Laryngopharyngeal reflux (LPR) is a highly prevalent condition in otolaryngology practice, characterized by reflux of gastric contents into the pharynx and larynx. Although proton pump inhibitors (PPIs) remain first-line therapy, many patients report persistent symptoms. In refractory cases, histamine-2 receptor antagonists (H2RAs) are often employed as adjunctive or standalone therapy due to their rapid onset and accessibility. However, their utility as daily therapy is limited by tachyphylaxis, with significant loss of acid suppression within days of continuous use. Despite longstanding evidence from gastroenterology literature discouraging daily H2RA therapy, these agents remain frequently prescribed in otolaryngology practice. Contemporary ear, nose, and throat (ENT)-specific guidance on their role in LPR is lacking. In patients with ongoing laryngopharyngeal symptoms despite optimized PPI therapy, a systematic, phenotype-driven approach is recommended, incorporating objective testing with hypopharyngeal-esophageal pH-impedance monitoring, alternative agents including alginates, and consideration of surgical or endoscopic interventions. Greater adherence to evidence-based recommendations may improve outcomes.
Objectives:To evaluate the impact of increasing AJCC T stage on postoperative morbidity in patients undergoing thyroidectomy for papillary thyroid cancer. Study Design:Retrospective cross-sectional database study. Setting:The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects surgical outcomes data from ~700 US hospitals. Methods:NSQIP Participant User Files were queried for thyroidectomy procedures (CPT codes 60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260) from 2016 to 2020 with a pathology-confirmed diagnosis of papillary thyroid cancer. Primary exposure was T stage and outcomes included hoarseness, hypocalcemia, and hematoma formation. Multivariate analysis controlled for N stage, total thyroidectomy, multifocality, and neck dissection. Results:A total of 10,901 cases were identified (74.2% female; mean age 50.1 ± 15.1 years). Compared to early-stage tumors, T3 cancers were associated with increased risk of hoarseness (OR 1.614, 95% CI 1.260-2.074, P < .01) and 30-day hypocalcemia (OR 1.296, 95% CI 1.022-1.645, P = .03). Upstaging to T4 further increased risks of hoarseness (OR 2.971, 95% CI 2.039-4.282, P < .01), hematoma (OR 2.266, 95% CI 1.027-4.999, P = .04), and hypocalcemia (OR 1.542, 95% CI 1.007-2.364, P < .05). No significant morbidity difference was observed between T1 and T2 tumors. Conclusion:Increasing T stage is associated with significantly higher postoperative morbidity in patients with papillary thyroid cancer, particularly when advancing to T3 or T4. These findings highlight the importance of preoperative risk assessment and surgical planning in advanced disease.
Objective:To evaluate antibiotic utilization as a process measure in pediatric tracheostomy patients, establishing baseline variation across diagnostic categories to inform quality improvement and stewardship initiatives. Methods:We retrospectively studied pediatric tracheostomy patients at a tertiary children's hospital (2015-2024). Antibiotic use was quantified across diagnostic categories, with prophylactic courses defined as 2 days or less. Cultures were reviewed to distinguish true bacterial infections from viral detections and colonization. Mixed-effects logistic regression modeled infection risk, accounting for patient clustering. Sensitivity analyses excluded patients hospitalized over 365 days. Results:Of 429 patients (6.8 months [IQR 4.3-55.9]), respiratory conditions were most common (43.8%), followed by cardiac (19.3%). Cardiac patients had the highest antibiotic exposure (mean 52.1 days) despite low infection rates (17.8%), while trauma patients had the highest infection rates (31.5%). Diagnostic category did not significantly affect infection risk after accounting for clustering. Only 19.6% of 38,030 cultures showed true bacterial infection (median time 14.1 days posttracheostomy). Viral detection cascades triggered 11.4% of bacterial cultures within 48 hours. Discussion:Antibiotic prescribing patterns often reflect institutional preferences rather than true infection risk. Individual patient factors more strongly predict infection than diagnostic category. This highlights the need for personalized stewardship and standardized viral detection protocols. Implications for Practice:High variability in antibiotic utilization across diagnostic categories represents a measurable stewardship target. Reducing unnecessary exposure may decrease length of stay, healthcare costs, and antibiotic-associated complications.
