It's a rash: Antibiotic allergies in the modern era of antibiotic stewardship.
Child; Antimicrobial stewardship; Sinusitis; Otitis media; Tonsillitis
OBJECTIVES: To determine whether current guidelines emphasizing antibiotic stewardship in pediatrics have been associated with reduced prevalence of antibiotic allergies in children severely affected by otitis media undergoing bilateral myringotomy with tympanostomy tube insertion (BMT) or by recurrent sinusitis or adenotonsillitis undergoing adenoidectomy with or without tonsillectomy. METHODS: Case series of consecutive patients undergoing BMT or adenoidectomy with/without tonsillectomy for recurrent acute otitis media, recurrent sinusitis, or recurrent tonsillitis during November 2008 or November 2017 at a tertiary care children's hospital. Children with primarily obstructive indications for surgery, with prior tube placement or adenoidectomy, or with surgery by an outside provider were excluded. Demographics, type of surgery, and allergies or allergic symptoms were collected from the electronic medical record. Factors associated with antibiotic allergies were compared using logistic regression, Wilcoxon rank-sum, or Chi-squared test. RESULTS: Seventy-five children who underwent surgery during 2008 and 75 children who underwent surgery in 2017 were included. Overall, median age at surgery was 3.24 years (range 0.56-17.49 years). Seventy-nine (52.7%) patients were female and 95 (63.3%) had private insurance. BMT was the most common surgery (82 children, 54.7%) followed by tonsillectomy with adenoidectomy (46 children, 30.7%), and adenoidectomy without tonsillectomy (39 children, 26.0%). Symptoms of allergic rhinitis were reported by 53 (35.3%) patients, and 11 (7.3%) and 5 (3.3%) had positive environmental and food allergy testing, respectively. Surprisingly, there was not a significant difference between the prevalence of antibiotic allergies in patients undergoing surgery during 2017 (17 patients, 22.7%) compared with 2008 (14 patients, 18.7%) (OR: 1.28, 95% CI: 0.578-2.82, p = 0.546). However, antibiotic allergies were less common in females (OR: 0.413, 95% CI: 0.182-0.937, p = 0.034) and more common in patients with a family history of antibiotic allergies (OR: 36.9, 95% CI: 5.12-∞, p < 0.001). CONCLUSION: Pediatric otolaryngology surgical patients continue to exhibit a similar and high prevalence of antibiotic allergies in 2017 compared with 2008. Future studies are needed to determine whether this is because of overdiagnosis of antibiotic allergies or a failure of antibiotic guideline adherence to reduce antibiotic allergy prevalence.
Shaffer AD;Melachuri M;Dohar JE
International Journal Of Pediatric Otorhinolaryngology
2021
2021-01-30
journalArticle
<a href="http://doi.org/10.1016/j.ijporl.2021.110638" target="_blank" rel="noreferrer noopener">10.1016/j.ijporl.2021.110638</a>
Pathophysiology of aspiration in a unilateral SLN lesion model using quantitative analysis of VFSS.
Pathophysiology; Dysphagia; Superior laryngeal nerve; Videofluoroscopy; Swallow
OBJECTIVE: The purpose of this study was to elucidate the pathophysiology of aspiration in previously studied female infant piglets after a unilateral superior laryngeal nerve (uSLN) lesion. METHODS: Videofluoroscopic swallow studies (VFSS) were acquired from 15 female piglets ages 2-3 weeks (9 with uSLN lesion and 6 controls). VFSS were analyzed at 30 frames/second sampling rate. Quantitative measures were conducted and compared between groups using published methodologies for VFSS assessment in adult and infant humans. Measures included the: 1) number of lingual-palatal contacts (LPC) (i.e. pre-swallow), 2) total pharyngeal transit time (TPT), 3) offset of swallow (offP), as well as onset of: 4) pharyngeal stage (onP), 5) pharyngoesophageal segment opening (oPES), 6) maximum PES opening (maxPES), 7) airway closure onset (oAC), and 8) maximum airway closure (maxAC). Measures 5-7 were determined relative to onP. Bolus residue was rated by severity (0 (none) to 3 (severe)). A gamma regression was used to compare continuous measures between lesioned and control groups. RESULTS: The number of LPC (p = .006), TPT (p = .023) and timing of maxAC (p = .041) were significantly greater in the uSLN lesion than the control group. CONCLUSIONS: Outcomes of this study replicated prior published findings and elucidated that piglets with right uSLN lesions exhibited delayed maxAC. Noteworthy was the use of clinically relevant quantitative videofluoroscopic measures in piglets for comparison to future studies in human pediatric populations.
