INTRODUCTION:In the mid-nineteenth century, with the world in the grip of repeated diphtheria epidemics, tracheostomy evolved as a potentially lifesaving tool for pediatric patients. Though intubation and antitoxin eventually made the procedure all but unnecessary in diphtheria, this period spurred discussion of technique, complications, and aftercare that advanced the field of airway surgery. Growing acceptance for tracheostomy allowed twentieth-century physicians to adapt the procedure to chronic respiratory failure and pulmonary toilet and paved the way for it to become one of the most common airway surgeries performed today. METHODS:We performed a literature review with an emphasis on the use of primary sources with the objective of describing the development of tracheostomy during the mid-nineteenth to twentieth century. RESULTS:Tracheostomy has been used in the treatment of upper airway obstruction from foreign body since the second and third centuries B.C.E. In the nineteenth century, obstruction from pharyngeal pseudomembrane related to Corynebacterium diphtheriae infection became commonplace and associated with significant risk of mortality. Pierre Fidele Bretonneau and his pupil Armand Trousseau were the first to perform tracheostomy in cases of diphtheria. By 1887, over 20,000 tracheostomies had been performed in the treatment of diphtheria in Europe and America. Disagreements abounded over preferred timing, the role of anesthesia, placement technique, and post-operative care, with widespread discussion in the medical literature. Though intubation and diphtheria antitoxin ultimately replaced tracheostomy in the treatment of these patients, the use of tracheostomy in the management of upper airway obstruction from other etiologies increased after this period. DISCUSSION:The use of tracheostomy in pediatric patients with diphtheria was instrumental in standardizing the procedure, identifying its complications and their management, and promoting public acceptance of the practice as a treatment for upper airway obstruction. Today, although most of us will never see a case of diphtheria, we continue to face patients in what Scottish surgeon James Spence called "the agonies of suffocation." That we have the tools to manage complex airway obstruction comes in part from the heroic efforts of the physicians of the nineteenth century who, despite heartbreaking losses, advanced the technique of tracheostomy in their fight against childhood diphtheria.

In this case series, we present four unique cases of Riga–Fede disease (RFD), a rare disorder characterized by mucosal trauma as a result of repetitive tongue protrusion against the incisors, leading to the development of a large oral mass/ulceration. Due to the rapid development and growth of these lesions mimicking malignancy, it is important for the general and pediatric otolaryngologist to correctly diagnose and treat this benign disorder. This series highlights the variable clinical presentations, along with comorbidities of RFD, as well as the importance of interdisciplinary care between the pediatric otolaryngologist and pediatric dentist in its management. Laryngoscope, 134:4803–4805, 2024

"Letter to editor regarding “Clinical practice guidelines on management of infantile hemangioma: a systematic quality appraisal using the AGREE II instrument”." Pediatric Hematology and Oncology, ahead-of-print(ahead-of-print), pp. 1–2

Objective To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements. Methods An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery. Results After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. Conclusion This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.

Stridor in the newborn period may result from numerous causes, both congenital and acquired. Its presentation is diverse, and understanding the subtleties of that diversity is the key to determining the likely cause of the stridor, as well as the urgency for specialist evaluation. This article presents a framework for evaluating the quality of stridor in the newborn, as well as a review of the characteristics of stridor associated with entities commonly encountered in the neonatal airway.

Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.

Infantile hemangiomas (IHs) of the airway are far less common than their cutaneous counterparts, and their symptoms mimic those of viral croup. As a result, by the time these lesions are diagnosed, they are often advanced and causing airway compromise. Fortunately, the evolution of propranolol as an effective and safe pharmacotherapy has simplified management of IH and reduced the likelihood of complications previously seen with steroid therapy and surgery. Nevertheless, the otolaryngologist must be prepared with an alternate plan to manage lesions refractory to pharmacotherapy. This article reviews the clinical presentation and current management of IHs of the airway.

