September 2019 HSC Section 1 Congenital and Pediatric Problems

Byars SG, Stearns SC, Boomsma JJ. Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood. JAMA Otolaryngol Head Neck Surg . 2018; 144(7):594-603. EBM level 3.....................................................................102-111

Rosenfeld RM. Old barbers, young doctors, and tonsillectomy. JAMA Otolaryngol Head Neck Surg . 2018; 144(7):603-604. EBM level 5..............................................................................111-112

Summary : Although not directly discussing obstructive sleep apnea (OSA), this highly referenced and controversial study is a must-read for clinicians treating OSA in children. Tonsillectomy and adenoidectomy (T&A) is most commonly performed for airway obstruction, and firmly stands as first-line surgical treatment for OSA in children. The study represents a “big data” population- based cohort study from Denmark and concluded that T&A was associated with long-term risks of respiratory, infectious, and allergic diseases. The article is followed by an invited commentary by Richard M. Rosenfeld, MD, MPH, a pediatric otolaryngologist, who masterfully critiques the study and puts it into a practical context for surgeons when counseling families of the long-term risks of T&A in children 9 years of age and younger. Lin CY, Chen CN, Kang KT, et al. Ultrasonographic evaluation of upper airway structures in children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg . 2018; 144(10):897-905. EBM level 2.................................................................................................113-121 Summary : This prospective, observational study compared ultrasonographic assessment of upper airway structures in children with OSA vs. primary snoring and, surprisingly, found that there was no statistically significant difference in tonsillar dimensions or volume. However, the mean thicknesses for both the total lateral pharyngeal wall and total neck at the retropalatal level were greater in children with OSA than in those with primary snoring. Rhinology Beswick DM, Messner AH, Hwang PH. Pediatric chronic rhinosinusitis management in rhinologists and pediatric otolaryngologists. Ann Otol Rhinol Laryngol. 2017; 126(9):634-639. EBM level 2...............................................................................................................................122-127 Summary : This article is a prospective comparison between management of pediatric chronic rhinosinusitis by pediatric otolaryngologists (members of ASPO) and rhinologists (members of ARS). This study found that overall, there are many similarities between management styles, but a few key differences exist, such as the use of perioperative systemic steroids and the use of CT imaging prior to adenoidectomy. House LK, Lewis AF, Ashmead MG. A cost-effectiveness analysis of the up-front use of balloon catheter dilation in the treatment of pediatric chronic rhinosinusitis. Am J Otolaryngol. 2018; 39(4):418-422. EBM level 4.....................................................................................................128-132 Summary : This article presents a cost-effectiveness study comparing adenoidectomy versus adenoidectomy combined with balloon catheter dilation for the treatment of chronic rhinosinusitis failing medical therapy. The cost effectiveness was measured by calculating the incremental cost- effective ratio and performing a sensitivity analysis. Due to the high incremental cost associated with a very small expected clinical benefit, adding balloon catheter dilation to adenoidectomy is not recommended based on this study.

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