Allergic rhinitis facts from an Irish pediatric population.

Objective: Assessing the main allergens in the pediatric population from the largest urban area in the country. Methods: Clinical letters of patients referred with possible allergic rhinitis (AR) were retrospectively reviewed over the past 5 years. Results: Five hundred and fifty-five patients were included. Males suffer twice as often with AR than females and have high titers of allergens. House dust mites (44.7%) and grass pollen (29%) were the main allergens in our area, with 48% of patients sensitized to both allergens. Half of the patients had the diagnosis of AR confirmed with positive allergen-specific tests. For the other half, the diagnosis was based on a clinical assessment performed by a pediatric otolaryngologist. Conclusions: Half of suspected AR children have environmental allergen sensitivity confirmed by testing, and a large number had a clinical diagnosis of AR after an otolaryngology consultation. Our findings can help clinicians to initiate AR treatment considering the most problematic allergens in the area.

Does Mandibular Distraction Change the Laryngoscopy Grade in Infants With Robin Sequence?

PURPOSE: To review a series of infants with Robin sequence (RS) who underwent mandibular distraction osteogenesis (MDO) at the authors' institution and document changes in pre- and postoperative laryngoscopy grades. MATERIALS AND METHODS: Consecutive patients with RS who underwent MDO from March 2005 to June 2017 were identified. Patients were included if they had a preoperative polysomnogram confirming obstructive sleep apnea, had failed nonoperative airway management, had undergone MDO by the senior author (C.M.R.), and had complete documentation. Patients were excluded if they did not have a laryngoscopy performed (ie, tracheostomy dependent) or if there was insufficient information in their medical record. Variables included demographic data, operative information, and laryngoscopic details at 3 time points: before MDO (T0), at device removal (T1), and at latest follow-up laryngoscopy (T2). Descriptive statistics were computed. Significance was set at a P value less than .05. RESULTS: Twenty-two infants with RS underwent MDO during the study period and 13 of these met criteria for inclusion. Mean age at MDO (T0) was 19.6 ± 38.8 weeks. Mean ages at device removal (T1) and latest follow-up laryngoscopy (T2) were 28.2 ± 41.5 and 62.7 ± 49.6 weeks, respectively. Three patients had Stickler syndrome; the others had nonsyndromic RS. Mean apnea-hypopnea index was 23.6 ± 16.6 preoperatively and 0.3 ± 0.7 after MDO (P = .011). At T0, a grade IIb laryngoscopic view was most common (46.1%) and only 3 patients (23.1%) had a grade I view. At T1, most patients (69.2%) had a grade I view and only 2 (14.4%) had a grade of IIb or worse (P = .011). At T2, all but 1 patient had a grade I view. CONCLUSION: In addition to resolving obstructive apnea, MDO is associated with an improvement in the grade of laryngoscopic view. This could increase airway safety at home and improve ease of intubation for future operations.

Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children.

OBJECTIVE(S): The objective was to describe the characteristics of hearing losses documented in patients treated with clarithromycin alone for nontuberculous mycobacterial NTM lymphadenitis in a pediatric tertiary care center over a 12-year period. METHODS: An institutional review board (IRB) approval was obtained. A database search was performed using the ICD-10 diagnosis codes 31.0, 31.1, and 31.8 between January 2004 and January 2017. A REDCap database was created to record variables. Patients were included if they received clarithromycin alone and had, at the minimum, a baseline audiology assessment, and 1 further evaluation during treatment. Fisher's exact test was used to analyze categorical variables, and Wilcoxon rank sum test was used to analyze continuous variables. RESULTS: A total of 167 patients with cervicofacial NTM were identified. Of them, 42 patients fulfilled inclusion criteria. Three children (7%) developed a hearing loss (HL) between 25 and 63 days after starting treatment. HL was unilateral in 2 children. HL persisted in 1 child following cessation of treatment. However, this patient had Rubinstein Taybi syndrome, limiting our ability to attribute the HL solely to clarithromycin. CONCLUSION: We noted a 7% hearing loss rate in our series. Confounding issues, such as 1 patient with a syndrome potentially contributing to HL, and limitations to this study, including retrospective design and loss to follow-up, temper our ability to conclude that clarithromycin was the sole cause of these HL. However, enough supporting data for a role in clarithromycin causing HL exist that testing should be considered for patients undergoing long-term clarithromycin treatment.

Effect of tonsillectomy on the adult voice.

OBJECTIVES AND HYPOTHESIS: Anecdotal evidence suggests that tonsillectomy has no deleterious consequences on a person's voice under normal vocal demand. However, whether the enlarged dimensions of the oropharynx after tonsillectomy impair the quality of a professional voice user remains unclear. Therefore, we designed a study to determine whether adult tonsillectomy altered the resonance characteristics of the vocal tract in any way and whether these changes were transient or permanent. STUDY DESIGN: This is a prospective observational study with full institutional ethical approval. METHODS: All adult patients presenting for tonsillectomy for recurrent tonsillitis in our institution were recruited. Their voice was recorded preoperatively, postoperatively, and at 4 weeks postoperatively. The values of the first four formants were calculated in all recordings. The oropharyngeal dimensions were measured preoperatively and postoperatively. Tonsillar weights and volumes were also measured. RESULTS: The first formant was noted to rise postoperatively. The average value of F2 and F3 did not alter postoperatively or at 4 weeks. However, it was noted that the fourth formant was not universally present preoperatively but was present in all patients postoperatively and at 4 weeks. CONCLUSIONS: Altering the dimensions of the oropharynx after tonsillectomy causes the first formant to rise but has no effect on the third and fourth formants. However, the fourth formant appears in patients who previously did not demonstrate it. The fourth formant was present in a greater proportion of male patients preoperatively than female patients, but it was universally present postoperatively and at 4 weeks in both sexes. This suggests that increasing the horizontal dimensions of the oropharynx has a nontransient effect on the higher order formants of the voice.