Ohira S, Mochizuki F, Ueda M
… +3 more, Okamoto R, Mizushima Y, Komori M
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41931943
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OBJECTIVE: Western guidelines for bone conduction devices (BCDs) recommend implantation at age ≥5 years, but their applicability to Japanese children remains unclear due to potential racial differences in skeletal develo...OBJECTIVE: Western guidelines for bone conduction devices (BCDs) recommend implantation at age ≥5 years, but their applicability to Japanese children remains unclear due to potential racial differences in skeletal development. This study measured temporal bone thickness in Japanese children using computed tomography (CT) to determine the anatomically appropriate surgical age. METHODS: We analyzed head CT images from 217 Japanese children (0-15 years) without temporal bone abnormalities. Bone thickness was measured 1 cm posterior to the sigmoid sinus at two points: the "upper level" (superior semicircular canal level; Baha® site) and "lower level" (lateral semicircular canal level; Osia® site). We analyzed age-thickness correlations and determined the age at which 3 mm thickness was achieved. RESULTS: Bone thickness correlated positively with age. While no difference existed between sites at ages 0-2, the upper level developed more rapidly from age 3 onwards. The 3 mm thickness threshold was reached in 50% and 90% of cases at 5.3 and 10.3 years, respectively, for the Baha site, while it was 6.6 and 12.8 years for the Osia site. CONCLUSION: Anatomically, a conservative surgical indication age of 6-8 years is reasonable for Japanese children, compared with the Western 5-year standard. For children <10 years, a 3 mm fixture is preferred to prevent complications. The Baha site offers advantageous bone thickness in children >3 years. However, due to significant individual variation, preoperative CT assessment is very important.
Yano K, Aoki N, Nakamura Y
… +5 more, Shinkawa N, Kakizaki E, Sonoda A, Koppenol WH, Yukawa N
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41931942
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PURPOSE: Button battery injury results from tissue alkalization due to the generation of HO at the negative electrode by electrolysis. Here, we conducted in vitro experiments to test the hypothesis that the principal oxi...PURPOSE: Button battery injury results from tissue alkalization due to the generation of HO at the negative electrode by electrolysis. Here, we conducted in vitro experiments to test the hypothesis that the principal oxidation reaction occurs at the positive electrode and is the result of dissolution of metals constituting the electrode, and in the case of 3 V batteries, HO and chloride ions (Cl) are also oxidized. METHODS: 1) Physiological saline solutions were electrolyzed at 1.5 or 3 V in agarose gel for 2 h with an iron (Fe) nail or non-dissolving carbon (C) rod as the positive electrode. HO generation was visualized using a pH indicator. 2) A 1.5 or 3 V button battery was placed in agarose gel for 2 h. RESULTS: 1) At 1.5 V, HO was generated with a positive Fe electrode but not with a positive C electrode. At 3 V, HO was generated with a positive C electrode, although less intensely. At both voltages, precipitates formed where the diffusion fronts of HO and dissolved Fe met. 2) Precipitate was formed on the rim of the button battery where the ionic current was the most intense and dissolution proceeded. CONCLUSION: At 1.5 V, dissolution of the positive electrode was nearly the sole oxidation reaction. At 3 V, HO and Cl were also oxidized. These results confirm the hypothesis. Clinically, visible dissolution (corrosion) of the rim of the button battery on plain radiography could indicate considerable HO concentration, suggesting higher-grade mucosal injuries and more severe complications.
