Publications by authors named "Michele M Carr"

87 Publications

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

Ann Otol Rhinol Laryngol 2021 May 27:34894211018914. Epub 2021 May 27.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.

Objective: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients.

Methods: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21).

Results: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15,  < .05) and total IUS-12 scores (mean 28.63 vs 25.56,  = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men,  = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression ( = .256,  = .008) and IUS-12 scores ( = .214,  = .024). SDM correlated negatively with DASS-21 Depression ( = -.208,  = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression ( = 0.674,  = .048).

Conclusion: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.
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http://dx.doi.org/10.1177/00034894211018914DOI Listing
May 2021

Shared Decision Making: The 9-Item Shared Decision Making Questionnaire Does Not Discriminate Between Surgeons.

Cureus 2021 Apr 3;13(4):e14274. Epub 2021 Apr 3.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Purpose To determine if shared decision making (SDM) scores vary between individual otolaryngologists in a large specialty clinic.  Methods Consecutive patients that consented to surgery were surveyed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9), a validated scale for SDM. Demographic details included the respondent's age, gender, education level, marital status, whether the consent was for themselves or their child, whether surgery was for malignancy, and surgery being performed. Scores were evaluated for all demographic variables, as well as individual surgeons, surgeons' gender, age category, and subspecialty. Results A total of 233 patients completed the surveys. No significant differences were found among individual and total scores for SDM when compared among or between patient demographics (p > 0.05). A total of 10 surgeons for whom five or more SDM-Q-9s were completed were included in the study. No significant difference was found when SDM was evaluated for surgeon characteristics as well (p > 0.05).  Conclusion SDM scores do not vary between these otolaryngologists.
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http://dx.doi.org/10.7759/cureus.14274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093118PMC
April 2021

Perceptions of Safety Climate and Fatigue Related to ACGME Residency Duty Hour Restrictions in Otolaryngology Residents.

Otolaryngol Head Neck Surg 2021 May 4:1945998211010108. Epub 2021 May 4.

Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA.

Objective: To compare otolaryngology residents' perceptions of safety climate with respect to duty hour compliance and self-perceived fatigue.

Study Design: Cross-sectional study.

Setting: Forty-one otolaryngology residencies distributed across the United States.

Methods: A national sample of otolaryngology residents was surveyed electronically in 2019. The survey included demographic details, on-call descriptors, an 18-point Safety Climate Survey (SCS) modified to measure perceptions of program attitudes and practices around resident duty hour compliance, and the 33-point Chalder Fatigue Questionnaire (CFQ).

Results: Of 397 surveyed residents, 205 (51.6%) responded. The mean modified SCS score was 11.29 out of 18 (95% CI, 10.76-11.81). Respondents were most likely to disagree with "Residents are told when they are at risk of working beyond ACGME [Accreditation Council for Graduate Medical Education] duty hour restrictions," where 100 (48.8%) disagreed or strongly disagreed. The mean CFQ score was 15.99 of 33 (95% CI, 15.17-16.81). As the modified SCS score improved, CFQ scores decreased, indicating an inverse relationship between duty hour safety climate and fatigue. Having a protected postcall day off and having the program director, chief resident, or senior resident decide that a resident should take a postcall day off were all associated with higher modified SCS scores.

Conclusion: Otolaryngology residents perceived a safety climate that is suboptimal with regard to duty hour restriction issues. Additionally, an inverse relationship between fatigue and modified SCS scores suggests that fatigue among residents may be lower in programs where residents perceive that ACGME duty hour compliance is more important.
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http://dx.doi.org/10.1177/01945998211010108DOI Listing
May 2021

Costs and Charges for Pediatric Tonsillectomy in New York State.

Cureus 2021 Feb 11;13(2):e13286. Epub 2021 Feb 11.

Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Objective In this study, we aimed to determine the correlation between costs/charges related to admissions for pediatric tonsillectomy in New York State (NYS) and variables including discharge year, All Patient Refined (APR) severity of illness, length of hospital stay, payment typology, location, race, and institutional factors during 2009-2017. Methods Data were extracted from the Statewide Planning and Research Cooperative System (SPARCS) Hospital Inpatient Discharges database developed by the NYS Department of Health. Statistical analysis was employed to determine multiple linear regression coefficients with the costs and charges set as the dependent variable. Results Costs increased by an estimated $230.73 (p<.001) each year, and charges increased by an estimated $1,231.41 (p<.001) annually. For each categorical increase in severity of illness, costs increased by $1,019.21 (p<.001), and charges increased by $3,088.41 (p<.001). For each day spent in the hospital, costs increased by $3,539.23 (p<.001), and charges increased by $8,908.01 (p<.001). Unspecified managed care had the highest mean costs and charges (p<.001). Bronx County had the highest costs, and Queens County had the highest charges. Queens County demonstrated the largest gap between costs and charges. Conclusion This study revealed that the costs and charges related to admissions for elective tonsillectomy had risen from 2009 to 2017, and these changes were not accounted for by inflation alone. We found that the costs and charges for inpatient pediatric tonsillectomy were significantly correlated with discharge year, APR severity of illness, length of hospital stay, location of the hospital, and primary payer.
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http://dx.doi.org/10.7759/cureus.13286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955782PMC
February 2021

