Tempero MJ, Kfoury P, Seipp M
… +4 more, Otsuka K, Firpo MA, Al Nemer S, Park AH
Int J Pediatr Otorhinolaryngol
· 2026 Mar · PMID 41544404
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OBJECTIVE: This study aims to compare gene expression levels in pediatric versus adult cholesteatoma using bulk RNA sequencing. STUDY DESIGN: Retrospective analysis of prospectively collected human tissue. SETTING: Terti...OBJECTIVE: This study aims to compare gene expression levels in pediatric versus adult cholesteatoma using bulk RNA sequencing. STUDY DESIGN: Retrospective analysis of prospectively collected human tissue. SETTING: Tertiary medical center. METHODS: RNA sequencing was performed on 3 pediatric and 3 adult cholesteatoma tissue samples and differentially expressed genes were identified. Gene set enrichment analysis (GSEA) was performed to identify mechanistic pathways and differential cellular reprogramming. RESULTS: Bulk RNA sequencing of 3 pediatric and 3 adult cholesteatoma tissue samples identified 20,298 genes. Differential gene expression analysis revealed 14 genes: 6 downregulated in and 8 upregulated in pediatric cholesteatoma compared to adult tissue. The GSEA revealed 3 gene sets upregulated in pediatric samples compared to adults relevant in cholesteatoma literature: Tumor Necrosis Factor (TNF-α), Transforming Growth Factor Beta (TGF-β, and the Epithelial-Mesenchymal Transition (EMT). CONCLUSION: Pediatric cholesteatoma has distinct gene expression and pathway enrichment compared to adult disease, involving inflammation and fibrosis. This study highlights the complex inflammatory process seen in pediatric cholesteatoma and suggests molecular markers that could serve as potential therapeutic targets for treatment.
Albazee E, Albannai N, Alismail H
… +10 more, Alazemi Y, Alsaeed M, Alhammadi E, Awadh A, Alabdullah A, AlRaish M, Alawadhi A, Aldawas G, Alkaak M, Ismaeel D
Int J Pediatr Otorhinolaryngol
· 2026 Mar · PMID 41544403
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BACKGROUND: Otitis media with effusion (OME) is a leading cause of acquired conductive hearing loss in children. When performing an adenoidectomy for OME, surgeons must decide whether to supplement the procedure with a s...BACKGROUND: Otitis media with effusion (OME) is a leading cause of acquired conductive hearing loss in children. When performing an adenoidectomy for OME, surgeons must decide whether to supplement the procedure with a simple myringotomy or a myringotomy with tympanostomy tube (TT) insertion. While TT offers extended middle ear ventilation, it carries a risk of long-term complications. This systematic review of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of these two approaches. METHODS: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs up to August 2025. Eligible RCTs were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcomes were hearing improvement and resolution of effusion. Secondary outcomes included OME recurrence and postoperative complications. RESULTS: Eleven RCTs involving 955 pediatric patients were included. The addition of TT consistently resulted in superior short-term outcomes, with significantly better hearing levels and faster resolution of middle ear effusion within the first 3-6 months. However, these advantages were not sustained, and no significant differences in hearing or effusion rates were observed at 12-month follow-ups. In contrast, the TT group experienced a significantly higher incidence of long-term complications, including otorrhea, tympanosclerosis, and persistent tympanic membrane perforation. CONCLUSION: Adding a TT to adenoidectomy provides a transient benefit in hearing and effusion resolution but significantly increases the risk of long-term tympanic membrane complications. Adenoidectomy with myringotomy alone appears to be a safer and equally effective long-term strategy for managing pediatric OME.
