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S251 – Facial Symptoms Related to Allergic Rhinitis in U.S. Children
Scientific Posters
S251 – Facial Symptoms Related to Allergic Rhinitis in U.S. Children M Jennifer Derebery, MD (presenter); Eli O Meltzer, MD; John Boyle, PhD OBJECTIVES: In addition to general symptoms related to nasal congestion, common secondary symptoms of allergic rhinitis (AR) include headache, facial pain/pressure, and ear pain/pressure. The prevalence of secondary AR symptoms in U.S. children is described herein. METHODS: The prevalence of headache, facial pain/pressure, and ear pain/pressure in children with and without AR was studied in Pediatric Allergies in America, a national survey of parents of 500 children with current symptoms of nasal allergies and 504 children without nasal allergies (aged 4 to 17 years) among 35,757 U.S. households. Children aged 10 to 17 years were also interviewed, in addition to their parents. RESULTS: Parents report that the occurrence of headaches (55% vs 18%), facial pain/pressure (29% vs 3%), and ear pain/pressure (24% vs 5%) is more frequent in children with AR, compared with those without, respectively. These figures represent an approximately 3-fold increase in headaches, nearly a 10-fold increase in facial pain/pressure, and an approximately 5-fold increase in ear pain/pressure in children suffering from presumed AR, compared with children without
AR. Furthermore, headache (59%; 63%), facial pain/pressure (53%; 54%), and ear pain/pressure (56%; 44%) were rated moderately or extremely bothersome by more than half of parents and older children (aged 10 to 17 years) who reported experiencing these symptoms, respectively. CONCLUSIONS: The Pediatric Allergies in America survey suggests that children with presumed AR may suffer significant headache, facial pain/pressure, and ear pain/pressure from nasal allergy symptoms that are not shared by children without nasal allergies. S252 – The Efficacy of Tympanostomy Tubes In Down Syndrome Patients Brett M Cordes, MD (presenter); Nurupama Madduri, MD; Ellen M Friedman, MD OBJECTIVES: The purpose of this report is to relate a single institution’s experience with middle ear disease and the incidence and efficacy of tympanostomy tube (PET) insertion in children with Down syndrome. METHODS: Retrospective chart review of 130 consecutive pediatric Down syndrome patients seen at a single tertiary care children’s hospital between the years 2001-2007. Middle ear function, and speech and language development, is reported and those patients who underwent tympanostomy tube insertion for middle ear disease are analyzed. RESULTS: The mean age of the patient population was 4.5 years, ranging from 8 months to 10 years. 41/130 patients (31.5%) were treated with tympanostomy tube insertion for middle ear disease. Of this group, 11/41 patients (26.8%) and 2/11 patients (18.1%) required second and third tube insertions, respectively, for persistent pathology and failed tube function. The mean age at first tube insertion was 3.3 years, while the mean age at second and third tube insertion was 6.9 and 6.0 years. Outcome measures included a documented conductive hearing loss on audiological assessment and/or persistent middle ear effusion on physical exam. Speech and language skills were also assessed. CONCLUSIONS: Children with Down syndrome have an increased incidence and persistence of middle ear disease. Additionally, affected children may require multiple surgical interventions for persistent disease and failed tube function. The multiple medical problems often associated with Down syndrome result in an increased anesthetic risk for these patients. Therefore, we propose the utility of a durable tympanostomy tube for more efficient treatment and the avoidance of multiple interventions. S253 – Management of Pediatric Skull Base Abscesses Tyler G Kimbrough, MD, PhD (presenter); Abby C Meyer, MD; Marsha Finkelstein, MS; James D Sidman, MD
SCI. POSTERS
otitis media (OM). Mortality rates for LST are quoted as 8-25% in most recent larger case series. Controversy exists regarding the surgical and medical management of LST. We sought to clarify this by reviewing our experience in patients who presented with otogenic LST in the past 5 years. METHODS: A retrospective chart review was conducted. 7 patients were identified and charts were examined for presentation, co-existing intracranial complications, treatment, cultured organisms, and outcome. RESULTS: Patients most commonly presented with fever (5/7), otalgia (5/7), and mastoid tenderness (4/7). Co-existing intracranial complications were present in 4/7 patients, including meningitis (1/7), epidural abscess (2/7), otitic hydrocephalus (2/7), and cavernous sinus thrombosis (1/7). All patients received IV antibiotics and underwent mastoidectomy with unroofing of the sigmoid sinus, and tympanostomy tube placement. Thrombectomy was not performed on any patient. Anticoagulation was used on 5/7 patients without complication. Streptococcus sp. was the most common organism isolated (2/7). All patients recovered well without major sequelae. One patient with cavernous sinus thrombosis and otitic hydrocephalus had a persistent right visual field deficit. CONCLUSIONS: In this limited series, we demonstrate good outcomes by emergently treating LST from an otitic source with mastoidectomy and unroofing of the sigmoid sinus, IV antibiotics, and selective anticoagulation. We did not find thrombectomy to be necessary.
