Current opinion in otolaryngology & head and neck surgery, 2012
The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway rec... more The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway reconstruction has traditionally been the treatment of choice for this condition. Numerous recent publications now support the use of endoscopic techniques to both augment and sometimes replace open procedures. During the past 12 months, a significant interest in expanding the role of airway dilation with balloons to manage airway stenoses has emerged. Development of novel airway stents, to include bioabsorbable products, holds promise to decrease the morbidity of stenting procedures. Continued improvement in preoperative imaging, in the form of virtual bronchoscopy, may someday replace airway endoscopy for planning purposes. Additionally, perioperative management strategies and the use of novel adjuvants have been introduced with a goal of improving outcomes in both endoscopic and open techniques through better control of granulation. Ultimately, advances in tissue engineering may provide ...
International journal of pediatric otorhinolaryngology, 2001
Previous studies from our institution have noted difficulties in the surgical repair of subglotti... more Previous studies from our institution have noted difficulties in the surgical repair of subglottic stenosis (SGS) in children with Down Syndrome. The objectives of this paper were to update our 15 year experience in the Down Syndrome patient population, compare our results with our overall series of laryngotracheoplasty for SGS, and to report on the increased incidence of posterior glottic stenosis (PGS) within this group of patients. Medical records of all children with SGS and Down Syndrome evaluated between 1982 and 1997 were reviewed for history of prior intubation, tracheotomy, gastroesophageal reflux disease (GERD), pre-operative SGS grade, and decannulation. From this review several conclusions have been drawn. First, the risk factors for SGS appear to be the same in the Down Syndrome group as the general population. Second, SGS continues to be more prevalent among children with Down Syndrome than among children in the general population. Third, we have now found a higher rat...
Several studies have documented the prevalence and treatment of orbital complications secondary t... more Several studies have documented the prevalence and treatment of orbital complications secondary to pediatric rhinosinusitis, but to our knowledge, none have investigated the national health care burden of this disease since the introduction of the heptavalent pneumococcal vaccine (PCV-7). To identify the current public health burden of orbital complications of pediatric rhinosinusitis, and to determine if the introduction of the PCV-7 has resulted in a change in national practice patterns. Population-based study using the 2000 and 2009 Kids' Inpatient Databases to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009. Children diagnosed as having orbital complications of sinusitis were identified by corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes. Database analyses generated national estimates of summary statistics and comparison of trends over the 9-year period. Database analysis. National health care trends according to year. End points assessed included prevalence, age, sex, length of hospital stay, and treatment of disease. The estimated prevalence of orbital complications of sinusitis requiring hospitalization in the United States has slightly decreased from 5338 (95% CI, 4956-5720) admissions in 2000 to 4511 (95% CI, 4165-4858) in 2009. However, the mean age has increased from 4.77 (95% CI, 4.56-4.97) years to 6.07 (95% CI, 5.87-6.26) years. The proportion of children undergoing surgical treatment increased from 0.108 (95% CI, 0.093-0.123) to 0.195 (95% CI, 0.176-0.213). Total charges increased from $4,140,000 (95% CI, $3,440,000-$4,830,000) to $10,000,000 (95% CI, $8,480,000-$11,600,000) with a mean charge per admission increasing from $8390 (95% CI, $7096-$9685) in 2000 to $22,656 (95% CI, $19,997-$25,314) in 2009. The mean length of stay remained stable at 3.67 (95% CI, 3.37-3.97) to 4.05 (95% CI, 3.81-4.29) hospital days. The public health impact of orbital complications of pediatric rhinosinusitis continues to be substantial. Since the institution of the PCV-7 vaccine, national trends demonstrate a slightly decreased prevalence of hospital admissions. However, there is a shifting trend toward an older age at admission and a higher proportion of children undergoing surgical treatment.
