International Journal Of Pediatric Otorhinolaryngology[JOURNAL]
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200 papers
Cerebral thromboembolic events in vascular malformations: Case report and cohort study.
Baggett AD, Eckard P, Hairston H … +1 more , Richter GT
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42289146 · Publisher ↗
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Operative time and outcomes of intracapsular Tonsillectomy: Impact of patient factors and surgical trainee participation.
Heslop G, Soaper A, Aklasu G … +2 more , Tabangin M, Li C
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42287944 · Publisher ↗
OBJECTIVE: Intracapsular tonsillectomy (IT) is an increasingly utilized technique and was recently adopted in this quaternary care children's hospital. This study evaluates the impact of patient characteristics and surgi...
OBJECTIVE: Intracapsular tonsillectomy (IT) is an increasingly utilized technique and was recently adopted in this quaternary care children's hospital. This study evaluates the impact of patient characteristics and surgical trainee participation on operating time and postoperative clinical outcomes in a cohort of children who underwent IT. METHODS: A retrospective review was performed on patients ages <18 years who underwent IT from August 2023 to August 2024. Demographics, indications, trainee involvement, operative times, and postoperative complications were collected. Factors associated with operative times and complications were analyzed. RESULTS: Two-hundred and thirty-six patients underwent IT. The mean age was 5.6 ± 2.7 years and 47.1% of participants were female. Indications for surgery were sleep disordered breathing (96.2%) and recurrent tonsillitis (8.9%). Ninety-one (38.4%) procedures were performed by a trainee (resident or fellow) under supervision. Operative time was significantly higher in procedures performed by trainees compared to those performed by attending surgeons alone (28.6 vs. 20.3 min, p < 0.001. Weight, BMI-Z, and recurrent tonsillitis diagnosis were not significantly associated with operative time. Post-tonsillectomy hemorrhage rate was 1.4%, with one (0.4%) patient returning to the operating room. All patients with hemorrhage underwent IT performed by an attending surgeon alone. No other postoperative complications were observed. DISCUSSION: IT can be safely performed with trainees under supervision by an attending surgeon, without increased risk of adverse outcomes. Overall, postoperative complications are rare. Trainee involvement does confer increased operative time and can influence operating room efficiency.
Post-adenotonsillectomy pharyngeal stenosis in children - a systematic review.
Van Thillo M, Van Daele M, Saibene AM … +5 more , Maniaci A, Lechien J, Calvo C, Desuter G, van der Poel N
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42269545 · Publisher ↗
PURPOSE: Pharyngeal stenosis is a rare but potentially severe late complication following pediatric tonsillectomy, adenoidectomy, or adenotonsillectomy. Due to its low incidence, this condition is poorly characterized an...
PURPOSE: Pharyngeal stenosis is a rare but potentially severe late complication following pediatric tonsillectomy, adenoidectomy, or adenotonsillectomy. Due to its low incidence, this condition is poorly characterized and may be underrecognized. The aim of this systematic review was to synthesize the available literature on post-(adeno)tonsillectomy pharyngeal stenosis in children, focusing on patient and surgical characteristics, management strategies, outcomes, and potential risk and preventive factors. METHODS: A PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library systematic review was conducted according to PRISMA 2020 guidelines for studies reporting pharyngeal, nasopharyngeal, or oropharyngeal stenosis following adenoidectomy, tonsillectomy, or adenotonsillectomy in children. Data extraction and quality assessment were performed independently by two independent reviewers. RESULTS: Twenty-six studies comprising 109 pediatric patients were included. All studies were case reports or small case series. Pharyngeal stenosis was associated with significant morbidity, including airway obstruction, dysphagia, and speech disturbances, often presenting weeks to years after surgery. Management strategies varied widely, ranging from dilation and scar division to complex reconstructive procedures. Minimally invasive treatments frequently resulted in recurrence, whereas reconstructive flap techniques were more often associated with durable outcomes. CONCLUSION: Pharyngeal stenosis is a rare but serious late complication of pediatric (adeno)tonsillectomy. Increased awareness, meticulous surgical technique, and careful postoperative follow-up are essential to facilitate early recognition and prevention. Standardized reporting and multicenter collaboration are needed to improve evidence-based management.
Length of maxillomandibular discrepancy may not predict tongue base airway obstruction severity among infants with Robin Sequence.
Bryton CA, Tingen JN, Scott AR
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42269544 · Publisher ↗
OBJECTIVE: To evaluate the relationship between severity of micrognathia and mandibular distraction distance required to alleviate symptoms among neonates with isolated Robin Sequence (iRS), as measured by frontal nasome...