Career goal advising (CGA) is critical to medical student success in the increasingly competitive field of otolaryngology. Otolaryngology is underrepresented in the preclinical curriculum; therefore, early exposure and guidance are limited. At the University of North Carolina (UNC), a formal CGA program was created in 2018 to provide direct access to faculty mentorship. Advisors provide early exposure to otolaryngology, advise the interest group, and meet regularly with students throughout medical school training. All participating students were surveyed. Since inception, the match rate of students applying to otolaryngology from UNC has been 95%. The majority of these students matched at top 25 residency programs. Students reported high satisfaction with access, responsiveness to concerns, preparedness for the match, and confidence in specialty choice. Our program offers a sustainable response to the challenge of exposure and competitiveness in otolaryngology and may provide a template for medical schools to improve faculty mentorship within otolaryngology.
Peritonsillar abscess (PTA) is a common and essential otolaryngologic presentation, and bedside incision and drainage is a core procedural skill for otolaryngology residents. We report the design and preliminary validation of a low-cost, anatomically realistic simulation model for PTA drainage. The model integrates a molded silicone oropharynx with a drainable abscess cavity into a commercial dental task trainer. Thirty-eight otolaryngology trainees and faculty performed simulated drainage and completed a postsimulation survey evaluating realism and educational value. Face validity was supported by high realism scores (mean ≥4/5) and strong internal consistency (Cronbach's α = 0.85). Participants reported significant increases in procedural knowledge (mean increase: 1.17 points, P < .05) and confidence (mean increase: 1.13 points, P < .05). This modular, reusable model offers a scalable solution for simulation-based training in the development of this common and essential procedural skill in otolaryngology.
Objective:While healthcare disparities between rural and urban populations have been documented, access to subspecialty care in rural communities remains poorly characterized. This study aims to quantify rural-urban disparities regarding access to otolaryngologists in Georgia. Study Design:Cross-sectional. Setting:Center for Medicare and Medicaid Services (CMS), Georgia Composite Medical Board (GCMB), and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) databases. Methods:The CMS and GCMB databases were used to identify otolaryngologists in Georgia and their primary office location. Residency and fellowship training information was collected through the AAO-HNS database and institutional websites. County-level demographic data were obtained from the 2020 US Census. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (1-3) and nonmetropolitan (4-9) counties. Results:A total of 367 otolaryngologists were identified across Georgia's 159 counties (74 metropolitan, 85 nonmetropolitan). Common residency training states included Georgia (20.4%) and New York (6.8%). Overall, 42.5% of otolaryngologists completed fellowship training, with the most common being pediatric otolaryngology (23.7%) and facial plastics (21.8%). Metropolitan counties had an average travel distance of 10.23 miles to the nearest otolaryngologist and 1.91 otolaryngologists per 100,000 residents, compared to 20.32 miles and 0.76 otolaryngologists per 100,000 residents in nonmetropolitan counties (P < .001). Most otolaryngologists (n = 232, 63.2%) were in counties classified as code 1 (most urbanized), which also had the lowest travel burden to the nearest otolaryngologist. Additionally, 12.8% of otolaryngologists practiced in academic settings. Conclusion:There are significant rural-urban ENT-related disparities in the state of Georgia, with a shortage of otolaryngologists in rural counties.
