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Article ; Online: The Effect of the COVID-19 Pandemic on Pediatric Tympanostomy Tube Placement.

Diercks, Gillian R / Cohen, Michael S

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

2021 Volume 166, Issue 1, Page(s) 167–170

Abstract: Objective: To evaluate how the coronavirus disease 2019 (COVID-19) pandemic has affected tympanostomy tube placement and practice patterns.: Study design: A retrospective review of billing data.: Setting: A large-volume practice with both ... ...

Abstract	Objective: To evaluate how the coronavirus disease 2019 (COVID-19) pandemic has affected tympanostomy tube placement and practice patterns. Study design: A retrospective review of billing data. Setting: A large-volume practice with both community and tertiary care providers. Methods: As part of a quality initiative, billing data were queried to identify children <18 years of age who underwent tympanostomy tube placement between January 2019 and December 2020. Patient age, practice location, and case numbers were gathered. Results: The study included data from 2652 patients. Prior to state-mandated clinic and operating room restrictions, there were no significant differences in the number of tympanostomy tubes placed ( Conclusion: During the COVID-19 pandemic, the rate of pediatric tympanostomy tube placement has significantly decreased. The age of patients undergoing surgery has increased, and more children are being cared for in a tertiary setting. These findings may reflect changes in the prevalence of acute and chronic otitis media as the result of the pandemic.
MeSH term(s)	COVID-19 ; Child ; Child, Preschool ; Elective Surgical Procedures/trends ; Humans ; Infant ; Massachusetts ; Middle Ear Ventilation/trends ; Otitis Media/surgery ; Retrospective Studies
Language	English
Publishing date	2021-05-04
Publishing country	England
Document type	Journal Article
ZDB-ID	392085-9
ISSN	1097-6817 ; 0161-6439 ; 0194-5998
ISSN (online)	1097-6817
ISSN	0161-6439 ; 0194-5998
DOI	10.1177/01945998211008916
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Article ; Online: Hybrid laryngotracheal reconstruction vs single and double stage: Indications and outcomes.

Partain, Matthew P / Diercks, Gillian R / Horick, Nora / Hartnick, Christopher J

International journal of pediatric otorhinolaryngology

2021 Volume 151, Page(s) 110948

Abstract: Objectives: To describe outcomes from laryngotracheal reconstruction and decannulation rates for patients undergoing single stage, double stage and hybrid staged procedures at a single tertiary care institution and evaluate if the 1.5LTR is a viable ... ...

Abstract	Objectives: To describe outcomes from laryngotracheal reconstruction and decannulation rates for patients undergoing single stage, double stage and hybrid staged procedures at a single tertiary care institution and evaluate if the 1.5LTR is a viable reconstructive option for patients with subglottic stenosis. Study design: Retrospective chart review. Setting: Tertiary care otolaryngology specialty hospital and internationally. Subjects: All patients who underwent LTR by a single pediatric otolaryngology surgeon from 2008 to 2018. Methods: Charts were assessed for age, gender, etiology, type of reconstruction, comorbidities, length of stay, tracheostomy status and socioeconomic status. Analysis was performed using Microsoft Excel and multivariate logistic regression models. Results: 96 patients underwent laryngotracheal reconstruction at MEEI. Internationally, 36 patients underwent laryngotracheal reconstruction with the primary surgeon. Overall decannulation rates for ssLTR, dsLTR, and 1.5LTR were 95.6%, 77.8%, and 91.2% respectively. Our Operation Specific Decannulation Rates (one open airway procedure only) for ssLTR, dsLTR, and 1.5LTR were 87.5%, 33%, and 88% respectively. Adjusted odds of decannulation were not significantly different between males and females, white and non-white patients, or socioeconomic status. Neurological comorbidity was statistically significant for a decreased rate of decannulation (p = 0.0216). Conclusion: The 1.5LTR is a viable option for airway reconstruction with strengths derived from both the ssLTR and dsLTR. At our institution we have seen decannulation rates and operation specific decannulation rates with the 1.5LTR approaching our ssLTR. It has replaced the bulk of our dsLTRs, which we reserve for patients that have significant neurological deficits and cannot tolerate extended sedation. Level of evidence: 4.
MeSH term(s)	Comorbidity ; Female ; Humans ; Laryngostenosis/surgery ; Male ; Reconstructive Surgical Procedures ; Retrospective Studies ; Tracheal Stenosis/surgery ; Treatment Outcome
Language	English
Publishing date	2021-10-28
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2021.110948
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Article ; Online: Response to "Moral considerations in non-EXIT airway management".