The primary objective was to compare retention of knowledge of surgical risks in parents of child... more The primary objective was to compare retention of knowledge of surgical risks in parents of children having an adenotonsillectomy who received a preoperative handout or watched a video, in addition to standard counseling. A secondary objective was to determine whether time from counseling to day of surgery affects risk retention. Prospective randomized control study. Tertiary referral center. The study, conducted March 2010 through April 2011, included participants who had children undergoing adenotonsillectomy. The preoperative and postoperative test scores of those undergoing verbal counseling, counseling with handout, or counseling with video were compared. Forty-five participants were tasked to identify 9 risks of adenotonsillectomy. Preoperatively, participants identified an average of 6.8 (95% confidence interval [CI], 6.2-7.3) in the counseling group, 7.3 (95% CI, 6.4-8.3) in the counseling and handout group, and 6.6 (95% CI, 5.9-7.3) in the counseling and video group (P = .32). Postoperatively, participants identified an average of 5.8 (95% CI, 4.9-6.7) in the counseling group, 6.5 (95% CI, 5.3-7.6) in the counseling and handout group, and 5.2 (95% CI, 4.1-6.3) in the counseling and video group (P = .19). Time between preoperative counseling and day of surgery was inversely correlated with postoperative score (β -.34, P = .02). Participants were not able to identify all of the risks associated with adenotonsillectomy. There was no difference in identification of risks associated with adenotonsillectomy among different modalities of counseling. Participants retained more information when there was less time between the preoperative counseling and day of surgery.
Objective: 1) To review the otological presentation of children with primary ciliary dyskinesia (... more Objective: 1) To review the otological presentation of children with primary ciliary dyskinesia (PCD) treated medically and surgically. 2) To compare the audiological outcomes and complications of surgical management to medical management in children with PCD.
The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures ... more The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA. Retrospective analysis of 35 consecutive patients undergoing GGA using the GBAT system in conjunction with UPPP for the management of OSA during a 3-year period (1999 to 2002). Twenty-four patients had complete preoperative and postoperative polysomnographic data. A 70% reduction in the Respiratory Disturbance Index (RDI) and Apnea Index (AI) in the preoperative versus postoperative PSG (RDI, 52.9 +/- 17.1 versus 15.9 +/- 7.5; AI, 20.1 +/- 6.7 versus 6.1 +/- 4.5; P < or = 0.0001). The lowest oxygen desaturation increased from 80% to 88% (P = 0.0002), and the posterior airway increased from 7.9 to 12.6 mm (P < 0.0001). With a surgical cure defined as a greater than 50% reduction in the RDI and a final postoperative RDI of less than 20 events per hour, the true surgical cure rate was 67% (16 of 24 patients). The GBAT system performed in conjunction with UPPP can produce significant reductions in RDI and AI while improving the oxygen desaturation and enlarging the posterior airway space. The effective cure rates using the GBAT system are in agreement with previous reports in the literature using various GGA techniques. The GBAT may have some advantages in terms of simplicity and safety.
