International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2012
Multicenter Study Comparative StudyListen up: children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age.
Age-appropriate speech/language outcomes for children with early identified hearing loss are a possibility but not a certainty. Identification of children most likely to achieve optimal outcomes is complicated by the heterogeneity of the children involved in outcome research, who present with a range of malleable (e.g. age of identification and cochlear implantation, type of intervention, communication mode) and non-malleable (e.g. degree of hearing loss) factors. This study considered whether a homogenous cohort of early identified children (≤ 12 months), with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogenous cohort of children who were later identified (>12 months to <5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age. ⋯ This study found that most children with all severities of hearing loss and no other concomitant diagnosed condition, who were early diagnosed; received amplification by 3 months; enrolled into AV intervention by 6 months and received a cochlear implant by 18 months if required, were able to "keep up with" rather than "catch up to" their typically hearing peers by 3 years of age on measures of speech and language, including children with profound hearing loss. By 5 years, all children achieved typical language development and 96% typical speech.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2012
Methicillin-resistant Staphylococcus aureus (MRSA) pediatric tympanostomy tube otorrhea.
To describe our experience and clinical outcomes with the management of pediatric tympanostomy tube otorrhea secondary to methicillin-resistant Staphylococcus aureus (MRSA). ⋯ Appropriately treated recurrent or recalcitrant tympanostomy tube-related otorrhea should raise the suspicion for MRSA-related tympanostomy tube otorrhea. Fluoroquinolone ototopical medication should be considered for initial therapy. Sulfacetamide ototopical medication can be considered for failures. The adjunctive use of oral antibiotics, bactrim and clindamycin, and aminoglycoside ototopical medications did not improve clinical outcomes for medical therapy alone. We believe that some consideration be given to removal of the tympanostomy tube with or without replacement, after an initial treatment period with fluoroquinolone and/or sulfacetamide otopical medications. Our findings seem to suggest an improved rate with tympanostomy tube removal over medical therapy alone (p<0.0001). No standard management guidelines currently exist.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2012
Comparative StudyComparison between tracheal foreign body and bronchial foreign body: a review of 1,007 cases.
To determine the differences between tracheal foreign body aspiration and bronchial foreign body aspiration. ⋯ The nature of tracheal foreign body aspiration is different from bronchial aspiration. Clinical presentation and pre-operative radiographic findings are helpful for diagnosis. The clinician should understand the differences between tracheal and bronchial FB cases and provide the appropriate management when either is presented.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2012
Randomized Controlled Trial Comparative StudyComparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain.
To compare the efficacy of preoperative peritonsillar injection of ropivacaine, bupivacaine and lidocaine for pediatric tonsillectomy. ⋯ Ropivacaine infiltration is as effective as bupivacaine for post-tonsillectomy pain management in children. In view of potential side effects of bupivacaine-epinephrin combination, ropivacaine is a safer choice, for post-tonsillectomy pain relief.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2012
Comparative StudyTo drain or not to drain - management of pediatric deep neck abscesses: a case-control study.
Optimal management of deep neck abscesses has been the subject of debate for more than a century: surgical drainage has been the mainstay of treatment, but recently many centres have reported successful non-operative management in selected cases. ⋯ High dose intravenous antibiotics are an effective treatment for deep space neck abscesses and may obviate the need for surgical drainage, particularly in smaller abscesses. Children who do not respond quickly to antibiotics are more likely to require surgery to achieve resolution. Children with larger abscesses may respond to antibiotic therapy alone but should be closely observed. A trial of high dose intravenous antibiotics in stable children with close observation is warranted as first line treatment, especially for small deep space neck abscesses.