2017 Sec 1 Green Book

Fordham MT, Rock AN, Bandarkar A, et al. Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. Laryngoscope . 2015; 125(12):2799-2804. EBM level 4..................................................................................................................................62-67 Summary : This study is a prospective evaluation of the predictive utility of transcervical ultrasonography in identifying peritonsillar abscesses in children. The sensitivity and specificity of transcervical ultrasound when compared to clinical outcomes were 100% and 76.5%, respectively. There was a significant association between negative ultrasonography and successful medical management. Potential advantages of ultrasonography compared to CT are cost reduction, avoidance of unnecessary radiation exposure, avoidance of undue sedation, and real-time imaging. Garetz SL, Mitchell RB, Parker PD, et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics . 2015; 135(2):e477-e486. EBM level 1..................................................................................................................................68-77 Summary : Data from the Childhood Adenotonsillectomy Trial (CHAT), a randomized controlled trial of adenotonsillectomy versus watchful waiting for mild obstructive sleep apnea, were evaluated to compare improvements in disease-specific and global quality of life between groups. Greater improvements in most quality-of-life and symptom severity measurements were found in the adenotonsillectomy group using the Pediatric Quality of Life Inventory, the Obstructive Sleep Apnea-18 (OSA-18), the Sleep-Related Breathing Subscale of the Pediatric Sleep Questionnaire (PSQ-22), and the modified Epworth Sleepiness Scale. Results were not influenced by obesity or baseline sleep study indices, but some of the symptom measures were influenced by race. Prosser JD, Shott SR, Rodriguez O, et al. Polysomnographic outcomes following lingual tonsillectomy for persistent obstructive sleep apnea in Down syndrome. Laryngoscope . 2017; 127(2):520-524. EBM level 4..................................................................................78-82 Summary : This is a retrospective review of polysomnography outcomes after lingual tonsillectomy in children with Down syndrome with residual obstructive sleep apnea following adenotonsillectomy. There were significant improvements in change scores for apnea-hypopnea index (AHI), obstructive AHI, apnea index, hypopnea index, and oxygen saturation nadir, but not in time with CO 2 >50 mm Hg. The AHI was <5 events/hour in 61.9% of patients and ≤1 in 19% of patients. The study suggests that children with Down syndrome and persistent obstructive sleep apnea after adenotonsillectomy should be evaluated for lingual tonsil hypertrophy. Rhinology Garin A, Thierry B, Leboulanger N, et al. Pediatric sinogenic epidural and subdural empyema: the role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol . 2015; 79(10):1752-1760. EBM level 4........................................................................................83-91 Summary : Controversy exists as to whether minimally invasive endoscopic approaches are sufficient to treat serious suppurative intracranial complications of pediatric sinusitis. This study supports an important role for endoscopic sinus surgery in these cases and a role as sole surgical intervention for small epidural empyema.

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