Abstract Objective Reconstructive surgeons have been utilizing free tissue flaps to reconstruct defects from tumor excision since the late 1950s. Many advancements have been made since, and the most common forms of magnification are operating microscopes and loupes to anastomose the vessels from the donor and recipient sites. Data Sources Studies reporting the usage of loupes and microscopes on free tissue flaps utilization were identified using predefined inclusion criteria from 1995 to 2024 from Scopus, PubMed, Embase, MEDLINE, Web of Science, and CENTRAL databases. Review Methods A systematic search was conducted using the PRIMSA guidelines, yielding a total of 262 articles, 11 of which met the inclusion criteria. All studies underwent a 2‐stage blinded screening, extraction, and evaluation process. Primary outcomes were flap survival rate based on patients undergoing microvascular surgery or reconstruction using a surgical loupe or operating microscope. Secondary outcomes included operation time, anastomosis time, hospital stay, arterial and venous thrombosis rate, and overall complication rate. Results On average, Loupes showed a reduced operative time compared to microscopes (482 vs 619 minutes; Loupes vs microscope). Using Fisher's exact test, loupes demonstrated significantly lower rates of overall complication (6.0% vs 15.3%) and overall flap loss (2.7% vs 7.0%) ( P < .0001), as well as reduced complete flap loss (1.7% vs 4.9%, P < .01) and partial flap loss (4.0% vs 8.1%, P < .05). Forest plot analysis consistently favored loupes across all outcomes. Conclusion The parameters that we identified to favor loupes are vital metrics in microscopic flap surgery. Flap failure can have consequences on patients, including longer ICU and hospital stays, increased mortality, and worsened functionality outcomes.
Objective:To evaluate the incidence of Patulous Eustachian Tube (PET) following bariatric surgery using standardized diagnostic criteria. Study Design:Prospective cohort study. Setting:Tertiary academic medical center in northern Mexico. Methods:Sixty-four adults undergoing Roux-en-Y gastric bypass or sleeve gastrectomy were enrolled from April 2024 to June 2025. Otological assessments were conducted preoperatively, immediately postoperatively, and at 3 months postsurgery. PET diagnosis was determined using the Japan Otological Society (JOS) criteria. The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) was administered at each visit. Weight loss parameters were recorded, and correlated with PET outcomes. Results:64 enrolled patients, 12 were excluded, and 52 were analyzed. The mean patient age was 39.4 years (SD ± 10.7); 73.1% were women. Mean weight loss at 3 months was 22.8 kg (19.3% of initial body weight). No patients met criteria for definite PET at any time point. The proportion of patients with possible PET increased from 9.6% preoperatively to 23.1% at 3 months (P = .07). ETDQ-7 scores did not change significantly across time points (median 8-9; P = .55). No significant correlation was observed between magnitude of weight loss and PET outcomes. Conclusion:Despite significant weight loss, no confirmed cases of PET 3 months after bariatric surgery. These findings suggest that previously reported high PET incidence rates may reflect inconsistent diagnostic standards rather than true clinical pathology. Symptom-driven evaluation rather than routine PET screening may be more appropriate in the early postoperative period. Larger studies with longer follow-up are needed to assess long-term risk.
Objective Cutaneous carcinoma of the scalp is a common, but underreported, and complications of scalp irradiation remain poorly described. Many patients receive primary or postoperative radiation to the scalp, and complications from treatment are not well described. Calvarial osteoradionecrosis can be difficult to treat, and it is imperative that research be done to learn more about this disease. In this case series, we attempt to define its incidence and identify risk factors for the development of osteoradionecrosis of the calvarium.Study Design Retrospective study.Setting Single tertiary academic medical center.Methods Information, including diagnosis, surgery, radiation dose, past medical history, time to bone exposure, and treatment, was analyzed for all patients undergoing scalp irradiation from 2018 to 2023.Results Forty-five patients received scalp irradiation for cutaneous head and neck cancer, and 14 developed calvarial osteoradionecrosis. Ten patients had both their original surgery and radiation at our institution, yielding an institutional incidence of 24.4% of calvarial osteoradionecrosis. All patients who developed calvarial osteoradionecrosis originally underwent surgery followed by postoperative radiation, with the median amount of time between surgery and radiation being 42 days (36-114 days) and a median radiation dose of 57.5 grays in 25 fractions. The average time between completion of radiation therapy and development of osteoradionecrosis was 890 days (2.4 years). All patients were managed conservatively without surgical intervention, hospitalization, or intracranial complications.Conclusion Osteoradionecrosis of the calvarium is an underreported late complication of scalp radiation that can be managed conservatively.
