Simulated Surgical Model Design for Myringotomy and Tympanostomy Tube Insertion in Children using Medical Image Processing and 3D-Printing Technologies

Objective: Researchers aimed to design surgical simulation models using medical image processing and 3D-printing technologies to train otolaryngologie residents with correct surgical techniques and study their skills improvement. Materials and Methods: The models were produced for three age ranges (group A: 8-12 years old, group B: 3-7 years old, and group C: 10 months - 2 years old). Eleven residents were practiced from older to younger child models. Overall surgical time and results were evaluated to determine improvement. Both residents and specialists assessed satisfaction surveys after training. Results: The median operational time was significantly reduced by 64.57% in model A and 50.24% in model B (p < 0.05). Operating time and surgical skills improved in order from models A, B, and C. Model C showed the most improvement with correct operational techniques in myringotomy incision (66.7%, p = 0.003) and tympanostomy tube insertion (48.5%, p = 0.011). Residents’ and specialists’ satisfaction assessments exhibited prominent satisfaction results with surgical simulation model training. Conclusion: Surgical simulation models training enhanced residencies’ confidence and improved correct surgical techniques. Residencies can gradually practice skills from fundamental to more complicated techniques in younger child model where symptom occurs

Ectopic Brain Tissue in a Child: A Case Report A Case of Ectopic Brain Tissue in the Nasophaynx in Thailand

Brain heterotopia is a benign tumor composed of differentiated neural tissue that is located outside the cranial vault. This condition is uncommon and presents as a congenital pharyngeal mass. Here, we report a case of neuroepithelial heterotopia in the nasopharyngeal area of a six-month-old boy who presented with cleft palate and stridor. The tumor demonstrated aggressive growth with oropharyngeal involvement. Radiologic finding revealed a large heterogeneous enhancement on the left side of the nasopharynx, involving the uvula, left lateral pharyngeal wall, and left tonsil. No connection to the brain or spinal cord was apparent on imaging. Histologic features included presence of neuroglial heterotopias, composed predominately of glial cells in a surrounding neurofibrillary matrix. Surgery was the selected intervention, with wide excision performed via cleft palate. Previously published literature relevant to this case were reviewed and discussed. Recurrence is common in incomplete resection, although there was no evidence of recurrence at the two-year follow-up in this patient

Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

ObjectivesDifferent pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children.Study DesignRetrospective, cross-sectional study.MethodsWe recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep.ResultsThe prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO2 (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA.ConclusionThe prevalence of REM-related OSA was 50.3%. OAHIREM should be considered as an important parameter in future clinical research studies done in children with OSA.</jats:sec

Surveillance of Otitis Media With Effusion in Thai Children With Cleft Palate

Objective: To study the incidence and outcome of management of otitis media with effusion in Thai children with cleft palate. Design: Retrospective cohort study in the tertiary care center. Patients: Ninety-five children with cleft palate were referred for ear evaluation, from June 1997 to January 2015. Fifteen children (15.8%) had associated craniofacial syndromic anomalies. Main outcome measures: Cumulative incidence of otitis media with effusion, rate of ventilation tube insertion, duration of indwelling tubes, hearing outcome, and complications of ventilation tubes. Results: Ear examinations were done every 8 to 12 weeks throughout the study. Cumulative incidence of otitis media with effusion was 53.7% in children within 12 months of age and 81.1% within 24 months of age. At the end of the study, all of the patients had at least 1 episode of otitis media with effusion. Eighty-eight children (92.6%) had palatoplasty, and there was no significant difference in the incidence of otitis media before and after palatoplasty. The mean hearing level at recruitment was 40.8 ±18.4 dB. Ventilation tube insertion was done in 76 patients (80%). The median time for indwelling tubes was 11.7 months. Rate of ventilation tube insertion was 0.5/year. The mean hearing level at last follow-up was 23.5 ± 14 dB. Otorrhea through tube was found in 24 cases (31.6%). Conclusion: Otitis media with effusion was common in Thai children with cleft palate. Surveillance of middle ear effusion and ventilation tube insertion contributed to a favorable hearing outcome. </jats:sec

Development of an Odor Identification Test Kit for Thai Children

Objective: To develop and validate an odor identification test kit for Thai children that can be adapted for use in Southeast Asian countries. Materials and Methods: The test kit was developed in three phases, using local fresh substances. Phase 1 involved designing the test kit and selecting odorants from a pool of 17. Phase 2 focused on test validation in normal subjects, assignment of smell scores, and assessment of test-retest reliability. Phase 3 validated the test in children with subjective olfactory dysfunction and children with repaired cleft palate. Cut-off scores were determined using receiver operating curve analysis. Results: The participants were children aged 5-12 years. Sample sizes in Phases 1, 2, and 3 were 53, 31, and 36, respectively. Seven odorants that met the selection criteria were chosen. The average score for normal subjects was 6.7 (SD 0.7), with a significant difference between age groups (p = 0.036). Children with olfactory dysfunction had an average score of 3.8 (SD 1.6), significantly lower than normal children (p < 0.001). Children with repaired cleft palate showed no significant difference in smell scores compared to normal subjects. A cut-off score of 5.5 points was used to distinguish between normal and abnormal olfactory function, with an area under the curve of 0.928. Conclusion: Children aged 5-12 years were able to complete the 7-item odor identification test developed from local fresh substances. The test kit demonstrated good reliability and effectively distinguished between children with and without smell loss, using a cut-off score of 5.5

Validity and Reliability of the Thai Version of the Pediatric Obstructive Sleep Apnea Screening Tool

Objective: Obstructive sleep apnea (OSA) is highly prevalent in children and requires an expensive and relatively unavailable sleep study for diagnosis. This study was undertaken to translate the previously validated OSA screening tool (POSAST) to the Thai language and assess its accuracy and test-retest reliability in at-risk symptomatic children. Study design: Prospective cross-sectional cohort study Methods: Pediatric patients clinically referred for suspected OSA who underwent overnight polysomnography (PSG) were recruited, and caregivers completed the Thai version of the POSAST. The same questionnaire was completed again after 2-4 weeks. Results: One hundred and ten subjects completed the study. The mean age was 8.4±2.9 years. The mean apnea-hypopnea index (AHI) was 10.9±11.9 events/hour. Test-retest reliability (Pearson correlation coefficient = 0.96, P&lt;0.001) and internal consistency (Cronbach’s alpha coefficient = 0.82, P&lt;0.001) between each question were excellent. A cumulative equation-derived score cut-off of 1.9 yielded 78.4% sensitivity and 50.0% specificity, while a numerical additive score cut-off of 8 corresponded to 81.1% sensitivity and 52.8% specificity for diagnosing moderate and severe OSA (AHI ≥5 events per hour) Conclusion: The internal consistency and reproducibility of the Thai version of the POSAST are satisfactory, display acceptable validity, and the instrument can be used for screening symptomatic Thai children for OSA.</jats:p