Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41477923
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OBJECTIVE: To analyze the epidemiological characteristics, risk factors, and follow-up outcomes of neonatal hearing loss, thereby providing a basis for optimizing screening and intervention strategies. METHODS: A total o...OBJECTIVE: To analyze the epidemiological characteristics, risk factors, and follow-up outcomes of neonatal hearing loss, thereby providing a basis for optimizing screening and intervention strategies. METHODS: A total of 15,818 newborns born at Shenzhen Maternity and Child Healthcare Hospital between January and December 2022 were enrolled. Initial screening was conducted using distortion product otoacoustic emissions (DPOAE). Infants who referred underwent rescreening with a combination of DPOAE and automated auditory brainstem response (AABR), and those who failed were referred for comprehensive diagnostic evaluation at 3 months of age, including auditory brainstem response (ABR), auditory steady-state response (ASSR), and acoustic immittance testing. Pass rates and loss-to-follow-up rates at each stage were analyzed, along with the characteristics and risk factors of confirmed hearing loss. RESULTS: Of the cohort, 15,643 newborns completed the initial screening, with a pass rate of 96.71 %. Forty-six cases were confirmed with hearing loss, yielding a detection rate of 2.94 per 1000. The pass rate for the right ear (97.93 %) was significantly higher than for the left ear (97.55 %) (P < 0.001). Among the diagnosed cases, hearing loss was predominantly unilateral (56.52 %), mild-to-moderate in degree (73.91 %), and conductive in type (50.00 %). The primary risk factors identified were preterm birth (30.43 %), low birth weight (17.39 %), craniofacial anomalies (15.22 %), and hyperbilirubinemia (13.04 %). Follow-up and genetic testing were completed for 42 infants. Pathogenic variants in GJB2 or SLC26A4 genes were identified in 4 cases (9.52 %). Hearing returned to normal in 10 infants (23.81 %), while the hearing status of those with severe-to-profound loss remained stable. A significant difference was observed in the distribution of hearing loss between the initial diagnosis and follow-up (P < 0.05). CONCLUSION: This study found a neonatal hearing loss detection rate consistent with previous reports, observed a higher screening pass rate in the right ear. The hearing loss was predominantly unilateral and mild-to-moderate, with follow-up revealing a dichotomous trend of either spontaneous recovery or persistence. This pattern highlights the necessity of enhancing follow-up management during the critical window between rescreening and diagnosis, and of formulating stratified and individualized intervention and follow-up protocols.
Zayan K, Shaffer A, Rushchak M
… +11 more, Maguire R, Kitsko D, Alper C, Simons J, Jabbour N, Tobey A, Dohar J, Stapleton A, Whelan R, Bennett Z, Chi D
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41475335
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INTRODUCTION: Tympanostomy tubes (TTs) are a common otolaryngologic procedure. Historically, tubes placed in the anterior inferior (AI) quadrant were thought to last longer, reduce ossicular damage, and minimize hearing...INTRODUCTION: Tympanostomy tubes (TTs) are a common otolaryngologic procedure. Historically, tubes placed in the anterior inferior (AI) quadrant were thought to last longer, reduce ossicular damage, and minimize hearing loss. However, perforation risk remains at 2-16 %. AI perforations may require more complicated repair compared to PI perforations. This study aims at comparing early hearing outcomes between AI and PI TT placement after 3 months. METHODS: Randomized controlled trial was conducted at a tertiary pediatric hospital. Children (6 months-14 years) undergoing initial TT placement were randomized to receive a tube in AI in one ear and a tube in the PI quadrant in the opposite ear. Exclusion criteria included non-RAOM indications, tube type other than Armstrong, anatomical abnormalities, or genetic conditions. Audiometry and caregiver questionnaires at 3-month follow-up were analyzed using McNemar's Chi-squared test. RESULTS: Of 386 enrolled, 118 completed audiometry (73 with ear-specific data). Only one patient had mild hearing loss (30 dB PTA at 500 Hz) in the PI ear. Tympanometry in 41 participants showed similar rates of flattened admittance: 9.8 % in PI vs. 7.3 % in AI (OR: 1.00). Caregivers of 303 participants reported tube blockage in 5.6 % (PI) vs. 5.9 % (AI) and otorrhea in 25.7 % (PI) vs. 24.4 % (AI). Provider forms for 86 patients showed similar occlusion rates. Tube patency could not be assessed in 41.9 % of PI vs. 3.5 % of AI tubes due to visualization limitations. CONCLUSION: No significant differences in hearing, tube extrusion, or function were observed between AI and PI TT placement at first follow-up.