OBJECTIVE: To evaluate the relationship between severity of micrognathia and mandibular distraction distance required to alleviate symptoms among neonates with isolated Robin Sequence (iRS), as measured by frontal nasomental (FNM) angle from pre-operative CT-based surgical planning models. STUDY DESIGN: This pilot study was a retrospective cohort included sixteen neonates with iRS. Data was collected via chart review. SETTING: Urban, tertiary care academic medical center. METHODS: Severity of preoperative micrognathia was approximated via measuring frontal nasomental (FNM) angle from pre-operative CT-based surgical planning models. Linear regression was used to determine the association between FNM angle and distraction distance. The correlation coefficient and F-statistic were calculated to determine the overall significance of the regression model. A p-value less than 0.05 was considered statistically significant. RESULTS: The mean age at surgery was 40.38 days and 50% were male. The mean distance distracted during surgery was 11.45 mm. After controlling for other possible confounding factors, there was no statistically significant relationship between FNM angle and required distraction distance (Adj R = -0.2, p = 0.71). Similarly, no association was found between the activation distance required and pre-operative maximum pCO (Adj R2 = -0.453, p = 0.92). CONCLUSION: These findings suggest that severity of micrognathia may not proportionately represent the degree of glossoptosis causing upper airway obstruction and FTT in infants with iRS.
Is Pterygoid hamulus fracture a pre requisite for cleft palate surgery? - A Systematic review of surgical, otologic, and speech outcomes.
Mishra N, Krishnan A, Anandkumar J … +3 more , Mahajan A, Kumar S, Udyavar T
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42269543 · Publisher ↗
BACKGROUND: Palatoplasty for cleft palate repair often incorporates adjunctive manoeuvres aimed at achieving tension-free closure. Fracture of the pterygoid hamulus has traditionally been performed for this purpose; howe...
BACKGROUND: Palatoplasty for cleft palate repair often incorporates adjunctive manoeuvres aimed at achieving tension-free closure. Fracture of the pterygoid hamulus has traditionally been performed for this purpose; however, its necessity and influence on postoperative outcomes remain controversial. OBJECTIVE: This systematic review aimed to evaluate whether fracture of the pterygoid hamulus during palatoplasty is required and to assess its impact on surgical, otolaryngological, and speech outcomes. MATERIALS AND METHODS: A systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science were conducted for studies published between January 2000 and December 2024. Randomized controlled trials, cohort studies, and case-control studies comparing palatoplasty performed with and without pterygoid hamulus fracture were included. Primary outcomes were postoperative hearing and otological status; secondary outcomes included surgical success, complications, and speech outcomes. RESULTS: Seven studies encompassing 543 patients met the inclusion criteria. Across all included studies, audiological assessments-using brainstem evoked response audiometry, tympanometry, otoacoustic emissions, and otoscopy-demonstrated no statistically significant differences between patients who underwent hamulotomy and those who did not. Surgical outcomes and speech-related measures were also comparable. Minor differences in otoscopic findings were reported in isolated studies; however, these were not supported by corresponding audiometric changes and were considered clinically insignificant. CONCLUSION: Routine fracture of the pterygoid hamulus during palatoplasty does not confer additional benefit in terms of hearing, surgical success, or speech outcomes. The procedure may be considered selectively in specific cases where additional release is required to achieve tension-free closure, rather than being employed routinely.
The anterior commissure conundrum: A decade of single-institutional experience in the management of congenital laryngeal webs.
Saravanamuthu T, Balaji V, Manasa L … +3 more , Parachur P, Annamalai N, Subramanian T
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42263361 · Publisher ↗
BACKGROUND: Congenital laryngeal webs are rare laryngeal anomalies resulting from incomplete re-canalization of the primitive larynx. They present a significant therapeutic challenge, requiring a delicate balance between...
BACKGROUND: Congenital laryngeal webs are rare laryngeal anomalies resulting from incomplete re-canalization of the primitive larynx. They present a significant therapeutic challenge, requiring a delicate balance between establishing a patent airway and preserving vocal function. This study details a ten-year, single-surgeon experience at a tertiary care centre to evaluate the efficacy of a graded management protocol and long-term outcomes. METHODS: A retrospective chart review was conducted for 23 pediatric patients managed for congenital laryngeal webs between 2015 and 2025. Data regarding demographics, Cohen's classification, presenting symptoms, surgical management, and postoperative outcomes were analyzed. Treatment choice was dictated by web severity: endoscopic release for thin webs, open web release with keel placement for thick webs without subglottic extension and open reconstruction for thick webs with subglottic extension. RESULTS: The cohort included 23 patients (10 males, 13 females) with a mean age of 4.5 years. The study population presented with severe pathology; Type III webs were the most prevalent (65.2%). Consequently, respiratory symptoms (82.6%) were more common than isolated voice abnormalities (78.2%). Management strategies included endoscopic web release (17.4%), endoscopic web release and keel placement (21.7%), open web release with keel placement (8.7%) and open laryngotracheal reconstruction (LTR) (34.8%). Post-operative airway patency was achieved in all tracheostomized patients, yielding a 100% decannulation rate (8/8). Revision surgery was required in 2 patients (1 in Type III and 1in Type IV), (8.7%). Perceptual voice analysis yielded a mean GRBAS score of G2R1B1A1S1. CONCLUSIONS: Congenital laryngeal webs are rare but clinically significant airway anomalies that may present with a wide spectrum of respiratory and phonatory symptoms. A tailored algorithm-reserving endoscopic techniques for thin webs and open LTR for thick webs-results in excellent decannulation rates. Overall, a multidisciplinary approach with careful surgical technique and long-term follow-up is essential to optimize both airway stability and voice outcomes in children with congenital laryngeal webs.