ABSTRACT Airway Student/Resident Case Report PostersSESSION TYPE: Medical Student/Resident Case R... more ABSTRACT Airway Student/Resident Case Report PostersSESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Recurrent pneumonia is uncommon in children and typically associated with prematurity, congenital respiratory tract abnormalities, and cardiovascular or neurological diseases. We present the case of a child with recurrent pneumonia and hemoptysis, secondary to a retained airway foreign body, who required a pulmonary resection.CASE PRESENTATION: EB is a 4-year-old male, with a 2 year history of chronic cough, who presented with a 2-day history of fever, cough, and hemoptysis. He was treated for 6 episodes of right lower lobe (RLL) pneumonia in the previous 2 years. Chest radiograph showed a RLL opacity and intravenous antibiotics were initiated. Chest computed tomography (CT) with contrast showed a nonspecific RLL consolidation with fluid and debris filled airways. Based on history and imaging results, flexible bronchoscopy with bronchoalveolar lavage (BAL) was performed. Flexible bronchoscopy revealed normal bronchial anatomy, but the orifice of the RLL bronchus was edematous, inflamed, and obstructed by granulation tissue. Distal to the obstruction, the visualized RLL airways had minimal secretions, but were dilated and appeared necrotic. BAL culture grew pan-sensitive non-mucoid Pseudomonas aeruginosa and EB was treated with a prolonged course of intravenous antibiotics. Following the antibiotics, repeat chest CT showed persistent RLL consolidation, atelectasis, and bronchiectasis (Figure 1). Repeat flexible bronchoscopy revealed a foreign body embedded in the granulation tissue at the orifice of the RLL. Rigid bronchoscopy could not remove the foreign body. Based on imaging and bronchoscopy findings, the RLL did not appear salvageable; therefore, lung resection was pursued, since surgery offered the opportunity to remove the foreign body and excise the diseased lung. The resected tissue was grossly abnormal with marked airway consolidation, fibrosis, and chronic inflammation (Figure 2). EB tolerated the procedure well with improved aeration of the right lung, and was discharged home on post-operative day five.DISCUSSION: While most children with FBA fully recover, a retained airway foreign body may lead to serious pulmonary complications, secondary to the resulting inflammation. Recurrent pneumonia, atelectasis, and bronchiectasis are common complications of the prolonged presence of an airway foreign body. Surgery is occasionally required for patients with long-standing pulmonary sequelae.CONCLUSIONS: Recurrent localized pneumonia in children should raise suspicion for a retained foreign body. Retained airway foreign bodies can lead to long term complications and recurrent pneumonia in children should be investigated with chest CT and flexible bronchoscopy.Reference #1: Karakoc F, Karadag B, Akbenlioglu C, et al. Foreign body aspiration: what is the outcome?. Pediatr Pulmonol. 2002;34(1):30-6.DISCLOSURE: The following authors have nothing to disclose: Nicholas Friedman, John Horton, Donald Moffitt, Mark Boseley, Jason CabootNo Product/Research Disclosure Information.
Archives of Otolaryngology–Head & Neck Surgery, 2007
To report preliminary results regarding the safety and efficacy of the 585-nm pulsed-dye laser (P... more To report preliminary results regarding the safety and efficacy of the 585-nm pulsed-dye laser (PDL) for the treatment of juvenile-onset recurrent respiratory papillomatosis (JORRP) in the pediatric population. Prospective longitudinal cohort study. Two pediatric otolaryngology referral centers. Twenty-three pediatric patients ranging in age from 6 months to 17 years. The 585-nm PDL was used for at least 1 treatment on each of these patients to treat JORRP of the true vocal folds or anterior commissure. Complications from the use of the 585-nm PDL in the treatment of JORRP. There was no evidence of anterior commissure webbing or true vocal fold scarring in this group of 23 patients followed up for 3 months to 1 year. The 585-nm PDL seems to be a safe instrument for treatment of JORRP. There is the potential that improved voice outcomes may be apparent when compared with traditional therapies because the vocal fold epithelium seems to be unharmed when treated with this method. Furthermore, the lack of epithelial damage incurred by the 585-nm PDL should enable more aggressive surgical excision of anterior commissure disease. Further prospective longitudinal studies examining voice outcomes are needed.
Archives of Otolaryngology–Head & Neck Surgery, 2006
To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to as... more To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to assess voice changes over time in the pediatric population. Prospective longitudinal study. Outpatient pediatric otolaryngology office practice. One hundred twenty parents of children aged 2 through 18 years having a variety of otolaryngological diagnoses including disorders that affect the voice. The previously validated Pediatric Voice Outcomes Survey and the PVRQOL were jointly administered to the parents of the study participants. Test-retest reliability was accomplished by having 70 caregivers repeat the instrument 2 weeks after the initial visit. The Cronbach alpha value was calculated to determine reliability. Instrument validity was determined by examining convergent and discriminant validity. Correlation of PVRQOL scores with Pediatric Voice Outcomes Survey scores. Reliability of the PVRQOL was established by evaluating the Cronbach alpha value (.96; P<.001) and by test-retest reliability (weighted kappa value, 0.8). Validity of the PVQROL was tested by evaluating its ability to show significant change in voice-related quality-of-life after adenoidectomy (discriminant validity) (P<.001). The PVQROL also proved valid when the overall score was correlated with the previously validated Pediatric Voice Outcomes Survey (r = 0.7; P<.001). The PVRQOL is a more comprehensive survey than the previously validated Pediatric Voice Outcomes Survey and is another valid instrument to examine the health-related quality-of-life issues in pediatric voice disorders.