Kraus F, Shehata-Dieler W, Hagen R
… +1 more, Hackenberg S
Int J Pediatr Otorhinolaryngol
· 2026 Mar · PMID 41538981
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Pediatric dysphagia represents a complex and multifactorial clinical challenge with potentially profound implications for development, nutritional status, pulmonary health, and overall quality of life. In infants and chi...Pediatric dysphagia represents a complex and multifactorial clinical challenge with potentially profound implications for development, nutritional status, pulmonary health, and overall quality of life. In infants and children, the early identification of swallowing difficulties is critical due to their impact on growth trajectories, neurodevelopment, and the psychosocial well-being of both the child and caregivers. This comprehensive article examines the importance of a systematic, interdisciplinary diagnostic approach in evaluating pediatric dysphagia in a university hospital. Based on a ten-year retrospective cohort study involving 223 pediatric patients aged one month to sixteen years, we investigate how the integration of clinical history, physical examination, and state-of-the-art instrumental techniques - such as flexible endoscopic evaluation of swallowing (FEES) - within a collaborative, multi-specialist framework can enhance diagnostic precision. Findings underscore the necessity of individualized, developmentally sensitive diagnostic pathways involving phoniatricions, ENT specialists, pediatricians, speech-language pathologists, radiologists and nutrition experts.
Int J Pediatr Otorhinolaryngol
· 2026 Mar · PMID 41534467
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OBJECTIVES: To develop and validate a high-fidelity, low-cost paediatric airway simulation model for endoscopic procedures, replicating a range of laryngeal pathologies. The study assessed the model's face, content, and...OBJECTIVES: To develop and validate a high-fidelity, low-cost paediatric airway simulation model for endoscopic procedures, replicating a range of laryngeal pathologies. The study assessed the model's face, content, and construct validity and evaluated its educational value for airway surgery training. METHODS: A prospective, multicentre validation study was conducted across three international paediatric otolaryngology courses. Eighty otolaryngologists of varying seniority completed a 19-item Likert questionnaire assessing face and content validity for laryngomalacia, subglottic stenosis and laryngeal cyst models. A subgroup of registrars undertook repeated supraglottoplasty practice to assess construct validity through performance scores and completion time. RESULTS: All 80 participants completed validation surveys. Mean face and content validity scores exceeded 4/5 across all models, indicating strong anatomical fidelity and educational value. The simulator was rated highly for improving endoscopic technique (mean content score 4.79 ± 0.41). In the construct validity subgroup, supraglottoplasty completion time improved by 7.54m (t = 3.55, p = 0.01) with skill scores increasing by +1.25 points (t = -3.56, p = 0.01). Junior trainees showed greater improvement than seniors. Participants provided favourable qualitative feedback on realism and instrument handling. CONCLUSIONS: This modular, 3D-printed paediatric airway simulator demonstrates face, content and construct validity, with reproducible educational benefits across an international cohort. Its low cost, modularity and interchangeable inserts supports scalable adoption in training programmes. Future work should assess transferability of skills to clinical practice and optimise tissue fidelity for improved haptic realism.
Billings KR, Sachse SJ, Ghadersohi S
… +5 more, Kanaris AA, Schappacher RL, Yoon RD, Szymczak AJ, Hazkani I
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41529612
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OBJECTIVE: Post-tonsillectomy hemorrhage is a common risk after tonsillectomy. The goal of this study is to analyze the rate of recurrent PTH (R-PTH), and to determine potential risk factors for recurrent bleeding. METHO...OBJECTIVE: Post-tonsillectomy hemorrhage is a common risk after tonsillectomy. The goal of this study is to analyze the rate of recurrent PTH (R-PTH), and to determine potential risk factors for recurrent bleeding. METHODS: Retrospective cohort study of patients <18 years of age evaluated at a tertiary care pediatric hospital for PTH. Risk factors for patients with R-PTH episodes were evaluated, when compared to patients with a single bleeding episode. An assessment of healthcare utilization in those with R-PTH was performed. RESULTS: Among 18,819 tonsillectomies performed in the study period, 382 (2.0 %) had a PTH. Of these, 42 patients (11.0 %) experienced R-PTH: 35 patients (9.2 %) with two bleeding episodes, and 7 patients (1.8 %) with three. Patients with R-PTH were male (n = 26, 61.9 %), Hispanic/Latino (n = 19, 45.2 %), and English-speaking (n = 33, 78.6 %). The overall risk of R-PTH following tonsillectomy was 0.2 %, and the relative risk of R-PTH after an initial PTH was 5.4 times. None of the factors analyzed were found to have a significant association with R-PTH, although a greater proportion of patients with R-PTH were found to have a history of chronic tonsillitis (21.4 % vs 14.4 %). Healthcare utilization, an aggregate measurement of primary care, otolaryngology, telemedicine, and emergency department visits unrelated to PTH, was significantly higher in R-PTH patients (2.5 vs. 1.8 occurrences, p = 0.023). CONCLUSIONS: The rate of R-PTH was small (0.2 %), although those patients with an initial PTH had a relative risk of 5.4 for a R-PTH episode. No clear risk factors for R-PTH were identified. Increased healthcare utilization was noted in those with R-PTH.
