BACKGROUND:Recurrent respiratory papillomatosis (RRP) is characterized by repeated formation of papillomas in the respiratory tract and is caused by human papillomavirus (HPV) types 6 and 11. Women with genital HPV infection are slow to develop weak humoral immunity, but respond robustly to the HPV vaccine. We wondered if people with RRP had a similar immune response.METHODS:A convenience cross-sectional sample of patients with RRP were recruited into one of four groups: 1) adults and adolescents with active RRP, 2) children with active RRP, 3) RRP patients who had undergone HPV vaccination prior to enrollment and, 4) people with RRP who were in remission. Anti-HPV6 and HPV11 serology was determined by cLIA on a single blood draw.RESULTS:Of the 70 subjects enrolled, 36, 16, 8, and 10, were in groups 1, 2, 3, and 4, respectively. 47% of participants aged >11 years and 81% aged ≤11 years possessed no antibodies against HPV6 or HPV11 (ie. double seronegative). 61% of patients in remission were double seronegative. All participants who had received HPV vaccine previously were seropositive to at least one of these low risk HPV types (ie none of them were double seronegative). Among patients who had active RRP and never had HPV vaccination (n = 52) there was an association between duration of symptoms and seropositivity. Of those who were seropositive, the geometric mean duration of symptoms was 11 years compared to 4.7 years for those who were seronegative (p = 0.001).CONCLUSION:People with RRP are capable of developing a humoral response to HPV6 and HPV11. That response appears to be robust when initiated by the HPV vaccine, but either nonexistent or slow to develop in response to infection. Most in remission do not have demonstrable antibody levels against HPV6 or HPV11.