Objective:Characterize the long-term vocal outcomes of patients who required ICU care for COVID-19 infection. Study Design:Prospective cohort study. Setting:Multi-institutional North American Airway Collaborative Study. Methods:Patients with a COVID-19 diagnosis requiring ICU admission were identified via ICD-10 codes and recruited after discharge to complete patient-reported outcome measures (PROM) in voice (Voice Handicap Index: VHI-10), communication (Communicative Participation Item Bank: CPIB), and breathing (Clinical COPD Questionnaire: CCQ). Multivariate analysis investigated the association between clinical variables and PROMs. Results:308 patients enrolled; 271 were admitted with COVID to the ICU. 221 were intubated (81.5%); 50 patients admitted to the ICU did not require intubation (18.5%). Mean follow-up was 489 days after discharge (95% CI: 452-526). Mean intubation duration was 17 days (95% CI: 15-19). Median endotracheal tube (ETT) size was 7.5. Intubation was associated with higher VHI-10 score (15 vs 10; P = .01) and lower CPIB score (27 vs 30; P < .01). When controlling for ETT size, multivariate analysis did not show a relationship between intubation duration and VHI-10 or CPIB scores but was associated with worse CCQ score (P = .04). Conclusion:Survivors of COVID infection requiring ICU admission and intubation have persistent functional impairments in voicing and breathing more than 1 year after their hospitalization. While COVID survivorship and "long COVID" have centered on neuropsychiatric and metabolic outcomes, this study highlights the unappreciated negative impact of endotracheal intubation on voice and communication related to this illness and reinforces the relationship between duration of intubation and subjective dyspnea after surviving critical illness.
Objective To assess the prevalence of the GJB2 c.35delG mutation among Moroccan patients with nonsyndromic sensorineural hearing loss (NSHL) and compare it with frequencies reported in other North African populations.Study Design Retrospective cohort study.Setting Multidisciplinary tertiary care hearing loss genetics clinic.Methods A total of 304 unrelated Moroccan patients with prelingual bilateral (NSHL), recruited between May 2022 and June 2025, were included. Genomic Deoxyribonucleic Acid (DNA) was extracted from peripheral blood samples, and the c.35delG mutation was detected via PCR amplification and Sanger sequencing. Demographic and clinical data, including age at diagnosis, sex, and family history, were systematically collected.Results The c.35delG mutation contributed to 18% of (NSHL) cases in this cohort, with homozygosity being the most frequent genotype. The mutation was especially prevalent in patients from consanguineous families. Clinically, hearing loss was early-onset, bilateral, and mostly profound, demonstrating a strong genotype-phenotype correlation. The observed frequency aligns with regional data from other North African populations, reflecting a shared genetic background.Conclusion The c.35delG mutation is a major cause of (NSHL) in Morocco, though slightly less frequent than reported in previous national studies. These findings support incorporating GJB2 genetic screening into early diagnostics, genetic counseling, and targeted prevention programs, particularly in populations with high consanguinity rates.
