Publications by authors named "Tzyynong L Friesen"

5 Publications

  • Page 1 of 1

Fatigue in Children With Unilateral and Bilateral Hearing Loss.

Otol Neurotol 2021 Oct;42(9):e1301-e1307

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.

Objective: To determine whether children with unilateral hearing loss (UHL) experience similar levels fatigue as children with bilateral hearing loss (BHL) or normal-hearing (NH).

Design: Cross-sectional study.

Setting: Two tertiary care otolaryngology practices.

Participants: Children, 5 to 18 years old, with UHL or BHL and their parents.

Main Outcome Measures: PedsQL Multidimensional Fatigue Scale (MFS) survey.

Results: Overall response rate was 90/384 (23%). Mean age of child participants was 10.7 years old (standard deviations [SD] 3.1); 38 (42%) were men and 52 (58%) were women. Sixty-nine (77%) children had UHL, 21 (23%) had BHL. Children with BHL (mean 65, SD 21) and UHL (mean 75, SD 17) reported greater levels of fatigue than children with NH (BHL difference -15, 95% confidence interval [CI] -25 to -5; UHL difference -6, 95% CI -13-1.2). Parent-proxy reports for children with BHL (mean 67, SD 20) and UHL (mean 76, SD 20) reported more fatigue than NH (BHL difference -22, 95% CI -33 to -12; UHL difference -14; 95% CI -20 to -8). Sub-section scores for general, sleep, and cognitive fatigue were higher for children with BHL and UHL than NH.

Conclusion And Relevance: Children with UHL and BHL reported significantly more fatigue than children with NH, and children with BHL reported more fatigue than UHL. These findings underscore the need to increase auditory rehabilitation and educational resources for children with UHL and support the use of the PedsQL MFS questionnaire as a measure to follow disability experienced by children with HL as they undergo hearing rehabilitation.
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October 2021

Put your money where your mouth is.

Clin Case Rep 2021 Apr 1;9(4):2496-2497. Epub 2021 Mar 1.

Division of Otolaryngology-Head and Neck Surgery Department of Surgery University of California San Diego La Jolla CA USA.

Suspicion for battery ingestion should be maintained for any round radiopaque foreign body. Presence of the classic "double ring" sign on plain film should prompt emergent operative removal, although it is not pathognomonic.
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April 2021

Bronchial stenting in infants with severe bronchomalacia: Technique and outcomes.

Int J Pediatr Otorhinolaryngol 2021 Jun 6;145:110703. Epub 2021 Apr 6.

Division of Pediatric Otolaryngology, Rady Children's Hospital and UC San Diego School of Medicine, 3020, Children's Way, San Diego, CA, USA. Electronic address:

Objectives: To report the first use of a balloon expandable bare metal stent for treating infant bronchomalacia.

Background: Infant bronchomalacia often requires prolonged mechanical ventilation and can be life-threatening. Effective treatment for severe infant bronchomalacia continues to be elusive. We present three cases of bronchial stenting for no-option or treatment refractory infant bronchomalacia.

Methods: Three consecutive cases of stenting to relieve conservative treatment refractory severe infant bronchomalacia were performed between February 2019 and December 2020. Initial diagnosis was confirmed with Computed Tomography (CT) angiography. Patients underwent rigid micro laryngoscopy, bronchoscopy, and flexible bronchoscopy to evaluate the airway. Initial conservative management strategies were pursued. Patients failing initial conservative management strategies were considered for rescue bronchial stenting.

Results: Our initial clinical experience with a coronary bare metal stent for these procedures has been favorable. The stent was easy to deploy with precision. We did not encounter stent embolization or migration. There was sufficient stent radial strength to relieve bronchomalacia without causing restenosis or erosion. There was no significant granulation tissue formation. In one patient, the stent was removed after 12 months of somatic growth; this was uneventful and bronchial patency was maintained. There were no complications in any of our patients regarding stent placement and reliability.

Conclusion: In cases of three infants with severe bronchomalacia, we found that bronchial stenting with the bare metal coronary stent was effective in relieving bronchial stenosis.
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June 2021

Speech and Audiology Outcomes After Single-Stage Versus Early 2-Stage Cleft Palate Repair.

Ann Plast Surg 2021 05;86(5S Suppl 3):S360-S366

From the Division of Plastic Surgery, University of California.

Purpose: The timing and management of patients with cleft palates have been controversial. Early soft palate closure at the time of cleft lip repair followed by hard palate closure at a second stage has been hypothesized to improve speech and audiology outcomes. This study compares cleft palate patients who have undergone single-stage versus 2-stage cleft palate repairs and the outcomes on speech and hearing.

Methods: A retrospective chart review identified patients with diagnosis of cleft lip with complete cleft palate who underwent either single or 2-stage repair from 2006 to 2012. Data collected included age at each surgery, necessity of further speech surgery for velopharyngeal insufficiency, frequency of tympanostomy tube placement, presence of hearing loss, and speech assessment data graded per the validated Americleft speech scale.

Results: A total of 84 patients were identified and subdivided into groups of single-stage and 2-stage repair. The mean age at the time of single-stage palate repair was 13.3 months. For the 2-stage group, the mean ages were 4.2 and 11.8 months for the soft palate and hard palate repairs, respectively. Comparing the single-stage versus 2-stage palate repairs, there was no significant difference in all speech parameters including hypernasality, hyponasality, nasal air emission, articulation, expressive language, receptive language, speech intelligibility, and speech acceptability for both unilateral and bilateral cleft lip/palate patients. Two-stage repair was associated with increased number of tympanostomy tube placement compared with single-stage repair (relative risk, 1.74; P = 0.009), and the first set of tubes was performed at a statistically significantly younger age, 4.5 months in the 2-stage repair compared with 16.9 months in the single-stage (P = 0.012) with 87.5% performed with first stage of repair. However, there was no difference in the types, degrees of hearing loss, or the presence of at least mild conductive hearing loss at latest follow-up audiograms between the groups.

Conclusions: There was no significant benefit with respect to speech or hearing outcomes between single-stage and 2-stage cleft palate repairs. This advocates for surgeon and family preference in the timing of cleft palate repair.
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May 2021

Predictors of Pediatric Tracheostomy Outcomes in the United States.

Otolaryngol Head Neck Surg 2020 09 21;163(3):591-599. Epub 2020 Apr 21.

Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA.

Objectives: To investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities.

Study Design: Retrospective national database review.

Setting: Fifty-two children's hospitals across the United States.

Subjects And Methods: Hospitalization records from Pediatric Health Information System database dated 2010 to 2018 with patients younger than 18 years and procedure codes for tracheostomy were extracted. The primary outcome was total length of stay. The secondary outcomes were 30-day readmission, mortality, and posttracheostomy length of stay.

Results: A total of 14,155 children were included in the analysis. The median total length of stay was 77 days and increased from 59 to 103 days between 2010 and 2018 ( < .001). The median posttracheostomy length of stay was 34 days and also increased from 27 to 49 days ( < .001). On multivariate regression analyses, the total and posttracheostomy lengths of stay were significantly increased in children younger than 1 year, patients of black race, hospitals in the non-West regions, those discharged to home, and those with comorbidities. Socioeconomic indicators such as insurance type and estimated household income were associated with no difference or small effect sizes. Regions and comorbidities were associated with differences in 30-day readmission (overall 26%), while in-hospital mortality was primarily associated with age and comorbidities (overall 8.6%).

Conclusion: Pediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.
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September 2020