April 25, 2011
Presidential Keynote Address And New Research Highlights From The American Society Of Pediatric Otolaryngology Meeting
The American Society of Pediatric Otolaryngology (ASPO) will hold its annual meeting, April 29 "“ May 1, during the 2011 Combined Otolaryngology Spring Meetings (COSM) - a joint meeting of eight otolaryngological societies in Chicago, IL.
During the ASPO meeting, hundreds of pieces of new research and dozens of scientific sessions featuring expert panelists will be presented focusing on children's ear, nose, and throat health. National health statistics reveal that pediatric ear, nose, and throat disorders remain among the primary reasons children visit a physician, with ear infections ranking as the number one reason for an appointment. All sessions are embargoed until date and time of presentation. Here are some of the lectures and sessions that will be unveiled during the meeting:Presidential Keynote Lecture - Contemporary Management of Pediatric Chronic Rhinosinusitis
Speaker: Rodney Lusk, MD
Date: Friday, April 29, 2011
Time: 1:10 "“ 1:45pm
Rodney P. Lusk, MD, Director, Boys Town Ear, Nose & Throat Institute and Director, Cochlear Implant Center in Omaha, NE, will give the Presidential Keynote Lecture, "Contemporary Management of Pediatric Chronic Rhinosinusitis" at the American Society of Pediatric Otolaryngology annual meeting in Chicago, IL.
Dr. Lusk's Presidential Keynote address will give a "snap shot" of Pediatric Otolaryngologists current management of pediatric chronic sinusitis. This was accomplished through an electronic poll of ASPO members.
He will highlight the following key points:
# 75% of Pediatric Otolaryngologists practice in Academic settings
# Primary therapies continue to be broad spectrum antibiotics
# Topical nasal steroid spray and nasal irrigation usage
# CT scans continue to be the primary mode of imaging
# Adenoidectomy is the first surgical intervention with anterior ethmoid and maxillary antrostomies to follow
# And although more than half of the surveyed surgeons have been trained in balloon sinuplasty only 6% are using it to treat children
# Future research and treatment options
"It is an honor to give the keynote address at COSM and highlight a common problem that focuses on research, education and patient care," said Rodney Lusk, MD. "This is the highlight of my career!"
Dr. Lusk has served in a number of leadership positions both locally and nationally. He has been President of the American Academy of Otolaryngology, the American Society of Pediatric Otolaryngology and the American Broncho-Esophagology Association, honored with the American Academy of Otolaryngolgoy-Distinguished Service Award and recognition as Best Doctor, by Best Doctors of America.
Dr. Lusk received his Medicine Degree from the University of Missouri in Columbia. He completed his residency in Otolaryngology-Head and Neck Surgery at the University of Iowa Hospitals and completed a Pediatric Otolaryngology Fellowship at Children's Hospital of Pittsburg. Dr. Lusk specializes in cochlear implants, pediatric chronic sinusitis and pediatric head and neck lesions. He currently practices at Boys Town Ear, Nose and Throat Institute at Boys Town Medical Campus-Downtown Clinic in Omaha, NE.
Plenary Session Presentation "“ Cochlear Implants Under 6 Months
Speaker: Liliana Colletti, PhD
Date: Friday, April 29, 2011
Time: 2:20 "“ 2:27pm
Infants under 6 months of age with bilateral profound sensorineural hearing loss may be candidates for cochlear implants (CI) at an early age. In the US this procedure is approved by the FDA only after 12 months of age.
12 infants aged 2- 6 months, 9 infants aged 7-12 months and 34 children aged 13- 48 months, identified with profound bilateral hearing loss, who underwent early cochlear implantation, were enrolled in the study and followed longitudinally. The contribution to auditory-based communication outcomes due to the age at CI fitting was assessed at regular intervals in children starting at 2, 3, 4 and 5 years of age.
"Research clearly demonstrated for the first time the critical importance of very early CI implantation on communication outcomes," said study author Liliana Colletti, PhD. "The age at fitting CI ranged from 2 to 48 months, and the degree of hearing loss was bilateral and profound in all children."
The study required a participant pool that included infants, toddlers and older children fitted at different ages and the assistance of specialized anesthesiological teams. Limitations of longitudinal studies include selection biases. Age at CI implantation was a significant factor in all outcome measures contributing significantly to speech perception, speech production, and language outcomes. Intra, immediate, post-operative and long term complications showed no statistical difference among groups.
Plenary Session Presentation "“ Heavy Metals Exposure and Hearing Loss in US Adolescents
Presenter: Josef Shargorodsky, MD, MPH
Date: Saturday, April 30, 2011
Time: 8:07 "“ 8:14am
Blood lead levels well below the current recommended safe limit are associated with substantially increased odds of high frequency hearing loss.
