Lingual Hamartomas: Clinical Characteristics, Diagnostic Evaluation, Treatment, and Outcomes.

OBJECTIVES/HYPOTHESIS: To further clinically characterize lingual hamartomas, and to consolidate literature by analyzing clinical presentation, diagnostic evaluation, treatment, and outcomes. STUDY DESIGN: Retrospective chart review and literature review. METHODS: Case series from 1989 to 2020 at a tertiary pediatric center; follow-up ranging from 2 months to 12 years. Patient demographics, clinical presentations, physical examination findings, surgical pathology, operative methods, pre-operative imaging, and follow-up. A review of English-language literature from 1945 to 2020 was conducted. RESULTS: Seven patients (four male, three female) with nine lingual hamartomas were identified. Average age at surgical excision was 7.9 months (SD 3.5 months, range 3 to 14 months). Follow-up ranged from 2 months to 12 years, with all patients having no recurrence. Physical examination identified five pedunculated hamartomas and two sessile hamartomas. One patient had a neck CT, one had neck ultrasound, and two had facial MRIs. CT and ultrasounds confirmed presence of cervical thyroid. MRI suggested no muscular invasion for one patient, whereas motion artifact obscured findings for the other patient. Most patients who presented with dysphagia or poor weight gain achieved post-surgical improvement. The present cases combined with the literature review identified 57 patients with 63 lingual hamartomas. CONCLUSIONS: Lingual hamartomas appear as hypovascular pedunculated masses near the foramen cecum. There is no demographic predisposition, and most are identified during infancy. Imaging is not necessary, unless there is concern for lingual thyroid, in which case thyroid ultrasound should be performed. Surgical excision is curative, with dysphagia resolution and low likelihood for recurrence. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2080-E2088, 2021.

Historical patterns in presentations at the American Society of Pediatric Otolaryngology (ASPO): using a searchable database of the ASPO Program to show the trends of an otolaryngology subspecialty.

OBJECTIVES: To describe the development of American Society of Pediatric Otolaryngology (ASPO). To utilize a searchable database of meeting programs to demonstrate content presented at a major meeting since its inception. To utilize a searchable database of meeting programs to show trends of pediatric otolaryngology. METHODS: Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck masses, and sinus disease. First author, location of first author, length of presentation, and publication status were collected for each podium presentation. RESULTS: An average of 49 (range 31-76) podium presentations were presented at each meeting. The average length of podium presentation was 8.3 min (range of 5-20 min). Tonsil and adenoids made up 9% (range 0-22%) of the program, otology made up 26% (range 15-44%) of the program, airway made up 34% (18-48%) the program, head and neck masses made up 8.7% (0-18.5%) of the program, sinus disease made up 6.2% (0-23%) of the program. Fifty-four percent (54%) of podium presentations were published. CONCLUSION: This is a unique example of utilizing searchable databases constructed from published programs of a major otolaryngology meeting to assess topics presented and areas of emphasis. The areas of emphasis at ASPO over its 26 years are airway, otology, tonsil and adenoid issues, head and neck masses, and sinus disease in the pediatric population. Percent of time given to each topic has changed from ASPO's beginning to today.

Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery.

OBJECTIVES: 1. To discuss the presentation, work up, and treatment of a series pediatric patients presenting with acute otogenic lateral sinus thrombosis (OLST). 2. To review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis. STUDY DESIGN: Retrospective case series. METHODS: Retrospective case series of seven patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using PubMed search terms "thrombosis and otitis media and anticoagulation" limited to English. RESULTS: Seven patients presented with acute otomastoiditis with sigmoid sinus thrombosis. Six patients were treated with anticoagulation for 1.5-12 months. Six patients underwent myringotomy with tube and 4 patients underwent cortical mastoidectomy without thrombectomy. Six patients had resolution of thrombosis by imaging in less than 6 months. Literature review of 19 pts with OLST showed that 95% had mastoidectomy and 84% had myrigotomy with tube. All 19 patients received anticoagulation. Sixteen patients had complete clinical recovery with recanalization or resolution of clot in 3 patients. CONCLUSIONS: The treatment of OLST is controversial. Most (23/26) patients had complete clinical recovery despite clot resolution in 9 of the 26 patients. Four patients had bleeding complication with anticoagulation. This series and literature review highlights the controversy of surgery and use of anticoagulation in the treatment of OLST and the need for further investigation.