International journal of pediatric otorhinolaryngology最新文献

{"title":"Airway management in pediatric patients undergoing microvascular free tissue transfer reconstruction after mandibulectomy","authors":"Elizabeth O. Shay ,&nbsp;Madhuri Kesani ,&nbsp;Michael G. Moore ,&nbsp;Avinash V. Mantravadi ,&nbsp;Michael W. Sim ,&nbsp;Jessica Yesensky ,&nbsp;Janice L. Farlow ,&nbsp;David Campbell ,&nbsp;Diane W. Chen","doi":"10.1016/j.ijporl.2024.112163","DOIUrl":"10.1016/j.ijporl.2024.112163","url":null,"abstract":"<div><h3>Objectives</h3><div>Microvascular free tissue transfer (MVFTT) for head and neck reconstruction is infrequently performed in pediatric patients. There is a paucity of data on perioperative airway management in pediatric MVFTT, such as the need for tracheostomy, which can pose higher morbidity to young patients due to potential long-term effects on the softer, more pliable laryngotracheal cartilage. Our objective was to report airway outcomes on pediatric patients undergoing MVFTT after segmental mandibulectomy with or without tracheostomy.</div></div><div><h3>Methods</h3><div>Retrospective chart review of pediatric patients who underwent MVFTT reconstruction after segmental mandibulectomy at a tertiary care center from 2014 to 2023. Demographic variables, surgical characteristics, and hospital clinical outcomes were recorded. Statistical analyses were performed with JMP Pro, Version 16.0.0 (2021) SAS Institute Inc., Cary, NC, 1989–2021.</div></div><div><h3>Results</h3><div>Ten patients (median age 11.5 years old, IQR: 9.0–13.3) underwent fibular free flap reconstruction. Mandibular pathologies included 3 ameloblastoma, 2 mesenchymal chondrosarcoma, 2 desmoplastic fibroma, 1 Ewing sarcoma, 1 chondroblastic osteosarcoma, and 1 desmoid tumor. Two patients received upfront tracheostomy at time of initial surgery for a subtotal mandibulectomy and a sub-hemimandibulectomy, respectively. Both patients were decannulated within 1 week after surgery and prior to discharge. The median ICU and hospital length of stay for patients who underwent tracheostomy was 3.5 days [IQR: 3.0–4.0] and 8.5 days [IQR: 8.0–9.0] respectively. Of the remaining 8 patients without tracheostomy, surgical defects were hemimandibulectomy and anterior subtotal mandibulectomy. Median intubation duration was 1.0 day [IQR: 1.0–2.5]. The median ICU and hospital length of stay for these patients were 3.0 days [IQR: 2.0–6.3] and 8.5 days [IQR: 7.3–13.0], respectively. No patient had to be reintubated for respiratory failure following extubation or had long-term airway complications during the follow-up period.</div></div><div><h3>Conclusions</h3><div>Fibular free flap reconstruction without tracheostomy can be feasible in pediatric patients with mandibular defects, which can potentially reduce hospital resources required for fresh tracheostomy care needs and avoid additional surgical morbidity. Further studies in larger populations and prospective approaches are warranted.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112163"},"PeriodicalIF":1.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence as an auxiliary tool in pediatric otitis media diagnosis","authors":"Zhengjun Zhong ,&nbsp;Xu Guo ,&nbsp;Desheng Jia ,&nbsp;Hongying Zheng ,&nbsp;Zebin Wu ,&nbsp;Xuansheng Wang","doi":"10.1016/j.ijporl.2024.112154","DOIUrl":"10.1016/j.ijporl.2024.112154","url":null,"abstract":"<div><h3>Objectives</h3><div>In order to promote the use of AI technology as the auxiliary tool in pediatric otitis media diagnosis, we use the convolutional neural networks and deep learning for image classification and disease diagnosis. We also designed a Pediatric Otitis Media Classifier to analyze and classify the images for physicians.</div></div><div><h3>Methods</h3><div>A pediatric otitis media classifier was designed for junior physicians (doctors who have been engaged in clinical practice for a short time) as an auxiliary diagnostic tool. To design this classifier for children with otitis media, we used a large number of images of acute otitis media (AOM), secretory otitis media (OME), and normal otoscope images to obtain the optimal convolutional neural network model.