Otolaryngology http://oto.sagepub.

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Pan American Guideline on Tonsillitis and Adenoid Hypertrophy

Carlos De La Torre Gonzalez, Jose L. Mayorga Butron, Luis A. Macas Fernndez, Tania M. Sih, Julian Chaverri-Polini, Amarilis M. Melendez-Medina and Marcos Mocellin Otolaryngology -- Head and Neck Surgery 2012 147: P234 DOI: 10.1177/0194599812451426a347 The online version of this article can be found at: http://oto.sagepub.com/content/147/2_suppl/P234.1

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P234 Childrens Hospital. Data in the form of pure tone audiometry, sound field audiometry, tympanometry, and otoacoustic emissions was collected and reviewed. The prevalence, incidence, age of onset, type, and severity of hearing loss were determined. Results: The prevalence of hearing loss was 24% and the incidence was 9%. The mean age of onset was 5.8 years. A conductive hearing (50-56%) loss was more common than sensorineural (39-44%) or mixed (11%) hearing loss. The majority of patients had a mild hearing loss (67%). Conclusion: Hearing loss was found in 24% of patients. The average age of onset was 5.8 years. Our data supports screening children with osteogenesis imperfecta for hearing loss starting at a young age.

OtolaryngologyHead and Neck Surgery 147(2S) Conclusion: This clinical practice guideline provides guidance for the medical treatment of children with acute tonsillitis and adenoid hypertrophy.

POSTERS

Pediatric Otolaryngology Pediatric Epiglottitis: Predictors of Conservative Treatment Marci J. Neidich, MD (presenter); Angela P. Black, MD; Catherine K. Hart, MD; Lina Lander, ScD; Rahul K. Shah, MD; Kaalan E. Johnson, MD
Objective: 1) To evaluate predictors of conservative management in pediatric patients with epiglottitis. 2) To use national trends, variances, and outcomes to better understand current management trends of this rare though highly morbid disease. Method: The Kids Inpatient Databases (2006 and 2009) were searched using ICD-9 CM codes for acute epiglottitis with (464.30) and without (464.31) obstruction. Demographics and hospital characteristics of pediatric patients who required airway intervention (defined as intubation or tracheotomy) were compared with those who were managed conservatively without airway intervention. Results: A total of 820 patients were included in the analysis, and 115 (14%) required intervention and 86% were managed conservatively. Mortality was less than 10 patients. There were no significant differences between groups with respect to age, gender, or race. Characteristics predictive of conservative management include urgent admission type (vs emergent, P = .015), urban nonteaching hospital (vs urban teaching, P = .002), nonchildrens hospital (vs childrens unit or childrens hospital, P < .0001) and small/mediumsized hospital (vs large, P = .03). Length of hospital stay was shorter (mean 3.65 days vs 10.87 days, P = .01) and cost was lower in patients who were managed conservatively (mean $18,487 vs $83,037, P < .0001). Conclusion: The majority of pediatric epiglottitis patients are currently managed without intubation or tracheotomy with low mortality. Conservatively managed admissions are more likely for nonemergent presentations at nonpediatric, nonteaching, small/medium-sized hospitals, and are lower in cost. Additional studies are needed to further characterize patients which would be appropriate for conservative management.

Pediatric Otolaryngology Pan American Guideline on Tonsillitis and Adenoid Hypertrophy Carlos De La Torre Gonzalez, MD (presenter); Jose L. Mayorga Butron, MD; Luis A. Macas Fernndez; Tania M. Sih, MD; Julian Chaverri-Polini, MD; Amarilis M. Melendez-Medina, MD; Marcos Mocellin, MD
Objective: This evidence-based clinical practice guideline (CPG) aims to improve clinical decision making of general practitioners and specialists in the treatment of acute tonsillitis and adenoid hypertrophy and supports clinicians in clinical decision making for medical treatment, targeting the pathophysiological process and evidence-based efficacy, safety, and tolerability. Method: Pan-American Association of Otorhinolaryngology and Head and Neck Surgery in partnership with Ibero American Agency for Development and Assessment of Health Technologies developed a clinical practice guideline on medical management of acute tonsillitis and adenoid hypertrophy in children. This document provides punctual evidence-based recommendations for primary care physicians and otolaryngologists on the medical management of these conditions and complies with evidence-based medicine fundamentals and with well-validated guidelines methodology as recommended by the National Institute for Clinical Excellence, the National Institutes of Health, and the Scottish Intercollegiate Guidelines Network. Results: This document provides from A Grade to D Grade of clinical recommendations for treatment of these conditions. The Guideline Development Group made recommendations based on well-designed randomized controlled trials and systematic reviews. Some clinical questions could not be answered by high-quality research and for these questions a Panel Delphi was conducted to provide clinical guidance. Overall there is a need for well-designed RCTs and economic assessments to answer most of the gaps of knowledge for the treatment of acute tonsillitis and adenoid hypertrophy.

Pediatric Otolaryngology Pediatric Parotidectomy: Postoperative Facial Nerve Function James A. Owusu, MD (presenter); Noah P. Parker, MD; Frank Rimell, MD
Objective: The purpose of this study was to analyze the incidence of postparotidectomy facial nerve dysfunction in pediatric patients and to evaluate the association between patient demographics or underlying pathology and functional outcomes.

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