The Laryngoscope
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Comparative Study
Analysis of outcomes in treatment of obstructive sleep apnea in infants.
To investigate interventions used for treatment of obstructive sleep apnea (OSA) in infants. ⋯ Observation was the most common nonsurgical intervention and the most common intervention in patients younger than 12 months. Adenotonsillectomy was the most common surgical and overall intervention. Adenotonsillectomy had the greatest subjective efficacy, and tracheostomy had the greatest objective efficacy.
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In this study, we detailed factors governing legal outcomes in iatrogenic orbital injury, with the purpose of discussing strategies to minimize liability and enhance patient safety. ⋯ The potential for permanent sequelae of iatrogenic orbital injury makes this complication susceptible to malpractice litigation. Otolaryngologists were the most common defendants. Although cases were resolved in the defendant's favor 60% of the time, payments made were considerable, averaging $1.13 million. Steps to minimize liability and improve patient safety include an informed consent process explicitly listing risks, including diplopia and blindness, and obtaining timely ophthalmology consultation when a complication is recognized.
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To evaluate the incidence, safety, and efficacy of adenotonsillectomy for the treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in infants 12 months of age and younger. ⋯ Adenotonsillectomy in infants under 12 months old is uncommonly performed, but is more effective in treating OSA/SDB in patients who are healthy than in those with comorbid conditions. Postoperative PICU monitoring is recommended given that the risks of postoperative complications in this young age group is high (28%) and often related to perioperative oxygen requirements. Patients should also be counseled about the potential for symptomatic adenoid regrowth, for which revision adenoidectomy may be indicated.