</div></div><div><h3>Results</h3><div>The average recognition accuracies of the ZFNet and the TSL16 for classification were 97.87 % and 97.62 %, far exceeding the accuracy of human diagnosis. The results of using the Pediatric Otitis Media Classifier show that we can use the classifier to correctly identify the image types of child middle ear infections.</div></div><div><h3>Conclusions</h3><div>We developed the Pediatric Otitis Media Classifier for the successful automated classification of AOM and OME in children using otoscopic images. In contrast to the traditional diagnosis of pediatric otitis media, which relies heavily on the experience of doctors, the diagnostic accuracy of even experienced physicians is only approximately 80 %. With AI technology, we can improve the accuracy rate to over 98 %, which can effectively assist doctors in auxiliary diagnosis. It also reduces delayed treatment, antibiotic misuse, and unnecessary surgery caused by misdiagnosis.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112154"},"PeriodicalIF":1.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid-laden macrophage index as a marker of aspiration in children, is it reliable? A scoping review","authors":"Ostap Orishchak ,&nbsp;Alexander Moise ,&nbsp;Faisal Al-Osamey ,&nbsp;Kimberley Kaspy ,&nbsp;Sam J. Daniel","doi":"10.1016/j.ijporl.2024.112151","DOIUrl":"10.1016/j.ijporl.2024.112151","url":null,"abstract":"<div><h3>Introduction</h3><div>A diagnostic pathway to detect aspiration is challenging and usually requires a multidisciplinary approach and a variety of tests. Lipid-laden macrophage index (LLMI) was first described in 1985 by Corwin and Irwin as a promising tool to detect aspiration. Information in the literature as well as physicians’ opinions about the clinical value of the LLMI remains controversial.</div></div><div><h3>Objectives</h3><div>To assess the clinical value and possible limitations of LLMI as a diagnostic marker for detecting aspiration in children.</div></div><div><h3>Methods</h3><div>Based on the available literature we thought to answer the following questions: 1. Is there a reliable cutoff value of LLMI to detect aspiration? 2. What are the limitations of LLMI? We queried 8 electronic databases: Medline, Embase, CINAHL, Cochrane, Global Health, Web of Science, Africa Wide Information, and Global Index Medicus. Studies were selected based on established study criteria. Search was limited to publications in English language including human and animal studies. Authors reviewed 2900 articles and identified 21 relevant to the studied subject.</div></div><div><h3>Results</h3><div>Research reveals different proposed cutoff values for aspirators ranging from 85 to 200 macrophages. LLMI reliability has several limitations including: inter- and intraobserver variability among pathologists scores, inability to differentiate between exogenous and endogenous lipid content, inconsistencies in the definition of the term “aspiration” in various publications. Also, studies in animal models have shown that the nature of the disease, frequency of aspiration, and the time frame when bronchoalveolar lavage (BAL) is performed, could all contribute to the overlap in LLMI in aspirators versus non-aspirators.</div></div><div><h3>Discussion</h3><div>Our research demonstrates the limitations of LLMI in distinguishing between aspirators and non-aspirators. We believe based on these findings that airway teams should audit their local data as to the value of BAL in detecting aspiration in their patient population.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112151"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National survey on Congenital Cytomegalovirus Awareness and Screening Practices among Healthcare Professionals","authors":"Nezar Hamed ,&nbsp;Mohamad-Hani Temsah ,&nbsp;Yasser Sabr ,&nbsp;Yassin Abdelsamad ,&nbsp;Mohammed A. Alghamdi ,&nbsp;Nouf Saleem Yaqoub ,&nbsp;Muataz H. Alhashem ,&nbsp;Abdullah Fahad Alnuwaybit ,&nbsp;Raghad AlKhashan ,&nbsp;Abduallah Mawkili ,&nbsp;Abdulrahman Hagr","doi":"10.1016/j.ijporl.2024.112150","DOIUrl":"10.1016/j.ijporl.2024.112150","url":null,"abstract":"<div><h3>Objectives</h3><div>Congenital cytomegalovirus (CMV) infection, resulting from maternal-fetal transmission of CMV, poses a substantial risk to maternal and child health. It is the most prevalent congenital viral infection, and the prevention and management of this condition rely heavily on the knowledge and awareness of healthcare professionals.