Reversible profound sensorineural hearing loss due to propranolol sensitive hemangioma in an infant with PHACE syndrome.

PHACE syndrome is the association of large or segmental infantile hemangiomas of the face or scalp with abnormalities within the posterior fossa, arteries, cardiovascular system, and eyes. We present a case of reversible profound sensorineural hearing loss due to a cerebellopontine angle infantile hemangioma that was successfully treated with propranolol.

Novel Application of Steroid Eluting Stents in Choanal Atresia Repair: A Case Series.

PURPOSE: To describe the application of mometasone furoate eluting sinus stent technology in the treatment of choanal atresia (CA) in the hopes of preventing postsurgical stenosis. METHODS: We analyzed 3 consecutive patients aged 4 days to 16 years undergoing repair of CA at a tertiary pediatric hospital. Mometasone furoate eluting sinus stents were placed intraoperatively. Postoperative need for revision surgery as well as routine surveillance endoscopy were used to determine success of surgery. RESULTS: Three patients of varying age and etiology underwent successful repair of choanal atresia/stenosis. The steroid eluting sinus stent was deployed successfully in all 3 cases. There was no identifiable restenosis in any of the 3 patients with 12-month follow-up. There were no complications noted throughout the follow-up period. CONCLUSIONS: Choanal atresia is a rare disorder that can prove difficult in postsurgical management. In our case series, mometasone furoate eluting stents were effective and safe for the management of this disease process. Further prospective studies are needed to determine the exact safety profile, long-term consequences, and efficacy of steroid eluting sinus stents in the pediatric population.

Predictors of Airway Intervention in Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema.

OBJECTIVES: Identify factors associated with angiotensin-converting enzyme inhibitor-induced angioedema (AIIA), including (1) time of presentation, (2) clinical symptoms, and (3) anatomical regions in the head and neck, that may indicate need for airway intervention. STUDY DESIGN: Case series with chart review. SETTING: Three university tertiary care hospitals. SUBJECTS AND METHODS: Medical records of adult patients presenting to the emergency department (ED) diagnosed with AIIA within a 3-year period were reviewed. Time at presentation, presenting symptoms, physical examination findings, treatment, length of hospitalization, and outcomes were examined. Univariate analysis was performed. RESULTS: 311 patients were diagnosed with AIIA and evaluated with flexible laryngoscopy by an otolaryngologist. Patients requiring airway intervention most often presented within 4 hours of onset. Dysphagia, dysphonia, drooling, respiratory distress, and globus sensation were associated with airway intervention (χ(2) range, 9.1-47.1). Patients with edema of the face, lower lip, and upper lip were at low risk for airway intervention (odds ratio = 0.4, 0.3, and 0.4, respectively; all P values <.05), while those with involvement of the tongue, soft palate, vallecula, aryepiglottic folds, and true vocal cords were associated with highest risk (odds ratio = 11.1, 12.3, 9.9, 8.5, and 33.5, respectively; all P values < .001). CONCLUSION: This is the largest patient series to date of AIIA patients evaluated with flexible laryngoscopy. Physicians should be aware of certain risk factors that will require a higher acuity level of care, including (1) presentation within 4 hours of symptom onset, (2) symptoms such as drooling and respiratory distress, (3) and involvement of the tongue, soft palate, and larynx.

The association between pediatric general emergency department visits and post operative adenotonsillectomy hospital return.

PURPOSE: To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following adenotonsillectomy. METHODS: Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. RESULTS: There was a significant relationship between patients who visited the ED pre-operatively, 25% (N=96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit (χ(2)=53.6, df=1, p<0.001), female gender (female=56.9%; male=43.1%; χ(2)=4.2, df=1, p=0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST=18%; RST=17.5%; OSA=11.8%; χ(2)=12.8, p=0.002) and having a post-operative ED visit. CONCLUSION: Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints.