International Journal of Pediatric Otorhinolaryngology 73 (2009) 1489–1493

Announcement

International Journal of Pediatric Otorhinolaryngology sponsored poster prizes

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

journa l homepage: www.e lsev ier .com/ locate / i jpor l

The winners of the awards at the following conferences were:

XIX WORLD CONGRESS OF OTORHINOLARYNGOLOGY

IFOS 2009 June 1–5, 2009 – Sao Paulo – Brazil

1st Prize

BEST ORAL PRESENTATION ON PEDIATRIC OTOLARYNGOLOGY

OR-338

RISK FACTOR FOR POST-INTUBATION SUBGLOTTIC STENOSIS IN INFANTS

WITH ACUTE VIRAL BRONCHIOLITIS

Authors: Claudia Schweiger; Denise Manica; Fernando B. Do Amaral;

Priscila G. Ferreira; Kelli W. Gomes; Sabrina Kahler; Kizzy L. Corezola;

Camila Da Re; Paulo J.C. Marostica; Mariana M. Smith; Paulo R.A.

Carvalho; Gabriel Kuhl

Denise Manica

Hospital de Clınicas de Porto Alegre

Servico de Otorrinolaringologia

Biblioteca do Servico de Otorrinolaringologia

Ramiro Barcelos 2350

Largo Eduardo Z. Faraco

CEP 90035-903

Porto Alegre – RS – Brazil.

USAGE OF ADDITIONAL DOSES OF SEDATION AS A RISK FACTOR

FOR POST-INTUBATION SUBGLOTTIC STENOSIS IN INFANTS WITH

ACUTE VIRAL BRONCHIOLITIS

Introduction: The acute viral bronchiolitis is usually a benign course

disease, but some children can develop such a severe respiratory

dysfunction that they may need orotracheal intubation. This can lead

to some potential complications, being the subglottic stenosis (SGS)

one of the most disabling adverse outcomes.

Objective: To evaluate the incidence of SGS in children undergoing

orotracheal intubation for acute viral bronchiolitis and its potential

risk factors.

Methods: We enrolled in this study all the children admitted to

Hospital de Clınicas de Porto Alegre pediatric intensive care unit

(PICU) which were under orotracheal intubation for at least 24 hours.

0165-5876/$ – see front matter

doi:10.1016/j.ijporl.2009.07.001

After extubation, patients underwent nasofibrolaryngoscopy. In the

first evaluation, they were divided in two groups: NA group - normal

or slightly abnormal laryngeal exam - and AA group - moderate to

severe laryngeal alterations. Children from NA group who developed

symptoms during their post PICU follow up and all the children in the

AA group underwent a new examination in 7 to 10 days. In this second

evaluation, they were again classified as NC group - without chronic

alterations - and SGS group - presenting subglottic stenosis.

Results: There were 58 patients included between november/2005

and august/2008. The incidence of SGS was 10,42%. All the children

who developed SGS presented examinations with moderate to severe

alterations right after extubation. The intubation period in days, the

number of reintubations, the number of days in which the tube was

mobilized and the number of days with extra sedation were not

statistically different between the two groups. The children who

developed SGS, however, needed more extra doses of sedation than

those who did not.

Conclusion: The need of extra doses of sedation is possibly related to

the level of patient’s agitation during the intubation period and it

seems to be a crucial factor in SGS development.

American Society of Pediatric Otorhinolaryngology

ASPO ANNUAL MEETING

22nd–25th May 2009, Seattle, USA

Poster Winners

CLINCAL

1st Prize

No. 25

GENE TRANSFER IN RESPIRATORY EPITHELIUM USING SYNTHETIC

VECTORS AND FOLIC ACID RECEPTOR: A NEW THERAPY FOR CYSTIC

FIBROSIS

Mornet (M.D.)

Mornet, M.D. (1), Martins-Carvalho Christine, M.D. (1), Montier Tristan,

Ph.D. (2), Valette Gerald, M.D. (1), Marianowski Remi, M.D., Ph.D. (1)

1) Department of Oto-Rhino-Laryngology CHU Morvan Universityof Brest

Announcement / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1489–14931490

2) INSERM U 613 Genetique Moleculaire Epidemiologie GenetiqueI3S University of Brest

Aim of study: Synthetic vectors for cystic fibrosis (CF) gene therapy

require efficient and safe gene transfer into airway epithelial cells.