</div></div><div><h3>Methods</h3><div>This cross-sectional survey was conducted between March 1, 2023, and August 31, 2023, across multiple tertiary centers in various Saudi Arabian cities. It assessed the understanding and awareness of congenital CMV infection among 400 healthcare professionals from diverse specialties. The study utilized a structured questionnaire to evaluate knowledge levels, obtain demographic data, and identify factors influencing awareness.</div></div><div><h3>Results</h3><div>The study revealed significant disparities in knowledge levels, with around 84 % of participants categorized as having “low\" knowledge. Obstetricians and gynecologists exhibited better knowledge. Factors like specialization, age, and professional experience significantly affected knowledge levels. Additionally, many healthcare professionals perceived a lack of information and awareness regarding CMV among their peers.</div></div><div><h3>Conclusion</h3><div>Congenital CMV infection is a major public health concern with potential severe consequences. The study identified knowledge disparities, particularly among non-specialist healthcare practitioners, emphasizing the need for targeted educational programs and focused awareness initiatives. Key factors, such as expertise, age, and experience, underscore the importance of addressing ongoing knowledge gaps, highlighting the need for continuous efforts to mitigate challenges associated with CMV infection.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112150"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aerosol mitigation in upper airway surgery","authors":"Herrmann BW ,&nbsp;Choi MH ,&nbsp;Vance ME ,&nbsp;Pickett-Nairne K ,&nbsp;Cooper EH ,&nbsp;Friedman NR","doi":"10.1016/j.ijporl.2024.112153","DOIUrl":"10.1016/j.ijporl.2024.112153","url":null,"abstract":"<div><h3>Background</h3><div>Aerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room.</div></div><div><h3>Methods</h3><div>Utilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5–10 μm in diameter were measured. Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations.</div></div><div><h3>Results</h3><div>SES was effective compared to controls, but inferior to intraoral mitigation strategies (p &lt; 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p &lt; 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles.</div></div><div><h3>Conclusions</h3><div>Intraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112153"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracapsular versus extracapsular tonsil surgery: Comparison of postoperative haemorrhage outcomes in the Australasian setting","authors":"Tze Ling Loh ,&nbsp;Pei Toh ,&nbsp;Telvinderjit Singh Harbhajan Singh ,&nbsp;Shane Anderson ,&nbsp;Kelvin Kong ,&nbsp;Mithma Ekanayake ,&nbsp;John-Charles Hodge ,&nbsp;Megan Hobson ,&nbsp;Graeme van der Meer ,&nbsp;Hannah Burns ,&nbsp;Shyan Vijayasekaran ,&nbsp;Niall Jefferson","doi":"10.1016/j.ijporl.2024.112147","DOIUrl":"10.1016/j.ijporl.2024.112147","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the incidence and timing of postoperative haemorrhage between intracapsular (ICT) and extracapsular tonsillectomy (ECT) techniques and evaluate factors influencing haemorrhage risk and severity.</div></div><div><h3>Methods</h3><div>A retrospective review of patients undergoing tonsillectomy over 5 years across otolaryngology services in Australia and New Zealand. Primary outcomes were rate and timing of post-tonsillectomy haemorrhage.</div></div><div><h3>Results</h3><div>A total of 12,275 patients were included in this study. The overall post-tonsillectomy bleed rate was 3.3 %, with 0.65 % requiring return to theatre. ICT had a significantly lower bleed rate of 1.7 % compared to 4.1 % for ECT (p &lt; 0.001). The rate of return to theatre was markedly lower for ICT (0.08 %) compared to ECT (0.93 %, p &lt; 0.001). Median day of bleeding was not different between the techniques. Patients undergoing surgery for recurrent tonsillitis had the highest rate of postoperative haemorrhage (15 %), while those with sleep-disordered breathing alone had the lowest (3 %, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>ICT results in significantly lower rates of postoperative haemorrhage and need for surgical intervention compared to ECT. This was most pronounced in paediatric patients with sleep-disordered breathing. ICT may be considered a preferable option for certain patient groups, especially younger children with sleep-disordered breathing, though more evidence is needed to confirm its efficacy and safety in patients with recurrent tonsillitis.