Archives of Otolaryngology - Head and Neck Surgery, 2008
A 75-year-old man presented with a history of painless and palpable submandibular masses, which h... more A 75-year-old man presented with a history of painless and palpable submandibular masses, which he had noticed 1 month earlier. On physical examination, firm and slightly tender masses were palpated at both submandibular areas. The saliva was clear, and the results ...
Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem impl... more Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem implications and associated complications. OSAS affects children from infancy to adulthood and is responsible for behavioral, cognitive, and growth impairment as well as cardiovascular and perioperative respiratory morbidity and mortality. OSAS is associated commonly with comorbid conditions, including obesity and asthma. Adenotonsillectomy is the most commonly used treatment option for OSAS in childhood, but efforts are underway to identify medical treatment options.
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) ... more Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) has been primarily described in the neurology and psychiatry literature. The symptoms of this syndrome typically are a range of obsessive compulsive disorders and neuromuscular tics. The otolaryngologist occasionally becomes involved with these children when it is deemed that chronic tonsil infections are the source. We report here on a child diagnosed with PANDAS who presented with severe ventricular hyperfunction and adductor spasmodic dysphonia. She was treated with botulinum toxin, which resulted in a significant improvement in subjective voice as well as reduced jitter and shimmer on objective voice measurements. D
Current opinion in otolaryngology & head and neck surgery, 2012
The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway rec... more The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway reconstruction has traditionally been the treatment of choice for this condition. Numerous recent publications now support the use of endoscopic techniques to both augment and sometimes replace open procedures. During the past 12 months, a significant interest in expanding the role of airway dilation with balloons to manage airway stenoses has emerged. Development of novel airway stents, to include bioabsorbable products, holds promise to decrease the morbidity of stenting procedures. Continued improvement in preoperative imaging, in the form of virtual bronchoscopy, may someday replace airway endoscopy for planning purposes. Additionally, perioperative management strategies and the use of novel adjuvants have been introduced with a goal of improving outcomes in both endoscopic and open techniques through better control of granulation. Ultimately, advances in tissue engineering may provide ...
International journal of pediatric otorhinolaryngology, 2001
Previous studies from our institution have noted difficulties in the surgical repair of subglotti... more Previous studies from our institution have noted difficulties in the surgical repair of subglottic stenosis (SGS) in children with Down Syndrome. The objectives of this paper were to update our 15 year experience in the Down Syndrome patient population, compare our results with our overall series of laryngotracheoplasty for SGS, and to report on the increased incidence of posterior glottic stenosis (PGS) within this group of patients. Medical records of all children with SGS and Down Syndrome evaluated between 1982 and 1997 were reviewed for history of prior intubation, tracheotomy, gastroesophageal reflux disease (GERD), pre-operative SGS grade, and decannulation. From this review several conclusions have been drawn. First, the risk factors for SGS appear to be the same in the Down Syndrome group as the general population. Second, SGS continues to be more prevalent among children with Down Syndrome than among children in the general population. Third, we have now found a higher rat...
