- Email: [email protected]
SP360 – Why do pediatric tympanoplasties fail to success?
Program Poster Presentations
SP356 – VPI following adenotonsillectomy in Prader-Willi syndrome Christopher Andrew Mantle, MD, MPH (presenter); Steven Goudy, MD OBJECTIVES: 1) Determine the occurrence rate of velopharyngeal insufficiency (VPI) following adenotonsillectomy in patients with Prader-Willi syndrome (PWS). 2) Propose preoperative and postoperative speech evaluation for PWS patients undergoing adenotonsillectomy. METHODS: Retrospective review of 8 patients with PWS that underwent adenoidectomy, tonsillectomy, or both between 2000-2008. Data collected: demographics, surgical indications, follow-up, and perceptual measures of resonance and articulation. VPI was diagnosed based on evaluation of resonance, nasal-rustle, nasal-air-emission, nasal or pharyngeal frication, weak pressure-phenomes, nasal-assimilation, and backing. Nasometry and nasopharyngeal endoscopy were also used. RESULTS: Six adenotonsillectomies, 2 tonsillectomies, and 2 adenoidectomies were performed on 8 PWS-patients (mean age: 6.75yr). Six patients were diagnosed with OSA and 2 with sleep disordered breathing (SDB). Tonsil-grade ranged from 2-3 out of 4. Adenoid-size ranged from not-enlarged to moderately-enlarged. Average follow-up was 26 months. No patients demonstrated hypernasal-resonance preoperatively. Four patients (50%) were diagnosed with VPI following surgery. Hypernasality among VPI-patients ranged from moderate to severe. Nasal-rustle and nasal-air-emission was present in all VPI-patients. Articulation was also poor, with all VPI-patients demonstrating weak pressure-phenomes and nasal-assimilation. All 4 PWS-patients with VPI received postoperative speech-therapy and 1 received a posterior pharyngeal flap. CONCLUSIONS: PWS-patients are at increased risk of developing VPI following adenotonsillectomy, which is often necessary for management of OSA or SDB in this patient population. Routine preoperative counseling and postoperative monitoring for VPI is necessary. SP360 – Why do pediatric tympanoplasties fail to success? Joao Carlos Ribeiro, MD (presenter) OBJECTIVES: There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors
thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery. This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure. METHODS: A retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. Ninety-one ears had full records and were included in the study. Age, gender, size, site of perforation, status of operated and contra lateral ear, underlying cause of the perforations, surgical technique, pre- and post-operative hearing levels, post-operative follow-up time, and post-operative complications were recorded. RESULTS: Anatomical success was achieved in 85.7% and functional success was 76.9% after a mean follow up of 25.617.1 months. The incidence of minor and major complications were 29% in patients aged less than 10 and 21% in those older than 10 (p ⫽ n.s.). We report 17.1% minor postoperative complications in successful cases: otitis media with effusion (7%), injury to the chorda tympani nerve (5.7%), wound infection (2.9%), otitis externa (2.9%), and transient vertigo (1.4%). Among the 21 reperforations observed, 92.3% occurred before one year. CONCLUSIONS: Surgical outcome was not influenced by age or any of the pre-operative factors related. The majority of perforations occur within the first year. Success in closure of the perforation and improvement in hearing is comparable to adult studies.
Practice Management Session SP382 – Surgical drainage of infratemporal fossa abscess Hiroko Monobe, MD (presenter); Ryoji Kagoya, MD; Hitoshi Tojima, MD OBJECTIVES: 1) To understand the clinical picture of gas gangrene involving the infratemporal fossa. 2) To be able to assess the most appropriate surgical drainage pathway indicated in each of these cases. METHODS: The charts of four patients ranging from 45 to 81 years old who had consulted our emergency room between 2007 and 2008 complaining of fever, severe pain of his/her face, and difficulty in eating were reviewed retrospectively. Infratemporal fossa gangrene was confirmed in each of these cases by computed tomography with contrast enhancement. RESULTS: Three patients showed signs of systemic sepsis. Intravenous antibiotics were administered aggressively, and surgical drainage was performed under general anesthesia in each case. We used an intraoral approach in combination with a temporal approach in three cases, and a trans-maxillary sinus approach in one case. Tracheostomies were performed in all patients. Post-operative irrigation was performed via a drain-
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.
POSTERS
tion. Tubes extruded later from ears that had more episodes of otorrhea. Adenoidectomy performed at the time of ventilation tube insertion was associated with fewer otorrhea episodes. Younger age at the time of initial ventilation tube placement was associated with a greater incidence of additional tube placement. One in six patients will probably require a second set of ventilation tubes.
