2025

• Analysis of Pediatric Acute Upper Airway Pathology During Local Wildfires and Increased PM 2.5 Burden.

  Kiessling, P., Meister, K., Sidell, D., O'Bryan, M., Erickson-DiRenzo, E., Balakrishnan, K.

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

  ABSTRACT
  OBJECTIVE: As wildfires worldwide increase in severity and frequency, fine particulate matter (PM 2.5), generated as a component of wildfire smoke, increasingly impacts air quality. Children are particularly vulnerable to poor air quality in numerous ways, including inhalation of more air in proportion to their body size than adults. Though its adverse impacts on the lower airway are well demonstrated, the clinical effects of PM 2.5 on the pediatric upper airway are poorly understood and warrant investigation.STUDY DESIGN: Retrospective cohort study.SETTING: Tertiary academic medical center.METHODS: From 2014 to 2023, patient presentations to a pediatric emergency department in Northern California during exposure periods of elevated PM 2.5 burden associated with nearby wildfires were identified. Patient diagnoses, presenting symptoms, and management were analyzed. Comparison group patients were evaluated during date-matched control periods with confirmed normal air quality. Chi-squared analyses determined significance.RESULTS: During periods of increased wildfire-generated PM 2.5 burden, a significantly greater proportion of pediatric patients presented to the emergency department with upper airway pathology compared to matched control periods of healthy air quality. Further, a significantly greater proportion of patients were diagnosed with croup during wildfires. Of patients presenting with upper airway pathology, a significantly greater proportion experienced dysphonia during wildfires and had a negative strep test.CONCLUSION: Wildfire-generated PM 2.5 may contribute to increased rates of croup presentations, and PM 2.5 may disproportionately affect the larynx in the pediatric upper airway. Larger population-based studies and preclinical models may clarify these clinical manifestations of a growing public health threat.

  https://www.ncbi.nlm.nih.gov/pubmed/40062612 https://doi.org/10.1002/ohn.1191

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• Incidence of Pediatric Graves' Disease in the United States: An Epidemiological Analysis of 2007-2022 Outpatient Insurance Claims.

  Polkampally, S., Halagur, A. S., Green, A., Wei, E., Qian, J., Donner, J., Seeley, H., Meister, K.

  Thyroid : official journal of the American Thyroid Association

  ABSTRACT
  Background: Graves' disease is the leading cause of hyperthyroidism in children and adolescents, with recent studies indicating a rising incidence. Epidemiological data on trends and determinants influencing this rise remain limited. This study aims to assess the trends in incidence of pediatric Graves' disease in the United States and stratify incidence patterns based on patient sex, age, geographic region, urban vs. rural setting, and insurance plan type. Methods: This retrospective cohort study utilized the Merative™ Marketscan® outpatient insurance claims database from 2007 to 2022. Pediatric patients diagnosed with Graves' disease were identified using International Classification of Diseases (ICD)-9 and ICD-10 codes. Annual incidence rates were analyzed over the study period to detect temporal trends. Incidence rates were further stratified by demographic variables including sex, age, geographic region, community setting (urban vs. rural), and insurance plan. Statistical methods included chi-square, ANOVA, and linear regression models to identify significant trends and differences across subgroups. Results: 3377 total new diagnoses of pediatric Graves' disease were identified during the 16-year study period. The average annual incidence rate was 3.33 per 100,000 (SD = 0.33), with an annual increase of 0.042 per 100,000 (p = 0.39). Marked differences in average annual incidence rates were observed across sex and age group; female patients exhibited greater average annual incidence rate (5.04 per 100,000) compared with male patients (1.67 per 100,000). Adolescents, patients 13-17 years of age, had the highest average annual incidence rate (5.72 per 100,000) compared with other age groups. On multivariable regression analysis, female patients had a significant increase in annual incidence by 1.69 cases per 100,000 compared with male patients [CI: 0.82-2.56]. Adolescents also saw a significant increase in adjusted annual incidence by 4.92 cases per 100,000 compared with the other age groups [CI: 3.80-6.04]. No significant change in annual incidence rate was observed across insurance plan, geographic region, or rural status. Conclusions: This study quantifies and delineates trends in pediatric Graves' disease incidence in the United States. The greatest average incidence rate was observed among female and adolescent patients. This study underscores the importance of monitoring Graves' disease trends to facilitate early disease detection and management. Further research is needed to elucidate the genetic and environmental factors underlying these epidemiological trends.

  https://www.ncbi.nlm.nih.gov/pubmed/40982291 https://doi.org/10.1177/10507256251382559

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• Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement.