Several studies have documented the prevalence and treatment of orbital complications secondary t... more Several studies have documented the prevalence and treatment of orbital complications secondary to pediatric rhinosinusitis, but to our knowledge, none have investigated the national health care burden of this disease since the introduction of the heptavalent pneumococcal vaccine (PCV-7). To identify the current public health burden of orbital complications of pediatric rhinosinusitis, and to determine if the introduction of the PCV-7 has resulted in a change in national practice patterns. Population-based study using the 2000 and 2009 Kids' Inpatient Databases to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009. Children diagnosed as having orbital complications of sinusitis were identified by corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes. Database analyses generated national estimates of summary statistics and comparison of trends over the 9-year period. Database analysis. National health care trends according to year. End points assessed included prevalence, age, sex, length of hospital stay, and treatment of disease. The estimated prevalence of orbital complications of sinusitis requiring hospitalization in the United States has slightly decreased from 5338 (95% CI, 4956-5720) admissions in 2000 to 4511 (95% CI, 4165-4858) in 2009. However, the mean age has increased from 4.77 (95% CI, 4.56-4.97) years to 6.07 (95% CI, 5.87-6.26) years. The proportion of children undergoing surgical treatment increased from 0.108 (95% CI, 0.093-0.123) to 0.195 (95% CI, 0.176-0.213). Total charges increased from $4,140,000 (95% CI, $3,440,000-$4,830,000) to $10,000,000 (95% CI, $8,480,000-$11,600,000) with a mean charge per admission increasing from $8390 (95% CI, $7096-$9685) in 2000 to $22,656 (95% CI, $19,997-$25,314) in 2009. The mean length of stay remained stable at 3.67 (95% CI, 3.37-3.97) to 4.05 (95% CI, 3.81-4.29) hospital days. The public health impact of orbital complications of pediatric rhinosinusitis continues to be substantial. Since the institution of the PCV-7 vaccine, national trends demonstrate a slightly decreased prevalence of hospital admissions. However, there is a shifting trend toward an older age at admission and a higher proportion of children undergoing surgical treatment.
The primary objective was to compare retention of knowledge of surgical risks in parents of child... more The primary objective was to compare retention of knowledge of surgical risks in parents of children having an adenotonsillectomy who received a preoperative handout or watched a video, in addition to standard counseling. A secondary objective was to determine whether time from counseling to day of surgery affects risk retention. Prospective randomized control study. Tertiary referral center. The study, conducted March 2010 through April 2011, included participants who had children undergoing adenotonsillectomy. The preoperative and postoperative test scores of those undergoing verbal counseling, counseling with handout, or counseling with video were compared. Forty-five participants were tasked to identify 9 risks of adenotonsillectomy. Preoperatively, participants identified an average of 6.8 (95% confidence interval [CI], 6.2-7.3) in the counseling group, 7.3 (95% CI, 6.4-8.3) in the counseling and handout group, and 6.6 (95% CI, 5.9-7.3) in the counseling and video group (P = .32). Postoperatively, participants identified an average of 5.8 (95% CI, 4.9-6.7) in the counseling group, 6.5 (95% CI, 5.3-7.6) in the counseling and handout group, and 5.2 (95% CI, 4.1-6.3) in the counseling and video group (P = .19). Time between preoperative counseling and day of surgery was inversely correlated with postoperative score (β -.34, P = .02). Participants were not able to identify all of the risks associated with adenotonsillectomy. There was no difference in identification of risks associated with adenotonsillectomy among different modalities of counseling. Participants retained more information when there was less time between the preoperative counseling and day of surgery.
Objective: 1) To review the otological presentation of children with primary ciliary dyskinesia (... more Objective: 1) To review the otological presentation of children with primary ciliary dyskinesia (PCD) treated medically and surgically. 2) To compare the audiological outcomes and complications of surgical management to medical management in children with PCD.
