Pediatric sialendoscopy: initial experience in a pediatric otolaryngology group practice.

OBJECTIVES/HYPOTHESIS: To describe the initial results of sialendoscopy as a diagnostic and therapeutic tool in pediatric inflammatory salivary gland disease. STUDY DESIGN: Retrospective review of patient medical records from a private practice consisting of three fellowship-trained pediatric otolaryngologists. METHODS: Consecutive pediatric patients with either recurrent or chronic sialadenitis underwent diagnostic and therapeutic sialendoscopy as an alternative to continued antibiotic therapy or surgical gland excision. Data collected included age, gender, indications for surgery, intraoperative findings, complications, recurrences, follow-up intervals, and need for additional procedures. RESULTS: Twelve pediatric patients underwent sialendsocopy (9 cases of juvenile recurrent parotitis, 3 cases of chronic submandibular sialadenitis. Intraoperative findings included ductal stricture (n = 8), thick intraductal mucus (n = 6), and ductal calculus (n = 1). The only postoperative complication was one case of a submandibular gland, which remained enlarged for 1 month postoperatively before resolving. Average follow-up was 16.5 months (range: 1-49 months), during which time two patients had recurrence (17%). One patient had repeated recurrences that only resolved after salvage parotidectomy. Another patient had one isolated recurrence that resolved with antibiotics. To date, 92% of patients have not required any further surgical intervention after a sialendoscopy procedure. CONCLUSIONS: Sialendoscopy was successfully implemented as a safe and effective technique for management of recurrent and chronic parotid and submandibular sialadenitis in a pediatric otolaryngology practice. LEVEL OF EVIDENCE: 4.

Murine intracochlear drug delivery: reducing concentration gradients within the cochlea.

Direct delivery of compounds to the mammalian inner ear is most commonly achieved by absorption or direct injection through the round window membrane (RWM), or infusion through a basal turn cochleostomy. These methods provide direct access to cochlear structures, but with a strong basal-to-apical concentration gradient consistent with a diffusion-driven distribution. This gradient limits the efficacy of therapeutic approaches for apical structures, and puts constraints on practical therapeutic dose ranges. A surgical approach involving both a basal turn cochleostomy and a posterior semicircular canal canalostomy provides opportunities for facilitated perfusion of cochlear structures to reduce concentration gradients. Infusion of fixed volumes of artificial perilymph (AP) and sodium salicylate were used to evaluate two surgical approaches in the mouse: cochleostomy-only (CO), or cochleostomy-plus-canalostomy (C+C). Cochlear function was evaluated via closed-system distortion product otoacoustic emissions (DPOAE) threshold level measurements from 8 to 49 kHz. AP infusion confirmed no surgical impact to auditory function, while shifts in DPOAE thresholds were measured during infusion of salicylate and AP (washout). Frequency dependent shifts were compared for the CO and C+C approaches. Computer simulations modeling diffusion, volume flow, interscala transport, and clearance mechanisms provided estimates of drug concentration as a function of cochlear position. Simulated concentration profiles were compared to frequency-dependent shifts in measured auditory responses using a cochlear tonotopic map. The impact of flow rate on frequency dependent DPOAE threshold shifts was also evaluated for both surgical approaches. Both the C+C approach and a flow rate increase were found to provide enhanced response for lower frequencies, with evidence suggesting the C+C approach reduces concentration gradients within the cochlea.