Pediatric penetrating cervical trauma in HCUP: Associations with hospital length of stay and cost.

Int J Pediatr Otorhinolaryngol 2021 Apr 25;143:110661. Epub 2021 Feb 25.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.

Objective: To describe pediatric penetrating cervical trauma (PCT) and determine factors associated with increased length of stay (LOS) and total hospital charges.

Study Design: Retrospective review of Healthcare Cost and Utilization Project (HCUP) from the Kids' Inpatient Database (KID) for 2016.

Setting: Public database.

Methods: A retrospective analysis of the HCUP from the KID for 2016 for inpatients ≤18 years of age. Comparisons between PCT and non-PCT patients were made, including hospital LOS and total charges.

Results: There were 1279 patients with neck trauma of which 686 (53.6%) were identified as sustaining PCT. Patients with PCT were older (13.2 vs 11.8 yr, p = .001), and were more likely to be male (65.9% vs 54.8%, p < .001) and African-American (21.9% vs 15.9, p = .01). PCT patients were less likely to have a vascular injury (6.1% vs 20.1%, p < .001) and they were more likely to undergo airway evaluation (8.3% vs 2.2%, p < .001). Within the PCT group, 11.5% had open pharyngeal/esophageal lacerations, 6.1% had open tracheal injuries, 2.0% had open thyroid injuries, and 1.6% had open laryngeal injuries. LOS and total charges were not different between children with and without PCT (mean LOS 6.5 days, mean total charges US$106,000). Linear regression analysis showed significant associations with LOS for age, tracheal open injuries, cervical or vascular injury, and undergoing airway evaluation and/or esophagoscopy. Total charges associations were similar.

Conclusion: LOS and total charges were not different in children with PCT and non-PCT, but both were increased when there were more cervical injuries and more related procedures done.
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http://dx.doi.org/10.1016/j.ijporl.2021.110661DOI Listing
April 2021

Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis.

Otolaryngol Head Neck Surg 2021 Feb 16:194599821989633. Epub 2021 Feb 16.

Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.

Objective: A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database.

Study Design: Retrospective review of 2016 Kids' Inpatient Database, part of the Healthcare Cost and Utilization Project.

Setting: Academic, community, general, and pediatric specialty hospitals in the United States.

Methods: code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges.

Results: In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( < .001) and higher total charges ( < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( < .001) contributed significantly to LOS and total charges.

Conclusion: Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.
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http://dx.doi.org/10.1177/0194599821989633DOI Listing
February 2021

Maxillofacial trauma in children: Association between age and mandibular fracture site.

Am J Otolaryngol 2021 Mar-Apr;42(2):102874. Epub 2020 Dec 29.

Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States; Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States. Electronic address:

Purpose: To describe the association between age and location of facial fractures in the pediatric population.

Materials And Methods: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures.

Results: A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (β=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (β=-0.090, p<0.001).

Conclusions: Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.
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http://dx.doi.org/10.1016/j.amjoto.2020.102874DOI Listing
December 2020

Airway foreign bodies in pediatric patients: An analysis of composition and age via HCUP KID.

Int J Pediatr Otorhinolaryngol 2021 Mar 14;142:110559. Epub 2020 Dec 14.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA. Electronic address:

Objective: To compare outcomes for children food and non-food airway foreign body (AFB) diagnoses and to compare outcomes for patients age <2 versus ≥2 years with an AFB diagnosis.

Methods: Data from 2016 HCUP KID was used to compare outcomes for food and non-food AFB diagnoses based on location in the larynx, trachea, bronchus, and whole group (including these three specified locations and location unspecified). Outcomes were also compared for children aged <2 versus ≥2 years. Demographic data included age, race, gender, primary payer, location and teaching status of the hospital. Available co-morbidity data included APR-DRG mortality and APR-DRG severity. Outcomes were length of stay (LOS), total charge, mortality, and performance of a tracheotomy.