The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures ... more The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA. Retrospective analysis of 35 consecutive patients undergoing GGA using the GBAT system in conjunction with UPPP for the management of OSA during a 3-year period (1999 to 2002). Twenty-four patients had complete preoperative and postoperative polysomnographic data. A 70% reduction in the Respiratory Disturbance Index (RDI) and Apnea Index (AI) in the preoperative versus postoperative PSG (RDI, 52.9 +/- 17.1 versus 15.9 +/- 7.5; AI, 20.1 +/- 6.7 versus 6.1 +/- 4.5; P < or = 0.0001). The lowest oxygen desaturation increased from 80% to 88% (P = 0.0002), and the posterior airway increased from 7.9 to 12.6 mm (P < 0.0001). With a surgical cure defined as a greater than 50% reduction in the RDI and a final postoperative RDI of less than 20 events per hour, the true surgical cure rate was 67% (16 of 24 patients). The GBAT system performed in conjunction with UPPP can produce significant reductions in RDI and AI while improving the oxygen desaturation and enlarging the posterior airway space. The effective cure rates using the GBAT system are in agreement with previous reports in the literature using various GGA techniques. The GBAT may have some advantages in terms of simplicity and safety.
ABSTRACT Airway Student/Resident Case Report PostersSESSION TYPE: Medical Student/Resident Case R... more ABSTRACT Airway Student/Resident Case Report PostersSESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Recurrent pneumonia is uncommon in children and typically associated with prematurity, congenital respiratory tract abnormalities, and cardiovascular or neurological diseases. We present the case of a child with recurrent pneumonia and hemoptysis, secondary to a retained airway foreign body, who required a pulmonary resection.CASE PRESENTATION: EB is a 4-year-old male, with a 2 year history of chronic cough, who presented with a 2-day history of fever, cough, and hemoptysis. He was treated for 6 episodes of right lower lobe (RLL) pneumonia in the previous 2 years. Chest radiograph showed a RLL opacity and intravenous antibiotics were initiated. Chest computed tomography (CT) with contrast showed a nonspecific RLL consolidation with fluid and debris filled airways. Based on history and imaging results, flexible bronchoscopy with bronchoalveolar lavage (BAL) was performed. Flexible bronchoscopy revealed normal bronchial anatomy, but the orifice of the RLL bronchus was edematous, inflamed, and obstructed by granulation tissue. Distal to the obstruction, the visualized RLL airways had minimal secretions, but were dilated and appeared necrotic. BAL culture grew pan-sensitive non-mucoid Pseudomonas aeruginosa and EB was treated with a prolonged course of intravenous antibiotics. Following the antibiotics, repeat chest CT showed persistent RLL consolidation, atelectasis, and bronchiectasis (Figure 1). Repeat flexible bronchoscopy revealed a foreign body embedded in the granulation tissue at the orifice of the RLL. Rigid bronchoscopy could not remove the foreign body. Based on imaging and bronchoscopy findings, the RLL did not appear salvageable; therefore, lung resection was pursued, since surgery offered the opportunity to remove the foreign body and excise the diseased lung. The resected tissue was grossly abnormal with marked airway consolidation, fibrosis, and chronic inflammation (Figure 2). EB tolerated the procedure well with improved aeration of the right lung, and was discharged home on post-operative day five.DISCUSSION: While most children with FBA fully recover, a retained airway foreign body may lead to serious pulmonary complications, secondary to the resulting inflammation. Recurrent pneumonia, atelectasis, and bronchiectasis are common complications of the prolonged presence of an airway foreign body. Surgery is occasionally required for patients with long-standing pulmonary sequelae.CONCLUSIONS: Recurrent localized pneumonia in children should raise suspicion for a retained foreign body. Retained airway foreign bodies can lead to long term complications and recurrent pneumonia in children should be investigated with chest CT and flexible bronchoscopy.Reference #1: Karakoc F, Karadag B, Akbenlioglu C, et al. Foreign body aspiration: what is the outcome?. Pediatr Pulmonol. 2002;34(1):30-6.DISCLOSURE: The following authors have nothing to disclose: Nicholas Friedman, John Horton, Donald Moffitt, Mark Boseley, Jason CabootNo Product/Research Disclosure Information.
