Objective: Timely diagnosis and management of pediatric sensorineural hearing loss (SNHL) is essential for best outcomes. This study evaluated the differences of health access among cochlear implant (CI) centers of countries with different health care systems. Study Design: Retrospective. Setting: Multicenter, tertiary pediatric CI referral center in four different countries: United States (USA), France (FR), Australia (AUS), and Brazil (BR). Patients: Pediatric (age 0-21 years (0-16 years AUS)) patients receiving CI between January 2017 and December 2019. Intervention(s): CI. Main Outcome Measure(s): Primary outcome measures included age at milestones in CI process and age at implantation. Results: There were 1,673 patients who underwent CI surgery at four multinational designated institutions were identified (n = 143 AUS; 153 BRA; 1,158 FR; and 219 USA). Median age at time of hearing loss diagnosis (p < 0.0001), median age at hearing aid (HA) fitting (p < 0.0001), and CI evaluation (p < 0.0001) differed between countries. However, age at CI surgery was not significantly different between countries. Time from diagnosis to HA fitting was impacted by country (p < 0.0001) and language (p = 0.01) but not by private compared with public insurance. There were 512 children with available data regarding onset of hearing loss as prelingual n = 358 (70%) and postlingual n = 154 (30%). In patients with prelingual severe to profound hearing loss, country and race/ethnic origin affected age at diagnosis (p < 0.0001, p = 0.001), HA fitting (p < 0.0001, p < 0.001), candidacy evaluation (p = 0.0001, p = 0.02), and CI surgery (p = 0.0027, p = 0.001). Conclusions: Age at pediatric CI was comparable across the CI centers compared in the four countries. This is encouraging given the effect of neuroplasticity on pediatric CI outcomes, despite different health care expenditures and delivery systems in the four countries. Improvement in care access for certain populations may decrease disparities in pediatric CI access worldwide.

This patient was found to have a scirrhous carcinoma with extensive perineural invasion and without any evidence of minor salivary gland carcinoma. To our knowledge, this is the first report of isolated scirrhous carcinoma of the oral cavity. Treatment was surgery and adjuvant chemoradiation, and there was complete disease response.

Objective: To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children. Study Design: Retrospective. Setting: Tertiary pediatric CI referral center. Patients: All patients under 18 years of age receiving CI between March 2018 and February 2020. Interventions: CI. Main Outcome Measures: Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI. Results: Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 +/- 0.8 yr versus 3.1 +/- 0.7 yr, p = 0.007) and those from low-income areas (8.6 +/- 7.6 yr versus 2.4 +/- 3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 +/- 0.6 yr versus 2.2 +/- 0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 +/- 107d versus 291 +/- 64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 +/- 0.2 versus 1.0 +/- 0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 +/- 132 d versus 197 +/- 67 d, p = 0.007), developmental evaluation (517 +/- 106 d versus 150 +/- 56 d, p = 0.003), speech evaluation (482 +/- 107 d versus 163 +/- 65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 +/- 107d versus 184 +/- 59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 x 10(-4)) and children with public insurance (p = 0.016; p = 0.002). Conclusions: Disparities in access to CI continue to affect timing of pediatric cochlear implantation.

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OBJECTIVE:While adenotonsillectomy (AT) remains first line therapy for pediatric obstructive sleep apnea (OSA), management of children who are not candidates for AT or who have residual OSA post AT varies and spans across multiple specialties. We aim to report our experience in managing this population through a multidisciplinary sleep clinic composed of specialists in pediatric dentistry, otolaryngology, plastic surgery, and pulmonary/sleep medicine. STUDY DESIGN:Retrospective chart review. METHOD:The medical records of children attending our complex sleep apnea clinic were reviewed. Data pertaining to demographics, underlying diagnoses, prior evaluation and treatment, recommendations, and initial therapy were collected. RESULT:Two-hundred and thirty patients (mean age 10.7 ± 5.1 years, 62.2% male) were assessed. Underlying conditions included Trisomy 21 (n = 65, 28.2%), other genetic syndromes (n = 37, 16.1%), obesity in an otherwise typically developing child (n = 36, 15.2%), cerebral palsy (n = 27, 11.7%), and craniofacial syndromes (n = 7, 3.0%). Mean obstructive apnea hypopnea index (OAHI) was 14.2 events/hour at first clinic visit, and the majority of children had previously undergone at least one upper airway surgery (n = 168, 73.0%), primarily adenotonsillectomy. Recommended initial treatment plans included positive airway pressure (PAP) therapy (n = 108, 47.0%), surgery (n = 75, 32.6%), allergy management (n = 52, 22.6%), and/or weight loss (n = 34, 14.8%). Patients prescribed PAP therapy with follow up data were found to be adherent 43.9% of the time. Surgical patients with post-operative polysomnography had pre-operative OAHI 15.6 ± SD13.4 decrease to 10.7 ± 14.2 events/hour (p = 0.61). CONCLUSION:Genetic conditions and obesity were the most common underlying diagnoses cared for in the complex sleep apnea clinic. Patients presented with severe OSA, most having already had upper airway surgery. Management plans were frequently adjusted, and we observed improvement in SDB in a sub-segment of patients, suggesting benefit to a coordinated, multi-disciplinary approach.