LIon - ESPO 2012

eSpo 2012amSterdam 

11 th International Congress of the European Society 

of Pediatric Otorhinolaryngology 

Pediatric Otorhinolaryngology: 

From experience-based to evidence-based practice

Sponsors 

• ALK-Abelló 

• ArthroCare 

• Bacicoline-B 

• Daleco Pharma b.v. 

• Medtronic 

eSpo 

• Advanced Bionics 

• Atos Medical BV 

• Carl Reiner 

• GlaxoSmithKline Biologicals 

• Grupo Uriach 

• Karl Storz 

• Medtronic International Trading 

• Oticon Medical 

• Smiths Medical Nederland B.V. 

• Synthes - Anspach 

2012amSterdam 

Pediatric Otorhinolaryngology: 

From experience-based to evidence-based practice 

Exhibitors

Contents 

Preface ESPO President 5 

Welcome message 7 

Committees 8 

History 9 

General Information 10 

Social Events 13 

Amsterdam 14 

Sponsors and exhibitors 16 

Exhibition and presentation 17 

Scientific Programme 19 

Introduction 19 

Instructions for oral and poster presentations 20 

Poster and junior prizes 20 

Scientific programme 23 

Programme poster presentations 34 

Abstracts 40 

Plenary sessions 40 

Round tables 42 

Workshops 46 

Corporate sessions 50 

Free paper sessions 52 

LION live surgery meetings 56 

Oral presentations 57 

Poster sessions 119 

Programme at a glance 301 

Floorplan 312 

Authors index 315 

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Preface eSpo president 

Dear friends and colleagues, 

It has been already two years since our ESPO congress in Pamplona. At that occasion, we 

registered 800 attendees, representing 63 countries. Apart from the figures, which alone were 

brilliant, it also was considered a success thanks to the magnificient participation in terms of 

free papers, round tables, instructional courses, lectures, all of an outstanding scientific level. 

Now, here in Amsterdam, those figures are going to be exceeded. This is because of the 

growing interest in pediatric ENT, our highly valued subspeciality that has major impact 

on children’s health. 

A child is never, and under no circumstances, a small adult. Children have their own unique 

pathology, which is different from an adult’s, and here is where the importance of treatments 

used in pediatric ENT, are vital for our success. 

Over these years, the ESPO congresses have become the ENT reference in pediatric meetings 

across the world. Not only for the numerous participants, representing 5 continents, but 

mainly due to the high quality of the work presented. 

I encourage you to fully participate in this congress, in this beautiful city so full of colour, 

tulips, canals, and enchanting magic surroundings. 

WELCOME TO AMSTERDAM 

Javier Cervera 

ESPO President 

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Welcome message 

Dear friends and colleagues, 

On behalf of the ESPO2012 organising committee, we welcome you to Amsterdam. With your 

valuable contributions and the support of our scientific committee and moderators, we have 

been able to put together and exciting interactive programme. 

ESPO2012 will be a compact meeting of two and a half days concentrating on the exchange 

of recent clinical insights and innovative scientific ideas. We hope that you will enjoy the 

plenary sessions that will bring all participants together each morning and afternoon. 

The sessions cover fundamental issues in Pediatric Otorhinolaryngology, from the theme 

of our congress ‘Evidence Based Practice’, along patient participation and ethics, to surgical 

innovations and new technologies. 

Our moderators and instructors have put together exciting round tables and workshops 

that cover day-to-day clinical issues as well as cutting edge technologies. 

We are thankful to all those authors who have submitted abstracts. We received almost 

600 very good abstracts ranging from case reports, invaluable in our field, to systematic 

reviews in all areas of Pediatric Otorhinolaryngology. These papers have been scheduled as 

oral presentations in parallel sessions or poster presentations. The posters will be displayed 

electronically throughout the congress according to the poster programme. There will be 

ample time for discussion in each session, so please do contribute with your experience 

and questions. 

The prizes for the best papers presented by a junior participant and the best posters will 

be awarded during the closing ceremony on Wednesday. 

We explicitly thank our sponsors who have organized exciting corporate symposia, like those 

on surgical techniques and implant technology, some of which will be demonstrated live in 

our surgical broadcasts scheduled during the scientific programme. 

And we thank the sponsors taking part in the trade exhibition. Their support enables us 

to add that extra touch to ESPO2012, that will make it into a memorable experience. 

The ESPO congresses are organized to bring together clinicians and researchers from all over 

the world to exchange experiences and ideas, develop friendships and collaborations and to 

carry our common focus of interest, Pediatric Otorhinolaryngology, into the future. We hope 

that you will enjoy ESPO2012 and make the most of your stay in this colourful city. 

Anne Schilder and Hans Hoeve 

ESPO2012 chairmen 

For up to date information and highlights, please also follow us 

on twitter @Espocongress and #ESPO2012 

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Committees 

Local executive committee 

• Anne Schilder - chairman 

• Hans Hoeve - vice chairman 

• Maroeska Rovers - secretary general 

• Lucienne Speleman - social events 

• Laura Meltzer - social events 

• Vedat Topsakal – sponsor liaison 

• Bas Pullens – poster programme 

• Wilko Grolman – treasurer 

Local organizing committee 

• Ronald Admiraal 

• Debby Bogaert 

• Rolien Free 

• Jet de Gier 

• Bernd Kremer 

• Astrid König 

• Emmanuel Mylanus 

• Rico Rinkel 

• Rinze Tange 

• Erwin van der Veen 

International scientific committee 

• Umut Akyol, Ankara, Turkey 

• Martin Bailey, London, United Kingdom 

• An Boudewyns, Antwerpen, Belgium 

• Martin Burton, Oxford, United Kingdom 

• Cor Cremers, Nijmegen, The Netherlands 

• Inge Dhooge, Ghent, Belgium 

• Noel Garabedian, Paris, France 

• Gábor Katona, Budapest, Hungary 

• Thomas Lenarz, Hannover, Germany 

• Manuel Manrique, Pamplona, Spain 

• Paola Marchisio, Milan, Italy 

• Anne Pitkaranta, Helsinki, Finland 

• Rich Rosenfeld, New York, USA 

• Lieke Sanders, Utrecht, The Netherlands 

• Glennis Scadding, London, United Kingdom 

• Noboru Yamanaka, Wakayama, Japan

History 

The European Society of Pediatric Otorhinolaryngology (ESPO) 

The European Society of Pediatric Otorhinolaryngology (ESPO) aims to promote the quality of 

care of children with otorhinolaryngologic disorders within Europe. 

ESPO’s objectives are to: 

- facilitate the dissemination of knowledge of otorhinolaryngologic disorders in children 

- advocate the cooperation between ESPO members in various countries 

- support clinical and basic research, and promote documentation of difficult cases 

- enhance scientific communication by organizing congresses and conferences 

- promote training programmes for otorhinolaryngologists with a specific interest in 

pediatric ORL diseases, and redefine standards of professional practice 

- establish links with other organizations concerned with the care for children with 

ORL disorders 

ESPO was founded in 1994 and succeeded the European Working Group in Pediatric 

Otorhinolaryngology (EWGPO). Recent ESPO congresses were held in Oxford (2002), 

Athens (2004), Paris (2006), Budapest (2008) and Pamplona (2010). 

ESPO board 

• Javier Cervera Escario - president 

• John Graham - secretary general 

• Chris Raine - treasurer 

• Anne Schilder - president elect 

• Noël Garabédian - past president 

• Gábor Katona - member 

Honorary ESPO members 

• Renato Fior 

• John Evans 

• Pekka Karma 

• Carel Verwoerd 

• Jetty Verwoerd-Verhoef 

Congress Secretariat 

Congress & Meeting Services Holland 

Lidy Wernink and Sanne van den Biggelaar 

P.O. Box 957 

5600 AZ Eindhoven 

The Netherlands 

Tel: +31 (0)40 2132222 

info@congresservice.nl 

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General information 

Congress Venue 

The congress is held at the NH Grand Hotel Krasnapolsky, Amsterdam, 

The Netherlands. This 5-star hotel is located on the Dam Square in the 

middle of old Amsterdam and can be reached by car or public transport 

in less than 30 minutes from Schiphol Airport. 

NH Grand Hotel Krasnapolsky 

Dam 9 

1012 JS Amsterdam 


Tel +31 (0)20 5545000 

Fax +31 (0)20 5545500 

groups.amsterdam@nh-hotels.com 

www.nh-hotels.com 

Registration Desk 

The ESPO2012 registration and information desk is situated in the 

conference area of the hotel. 

The opening hours are: 

Sunday May 20 15.30 - 20:00 hrs 

Monday May 21 07.30 - 18.00 hrs 

Tuesday May 22 07.30 - 18.00 hrs 

Wednesday May 23 07.30 - 13.00 hrs 

The registration fee includes the following: 

- access to all sessions of the congress 

- access to the trade exhibition 

- programme and abstract book 

- invitation to the welcome reception 

- coffee, tea and lunches during the congress 

Badges 

Upon registration you will receive a name badge. Please wear this badge 

at all times. 

Certificates and Accreditation 

A certificate of attendance will be included in your conference bag. Attendants 

will be granted15 European (CME) credits by The European 

Accreditation Council for Continuing Medical Education (EACCME). 

Congress Language 

The official language of the Congress will be English. No simultaneous 

translation will be available. 

Messages 

Messages may be left or collected at the ESPO2012 registration desk during 

opening hours. 

Coffee, Tea and Lunch Breaks 

During the planned breaks coffee, tea and lunch will be served in the 

exhibition areas. 

Cloakroom 

The cloakroom is located in the conference area of the hotel, close to 

the registration desk and will be open during the Congress registration 

hours. 

Insurance 

In registering for the ESPO2012 Congress, delegates agree that neither 

the organising committee nor the congress secretariat Congress & 

Meeting Services Holland is responsible for individual medical, travel 

or personal insurance. Delegates are requested to arrange their own insurances. 

The organisers cannot assume liability for changes in the programme 

due to external circumstances. 

© www.iamsterdam.com

© www.dreamstime.com

© Beatzone 

© Fifteen Amsterdam 

Social events 

Opening Ceremony 

Sunday 20 May 2012, 17:00 hrs 

The 11th International Congress of the European Society of Pediatric Otorhinolaryngology 

will be opened on Sunday, 20 May 2012 at 17.00 hrs with a spectacular performance by the 

children of the Amsterdam dance school ‘Beatzone’. 

After this performance, Jan Bouke Wijbrandi, executive director for UNICEF the Netherlands 

will deliver a lecture entitled “UNICEF’s approach to young child development”. 

After the opening ceremony there will be a welcome reception in NH Grand Hotel 

Krasnapolsky’s Winter Garden, which will give you the opportunity to catch up with friends 

and colleagues. 

Congress dinner 

Tuesday 22 May 2012, 18:30 hrs 

We are pleased to invite you to the ESPO2012 congress dinner on Tuesday 22 May 2012. 

After Tuesday’s last scientific session boats will depart from the dock behind NH Grand Hotel 

Krasnapolsky to take you on a scenic tour of the famous canals of Amsterdam finishing at 

Jamie Oliver’s successful restaurant ‘Fifteen Amsterdam’. 

The restaurant is located at the Jollemanhof 9, 1019 GW Amsterdam in the Amsterdam 

Docklands area. The spectacular waterfront location and great food provides the ideal setting 

for an informal buffet dinner accompanied by the jazzy tunes of DJ Alwin. At the end of the 

event buses will be available to take you back to NH Grand Hotel Krasnapolsky. 

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© www.iamsterdam.com 



Amsterdam 

Tourist Information 

With Amsterdam offering so many things to see and do, it is quite impossible to get bored in 

this city. The distinctive Amsterdam cityscape is dominated by canal houses, most of them built 

as residences for wealthy citizens. You will find 51 museums, 22 paintings by Rembrandt, and 

206 paintings by Van Gogh all within walking distance of each other. 

Amsterdam is a city that has all the advantages of a big city – culture, history, entertainment, 

good public transport – with few of the disadvantages: it is physically small, beautiful, and has 

relatively little traffic. For tourist information please visit the Concierge Desk of the NH Grand 

Hotel Krasnapolsky located in the reception area of the hotel. 

Some suggested websites: 

www.iamsterdam.com/en 

www.atcb.nl/en-home 

Shopping 

Shopping hours are 09:00 or 10:00 to 18:00 hrs (17:00 on Saturday). Shops are closed Monday mornings. 

There is late-night shopping on Thursdays until 21:00 hrs. On Sunday most shops in the 

city centre are open 12:00 to 18:00 hrs. 

For some shopping inspiration visit: 

www.21stcenturyamsterdam.com 

www.theninestreets.com 

Restaurants 

Amsterdam has over 1000 restaurants catering for the tastes, needs and budgets of everyone. 

Dining in this diverse and vibrant city can range from fast food to haute cuisine with every nation 

faithfully represented. 

For some suggestions visit: 

www.specialbite.nl 

www.iens.nl 

www.timeout.com/amsterdam 

www.amsterdamhotspots.nl

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major partners 

main partners 

sponsors & exhibitors 

• Advanced Bionics 

• Atos Medical 

• Carl Reiner 

• Elsevier 

• ESPO 2014 

• IAPO 

• GlaxoSmithKline Biologicals 

• Grupo Uriach 

• Karl Storz 

• Medtronic International Trading 

• Neurelec 

• Olympus Europa Holding 

• Oticon Medical 

• Smiths Medical Nederland 

• Synthes - Anspach

Exhibition and presentation 

Development of pediatric otolaryngology through the ages: 

Exhibition and presentation 

Within the exhibition area and during the breaks of the sessions the development in pediatric 

otolaryngology will be demonstrated. The exhibition is made possible by the support of 

Karl Storz and Med-El. At their stands the exhibition will take place: at the stand of Karl Storz 

a selection of their historic endoscopic and diagnostic instruments are exhibited as well as 

the Thosts sets for the treatment of subglottic stenosis. At the Med-El-stand different stages 

of hearing aids will be presented as well as a series of mastoid bones showing the growth of 

the ear structures form neonatal- until teenage-age. 

Between the sessions a series of slide-shows will show the changing of adenoid- and 

tonsillectomy instruments as well as changing forms of pediatric canulas. 

Exhibition 

A range of companies will exhibit their products and services. The trade exhibition is located 

in the The Winter Garden, Reflet Restaurant and Amstel Room. 

Exhibition Secretariat 

Congress Company 

Arjan Appel and Bram Huntink 

Bruistensingel 200 

P.O. Box 2428 

5202 CK 's-Hertogenbosch 


Tel: +31(0)73 7003500 

Fax: +31 (0)73 7003505 

info@congresscompany.com 

www.congresscompany.com 

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Scientific programme 

Introduction 

Invited Plenary Sessions 

The plenary sessions that will start each morning and afternoon will cover fundamental 

issues in Pediatric Otorhinolaryngology. These sessions will feature renowned speakers from 

various continents. For these invited lectures the prefix I has been used throughout the 

programme. 

Oral and Poster Presentations 

Almost 600 abstracts were submitted to ESPO2012! According to independent review by our 

Scientific Committee these papers have been scheduled as oral presentations in parallel 

sessions or as poster presentation that will be displayed electronically on 40 inch screens 

throughout the congress according to the programme. For these free papers the prefixes O 

and P have been used throughout the programme. 

Round Tables 

We have a range of round tables organised by experts addressing important topics in 

Pediatric Otorhinlaryngology. For these round tables the prefix RT has been used 

throughout the programme. 

Workshops 

Our workshops provide a unique opportunity to hear from keynote and conference speakers 

in a smaller and more intimate setting. 

For these workshops the prefix WS has been used throughout the programme. 

Corporate Sessions 

Corporate sessions have been organised by several pharmaceutical and medical technology 

companies in close collaboration with the programme committee. They are an integral part 

of the scientific programme. 

Abstract Book 

All free abstracts (oral and poster) as well as the abstracts of the invited lectures, round tables, 

workshops and corporate sessions have been arranged according to the prefixes described 

above and numbered according to their order in the session. All abstracts are referenced in 

the authors’ index. 

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Instructions for oral and poster presentations 

Oral Presentations 

The maximum duration of the free oral presentations is 10 minutes, followed by 2-3 minutes 

for some technical questions from the audience. After all presentations of the session there 

will be 15 minutes for a comprehensive discussion of all presentations. 

A laptop and beamer will be available in all meeting rooms. Please bring your presentation on 

a memory stick to the audio-visual technician in the room in which you will be presenting at 

the latest during the break before your session. Your presentation will be loaded in the 

computer. It will not be possible for presenters to use their own laptop. 

Poster Presentations 

The posters will be displayed electronically on 40 inch screens. A total of 16 screens are situated 

in the Golden Palm Bar. Please check the poster program for your poster’s timeslot and screen. 

Your poster will start up automatically. When on display, you are invited to present your 

poster to the surrounding audience. 

Poster and junior prizes 

In collaboration with the ESPO Board, the Local Organizing Committee of ESPO2012 will 

present prizes for the three best posters at the Congress. A junior prize will be awarded to 

the best paper presented by a junior participant (aged younger than 35 years). 

All posters and ‘junior’ presentations willl be judged by a jury of distinguished experts who 

will take note of both the content of the research presented, as well as the quality of the 

presentation. 

The prizes, a certificate and a cheque, will be presented to the winners during the closing 

ceremony on Wednesday May 23, 2012.

© www.iamsterdam.com

Scientific programme 

SUNDAY 20 MAY 2012 

16.00 - 17.00 CORPORATE SESSION supported by GSK 

St. John’s Room Otitis media – what has changed in the era of 

pneumococcal conjugate vaccines? 

C1.01 Burden of otitis media- perspectives of parents 

Colin Barber 

C1.02 Etiology of otitis media before and after pneumococcal 

conjugate vaccination 

Gerhard Grevers 

C1.03 Impact of pneumococcal conjugate vaccines on acute 

otitis media 

Paola Marchisio 

17.00 - 18.00 OPENING CEREMONY 

Grand Ballroom Opening by Javier Cevera, Anne Schilder & 

Hans Hoeve 

UNICEF’s approach to young child development 

by Jan Bouke Wijbrandi 

Performance by ‘Beatzone’ 

18.00 - 20.00 WELCOME RECEPTION 

Exhibition 

MONDAY 21 MAY 2012 

09.00 - 10.15 PLENARY SESSION 1 

Grand Ballroom Evidence based practice in pediatric otorhinolaryngology 

CHAIRMAN: John Graham 

MODERATOR: Rob Scholten 

Variations on a theme, too much, too little, too late? 

Martin Burton 

I1.01 Evidence-based common sense 

Rich Rosenfeld 

09.00 - 18.00 POSTER PRESENTATIONS 

Golden Palm Bar 

10.15 - 10.45 COFFEE 

10.45 - 12.00 PARALLEL SESSIONS 

10.45 - 12.00 ROUND TABLE 1 

Grand Ballroom Evidence based medicine in pediatric laryngology 

CHAIRMAN: Martin Bailey 

MODERATORS: Reza Rahbar and Mark Aarts 

Supraglottoplasty: evidence and outcome 

George Zalzal 

Management of RRP 

Craig Derkay 

Management of bilateral vocal cord paralysis 

Patrick Froehlich 

LTR vs CTR for subglottic stenosis 

David Albert 

10.45 - 12.00 LION LIVE SURGERY MEETING hosted by MED-EL 

St. John’s Room MODERATORS: Thomas Lenarz, Wilko Grolman and 

Christine Mühlöcker 

Surgery performed by Prof.dr Baumgartner, 

streamed live from Vienna, Austria. 

Demonstration of a Bonebridge live-surgery 

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10.45 - 12.00 FREE PAPER SESSION 1 

Foyer Room Innovations and new technologies in pediatric rhinology 

CHAIRMAN: Glenis Scadding 

MODERATORS: Sanjay Parikh and Wytske Fokkens 

24 

FP1.01 Endoscopic transnasal resection of pediatric skull base 

tumors – Has it come of age? 

Christos Georgalas 

O001 Long-term results of functional endoscopic sinus surgery 

in children with chronic rhinosinusitis 

M.E. Cornet 

O002 Is it really necessary to delay intranasal steroid 

treatment after fess ? An animal study 

S. Atmaca 

O003 Evaluation of the nasal airway increase induced by 

Rapid Maxillary Expansion (RME) by MRI 

C.P. Valera 

O004 Orbital and peri-orbital infections in pediatric 

population: etiology, clinical presentation, radiological 

characteristics and outcome predictors 

A.Wolfovitz 

O005 Secondary rhinosinusitis in children treated for 

craniofacial malignancies 

P. Fayoux 


Amsterdam Room Language as a medical/biological concern! 

CHAIRMAN: Robert Ruben 

MODERATORS: Mark Haggard and Ellen Gerrits 

FP2.01 Primary language development: Basic processes and 

pathology 

Frank Wijnen 

Language - a basic tenet of pediatric otolaryngology: 

A determinant of intervention and outcome 

Robert Ruben 

FP2.02 The role of low-frequency hearing in the acquisition of 

morphology in hearing impaired children 

Martine Coene 

O006 The assessment of phonemic hearing in school children 

and teenagers with hearing loss 

A. Niedzielski 

O115 Is the hearing language link really pre-dominant in the 

impact of OME ? 

J. Zirk-Sadowski 

10.45 - 12.00 WORKSHOP 1 

Seasons Room How to recognize the syndromal child 

CHAIRMAN: Rolien Free 

Instructors: Raoul Hennekam and 

Maria Bitner Glindzicz 

12.00-13.30 LUNCH 

12.15 - 13.15 CORPORATE LUNCH SESSION supported by MED-EL: 

Grand Ballroom The Bonebridge – a new era in bone conduction 

stimulation 

Introducing the world’s first active Bone Conduction Implant 

12.15 - 13.15 CORPORATE LUNCH SESSION supported by ALK-ABELLO: 

St. John’s Room Allergic diseases in childhood: a journey through 

the allergic march: Is it possible to stop the march? 


Grand Ballroom Innovations and new technologies in pediatric 

otorhinolaryngology 

CHAIRMAN: Wilko Grolman 

MODERATOR: Gerry O’Donoghue 

Surgical simulation: Towards minimal invasive management 

of the pediatric airway 


Robotic surgery and surgical navigation in pediatric otology 

Thomas Lenarz 


Grand Ballroom Cutting edge pediatric laryngology 

CHAIRMAN: Carel Verwoerd 

MODERATORS: Marin Birchall and Bernd Kremer 

Interventional radiology and the pediatric airway 

Derek Roebuck 

Creating airways from stem cells 

Martin Birchall 

O007 The management of recurrent croup in children 

S.M.Wang 

O008 Tracheostomy decannulation in children: experience at 

Great Ormond Street hospital 

J. Tweedie 

O009 Uk study of inhaled and ingested foreign bodies 

C.M.Bailey


St. John’s Room Evidence based medicine in pediatric otology 

CHAIRMAN: Michal Luntz 

MODERATORS: Adrian James and 

Peter Paul van Benthem 

O010 Analysis of tympanic and middle ear anatomy through 

multiple-wavelength light otoscopy and image processing 

C. Roehm 

O011 Differing seasonal delays of facets of OM(E) 

presentation in hospital referred cases 

S.A.Filipovic 

O012 Quality assurance for a sustained prospective 

observational study in middle ear surgery 

V.W.F.M. Van Rompaey 

O013 The management of tympanic membrane perforations 

in children 

P.J. Robinson 

O014 Myringoplasty: a Swedish quality register of 

Otorhinolaryngology 

E. Westman 

O015 Bilateral versus unilateral bone anchored hearing aids 

for children with bilateral permanent conductive hearing loss: 

a systematic review 

N.K. Chadha 

15.00 - 16.15 ROUND TABLE 2 

Amsterdam Room Comprehensive approach to the drooling and 

aspirating child 

CHAIRMAN: Yvan Vandenplas 

MODERATORS: Dana Thompson and 

Lucienne Speleman 

Drooling and swallowing dysfunction in the neurologically 

impaired child 

Sam Daniel 

Swallowing dysfunction in the non-neurologically 

impaired child 

Gresham Richter 

The role of PPIs and reflux management of swallowing 

dysfunction and aspiration 

Yvan Vandenplas 

Surgical management of the aspirating child 

Mark Gerber 


Foyer Room Head and Neck surgery 

CHAIRMAN: Colin Barber 

MODERATORS: Hamid Daya and Christian Sittel 

O016 Management of first branchial cleft anomalies 

Y. Bajaj 

O017 The Introduction of a protocol for the management of 

Paediatric Cervical Lymphadenopathy 

R. Locke 

O018 Paediatric head and neck pathology - a 10 year 

experience 

T.S. Ahmed 

O019 Educating children about choking hazards 

J.P. Ludemann 

O020 Non tuberculous mycobacterial cervicofacial adenitis: 

a 30 years retrospective review 

O. Piccin 

O021 Neonatal tracheostomies: experiences over the last 

decade at the royal manchester children's hospital 

S. Alvi 

15.00 - 16.15 WORKSHOP 2 

Seasons Room Temporal bone imaging – what the radiologist and 

surgeon should tell each other 

CHAIRMAN: Vedat Topsakal 

Instructors: Jan Casselman & Erwin Offeciers 

16.15 - 16.45 TEA 

WS2.01 Temporal bone imaging – what the radiologist and 

surgeon tell each other 

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Grand Ballroom URTI, the evidence! 

CHAIRMAN: Ann Hermansson 

MODERATORS: Peter Morris and Niels van Heerbeek 

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O022 Different antibiotic treatments for group A streptococcal 

pharyngitis - a meta-analysis 

M.L. van Driel 

O023 Effectiveness of adenoidectomy in children with 

recurrent upper respiratory tract infections: open randomised 

controlled trial 

M.T.A. van den Aardweg 

O024 Tonsillectomy for periodic fever, aphthous stomatitis, 

pharyngitis and cervical adenitis syndrome (PFAPA) 

D. Ramsden 

O025 Posttonsillectomy haemorrhage rates related to surgical 

technique 

A.C. Hessén Söderman 

O026 Presentation of large datavolumes with the 

valuecompasses - a qualitive method 

J. Stalfors 

O117 Ome; aiming the right therapy at the right patient 

J.A. De Ru 

16.45 - 18.00 ROUND TABLE 3 

St. John’s Room Evidence based cochlear implantation at the edge … 

of an envelope? 

CHAIRMAN: Manuel Manrique 

MODERATORS: Blake Papsin and Rolien Free 

Hearing preservation in cochlear implantation in children 

and possibilities in single sided deafness 

Anke Lesinski 

RT3.01 Steroids and neurotrophins for protecting the inner 

ear during cochlear implantation – experimental and 

clinical studies 

Stephen O’Leary 

Cochlear implantation in cochlear malformations and when 

to use ABI 

Levent Sennaroglu 

Inflammatory response of the cochlea 

Keiko Hirose 

16.45 - 18.00 ROUND TABLE 4 

Amsterdam Room Pediatric Anesthesia: Is there teamwork in the 

air(way)? 

CHAIRMAN: Andy Inglis 

MODERATORS: Markus Weiss and Bouwe Molenbuur 

Red flags in pediatric anesthesia, sharing the airway 

Andreas Machotta 

Can intubate, cannot ventilate 

Elly Vermeulen 

O027 Prehospital endotracheal cuff pressure as risk factor for 

iatrogenic tracheal stenosis 

J.M.Th. Draaisma 

16.45-18.00 FREE PAPER SESSION 7 

Foyer Room Balance and vertigo: An overlooked problem in pediatric 


CHAIRMAN: Margaretha Casselbrant 

MODERATORS: Sharon Cushing and Leen Maes 

Pediatric balance disorders: Prevalence and the spectrum 

of disease 

Robert O’Reilly 

Vestibular evaluation in young children: Important points and 

recent advances 

Sylvette Wiener-Vacher 

O028 Learning postural control in children - Plasticity or 

exploratory learning? 

F. Tjernström 

O029 The influence of a vestibular dysfunction on the motor 

development of deaf and hard of hearing children 

P.T. De Kegel 

O031 Pediatric vestibular and balance disorders: risk factors 

and causes from 300+ pediatric patients 

J.R. Levi 

O030 Effects of cochlear implantation on vestibular function 

N. Loundon


Seasons Room OSA and tonsillectomy in children 

CHAIRMAN: Harvey Coates 

MODERATORS: Anne-Laure Mansbach and 

Khalid Al Mazou 

O032 The natural course of osa in children with syndromic 

craniosynostosis 

C. Driessen 

O033 Drug-induced sleep endoscopy for upper airway 

evaluation in children with down syndrome 

M. Maris 

O034 A patient questionnaire can give valid information on 

the prescence of morbidity after tonsillar surgery - results of a 

validation study 

C. Hemlin 

O035 Systematic review of randomized controlled trials 

comparing intracapsular tonsillectomy with total 

tonsillectomy in a pediatric population 

J. Walton 

O036 Changing trends of tonsillectomy for obstructive 

sleep apnoea 

A. Zaman 

O037 Pediatric tonsillotomy; a comparison of high- and low 

radiofrequency techniques with regard to postoperative 

bleeding, pain, infection and symptom relief 

O. Sunnergren 

TUESDAY 22 MAY 2012 



07.45 - 08.45 WORKSHOP 3 

Grand Ballroom Handling the patient load in different societies 

CHAIRMAN: Anne Schilder 

INSTRUCTOR: Seth Pransky 

WS3.01 Can computer aided patient flow management deal 

with chaos in the understaffed clinic? 

Ari Derowe 

WS3.02 Effective use of the extended working day to maximise 

capacity in the UK National Health Service 

Michael Kuo 

WS3.03 Integrating non-physician providers into complex 

pediatric otolaryngology care 

Steve Handler 

07.45 - 08.45 WORKSHOP 4 

St. John’s Room Imaging the pediatric airway 

CHAIRMAN: Astrid König 

INSTRUCTOR: Ben Hartley and Alistair Calder 

O038 Role of Cone-beam-CT in pediatric-ENT diagnostics 

C. Güldner 

07.45 - 08.45 WORKSHOP 5 

Amsterdam Nasal obstruction in the newborn and infant 

CHAIRMAN: Lucienne Speleman 

INSTRUCTOR: Jean Michel Triglia and Bob Ward 

Newborn nasal obstruction: Symptoms, evaluation and 

treatment 

Karin Oomen 

Numerical modeling: New tool in nasal obstruction 

management in children 

Richard Nicollas 

Congenital piriform aperture stenosis: Diagnosis, evaluation, 

timing of surgery 

Bob Ward 

Choanal atresia: Towards an individualized treatment? 

