Objective:Signaling was introduced to the otolaryngology match in 2021, with 5 signals allotted to applicants in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. This study investigated the modifying effect of signaling volume on the relationship between away rotations and matching in otolaryngology from 2018 to 2024. Study Design:Cross-sectional. Setting:National survey of US medical students. Methods:We used the Texas Seeking Transparency in Application to Residency (STAR) survey responses of otolaryngology applicants from 2018 to 2024. Using multivariate logistic regression, we determined the odds of matching where away rotations were performed and how these odds varied across the pre-volume (2018-2020), low-volume (2021-2023), and high-volume (2024) signaling eras. Results:In total, 28.3% (n = 855) of otolaryngology applicants from 2018 to 2024 completed the Texas STAR survey. Using multivariate logistic regression, adjusting for applicant characteristics, and including an interaction term between performing away rotations and signaling time period, applicants in the high-volume signaling era were found to be significantly less likely to match at programs where away rotations were performed (odds ratio [OR]: 0.56, 95% CI: 0.33-0.95; P < .05) compared to the pre-signaling era. The same trend was seen in the low-volume signaling era, though not statistically significant (OR: 0.76, 95% CI: 0.47-1.22, P = .24). The most impactful factor on matching across all study years was performing an away rotation (OR: 12.1, 95% CI: 9.0-16.5, P < .001). Conclusion:The introduction of signaling and the recent increase in signal number are associated with decreased likelihood of matching at a program where an away rotation was performed compared to the pre-signaling era. Level of Evidence:V.

Introduction: Pediatric-type follicular lymphoma (PTFL) is a rare B-cell lymphoma that primarily affects the head and neck, accounting for approximately 1.5-2% of childhood lymphomas. Distinguishing between follicular lymphoma and PTFL is critical due to their distinct clinical characteristics, which influence prognosis and treatment. Case presentation: Two patients, a 14-year-old male (Case 1) and a 17-year-old male (Case 2), presented to the pediatric otolaryngology clinic with complaints of an isolated neck and parotid masses, respectively. In Case 1, physical examination revealed a 5 cm upward-growing neck mass without accompanying B symptoms or discomfort. CT scan, needle biopsy, and MRI with contrast confirmed the presence of the mass, which was subsequently surgically excised. In Case 2, the patient had an enlarging left-sided parotid mass, along with night sweats, fatigue, and arthralgias. Ultrasound and contrast-enhanced MRI confirmed a well-defined solid vascular mass within the left parotid gland, which was subsequently surgically excised. Pathological examination confirmed PTFL in both cases, leading to a positron emission tomography (PET)/CT scan for further evaluation and staging. Conclusion: This case series underscores the importance of pediatric surgeons to consider PTFL in the differential diagnosis of head and neck masses, as it can be effectively cured through surgical excision.

Objective: To report our institutional experience in diagnosing and surveilling patients with infantile subglottic hemangioma (SGH) using in-office flexible fiberoptic laryngoscopy (FFL) with video technology, without requiring operative endoscopy in the era of propranolol use. Methods: A retrospective case series was conducted on 4 children diagnosed with SGH between 2016 and 2022 at our institution. Results: Awake FFL with video technology provided adequate visualization of SGH lesions for diagnosis, without any complications. Serial examinations of the airway were performed in the outpatient setting and each SGH gradually regressed, with marked improvement in respiratory symptoms within 48 hours of oral propranolol initiation. Conclusion: Our findings showed that in select patients, FFL with video technology can successfully identify SGH lesions without general anesthesia exposure. FFL may be used as a low-risk screening tool for propranolol therapy initiation in some patients, but operative endoscopy should remain the gold standard procedure for others. By utilizing FFL in this manner, it is possible to diagnose SGH lesions and start propranolol therapy without exposing all patients to the risks of operative endoscopy.

