ABSTRACT Objective To evaluate whether parent‐captured oropharyngeal videos obtained using a handheld telemedicine device can assess tonsil size in children with sleep‐disordered breathing compared with in‐person clinical examination. Methods We conducted a prospective diagnostic accuracy study at a single tertiary pediatric referral center. A consecutive sample of 169 children scheduled for tonsillectomy, adenoidectomy, or adenotonsillectomy was enrolled. Parents obtained oropharyngeal videos using a handheld telemedicine device (TytoCare). Three blinded pediatric otolaryngologists independently graded tonsil size using the Brodsky scale. Interrater agreement, diagnostic performance relative to in‐person examination, and video usability were assessed. Results Among 169 children (median age 4.4 years, IQR 3.3–7.6), 53% underwent adenotonsillectomy and 46% adenoidectomy alone. Interrater agreement for tonsil size grading was strong (Kendall's W = 0.88, p < 0.01) and remained substantial when grades were dichotomized as 0–2 versus 3–4 (Fleiss κ = 0.65, 95% CI: 0.58–0.73). Using the in‐person examination as the reference standard, sensitivity was 70%, specificity was 86%, positive predictive value was 84%, and negative predictive value was 73%. Twenty‐one videos (12%) were unusable by all evaluators and 54 (32%) by at least one evaluator, with higher rates in younger children. Conclusion Parent‐captured oropharyngeal videos may provide a feasible method for remote tonsil size assessment in selected children with sleep‐disordered breathing. Strong interrater agreement and generally favorable parental attitudes support further evaluation of this approach, while additional validation is needed before routine reliance on video‐based assessment for surgical decision‐making. Level of Evidence 2.
ABSTRACT Objective To identify predictors of surgical success after pediatric tonsillectomy for obstructive sleep apnea (OSA) and estimate the degree to which non‐random selection into postoperative polysomnography (PSG) distorts outcome associations. Methods Retrospective nested cohort study at a quaternary pediatric center (2016–2024). From 940 children undergoing tonsillectomy for OSA, 389 had preoperative PSG and 174 had both preoperative and postoperative PSG. Inverse probability weighting (IPW) corrected for non‐random selection into follow‐up PSG. Surgical success was defined as postoperative AHI < 5 events/h. Results The outcome cohort included 174 children (median age 6.0 years; 62% male; 45% obese; median preoperative AHI 16.5 events/h). Surgical success was achieved in 122 (70.1%). Follow‐up PSG was associated with higher preoperative AHI (OR 1.06 per event/h), medical complexity (OR 2.22), and multiple comorbidities (OR 1.86), with good discrimination (AUROC 0.795). In IPW‐adjusted analysis, each additional event/h of preoperative AHI was associated with lower odds of surgical success (OR 0.96 per event/h; p < 0.001). The estimated effect of obesity strengthened after weighting (OR 0.53 vs. 0.66 unweighted), though the association did not reach statistical significance ( p = 0.15). Children with very severe OSA (AHI > 30) achieved success in only 41.7%. Conclusion Higher preoperative AHI was associated with lower odds of surgical success after tonsillectomy. The obesity estimate did not reach statistical significance after weighting, but whether this reflects a true absence of effect, limited power, or confounding by AHI severity cannot be determined from this dataset. Children with very severe OSA should be counseled that surgery alone is unlikely curative. Level of Evidence 4.
ABSTRACT Objective To establish common clinicopathological themes of pediatric parotidectomy, aid decision making, and compare this to previously reported features and outcomes. Methods Retrospective cohort analysis of all pediatric parotidectomies over a 10‐year period at a tertiary level pediatric hospital. Results Thirty‐one patients were identified (15 male, 16 female) between the ages of 1 and 16. Primary parotid tumor was the most common reason for surgery ( n = 15), followed by congenital abnormalities ( n = 12). The most common histopathological diagnosis was acinic cell carcinoma ( n = 6). The most common complication was temporary facial nerve weakness (29%). Conclusion Primary parotid tumors were the most common reason for parotidectomy, and most of these were malignant. Of these, Acinic Cell Carcinoma was more prevalent than Mucoepidermoid Carcinoma. Pediatric parotidectomy is safe with a low permanent complication rate, but patients should be specifically counseled about temporary facial nerve weakness and the small risk of permanent injury. Level of Evidence 4.
ABSTRACT Objective Early diagnosis and treatment of sinonasal malignant lymphoma are crucial because of its diverse clinical and imaging findings and poor prognosis associated with certain histological subtypes. However, the markers that predict the diagnosis and prognosis according to the histological subtypes are unclear. This study aimed to identify these markers. Methods We retrospectively analyzed 66 malignant lymphomas diagnosed using biopsy specimens obtained from the nasal cavity and sinus and treated at our institution. Age, sex, main symptom, primary site, disease stage, histopathological type, blood test parameters, follow‐up period, treatment details, and prognosis were analyzed. Overall survival was defined as the time from diagnosis to death from any cause. Progression‐free survival was defined as the time from diagnosis to disease progression, relapse, or death. Survival curves were estimated using the Kaplan–Meier method and compared using the log‐rank test. Results Diffuse large B‐cell lymphoma (DLBCL) was the most common histological subtype (45 patients), followed by extranodal natural killer (NK)/T‐cell lymphoma (ENKTL; 15 patients). The 5‐year progression‐free survival rates were 50.0% for DLBCL and ENKTL for 28.1%. ENKTL was associated with a significantly poorer prognosis than DLBCL. Among patients with sinonasal DLBCL, CD5‐positivity tended to have a poorer prognosis. Conclusion Sinonasal malignant lymphoma exhibits heterogeneous clinical behavior according to the histological subtype. CD5‐positive sinonasal DLBCL tended to result in worse outcomes. To our knowledge, this is the first study to investigate the prognostic significance of CD5 expression in sinonasal DLBCL. Further studies are needed to clarify its prognostic significance. Level of Evidence 3.
ABSTRACT Introduction Up to 25% of patients with voice disorders report concurrent psychosocial stress, which has been shown to cause laryngeal microbiome dysbiosis. Microbiome dysbiosis underlies disease pathophysiology in other organs, leading to uncontrolled inflammation via epithelial barrier dysfunction. There is a need to delineate microbial versus nonmicrobial epithelial stress pathways in the vocal folds (VF) in order to clarify how psychosocial stress may contribute to VF epithelial disease. Methods C57BL/6 conventionally‐raised (CR) and germ‐free (GF) adult mice were equally allocated to stressed and unstressed groups ( n = 64, 32 per mouse‐type/group, equal sexes). Stressed animals completed a validated restraint stress protocol. Following stress, larynges were collected. Outcomes of VF epithelial barrier dysfunction were compared across stressed, unstressed GF, and CR mice. Immunofluorescence/Immunohistochemistry determined protein expression of epithelial adherens junctions, mucins, and proliferation in mid‐membranous VF tissue. Transmission electron microscopy assessed VF epithelial permeability. Results Regardless of microbiota status, stressed animals had reduced protein expression of VF epithelial adherens junctions, mucins (MUC1, 4) and increased epithelial permeability. Presence of microbiota was associated with stress‐induced increases epithelial proliferation, observed in CR, but not GF mice. Conclusion Presence of microbiota was associated with stress‐induced increase in VF epithelial proliferation. This increased proliferation may represent an adaptive response to damaged cells to maintain epithelial integrity. Collectively, these findings provide a foundation for identifying VF epithelial targets that could be leveraged in probiotic‐based therapies. Level of Evidence N/A