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S251 – Facial Symptoms Related to Allergic Rhinitis in U.S. Children M Jennifer Derebery, MD (presenter); Eli O Meltzer, MD; John Boyle, PhD OBJECTIVES: In addition to general symptoms related to nasal congestion, common secondary symptoms of allergic rhinitis (AR) include headache, facial pain/pressure, and ear pain/pressure. The prevalence of secondary AR symptoms in U.S. children is described herein. METHODS: The prevalence of headache, facial pain/pressure, and ear pain/pressure in children with and without AR was studied in Pediatric Allergies in America, a national survey of parents of 500 children with current symptoms of nasal allergies and 504 children without nasal allergies (aged 4 to 17 years) among 35,757 U.S. households. Children aged 10 to 17 years were also interviewed, in addition to their parents. RESULTS: Parents report that the occurrence of headaches (55% vs 18%), facial pain/pressure (29% vs 3%), and ear pain/pressure (24% vs 5%) is more frequent in children with AR, compared with those without, respectively. These figures represent an approximately 3-fold increase in headaches, nearly a 10-fold increase in facial pain/pressure, and an approximately 5-fold increase in ear pain/pressure in children suffering from presumed AR, compared with children without
AR. Furthermore, headache (59%; 63%), facial pain/pressure (53%; 54%), and ear pain/pressure (56%; 44%) were rated moderately or extremely bothersome by more than half of parents and older children (aged 10 to 17 years) who reported experiencing these symptoms, respectively. CONCLUSIONS: The Pediatric Allergies in America survey suggests that children with presumed AR may suffer significant headache, facial pain/pressure, and ear pain/pressure from nasal allergy symptoms that are not shared by children without nasal allergies. S252 – The Efficacy of Tympanostomy Tubes In Down Syndrome Patients Brett M Cordes, MD (presenter); Nurupama Madduri, MD; Ellen M Friedman, MD OBJECTIVES: The purpose of this report is to relate a single institution’s experience with middle ear disease and the incidence and efficacy of tympanostomy tube (PET) insertion in children with Down syndrome. METHODS: Retrospective chart review of 130 consecutive pediatric Down syndrome patients seen at a single tertiary care children’s hospital between the years 2001-2007. Middle ear function, and speech and language development, is reported and those patients who underwent tympanostomy tube insertion for middle ear disease are analyzed. RESULTS: The mean age of the patient population was 4.5 years, ranging from 8 months to 10 years. 41/130 patients (31.5%) were treated with tympanostomy tube insertion for middle ear disease. Of this group, 11/41 patients (26.8%) and 2/11 patients (18.1%) required second and third tube insertions, respectively, for persistent pathology and failed tube function. The mean age at first tube insertion was 3.3 years, while the mean age at second and third tube insertion was 6.9 and 6.0 years. Outcome measures included a documented conductive hearing loss on audiological assessment and/or persistent middle ear effusion on physical exam. Speech and language skills were also assessed. CONCLUSIONS: Children with Down syndrome have an increased incidence and persistence of middle ear disease. Additionally, affected children may require multiple surgical interventions for persistent disease and failed tube function. The multiple medical problems often associated with Down syndrome result in an increased anesthetic risk for these patients. Therefore, we propose the utility of a durable tympanostomy tube for more efficient treatment and the avoidance of multiple interventions. S253 – Management of Pediatric Skull Base Abscesses Tyler G Kimbrough, MD, PhD (presenter); Abby C Meyer, MD; Marsha Finkelstein, MS; James D Sidman, MD
SCI. POSTERS
otitis media (OM). Mortality rates for LST are quoted as 8-25% in most recent larger case series. Controversy exists regarding the surgical and medical management of LST. We sought to clarify this by reviewing our experience in patients who presented with otogenic LST in the past 5 years. METHODS: A retrospective chart review was conducted. 7 patients were identified and charts were examined for presentation, co-existing intracranial complications, treatment, cultured organisms, and outcome. RESULTS: Patients most commonly presented with fever (5/7), otalgia (5/7), and mastoid tenderness (4/7). Co-existing intracranial complications were present in 4/7 patients, including meningitis (1/7), epidural abscess (2/7), otitic hydrocephalus (2/7), and cavernous sinus thrombosis (1/7). All patients received IV antibiotics and underwent mastoidectomy with unroofing of the sigmoid sinus, and tympanostomy tube placement. Thrombectomy was not performed on any patient. Anticoagulation was used on 5/7 patients without complication. Streptococcus sp. was the most common organism isolated (2/7). All patients recovered well without major sequelae. One patient with cavernous sinus thrombosis and otitic hydrocephalus had a persistent right visual field deficit. CONCLUSIONS: In this limited series, we demonstrate good outcomes by emergently treating LST from an otitic source with mastoidectomy and unroofing of the sigmoid sinus, IV antibiotics, and selective anticoagulation. We did not find thrombectomy to be necessary.
P159