AbstractObjectiveTo assess differences in otorrhea, tympanic membrane perforation, and time to extrusion in children receiving one of four commonly used, short‐term ventilation tubes for the first time.MethodsRetrospective chart review of 2 years of postoperative follow‐up to analyze patient outcomes after insertion of either a Paparella type‐I Activent, Armstrong Beveled, Modified Armstrong, or Armstrong Microgel ventilation tube. Incidence of complications was determined by reviewing provider notes. Adjusted multivariate logistic regression models were used to determine odds ratios of complications among the four tube types.ResultsA total of 387 patients were reviewed. The mean age was 2.4 years and 35.9% were female. Armstrong beveled tubes had the highest odds of otorrhea. Paparella type‐I tube had the shortest time to extrusion of about 9 months, while Armstrong Beveled had the longest, at almost 19 months. When evaluating episodes of otorrhea each child experienced on average, per month, Armstrong beveled tubes had the highest monthly rate of otorrhea and Paparella type‐I the least. No significant differences were found regarding tympanic membrane perforation.ConclusionsThis retrospective chart review showed that no tube was clinically superior across all complications. The findings from this study may give otolaryngologists an opportunity to consider choosing a specific type of tube according to the clinical situation. The large variations in extrusion times should be considered in terms of patient age, seasonality, and desired duration of tube placement.Level of Evidence4.

AbstractObjectiveThe process of resident recruitment is costly, and our surgical residency program expends significant time on the resident selection process while balancing general duties and responsibilities. The aim of our study was to explore the relationship between otolaryngology–head and surgery (OHNS) residents' National Residency Matching Program (NRMP) rank‐list position at our institution and their subsequent residency performance.Study DesignRetrospective cohort study.SettingSingle site institution.MethodsWe retrospectively reviewed 7 consecutive resident classes (2011‐2017) at a single tertiary OHNS residency program. We reviewed each resident's absolute rank order in the NRMP matches. Measures of residency performance included overall faculty evaluation during postgraduate year 5 (PGY5), annual in‐service examination scores (scaled score), and the number of manuscripts published in peer‐reviewed journals. Correlations between NRMP rank order and subsequent residency performance were assessed using Spearman's rho correlation coefficients (ρ).ResultsTwenty‐eight residents entered residency training between 2011 and 2017. The average rank position of the trainees during this study was 9.7 (range: 1‐22). We found no significant correlation between rank order and faculty evaluation during PGY5 (ρ = 0.097, P = .625) or number of publications (ρ = −0.256, P = .189). Additionally, when assessing the association between rank order and annual Otolaryngology Training Examination‐scaled scores, no statistically significant relationship was found between the 2 (P > .05).ConclusionOur results showed that there were no significant correlations between OHNS rank order and various measures of success in residency training, which aligns with existing literature. Further investigation of this relationship should be conducted to ensure the applicability of our findings.

OBJECTIVE:Infantile subglottic hemangioma (SGH) poses a risk of airway compromise if untreated. Traditionally, operative endoscopy (OH) diagnoses SGH, but since the discovery of beta-blockers' efficacy in treating infantile hemangiomas (IHs) in 2008, and advances in endoscopic technology, nonoperative methods have emerged. This review identifies endoscopic practices for diagnosing and monitoring infantile SGH during the oral beta-blocker treatment era. DATA SOURCES:A comprehensive literature search in October 2022 and August 2023 covered PubMed, Embase, Cochrane Library, SCOPUS, and Web of Science. REVIEW METHODS:The search was limited to English-language studies published since 2008, considering this when propranolol was demonstrated as an effective treatment option for IH. The articles were screened for relevance based on predefined inclusion and exclusion criteria. RESULTS:After inclusion and exclusion criteria, sixty final studies were identified, describing 240 cases of infantile SGH. Most children were diagnosed using OE alone (73.3%; n = 176/240), 23.3% (n = 56/240) using office-based laryngoscopy procedures (OBPs) followed by OE, 3.3% using OBP alone (n = 8/240). There were no reported diagnostic endoscopy-related complications. Twenty-nine studies described using endoscopy plus diagnostic imaging to either confirm an SGH lesion, characterize the extent of disease spread, or rule out other causes of presenting symptoms. The proportion of infants diagnosed with OE alone decreased from 2008 to 2023. CONCLUSION:Operative endoscopy remains the SGH diagnostic standard, but OBP adoption is increasing. Further research is needed to determine the optimal SGH diagnosis and management approach. LEVEL OF EVIDENCE:NA Laryngoscope, 135:1287-1294, 2025.