Archives of Otolaryngology–Head & Neck Surgery, 2007
To report preliminary results regarding the safety and efficacy of the 585-nm pulsed-dye laser (P... more To report preliminary results regarding the safety and efficacy of the 585-nm pulsed-dye laser (PDL) for the treatment of juvenile-onset recurrent respiratory papillomatosis (JORRP) in the pediatric population. Prospective longitudinal cohort study. Two pediatric otolaryngology referral centers. Twenty-three pediatric patients ranging in age from 6 months to 17 years. The 585-nm PDL was used for at least 1 treatment on each of these patients to treat JORRP of the true vocal folds or anterior commissure. Complications from the use of the 585-nm PDL in the treatment of JORRP. There was no evidence of anterior commissure webbing or true vocal fold scarring in this group of 23 patients followed up for 3 months to 1 year. The 585-nm PDL seems to be a safe instrument for treatment of JORRP. There is the potential that improved voice outcomes may be apparent when compared with traditional therapies because the vocal fold epithelium seems to be unharmed when treated with this method. Furthermore, the lack of epithelial damage incurred by the 585-nm PDL should enable more aggressive surgical excision of anterior commissure disease. Further prospective longitudinal studies examining voice outcomes are needed.
Archives of Otolaryngology–Head & Neck Surgery, 2006
To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to as... more To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to assess voice changes over time in the pediatric population. Prospective longitudinal study. Outpatient pediatric otolaryngology office practice. One hundred twenty parents of children aged 2 through 18 years having a variety of otolaryngological diagnoses including disorders that affect the voice. The previously validated Pediatric Voice Outcomes Survey and the PVRQOL were jointly administered to the parents of the study participants. Test-retest reliability was accomplished by having 70 caregivers repeat the instrument 2 weeks after the initial visit. The Cronbach alpha value was calculated to determine reliability. Instrument validity was determined by examining convergent and discriminant validity. Correlation of PVRQOL scores with Pediatric Voice Outcomes Survey scores. Reliability of the PVRQOL was established by evaluating the Cronbach alpha value (.96; P<.001) and by test-retest reliability (weighted kappa value, 0.8). Validity of the PVQROL was tested by evaluating its ability to show significant change in voice-related quality-of-life after adenoidectomy (discriminant validity) (P<.001). The PVQROL also proved valid when the overall score was correlated with the previously validated Pediatric Voice Outcomes Survey (r = 0.7; P<.001). The PVRQOL is a more comprehensive survey than the previously validated Pediatric Voice Outcomes Survey and is another valid instrument to examine the health-related quality-of-life issues in pediatric voice disorders.
Archives of Otolaryngology - Head and Neck Surgery, 2008
A 75-year-old man presented with a history of painless and palpable submandibular masses, which h... more A 75-year-old man presented with a history of painless and palpable submandibular masses, which he had noticed 1 month earlier. On physical examination, firm and slightly tender masses were palpated at both submandibular areas. The saliva was clear, and the results ...
Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem impl... more Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem implications and associated complications. OSAS affects children from infancy to adulthood and is responsible for behavioral, cognitive, and growth impairment as well as cardiovascular and perioperative respiratory morbidity and mortality. OSAS is associated commonly with comorbid conditions, including obesity and asthma. Adenotonsillectomy is the most commonly used treatment option for OSAS in childhood, but efforts are underway to identify medical treatment options.
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) ... more Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) has been primarily described in the neurology and psychiatry literature. The symptoms of this syndrome typically are a range of obsessive compulsive disorders and neuromuscular tics. The otolaryngologist occasionally becomes involved with these children when it is deemed that chronic tonsil infections are the source. We report here on a child diagnosed with PANDAS who presented with severe ventricular hyperfunction and adductor spasmodic dysphonia. She was treated with botulinum toxin, which resulted in a significant improvement in subjective voice as well as reduced jitter and shimmer on objective voice measurements. D
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Papers by Mark Boseley