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pediatric otolaryngology-

Head & neckS u r g e r y

clinical reference guide

Sanjay R. Parikh, MD, FACS

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Foreword by Michael Cunningham, MD, FACS xiPreface xiiiAcknowledgments xivAbout the Editor xvAbout the Section Editors xviContributors xix

Section I Embryology 1Steven L. Goudy and Sanjay R. Parikh

Chapter 1 Embryology of the Ear 3Theodore R. McRackan and Steven L. Goudy

Chapter 2 Embryology of the Lip and Palate 11Noel Jabbour and Steven L. Goudy

Chapter 3 Embryology of the Neck 17Christopher T. Wooten

Chapter 4 Embryology of the Nose and Paranasal Sinuses 29Frank W. Virgin, Jr.

Chapter 5 Embryology of the Face 33Tara Ramachandra and Steven L. Goudy

Section II Otology 41Steven L. Goudy, David R. White, and Sanjay R. Parikh

Chapter 6 Assessment of Pediatric Hearing 43Dale A. Tylor

Chapter 7 Assessment of Pediatric Balance 53Sharon L. Cushing

Chapter 8 Pediatric Tinnitus 67Marc Bennett

contentS

v

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vi Pediatric Otolaryngolog y-Head and Neck Surgery: A Clinical Reference Guide

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Chapter 9 Congenital Inner and Middle Ear Anomalies 77George B. Wanna and Stanley Pelosi

Chapter 10 Microtia and Atresia 83Sivakumar Chinnadurai

Chapter 11 Sensorineural Hearing Loss 91Henry Ou

Chapter 12 Nonsurgical Hearing Rehabilitation 103Joshua R. Mitchell and Steven L. Goudy

Chapter 13 Surgical Hearing Rehabilitation 109David L. Horn

Chapter 14 Auditory Neuropathy Spectrum Disorder 119Daniel Q. Sun and Margaret L. Skinner

Chapter 15 Eustachian Tube Dysfunction 129Brian Ho, Jessica van Beek-King, and George F. Harris, IV

Chapter 16 Acute Otitis Media 137Travis D. Reeves and Christopher M. Discolo

Chapter 17 Otitis Media with Effusion 143George Sim and Shyan Vijayasekaran

Chapter 18 Complications of Otitis Media 149Allison M. Dobbie

Chapter 19 Cholesteatoma 157David L. Horn

Chapter 20 Disease of the External Ear 165M. Taylor Fordham and Christopher M. Discolo

Chapter 21 Injuries of the Auricle and External Auditory Canal 175Douglas R. Sidell and Daniel I. Choo

Chapter 22 Otologic Tumors 187Pamela A. Mudd and Ken Kazahaya

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CONTENTS vii

Chapter 23 The Facial Nerve 201David J. Crockett and Jeremy D. Meier

Section III Rhinology 213Emily F. Boss, Soham Roy, and Sanjay R. Parikh

Chapter 24 Nasal Physiology 215Kelley M. Dodson and Adrienne L. Childers

Chapter 25 Rhinosinusitis: Definitions and Diagnosis 221Julie L. Wei

Chapter 26 Acute Rhinosinusitis 231Timothy P. McEvoy and Kris R. Jatana

Chapter 27 Chronic Rhinosinusitis 239Scott C. Manning

Chapter 28 Allergic Rhinitis 247Jonathan Liang, David F. Smith, and Sandra Y. Lin

Chapter 29 Cystic Fibrosis and Other Systemic Disorders 263Dylan K. Chan and Sanjay R. Parikh

Chapter 30 Complications of Rhinosinusitis 275Jiovani M. Visaya and Eli Grunstein

Chapter 31 Nasal Obstruction 287Jonathan R. Mark and Craig S. Derkay

Chapter 32 Nasal Foreign Bodies 301Nitin Patel and Rahul K. Shah

Chapter 33 Epistaxis 307Elton Lambert and Soham Roy

Chapter 34 Rhinologic and Skull Base Tumors 315Randall A. Bly and Sanjay R. Parikh

Section IV Laryngology and Bronchoesophagology 323Soham Roy, David R. White, and Sanjay R. Parikh

Chapter 35 Laryngeal Physiology 325Lauren A. Kilpatrick and Gresham T. Richter

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viii Pediatric Otolaryngolog y-Head and Neck Surgery: A Clinical Reference Guide

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Chapter 36 Evaluation of the Larynx 331David J. Crockett and Jeremy D. Meier

Chapter 37 Congenital Abnormalities of the Larynx 337Steven M. Andreoli and David R. White

Chapter 38 Laryngeal Infections 345Jeffrey Cheng and Steve E. Sobol

Chapter 39 Vocal Fold Immobility 359Derek J. Rogers and Christopher J. Hartnick

Chapter 40 Acquired Vocal Fold Lesions 369Clarice Clemmens and Karen B. Zur

Chapter 41 Gastroesophageal and Laryngopharyngeal Reflux Disease 377Bianca Siegel and Lee P. Smith