BACKGROUND:External Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side. CASE PRESENTATION:A 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued. CONCLUSIONS:EJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

Currently, mal de debarquement syndrome (MdDS) has been reported only among adults. This case series de-scribes 3 pediatric patients with MdDS. MdDS presentation in children is similar to that of adults, although the fre-quency of comorbid conditions is greater. Diagnostic delays are common and likely due to under-recognition of MdDS among children.

Objective This study aimed to present 2 children clinically diagnosed with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome and treated with intracapsular tonsillectomy with adenoidectomy (ITA). Methods We conducted a retrospective analysis of 2 children who were referred for an otolaryngology consultation between 2019 and 2022 for surgical treatment of PFAPA syndrome. Both patients had symptoms strongly suggestive of PFAPA and were at risk for total tonsillectomy (TT) complications. ITA was performed using a microdebrider. Both patients were followed up postoperatively to assess for symptomatic resolution and complications. Results Two children exhibited recurrent febrile episodes prior to ITA. The procedure was efficacious in both patients, with neither experiencing postoperative complications or recurring PFAPA symptoms for over 1 year after surgery. Conclusion Our study reported on the use of ITA as a surgical treatment option for PFAPA. We showed that ITA eliminated febrile attacks and was safely performed without postoperative complications in 2 pediatric patients after 1‐year follow‐up. Future studies involving larger cohorts of PFAPA patients and lengthier follow‐ups will need to be conducted to further evaluate ITA as a surgical option. Laryngoscope , 134:1967–1969, 2024

OBJECTIVE:This report describes a new observation of hyperglycemia in a child with Type 1 diabetes after off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage and reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients.METHODS:We describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE.RESULTS:A 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. While the patient's airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient's continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. We also review 21 pediatric otolaryngology cases of iatrogenic Cushing's syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day.CONCLUSION:This is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions, to the best of our knowledge. Counseling families on precise dose administration and potential endocrine disturbances is critical when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes.

BACKGROUND:Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema. OBJECTIVE:To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema. METHODS:A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review. RESULTS/DISCUSSION:Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.

BACKGROUND:Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is a clinical syndrome of unclear etiology. PFAPA has generally been considered a non-hereditary fever syndrome; however, this has been called into question with recent reports of family clustering. Few reports have been published describing siblings with PFAPA. To our knowledge, this is the first report of siblings with near simultaneous onset of disease followed by synchronous disease flares.CASE PRESENTATION:We describe the case of near simultaneous onset of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis in siblings followed by synchronous disease flares of clear frequency and nearly identical character. Flares were characterized predominantly by fever, aphthous ulceration, cervical lymphadenitis, and the absence of infection. The fever episodes demonstrated a robust response to glucocorticoids and recurred in the same staggered manner every four weeks, with complete absence of symptoms and normal growth and development between episodes. Nine months after onset, the older sibling, a 5-year-old female, underwent tonsillectomy resulting in dramatic resolution of episodes. At the same time, her 2-year-old sister experienced resolution of her fever episodes, though she did not undergo tonsillectomy herself.CONCLUSION:This is an unusual case of simultaneous onset PFAPA followed by synchronous disease flares. PFAPA is an uncommon clinical syndrome, and it is rarely diagnosed in siblings. The etiology of PFAPA remains unclear. Though the disease is classically considered sporadic, there is a growing body of evidence to suggest that PFAPA may be heritable.