Objective:To systematically review the literature for medical therapies that promote facial nerve regeneration and recovery. Data Sources:PubMed/Medline, Embase, and SCOPUS databases were searched for English-language studies published from inception through May 2025. Review Methods:Human studies evaluating the efficacy of medical therapy on facial nerve regeneration using validated facial nerve grading scales were included. Results:Nine studies were included in qualitative analysis, and 6 were included in a meta-analysis. Treatments included nimodipine (n = 6), pentoxifylline (n = 1), co-enzyme Q10 (n = 1), and extracellular vesicles (n = 1). All studies used HB score, and recovery was defined as HB score ≤3. Recovery was observed in 94% (95% CI:[90%, 97%]) of patients treated with nimodipine and 84% (95% CI: [70%, 97%]) of control patients; this was not statistically significant (OR 2.26, 95% CI: [0.97, 5.26]). Nimodipine significantly decreased HB score by 1.66 (95% CI: [0.81, 2.52]) before and after treatment. Pentoxifylline and extracellular vesicles demonstrated some efficacy, while co-enzyme Q10 was not efficacious. Conclusion:Nimodipine improved HB score but was not significantly associated with recovery to HB score ≤3 compared to controls. Pentoxifylline and extracellular vesicles may have some efficacy, but co-enzyme Q10 is not effective. Further research is required to uncover additional treatments.
Objective:To identify predictors of auditory function in treatment-naïve vestibular schwannomas (VS) while accounting for age-related hearing loss, investigating baseline volumetrics and audiometrics in a pre-intervention stereotactic radiosurgery (SRS) cohort. Study Design:Cross-sectional study. Setting:Single-center national SRS referral program with a prospective database. Methods:All consecutive patients with newly diagnosed unilateral VS and complete pre-intervention imaging and audiometric data were included. High-definition MRI and bone CT with co-registration and fusion enabled morphometric and volumetric analysis of VS and internal auditory canal (IAC) dimensions. Univariate tests, multivariate logistic regression with interaction terms, and regularized regression identified factors associated with serviceable hearing (Gardner-Robertson scores 1-2). Results:Among 533 patients (50.65% male, mean age 57.04 years), 72.6% had serviceable hearing. Median VS volume was 875.3 mm3 (IQR: 328.6-1732.5). The final multivariate model (AUC = 0.719) retained age (OR = 0.920, P = .0144), canal filling ratio (CFR; OR = 0.465, P = .0446), and a significant age × intracanalicular-to-total tumor volume ratio interaction (P = .0318). Age-stratified analyses revealed that the CFR-hearing relationship reversed across age groups: in younger patients (<40 years), higher canal filling was associated with better hearing preservation (94% vs 73%), while this pattern reversed in older patients (>60 years). Younger patients also demonstrated greater canal dilation (P = .002), though this lacked independent predictive value (P = .366). Conclusion:While age dominates hearing prediction in VS, canal filling ratio significantly modifies this relationship in an age-dependent manner, representing a clinically accessible imaging biomarker with age-specific thresholds and effects.
Objective:The clinical assessment of adenoid hypertrophy presents 2 practical challenges: (1) the need for an objective, reproducible estimate of nasopharyngeal obstruction in children when cooperation is limited and (2) the need for a reliable radiographic metric to support interdisciplinary assessment and communication between dental/orthodontic providers and otolaryngologists. To address these challenges, this study aimed to evaluate the diagnostic performance of a novel radiographic index-Adenoid/Nasopharynx Area Ratio-derived from lateral cephalometric radiographs. Study Design:Retrospective cohort study. Setting:Eye & ENT Hospital of Fudan University and affiliated orthodontic clinics, Shanghai, China (June 2023-August 2024). Methods:Consecutive children aged 2 to 14 years flagged for suspected adenoid hypertrophy during routine dental examinations were screened; eligible participants were enrolled after prespecified exclusions. De-identified data were analyzed between August and October 2024. Results:ANAR showed a numerically higher correlation with endoscopic grades than the A/N ratio (r = 0.649 vs 0.603). For severe obstruction, ANAR cutoff 0.64 yielded sensitivity 70.9% and specificity 82.3% (AUC 0.834; 95% CI, 0.76-0.90); the A/N ratio AUC was 0.793. Inter-rater reliability for ANAR measurement was good (intraclass correlation coefficient [A,1] = 0.924; 95% confidence interval, 0.848-0.963; n = 30). Conclusion:Adenoid/Nasopharynx Area Ratio is a practical, reproducible planimetric index derived from lateral cephalograms that may support opportunistic upper airway assessment when imaging is already obtained for dental/orthodontic care. Nasal endoscopy remains the reference standard; ANAR is complementary, and additional radiographs solely for adenoid evaluation are not recommended.
