Tympanocentesis results of a Canadian pediatric myringotomy population, 2008 to 2010.

OBJECTIVE: This study was completed to evaluate the middle ear microbiology of a pediatric population with chronic otitis media with effusion and to determine if there has been a change in the spectrum of microorganisms or their antibiotic susceptibility in the modern age of antibiotic therapy. DESIGN: Retrospective chart review. SETTING: A Canadian academic pediatric otolaryngology practice. METHODS: This study includes all consecutive patients under the care of one pediatric otolaryngologist undergoing myringotomy and tube placement between the dates of September 2008 and August 2010. Tympanocentesis was performed on each middle ear immediately following the myringotomy, and the specimen was sent for microbiologic analysis. MAIN OUTCOME MEASURES: Culture results and sensitivities were compared to previous similar studies. RESULTS: A total of 246 children (average age of 4 ± 3 years) and 506 ears had culture results as follows: normal flora, 47%; no growth, 35%; Haemophilus influenzae, 9%; Streptococcus pneumoniae, 4%; Moraxella catarrhalis, 3%; and Staphylococcus aureus, 2%. Ten of the 11 S. aureus cultures were methicillin resistant. The rate of pathogenicity decreased from 36.5% in children aged < 4 years to 15.3% in children aged 4+ years (p  =  .001). CONCLUSION: H. influenzae continues to lead as the most common pathogen; however, S. aureus is increasing in frequency. Pathogenicity decreases with age and appears to be lower in children with a cleft palate.

Feeding and mandibular distraction osteogenesis in children with Pierre Robin sequence: a case series of functional outcomes.

INTRODUCTION: In addition to upper airway obstruction, many patients with micrognathia and Pierre Robin sequence also have swallowing abnormalities and reflux. Many studies have demonstrated the effectiveness in alleviating the airway symptoms with mandibular distraction osteogenesis, but very few studies have focused on feeding and reflux outcomes. METHODS: A retrospective chart review was performed to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis with completed pre- and post-operative upper gastroesophageal series and videofluoroscopic swallow assessments. RESULTS: All six children in our series demonstrated significant improvements in both airway obstructive symptoms and feeding abnormalities. More specifically, all patients showed clinical and objective improvements in reflux and swallowing function after distraction surgery. CONCLUSION: Objective and symptomatic improvements in swallowing function and reflux disease can be seen after mandibular distraction osteogenesis in children with Pierre Robin sequence.

Incidence of parathyroid tissue in level VI neck dissection.

BACKGROUND: Level VI central neck dissections are commonly completed with thyroidectomy. This procedure involves risk of damage to, or incidental excision of, one or more of the parathyroid glands. METHODS: This study examined the pathology reports of patients undergoing thyroid surgery to determine the incidence of parathyroid tissue associated with level VI neck dissections and the risk factors associated with incidental parathyroidectomy. RESULTS: Ninety pathology specimens were analyzed. The incidence of parathyroid tissue associated with level VI neck dissections was 41.4%. We discovered that a higher frequency of incidental parathyroid tissue was located in level VI neck dissections among patients discovered to have malignant thyroid disease. There was no significant association between incidental parathyroidectomy and the sex of the patient, the age of the patient, the type of thyroid surgery, or transient or permanent hypoparathyroidism. CONCLUSION: A large percentage of level VI neck dissections in thyroid surgery were associated with incidental parathyroid tissue. A more detailed examination of surgical specimens may decrease this possibly preventable surgical complication.

Survey of nasopharyngoscope decontamination methods in Canada.

BACKGROUND: nasopharyngoscopes are essential tools in modern otolaryngology practice. Owing to their frequent and diverse use, it is important to ensure that they can be efficiently and thoroughly cleaned. To date, there are no official national guidelines provided by the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) for decontamination of nasopharyngoscopes. OBJECTIVE: to compare flexible nasopharyngoscope decontamination practices across Canada. METHODS: a questionnaire regarding nasopharyngoscope cleaning procedures was distributed online to all otolaryngologists registered with the CSOHNS. The survey was anonymous. Topics addressed province, practice type, maintenance, operations, ventilation, and process development. RESULTS: thirty-five percent of the 505 Canadian otolaryngologists contacted participated in the survey. Automated sterilization of nasopharyngoscopes is employed by 16% of participants, of which the majority of this use is in hospital settings. Over 61.3% of participants use a multistep decontaminating soak for cleaning. Decontamination procedures were created within the department in 59% of cases, and over 28.3% of participants are unsure as to whether their procedures adhere to infectious disease and industry standards. CONCLUSION: various procedures are employed throughout Canada owing to a lack of standardization. Survey responses indicate that Canadian otolaryngologists would appreciate a national standard for the cleaning of flexible nasopharyngoscopes, particularly for nonhospital practices.

Laryngeal reconstruction following CO2 laser surgery for glottic cancer.

CO(2) laser has become a common surgical technique in the management of glottic cancer. The patients treated with this modality may benefit from additional phonosurgical techniques used to improve postoperative vocal outcome.The aim of this article was to review those phonosurgical techniques described for glottic reconstruction after CO(2) laser excision of glottic cancer. The indications for using each technique are discussed, with particular attention paid to functional outcomes following these reconstructive efforts.