Synthetic vectors are potentially less toxic and less immunogenic

than viral vectors allowing repeated delivery. However, synthetic

vectors remain aspecific and less efficient than viral vectors. Respira-

tory epithelium offers few targets for gene transfer among which folic

acid receptor has a high affinity. We studied the folic acid receptor as a

target for gene transfer by using a new innovative synthetic vector

coupled with folic acid. The aim of this study was to determine

the transfection efficiency of our vector using in vitro models of

human respiratory epithelium and to compare it with KLN 47 and

Lipofectamin.

Methods: Our synthetic vector links a neutral and a cationic lipid.

A folic acid ligand is carried by a neutral colipid derived from

archaebacteria. We used a pCMV-Luc plasmid and determined gene

transfer efficiency by measuring luciferase expression on human

respiratory cells and cytolysis by measuring the release of adenylate

kinase.

Results: Specific gene transfer using competitive inhibition by free

folic acid was demonstrated. Our neutral targeting vector was tenfold

more efficient human respiratory cell line than Lipofectamin and KLN

47 at the same toxicity level.

Conclusion: Despite a small expression on human respiratory epithe-

lium, folic acid receptor is a pertinent target for non-viral gene transfer.

This vector remains to be tested on animal model but gene transfer

might be increased by decreasing aspecific electrostatic disturbance.

2nd Prize

No. 10

EVALUATION OF OLFACTORY FUNCTION IN CHILDREN UTILIZING A

SIX-ITEM SCRATCH AND SNIFF TEST

Christopher E. Grindle (M.D.)

Christopher E. Grindle, M.D. (1), William Parkes, M.D. (1), Carly Jornlin

(3), Pamela Dalton, Ph.D. (2), Julie Manella, Ph.D. (2), Beverly J.

Cowart, Ph.D. (2), Edmund A. Pribitkin, M.D. (1), Patrick C. Barth,

M.D. (1,3), Richard J. Schmidt, M.D. (1,3), James S. Reilly, M.D. (1,3)1) Department of Otolaryngology, Thomas Jefferson University2) Monell Chemical Senses Center, Philadelphia, PA3) Nemours/AI duPont Hospital for Children, Wilmington, DE

Purpose: To evaluate a child-specific test that utilizes stimuli that can

be administered in less than 5 min.

Methods: The Brief Smell Identification Test (BSIT) is a 12-item

scratch/sniff test. The goal was to create two versions which could

identify up to 6 items per test (Table 1).

Children between 3 and 17 years of age were tested. To determine

familiarity with the odor stimuli, the accompanying parent or guar-

dian also took the same version of the test.

There are four response options: one is correct and three are distractors.

Among the distractors, was one item that is perceptually similar to the

correct item (chocolate vs. coffee) and is considered a ‘near miss’. The

other two are considered true distractors. A correct response is given a

score ‘‘1’’ and a near miss score ‘‘0.5’’. Distractors are scored at ‘‘0’’.

Results: 149 children have been tested. The number of correct

response items increases with age categories (P < 0.05). Certain items

are better recognized even among the oldest age group.Conclusions:

Olfactory testing can be accomplished in children as young as 3 years

of age. Olfactory awareness and sensitivity increase with age and have

better reliability with specific stimuli.

3rd Prize

No. 4

A REVIEW OF ESOPHAGEAL DISC BATTERY INGESTIONS AND A

PROTOCOL FOR MANAGEMENT

Stanley J. Kimball (M.D.)

Stanley J. Kimball D.O. (1), Albert H. Park, M.D. (2), Michael D. Rollins

II, M.D. (3), J. Grimmer, M.D. (2), Harlan Muntz, M.D. (2), Marshall

Smith, M.D. (2)

1) Department of General Surgery, Mount Carmel Health System,Columbus, OH

2) Department of Otolaryngology-Head and Neck Surgery, Uni-versity of Utah, Salt Lake City, UT

3) Department of Pediatric Surgery, University of Utah, Salt LakeCity, UT

Objective: We present the harmful effects from a series of patients

with esophageal disc battery requiring endoscopic retrieval and

describe a protocol for management.