Max April 

Zebras in the infant nose: Unusual cases of nasal obstruction 

Jean Michel Triglia 


Foyer Room Developments in cochlear implantation in children 

CHAIRMAN: Henryk Skarzynski 

MODERATORS: Nathalie Loundon and Iain Bruce 

O039 Evidence supporting simultaneous bilateral cochlear 

implantation in children 

A. Gordon 

O040 Cochlear implantation in syndromic children - 

the great ormond street hospital experience 

Y. Bajaj 

O041 Cochlear reimplantation in pediatric population 

N. Loundon 

O042 Distribution of cochlear duct lengths and electrode choice 

C. Jolly 

O043 Fine structure processing and music perception: 

Implications for pediatric cochlear implantation 

D.R. Friedland 

O044 Sound caterpillar - assessment and training of sound 

and music perception skills in hearing impaired children 

L. De Bruyn 

27


07.45 - 08.45 WORKSHOP 6 

Seasons Room Non-accidental injuries in children 

CHAIRMAN: Elzbieta Hassmann-Pozanska 

Instructors: Ad Bosschaart and 

Thea van Zeben-van der Aa 

28 

WS6.01 Child abuse and ENT 

A. Hermansson 


Grand Ballroom Research ethics and conflict of interest 

CHAIRMAN: Kari Kvaerner 

MODERATOR: Chris Raine 

10.15 - 10.45 COFFEE 

I3.01 The ethical imperative of good reporting of research 

Doug Altman 

Management of conflict of interest, a Board Room perspective 

Frank Miedema 

10.45 - 12.00 PARALLEL SESSIONS 

10.45 - 12.00 ROUND TABLE 5 

Grand Ballroom Conductive hearing loss in children: when do 

implantable devices come in? 

CHAIRMAN: Milan Profant 

MODERATORS: Michael Rothera and 

Emmanuel Mylanus 

Etiology pediatric of conductive hearing impairment; 

surgical aspects? 

Hans Thomeer 

RT5.01 Management of congenital atresia & active middle 

ear implants 

Henning Frenzel 

Management of conductive hearing loss with bone 

conduction devices in children 

Michael Rothera 

Management of congenital oval window pathologies, 

where is the limit to reconstructive surgery? 

Levent Sennaroglu 

Transcutaneous bone conduction revisited 

Myrthe Hol 


St. John’s Room Mucosal immunology and microbiology in otitis media 

CHAIRMAN: Noboru Yamanaka 

MODERATORS: Marie Gisselsson Solén and Debby Bogaert 

O045 Alternative sampling methods for detecting bacterial 

pathogens in children with an upper respiratory tract infection: 

revisiting the gold standard 

M.R. van den Bergh 

O046 Modulated lipooligo-saccharide structure prevents nontypeable 

haemophilus influenzae from igm-mediated 

complement killing during otitis media 

J.D. Langereis 

O047 Otitis media in new zealand: middle ear microbiology 

and nasopharyngeal carriage in a 3+1 conjugated 

pneumococcal vaccinated cohort 

N.A. Mills 

O048 Minimal biofilm eradication concentration of 

antimicrobial agents against Haemophilus influenzae 

isolated from acute otitis media 

S. Takei 

` O049 Immunologic findings in young children with early 

onset of acute otitis media 

K. Gisselsson Solén 


Amsterdam Room Cleft palate & 22q11.2 deletion syndrome 

CHAIRMAN: Jetty Verwoerd-Verhoef 

MODERATORS: Gabor Katona and Ronald Admiraal 

O050 Head and Neck Manifestations of 22q11.2 Deletion 

Syndromes 

T. Marom 

O051 Incidence of otitis media with effusion and its sequelae in 

cleft palate children at different age groups 

Z. Csakanyi 

O052 In search of the optimal surgical treatment for 

velopharyngeal dysfunction in 22q11.2 deletion syndrome: 


N.E. Spruijt 

O053 Dysphonia in a Cleft population. Associations with 

Cleft type, Velo-Pharyngeal dysfunction and socio-economic 

deprivation 

D. Wynne 

O054 Pure phase β-Tricalcium Phosphate as a bone substitute 

for alveolar cleft closure: A pilot study 

N.G. Janssen


Foyer Room Progress in otitis media with effusion 

CHAIRMAN: Pekka Karma 

MODERATORS: George Spratley and 

Michal Grzegorowski 

O057 Susceptibility to chronic otitis media with effusion is 

associated with polymorphism at the loci fbxo11 and smad2 

M.F. Bhutta 

O056 Forced response test age 3 and 4 years in children with 

recurrent Otitis Media or chronic Otitis Media with effusion 

M. Casselbrant 

O059 Two separate paths to parent quality of life in persistent 

otitis media with effusion (OME) 

M. Haggard 

O055 Antibiotics for otitis media with effusion in children: 

a Cochrane systematic review 

A. van Zon 

O058 Comparison between microdebrider endoscopic-assisted 

adenoidectomy and traditional adenoidectomy in the 

management of otitis media with effusion in children 

G.A. Marciante 

O060 Influence of current and future ventilation tube design 

on the magnitude of stress imposed at the implant / tympanic 

membrane interface 

D. Fitzgerald 

10.45 - 12.00 WORKSHOP 7 

Seasons Room Laryngeal cleft 

CHAIRMAN: Bas Pullens 

INSTRUCTORS: Reza Rahbar and Noel Garabédian 

12.00 - 13.30 LUNCH 

12.15 - 13.15 CORPORATE LUNCH SESSION supported by ARTHROCARE: 

Grand Ballroom Coblation: Diagnosis and treatment of obstructive sleep apnea 

12.15 - 13.15 CORPORATE LUNCH SESSION supported by COCHLEAR: 

St. John’s Room Performance. And more. 


Grand Ballroom Curative therapy of deafness: The road ahead 

CHAIRMAN: Cor Cremers 

MODERATOR: Françoise Denoyelle 

I4.01 Curative therapy of deafness: The road ahead 

Christine Petit 

Sensitive periods for therapy of deafness 

Andrej Kral 

15.00 - 16.15 ROUND TABLE 6 

Grand Ballroom Open versus closed surgery for laryngotracheal stenosis. 

Experience, evidence, guidelines? 

CHAIRMAN: Noel Garabédian 

MODERATORS: John Russel and Hans Hoeve 

O061 Paediatric laryngotracheal reconstruction : Great 

Ormond Street experience 

Y. Bajaj 

O062 Balloon dilatation of the paediatric airway: the Great 

Ormond Street experience 

C.E. Rennie 

A multi-institutional experience for endoscopic posterior 

cricoid grafting in 25 children 

Vikash Modi 

Building towards an algorithm for laryngotracheal 

reconstruction 

Alan Cheng 

Much experience, but how much evidence? 

Reza Rahbar, Mike Rutter and Philippe Monnier 

15.00 - 16.15 OTOLOGIC LIVE SURGERY BY LION 

St. John’s Room MODERATORS: Thomas Lenarz and Wilko Grolman 

Surgery performed by one of the experienced 

surgeons from MHH, Hannover, Germany. 

The surgical procedure will be a cochlear 

implantation using the C422 device by Cochlear. 

15.00 - 16.15 ROUND TABLE 7 

Amsterdam Room Down syndrome: a challenge for the ENT surgeon 

CHAIRMAN: Patrick Sheehan 

MODERATORS: Sally Shott & An Boudewyns 

Diagnosis and treatment of hearing loss in Down Syndrome 

Ad Snik 

Upper airway infections in Down syndrome 

Marceline van Furth 

Sleep-disordered breathing in Down syndrome 

Sally Shott 

O067 Sleep problems in children with Down syndrome 

M. Maris 

29



Foyer Room Genetics of deafness: From research to improved 

diagnostics and clinical care 

CHAIRMAN: Alessandro Martini 

MODERATORS: Guy Van Camp and Dirk Kunst 

30 

FP13.01 Genetics of deafness: From research to improved 


Guy Van Camp and Dirk Kunst 

FP13.02 Clinical otogenetics:from research to improved 

clinical care 

Nicole Weegerink 

O063 External ear anomalies and hearing impairment in 

Noonan Syndrome 

D.C. van Trier 

O064 Audiologic and genetic determination of hearing loss in 

osteogenesis imperfecta 

F. Swinnen 

O065 High prevalence of inner ear and/or internal auditory 

canal anomalies in pediatric unilateral hearing loss 

S. Masuda 

O066 Genotype phenotype correlation in usher syndrome 

S. Marlin 


Seasons Room Complementary and integrative medicine in pediatric 


CHAIRMAN: Tania Sih 

MODERATORS: Paola Marchisio and Ines von Rosenstiel 

16.15 - 16.45 TEA 

O068 Evidence based complimentary and alternative medicine 

for Otitis Media 

J.R. Levi 

O069 Hypertonic saline is better than normal saline for 

seasonal allergic rhinitis in children 

S. Bianchini 

O070 Complementary and integrative therapies in acute 

and chronic inflammatory processes of the nose and paranasal 

sinuses 

L.M. Bellussi 

O071 Use of complementary alternative medicine in pediatric 

otolaryngology patients 

R. Cohen-Kerem 

O072 Treatment of acute rhinosinusitis with a herbal product: 

evidence has been reached 

M. Popp 

16.45 - 18.00 ROUND TABLE 8 

Grand Ballroom Pierre Robin sequence: to distract or not to distract? 

CHAIRMAN: Peter Bull 

MODERATORS: Michelle Wyatt and Irene Mathijssen 

RT8.01 How badly is the airway obstructed in Pierre Robin 

sequence? 

Koen Joosten 

RT8.01 How retrognathic and glossoptotic is the Pierre Robin 

patient? 

Eppo Wolvius 

O073 Airway management in pierre robin patients using 

nasopharyngeal airway 

Y. Bajaj 

O074 Pierre Robin syndrome: comparison between 

tracheotomy and noninvasive ventilation 

V. Couloigner 

RT8.02 Diagnosis and treatment of Pierre Robin sequence 

Corstiaan Breugem 


St. John’s Room Universal neonatal hearing screening: Meeting the goals 

CHAIRMAN: Antonio Della Volpe 

MODERATORS: Adrian Davis and Ingeborg Dhooge 

O076 The impact of universal neonatal hearing screening 

on the timing of cochlear implantation in children with 

congenital hearing loss 

M. Elloy 

O078 Yield of medical investigations of babies with 

permanent unilateral deafness identified via newborn hearing 

screening 

S.A.B. Ratnayake 

O079 ABR morphology and analysis in very preterm NICU 

infants 

S. Coenraad 

O075 Screening for delayed-onset hearing loss in preschool 

children who previously passed the newborn hearing screening 

L.V. Jingrong 

O077 Audiological and vestibular findings in congenital 

cytomegalovirus infection: Results of a prospective 

cohort study 

J. Goderis

16.45 - 18.00 ROUND TABLE 9 

Amsterdam Room Effective teaching in pediatric otorhinolaryngology 

CHAIRMAN: Seth Pransky 

MODERATORS: Umut Akyol and Jochen Bretschneider 

Aspects of medical education in 2012 – An experienced based 

approach 

Jochen Bretschneider 

O080 Educating Tomorrow's GPs - A workbook on paediatric 

otolaryngology for general practitioners 

M.M.C. Yaneza 

O081 Registrar paediatric bronchoscopy experience 

M. Saunders 

RT9.01 Using medical simulation to teach decision making 

and teamwork in the operating room 

Mark Volk 

Pan-European assessment of specialist education by 

e-platform, UEMS experience can be used as an effective tool 

to harmonize pediatric ORL training 

Umut Akyol 


Foyer Room Surgery in conductive hearing loss 

CHAIRMAN: Erwin Offeciers 

MODERATORS: Marc Pellicer and Thomas Nikolopoulos 

O082 VSB in conductive hearing loss management in 

aural atresia 

M. Profant 

O083 Active middle ear implant Vibrant Soundbridge in 

high frequency sensorineural hearing loss 

K. Boeheim 

O086 The Vibrant Soundbridge for the treatment of mixed 

and conductive hearing losses in children 

A. Wolf-Magele 

O084 Bonebridge: Results from a clinical investigation 

with a new active bone conduction implant 

A.L. Hinze 

O085 Resonance frequency analysis of osseo-integrated 

implants for bone conduction in a paediatric population - 

a novel approach for assessing stability 

C. McLarnon 

O087 Congenital minor ear anomalies. Outcomes of surgery 

and some syndromal aspects 

. H.G.X.M. Thomeer 

16.45 - 18.00 WORKSHOP 8 

Seasons Room Improving clinical decision making - What do you do 

in OME? 

CHAIRMAN: Karin Oomen 

INSTRUCTORS: Geert van der Heijden and David Albert 

Introduction of the challenge for clinicians 

David Albert 

Expert view on decision making from an epidemiologist 

Geert van der Heijden 

O088 Regional and local variation of ventilation tube 

insertion in England: a quantitative analysis 

N. Bohm 

Scenarios in OME and LTR 

Marianne Elloy 

Implementation of guidelines 

Mark Haggard 

WEDNESDAY 23 MAY 2012 



07.45 - 08.45 WORKSHOP 9 

Grand Ballroom Dutch Flemish Working Group of Pediatric 

Otorhinolaryngology (NVWPO) 

Decision-making in pediatric airway treatment. 

Case discussions 


INSTRUCTOR: Frans Gordts 

Dana Thompson 

Noel Garabédian 

Philippe Monnier 

07.45 - 08.45 WORKSHOP 10 

St. John’s Room How to write a systematic review? 

CHAIRMAN: Laura Meltzer 

INSTRUCTORS: Maroeska Rovers and Martin Burton 

31



Amsterdam Room Pediatric otology 

CHAIRMAN: Richard Kuylenstierna 

MODERATORS: Zsolt Farkas and Michel Mondain 

32 

O090 VIIIth Nerve anomalies and congenital deafness 

N. Loundon 

O089 Unilateral auditory neuropathy spectrum disorder in 

children 

A.L. Mansbach 

O092 Impact of middle ear effusion on Auditory Brainstem 

Response (ABR) threshold in neonates tested during 

natural sleep 

I.M.P. Schatteman 

O094 Auditory maturation in premature infants, a potential 

pitfall for early cochlear implantation 

J.R. Hof 

O091 Outcome of cochlear implantation in asymptomatic 

congenital Cytomegalovirus deafened children 

V. Malik 

O093 Bilingual rehabilitation strategy in cochlear implanted 

non native Italians 

N. Nassif 


Foyer Room Challinging issues in pediatic otorhinolaryngology 

CHAIRMAN: Craig Derkay 

MODERATORS: Palma Benedek and Els De Leenheer 

O095 Dog bites to the head and neck in children- an 

increasing problem in the UK 

G. Narasimhan 

O096 Non accidental injury should be considered in children 

presenting with oropharyngeal injuries 

G. Odoch 

O097 Osas in Down children: Comparison of 

rhino-pharingo-laryngeal fibroscopic findings and 

polysomnography results 

M. Romagnoli 

O098 Hearing impairment in children with Stickler syndrome: 

review of phenotype and correlation with genotype 

F. Acke 

O099 DFNA54: Candidate gene analysis through sequence 

capture and next-generation-sequencing 

N. Gürtler 

07.45 - 08.45 WORKSHOP 11 

Seasons Room Intubating the difficult airway with laryngeal mask and 

flexible bronchoscope 

CHAIRMAN: George Thomas 

INSTRUCTORS: Hans Hoeve and Andreas Machotta 


Grand Ballroom Guidelines and patient participation 

CHAIRMAN: Anne Pitkaranta 

MODERATOR: Hendrik Verschuur 

10.15-10.45 COFFEE 

I5.01 Patient participation: Who’s life is it anyway? 

Lester Firkins 

I5.02 Professionals and patients as partners in guidelines 

Jako Burgers 


Grand Ballroom Guidelines in upper respiratory tract infections and 

otitis media 

CHAIRMAN: Javier Cervera 

MODERATORS: Rich Rosenfeld and Jet van den Akker 

O105 Treatment of acute otitis media - new Swedish 

guidelines from 2010 

K. Gisselsson Solén 

O104 Have National Institute for Clinical Excellence 

guidelines on management of Otitis Media with Effusion 

changed practice? 

M. Daniel 

O106 Patterns of internet use by parents of children 

attending a paediatric otolaryngology service 

R.W. Glynn 

O107 Patient Reported Outcome Measures (PROM) after 

tonsillectomy performed in patients with obstructive 

respiratory problems 

M. Bogaerts 

O116 Good agreement between parents and physician in 

the assessment of ear discharge in children 

T.M.A. van Dongen 

FP20.01 Otitis Media guidelines: concepts and controversies 

Rich Rosenfeld

10.45 - 12.00 ROUND TABLE 10 

St. John’s Room The atelectatic ear: surveillance, ventilation tubes 

or surgery? 

CHAIRMAN: Gabor Katona 

MODERATORS: Françoise Denoyelle and Rinze Tange 

PANEL: Keiko Hirose, Gabor Katona, Adrian James, 

Yukiko Iino and Patrick Froehlich 

Minimally invasive middle ear surgery 


Tympanic membrane reinforcement 

Françoise Denoyelle 

O102 Analysis of gene expression profiles in tympanic 

membrane following perforation using cDNA microarrays 

E.K. Hassmann-Poznanska 

O103 Tympanic membrane retraction pockets 

M. Graziadio 


Amsterdam Room Vascular and lymphatic malformations of the head 

and neck 

CHAIRMAN: Ben Hartley 

MODERATORS: Jonathan Perkins and 


Management of lymphatic malformations of the head and 

neck in children 

Ben Hartley 

How basic science understanding of LM and lymphatics have 

changed my approach and others to LM treatment 

Jonathan Perkins 

O100 Surgical excision as primary treatment for paediatric 

lymphatic malformations 

Y. Bajaj 

O101 Treatment of infantile Hemangiomas with Atenolol or 

Propranolol: Cohort Study with historical control group 

M.F. Raphael 


Foyer Room Airway: an update 

CHAIRMAN: Sergio Bottero 

MODERATORS: Robert Black and Gavin Morrison 

O108 Histological structure and development of tracheal pars 

membranacea in human 

G. Hosana 

O109 The presentation and diagnosis of laryngomalacia in 

children aged over two years 

J. Lawrence 

O112 The misuse of radiography in diagnosis of pediatric 

airway foreign bodies 

L.A. Makoshi 

O111 Supraglottic obstruction: A new operation for prolapse 

of the epiglottis 

K. Amonoo-Kuofi 

O113 Bronchoscopic assisted recurrent congenital 

tracheoesophageal fistula repair 

E. Reindorp-Kfir 

O110 Prevention of Airway Fires: Endotracheal tubes and 

surgical devices 

L.P. Smith 

10.45 - 12.00 ROUND TABLE 11 

Seasons Room Pediatric otorhinolaryngology in the developing world 

CHAIRMAN: Jan Grote 

MODERATORS: Hans Borgstein 

Rupa Vedantam 

Wakisa Mulwafi 

Diego Santana 

O114 High rate of hearing loss in Angolan children with 

sickle-cell disease 

A.Taipale 

12.00 - 12.30 CLOSING CEREMONY 

Grand Ballroom 

12.30 - 13.00 LUNCH 

33

09:00 – 09:45 

09:45 – 10:30 

10:30 – 11:15 

11:15 – 12:00 

12:00 – 12:45 

12:45 – 13:30 

13:30 – 14:15 

14:15 – 15:00 

15:00 – 15:45 

15:45 – 16:30 

16:30 – 17:15 

17:15 – 18:00 

34 

Poster programme 

A total of 16 screens are situated at the Golden Palm Bar which will display the various posters. 

Each poster has a timeslot of 45 minutes in which it will automatically be displayed. Please 

view the timetable below. The timeslots are noted to the left for each day separately. Different 

areas of interest have been given different colours (e.g. green for otology, blue for laryngology 

and head & neck surgery). These are divided further in different topics within their field (e.g. 

evidence based medicine in otology, innovations in laryngology) to further suit your interests. 

On the right side of the timetable, it shows which poster (P number) is shown on which screen 

(screen nr). The abstracts for the posters are found in this abstract book. The poster abstracts 

are marker with a P number (P001, P002, etc.). 


Laryngology and Head and Neck Surgery 

Otology 

Rhinology and Upper Respiratory Tract Infections 

Other 


Evidence-based medicine in pediatric otology 

(incl. otitis media and cholesteatoma) 



Craniofacial malformations 


Pediatric anesthesiology 

Evidence-based medicine in pediatric laryngology and head and neck surgery 

Neonatal hearing screening 

Cleft palate and 2q11.2 deletion syndrome 

Innovations and new technologies in pediatric rhinology 

Complementary and integrative medicine in pediatric otorhinolaryngology 

Effective teaching in pediatric otorhinolaryngology 

Evidence-based medicine in upper respiratory tract infections 

(incl. tonsil and adenoid disease) 

Evidence-based medicine in upper respiratory tract infections 

(incl. tonsil and adenoid disease) 

Evidence-based medicine in pediatric laryngology and head and neck surgery 

Innovations and new technologies in pediatric laryngology and head and 

neck surgery 


neck surgery 

Screen 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 

P001 P002 P003 P004 P005 P006 P007 P008 P009 P010 P011 P012 P013 P014 

P015 P016 P017 P018 P019 P020 P021 P022 P023 P024 P025 P026 P027 

P028 P029 P030 P031 P032 P033 P034 P035 P036 P037 P038 P039 P040 P041 P042 P043 

P044 P045 P046 P047 P048 P413 

P050 P051 P052 P053 P054 P055 P056 P057 P058 P059 



P092 P093 P094 P095 P096 

P097 P098 P099 P100 P101 P102 P103 P104 

P105 P107 P108 P109 P110 P111 P112 P113 P114 P115 P116 

P117 P118 P119 



P152 P153 P154 P155 P156 P157 P158 P159 P160 

P161 P162 P163 P164 P165 P166 P167 

P168 P169 P170 P171 P172 P173 P174 P175 P176 P177 P178 P179 P180 P181 P182 P183


08:15 – 09:00 

09:00 – 09:45 

09:45 – 10:30 

10:30 – 11:15 

11:15 – 12:00 

12:00 – 12:45 

12:45 – 13:30 

13:30 – 14:15 

14:15 – 15:00 

15:00 – 15:45 

15:45 – 16:30 

16:30 – 17:15 

17:15 – 18:00 


08:15 – 09:00 

09:00 – 09:45 

09:45- 10:30 

10:30 – 11:15 

11:15 – 12:00 






Implantable devices in conductive hearing loss 

Innovations and new technologies in sensorineural hearing loss 

(incl. cochlear implantation) 

Pediatric otorhinolaryngology in the developing world 





Open versus closed surgery for laryngotracheal stenosis 

Laryngeal cleft 

Feeding and swallowing 

Guidelines and patient participation 

Cystic fibrosis and primary ciliary dyskinesia 

Evidence-based medicine in pediatric rhinology 

Guidelines in upper respiratory tract infections 


Nasal obstruction in newborns and Infants 


neck surgery 

Vascular and lymphatic malformations of the head and neck 

NO POSTERS 


Nasal obstruction in newborns and Infants 

Otogenetics 

Curative therapy of deafness 

Balance 

Speech and language and auditory processing disorders 

Implantable devices in conductive hearing loss 

Atelectasis and retraction pockets 


Conflict of interest in research and publishing 

Down syndrome 

Pediatric otorhinolaryngology in the developing world 

Neonatal hearing screening 



Screen 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 

P184 P185 P186 P187 P188 P189 P190 P191 P192 P193 P194 P195 P196 P197 P198 

P199 P200 P201P P202 P203 P204 P205 P206 P207 P208 P209 P210 P211 P212 P213 


P229 P230 P231 P232 P233 P234 P235 P236 P237 P238 P239 P240 P241 P242 




P291 P292 P292 P294 P295 P296 P297 P298 P299 P300 P301 

P302 P303 P304 P305 P443 

P306 P307 P308 P309 P310 P311 P312 P313 

P314 P316 P093 P317 P318 P319 P320 

P321 P322 P323 

P324 P325 P326 P327 P328 P329 P330 P331 P332 P333 P334 P335 

P336 P337 P338 P339 P340 P341 P342 

P343 P344 P345 P346 P347 P348 

P349 P350 P351 

P352 P353 P354 P355 

P356 P357 P358 P359 P360 P361 P362 P363 P364 P365 

Screen 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 


P381 P382 P383 P384 P385 P386 P387 P388 P389 P390 

P391 P392 P393 P394 P395 

P396 

P397 P398 P399 P400 P401 P402 P403 

P404 P405 P406 P407 

P408 P409 P410 

P411 P412 P049 

P414 P415 

P416 P417 P418 P420 

P421 P422 P423 P424 P425 P426 

P427 P428 P429 P430 P431 

P432 P433 P434 P435 P436 P437 P438 P439 P440 P441 P442 

35

PLENARY SESSION 1 

I 1.01 

EVIDENCE-BASED COMMON SENSE 

Richard Rosenfeld 

SUNY Downstate Medical Center, BROOKLYN, USA 

E-MAIL: richrosenfeld@ag.e2.exmx.net 

William Osler once observed “Common sense in medical matters is rare, 

and is usually in inverse ratio to the degree of education”. Perhaps anticipating 

the modern era of guidelines, systematic reviews, and comparative 

effectiveness research, Osler knew that a healthy dose of old-fashioned 

common sense would always be needed to temper the delusory certainty 

that springs from a slavish devotion to ‘evidence’. In that spirit, this talk 

pokes fun at some of the seductions of evidence worship and pays homage 

to the Osler’s appreciation of common sense. Concepts that will be emphasized 

include avoiding harm, defining benefits honestly, creating a 

placebo response, and tempering evidence with judgment. The talk concludes 

with a suggested paradigm for incorporating uncertainty and common 

sense into medical decision making. 


NEW DEVELOPMENTS IN TELEMEDICINE 

Prof. Dr. Wilko Grolman 

UMC Utrecht, UTRECHT, The Netherlands 

E-MAIL: W.grolman@umcutrecht.nl and www.lion-web.org 

During the presentation new telemedicine for education and CME like 

the LION project are discussed. The LION project is a project that was initiated 

by a group of leading ENT surgeons in Europe to push the concept 

of distant medical education. Also the concept of telemedice a la carte will 

be explained. 

40 

plenary sessions 


I 3.01 

THE ETHICAL IMPERATIVE OF GOOD REPORTING 

OF RESEARCH 

Doug Altman 

Centre for Statistics in Medicine, University of Oxford, United Kingdom 

E-MAIL: doug.altman@csm.ox.ac.uk 

Research related to the health of humans should have the potential to advance 

scientific understanding or improve the treatment or prevention of 

disease. However, for many research studies no results are ever published, 

so that nobody can benefit from that research. Further, when researchers 

do publish the results of their studies those reports often lack critical information 

that diminishes or even nullifies any scientific value. 

Authors should describe transparently what they did and what was found. 

Published guidelines for reporting completed research studies, such as 

CONSORT for reporting randomized trials, provide clear guidance for various 

types of research. But the general quality of reporting in medical journals 

remains disappointingly poor. 

Assessing the reliability of published articles is seriously impeded by inadequate 

reporting. Clinicians cannot judge whether to use a treatment 

and the data cannot be included in a systematic review. Bad reporting thus 

has serious consequences for clinical practice, research, policy making, and 

ultimately for patients. 

The current situation is unacceptable – I will consider how we might do 

better.


I 4.01 

COCHLEAR THERAPY OF DEAFNESS: THE ROAD AHEAD 

Christine Petit 

College de France, Unité de Génétique et Physiologie de l’Audition, 

PARIS, France 

E-MAIL: christine.petit@pasteur.fr 

At the beginning of the 1990’s, nearly from scratch, the molecular bases of 

sensorineural forms of deafness started to be clarified. As a result, nowadays, 

evidence has been provided of the involvement of more than 140 loci 

in early-onset forms of isolated deafness. Sixty-eight of the corresponding 

genes have been identified. These forms are monogenic disorders. Owing 

to the generation of mouse models for the various early-onset forms, the 

pathogenesis of most of them have now been elucidated and allowed to 

classify them into four categories: pure mechanical defects, ionic homeostasis 

defects, hair cell synaptic defects and hair bundle defects. The latter 

is the largest class. Moreover, thanks to multidisciplinary approaches to 

investigate these mouse models in depth, this genetic approach not only 

gave impetus to the molecular physiology of the cochlea but also led to 

new insights into the development and functioning of the cochlea. On the 

basis of the knowledge of the pathogenicity of the various forms, a proper 

framework of relevant therapeutic approaches can now be established. As 

an immediate consequence, for some of these forms of deafness, the potential 

indication for cochlear implantation can be revisited, i.e. for some 

auditory neuropathies. In parallel, restoration of hearing by using celland 

gene-based therapy is under development. Promising results have recently 

been obtained by using gene transfer. I will discuss the mulifacets 

of gene therapy that, if successful, may dramatically modify our ability to 

treat the various forms of deafness. 


I 5.01 

PATIENT PARTICIPATION - WHO’S LIFE IS IT ANYWAY 

Lester Firkins 

E-MAIL: lesterfirkins@mac.com 

Lester Firkins will be sharing his straightforward views on the merits and 

simplicity of Patient participation from a lay point of view. 

Lester is Chair of the James Lind Alliance, Strategy and Development Group 

and his presentation will include an explanation of the process which enables 

Clinicians and Patients to work together. 

Lester was also Co-Chair of a high profile MRC Clinical Trial into Prion 

Disease (with Sir Iain Chalmers) and was awarded an OBE in this years Honours 

list. 

I 5.02 

PROFESSIONALS AND PATIENTS AS PARTNERS IN 

GUIDELINES 

Jako Burgers 

Dutch College of General Practitioners (NHG), Head department 

Guideline Development & Research, UTRECHT, The Netherlands 

E-MAIL: J.Burgers@nhg.org 

Clinical practice guidelines are defined as statements that include recommendations 

intended to optimize patient care that are informed by a systematic 

review of evidence and an assessment of the benefits and harms 

of alternative care options. The guideline development process follows the 

principles and practice of evidence-based medicine, integrating clinical 

expertise and patient values with the best available research evidence. For 

developing high quality guidelines, all relevant professional groups should 

be involved, and views and preferences from the target patient population 

should be sought. Involvement of patients or their representatives is particularly 

useful in the scoping phase and in the process of formulating recommendations, 

which includes considered judgment of patient views and 

preferences. The final guideline should assist professionals and patient in 

shared decision making, assuming mutual respect and partnership. In 

this presentation, I will discuss the similarities and differences between 

guideline development and individual patient care, illustrated with examples 

derived from 20 year guideline experience. 

41

ROUND TABLE 3 

Evidence based cochlear implantation at the edge of the knowledge 

envelope - new frontiers in cochlear implantation in children 

During this round table session four keynote speakers will present on the 

new frontiers in cochlear implantation in children and discuss future developments 

in this field. 