The LaryngoscopeVolume 131, Issue 3 p. E978-E979 Otology-Neurotology In Response to Letter to the Editor Regarding In-Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery Lawrence R. Lustig MD, Corresponding Author Lawrence R. Lustig MD lrl2125@cumc.columbia.edu orcid.org/0000-0001-6718-9838 Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorEli Grunstein MD, Eli Grunstein MD Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorSusannah Hills MD, Susannah Hills MD Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorAmy Ingram MD, Amy Ingram MD Advanced ENT & Allergy, Louisville, Kentucky, U.S.A.Search for more papers by this authorAndrew R. Gould MD, Andrew R. Gould MD Advanced ENT & Allergy, Louisville, Kentucky, U.S.A.Search for more papers by this authorD. Macy Vidrine MD, D. Macy Vidrine MD South Carolina ENT Allergy & Sleep Medicine, Columbia, South Carolina, U.S.A.Search for more papers by this authorRobert Puchalski MD, Robert Puchalski MD South Carolina ENT Allergy & Sleep Medicine, Columbia, South Carolina, U.S.A.Search for more papers by this authorJacob W. Zeiders MD, Jacob W. Zeiders MD South Florida Pediatric Otolaryngology, Fort Lauderdale, Florida, U.S.A.Search for more papers by this authorRandall A. Ow MD, Randall A. Ow MD Sacramento Ear Nose and Throat, Roseville, California, U.S.A.Search for more papers by this authorChristopher R. Thompson MD, Christopher R. Thompson MD Ear Nose and Throat Specialists of Abilene, Abilene, Texas, U.S.A.Search for more papers by this authorJonathan R. Moss MD, Jonathan R. Moss MD Charlotte Eye Ear Nose & Throat Associates, Matthews, North Carolina, U.S.A.Search for more papers by this authorRitvik Mehta MD, Ritvik Mehta MD California Head and Neck Specialists, Carlsbad, California, U.S.A.Search for more papers by this authorAudrey Calzada MD, Audrey Calzada MD California Head and Neck Specialists, Carlsbad, California, U.S.A.Search for more papers by this authorJohn E. McClay MD, John E. McClay MD Frisco ENT for Children, Frisco, Texas, U.S.A.Search for more papers by this authorAmy Brenski MD, Amy Brenski MD Frisco ENT for Children, Frisco, Texas, U.S.A.Search for more papers by this authorJohn Gavin MD, John Gavin MD Albany ENT and Allergy, Albany, New York, U.S.A.Search for more papers by this authorErik H. Waldman MD, FACS, Erik H. Waldman MD, FACS Yale New Haven Children's Hospital, New Haven, Connecticut, U.S.A.Search for more papers by this authorJohn Ansley MD, John Ansley MD Carolina Ear Nose & Throat Clinic, Orangeburg, South Carolina, U.S.A.Search for more papers by this authorDavid M. Yen MD, David M. Yen MD Specialty Physician Associates, Bethlehem, Pennsylvania, U.S.A.Search for more papers by this authorDavid M. Brown MD, David M. Brown MD Specialty Physician Associates, Bethlehem, Pennsylvania, U.S.A.Search for more papers by this authorNeil K. Chadha MBChB, Neil K. Chadha MBChB British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorFrederick K. Kozak MD, Frederick K. Kozak MD British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorMichael T. Murray MD, Michael T. Murray MD Camino Ear, Nose & Throat Clinic, San Jose, California, U.S.A.Search for more papers by this authorChristopher York MD, Christopher York MD ENT Clinics of San Antonio, San Antonio, Texas, U.S.A.Search for more papers by this authorRobert C. Sprecher MD, Robert C. Sprecher MD Nemours Children's Specialty Care, Jacksonville, Florida, U.S.A.Search for more papers by this authorDenise A. Sherman MD, Denise A. Sherman MD Nemours Children's Specialty Care, Jacksonville, Florida, U.S.A.Search for more papers by this authorScott R. Schoem MD, MBA, Scott R. Schoem MD, MBA Connecticut Children's Medical Center, Hartford, Connecticut, U.S.A.Search for more papers by this authorDan Harfe MSE, MBA, Dan Harfe MSE, MBA Tusker Medical, Inc, Menlo Park, California, U.S.A.Search for more papers by this authorLaura J. England PhD, Laura J. England PhD Tusker Medical, Inc, Menlo Park, California, U.S.A.Search for more papers by this authorCharles A. Syms III MD, Charles A. Syms III MD Ear Medical Group, San Antonio, Texas, U.S.A.Search for more papers by this author Lawrence R. Lustig MD, Corresponding Author Lawrence R. Lustig MD lrl2125@cumc.columbia.edu orcid.org/0000-0001-6718-9838 Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorEli Grunstein MD, Eli Grunstein MD Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorSusannah Hills MD, Susannah Hills MD Columbia University Medical Center, New York, New York, U.S.A.Search for more papers by this authorAmy Ingram MD, Amy Ingram MD Advanced ENT & Allergy, Louisville, Kentucky, U.S.A.Search for more papers by this authorAndrew R. Gould MD, Andrew R. Gould MD Advanced ENT & Allergy, Louisville, Kentucky, U.S.A.Search for more papers by this authorD. Macy Vidrine MD, D. Macy Vidrine MD South Carolina ENT Allergy & Sleep Medicine, Columbia, South Carolina, U.S.A.Search for more papers by this authorRobert Puchalski MD, Robert Puchalski MD South Carolina ENT Allergy & Sleep Medicine, Columbia, South Carolina, U.S.A.Search for more papers by this authorJacob W. Zeiders MD, Jacob W. Zeiders MD South Florida Pediatric Otolaryngology, Fort Lauderdale, Florida, U.S.A.Search for more papers by this authorRandall A. Ow MD, Randall A. Ow MD Sacramento Ear Nose and Throat, Roseville, California, U.S.A.Search for more papers by this authorChristopher R. Thompson MD, Christopher R. Thompson MD Ear Nose and Throat Specialists of Abilene, Abilene, Texas, U.S.A.Search for more papers by this authorJonathan R. Moss MD, Jonathan R. Moss MD Charlotte Eye Ear Nose & Throat Associates, Matthews, North Carolina, U.S.A.Search for more papers by this authorRitvik Mehta MD, Ritvik Mehta MD California Head and Neck Specialists, Carlsbad, California, U.S.A.Search for more papers by this authorAudrey Calzada MD, Audrey Calzada MD California Head and Neck Specialists, Carlsbad, California, U.S.A.Search for more papers by this authorJohn E. McClay MD, John E. McClay MD Frisco ENT for Children, Frisco, Texas, U.S.A.Search for more papers by this authorAmy Brenski MD, Amy Brenski MD Frisco ENT for Children, Frisco, Texas, U.S.A.Search for more papers by this authorJohn Gavin MD, John Gavin MD Albany ENT and Allergy, Albany, New York, U.S.A.Search for more papers by this authorErik H. Waldman MD, FACS, Erik H. Waldman MD, FACS Yale New Haven Children's Hospital, New Haven, Connecticut, U.S.A.Search for more papers by this authorJohn Ansley MD, John Ansley MD Carolina Ear Nose & Throat Clinic, Orangeburg, South Carolina, U.S.A.Search for more papers by this authorDavid M. Yen MD, David M. Yen MD Specialty Physician Associates, Bethlehem, Pennsylvania, U.S.A.Search for more papers by this authorDavid M. Brown MD, David M. Brown MD Specialty Physician Associates, Bethlehem, Pennsylvania, U.S.A.Search for more papers by this authorNeil K. Chadha MBChB, Neil K. Chadha MBChB British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorFrederick K. Kozak MD, Frederick K. Kozak MD British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorMichael T. Murray MD, Michael T. Murray MD Camino Ear, Nose & Throat Clinic, San Jose, California, U.S.A.Search for more papers by this authorChristopher York MD, Christopher York MD ENT Clinics of San Antonio, San Antonio, Texas, U.S.A.Search for more papers by this authorRobert C. Sprecher MD, Robert C. Sprecher MD Nemours Children's Specialty Care, Jacksonville, Florida, U.S.A.Search for more papers by this authorDenise A. Sherman MD, Denise A. Sherman MD Nemours Children's Specialty Care, Jacksonville, Florida, U.S.A.Search for more papers by this authorScott R. Schoem MD, MBA, Scott R. Schoem MD, MBA Connecticut Children's Medical Center, Hartford, Connecticut, U.S.A.Search for more papers by this authorDan Harfe MSE, MBA, Dan Harfe MSE, MBA Tusker Medical, Inc, Menlo Park, California, U.S.A.Search for more papers by this authorLaura J. England PhD, Laura J. England PhD Tusker Medical, Inc, Menlo Park, California, U.S.A.Search for more papers by this authorCharles A. Syms III MD, Charles A. Syms III MD Ear Medical Group, San Antonio, Texas, U.S.A.Search for more papers by this author First published: 16 October 2020 https://doi.org/10.1002/lary.29044Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume131, Issue3March 2021Pages E978-E979 RelatedInformation