Methods: This is a retrospective chart review regarding patients

who underwent endoscopic retrieval of foreign body over a 10 year

period. Endoscopic operative reports were reviewed to determine

whether a disc battery was present. Further chart review included

gender, age, presenting symptoms, pre-operative radiography,

intra-operative findings, treatment provided, outcome and follow-

up.

Results: Ten cases involving an esophageal disc battery requiring

endoscopic retrieval were identified over a 10 year period. Three

patients had minimal esophageal damage; the other seven cases

involved more severe and extensive esophageal damage involving

muscularis (five) or perforation (two). One of these patients had an

extensive injury that extended into the trachea resulting in a tra-

cheoesophageal fistula. Two case reports are presented outlining the

conservative and surgical management of esophageal perforation

after impacted disc battery is misdiagnosed.

Conclusion: Severe injury occurs rapidly when a disc battery is

impacted within the esophagus. A high index of suspicion for a foreign

body being a disc battery is necessary to quickly rule out this entity.

Emergent endoscopic retrieval is required to minimize more severe

sequelae. We outline a protocol for the management of this hazardous

problem.

Announcement / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1489–1493 1491

Delivery of Health Care

1st Prize

No. 1

UTILITY OF ONLINE INTERACTIVE FAMILY EDUCATION FOR PEDIA-

TRIC OTOLARYNGOLOGY PROCEDURES

Abby R. Nolder (M.D.)

Abby R. Nolder, M.D. (1), Charles M. Bower, M.D. (2), Gresham T.

Richter, M.D. (2)

1) Department of Otolaryngology-Head and Neck Surgery, Uni-versity of Arkansas for Medical Sciences

2) Arkansas Children’s Hospital Division of Pediatric Otolaryngol-ogy, University of Arkansas for Medical Sciences

Objective: The surgeon’s goal to provide detailed informed consent for

common otolaryngology procedures remains a challenge in today’s

busy pediatric practice. Technical resources have emerged to supple-

ment education for patients and their families. This study is designed to

analyze the utility of an interactive online resource providing preo-

perative details for routine pediatric otolaryngology procedures.

Design: 14 month retrospective review of program usage.

Setting: Tertiary referral center.

Main outcome measures: Usage and satisfaction of an online resource

accessible to families of children undergoing tonsillectomy and myr-

ingotomy procedures.

Results: 653 and 685 families were provided codes to access an online

resource illustrating tonsillectomy and myringotomy procedures,

respectively. An average of 77% and 73% of families completed the

program. 247 viewers completed the optional survey at the conclusion

of the program. 97% of respondents agreed that the online program

affected their understanding of their child’s surgery, 89% agreed that the

program answered their questions and saved a call to their physician’s

office, and 93% agreed that the program increased their confidence in

their child’s doctor. 42% of parents also had their child watch, with 87%

agreeing that the program helped them explain what to expect.

Conclusions: As a supplement to traditional informed consent, online

resources appear to be used when available, reduce office calls, and

provide parents and children with greater confidence in their surgeon

and better understanding of their planned surgical procedure.

2nd Prize

No. 31

SURVEY OF THYROGLOSSAL DUCT CYST IN A SUBSPECIALTY REFER-

RAL PRACTICE

Lawrence M. Simon (M.D.)

Lawrence M. Simon, M.D. (1), Dale A. Tylor, M.D. (1), Wen Jiang, M.D.

(1), Daniela Carvalho, M.D. (1), Marcella R. Bothwell, M.D. (1), Donald B.

Kearns, M.D. (1), Seth M. Pransky, M.D. (1), Anthony E. Magit, M.D. (1)

1) Division of Otolaryngology, Children’s Specialists of San Diego

Objectives: Describe the epidemiology and treatment outcomes for

thyroglossal duct remnants in a tertiary care pediatric otolaryngology

practice.

Study Design: Retrospective case review.

Setting: Tertiary referral practice.

Patients: Patients treated for thyroglossal duct remnants from 2002

to 2006. Subjects were identified using the diagnosis code for thyr-

oglossal duct cyst or the procedure code for excision of thyroglossal

duct cyst or sinus.

Main outcome measures: Data extracted included: age at presenta-

tion, gender, comorbid conditions, presence of malignancy, rate of

recurrence, and the relationship between pre-operative infection and

recurrence risk.