Dr. Keiko Hirose, Washington University, USA, will lecture on the inflammatory 

responses of the cochlea and on possibilities for healing of the intracochlear 

inflammation. Is soft surgery atraumatic at all? And how does 

the electric stimulation affect the intracochlear tissue in the long run? 

Which effects will repeated cochlear implantation have on the cochlea? 

Professor Stephan O’Leary, ENT surgeon, Melbourne University, Australia, 

will continue with possibilities for cytoprotection, the use of intratympanic 

medication and the use of neurotrophic medication for protection 

of inner ear. 

Professor dr. Anke Lesinski -Schiedat, ENT surgeon Hannover University, 

Germany, shall present on hearing preservation in cochlear implantation 

in children and possibilities in single sided deafness. 

Dr. Levent Sennaroglu, Ankara University, Turkey, will present on his experiences 

with cochlear implantation in cochlear malformations, which 

electrodes to choose in which anomaly and when to use ABI. 

RT 3.01 

STEROIDS AND NEUROTROPHINS FOR PROTECTING THE 

INNER EAR DURING COCHLEAR IMPLANTATION – 

EXPERIMENTAL AND CLINICAL STUDIES 

Stephen O’Leary, Hayden Eastwood 1 , Joanne Enticott 1 , Gordana Kel 1 , 

David Sly 1 , Peter Monksfield 2 

1 Dept Otolaryngology, The University of Melbourne, 

Royal Victorian Eye and Ear Hospital, MELBOURNE, Australia, 

2 Dept Otolaryngology, University Hospital Birmingham, UK 

Preservation of residual hearing and vestibular function is now a key aim 

of cochlear implantation (CI). In addition to good electrode design and 

impeccable surgical technique, pharmacological protection of the cochlea 

is emerging as a potentially important strategy for protecting the inner 

ear during surgery. Here we review the outcomes of experimental and 

42 

round tables 

clinical studies performed in our Department, that demonstrate the translational 

potential and clinical efficacy of a single dose of glucocorticosteroids 

in protecting the inner ear during CI. Specifically, we have shown 

that both local and systemic delivery of steroids protects hearing in experimental 

cochlear implantation, and a recent randomised controlled trial 

demonstrated a reduced incidence of dizziness in cochlear implant patients 

receiving local delivery of methyl-prednisolone to the round window 

during surgery. In addition, we present new data that examines how 

tissue response to cochlear implantation (CI) influences residual hearing. 

Specifically, we assessed whether the extent of intracochlear foreign body 

response (FBR) one month after CI surgery influences post-operative hearing 

by correlating these factors in 76 guinea pigs from four hearing-preservation 

CI experiments conducted in our laboratories. These studies reveal 

that a more extensive FBR was associated with a greater threshold shift 

(i.e. poorer hearing) on the auditory brainstem response (ABR) 4 weeks 

after surgery, although large post-operative threshold shifts were also observed 

even when there was minimal FBR. There was a significant correlation 

between the percentage of scala tympani (ST) occupied by the FBR 

and ABR threshold shifts between 1 and 4 weeks after surgery; threshold 

recovery was associated with minimal FBR only. These results support the 

theory that following CI surgery cochlear mechanics may be dampened 

by the presence of fibrosis within ST. But they also demonstrate that more 

extensive cochlear injury (and inflammation) is associated with more extensive 

fibrosis, so the key to minimising fibrosis is likely atraumatic surgery. 

It remains to be seen whether pharmacological intervention can also 

reduce the extent of the FBR. 

Neurotrophins are emerging as a potential drug therapy for inner ear protection 

during surgery. Here the target of therapy is the auditory nerve, 

and recent studies demonstrate that trophic benefits, namely neural survival 

and dendritic outgrowth, may outlast the period of application of 

these proteins to the ear after ototoxic deafening. We have recently shown 

that in addition, neurotrophins improve to better-than-normal levels, 

ABR thresholds in guinea pigs with normal hearing. These two observations 

suggest new possibilities for these neurotrophins in protecting the 

inner ear during surgery.

ROUND TABLE 5 

Conductive hearing loss in children: when do implantable devices 

come in? 

RT 5.01 

MANAGEMENT OF CONGENITAL ATRESIA & ACTIVE MIDDLE 

EAR IMPLANTS 

Dr. Henning Frenzel 

Department of Otorhinolaryngology and Plastic Operations 

University Hospital Schleswig-Holstein, LÜBECK, Germany 

BACKGROUND 

Patients with microtia-atresia need comprehensive rehabilitation at the 

interface between otologic and plastic surgery. The present strategies of 

functional rehabilitation with bone anchored implants or surgical atresia 

repair have been extended by the feasibility of active middle ear implants. 

The aim of the present research is to evaluate a new flowchart of treatment 

for patients with congenital aural atresia in consideration of active middle 

ear implants. 

METHODS 

Bilateral cases are provided with a conductive hearing aid after birth and 

implanted with an active middle ear implant within the second year. Unilateral 

cases are provided with a conductive hearing aid and implanted 

with a middle ear or bone anchored device in early childhood. Unilateral 

cases without amplification in the vulnerable time after birth are carefully 

selected for late implantation. At age 8-10 the auricular reconstruction is 

completed. 

RESULTS 

The results of early implantation are equally good as the previously published 

results of children and adolescents. The implantation in a 15 monthold 

patient yielded a mean threshold with the Vibrant Soundbridge of 21 

dB on both sides. Mean functional gain was 50 dB. The local tissues are unaltered 

and ready for auricular reconstruction. In total our atresia/microtia 

cohort with a Vibrant Soundbridge includes 19 cases with a median age 

of 15 years (range 6 – 25 years). The mean functional gain is 41 dB HL (SD: 

12). The mean aided threshold is 27 dB HL (SD: 6). The mean speech perception 

in quiet is 93% (SD: 9). 

CONCLUSIONS 

Active middle ear implants allow for an early and selective stimulation of 

the auditory pathway in children with congenital conductive hearing loss. 

A selective stimulation at age 12-18 months is expected also to allow for a 

normal development of binaural hearing functions, in contrast to bone 

anchored hearing aids. This new option was implemented into a new flowchart 

for unilateral and bilateral aural atresia or microtia. 

ROUND TABLE 6 

RT OPEN VS CLOSED LARYNGEAL STENOSIS 

Laryngeal stenosis, both acquired and congenital, is treated in many different 

ways: open surgery, reconstruction or resection with or without 

grafts, endoscopic surgery, dilatation. We will try to reach some conclusions 

regarding effective management of stenosis possibly based more on 

evidence than on experience. 

ROUND TABLE 7 

DOWN SYNDROME: A CHALLENGE FOR THE ENT SURGEON 

MODERATORS: S. Shott, A. Boudewyns 

CHAIRMAN: P. Sheehan 

SPEAKERS: S. Shott, A. Snik, M. van Furth 

In this Round Table, we will discuss major interest points for ENT surgeons 

related to children with Down Syndrome. The guidelines on health 

supervision for children with Down syndrome, published by the American 

Academy of Pediatrics (2011) will be used as a framework for the discussion. 

Obstructive sleep apnea (OSA) and sleep disordered breathing occur at an 

alarming high rate in children with Down Syndrome (DS). Prof. Dr. S. Shott 

will review current data regarding the incidence of OSA in DS and discuss 

some of the reasons why this is such a common finding. Signs and symptoms 

will be reviewed. Potential complications of untreated OSA will be 

discussed. Current treatment options, both medical and surgical, as well 

as treatment outcome studies will be presented. Current research being 

done on OSA in DS at Cincinnati Children’s Hospital, Cincinnati, Ohio, 

USA, along with the Aerospace Engineers at University of Cincinati will 

also be presented. 

Hearing impairment is rather common amongst children with Down syndrome; 

either of the sensorineural type, conductive type or mixed. Because 

of the interfering effects of intellectual disability, poor speech production 

abilities and hearing loss on language development, hearing loss should 

be treated aggressively. Dr. Ir. A. Snik will discuss options to establish stable 

hearing in children with Down syndrome.. Furthermore, an overview 

of the literature will be presented with respect to central auditory processing 

and consequences for treatment. 

Children with DS have an increased risk of respiratory tract infections 

(RTIs). RTIs can be divided in infections of the upper respiratory tract 

(URTI) (e.g. sinusitis, middle ear infections, rhinitis, tonsillitis, pharyngitis, 

laryngitis subglottica) and lower respiratory tract (LRTI) (e.g. pneumonia, 

bronchiolitis), which can be of diverse pathogenic origin (e.g. viral, 

bacterial, fungal or a combination of these). 

43

Although data on the frequency of URTI in children are not exactly known 

and may vary in different studies because of different definitions and criteria 

by which they are assessed, the frequency of URTIs in children with 

DS seems increased compared to healthy controls: 12% have more than 3 

URTIs in 12 months. The most frequently described infections include 

pharyngitis in 27% and otitis media with effusion in 55%. Abnormal 

anatomy of the upper respiratory tract may predispose children with DS 

to (chronic) URTIs. Stenotic ear canals, present in 40-50% of the newborns 

with DS, result in cerumen impaction. Midface hypoplasia is common in 

these children as well, with smaller and abnormally inserted Eustachian 

tubes, and smaller nasal area as well as nasal sinuses. This, in combination 

with dysfunction of Eustachian tubes, may lead to accumulation of middle 

ear fluid and obstruction of airflow, making these children prone to otitis 

media. Hypoplasia of the nose and sinuses contributes to nasal obstruction, 

rhinorrhea and sinusitis. Hyperproduction of mucus was shown for 

most children with DS in a study performed by Piatti et al., but the ultrastructure 

and functions of the nasal cilia were normal. An overview of 

these RTIs with a focuss on ENT infections will be presented by Prof. Dr. 

M. van Furth. 

ROUND TABLE 8 

Pierre Robin sequence: to distract or not to distract? 

RT 8.01 

THE MULTIDISCIPLINARY APPROACH OF 

THE INFANT WITH UPPER AIRWAY OBSTRUCTION 

AND A HYPOPLASTIC MANDIBLE 

Koen Joosten and Eppo Wolvius 

Erasmus MC-Sophia 

Children with craniofacial anomalies are predisposed to upper airway obstruction. 

This obstruction may be seen at the level of the (hypoplastic) 

midface, i.e. in craniosynostosis syndromes, at the level of the hypoplastic 

mandible, i.e.in Robin sequence, or at both levels, i.e. in Treacher Collins 

Syndrome and Hemifacial Microsomia. 

Traditionally, the isolated Pierre Robin (i-PR) sequence is characterized by 

the sequence of clinical events that result from the hypoplastic mandible. 

The tongue becomes posteriorly displaced (glossoptosis) and may obstruct 

the upper airway. In addition, difficulties with oral feeding and swallowing 

may be encountered. Syndromic patients with PR (s-PR) sequence may 

also present with other co-morbidity. Conditions of syndromic patients 

are generally more severe and sometimes very difficult to treat. 

The degree of respiratory obstruction varies significantly, ranging from 

mild obstruction that requires no intervention to cases with severe airway 

obstruction shortly after birth that require invasive respiratory support. 

The decision on how to manage these infants is often based on experience 

of a particular centre and could be therefore controversial. Invasive respiratory 

support consists of the use of a nasopharyngeal tube, non-invasive 

44 

ventilation or placement of a tracheostomy. Once infants are trachestomydependent, 

the goal is to achieve early decannulation to avoid the risks of 

morbidity and mortality which are associated with long-term tracheostomies. 

While decannulation without surgical intervention of the 

mandible is generally a long-term commitment, numerous reports with 

small series of patients present successful decannulation following 

mandibular lengthening using the distraction technique. However, this 

technique in infants is not without complications and the long-term stability 

and side effects of this relatively new technique are so far unknown. 

Early recognition of symptoms and prompt effective treatment by a specialised 

craniofacial team are important aspects for successful care in infants 

with PR. In this triptych presentation the clinical and surgical 

aspects of the multidisciplinary management of the infants with PR and 

various degrees of upper airway obstruction pathology are highlighted. 

The timing and (non)surgical options will be discussed in infants with 

isolated and syndromic Pierre Robin sequence. 

RT 8.02 

ROBIN SEQUENCE: DIAGNOSIS AND MANAGEMENT OF 

AIRWAY OBSTRUCTION 

Corstiaan Breughem 

The literature is replete with different descriptions of Robin sequence /syndrome. 

However this group of patients is still associated with significant 

morbidity and even mortality. With many different descriptions and associated 

syndromes, it is difficult to plan a general approach to this group 

of patients. 

In this presentation we will present the approach our institution has when 

confronted with a child with a possible Robin sequence. This approach 

was made after critical review of the literature and our own results. It is 

generally accepted that Robin sequence consists of micrognathia, glossoptosis 

and breathing problems. Often these patients have an associated cleft 

palate. Once the diagnosis of a sequence is made, possible associated syndromes 

are investigated. It is paramount to investigate and quantify the 

breathing problems, as well as the feeding problems. This needs a multidisciplinary 

approach. Once the diagnosis of airway obstruction is made, 

the exact level of pathology is defined. If positional change gives unsatisfactory 

improvement, surgical intervention is needed. In our unit surgical 

distraction of the mandible is performed. We will present our results, compare 

this to the literature, including possible complications and the influence 

surgery possible has on outgrowth of the mandible.

ROUND TABLE 9 

Effective teaching in pediatric otorhinolaryngology 

RT 9.01 

USING MEDICAL SIMULATION TO TEACH COMMUNICATION 

AND TEAMWORK IN THE OPERATING ROOM 

Mark S. Volk 

Department of Otolaryngology and Communications Enhancement 

and Children’s Hospital Simulator Program, Children’s Hospital, 

BOSTON, Massachusetts, USA 

The main source of medical errors in the hospital, and in the operating 

room in particular, is a lack of communication and poor teamwork. Despite 

this, medical personnel are usually not trained in these skills. Crisis 

Resource Management (CRM) is a set of principles developed by the commercial 

airlines in the 1970’s to teach proficiency in communication and 

teamwork. Using these principles, both the airline and nuclear power industries 

have been able to improve safety by improving teamwork. 

The Department of Otolaryngology at Children’s Hospital Boston along 

with the Children’s Hospital Simulator Program have developed and are 

utilizing a unique course. Using medical simulation, Otolaryngology 

housestaff and attending surgeons are being trained to use CRM during 

simulated low frequency, high risk events. The simulation scenarios are 

unique because they are multidisciplinary (surgeons, anesthesiologist and 

nurses) and occur in the participants’ native operating room environment. 

Each course is comprised of a short didactic session and three simulation 

scenarios, each followed by a structured debriefing session. 

The presentation will outline the rationale and describe the details of this 

program. 

ROUND TABLE 11 

PEDIATRIC OTOTRHINOLARYNGOLOGY IN 

THE DEVELOPING WORLD 

How do these ‘economically non-affluent’ countries in Africa, Latin America 

an Asia manage to provide otolaryngology services on budgets that are 

often only a minute fraction of those available in many Western countries? 

With a tiny staff and a huge number of patients, when the annual budget 

for the entire hospital may be close to the cost of a few cochlear implants?. 

We have brought together a panel from three continents to discuss these 

issues and offer possible solutions to the problems affluent regions will 

soon be facing, now the banking crisis has impoverished an increasing 

number of countries, and exposed all others to violent rounds of economising. 

We will be examining both the general organisational as well as a 

number of more specific clinical problems. 

45

WORKSHOP 1 

WS 1.01 

SYNDROMOLOGY 

Interactive workshop 

prof. R.C.M. Hennkam & dr M. Bitner-Glindzicz 

General ENT surgeon see large numbers of children in their clinics on a 

daily basis, and patients will mainly be divided in general groups like patients 

with infections or hearing loss. The background of these problems 

is often multifactorial, and gradually it becomes clear many syndromes 

present themselves in the head and neck region or are related to the related 

sensory organs. This puts the ENT surgeon in the front-row with a function 

and responsibility for screening for syndromes and genetic disorders. 

In this interactive workshop Raoul Hennekam (University of Amsterdam) 

will focus on morphological aspects of ENT investigations, while Maria 

Bitner-Glindzicz (University College London) will elaborate on syndromic 

causes of hearing loss. Both speakers will also deal with related systemic 

medical consequences. Molecular genetic backgrounds will not be discussed 

unless truly of importance to understand the clinic. 

46 

workshops 

WORKSHOP 2 

Temporal bone imaging – what the radiologist and surgeon 

should tell each other 

• Sensorineural (congenital and acquired) deafness 

• Conductive hearing loss with an intact tympanic membrane 

• Cholesteatoma imaging 

WS 2.01 

IMAGING OF THE EAR – A CLINICORADIOLOGICAL 

CONVERSATION 

Jan Casselman & Erwin Offeciers 

Dept. of Radiology, Sint-Jans Hospital, Bruges & Depts. of Radiology 

& ORL, Sint-Augustinus Hospital, Wilrijk – ANTWERPEN, Belgium 

The authors will illustrate how state-of-the-art imaging can improve the 

diagnostic work-up, thus affecting the therapeutic outcome, and facilitate 

the follow-up. 

They emphasize the importance of a close collaboration between the clinician 

and the radiologist in patients presenting with 1/ congenital and 

acquired sensorineural hearing loss; 2/ cholesteatoma; 3/ conductive or 

mixed hearing loss with an intact tympanic membrane. 

1/ In congenital and acquired sensorineural hearing loss MRI plays a predominant 

role. Using clinical examples, the authors will present an overview 

of the most important pathological entities. 2/ In the work-up of 

cholesteatoma non-EPI Diffusion Weighted imaging helps the clinician 

to make a correct diagnosis when in doubt, and in conjunction with Conebeam 

CT facilitates planning the surgical approach and informs about 

potential complications during surgery. For the follow-up after cholesteatoma 

surgery non-EPI DW MRI has replaced routine exploratory second 

stage surgery. 3/ The lower irradiation dose and improved resolution of 

Conebeam CT, as compared to conventional high resolution CT, has led 

to its routine application in the preoperative work-up of patients presenting 

with conductive or mixed hearing loss with an intact tympanic membrane. 

It plays an important role in identifying contra-indications to 

functional surgery and in informing the surgeon about potential difficulties 

and complications during surgery, thus allowing the clinician to inform 

his patient more comprehensively and to better plan his operation. 

Recent advances in imaging have impacted heavily on the management 

of otological and neurotological patients. The aim of our Imaging Workshop 

is to provide the clinician with the state-of-the-art information that 

allows him to ask his radiologist the pertinent questions.

WORKSHOP 3 

Handling the patient load in different societies 

Seth Pransky 

The success of pediatric otolaryngology as a subspecialty has resulted in 

tremendous demand for this specialty care. In virtually all tertiary care centers 

it has proven to be quite challenging to manage the patient load and need for 

operative services. Inadequate reimbursement has made it difficult to hire a 

sufficient number of appropriately trained specialists to handle the clinical 

demands. As a result of ever increasing access issues, different strategies have 

been utilized to try and cope with the workload. This workshop will discuss 

the use of physician extenders, including physician assistants and nurse practitioners, 

as well as computer assisted patient flow management systems and 

extended workdays to help find creative solutions to prolonged wait times, 

patient frustration and physician dissatisfaction and burnout. 

WS 3.01 

CAN COMPUTER AIDED PATIENT FLOW MANAGEMENT DEAL 

WITH CHAOS IN THE UNDERSTAFFED CLINIC? 

Ari DeRowe 

Director-Pediatric Otolaryngology Unit, Tel-Aviv Sourasky Medical 

Center, Dana Children’s Hospital, Tel-Aviv Sackler School of Medicine 

Pediatric Otolaryngology is an emerging sub-specialty in Israel. As such 

demand for specialized treatment by parents and pediatricians has overwhelmed 

the supply of sub-specialty trained pediatric otolaryngologists. 

This is exemplified in the outpatient clinic were long waiting times cause 

unrest and as the families loose patience unhappiness prevails. 

In an attempt to contain the situation our hospital introduced a computer 

aided patient flow management system. We monitored patient satisfaction 

before and after introduction of the system. Our impression was that the 

system didn’t decrease the chaos. However, an additional burden on the 

physician along with the electronic medical record was deemed superfluous. 

It appears that in an attempt to decrease chaos in the pediatric otolaryngology 

clinic computers are not a substitute for staff. 

WS 3.02 

EFFECTIVE USE OF THE EXTENDED WORKING DAY TO 

MAXIMISE CAPACITY IN THE UK NATIONAL HEALTH SERVICE 

Michael Kuo 

United Kingdom 

Capacity to carry out elective and emergency surgery remains a recurrent 

challenge for all hospitals in the NHS as the clinical workload seems to in- 

crease inexorably. As surgery becomes increasingly specialized, it is increasingly 

unsatisfactory to perform surgery with an operating theatre team 

which is non-specialist, as is often required in the emergency setting. We 

have exploited an extension of the elective working day in both the out-patient 

clinic and in the operating theatre in order to address these needs. The 

maintenance of a state-of-the-art operating theatre is expensive but in the 

majority of hospitals, these are only in use during ‘office hours’, which 

leaves considerable redundancy in the system. Extending the working day 

allows for a more cost-effective use of this resource as well as bed capacity. 

However, the deployment of the extended day is not without its challenges 

in paediatric otolaryngology and this presentation will discuss some of 

these as well as the lessons that we have learned at the Birmingham Children’s 

Hospital over three years to make the surgical extended working day 

efficient, safe, cost-effective and convenient for parents and children. 

WS 3.03 

INTEGRATING NON-PHYSICIAN PROVIDERS INTO 

COMPLEX PEDIATRIC OTOLARYNGOLOGY CARE 

Steve Handler 


Pediatric Otolaryngology at The Children’s Hospital of Philadelphia (CHOP) 

has a 25 year history of incorporating Pediatric Nurse Practitioners (PNPs) 

and Physician Assistants (PAs) into our busy clinical practice. At the present 

time, we employ 25 PNP/PAs (20.8 FTEs) in addition to 2 RNs to assist 13 Pediatric 

Otolaryngologists (12.25 FTEs) in completing 38,000 outpatient visits 

and 11,000 surgical procedures a year. Their participation in the outpatient 

experience allows us to see 35-40 patients, to complete documentation in 

our electronic health record (EHR) and to generate a letter to the referring 

physician in a 5 hour session. 

All new and most established patients are seen by both MD and PNP/PA, 

which results in one integrated, comprehensive examination progress note. 

The PNP/PAs also create a hospital required history and physical (H & P) 

for patients who will be having surgical procedures and complete a preanesthesia 

evaluation for those same patients, thus saving those families a 

separate pre-operative visit to the hospital. One of their main responsibilities 

is to coordinate care of our patients among the various hospital divisions, 

assuring appropriate consultations and facilitating combined 

surgical procedures and to provide the initial response to all patient calls 

and requests from medical practitioners for appointments. 

The PNP/PAs role in the division has been uniformly appreciated by our 

physician staff and by our patients, who value the comprehensive care that 

this paradigm provides. 

47

WORKSHOP 4 

WS 4.01 

IMAGING THE PEDIATRIC AIRWAY 

Ben Hartley & Alistair Calder 

The gold standard for examination of the paediatric airway has been rigid 

endsocopy under general anaesthesia. The advent of the Hopkins rod telescope 

and high definition video has increased the detail enormously. 

Rigid endoscopy however needs specialists skills and equipment and specialist 

anaesthesia that in reality is only available in a very small number 

of centres. 

Increasingly there is a call for more widely available radiology to provide 

the diagnosis without endoscopy and preferably without anaesthesia. 

In this session we will examine a radiology can complement and possibly 

replace airway endoscopy in certain areas including laryngeal ultrasound, 

bronchography, CT virtual bronchoscopy and MRI imaging. 

WORKSHOP 5 

WS 5.01 

NASAL OBSTRUCTION IN THE NEWBORN AND INFANT 

Jean Michel Triglia & Bob Ward 

Our workshop deals with several aspects of nasal obstruction in the newborn 

and infant, starting with a general overview of symptoms, evaluation 

and treatment. Two relatively common anatomical etiologies of nasal obstruction, 

congenital pyriform aperture stenosis and choanal atresia, will 

be discussed in detail, as will some of the more unusual nasal obstruction 

cases or so-called ‘zebras in the infant nose’. We will furthermore focus on 

current operative techniques as well as novel tools in nasal obstruction 

management, such as numerical modeling as a quantitative evaluation of 

surgical outcome. 

With this session, we hope to shine a broad light on a frequently encountered 

pediatric problem which, depending upon etiology, can range from 

innocent to potentially severe in nature. 

48 

WORKSHOP 6 

Non-accidental injuries in children 

WS 6.01 

CHILD ABUSE AND ENT 

Ad Bosschaart 

Dutch Asthma Centre Davos, Switzerland 

Ann Hermansson 

University Hospital Lund, Sweden 


Coordinator child abuse team, Maastricht University Medical Center, 


INTRODUCTION 

Child abuse is a complex and threatening situation for children and their 

families. At the same time doctors find it difficult and demanding to handle 

cases of suspected child abuse. Children, however, have the right to expect, 

and rely on effective action against suspected abuse by childcare 

professionals. In 2002 and 2012 in the Netherlands, two large prevalence 

studies, showed that more than 100.000 children (< 18 years) were maltreated 

each year, which represents 3% of all children in the Netherlands. 

Child abuse is a common problem and often physical signs and symptoms 

are found in the head and neck area. Studies show that in 65-75% of physical 

abuse cases in children signs are found within the head and neck area. There 

are various explanations why lesions so often are found in this area. If one 

is very angry at a child, aggression will often focus on the face of the child 

perhaps since the face is like a personification of the character of the child. 

Further the head is often within reach and not covered by clothing. 

Thus ENT-specialists must often see physical signs and symptoms of physical 

abuse in children but these might not be recognized if the physician 

is not aware of the problem. 

CONTENT 

The workshop will focus mainly on physical signs of child abuse in the 

ENT region of the body ie face and neck. Several casus are presented in 

which child maltreatment should be part of the differential diagnosis. In 

an interactive way we challenge the audience to discuss the characteristics 

of the physical signs and reasons why child maltreatment must be considered 

as the main cause of the lesion. 

Furthermore, the reporting of child maltreatment will be discussed. Because 

this varies between countries, this will be done in an overall way. 

AIMS 

The aims are to make the ENT-specialist aware of the fact that child maltreatment 

might frequently be the cause of lesions in the face and neck 

area and should be considered more often. The aim is also to give the ENTspecialist 

advise how to handle a suspected case of child maltreatment in 

his own setting.

WORKSHOP 7 

WS 7.01 

LARYNGEAL CLEFT 

Reza Rahbar & Noel Garabedian 

The objective of this work shop is to discuss the presentation, evaluation, 

and medical and surgical management (Endoscopic and Open Technique) 

of Laryngeal cleft 

WORKSHOP 8 

WS 8.01 

IMPROVING CLINICAL DECISION MAKING: 

WHAT DO YOU DO IN OME? 

DECISION MAKING IN PAEDIATRIC ENT 

David Albert, Marianne Elloy, Mark Haggard & Geert van der Heijden 

Decision making is at the centre of good clinical practice. This session focuses 

on the practical problems that paediatric ENT surgeons have in 

using evidence, guidelines and experience to optimise our decision making. 

It looks at the problems we face on a daily basis in optimising our 

decision both in ‘simple’ and ‘complex’ clinical situations. The aim is to 

challenge the delegates to consider how they make their clinical decisions. 

We have enlisted the help of an expert in clinical decision making to help 

us in our real clinical situations. 

We explore what can be included in National Guidelines and what has to 

be left out, as well as how Guidelines are implemented in a resource capped 

environment. We look at the use of carefully prepared clinical scenarios 

presented to an expert panel to achieve a consensus view based on evidence 

and experience. To cope with the multifactorial nature of decision making 

we consider computer modelling which can allow any number of 

weighted factors to be included in the decision based on a weighted riskbenefit 

analysis. 

WORKSHOP 9 

WS 9.01 

NVWPO-MEETING: ‘WHAT WOULD YOU DO?’ 

case-presentation and discussion 

Dana Thompson, Noël Garabedian, Philippe Monnier & Astrid König 

During this meeting the participants will discuss the spectrum of pediatric 

airway problems from laryngomalacia until intubation trauma and laryngeal 

stenosis with the emphasis on decision making and treatment 

planning. The cases are submitted by the members of the NVWPO (Nederlands-Vlaams-Werkgroep 

voor pediatrisch otolaryngology = Dutch- 

Flemish-society of pediatric ENT). 

WORKSHOP 10 

WS 10.01 

HOW TO WRITE A SYSTEMATIC REVIEW 

Maroeska Rovers & Martin Burton 

During this workshop we will give a short introduction for users of systematic 

reviews, as well as for participants who are considering writing a review 

themselves and want to get more information about the whole 

process. 

Participants gain insight into the background of systematic reviews and 

their role in evidence-based medicine. 

WORKSHOP 11 

WS 11.01 

INTUBATING THE DIFFICULT AIRWAY WITH LARYNGEAL 

MASK AND FLEXIBLE BRONCOSCOPE 

Hans Hoeve & Andreas Machotta 

This workshop concerns difficult intubation. How do we recognize and 

anticipate a difficult airway, how do we safely anesthetize the child, and 

how do we intubate it? You will have the opportunity to practise hands 

on fiberoptic intubation through a laryngeal mask. 

49

CORPORATE LUNCH SESSION supported by GSK 

Otitis media – what has changed in the era of pneumococcal 

conjugate vaccines? 

CHAIRMAN : Prof. Paola Marchisio 

Italy 

WELCOME AND INTRODUCTION 

Prof. Paola Marchisio 

Italy 

C 1.01 

BURDEN OF OTITIS MEDIA – PERSPECTIVES OF PARENTS 

Dr. Colin Barber 

New Zealand 

Acute otitis media (AOM) is one of the most frequent bacterial infections 

for which medical advice is sought, and a major contributor to antibiotic 

prescriptions in young children. 

As a consequence, AOM places a considerable disease burden on primary 

healthcare physicians and specialists (despite AOM incidence estimates 

differences between studies/regions), as well as causing significant economic 

costs, both direct (including physician visits, prescriptions, and surgery) 

and indirect (including lost income, reduced productivity, and travel 

costs). 

AOM also presents a significant distress for the individual patients and 

their caregivers. A recently conducted survey in 12 countries across Europe 

and Asia-Pacific, Canada, Mexico, South Africa and Japan showed that pain, 

disturbed sleep and irritability were considered to be a significant burden 

on children with the infection. This survey also shows that AOM affects 

the whole family due to sleepless nights and worry, or disruption to working 

lives and potential loss of income. It furthermore sheds light on the 

challenges associated with implementation of a‘watch-and-wait’ strategy 

against antibiotic prescriptions: at least 85% of parents surveyed remembered 

having been prescribed an antibiotic to treat their child’s acute 

middle ear infection, with three quarters being instructed to give the medication 

to their child immediately. 95% of those parents eventually administered 

an antibiotic, with only 18% of them first having waited to see 

if symptoms would improve without antibiotics. This adds emphasis to 

the need for new preventative approaches to the management of acute 

middle ear infection. 