Leow TYS, Bekkers S, Henriet SSV
… +8 more, Hol MKS, Janssen AM, Jansen TTG, Kunst HPM, Pegge SAH, Waterval JJ, van Ingen J, Van Aerde KJ
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41529611
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BACKGROUND: This study aims to evaluate the drug-induced adverse events of our institutional multidisciplinary clinical pathway for M. abscessus treatment and gives suggestions for monitoring and management of adverse ev...BACKGROUND: This study aims to evaluate the drug-induced adverse events of our institutional multidisciplinary clinical pathway for M. abscessus treatment and gives suggestions for monitoring and management of adverse events. METHODS: Patients treated according to a published institutional clinical pathway in our tertiary referral centre were included. Main outcome measures were the type and frequency of adverse events documented. In addition, reasons for drug cessation or interruption were evaluated. RESULTS: Ten patients were included (mean age: 8 years old; male: 70 %). All patients suffered from adverse events, in 90 % of the cases leading to pre-term drug interruption (40 %) or even cessation (70 %) of one or more antibiotics. Most common adverse events were gastrointestinal (100 %), weight loss (60 %), elevated liver enzymes (70 %), hypoalbuminemia (90 %) and hypertriglyceridemia (70 %). Most adverse events were likely caused by tigecycline. All children were clinically cured after the treatment and did not suffer from long-term physical adverse events. CONCLUSIONS: The multidrug treatment for M. abscessus otomastoiditis is frequently complicated by adverse events. Management by a specialized team is recommended. Frequent clinical monitoring, regular blood tests, audiograms and ECGs are recommended. Prophylactic antiemetics should be administered due to the high frequency of nausea and vomiting, particularly with tigecycline.
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41506144
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OBJECTIVE: Critically appraise the literature for anesthetic agents and routes of administration and their impacts on successful sedation and auditory brainstem response (ABR) testing outcomes in children. METHODS: Searc...OBJECTIVE: Critically appraise the literature for anesthetic agents and routes of administration and their impacts on successful sedation and auditory brainstem response (ABR) testing outcomes in children. METHODS: Searches of PubMed, Cochrane, and Web of Science for all available literature, last accessed February 2025, using "auditory brainstem response", "anesthesia", "anesthetic", "IV anesthesia", "volatile anesthesia", "oral anesthesia", "pediatric", "sevoflurane", and "hearing loss" with "AND". Non-English, non-pediatric, studies unrelated to anesthetic agents and ABR were excluded. RESULTS: 510 studies screened, 24 included (6053 patients (35.2 % female)). Eight studies with 282 patients reported the impact of different anesthetics on ABR waveforms, and sixteen with 5771 participants reported the rate of successful sedation. Sixty-nine patients from three studies demonstrated no significant difference in waveforms among different anesthetic agents. Four studies with 144 participants reported significant alterations of waveforms between pharmacologic and non-anesthetized groups. One study with 79 participants found that sevoflurane produced more false positives, resulting in more severe hearing loss diagnoses than propofol. Anesthetic agents with various routes of administration demonstrated different levels of efficacy in achieving sedation, with IV propofol and intranasal dexmedetomidine exhibiting improved performance. CONCLUSION: Current literature demonstrates the use of multiple anesthetic agents and routes of administration during ABR testing in children with varying degrees of successful sedation and extent of impact on ABR waveforms. Limited data suggest that IV propofol is highly effective in achieving sedation with a lower impact on ABR testing outcomes. Nevertheless, further investigation is required to guide anesthetic selection during ABR testing in children.