Results: 2973 patients were included. 49.1% were less than 2 years old, the remainder (50.9%) were between 2 and 20 years old. Food AFBs made up 26.0% and 74.0% were other specified non-food AFBs. Overall mortality was 3.7%, and 3.8% underwent tracheotomy. Children with non-food AFBs were significantly older, had significantly longer median LOS, and higher median total charges, when compared to food AFBs. Non-food AFBs had a significantly higher likelihood of tracheotomy. Patients aged 2 or more years with bronchial AFBs had significantly higher total charges, LOS, and APR-DRG risk mortality and severity than <2 year old patients with bronchial AFBs.

Conclusion: AFBs remain a serious health concern, especially non-food objects in older children which have elevated risks.
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http://dx.doi.org/10.1016/j.ijporl.2020.110559DOI Listing
March 2021

Characterization of Medical Malpractice Litigation after Rhinoplasty in the United States.

Aesthet Surg J 2020 Dec 17. Epub 2020 Dec 17.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.

Background: Rhinoplasty is one of the most common operations performed with favorable results and high patient satisfaction. However, when complications occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction.

Objectives: 1) To identify motives for seeking medical malpractice litigation after rhinoplasty; 2) To examine outcomes of malpractice litigation after rhinoplasty in the United States.

Methods: The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes.

Results: Twenty-three cases were identified between 1960 and 2018, located in 12 states in the United States. Plaintiffs were 70% female. Otolaryngologists were cited in 11 cases while 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved "technical" errors (69.6%), "unsatisfactory" outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. Contributing factors in cases alleging malpractice included poor aesthetic outcome/disfigurement (60.7%), new (post-surgical) onset/persistent nasal symptoms (30.4%), postoperative pain (21.7%), orbital/ocular injury (17.4%), burns (4%), nerve damage (4%), and issues with sleep (4%).

Conclusions: Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The most common reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient's surgical expectations, obtaining detailed informed consent while maintaining frequent and caring communication with the patient.
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http://dx.doi.org/10.1093/asj/sjaa380DOI Listing
December 2020

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

Otolaryngol Head Neck Surg 2020 Dec 8:194599820978262. Epub 2020 Dec 8.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.

Objective: To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent.

Study Design: Prospective cohort study.

Setting: Tertiary care children's hospital.

Methods: Children who met American Academy of Otolaryngology-Head and Neck Surgery's guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model.

Results: A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean score, 1.13 (95% CI, -0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or score among the 4 types of effusion ( < .05). WBT showed a significant difference in median absorption among the effusion groups ( < .001), with a medium effect size of 0.35.

Conclusions: WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.
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http://dx.doi.org/10.1177/0194599820978262DOI Listing
December 2020

Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery.

Otolaryngol Head Neck Surg 2020 Dec 8:194599820973644. Epub 2020 Dec 8.

Jacobs School of Medicine and Biomedical Sciences, Department of Otolaryngology, University at Buffalo, Buffalo, New York, USA.

Objective: To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC).

Study Design: Cross-sectional.

Setting: Academic pediatric otolaryngology outpatient clinic.

Methods: Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale-21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12).

Results: A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended.

Conclusion: In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.
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http://dx.doi.org/10.1177/0194599820973644DOI Listing
December 2020

Program Directors' Opinions About Otolaryngology Resident Teaching Medical School Anatomy.

Cureus 2020 Oct 17;12(10):e10999. Epub 2020 Oct 17.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Purpose To evaluate whether otolaryngology residency program directors (PDs) provide residents to teach pre-clinical medical students anatomy and to outline their perceptions of this practice. Methods An anonymous online survey was sent to active U.S. otolaryngology residency PDs in 2019, assessing each program's involvement in teaching medical student anatomy. Results Forty-five of 121 (37.1%) of surveyed otolaryngology PDs responded. Sixteen of the 44 (36.4%) residency programs that were associated with a medical school provided residents to teach anatomy ("Teaching Programs"). The 29 (64.4%) remaining programs did not provide residents ("Non-teaching Programs"). No significant differences were found between Teaching and Non-teaching Programs (P<0.05) for the size of the program, the presence of fellowships, the size of medical school, whether residents had won teaching awards, or the number of otolaryngology residency applicants from that school. In general, all PDs responded positively about residents teaching medical school anatomy. Non-teaching Programs primarily cited not being approached by the medical school as a reason for not providing residents to teach. Conclusion The majority of respondent otolaryngology PDs have a positive view of residents teaching medical students but few do it. Otolaryngology departments will need to take the lead on developing opportunities to put students and residents together for anatomy education.
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http://dx.doi.org/10.7759/cureus.10999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669255PMC
October 2020

Pediatric Drug-Induced Sleep Endoscopy: Technique and Scoring System.