50 

corporate sessions 

C 1.02 

ETIOLOGY OF OTITIS MEDIA BEFORE AND AFTER 

PNEUMOCOCCAL CONJUGATE VACCINATION 

Prof. Gerhard Grevers 

Germany 

Middle ear infections occur when bacteria and/or viruses spread from the 

nasopharynx to the middle ear. Preceding viral upper respiratory tract infection 

predisposes to the development of this acute bacterial complication. 

The predominant causative bacterial pathogens are Streptococcus 

pneumoniae and Haemophilus influenzae (predominantly non-typeable 

strains; NTHi), together accounting for 60–80% of bacterial acute otitis 

media (AOM) cases. 

A recently conducted meta-analysis of AOM etiology studies (conducted 

in 11 countries across 4 continents) utilizing similar case definitions and 

sampling techniques revealed that S. pneumoniae and H. influenzae are 

implicated in approximately 10 times more AOM episodes than Moraxella 

catarrhalis and Streptococcus pyogenes, and are more frequently associated 

with fever than episodes with the other bacteria. 

The analysis also suggests that S. pneumoniae and H. influenzae are both 

involved in first reported episodes of AOM. Especially in the post-pneumococcal 

conjugated vaccine (PCV7) era, H. influenzae is reported as a 

major early pathogen, but it was important in the pre-PCV7 era as well. 

Recurrent OM episodes appear more likely to yield H. influenzae than 

non-recurrent episodes. 

S. pneumoniae is more likely to be the causative pathogen in episodes affecting 

PCV7-unvaccinated children than in those who had received PCV7. 

H. influenzae is more frequently identified in AOM episodes in children 

who were previously vaccinated with PCV7 compared with unvaccinated 

children. This is in line with other data which suggest that the use of PCVs 

is driving a shift in the etiology of AOM.

C 1.03 

IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINES 

ON ACUTE OTITIS MEDIA 

Prof. Paola Marchisio 

Italy 

Pneumococcal conjugated vaccines (PCV) are globally available for prevention 

of potentially life-threatening pneumococcal diseases, such as pneumonia 

and meningitis, as well as non-invasive but prevalent, costly and 

distressing diseases as acute middle ear infections. 

In randomised clinical trials evaluating different PCV-formulations 

against AOM, vaccine efficacy against overall AOM ranged from 0-9 % for 

OMP-/CRM-based 7-valent formulations up to 34 % for an 11-valent Haemophilus 

influenzae Protein D-conjugated vaccine. Interestingly, the efficacy 

against AOM due vaccine serotypes was remarkably similar between 

these formulations/trials, and ranged between 56-58 %. The discrepancy 

between overall and vaccine-type AOM impact suggests that the net-allcause 

AOM result is multifactorial (differences in study background; design; 

local epidemiology; impact, if any, on non-vaccine serotypes/other 

pathogens). Careful re-analyses of these trials may help to understand the 

individual factors at play. 

In observational database studies analysing post-marketing data, largely 

from US and Canada, effectiveness estimates against overall AOM varied 

widely, ranging from 3-43%. In most cases, OM visits rates were declining 

already before PCV7CRM introduction, which warrants caution when interpreting 

the data. Unfortunately, these studies typically rely on comparisons 

with historical data, which may be biased by secular trends (e.g. due 

to antimicrobial resistance, shifts in serotype distribution, and changes 

in diagnostic practises). As double-blinded, parallel-controlled trials are 

the gold standard for demonstrating vaccine effects, the currently ongoing 

trial in Finland (FinIP), a community-randomised double-blind trial 

with PHiD-CV, promises more accurate estimates of both the direct and 

indirect effects of the introduction of PCV mass vaccination programs on 

AOM-related endpoints. 

CORPORATE LUNCH SESSION supported by ALK-ABELLO 

ALLERGIC DISEASES IN CHILDHOOD: 

A JOURNEY THROUGH THE ALLERGIC MARCH, 

IS IT POSSIBLE TO STOP THE MARCH? 

ABSTRACT 

The lunch session will be an interactive meeting. At the end of the workshop/presentation 

the participants have learned that: 

- Allergy is a major burden in children 

- The majority of children will go ‘through the allergic march’, and will 

start early in life with atopic dermitis, food allergy, allergic rhinitis and 

asthma. 

- Is primary prevention of allergic diseases possible? Is secondary prevention 

possible? 

Indications and contra-indications of immunotherapy 

SPEAKER 

Dr. Hans de Groot, MD PhD 

Allergologist 

Department of Pediatric Allergology 

Diaconessenhuis Voorburg, Reinier de Graaf Groep, 

DELFT, The Netherlands 

SPEAKER 

Dr. Aline B. Sprikkelman, MD PhD 

Pediatric Pulmonologist 

Department of Pediatric Respiratory Medicine and Allergy 

Emma Children’s Hospital AMC 

AMSTERDAM, The Netherlands 

PANEL 

Dr. Glenis K. Scadding, MD, FRCP 

Hon Consultant Allergist and Rhinologist 

Royal National TNE Hospital 

LONDON, United Kingdom 

CORPORATE SESSION supported by COCHLEAR 

World expert speakers share their latest insights about clinical management 

of deaf and hearing impaired children. Topics cover severe, profound 

and partial deafness as well as conductive and mixed hearing loss. 

51

FREE PAPER SESSION 1 


FP 1.01 

ENDOSCOPIC TRANS-NASAL RESECTION OF PEDIATRIC 

SKULL BASE TUMORS: HAS IT COME OF AGE? 

C. Georgalas, W.R. Van Furth, S. Reinartz, R. Willemse, W.P. Vandertop, 

W. Fokkens 

INTRODUCTION 

The treatment of pediatric skull base tumors subject of long lasting debate. 

Discussion focuses on approach, extent of resection, application and timing 

of radiation therapy, and avoidance of complications. 

BACKGROUND AND AIMS 

The evolution of endoscopic trans-nasal surgery has been based on improved 

optics and instrumentation, reliable closure techniques, making 

it a viable alternative to external approaches such as craniotomies. In this 

presentation we will focus not so much on the “less invasive” nature of 

the endoscopic approach, but to specific benefits relating to the actual 

tumor removal as illustrated with short surgical videos. 

RESULTS 

These benefits include: superior visualization during tumor removal and 

minimal manipulation of important neurovascular structures including 

the optic nerves and chiasm. We will summarize our results with this approach 

and review the available literature regarding endoscopic transnasal 

approach focusing on visual and quality of life outcomes. 

CONCLUSIONS 

Initial experience with the endoscopic trans-nasal approach for pediatric 

skull base tumor resection shows promising results. 

52 

free papers 


Language as a medical/biological concern! 

FP 2.01 

PRIMARY LANGUAGE DEVELOPMENT: BASIC PROCESSES 

AND PATHOLOGY 

Frank Wijnen 

Utrecht University, Utrecht Institute of Linguistics OTS 

Long before they begin to speak, children are hard at work learning their 

native language(s). Within the first 6 months of life, they learn which 

speech sounds are important and which can be ignored. Soon after this, 

they begin to understand which sounds can and which cannot occur together, 

and by applying this knowledge they segment the speech they hear 

into syllables and words. Most children recognize and understand several 

words before they utter their first word. Several months before they produce 

their first two-word sentence, they recognize word order patterns 

and sequential dependencies between words and grammatical markers. 

Obviously, these impressive feats would not be feasible without a properly 

functioning auditory system. The auditory system provides the primary 

data that the brain’s learning mechanisms have to work with. Applying 

behavioral and neurocognitive techniques, researchers at several labs, including 

Utrecht, have shown that distributional and statistical learning 

are critical components in the child’s construction of a system of linguistic 

categories and rules that will eventually enable it to understand and produce 

an unlimited number of messages. 

Approximately 7% of all children present (severe) difficulties with native 

language acquisition in the absence of obvious sensory, neurological, psychological, 

or educational causes. This condition, known as Specific Language 

Impairment (SLI), is marked by lasting deficits in oral language skills, 

which often result in serious communicative disability that persists into 

adulthood, and may lead to psychological and societal handicaps. SLI has 

a genetic basis and is associated with micro-anatomical abnormalities in 

parts of the central nervous system, but its exact etiology is still a hotly 

debated issue. It is undisputed, however, that SLI is a serious clinical condition 

with far-reaching consequences, and thus calls for early diagnosis 

and intervention.

FP 2.02 

THE ROLE OF LOW-FREQUENCY HEARING IN THE 

ACQUISITION OF MORPHOLOGY IN HEARING IMPAIRED 

CHILDREN 

Martine Coene 

INTRODUCTION 

Pitch-marked elements are more prominent in running speech than those 

that are unmarked. Particular morphemes, such as the indefinite article 

(a), occur more frequently in the presence of a pitch-marked noun. Children 

therefore acquire indefinite articles more easily than their definite 

counterparts (the). In previous work we have found that the grammar of 

cochlear-implanted children does not show the same preference for indefinite 

articles. These findings are assumed to result from their deficient 

perception of voice pitch. In order to test this hypothesis, different populations 

of deaf and hearing subjects have been tested on their perception 

of low-frequency hearing, in particular pitch-related morphology. 

MATERIALS AND METHOD 

19 deaf adults, 19 deaf children (age range 5-15 years) wearing different 

types of hearing devices (CI, HA and bilateral CI+HA) and 30 hearing adults 

and 19 hearing children (age range 6,5-12 years) have been tested on 2 intonation 

tasks, in which pairs of mono- or bisyllabic words were to be discriminated 

on the basis of differences in pitch accent in a same/different 

paradigm (16 pairs of natural speech words and 16 pars of words low-pass 

filtered at 500 Hz). 

RESULTS 

Performance outcomes in discrimination were examined in terms of the 

type of hearing device and type of stimulation. The results confirm that 

CI-users perform significantly worse on intonation tasks than hearing 

controls. The simultaneous use of a HA in the opposite ear significantly 

improves their performance. 

CONCLUSION 

CI-children have difficulties in hearing subtle changes in fundamental 

frequency. This is reflected in their poor performance on intonation tasks. 

Therefore, pitch-marked nouns are less easily perceived in incoming 

speech, resulting in a delay in the acquisition of indefinite articles. EAS is 

expected to improve low-frequency hearing and as such to have a beneficial 

effect on the acquisition of intonation-related morphology. 


Cleft palate & 22q11.2 deletion syndrome 

The complex care of cleft palate patients is one of the most unique parts 

of pediatric otorhinolaryngology. Plastic surgery in reconstruction of 

cleft palate, otological, audiological and phoniatrical treatment of ear-, 

hearing-, and speech problems of these children are all difficult areas to 

be solved. Disorders in suction, deglution and chewing, developmental 

disturbances of the maxilla are complex and multidisciplinary tasks. Functional-aesthetic 

reconstruction of the cleft nose is thought to be the top 

challenge of rhinosurgery. Different syndromes with genetical backgrounds 

related to cleft palate, especially 22q11.2 microdeletion syndrome 

involve almost all fields of otorhinolaryngology and head-neck surgery. 

The lectures of this session give a cross-sectional view of this exciting field 

with the participation of excellent experts. 


FP 13.01 

GENETICS OF DEAFNESS: FROM RESEARCH TO IMPROVED 

DIAGNOSTICS AND CLINICAL CARE 

Guy Van Camp 

Dept. of Medical Genetics, University of Antwerp 

OBJECTIVE 

To provide an overview of the current status of research into genetics of 

deafness, and the diagnostic applications. 

METHODS 

Overview from the scientific literature and unpublished research results. 

RESULTS 

Genes play an important role in the aetiology of deafness in children. Because 

of rising standards in health care in developed countries, environmental 

factors causing deafness have declined. Many of these responsible 

genes have been discovered over the last two decades, since the development 

of positional cloning in genetics. More than 50 genes for nonsyndromic 

deafness have been discovered over the last 15 years. It is really 

striking how many of the genes that play an important role in this process 

have been discovered by genetic studies. In this respect, genetics has been 

more successful than traditional biochemistry. After identification of a 

gene for genetic deafness, its function can be studied in various ways using 

mouse models, its expression can be studied by immunohistochemistry 

or in situ hybridisation, or various in vitro and in vivo experiments can 

be carried out. It is fair to say that inner ear biology has received a large 

boost from genetics over the last 15 years, and many of the most exciting 

results have been based on an initial genetic finding. This research has led 

to a much better understanding of the physiology of hearing. 

53

54 

Another application of the gene identifications is genetic testing. Genetic 

testing for deafness is now available worldwide, but there are still many 

limitations. Genetic testing for deafness in children currently gives a positive 

result in less than 25% of cases, mainly because only a few genes can 

be tested because of the high cost. Testing of all known deafness genes 

with current technology would be much too expensive. However, new sequencing 

technologies have been developed that are much more powerful. 

The first applications of this technology are arising, and these hold great 

promise for use in DNA diagnostics. 

CONCLUSION 

Research has provided overwhelming results in this field over the last 10 

years, and diagnostic applications have been developed. However, current 

routine diagnostics are lagging behind, and new promising diagnostic 

methods, based on next generation sequencing, are being developed. 

FP 13.02 

CLINICAL OTOGENETICS: FROM RESEARCH TO IMPROVED 

CLINICAL CARE 

N.J.D. Weegerink 

UMC St. Radboud Nijmegen, NIJMEGEN, The Netherlands 

CO-AUTHOR: H.P.M. Kunst 

OBJECTIVE 

Hearing impairment is the most common birth defect and the most prevalent 

sensorineural disorder in developed countries. More than 50% of 

prelingual hearing impairment is genetic, most often autosomal recessive 

and nonsyndromic. Postlingual hearing impairment is much more frequent 

than prelingual hearing impairment and has mostly a multifactorial 

inheritance, although monogentic forms exists with mainly 

autosomal dominant inheritance. The heterogeneity in autosomal dominant 

nonsyndromic hearing impairment (DFNA) is high with multiple 

genes implicated in the pathogenesis. To distinguish phenotypic differences 

in nonsyndromic hearing impairment, genotype-phenotype correlations 

are presented. 

METHODS 

Describing large groups of patients with hereditary hearing impairment 

are very important for establishing genotype-phenotype correlations. An 

Age Related Typical Audiograms (ARTA) gives a comprehensive phenotype 

presentation and is therefore extremely useful in characterization of progressive 

DFNA types. 

RESULTS 

An ARTA can be used to compare the type of hearing impairment, the age 

of onset and the progression of hearing impairment in relation to the 

genotypes. An ARTA does not only help in selecting potentially interesting 

loci for linkage analysis or genes for mutation analysis, but it is also valuable 

for genetic and individual counseling. 

CONCLUSIONS 

Establishing genotype-phenotype correlations will facilitate the discovery 

of new deafness causing genes, the development of routine DNA-diagnostics 

of hereditary hearing impairment and the understanding of the 

(dys)function of the inner ear. There is no doubt that additional groups of 

patients with hereditary hearing impairment need to be collected to distinguish 

phenotypic differences between different genetic types of hearing 

impairment. 


FP 20.01 

Otitis media guidelines: concepts and controversies 

Rich Rosenfeld 

Despite a plethora of published clinical practice guidelines (CPGs) on managing 

otitis media there remains significant controversy at the regional, 

national, and international level. This presentation begins with a rapid 

review of standards for trustworthy clinical practice guidelines, based on 

consensus from the Guidelines International Network and the United States 

Institute of Medicine. Attention will then turn to a selective review of 

otitis media guidelines and related controversies, emphasizing antibiotic 

management of acute otitis media, interventions for otitis media with effusion, 

and indications for tympanostomy (ventilating) tube insertion. 

Also considered is the challenge of applying guidelines to the care of individual 

patients, including the role of shared decision making.

56 

LIon live surgery meetings 

The LION Foundation was founded in 2006 as a nonprofit organization. LION is dedicated 

to promote medical and surgical high quality Continuing Medical Education 

programs (lion-web.org). During the ESPO meeting 2012 the LION foundation will facilitate 

two live surgical events. 

MONDAY 10.45 – 12.00 

The first interactive live surgery event will be on Monday. The LION Live Surgery meeting 

will be hosted by Med-El. The surgery will be performed by Prof. dr. Baumgartner 

steamed live from VIENNA, Austria. 

TUESDAY 15.00 – 16.15 

The second interactive live surgery event will be on Tuesday. This event will be hosted 

by Cochlear. The surgery will be performed by one of the experienced surgeons from 

MHH, HANNOVER, Germany. The Surgical procedure will be a cochlear implantation 

using the C422 device by Cochlear.

oral presentations

O 001 

LONG-TERM RESULTS OF FUNCTIONAL ENDOSCOPIC SINUS 

SURGERY IN CHILDREN WITH CHRONIC RHINOSINUSITIS 

M.E. Cornet 

Academic Medical Centre, ENT department, AMSTERDAM, 


E-MAIL: m.e.cornet@amc.uva.nl 

OBJECTIVE 

Paediatric chronic rhinosinusitis (CRS) is a problem often seen by paediatricians 

and ENT surgeons. Although functional endoscopic sinus surgery 

(FESS) is proven to be an effective treatment, it is still unclear what the 

long term outcomes are in children. Therefore the objective of this study 

was to assess long term results of FESS in children with CRS. 

MATERIAL AND METHODS 

In this prospective trial we included children with CRS undergoing FESS 

in the AMC in Amsterdam between 2000-2010. All patients completed 

symptom- and quality of life questionnaires (RSOM) before surgery. We 

send the same questionnaire as a postal survey. 

RESULTS 

In total 50 children (23 boys, 27 girls) underwent FESS because of CRS. Most 

of them (81%) had CRS with nasal polyps and 21 % CF (8). The response rate 

postoperatively was 74% and the mean follow-up period was 4.3 years (± 

2.8). The mean age at surgery was 13 years old(± 2.9). The mean pre-operative 

total-RSOM score was 43.4. Postoperatively, the mean total score was 

31.3 (p=0.04). Separate scores for the domains of nasal symptoms, sleeping 

and practical problems were significantly better after FESS. In a separate 

question 79 % reported overall improvement of nasal complaints at long 

term follow-up. These results were comparable when only the children 

with nasal polyps were evaluated. Only 16% (6) of the patients needed a 

subsequent surgical intervention. 

CONCLUSION 

This study demonstrates that there is significant long term improvement 

in quality of life after FESS in children with CRS with nasal polyps. 

O 002 

IS IT REALLY NECESSARY TO DELAY INTRANASAL STEROID 

TREATMENT AFTER FESS ? AN ANIMAL STUDY 

C. Bayraktar, C. Atmaca, S. Guvenc, D. Karayigit, E. Atmaca, M. Yarim 3 , 

A. Aksoy 

19 Mayis University Hospital Faculty of Medicine, Otolaryngology, 

SAMSUN, Turkey 

E-MAIL: cem_dr23@hotmail.com 

OBJECTIVES 

The aim of this study is to investigate the effect of early intranasal steroid 

administration on wound healing after sinus surgery. 

METHODS 

Forty-two, adult male New Zealand rabbits underwent bilateral 3mmpunch 

resection of the concha nasalis ventralis. The animals were divided 

into 3 groups as saline, late steroid (LS) and early steroid (ES). Saline group 

recieved saline drops, LS group recieved saline drops for 7 days followed by 

intranasal mometasone furoate (IMF) 50 g/nostril/day and ES group recieved 

IMF (same dose) starting on post-op day 1. The animals were sacrificed 

on post-op days 10 and 21. Left nasal specimens were examined 

histopathologically and immunohistochemically for matrix metalloproteinase 

9 (MMP-9) antigen. Right nasal specimen hydroxyproline levels 

were measured by high performance liquid chromatography (HPLC) as 

mg/g in wet tissue. 

RESULTS 

LS and ES groups were similar with regards to MMP-9 immunostaining 

on days 10 an 21. On day 10, ES group revealed significantly intense MMP- 

9 immunostaining when compared with saline group (p=0.017) and LS and 

ES groups revealed significant fibrosis when compared with saline group 

(p=0.017). Hydroxyproline levels were similar in all groups on day 10. ES 

group revealed significantly higher hydroxyproline levels when compared 

with LS group on day 21 (p=0.02). 

CONCLUSION 

Early intranasal steroid treatment has no detrimental effect in the postop 

wound healing after sinus surgery. 

59

O 003 

EVALUATION OF THE NASAL AIRWAY INCREASE INDUCED 

BY RAPID MAXILLARY EXPANSION (RME) BY MRI 

C.P. Valera 1 , M.J.R. Reis 1 , E. Itikawa 2 , F.M.G. Gallarreta 1 , 

T. Anselmo-Lima 1 

1 School of Medicine of Ribeirão Preto - University of São Paulo, 

Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, 

RIBEIRAO PRETO, Brazil 

E-MAIL: facpvalera@uol.com.br 

2 School of Dentistry of Ribeirão Preto - University of São Paulo, 

RIBEIRÃO PRETO, Brazil 

OBJECTIVES 

Investigators have long been concerned about the consequences of RMEon 

nasal cavity and breathing pattern. However this subject continues to be 

controversial.The objective of the present study was to analyze the effect 

of RME on nasal airway in mouth-breathing children, by MRI. 

METHODS 

Twenty-seven children aged 7 to 10 years were evaluated. Inclusion criteria 

were:maxillary atresia and uni- or bilateral posterior crossbite andotorhinolaryngologic 

diagnosis of mouth breathing due to pharyngeal tonsil 

hypertrophy. The Haas disjunctor was placed, and the MRI was performed 

before and 6 months after its installation. Nasal structures were identified, 

and nasal airway was quantified in pixels. Nasal airway volume was then 

compared between the analyzed periods, through paired statistical tests. 

RESULTS 

There was no significant difference in total, anterior or posterior nasal airwayvolumes 

after MRE. Conclusion:RME does not influence on nasal airway 

volume, and thus should not be prescribed for this solely purpose. 

60 

O 004 

ORBITAL AND PERI-ORBITAL INFECTIONS IN PEDIATRIC 

POPULATION: ETIOLOGY, CLINICAL PRESENTATION, 

RADIOLOGICAL CHARACTERISTICS AND OUTCOME 

PREDICTORS 

A.Wolfovitz, R.Shihada, N.Yehudai, M.Luntz 

Bnai-Zion Medical Center, Otolaryngology - Head and Neck Surgery, 

HAIFA, Israel 

E-MAIL: amit.wolfovitz@gmail.com 

OBJECTIVES 

To identify and analyze clinical and radiologic predictors for a rigorous 

clinical course in pediatric orbital and periorbital infections. 

METHODS 

A retrospective observational case study of 122 children diagnosed and 

treated for orbital or periorbital infections between 2005 and 2011. Cases 

were managed by the pediatric department only or in accordance with the 

otolaryngology department. All children who were referred for otolaryngology 

consultation underwent a CT scan. 

RESULTS 

The mean age of the children was 4.3 4.3 years (range, 2 months-17.5 years) 

with male gender predominance. The main etiologies included: eyelid infection 

(32.8%), acute maxillary and/or ethmoidal sinusitis (21.3%) and 

trauma (18%). CT scan was performed in 36 (29.5%) of the children and 

demonstrated orbital involvement in 63.9% of the cases (orbital cellulitis 

in 22.2%, subperiosteal abscess in 36.1%, and orbital abscess in 5.6%) In 7 of 

the 122 children (5.7%) surgical intervention was necessary. Higher probability 

for complications was associated with a male gender, ipsilateral sinusitis, 

elevated indexes of inflammation and older age. 

CONCLUSIONS 

Prognosis of pediatric orbital and periorbital infections is good. Older 

males with ipsilateral sinusitis and elevated inflammatory indexes require 

a higher level of suspicion regarding the possibility of a rigorous clinical 

course.

O 005 

SECONDARY RHINOSINUSITIS IN CHILDREN TREATED 

FOR CRANIOFACIAL MALIGNANCIES 

P. Fayoux 1 , N.X. Bonne 1 , G. Hosana 1 , H. Sudour 2 , P. Leblond 2 

1 University Hospital of Lille, Pediatric Otolaryngology Head Neck 

Surgery, 59000 LILLE, France 

E-MAIL: pierre.fayoux@chru-lille.fr 

2 Oscar Lambret Cancer Institute, LILLE, France 

OBJECTIVES 

Rhinosinusitis (RS) can occur secondary to the treatment of craniofacial 

malignancies, particularly following radiation therapy and are an important 

factor of discomfort. The aim of this study is to determine the incidence, 

course and impact on quality of life (QoL) of secondary RS in 

children treated for a craniofacial malignancy. 

METHODS 

Study included all children treated in a tertiary referral department of pediatric 

oncology for a non-hematologic craniofacial malignancy between 

2000 and 2009, with at least 2 years of follow-up after treatment. Patients 

with chronic RS or allergy before diagnosis of the malignancy were excluded. 

Sinus disease was assessed following a systematic review of magnetic resonance 

imaging performed during oncologic follow-up. Extent of the RS 

was staged using Lund-MacKay score. Impairment in health-related QoL 

was scored using the self-reported questionnaire Sinuso-Nasal Outcome 

Test 22 (SNOT22) and compared to a group of 30 children treated for an 

extra-craniofacial sarcoma. 

RESULTS 

Twenty six patients fulfilled inclusion criteria. A RS was observed in 20 patients 

(77%). The RS appeared immediately after the end of treatment (5/20) 

or within the first year after treatment (15/20). Along a mean follow-up of 

72 months, RS remained stable or exacerbated in 16 patients and improved 

in 4 patients. The means score of SNOT 22 was significantly higher in the 

craniofacial group (23.5) than those observed in the extra-craniofacial 

group (8.8) (p

O 007 

THE MANAGEMENT OF RECURRENT CROUP IN CHILDREN 

S.M.Wang 1 , I. Rankin 1 , A.Waters 2 , W.A. Clement 2 , H.Kubba 2 

1 University of Glasgow, GLASGOW, United Kingdom 

E-MAIL: 0902584w@student.gla.ac.uk 

2 The Royal Hospital for Sick Children Yorkhill, GLASGOW, 


OBJECTIVES 

Recurrent croup is relatively common but little is known about its aetiology 

and prognosis. We performed a retrospective study to describe the outcome 

of investigation and management of these children. 

METHODS 

Case records were reviewed for all children presenting with recurrent 

croup at The Royal Hospital for Sick Children from November 2002 to 

March 2011. Specific data collected included sex, age of onset, age at presentation, 

duration of croup prior to referral, number of episodes, comorbidity, 

hospital admissions, investigations performed, treatments given, 

duration of follow up and status at last follow up. 

RESULTS 

90 children with recurrent croup were identified. 25 patients (28%) had 

anatomical airway abnormalities of which 16 (18%) demonstrated various 

degrees of subglottic stenosis. Most airway anomalies were managed conservatively 

but 2 required surgery. 23 children (26%) had positive microlaryngobronchoscopy 

findings of reflux and these children often 

responded well to anti-reflux medication. 41 children (45%) had no cause 

identified and they were the group most likely to continue having episodes 

of croup at last follow up: one death occurred in this group. 

CONCLUSIONS 

Recurrent croup requires microlaryngobronchoscopy for diagnosis of airway 

anomalies and reflux laryngitis. Children with normal findings 

should be observed closely. Routine measurement of IgE and complement 

proteins is unhelpful. 

62 

O 008 

TRACHEOSTOMY DECANNULATION IN CHILDREN: 

EXPERIENCE AT GREAT ORMOND STREET HOSPITAL 

J. Tweedie, C. Pepper, S .Pal, M. Elloy, C. Jephson, L. Cochrane, 

M. Wyatt, B. Hartley, D. Albert 

Great Ormond Street Hospital for Children, Department of Paediatric 

Otolaryngology, LONDON, United Kingdom 

E-MAIL: dtweedie@doctors.org.uk 

OBJECTIVES 

Few published series have specifically considered tracheostomy decannulation 

in children. We review the outcomes of decannulation trials over a 

nine-year period at this centre. In particular, we examine the circumstances 

of primary and secondary failures, together with patient and environmental 

factors which might affect failure rates. 

METHODS 

Patients were identified from prospectively-collected hospital databases, 

and data collected from computerised records and casenote review. All underwent 

microlaryngobronchoscopy and preassessment prior to a trial of 

decannulation according to our four-day standardised protocol. Carers received 

life support training before discharge. 

RESULTS 

203 consecutive children had trials of decannulation between January 2003 

and December 2011, patient age range 5 months -17 years (median 4.4 

years). These children had undergone tracheostomy for a variety of indications. 

170 decannulations (83.7%) were successful. 30 patients (14.8%) 

failed decannulation in hospital (primary failures) and a further three 

(1.5%) were decannulated and discharged but re-admitted for repeat tracheostomy 

(secondary failures). There were no deaths or serious complications 

observed, and the majority of failures have now been decannulated 

successfully. The age range of failures was 6 months to 14 years (median 

3.8 years). The indications for tracheostomy were similar in this group, 

but multiple co-morbidities were typically commoner than among those 

decannulated successfully. No seasonal trends were observed. 

CONCLUSION 

The majority of children were decannulated successfully. The most obvious 

factor associated with failure of decannulation was the presence of 

multiple comorbidities. Our low secondary failure rate and absence of serious 

complications supports our decannulation protocol.

O 009 

UK STUDY OF INHALED AND INGESTED FOREIGN BODIES 

C.M.Bailey 1 , G. Cosh 2 , C. Chapman 2 , J. Opperer 2 , G. Rider 3 

1 Great Ormond Street Hospital for Children, Department of 

Paediatric Otolaryngology, LONDON, United Kingdom 

E-MAIL: CMartin.Bailey@btopenworld.com 

2 ITS Testing Services (UK) Ltd, LONDON, United Kingdom 

3 Intertek Consumer Goods North America and RAM, OAK BROOK, 

USA 

OBJECTIVES 

To develop an up-to-date, representative UK database of inhaled and ingested 

foreign bodies (FB’s) in children, in order to identify emerging 

trends and inform risk analysis. 

METHODS 

Eight regional UK children’s hospitals were recruited to participate in a 

two-year prospective study of inhaled and ingested foreign bodies requiring 

operative removal, commencing in the summer of 2009. A standard 

data sheet was employed, based upon that used for similar, previous injury 

database studies organized by Intertek. It included a range of questions 

covering basic patient information, characteristics of the foreign body, 

clinical data such as the location of the foreign body and method of removal, 

an outline of the medical care required and severity of symptoms, 

the method of diagnosis, and a description of the incident. Data sheets 

were completed for a total of 331 patients. 

RESULTS 

Data analysis so far has shown a peak age for FB injury of 2-3 years. 61% of 

objects were metallic (70% of those being coins), 26% were food and 13% 

were plastic. 60% were three-dimensional and 35% were two-dimensional. 