IMPORTANCE:Foreign body (FB) aspiration into the airway is a significant cause of pediatric morbidity and mortality, yet the clinical presentation is diverse and dynamic. There are conflicting recommendations which pre-procedural findings support performing a bronchoscopy, the gold standard for diagnosis and removal of FBs, however a procedure that entails general anesthesia and possible risks.OBJECTIVE:Decision whether to proceed to a bronchoscopy may be challenging. Our goal was to enhance decision-making by analyzing the diagnostic values of the different pre-procedural findings in this setting.DATA SOURCES:A comprehensive search was performed in PUBMED, EMBASE and Cochrane Review databases to find studies from the last 19 years that reported pre-procedural history, physical examination and radiological findings in patients who had bronchoscopies.STUDY SELECTION:Studies were included of pediatric populations if they contained bronchoscopy results (positive and negative for foreign body) with a breakdown according to pre-intervention findings.DATA EXTRACTION AND SYNTHESIS:Titles and abstracts retrieved from our search were screened. Thereafter, full-texts were carefully reviewed and selected for inclusion if the aforementioned criteria were met. PRISMA guidelines for systematic review and meta-analyses were followed.MAIN OUTCOME(S) AND MEASURE(S):Cumulative weighted prevalence, sensitivity, specificity, positive and negative predictive values of each pre-procedural finding were calculated, as well as for the "classic triad" (history of an acute event, wheezing, and unilateral decreased breath sounds). Calculation for other combinations of findings, or optimally, constructing a weighted score based on all the findings for each specific patient were not possible to perform, as the specific data breakdown is rarely reported.RESULTS:Fifteen studies met inclusion criteria, totaling 5606 patients who underwent bronchoscopies. All studies but one were single center based and all except one were retrospective. No single finding has both positive and negative predictive values over 50%. The "classic triad" has 90% specificity, however only 35% sensitivity.CONCLUSIONS:The data is very heterogeneous with regard to pre-procedural findings and how best to guide treatment according to them. This meta-analysis provides cumulative weighted metrics for each finding, to optimize decision-making for the individual patient. Future reporting of data should be enhanced, so that combinations of findings for a specific patient can be used to optimize management.LEVEL OF EVIDENCE:4.

Objective: Laryngopharyngeal and Gastroesophageal reflux (LPR and GER) are distinct clinical entities that present with a range of non-specific symptoms. The exact prevalence in the pediatric population is unknown. While there has been an increase in the use of PPIs, lack of clear guidelines, conflicting evidence regarding efficacy and safety concerns with long-term use require physicians to use their own anecdotal experience and clinical judgement when treating patients. The goal of this study was to evaluate practice patterns among pediatric otolaryngologists regarding the use of proton-pump inhibitors for reflux-related conditions. Methods: A survey was submitted to American Society of Pediatric Otolaryngology (ASPO) members to determine practice patterns regarding use of PPIs for reflux-related conditions in the newborn and infant population. Statistical analysis using Fisher's exact test was performed. Results: 37% of respondents would not prescribe PO PPIs in neonates, with 50% not prescribing IV PPIs. 60% would prescribe a PPI as second or third-line treatment for infants (10 weeks to 1-year). Only 10% would prescribe as first-line in this age group. 48% would prescribe PPIs once daily and 19% as BID. No significant practice differences exist based on years of experience, number of relevant patients seen, and setting of practice. Conclusion: There was no agreement regarding dosage, frequency and duration of PPI treatment for reflux disease in neonates and infants. There was also no correlation with experience or practice setting. This emphasizes the need for a multidisciplinary approach and consensus statement to guide management of GER and LPR in this population.

Importance: Vascular anomalies of the head and neck are relatively rare lesions. Management is challenging because of the high likelihood of involvement of functionally critical structures. Multiple modalities of treatment exist for vascular anomalies of the head and neck, including medical therapies, sclerotherapy and embolization procedures, and surgery. This review focuses on the accurate diagnosis and the relative roles of the various therapeutic options.Observations: Vascular anomalies are classified by the International Society for the Study of Vascular Anomalies into 2 major groups: vascular tumors and vascular malformations. Vascular tumors encompass proliferative lesions ranging from infantile and congenital hemangiomas to kaposiform hemangioendothelioma. Alternatively, vascular malformations are embryologic errors in vasculogenesis. This article focuses on the management of vascular malformations. The 3 primary vascular malformation subclassifications are lymphatic, venous, and arteriovenous. The burden of disease, diagnosis, and current management options are discussed in detail for each subtype.Conclusions and Relevance: Most vascular malformations of the head and neck require a multidisciplinary approach. Available medical, interventional radiologic, and surgical interventions are constantly evolving. Optimization of function and cosmesis must be balanced with minimization of treatment-associated morbidity. Otolaryngologists-head and neck surgeons must remain up to date regarding options for diagnosis and management of these lesions. PMID: 33237296