Transoral endoscopic approach for thyroglossal duct cysts in pediatric patients: Technique, safety, and feasibility.
Wu W, Wang Z, Lin J … +1 more , Li F
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42263360 · Publisher ↗
BACKGROUND: The Sistrunk procedure for thyroglossal duct cyst (TGDC) resection leaves a visible neck scar. Transoral endoscopic approaches offer potential cosmetic advantages, but pediatric data remain limited. This stud...
BACKGROUND: The Sistrunk procedure for thyroglossal duct cyst (TGDC) resection leaves a visible neck scar. Transoral endoscopic approaches offer potential cosmetic advantages, but pediatric data remain limited. This study evaluated the feasibility, safety, and outcomes of a modified transoral endoscopic vestibular approach for pediatric TGDC. METHODS: We retrospectively review 20 pediatric patients undergoing TGDC resection between November 2023 and October 2024. Seven underwent transoral endoscopic vestibular resection (gasless technique with unilateral oral distractor and mental nerve preservation), and 13 underwent transcervical Sistrunk procedure. Outcomes including operative details and cosmetic satisfaction were compared. RESULTS: All transoral procedures were completed without conversion. Operative time (230.7 ± 32.3 vs. 80.0 min, p < 0.05) and hospital stay (3.9 ± 0.4 vs. 2.0 days) were significantly longer in the transoral group. One patient (14.3%) experienced transient mental nerve paresis resolving by 6 months; one transcervical patient (7.7%) developed seroma. Cosmetic satisfaction was significantly higher in the transoral group (VAS 9.9 ± 0.4 vs. 6.0 at 12 months, p < 0.01). CONCLUSIONS: Transoral endoscopic vestibular resection of pediatric TGDC is technically feasible with superior cosmetic satisfaction compared to transcervical excision, despite longer operative time and hospitalization. Strict adherence to the 'safety zone between the mandibular canines' minimizes mental nerve injury. These preliminary findings require validation in larger cohorts.
Tympanoplsty with or without mastoidectmy is highly effective treatment of chronic otitis media in padiatric age group.
Singh H, Patel M, Arora U … +1 more , Chaudhary N
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42250460 · Publisher ↗
OBJECTIVE: The study was conducted to assess the prognostic value of different variables on the outcome of a Type first tympanoplasty alone and combined with intact canal wall mastoidectomy in Chronic Otitis Media (CSOM)...
OBJECTIVE: The study was conducted to assess the prognostic value of different variables on the outcome of a Type first tympanoplasty alone and combined with intact canal wall mastoidectomy in Chronic Otitis Media (CSOM) in pediatric patients. DESIGN: The Retrospective study. STUDY SELECTION: The Retrospective study was conducted from April 2017 to April 2023, in which200 pediatric patients were assessed in Department of Otorhinolaryngology and Head & Neck Surgery in territory rural health center. In which 140 patients were enrolled our study according to the selective criteria. All 140 patients presented with diminished hearing loss and ear symptoms. The complete Clinical examination, Otoscopic, tuning forks test, and radiological evaluation were done in all patients. Hearing assessments were done by manual pure-tone audiometry for all patients. Those patients who suffered from rhino sinusitis, adenoid hypertrophy, Furunculosis, Otomycosis, cholesteatoma ear, craniofacial dysmorphias and suspicious malignancy of external and middle ear were excluded from study. A Retrospective study of each patient medical record was undertaken, demographic, preoperative and postoperative information was recorded. Manual Pure Tone Audiometric data was recorded according to previously published guideline of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Eustachian tube function assessment done by tympanometry of all patients after 12 weeks of surgery. All one forty patients had ear diseases and impaired hearing was identified. All patients were age between 06 yrs and 18 yrs. The patients were divided into two groups, one in which tympanoplasty type first (Group-1) was performed and other intact canal wall mastoidectomy with tympanoplasty type first (Group-2). All the surgeries were performed by post aural approach under general anesthesia. The autologous temporalis fascia was used as graft material in all surgeries and medial graft technique was performed in all cases. The resulting data were recorded for further comparison and analysis. For the purpose of this study, success was defined for each patient using the following three criteria: [5] INTERVENTION: None. RESULTS: All one forty patients with ear diseases and impaired hearing were selected according to the inclusion criteria. The patients were divided into two groups, one in which tympanoplasty type first (Group-1) was performed and other intact canal wall mastoidectomy with tympanoplasty type first (Group-2). All the patients were followed up for at least 6 months to 5years. Our study shows females, 82 (59%) were more common than males 58 (41%) patients. Ear diseases and hearing loss involved commonly in right ear (76) than the left ear (64). Chronic Suppurative Otitis Media (CSOM) with Tympanic Membrane perforation were found in 130 (93%) cases, Retraction pocket was 6 (4%) and 4 (3%) patients had atelectasis. Ninety-Two patients have age group between 15 years and 18 years of age. The Large central perforation found in 61 patients. The success rate of tympanic membrane healing was very high in the entire groups in our study. 