  Kothari, R., Donner, J. R., Balakrishnan, K., Hartman, G., Alazraki, A., Antal, Z., Bauer, A., Chelius, D., Cherella, C., Dahl, J. P., Dimachkieh, A., Fox, L. A., Helmig, S., Jiang, W., Kazahaya, K., Laetsch, T. W., Lodish, M., Mahajan, P., Parsons, L., Prickett, K., Quintanilla-Dieck, L., Rastatter, J., Rothstein, D. H., Simons, J., Sheyn, A., Wagner, A., Waguespack, S. G., Wasserman, J. D., Wassner, A. J., Seeley, H., Meister, K. D.

  Thyroid : official journal of the American Thyroid Association

  ABSTRACT
  Background: The incidence of pediatric thyroid cancer has been increasing, and care varies due to socioeconomic disparities or differing practice patterns. Clinical guidelines call for care in multidisciplinary teams to minimize variance and provide protocols. Based on expert opinion, we hope to describe the form and function of such multidisciplinary teams for pediatric thyroid programs. Methods: A modified Delphi method to reach consensus statements over two rounds. Twenty-one experts with varying backgrounds responded to each statement on a 9-point Likert scale. Upon completion of the survey, the panel reviewed and shared the results and comments from participants and modified the statements accordingly. This process was repeated such that statements reached consensus, were deemed no consensus, or had no change in the mean. Results: There was an 88% and 83% completion rate for Rounds 1 and 2, respectively. A consensus was observed that there is a distinct definable model of care for pediatric thyroid patients. No consensus was reached for the age range of patients, but programs should care for children with medullary thyroid cancer, differentiated thyroid cancer, and patients with genetic predisposition syndromes. A comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine-needle aspiration (FNA) proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator. Necessary support services involve care coordination, access to a multidisciplinary tumor board, ability to perform ultrasound-guided FNA, and access to molecular testing. The panel emphasized cross-institutional collaborative research prioritizing guidelines development, disease-specific outcomes, treatment toxicity, and the molecular landscape of thyroid cancer. Conclusions: These consensus statements can be beneficial in improving multidisciplinary care, by describing which elements of pediatric thyroid programs should be consistent across institutions. Overall, the panel agreed that pediatric thyroid centers should provide integrated care with defined team members, services, resources, and research priorities. This model has the potential to standardize various aspects of clinical care and enhance our ability to study patient outcomes, improve health care delivery, and increase scholarly collaboration.

  https://www.ncbi.nlm.nih.gov/pubmed/39950999 https://doi.org/10.1089/thy.2024.0496

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• A Deep Learning-Based Artificial Intelligence Model Assisting Thyroid Nodule Diagnosis and Management: Pilot Results for Evaluating Thyroid Malignancy in Pediatric Cohorts.

  Ha, E. J., Lee, J. H., Mak, N., Duh, A. K., Tong, E., Yeom, K. W., Meister, K. D.

  Thyroid : official journal of the American Thyroid Association

  ABSTRACT
  Purpose: Artificial intelligence (AI) models have shown promise in predicting malignant thyroid nodules in adults; however, research on deep learning (DL) for pediatric cases is limited. We evaluated the applicability of a DL-based model for assessing thyroid nodules in children. Methods: We retrospectively identified two pediatric cohorts (n = 128; mean age 15.5 ± 2.4 years; 103 girls) who had thyroid nodule ultrasonography (US) with histological confirmation at two institutions. The AI-Thyroid DL model, originally trained on adult data, was tested on pediatric nodules in three scenarios axial US images, longitudinal US images, and both. We conducted a subgroup analysis based on the two pediatric cohorts and age groups (≥14 years vs. < 14 years) and compared the model's performance with radiologist interpretations using the Thyroid Imaging Reporting and Data System (TIRADS). Results: Out of 156 nodules analyzed, 47 (30.1%) were malignant. AI-Thyroid demonstrated respective area under the receiver operating characteristic (AUROC), sensitivity, and specificity values of 0.913-0.929, 78.7-89.4%, and 79.8-91.7%, respectively. The AUROC values did not significantly differ across the image planes (all p > 0.05) and between the two pediatric cohorts (p = 0.804). No significant differences were observed between age groups in terms of sensitivity and specificity (all p > 0.05) while the AUROC values were higher for patients aged <14 years compared to those aged ≥14 years (all p < 0.01). AI-Thyroid yielded the highest AUROC values, followed by ACR-TIRADS and K-TIRADS (p = 0.016 and p < 0.001, respectively). Conclusion: AI-Thyroid demonstrated high performance in diagnosing pediatric thyroid cancer. Future research should focus on optimizing AI-Thyroid for pediatric use and exploring its role alongside tissue sampling in clinical practice.