55% of FB’s were ingested and 40% inhaled. At their worst, none of the children 

were in extremis, 9% had severe symptoms, 23% moderate, 52% mild 

and 10% were symptom-free. Analysis has included comparison with databases 

assembled by Intertek from previous European and Global studies. 

CONCLUSIONS 

Data analysis has provided important epidemiological information for use 

in injury prevention, which can be achieved by a combination of advice to 

manufacturers, parental education, and government legislation. 

O 010 

ANALYSIS OF TYMPANIC AND MIDDLE EAR ANATOMY 

THROUGH MULTIPLE-WAVELENGTH LIGHT OTOSCOPY 

AND IMAGE PROCESSING 

C. Roehm 1 , L. Cheng 2 , T. Valdez 3 

1 University of Connecticut Health Center, Otolaryngology, 

FARMINGTON, USA 

E-MAIL: corrie.roehm@gmail.com 

2 Trinity College, HARTFORD, CT, USA 

3 Connecticut Children’s Medical Center, HARTFORD, CT, USA 

OBJECTIVE 

To assess the utility of visible light video-otoscopy using multiple wavelengths 

(405, 450, 532 and 635 nanometers) and fluorescence imaging to 

isolate transtympanic characteristics unique from standard white-light 

otoscopy. Exploring digital signal processing algorithms to extract those 

differences. 

STUDY DESIGN 

Experimental study with diagnostic test assessments 

Setting: Tertiary care Children’s hospital. 

SUBJECTS AND METHODS 

High-definition video and still imaging of tympanic membranes in 20 

normal ear subjects were obtained under 405, 450, 532 and 635 nanometer 

(nm) wavelength illumination using a high-definition color CCD video 

otoscope and fluorescence filters. After the image formation stage, postprocessing 

procedures including digital enhancement through linear unsharp 

algorithms and segmentation techniques were developed to 

differentiate standard tympanic anatomy. 

RESULTS 

Under 405nm wavelength light, improved definition of the malleus, annulus 

and tympanic membrane was seen compared to white light and the 

other three individual wavelengths. Large absorption by hemoglobin 

along the vasculature of the annulus and malleus was seen using 532 nm 

wavelength light. Cerumen, keratin debris and the bony promontory were 

found to have autofluorescence and reflective properties on both 405 nm 

and 450 nm wavelength. Adequate segmentation of malleus and vasculature 

was achieved in all cases. 

CONCLUSION 

Specific visible light reflectance and fluorescence high-definition CCD otoscopy 

at individual wavelengths offers additional definition of transtympanic 

features over traditional white light otoscopy, specifically highlighting 

bony landmarks including the ossicular chain and promontory. 

Processing of digital images further enhances and categorizes pixel data 

with segmentation to identify standard anatomic structures. 

63

O 011 

DIFFERING SEASONAL DELAYS OF FACETS OF OM(E) 

PRESENTATION IN HOSPITAL REFERRED CASES 

S.A.Filipovic 1 , P.Marchisio 2 , D.J.Djeric 1 , M.Haggard 3 , H.Spencer 3 

1 Clinical Center Belgrade, Audiology rehabilitation, BEOGRAD, 

Serbia 

E-MAIL: flandris@gmail.com 

2 University of Milan, MILAN, Italy 

3 Cambridge University, CAMBRIDGE, United Kingdom 

BACKGROUND 

The known winter maximum population incidence of AOM episodes is 

due mainly to the autumn rise in respiratory virus circulation. Seasonalities 

for facet severities have not been studied systematically. 

METHODS 

Using the Eurotitis-2 database, we modelled determinants of three OME 

facets in the OM8-30 questionnaire: URTI (6 items), general disease severity 

(as the sum of reported hearing difficulties and ear infection symptoms: 7 

items), and developmental impact (behaviour, 6; speech/language, 3; 

schooling concerns, 1; and parent quality of life, 5; total 15 items). Multiple 

regressions accessed over 1650 referrals. Controlling for hospital centre (13) 

and demographics (age, gender, maternal education), we captured timings 

via paired sine and cosine functions of calendar month and interpolation 

of their two estimates. URTI was cascade driver for severity, disease severity 

for development. 

RESULTS 

With demographics and centre controlled, each of the 3 facets showed significant 

driver and season effects for severity score values. Smoothed seasonal 

maxima were late February for URTI, early April for OM diseases 

severity, and mid-June for downstream development — reversed from winter 

OM incidence peak. These delays in cross-sectional case data suggest 

seasonally differing disease/impact stage, rather than radically differing 

case-types. 

CONCLUSIONS 

1 A general short-term marker of OME severity, summing RAOM and reported 

hearing difficulties, has conventional early spring maximum 

and predicts developmental impact. 

2 Impact is delayed relative to disease, consistent with being caused by 

accumulated effects. The relative emphasis between disease and impact 

changes through the year in hospital cases, and clinicians need to use 

this fact. 

64 

O 012 

QUALITY ASSURANCE FOR A SUSTAINED PROSPECTIVE 

OBSERVATIONAL STUDY IN MIDDLE EAR SURGERY 

V.W.F.M. Van Rompaey 1 , M.Vanderveken 1 , M.Yung 2 , H. Van de Heyning 1 

1 Antwerp University Hospital, Otorhinolaryngology and Head & Neck 

Surgery, EDEGEM, Belgium 

E-MAIL: vvr@telenet.be 

2 The Ipswich Hospital NHS Trust, IPSWICH, United Kingdom 

OBJECTIVE 

To implement quality assurance for a prospective observational study in 

middle ear surgery. To handle increasing amounts of data, clinical data management 

systems (CDMS) can help to input individual data, collect them in 

a central data repository and analyze surgery-specific cumulative outcome. 

METHODS 

The study protocol was streamlined using the GRACE principles (Good 

Research for Comparative Effectiveness) on design of high-quality observational 

studies. The sequence of taking clinical notes, completing the pro 

formas manually and inputing them online in the Ear Audit is replaced 

by (less time-consuming) digital pro formas in the electronic patient 

record system. Individual variables are exported to a CDMS combining 

clinical, questionnaire and audiometric data. This kind of data integration 

is complex due to separate data input by surgeons and audiologists. Therefore 

we constructed an informatics blueprint to map the CDMS. The information 

framework generates individual surgical reports and allows 

anonymous and prospective inclusion in the department’s CDMS. Data 

are reported using the STROBE principles (Strengthening the Reporting 

of Observational Studies in Epidemiology). 

RESULTS 

Every trimester surgery-specific cumulative outcome is reported using a 

predefined template. These templates can also be generated real-time at 

clinician or departmental level, etc. Every partner has the potential to generate 

their own template (e.g. surgeon, allograft tissue technologist, quality 

manager, etc.). 

CONCLUSION 

Prospective observational studies have an enormous potential to meet 

sample size needs in middle ear surgery and address relevant topics in surgical 

management strategies. The future lies in implementation of surgical 

quality management systems for each contributing center.

O 013 

THE MANAGEMENT OF TYMPANIC MEMBRANE 

PERFORATIONS IN CHILDREN 

P.J. Robinson, M. Rollin 

Bristol Royal Hospital for Children, Otolaryngology, BRISTOL, 


E-MAIL: philiprobinson@blueyonder.co.uk 

This presentation will discuss the management of tympanic perforations 

in children based upon a study of the natural history of 2701 perforations 

in 1761 children. The data analysed was drawn from a database of 147565 

consultations carried out by the Bristol Paediatric Audiology service over 

a 20 year period. 

After a 2.5 year folllow up, rates of spontaneous closure were 90% in children 

under 7 years at the time of diagnosis and 75% in children diagnosed 

between the ages of 7 & 12 years. The time to closur eincreased by 7% for 

each 1 year increase in age at diagnosis. No significant difference in time 

to closure was found between boys and girls, nor between ventilation tube 

related perforations and others. 

A period of watchful waiting is initially appropriate but there appears to 

be no benfit in waiting more than 2.5 years. 

Facotrs (and myths) involved in successful tympanoplasty surgery in 

young children will also be discussed. 

O 014 

MYRINGOPLASTY: A SWEDISH QUALITY REGISTER OF 

OTORHINOLARYNGOLOGY 

E. Westman 1 , P.O. Eriksson 2 , M.H. Hultcrantz 3 , M. Berglund 4 , 

B. Carlborg 5 

1 ENT clinic, Surgical center, SUNDSVALL, Sweden, 

E-MAIL: eva.westman@lvn.se 

2 Section of Otosurgery, Uppsala University Hospital, UPPSALA, Sweden 

3 Karolinska University Hospital, STOCKHOLM, Sweden 

4 NÄL, TROLLHÄTTAN, Sweden 

5 Lund University, MALMÖ, Sweden 

OBJECTIVE 

In order to reinforce quality assurance the Swedish Association for Otorhinolaryngology 

and Head & Neck Surgery has focused on developing several 

quality indicators for more than one representative diagnoses. One of the 

diagnosis in the Swedish Quality Register of Otorhinolaryngology is myringoplasty. 

Myringoplasty is a common otosurgical procedure. The Register 

started in 1997. Four documents are used, one preoperative, one postoperative, 

one at the follow up visit at 6-12 months and a survey sent to the 

patient after 6-12 months. In the user’s hand no software beside a regular 

web browser is needed for registration. ENT unit specific results compared 

to the national average are available through a secure server based password 

system. The data server stores all data and is always available. There 

are interactive web pages for analysis of relevant data. From 2007 31 of the 

32 clinics performing myringoplasty are participating. The average rate 

for all clinics of acquiring a whole ear drum after a conventional myringoplasty 

is 90% 6-12 months postoperatively. In the survey 86 % of the patients 

stated that they had improved. About 20% of the registered myringoplasty 

procedures are performed by using fat graft. 

CONCLUSIONS 

More than 3300 myringoplasty procedures in Sweden have been registered 

since 1997 in the Swedish Quality Register of Otolaryngology. The register 

contains data from preoperative and postoperative examination and from 

a follow up visit after 6-12 months including a patient survey. Since 2008 

there is also a public presentation of selected statistically analyzed data. 

65

O 015 

BILATERAL VERSUS UNILATERAL BONE ANCHORED 

HEARING AIDS FOR CHILDREN WITH BILATERAL 

PERMANENT CONDUCTIVE HEARING LOSS: 

A SYSTEMATIC REVIEW 

N.K. Chadha 1 , R.M. Janssen 1 , P. Hong 2 

1 University of British Columbia, Division of Pediatric Otolaryngology, 

VANCOUVER, Canada 

E-MAIL: nchadha@cw.bc.ca 

2 Dalhousie Unversity, HALIFAX, Canada 

OBJECTIVE 

To systematically review the evidence for bilateral versus unilateral implantation 

of bone-anchored hearing aids (BAHA) in children with bilateral 

permanent conductive hearing loss (CHL). 

METHODS 

Following a specified protocol, a detailed search strategy was employed 

using MEDLINE, EMBASE, and the Cochrane databases for studies published 

between 1977 and July 2011. Reference lists of articles were crosschecked 

and where indicated authors were contacted to obtain further 

unpublished data. Identified studies were assessed independently by two 

authors against pre-determined inclusion criteria. 

RESULTS 

We identified 7 studies for inclusion, which comprised 4 retrospective cohort 

studies, 3 case-control studies, and no randomized controlled trials, 

incorporating a total of 40 children with bilateral BAHA. In most studies, 

comparison between unilateral and bilateral BAHA was intra-subject. The 

age range of included children was 5 to 18 years. Outcomes consisted of 

audiometric measures, subjective reports of benefit, and quality of life 

measures. A benefit of bilateral BAHA over unilateral BAHA was seen audiometrically 

for tone thresholds (1 study), speech in quiet (2 studies), and 

lateralisation (1 study). Overall, patients perceived subjective benefit from 

bilateral over unilateral BAHA (1 study) and showed quality of life improvement 

(1 study). One adverse outcome was reported (loss of implant). 

CONCLUSIONS 

Bilateral BAHA in children may provide objective and subjective benefit 

compared to unilateral BAHA, although this review was limited by the 

small number of available studies and low evidence level. There is clearly 

a need for further research in this area and this review provides detailed 

guidance to facilitate this. 

66 

O 016 

MANAGEMENT OF FIRST BRANCHIAL CLEFT ANOMALIES 

Y. Bajaj 1 , K. Kapoor 2 , D. Tweedie 3 , S. Ifeacho 3 , B. Hartley 3 

Great Ormond Street Hospital, LONDON, United Kingdom 

E-MAIL: ybajaj@hotmail.co.uk 

INTRODUCTION 

First branchial cleft anomalies are uncommon and account for less than 

10% of all branchial cleft defects. 

METHODS 

The results were collated from a prospectively collected database of patients 

with first cleft anomaly operated on from January 2006 to November 

2010 at Great Ormond Street Hospital. 

RESULTS 

In this study 15 children (8 male, 7 female) with first branchial anomaly 

were included. Majority of these patients were less than 5 years at the time 

of operation. Seven of these patients had recurrent infections in the past. 

In the majority of cases (12/15), the tract was a blind ending sinus. In six 

cases the sinus tract was entirely deep to the facial nerve, while in eight 

cases the tract was superficial to facial nerve. All these cases had macroscopic 

evidence of skin or cartilage in the lining of the tract. Four of these 

were completely duplicated ear canals with cartilage lined with hair bearing 

skin. Complete excision was achieved in all these cases. In this series 

we had one complication (temporary marginal mandibular nerve weakness). 

All these patients were followed up in the clinic for at least 6 months 

post-operatively. Good outcome was achieved in all these cases, and there 

were no recurrences. 

CONCLUSION 

First branchial cleft anomalies are rare and clinicians should have a high 

index of suspicion in patients with a cyst or sinus in the ear canal or around 

the ear and upper neck, which may become infected. Definitive excision 

with facial nerve exposure has excellent outcomes.

O 017 

THE INTRODUCTION OF A PROTOCOL FOR THE 

MANAGEMENT OF PAEDIATRIC CERVICAL 

LYMPHADENOPATHY 

R. Locke, F. MacGregor, H. Kubba 

Royal Hospital for Sick Children, ENT, GLASGOW, United Kingdom 

E-MAIL: richard.locke7@ntlworld.com 

OBJECTIVE 

Neck lumps are common in children, with cervical lymphadenopathy 

being the most frequent cause and malignancy being rare. When presented 

with a child with a neck lump however the clinician has to be able to exclude 

malignancy, and not over investigate or perform unnecessary procedures. 

All new patients referred with a neck lump were seen at a 

dedicated clinic at the Royal Hospital for Sick Children, Glasgow. All patients 

were seen on an urgent basis, and a neck lump protocol was followed 

for each patient. 

METHOD 

Two hundred and four patients referred to the neck lump clinic over a 6 

month period were managed according to the protocol. The median age 

was 4years and 3months. Patients with suspicious features according to 

the protocol were investigated with chest x-ray, ultrasound neck and blood 

tests for full blood count and viral serology. 

RESULTS 

The lymphadenopathy had resolved or there was an alternative diagnosis 

in 150 cases. Of the remaining 54 patients, the diagnosis at initial assessment 

was reactive lymphadenopathy in 47 (90%). Twenty five were discharged 

and 25 were investigated and of these 21 (84%) were diagnosed with 

reactive lymphadenopathy and discharged. Four children underwent 

lymph node biopsy. No malignancies were identified. No patient attended 

more than twice unless they underwent open biopsy. 

CONCLUSIONS 

The authors believe that this is the first prospective study examining a 

protocol for the management of cervical lymphadenopathy in children 

and would advocate it as a way of assisting in the management of paediatric 

cervical lymphadenopathy. 

O 018 

PAEDIATRIC HEAD AND NECK PATHOLOGY - A 10 YEAR 

EXPERIENCE 

T. S. Ahmed, D. Rossiter, H. Daya 

St George’s Hospital, Department of ENT Surgery, LONDON, 


E-MAIL: t.ahmed@doctors.org.uk 

OBJECTIVES 

To outline the spectrum of paediatric head and neck pathology presenting 

to a Tertiary Paediatric Centre over 10 year period with specific emphasis 

on malignant pathology. 

METHODS 

Children aged 16 or below who underwent elective surgery for neck pathology 

between 2000 and 2010 were identified from clinical coding and theatre 

databases. Demographical, procedural and hospital episode data were extracted 

and correlated with histopathological findings. Simple cutaneous 

lesions were excluded from analysis. 

RESULTS 

Four hundred and twelve children underwent surgery over this period 

(average 37 cases per year). There was a male predominance (58.6%) with a 

mean age of 7.9. A third (33.8%) of patients were aged 0-4. The majority of 

cases were under the care of otolaryngologists (53.0%) and paediatric surgeons 

(38.8%). Malignancy was found in 98 cases (28.8%): the majority of 

which were lymphomas. Other rarer malignancies included rhabdomyosarcomas, 

thyroid and parotid malignancies. Developmental anomalies 

accounted for 20.4% of the pathological specimens. Inflammatory 

lymphadenopathy comprised a significant proportion of the cases including 

reactive lymphadenopathy (110 cases), non-tuberculous mycobacterial 

infection (13 cases) and other granulomatous conditions including tuberculosis 

(15 cases). 

CONCLUSIONS 

This study provides an overview of the range of head and neck pathology 

that may present to the paediatric otolaryngologist. Malignant disease 

comprised a larger than expected proportion of cases compared to previous 

studies which have shown rates of 15% of biopsied neck masses being malignant 

which may be explained by an increased threshold for biopsying 

lymph nodes in the paediatric age group. 

67

O 019 

EDUCATING CHILDREN ABOUT CHOKING HAZARDS 

J.P. Ludemann 1 , M. Nashon 2 , D. Adler 2 , S. Scott 2 

1 BC Children’s Hospital, VANCOUVER, Canada 

E-MAIL: jludemann@cw.bc.ca 

2 University of British Columbia, VANCOUVER, Canada 

INTRODUCTION 

Despite formal and concerted efforts in health advocacy by Pediatric Otolaryngologists 

since at least 1923, foreign body aspiration and ingestion 

remain major, and sometimes lethal, public health problems. Various factors 

have been identified which may explain our difficulty in educating 

the parents of young children about choking hazards. These factors have 

limited the success of most public awareness campaigns, with the exception 

of those (in Israel and Crete) that uniquely featured direct exhibitional 

teaching on choking risks, prevention and treatment by Otolaryngologists 

to parents and children at pediatric care centers and schools. 

OBJECTIVES AND METHODS 

Based on this evidence, we constructed an educational intervention tool, 

consisting of an animated video and an interactive website on choking 

hazards, prevention and treatment; and studied its impact on 28 students 

in a grade 5 classroom in British Columbia, Canada. Prior to and after experiencing 

the video and website, the students were probed in an interview 

format about their understanding of the meaning of choking and its prevention. 

RESULTS (AND FUTURE DIRECTIONS) 

We learned that our educational tool (1) effected these students’ perceptions 

and understandings about choking hazards and (2) fit well within their science 

and social responsibility curricula. We are in the process of refining 

the website for grade 5 students and plan to develop web-based tools aimed 

at educating high school students, as well as teachers and parents. 

CONCLUSIONS 

We are optimistic that this multi-generational approach will eventually 

have the desired impact in reducing choking incidence, morbidity and 

mortality. 

68 

O 020 

NON TUBERCULOUS MYCOBACTERIAL CERVICOFACIAL 

ADENITIS: A 30 YEARS RETROSPECTIVE REVIEW 

O. Piccin, I. Pelligra, I. Fernandez, G. Macrì, C. Bergonzoni, D. Saggese 

S. Orsola-Malpighi University Hospital, Otolaryngology, BOLOGNA, 

Italy 

E-MAIL: ottavio.piccin@gmail.com 

OBJECTIVE 

To present our experience with the use of diagnostic tools in children with 

NTM cervicofacial adenitis over 30 years period. The therapeutic management 

is also discussed. 

METHODS 

Case series of 65 children with chronic lymphadenitis clinically suspected 

for NTM-infection. Diagnostic protocol included chest X-ray, ultrasonography, 

intradermal skin testing, histological examination and specimen 

culture. Since 2009 Quantiferon-TB test and PCR were also performed. CTscan 

was done only in selected cases. Involved nodes were treated surgically 

in 63 cases. Two patients with uncommon extension underwent partial 

resection. Postoperative antitubercolar chemotherapy was performed in 

10 patients. 

RESULTS 

NTM-infection was diagnosed in 57 cases and TM-infection in 2 cases. In 

6 cases the etiologic diagnosis was not achieved. Surgery was curative in 

62 cases. One patient required re-intervention. Two patients with NTMinfection 

and partial surgical treatment, were cured by anti-tubercolous 

chemotherapy. No advantages of chemotherapy has been showed when it 

was administered after removal of all involved nodes. No permanent postoperative 

complications occurred. 

CONCLUSIONS 

Differential diagnosis of TM versus NTM-lymphadenitis is essential. The 

proper diagnostic protocol allows etiologic diagnosis in most cases, but 

undetermined diagnosis can occur. Therefore, a high level of attention is 

required for correct diagnosis, especially in the era of re-emerging TB-infection. 

Surgical excision of all affected tissue is the best treatment. Prolonged 

anti-tubercolous chemotherapy should be considered in case of 

recurrent disease, origin from areas at high-risk for TM-infection and 

when etiologic diagnosis is not available.

O 021 

NEONATAL TRACHEOSTOMIES: EXPERIENCES OVER THE 

LAST DECADE AT THE ROYAL MANCHESTER CHILDREN’S 

HOSPITAL 

S. Alvi 1 , J. Bates 2 , I. Bruce 2 , M. Rothera 2 

1 NHS, STOCKPORT, United Kingdom 

E-MAIL: sirhanalvi@hotmail.com 

2 Royal Manchester Children’s Hospital, MANCHESTER, 


OBJECTIVES 

The technique, indication and role of tracheostomy in the management 

of airway obstruction in children continues to evolve. The management 

of airway obstruction in neonates and pre-term infants can be particularly 

challenging. The aim of this study was to assess the indications for tracheostomy, 

the underlying pathologies, the surgical technique and the 

outcome in this important group. 

METHODS 

All neonates and preterm infants who had undergone tracheostomy over 

the last 10 years were identified for this retrospective study. Demographic 

data was collected along with details of co-morbidity, intubation history, 

the indication for tracheostomy, surgical technique, complications and 

outcome. 

RESULTS 

In total 282 tracheostomies were completed in the period, 28 of which were 

either a neonate or preterm infant from the Neonatal Intensive Care Unit. 

The average gestational age at birth was 33+1 weeks (range 25 to 41+6 

weeks) and the average corrected age at tracheostomy was term + 1 day 

(ranging from 54 days premature to term + 46). A variety of indications for 

tracheostomy were identified, with the commonest being subglottic 

stenosis (n=7), prolonged weaning (n=5) and vocal cord abductor palsy 

(n=5). 14 children have since been decannulated. An ‘out of hospital’ tracheostomy 

complication was implicated in 1 of the 3 deaths recorded in 

this group. 

CONCLUSION 

Airway management in neonates and preterm infants presents the clinician 

with unique challenges reflecting the changing cardiorespiratory 

physiology in this age-group. We feel that this study represents valuable 

data on this under researched subgroup. 

70 

O 022 

DIFFERENT ANTIBIOTIC TREATMENTS FOR GROUP A 

STREPTOCOCCAL PHARYNGITIS - A META-ANALYSIS 

M.L. van Driel 1 , I. de Sutter 2 , H. Habraken 3 , T. Christiaens 2 

1 University of Queensland, Discipline of General Practice, HERSTON, 

Australia 

E-MAIL: m.vandriel@uq.edu.au 

2 Ghent University, GHENT, Belgium 

3 Project Farmaka, GHENT, Belgium 

OBJECTIVES 

Antibiotics provide only modest benefit in sore throat, although effectiveness 

increases with positive throat swabs for group A beta-haemolytic 

streptococci (GABHS). It is unclear which antibiotic is the best choice if indicated. 

We assessed the comparative efficacy of different antibiotics in 

GABHS tonsillopharyngitis. 

METHODS 

Meta-analysis of randomised, double-blind trials comparing different antibiotics 

reporting clinical outcomes. 

RESULTS 

17 trials (n=5352) were included; 16 compared with penicillin (6 

cephalosporins, 6 macrolides, 3 carbacephem and 1 sulfonamides), one trial 

compared clindamycin and ampicillin. There was no difference in symptom 

resolution between cephalosporins and penicillin (ITT analysis; N = 

5; n = 2018; odds ratio for absence of resolution of symptoms (OR) 0.79, 0.55 

to 1.12). Clinical relapse was lower with cephalosporins but only in adults 

(OR 0.42, 95% CI 0.20 to 0.88; NNTB 33). There were no differences between 

macrolides and penicillin. Carbacephem showed better symptom resolution 

post-treatment (N = 3; n = 795; OR 0.70; 0.49 to 0.99; NNTB 14), but 

only in children (N = 2; n = 233; OR 0.57; 0.33 to 0.99; NNTB 8.3). Children 

experienced more adverse events with macrolides (N = 1, n = 489; OR 2.33; 

95% CI 1.06 to 5.15). 

CONCLUSION 

There is insufficient evidence for clinically meaningful differences between 

antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests 

cephalosporins are more effective than penicillin for relapse, but the 

NNTB is high. Data on complications are scarce. Considering the low cost 

and absence of resistance, penicillin can still be recommended as first 

choice.

O 023 

EFFECTIVENESS OF ADENOIDECTOMY IN CHILDREN WITH 

RECURRENT UPPER RESPIRATORY TRACT INFECTIONS: 

OPEN RANDOMISED CONTROLLED TRIAL 

M.T.A. van den Aardweg, C.W.B. Boonacker, M.M. Rovers, A.W. Hoes, 

A.G.M. Schilder 

University Medical Center Utrecht, Otolaryngology, UTRECHT, 


E-MAIL: m.t.a.vandenaardweg@umcutrecht.nl 

OBJECTIVE 

To assess the effectiveness of adenoidectomy in children with recurrent 

upper respiratory tract infections (URTI). 

METHODS 

Open randomised controlled trial (11 general and two academic hospitals), 

including 111 children aged 1-6 years selected for adenoidectomy for recurrent 

URTI. They were randomised to a strategy of immediate adenoidectomy 

with or without myringotomy or a strategy of initial watchful 

waiting. The primary outcome was the number of URTI episodes per person 

year. Secondary outcomes were days with URTI per person year, prevalence 

of URTI, middle ear complaints with fever, days with fever, health 

related quality of life and costs. 

RESULTS 

During the 24 months follow-up, there were 7.91 episodes of URTI per person 

year in the adenoidectomy group and 7.84 in the watchful waiting 

group (incidence rate difference 0.07, 95% confidence interval (0.70 to 0.85). 

No relevant differences were found for days with URTI or middle ear complaints 

with fever, nor for health related quality of life. The prevalence of 

URTI decreased over time in both groups. Children in the adenoidectomy 

group had significantly more days with fever than the children in the 

watchful waiting group (difference 3,51; 95% confidence interval 2,33 to 

4,69). The median total of direct and indirect costs were €1,385 (US$ 1,995) 

and € 844 (US$ 1,216) per patient for the adenoidectomy and watchful 

waiting group, respectively. 

CONCLUSION 

In children selected for adenoidectomy for recurrent URTI, a strategy of 

immediate surgery increases costs and confers no clinical benefits over a 

strategy of initial watchful waiting. 

O 024 

TONSILLECTOMY FOR PERIODIC FEVER, APHTHOUS 

STOMATITIS, PHARYNGITIS AND CERVICAL ADENITIS 

SYNDROME (PFAPA) 

D. Ramsden, J. Pollard, J. Burton 

Oxford University Hospital, ENT Department, OXFORD, 


E-MAIL: jamesdramsden@yahoo.co.uk 

OBJECTIVES 

To assess the efficacy of tonsillectomy in children with PFAPA syndrome. 

METHODS 

A systematic Cochrane review of evidence for randomised studies comparing 

adeno-tonsillectomy with non-surgical treatment. Two authors independently 

assessed trial quality and extracted data. 

RESULTS 

Two trials involving 67 children were included. One high quality study 

demonstrated a dramatic benefit of adenotonsillectomy in children with 

PFAPA diagnosed according to rigid, standard criteria with a relative ‘risk’ 

(RR) of symptom resolution after 18 months of 12.63 (95% CI 1.81 to 87.98) 

and a lower rate of episodes per patient-month (rate ratio 0.07; 95% CI 0.04 

to 0.13). A less methodologically rigorous study enrolled some children 

with PFAPA, but probably included others with alternative types of recurrent 

pharyngitis, and performed tonsillectomy alone. This also demonstrated 

a significant benefit for surgery at six months: RR 1.93 (95% CI 1.11 

to 3.36); rate ratio episodes per patient-month 0.10 (95% CI 0.04 to 0.28). The 

pooled relative risk of symptom resolution was 3.25 (95% CI 1.78 to 5.92) 

and the resulting number needed to treat (NNT) 2 (95% CI 1 to 3). 

CONCLUSIONS 

Tonsillectomy is an effective treatment for PFAPA. However, this is a selflimiting 

condition and carers of children with PFAPA must weigh the risks 

and consequences of surgery against the alternative of a finite period of 

recurrent episodes of disease at predictable intervals, potentially requiring 

time off school and the regular use of medication. It is uncertain whether 

adenoidectomy combined with tonsillectomy adds any additional benefit 

to tonsillectomy alone. 

71

O 025 

POSTTONSILLECTOMY HAEMORRHAGE RATES RELATED TO 

SURGICAL TECHNIQUE 

A.C. Hessén Söderman 1 , E.Ericsson 1 , C. Hemlin 2 , E. Hultcrantz 3 , 

K. Roos 4 , O.G. Sunnergren 5 , J.S. Stalfors 6 

1 Karolinska University Hospital, Department of ENT, 

STOCKHOLM, Sweden 

E-MAIL: anne-charlotte.hessen-soderman@karolinska.se 

2 Department of ENT Aleris Sabbatsberg Hospital, STOCKHOLM, 

Sweden 

3 Division of ENT, Department of clinical and experimental medicine 

Linköping Univ, LINKÖPING, Sweden 

4 Department of ENT, Capio Lundby Hospital, GÖTEBORG, Sweden 

5 Department of ENT, County Hospital Ryhov, JÖNKÖPING Sweden 

6 Department of ENT, Sahlgrenska University Hospital, GÖTEBORG, 

Sweden 

OBJECTIVES 

To study posttonsillectomy haemorrhage (PTH) rates in children, related 

to surgical technique. 