Chapter 42 Subglottic Stenosis 383Karthik Balakrishnan, Douglas R. Sidell and Michael J. Rutter

Chapter 43 Aerodigestive Foreign Bodies 393Tiffany Raynor

Chapter 44 Dysphagia 403Deepak Mehta

Chapter 45 Congenital Tracheal Anomalies 411Fred M. Baik and Sanjay R. Parikh

Section V Head and Neck Surgery 419Paul R. Krakovitz, Carlton J. Zdanski, and Sanjay R. Parikh

Chapter 46 Examination and Classification of Neck Masses 421Anne F. Hseu and Prashant S. Malhotra

Chapter 47 Branchial Cleft Anomalies 433Evan J. Propst and Vito Forte

Chapter 48 Congenital Neck Masses 441Jeyanthi Kulasegarah and John Russell

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Chapter 49 Cervical Adenitis and Neck Space Infections 449Jason A. Brant and Mark D. Rizzi

Chapter 50 Pharyngitis 465Matthew G. Yantis and Harold Pine

Chapter 51 Evaluation of Pediatric Sleep 479Neal Jackson and Anita Jeyakumar

Chapter 52 Management of Obstructive Sleep Apnea 489Lawrence M. Simon and Stacey L. Ishman

Chapter 53 Craniofacial Surgery 501Christopher M. Discolo

Chapter 54 Cleft Lip and Palate 513Krishna G. Patel

Chapter 55 Velopharyngeal Insufficiency 525Lorien Paulson

Chapter 56 Salivary Glands and Sialorrhea 535Austin S. Rose and John P. Dahl

Chapter 57 Sialadenitis 545John P. Dahl and Carlton J. Zdanski

Chapter 58 Salivary Gland Tumors 555John P. Dahl and Carlton J. Zdanski

Chapter 59 Pediatric Thyroid Disorders 563Kyra Osborne and Paul R. Krakovitz

Chapter 60 Head and Neck Malignancies 571Karthik Rajasekaran, Timothy M. Haffey and Paul R. Krakovitz

Chapter 61 Hemangiomas 577Lisa M. Buckmiller

Chapter 62 Vascular Malformations 589Lisa M. Buckmiller

CONTENTS ix

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x Pediatric Otolaryngolog y-Head and Neck Surgery: A Clinical Reference Guide

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Chapter 63 EXIT (Ex utero intrapartum treatment) Procedure 605Anna Hang and Carlton J. Zdanski

Section VI Evidence and Guidelines in Pediatric Otolaryngology 615Emily F. Boss and Sanjay R. Parikh

Chapter 64 Evidence and Guidelines: Tympanostomy Tubes 617David E. Tunkel

Chapter 65 Evidence and Guidelines: Tonsillectomy 627Oshri Wasserzug and Ron B. Mitchell

Chapter 66 Evidence and Guidelines: Surgery for Pediatric Rhinosinusitis 637Eleni Benson and Emily F. Boss

Section VII Common Syndromes 649Carlton J. Zdanski and Sanjay R. Parikh

Chapter 67 Craniofacial Syndromes 651Amelia Drake

Chapter 68 Hearing Loss Syndromes 659Laura H. Swibel Rosenthal and Anahita Jalilvand

Chapter 69 Neck Syndromes 667Grace G. Kim and Carlton J. Zdanski

Index 675

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Pediatric Otolaryngology-Head and Neck Surgery: A Clinical Reference Guide is a valuable new educational resource for residents and fellows in training who desire a comprehensive and concise source of information with respect to the discipline of pediatric otolaryngology. The guide also fills a necessary niche in terms of providing an informative text designed for the rapidly expanding group of physician extenders—physician assis-tants, nurses, and nurse practitioners—providing pediatric otolaryngo-logic care.

The guide’s 69 chapters are divided into 7 sections. Four sections cover the major subspecialty fields of otology, rhinology, laryngology, and bronchoesophagology, and head and neck surgery. Two sections—embryology and common syndromes—are critical to the pediatric otolar-yngology focus of the text. The section on Evidence-Based Guidelines in Pediatric Otolaryngology is unique and reflects the current emphasis on clinical outcomes throughout Otolaryngology-Head and Neck Surgery.

The editor, Dr. Sanjay Parikh, and his section editors—Drs. Emily Boss, Steven Goudy, Paul Krakovitz, Soham Roy, David White, and Carlton Zdanski—are among the up and coming leaders in the field of pediatric otolaryngology. The authors of many of the chapters are simi-larly of the most recent decade of pediatric otolaryngologists, representing over 30 well-respected institutions. As such, they bring a fresh perspective to longstanding topics, introducing innovative diagnostic techniques and novel therapeutic interventions.