Cureus 2020 Oct 2;12(10):e10765. Epub 2020 Oct 2.

Department of Otolaryngology, Head and Neck Surgery, University at Buffalo, Buffalo, USA.

Drug-induced sleep endoscopy (DISE) is an invaluable tool for identifying sites of obstruction for patients with obstructive sleep apnea (OSA). During DISE, the patient is in a state of drug-induced sleep, and a flexible laryngoscope is passed through the nose into the upper airway. Sites of obstruction are visualized and scored to guide surgical management. Currently, there is no universally accepted method of DISE analysis and scoring. This limitation in comparability impedes large-scale analysis between clinicians, institutions, and studies. In this report, we propose a standardized method of scoring and performing DISE in children with OSA. Our DISE scoring system is internally developed, consistent through the study, and addresses all levels of potential upper airway obstruction.
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http://dx.doi.org/10.7759/cureus.10765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606258PMC
October 2020

Patterns of pediatric cervical spine fractures in association with mandibular and facial fractures.

Int J Pediatr Otorhinolaryngol 2020 Dec 7;139:110428. Epub 2020 Oct 7.

Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA. Electronic address:

Objectives: To determine the incidence, demographics, and outcomes of concurrent cervical spine (C-spine) fractures in pediatric facial trauma.

Methods: The Kids' Inpatient Database (KID) from the 2016 Healthcare Cost Utilization Project (HCUP) was queried for various facial fractures using International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes. Mandible fractures were further subdivided into fracture site. Patients aged 0-18 were included, and rates of C-spine fracture were analyzed with regards to demographic factors, length of stay, total charges, mortality rate, hospital characteristics, and concurrent facial fractures.

Results: Of 5568 patients included, 4.18% presented with C-spine fracture. Children with C-spine fractures were significantly older (15.02 vs 12.76 years, p < 0.001) and length of stay was significantly longer (11.33 vs 6.44 days, p < 0.001). There was no difference in rate of C-spine fracture when stratified by gender, time of week/year, hospital location/type, or facial fracture other than subcondylar fractures. Subcondylar fractures were positively associated with C-spine fractures (OR 2.08, p = 0.002). C-spine fractures were associated with significantly higher mortality, length of stay, rate of tracheostomy, transfer out of index hospital, and total hospital charges.

Conclusions: A significant association exists between subcondylar mandible and C-spine fractures. Awareness of this information is vital for clinicians who manage pediatric facial trauma and alerts them to the need to rule out C-spine fractures in this group as these patients have significantly higher lengths of stay, total mean hospital costs, mortality and tracheostomy rates.
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http://dx.doi.org/10.1016/j.ijporl.2020.110428DOI Listing
December 2020

A Case of Pediatric Aspiration of a Metallic Spring.

Cureus 2020 Aug 24;12(8):e9987. Epub 2020 Aug 24.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, USA.

Prolonged retention of a foreign body after aspiration can lead to numerous respiratory complications. We present a case in which an unwitnessed aspiration of a metal spring by a child led to several months of unilateral wheezing and subsequent physical changes in his left mainstem bronchus. The prompt removal of an airway foreign body requires a high index of suspicion by the physician in order to facilitate proper workup to confirm the diagnosis, allow for prompt management, and minimize damage to the airway.
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http://dx.doi.org/10.7759/cureus.9987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511068PMC
August 2020

Loss of Unilateral Lacrimation Following Adenoidectomy.

Cureus 2020 Jul 21;12(7):e9312. Epub 2020 Jul 21.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Complications following an adenoidectomy are rare. A 13-month-old female developed unilateral lacrimation impairment following an adenoidectomy and bilateral ventilation tube insertion. The patient's post-operative course was marked by a fever, rhinorrhea, and dehydration. We suspect the impairment to be secondary to injury by suction cautery or post-operative inflammatory response and infection. Over the first nine months after surgery, the impairment spontaneously remitted.
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http://dx.doi.org/10.7759/cureus.9312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440260PMC
July 2020

Flipping the Classroom in Otolaryngology Residencies.