METHODS 

Register study from the National Tonsil Surgery Register in Sweden from 

1.03.2009 to 1.11.2011. Children 0-15 years that had been subjected to total 

tonsillectomy with or without adenoidectomy (TE or TE+A) were included 

in the study. The surgeon answers a postoperative questionnaire concerning 

data about surgery, including possible primary PTH, in this study defined 

as PTH that occurs during hospital stay. Secondary PTH is reported 

by the patient/parent in a questionnaire answered 30 days after surgery. 

RESULTS 

5579 children fulfilling the criteria were identified in the database. In 3983 

patients cold steel had been used, in 609 coblation, in 507 diathermy scissors 

and in 480 the technique was categorized as ‘Other’. The last group 

includes laser and ultrasonic scalpel as well as non-defined techniques. 

117/5579 patients (2.1%) had experienced a primary bleeding, 92/3983 (2,3%) 

after cold steel, 12/609 (2,0%) after coblation and 8/507 (1,6%) after diathermy 

scissors. Secondary PTH:s were reported by 175/3833 (4.6%) patients/parents. 

113/2764 (4.1%) after cold steel, 2/419 (4.8%) after coblation and 22/115 (7.0%) 

after diathermy scissors. The PTH rates related to surgical technique were 

equal regarding both primary PTH (p=0.2411) and secondary PTH 

(p=0.0657). 

CONCLUSIONS 

PTH is rare. Secondary PTH is more common than primary. Cold steel is 

still most commonly used for TE in Sweden. In the present material, the 

postoperative haemorrhage rate was equal regardless which TE technique 

was used. 

72 

O 026 

PRESENTATION OF LARGE DATAVOLUMES WITH THE 

VALUECOMPASSES - A QUALITIVE METHOD 

J. Stalfors 1 , C. Hemlin 2 , L. Hessen-Söderman 3 , E. Hultcrantz 4 , K. Roos 5 , 

O. Sunnergren 6 , E. Ericsson 7 

1 Sahlgrenska University Hospital, ENT-department, GÖTEBORG, 

Sweden 

E-MAIL: joacim@stalfors.se 

2 Aleris Sabbatsberg Hospital, STOCKHOLM, Sweden 

3 Karolinska University Hospital, DANDERYD, Sweden 

4 Linköping University Hospital, LINKÖPING, Sweden 

5 Capio Lundby Hospital, GÖTEBORG, Sweden 

6 County Hospital Ryhov, JÖNKÖPING, Sweden 

7 Department of Medical and Health Sciences, Linköping University, 

LINKÖPING, Sweden 

OBJECTIVES 

In the National Tonsil Surgery Register in Sweden a large volume of data 

is collected. The purpose of the register is to compile outcome data with 

regard to tonsil surgery to be used for description of the activities of respectively 

clinic, clinical improvement programs and research. Until 2011 

more than 23 000 patients have been included and for each patient 50 parameters 

are registered. There is a need for an intuitive and direct method 

of presenting data for the registering clinics where outcome results deviating 

from the national median are identified. 

METHODS 

Value compasses is a graphical presentation of data. Data for each clinic 

is calculated as proportions of the national min-max result. The result is 

plotted graphically in a umbrella chart. The national values below the 

median value are represented as a red field. The outcome of each participating 

unit is presented as a green field. The following outcome parameters 

are presented: 

- proportion of patients stating symptom relief 6 months after surgery 

- frequency of postoperative bleeding 

- median duration (days) of analgetic use 

- patient experience of given patient information 

- unplanned contact with healthcare postoperatively due to pain 

- bleeding or infection 

- proportion of daycare surgery 

- proportion of tonsillotomies. 

RESULTS 

The Value compass is a graphical qualitative mean of presenting large volumes 

of patient outcome data. Outliners are identified through its graphical 

interface and signal a possible need for a more detailed analysis. The 

value compass method and data for 2011 will be presented at the meeting.

O 027 

PREHOSPITAL ENDOTRACHEAL CUFF PRESSURE AS RISK 

FACTOR FOR IATROGENIC TRACHEAL STENOSIS 

J.M.Th. Draaisma 1 , H. Marres 1 , B.M. Gerritse 2 

1 Radboud University Nijmegen Medical Centre, Pediatrics, 

NIJMEGEN, The Netherlands, e-mail: j.draaisma@inter.nl.net 

2 Amphia Hospital, BREDA, The Netherlands 

OBJECTIVES 

The aim of this study was to determine the endotracheal cuff pressure as 

risk factor for iatrogenic tracheal stenosis during prehospital treatment. 

METHODS 

Prospective study of all patients intubated in the field by a Helicopter Medical 

Team with a low-pressure high-volume cuffed endotracheal tube during 

a six months period. The recommended upper pressure limit is 25 cm 

water. Endotracheal cuff pressure was measured only after the standard 

prehospital routine for intubation and insufflation of the cuff had been 

performed. Medical personnel charged with the insufflation were not informed 

regarding the purpose of the study. Insufflation was performed 

according to the dutch EMS-guidelines (SOSA). 

RESULTS 

From 241 patients included in the study. Indications for prehospital intubation 

were brain injury, major trauma, and cardiac resuscitation. 88% of 

the patients had a cuff pressure above the recommended upper pressure 

limit of 25 cm water. The mean cuff pressure of all patients was 69 31 cm 

water. Of the 45 children intubated in the field, 41 (91%) had a cuff pressure 

above 25 cm (range 5-140 cm) water. The cuff pressure was higher than the 

diastolic blood pressure in 10 children, and higher than the systolic blood 

pressure in 2 children (cardiac resuscitations excluded). 

CONCLUSIONS 

Inadmissible high cuff pressures are frequently measured after prehospital 

intubation in the Netherlands. Only 9% of the children had a cuff pressure 

within limits. Training of all personnel involved in field intubation is urgently 

required, and cuff pressures have to be measured. 

O 028 

LEARNING POSTURAL CONTROL IN CHILDREN - PLASTICITY 

OR EXPLORATORY LEARNING? 

F. Tjernström, M.Magnusson, M. Magnusson 

University Hospital Lund, Otorhinolaryngology, Head And Neck 

Surgery, LUND, Sweden, e-mail: Fredrik.Tjernstrom@med.lu.se 

INTRODUCTION 

The ability to maintain postural control is dependent upon sensory feedback 

mechanisms and feed-forward mechanisms. The latter are probably 

partly stored in the human genome (ontogenesis) and partly generated 

through experience. Postural control in children has been extensively researched, 

but few studies have had the actual learning or adaptation as 

the primary objective. Children are considered to have a greater central 

nervous plasticity than adults and the methodology of learning a new task 

is different than adults, so it would be conceivable that children’s postural 

learning also differ from adults. 

METHODS 

Posturography with vibratory calf stimulation delivered on 5 consecutive 

days and after 3 months to a child group (n=13 age 7-9) and an adult group 

(n=12 age 15-32). 

RESULTS 

The children did not reduce their torque variance during each test as the 

adults did. Furthermore, in the children group the mean of elicited torque 

on the 2nd day was on a lower level then they finished on day 1 (p

O 029 

THE INFLUENCE OF A VESTIBULAR DYSFUNCTION ON THE 

MOTOR DEVELOPMENT OF DEAF AND HARD OF HEARING 

CHILDREN 

P.T. De Kegel 1 , A.U.D. Maes 2 , P.T. Van Waelvelde 1 , I. Dhooge 2 

1 Artevelde University College - Ghent University, Rehabilitation 

Sciences and Physiotherapy Ghent, GHENT, Belgium 

E-MAIL: alexandra.dekegel@ugent.be 

2 Ghent University, Department of Oto-rhino-laryngolgy, GHENT, 

Belgium 

OBJECTIVES 

To identify the predictive ability of vestibular function test results on 

motor performance among hearing impaired (HI) children. 

METHODS 

51 typically developing (TD) and 48 HI children with unilateral (n = 9) or bilateral 

hearing impairment (n = 39) of more than 40 dB HL between 3 and 

12 years, were tested by Movement ABC-2, clinical balance tests, posturography, 

rotatory chair testing and vestibular evoked myogenic potentials 

(VEMP). From the group of HI children 23 wore cochlear implants (CI). 

RESULTS 

Total and balance performance on M ABC-2, performance on clinical balance 

as well as the sway velocity in stance on a cushion with eyes closed 

(CEC) and in unilateral stance differed significantly between the two 

groups. Presence of a VEMP response is an important clinical parameter 

because comparison of motor performance among HI children between 

those with present and absent VEMPs showed significant differences in 

balance performance. The three most important predictor variables on 

motor performance by bivariate regression analyses are the gain value at 

0.01 and 0.05 Hz frequency, as well as the VEMP asymmetry ratio. A multivariate 

regression model to predict one leg hopping is able to explain 

88,4% of the variance (F(8,20) = 27,653; p < 0,001) based on the age, 0.05 Hz 

rotatory chair asymmetry and gain values, VEMP asymmetry ratio and N1 

latency, and etiology. 

CONCLUSION 

HI children perform significantly weaker on balance performance than 

TD children. Combination of rotatory chair and VEMP testing can be used 

to predict balance performance. 

74 

O 030 

EFFECTS OF COCHLEAR IMPLANTATION ON VESTIBULAR 

FUNCTION 

N. Loundon 1 , B.Thierry 1 , S. Wiener-Vacher 2 , S. Marlin 1 , E.N. Garabedian 1 

1 A. Trousseau Children’s Hospital, ENT, PARIS, France, 

E-MAIL: natalie.loundon@trs.aphp.fr 

2 Robert Debré, PARIS, France 

OBJECTIVES 

To evaluate the impact of cochlear implantation (CI) on vestibular function 

(VF) in a pediatric population. 

DESIGN AND SETTING 

Retrospective study from 1990 to 2010, tertiary referral academic center. 

PATIENTS AND METHODS 

Among the 720 children who received a CI during the study period, 43 patients 

had a post operative vestibular assessment, 16 of them also had a 

pre-operative tests. The vestibular testing included calorimetric stimulation 

and vestibular evoked myogenic potential. Etiologies of deafness were 

connexin (n=7), Pendred (n=2), meningitis (n=2), CMV (n=2), Usher (n=3), 

Waardenburg (n=1), unknown (n=26). 

RESULTS 

Median age at CI was 3 years (yrs) 3 months (mo). Median age at post CI 

vestibular testing was 5yrs 4mo. Pre-operative tests showed 8 bilateral normal 

responses and 8 pathological tests. Post-operative tests showed 23 bilateral 

normal responses and 20 pathological tests. Among those 20 tests, 

6 had unilateral dysfunction on the side of implantation, 14 had bilateral 

dysfunction. In patients who had pre and post-implantation tests, 14/16 

did not have any vestibular modification, 2 had bilateral changes after unilateral 

implantation. In patients who had only post-implantation tests, 

15/27 were bilaterally normal and 12/27 had abnormal VF on implantation’s 

side and/or the other side. 

DISCUSSION 

In 54% (23/43), VF was normal after implantation. 0% (17/43), VF was not 

altered after implantation. In 6% (3/43), VF was abnormal on implantation’s 

side with no pre-operative examination and any predictive factor of 

vestibular injury such as cochlear malformation or opposite vestibular 

dysfunction. Further examination is needed to assert this percentage.

O 031 

PEDIATRIC VESTIBULAR AND BALANCE DISORDERS: RISK 

FACTORS AND CAUSES FROM 300+ PEDIATRIC PATIENTS 

J.R. Levi, T. Perry, E. Zwicky, R. O’Reilly, T. Morlet 

Nemours A.I. Dupont Hospital for Children, Surgery, Division of 

Otolaryngology, WILMINGTON,, USA, e-mail: jlevi@nemours.org 

OBJECTIVE 

The etiology of vestibular/balance disorders in children isquite different 

than their adult counterparts. Few studies havereported risk factors or 

causation for pediatric balance disorders;our aim was to characterize these 

in over 300 children with balancedisorders. 

METHODS 

A retrospective chart review was performed on over 300children with balance 

disorders at the Vestibular Disorders Program atA.I. duPont Hospital 

for Children from September 2003 - December 2011. Patients were referred 

when parents had concerns about coordinationor children had dizziness 

or lightheadedness. Children underwentcomprehensive testing including 

vestibular nystagmography, rotarychair, vestibular evoked myogenic potentials, 

gross motor development,gait analysis, and static and dynamic 

balance assessment and a fullaudiologic workup. Temporal bone and central 

nervous system imagingwas obtained. Charts were reviewed for family, 

prenatal, birth,developmental, and medical history. 

RESULTS 

The most common diagnosis was peripheral vestibulopathy(approximately 

27 %) including enlarged vestibular aqueduct, benignparoxysmal 

positional vertigo, otitis media, and sensorineural hearingloss. Migraine 

was also common (approximately 19%). Chiarimalformations accounted 

for approximately 12 % and traumatic braininjury occurred in approximately 

9%. Family history of migraine,headaches, vision impairments, or 

vertigo may be a risk factor forbalance disorders. Also, a personal history 

of prematurity,developmental delay, vision problems or obesity may be a 

risk factor.Some children had psychological disorders or mental retardation.Co-morbid 

conditions included pervasive developmental disorder 

anddisruptive behavior. 

CONCLUSIONS 

This represents one of the first reports characterizingrisk factors and 

causes of pediatric vestibular disorders. 

O 032 

THE NATURAL COURSE OF OSA IN CHILDREN WITH 

SYNDROMIC CRANIOSYNOSTOSIS 

C. Driessen 1 , K.F.M. Joosten 2 , L.J. Hoeve 2 , E.B. Wolvius 2 , I.M.J. Mathijssen 2 

1 Erasmus MC, ROTTERDAM, The Netherlands 

E-MAIL: c.driessen@erasmusmc.nl 

2 Erasmus MC Sophia, ROTTERDAM, The Netherlands 

OBJECTIVE 

Patients with syndromic craniosynostosis have a 40%-risk to develop obstructive 

sleep apnea syndrome (OSA), mainly due to midface hypoplasia. 

Our aim is to describe the natural course of OSA in untreated patients with 

syndromic craniosynostosis. 

METHODS 

This prospective study was conducted from January 2007 to December 

2010. An annual sleep study was performed up to the age of six years and 

once every three-years after the age of six. We compared consecutive measurements 

in children with an untreated airway using the obstructive 

apnea-hypopnea index (oAHI) and oxygenation-desaturation index (ODI). 

RESULTS 

One-hundred-forty patients were included, of whom 258 sleep studies 

were captured. OSA was present in 42% of all patients. In 70 patients consecutive 

sleep studies were performed. A linear mixed effects model of the 

oAHI logarithm showed higher values for the patients with midface hypoplasia. 

The omnibus likelihood ratio test (LRT) showed a different longitudinal 

evolution in oAHI between patients with and without midface 

hypoplasia (LRT = 12.9, p = 0.012). In paired measurements, the the oAHI 

(Z = -2.9, p = 0.004) and OSA severity score (Z = -3.0, p = 0.003) significantly 

decreased over time, especially in the first years of life. 

CONCLUSIONS 

This study confirms the high prevalence of OSA in children with syndromic 

craniosynostosis. We demonstrate that OSA remains stable or improves 

over time without treatment. All children with syndromic 

craniosynostosis should be screened around the age of one, which outcome 

is the most important predictor for persistent sleep disordered breathing. 

75

O 033 

DRUG-INDUCED SLEEP ENDOSCOPY FOR UPPER AIRWAY 

EVALUATION IN CHILDREN WITH DOWN SYNDROME 

M. Maris, S. Verhulst, M. Wojciekowski, P. Van de Heyning, 

A. Boudewyns 

Antwerp University Hospital, EDEGEM, Belgium, 

E-MAIL: mieke_maris@hotmail.com 

OBJECTIVES 

About 30-60% of Down syndrome (DS) children have obstructive sleep 

apnea (OSA). Adenotonsillectomy is the treatment of choice, but OSA persists 

in about 50% of DS children. These children are predisposed to multilevel 

airway collapse during sleep and a complex interaction of both 

anatomical and neuromuscular factors seems to be involved. Management 

of OSA in DS includes assessing the severity and the site (s) of upper airway 

(UA) obstruction. We therefore performed drug induced sleep endoscopy 

(DISE) in DS children with OSA proven by polysomnography (PSG). 

METHODS 

DISE was performed in 5 DS children (age 2-14years) and OSA (AHI range 

1,3 to 34,6/h) to investigate the pattern of upper airway collapse. Subsequently, 

an adenotomy (n=1) or adenotonsillectomy (n=4) was performed. 

RESULTS 

The majority of DS children evaluated had adenoid hypertrophy (80%) and 

oropharyngeal lateral wall collapse at the level of the palatine tonsils 

(100%). In none of them, the tonguebase was the major site of UA obstruction. 

Postoperative PSG showed an improvement in all cases and an AHI

O 035 

SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS 

COMPARING INTRACAPSULAR TONSILLECTOMY WITH 

TOTAL TONSILLECTOMY IN A PEDIATRIC POPULATION 

Y. Ebner 1 , J. Walton 2 , G. Stewart 3 , M. April 3 

1 Meir Medical Center, Otolaryngology, KFAR SABA, Israel, 

E-MAIL: yaniv.ebner@gmail.com 

2 Addenbrookes Hospital, CAMBRIDGE, United Kingdom 

3 Weill Cornell Medical College, NEW YORK, USA 

OBJECTIVE 

To perform a systematic literature review and data synthesis of level one 

evidence comparing recovery related outcomes after intracapsular tonsillectomy 

(IT) (any technique) with those of total tonsillectomy (TT) (any 

technique) in a pediatric population. 

METHODS 

Two independent reviewers comprehensively searched databases and references 

from indexed articles. Inclusion criteria were randomized controlled 

trials conducted on a pediatric population comparing IT performed by any 

technique of dissection, with TT also performed by any technique of dissection. 

Independent data extraction by two reviewers on the following 

outcomes; postoperative pain, analgesic use, recovery time, diet, bleeding 

rate, infection, and regrowth rate requiring further surgical intervention. 

Heterogeneity of outcome measures and lack of reporting of raw data precluded 

formal meta-analysis. Where quantitative data could be extracted, 

pooled data analysis was performed using non parametric tests. 

RESULTS 

16 studies were included with a total of 1312 participants, 699 in the partial 

tonsillectomy group, and 635 in the total tonsillectomy group. Mean number 

of days before resolution of pain was 5.0 0.83 days in the IT group 

(n=263) and 7.6 2.14 days in the TT group (n=208), p = 0.045. Secondary 

haemorrhage was seen in 5/699 in the IT group, and in 13/635 in the TT 

group, p = 0.035. No significant differences were found between the two 

groups in relation to the other outcomes studied. 

CONCLUSION 

Recovery related outcomes for intracapsular tonsillectomy were superior 

to total tonsillectomy (secondary haemorrhage rate, number of days until 

pain free) in a pediatric population with obstructive symptoms (level 1 evidence). 

O 036 

CHANGING TRENDS OF TONSILLECTOMY FOR OBSTRUCTIVE 

SLEEP APNOEA 

A. Zaman 1 , R. Sharma 2 , R. Clarke 2 , S. De 2 , A. Donne 2 

1 LONDON, United Kingdom, e-mail: azrinazaman@doctors.org.uk 

2 Alder Hey Children’s Hospital, LIVERPOOL, United Kingdom 

OBJECTIVES 

In times of financial constraint, Health Departments seem to identify tonsillectomy 

for recurrent tonsillitis as a low priority surgery hence a justifiable 

cut but the value of tonsillectomy in the treatment of Obstructive 

Sleep Apnoea (OSA) is recognised. Most published data would suggest that 

approximately 20% of tonsillectomies are performed for OSA. Our aim is 

to review the indication and rates for tonsillectomy performed in Alder 

Hey in the last decade. We also assessed for gender difference and readmission 

rates in tonsillectomies performed for tonsillitis versus OSA. 

METHODS 

We examined the records of the coding/finance department at Alder Hey 

over the last decade to identify tonsillectomies performed for OSA. 

RESULTS 

During this period 14000 tonsillectomies were performed. For the earlier 

5 year period the proportion of tonsillectomies performed for OSA was 

fairly steady but is followed by an increase from 55%-65% for the following 

5 years. Sixty-two percent of patients who had tonsillectomy for OSA were 

male whilst 43% of patients who had tonsillectomy for recurrent tonsillitis 

were male. 

CONCLUSION 

There is an increased proportion of tonsillectomies performed for OSA progressively 

which may be due to numerous factors including; increased 

sensitivity to this indication, better coding, increased referral pattern to 

our tertiary centre. There is a higher proportion of male compared to female 

patients who have tonsillectomies for OSA. 

77

O 037 

PEDIATRIC TONSILLOTOMY; A COMPARISON OF HIGH- 

AND LOW RADIOFREQUENCY TECHNIQUES WITH REGARD 

TO POSTOPERATIVE BLEEDING, PAIN, INFECTION AND 

SYMPTOM RELIEF 

O. Sunnergren 1 , E. Ericsson 1 , C. Hemlin 2 , A.C. Hessén Söderman 3 , 

E. Hultcrantz 4 , K. Roos 5 , J. Stalfors 6 

1 Linköping University, Department of ENT, LINKÖPING, Sweden, 

E-MAIL: sunnergren@telia.com 



4 Linköping University Hospital, LINKÖPING, Sweden 


6 Sahlgrenska University Hospital, GÖTEBORG, Sweden 

OBJECTIVES 

In recent years there has been a shift in Sweden from tonsillectomy to radiofrequency 

(RF) tonsillotomy (TT) as the most performed surgical procedure 

on tonsils in children. The used RF techniques are either of high- 

(4.0 MHz unipolar) or low- (0.5 MHz bipolar/”coblation”) frequency. This 

study compares the prevalence of the different RF methods and their rates 

of postoperative bleedings, unplanned postoperative contacts due to 

pain/suspected infection and degree of self reported symptom relief. 

METHODS 

All 932 RF TT’s in children 0-15 years, without simultaneous adenoidectomy, 

registered in the National Tonsil Surgery Register in Sweden (March 

2009-September 2011) were included. Type of technique and bleedings occurring 

during hospital stay were prospectively reported by the surgeon. 

Patient questionnaires were used to collect data on: postoperative bleedings 

after discharge causing either renewed healthcare contact, readmission 

or reoperation, unplanned healthcare contact due to pain or suspected 

infection (within 30 days) and symptom relief (6 months). 

RESULTS 

498 high RF TT and 434 low RF TT were performed. The primary indication 

for surgery was in >91% tonsillar hypertrophy causing upper airway obstruction. 

There were no significant differences between the techniques 

for any type of postoperative bleeding, unplanned healthcare contacts due 

to pain/suspected infection or in degree of symptom relief after 6 months 

(96% reporting ‘complete’ or ‘almost complete’ relief). 

CONCLUSIONS 

High- and low radiofrequency techniques used for tonsillotomy in children 

with tonsillar hypertrophy seems to be equal with regard to postoperative 

bleeding, pain and postoperative infection as well as outcome of 

symptom relief. 

78 

O 038 

ROLE OF CONE-BEAM-CT IN PEDIATRIC-ENT DIAGNOSTICS 

C. Güldner, I. Diogo, R. Weber, J.A. Werner, A. Teymoortash 

University of Marburg, Department ENT, Head and neck surgery, 

MARBURG, Germany 

E-MAIL: gueldner@staff.uni-marburg.de 

INTRODUCTION 

Cone-beam-CT (CBCT) is a quite new diagnostic tool in preoperative imaging 

of the anterior and lateral skull base in ORL. Especially in diagnostics 

of the chronic rhinosinusitis, chronic otitis media or cochlea implantation 

CBCT is a usefull alternative to a conventional CT. Furthermore, aspects 

of dose reduction in comparison to CT are one more argument to use it in 

preoperative radiological imaging. 

MATERIAL 

Over 5000 data-sets of CBCT of the past 8 years over all patients were evaluated 

regarding indication, artifacts and limits in dependence of age and 

dose. 

RESULTS 

More than 300 data-sets of children of CBCT could be analyzed. About 70% 

were performed because of clinical suspicion of chronic rhinosinusitis. 

About 20% of the indications were the suspicion of a chronic middle ear 

disease or planned cochlea implantation. Traumatic cases were the residual 

10%. Regarding imaging quality, down to an age of 5 years CBCT was performed 

with really good results. In sporadic cases the recording time of 9s 

with resulted in artifacts or wiggly images. Overall, about 97% of the performed 

images could answer the necessary questions (e.g. anatomic landmarks 

before surgery, fractures, position of cochlea electrode). 

CONCLUSION 

In our experience, CBCT is an excellent tool in preoperative imaging of the 

chronic diseases of ear and nose as well as in cochlea implantation. At this 

moment, because of the impossibility of reliable differentiation between 

soft tissues, we do not see any reliable indication in suspicion of neoplastic 

diseases, orbital complication of acute sinusitis or acute mastoiditis.

O 039 

EVIDENCE SUPPORTING SIMULTANEOUS BILATERAL 

COCHLEAR IMPLANTATION IN CHILDREN 

A. Gordon, L. Cushing, L. James, C. Papsin 

The Hospital for Sick Children, Archie’s Cochlear Implant Laboratory, 

TORONTO, Canada 

E-MAIL: karen.gordon@utoronto.ca 

OBJECTIVES 

Our overarching aim is to provide children with the best opportunity to 

develop binaural hearing. Over a series of studies, we have assessed the 

benefits and risks of providing children with bilateral cochlear implants 

in one surgery (simultaneously) rather than in two separate procedures 

(sequentially). Our hypothesis is that limiting both bilateral and unilateral 

auditory deprivation is important for development of the bilateral auditory 

pathways. 

METHODS 

We have prospectively measured auditory development in >300 children 

who received bilateral cochlear implants either simultaneously (>200 children) 

or sequentially. Surgical times and complications resulting from 

both procedures were assessed. In addition, electrophysiological measures 

and behavioral responses were completed to measure auditory changes 

with bilateral implant use. 

RESULTS 

Bilateral cochlear implantation had similar risks/complications for both 

simultaneous and sequential procedures but simultaneous implantation 

led to the greatest cost savings. Speech perception in noise was similar for 

both groups. On the other hand, sequential bilateral implantation resulted 

in asymmetries in auditory function at the level of the auditory brainstem 

and cortex which were not evident in children receiving bilateral cochlear 

implants simultaneously. These asymmetries were also seen in speech detection 

and recognition. Children with long periods of both bilateral and 

unilateral deprivation (late implanted, long inter-implant delays) showed 

the smallest improvements in speech perception with their bilateral implants. 

CONCLUSION 

Early simultaneous bilateral cochlear implantation offers reduced surgical 

time compared to sequential procedures and symmetric development of 

the bilateral auditory pathways thus providing better potential for development 

of binaural hearing in children with bilateral deafness. 

O 040 

COCHLEAR IMPLANTATION IN SYNDROMIC CHILDREN - 

THE GREAT ORMOND STREET HOSPITAL EXPERIENCE 

Y. Bajaj 1 , N. Gibbins 2 , B. Hartley 2 , C. Jephson 2 , D. Albert 2 , M. Wyatt 2 , 

L. Cochrane 2 

Great Ormond Street Hospital, LONDON, United Kingdom, 

E-MAIL: ybajaj@hotmail.co 

OBJECTIVE 

The objective of this study was to report surgical findings and outcomes 

of cochlear implantation in a large series of children with syndromes from 

one centre. 


All the syndromic children who have undergone cochlear implantation at 

Great Ormond Street Hospital, London, from January 2000 to December 

2010 were included in this study. The surgical details and audiological outcomes 

were collected. 

RESULTS 

Over the ten year period, of this study, a total of 88 cochleas in 67 children 

with syndromes were implanted. The common syndromes in the implanted 

children in this study were Ushers (33 cochleas), Wardenburgs (9 

cochleas), Pendreds (4 cochleas), Jervell Lange Neilsen (4 cochleas), Enlarged 

vestibular aqueduct (7 cochleas), Cogans (4 cochleas), CHARGE (6 cochleas), 

Branchio Oto Renal (4 cochleas). Intra-operatively full insertion was 

achieved in 93.1% (82/88) cochleas, partial insertion in 3 cochleas and abandoned 

in 3 cochleas. Early complications were seen in 6.8% (6/88) implantations 

and late in another 7.9% (7/88). All the 64/67 children who were 

implanted are still using the implant. The audiology results with the implant 

were found to be good (average 35-40 db hearing) in majority (92.1%). 

The speech production was excellent in 15.6% and good in 37.5% . Overall 

benefit perceived by the parents was reported good in 79.6% (51/64) and 

satisfactory in 20.3% (13/64) patients. 

CONCLUSION 

Good surgical results are achieved in syndromic children. Good audiological 

and speech outcomes were achieved in this study and subjective improvement 

in quality of life was achieved in these patients. 

79

O 041 

COCHLEAR REIMPLANTATION IN PEDIATRIC POPULATION 

N. Loundon, F. Glynn, M. Blanchard, I. Rouillon, E.N Garabedian 

A. Trousseau, Children’s Hospital, ENT department, PARIS, France 


OBJECTIVES 

To report our pediatric cochlear reimplantation data, to assess their causes, 

surgical challenges and functional outcomes. 

DESIGN AND SETTING 

Retrospective study from 1990 to 2011, tertiary referral academic centre. 

PATENTS AND METHODS 

Causes for reimplantation were classified as: hard (HF) and soft (SF) device 

failure, medical reason (M) and up grading (Up). Operative records and device 

analysis reports were reviewed. Results compared speech perception 

in open set words (OSW) before and after revision surgery. 

RESULTS 

800 cochlear implantations were performed during the study period. There 

were 66 reimplantations in 61 patients. Among these, 5 were second reimplantations 

(8%). (HF) represented 50% of cases, (SF) 22.5%, (M) 20% and (Up) 

7.5%. The main reason for HF were loss of hermeticity and cracked casing 

following head trauma. (M) was mainly related to cutaneous inflammatory 

problems as a consequence of head trauma in 60% of cases. Surgical 

difficulties were mainly due to neo-osteogenesis related to the use of bone 

dust. In three cases, the insertion of the electrode array was incomplete at 

revision surgery. Reimplantation rates were: 5% for Cochlear , 31.5% for 

Advanced Bionics and 30.9% for Neurelec. Audiological results were the 

same as pre-operative levels in 23% and better in 74% of cases at 12 months 

post reimplantation. 

CONCLUSIONS 

Reimplantation rate do not differ from literature and increase with time. 

Surgical team and patients should be aware of the surgical difficulties that 

can be encountered. Auditory performances after reimplantation are better 

in most cases, but can be worse in few cases. 