Objective:To evaluate long-term swallowing outcomes in patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) following neoadjuvant chemotherapy (NAC) and transoral robotic surgery (TORS) (NAC + S). Study Design:Retrospective cross-sectional study. Setting:Single academic institution. Methods:Patients completed the MD Anderson Dysphagia Inventory (MDADI) at various time points following the completion of treatment. Patients requiring adjuvant treatment, experiencing recurrent disease, or who did not complete an MDADI at least 5 years following treatment were excluded from the study. A linear regression model was explored to determine the relationship between time since treatment and MDADI score. Results:A total of 21 patients treated with the NAC + S protocol were included. The average time between treatment and the most recent follow-up was 101.5 months. 1 patient had a composite MDADI score indicating poor function (<60), 3 indicating adequate function (≥60 to <80), and 17 indicating optimal function (≥80). There was no significant change in overall MDADI score (P = .469), global score (P = .163), emotional score (P = .528), and physical score (P = .903) over time. A small yet significant improvement in functional score of 1.06 points per year was seen over time (P = .0096). Conclusion:Patients who were successfully treated with NAC + S maintain their favorable swallowing outcomes on long-term follow-up. A small improvement in functional MDADI sub-score may represent compensatory strategies or rehabilitation over time.
Objective:The Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated disease-specific patient-reported outcome measure for assessing health-related quality of life in nasal obstruction. This study aimed to translate, culturally adapt, and validate the Vietnamese version of the NOSE questionnaire. Study Design:Prospective cohort study. Setting:Tertiary academic center. Methods:Using a standardized forward-backward translation protocol, the Vietnamese NOSE (VN-NOSE) was developed and psychometrically validated in 143 participants (101 patients with nasal obstruction and 42 healthy controls). Among symptomatic patients, 47 undergoing endoscopic septoplasty with inferior turbinoplasty completed assessments preoperatively and at 1 week, 3 weeks, and 3 months postoperatively. Internal consistency, test-retest reliability, construct validity, discriminant validity, responsiveness, and the minimal clinically important difference (MCID) were evaluated. Correlations with a visual analogue scale (VAS), a 6-point Likert scale, and peak nasal inspiratory flow (PNIF) were analyzed. Results:The VN-NOSE showed excellent internal consistency (Cronbach's α = 0.95) and test-retest reliability (intraclass correlation coefficient = 0.993). A strong correlation was observed with the VAS, but not with PNIF. Postoperative NOSE scores improved significantly over time (P < .01), with a large effect size at 3 months (Cohen's d = 2.17). The VN-NOSE effectively discriminated between patients and controls. The MCID, estimated using both distribution- and anchor-based methods, was approximately 15 points. Conclusion:The VN-NOSE is a reliable, valid, and responsive instrument for clinical and research use in Vietnamese patients with nasal obstruction, with an MCID of 15 points.
Objective:To systematically review the literature on voice outcomes following laryngochondroplasty (LCP). Data Sources:PubMed, Scopus, and Embase. Review Methods:A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English between January 1990 and January 27, 2026, evaluating voice quality after LCP, were eligible. Included study designs were randomized controlled clinical trials, cohort studies, case-control studies, and case series. Extracted data encompassed study design, sample size, surgical technique, voice assessment methods, and reported outcomes. Results:Of 344 articles identified, 126 duplicates were removed, and 162 articles were excluded by screening title and abstract. The full texts of the remaining 44 articles were reviewed, and 20 met the eligibility criteria, representing a cohort of 760 patients. Most studies relied on subjective or qualitative voice assessments; only two incorporated objective acoustic analyses. Postoperative voice changes were reported in 98 of 777 patients (12.6%), more in patients operated via the transcervical approach (13%), than via the transvestibular approach (5.2%). Fewer reports of voice changes were found when utilizing the transcervical technique with vocal fold localization than without (2.8% vs 29.6%, respectively). More reports of voice changes were found in studies from lead authors affiliated with Otolaryngology-Head and Neck Surgery departments than in those affiliated with plastic surgery departments (15.3% vs 9.9%, respectively). Conclusions:Voice changes may occur following LCP, and the surgical approach may affect the risk. Larger prospective studies using standardized and objective voice measures are needed to confirm these findings.