Vaishag RN, Varma N K S, Balu R
… +2 more, Prabha RD, V V A
Int J Pediatr Otorhinolaryngol
· 2026 Feb · PMID 41468629
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OBJECTIVE: Reduced airway dimensions of the upper pharynx due to transverse maxillary deficiency has a prevalence of 18 % among young adults. Bone anchored palatal expansion with miniscrew assisted rapid maxillary expans...OBJECTIVE: Reduced airway dimensions of the upper pharynx due to transverse maxillary deficiency has a prevalence of 18 % among young adults. Bone anchored palatal expansion with miniscrew assisted rapid maxillary expansion (MARPE) appliance has expanded the envelope of treatment options available to treat maxillary constriction in adolescents and young adults. The purpose of the study was to evaluate the volumetric changes in airway dimensions following MARPE and to correlate clinical airway changes using flexible nasopharyngoscopy. METHODS: Ten adolescents (aged 15-20 years) with transverse maxillary deficiency satisfying the inclusion criteria were selected for the study and treated with MARPE. The changes with MARPE in dental, skeletal, and airway dimensions were evaluated clinically and radiographically with flexible nasopharyngoscopy and cone-beam computed tomography (CBCT) respectively. The volumetric changes were compared using paired sample t-test and the change in airway collapse was compared using Pearson Chi-square test. RESULTS: A significant increase in intermolar distance, interpremolar distance, maxillary inter-buccal and inter-lingual distance, molar bucco-lingual angulation, nasopharyngeal volume, and total airway volume was seen post expansion. Oropharyngeal volume and minimum cross-sectional area, showed a volumetric increase. Clinical evaluation showed a significant improvement in the airway collapse at the level of oropharynx. This corresponded with the findings of the radiographic evaluation. CONCLUSION: The study results showed a significant improvement in nasopharyngeal and total airway volume following MARPE with significant improvement in pharyngeal airway in the region of oropharynx. MARPE can be recommended as a promising therapy for airway constriction in adolescents and young adults.
Jagger A, Sheehan J, Francis KL
… +4 more, Barker M, Hood F, Sung V, Poulakis Z
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41435690
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PURPOSE: To evaluate the impact of a preparatory information video on parent knowledge and anxiety. The video was viewed prior to infant diagnostic audiology, following referral from a universal newborn hearing screening...PURPOSE: To evaluate the impact of a preparatory information video on parent knowledge and anxiety. The video was viewed prior to infant diagnostic audiology, following referral from a universal newborn hearing screening program. METHODS: Randomised controlled trial comparing the provision of an information video in addition to usual care (intervention) versus usual care only. Parents of infants who were referred to audiology by the Victorian Infant Hearing Screening Program between February and December 2024 were assessed for eligibility. Parent knowledge and preparedness about infant audiological testing was measured using a study designed questionnaire (score range 0-9) and anxiety was assessed using a standardised measure. Mean differences were compared between the groups. Number of appointments required to reach a complete diagnosis was also measured and parent feedback regarding usefulness of the video was sought. RESULTS: The intervention group scored 2.1 (95 % confidence interval 1.6-2.6) points higher on total knowledge score compared to the usual care group. Analysis of knowledge questionnaire items at an individual level showed the proportion of correct responses was up to 48 % higher in the intervention group. No difference in anxiety scores or the number of appointments required to reach a complete diagnosis was observed. More than 94 % of participants would recommend the video to other parents. CONCLUSION: Routine provision of preparatory video information prior to infant diagnostic audiology is recommended. In addition to usual care, video information embedded within clinical services can improve parent knowledge and preparedness, and support parent health literacy. Trial ID ACTRN12623000886684.
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41429084
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INTRODUCTION: Recurrent respiratory papillomatosis (RRP) can represent a significant clinical challenge in the world of paediatric airway disease. The disease's severity and progression may vary and therefore necessitate...INTRODUCTION: Recurrent respiratory papillomatosis (RRP) can represent a significant clinical challenge in the world of paediatric airway disease. The disease's severity and progression may vary and therefore necessitate a constantly evolving and evidence-based approach. The most recently pioneered arm of managing RRP is the use of VEGF monoclonal antibody, bevacizumab. This is a challenging case of aggressive paediatric RRP that has required the use of all available treatment modalities. THE PATIENT: A 10-year-old girl, with significant medical and neurological history, was diagnosed with aggressive airway-obstructing RRP at 2 years of age. Over the years, she has undergone various RRP treatments, which have failed to control her disease progression. THE PRIMARY DIAGNOSES INTERVENTIONS AND OUTCOMES: Following failure of traditional management adjuncts, and due to the increasing frequency and need for surgical debridement, an evidence-based decision was made to administer bevacizumab. This was administered locally, and resulted in temporary improvement. Therefore, systemic bevacizumab was eventually sought with excellent outcomes within the first year. CONCLUSION: Aggressive RRP, particularly in the presence of other comorbidities, presented a management dilemma in this case. The aggressive nature of the disease necessitated out-of-box thinking, seeking evidence from the literature, and a consultation with national experts on the application of alternative treatment options such as intralesional and, subsequently, systemic bevacizumab. The latter has so far produced a yearlong excellent control of the condition. The article discusses suggestions for multicentre research into this treatment modality, and for the standardisation its administration protocols in adults and children.