Stevens M; Mayerl CJ; Bond L; German RZ; Barkmeier-Kraemer JM
International Journal of Pediatric Otorhinolaryngology
2021
2021-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ijporl.2020.110518" target="_blank" rel="noreferrer noopener">10.1016/j.ijporl.2020.110518</a>
Binaural interaction of bone-conducted auditory brainstem responses in children with congenital atresia of the external auditory canal.
Adolescent; Audiometry; Auditory; Bilateral/congenital/physiopathology; Bone Conduction/*physiology; Brain Stem/*physiology; Child; Conductive/congenital/physiopathology; Ear; Ear Canal/*abnormalities/physiopathology; Evoked Potentials; Evoked Response; Hearing Loss; Humans; Middle/abnormalities; Preschool; Pure-Tone; Temporal Bone/abnormalities
Bilateral bone-conducted auditory brainstem responses (BC-ABRs) were recorded in children with atresia of the external auditory canal bilaterally (AECB) in order to compare the response characteristics to normal hearing adults. The binaural interaction component (BIC) of the ABR occurs when the sum of the monaural-evoked ABR amplitudes are different in amplitude when compared to the binaural-evoked ABR amplitude. Previous electrophysiological work from our lab has shown that children with AECB lateralize bone-conducted (BC) sound. Furthermore, we have found in normal-hearing adults that BICs exist using BC clicks. In adults, BC-BIC occurred in the latency region corresponding to waves IV-VI, whereas for children with AECB corresponding peak latencies occurred earlier. Same as normal-hearing adults, BC-ABR IV-V complex peak amplitudes for sum of the BC-monaural right and
Sheykholeslami Kianoush; Habiby Kermany Mohammad; Sebastein Schmerber; Kaga Kimitaka
International journal of pediatric otorhinolaryngology
2003
2003-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0165-5876(03)00197-6" target="_blank" rel="noreferrer noopener">10.1016/s0165-5876(03)00197-6</a>
Effects of FGF-2 and OP-1 in vitro on donor source cartilage for auricular reconstruction tissue engineering.
Bone Morphogenetic Protein 7/*pharmacology; Cell Differentiation/drug effects; Cells; Child; Chondrocytes; Chondrocytes/*drug effects/physiology; Congenital Abnormalities/diagnosis/*surgery; Congenital Microtia; Cultured; Ear Cartilage/surgery; Ear/*abnormalities/surgery; FGF-2; Fibroblast Growth Factor 2/*pharmacology; Humans; Male; Microtia; OP-1; Reconstructive Surgical Procedures/*methods; Reference Values; Tissue Donors; Tissue engineering; Tissue Engineering/*methods
OBJECTIVE: Microtia is a congenital partial or total loss of the external ear with current treatment approaches involving autologous construction from costal cartilage. Alternatively, tissue engineering provides possible use of normal or microtia auricular chondrocytes harvested from patients. This study investigated effects in vitro of basic fibroblast growth factor (FGF-2) and osteogenic protein 1 (OP-1) on human pediatric normal and microtia auricular chondrocytes and their potential proliferation and differentiation for cellular expansion. A working hypothesis was that FGF-2 promotes proliferation and OP-1 maintains an auricular phenotype of these cells. METHODS: Two patients, one undergoing otoplasty and one an ear construction, yielded normal and microtia auricular chondrocytes, respectively. The two donor sets of isolated chondrocytes were equally divided into four experimental cell groups. These were controls without added growth factors and cells supplemented with FGF-2, OP-1 or FGF-2/OP-1 combined. Cells were cultured 3, 5, 7, and 10 days (3 replicates/time point), counted and assayed by RT-qPCR to determine elastin and types II and III collagen gene expression. RESULTS: Compared to control counterparts, normal and microtia chondrocytes with
Shasti Mark; Jacquet Robin; McClellan Phillip; Yang Julianne; Matsushima Seika; Isogai Noritaka; Murthy Ananth; Landis William J
International journal of pediatric otorhinolaryngology
2014
2014-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ijporl.2013.11.028" target="_blank" rel="noreferrer noopener">10.1016/j.ijporl.2013.11.028</a>