H3096- Section on Otolaryngology-Head and Neck Surgery Program

The Non-Stop Cough: Current Guidelines and Recommendations

Topic: Otolaryngology

Sponsors: Section on Otolaryngology-Head and Neck Surgery (SOOHNS)

Monday, October 24
1:00PM - 5:00PM
Marriott Marquis, Golden Gate C

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The child who can’t stop coughing can be a diagnostic and management challenge for even the most experienced pediatrician. The objective of this session is to provide participants with the latest guidelines for managing patients with chronic cough. A panel of national and international experts will discuss the multiple etiologies of chronic cough with special attention on the approach and behavioral management of somatic (habit) cough. Participants are encouraged to bring challenging cases to discuss with the experts.

1:00PM Introduction
1:15PM CHEST Guidelines: What To Do for the Child With Somatic (Habit) Cough
Anne Chang, MBBS, FRACP, PhD
2:00PM Management of Laryngeal Cough Disorders
Adam Klein, MD, FACS
2:35PM When in Doubt, Blame Reflux!
Matthew Ryan, MD, FAAP
3:10PM Behavioral Therapy for the Non-Stop Cough
Sarah Schneider, MS, CCC-SLP
3:45PM Panel: Difficult Case Presentations and Audience Questions
Moderator: Steven Sobol, MD, MSc, FAAP
4:15PM Abstract Session
Moderator: Steven Sobol, MD, MSc, FAAP
5:00PM Adjourn

Anne Chang, MBBS, FRACP, PhD

Division Leader
Menzies School of Health Research (Darwin) , Australia

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Adam Klein, MD, FACS

Associate Professor
Emory University School of Medicine
Atlanta, Georgia

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Matthew Ryan, MD, FAAP

Associate Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

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Sarah Schneider, MS, CCC-SLP

HS Assistant Clinical Professor, Speech Language Pathology Director
UCSF Department of Otolaryngology
San Francisco, California

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 Attendees

Faculty

Anne Chang, MBBS, FRACP, PhD

Division Leader
Menzies School of Health Research (Darwin) , Australia

MR

Matthew Ryan, MD, FAAP

Associate Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

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Oral (Podium)

Otorhinolaryngological Manifestations Among Hiv Positive Children in Coastal Karnataka

Monday, October 24
4:15PM - 4:30PM
Marriott Marquis, Golden Gate C

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Introduction: With changed clinical profile of HIV related diseases, our study attempted to analyse otorhinolaryngological manifestations in HIV positive children coming to ART center of a tertiary referral in South India.

Materials and Methods: Records of 137 children registered at ART center, Government Wenlock Hospital, Kasturba Medical College, Mangalore from 2004 till 2010 were studied and data for this retrospective study was collected.

Results: Twenty three (16.8%) children developed otorhinolaryngological manifestations, which were upper respiratory tract infection (13.1%), oral candidiasis (1.4%), otitis media (1.4%) and parotitis (1%). With increasing WHO stage, the ENT manifestations increased (p < 0.05) while CD4 count decreased (p>0.05), 35% and 44% cases with ENT manifestations had CD4 counts above 500 cells/mm3 and below 200 cells/mm3 respectively (p>0.05). 24% children on HAART and 10.7% not on HAART developed ENT illnesses (p < 0.05).

Conclusion: With the current ART protocols, ENT manifestations are seen in 17% HIV positive children, most of which are aspecific.

Keywords: AIDS, CD4 count, HAART, HIV, Otorhinolaryngology

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Oral (Podium)

Efficacy and Safety of Ciprofloxacin and Fluocinolone Solution in the Treatment of Acute Otitis Media with Tympanostomy Tubes Otorrhea in Children: A Comparative Clinical Trial

Monday, October 24
4:30PM - 4:45PM
Marriott Marquis, Golden Gate C

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Purpose: Evaluate the efficacy and safety of topical ciprofloxacin 0.3% plus fluocinolone acetonide 0.025% otic solution (CIPRO+FLUO) relative to ciprofloxacin 0.3% (CIPRO) alone, and to fluocinolone acetonide 0.025% alone in children with Acute Otitis Media with Tympanostomy Tubes Otorrhea (AOMT).
Methods: This trial was conducted at multiple sites and was approved by the FDA and respective IRBs. 662 patients between 6 months and 12 years old with AOMT in at least one ear were enrolled. All patients were randomized and assigned to one of the 3 cohorts in a 1:1:1 ratio to receive CIPRO+FLUO, CIPRO alone or FLUO alone treatment for 7 days. Patients were monitored for compliance and presence of otorrhea using diaries and office visits. Middle ear exudate was submitted for a microbiological evaluation at visits 1, and 3 and 4 if present. The primary efficacy parameter was the time to cessation of otorrhea, defined as the first day on which otorrhea was absent and remained absent until the completion of the study. The secondary efficacy parameters included assessment of volume, color, consistency and viscosity of otorrhea, degree of pain, condition of the ear canal and the TM, presence of granulation tissue, and status of the PE tube. Clinical success was defined as complete resolution of clinical signs present at baseline. Clinical failure was defined as worsening, lack of change, or minimal improvement. Sustained microbiological cure was defined as eradication of pathogenic bacteria at both visits 3 and 4. Safety was assessed by the incidence of adverse events related to the study medication. Audiograms performed at visits 1 and 4 were compared. Statistical analyses were performed using SAS v9.3 software.
Results: 662 children were enrolled. The median age was 2.51 years, 59.1% were male. The median time to cessation of otorrhea in patients receiving CIPRO+FLUO was 4.23 days (95%CI: 3.65-4.95), as compared with 6.95 days (95%CI: 5.66-8.20) in those receiving CIPRO alone (p < 0.001). In the FLUO group the number of patients with otorrhea was greater than the number of patients with cessation of otorrhea. The clinical cure rate at visit 4 was 80.6% in CIPRO+FLUO group, 67.4% (p=0.002) in CIPRO, and 47.6% (p < 0.001) in FLUO alone groups. Sustained microbiological cure was noted in 79.7% in the CIPRO+FLUO group vs 67.7% and 37.6%, in the CIPRO and the FLUO groups. Analyses of adverse events (AE) demonstrated that 3.1% of CIPRO+FLUO, 3.6% of CIPRO, and 4.7% of FLUO patients reported at least one AE related to the study medication.
Conclusion: The combination of CIPRO 0.3% and FLUO 0.025% for 7 days is more effective than treatment with either CIPRO or FLUO alone for AOMT. It is safe, effective and is well tolerated in children.