Don DM, Osterbauer B, Gillett E
… +1 more, Ward SD
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41930795
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BACKGROUND: Children with Down Syndrome (DS) may be uniquely predisposed to positional obstructive sleep apnea (POSA) due to their anatomic features. Our objective was to determine the prevalence and predisposing factors...BACKGROUND: Children with Down Syndrome (DS) may be uniquely predisposed to positional obstructive sleep apnea (POSA) due to their anatomic features. Our objective was to determine the prevalence and predisposing factors of POSA in a DS pediatric population in comparison to a control cohort. METHODS: Overnight polysomnograms of children with and without DS were retrospectively reviewed between November 2016 and December 2023. Demographics and sleep data were collected; POSA was defined as an obstructive apnea-hypopnea index (OAHI) that was at least twice as high in the supine vs. non-supine position. RESULTS: DS children had more severe OSA as evidenced by OAHI in different sleep states and body positions than controls. Prevalence of POSA was slightly higher in controls than DS group (48% vs. 36%, p = 0.078). The majority of control children with POSA exhibited mild OSA, while DS children with POSA had a more equal distribution in all OSA severity categories. DS was associated with a decreased odds of having POSA (OR 0.45, 95%CI: 0.2, 0.97, p = 0.042). CONCLUSION: DS subjects demonstrated more severe OSA and a predisposition towards experiencing significant apneic events in all body positions and sleep stages. The expression of this clinical phenotype of OSA in DS children may be caused by multiple factors, but we hypothesize that it is due primarily to their hypotonia and greater airway collapsibility. Our findings suggest that positional therapy must be individualized for children with DS.
Singh AB, Patel K, Pandey A
… +4 more, Singh G, Rai RK, Pant N, Rawat J
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41911610
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INTRODUCTION: Torticollis is a common disorder that may occur in newborns to adults. The most common cause of torticollis is the tightness and shortening of one sternomastoid muscle, also known as congenital muscular tor...INTRODUCTION: Torticollis is a common disorder that may occur in newborns to adults. The most common cause of torticollis is the tightness and shortening of one sternomastoid muscle, also known as congenital muscular torticollis (CMT). This paper presents our experience in surgical management of torticollis, where secondary effects were observed. MATERIALS AND METHODS: This 10-year retrospective observational study included all patients with CMT. The demographic and clinical details of the patients were recorded. The treatment included surgical division of both lower heads of the sternocleidomastoid. The patients were followed for a year to monitor for any recurrence and assess compliance with exercises. RESULTS: All patients (n = 13) had a fibrotic sternomastoid muscle on the affected side. The mean age was 4.65 years. Ten patients had a right torticollis (male to female: 7:6). Plagiocephaly and hemifacial hypoplasia were present in all patients. Compensatory scoliosis was noted in nine patients. There was no intraoperative or postoperative complication. In the follow-up, all patients had responded to the surgical intervention and physiotherapy. Hemifacial hypoplasia was evident at the 1-year follow-up in all patients. CONCLUSION: The delayed presentation of CMT can be a cause of concern for attendants due to the resultant cosmetic and functional problem. Proper clinical diagnosis is imperative. Surgical intervention in form of complete division of the affected sternomastoid muscle is of utmost importance. Parental counselling about follow-up and physiotherapy is needed for desired outcome.
Genova Gaia L, Torre M, D'Agostino R
… +2 more, Fiz F, Fiz I
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41903351
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OBJECTIVES: Laryngotracheal reconstruction (LTR) and partial crico-tracheal resection (PCTR) are the gold-standard treatments for pediatric laryngotracheal stenosis (LTS). However, they may lead to different rates of dec...OBJECTIVES: Laryngotracheal reconstruction (LTR) and partial crico-tracheal resection (PCTR) are the gold-standard treatments for pediatric laryngotracheal stenosis (LTS). However, they may lead to different rates of decannulation, complications, and retreatments. We compared the outcomes in pediatric patients who underwent LTR and PCTR. METHODS: We conducted a retrospective monocentric data review of patients who underwent LTR and PCTR for LTS between 2009 and 2023. We compared decannulation rates, complication rates, and the need for adjuvant treatment between groups. We analyzed risk factors associated with adverse outcomes. RESULTS: We included 59 patients, 30 (50.8%) underwent LTR and 29 (49.2%) PCTR. There was no difference between groups in age, sex, aetiology, or stenosis grade, as assessed by the ELS (European Laryngological Society) score. The overall decannulation rate (57% for LTR vs 71% for PCTR, p = NS), complication rate (53.3% for LTR vs 65.5% for PCTR, p = NS), and need for additional treatments (73.2% for LTR vs 51.7% for PCTR, p = NS) were comparable. The presence of comorbidities was associated with a lower overall decannulation rate (28.6% with vs. 77.4% without, p = 0.002). Comorbidities (72.4% with vs. 41.4% without, p = 0.03) and ELS score (37.3% for ELS ≥ IIIb vs. 18.6% for ELS < IIIb, p = 0.002) were more frequent in patients requiring additional treatments. Complications were more frequent in patients with higher ELS score (39% for ELS ≥ IIIb vs. 20.3% for ELS < IIIb, p = 0.002). CONCLUSIONS: LTR and CTR/TR for pediatric LTS showed comparable outcomes. However, patients with comorbidities had lower decannulation rates and required more treatments. A higher stenosis grade was more frequently associated with complications.
