IMPORTANCE Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. OBJECTIVE To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. DESIGN, SETTING, AND PARTICIPANTS In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. MAIN OUTCOMES AND MEASURES The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. RESULTS Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. CONCLUSIONS AND RELEVANCE In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.

4. Laryngoscope, 128:610-617, 2018.

Serial in-office ISI are safe and well-tolerated in adults with SGS/PTS. This technique can reduce the surgical burden on these patients and may obviate the need for future airway intervention.

The SAI flap provides an alternative to free-tissue transfer for soft-tissue reconstruction after head and neck oncologic surgery. This flap is easy to harvest and versatile. However, the SAI flap has limitations in length and, because it is a rotational flap, is less capable of reconstructing some complex head and neck defects.

Objective-To evaluate the risk of bacterial infection and use of antibiotics in otherwise healthy children infected with respiratory syncytial virus (RSV) admitted to the intensive care unit (ICU).Methods-Demographics, clinical information, interventions and outcomes were extracted from the charts of consecutive patients with laboratory-confirmed RSV infection at Children's Hospital, Boston from October 1990 through April 2002. Patients born at <36 weeks gestational age or with preexisting medical conditions were excluded.Results-The median age of the 165 previously healthy infants infected with RSV was 42 days. Almost all patients received supplementary FiO 2 , and 63 (38.2%) patients required mechanical ventilator support. No patients died. The median length of stay was 3 days in the ICU and 7 days in the hospital. Most patients had bacterial cultures sent: 155 (93.9%), blood cultures; 121 (73.3%), urine cultures; and 85 (51.5%) cerebrospinal fluid cultures. Only 1 blood culture was positive, and 1 potential urinary tract infection was identified in a patient with a negative urinalysis. All intubated patients and 80.4% of nonintubated patients received antibiotic therapy.Conclusions-In otherwise healthy infants admitted to the ICU with RSV infection, bacteremia, urinary tract infection and meningitis are uncommon. Although bacterial pneumonia in this cohort may be more prevalent, overdiagnosis is common. Keywordsrespiratory syncytial virus; bronchiolitis; intensive care unit; sepsis Respiratory syncytial virus (RSV) commonly infects the lower respiratory tract of infants and young children and is the most common pathogen causing bronchiolitis. Although ∼1-2% of all children are hospitalized for viral lower respiratory infections in infancy, 1 only 5-10% of these hospitalized infants require intensive care in a specialized unit (ICU). Many infants admitted to the ICU with RSV infection have underlying conditions such as cardiac disease, immunocompromise or chronic lung disease that predispose them to a more severe clinical course. 2 Additionally the small airways of very young, otherwise healthy infants can also lead to significant respiratory compromise from RSV infection requiring mechanical ventilator support.Very young infants are at high risk for serious sequelae of bacterial infection and a standard laboratory evaluation (white blood cell count, urinalysis, cerebrospinal fluid (CSF) analysis and blood, urine and CSF cultures) is generally considered for infants presenting with fever NIH Public Access The objective of this study was to identify the risk of bacteremia, bacterial meningitis, urinary tract infection and bacterial pneumonia in otherwise healthy infants admitted to a a single pediatric intensive care unit during a 12-year period and to describe antibiotic use and potential rationale for use in this population. MethodsRSV was identified by enzyme-linked immunosorbent assay, direct fluorescent antibody or viral culture from samples obtained from nasal washes, nasopharyngeal swabs or endot...