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Oral Presentations Provide Pediatric Otolaryngology Update

Clinical research into pediatric otolaryngology is moving as quickly as research on adolescent or adult conditions. Here are capsule summaries of three of the pediatric oral presentations during the final day of AAO-HNS’s 2013 Annual Meeting & OTO EXPOSM in Vancouver, BC, Canada.

Otitis media is the second most prevalent clinical problem in children and infants, but little is known about potential differences between normal term and preterm infant birth in relation to otitis media.

“Data from the 1980s tell us that preterm newborns have more otitis media than term newborns, but we know little about the predictors of otitis media in these infants, said Priyanka Shah, MD, Wayne State University School of Medicine, Detroit, MI. “We wanted to determine if there are good predictors of middle ear disease in premature infants,” she said.

Researchers used clinical records from all infants younger than 36 weeks admitted to the NICU or SCN to search for any relationships between otitis media and birth weight, birth head circumference, or gestational age. They found a positive correlation for all three.

“We found that an increase in gestational age of just one week decreased the odds of otitis media by 30 percent,” Dr. Shah said.

The group also found that smaller birth head circumference carries a 17 percent risk of otitis media (p=0.03) while lower birth weight carries a 14 percent increased risk of otitis media (p=0.003).

 

Surprise Risk for Older Siblings

It is well known that swallowing foreign objects is an important cause of morbidity and mortality in children and account for seven percent of accidental deaths in children younger than 4 years old. A prospective case control study has found that being an older sibling quadruples the risk of swallowing a foreign body compared to not having a younger sibling (p=0.02).

There is no significant difference in risk associated with having an older sibling, having any sibling, or having multiple siblings.

Regardless of age, most foreign bodies are acquired at home under parental supervision, said lead author Matthew Bartindale, fourth year medical student at the  Stritch School of Medicine, Loyola University, Maywood, IL. Results from “Older Siblings Are at Increased Risk for Head and Neck Foreign Bodies” suggest that the increased risk to older siblings appears to be decreased parental supervision and attention. Older siblings showed a greater risk for both involuntary and voluntary acquisition of foreign bodies.

“We hope that more attention may decrease the risk, especially given that most foreign bodies are acquired at home with parental supervision,” Mr. Bartindale said. “Increased awareness of unrecognized risks can lead to prevention.

 

Adjunctive Therapy for RRP

Recurrent Respiratory Papillomatosis, or RRP, can be a major clinical challenge.

The typical treatment is repeated surgical debridement, often using adjunctive therapy. But which adjunct is most effective?

“There’s not much in the literature about adjunctive therapy for RRP,” said Ryan Meacham, MD, The University of Tennessee health Science Center, Memphis, TN. “The most common agents are measles, mumps rubella vaccine and cidofovir.”

Dr. Meacham was lead author for “Comparison of MMR and Cidofovir as Adjuncts for Recurrent Respiratory Papillomatosis.” Researchers conducted a retrospective study of RRP patients younger than 18 treated at LeBonheur Children’s Hospital from 2003 to 2012. The choice to use MMR or cidofovir was up to the parents.

A total of 15 patients were followed, five with cidofovir, six with MMR, three who used a combination, and one who had no adjunctive therapy.

The results, Dr. Meacham said, were not conclusive. MMR was numerically superior to cidofovir in terms of remission rates, time between debridements, and the number of debridements administered, but there was not a statistically significant difference between the two adjuncts.

“We think the difference may be accounted for by the MMR group being followed longer,” he said. “We need a multi-institutional randomized controlled trial to determine if one is superior.”