100 percentages healing of T.M. was found in 06 years to 10 years of age groups. Our study shows 96.57% success rate of graft healing in intact canal wall mastoidectomy with type first tympanoplasty and 89.77% show in type first tympanoplasty in pediatric age group. Our study shows 91.30% improve of conductive hearing loss in intact canal wall mastoidectomy with type first tympanoplasty and 88.57% show in type first tympanoplasty in healed graft in pediatric age group. Five out of one forty patients were improving hearing from 50dB-80dB to 30 dB and 35 dB respectively. The overall success rate of the conductive hearing was about 90 percentages. We performed analysis of the predictive variables according to the success criteria of the healing with the normal hearing.
A novel surgical technique for the management of recurrent thyroglossal duct cysts using Dakin's solution packing.
Szekely J, Karthikeyan H, Siddiqui A … +3 more , Tracy M, Quaye G, Khalifee E
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42247907 · Publisher ↗
OBJECTIVE: The aim of this study is to evaluate the risk factors for thyroglossal duct cyst (TGDC) recurrence after the Sistrunk procedure and to report our experience with Dakin's solution (DS) packing as a novel surgic...
OBJECTIVE: The aim of this study is to evaluate the risk factors for thyroglossal duct cyst (TGDC) recurrence after the Sistrunk procedure and to report our experience with Dakin's solution (DS) packing as a novel surgical technique for managing recurrent TGDCs. METHODS: A retrospective chart review was performed of patients younger than 18 years who underwent a modified Sistrunk procedure. Collected data included age, sex, history of cutaneous sinus tract and incision and drainage, infections, trainee presence, procedures for managing primary and recurrent TGDC, recurrence, length of hospital stay, readmission and complications. RESULTS: A total of 150 patients with a median age of 5.46 years who underwent a modified Sistrunk procedure were included. Twelve (8.0%) patients had recurrence. Univariate analysis revealed increased recurrence risk with a history of cutaneous sinus tract and infections prior to Sistrunk and decreased risk with trainee presence during Sistrunk (p < 0.05). While controlling for the remainder of factors, history of cutaneous sinus tract continued to show increased odds of recurrence (p < 0.05). Eight patients with a median age of 6.78 years received DS packing for management of recurrent TGDC. The median duration of packing changes and length of hospital stay was 14 and 2.5 days, respectively. One readmission and no recurrences were observed after patients received DS packing. No other complications attributable to DS packing were observed. CONCLUSION: History of a cutaneous sinus tract was associated with an increased risk of TGDC recurrence on multivariate analysis. This study supports the feasibility and preliminary safety of DS packing as a modality for treating recurrent TGDCs. Larger prospective studies are needed to determine efficacy and safety, as well as to identify the patient subgroups most likely to benefit from this intervention.
Adapting and validating the ETDQ-7 for the pediatric population.
Alsayegh R, Kim ST, Chowdhury R … +3 more , Sygal N, Lamonde F, Gurberg J
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42247906 · Publisher ↗
BACKGROUND: Eustachian Tube Dysfunction (ETD) affects up to 40% of children and carries a significant impact on their development and quality of life. The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) was created...
BACKGROUND: Eustachian Tube Dysfunction (ETD) affects up to 40% of children and carries a significant impact on their development and quality of life. The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) was created to assess the impact of ETD on the quality of life of adults; however, it has not been validated in children. Our study aims to adapt and validate the ETDQ-7 in the pediatric population. METHODS: Thirty-eight guardians of patients aged 4 years and older with ETD, along with 38 control participants, completed an adapted version of the ETDQ-7 questionnaire (pETDQ-7) during their visit to a tertiary care pediatric otolaryngology clinic. Otoscopy, tympanometry, as well as reported otologic symptoms were used to distinguish the two groups. The pETDQ-7 was then repeated by the responders 4 weeks later. RESULTS: A total of 76 participants were included, with 38 in each arm. The mean age in the ETD group was 8.78 SD(±4.02) and 9.00 SD(±3.56) in the control group. A statistically significant difference in pETDQ-7 score was noted between the ETD and control groups (p < 0.0001), and the optimal cutoff point score for patients with ETD was a score of 10 points and above (p < 0.0001). Reliability testing demonstrated internal consistency for the entire questionnaire (Cronbach α=0.8622). CONCLUSIONS: The pETDQ-7 appears to be a reliable and valid symptom assessment tool for pediatric patients with ETD that effectively quantifies the quality of life impact of this disease and could help monitor treatment outcomes in this population in the future.
