Timing of First Set of Pressure Equalization Tubes in Pediatric Patients With Cleft Deformities.

OBJECTIVES: Children with cleft palates often have comorbid eustachian tube dysfunction requiring pressure equalization tubes (PETs). PETs can relieve middle ear effusions that impede hearing. Ideal PET placement timing in this population is controversial. In this study, the audiologic exam passing rates of patients with cleft palate prior to and following PET insertion were assessed. Rates for patients receiving PETs at different ages were compared. It was hypothesized that earlier PET placement may benefit patients with additional months of improved hearing. METHODS: A retrospective chart review was performed of patients with cleft palate between November 22, 2016 and November 22, 2021 at a tertiary center. Statistical analysis compared passing/normal audiologic exams in patients receiving PETs at different ages. RESULTS: A total of 348 patients had cleft palate diagnoses, received PETs, and had adequate hearing data for inclusion. Those with PETs inserted at 3 months of age or less had an increase in percent of patients passing audiologic exams following versus prior to PET insertion of 13% (1.3 times improvement). Those receiving PETs between 7- and 12-months had the largest rate of improvement (42%) (2.4 times improvement); other groups had changes in passing rates between 31% and 40%. The rate of passing audiologic exams following PET insertion was high across all groups, ranging from 66% to 81%. CONCLUSION: This is one of the first studies exploring the timing of PET placement in this population and showed that patients receiving PETs at 3 months of age or younger passed subsequent audiologic exams at similar rates relative to those receiving PETs later in life. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3391-3394, 2024.

Children's Visual Perception of Facial Scarring and Cleft Lip Deformity Using Eye Tracking Data.

OBJECTIVE: The purpose of this study is to determine children's perception of secondary cleft lip deformity (SCLD) using objective eye tracking technology and subjective responses on a survey to understand pediatric perceptions of facial scarring. DESIGN: Cross-sectional study of participants aged 5-17 years old. METHODS: Participants viewed images of children's faces with an eye tracking device. Sixteen images were displayed, 12 with unilateral SCLD and four with no facial scarring. Eye tracking data were obtained. Gaze samples were analyzed for areas of interest (AOIs). Immediately after viewing each image, participants answered two survey questions relating to facial asymmetry attitude toward the child pictured. For analysis, participants were divided into age groups. RESULTS: A total of 259 participants were enrolled (42.5% female). Mean age was 10.5 years and 78% identified as White. In all age groups, total fixation time was greater for SCLD compared to control images. Early elementary age children spent significantly less time assessing the nose AOI compared to other groups, and also spent the least total fixation time and had the lowest visit count on all AOIs. Subjective survey questions showed similar trends with elementary age not noticing facial asymmetry compared to older age groups. CONCLUSION: This study demonstrates the successful use of eye tracking technology in children as young as 5 years old. This study suggests that SCLD is perceived as less noticeable in elementary age children and becomes more noticeable to older groups. Understanding peer perception on SCLD from this study may impact decision on revision surgery for SCLD. LEVEL OF EVIDENCE: IV Laryngoscope, 134:2726-2733, 2024.

Hearing Outcomes in Stickler Syndrome: Variation Due to COL2A1 and COL11A1.

OBJECTIVES: Stickler syndrome (SS) is a heterogeneous inherited connective tissue disorder, often due to a mutation in COL2A1 or COL11A1. Mutations in these genes cause collagen abnormalities affecting ocular, auditory, orofacial, and skeletal systems, including hearing loss, micrognathia, and cleft palate. Understanding the variability of hearing phenotypes based on genetic mutation has a significant impact on treatment and long-term care. DESIGN: A retrospective chart review of pediatric patients with a confirmed diagnosis of SS between January 2003 and December 2018 at a tertiary pediatric hospital was performed. Patients were excluded if they did not have genetic evaluation, craniofacial/ear, nose, and throat evaluation, and/or audiologic testing. Charts were reviewed for the following information: age, race, sex, SS diagnosis, genetic variant of SS, and audiological testing data. RESULTS: There were 29 confirmed patients with SS who met criteria, 16 with type I (COL2A1) and 13 with type II (COL11A1). Of the 13 patients with type II, 12 (92%) demonstrated hearing loss, ranging in severity from mild to severe. In type I, 25% of patients had mild or resolved hearing loss. CONCLUSION: Results suggest that patients with type II SS are more likely to have congenital hearing loss than type I. Data also suggest that the COL11A1 mutation shows consistently more severe hearing loss than the COL2A1 mutation.