80 

O 042 

DISTRIBUTION OF COCHLEAR DUCT LENGTHS AND 

ELECTRODE CHOICE 

C. Jolly 1 , G. Alexiades 2 , E. Erixon 3 , H. Rask Andersen 3 

1 MED-EL, R&D, INNSBRUCK, Austria 

E-MAIL: claude.jolly@medel.com 

2 NYEE, NY, USA 

3 Otokirurgiska, UPPSALA, Sweden 

Cochlear size is adult at birth. Analysis of adult cochlea duct length (CDL) 

are directly relevant to children. Two histological studies (n=95) report 

human cochlear length at the Organ of Corti ranging from 25 to 35 mm, 

a 40% variation normally distributed. CDL is defined as the distance from 

the center of the round window membrane to the helicotrema. Deep insertion 

electrode should be capable of insertion up to 2 turns (720 degrees) 

or less, and avoid the small and fragile apical turn. Based on histology, 

variation of 2 turns of scala tympani length is between 21 and 31 mm. With 

discrete electrode lengths of 20, 24, 28 and 31 mm, cochlear coverage up to 

the apical region and without contacts outside the cochlea is feasible if no 

scala tympani malformations are present. Pre operative radiological measurement 

of 2 turns CDL at the Organ of Corti are necessary to choose the 

electrode adapted for a specific patient cochlea length without penetrating 

the apical region. A straightforward method exists to evaluate 2 turn CDL 

using the dimension A. A is defined as the length from the center of the 

round window to the opposite bony lateral wall and through the center 

of the modiolus. The correlation between the A value and 2 turn cochlear 

duct length is .92. Evaluation of cochlear duct length is imperative to minimize 

trauma and maximize benefits with good cochlear coverage.

O 043 

FINE STRUCTURE PROCESSING AND MUSIC PERCEPTION: 

IMPLICATIONS FOR PEDIATRIC COCHLEAR IMPLANTATION 

D.R. Friedland, A.P. Johnson, C.L. Runge 

Medical College of Wisconsin, Otolaryngology and Communication 

Sciences, MILWAUKEE, USA 

E-MAIL: dfriedland@mcw.edu 

OBJECTIVES 

To identify whether processing strategy provides benefit for recognizing 

musical instruments with a cochlear implant. 

METHODS 

Forty-nine normal hearing children and 21 children with cochlear implants 

were tested on a 6-choice musical instrument identification task. 

In addition, a similar instrument identification task was presented to 15 

adult cochlear implant users utilizing novel fine structure processing (FSP) 

and high definition continuous interleaved sampling (HDCIS) maps. 

RESULTS 

Normal hearing children reached adult levels of musical instrument identification 

by around age 12 years. While implanted children improved their 

instrument identification performance with age, they performed well 

below their age-matched normal hearing counterparts. The effect of processing 

strategy could not be adequately analyzed in children due to variability 

in duration of implant use and the small sample size. Analysis of 

performance of adult subjects who routinely used FSP as their daily strategy 

showed they perform significantly better overall on a musical instrument 

identification task than those using HDCIS daily (p=0.03). 

CONCLUSION 

Children who develop with a cochlear implant as their principal access to 

auditory information do not achieve the same level of ability to recognize 

musical instruments as their normal hearing counterparts. Based on the 

adult testing, however, chronic use of FSP may improve overall auditory 

performance with musical instrument identification. Chronic use of FSP 

may therefore promote or maintain important central auditory processes 

for complex sound perception. This may have greater implications for the 

pediatric population who use such processing strategies during critical 

periods in auditory development. 

O 044 

SOUND CATERPILLAR - ASSESSMENT AND TRAINING OF 

SOUND AND MUSIC PERCEPTION SKILLS IN HEARING 

IMPAIRED CHILDREN 

L. De Bruyn, B. Philips, D. Moelants, P. Coussement, M. Leman, 

I. Dhooge 

Ghent University, Musicology, GENT, Belgium 

E-MAIL: leen.debruyn@ugent.be 

OBJECTIVES 

We assessed and compared the development of timbre and melody discrimination 

and representation skills in prelingually deaf children using 

cochlear implants (CI), in severe hearing-impaired children using hearing 

aids (HA) and in normal-hearing children (NH). 

METHODS 

36 CI children, 36 HA children and 136 NH children, divided in three age 

categories (6-8 yo, 9-10 yo, 11-12 yo), were asked to perform timbre and 

melody discrimination and representation tasks in the framework of a social, 

interactive sound game - Sound Caterpillar - developed as an assessment 

battery within the scope of this research project. 

RESULTS 

Results show no significant differences between NH, HA and CI for timbre 

discrimination and show a clear development of timbre discrimination 

abilities with age regardless of the hearing impairment or aid. For melody 

discrimination we find a strong development in older NH-children, 

whereas this improvement is not established in HA and CI children. Moreover, 

both HA and CI children do not succeed in obtaining better than 

chance scores for melody discrimination up to the age of 12. Concerning 

sound representation, HA and CI children focus much more on aspects of 

sound quality to represent sounds, whereas NH-children rely on sound 

identification or association. 

CONCLUSIONS 

We established and compared developmental curves for timbre and 

melody discrimination in CI, HA and NH children. These results are now 

used to further develop the social sound game Sound Caterpillar into a research-based 

and age-appropriate auditory training tool for severe hearing 

impaired children. 

81

O 045 

ALTERNATIVE SAMPLING METHODS FOR DETECTING 

BACTERIAL PATHOGENS IN CHILDREN WITH AN UPPER 

RESPIRATORY TRACT INFECTION: REVISITING THE GOLD 

STANDARD 

M.R. van den Bergh 1 , D. Bogaert 2 , L. Dun 2 , J. Vons 1 , M..L Chu 2 , 

K. Trzcinski 2 , R.H. Veenhoven 1 , E.A.M. Sanders 2 , A.M.G. Schilder 2 

1 Spaarne Hospital, HOOFDDORP, The Netherlands 

E-MAIL: mvandenbergh@spaarneziekenhuis.nl 

2 Wilhelmina Children’s Hospital, UMC Utrecht, UTRECHT, 


OBJECTIVE 

Transnasal nasopharyngeal sampling is considered the gold standard for 

detecting bacterial pathogens involved in upper respiratory tract infections 

(URTI). A simpler method of collecting a representative sample 

would however be preferable, especially when samples need to be obtained 

repeatedly. Therefore, we evaluated the accuracy of alternative sampling 

methods. 

METHODS 

Children (n=66) aged 0-4 years with rhinorrhea as symptom of an URTI 

were sampled by [1] a nasopharyngeal swab, [2] a nasal swab, and [3] blowing 

the nose in a paper tissue, that was subsequently [3a] sampled with a 

swab and [3b] transported as a whole in phosphate-buffered saline to the 

laboratory. Conventional culture methods were used to isolate S. pneumoniae 

(Spn), H.influenzae (Hi), M.catarrhalis (Mc) and S.aureus (Sa). 

RESULTS 

Spn was detected in [1] 64%, [2] 64%, [3a] 65% and [3b] 74% of samples. Hi was 

recovered from [1] 70%, [2] 67%, [3a] 64% and [3b] 65% of samples. Mc was detected 

in [1] 71%, [2] 74%, [3a] 68% and [3b] 68% of samples and Sa in [1] 33%, 

[2] 27%, [3a] 23% and [3b] 38% of samples. Concordance between the different 

methods was high for each bacterial pathogen (77% to 97%). Spn was recovered 

more frequently from a paper tissue than from a nasopharyngeal 

swab (P=0.039) and nasal swab (P=0.039). 

CONCLUSIONS 

Culture of a paper tissue with nasal discharge offers a reliable alternative 

to detect bacterial pathogens in children with rhinorrhea as a symptom 

of an URTI and was superior to the gold standard in detecting Spn. 

82 

O 046 

MODULATED LIPOOLIGOSACCHARIDE STRUCTURE 

PREVENTS NON-TYPEABLE HAEMOPHILUS INFLUENZAE 

FROM IGM-MEDIATED COMPLEMENT KILLING DURING 

OTITIS MEDIA 

J.D. Langereis 1 , K. Stol 1 , E.K. Schweda 2 , B. Twelkmeyer 3 , H.J. Bootsma 1 , 

S.P.W. De Vries 1 , P. Peter 1 , D.A. Diavatopoulos 1 , P.W.M. Hermans 1 

1 Radboud University Nijmegen Medical Centre, Laboratory of 

Pediatric Infectious Diseases, NIJMEGEN, The Netherlands 

E-MAIL: j.langereis@cukz.umcn.nl 

2 Linko¨ping University, LINKO¨PING, Sweden 

3 Karolinska Institutet, HUDDINGE, Sweden 

BACKGROUND 

Non-typeable Haemophilus influenzae (NTHi) is a Gram-negative, 

human-restricted pathogen. Although this bacterium typically colonizes 

the nasopharynx in the absence of clinical symptoms, it also is one of the 

major pathogen causing otitis media (OM) in children. Complement represents 

an important aspect of the host defense against NTHi. In general, 

NTHi is efficiently killed by complement-mediated killing, however, various 

resistance mechanisms have also evolved. 

METHODS 

We measured complement resistance of NTHi isolates isolated from the 

nasopharynx and the middle ear fluids of OM patients. Furthermore, we 

determined the molecular mechanism of NTHi complement resistance. 

RESULTS 

Complement resistance was strongly increased in isolates from the middle 

ear, which correlated to decreased binding of IgM. We identified a crucial 

role for the R2866_0112 gene in complement resistance. Deletion of this 

gene altered the LOS composition of the bacterium, which increased IgM 

binding and complement-mediated lysis. In a novel mouse model of coinfection 

with influenza virus we demonstrate decreased virulence for the 

R2866_0112 deletion mutant. 

CONCLUSION: 

These findings identify a novel mechanism by which NTHi modulates its 

LOS structure to prevent recognition by IgM and activation of complement. 

Importantly, this mechanism plays a crucial role in the ability of 

NTHi to cause OM.

O 047 

OTITIS MEDIA IN NEW ZEALAND: MIDDLE EAR 

MICROBIOLOGY AND NASOPHARYNGEAL CARRIAGE IN A 3+1 

CONJUGATED PNEUMOCOCCAL VACCINATED COHORT 

N.A. Mills 

Starship Children’s Hospital, Paediatric Otoloryngology, AUCKLAND, 

New Zealand 

E-MAIL: nikki@webrage.co.nz 

BACKGROUND 

Otitis media is the most common illness in under 3 year olds requiring 

medical consultation in New Zealand. In 2008 the heptavalent Streptococcus 

pneumoniae conjugate vaccine (PCV7) was introduced nationwide. We 

aimed to describe infectious aetiology of rAOM and cOME prior to nationwide 

change to PCV10. We describe nasopharyngeal carriage rates of known 

otopathogens in children with and without history of otitis media. 

METHODS 

Between May and October 2011, middle ear (MEF) and nasopharyngeal 

samples (NP) from 325 children aged

O 049 

IMMUNOLOGIC FINDINGS IN YOUNG CHILDREN WITH 

EARLY ONSET OF ACUTE OTITIS MEDIA 

K Gisselsson Solén 1 , K Hermansson 1 , G Melhus 2 , N Brodszki 3 

1 University Hospital Lund, Dpt of Otorhinolaryngology, Head and 

Neck Surgery, LUND, Sweden, e-mail: marie.solen@gmail.com 

2 Dpt of Clinical Bacteriology, Uppsala University, UPPSALA, Sweden 

3 Dpt of Paediatrics, Lund University Hospital, LUND, Sweden 

BACKGROUND 

Recurrent acute otitis media (rAOM) affects about 10% of children. It is not 

clear why some children contract rAOM, however, minor immunologic 

aberrations have been reported to be more frequent in this group. 

METHODS 

One hundred and five children participating in a pneumococcal vaccination 

study were offered immunological investigation including analyses 

of complement function, immunoglobulins with subclasses and cellular 

immunity. The study inclusion criterion was an acute otitis media onset 

before six months of age, indicating a high risk for developing rAOM. The 

children were followed closely for three years. 

RESULTS 

Sixty patients underwent some kind of immunological testing, 30 of whom 

had severe rAOM (defined as six episodes in one year) and 12 of whom did 

not develop rAOM at all. The most commonly detected aberrations were 

low levels of IgG2 (27%), C1q (31%) and mannan-binding lectin (22%). There 

was a co-variation between subnormal levels of IgG2 and C1q. Four children 

were diagnosed with immune deficiencies that required treatment 

and one child was diagnosed with a rare chromosomal abnormality. 

CONCLUSION 

Though patient numbers were small, low levels of IgG2, C1q and MBL were 

found frequently in the study group. 

84 

O 050 

HEAD AND NECK MANIFESTATIONS OF 

22Q11.2 DELETION SYNDROMES 

TM Marom, YR Roth, AG Goldfarb, UC Cinamin 

Edith Wolfson Medical Center, Otolaryngology-Head and Neck Surgery, 

HOLON, Israel 

E-MAIL: maromtal@orange.net.il 

BACKGROUND AND OBJECTIVE 

The allelic loss of 22q11.2 results in various developmental failures of pharyngeal 

pouches derivatives (22q11.2 deletion syndromes, 22q.11DS), consequently 

affecting the anatomy and physiology of head and neck (H&N) 

organs. The objective of this paper was to describe H&N manifestations 

of this syndrome. 


Two 22q11.2DS patients with H&N manifestations were studied along 

with a comprehensive review of the English literature, from 1975 to 2010 

regarding the associated H&N malformations among 22q11.2DS. 

RESULTS 

A 24 year-old mentally-disabled 22q11.2DS male presented with right 

hemithyroid enlargement, causing significant compressive signs. Sonography 

revealed a homogenous 8X3 cm lesion, replacing almost the entire 

thyroid lobe. Fine needle aspiration revealed colloid material and abundant 

eosinophils. The hemithyroidectomy specimen confirmed follicular 

adenoma. A 19 year-old, mentally-disabled 22q11.2DS female, underwent 

CT-angiography due to an upper GI bleeding, which revealed a vascular 

malformation in the infratemporal fossa. Literature review of the associated 

malformations in 22q11.2DS revealed abnormalities and malfunctions 

of the thyroid gland, parathyroid glands, thymus agenesis, cleft palate, 

aberrations of the carotid artery system, and malformations of the larynx 

and trachea. 

DISCUSSION 

22q11.DS patients may present with H&N anatomical abnormalities, along 

with hormonal dysfunctions, which require special awareness once treatment 

is offered, especially when concerning anesthetic and surgical aspects.In 

addition, hSNF5/INI1, a tumor suppressor gene, detected at 

location 22q11.2 was described to be “knocked out”in some 22q11.2 DS patients. 

This may be associated with H&N tumors reported in these patients.

O 051 

INCIDENCE OF OTITIS MEDIA WITH EFFUSION AND ITS 

SEQUELAE IN CLEFT PALATE CHILDREN AT DIFFERENT AGE 

GROUPS 

Z. Csakanyi, G. Katona 

Heim Pal Children’s Hospital, Pediatric ENT Dept., BUDAPEST, 

Hungary 

E-MAIL: csakanyi.zsuzsanna@gmail.com 

OBJECTIVES 

Prolonged clinical course of middle ear and hearing problems are frequently 

observed in cleft palate (CP) children. In this study, incidence of 

otitis media with effusion (OME) and its sequelae was assessed in different 

age groups of CP children. Optimization of otologic care for CP patients 

was also considered. 


Medical reports of 230 CP children between one and 18 years were reviewed 

retrospectively in the last five years. Otologic history, otomicroscopic status 

and audiometric results were assessed considering three age groups: 

up to three years (Group I), between three and six years (Group II), and 

above six years (Group III). Attention was paid to the long-term otologic 

complications and audiologic outcome. 

RESULTS 

The incidence of OME in CP patients for Group I was 60.3%, declining progressively 

to 38% in Group II, and to 13.5% in Group III. Retraction, tympanosclerosis, 

perforation of the tympanic membrane and cholesteatoma 

were found in 52.5% in Group II and 36% in Group III patients. In Group II, 

17.9% of patients presented a moderate hearing loss, while in Group III 9.1% 

of children showed a mild conductive hearing loss. 

CONCLUSIONS 

High incidence of OME is found in infants and toddlers. Sequelae of OME 

affect a large number of preschool and primary school children. Nevertheless, 

long-term prognosis seems to be favourable. Close monitoring of 

CP children contributes to early diagnosis and treatment of middle ear 

disease that may promote better otological outcome in older CP patients. 

O 052 

IN SEARCH OF THE OPTIMAL SURGICAL TREATMENT FOR 

VELOPHARYNGEAL DYSFUNCTION IN 22Q11.2 DELETION 

SYNDROME: A SYSTEMATIC REVIEW 

N.E. Spruijt 1 , J. Reijman-Hinze 2 , G. Hens 3 , V. Vander Poorten 3 , 

A.B. Mink van der Molen 1 

1 University Medical Center Utrecht, Plastic Surgery, UTRECHT, 


E-MAIL: N.E.Spruijt@umcutrecht.nl 

2 Free University Medical Center, AMSTERDAM, The Netherlands 

3 University Hospital, LEUVEN, Belgium 

OBJECTIVES 

Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal 

dysfunction (VPD) tend to have residual VPD following surgery. This systematic 

review seeks to determine whether a particular surgical procedure 

results in superior speech outcome or less morbidity. 

METHODOLOGY 

A combined computerized and hand-search yielded 70 studies, of which 

27 were deemed relevant for this review, reporting on a total of 525 patients 

with 22qDS undergoing surgery for VPD. The methodological quality of 

these studies was assessed using criteria based on the Cochrane Collaboration’s 

tool for assessing risk of bias. 

RESULTS 

Heterogeneous groups of patients were reported on in the studies. The 

surgical procedure was often tailored to findings on preoperative imaging. 

Overall, 50% of patients attained normal resonance, 48% attained normal 

nasal emissions scores, and 83% had understandable speech postoperatively. 

However, 5% became hyponasal, 1% had obstructive sleep apnea 

(OSA), and 17% required further surgery. There were no significant differences 

in speech outcome or OSA between patients who underwent a fat 

injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, 

Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. 

More patients who underwent a palatoplasty needed further surgery than 

those who underwent a pharyngoplasty (50% versus 7-13%, p=0.03). 

CONCLUSIONS 

In the heterogeneous group of patients with 22qDS and VPD, a grade C 

recommendation can be made to minimize the morbidity of further surgery 

by choosing to perform a pharyngoplasty directly instead of only a 

palatoplasty. 

85

O 053 

DYSPHONIA IN A CLEFT POPULATION: ASSOCIATIONS 

WITH CLEFT TYPE, VELO-PHARYNGEAL DYSFUNCTION 

AND SOCIO-ECONOMIC DEPRIVATION 

D. Wynne 1 , S. Chen 2 , L. Campbell 3 , L. Crampin 3 , M. Devlin 1 , A. Ray 1 , 

C.J. Russell 1 

1 Royal Hospital for Sick Children, West of Scotland Cleft Service, 

GLASGOW, United Kingdom 

E-MAIL: david.wynne@nhs.net 


3 Glasgow Dental Hospital, GLASGOW, United Kingdom 

Cleft speech issues including velo-pharyngeal dysfunction (VPD) and articulation 

errors are well recognised and researched. In contrast voice issues 

(dysphonias) have received much less attention. This study describes 

the extent of the problem in the West of Scotland cleft population and investigates 

potential causal associations. 

Retrospective analysis of consensus reported (Cleft Audit Protocol for 

Speech - Augmented) speech samples of all patients audited between 2007 

and 2010 were undertaken. Demographics, diagnosis and treatments were 

obtained from hospital notes. Individual scores for Scottish Index of Multiple 

Deprivations were obtained on the basis of patient postcode. 

Adequate speech samples were available in 154/172(89.5%) patients. Overall 

prevalence of dysphonia was 10.3%. Age (5:17.4% 10: 7.1% and 15: 8.1%) and 

sex specific (male:7.2%, female:14.1%) differences were not statistically significant. 

Isolated cleft palate (p=0.04), VPD (p=0.008) and socio-economic 

deprivation (p=0.002) demonstrate significant associations with dysphonia. 

While current theories of dysphonia pathogenesis in cleft patients suggest 

increased use of glottal stops to compensate for VPD, no previous studies 

have been able to demonstrate this link statistically. This study is the first 

to achieve such a demonstration. Furthermore the data presented suggests 

more complexity to the causal relationship with both cleft type and patient 

social-economic status showing significant associations with dysphonia. 

Dysphonia has significant psychological impact in children as well as potential 

long-term sequelae. This under-recognised problem deserves further 

attention. 

86 

O 054 

PURE PHASE β-TRICALCIUM PHOSPHATE AS A BONE 

SUBSTITUTE FOR ALVEOLAR CLEFT CLOSURE: A PILOT STUDY 

N.G. Janssen, A.P. de Ruiter, R. Koole 

Utrecht University Medical Centre, Oral and Maxillofacial surgery, 

UTRECHT, The Netherlands 

E-MAIL: N.G.Janssen-2@umcutrecht.nl 

OBJECTIVES 

After succesful implementation of pure-phase β-Tricalcium Phosphate 

(β-TCP) in an alveolar cleft model in goats, as well as in the human symphyseal 

defect after chin bone grafting, the authors have started in 2010 

with alveolar cleft grafting with β-TCP. 

METHOD 

Seven patients with an unilateral alveolar cleft, age 9-11 years, underwent 

an alveolar grafting procedure with β-TCP . Preoperatively, 1 week postoperatively 

and 6 months postoperativelyCone Beam CT scans were performed 

of the maxillary region. Volumetric analysis and canine eruption patterns 

were analysed by means of 3-D software (OsiriX DICOM Viewer v. 3.9). 

RESULT 

Six patients were successfully grafted with β-TCP. Mean bone volume in 

the reconstructed cleft was 73%. There was one failure that was attributed 

to inadequate watertight mucoperiosteal closure. 

CONCLUSIONS 

This is the first clinical alveolar grafting study with a β-TCP with an osteogenic 

potential to be published as for today. It’s results are very promising 

and a larger study will be conducted in the near future. However, 

watertight alveolar cleft closure seems to be even more important in synthetic 

bone grafting with granules compared to autologous bone grafting.

O 055 

ANTIBIOTICS FOR OTITIS MEDIA WITH EFFUSION IN 

CHILDREN: A COCHRANE SYSTEMATIC REVIEW 

A van Zon 1 , G.J. van der Heijden 1 , T.M.A. van Dongen 1 , M.J. Burton 2 , 

A.G.M. Schilder 1 

1 University Medical Centre Utrecht, UTRECHT, The Netherlands 

E-MAIL: alicevanzon@gmail.com 

2 UK Cochrane Centre, OXFORD, United Kingdom 

OBJECTIVE 

To assess the effects of antibiotics in children with otitis media with effusion 

(OME). 

METHODS 

A search on CENTRAL, PudMed, Embase and other electronic databases 

for published and unpublished trials. Two authors assessed trial quality 

and extracted data independently. We presented dichotomous results as 

risk differences as well as risk ratios with their 95% confidence intervals. 

RESULTS 

In the 23 included RCTs (3027 children) we found no convincing evidence 

of a beneficial effect of antibiotics on the resolution of OME that is both 

clinically and statistically relevant. The studies varied widely in terms of 

duration of OME, age of participants, type, dose and duration of antibiotics 

and outcome measures. Insufficient or no evidence was available concerning 

hearing level, language and speech and other relevant outcomes. Adverse 

effects occurred slightly more common in children treated with 

antibiotics. Subgroups that benefit more or less from antibiotics could not 

be identified. 

CONCLUSION 

Based on these results and the potential implications of large scale antibiotic 

prescription in OME regarding antibiotic resistance, we do not recommend 

antibiotics for children with uncomplicated OME. 

O 056 

FORCED RESPONSE TEST AGE 3 AND 4 YEARS IN CHILDREN 

WITH RECURRENT OTITIS MEDIA OR CHRONIC OTITIS 

MEDIA WITH EFFUSION 

L. Casselbrant, E. Mandel, D. Swarts, T. Seroky, K. Tekely, J. Doyle 

Children’s Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 

PITTSBURGH, USA, e-mail: margaretha.casselbrant@chp.edu 

OBJECTIVE 

This longitudinal study aimed to determine whether ETF variables discriminate 

between children with recurrent AOM (rAOM) and those with 

chronic OME (cOME) and measure the effect of growth on ETF. Methods: 

Children 3 years of age with a confirmed history of rAOM or OME are enrolled 

and followed with yearly ETF testing. We report here the results of 

the Forced Response Test (FRT) in children at 3 and at 4 years of age. 

RESULT 

Correlation coefficients were high and significant (p < 0.05) with the slopes 

approaching 1.0 (no change with age) for the opening pressure, steady state 

pressure, and passive resistance. Active flow rate, log of the active resistance, 

and log dilatory efficiency were not correlated. ANOVA documented 

a significant group effect (p < 0.05) for the passive function variables opening 

pressure, steady state pressure, closing pressure and steady state 

resistance. Of interest, 89% of swallow patterns (tubal dilation vs constriction) 

were concordant at the two time points. 

CONCLUSIONS 

These results indicate that there is a significant change in the passive ETF 

variables in children from age 3 years to 4 years. However, for the active 

ETF variables no change could be documented. The continued follow up 

of the children will elucidate the effect of growth on ETF in the two groups 

and the time course to resolution of their middle ear disease. 

87

O 057 

SUSCEPTIBILITY TO CHRONIC OTITIS MEDIA WITH 

EFFUSION IS ASSOCIATED WITH POLYMORPHISM AT THE 

LOCI FBXO11 AND SMAD2 

F. Bhutta 1 , M.J. Burton 1 , A. Goel 2 , M. Farrall 2 , S.D.M. Brown 3 

1 University of Oxford, Nuffield Dept of Surgical Sciences, OXFORD, 


E-MAIL: m.bhutta@doctors.org.uk 

2 Wellcome Trust Centre for Human Genetics, OXFORD, 


3 MRC Harwell, OXFORDSHIRE, United Kingdom 

OBJECTIVES 

Epidemiological studies have shown high heritability for both recurrent 

acute otitis media (rAOM) and chronic otitis media with effusion (COME) 

in childhood. We have recovered two models of chronic otitis media from 

a mouse mutagenesis programme at MRC Harwell. The Jeff mouse has a 

point mutation in the Fbxo11 locus and the Junbo mouse has a point mutation 

at Evi1. Both Fbxo11 and Evi1 are known to interact with SMAD 

proteins in the TGF-β signaling pathway. Polymorphism at FBXO11 has 

previously been associated with human susceptibility to rAOM. 

METHODS 

From April 2009 to November 2011 we recruited and genotyped family trios 

undergoing ventilation tube insertion in the UK, predominantly for 

chronic otitis media with effusion. We extracted recognised human single 

nucleotide polymorphisms (SNPs) from the HapMap database, for the loci 

FBXO11, EVI1, SMAD2 and SMAD4. After data cleaning, association testing 

was performed using the TRANSMIT test. 

RESULT 

500 family trios were genotyped. 4.7% of individuals were excluded due to 

low genotyping success. We found evidence of association with SNPs in 

SMAD2 (rs1792658, p

O 059 

TWO SEPARATE PATHS TO PARENT QUALITY OF LIFE IN 

PERSISTENT OTITIS MEDIA WITH EFFUSION (OME) 

M. Haggard 1 , J.M. Zirk-Sadowski 1 , H. Spencer 2 , K. Trzpis 3 

1 University of Cambridge, Experimental Psychology, CAMBRIDGE, 


E-MAIL: mph38@cam.ac.uk 

2 Experimental Psychology, CAMBRIDGE, United Kingdom 

3 Medical University, BIALYSTOK, Poland 

OBJECTIVES 

We previously modelled successfully the causal cascade from disease manifestation 

to developmental impact and quality of life (QoL) in OME, using 

a large UK sample of persistent OME cases referred to secondary care. We 

sought generalisation of the found pathways of influence, from a differing 

healthcare system (Poland), using shorter-form measures from OM8-30. 

METHODS 

We assessed 297 cases clinically, most receiving surgery. Tympanometry, 

HL, age, date seen, sex and maternal education plus the 9 facet scores from 

the OM8-30 questionnaire were analysed. The correlation matrix was summarised 

via factor analysis, multiple regressions and structural equation 

models (SEMs). 

RESULT 

Behaviour problems were significantly (P < 0.05) predicted in univariate 

correlations by schooling concerns, URTI history, speech/ language delay, 

and time of year, but not by measured or reported hearing, recurrent acute 

otitis history (RAOM), or sleep disturbance. Parent QoL was significantly 

predicted by behaviour problems (strongly), reported hearing, sleep disturbance, 

speech/language, schooling concerns, and overall health, but 

not by measured hearing nor by RAOM alone. In multiple regressions for 

Parent QoL, the sum of the standardised reported hearing and RAOM 

scores, predicted significantly, but they did not individually. 

CONCLUSIONS 

1) cascaded influential links from disease markers through developmental 

mediators (including the often overlooked URTI sleep disturbance) to QoL 

are generalised, via highest correlations obtaining between hypothesised 

adjacent stages. (2) Combining reported hearing difficulties and RAOM 

score into a single disease severity is recommended for reasons of distribution, 

measure reliability, and underlying relevance to the downstream 

mediators of impact. 

O 060 

INFLUENCE OF CURRENT AND FUTURE VENTILATION TUBE 

DESIGN ON THE MAGNITUDE OF STRESS IMPOSED AT THE 

IMPLANT / TYMPANIC MEMBRANE INTERFACE 

M.A. Fitzgerald, W. Blayney, P. Vard, D.Kelly, P.Prendergast 

Temple Street Children’s University Hospital &Trinity Centre for 

Bioengineering, Otolaryngology, Head and Neck Surgery, DUBLIN, 

Ireland 

E-MAIL: flyingcircus@hotmail.com 

OBJECTIVES 

To compare ventilation tube displacement & tympanic membrane stresses 

following implantation of tubes with varied design characteristics. 

METHODS 

Creation of a validated finite element vibroacoustic model of outer and 

middle ear allows computation of implant and membrane displacements 

and stresses as five elements of the design (shaft length, flange diameter, 

flange thickness, material, 3-d shaft configuration) are altered. 

RESULT 

Tube design has a pronounced effect on frequency response of the tympanic 

membrane. This is not limited to location of tube, and affects the 

whole membrane. 

CONCLUSIONS 

The identification of design factors that influence stress at the tympanic 

membrane help highlight areas of ventilation tube design which may be 

improved, thus leading to creation of an optimal tympanostomy tube. 

89

O 061 

PAEDIATRIC LARYNGOTRACHEAL RECONSTRUCTION: GREAT 

ORMOND STREET EXPERIENCE 

Y. Bajaj, L. Cochrane, C. Jephson , M. Wyatt, C.M. Bailey, D. Albert, 

B. Hartley 



BACKGROUND 

The objective of this study was to present our results of laryngotracheal 

reconstruction procedures done at Great Ormond Street Hospital over the 

past 10 years. 

METHODS 

All the patients who underwent open airway reconstruction surgery from 

January 2000 to December 2010 were included. 