Objectives/HypothesisEvaluate technical success, tolerability, and safety of lidocaine iontophoresis and tympanostomy tube placement for children in an office setting.Study DesignProspective individual cohort study.MethodsThis prospective multicenter study evaluated in‐office tube placement in children ages 6 months through 12 years of age. Anesthesia was achieved via lidocaine/epinephrine iontophoresis. Tube placement was conducted using an integrated and automated myringotomy and tube delivery system. Anxiolytics, sedation, and papoose board were not used. Technical success and safety were evaluated. Patients 5 to 12 years old self‐reported tube placement pain using the Faces Pain Scale–Revised (FPS‐R) instrument, which ranges from 0 (no pain) to 10 (very much pain).ResultsChildren were enrolled into three cohorts with 68, 47, and 222 children in the Operating Room (OR) Lead‐In, Office Lead‐In, and Pivotal cohorts, respectively. In the Pivotal cohort, there were 120 and 102 children in the <5 and 5‐ to 12‐year‐old age groups, respectively, with a mean age of 2.3 and 7.6 years, respectively. Bilateral tube placement was indicated for 94.2% of children <5 and 88.2% of children 5 to 12 years old. Tubes were successfully placed in all indicated ears in 85.8% (103/120) of children <5 and 89.2% (91/102) of children 5 to 12 years old. Mean FPS‐R score was 3.30 (standard deviation [SD] = 3.39) for tube placement and 1.69 (SD = 2.43) at 5 minutes postprocedure. There were no serious adverse events. Nonserious adverse events occurred at rates similar to standard tympanostomy procedures.ConclusionsIn‐office tube placement in selected patients can be successfully achieved without requiring sedatives, anxiolytics, or papoose restraints via lidocaine iontophoresis local anesthesia and an automated myringotomy and tube delivery system.Level of Evidence2b Laryngoscope, 130:S1–S9, 2020

Background Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. Methods A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. Results We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. Conclusion In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.

