Predictors of Success of Adenoidectomy in the Treatment of Pediatric Chronic Rhinosinusitis.

Objectives: There is consensus for adenoidectomy as treatment of chronic rhinosinusitis (CRS) in children younger than 6 years but less consensus for those aged 6 years and older. The present clinical research study investigated predictors of adenoidectomy success for pediatric CRS. Methods: A retrospective chart review was conducted for 107 children who presented to an otolaryngology clinic and had an adenoidectomy for CRS after failure of maximal medical therapy. Results: The majority of sample was male (N = 63; 58.9%) with mean age of 4.88 (SD = 2.54) and mean Lund-Mackay score of 7.76 (SD = 3.87). Patients who had success with adenoidectomy were older on average [mean (M) = 5.46; SD = 2.83] than patients who failed the procedure (M = 4.36; SD = 2.40; F = 4.06, P = .047). This equated to 67.9% of children aged 6 years and older and 39.2% of children younger than 6 years succeeding with the surgery. Conclusions: Adenoidectomy is a good first-line surgery for children aged 12 years and younger, especially in the 6 to 12 years group which had a high rate of success with 68% experiencing remission of symptoms after surgery.

Acute Emphysematous Epiglottitis: A Case Report.

Epiglottitis is a bacterial infection of the upper respiratory tract that can be rapidly progressive and life-threatening. Though predominantly seen in unvaccinated children, there seems to be a shift with the incidence of adult cases rising following the Haemophilus Influenza B (HiB) vaccine. There are several reports of epiglottitis manifesting as an abscess, but few cases report on the formation of an emphysematous abscess. Additionally, little is known on the bacterial etiology of such infections. Here, we present a case of a patient found to have acute emphysematous epiglottis managed with fiberoptic intubation, drainage, and culture of the abscess. Laryngoscope, 133:2747-2750, 2023.

Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis.

OBJECTIVES: Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. METHODS: This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. RESULTS: Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. CONCLUSIONS: Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.

The use of SN-5 to differentiate chronic rhinosinusitis and chronic adenoiditis in children.

BACKGROUND: Chronic adenoiditis (CA) and chronic rhinosinusitis (CRS) present with similar symptoms, but an accurate diagnosis is critical for optimal treatment. We aim to differentiate CRS and CA based on sinonasal symptoms using the Sinus and Nasal Quality of Life Survey (SN-5) in children. METHODS: This is a retrospective cohort study. Children (age 12 and younger) presenting with chronic sinonasal symptoms were divided into 2 groups based on CT scan sinus findings: CA group included patients with CT Lund-Mackay (LM) score <5 and CRS group included patients with CT LM score of 5 and more. SN-5 scores for each group were then compared, and both groups were compared to a control group. Other demographic data were also collected and analyzed. RESULTS: There were 27 patients in the CA group, 42 patients in CRS group and 38 patients in the control group. Mean SN-5 scores were 2.03±0.71 for the control group, 3.49±1.00 for the CA group, and 4.53±0.77 for the CRS group (p < 0.0001); Statistical significance persisted when CA and CRS were compared in subset analysis (p < 0.0001). CT LM score was 2.70±2.07 for the CA group and 9.94±3.46 for the CRS group (p < 0.0001). Rates of asthma, allergic rhinitis, and smoke exposure differed between the three groups (p < 0.01), but they were not statistically different when CA and CRS were compared in subset analysis. CONCLUSION: Children with CRS have higher SN-5 score than children with CA. SN-5 score can be used to help otolaryngologists differentiate between these two clinical entities.

Outcomes of Endolymphatic Sac Surgery for Meniere's Disease with and without Comorbid Migraine.

PURPOSE: To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine. MATERIALS AND METHODS: A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. RESULTS: Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p=0.01), shorter duration of vertigo episodes (143 vs. 393 min, p=0.02), and younger age (36.6 vs. 50.8 yr, p=0.005) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 (p < 0.001). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference (p=0.59). Of the patients who required secondary treatment (10.42%), none had migraine. CONCLUSIONS: Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.

Outcomes of unilateral idiopathic sudden sensorineural hearing loss: Two decades of experience.

OBJECTIVES: (a) Determine the demographic and medical risk factors for patients who presented with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL); (b) identify treatments that patients underwent; (c) evaluate the adequacy of follow-up and compliance with long-term hearing rehabilitation. METHODS: Retrospective review of patients who presented with unilateral ISSNHL between January 1998 and December 2017 at a tertiary care academic medical center. RESULTS: Two hundred-four patients met inclusion criteria. Of these, 129 (63.2%) did not undergo treatment at an outside hospital prior to our evaluation. In this subgroup, the average pretreatment pure tone average (PTA) was 61.9 ± 2.5 dB (dB). The most common treatment was oral steroids and was recommended in 76 patients (59.9%). Patients also underwent intratympanic (IT) steroid injections (7.2%) or oral steroids followed by salvage IT injections (19.4%). Mean follow-up duration was 17.9 (±29.2) months, and posttreatment PTA (45.6 ± 2.6 dB) was significantly better than baseline (P < .001). In this cohort, hearing amplification was infrequently recommended. Less than 20% of patients reported active hearing amplification use at their most recent visit. At follow-up, 90 patients (69.8%) reported subjective improvement in hearing after treatment. Only 55 patients (42.6%) showed improvement in PTA compared to their pretreatment audiograms. CONCLUSION: Many patients with ISSNHL experienced audiometric improvement after treatments, but most had persistent hearing loss. The duration of follow-up was short. Most patients did not use long-term hearing amplification. Future studies are needed to identify factors that contribute to reduced follow-up and low compliance with hearing amplification use in ISSNHL. LEVEL OF EVIDENCE: 2c.

Distinguishing acute from chronic aortic dissections using CT imaging features.

The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 patients were reviewed for a variety of imaging features. Statistical tests assessed for differences in the frequency of these features. A predictive model was created and tested on an additional 120 CT scans from 115 patients. Statistically significant features of AAD included periaortic confluent soft tissue opacity, curved dissection flap, and highly mobile dissection flap, and features of CAD included thick dissection flap, false lumen (FL) outer wall calcification, FL thrombus, dilated FL, and tear edges curling into the FL. The model predicted the chronicity of a dissection with an area under the curve of 0.98 (CI 0.98-1.00). AADs and CADs demonstrated significantly different CT imaging features.