The guide’s overall concept of enlisting young authors with senior mentorship, coupled with a textbook of manageable size, provides for an excellent contemporary review to guide current and future generations of otolaryngologists in the care of infants, children, and adolescents.

—Michael J. Cunningham, MD, FACSOtolaryngologist-in-Chief

Department of Otolaryngology and Communication EnhancementChildren’s Hospital Boston

Department of Otology and LaryngologyHarvard Medical School

Boston, Massachusetts

foreWord

xi

Evidence and Guidelines in Pediatric Otolaryngology

Editors: Emily F. Boss and Sanjay R. Parikh

SECTION

VI

617

CHAPTER

Evidence and Guidelines: Tympanostomy TubesDavid E. Tunkel

64

Introduction ............................................................. 618Indications for Surgery ...................................................... 618

Risks and Sequelae of Tympanostomy Tubes .......... 624Follow-Up Issues ...................................................... 624References ................................................................. 625

618 Pediatric Otolaryngolog y-Head and Neck Surgery: A Clinical Reference Guide

InTRodUcTIon• Tympanostomy tube insertion is the most common ambulatory

surgical procedure in children in the U.S.• By age 3 years almost 7% of children will have tympanostomy tubes• 667,000 children <15 yrs old undergo tympanostomy tube

placement yearly• Most common indications for tubes are otitis media with effusion

and recurrent acute otitis media (most evidence and guidelines are for these diagnoses)

• Less common indications for tympanostomy tubes include complications of otitis media, structural changes of the tympanic membranes (eg, atelectasis), and barotrauma—limited knowledge exists to make evidence-based recommendations for these indications

• Although tympanostomy tube placement is common, controversies and differences of opinion remain about:1. Appropriate indications for tympanostomy tubes2. Possible overuse of tubes for recurrent acute otitis media or

middle ear effusions of short duration3. Appropriate perioperative care and long-term follow-up

Indications for Surgery

Acute otitis Media• Tympanostomy tubes do not have a role in treatment of

uncomplicated isolated acute otitis media• Tympanostomy tubes can be placed at the time of myringotomy

for children with complications of acute otitis media (facial nerve paralysis, mastoiditis, lateral sinus thrombosis, etc). Although no RCTs support this recommendation, surgical drainage of middle ear space is useful adjunct to medical therapy, and allows culture to direct medical therapy

Recurrent Acute otitis Media• Usually defined as 3 episodes in 6 months, or 4 episodes of otitis

media occurring over a year with 1 episode within 6 months of presentation

• Prior to 2013 few if any evidence-based guidelines recommended tympanostomy tubes for recurrent acute otitis media (includes U.S., Japan, Italy, others)

• AAP Clinical Practice Guideline on Acute Otitis Media published March 2013 contained an action statement that says clinicians

ChAPTeR 64 Evidence and Guidelines: Tympanostomy Tubes 619

may offer tympanostomy tubes for recurrent acute otitis media1 (Considered an “option” as supporting literature is scant)

• Cochrane review included only 2 studies which met inclusion criteria, and found tympanostomy tubes reduced the number of acute otitis media episodes by 1.5 in the first 6 months after surgery; long-term benefits of tubes have not been demonstrated2

• One systematic review found insufficient evidence that tympanostomy tubes had a beneficial effect for recurrent acute otitis media3

• Another systematic review found tympanostomy tube efficacy for reduction of recurrent acute otitis media similar to antibiotic prophylaxis, with the reduction of 1 episode of acute otitis media in the 6 months following surgery. estimated number needed to treat to prevent 1 episode of acute otitis media was between 2 and 54

• Large quality-of-life improvements have been demonstrated after placement of tympanostomy tubes, but these studies usually included mixed populations of children with acute otitis media, middle ear effusions, or both

• AAoHnS clinical Practice Guideline on Tympanostomy Tubes (Table 64–1) published July 2013 makes several recommendations about the use of tympanostomy tubes for recurrent acute otitis media:5

1. Clinicians should NOT perform tympanostomy tube insertion in children with a history of recurrent acute otitis media who do not have a middle ear effusion in at least 1 ear at the time of evaluation:a. The children in the control groups of antibiotic prophylaxis

trials for prevention of acute otitis media had no middle ear effusions on entry to the trial and had very favorable natural history, with most children experiencing less than 2 infections in the study period

b. Children with a history of recurrent acute otitis media and a normal examination at presentation may be “overdiagnosed”

2. Clinicians ShOULD offer tympanostomy tube insertion in children with history of recurrent acute otitis media who have middle ear effusion in 1 or both ears at the time of evaluationa. Trials that did not exclude children with middle ear effusion

suggest a modest reduction in number of episodes of acute otitis media after tympanostomy tubes

b. Although reduction of episodes of acute otitis media is the primary goal, tympanostomy tubes may reduce pain during episodes of acute otitis media and can allow treatment of otorrhea with ototopical antibiotics

620

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