Objective:To describe posttonsillectomy telephone triage utilization and short-term outcomes in a single tertiary pediatric system. Study Design:Retrospective cohort study. Setting:Tertiary care children's hospital. Methods:All patients aged 0 to 18 years (N = 12,167) who underwent tonsillectomy between January 2020 and December 2024 were included. Primary outcomes included timing and type of telephone calls, emergency department (ED) visits, and bleeding events within 30 postoperative days. Secondary outcomes included intervention rates based on presentation pathway (telephone triage vs direct ED presentation). Results:Among 12,167 patients, 2483 (20.4%) contacted telephone triage within 30 days. Of callers, 2273 (91.5%) were managed without ED referral; 210 (8.5%) were referred to the emergency department. Of bleeding related calls, 111 (66.9%) were managed without ED referral, and 41/60 (68.3%) patients referred to the ED did not require surgical intervention. Telephone triage demonstrated 91.5% effectiveness and prevented 2273 ED visits. Patients utilizing telephone-based triage were more likely to have Medicaid insurance (P < .001) and live in high-disadvantage neighborhoods (P < .001). Conclusions and Relevance:Telephone-based triage is an effective measure to help reduce ED visits for pediatric posttonsillectomy patients. The majority of patients who utilized telephone-based triage were successfully managed at home across all types of complications. There is a potential $158,000 to $360,000 in healthcare savings seen after implementing this program. High-disadvantage patients were more likely to use telephone-based triage but achieved similar outcomes to low-disadvantaged peers. In this cohort, a structured phone-triage pathway safely managed most concerns without ED referral.
Abstract Objective To assess the first lithium coin‐cell battery (CCB) technology on the consumer market with ingestion burn protection claims in context of medical management practices. Study Design Cadaveric porcine esophageal model. Setting Tertiary care children's hospital research institute and third‐party laboratory. Methods Anterior‐posterior X‐ray imaging was performed. Using in vitro porcine tissue segments, traditional CCBs and protective CCBs were assessed for visible appearance and surface pH over 60 minutes; another group was assessed for 24 hours. A separate experiment evaluated existing protocols to administer honey/sucralfate and perform 0.25% acetic acid irrigation. Results All protective CCBs demonstrated diagnostic double‐ring/halo sign on X‐ray. Traditional CCBs demonstrated diffusely highly alkaline pH of 13 and significant tissue necrosis. For protective CCBs, regions of tissue pH increased to 12‐13; however, substantially reduced tissue injury without obvious necrosis was noted. At 24 hours, protective CCBs compared to traditional CCBs maintained reduced visible tissue injury at both positive and negative poles. Honey, sucralfate or 0.25% acetic acid irrigations effectively neutralized pH. Conclusion To our knowledge, this is the first study in the medical literature to assess recently marketed protective CCBs. X‐ray diagnosis, preremoval honey/sucralfate use, emergent removal for esophageal lodgment, postremoval 0.25% acetic acid esophageal irrigation practices should not change. While protective CCBs showed substantial reduction of injury severity, the highly alkaline pH at negative pole still warrants neutralization treatments and further study. Widespread adoption of advanced technologies for child safety across the battery, electronics, and consumer goods industries could prevent severe injuries or deaths.
