Pediatric Audiology: Diagnosis, Technology, and Management 3rd ednJ R Madell, C Flexer, J Wolfe, E C Schafer Thieme, 2019 ISBN 978 1 62623 401 7 eISBN 978 1 62623 402 4 pp 440 Price €94.99 US$109.99 £84.50 - Volume 133 Issue 6

Background: Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence. Methods: A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment. Results and conclusion: There are many gaps in the evidence base for the surgical correction of obstructive sleep apnoea. There is emerging evidence favouring subtotal tonsillectomy. There is continuing uncertainty around the prediction of the level of post-operative care that any individual child might require. The long-term benefit of surgical correction is a particularly fertile ground for further research.

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Background: Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction. Methods: A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer? Results and conclusion: There is a considerable lack of evidence regarding most of these fundamental questions. Notably, screening measures show low specificity and can be insensitive to mild obstructive sleep apnoea. There is a surprising lack of clarity in the definition (let alone estimate of severity) of sleep-disordered breathing, relying on what may be arbitrary test thresholds. Areas of potential research might include investigation of the mechanisms through which obstructive sleep apnoea causes co-morbidities, whether neurocognitive, behavioural, metabolic or cardiovascular, and the role of non-surgical management.

Background: The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with spontaneous resolution the norm. Objectives: To identify gaps in the knowledge and identify topics for future study. Method: Systematic review of the literature. Results: The literature suggests that there is a range of abnormalities leading to the typical collapsing upper airway, and that neurological disease, other airway abnormalities, syndromes and gastroesophageal reflux all contribute to disease severity and influence outcomes. The procedures involved in supraglottoplasty are rarely specified, the indications for surgery are vaguely defined and the role of medical therapy is unclear. Conclusion: Every review article or survey of opinion suggests that there is still a marked variation in individual practice and a lack of consensus.

There should be continued support and drive for innovation and implementation of smartphone-based access to local guidelines. This is the first study, that we're aware of, assessing the use of a smartphone-based clinical handbook in ENT surgery. Use of a smartphone-based handbook is superior to printed or intranet-based guidelines. Use of smartphone apps can support junior doctors with delivery of care. Smartphone-based access to guidelines encourage learning and education to improve the induction process for new doctors. This article is protected by copyright. All rights reserved.

SURGICAL PEDIATRIC OTOLARYNGOLOGY, 2nd edn W P Potsic , R T Cotton , S D Handler , K B Zur Thieme, 2016 ISBN 978 1 60406 772 9 eISBN 978 1 60406 773 6 pp 694 Price €154.99 US$169.99 - Volume 130 Issue 6

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Objectives: To assess for identifiable risk factors for failed surgical intervention in children with laryngomalacia.Methods: Retrospective case note review between September 2007 and March 2012. Case notes were reviewed for demographic data, symptoms, co-morbidities, operative technique, postoperative recovery, complications, length of hospital stay including intensive care unit (ICU) care, and resolution of symptoms.Results: 148 children underwent supraglottoplasty. Case notes were available for 115 (78%) patients. 35% (41/115) of cases were females and 65% (74/115) were male. A bimodal age distribution was observed with peaks at 3 months and 3.5 years. Those over one year of age were more likely to have complications (p = 0.035). There was no significant difference in outcomes for age (p > 0.05). In patients less than one year, reflux symptoms were significantly associated with a higher likelihood of failure of the operation (p = 0.013). Patients under one year with pre-operatively identified comorbid conditions were less likely to have an improvement in breathing (p = 0.002). Cold steel was used in 55% (63/115) of cases, laser only in 17% (20/115) cases and a combination of the two techniques in 28%, (32/115). There was no association between the surgical technique used and complications (p = 0.558). There was no association between improvement in symptoms and surgical technique used (p = 0.560). There was a significant association between delayed post-operative neurological diagnosis and failure of the operation (p < 0.001). 21 (18%) patients required a second procedure.Conclusions: Pre-operative predictors of failure were patients with reflux symptoms (p = 0.013). Patients that required a second procedure were 37 times more likely to have a delayed diagnosis of an underlying neurological condition. Failure of symptoms to improve after supraglottoplasty should alert the clinician to the possibility of an underlying neurological disorder. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Clinical OtolaryngologyVolume 38, Issue 6 p. 563-564 Correspondence: Letters Electrocautery smoke evacuation simplified M. Puvanendran, M. Puvanendran [email protected] James Cook University Hospital, Middlesbrough, UKSearch for more papers by this authorK. Blackmore, K. Blackmore James Cook University Hospital, Middlesbrough, UKSearch for more papers by this author M. Puvanendran, M. Puvanendran [email protected] James Cook University Hospital, Middlesbrough, UKSearch for more papers by this authorK. Blackmore, K. Blackmore James Cook University Hospital, Middlesbrough, UKSearch for more papers by this author First published: 17 December 2013 https://doi.org/10.1111/coa.12193Read 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. Volume38, Issue6December 2013Pages 563-564 RelatedInformation

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Objective: We report a rare case of avascular necrosis of the maxilla secondary to oral bisphosphonates.Methods: Case report and review of the world literature concerning avascular necrosis as a result of bisphosphonate therapy.Case report: A 62-year-old woman presented with unilateral nasal obstruction, swelling of the cheek and an ulcerating lesion of the upper alveolus. She had a past medical history of osteoporosis, for which she took oral bisphosphonates. Investigation revealed necrosis of the maxilla, and avascular necrosis secondary to oral bisphosphonates was diagnosed.Conclusion: There have been several documented cases of avascular necrosis of the mandible and maxilla following intravenous bisphosphonates or dental procedures. In our case, bisphosphonates were only taken orally and no dental work had been undertaken. This patient's clinical presentation was highly suggestive of malignancy, and we would like to communicate this unusual case to other otolaryngologists.