Surgeons' perspectives on patient-specific 3D-printed temporal bone models: What do we need?
Omari A, Nwosu OI, Frithioff A … +1 more , Andersen SAW
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42247905 · Publisher ↗
PURPOSE: Patient-specific 3D-printed temporal-bone (PS-TB) models may improve rehearsal, planning and navigation in temporal-bone surgery, yet their optimal use-cases, required fidelity, and desirable enhancements remain...
PURPOSE: Patient-specific 3D-printed temporal-bone (PS-TB) models may improve rehearsal, planning and navigation in temporal-bone surgery, yet their optimal use-cases, required fidelity, and desirable enhancements remain undefined from the surgeon's perspective. The purpose is to investigate surgeons' preferred use-cases, physical resemblance requirements, and valuable enhancements for PS-TB models. METHODS: Otosurgeons from national and international societies were surveyed in the period December 2024-April 2025. Respondents were stratified into either high-volume (HV) surgeons defined as performing ≥50 mastoidectomies per year or low-volume (LV) surgeons. The survey consisted of 88 questions comprising Likert-scale rating (1-5) and free-text responses. Group means were compared with Welch t-tests. RESULTS: Of the 87 participating surgeons, 69 completed the questionnaire (79% response rate; 55 LV/32 HV). PS-TB models were perceived most clinically relevant for pre-operative rehearsal in cases of anatomical malformation (4.14 LV vs 3.62 HV) and least relevant in tympanoplasty and stapes surgical cases. Overall mean perceived pre-operative relevance across procedures was higher for LV than HV surgeons (2.80 vs 2.36; p < 0.01). The same was found for intraoperative use (2.67 vs 2.30; p < 0.05). Critical anatomical landmark structures should have sub-millimeter precision, in particular the facial nerve and lateral semicircular canal (≥4.3). Model enhancements that support visualization of critical structures are rated likely to add clinical value. CONCLUSION: Otosurgeons perceive PS-TB models as a relevant tool for cases of malformed anatomy or otherwise complex surgery, especially among LV surgeons. However, models need to replicate critical landmarks with sub-millimeter accuracy. These requirements define a trajectory towards improving model value for clinicians.
Mediating effects of postoperative complications in children with high-risk obstructive apnea following adenotonsillectomy.
Gupta A, Gedamu H, Kou YF … +4 more , Liu C, Wang C, Chorney S, F Johnson R
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42242175 · Publisher ↗
BACKGROUND: Pediatric patients with high-risk obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT) are at increased risk for postoperative complications. While prior studies have identified risk factors using...
BACKGROUND: Pediatric patients with high-risk obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT) are at increased risk for postoperative complications. While prior studies have identified risk factors using univariate analysis and logistic regression, the mediating variables that explain how OSA severity leads to postoperative complications have not been studied. Identifying these mediating factors can guide risk stratification and targeted interventions for this vulnerable patient population. METHODS: 307 pediatric patients (<18 years) with high-risk OSA who underwent AT and polysomnography (PSG) from 2019 to 2021 were included. Causal-mediation analysis was conducted. Primary outcomes were intensive care unit (ICU) intervention, major respiratory intervention, and prolonged hospitalization (>48 h). Twenty-five different patient characteristics and PSG parameters were analyzed as mediators. RESULTS: The relationship between high-risk OSA and all three postoperative complications is mediated by O nadir (P < 0.001), CO max (P<0.002), and time spent with oxygen saturation below 90% (TST O <90%) (P < 0.001). Sensitivity analyses revealed that the effects are sensitive to moderate levels of unmeasured confounding. CONCLUSION: Prior univariate analysis identified O nadir and CO max as significantly associated with postoperative complications. In this study, TST O <90% emerged as a novel and consistent mediator, suggesting it may be an important marker for identifying high-risk patients that simple OSA severity scores may miss. While causal mediation analysis clarified which variables acted as candidate mediators, sensitivity analysis revealed that they are sensitive to moderate levels of unmeasured confounding and should be interpreted cautiously.
Management of pediatric sialorrhea: A systematic review with a stepwise evidence-based clinical algorithm.
