International journal of pediatric otorhinolaryngology
-
Int. J. Pediatr. Otorhinolaryngol. · May 2020
Efficacy of commercial nasal bridle use in reducing feeding tube dislodgements in pediatric patients following double stage laryngotracheoplasty.
Maintaining placement of the nasogastric feeding tube (NGT) is imperative in the double stage laryngotracheoplasty (dsLTP) patient because of concerns for adequate nutrition and hydration in the postoperative period. Additionally, multiple reinsertions due to displacement potentiate surgical morbidities. The purpose of this study was to compare NGT dislodgment rates in children with and without a commercial nasal bridle following a dsLTP surgical procedure and to determine if the use of a commercial nasal bridle decreases accidental tube dislodgements. ⋯ The commercial nasal bridle significantly reduced NGT displacements without complication in the examined pediatric sample s/p dsLTP. Bridle use was associated with decreased radiology exposure and LOS and was successfully used in the outpatient setting.
-
Int. J. Pediatr. Otorhinolaryngol. · Apr 2020
Observational StudyEvaluation of the effect of Boyle-Davis mouth gag on intracranial pressure in patients undergoing adenotonsillectomy by using ultrasonographic optic nerve sheath diameter measurement.
We aimed to evaluate the effect of an increase in intracranial pressure (ICP) due to sympatho-adrenergic response caused by mouth gag and tongue depressor during adenotonsillectomy by measuring the optic nerve sheath diameter (ONSD) by ultrasonographic method. ⋯ This study showed that the Boyle-Davis mouth gag used during the adenotonsillectomy operation resulted in a significant increase in the diameter of the optic nerve sheath measured ultrasonographically and increased the ONSD even further during the time the mouth gag was remained in situ. In children with intracranial pathologies who will undergo adenotonsillectomy or those with increased ICP-related risk factors, the risks that may arise from the effect of the Boyle-Davis mouth gag on ICP should be considered.
-
Int. J. Pediatr. Otorhinolaryngol. · Mar 2020
ReviewThe immunology of the periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome; what can the tonsils reveal. A literature review.
Tonsillectomy (TE) or adenotonsillectomy (ATE) may have a beneficial effect on the clinical course in children with the periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. However, an immunological reason for this effect remains unknown. This literature review summarizes the current knowledge regarding the immunological role of the tonsils in the PFAPA syndrome. ⋯ A uniform immunological or microbiological pattern explaining the clinical effect of TE in children with PFAPA has not been revealed. Future targeted immunological studies of tonsils in PFAPA patients could possibly illuminate the understanding of the immunology in this disease.
-
Int. J. Pediatr. Otorhinolaryngol. · Feb 2020
Advanced practice providers and children's hospital-based pediatric otolarynology practices.
Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting. ⋯ The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.
-
Int. J. Pediatr. Otorhinolaryngol. · Feb 2020
Outcomes intensive care unit placement following pediatric adenotonsillectomy.
Adenotonsillectomy (AT) is the most common surgical procedure for the treatment of sleep related breathing issues in children. While overnight observation in the hospital setting is utilized frequently in children after a AT, ICU setting is commonly used for patients with sleep apnea. This objective of this study is to examine factors associated with the preoperative decision to admit patients to PICU following AT as well as co-morbidities that may justify necessity for higher level of care. ⋯ This study suggest that while our pre-operative referral program for PICU placement is effective in identifying patients needing higher levels of care, the program places many patients in the PICU who did not utilize respiratory support or suffer from complications. We observed some misalignment between characteristics associated with planned ICU stays and actual complications. This suggests that patients with specific clinical histories, not findings on their sleep studies, should be prepared to receive higher levels of care.