Decreasing Telephone Calls for Tympanostomy Tube Otorrhea: A Pilot Study

The “Clinical Practice Guideline: Tympanostomy Tubes in Children” published in 2013 by the American Academy of Otolaryngology—Head and Neck Surgery Foundation encourages that an “educational video, or other teaching aid, should be developed to illustrate how parents/caregivers” may manage postoperative complications such as tube otorrhea; however, the current literature is devoid of such patient safety and quality improvement measures. Our objective was to develop an effective educational model to assist parents and caregivers in understanding the signs and symptoms of tympanostomy tube (TT) otorrhea and how to independently institute the appropriate otologic treatment. A 3.5 × 2-inch instructional card was designed to illustrate TT otorrhea and describe the subsequent steps necessary to obtain and institute the appropriate medical therapy. This was distributed to caregivers of all patients undergoing TT placement in September 2016; patients undergoing TT placement in May 2016 served as the preintervention control cohort. Group comparisons were made before and after implementation of the educational model by number of telephone calls our clinic triaged regarding untreated TT otorrhea, as documented within the electronic medical record. A total of 30 sets of TT were placed in September 2016, compared to 27 sets of TT in May 2016. Postoperatively, a run chart revealed a significant shift (ie, 7 consecutive points) in the number of telephone calls received (16-5 calls) after establishment of the proposed educational model. This clinical experience demonstrates the utility of patient-driven management of TT otorrhea through ancillary educational material. Given the superiority of topical otic therapy, continued translation efforts are needed for continued focus on practice implementation and dissemination

Centrifuge Modeling Studies of Site Response in Soft Clay over Wide Strain Range

Centrifuge models of soft-clay deposits were shaken with suites of earthquake ground motions to study site response over a wide strain range. The models were constructed in an innovative hinged-plate container to effectively reproduce one-dimensional ground-response boundary conditions. Dense sensor arrays facilitate back-calculation of modulus-reduction and damping values that show modest misfits from empirical models. Low-amplitude base motions produced nearly elastic response in which ground motions were amplified through the soil column, and the fundamental site period was approximately 1.0 s. High-intensity base motions produced shear strains higher than 10%, mobilizing shear failure in clay at stresses larger than the undrained monotonic shear strength. The authors attribute these high mobilized stresses to rate effects, which should be considered in strength-parameter selection for nonlinear analysis. This nonlinear response deamplified short-period spectral accelerations and lengthened the site period to 3.0 s. The nonlinearity in spectral amplification is parameterized in a form used for site terms in ground-motion prediction equations to provide empirical constraint unavailable from ground-motion databases. © 2013 American Society of Civil Engineers

Results of pediatric endoscopic and endoscopically assisted tympanoplasty

Objectives: To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty. Methods: Retrospective review of single surgeon experience. Results: During a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years). All tragal cartilage grafts (31/31; 100%) survived. Twenty-seven surgeries (27/31; 82%) resulted in an intact drum (17/31; 55%) or a microperforation (10/31; 32%). In four cases (4/31; 13%) significant perforations formed in previously unaffected portions of the drum. Conclusion: Transcanal endoscopic cartilage inlay tympanoplasty offers a practical, minimally invasive approach to tympanoplasty for children of any age. It avoids postauricular or endaural incisions, tympanomeatal flap elevation, and canalplasty. Graft survival is uniform. Microperforation at the graft margins remained in 1/3 of children. Technical modifications may lead to higher rates of tympanic closure

Infants Are More Likely Than Older Children to Have Surgery for Cervical Infections

Objectives. To identify differences in cervical infection management in infants versus older children. Methods. Charts of patients 0–18 years, diagnosed with a cervical infection at our institution between 2004 and 2015, were included. Age, gender, presenting symptoms, comorbidities, CT scan findings and management including admission, procedures, antibiotics, cultures, length of stay, readmission rates, and complications were included. Results. 239 patients were included: mean age was 4.6 years, with 55.6% boys and 44.4% girls. Mean length of stay was 3.2 days, with no significant difference between age categories. 12.55% were readmitted within 30 days with no significant difference when stratified for age (p = 0.268). The most common presenting symptoms were fever (74.3%), swelling (71.4%), and neck pain (48.2%). Infants had fewer symptoms documented than older children. 51% has lateral neck infections, and these were more common in younger children (p < 0.001). The most common antibiotic used was amoxicillin-clavulanic acid in 53.96% of inpatients and 48.05% of outpatients. Infants were most likely to have MRSA isolates (29.2% versus 11.7% of older children, p = 0.011). 70.0% went to the operating room for incision and drainage procedures. Younger children were more likely to undergo surgery, with an odds ratio of 2.38 for children under 1 year. (p = 0.029). 90.9% of infants underwent surgery with radiolucencies of at least 1 cm diameter in contrast to 50% of children over 8 years old. Conclusions. This study emphasizes the importance of considering early operative treatment of cervical abscesses in infants despite fewer symptoms and smaller radiolucencies on CT