The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%.

Background Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue. We used long-range FD-OCT to image the subglottis in intubated pediatric patients undergoing minor head and neck surgical procedures in the operating room. Methods A long-range FD-OCT system and rotary optical probes (1.2 mm and 0.7 mm outer diameters) were constructed. Forty-six pediatric patients (ages 2–16 years) undergoing minor upper airway surgery (e.g. tonsillectomy, adenoidectomy) were selected for intraoperative, trans-endotracheal tube FD-OCT of the subglottis. Images were analyzed for anatomical landmarks and subepithelial histology. Volumetric image sets were rendered into virtual 3D airway models in Mimics software. Results FD-OCT was performed on 46 patients (ages 2–16 years) with no complications. Gross airway contour was visible on all 46 data sets. Twenty (43%) high-quality data sets clearly demonstrated airway anatomy (e.g., tracheal rings, cricoid, vocal folds) and layered microanatomy of the mucosa (e.g., epithelium, basement membrane, lamina propria). The remaining 26 data sets were discarded due to artifact, high signal-to-noise ratio or missing data. 3D airway models allowed for user-controlled manipulation and multiplanar airway slicing (e.g. sagittal, coronal) for visualization of OCT data at multiple anatomic levels simultaneously. Conclusions Long-range FD-OCT produces high-resolution, 3D volumetric images of the pediatric subglottis. This technology offers a safe and practical means for in vivo evaluation of lower airway microanatomy in intubated pediatric patients. Ultimately, FD-OCT may be applied to serial monitoring of the neonatal subglottis in long-term intubated infants at risk for acquired SGS.

Objectives: Optical coherence tomography (OCT) is an imaging modality that uses a broadband light source to produce high‐resolution cross‐sectional images in living tissue (8–20 μm). A prospective study of normal, benign, and pathologic tissues in the pediatric airway was conducted to assess the utility of OCT technology in characterizing the microanatomy of the pediatric upper aerodigestive tract in vivo. Study Design: Prospective clinical trial. Materials and Methods: Fifteen patients from 1 to 17 years of age underwent surgical endoscopy and OCT for various airway disorders. OCT imaging was performed at a frame rate of 1 Hz using a 1.3‐μm broadband light source to produce images 1.6 × 6 mm in vertical and horizontal dimensions. The epithelium, lamina propria, and unique tissue microstructures were visualized and then measured using digital micrometry. Direct comparison of OCT images with endoscopic photography was performed. Results: Systematic imaging of the oral cavity, oropharynx, hypopharynx, and larynx was performed in all 15 patients. Normal microstructures identified included papillae, ducts, glands, and vessels, whereas pathologic conditions included distinct zones of mature scar, granulation tissue, edema, ulceration, and papillomatosis. Endoscopic photographs were well correlated with OCT images. Conclusions: OCT is capable of obtaining high‐resolution microanatomy images of pediatric airway in vivo tissue. OCT clearly identifies the epithelium and lamina propria while providing detailed structural information on normal and diseased tissues. OCT is a promising emerging imaging modality for use in current pediatric patient populations.

Rationale: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury.Objectives: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness.Methods: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. Measurements and Main Results:Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P , 0.001; multiple r 2 = 0.44) and subglottic (P , 0.001; multiple r 2 = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure.Conclusions: LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates.Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).