Diercks, Gillian R / Hartnick, Christopher J

International journal of pediatric otorhinolaryngology

2016 Volume 81, Page(s) 102

MeSH term(s)	Airway Obstruction/therapy ; Female ; Humans ; Lymphatic Abnormalities/therapy ; Pharyngeal Diseases/therapy ; Vascular Malformations/therapy
Language	English
Publishing date	2016-02
Publishing country	Ireland
Document type	Comment ; Letter
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2015.11.033
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Article ; Online: Asymptomatic COVID-19 infection in a child with nasal foreign body.

Diercks, Gillian R / Park, Brian J / Myers, Laura B / Kwolek, Christopher J

International journal of pediatric otorhinolaryngology

2020 Volume 135, Page(s) 110092

Abstract: While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, ...

Abstract	While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, raising concern about risk to healthcare workers during aerosol generating procedures (APGs) in the airway and nasopharynx. Herein we describe the first case of a nasal foreign body in an asymptomatic child with SARS-CoV-2 infection. We discuss management of this child and highlight the importance of considering asymptomatic infection and preoperative testing when planning procedures of the airway in the COVID-19 era.
MeSH term(s)	Asymptomatic Infections ; Betacoronavirus/genetics ; Betacoronavirus/isolation & purification ; COVID-19 ; COVID-19 Testing ; Child, Preschool ; Clinical Laboratory Techniques ; Coronavirus Infections/diagnosis ; Endoscopy/methods ; Female ; Foreign Bodies/surgery ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Nose/surgery ; Nose/virology ; Pandemics ; Pneumonia, Viral/diagnosis ; Preoperative Care ; Reverse Transcriptase Polymerase Chain Reaction ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-05-08
Publishing country	Ireland
Document type	Case Reports
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2020.110092
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Article ; Online: Vagal stimulation and laryngeal electromyography for recurrent laryngeal reinnervation in children.

Caloway, Christen L / Diercks, Gillian R / Randolph, Gregory / Hartnick, Christopher J

The Laryngoscope

2019 Volume 130, Issue 3, Page(s) 747–751

Abstract: Ansa-to-recurrent laryngeal nerve (ANSA-RLN) reinnervation procedures are now often first-line treatments for some children with unilateral vocal fold immobility. Although many describe that children with prolonged denervation and true vocal fold atrophy ...

Abstract	Ansa-to-recurrent laryngeal nerve (ANSA-RLN) reinnervation procedures are now often first-line treatments for some children with unilateral vocal fold immobility. Although many describe that children with prolonged denervation and true vocal fold atrophy should not undergo this procedure, there has been no gold-standard means of identifying true denervation. Here, we describe a novel technique using evoked vagal electromyography to predict degree of chronic nerve injury prior to recurrent laryngeal nerve reinnervation in children. This is a simple, readily available technique that may play an important role in predicting likelihood of success with pediatric ANSA-RLN reinnervation. Laryngoscope, 130:747-751, 2020.
MeSH term(s)	Adolescent ; Cervical Plexus/surgery ; Child, Preschool ; Electromyography ; Female ; Humans ; Larynx/physiology ; Neurosurgical Procedures/methods ; Recurrent Laryngeal Nerve/surgery ; Vagus Nerve Stimulation ; Vocal Cord Paralysis/surgery
Language	English
Publishing date	2019-06-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.28135
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Article ; Online: Asymptomatic COVID-19 infection in a child with nasal foreign body

Diercks, Gillian R. / Park, Brian J. / Myers, Laura B. / Kwolek, Christopher J.

