BackgroundDetection of olfactory dysfunction is important for fire and food safety. Clinical tests of olfaction have been developed for adults but their use in children has been limited because they were felt to be unreliable in children under six years of age. We therefore administered two olfactory tests to children and compared results across tests.MethodsTwo olfactory tests (Sniffin’ Sticks and University of Pennsylvania Smell Identification Test (UPSIT)) were administered to 78 healthy children ages 3 to 12 years. Children were randomized to one of two groups: Group 1 performed the UPSIT first and Sniffin’ Sticks second, and Group 2 performed Sniffin’ Sticks first and UPSIT second.ResultsAll children were able to complete both olfactory tests. Performance on both tests was similar for children 5 and 6 years of age. There was an age-dependent increase in score on both tests (p < .01). Children performed better on the Sniffin’ Sticks than the UPSIT (65.3% versus 59.7%, p < .01). There was no difference in performance due to order of test presentation.ConclusionsThe Sniffin’ Sticks and UPSIT olfactory tests can both be completed by children as young as 5 years of age. Performance on both tests increased with increasing age. Better performance on the Sniffin’ Sticks than the UPSIT may be due to a decreased number of test items, better ability to maintain attention, or decreased olfactory fatigue. The ability to reuse Sniffin’ Sticks on multiple children may make it more practical for clinical use.

BACKGROUND AND OBJECTIVE: Infant “sleep machines” (ISMs) produce ambient noise or noise to mask other sounds in an infant’s room with the goal of increasing uninterrupted sleep. We suggest that the consistent use of these devices raises concerns for increasing an infant’s risk of noise-induced hearing loss. We therefore sought to determine the maximum output levels of these sleep machines. METHODS: Sound levels of 14 ISMs played at maximum volume were measured at 30, 100, and 200 cm from the machine using correction factors to account for a 6-month-old’s ear canal. RESULTS: Maximum sound levels at 30 cm were &gt;50 A-weighted dB for all devices, which is the current recommended noise limit for infants in hospital nurseries. Three machines produced output levels &gt;85 A-weighted dB, which, if played at these levels for &gt;8 hours, exceeds current occupational limits for accumulated noise exposure in adults and risks noise-induced hearing loss. CONCLUSIONS: ISMs are capable of producing output sound pressure levels that may be damaging to infant hearing and auditory development. We outline recommendations for safer operation of these machines.

IMPORTANCE Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain.OBJECTIVE To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival. DESIGN, SETTING, AND PARTICIPANTSA multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years). MAIN OUTCOMES AND MEASURESOutcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years. RESULTSIn all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, −6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, −2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, −4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control.CONCLUSIONS AND RELEVANCE This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.