A previously healthy 3-year-old girl was scheduled for tonsillectomy, adenoidectomy, and bilateral tympanostomy tube placement for otitis media with effusion and sleep-disordered breathing. Intraoperatively, a large nasal mass was noted. On physical examination, she had 4+ tonsils, mild hypertelorism, and an exophytic, lobulated nasal mass on anterior rhinoscopy. Computed tomography (CT) demonstrated an expansile mass filling both nasal cavities, with bony erosion of the anterior skull base, right sphenoid sinus, right orbital apex, and hard palate (figure 1, A). Magnetic resonance imaging (MRI) illustrated an extensive sinonasal mass that was T2 hyperintense and T1 slightly hypointense with diffuse enhancement after contrast administration (figure 1, B). Nasal endoscopy and biopsy were performed under general anesthesia. Histologic examination showed a moderately cellular lesion composed of fascicles of bland spindle cells embedded in a variably collagenous stroma (figure 2, A). Immunohistochemistry showed spindle cells with diffuse and strong nuclear and cytoplasmic reactivity for beta-catenin (figure 2, B). A diagnosis of desmoid-type fibromatosis was made. An endoscopic tumor resection was performed. The tumor had a broad attachment that spanned from orbit to orbit and from clivus to the ethmoid roof. The tumor was grossly resected, leaving microscopic disease adherent to the anterior cranial fossa dura and right optic nerve region. Nasal endoscopy under anesthesia performed 1 month later identified no gross residual disease. Desmoid-type fibromatosis, also known as aggressive fibromatosis or desmoid tumor, is a rare neoplasm of deep soft tissues that is histologically characterized by an infiltrative, low-grade fibroblastic proliferation and clinically characterized by a tendency for local recurrence but no metastatic potential. These tumors usually occur outside the abdomen in children and in the abdominal wall in women of child-bearing age, but they are equally likely to be abdominal or extra-abdominal in later adulthood. PEDIATRIC OTOLARYNGOLOGY CLINIC

This study describes a standardized screening protocol for diagnosis of invasive mold infections in pediatric oncology patients with neutropenia and prolonged or recurrent fever.

Sialolipoma is a rare tumor that occurs in the head and neck. We present a case arising from a minor salivary gland in an infant. The 6-month-old infant presented with difficulty swallowing, frequent reflux, and snoring that had been worsening several weeks before presentation. Physical examination showed a large mass arising from the tongue base. The patient was taken to the operating room for transoral removal of a presumed cyst. Histologic examination of the lesion showed a well-circumscribed lesion composed of lobules of mature adipose tissue and nodules of entrapped, non-neoplastic acini and ductules separated by thin, fibrous septae, consistent with a sialolipoma. To the best of our knowledge, this is the first reported case of a sialolipoma at the tongue base in a child. The patient has had no evidence of recurrence at 1 year of follow-up.

IMPORTANCE Congenital pyriform fossa sinus tracts predispose to neck masses and neck abscesses in pediatric and occasionally adult patients. Traditional management involves open excision with substantial potential morbidity. Endoscopic management allows an alternative, less morbid treatment approach. OBJECTIVE To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts. DESIGN, SETTING, AND PATIENTS Retrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital. INTERVENTION Endoscopic electrocauterization of pyriform fossa sinus tract opening. MAIN OUTCOMES AND MEASURES Recurrence of symptoms after endoscopic treatment. RESULTS Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was reported. CONCLUSIONS AND RELEVANCE Endoscopic cauterization seems to be an effective and potentially permanent treatment for congenital pyriform fossa sinus tracts.

Purpose of reviewTo review the body of literature on the treatment options for nontuberculous cervicofacial lymphadenitis in children, focusing on the most recent reports describing outcomes utilizing either observation alone, medical therapy or various forms of surgical intervention. Recent findingsLarge studies have defined the time course of the disease and the safety and efficacy in treating nontuberculosis cervicofacial lymphadenitis with a wait-and-see approach. SummaryNontuberculosis cervicofacial lymphadenitis is a disease with several stages that provides for various treatment options. All treatment regimens – wait-and-see approach, medical therapy, and surgical excision – have their risks and benefits. The current body of literature allows the otolaryngologist an assortment of treatment choices that permits him to tailor the treatment with an individualized approach for each family's preferences.