International Journal of Pediatric Otorhinolaryngology

2020 Volume 135, Page(s) 110092

Keywords	Pediatrics, Perinatology, and Child Health ; Otorhinolaryngology ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2020.110092
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Article ; Online: Modified surgical approach to hypoglossal nerve stimulator implantation in the pediatric population.

Bowe, Sarah N / Diercks, Gillian R / Hartnick, Christopher J

The Laryngoscope

2017 Volume 128, Issue 6, Page(s) 1490–1492

Abstract: Upper airway stimulation with the hypoglossal nerve stimulator is a promising treatment modality for severe obstructive sleep apnea in carefully selected patients with Down syndrome. The pediatric population presents a greater variety in body habitus, ... ...

Abstract	Upper airway stimulation with the hypoglossal nerve stimulator is a promising treatment modality for severe obstructive sleep apnea in carefully selected patients with Down syndrome. The pediatric population presents a greater variety in body habitus, including thorax size. A modified surgical approach, utilizing a medially placed, single chest incision, instead of two separate chest incisions, provides an alternative that is particularly useful for pediatric patients with small stature. As this technology is evaluated for Food and Drug Administration clearance in the pediatric population, it is important to consider modifications in surgical technique, partnering prior surgical experience with the technical support of company representatives. Laryngoscope, 128:1490-1492, 2018.
MeSH term(s)	Child ; Down Syndrome/complications ; Down Syndrome/surgery ; Electric Stimulation Therapy/methods ; Female ; Humans ; Hypoglossal Nerve/surgery ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/surgery
Language	English
Publishing date	2017-08-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.26808
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Article ; Online: Factors associated with frenotomy after a multidisciplinary assessment of infants with breastfeeding difficulties.

Diercks, Gillian R / Hersh, Cheryl J / Baars, Rebecca / Sally, Sarah / Caloway, Christen / Hartnick, Christopher J

International journal of pediatric otorhinolaryngology

2020 Volume 138, Page(s) 110212

Abstract: Objective: Frenotomy for ankyloglossia has increased nearly 10-fold over the past few decades despite insufficient evidence that the procedure improves breastfeeding outcomes. There is no universally accepted method for identifying patients who may ... ...

Abstract	Objective: Frenotomy for ankyloglossia has increased nearly 10-fold over the past few decades despite insufficient evidence that the procedure improves breastfeeding outcomes. There is no universally accepted method for identifying patients who may benefit from the procedure. The objective of this study is to determine if comprehensive feeding evaluations and targeted interventions can identify children who should undergo procedures, and to identify factors associated with lip or tongue frenotomy to treat breastfeeding difficulties. Methods: This observational quality improvement study followed infant-mother dyads between March 2018 and December 2019 referred to our tertiary care center for breastfeeding difficulties. Speech and language pathologists performed comprehensive feeding evaluations on infants prior to surgical consultation for frenotomy. Infants' oral anatomy and function and their ability to breast and bottle feed were assessed, and techniques for mothers to address feeding difficulties without a procedure were offered prior to surgical consultation. Infants either found success over a short observation period or underwent procedures (lip and/or tongue frenotomy). Results: 153 patients (mean age 47.0 days (stdev 39.0 days, 56.2% male) were referred for surgical division of the lingual frenulum. Following development of a program utilizing pediatric speech language pathologists to perform feeding evaluations prior to surgical consultation, 69.9% of patients subsequently did not undergo surgical procedures. 11 (23.9%) underwent labial frenotomy alone and 30 (65.2%) underwent both labial and lingual frenotomies. Frenotomy was associated with significantly increased worry subscale of the Feeding Swallow Impact Survey (FSIS) and decreased mean Breastfeeding Self Efficacy Scale score (p = 0.0001, p = 0.006, respectively). Tongue appearance was significantly associated with having a procedure, while lip appearance was not. The Bristol Breastfeeding Assessment Tool (BBAT) was lower in children undergoing tongue and/or lip frenotomy (p = 0.0006), while the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) appearance and function scores were lower in children undergoing lingual frenotomy with or without lip frenotomy (p = 0.0008, p = 0.0009, respectively). Conclusions: The majority of patients referred for ankyloglossia may benefit from nonsurgical intervention strategies based on findings from comprehensive feeding evaluation. Frenotomy is associated with higher maternal feeding-related worry and reduced breastfeeding self-efficacy scores. While tongue appearance is associated with frenotomy, functional assessment is critical for identifying patients who may also benefit from lip frenotomy.
MeSH term(s)	Ankyloglossia/surgery ; Breast Feeding ; Female ; Humans ; Infant ; Lingual Frenum/surgery ; Male ; Treatment Outcome
Language	English
Publishing date	2020-07-11
Publishing country	Ireland
Document type	Journal Article ; Observational Study
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2020.110212
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Article: Asymptomatic COVID-19 infection in a child with nasal foreign body