Huang X, Chen J, Wu T
… +3 more, Wang C, Ning B, Yang L
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41418631
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BACKGROUND: Clinicians need simple, clinic-ready rules to sort children with allergic rhinitis (AR) by near-term symptom burden. We examined whether peripheral blood eosinophil percentage (Eos %) yields useable threshold...BACKGROUND: Clinicians need simple, clinic-ready rules to sort children with allergic rhinitis (AR) by near-term symptom burden. We examined whether peripheral blood eosinophil percentage (Eos %) yields useable thresholds for first-pass triage. METHODS: We performed a cross-sectional secondary analysis of a public pediatric dataset, including children with AR and non-missing Eos % and Total Nasal Symptom Score (TNSS). "High burden" was prespecified as TNSS ≥21 (cohort upper quartile). We estimated ROC/AUC, derived the Youden cut-off with 1000-bootstrap CIs, and identified targeted operating points emphasizing high sensitivity (≥0.80) or high specificity (≥0.80). Clinical utility was assessed using decision curve analysis (DCA) for threshold probabilities 0.15-0.30. Sensitivity analyses varied the TNSS cut-point and stratified by sex. RESULTS: Among 199 children, 26.6 % met the high-burden definition. Eos % discrimination was modest (AUC 0.606; 95 % CI 0.518-0.699). The Youden cut-off was 6.8 % (95 % CI 2.8-9.1), yielding sensitivity 0.53 and specificity 0.68 (accuracy 0.64; PPV 0.37; NPV 0.80). A ∼3.7 % rule achieved sensitivity 0.81/specificity 0.33, whereas an ∼8.5 % rule achieved specificity 0.81/sensitivity 0.32. DCA supported fixed rules in the 6-8 % band compared with treat-all/none for pt = 0.15-0.30. Findings were directionally consistent using TNSS ≥20 or ≥22 and across sex strata (boys: AUC 0.569, optimal 6.8 %; girls: AUC 0.691, optimal 3.1 %). CONCLUSIONS: Eosinophil percentage (Eos %) exhibited modest discriminatory ability (AUC 0.606; 95 % CI 0.518-0.699) for triage in pediatric allergic rhinitis. Low thresholds of ∼3-4 % for screening, 6-8 % for balanced triage (optimal ∼6.8 %), and ∼8-9 % for confirmation offered limited utility when combined with symptom assessments. Due to weak performance, CI proximity to 0.5, and false-positive risk (e.g., PPV 0.37 at optimal cutoff), Eos % is inadequate alone and serves only as a weak complementary signal; prospective validation is essential.
Han VK, Tiwana HS, Kennedy DG
… +4 more, Wang B, Patel SK, Lara FR, Levi JR
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41418630
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OBJECTIVE: Peritonsillar abscess (PTA) is a common deep neck infection that can cause severe complications if untreated. While management strategies are well established, limited evidence exists on how hospital type, saf...OBJECTIVE: Peritonsillar abscess (PTA) is a common deep neck infection that can cause severe complications if untreated. While management strategies are well established, limited evidence exists on how hospital type, safety-net (SNH) versus non-safety-net hospitals (non-SNHs), affects treatment, readmissions, and outcomes. This study evaluated national PTA outcomes with a focus on hospital type and patient demographics. METHODS: We performed a retrospective cohort study using the 2020 HCUP National Readmission Database to identify PTA admissions and 30-day readmissions. Demographic, clinical, and hospital-level factors were analyzed, including length of stay (LOS) and charges. Comparisons were made between SNHs and non-SNHs. RESULTS: Among 3915 admissions, the overall 30-day readmission rate was 4.9 % (n = 190). Patients under 25 years comprised 41.5 % of admissions and had higher readmission rates (5.2 %) compared with older patients. Readmissions did not differ by sex, insurance, or income quartile. Non-SNHs treated higher PTA volumes, while SNHs cared for more Medicaid and lower-income patients. Outcomes were similar across hospital types: mean LOS was slightly longer at SNHs (2.6 vs. 2.4 days, p = 0.04), and mean charges were higher at non-SNHs ($26,012 vs. $22,475, p < 0.01). Readmission rates were comparable (SNH 4.8 % vs. non-SNH 5.0 %, p = 0.71). CONCLUSION: PTA management is consistent across hospital types, with no significant outcome differences between SNHs and non-SNHs. Younger patients had higher readmission risk, and cost disparities between hospital types highlight the need for further research on resource utilization and the role of tonsillectomy.
