventricular repolarization parameters, particularly QTc prolongation, independent of confounding factors. These findings may suggest an underlying electrophysiological vulnerability and warrant further investigation regarding arrhythmia risk in this population.
OBJECTIVE:To provide an updated comprehensive assessment of the Pediatric Otolaryngology workforce in the United States inclusive of compensation, productivity, practice patterns, and on-call burden. STUDY DESIGN:Cross-sectional electronic survey. METHODS:A structured electronic survey was developed by members of the American Society of Pediatric Otolaryngology (ASPO) Workforce and Compensation Committee. The survey evaluated six domains: demographics, compensation, workforce dynamics, productivity, on-call burden, and future priorities, and was distributed to all 480 presumedly actively-practicing, domestic ASPO members. RESULTS:The survey response rate was 68% (327/480). Ninety-one percent of respondents held an academic appointment with relatively equal percentages of each rank responding. The median clinical compensation was $525,000, which is a 17.4% increase from the 2019 ASPO survey median and 27.4% higher than the median reported by the AAO-HNS 2023 workforce survey. Median income varied by age, gender, and geographic region, but compensation per wRVU did not differ by gender. Over 80% of respondents noted increased wait times for completing patient appointments and elective surgeries. Ninety-four percent of practices employ advanced practice providers and anticipate additional hires. Difficulty filling open positions, anticipated workforce shortages, and concerns about provider retention were prevalent themes expressed by respondents. CONCLUSIONS:Despite increasing compensation for pediatric otolaryngologists since 2019, workforce sustainability remains a pressing concern. These data provide a contemporary, specialty-specific analysis of the pediatric otolaryngology workforce that varies significantly from estimates published by large national organizations. Ongoing physician-led assessment can highlight the value of pediatric otolaryngologists and determine priorities for organizational advocacy.
INTRODUCTION:With expanded candidacy, cochlear implantation candidates increasingly present with residual acoustic hearing. The level and stability of residual hearing is particularly relevant when considering electro-acoustic stimulation (EAS). While adult data suggest relative stability, the natural history of residual hearing in children-who often have distinct and potentially progressive etiologies-remains poorly defined. METHODS:We conducted a retrospective cohort study of pediatric (<18 years) and adult patients who underwent unilateral cochlear implantation. Inclusion required contralateral (non-implanted) low-frequency pure-tone average (LF-PTA; 250-500 Hz) ≤85 dB HL and interaural difference ≤15 dB HL. One-year changes in LF-PTA, mid-frequency PTA (MF-PTA; 750-2000 Hz), and PTA (500-4000 Hz) were compared using Mann-Whitney U tests. The proportion with clinically meaningful decline (≥15 dB HL) was compared using Fisher's exact test. Longitudinal trajectories were assessed descriptively. RESULTS:Mean one-year LF-PTA, MF-PTA, and PTA changes between children and adults were not statistically different. However, clinically meaningful LF-PTA decline (≥15 dB) occurred more frequently in children (5/24; 20.83%) than adults (2/46; 4.34%) (p = 0.04). Longitudinal trajectories demonstrated substantial inter-individual variability without a consistent pattern of progressive loss. Etiology-specific trends showed relative stability in birth-related hearing loss, whereas ototoxic, genetic, and enlarged vestibular aqueduct etiologies demonstrated greater decline. CONCLUSIONS:Residual low-frequency hearing in children is generally stable but more variable, with a higher rate of clinically significant decline than in adults one year post-implant. These findings suggest underlying disease progression contributes to hearing changes and should inform counseling and EAS candidacy.