  https://www.ncbi.nlm.nih.gov/pubmed/40454939 https://doi.org/10.1089/thy.2024.0627

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• Pediatric tracheal mucoepidermoid carcinoma treated with cricotracheal resection: A rare case and review of literature

  Kiessling, P., Kim, G., Meister, K., Balakrishnan, K., Din, T.

  OTOLARYNGOLOGY CASE REPORTS

  ABSTRACT
  To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1-15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4-22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05-0.53, p < 0.01).Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.

  https://www.ncbi.nlm.nih.gov/pubmed/39577142 https://doi.org/10.1016/j.xocr.2025.100654

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• Pediatric tracheal mucoepidermoid carcinoma treated with cricotracheal resection: A rare case and review of literature (vol 34, 100645, 2025)

  Kiessling, P., Kim, G., Meister, K., Balakrishnan, K., Din, T.

  OTOLARYNGOLOGY CASE REPORTS

  ABSTRACT
  We investigate the utility of microbial cell-free DNA (mcfDNA) from the blood to predict surgical culture results. In this study, only 26.9% of patients had mcfDNA results that were considered predictive of the causative organism(s). There was a significant burden of contamination in the cohort, emphasizing that dedicated protocols must be followed when running gene-based diagnostics. Healthy patients showed detectable mcfDNA signals, though typically at lower molecules per milliliter for similar pathogens.

  https://www.ncbi.nlm.nih.gov/pubmed/40539015 https://doi.org/10.1016/j.xocr.2025.100663

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• Efficacy of microbial cell-free DNA testing for detecting pathogens in pediatric patients with head and neck infections-An initial study

  Xu, A., Miranda, A., Lin, H., Din, T., Balakrishnan, K., Truong, M., Ahmad, I., Meister, K.

  PEDIATRIC INVESTIGATION

  ABSTRACT
  To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1-15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4-22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05-0.53, p < 0.01).Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.

  https://www.ncbi.nlm.nih.gov/pubmed/39577142 https://doi.org/10.1002/ped4.12462

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• Efficacy of microbial cell-free DNA testing for detecting pathogens in pediatric patients with head and neck infections-An initial study.

  Xu, A., Miranda, A., Lin, H. F., Din, T., Balakrishnan, K., Truong, M. T., Ahmad, I., Meister, K.

  Pediatric investigation

  ABSTRACT
  We investigate the utility of microbial cell-free DNA (mcfDNA) from the blood to predict surgical culture results. In this study, only 26.9% of patients had mcfDNA results that were considered predictive of the causative organism(s). There was a significant burden of contamination in the cohort, emphasizing that dedicated protocols must be followed when running gene-based diagnostics. Healthy patients showed detectable mcfDNA signals, though typically at lower molecules per milliliter for similar pathogens.

  https://www.ncbi.nlm.nih.gov/pubmed/40539015 https://doi.org/10.1002/ped4.12462

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2024

• Impact of demographics and social vulnerability on outcomes in pediatric medullary thyroid cancer.

  Rahman, A., Low, C., Huang, A., Meister, K., Balakrishnan, K.

  International journal of pediatric otorhinolaryngology

  ABSTRACT
  To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1-15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4-22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05-0.53, p < 0.01).Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.

  https://www.ncbi.nlm.nih.gov/pubmed/39577142 https://doi.org/10.1016/j.ijporl.2024.112166

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• Use of temporary tracheostomy occlusion to reduce the risk of sternal wound infection after sternotomy in congenital cardiac surgery.

  Azimzadeh, J. B., Sidell, D. R., Balakrishnan, K., Mathew, R., Asija, R., Rutter, M. J., Meister, K. D.