Incidence of mandibular distraction osteogenesis in Stickler Syndrome: Variation due to COL2A1 and COL11A1.

OBJECTIVE: To determine whether the two most common genetic mutations seen in Stickler Syndrome (SS) (COL2A1 and COL11A1) affect the incidence of mandibular distraction osteogenesis (MDO) and what impact Robin sequence (RS) has on diagnosis. SS is an autosomal dominant connective tissue disorder characterized by almost complete penetrance. COL2A1 and COL11A1 are the two most common mutations seen in SS patients. SS often presents at birth with RS, which is characterized by the triad of micrognathia, glossoptosis, and tongue-based airway obstruction. MDO is one surgical intervention that has been shown to be successful in relieving tongue base obstruction and is the surgical intervention of choice for this condition. METHODS: A retrospective chart review was performed on all patients with a diagnosis of SS at a tertiary pediatric hospital between January 1, 2003 and December 31, 2018. The included patient charts were reviewed for demographic information, SS mutation, and history of MDO. Forty-six patients had a clinical diagnosis of SS. Of those, 31 met inclusion criteria which involved having a molecular diagnosis of SS and sufficient follow up information to determine if MDO was indicated or performed. Twenty-two of the 31 included patients had a diagnosis of RS (70.96%). Thirteen of the 31 patients (41.94%) included in this study required MDO as a neonate. RESULTS: Fifty-percent of patients with type I (COL2A1) required MDO as a neonate compared to only 31% of patients with type II (COL11A1), though the difference between the two groups was not statistically significant. CONCLUSION: The findings of this study suggest that patients with type I mutation may have a higher incidence of MDO than patients with a type II mutation, though further research with larger sample sizes is needed. This information is helpful in counseling those with SS or family history of SS about what they can expect related to RS and need for MDO based on genetic findings. LEVEL OF EVIDENCE: 3.

Submucous Cleft Palate Repair in Patients With 22q11.2 Deletion Syndrome.

OBJECTIVE: To determine whether surgical intervention for submucous cleft palate (SMCP) is more common in children with 22q11.2 deletion syndrome (22q DS) compared to children without 22q DS. DESIGN: Retrospective chart review. SETTING: Tertiary pediatric hospital and 22q11.2 DS specialty clinic. PARTICIPANTS: One hundred forty-two children seen at the tertiary hospital or clinic during a 20-year period (June 1999-June 2019) with documented SMCP with and without 22q DS. MAIN OUTCOME MEASURE: Percentage of children with SMCP with and without 22q DS requiring surgical intervention for velopharyngeal insufficiency. RESULTS: Patients with 22q DS had a significantly higher frequency of SMCP repair than those without 22q DS (89.7% vs 32.0%, P < .001, χ2 = 37.75). The odds of requiring SMCP repair were 18.6 times higher in those with 22q DS compared to those without (odds ratio = 18.6, CI = 6.1-56.6). CONCLUSIONS: This study provides new evidence suggesting patients with 22q DS require SMCP surgical repair for velopharyngeal insufficiency at a significantly higher rate than those without 22q DS. As the majority of patients with 22q DS with SMCP require surgical intervention, future prospective studies looking at early versus late repair of SMCP in patients with 22q DS are needed to guide the surgical repair timeline in this population.

Developing an Eye-Tracking Protocol to Determine Children's Visual Perception of Secondary Cleft Lip Deformity.

OBJECTIVE: To develop a protocol that will be used to measure children's perception of secondary cleft lip deformity (SCLD) using objective eye-tracking technology. DESIGN: Cross-sectional study. Data collection May and June of 2018. SETTING: Single tertiary care pediatric hospital with a well-established cleft team. PARTICIPANTS: Participants were recruited from a general pediatric otolaryngology clinic. Sixty participants from 4 age groups (5-6, 10, 13, and 16 years) were enrolled on a voluntary basis. INTERVENTION: Pediatric participants viewed images of children's faces while wearing eye-tracking glasses. Ten images with unilateral SCLD and 2 control images with no facial scarring were viewed as gaze was assessed. MAIN OUTCOME AND MEASURE: Successful gaze fixation was recorded across all age groups. RESULTS: This article illustrates the types of data generated from glasses-based eye tracking in children. All children, regardless of age, spent more time with their gaze on a SCLD images (mean = 4.23 seconds; standard deviation [SD] = 1.41 seconds) compared to control images (mean = 3.97 seconds; SD = 1.42). Younger age groups spent less time looking at specific areas of interest in SCLD images. CONCLUSION: In this pilot study, we were able to successfully use eye-tracking technology in children to demonstrate gaze preference and a trend toward visual perception of SCLD changing with age. This protocol will allow for a future study, with larger and more diverse populations. Better understanding of how SCLD is perceived among children and adolescents has the potential to guide future interventions for SCLD and other facial deformities in pediatric patients.

