Objectives Determine the incidence of vocal cord paralysis and dysphagia after aortic arch reconstruction including Norwood procedure. Setting Tertiary Children’s Hospital Study Design Retrospective cohort. Methods Database/chart review of neonates requiring Norwood or arch surgery between January 2005 through December 2012. Demographics, postoperative vocal cord function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed. Results One hundred fifty-one consecutive subjects(96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days(IQR 7–13) for Norwood, 24 days(IQR 12–49) for arch reconstruction(p<0.001). Documentation of VC motion abnormality was found in 60/104(57.6%) subjects, and unavailable in 47:16 without documentation and 31 who expired prior to extubation. There were no significant differences in proportions of documented VC motion(p=0.337), dysphagia(p=0.987), and VC paralysis(p=0.706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without UVCP, dysphagia was present (56% Norwood,61% arch). Overall, 120/151(79.5%) required feeding evaluation and modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55/151(36.4%) patients. Of those with VC paralysis, only 23(22%) had any otolaryngology follow-up after discharge from surgery. Over 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis. Conclusion There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.

Objectives Chronic rhinosinusitis(CRS) results in significant morbidity and healthcare expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS has been demonstrated but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on CT scan, and summarize parental reports of subsequent use of nasal irrigation for recurring symptoms. Study Design Retrospective cohort study and cross-sectional survey. Methods Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012. Results One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion(95.2%), cough(79.8%), rhinorrhea(60.6%), headache(48.1%), and fatigue(40.4%). Comorbidities include positive allergy test(50%), asthma(57.3%), and GERD(28.2%). After 6 weeks 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (p<0.001). Of the 54 parents who completed the prospective surveys, 53.7% reported using irrigation again in the last 12 months(median 1, IQR 3). Only 9 patients underwent FESS after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years of age older than those that did not receive FESS(p=0.0005). Median length of follow-up was 48 months(range 20–113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey versus not. Conclusion Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces need for FESS and CT imaging.

Radiofrequency (RF) ablation for atrial fibrillation is commonly performed. Atrioesophageal fistulas are an uncommon complication of RF ablation and can present with status epilepticus due to an extensive vascular air embolus. Initial treatment may require a high level of suspicion of this rare occurrence to help prevent further injury and increase the likelihood of a meaningful recovery.

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