Importance The field of vascular anomalies presents diverse challenges in diagnosis and management. Although many lesions involve the head and neck, training in vascular anomalies is not universally included in otolaryngology residencies and pediatric otolaryngology (POTO) fellowships. Objective To explore the education in, exposure to, and comfort level of otolaryngology trainees with vascular anomalies. Design, Setting, and Participants A survey was distributed to 39 POTO fellows and 44 residents in postgraduate year 5 who matched into POTO fellowships from April 22 through June 16, 2014. Main Outcomes and Measures Survey responses from trainees on exposure to, education on, and comfort with vascular anomalies. Results Forty-four residents in postgraduate year 5 who applied to POTO fellowships and 39 POTO fellows were emailed the survey. Fourteen respondents were unable to be contacted owing to lack of a current email address. Thirty-six of 69 residents and fellows (18 fellows and 18 residents [52%]) responded to the survey. Twenty-seven trainees (75%) reported no participation in a vascular anomalies clinic during residency; 6 of these 27 individuals (22%) trained at institutions with a vascular anomalies clinic but did not participate in the clinic, and 28 of the 36 respondents (78%) reported that they had less than adequate or no exposure to vascular anomalies in residency. Among POTO fellows, 11 of 17 (65%) did not participate in a vascular anomalies clinic during fellowship, even though 8 of the 11 had a vascular anomalies clinic at their fellowship program. During fellowship training, 12 of 18 fellows (67%) reported that they had adequate exposure to vascular anomalies. Only 20 respondents (56%) felt comfortable distinguishing among diagnoses of vascular anomalies, and only 4 residents (22%) and 9 fellows (50%) felt comfortable treating patients with vascular anomalies. All fellows believed that training in vascular anomalies was important in fellowship, and 100% of respondents indicated that increased exposure to diagnosis and management of vascular anomalies would have been beneficial to their ability to care for patients. Conclusions and Relevance These data indicate that most otolaryngology trainees do not receive formal training in vascular anomalies in residency and that such training is valued among graduating trainees. Conversely, most POTO fellows felt their exposure was adequate and 50% of fellows felt comfortable treating vascular anomalies. However, 65% of POTO fellows had no participation in a vascular anomalies clinic, where many patients are managed by a multidisciplinary team. This finding may indicate that POTO fellows may have a false sense of confidence in managing patients with vascular anomalies and that residency and fellowship programs may consider changes in didactic and clinical programs.

Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the unique ability to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. Unfortunately, a subset of IHs rapidly develop complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary clinician has the task of determining which lesions require early consultation with a specialist. Although several recent reviews have been published, this clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH. Its purpose is to update the pediatric community regarding recent discoveries in IH pathogenesis, treatment, and clinical associations and to provide a basis for clinical decision-making in the management of IH.

OBJECTIVE:To develop general and site-specific treatment effect and outcome measures to standardize the reporting of head and neck lymphatic malformation (HNLM) treatments.STUDY DESIGN:Consensus statement/expert opinion.SETTING:Multiple tertiary academic institutions.SUBJECTS AND METHODS:The modified Delphi method is an iterative process of collecting expert opinions, refining opinions through discussion and feedback, statistically aggregating opinions, and using these aggregates to generate consensus opinion in the absence of other data. The modified Delphi method was used by a multi-institutional group of otolaryngology and interventional radiology experts in the field of vascular anomalies to formulate a list of recommended reporting outcomes for the study and treatment of head and neck lymphatic malformations.RESULTS:Through 3 rounds of iteration, 10 expert panelists refined 98 proposed outcome measures and 9 outcome categories to a final consensus set of 50 recommended outcome measures in 3 global categories (general, demographics, and treatment complications) and 5 site-specific categories (orbit, oral cavity, pharynx, larynx, and neck).CONCLUSIONS:We propose the first consensus set of standardized reporting measures for clinical and treatment outcomes in studies of HNLMs. Consistent outcome measures across future studies will facilitate comparison of treatment options and allow systematic review. We hope that these guidelines facilitate the design and reporting of subsequent HNLM studies.

OBJECTIVE:To evaluate the effectiveness of systemic propranolol in airway infantile hemangioma (AIH) treatment.DESIGN:Case series with chart review.PARTICIPANTS:Patients with AIH treated with propranolol between 2009 and 2012 with at least a 1-year follow-up.OUTCOMES:Presenting age, treating institution, syndrome presence, presenting AIH stage, endoscopy status, propranolol initiation location/dose/duration, time to stridor resolution, adjunctive medical and surgical therapy, and treatment-associated complications.RESULTS:Twenty-seven patients met inclusion criteria. Average age of diagnosis was 2.3 months (range, 1-5 months). The AIHs were stage 1 in 7 of 27 (26%), stage 2 in 12 of 27 (44%), and stage 3 in 8 of 27 (30%). Propranolol initiation was inpatient in 25 of 27 (93%) and outpatient in 2 of 27 (7%). Propranolol dose was maintained at 2 mg/kg/d in all patients for a minimum of 7 months (range, 7-34 months; median, 15 months). Stridor was eliminated within 24 hours or less of propranolol initiation in 23 of 27 (85%). At diagnosis, staging and propranolol initiation in 11 of 27 (41%) were managed with propranolol alone; the remaining 16 of 27 (59%) also had a steroid injection. The use of adjuvant therapy at the time of propranolol initiation and the size of the AIH were not statistically correlated. Twelve patients had additional treatments after the initiation of propranolol due to recurrence of respiratory symptoms, 1 of 27 (4%) of whom was considered a nonresponder. No complications related to propranolol use were noted.CONCLUSIONS:This multisite study of AIH treatment with propranolol demonstrates similar effectiveness to surgical treatment modalities. Propranolol therapy for AIH had no complications, had potentially lower resource utilization, and should be considered a first-line AIH treatment.

