International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Jan 2013
Comparative StudyThe role of advanced practice providers in pediatric otolaryngology academic practices.
The goal of this study was to examine the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) in pediatric academic otolaryngology programs to provide a better understanding of their scope of practice, levels of autonomy, clinical duties, teaching opportunities and research participation. ⋯ NPs and PAs have complimentary skill sets ideal for the pediatric otolaryngology workplace, although job activities and "best fit" are hospital and practice dependent. Our study suggests that the use of PAs and NPs will continue to grow to meet increased demand for services in the field of pediatric otolaryngology. Employing advanced practice providers enables academic centers to improve access, provide additional financial remuneration, reduce wait times for new patients, and allow attending physicians to meet increased practice demands.
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Int. J. Pediatr. Otorhinolaryngol. · Jan 2013
Comparative StudyPrevalence of ventilation tubes in children with a tracheostomy tube.
To estimate the prevalence of operative ear disease in pediatric patients with tracheostomy tubes, as well as to identify risk factors predictive of operative otologic interventions in this patient cohort. ⋯ The presence of a tracheostomy is associated with an increased risk of requiring ventilation tube placement over the population at large. Risk factors for operative middle ear disease among these children include age at time of the tracheostomy, craniofacial abnormalities, term birth, and home living situation.
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Int. J. Pediatr. Otorhinolaryngol. · Jan 2013
Case ReportsMultilevel airway obstruction including rare tongue base mass presenting as severe croup in an infant.
Laryngomalacia is the most common cause of neonatal stridor, accounting for up to 60% of cases [1]. Less common causes of neonatal stridor include subglottic or tracheal stenosis, or congenital masses of the upper airway. ⋯ These infants deserve an endoscopic evaluation to better diagnose and manage respiratory distress. Here we present a rare case of an infant initially diagnosed with croup, but ultimately found to have multilevel airway obstruction including severe laryngomalacia and an obstructing tongue base mass.
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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.