Hung YC, Chang YP, Chan YC
… +5 more, Lo M, Chen PC, Chang ST, Liao Y, Hong HM
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41485394
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PURPOSE: To develop and validate a neural network-based Kid's Listening Performance Checklist (KLiP) for early identification of listening difficulties in children aged 3-6 years, and to evaluate its effectiveness as a s...PURPOSE: To develop and validate a neural network-based Kid's Listening Performance Checklist (KLiP) for early identification of listening difficulties in children aged 3-6 years, and to evaluate its effectiveness as a surveillance tool in real-world settings. METHODS: Development followed a multi-phase process: (1) systematic resource review to create preliminary items, (2) expert evaluation for content validity (7 experts), (3) assessment of inter-rater reliability between parents and teachers (182 parent-teacher pairs), (4) discriminant validity testing, (5) neural network model development trained on data from 341 children (202 with typical hearing, 139 with hearing loss), and (6) real-world validation testing with 71 parent-child pairs who completed both KLiP and hearing screening. RESULTS: The KLiP checklist comprises eight discriminating behavioral items and six risk factors. The neural network model achieved 90% sensitivity and 97% specificity in distinguishing between children with and without hearing loss in the development dataset. In preliminary real-world testing, high KLiP scores (≥0.5) appeared to identify children requiring further audiological attention, while low scores (<0.5) strongly indicated typical hearing abilities in children without developmental concerns. CONCLUSIONS: This preliminary study suggests that KLiP may demonstrate potential as a first-line surveillance tool for identifying listening difficulties in preschool children. Beyond surveillance, its implementation as an online platform with automated risk assessment and educational resources promotes awareness of listening difficulties among parents and teachers, supporting early identification within the pediatric hearing healthcare framework.
Cengi̇z DU, Sarioğlu SC, Mazooğlu B
… +2 more, Avşar Demi̇r A, Aslan M
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41483756
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BACKGROUND: It is better to perform the VEMP test with bone conduction stimulus in the pediatric group, where conduction-type pathologies can be frequently observed. AIM: This study aimed to establish normative values of...BACKGROUND: It is better to perform the VEMP test with bone conduction stimulus in the pediatric group, where conduction-type pathologies can be frequently observed. AIM: This study aimed to establish normative values of the Vestibular-Evoked Myogenic Potential (VEMP) test in pediatric individuals using bone-conduction stimuli at different frequencies (250 Hz, 500 Hz, 750 Hz) and to evaluate its test-retest reliability. MATERIALS AND METHODS: This study employed a descriptive design and included 37 healthy individuals aged 8-18 years. Cervical VEMP and ocular VEMP tests were conducted using a B-71 bone vibrator that delivered tone-burst stimuli at frequencies of 250, 500, and 750 Hz at 60 dB nHL. The first test was administered by one clinician, and the second test was conducted by another clinician one week later. Test-retest analysis evaluated wave latencies, interlatencies, amplitudes, and amplitude asymmetry values. Since the data showed normal distribution, parametric tests were used; within-group comparisons were analyzed with paired t-tests, between-group comparisons with independent t-tests, and ICC values were calculated to assess reliability. RESULTS: In cervical VEMP using bone-conduction stimuli, the intraclass correlation coefficient (ICC) values for the assessment parameters ranged from 0.60 to 0.87 at 250 Hz, from 0.54 to 0.74 at 500 Hz, and from 0.50 to 0.78 at 750 Hz. In ocular VEMP using bone-conduction stimuli, the ICC values ranged from 0.60 to 0.84 at 250 Hz, from 0.68 to 0.84 at 500 Hz, and from 0.65 to 0.79 at 750 Hz. CONCLUSION: Cervical and ocular VEMP tests using bone-conduction stimuli are reliable methods for evaluating the functional integrity of the vestibular system in pediatric populations.