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41895013
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OBJECTIVE: Secondary post-tonsillectomy hemorrhage (PTH) remains a clinically significant complication in pediatric patients, and reliable preoperative predictors are limited. This study aimed to investigate the associat...OBJECTIVE: Secondary post-tonsillectomy hemorrhage (PTH) remains a clinically significant complication in pediatric patients, and reliable preoperative predictors are limited. This study aimed to investigate the association between inflammatory and immunonutritional indices and secondary PTH, with particular emphasis on prognostic nutritional index (PNI) and hemoglobin-albumin-lymphocyte-platelet (HALP) score. METHODS: This retrospective cohort study included 2250 pediatric patients who underwent tonsillectomy or adenotonsillectomy. Ninety patients who developed secondary PTH were compared with 2160 patients without hemorrhage. Preoperative inflammatory and immunonutritional indices, including PNI, HALP, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were analyzed. In patients with secondary PTH, dynamic changes between the day of surgery (T0) and the day of bleeding (T1) were evaluated. Receiver operating characteristic (ROC) analyses were performed to assess predictive performance. RESULTS: Patients with secondary PTH demonstrated significantly lower preoperative PNI and HALP values, along with higher SII, NLR, and PLR levels compared with patients without hemorrhage (all p < 0.001). In the PTH group, PNI and HALP declined significantly on the bleeding day, whereas inflammatory indices increased (p < 0.001). ROC analysis showed that PNI (AUC = 0.704) and HALP (AUC = 0.666) provided meaningful discrimination for secondary PTH, comparable to traditional inflammatory markers. CONCLUSION: Both preoperative and dynamic peri-hemorrhagic changes in immunonutritional indices are closely associated with secondary post-tonsillectomy hemorrhage. PNI and HALP may serve as practical adjunctive tools for risk stratification, supporting a multidimensional inflammatory-nutritional assessment in pediatric tonsillectomy patients.
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41861650
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OBJECTIVE: This study aimed to determine which musical training protocols are effective for the rehabilitation of children with cochlear implants. The analysis focused on identifying the specific components and character...OBJECTIVE: This study aimed to determine which musical training protocols are effective for the rehabilitation of children with cochlear implants. The analysis focused on identifying the specific components and characteristics of successful interventions. A meta-analysis was not feasible due to substantial heterogeneity in study methods, outcome measures, and intervention designs. MATERIALS AND METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42023434046). Searches were performed without restrictions on date or language. Studies involving children up to 12 years old with sensorineural hearing loss, unilateral or bilateral cochlear implant users, and exposed to some form of musical training as an intervention were included. Exclusion criteria encompassed studies involving participants older than 12 years or those not evaluating the effects of musical training. RESULTS: A total of 1876 studies were identified across the searched databases. After removing duplicates and screening titles and abstracts, 27 studies were selected for full-text assessment. Following qualitative analysis, 21 studies were excluded for not meeting the established criteria, resulting in six studies included in this review. CONCLUSION: This systematic review highlights the potential of active musical training programs, grounded in the musical learning process, as effective interventions for auditory rehabilitation in children with cochlear implants.