  Cardiology in the young

  ABSTRACT
  OBJECTIVE: To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023.METHODS: We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children's hospital. Clinical variables were extracted from the hospital medical records. The rates of antibiotic use and minor and major complications during the period when the stoma plug was in place were recorded.RESULTS: Totally, 19 patients underwent tracheal stoma plugging prior to sternotomy and were included in our analysis. There were two cases of sternal wound infection; one case occurred while the stoma plug was in place, and one developed four days following plug removal. There was one minor complication, with one patient requiring stoma revision via serial dilation at bedside at the time of recannulation. There were no deaths.CONCLUSION: Temporary occlusion of the tracheal stoma with an impermeable plug is a viable option for reducing the risk of sternal wound infection in children with a pre-existing tracheostomy who are undergoing sternotomy.

  https://www.ncbi.nlm.nih.gov/pubmed/38410052 https://doi.org/10.1017/S1047951124000106

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• Suprazygomatic Maxillary Nerve Blocks and Opioid Requirements in Pediatric Adenotonsillectomy: A Randomized Clinical Trial.

  Lin, C., Abboud, S., Zoghbi, V., Kasimova, K., Thein, J., Meister, K. D., Sidell, D. R., Balakrishnan, K., Tsui, B. C.

  JAMA otolaryngology-- head & neck surgery

  ABSTRACT
  Importance: Pain management following pediatric adenotonsillectomies is opioid-inclusive, leading to potential complications.Objective: To investigate the use of suprazygomatic maxillary nerve (SZMN) blocks to reduce pain and opioid use after pediatric intracapsular adenotonsillectomy and to measure recovery duration and incidence of complications.Design, Setting, and Participants: This was a randomized, blinded, prospective single-center tertiary pediatric hospital that included 60 pediatric patients (2-14 years old) scheduled for intracapsular adenotonsillectomy from November 2021 to March 2023. Patients were excluded for having combined surgical procedures, developmental delay, coagulopathy, chronic pain history, known or predicted difficult airway, or unrepaired congenital heart disease. Participants were randomized to receive bilateral SZMN blocks (block group) or not (control group).Intervention: SZMN block administered bilaterally under general anesthesia for intracapsular adenotonsillectomy.Primary Outcomes and Measures: Opioid consumption, FLACC (Face, Legs, Activity, Cry, Consolability) scores, and rates of opioid-free postanesthesia care unit (PACU) stay. Secondary outcomes were recovery duration and incidence of adverse effects, ie, nausea, vomiting, block site bleeding, and emergency delirium.Results: The study population included 53 pediatric patients (mean [SD] age, 6.5 [3.6] years; 29 [55%] females; 24 [45%] males); 26 were randomly assigned to the SZMN block group and 27 to the control group. The mean (SD) opioid morphine equivalent consumption during PACU stay was 0.15 (0.14) mg/kg for the 27 patients in the control group compared with 0.07 (0.11) mg/kg for the 26 patients in the block group (mean difference, 0.08; 95% CI, 0.01-0.15; Cohen d, 0.64). The block group had a higher incidence of opioid-free PACU stays (n= 7 patients; 58%) compared with the control group (n=15 patients; 26%) (mean difference, 32%; 95% CI, 5%-53%). Patients in the block group experienced lower FLACC scores (0.7 vs 1.6; mean difference, 0.9; 95% CI, 0.2-1.6; Cohen d, 0.7). The overall occurrence of adverse events was similar in the 2 groups, with no reported nerve block-related complications.Conclusions and Relevance: The results of the randomized clinical trial indicate that SZMN blocks are a useful adjunct tool for managing postoperative pain in pediatric intracapsular adenotonsillectomy. Use of these blocks during adenotonsillectomy provided clinically meaningful reductions of postoperative opioid consumption with a low risk of complications.Trial Registration: ClinicalTrials.gov Identifier: NCT04797559.

  https://www.ncbi.nlm.nih.gov/pubmed/38780948 https://doi.org/10.1001/jamaoto.2024.1011

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• Use of Neoadjuvant Vandetanib in Aggressive Pediatric Medullary Thyroid Carcinoma.

  Kothari, R., Kreimer, S., Nadel, H., Seeley, H., Hartman, G., Meister, K. D.

  JCO precision oncology

  ABSTRACT
  Novel use of vandetanib in a child with aggressive MTC with prolonged response to treatment.

  https://www.ncbi.nlm.nih.gov/pubmed/38207224 https://doi.org/10.1200/PO.23.00257

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• Easier for the next 'Gen': Early success of one dose rTSH injection prior to I-131 radioligand therapy in children and teens

  Seekins, J., Seeley, H., Meister, K., Nadel, H.

