ABSTRACT
OBJECTIVES: Otitis media with effusion (OME) is a common disease of childhood that is largely asymptomatic. However, middle ear fluid can persist for months and negatively impact a child's quality of life. Many cases of OME remain chronic and require surgical intervention. Because biofilms are known to contribute to the persistence of many diseases, this study examined effusions collected from children with chronic OME for the presence of essential biofilm structural components, members of the DNABII family of bacterial DNA-binding proteins. METHODS: Middle ear effusions were recovered from 38 children with chronic OME at the time of tympanostomy tube insertion. A portion of each specimen was submitted for microbiology culture. The remaining material was assessed by immunoblot to quantitate individual DNABII proteins, integration host factor (IHF), and histone-like protein (HU). RESULTS: Sixty-five percent of effusions (24 of 37) were culture-positive for bacterial species or yeast, whereas 35% (13 of 37) were culture-negative. IHF was detected in 95% (36 of 38) at concentrations from 2 to 481 ng/µL effusion. HU was detected in 95% (36 of 38) and quantitated from 13 to 5,264 ng/µL effusion (P ≤ 0.05 compared to IHF). CONCLUSION: Because DNABII proteins are essential structural components of bacterial biofilms, these data lend further support to our understanding that biofilms are present in the vast majority of chronic middle ear effusions, despite negative culture results. The presence and ubiquity of DNABII proteins in OME specimens indicated that these proteins can serve as an important clinical target for our novel DNABII-directed strategy to treat biofilm diseases such as chronic OME. LEVEL OF EVIDENCE: NA Laryngoscope, 130:806-811, 2020.
Subject(s)
Bacterial Proteins/analysis , Biofilms , Exudates and Transudates/chemistry , Otitis Media with Effusion , Adolescent , Bacterial Structures , Child , Child, Preschool , Exudates and Transudates/microbiology , Female , Humans , Infant , Male , Otitis Media with Effusion/microbiology , Young AdultABSTRACT
OBJECTIVES/HYPOTHESIS: Pediatric esophageal button battery (BB) injuries can progress even after removal and continue to be a significant source of morbidity and mortality. The objective in this case series is to present initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal. STUDY DESIGN: Retrospective case series. METHODS: Pediatric patients who underwent rigid esophagoscopy for BB removal between October 2016 and December 2017 and who had the injury site irrigated with 120 to 150 mL sterile 0.25% acetic acid (pH = 3) were included in the study. Outcome measures included visual tissue appearance after irrigation, immediate or delayed esophageal perforation, and evidence of eventual esophageal stricture formation. RESULTS: Six pediatric patients (aged 19 months-10 years) had a 3 V lithium BB lodged in the esophagus for 2 to 18 hours and had irrigation of the esophageal injury site with sterile 0.25% acetic acid in the operating room after BB removal. None of the patients showed any evidence of thermal tissue injury. By surgeon assessment, all cases had improved visual esophageal tissue appearance. Neither immediate post-operative or delayed onset esophageal perforation nor eventual stricture development were seen. CONCLUSIONS: Esophageal irrigation in the operating room with sterile 0.25% acetic acid after BB removal, to neutralize the highly alkaline tissue microenvironment (pH 10-13) was safe and resulted in improved visual mucosal appearance. This immediate tissue pH neutralization may help halt the progression of liquefactive necrosis by immediately bringing tissue pH to physiologic range. This post-removal irrigation technique is recommended by current National Capital Poison Center BB guidelines. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1772-1776, 2019.
Subject(s)
Burns, Chemical/therapy , Electric Power Supplies/adverse effects , Esophagus/injuries , Foreign Bodies/therapy , Therapeutic Irrigation/methods , Burns, Chemical/etiology , Child , Child, Preschool , Esophageal Perforation/etiology , Esophageal Perforation/therapy , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Esophagoscopy , Esophagus/surgery , Female , Foreign Bodies/complications , Humans , Hydrogen-Ion Concentration , Infant , Lithium , Male , Radioisotopes , Retrospective Studies , Treatment OutcomeABSTRACT
A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution.