IMPORTANCELaryngoscopes are used by otolaryngologists in a variety of hospital emergency and critical care settings. However, only rarely have quality-related aspects of laryngoscope function and application been studied.OBJECTIVESTo compare the illuminance of laryngoscopes commonly used in a hospital setting to established standards and to assess the potential effects of maintenance practices on laryngoscope illuminance.DESIGN, SETTING, AND PARTICIPANTSObservational study of laryngoscope light output and cross-sectional survey of individuals charged with laryngoscope maintenance in a tertiary care children's hospital.INTERVENTIONSIlluminance was chosen as the unit of measurement (lux). Laryngoscopes in the operating room, emergency department, and pediatric intensive care unit were tested according to a standard technique. Illuminance standards for laryngoscopes, published by the International Organization for Standardization (ISO) (500 lux) and in the medical literature (867 lux) were used as benchmarks.MAIN OUTCOMES AND MEASURESMean laryngoscope illuminance by type of laryngoscope and light source and percentage of laryngoscopes with illuminance below established standards as well as nonfunctioning units. Maintenance practices were evaluated as a secondary outcome.RESULTSA total of 319 laryngoscopes were tested; 283 were incandescent bulb units used by anesthesiologists, emergency physicians, and intensivists and 36 were xenon light units used by otolaryngologists. Mean (SD) illuminance was 1330 (1160) lux in the incandescent group and 16,600 (13,000) lux in the xenon group (P < .001). Substandard illuminance was observed only in the incandescent group, in 29% to 43% of laryngoscopes; 5% of the incandescent group did not turn on at all. Maintenance of laryngoscopes was performed on a reactive rather than a preventive basis.CONCLUSIONS AND RELEVANCEAt our facility, approximately one-third of incandescent laryngoscopes exhibited substandard light output. On the basis of these findings, our hospital has converted all of its incandescent laryngoscopes to light-emitting diode (LED) devices. Such changes, as well as the institution of a quality-control program including scheduled laryngoscope inspection and battery and bulb replacement for incandescent laryngoscopes, may reduce adverse events associated with poor-quality direct laryngoscopy.