Cureus 2020 Jul 3;12(7):e8981. Epub 2020 Jul 3.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Objective To understand the use of the flipped classroom (FC) - learning core content prior to an academic session, with class time devoted to applying this content - in otolaryngology residency education. Methods An electronic survey of 107 otolaryngology program directors (PDs), including demographic details, the flipped classroom perception instrument (FCPI), and the otolaryngology programs' current use of FC. Results Forty-four (41%) PDs completed the FCPI. Seventy-one point one (71.1%) of respondents were male, 60% were 30-49 years, and the remainder were older. Sixty-two percent (62%) had fellowships associated with their program, 21.7% of programs used the FC model Very Often, 17.4% Somewhat Often, 28.3% Sometimes, 17.4% Somewhat Rarely, 8.7% Very Rarely, and 6.5% Never. Attitudes toward FC principles were positive with modes "strongly agree" for all, except for "online modules enhance learning" where the mode was "slightly agree" with significantly higher scores for PDs over age 50 than for those younger (4.17 vs. 3.63, p=0.033). There were no other significant differences comparing male vs. female PDs, younger vs. older PDs, smaller vs. larger programs, programs with or without fellowships, programs with 100% vs. <100% board exam pass rates, or programs in different geographical regions. The pre-class activity mean score was 4.34 (95% CI 4.12-4.56) and the in-class mean score was 4.18 (95% CI 3.99-4.37). There was no significant correlation between the likelihood of using a flipped classroom and attitude scores. Conclusion PDs value both the pre-class and interactive in-class principles of FCs but only 37.8% of programs use FC often, suggesting that practical approaches to implementation in this group could improve education in this population.
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http://dx.doi.org/10.7759/cureus.8981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402438PMC
July 2020

Standardization and Reduction of Narcotics After Pediatric Tonsillectomy.

Otolaryngol Head Neck Surg 2021 05 4;164(5):932-937. Epub 2020 Aug 4.

Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.

Objectives: (1) To measure caregiver satisfaction with a nonstandardized postoperative pain regimen after pediatric tonsillectomy. (2) To implement a quality improvement project (QIP) to reduce the number and volume of narcotics prescribed and to describe the effect on caregiver satisfaction.

Methods: A prospective cohort study at a tertiary children's hospital examined postoperative narcotics prescribed to children following adenotonsillectomy. A QIP was implemented 3 months into the observation, with the goal to standardize nonnarcotic analgesics and reduce the volume of narcotics prescribed. Caregivers were called 2 to 3 weeks postoperatively to assess pain control and caregiver satisfaction.

Results: Over an 8-month period, 118 patients were recruited (66 before the QIP, 52 after induction). Prior to the QIP, 47% of patients were prescribed postoperative narcotics, as opposed to 27% after the QIP ( < .05). There was a significant reduction in the volume of narcotics prescribed before (mean ± SD, 300 ± 150 mL) versus after (180 ± 111 mL) the initiative ( < .05). The per-kilogram dose did not change over the study time frame. On a 5-point Likert scale, there was no difference in the caregivers' satisfaction regarding pain control before (4.37 ± 0.85) versus after (4.35 ± 1.0) the project started.

Discussion: A system shift was identified with the establishment of a posttonsillectomy pain control protocol associated with a reduction in prescribed narcotics without a significant change in caregiver satisfaction.

Implications For Practice: Implementing a standardized plan for the use of nonnarcotic medications was associated with reduced frequency and volume of narcotics prescribed. Future work will further standardize our postoperative pain regimen.
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http://dx.doi.org/10.1177/0194599820946274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858697PMC
May 2021

Foreign Body Aspiration Presenting as Pneumothorax in a Child.

Cureus 2020 May 16;12(5):e8161. Epub 2020 May 16.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

A typical presentation of a foreign body aspiration (FBA) in a child includes witnessed choking, respiratory distress, cyanosis, coughing, wheezing, diminished breath sounds, and/or altered mental status. Following an extensive literature review, we found pneumothorax occurring secondary to FBA is a rare occurrence and should elicit prompt treatment. This 17-month-old female was admitted for respiratory syncytial virus (RSV) bronchiolitis and developed a subsequent pneumothorax during her hospital stay, consequent to aspiration of a cashew fragment two weeks before presentation. In light of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored expert panel's addended guidelines, published and endorsed by the American Academy of Pediatrics (AAP) in 2017, we highlight a potential complication of increasing encouragement of peanut consumption in children as young as four months.
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http://dx.doi.org/10.7759/cureus.8161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294853PMC
May 2020

The Effect of Ibuprofen Dosing Interval on Post-Tonsillectomy Outcomes in Children: A Quality Improvement Study.