Infections with invasive molds are an important cause of morbidity and mortality with published mortality rates of 21-48% among pediatric cancer patients infected by these organisms. Diagnosing invasive fungal infections is difficult because signs and symptoms are non-specific, and delays in diagnosis limit successful debridement of infected tissues. Despite this, there are no uniform guidelines for the diagnosis of invasive fungal infections. The deaths of three teens, at our institution, with leukemia and widespread mold, lead to the creation of a screening protocol for invasive fungal infection in November 2006. Neutropenic patients with persistent fever at 5 days or recurrent fever after defervescing were evaluated with a non-contrast computed tomography (CT) of the chest, abdominal ultrasound, and nasal endoscopy, performed at the bedside, by an otorhinolaryngologist. Initially the screen included CT of the abdomen, but the proclivity of mold for solid organ involvement supported the use of ultrasound as a screening tool. Additional studies were obtained as clinically indicated. To determine the impact of this screening protocol on mortality associated with invasive mold, we performed a retrospective chart review of patients receiving intensive therapy for hematologic malignancies from 2004-2011 who were diagnosed as having proven, probable, or possible invasive mold (candida excluded) infections (N=52) using the European Organization for Research and Treatment of Cancer and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Of the 20 mold infections in the pre-protocol group, 14 were classified as proven, 6 as possible. Among the 32 infections in the post-protocol group, 22 were proven, 4 probable, and 6 possible. Organisms included Aspergillus, Bipolaris, Curvalaria, Exserohilum, Fusarium, Rhizopus, and Scedosporium. Clinically indicated evaluations among the 20 patients in the pre-protocol group included, 16 chest CTs, 20 abdominal CTs or ultrasounds, and 7 underwent evaluation of their sinuses by direct nasal endoscopy. The lungs were the most common site of infection, with involvement detected in 15/20 patients (75%). Five patients (25%) had sinus involvement; in 1 patient this was the only site of disease. All 5 were symptomatic with rhinorrhea, congestion, facial pain, or facial numbness. Of the 32 patients in the post-protocol group, 30 had chest CTs, 32 had abdominal imaging (5 CT, 27 ultrasound), and 31 had direct nasal endoscopy. One patient did not have an ENT evaluation or chest CT because fungal disease was only detected post-mortem, and in 1 patient, cardiovascular instability precluded CT imaging. The lungs were again the most common site affected, with fungal pneumonia seen in 23/32 patients (72%). Fourteen patients (44%) had sinus involvement; in 4 patients this was the only site of disease. Nine patients with sinus involvement had no nasal symptoms or findings on routine physical exam. Mortality specifically associated with invasive mold infection decreased significantly after initiation of the screening protocol. Before implementing the screening protocol, 8/20 patients (40%) who developed invasive mold infections died from the infection; afterward 4/32 (12.5%), (Fisher's exact p=0.04). Prior to routine evaluation of the sinuses by direct nasal endoscopy, 5/20 patients with mold infections had demonstrable disease in the sinuses and all had symptoms referable to sinus disease prior to evaluation. Once direct nasal endoscopy was implemented as part of the screening protocol, 14/32 patients with invasive mold infection were found to have sinus disease; 9 had no symptoms other than fever. Age, gender, race and length of hospital stay did not differ significantly before and after implementing the screening protocol. Before implementation, 8/20 patients (40%) died from all causes; afterward 6/32 (19%), (Fisher's exact p=0.12). A screening protocol for the evaluation of neutropenic patients with persistent or recurrent fever led to early detection of invasive fungal infections in patients with hematologic malignancies and a significant decrease in infection associated mortality. Non-invasive, direct nasal endoscopy, performed at the bedside, is an effective tool for diagnosis of invasive fungal sinusitis and often detects fungal sinusitis before specific symptoms develop. Disclosures: No relevant conflicts of interest to declare.

Purpose of review To review the body of literature on the treatment options for nontuberculous cervicofacial lymphadenitis in children, focusing on the most recent reports describing outcomes utilizing either observation alone, medical therapy or various forms of surgical intervention. Recent findings Large studies have defined the time course of the disease and the safety and efficacy in treating nontuberculosis cervicofacial lymphadenitis with a wait-and-see approach. Summary Nontuberculosis cervicofacial lymphadenitis is a disease with several stages that provides for various treatment options. All treatment regimens - wait-and-see approach, medical therapy, and surgical excision - have their risks and benefits. The current body of literature allows the otolaryngologist an assortment of treatment choices that permits him to tailor the treatment with an individualized approach for each family's preferences.