  ABSTRACT
  Importance: Pain management following pediatric adenotonsillectomies is opioid-inclusive, leading to potential complications.Objective: To investigate the use of suprazygomatic maxillary nerve (SZMN) blocks to reduce pain and opioid use after pediatric intracapsular adenotonsillectomy and to measure recovery duration and incidence of complications.Design, Setting, and Participants: This was a randomized, blinded, prospective single-center tertiary pediatric hospital that included 60 pediatric patients (2-14 years old) scheduled for intracapsular adenotonsillectomy from November 2021 to March 2023. Patients were excluded for having combined surgical procedures, developmental delay, coagulopathy, chronic pain history, known or predicted difficult airway, or unrepaired congenital heart disease. Participants were randomized to receive bilateral SZMN blocks (block group) or not (control group).Intervention: SZMN block administered bilaterally under general anesthesia for intracapsular adenotonsillectomy.Primary Outcomes and Measures: Opioid consumption, FLACC (Face, Legs, Activity, Cry, Consolability) scores, and rates of opioid-free postanesthesia care unit (PACU) stay. Secondary outcomes were recovery duration and incidence of adverse effects, ie, nausea, vomiting, block site bleeding, and emergency delirium.Results: The study population included 53 pediatric patients (mean [SD] age, 6.5 [3.6] years; 29 [55%] females; 24 [45%] males); 26 were randomly assigned to the SZMN block group and 27 to the control group. The mean (SD) opioid morphine equivalent consumption during PACU stay was 0.15 (0.14) mg/kg for the 27 patients in the control group compared with 0.07 (0.11) mg/kg for the 26 patients in the block group (mean difference, 0.08; 95% CI, 0.01-0.15; Cohen d, 0.64). The block group had a higher incidence of opioid-free PACU stays (n= 7 patients; 58%) compared with the control group (n=15 patients; 26%) (mean difference, 32%; 95% CI, 5%-53%). Patients in the block group experienced lower FLACC scores (0.7 vs 1.6; mean difference, 0.9; 95% CI, 0.2-1.6; Cohen d, 0.7). The overall occurrence of adverse events was similar in the 2 groups, with no reported nerve block-related complications.Conclusions and Relevance: The results of the randomized clinical trial indicate that SZMN blocks are a useful adjunct tool for managing postoperative pain in pediatric intracapsular adenotonsillectomy. Use of these blocks during adenotonsillectomy provided clinically meaningful reductions of postoperative opioid consumption with a low risk of complications.Trial Registration: ClinicalTrials.gov Identifier: NCT04797559.

  https://www.ncbi.nlm.nih.gov/pubmed/38780948 https://doi.org/10.1001/jamaoto.2024.1011

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• The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series

  Kim, G. S., Seeley, H., Noel, J., Ahmad, I., Meister, K.

  LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY

  ABSTRACT
  Novel use of vandetanib in a child with aggressive MTC with prolonged response to treatment.

  https://www.ncbi.nlm.nih.gov/pubmed/38207224 https://doi.org/10.1002/lio2.1198

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• The Barriers and Facilitators of Shared Decision Making in Pediatric Otolaryngology: A Qualitative Study.

  Khan, U., Luther, E., Cassidy, C. E., Boss, E., Meister, K. D., Bohm, L., Elise Graham, M., Hong, P.

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

  ABSTRACT
  OBJECTIVE: To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology.STUDY DESIGN: A qualitative study.SETTING: Semistructured interviews of pediatric otolaryngologists.METHODS: The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM-B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM-B domains were performed by 2 separate reviewers.RESULTS: A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult "agenda" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret.CONCLUSION: Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors.

  https://www.ncbi.nlm.nih.gov/pubmed/39360346 https://doi.org/10.1002/ohn.972

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• The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series.

  Kim, G. S., Seeley, H., Noel, J., Ahmad, I., Meister, K.

  Laryngoscope investigative otolaryngology

  ABSTRACT
  To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population.Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology.Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat.RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population.4.

  https://www.ncbi.nlm.nih.gov/pubmed/38362180 https://doi.org/10.1002/lio2.1198

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2023

• Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results.

  Su-Velez, B. M., Hartman, G. E., Seeley, H., Orloff, L. A., Noel, J. E., Meister, K. D.