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112147"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal follow-up of hearing, speech, and language skills in 6-year-old children with congenital moderate hearing loss","authors":"Anna Nyman ,&nbsp;Marion Lieberman ,&nbsp;Madelen Snickars ,&nbsp;Anna Persson","doi":"10.1016/j.ijporl.2024.112148","DOIUrl":"10.1016/j.ijporl.2024.112148","url":null,"abstract":"<div><h3>Objectives</h3><div>Children born with moderate hearing loss present with speech and language outcomes at both ends of the spectrum. To explore reasons for this, the objective of this study was to follow up a group of children born with moderate sensorineural hearing loss at 6 years of age (n = 7) by investigating their outcomes in hearing, speech, and language development from time point of hearing aid fitting at 6 months. Another objective was to investigate the relationship between earlier outcomes on precursing variables to the current status in auditory, speech and language development.</div></div><div><h3>Method</h3><div>Earlier data from a project with the same participants of auditory variables, speech, and language development were compared to the current study outcomes at 6 years of age. Children in this study performed standardized tests of phonology (SVANTE), expressive vocabulary (BNT), and speech-in-noise test (Hagerman's sentences). Parents reported on their child's functional auditory performance in everyday life (PEACH), and demographics and general development (questionnaire). Etiology and frequency of speech and language-directed intervention from time point of diagnosis to 6 years of age were collected through medical journals.</div></div><div><h3>Results</h3><div>Hearing levels were stable over time in all children but one, who had received bilateral cochlear implants. Performance on speech-in-noise testing varied in aided condition (−0.8 to 8, mean 2.65, SD 3.09) and unaided condition (7.2 dB–21.2 dB, mean 12.06, SD 4.82). Scores on the PEACH indicated further review in four of the seven children. Mean group score on consonant proficiency had increased from 3 to 6 years of age and were within age norms. Vocabulary scores were below the norms of children with typical hearing. Outcomes on vocabulary measures at 2.5 years showed strong correlations that were significant to scores on the BNT at 6 years of age (<em>r</em> = 0.87, p = 0.05). Correlations between hours of hearing aid use and vocabulary was not significant at 6 years of age. The frequency of intervention sessions in the first 6 years varied between participants (4–55, mean 19.1, SD 17.1).</div></div><div><h3>Conclusion</h3><div>Despite homogeneous hearing and other background variables in the participants from birth, large individual variations in speech and language outcomes at 6 years of age were found. Considering the many factors involved that impact the development of children with moderate hearing loss, the results suggest that monitoring early precursors in auditory, speech and language development may be helpful in setting commensurate goals for each child. Detecting additional conditions that may pose challenges in future speech and language as early as possible is important. There is ample room for improvement in terms of increasing the frequency of intervention for children with moderate hearing loss and their families.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112148"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of chest X-ray for the depth of tracheal intubation in infants","authors":"Junnan Chen ,&nbsp;Shaoping Wu ,&nbsp;Shouxing Duan ,&nbsp;Yongfa Zhang","doi":"10.1016/j.ijporl.2024.112149","DOIUrl":"10.1016/j.ijporl.2024.112149","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the predictive value of chest X-ray for the depth of tracheal intubation in infants.