We are pleased to have the opportunity to serve as guest editors for this issue of Pediatric Annals. To highlight some of the diagnostic and therapeutic dilemmas that clinicians face on a regular basis, we have focused on five different aspects of pediatric otolaryngology, all of which are commonly seen in general pediatrics.
Universal newborn hearing screening has done an outstanding job with helping to identify children with congenital hearing loss. However, passing the newborn screening does not eliminate the risk for the development of hearing loss later in childhood. Congenital cholesteatoma is usually undetectable at birth, and Drs. David Walker and Michael J. Shinners highlight an illustrative case of a patient who presented with conductive hearing loss and posterior-superior cholesteatoma at age 8 years. After resection of the lesion, hearing was restored via ossicular reconstruction. The article describes the need for ongoing vigilance to detect lesions before they grow enough to become destructive.
Drs. Philip D. Knollman, Ann Giese, and Mihir K. Bhayani describe a preadolescent with hyperthyroidism secondary to Graves' disease. When antithyroid medication did not lead to remission, additional treatment with total thyroidectomy was pursued. This article highlights the treatment algorithm and management options for recalcitrant cases.
Complications from acute otitis media still occur, and Drs. Emily Obringer and Judy L. Chen describe a young child with acute mastoiditis who developed a subperiosteal abscess. Although traditional management would have included a cortical mastoidectomy, this article illustrates a trend toward successful management with drainage of the abscess, tympanostomy tube placement, and intravenous antibiotics.
Sleep-disordered breathing and obstructive sleep apnea are usually successfully managed with adenotonsillectomy. However, some patients, such as those who are obese or have craniofacial syndromes, are at a higher risk for persistent obstruction after tonsil and adenoid removal. Management options for children who do not tolerate continuous positive airway pressure (CPAP) devices are limited. Dr. Jonathan Pomerantz describes a child with trisomy 21 who has persistent obstructive sleep apnea along with daytime symptoms after adenotonsillectomy. The article highlights the diagnostic tests used to identify the level of obstruction as well as the successful management with lingual tonsillectomy and inferior nasal turbinate reduction with lateralization after the child refused CPAP therapy.
In their article, Drs. John Palla and Aaron D. Friedman describe an illustrative case of an 11-year-old child with new onset shortness of breath and stridor. The clinical history is important to help make the diagnosis of paradoxical vocal cord motion (PVCM). Patients with a combination of asthma and PVCM can be especially hard to diagnosis and manage. Sometimes both endoscopy and pulmonary function testing are needed to help rule out other potential pathology.
We would like to thank Dr. Joseph R. Hageman (The University of Chicago Pritzker School of Medicine) for his help and guidance in the preparation of this issue.