T he middle turbinate has long been recognized as a key structure in endoscopic sinus surgery. Management of this important physiological structure and anatomical landmark has been a topic of interest for years. 1 While in the past there has been controversy over whether the middle turbinate should be resected or maintained in place, 2 many experts prefer to conserve the structure in most cases. 3 This leads to a discrete incidence of lateralization of the middle turbinate and scarring against the lateral nasal wall, which can lead to obstruction of the middle meatus and the need for revision procedures. 3,4 A variety of ways to keep the middle turbinate medialized have been described over the years. These include middle meatal packing, stent, or spacer placement 5 and controlled synechiae formation between the middle turbinate and the septum, both via abrasion formation 6 as well as other means. 7 In addition, suture medialization has previously been shown to be an effective means of preventing lateralization. 4,8,9 This technique has been criticized for being technically difficult and time consuming, mainly due to the need to tie a knot within the nasal cavity. We describe a knot-free modification to this established practice which addresses these concerns. TechniqueIn our practice, we have adopted a novel technique that has simplified and expedited the process of suture medialization of the middle turbinate by avoiding knot-tying within the nasal cavity. This is accomplished through the use of a monofilament barbed suture placed through both middle turbinates and the nasal septum. This knotless tissue-

Esophageal foreign body is a frequent pediatric presentation, and eosinophilic esophagitis (EoE) is an important underlying disease. To determine characteristics common in the presentation of esophageal foreign body indicative of underlying EoE and reach a recommendation for the appropriate scenario in which to obtain esophageal mucosal biopsy, 312 pediatric esophageal foreign bodies requiring operative removal were reviewed. Patients older than 18 years or with a known history of esophageal surgery or pathology were excluded. Eligibility criteria were met in 271 cases. Twenty-seven patients were biopsied, and 18 were diagnosed with EoE. The following factors were identified in the EoE population: food impaction (89%), older age (average 12.2 years), male sex (78%), atopic disease (61%), previous esophageal foreign body or frequent dysphagia (83%), and endoscopic abnormalities (100%). These factors are all associated with an underlying diagnosis of EoE, and patients meeting these criteria should be strongly considered for intraoperative esophageal mucosal biopsy.

Use of hydroxyapatite cement for treatment of incus necrosis in revision stapedectomy provides excellent hearing outcomes and is a reasonable alternative to total ossicular reconstruction prosthesis or malleovestibular prosthesis techniques.

ORAL PRESENTATIONS8.2 ± 4.4, P < .0001) and more commonly male (62% vs 52%, P = .025). Compared to controls, more children with CRS were white (CRS 77% white; 10% black; 13% other vs control 47% white; 33% black; 20% other, P < .0001). Likewise, children with CRS were less commonly insured with Medical Assistance (CRS 14% vs control 43%, P < .0001). Conclusion:Compared to the general population of children seen in this setting, children with CRS were more likely to be white/privately insured. This study is the first to evaluate race/ SES in relation to pediatric CRS. Future research should employ nationally representative data to assess true variation of demographic factors in children with CRS. Pediatric OtolaryngologyFloSeal with Adenotonsillectomy to Prevent Adverse Outcomes Steven R. Dyer, DO (presenter); Phani Durvasula, MD; Samba Bathula, MD; Saidshoib Sana, DO; Michael Haupert, DO, MBA; David Madgy, DO; James Dworkin, PhDObjective: The aim of study was to compare the postoperative complications associated with adenotonsillectomy with or without the application of FloSeal at the completion of the procedure in 2 similar groups.Method: This retrospective study was performed at a tertiary care pediatric hospital between January 2007 and December 2008, for OSA and chronic tonsillitis in patients between 1 and 18 years old. Eight hundred patients underwent adenotonsillectomy in an identical manner, with half reciving FloSeal intraoperatively. Outcomes measured were: hemorrhage, return to OR, and dehydration.Results: Age ranged from 1 to 18 years. Male gender was found to have a slight predominance without statistical significance (χ 2 = 0.01, P = .93). Preoperative diagnosis was more commonly OSA (79.9%) compared to chronic tonsillitis (20.1%). Primary bleed rate was found to occur in 2 subjects (0.3%); 1 FloSeal and 1 No FloSeal subject (χ 2 = 0.004, P = .95). Secondary bleeding was seen in 18 subjects (2.5%); 11 FloSeal and 7 No FloSeal (χ 2 = 1.32, P = .25). Dehydration was seen in 51 subjects (7.1%); 24 FloSeal and 27 No FloSeal (χ 2 = 0.01, P = .92). The need for return to OR was seen in 7 subjects (1%); 5 FloSeal and 2 No FloSeal (χ 2 = 1.59, P = .21). Conclusion:In our experience, the application of FloSeal hemostatic matrix after monopolar adenotonsillectomy demonstrates no additional reduction in postoerative complications encountered in the pediatric population. Method: Three hundred twelve cases of pediatric patients with an esophageal foreign body requiring esophagoscopy for removal were reviewed. Patients were excluded if a history of esophageal surgery or pathology was present. Factors common to those patients subsequently diagnosed with eosinophilic esophagitis (EE) were identified. Pediatric OtolaryngologyResults: Eligibility criteria were met in 271 cases. Of these, 27 underwent esophageal biopsy and 18 were diagnosed with EE.The following factors were compared between the EE population and the group as a whole: food impaction (89% of EE patients, 11% of non-EE patients), older age (average EE ...