</div></div><div><h3>Methods</h3><div>Basic data of 161 infants under 3 years old was collected. Tracheal length was measured on preoperative chest radiographs to guide intubation depth. Correlation analysis was performed to examine relationships between tracheal length, age, and body weight.</div></div><div><h3>Results</h3><div>161 cases (male/female = 142/19, no significant difference in sex, p = 0.09) were included, aged from 1 month to 28 months, weight from 2.5 kg to 18.0 kg. The endotracheal intubation depth reached the standard rate was 100 %, with 0 cases of over-deep or over-shallow intubation. Correlation analysis showed that tracheal length was positively correlated with both age and body weight, with stronger correlations observed in infants aged 1–12 months (r = 0.751 for age, r = 0.672 for weight, p &lt; 0.01) compared to those aged 13–28 months (r = 0.672 for age, r = 0.408 for weight, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Direct measurement of tracheal length on routinely performed chest X-rays is simple, feasible and safe, and may be another choice for guiding the depth of tracheal intubation in children.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112149"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental factors and the incidence of pediatric epistaxis: A systematic review with meta-analysis","authors":"Alireza Sharifi ,&nbsp;Peter H. Hwang ,&nbsp;Mohaddeseh Zojaji ,&nbsp;Sahar Ghaedsharaf ,&nbsp;Samad Samadizadeh ,&nbsp;Mohammad E. Ghaffari ,&nbsp;Z. Jason Qian","doi":"10.1016/j.ijporl.2024.112152","DOIUrl":"10.1016/j.ijporl.2024.112152","url":null,"abstract":"<div><h3>Background</h3><div>A growing body of literature explores environmental risk factors for pediatric epistaxis, yielding variable results. We aim to clarify these associations through a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, Cochrane Central Register of Control Trials, Web of Science, Medline, Google Scholars, and Embase were systematically searched up to April 2024. Eligible articles were reviewed, and the quality was assessed. A systematic review and meta-analysis was conducted to clarify correlations between the incidence of epistaxis and multiple environmental factors according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.</div></div><div><h3>Results</h3><div>A total of 8 studies, comprising 55,176 participants, met the inclusion criteria. The incidence of epistaxis peaked during the summer months (Proportion = 12.73 %, CI: 9.629 %–16.201 %). Significant risk factors included environmental variables elevated in the summer, including higher monthly mean temperatures, increased sunlight exposure, elevated O3 levels, and lower atmospheric pressure. In contrast, factors like mean monthly humidity, wind speed, SO2, CO, NO2, and PM-10 levels were not associated with an increased risk of epistaxis.</div></div><div><h3>Conclusions</h3><div>This meta-analysis underscores the significant impact of multiple environmental factors, particularly those more pronounced during the summer months, on the incidence of pediatric epistaxis.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"186 ","pages":"Article 112152"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a nurse-led paediatric epistaxis clinic at a tertiary hospital","authors":"Arshad Zubair ,&nbsp;Alison Flynn ,&nbsp;Heather Todd ,&nbsp;Grace Khong","doi":"10.1016/j.ijporl.2024.112146","DOIUrl":"10.1016/j.ijporl.2024.112146","url":null,"abstract":"<div><h3>Introduction</h3><div>Referrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times.</div></div><div><h3>Methods</h3><div>ENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022–February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times.</div></div><div><h3>Results</h3><div>Forty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3–16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (<em>p = 0.003, Wilcoxon rank sum test</em>). Overall quality of care in NPEC was described as \"very satisfactory\" and “fairly satisfactory” by 92 % and 8 % parents respectively.</div></div><div><h3>Conclusion</h3><div>Nurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112146"},"PeriodicalIF":1.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}