Anatomical distribution and treatment of paediatric hand fractures: a multi-centre study of 749 patients in the Netherlands.

LEVEL OF EVIDENCE: II.

National Improvement of Waiting Times: First Results From the Dutch Head and Neck Audit.

OBJECTIVE: Timely treatment initiation in head and neck cancer (HNC) care is of great importance regarding survival, oncological, functional, and psychological outcomes. Therefore, waiting times are assessed in the Dutch Head and Neck Audit (DHNA). This audit aims to assess and improve the quality of care through feedback and benchmarking. For this study, we examined how waiting times evolved since the start of the DHNA. STUDY DESIGN: Prospective cohort study. SETTING: National multicentre study. METHODS: The DHNA was established in 2014 and reached national coverage of all patients treated for primary HNC in 2019. DHNA data on curative patients from 2015 to 2021 was extracted on national (benchmark) and hospital level. We determined 3 measures for waiting time: (1) the care pathway interval (CPI, first visit to start treatment), (2) the time to treatment interval (TTI, biopsy to start treatment), and (3) CPI-/TTI-indicators (percentage of patients starting treatment ≤30 days). The Dutch national quality norm for the CPI-indicator is 80%. RESULTS: The benchmark median CPI and TTI improved between 2015 and 2021 from 37 to 26 days and 37 to 33 days, respectively. Correspondingly, the CPI- and TTI-indicators, respectively, increased from 39% to 64% and 35% to 40% in 2015 to 2021. Outcomes for all hospitals improved and dispersion between hospitals declined. Four hospitals exceeded the 80% quality norm in 2021. CONCLUSION: Waiting times improved gradually over time, with 4 hospitals exceeding the quality standard in 2021. On the hospital-level, process improvement plans have been initiated. Systematic registration, auditing, and feedback of data support the improvement of quality of care.

Chronic Meningitis Due to Otitis Media With Cholesteatoma in a Five-Year-Old Child With a Cochlear Implant.

Cochlear implants (CIs) restore hearing in patients with severe-to-profound deafness. Post-CI meningitis is a rare but redoubted complication. We present the case of a five-year-old CI recipient who experienced an episode of chronic meningitis caused by chronic otitis media with cholesteatoma encasing the electrode lead. We hypothesize that the cholesteatoma led to an ascending infection to the cochlea, passing through the labyrinths, resulting in chronic meningitis. Although positive neural responses were initially noted on cochlear electrical stimulation, these responses resolved a few weeks after reimplantation. Our report highlights the importance of careful otoscopic examination and diagnostic work-up in patients presenting with otogenic meningitis to rule out cholesteatoma formation and to ensure prompt surgical exploration if warranted.

Injection laryngoplasty for laryngeal cleft type I in an 8-week-old infant.

A laryngeal cleft is a rare anatomical deformity which is increasingly treated with injection laryngoplasty. Since diagnosis of laryngeal cleft type I is often made between 2 and 5 years of age, this treatment is rarely performed on very young children. In this case, we describe how injection laryngoplasty is performed safely on an 8-week-old child, and we illustrate its added value for the diagnostic process and for temporary symptom relief.

Relation between otitis media and sensorineural hearing loss: a systematic review.

OBJECTIVES: This systematic review summarises the evidence on the correlation between recurrent acute otitis media (rAOM) or chronic suppurative otitis media (CSOM) and sensorineural hearing loss (SNHL). RESEARCH METHODS: PubMed, Embase and Cochrane Library databases were searched from inception to 15 January 2021. Two authors independently identified articles, extracted data and performed quality assessment for included studies. Studies comparing the sensorineural hearing levels of patients with a history of rAOM/CSOM for >3 months to a control group were included. RESULTS: Screening of 4168 articles lead to inclusion of two case-control studies (control-group: patients non-OM) and seven cohort-studies (control group: contralateral ear). Quality assessment indicated considerable risk of bias in all studies. Reported populations varied (sample size 13-607, mean age 22-41.5 years, mean duration of disease 6.1-12.4 years). The OR for SNHL in the OM-group was 3.30-7.86 (95% CI 1.16 to 9.40, p<0.05) in cohort studies (n=2), and 0.05 (95% CI 0 to 0.78, p<0.05) in a case-control study. Mean/median bone conduction thresholds were respectively 1.19-32.21/0-10 dB higher on all frequencies (0.5-4 kHz) for the OM-group in four cohort studies (p<0.05). Two other studies reported no statistical test outcomes. CONCLUSION: Due to the high risk of bias of included studies, effect estimates heterogeneity and suboptimal research designs, no conclusion on the correlation between OM and SNHL can be made. It emphasises the need for future prognostic studies.