For decades, many otolaryngologists have instructed parents to avoid aural water exposure in their children with tympanostomy tubes. This recommendation is usually based on the premise that water will pass through the tube into the middle ear, creating a moist environment. Organisms such as Pseudomonas grow favorably in such environments, and their presence in the middle and external ear commonly results in otorrhea. Although protection of the ears may be a worthwhile strategy, some families face the extraordinary challenge and expense of maintaining earplugs or waterproof headbands, while children prohibited from the pool may be delayed in their acquisition of swimming skills. The clinician is left to determine whether these precautions are reasonable in order to reduce the cost and nuisance associated with treatment of suppurative drainage from the ear. Recommendations regarding swimming, other water exposures, and the need for water precautions vary widely among otolaryngologists and primary care providers, from no precautions to absolute abstinence from water exposure. A 2008 survey of 150 otolaryngologists in the northwestern United States found that 4% did not allow children with tympanostomy tubes to swim at all.1 Of those who permitted swimming, 51% required either ear protection or prophylactic drops. Many otolaryngologists limited the depth of swimming (no submersion of ears=7%; surface swimming only=30%; depth less than 2 feet=35%; no restrictions=28%). While these data suggest a relaxation of restrictions compared to earlier surveys, they still suggest a lack of consensus regarding best practices. The incidence of a single event of post-tympanostomy otorrhea, based largely on case series, varies in the literature from 3% to 83%. Most of these investigations did not distinguish the events by season or by association with upper respiratory infection. Among those that did, conclusions differ regarding the prevalence of otorrhea in summer versus winter, but most suggest a higher association with upper respiratory infection than with water exposure. The notion that swimming or bathing can precipitate an episode of otorrhea has been addressed in both in vitro and in vivo studies. In vitro investigations have estimated the pressure required for water to traverse a tympanostomy tube to be 12 cm to 23 cm H20, a level achieved at water depths of less than 1 foot. Such studies have also confirmed that water contamination of the middle ear is significantly greater at depths greater than 2 feet than at the surface. Additionally, these studies suggested that soap added to water lowers the surface tension on a tympanostomy tube, allowing water to enter more easily. However, the models used may not have accurately reflected the anatomy of the ear and the multitude of biological and biophysical factors, such as the variable opening pressure of the Eustachian tube, the role of cerumen, and the hydrophobic nature of tube materials that affect water accessing the middle ear. Most in vivo studies also have suggested that ears with tubes need not be protected from water. Prior to 2005, at least 14 studies failed to demonstrate statistical improvement in otorrhea rates in children abstaining from swimming or in children using earplugs or prophylactic otic drops. Although many of these studies suffered design flaws, including lack of randomization, blinding, checks of compliance, and small sample sizes, two meta-analyses have supported this conclusion.2, 3 A recent report by Goldstein et al., designed to eliminate these flaws, studied 172 children randomized to swimming with or without ear plugs.4 They noted no significant difference in the rates of otorrhea (47% and 56%, respectively); however, children using ear plugs had a lower incidence of otorrhea (0.07 episodes per month) compared with those without ear plugs (0.10 episodes per month). Despite this small statistical difference, these data equate to only 0.36 infections per child-year. Stated differently, a child would need to wear earplugs for 2.8 years to prevent a single episode of otorrhea. Swimming depth may be an important factor in tympanostomy tube otorrhea. As depth below the surface increases, so does the water pressure upon the tube and the likelihood of water entering the tube. The resulting moist environment in the middle ear is one in which certain bacteria thrive, resulting in otorrhea. The in vitro studies previously mentioned suggested an increased risk of otorrhea with increased depth. Unfortunately, investigators in most in vivo studies prohibited patients from diving. In one of the few relevant studies, Lounsbury et al. found that diving deeper than 6 feet was associated with a six-fold increase in otorrhea risk,5 although it should be noted that most of these children were swimming and diving in lakes or ponds. Sample sizes for divers in other studies were too small to be conclusive; however, the majority of the available data suggested that diving or deeper underwater exposure increases the rate of otorrhea. Water type is also thought to influence the likelihood of otorrhea. Animal studies have demonstrated middle ear inflammation due to water exposure only in the presence of bathwater. This is consistent with the in vitro studies that found soap in the water lowered the pressure at which water traversed a tympanostomy tube. Most studies reported insufficient statistical power to find significant increases in rates of otorrhea among patients swimming in pools or ocean; however, one study reported an increased rate of otorrhea with lake swimming. In all but the Goldstein study presented above, swimmers wearing ear plugs had a higher overall rate of otorrhea compared to swimmers without ear plugs or those using antibiotic ear drops, although the difference was not statistically significant. This may be explained by studies demonstrating increased bacterial counts in the external auditory canal after occlusion, as well as the fact that few devices can completely prevent water from reaching the tympanic membrane. The use of antibacterial eardrops was compared to swimming without eardrops in only two studies, both of which demonstrated no reduction in otorrhea using ototopical medications. Based on the available literature, children with tympanostomy tubes appear to be at minimal increased risk of developing otorrhea from swimming, providing they are restricted to surface exposure. Neither earplugs nor prophylactic eardrops are necessary for most children who swim at the surface in pool water and ocean water. The risk of otorrhea appears to increase with the depth of swimming below the surface, as well as with exposure to soapy water and lake water. Therefore, diving while swimming and head dunking in the bathtub are probably best avoided. Ear protection is a reasonable alternative for children who will inevitably engage in these activities, particularly older children who have a higher likelihood of diving and a larger ear canal volume. Parents of these children should be advised of the importance of cleansing occlusive devices between uses to reduce the risk of bacterial colonization. For children whose families emphasize the importance of water activities, the mild discomfort and nuisance associated with an episode of otorrhea may not justify the imposition of restrictions or the maintenance of earplugs. Others may experience greater discomfort and recurrence of their otorrhea; these children may derive greater benefit from the institution of water precautions. Ultimately, the decision to recommend water precautions should be individualized for each child with tympanostomy tubes. Studies regarding water precautions for tympanostomy tubes vary considerably in design, quality, and level of evidence. The available literature consists of level 2 to level 4 evidence, including two meta-analyses. Only the article by Goldstein et al. meets the criteria for level 1 evidence.4