Chen J, Xu H, Xu B
… +6 more, Xia M, Yang L, Chen F, Li K, Liu W, Hou F
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41406886
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OBJECTIVE: To evaluate the association between preoperative infection severity and surgical outcomes in patients undergoing excision for branchial cleft anomalies (BCAs). STUDY DESIGN: A single-center, retrospective coho...OBJECTIVE: To evaluate the association between preoperative infection severity and surgical outcomes in patients undergoing excision for branchial cleft anomalies (BCAs). STUDY DESIGN: A single-center, retrospective cohort study of patients with BCAs who underwent surgical excision at Sichuan Provincial People's Hospital between August 2014 and October 2023. METHODS: Patients were categorized into non-infected (n = 58), mildly infected (n = 169), and severely infected (n = 107) groups using a preoperative infection grading system. Data collected included demographics, clinical presentation, surgical duration, intraoperative blood loss, preoperative infection-control period, postoperative hospitalization, duration of postoperative antibiotic therapy, recurrence, infection, and other complications. Conduct appropriate statistical analyses on the above data. RESULTS: Age and sex distributions were similar among groups, while significant differences were observed in morphology, origin, and laterality. Non-infected and mildly infected cases were predominantly cystic, whereas severely infected cases had higher proportions of fistulae and sinuses. Preoperative infection-control periods differed significantly (P < 0.001), with longer durations in severely infected patients. Surgery duration, intraoperative blood loss, postoperative hospital stay, and duration of postoperative antibiotics increased with infection severity (all P < 0.01). No recurrence or postoperative infection occurred in the non-infected group. Mildly infected patients had low recurrence (2 %) and infection rates (4 %), while severely infected patients showed higher recurrence (8 %) and infection rates (18 %). Most events occurred within the first postoperative year. CONCLUSION: Preoperative infection severity in BCAs significantly affects surgical complexity, postoperative recurrence, and infection. Careful infection control prior to surgery is crucial, particularly for severely infected cases, to optimize outcomes and minimize complications.
Hesaka N, Shimamura Y, Ikeda K
… +2 more, Shimizu K, Chiba S
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41401656
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OBJECTIVE: To evaluate the effects of adenoidectomy and tonsillectomy (AT) on craniofacial morphology and physical growth in children with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective cohort study. METHODS:...OBJECTIVE: To evaluate the effects of adenoidectomy and tonsillectomy (AT) on craniofacial morphology and physical growth in children with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective cohort study. METHODS: Forty-two children diagnosed with OSA by polysomnography (PSG) were divided into surgical (AT, n = 28) and nonsurgical (n = 14) groups. Cephalometric parameters and height/weight standard deviations (SDs) were compared pre- and post-intervention. RESULTS: Significant changes in mandibular parameters (SNB, Facial Axis, FMA) were observed post-AT (p <0.0005, p <0.0005, p = 0.004, respectively). In univariate logistic regression analyses, age at the time of surgery(cut-off 5.5 years) and A/N ratio(cut-off 0.75) were significantly associated with postoperative improvement in height SD. CONCLUSION: AT may enhance mandibular growth and be associated with improved height development in children OSA, particularly in younger children. These findings are exploratory and require confirmation in larger, prospective studies.
Eyring JB, Hemeyer BM, Allen WP
… +4 more, Stewart C, Orb QT, Meier JD, Padia R
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41397340
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PURPOSE: To evaluate associations between recurrent croup and neighborhood-level social determinants of health, including socioeconomic status, education, physical infrastructure, environmental exposure, and healthcare a...PURPOSE: To evaluate associations between recurrent croup and neighborhood-level social determinants of health, including socioeconomic status, education, physical infrastructure, environmental exposure, and healthcare access. METHODS: We conducted a retrospective study of 252 recurrent and 594 isolated pediatric croup cases from seven hospitals and ten otolaryngology clinics across two health systems. Patient addresses were geocoded and linked to the Agency for Healthcare Research and Quality's Social Determinants of Health database. Multivariate logistic regression was used to assess associations between recurrent croup and neighborhood-level socioeconomic, environmental, and access-related factors. RESULTS: Patients with recurrent croup were younger (mean age 3.30 years vs. 4.84 years for isolated croup, p < .0001), and lived in areas of lower household income (p < .05) and educational attainment (p < .01). There were no significant differences in population density, air pollution, or distance to emergency departments between recurrent and isolated croup. CONCLUSIONS: Social determinants of health, particularly lower household income and education, were associated with recurrent croup. Physicians should consider these factors in the management of recurrent croup and engage in shared decision-making with parents to improve outcomes. Further research is needed to investigate additional environmental and demographic factors.