Results: 203 patients met the search criteria. Mean age at presenta-

tion and surgery were 5 and 6 years, respectively. There was a 1:1

female-to-male ratio, and the most common presentation was a

midline neck mass. There was an 11% recurrence rate, with an average

time between initial surgery and recurrence of 36 months. Approxi-

mately 50% had a history of infection, and of these, 20% required

incision and drainage. Of those with a history of infection, 25%

recurred after surgery, and 100% of patients with recurrent cyst

had pre-operative infection. Only 1 recurrence was seen in patients

with pre-operative incision and drainage. Rate of malignancy was 1%.

Conclusions: Thyroglossal duct remnants are a common entity

requiring surgical treatment. This case series suggests that pre-

operative infection is associated with an increased post-operative

recurrence rate. However, pre-operative incision and drainage does

not appear to share this association. These findings may assist in pre-

operative counseling and management of thyroglossal duct infection

prior to definitive surgery.

3rd Prize

No. 49

AIRWAY MEASURING DEVICE

David H. Chi (M.D.)

David H. Chi, M.D. (1), Kenji Shimada, Ph.D. (2)

1) Department of Pediatric Otolaryngology, Children Hospital ofPittsburgh, University of Pittsburgh

2) Department of Mechanical Engineering, Carnegie MellonUniversity

Subglottic stenosis is the most common acquired pediatric laryngeal

disorder and the most frequent pediatric laryngeal problem requiring

tracheotomy. The Myer–Cotton grading scale provides a mean of

estimating the severity of stenosis. The technique involves determining

an endotracheal tube that maintains an air leak at less than 30 cm of

water. The tube is then compared to the age appropriate endotracheal

tube to obtain a percentage narrowing. Clinicians may use this infor-

mation for surgical planning and monitoring. Advantages of this tech-

Announcement / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1489–14931492

nique are that it is the well accepted standard and utilizes readily

available endotracheal tubes. Potential limitations are that the tech-

nique: (1) assumes a concentric narrowing; (2) may be traumatic to the

soft tissue with multiple passages of the tube; and (3) may have

variability because it depends on a table of categorized normative data.

A new airway measuring apparatus, ‘Measuring Device and Method of

Measuring,’ has been developed that has received a United States

patent (No. 7,296,361) issued in November 2007. The device is

coupled with a Hopkins telescope to allow for visualization and

measurement of airway stenoses. The advantages of the device over

the current endotracheal tube sizing method are: (1) measurements

in multiple dimensions; (2) ease of use; (3) accuracy; (4) nontrau-

matic technique; and (5) Measurement of tracheal stenoses distal to

the subglottis. Prototypes of the device are being developed and

functional animal testing is planned. Initial design and prototypes

are demonstrated.

Case Reports

1st Prize

No.57

PEDIATRIC CERVICOFACIAL NECROTIZING FASCIITIS: A CASE

REPORT AND REVIEW OF A TEN YEAR NATIONAL PEDIATRIC DATA-

BASEErika King (M.D.)

Erika King, M.D. (1), Robert H. Chun, M.D. (1), Cecille G. Sulman, M.D. (1)

1) Department of Otolaryngology, Medical College of Wisconsin

Purpose: Necrotizing fasciitis (NF) is a rapidly progressive infection,

where early identification and treatment are critical to the preserva-

tion of life. The authors present a case of a pediatric cervicofacial NF

and a review of a 10 year pediatric inpatient database.

Methods: Case report of a healthy 5-year-old male who developed

necrotizing fasciitis of the lower lip 36 h following minor trauma.

International Classification of Disease, Ninth Revision Code 728.86

(NF) was the inclusion criteria for the Kid’s Inpatient Database (KID)

in 1997 and 2006.

Summary of results: A pediatric case will be presented with a thor-

ough photographic record demonstrating the need for rapid diagnosis

and treatment. In a review of the KID database from 1997 and 2006,

the relative risk of being discharged with NF in 2006 versus 1997 was

1.20. The odds ratio of being discharged with this disease in 2006

compared to 1997 was 1.19 (P = 0.018; 95% CI 1.03–1.4). Deaths with

a diagnosis of NF increased from 1997 versus 2006 from 3.9% to 5.4%.