Almohanna S, Alanazi NF, AlGhamdi MA … +1 more , Halawani M
Int J Pediatr Otorhinolaryngol · 2026 Jun · PMID 42242174 · Publisher ↗
BACKGROUND: Pediatric sialorrhea, or pathological drooling beyond early childhood, is commonly associated with neurological and motor impairments, particularly cerebral palsy. It can cause significant physical, psychosoc...
BACKGROUND: Pediatric sialorrhea, or pathological drooling beyond early childhood, is commonly associated with neurological and motor impairments, particularly cerebral palsy. It can cause significant physical, psychosocial, and caregiver burden. Despite multiple treatment modalities, management remains inconsistent, with no universally accepted guideline for assessment or treatment sequencing. OBJECTIVE: To evaluate current interventions and develop a practical, evidence-based, stepwise clinical management algorithm. METHOD: A PRISMA-guided systematic review was conducted. Medline, PubMed, Scopus, OVID, CENTRAL, and other databases were searched for studies reporting management strategies for pediatric sialorrhea. Randomized controlled trials were included for non-surgical interventions, while all study designs were considered for surgical management. Outcomes included drooling severity, frequency, adverse events, and treatment durability. Risk of bias was assessed using Cochrane RoB 2 and MINORS, while the GRADE framework evaluated evidence certainty. RESULTS: Twenty-two studies encompassing 1028 pediatric participants were included. Interventions were categorized as behavioral/rehabilitative, pharmacologic, botulinum toxin, and surgical therapies. Behavioral therapies, particularly oral motor therapy, produced modest short-term improvements in drooling severity and frequency (low-to-moderate certainty). Pharmacologic agents, primarily anticholinergics, demonstrated medium-term efficacy but were limited by systemic side effects (moderate certainty). Botulinum toxin injections offered reversible, short-to medium-term reductions (low certainty), while surgical interventions provided the most durable benefit in severe or refractory cases (moderate certainty). A stepwise, severity-informed algorithm was developed, integrating initial risk stratification, escalation principles, and multidisciplinary collaboration. CONCLUSION: Pediatric sialorrhea requires a structured, individualized approach. The proposed algorithm provides a stepwise management framework, emphasizes early conservative measures, and reserves invasive interventions for severe or refractory cases. Prospective validation is needed.
Can schools detect mild hearing loss? Evaluating screening accuracy and feasibility.
Robler SK, Stewart J, Reaves C … +6 more , Platt A, Arthur D, Turner EL, Miller A, Hirschfeld M, Emmett SD
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42236333 · Publisher ↗
OBJECTIVES: We evaluated the feasibility and diagnostic accuracy of screening at lower levels to detect mild hearing loss in rural school settings in Alaska. METHODS: In this prospective, observational diagnostic accurac...
OBJECTIVES: We evaluated the feasibility and diagnostic accuracy of screening at lower levels to detect mild hearing loss in rural school settings in Alaska. METHODS: In this prospective, observational diagnostic accuracy study, we compared performance of two pure-tone hearing screening levels (15 dB and 20 dB) against a benchmark audiometric evaluation using the former (PTA >25 dB) and updated (PTA ≥20 dB) World Health Organization (WHO) definitions of hearing loss. RESULTS: Among 318 children, a greater proportion screened positive at 15 dB than at 20 dB (18.6% vs 13.8%). Benchmark audiometry using the updated WHO definition identified mild hearing loss or greater in 4.8% of children. Sensitivity was higher for the 15 dB screen than the 20 dB screen (85.0% vs 75.0%), whereas specificity was lower (90.8% vs 94.3%). Screening at 15 dB yielded 21 more false positives and two fewer false negatives than screening at 20 dB. The updated WHO definition (PTA ≥20 dB) identified more children with mild hearing loss than the former definition (PTA >25 dB). CONCLUSIONS: Screening at 15 dB increased sensitivity and identified more children with mild hearing loss using the updated WHO definition. This improvement came with a higher number of false positives, however, highlighting the need for affordable, reliable screening technologies capable of detecting mild hearing loss in school environments with ambient noise. Use of the updated WHO definition (PTA ≥20 dB) appears better suited to identify children at risk for preventable noise- and infection-related hearing loss.
Pediatric tracheotomy: A 25-year experience at a portuguese tertiary children's hospital.
Almeida ML, Neves JF, Bartolomeu F … +3 more , Gomes MN, Caiado R, Miguéis J
Int J Pediatr Otorhinolaryngol · 2026 Jul · PMID 42235167 · Publisher ↗
Tracheotomy is a procedure that aims to ensure airway patency in patients with respiratory failure, when there is a high risk of upper airway obstruction or a need for prolonged mechanical ventilation. It has, as expecte...