ObjectiveTo evaluate the success of treatment of intracranial abscess occurring from acute sinus disease without utilizing craniotomy.MethodRetrospective chart review based at a tertiarty care children’s medical center. Children were evaluated from 1995 to 2010 with intracranial abscess formation from acute sinusitis. The main outcome measures were treatment modalities for acute intracranial and sinus disease.ResultsTwenty‐five children were evaluated from 1995 to 2010 with acute sinusitis resulting in brain abscesses. Over the first 10 years, 15 were treated successfully with an intracranial procedure and sinus surgery. Over the past 5 years, 10 cases of intracranial abscess were encountered, with 5 out of 10 treated successfully without the need for craniotomy. 4 out of 5 had small epidural abscesses treated with endoscopic sinus surgery and intravenous antibiotic, and 1 out of 5 had a small epidural and subdural abscess treated with medical therapy alone.ConclusionMedical management of intracranial abscess along with medical or surgical treatment of acute sinusitis may be a viable option for certain children with small epidural abscesses caused by acute sinusitis.

Objective Determine the impact of endoscopic sinus surgery on pulmonary function in children with cystic fibrosis. Method Retrospective chart review of cystic fibrosis patients at a tertiary children’s hospital who underwent endoscopic sinus surgery between 1995 and 2010. Main outcome measures include presurgical and 1‐ and 6‐month postsurgical pulmonary function tests (PFTs). Results Sixty‐two children underwent 110 endoscopic sinus surgeries. Pre‐ and post‐PFT data (FEVI and FVC) were available for 66 surgeries. Postoperative, only 10 out of 66 children (15%) at 1 month and 11 out of 66 (16%) at 6 months showed improvement following surgery. A total of 41 out of 66 children (62%) at 1 month and 42 out of 66 (64%) at 6 months showed no difference, while 15 out of 66 (23%) at 1 month and 13 out of 66 (20%) at 6 months were worse following surgery. There was no difference in pulmonary function following primary (28/66 [42%]) or revision (38/66 [58%]) surgeries. Conclusion Improvement of sinonasal symptoms achieved with endoscopic sinus surgery does not correlate with improvement in pulmonary function as measured by pre‐ and postoperative pulmonary function testing in children with cystic fibrosis.

ObjectiveReport a phenomenon of auto‐erosion of the uncinate process and medial maxillary wall in children with cystic fibrosis.MethodRetrospective chart review with IRB approval. Setting: Tertiary care children’s medical center. Patients: Children evaluated from 1995 to 2010 with cystic fibrosis and chronic sinusitis who were noted to have auto‐erosion of the uncinate process on endoscopic and radiographic evaluations.ResultsSix out of 62 (10%) children evaluated from 1995 to 2010 with cystic fibrosis and sinusitis without previous sinus surgery at a tertiary children’s hospital were noted to have auto‐erosion of the uncinate process and medial maxillary wall. Auto‐erosion appears to occur from expansion, pressure, and demineralization of the bones of the uncinate process and medial maxillary wall.ConclusionAuto‐erosion of the uncinate process is seen in children with sinusitis and cystic fibrosis. Auto‐erosion appears to be a non‐surgical self‐ventilating phenomenon associated with improvement of maxillary sinus disease on computed tomography.

OBJECTIVE:To compare the postoperative course, complication rate, and decannulation rate in children who underwent either sutureless or sutured posterior costal cartilage grafting during laryngotracheal reconstruction (LTR).DESIGN:Retrospective chart review.SETTING:Tertiary care children's medical center.PATIENTS:The study included children who required posterior costal cartilage grafting when undergoing LTR for subglottic stenosis between the years of 2000 and 2009 by the senior author (J.E.M.) and who had adequate records for review.MAIN OUTCOME MEASURES:Postoperative complications, including the incidence of graft prolapse, restenosis or reobstruction requiring surgical intervention, and decannulation rate.RESULTS:Forty-nine children who underwent 52 procedures met the inclusion criteria for this study. All patients had grade III acquired subglottic stenosis and underwent double-staged LTR. Twenty procedures were performed with a sutureless posterior graft, and 32 were performed with suture placement. None of the 20 procedures that were performed with a sutureless graft had prolapse of the graft into the airway compared with 2 of 32 prolapsed posterior grafts (6%) that were sutured (P = .52). Eleven of 20 children (55%) with sutureless posterior grafts compared with 24 of 32 children (75%) who underwent sutured posterior grafts required endoscopic surgical intervention for restenosis or reobstruction (P = .22). Decannulation was achieved in 19 of 20 sutureless cases (95%) and in 28 of 30 cases (93%) in which sutures were placed (P = .56) after a single LTR and necessary endoscopic interventions occurring at 6.3 months and 4.9 months, respectfully (P = .42).CONCLUSION:Sutureless posterior costal cartilage grafting in children with acquired grade III subglottic stenosis is an equally effective and secure technique compared with sutured posterior grafting during double-staged LTR.