Larvicidal activity of green synthesized silver nanoparticles using bark aqueous extract of Ficus racemosa against Culex quinquefasciatus and Culex gelidus

OBJECTIVE@#To investigate the larvicidal activity of synthesized silver nanoparticles (Ag NPs) utilizing aqueous bark extract of Ficus racemosa (F. racemosa) was tested against fourth instar larvae of filariasis vector, Culex quinquefasciatus (Cx. quinquefasciatus) and japanese encephalitis vectors, Culex gelidus (Cx. gelidus).@*METHODS@#The synthesized Ag NPs was characterized by UV-vis spectrum, X-ray diffraction (XRD), Scanning electron microscopy (SEM) and Fourier transform infrared (FTIR). The larvicidal activities were assessed for 24 h against the larvae of Cx. quinquefasciatus and Cx. gelidus with varying concentrations of aqueous bark extract of F. racemosa and synthesized Ag NPs. LC(50) and r(2) values were calculated.@*RESULTS@#The maximum efficacy was observed in crude aqueous extract of F. racemosa against the larvae of Cx. quinquefasciatus and Cx. gelidus (LC(50)=67.72 and 63.70 mg/L; r(2)=0.995 and 0.985) and the synthesized Ag NPs (LC(50)=12.00 and 11.21 mg/L; r(2)=0.997 and 0.990), respectively. Synthesized Ag NPs showed the XRD peaks at 2 θ values of 27.61, 29.60, 35.48, 43.48 and 79.68 were identified as (210), (121), (220), (200) and (311) reflections, respectively. The FTIR spectra of Ag NPs exhibited prominent peaks at 3,425, 2,878, 1,627 and 1,382 in the region 500-3,000 cm(-1). The peaks correspond to the presence of a stretching vibration of (NH) C=O group. SEM analysis showed shape in cylindrical, uniform and rod with the average size of 250.60 nm.@*CONCLUSIONS@#The biosynthesis of silver nanoparticles using bark aqueous extract of F. racemosa and its larvicidal activity against the larvae of disease spreading vectors. The maximum larvicidal efficacy was observed in the synthesized Ag NPs.

Acaricidal activity of synthesized titanium dioxide nanoparticles using Calotropis gigantea against Rhipicephalus microplus and Haemaphysalis bispinosa

OBJECTIVE@#To assess the acaricidal activity of titanium dioxide nanoparticles (TiO2 NPs) synthesized from flower aqueous extract of Calotropis gigantea(C. gigantea) against the larvae of Rhipicephalus (Boophilus) microplus [R. (B.) microplus] and the adult of Haemaphysalis bispinosa (H. bispinosa).@*METHODS@#The lyophilized C. gigantea flower aqueous extract of 50 mg was added with 100 mL of TiO(OH)2 (10 mM) and magnetically stirred for 6 h. Synthesized TiO2 NPs were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), and Energy dispersive X-ray spectroscopy (EDX). The synthesised TiO2 NPs were tested against the larvae of R. (B.) microplus and adult of H. bispinosa were exposed to filter paper impregnated method.@*RESULTS@#XRD confirmed the crystalline nature of the nanoparticles with the mean size of 10.52 nm. The functional groups for synthesized TiO2 NPs were 1 405.19, and 1 053.45 cm(-1) for -NH2 bending, primary amines and amides and 1 053.84 and 1 078.45 cm(-1) for C-O. SEM micrographs of the synthesized TiO2 NPs showed the aggregated and spherical in shape. The maximum efficacy was observed in the aqueous flower extract of C. gigantea and synthesized TiO2 NPs against R. (B.) microplus (LC50=24.63 and 5.43 mg/L and r(2)=0.960 and 0.988) and against H. bispinosa (LC50= 35.22 and 9.15 mg/L and r(2) = 0.969 and 0.969), respectively.@*CONCLUSIONS@#The synthesized TiO2 NPs were highly stable and had significant acaricidal activity against the larvae of R. (B.) microplus and adult of H. bispinosa. This study provides the first report of synthesized TiO2 NPs and possessed excellent anti-parasitic activity.