P211
SP356 – VPI following adenotonsillectomy in Prader-Willi syndrome Christopher Andrew Mantle, MD, MPH (presenter); Steven Goudy, MD OBJECTIVES: 1) Determine the occurrence rate of velopharyngeal insufficiency (VPI) following adenotonsillectomy in patients with Prader-Willi syndrome (PWS). 2) Propose preoperative and postoperative speech evaluation for PWS patients undergoing adenotonsillectomy. METHODS: Retrospective review of 8 patients with PWS that underwent adenoidectomy, tonsillectomy, or both between 2000-2008. Data collected: demographics, surgical indications, follow-up, and perceptual measures of resonance and articulation. VPI was diagnosed based on evaluation of resonance, nasal-rustle, nasal-air-emission, nasal or pharyngeal frication, weak pressure-phenomes, nasal-assimilation, and backing. Nasometry and nasopharyngeal endoscopy were also used. RESULTS: Six adenotonsillectomies, 2 tonsillectomies, and 2 adenoidectomies were performed on 8 PWS-patients (mean age: 6.75yr). Six patients were diagnosed with OSA and 2 with sleep disordered breathing (SDB). Tonsil-grade ranged from 2-3 out of 4. Adenoid-size ranged from not-enlarged to moderately-enlarged. Average follow-up was 26 months. No patients demonstrated hypernasal-resonance preoperatively. Four patients (50%) were diagnosed with VPI following surgery. Hypernasality among VPI-patients ranged from moderate to severe. Nasal-rustle and nasal-air-emission was present in all VPI-patients. Articulation was also poor, with all VPI-patients demonstrating weak pressure-phenomes and nasal-assimilation. All 4 PWS-patients with VPI received postoperative speech-therapy and 1 received a posterior pharyngeal flap. CONCLUSIONS: PWS-patients are at increased risk of developing VPI following adenotonsillectomy, which is often necessary for management of OSA or SDB in this patient population. Routine preoperative counseling and postoperative monitoring for VPI is necessary. SP360 – Why do pediatric tympanoplasties fail to success? Joao Carlos Ribeiro, MD (presenter) OBJECTIVES: There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors
thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery. This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure. METHODS: A retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. Ninety-one ears had full records and were included in the study. Age, gender, size, site of perforation, status of operated and contra lateral ear, underlying cause of the perforations, surgical technique, pre- and post-operative hearing levels, post-operative follow-up time, and post-operative complications were recorded. RESULTS: Anatomical success was achieved in 85.7% and functional success was 76.9% after a mean follow up of 25.617.1 months. The incidence of minor and major complications were 29% in patients aged less than 10 and 21% in those older than 10 (p ⫽ n.s.). We report 17.1% minor postoperative complications in successful cases: otitis media with effusion (7%), injury to the chorda tympani nerve (5.7%), wound infection (2.9%), otitis externa (2.9%), and transient vertigo (1.4%). Among the 21 reperforations observed, 92.3% occurred before one year. CONCLUSIONS: Surgical outcome was not influenced by age or any of the pre-operative factors related. The majority of perforations occur within the first year. Success in closure of the perforation and improvement in hearing is comparable to adult studies.
Practice Management Session SP382 – Surgical drainage of infratemporal fossa abscess Hiroko Monobe, MD (presenter); Ryoji Kagoya, MD; Hitoshi Tojima, MD OBJECTIVES: 1) To understand the clinical picture of gas gangrene involving the infratemporal fossa. 2) To be able to assess the most appropriate surgical drainage pathway indicated in each of these cases. METHODS: The charts of four patients ranging from 45 to 81 years old who had consulted our emergency room between 2007 and 2008 complaining of fever, severe pain of his/her face, and difficulty in eating were reviewed retrospectively. Infratemporal fossa gangrene was confirmed in each of these cases by computed tomography with contrast enhancement. RESULTS: Three patients showed signs of systemic sepsis. Intravenous antibiotics were administered aggressively, and surgical drainage was performed under general anesthesia in each case. We used an intraoral approach in combination with a temporal approach in three cases, and a trans-maxillary sinus approach in one case. Tracheostomies were performed in all patients. Post-operative irrigation was performed via a drain-
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.
POSTERS
tion. Tubes extruded later from ears that had more episodes of otorrhea. Adenoidectomy performed at the time of ventilation tube insertion was associated with fewer otorrhea episodes. Younger age at the time of initial ventilation tube placement was associated with a greater incidence of additional tube placement. One in six patients will probably require a second set of ventilation tubes.
P211