Diercks, Gillian R / Park, Brian J / Myers, Laura B / Kwolek, Christopher J

Int J Pediatr Otorhinolaryngol

Abstract	While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, raising concern about risk to healthcare workers during aerosol generating procedures (APGs) in the airway and nasopharynx. Herein we describe the first case of a nasal foreign body in an asymptomatic child with SARS-CoV-2 infection. We discuss management of this child and highlight the importance of considering asymptomatic infection and preoperative testing when planning procedures of the airway in the COVID-19 era.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #197689
Database	COVID19

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Article ; Online: Machine Learning for Accurate Intraoperative Pediatric Middle Ear Effusion Diagnosis.

Crowson, Matthew G / Hartnick, Christopher J / Diercks, Gillian R / Gallagher, Thomas Q / Fracchia, Mary S / Setlur, Jennifer / Cohen, Michael S

Pediatrics

2021 Volume 147, Issue 4

Abstract: Objectives: Misdiagnosis of acute and chronic otitis media in children can result in significant consequences from either undertreatment or overtreatment. Our objective was to develop and train an artificial intelligence algorithm to accurately predict ... ...

Abstract	Objectives: Misdiagnosis of acute and chronic otitis media in children can result in significant consequences from either undertreatment or overtreatment. Our objective was to develop and train an artificial intelligence algorithm to accurately predict the presence of middle ear effusion in pediatric patients presenting to the operating room for myringotomy and tube placement. Methods: We trained a neural network to classify images as " normal" (no effusion) or "abnormal" (effusion present) using tympanic membrane images from children taken to the operating room with the intent of performing myringotomy and possible tube placement for recurrent acute otitis media or otitis media with effusion. Model performance was tested on held-out cases and fivefold cross-validation. Results: The mean training time for the neural network model was 76.0 (SD ± 0.01) seconds. Our model approach achieved a mean image classification accuracy of 83.8% (95% confidence interval [CI]: 82.7-84.8). In support of this classification accuracy, the model produced an area under the receiver operating characteristic curve performance of 0.93 (95% CI: 0.91-0.94) and F1-score of 0.80 (95% CI: 0.77-0.82). Conclusions: Artificial intelligence-assisted diagnosis of acute or chronic otitis media in children may generate value for patients, families, and the health care system by improving point-of-care diagnostic accuracy. With a small training data set composed of intraoperative images obtained at time of tympanostomy tube insertion, our neural network was accurate in predicting the presence of a middle ear effusion in pediatric ear cases. This diagnostic accuracy performance is considerably higher than human-expert otoscopy-based diagnostic performance reported in previous studies.
MeSH term(s)	Algorithms ; Humans ; Intraoperative Period ; Machine Learning ; Middle Ear Ventilation ; Neural Networks, Computer ; Otitis Media with Effusion/diagnosis ; Otitis Media with Effusion/surgery ; Otoscopy
Language	English
Publishing date	2021-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2020-034546
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