Objectives Determine the effectiveness of endoscopic surgical treatment of subglottic stenosis (SGS) in children as a primary surgical modality to prevent laryngotracheal reconstruction (LTR) and as treatment for restenosis following primary LTR to prevent revision LTR. Patients Children undergoing various endoscopic surgical treatments from 1989 to 2006 for SGS. Results The number of children and success rates per grade of SGS and the number of procedures required to produce a successful result in 29 children initially managed endoscopically included grade I, three of three (100%), 1.3 procedures; grade II, eight of nine (88%), 2.6 procedures; and grade III, 13 of 17 (76%), 3.5 procedures. Of 102 patients undergoing open LTR, 56 of 102 required endoscopic interventions and 41 of 56 (73%) children were treated successfully. Conclusion Endoscopic intervention can be used to manage SGS either as a primary intervention or to treat reobstruction and restenosis following an open reconstructive procedure. Success rates decline as the severity of stenosis increases.

OBJECTIVE To evaluate the incidence and type of intracranial and inner ear abnormalities in children with sensorineural hearing loss (SNHL) identified with magnetic resonance imaging (MRI) and stratified by the degree and type of SNHL. DESIGN Retrospective review of medical records and MRIs. SETTING Tertiary care children's hospital. PATIENTS A total of 227 children aged 1 month to 17 years (mean age, 5.3 years; male to female ratio, 1:1) with a diagnosis of SNHL underwent MRI from June 1,1996, to June 1, 2002. Of these children, 170 had clinical information available and technically adequate MRIs and were included in the study. INTERVENTION Magnetic resonance imaging. MAIN OUTCOME MEASURE Identification of an abnormality of the intracranial contents, inner ear, and cochlear nerve. RESULTS Of the 170 children, 101 (59%) had bilateral SNHL and 69 (41%) had unilateral SNHL, comprising 271 ears with SNHL. Abnormalities of the inner ear were found in 108 ears (40%) with 87 (32%) having abnormalities of the cochlea, which were considered mild in 63 (23%) and moderate to severe in 24 (9%). Forty-nine of 271 ears (18%) with SNHL demonstrated an either absent (26/49 [53%]) or deficient (23/49 [47%]) cochlear nerve. Ears with severe and profound SNHL had more abnormalities than ears with mild and moderate SNHL (66/138 [48%] vs 23/80 [29%]; P = .006), and children having ears with unilateral moderate, severe, or profound SNHL had more inner ear abnormalities than children with bilateral moderate, severe, or profound SNHL (28/45 [62%] vs 54/144 [38%]; P = .004). CONCLUSIONS The overall incidence of inner ear abnormalities in ears of children with SNHL evaluated by MRI is 40%. The most common abnormalities seen were an abnormal cochlea and abnormal cochlear nerve. Children with severe and profound SNHL have a greater percentage of inner ear anomalies than children with mild or moderate SNHL. Children with unilateral hearing loss have a greater percentage of inner ear anomalies than children with bilateral SNHL.

OBJECTIVESTo examine the incidence of methicillin‐resistant Staphylococcus aureus (MRSA) in pediatric neck abscesses and compare these with abscesses caused by methicillin‐susceptible Staphylococcus aureus (MSSA) and other organisms (non‐SA).STUDY DESIGNRetrospective review of 245 children who underwent incision and drainage of neck abscesses from January 1, 2001, to December 1, 2005.RESULTSThe yearly incidence of MRSA increased from 9 percent to 40 percent during the study period. Abscesses in medial locations were less common in the MRSA group (P < 0.01) and MSSA group (P < 0.001) compared with the non‐SA group. Average patient ages were MRSA 18.9 months, MSSA 18.7 months, and non‐SA 47.6 months. Complication rates were MRSA 8 percent, MSSA 5 percent, and non‐SA 5 percent.CONCLUSIONSThe incidence of MRSA in pediatric neck abscesses is increasing dramatically. MRSA and MSSA usually infect younger patients in the lateral locations. Clinical courses were similar in all groups.