Ann Otol Rhinol Laryngol 2020 Dec 16;129(12):1210-1214. Epub 2020 Jun 16.

Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA.

Objective: In this Quality Improvement (QI project) it was hypothesized that an increase in dosing intervals for postoperative analgesia when alternating Ibuprofen and Acetaminophen would reduce post-tonsillectomy hemorrhage (PTH) rates for those undergoing tonsillectomies with or without adenoidectomy, while maintaining the standard of postoperative analgesia and reducing visits to the Emergency Room (ER) for reasons other than PTH. Data was collected from 353 children. Utilizing run chart analysis, it was determined that patients experiencing the 4-hour dosing interval had lower rates of PTH, fewer ER visits, and no increase in postoperative phone calls from caregivers.

Patients And Methods: Patients were treated with standing Acetaminophen 15 mg/kg q6h and Ibuprofen 10 mg/kg q6h for postoperative analgesia from July of 2017 until January of 2018. Starting January of 2018 through November of 2018, the dosage interval was lengthened 1 hour. Data relating to PTH, ER visits for reasons other than bleeding, and phone calls from caregivers was collected.

Results: Run charts were used to assess outcomes regarding PTH, postoperative visits to the ER for reasons other than PTH, and phone calls from caregivers. Our results suggest that a standing protocol of alternating Acetaminophen and Ibuprofen given every 4 hours improves the post-tonsillectomy hemorrhage rate without increasing ER visits or calls about pain.

Conclusions: This data shows promise in reducing PTH and ER visits with a longer dose interval when alternating Acetaminophen and Ibuprofen for postoperative analgesia in tonsillectomy patients. A randomized clinical trial should be carried out to further validate these claims.
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http://dx.doi.org/10.1177/0003489420934843DOI Listing
December 2020

Paradoxical Vocal Cord Motion Presaging Bilateral Vocal Cord Paresis in an Infant.

Cureus 2020 Apr 27;12(4):e7853. Epub 2020 Apr 27.

Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.

Paradoxical vocal cord motion (PVCM) is a condition characterized by inappropriate adduction of the vocal cords during respiration. Usually seen in children and adolescents, PVCM presentation in infants is uncommon. Once thought to be a product of psychiatric disease, there are now several other proposed etiologies including irritant-induced and secondary to neurologic disease. Previous studies showed that the treatment of gastric reflux in this age group leads to a resolution of symptoms. We present a case of PVCM in an infant with hydrocephalus and Chiari II malformation. She received reflux therapy and ventriculoperitoneal (VP) shunting with two revisions. Despite these interventions, she continued with symptoms and eventually progressed to bilateral vocal cord paralysis (VCP). There is a paucity of literature describing PVCM as a precursor to VCP. Clinicians should be aware that in this population, refractory PVCM may serve as a warning sign for further vocal cord function decline.
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http://dx.doi.org/10.7759/cureus.7853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255064PMC
April 2020

Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae.

Ann Otol Rhinol Laryngol 2020 Sep 29;129(9):901-909. Epub 2020 May 29.

Department of Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.

Objective: Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM).

Methods: A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation.

Results: A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts ( < .001). Infants were more likely to have prolonged duration of days from admission to surgery ( < .001), days from surgery to discharge ( < .001), and total length of stay (<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications ( = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%).

Conclusion: This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.
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http://dx.doi.org/10.1177/0003489420922862DOI Listing
September 2020

Surgical Team Exposure to Cautery Smoke and Its Mitigation during Tonsillectomy.

Otolaryngol Head Neck Surg 2020 09 26;163(3):508-516. Epub 2020 May 26.

Department of Otolaryngology Head and Neck Surgery, University of West Virginia, Morgantown, West Virginia, USA.

Objectives: To assess the exposure of surgical personnel to known carcinogens during pediatric tonsillectomy and adenoidectomy (T&A) and compare the efficacy of surgical smoke evacuation systems during T&A.

Study Design: Prospective, case series.

Setting: Tertiary children's hospital.

Subjects And Methods: The present study assessed operating room workers' exposure to chemical compounds and aerosolized particulates generated during T&A. We also investigated the effect of 3 different smoke-controlling methods: smoke-evacuator pencil cautery (SE), cautery with suction held by an assistant (SA), and cautery without suction (NS).

Results: Thirty cases were included: 12 in the SE group, 9 in SA, and 9 in NS. The chemical exposure levels were lower than or similar to baseline background concentrations, with the exception of methylene chloride and acetaldehyde. Within the surgical plume, none of the chemical compounds exceeded the corresponding occupational exposure limit (OEL). The mean particulate number concentration in the breathing zone during tonsillectomy was 508 particles/cm for SE compared to 1661 particles/cm for SA and 8208 particles/cm for NS cases. NS was significantly different compared to the other two methods ( = .0009).