Researchers evaluated the cross-sectional associations between blood lead, blood mercury, urine cadmium, and urine arsenic and audiometrically determined hearing loss in participants aged 12 to 19 years in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). There were 1,632 individuals available for analysis of blood lead and mercury, and 560 for urine cadmium and urine arsenic. Multivariate logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).
"Research showed, while arsenic, mercury and cadmium did not appear to have an overall association, blood lead levels above 2 micrograms per deciliter were associated with increased odds of hearing loss, said study author Josef Shargorodsky, MD. "This is important given that the CDC lead action level in children is 10 mcg/dl, so we may be seeing associations with hearing loss well below the current recommended levels."
Overall, researchers found that the association between blood lead level >2 Ãµg/dL and hearing loss was larger among individuals from families living below the federal poverty limit (or 2.23, 95% CI 1.21-4.12), and those with no loud noise exposure (or 2.16, 95% CI 1.30-3.59), but the interactions were not significant (p>0.21). There was no overall association between quartiles of blood mercury, urine cadmium, or urine arsenic and hearing loss.
Plenary Session Presentation "“Tonsillectomy is an Effective Treatment for Pediatric Patients with Dysphagia and Tonsillar Hypertrophy
Presenter: Daniel Clayburgh, MD, PhD
Date: Saturday, April 30, 2011
Time: 8:56 "“ 9:30am
Tonsillectomy is an effective treatment for oropharyngeal dysphagia with tonsillar hypertrophy.
It has long been believed that enlarged tonsils could obstruct swallowing in children, and that removing these enlarged tonsils would provide benefit. However, research shows tonsillectomy outcomes for dysphagia have not been studied well. Researchers found children's primary complaint is difficulty swallowing due to tonsillar enlargement, as well as children undergoing tonsillectomy for other reasons, tonsillectomy significantly improved symptoms related to difficulty swallowing.
"This study shows, for the first time, that tonsillectomy can provide significant symptomatic and overall health benefit to children with difficulty swallowing due to enlarged tonsils," said study author Daniel Clayburgh, MD, PhD. "Tonsillectomy also improved children's weight gain (children with swallowing problems are often underweight). This data provides scientific justification for tonsillectomy to improve swallowing in some pediatric patients."
Dysphagia related to tonsillar hypertrophy may be more common than previously recognized. When tonsillar hypertrophy is present in the setting of pediatric dysphagia, tonsillectomy may significantly improve swallowing-related quality of life.
Bluestone Lecture - New Breath: New Approaches to Airway Replacement and Regeneration
Presenter: Martin Birchall, MD, FRCS
Date: Saturday, April 30, 2011
Time: 9:10 "“ 9:45am
The loss of a normal airway is devastating. The first stem-cell based tissue engineered airway replacement was performed in an adult in 2008 and in a child in 2010.
Following successful preclinical work by a consortium of European clinical and scientific groups, a bioreactor-based, tissue engineering protocol was developed. A cyclic detergent-enzymatic method was used to remove donor cells from human trachea, re-colonized by epithelial cells and mesenchymal stem cell (MSC)-derived chondrocytes cultured from autologous biopsies or directly by MSCs.
Segments of critical broncho and tracheo-malacia were excised from recipients, and replaced by our tissue engineered implants. Different protocols were applied in the two cases. Our adult patient remains fully active, working fulltime and caring for her two children at three years. Her lung function tests are normal for her age, and the graft has a normal appearance, mucous clearance and mechanical properties at two years. There is no serological or biopsy sign of rejection and she is without immunosuppression. At one year, our child recipient is back at school, playing and growing.
"There are many conditions in children that are not easily treated by conventional therapies. Regenerative medicine is a rapidly growing field, which offers a wide range of new approaches for these 'orphan disorders'," said study author Martin Birchall, MD. "We have used stem cells and tissue engineering to create, for the first time in man, windpipe (trachea) replacements in adults and a UK child. Although close to death before surgery, he is now well and back at school one year later. Although much work remains to be done, these successes have opened the door to a new future of safe, effective and customized organ and tissue replacements."
The results show that regenerative medicine appears to offer an exciting box of new tools to apply to difficult airway problems.
Invited Karl Storz Lecture "“ Surgical Management of Laryngeal Clefts
Presenter: Noel Garabedian, MD
Date: Saturday, April 30, 2011
Time: 2:00 "“ 2:45
The laryngotracheal cleft is a rare congenital anomaly, first described in 1792 by Richter, it consists of a direct communication between the trachea and oesophagous.
The incidence of this uncommon pathology is 1 in 10,000 to 20,000 births. This incidence is most likely to be underestimated for three reasons: minor laryngeal clefts may be asymptomatic; endoscopic diagnosis is difficult, especially in type 1, the cleft is easily missed and severe clefts could lead to a child's death before the diagnosis.