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Oral (Podium)

Rate of Postoperative Return Visits on Adenotonsillectomy Patients at Age of 3

Monday, October 24
4:45PM - 5:00PM
Marriott Marquis, Golden Gate C

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Rate of Postoperative Return Visits on Adenotonsillectomy Patients at age of 3



Background:
The American Academy of Otolaryngology guidelines state that any patient under the age of 3 should be admitted for observation postoperatively from adenotonsillectomy. There is no literature or suggestions on the postoperative management of 3 year olds. As a result, admission rates vary between physicians for this age range

Objectives:
To compare the incidence of postoperative return rates among otherwise healthy 3 year old patients after adenotonsillectomy/tonsillectomy who were either kept for 24 hour postoperative observation (24HR group) or were discharged same day of surgery (SDS group).

Methods:
Retrospective chart review of patients 36-47 months that underwent adenotonsillectomy or tonsillectomy at Children’s Mercy Hospital from 1/3/2013-7/20/2015. Postoperative management, medications, and desaturations if inpatient collected. Return visits recorded from chart and telephone survey. Inclusion criteria: Patient age 36-47 months, undergoing tonsillectomy or adenotonsillectomy for sleep disordered breathing or recurrent tonsillitis, all documentation available for 1 month postoperatively, postoperative return visits to ED, Pediatrician, urgent care or outside ED to be determined by phone conversations with parents. Exclusion criteria: PSG demonstrating OSA with AHI>10, or O2 < 80%, craniofacial anomalies, underlying central or neurologic disorder, history of Tracheostomy, Sickle Cell disease, Mucopolysaccharidosis, Downs Syndrome or other genetic abnormalities affecting airway or requiring postoperative admission, history of any airway anomaly/disease/disorder other than hypertrophy of tonsils and adenoids, and Sleep disordered breathing, concurrent surgery on same day that involves respiratory tract.

Results:
A total of 350 charts were reviewed. 29 were excluded for co-existing conditions. 26 patient families did not want to participate in the phone survey. Out of 295 patients, 33 of 184 in SDS group (17.9%) and 2 of 111 in 24HR group (1.8%) had a postoperative visit to a physician within 1 month (p < 0.0001). Within all the types of postoperative visits, i.e. clinic, ED, urgent care, etc, postoperative ED visits were significantly different: 16.85% in 3HR and 0% in OBS group (p < 0.0001). Of the 184 OBS patients, 4.2% had inpatient desaturations requiring oxygen. None of the 4.2% needed positive pressure or admission to the ICU. 5 (2.7%) of the 24HR patients required surgical re-intervention for bleeding (p < 0.16).


Conclusions:
The postoperative return rates were significantly higher for the SDS group. Our data would suggest that observing 3 year old patients the night of surgery may reduce postoperative visits to healthcare providers. We cannot make any conclusions about respiratory compromise as the children sent home do not have oxygen monitoring. A further cost analysis to compare overnight observation costs to ED visits and ENT clinic visits may be useful information in clinical decision making in the future.


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Attendees who have added this session to their plan

Sweeti Shah, DO

Pediatric ENT Fellow
Children's Mercy Hospital
Kansas City, MO

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Zorik Spektor, MD

Director
Center for Pediatric ENT- Head and Neck Surgery
Charles E. Schmidt College of Medicine, Florida Atlantic University
Boynton Beach, FL

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Yamini Yamini, MD

PGY 3, Pediatrics
Cleveland Clinic Childrens Hospital
Cleveland, OH

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Daniel Jensen, MD

Faculty
Chidlren's Mercy Hospital
kansas city, MO

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Chetan Mandelia, MD

PGY 3, Pediatrics
Cleveland Clinic Children's Hospital
Cleveland Clinic Children's Hospital
Cleveland, OH

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Send Email for Felix Pumarola

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Pamela Nicklaus, MD

Faculty, Fellowship Director
Children's Mercy Hospital
kansas City, MO

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Suja Sreedharan, Head of Department, ENT

Kasturba Medical College Hospital
Mangalore, India

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Iftikhar Hussain, MD

Vital Prospects Clinical Research Institute, P.C
Tulsa, OK

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