Conclusions: Although the exposure levels to chemicals were considerably lower than the OELs, continuous exposures to these chemicals could cause adverse health effects to surgical personnel. These findings suggest that the use of a smoke-evacuator pencil cautery or an attentive assistant with handheld suction would reduce exposure levels to the aerosolized particles during routine T&A, compared to the use of cautery without suction.
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http://dx.doi.org/10.1177/0194599820917394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483982PMC
September 2020

Epiglottopexy with or without aryepiglottic fold division: Comparing outcomes in the treatment of pediatric obstructive sleep apnea.

Am J Otolaryngol 2020 Jul - Aug;41(4):102478. Epub 2020 Apr 4.

West Virginia University, Department of Otolaryngology, Head and Neck Surgery, United States of America. Electronic address:

Objective: To determine the success of epiglottopexy with or without aryepiglottic fold division for treatment of patients with obstructive sleep apnea (OSA) with epiglottic obstruction.

Study Design: Retrospective chart review.

Setting: Tertiary care academic hospital.

Methods: Children with sleep study proven OSA who underwent epiglottopexy with or without aryepiglottic fold division from January 2013 to June 2017 were included. The epiglottis contributed to airway obstruction in all patients. Pre- and post-operative apnea-hypopnea index (AHI) were compared. Age, sex, body mass index (BMI) z-score and post-operative complications were also evaluated. Success was defined by post-operative AHI < 5.0 with resolution of OSA symptoms or AHI ≤ 1.0 events per hour.

Results: Twenty-eight children (age 2-17 years) underwent either epiglottopexy with division of aryepiglottic folds (N = 18) or epiglottopexy alone (N = 10). There was no difference in preoperative age, AHI, or BMI between the groups. Post-operative AHI was lower in the group undergoing epiglottopexy alone (AHI 1.50) versus with aryepiglottic fold division (AHI 3.17) (P < 0.05). No difference was found in mean AHI improvement between the two groups. For the entire cohort, success criteria were met by 53.6% of patients for AHI < 5.0 without symptoms and 25.0% of patients for AHI ≤ 1.0, with no difference in surgical success between procedures (P > 0.05).

Conclusions: Children undergoing epiglottopexy with division of aryepiglottic folds for laryngeal collapse were as likely to have improved OSA symptoms as children undergoing epiglottopexy alone.
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http://dx.doi.org/10.1016/j.amjoto.2020.102478DOI Listing
October 2020

Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis.

Am J Rhinol Allergy 2020 Sep 7;34(5):694-702. Epub 2020 Apr 7.

Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia.

Background: Paranasal sinus balloon catheter dilation (BCD) represents a tool that has been shown to be safe in the management of pediatric chronic rhinosinusitis (pCRS); however, its efficacy compared to standard treatment regimens has not been well established.

Objective: The purpose of this meta-analysis was to evaluate the clinical utility of BCD in pCRS.

Methods: Articles reporting BCD for pCRS in patients under 18 years of age were identified via the following search terms: sinusitis OR rhinosinusitis AND balloon dilatation OR balloon dilation OR balloon sinuplasty OR sinuplasty AND adolescent OR children OR infant OR pediatric OR toddler. The primary outcome analyzed includes quality of life improvement as measured via Sinus and Nasal Quality of Life Survey (SN-5) or Sino-nasal Outcome Test (SNOT-22) scores.

Results: Eighty studies were abstracted; 10 studies were included for final qualitative analysis after dual investigator screening. Three studies described BCD with surgical controls, including adenoidectomy, saline irrigation, or maxillary antrostomy. Noninferiority was not demonstrated (ie, BCD is inferior) in 2 of 3 studies. Pooled analysis utilizing a random effects model revealed a decreased effect size yet no statistically significant difference between BCD and standard operative techniques as measured by quality of life measures ( = -0.04,  = 41%).

Conclusion: This work highlights a lack of published evidence regarding the role of BCD in pCRS. Two of the 3 included studies demonstrated the inferiority of BCD when compared to other standard surgical interventions, whereas meta-analysis was unable to detect any statistically significant difference between standard treatment regimens. Future scientific investigations are necessary to assess the comparative effectiveness of BCD in pCRS.
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http://dx.doi.org/10.1177/1945892420917313DOI Listing
September 2020

Effect of Electrocautery Settings on Particulate Concentrations in Surgical Plume during Tonsillectomy.