Gyawali BR, Dhenga S, Rauniyar S
… +2 more, Kc S, Pokhrel M
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41856054
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OBJECTIVES: To provide a comprehensive evaluation of state-of-art Laryngeal Electromyography (LEMG) in pediatric population and quantitatively assess its prognostic utility in vocal cord paralysis (VCP). METHODS: The sys...OBJECTIVES: To provide a comprehensive evaluation of state-of-art Laryngeal Electromyography (LEMG) in pediatric population and quantitatively assess its prognostic utility in vocal cord paralysis (VCP). METHODS: The systematic review and meta-analysis were carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across PubMed, Scopus, and Google Scholar. Eligible studies included case reports, case series, and observational studies. Data were extracted qualitatively and pooled using a random-effects model to evaluate the prognostic utility of LEMG in predicting VCP recovery. RESULTS: A total of 33 studies were included in the qualitative analysis, and five studies for meta-analysis. The mean age of patients in studies included for qualitative analysis was 6.77 ± 5.73 years, with an age range from day 1 of life to 18 years. In contrast, the studies included in the meta-analysis enrolled children ranging from day 1 of life to 14 years, with a mean age of 2.01 ± 1.03 years. A random-effects meta-analysis of sensitivity of three studies yielded a pooled sensitivity of 82% (95% CI: 51-96%). A meta-analysis of Positive Predictive Value (PPV) of two studies, showed a pooled PPV of 75.0% (95% CI: 27.0% to 96.0%). Cox Proportional Hazards regression analysis showed that patients with Motor Unit Action Potential (MUAP) present had 5.56 times higher likelihood of recovery than those without MUAP (Hazard Ratio = 5.56, 95% CI: 1.65-18.71, p = 0.00558). The Kaplan Meier (KM) curve analysis demonstrated patients with MUAP exhibited higher chances of recovery over time compared to those without MUAP (p = 0.00094). CONCLUSION: LEMG in pediatric laryngology serves a valuable diagnostic, therapeutic, and prognostic adjunct with diverse applications. It shows moderate accuracy in predicting favorable recovery in cases of VCP when normal MUAPs are present.
Wester G, Polson M, Landry M
… +4 more, Bui R, Michell M, Fourrier TL, Dewan K
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41856034
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BACKGROUND: With patients using social media for information, online perceptions are playing a larger role in patients deciding to pursue treatment. Information consumed on Instagram and TikTok may influence the likeliho...BACKGROUND: With patients using social media for information, online perceptions are playing a larger role in patients deciding to pursue treatment. Information consumed on Instagram and TikTok may influence the likelihood of patients to undergo a tonsillectomy. This investigation aims to grade the accuracy and favorability of available information on Instagram reels and TikToks regarding tonsillectomies. METHODS: In this cross-sectional study, "tonsillectomy" was searched on TikTok, and "#tonsillectomy" was searched on Instagram. The first 200 videos were independently viewed by two researchers who assessed these videos during a single period, while a third viewer managed data in dispute. Data was analyzed using descriptive statistics in Excel. RESULTS: Of 200 TikTok videos, 81.5% were patient experiences and 15.5% educational. Among patient experiences, 36.8% were unfavorable compared with 9.6% of educational videos. There was no significant difference in likes between educational and patient experience content (p = 0.64). Among 200 Instagram reels, 48.5% were consistent with the AAO-HNS Guidelines. Over 50% of reels were posted by patients or parents. Accuracy was 30.1% for patient/parent posts and 92.1% for physician-created posts. Reels were predominantly patient experiences (50.5%) or educational (45.5%), with a neutral tone in 60.5% of reels. CONCLUSIONS: Data presented indicates that users researching tonsillectomies on social media receive largely patient or parent-created content. There was high accuracy with videos posted by physicians, and accuracy declined among patients, parents, and other providers. Mean likes and comments were substantial, with the median much lower, suggesting most information viewed comes from select viral videos.