In 2006, the odds of death were 15.1 times higher in pediatric

discharges with a diagnosis of NF compared to discharges without

a diagnosis of NF (P < 0.0001; 95% CI 9.3–23.1).

Conclusion: Even with the advent of new treatments and antibiotics,

the incidence and death rates of NF have changed little over the last

ten years. While it is still a rare diagnosis, knowledge and awareness

of necrotizing fasciitis with aggressive medical and surgical treat-

ment are still the foundation in disease survival.

2nd Prize

No. 67

A NOVEL EUSTACHIAN TUBE ANOMALY

Anna K. Meyer (M.D.)

Anna K. Meyer, M.D. (1), Glenn E. Green, M.D. (2)

1) Division of Pediatric Otolaryngology, Dept. of Otolaryngology-Head & Neck Surgery, University of California, San Francisco

2) Division of Pediatric Otolaryngology, Dept. of Otolaryngology-Head & Neck Surgery, University of Michigan Hospitals

Purpose: Very few eustachian tube anomalies have been published in

the literature and have consisted of descriptions of diverticula, hypo-

plasia/aplasia, or aberrant associated musculature. We identified a

eustachian tube anomaly in a 21-month-old child and aimed to

classify it embryologically and anatomically.

Methods: A thorough investigation of the anatomical nature of the

fistula was performed, including physical examination awake and

under general anesthesia. Computed tomography with and without a

radio-opaque pledget placed in the fistula was obtained. Speech and

language evaluation was performed. A systematic review of the

literature on eustachian tube and branchial cleft and pouch anomalies

was completed.

Results: Our patient was found to have right hemifacial microsomia

with unilateral facial paresis, microtia, external auditory canal atresia,

hypoplasia of the palatal musculature and a eustachian tube fistula.

The fistula was a mucous-lined tract extending from behind the

microtic ear to the torus tubarius, with no obvious connection to

the middle ear. An aberrant right-sided palatal musculature was also

identified with a foreshortened palate, aberrant levator veli palatini

insertion, and an absent palatopharyngeal arch with fusion of the

salpingopharyngeus and the palatopharyngeous, without connection

to the soft palate. Our review of the literature revealed rare reports of

eustachian tube anomalies, none of which resembled our case. In

addition, our case did not adhere to any classification of known

branchial cleft and pouch anomalies.

Conclusion: We were able to describe a unique eustachian tube

anomaly not previously reported in the literature.

3rd Prize

No. 84

PLASTIC BRONCHITIS: BRONCHIAL CASTS MIMICKING AIRWAY

FOREIGN BODY

Ted Shen (M.D.)

Brian G. Lee, M.D. (1), Debra M. Don, M.D. (1,2), Larry Wang, M.D. (3),

Laura Hastings, M.D. (4), Kenneth A. Geller, M.D. (1,2)

1) Department of Otolaryngology-Head and Neck Surgery, KeckSchool of Medicine, University of Southern California

2) Division of Pediatric Otolaryngology, Childrens Hospital LosAngeles

3) Division of Pathology, Children’s Hospital Los Angeles4) Division of Anesthesiology, Children’s Hospital Los Angeles

Plastic bronchitis is a rare condition characterized by thick mucus

casts of the bronchi. It occurs in patients with inflammatory disorders

Announcement / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1489–1493 1493

of the lungs (Type I) and patients after cardiac reconstruction for

congenital defects (Type II). Extraction of the casts can be laborious as

the material tends to branch into secondary and tertiary bronchioles.

It can present acutely, with near complete obstruction of the bron-

chial airways. Thus recognition of the condition and emergent

bronchoscopy by an otolaryngologist may be life saving.

Pediatric otolaryngologists are frequently called upon to evaluate

children for possible foreign body aspiration. The presentation of

these patients is highly variable and astute clinical judgment requires

a high index of suspicion in evaluating such cases. A thorough history

is generally the most critical part of the evaluation. We present the

case of a child who presents with a history suspicious for foreign body

aspiration who in fact had plastic bronchitis.

Robert J. Ruben*Montefiore Medical Center, Otolaryngology, 3400 Bainbridge Ave, 3rd

Flr., Bronx, NY 10467-2404, United States

*Tel.: +1 718 920 2484; fax: +1 718 405 9014E-mail address: ruben@aecom.yu.edu