BACKGROUND: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.RESULTS: The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%).CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.). PMID: 23692173 Funding information This work was supported by: NCRR NIH HHS, United States Grant ID: UL1 RR024134 NCATS NIH HHS, United States Grant ID: UL1 TR000077 NHLBI NIH HHS, United States Grant ID: U01 HL083129 NHLBI NIH HHS, United States Grant ID: U01 HL083075 NHLBI NIH HHS, United States Grant ID: HL083129 NHLBI NIH HHS, United States Grant ID: HL083075 NCRR NIH HHS, United States Grant ID: UL1 RR024989 More Less keyboard_arrow_down

OBJECTIVE:To evaluate the financial impact of pursuing a fellowship in otolaryngology.STUDY DESIGN:Retrospective financial analysis using American Academy of Otolaryngology-Head and Neck Surgery survey data.SUBJECTS AND METHODS:The American Academy of Otolaryngology-Head and Neck Surgery report, entitled Socioeconomic Study among Members April 2011, gives a financial profile of respondents who reported their primary area of specialization as either general otolaryngology or a specific area of subspecialization. Weighted averages were calculated from the reported data. The weighted averages were used to calculate a net present value (NPV) over a 30-year contiguous career.RESULTS:The NPV for general otolaryngology was $4.73 million. The NPV for the following subspecialties in relation to general otolaryngology were (in hundred thousands) as follows: otolaryngologic allergy (-$1153), sleep medicine (-$677), otology/neurotology (-$339), laryngology (-$288), head and neck (-$191), pediatric otolaryngology (-$176), facial plastic surgery (-$139), skull base surgery ($122), rhinology ($285), and allergy and immunology ($350). Ninety-four percent of general otolaryngology respondents were in private practice. Most subspecialists worked in an academic setting.CONCLUSION:Fellowship training in otolaryngology will affect career earnings of prospective fellows. The overall financial impact of fellowship training, calculating in the delay in receiving a full clinical salary, should be factored into the decision to pursue fellowship training.

IMPORTANCE:This study provides multi-institutional practice guidelines for the initiation of propranolol hydrochloride treatment of routine infantile hemangiomas.OBJECTIVE:To provide information on current propranolol treatment practices for infantile hemangiomas among a cohort of pediatric otolaryngologists.DESIGN AND SETTING:A survey for initiation of propranolol therapy was created by the American Society of Pediatric Otolaryngology Vascular Anomalies Task Force Subcommittee. After an initial pilot of the survey by 4 task force members, the survey was modified and then distributed by e-mail. Results were transferred to spreadsheet format and analyzed.PARTICIPANTS:All 51 members of the task force.RESULTS:A total of 18 respondents from 15 institutions submitted completed surveys. Data from respondents at the same institution were aggregated and/or averaged to minimize regional bias. Fourteen of 15 responding institutions (93%) treat patients with infantile hemangioma as part of a multidisciplinary vascular anomalies team. Ten institutions (67%) routinely consult cardiology before initiation of propranolol therapy. The median propranolol hydrochloride initiation dosage is 2.00 (mean [SD], 1.65 [0.64]; range, 0.45-2.50) mg/kg/d. Postinitiation monitoring for propranolol therapy includes blood pressure (15 of 15 respondents [100%]), serum glucose levels (7 of 15 [47%]), and pulse oximetry (2 of 15 [13%]). Only 2 institutions routinely admit all patients for initiation of propranolol therapy. Typical duration of therapy ranges from 4 to 8 (5 of 15 [33%]) or 8 to 12 months (10 of 15 [67%]), and cessation of therapy in most cases is based on the clinical response (7 of 14 [50%]) or the age of the patient (6 of 14 [43%]).CONCLUSIONS AND RELEVANCE:Propranolol is a commonly used medication for the treatment of infantile hemangiomas among otolaryngologists in the Vascular Anomalies Task Force. Propranolol therapy is commonly initiated in the outpatient setting and continued for as long as 12 months.

The "Cochrane Corner" is a quarterly section in the journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review, "Antibiotics for Otitis Media with Effusion in Children," that does not support the routine use of antibiotics for treating otitis media with effusion in children. Although children treated with antibiotics had higher rates of effusion resolution, there was no impact on hearing levels or the need for tympanostomy tubes.