Singh S, Chun RH, Carlberg VM
… +4 more, Schloemer NJ, Adams J, Friedland DR, Puccia R
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41830665
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INTRODUCTION: Pediatric head and neck lymphatic malformations (HNLM) are heterogeneous lesions that often require multimodal care. Contemporary real-world data incorporating evolving interventional techniques and targete...INTRODUCTION: Pediatric head and neck lymphatic malformations (HNLM) are heterogeneous lesions that often require multimodal care. Contemporary real-world data incorporating evolving interventional techniques and targeted systemic therapy are limited. We describe patient characteristics, imaging utilization, treatment utilization/sequencing, and 90-day treatment-related complications within a multidisciplinary vascular anomalies program. METHODS: Retrospective single-institution chart review of patients <18 years with head and neck lymphatic malformations through the Birthmarks and Vascular Anomalies Program (BVAP) from 2014 to 2024 (n = 59). Demographics, lesion characteristics, imaging, treatment sequencing, and 90-day treatment-related complications were abstracted from the medical record. Analyses were descriptive; procedure-level complication rates were reported with exact 95% confidence intervals (CIs). RESULTS: Morphology was 42.4% microcystic, 37.3% macrocystic, and 20.3% mixed; 39.0% were multiregional. Median lesion diameter was 4.0 cm (IQR 2.1-6.4). MRI was obtained in 93.2% of patients. Sclerotherapy was used in 67.8% (86 sessions), most commonly doxycycline (45.8%) and bleomycin (35.6%). Resection without embolization occurred in 45.8%, laser therapy in 15.3%, and glue embolization surgery in 5.1%. Systemic therapy included sirolimus in 25.4%, with 4 patients transitioning to alpelisib. Eight patients (13.6%) underwent molecular testing; all tested had pathogenic PIK3CA variants. Ten patients (16.9%) experienced ≥1 complication. Procedure-level complications occurred after 5/86 sclerotherapy procedures (5.8%; 95% CI 1.9-13.0), 6/53 resections without embolization (11.3%; 95% CI 4.3-23.0), and 0/3 glue embolization procedures (0.0%; 95% CI 0.0-70.8). CONCLUSION: Pediatric HNLM often required multimodal, staged treatment with high MRI utilization and repeat procedures. Prospective multicenter studies with standardized outcomes and systematic molecular testing are needed to guide lesion-specific care.
Wang Y, Jiang Y, Li L
… +5 more, Chen H, Wang J, Zhang M, Bai X, Wu S
Int J Pediatr Otorhinolaryngol
· 2026 May · PMID 41830664
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BACKGROUND: Critically ill neonates in the neonatal intensive care unit (NICU) face a high risk of hearing loss (HL). This meta-analysis synthesized evidence on hearing screening status and influencing factors for HL in...BACKGROUND: Critically ill neonates in the neonatal intensive care unit (NICU) face a high risk of hearing loss (HL). This meta-analysis synthesized evidence on hearing screening status and influencing factors for HL in this vulnerable population to provide a foundation for optimizing screening strategies and intensive care practices. METHODS: A systematic search was conducted across 10 databases to identify high-quality observational studies. The search period spanned from the inception of each database to December 9, 2025. The primary outcomes were the initial hearing screening failure rate, prevalence of HL, and associated factors among critically ill neonates in NICUs. RESULTS: This study included 41 studies, involving a total of 56,886 critically ill neonates in NICUs. Meta-analysis results indicated that the initial hearing screening failure rate was 26% (95% CI: 21%-31%), while the overall prevalence of HL at follow-up was 3% (95% CI: 3%-4%). Very low birth weight (OR = 2.19, 95% CI: 1.29-3.73, P = 0.004), hyperbilirubinemia (OR = 2.96, 95% CI: 1.67-5.22, P < 0.001), craniofacial deformities (OR = 7.59, 95% CI: 3.41-16.89, P < 0.001), mechanical ventilation for ≥5 days (OR = 3.29, 95% CI: 2.15-5.02, P < 0.001) and administration of ototoxic drugs (OR = 2.93, 95% CI: 1.58-5.42, P < 0.001) were identified as risk factors for HL. CONCLUSION: These results pose significant challenges for pediatric healthcare management. It highlights the necessity for further research on neonatal hearing screening across diverse regions, offering evidence-based guidance for healthcare departments to implement targeted strategies to protect the hearing health of critically ill neonates.