Otolaryngol Head Neck Surg 2020 06 31;162(6):867-872. Epub 2020 Mar 31.

National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA.

Objectives: To describe the effect of monopolar electrocautery (EC) settings on surgical plume particulate concentration during pediatric tonsillectomy.

Study Design: Cross-sectional study.

Setting: Tertiary medical center.

Subjects And Methods: During total tonsillectomy exclusively performed with EC, air was sampled with a surgeon-worn portable particle counter. The airborne mean and maximum particle concentrations were compared for tonsillectomy performed with EC at 12 W vs 20 W, with smoke evacuation system (SES) and no smoke evacuation (NS).

Results: A total of 36 children were included in this analysis: 9 cases with EC at 12 W and SES (12SES), 9 cases with EC at 20 W and SES (20SES), 9 cases with EC at 12 W without SES (12NS), and 9 cases with EC at 20 W without SES (20NS). Mean particle number concentration in the breathing zone during tonsillectomy was 1661 particles/cm for 12SES, 5515 particles/cm for 20SES, 8208 particles/cm for 12NS, and 78,506 particles/cm for 20NS. There was a statistically significant difference in the particle number concentrations among the 4 groups. The correlation between the particle number concentration and EC time was either moderate (for 12SES) or negative (for remaining groups).

Conclusion: Airborne particle concentrations during tonsillectomy are over 9.5 times higher when EC is set at 20 W vs 12 W with NS, which is mitigated to 3.3 times with SES. Applying lower EC settings with SES during pediatric tonsillectomy significantly reduces surgical plume exposure for patients, surgeons, and operating room personnel, which is a well-known occupational health hazard.
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http://dx.doi.org/10.1177/0194599820914275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323892PMC
June 2020

Maxillary Frenulum in Newborns: Association with Breastfeeding.

Otolaryngol Head Neck Surg 2020 Jun 24;162(6):954-958. Epub 2020 Mar 24.

Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.

Objective: To relate maxillary and lingual frenulum configuration to breastfeeding success.

Study Design: Cross-sectional study.

Setting: Newborn nursery in tertiary care academic hospital.

Subjects And Methods: Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded.

Results: A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores ( > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85).

Conclusion: We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.
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http://dx.doi.org/10.1177/0194599820913605DOI Listing
June 2020

Decision Quality Among Parents Who Are Offered Ventilation Tube Insertion for Their Children.

Ann Otol Rhinol Laryngol 2020 Aug 4;129(8):748-754. Epub 2020 Mar 4.

Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.

Objective: To develop a Decision Quality (DQ) tool to measure parents' DQ concerning ventilation tube (VT) insertion in their children.

Method: Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT.

Results: Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were <18 months, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, < .001), higher DQ scores (83.00 vs 72.61, = .028) with higher SDM scores (88.70 vs 70.22, = .044) and higher values score (7.20 vs 6.36, = .034). Cronbach alpha for the DQ scale was 0.76. Spearman's rho for DQ score versus DC score was -0.458, < .001.

Conclusions: DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them.
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http://dx.doi.org/10.1177/0003489420909850DOI Listing
August 2020

Laryngomalacia in Neonates Versus Older Infants: HCUP-KID Perspective.

Clin Pediatr (Phila) 2020 06 28;59(7):679-685. Epub 2020 Feb 28.

West Virginia University, Morgantown, WV, USA.

This study evaluated the hospital course for neonates and older infants with a diagnosis of laryngomalacia (LM). Data came from the 2016 Kids' Inpatient Database of the Healthcare Cost Utilization Project. A total of 6537 children aged <1 year with a diagnosis of LM (International Classification of Diseases, 10th Revision, code Q31.5) were identified: 2212 neonates and 4325 non-neonates. Neonates had a higher mortality rate, 1.31% versus 0.72% in older infants, had more diagnoses (median 9 vs 7) and procedures (mean 85.24 vs 21.83), longer length of stay (median 10 vs 4 days), and higher total charges (median US$65 722 vs US$25 582). A total of 23.3% of neonates born during the admission and diagnosed with LM had undergone laryngoscopy. Second airway lesions were present in 12.33% of neonates and 15.77% of older infants. It appears that neonates are being discharged with a diagnosis of LM without laryngoscopy. Neonatal intensive care unit and newborn nursery policies should require visualization of the larynx prior to diagnosis of LM.
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http://dx.doi.org/10.1177/0009922820908917DOI Listing
June 2020