"Laryngeal clefts are rare and complex pathologies which require a multi-disciplinary approach," said Professor Noel Garabedian, MD. "An early diagnosis and involvement of specialized ORL and anesthetic teams make it possible to decrease dramatically mortality and to improve the functional outcome."
Based on the research for this study, the author arrived at the following guidelines:
# Type I cleft with mild symptoms may be managed conservatively except occasional cases.
# Type II and III clefts, previously standard surgery was performed by lateral pharyngotomy or anterior laryngofissure. Some authors proposed the use of posterior interposition graft: tibial periosteum, cartilage, fascia temporalis and muscular flap.
Recently there were reports of cases successfully managed endoscopically by laser incision of the mucosa and a two layers endoscopic closure. This technique allows avoidance of post operative intubation or tracheotomy.
# Type IV cleft may be repaired by a lateral pharyngo-esophagotomy and or thoracotomy or an anterior laryngofissure and sternotomy, with the use of cardiopulmonary bypass or ECMO.
Overall, the need for a revision procedure for partial failure is increased by the severity of the cleft.
Plenary Session Presentation "“ Complications of Otitis Media: The Possible Impact From Pneumoncoccal Vaccine And American Academy Of Pediatrics Guidelines
Presenter: Whitney Halgrimson, BA, BS
Date: Sunday, May 1, 2011
Time: 11:11 "“ 11:18
In the last decade, important changes that could impact the development and management of acute otitis media (AOM) were introduced: the heptavalent pneumococcal conjugate vaccine introduced in 2000 and the American Academy of Pediatrics amended treatment guidelines of AOM published in 2004. The goal of the study was to characterize the impact of these practice changes on the development of acute mastoiditis complicating AOM.
"The incidence of mastoiditis changed significantly during the past decade, characterized by an initial decrease, a plateau phase, and a subsequent rise," said study author Whitney Halgrimson, BA, BS. "Further investigation is needed to determine the relative contributions of pneumococcal conjugate vaccination, deferred antibiotic treatment of AOM, or other variables to this triphasic pattern."
Two databases were reviewed to establish the frequency of mastoiditis, the common variable for all AOM complications. State Hospital Association (SHA) inpatient records (2001-2008) and a retrospective chart review (2001-2008) on acute mastoiditis undertaken at a tertiary children's hospital (TCH) formed the data sources.
Results show the SHA and TCH datasets identified 170 and 107 children with mastoiditis, respectively. Children under 2 were disproportionately represented in both. Both showed decreased rate during the early decade, a flattening during the mid-decade and a dramatic increase during the late decade. When Segment 1 (2001-2003), Segment 2 (2002-2004) and Segment 3 (2004-2008) of the SHA were compared, the incidence decreased between Segment 1 and 2 (p=0.09) but increased significantly between Segment 2 and 3 (p=0.0005). A similar increase of TCH incidence of mastoiditis admission data beginning 2004 was found (p=0.04).
Plenary Session Presentation "“Pediatric Exposure to Choking Hazard Foods is Significantly Associated with Parental Knowledge of Choking Hazard Foods
Presenter: Brent Nichols, MD
Date: Sunday, May 1, 2011
Time: 11:25 "“ 11:32
Parental knowledge of choking hazard foods (CHF) is poor, according to a cross sectional survey that was presented to parents with a child under 4 years of age.
Parents were presented with a questionnaire asking knowledge of choking hazard foods (CHF), which CHF they allow their child to eat, household items that may be choking hazards, how often they cut food for child, how often the child sits to eat and the sources of their knowledge.
"The consumption of CHF in children under 4 is significantly associated with decreased parental knowledge, ethnicity and sometimes income," said study author Brent Nichols, MD. "As demonstrated, knowledge is significantly associated with a lower risk of consuming CHF, thus more parental education is needed."
Study results show 489 parents responded to the survey. The results are adjusted for significant covariates associations between correct knowledge of CHF and correct parents actions of disallowing CHF: fruit chunks (correct knowledge = 25%; correct action = 42%; AOR=3.5; P<0.0001; adjusted for ethnicity), hot dogs (59%; 28%; 1.7;0.02; ethnicity, income), popcorn (52%; 67%; 2.6;<0.0001;ethnicity), whole grapes (68%;51%;2.5;<0.0001;none), nuts (73%; 66%;2.5;0.002;ethnicity), chunks of peanut butter (45%; 79%;2.5;0.0003;ethnicity). 76% always supervise meals, 57% always cut food, 62% report learning CPR. Correct knowledge of dangerous household items: Coins (97%), marbles (94%), small batteries (93%), small toy parts (93%), dice (92%), pen caps (92%), safety pins (86%), balloons (84%), syringes (40%). Parents report the following as sources of choking hazard knowledge: Physicians (68%), Family/friends (52%), Books/magazines (40%), and the internet (25%).
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