Objectives/Hypothesis: To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.Study Design: Cross-sectional study. Methods: The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.Results: An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty-one percent of the patients were ≤3 years old, and 62% were male. Forty-eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.Conclusions: Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.

Objectives/Hypothesis To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events. Study Design Retrospective database review. Methods Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant. Results The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3‐1.6) and less common among white children (OR: 0.8, 95% CI: 0.8‐0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection. Conclusions Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity. Level of Evidence NA Laryngoscope, 129:995–1000, 2019

Objective: Compare experts’ ability to differentiate malignant and benign causes of facial nerve paralysis (FNP) using the initial presenting magnetic resonance image (MRI) for each patient. Methods: This retrospective case-controlled study compared MRIs for 9 patients with a malignant cause for FNP, 8 patients with Bell’s palsy, and 9 cochlear implant patients serving as controls. The initial presenting MRI for each condition was used such that raters were evaluating real-world rather than optimal studies. Three blinded expert raters independently evaluated each segment of the facial nerve for abnormalities, provided a diagnosis, and graded MRI quality. Cohen’s and Light’s kappa were used to calculate interrater reliability and overall index of agreement, respectively. Results: MRI protocols for the malignancy group were universally suboptimal. There was poor agreement among raters for abnormalities of the facial nerve along the brainstem (0.13), geniculate (0.10), tympanic segment (0.12), and mastoid segment (0.13); moderate agreement along the cisternal segment (0.58) and internal auditory canal (0.55); and fair agreement along the labyrinthine segment (0.26) and extratemporal segment (0.36). Agreement regarding final diagnosis was fair (0.37) when compared to the true diagnosis. There were 2 false negative interpretations (failure to correctly identify malignancy) and 1 false positive interpretation. Conclusion: MRI for FNP is often initially performed with an incorrect protocol and thus may fail to reliably differentiate neoplastic from inflammatory FNP even when interpreted by experienced clinicians. Nevertheless, expert readers correctly diagnosed 87.5% of malignant causes of FNP despite these limitations.

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This is the first report of resecting a venous malformation of the facial nerve with concomitant interposition nerve graft reconstruction via an exclusively endoscopic approach. This report adds to the growing body of evidence that TEES can manage diverse middle ear and lateral skull base pathology. Additional studies are needed to fully elucidate the risk-benefit profile of this technique.