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

  ABSTRACT
  Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series with chart review at a tertiary academic children's hospital, we investigated pediatric patients undergoing thyroid surgery and concurrent use of a probe-based NIRAF device. Thirteen patients (ages 6-18 years) underwent thyroid and/or neck dissection procedures, and 2 patients had revision procedures for a total of 15 cases with the NIRAF device. Eight cases had NIRAF values that matched surgeon opinion of parathyroid tissue or histology when available. Six cases had false positive NIRAF readings (40.0%) and 1 case had false negative readings (6.7%). Compared with surgeon opinion or histology, the NIRAF device confirmed 26 of 34 parathyroid gland candidates (76.5%). These devices need further investigation in pediatric patients, whose tissues may have different autofluorescence characteristics.

  https://www.ncbi.nlm.nih.gov/pubmed/36939554 https://doi.org/10.1002/ohn.272

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• Cough Sounds in Screening and Diagnostics: A Scoping Review.

  Hegde, S., Sreeram, S., Alter, I. L., Shor, C., Valdez, T. A., Meister, K. D., Rameau, A.

  The Laryngoscope

  ABSTRACT
  The aim of the study was to examine applications of cough sounds towards screening tools and diagnostics in the biomedical and engineering literature, with particular focus on disease types, acoustic data collection protocols, data processing and analytics, accuracy, and limitations.PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, IEEE Xplore, Engineering Village, and ACM Digital Library were searched from inception to August 2021.A scoping review was conducted on screening and diagnostic uses of cough sounds in adults, children, and animals, in English peer-reviewed and gray literature of any design.From a total of 438 abstracts screened, 108 articles met inclusion criteria. Human studies were most common (77.8%); the majority focused on adults (57.3%). Single-modality acoustic data collection was most common (71.2%), with few multimodal studies, including plethysmography (15.7%) and clinico-demographic data (7.4%). Data analytics methods were highly variable, with 61.1% using machine learning, the majority of which (78.8%) were published after 2010. Studies commonly focused on cough detection (41.7%) and screening of COVID-19 (11.1%); among pediatric studies, the most common focus was diagnosis of asthma (52.6%).Though the use of cough sounds in diagnostics is not new, academic interest has accelerated in the past decade. Cough sound offers the possibility of an accessible, noninvasive, and low-cost disease biomarker, particularly in the era of rapid development of machine learning capabilities in combination with the ubiquity of cellular technology with high-quality recording capability. However, most cough sound literature hinges on nonstandardized data collection protocols and small, nondiverse, single-modality datasets, with limited external validity. Laryngoscope, 2023.

  https://www.ncbi.nlm.nih.gov/pubmed/37672667 https://doi.org/10.1002/lary.31042

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• Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age.

  Ayoub, N., Balakrishnan, K., Meister, K., Grimm, D., Johnson, A., Maida, K., Sidell, D. R.

  International journal of pediatric otorhinolaryngology

  ABSTRACT
  Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL.This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected.49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing.IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.

  https://www.ncbi.nlm.nih.gov/pubmed/37058865 https://doi.org/10.1016/j.ijporl.2023.111542

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• Ankyloglossia: Clinical and Sociodemographic Predictors of Diagnosis and Management in the United States, 2004 to 2019.

  Wei, E. X., Meister, K. D., Balakrishnan, K., Cheng, A. G., Qian, Z. J.

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

  ABSTRACT
  OBJECTIVE: The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical and socioeconomic factors that determine which patients receive frenotomy.STUDY DESIGN: A retrospective analysis of commercially insured children.SETTING: Optum Data Mart database.METHODS: Trends in frenotomy including provider and setting were described. Multiple logistic regression was used to determine predictors of frenotomy.RESULTS: Diagnosis of ankyloglossia increased from 2004 to 2019 (from 3377 in 2004 to 13,200 in 2019), while lingual frenotomy similarly increased from 1483 in 2004 to 6213 in 2019. The proportion of inpatient frenotomy procedures increased from 6.2% to 16.6% from 2004 to 2019, with pediatricians having the highest odds of performing inpatient frenotomies (odds ratio:4.32, 95% confidence interval:4.08, 4.57). Additionally, during the study period, the proportion of frenotomies performed by pediatricians increased from 13.01% in 2004 to 28.38% in 2019. In multivariate regression analyses, frenotomy was significantly associated with the male sex, white non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings.CONCLUSION: Ankyloglossia has been increasingly diagnosed in the past 2 decades, and amongpatients with ankyloglossia, frenotomy is increasingly performed. This trend was driven at least in part due to increasing rates of pediatricians as proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic differences in the management of ankyloglossia were observed.

  https://www.ncbi.nlm.nih.gov/pubmed/36994937 https://doi.org/10.1002/ohn.332

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