Tracheotomy is a procedure that aims to ensure airway patency in patients with respiratory failure, when there is a high risk of upper airway obstruction or a need for prolonged mechanical ventilation. It has, as expected, profound implications for patients' quality of life and family dynamics. The aim of this study is to present the case series of pediatric tracheotomies over the last 25 years in a tertiary pediatric hospital. A retrospective observational study was conducted on pediatric patients who underwent tracheotomy at the Otolaryngology Department of Coimbra's Local Health Unit, between April 2000 and April 2025. A total of 44 patients were included, with a median age of 4 months and the majority (59%) being male. A median of 2 tracheotomy procedures were performed per year, with a maximum of 6 procedures performed in 2014. The most common indication for tracheotomy was airway obstruction (32%), followed by laryngeal immobility due to neurological impairment (29%), craniofacial anomalies (23%), cardiopulmonary disease (14%), and, lastly, traumatic injury (2%). Complications were recorded in 32% of patients, the majority being tracheal obstructions (5 cases) and accidental decannulations (5 cases). There was no tracheotomy related mortality. Overall mortality rate was 41% and it was higher in cases of neurological dysfunction, mostly due to progression of the underlying disease. Our results show that pediatric tracheotomy is a safe and effective procedure. Outcomes highlight the need for close monitoring and individualized perioperative care, especially in children with severe comorbidities.
Contemporary management of paediatric acute mastoiditis in Aotearoa New Zealand.
Noakes A, Stevenson J, Bird P … +5 more , Hale S, Rowlands S, Kong L, Keren B, Benoiton L
Int J Pediatr Otorhinolaryngol · 2026 Jul · PMID 42235166 · Publisher ↗
BACKGROUND: There has been a recent increase in the incidence of paediatric acute mastoiditis (AM) with a global trend towards more conservative management strategies. Our aim was to evaluate the contemporary management...
BACKGROUND: There has been a recent increase in the incidence of paediatric acute mastoiditis (AM) with a global trend towards more conservative management strategies. Our aim was to evaluate the contemporary management of paediatric AM in Aotearoa New Zealand. METHODOLOGY: A retrospective observational study including AM patients aged <18 years treated in five tertiary hospitals across Aotearoa New Zealand between 2014 and 2022. RESULTS: There were 212 cases of AM with 104 cases (49%) of uncomplicated AM and 108 cases (51%) of complicated AM. Complications included 75 cases (35%) of sub-periosteal abscess (SPA), 18 cases (8%) of meningitis or intra-cranial abscess, 21 cases (10%) of venous sinus thrombosis and 6 cases (3%) of petrous apicitis. 54 (52%) of uncomplicated AM cases were managed with medical therapy, 42 (40%) with conservative surgery and 8 (8%) with mastoidectomy. Additional surgery was required in 13 (13%) cases. Median length of stay was 3 days (range 1-23 days). 30 day unplanned readmissions occurred in 7 (7%) cases. There were no cases of recurrent AM. There were no significant differences in outcomes between treatment strategies. 40 (53%) of SPA cases were managed with incision and drainage/aspiration and 24 (33%) were managed with mastoidectomy. There was no significant difference in the proportion of cases requiring additional surgery. CONCLUSIONS: Conservative treatment strategies, including medical management or conservative surgery for uncomplicated AM and incision and drainage for SPA cases, may be considered in cases of paediatric AM.
Long-term outcomes after recovery from pediatric acute sinusitis with orbital complications.
Phung C, Wei K, Rizzi MD … +1 more , Buzi A
Int J Pediatr Otorhinolaryngol · 2026 Jul · PMID 42235165 · Publisher ↗
OBJECTIVE: This study aims to assess whether an occurrence of acute sinusitis with orbital complications in childhood is associated with the development of long-term complications, including the development of chronic rh...
OBJECTIVE: This study aims to assess whether an occurrence of acute sinusitis with orbital complications in childhood is associated with the development of long-term complications, including the development of chronic rhinosinusitis (CRS), and to identify clinical factors associated with persistent or recurrent disease. STUDY DESIGN: Retrospective cohort study. SETTING: A tertiary children's hospital. METHODS: We reviewed records of children diagnosed with acute sinusitis with orbital complications at a tertiary institution from January 2017 to June 2023. Episodes of subsequent acute sinusitis, sinus surgery, or the development of CRS were quantified and evaluated for correlation with several risk factors. RESULTS: One hundred eighty-one patients were included in the study. Average follow-up was 647 days. The mean age was 8.2 years and 66.3% were male. Medical management for the initial infection was more common (66.9%), while 33.1% underwent surgery. Mean hospital stay was 3.9 days, with 7.8% 30-day readmissions. Seven patients (3.9%) experienced another episode of complicated sinusitis similar to their initial presentation, and three (1.7%) required subsequent sinus surgery after resolution of the initial infection. CRS was subsequently diagnosed in 14 (7.8%) patients. There was no significant association between risk factors and our primary outcomes. Among 23 patients with follow-up imaging, mean Lund-Mackay scores improved (7.6 to 1.7). CONCLUSIONS: Most children with orbital complications of sinusitis recovered without long-term sequelae, and a small proportion developed CRS. Disease severity at presentation or initial treatment did not predict long-term outcomes. These findings suggest that routine follow up with primary care providers after the initial presentation was appropriate for most children.
Creation and evaluation of 3D printed compostable myringotomy sets: A sustainable proof of concept.
Zhang M, Golchin A, Kiessling P … +2 more , Miranda A, Meister K
Int J Pediatr Otorhinolaryngol · 2026 Jul · PMID 42235164 · Publisher ↗
BACKGROUND: Single-use disposable medical supplies contribute significantly to the healthcare sector's carbon footprint. While most myringotomy sets are reusable, there has been a trend towards single-use disposable kits...
BACKGROUND: Single-use disposable medical supplies contribute significantly to the healthcare sector's carbon footprint. While most myringotomy sets are reusable, there has been a trend towards single-use disposable kits. No published research investigates the creation of surgical supplies using compostable biopolymers, a possible mitigation strategy for single-use disposable waste. Polyhydroxyalkanoates (PHAs), biopolymers synthesized through bacterial fermentation, are compostable at a non-industrial level. This study presents a novel, fully compostable 3D printed myringotomy set as a proof-of-concept for sustainable alternatives within otolaryngology. METHODS: Speculums, curettes, dissectors, and forceps were modeled with Computer-Aided Design and printed using a Fused Deposition Modeling printer and PHA filament. The tools were evaluated for print accuracy and functionality with a simulated myringotomy and tympanostomy tube placement. RESULTS: The myringotomy sets were printed successfully, and all instruments performed comparably to traditional tools in simulation. The sizing of alligator forceps was limited by printer constraints, and due to material properties, the printed instruments differed from typical metal instruments in flexibility and tactical characteristics. Post-use analysis demonstrated significant composting with promising continuation. CONCLUSIONS: This proof-of-concept study demonstrates the potential for 3D printing compostable surgical tools using PHA filament. While refinements in print resolution and mechanical properties are needed, this approach offers a viable pathway for reducing medical waste and promoting sustainable practices in otolaryngologic surgery and beyond. Future research may investigate annealing methods, validation of sterility for the printed tools, standardized composting conditions, and conduct cost- and life-cycle analyses to assess the impact of replacing single-use disposable components or reusable myringotomy kits across diverse clinical settings, including resource-limited environments.
Mild loss, major consequences: Why mild hearing loss in children demands greater attention.
Emmett SD, Poe DS, Robler SK
Int J Pediatr Otorhinolaryngol · 2026 May · PMID 42230270 · Publisher ↗
Abstract loading — click title to view on PubMed.
Tonsil surgery is an effective treatment for pediatric obstructive sleep apnea irrespective of underlying comorbidities.
Virkkunen J, Kirjavainen T, Nokso-Koivisto J … +1 more , Sakki AJ
Int J Pediatr Otorhinolaryngol · 2026 Jul · PMID 42229113 · Publisher ↗
OBJECTIVE: To evaluate the effectiveness of tonsil surgery in managing obstructive sleep apnea (OSA) in children with comorbidities predisposing to OSA. METHODS: Children under 16 years of age with comorbidities who unde...
OBJECTIVE: To evaluate the effectiveness of tonsil surgery in managing obstructive sleep apnea (OSA) in children with comorbidities predisposing to OSA. METHODS: Children under 16 years of age with comorbidities who underwent tonsil surgery for OSA and had both pre- and postoperative polysomnography (PSG) within two years of surgery at Helsinki University Hospital, Finland, between 2009 and 2024 were retrospectively reviewed. RESULTS: The study comprised 33 children, of whom 26 (79%) underwent (adeno)tonsillotomy and 7 (21%) (adeno)tonsillectomy. All participants had medical comorbidities, such as craniofacial dysmorphisms and neurological disorders. The median obstructive apnea-hypopnea index (OAHI) decreased from 17.7 h (interquartile range, IQR 6.5 - 42.9) preoperatively to 1.9 h (IQR 0.3 - 8.4) postoperatively (p < 0.0001). Tonsil size was only weakly correlated with the postoperative reduction in OAHI (R 0.11, p = 0.035). In the tonsillotomy group, the median OAHI decreased from 23.1 h (IQR 6.3-45.2) to 1.8 h (IQR 0.2-8.5) (p < 0.0001). Improvements in PSG parameters were similar in the tonsillotomy and tonsillectomy groups. Postoperatively, 40% of the children needing ventilatory support were able to discontinue it. CONCLUSION: Tonsillar surgery alleviates OSA in most children irrespective of underlying comorbidities associated with OSA. In children with comorbidities, even operating on relatively small tonsils can lead to significant improvement in OSA. TT resulted in highly significant improvements in PSG parameters and the effectiveness of tonsillotomy seems equal to tonsillectomy.
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