RESULT 

Complete data was available for 199 patients. The procedures included Single 

stage LTR (57, 28.6%), Two stage LTR (115, 57.7%), Single stage stomal reconstruction 

(14), single stage CTR (8) and two stage CTR (5). The diagnoses 

at the endoscopy were laryngeal web (22), subglottic stenosis (152), posterior 

glottic stenosis (9), suprastomal collapse (15), supraglottic stenosis (1) 

and tracheal stenosis (1). At the completion of intervention 175/199 (87.9%) 

patients reported improvement in their symptoms. Of the two stage LTR 

procedures, 100/115 (86.9%) had their tracheostomy removed and 15/115 

(13.1%) have failed decannulation. Of the single stage LTR group, 50/57 

(87.7%) patients were better both on airway examination and symptomatically 

postoperatively. Patients who underwent single stage CTR had a better 

airway on examination and symptomatically improved in all cases (8/8). 

For the patients who underwent two stage CTR, the tracheostomy was decannulated 

in 3/5 (60%) and failed in 2/5 (40%). For the whole group, 15/199 

(7.5%) patients underwent a revision LTR. In this study complications occurred 

in 13/199 (6.5%). 

CONCLUSIONS 

Good outcomes are achieved with both LTR and CTR. Good results are obtained 

both with single stage or two stage LTR. An individual approach is 

required to treatment of paediatric airway stenosis to achieve good final 

outcome. 

90 

O 062 

BALLOON DILATATION OF THE PAEDIATRIC AIRWAY: 

THE GREAT ORMOND STREET EXPERIENCE 

E. Rennie, M. Elloy, D. Tweedie, B. Hartley 

Great Ormond Street Hospital. LONDON, United Kingdom 

E-MAIL: catherine.rennie@doctors.org.uk 

OBJECTIVES 

The management of subglottic stenosis (SGS) in children still presents a 

challenge to ENT surgeons. In the last 8 years balloon dilatation has become 

a useful tool in the management of airway stenosis. In this study we 

review the use of balloon dilatation by ENT surgeons at Great Ormond 

Street over the last 8 years. 

METHOD 

Patients were identified from a prospectively collated database, from which 

a retrospective review of the case notes was undertaken. We included all 

patients under the age of 18 years that underwent balloon dilatation at 

our institution between January 2004 and January 2012. The records were 

analysed for patient demographics, presenting symptoms, surgical technique, 

and airway description. The outcome measures were airway diameter, 

postoperative symptoms, tracheotomy status, and complications. 

RESULT 

421 balloon dilatations took place during the study period with some children 

requiring up to 12 dilatations. The most common use for balloon dilatation 

was for restenosis following laryngotracheal reconstruction. No 

complications were documented, and all patients made an uneventful recovery 

from surgery. 

CONCLUSION 

This review of the largest series of children undergoing balloon dilatation 

reported to date suggests that balloon dilation is a safe and effective procedure 

that is particularly well suited to recent stenosis after laryngotracheal 

reconstruction.

O 063 

EXTERNAL EAR ANOMALIES AND HEARING IMPAIRMENT 

IN NOONAN SYNDROME 

D.C. van Trier, E. Croonen, I. van der Burgt, J.M.Th. Draaisma, 

R.J.C. Admiraal 

UMC St Radboud Nijmegen, Pediatrics, NIJMEGEN, The Netherlands 

E-MAIL: d.vantrier@gmail.com 

OBJECTIVES 

External ear anomalies and hearing impairment are features of Noonan 

syndrome but have never been described extensively in a large cohort. 

METHODS 

From 97 Noonan Syndrome (NS) patients data were collected on otorhinolaryngological 

features, after written informed consent. External ear 

anomalies were described by clinical geneticists and 44 Noonan patients 

consulted otorhinolaryngologists for audiological tests. In 65 out of 97 patients 

a mutation was found, 43 PTPN11, ten SOS1, six SHOC2, four RAF, 

one MAP2K2 and one KRAS mutation. 

RESULT 

External ear anomalies were reported in 76 NS patients (78%). In 70 patients 

the ears were low-set, 27 patients had posteriorly rotated ears, 13 patients 

showed protruding ears and 18 had thickened helices. Hearing impairment 

was detected in 31 NS patients (32%), eight with sensorineural hearing 

impairment (range 2,5- 47 years) and two with permanent conductive 

hearing impairment (range 11- 22 years). Two other patients had mixed 

hearing impairment (24- 35 years) and 19 patients have had conductive 

hearing impairment in the past, due to otitis media with effusion. Their 

hearing impairment resolved between the ages of 2-18. Sensorineural hearing 

impairment varied between mild high-frequency HI to profound (uniand 

bilateral) deafness. Two NS patients received cochlear implants for 

their severe sensorineural hearing impairment. So 31 Noonan syndrome 

patients (32%) were reported with hearing difficulties during their lifes. 

No genotype-phenotype correlation was found. 

CONCLUSION 

Noonan syndrome is characterized by external ear anomalies and hearing 

impairment. Hearing tests have to be executed in all patients with Noonan 

Syndrome. 

O 064 

AUDIOLOGIC AND GENETIC DETERMINATION OF HEARING 

LOSS IN OSTEOGENESIS IMPERFECTA 

F. Swinnen 

Ghent University, Department of Otorhinolaryngology, GHENT, 

Belgium 

E-MAIL: info@congresservice.nl 

INTRODUCTION 

Osteogenesis imperfecta (OI) is a an autosomal dominantly inherited connective 

tissue disorder predominantly characterized by bone fragility, blue 

sclerae, and hearing loss. The genotype is associated with mutations in 

the genes COL1A1 and COL1A2, responsible for the synthesis of type I collagen. 

The disease is associated with large phenotypic and genotypic variability. 

Hearing loss has been reported to manifest in about half of the OI 

population. The present study provides a detailed description of the audiologic 

phenotype in OI. In addition, the correlation between audiologic 

phenotype and genotype in OI is studied as well as the association between 

the audiologic phenotype and the overall aberrant bone quality. 

METHODS 

A sample of 184 OI patients, aged 3 - 89 years, was investigated clinically, 

audiologically and genetically. Additionally, in 56 adult OI patients, bone 

mineral density measurements were performed in order to correlate the 

audiologic phenotype with the overall aberrant bone quality. 

RESULT 

In 52% of the OI patients included, hearing loss of different types (10.5% 

conductive; 29.8% mixed; 11.6% sensorineural) was observed. Age-relatedtypical 

audiograms were constructed. No correlation was observed between 

the occurrence or type of the hearing loss and the mutated gene, 

the nature of the type I collagen defect or the location of the mutation in 

the gene. Patients diagnosed with hearing loss of the conductive or mixed 

type had significantly lower bone mineral density than normal-hearing 

OI patients or those with pure sensorineural hearing loss (P

O 065 

HIGH PREVALENCE OF INNER EAR AND/OR INTERNAL 

AUDITORY CANAL ANOMALIES IN PEDIATRIC UNILATERAL 

HEARING LOSS 

S. Masuda 1 , S. Usui 1 , T. Matsunaga 2 

1 Mie National Hospital, Department of Otorhinolaryngology, TSU, 

MIE, Japan 

E-MAIL: masudas@mie-m.hosp.go.jp 

2 National Tokyo Medical Center, TOKYO, Japan 

OBJECTIVES 

Recently, radiological and genetic examination to hearing loss has progressed. 

The aim of this study was to elucidate the pathogenesis of unilateral 

hearing loss in children. 

METHODS 

Sixty-nine children with unilateral sensorineural hearing loss under 15 

years of age who visited our ENT clinic were examined. Middle ear diseases 

and abnormalities, conductive and combined hearing loss, and obvious 

acquired healing loss were excluded. All the children performed temporal 

bone CT scanning and some of them participated in genetic examination. 

RESULT 

Inner ear and/or internal auditory canal abnormalities were found in 84.6% 

of infants under one year of age and 55.8% children of 1 to 15 years of age. 

Thirty-two children had cochlear nerve canal stenosis, 20 had internal auditory 

canal stenosis, 15 had cochlear anomalies, 6 had vestibular and/or 

semicircular canal anomalies, and 2 had bilateral enlarged vestibular aqueducts. 

One of 2 patients with bilateral enlarged vestibular aqueducts had 

compound heterozygous mutation in the SLC26A4 gene. In 32 children 

with cochlear nerve canal stenosis, 16 were accompanied with internal auditory 

canal stenosis and 13 had no other anomalies. 

CONCLUSIONS 

In children with unilateral hearing loss, the prevalence of inner ear and/or 

internal auditory canal anomalies was very high and one child confirmed 

as the enlarged vestibular aqueduct syndrome. Radiological and genetic 

examination gave important information to consider the pathogenesis 

and management of unilateral hearing loss. 

92 

O 066 

GENOTYPE PHENOTYPE CORRELATION IN USHER 

SYNDROME 

S. Marlin 1 , C. Sain-Oulhen 1 , C. Bonnet 2 , N. Leboulanger 2 , L. Jonard 2 , 

S. Gherbi 2 , M. Louha 2 , N. Loundon 2 , N. Garabédian 2 

1 APHP, INSERM U587, Centre de référence des surdités génétiques, 

PARIS, France 

E-MAIL: sandrine.marlin@trs.aphp.fr 

2 Hôpital Armand Trousseau, PARIS, France 

INTRODUCTION 

Usher syndrome (USH) is characterized by hearing loss, retinitis pigmentosa 

(RP), and, in some cases, vestibular dysfunction. Three clinical subtypes 

can be distinguished according to degree and evolution capacities 

of the deafness, onset of the retinis pigmentosa and vestibular symptoms. 

USH is inherited in the autosomal recessive mode and is genetically heterogeneous 

with nine causative genes identified. 

OBJECTIVE 

Our goal is to establish a genotype-phenotype correlation needed to help 

the molecular diagnosis and thus the management of the patients. 

METHODS 

We studied 108 files with clinical and molecular data. The coding exons 

and flanking intronic sequences of all nine USH genes were amplified and 

sequenced. 

RESULT 

Our cohort consisted in 61 patients type I, 46 patients type II and one patient 

type III. 2 patients type I have subnormal vestibular functions, 25% 

of patients type II have evolutive deafness. Mutations have been shown 

for 97% of patients. There was no mutation in USH3A. 

CONCLUSION 

The clinical classification of the patients is difficult especially for the types 

III if we consider evolution capacities of the deafness in 25% in type II. The 

exhaustive genotyping led us to find a high rate of mutations, which is 

helped by the improvement of the preliminary phenotyping. No genotype-phenotype 

correlation has been found. We need to do functional 

studies on the Usher proteins to have a better understanding of the Usher 

pathogenesis. We have also already begun whole exome sequencing with 

the aim of discover new responsible gene in the different types of Usher.

O 067 

SLEEP PROBLEMS IN CHILDREN WITH DOWN SYNDROME 

M. Maris, S. Verhulst, M. Wojciekowski, P. Van de Heyning, 

A. Boudewyns 

Antwerp University Hospital, EDEGEM, Belgium 

E-MAIL: mieke_maris@hotmail.com 

OBJECTIVES 

Sleep initiating and maintenance problems are prevalent in children with 

development disabilities. In addition, obstructive sleep apnea syndrome 

(OSAS) is present in 30 - 60% of Down syndrome (DS) children. 

METHODS 

The parents of 45 DS children (mean age = 10,36 years 4.49 SD) completed 

the 33-item Child Sleep Habits Questionnaire (CSHQ). According to age, 

they were divided in 2 groups (4 - 12,9 years (n=24) and >13 years (n=11)). 

RESULT 

Seventy-two percent of the DS children in our population had sleep disturbance 

scores in the clinical range (mean score = 44,81, range 37-83). 

Thirty-three percent need a parent in the room to fall asleep. A restless 

sleep is reported in 63% of the younger children and in 36% of the older age 

group. More than half of the children wakes up at least once every night. 

Snoring was reported in 43%. A polysomnography (PSG) was performed in 

73% of the snoring children and 45% were found to have OSAS. (AHI > 1). 

Nine non snoring children underwent a PSG and a diagnosis of OSAS was 

made in 78%. Apneas were mainly reported in the age group > 13 years 

(18,2%). 

CONCLUSION 

A structured questionnaire proved useful for evaluation of a sleep problems 

in DS children. Our data confirm the high prevalence of sleep problems 

in DS children and caregivers should be aware of this. The prevalence 

of OSAS is underestimated in parental reports and all DS children should 

undergo a PSG at any point in their lifetime to exclude OSAS. 

O 068 

EVIDENCE BASED COMPLIMENTARY AND ALTERNATIVE 

MEDICINE FOR OTITIS MEDIA 

J.R. Levi 1 , K. Mc-Kee-Cole 2 , R. O’Reilly 1 

1 Nemours A.I. Dupont Hospital for Children, Surgery, Division of 

Otolaryngology, WILMINGTON, USA 

E-MAIL: jlevi@nemours.org 

2 Jefferson Medical College, PHILADELPHIA PA, USA 

AOM is the most common reason for physician visits in children, with 

treatment costing $2 billion annually (Stool SE, 1989). Initial observation 

in most patients, has increased interest in complimentary methods for 

symptomatic relief and disease resolution. 

OBJECTIVE 

Identify and evaluate evidence based complimentary modalities for AOM. 

METHODS 

A literature search was conducted from 1962-2011 for evidence-based complimentary 

methods for AOM. 

RESULT 

Homeopathy (which may also result in a reduction in recurrence and antibiotic 

use) and herbal ear-drops relieve pain (Wustrow et al, 2004). Supplements 

of EPA, vitamin A and selenium in children with ROM reduced 

the number of acute episodes (Linday et al, 2002). Probiotic use demonstrated 

a trend toward fewer episodes of AOM (Rautava et al, 2009). Patients 

undergoing osteopathic techniques had fewer episodes of AOM and fewer 

tympanostomy tubes however dropout rates make conclusions difficult. 

(Mills et al. 2003). Traditional Chinese and Japanese medicines showed infants 

receiving JTT had fewer hospital visits and antibiotics (Maruyama 

et al, 2009). Only xylitol has been studied in randomized, blinded trials; it 

has been shown to be effective only in 5-times-daily dosing and only as a 

chewing gum, which limits applicability (Uhari et al. 1996). Cases of OM 

with complications, and those that fail to improve should be treated with 

antibiotics and possibly surgery. Disease prevention includes avoiding 

bottle-feeding and second hand smoke and addressing poor nutritional 

status. 

CONCLUSION 

Many COM methodologies show positive trends, but few have shown benefit 

in a double-blind randomized controlled setting, and thus require additional 

study. 

93

O 069 

HYPERTONIC SALINE IS BETTER THAN NORMAL SALINE FOR 

SEASONAL ALLERGIC RHINITIS IN CHILDREN 

S. Bianchini 1 , P. Marchisio 1 , S. Torretta 1 , A. Varricchio 2 , E. Baggi 1 , 

M. Capasso 3 , P. Capaccio 1 , C. Gasparini 4 , F. Patria 4 , S. Esposito 1 , 

N. Principi 1 

1 University of Milan, Maternal and pediatric science, MILANO, Italy 

E-MAIL: bianchini.sonia@fastwebnet.it 

2 San Gennaro Hospital, NAPLES, Italy 

3 Ospedale Civile (Ave Gratia Plena), CASERTA, Italy 

4 IRCCS Ca’ Granda Policlinico, MILAN, Italy 

OBJECTIVES 

Allergic rhinitis (AR) is a very common childhood disease associated with 

a significant reduction in patients’ quality of life, which can be managed 

with different treatments. However, even the best approach does not relieve 

the symptoms in all patients. The aim of this study was to evaluate 

the effectiveness of nasal irrigation in children with seasonal AR. 

METHODS 

This prospective investigator-blinded study randomized children aged 5- 

10 years with documented seasonal grass pollen-related AR to normal (NI) 

or hypertonic (HI) nasal irrigation or no treatment (NT), and assessed their 

nasal symptoms and signs (rhinorrhea, itching, sneezing, nasal obstruction 

and turbinate swelling), bilateral middle ear effusion and adenoidal 

hypertrophy at baseline and four weeks later. 

RESULTS 

The study involved 220 children (80 randomized to HI, 80 to NI, and 60 to 

NT). At the end of the study, a significant improvement (P

O 071 

USE OF COMPLEMENTARY ALTERNATIVE MEDICINE IN 

PEDIATRIC OTOLARYNGOLOGY PATIENTS 

R. Cohen-Kerem, M. Gruber 

Carmel Medical Center, Otolaryngology head and neck surgert, 

HAIFA, Israel 

E-MAIL: Nrkerem@hotmail.com 

Little data is available on complementary alternative medicine (CAM) use 

in children attending otolaryngology services. We investigated the pattern 

of CAM use among children and adolescents attending a referral pediatric 

otolaryngology clinic. 

The study was designed as a cross sectional survey. 219 Anonymous questionnaires 

were administered to parents accompanying patients attending 

the pediatric otolaryngology clinic. No exclusions were made. The first 

part of the questionnaire was looking at the parents’ general attitude to 

CAM and whether they have consulted or considered a consultation with 

a CAM therapist. The second part dealt with patients that had CAM, type 

of therapy and their satisfaction. 

26.5% of patients had considered using CAM while 20.6% of the patients 

had used CAM at some point during their disease course. Commonly used 

treatments were homeopathy, naturopathy and acupuncture. Acupuncture 

and homeopathy were the most popular of those (42.9% and 35.7% respectively). 

Success rate was assessed subjectively and was dispersed quite 

equally between successful (35.7%), unsuccessful (30.3% each) and undetermined 

(39.4%). Successful treatment was described in terms of cure (43.8%), 

improvement (31.3%) and better awareness for the problem being addressed 

(25%). In most cases parents stated that the primary physician was 

aware of CAM use by the child (70.6%). 

CAM plays a substantial role amongst parents to children referred to pediatric 

otolaryngology consultation. The otolaryngologist awareness of 

his patients’ preference and interest may contribute to decision making 

regarding patient management. Further investigations regarding CAM 

and CAM subspecialties is warranted and cooperation with CAM therapists 

should be considered. 

O 072 

TREATMENT OF ACUTE RHINOSINUSITIS WITH A HERBAL 

PRODUCT: EVIDENCE HAS BEEN REACHED 

M. Popp 

Bionorica SE, NEUMARKT, Germany 

E-MAIL: regina.gers@bionorica.de 

A double-blind, placebo-controlled, multicentre Phase III study including 

several hundred outpatients with acute rhinosinusitis (ARS), has now been 

performed, assessing the efficacy and tolerability of Sinupret vs. placebo. 

Patients with Major Symptom Score (MSS; in accordance with European 

EPOS guideline) ≥ 8 and ≤ 12 points (range: minimum 0, maximum 15 

points) were randomly assigned to a 15-day treatment (2 coated tablets 

three times a day) with either the herbal product or placebo. Control visits 

were scheduled to take place 3, 7, 10, and 14 days after randomisation / 

baseline examination (Visit 1 / Day 0). Primary outcome criterion for efficacy 

assessment was the mean MSS assessed by the investigator at the end 

of treatment (Visit 5 / Day 14). Main secondary outcome measures included 

the change in symptoms and emotional and social consequences of ARS 

assessed by the patient (interference with sleep, daily functioning and 

general well-being, Sino-Nasal Outcome Test-20) and the investigator’s 

assessments of treatment response (responder rates). The clinical development 

was further monitored by ultrasonography of the paranasal sinuses. 

Average MSS improved significantly under the herbal product compared 

to placebo. The group difference at Visit 5 (primary endpoint) was considered 

medically relevant and was highly statistically significant in favour 

of Sinupret. MSS diary data revealed that a 2-days faster relief of symptoms 

in the course of healing compared to placebo was achieved. Results were 

confirmed by ultrasonography showing a significantly more pronounced 

remission of signs of acute rhinosinusitis in verum treated patients at the 

end of treatment. 

95

O 073 

AIRWAY MANAGEMENT IN PIERRE ROBIN PATIENTS USING 

NASOPHARYNGEAL AIRWAY 

Y. Bajaj 1 , F. Abel 2 , C. Wallis 2 , M. Wyatt 2 

1 Great Ormond Street Hospital, LONDON, United Kingdom 


INTRODUCTION 

Pierre Robin sequence is a congenital anomaly presenting with micrognathia, 

glossoptosis and a cleft palate. There have been reports on strategies 

to manage airway in these patients. The objective of this study was to present 

our experience of airway management in these patients. 

METHODS 

This study was conducted jointly between the respiratory and otolaryngology 

departments. Only the children with all three characteristics of 

this condition have been included. The data collected included the method 

of airway management and polysomnography data pre and post intervention. 

RESULT 

Data was collected on 104 Pierre Robin patients referred to us from 2000 

to 2010. Most of patients (64/104) were less than 4 weeks of age at referral. 

In this group, the airway symptoms were managed conservatively in 27 

(25.9%), with nasopharyngeal airway (NPA) in 63 (60.6%) and tracheostomy 

in 14 (13.4%) patients. The duration of NPA use varied from 3 weeks to 27 

months, the average being 7.9 months. There was an objective improvement 

on polysomnography in all 63 patients with NPA. NPA did not improve 

symptoms subjectively or objectively in 14 patients who underwent 

a tracheostomy. There were no NPA related complications in this study. 

In this study 86.5% (90/104) PRS patients were managed either conservatively 

or with the help of nasopharyngeal airway for few months. 

CONCLUSION 

In majority of children (86.5%), the airway obstruction can be managed by 

conservative measures or nasopharyngeal airway for few months. A small 

number of children need to be managed with a tracheostomy. 

96 

O 074 

PIERRE ROBIN SYNDROME: COMPARISON BETWEEN 

TRACHEOTOMY AND NONINVASIVE VENTILATION 

V. Couloigner 1 , M. Lebreton 2 , S. Pierrot 2 , N. Leboulanger 3 , 

E.N. Garabedian 3 , V. Abadie 2 , B. Fauroux 3 

1 PARIS, France 

E-MAIL: vincent.couloigner@nck.aphp.fr 

2 Hôpital Necker, APHP, PARIS, France 

3 Hôpital Armand Trousseau, APHP, PARIS, France 

AIM OF THE STUDY 

To compare tracheotomy and noninvasive ventilation (NIV) in terms of 

efficacy, side effect and impact on the quality of life in Pierre Robin syndrome 

(PRS). 


Setting: two pediatric tertiary care centers; methods: comparison between 

two retrospective case series; population: infants with severe forms of PRS; 

one group of patients (GNIV; n=8) was treated with noninvasive ventilation 

and the other one (GTRAC; n=11) with tracheotomy; outcome parameters 

were retrieved from patients’ clinical charts and from a quality of life questionnaire; 

statistical comparisons were performed using the Chi-square 

or the Student’s t tests. 

RESULT 

The median age at the beginning of treatment was lower in GTRAC (1 

month) than in GNIV (4 months) (p=0.006).The number of children with 

treatment-related complications was 91% (10/11) in GTRAC versus 12.5% 

(1/8) in GNIV (p=0.004). The number of hospital admissions was higher in 

case of tracheotomy (p=0.028). According to parental responses to the questionnaire, 

parent’s overall quality of life was similarly affected by both 

treatments, and patients’ one was similarly improved. Responses to the 

questionnaire differed for two parameters between groups: breathing 

while awake was more improved (p=0.003 after one week and p=0.04 after 

1 month of treatment), and financial burden was heavier (p=0.05) after tracheotomy. 

CONCLUSIONS 

NIV is an efficient and well-tolerated therapeutic tool in severe cases of 

PRS.

O 075 

SCREENING FOR DELAYED-ONSET HEARING LOSS IN 

PRESCHOOL CHILDREN WHO PREVIOUSLY PASSED THE 

NEWBORN HEARING SCREENING 

L.V. Jingrong 

Xinhua Hospital, Otolaryngology Head & Neck surgery, Shanghai, 

China 

E-MAIL: ent@xinhua-ent.com 

OBJECTIVE 

The goal of this study was to investigate the prevalence of delayed-onset 

hearing loss in preschool children who previously passed newborn hearing 

screening in Shanghai, China. 

METHODS 

Between October 2009 and September 2010, 21,427 preschool children were 

enrolled from five areas of Shanghai, who had passed newborn hearing 

screening. Children were screened for delayed-onset hearing loss with pediatric 

audiometers. Children with positive results in initial and re-screening 

tests were assessed audiologically and for risk indicators according to 

the Year 2007 Statement of the American Joint Committee on Infant Hearing 

(JCIH). 

RESULT 

During the study period, 445 children (2.08%) were referred for audiologic 

assessment; 16 (0.75/1000, 95% CI 0.38-1.12) had permanent delayed-onset 

hearing loss. Of these, five (0.23/1000) had bilateral moderate hearing loss; 

seven (0.33/1000) had mild bilateral hearing loss; and four (0.19/1000) had 

unilateral moderate or mild hearing loss. JCIH risk indicators were established 

for six children (6/16, 37.5%), including parental concern regarding 

speech and language developmental delay, neonatal intensive care unit 

with assisted ventilation or hyperbilirubinemia, recurrent otitis media 

with effusion, craniofacial malformation, and family history (n = 1 for 

each). The remaining ten (62.5%) had no related risk factors. 

CONCLUSIONS 

A significant proportion of preschool children have undiagnosed delayedonset 

hearing loss. Hearing screening in preschool is recommended for an 

early detection. 

O 076 

THE IMPACT OF UNIVERSAL NEONATAL HEARING 

SCREENING ON THE TIMING OF COCHLEAR IMPLANTATION 

IN CHILDREN WITH CONGENITAL HEARING LOSS 

M. Elloy 1 , G.M. O’Donoghue 2 

1 Great Ormond Street Hospital, Paediatric ENT, LONDON, 


E-MAIL: mdelloy@yahoo.com 

2 Queens Medical Centre, NOTTINGHAM, United Kingdom 

OBJECTIVES 

This study aims to assess the impact of the introduction of Universal 

Neonatal Hearing Screening(UNHS) on the timing of cochlear implantation 

in children with congenital hearing loss and explore factors which 

may contribute to failing to achieve implantation by the age of one year. 

METHODS 

All patients under the age of 5 years with congenital bilateral profound 

sensorineural hearing loss referred for assessment between August 1993 

and September 2009, were identified from a prospectively recorded database 

at Nottingham’s Cochlear Implant programme(NCIP). 

The mean age at implantation was calculated for pre and post UNHS 

groups. A retrospective case note review was undertaken of all patients in 

the post UNHS group, in particular focusing on potential areas for delay 

in the assessment and referral process. 

RESULT 

The mean age at implantation was 44 months pre UNHS(n=334) and 18 

months post UNHS(n=35). 0.6% of the pre UNHS group and 15.6% of the 

post UNHS group had undergone cochlear implantation by the age of 12 

months. External factors which contributed to delay in the timing of surgery 

included delay in referral to NCIP(46.9%), Medical co-morbidities(25%), 

Diagnostic challenges(12.5%), Parental Choice(9.4%), Recurrent Acute Otitis 

media(9.4%), Administration(9.4%) and patients moving house during the 

assessment process(3.1%). 

CONCLUSION 

The timing of cochlear implant surgery improved following the implementation 

of UNHS, however, the majority of children were still not being 

implanted by the age of one year. A number of factors contributed to this 

delay in surgery, those which can be improved include referral and assessment 

pathways. 

97

O 077 

AUDIOLOGICAL AND VESTIBULAR FINDINGS IN 

CONGENITAL CYTOMEGALOVIRUS INFECTION: RESULTS OF 

A PROSPECTIVE COHORT STUDY 

J. Goderis, I. Dhooge, M. Vandevelde, B. Philips, E. De Leenheer, 

H. Van Hoecke, K. Smets, A. Keymeulen 

Universitary Hospital Ghent, Ear Nose Throat, 9000 GHENT, Belgium 

E-MAIL: julie.goderis@ugent.be 

Congenital cytomegalovirus ‘cCMV’ infection is the leading cause of nongenetic 

sensorineural hearing loss in childhood. It is the most common 

congenital infection in the developed world, affecting 1 to 2 % of live born 

infants. Approximately 10% of the infected babies will be symptomatic at 

birth. Severe neurologic deficits are commonly seen in this group. In both, 

symptomatic and asymptomatic children with cCMV infection, sensorineural 

hearing loss is a frequent sequel. Previous studies have demonstrated 

that the onset of hearing loss caused by cCMV infection can be 

immediate at birth or delayed, the hearing loss can be variable in severity 

and can be progressive or fluctuating during the first childhood years. 

Since January 2007, a prospective multicenter study is conducted to gain 

further information on the epidemiology, short- and long-term sequelae 

of cCMV infection and to examine the impact of ganciclovir treatment. 

Children incorporated in the registry are monitored with serial age-specific 

evaluations using a standard protocol during the first 6 years of life. 

We will present the serial audiological data of a cohort of 100 children incorporated 

in the cCMV registry at Ghent University Hospital. The clinical 

features of hearing loss caused by cCMV infection will be discussed and 

the results compared with the literature. 

Very little is known on the impact of cCMV on the vestibular system. We 

will present the results of a pilot cohort study on the motor skills and 

vestibular function in a subgroup of this cohort of children with cCMV. 

98 

O 078 

YIELD OF MEDICAL INVESTIGATIONS OF BABIES WITH 

PERMANENT UNILATERAL DEAFNESS IDENTIFIED VIA 

NEWBORN HEARING SCREENING 

S.A.B. Ratnayake, B. Mac Ardle, K. Harrop-Griffiths 

Royal National Throat Nose Ear Hospital, Nuffield Hearing & Speech 

Centre, LONDON, United Kingdom 

E-MAIL: sudhira.ratnayake@doctors.org.uk 

OBJECTIVES 

(1) To identify the yield of aetiological medical investigations in babies 

with permanent unilateral hearing loss (UHL) 

(2)To identify the association between aetiological medical investigations, 

risk factors for deafness, audiological profile and stability of hearing loss 

METHOD 

This was a 14-year retrospective case-note study of 59 babies with permanent 

UHL confirmed by Auditory Brainstem Response test performed at 

a tertiary Paediatric Audiovestibular Medicine Department following referral 

via the newborn hearing screening programme. The associations 

between the aetiological medical investigations, risk factors for deafness 

and audiological profile were analysed using Chi-square statistics. 

RESULTS 

Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) 

gave high yields (75% and 80%, respectively). Congenital Cytomegalovirus 

(CMV) infection was present in 22% of neonates. Significant associations 

were found between the presence of dysmorphic features and a positive 

CT finding (p- value = 0.005) and the type of UHL (p-value = 0.004). Degree 

of UHL had a strong association with a positive MRI result (p-value < 0.001). 

Two children with congenital CMV infection had progressive deafness 

whereas others had stable UHL. 

CONCLUSIONS 

We recommend prioritising imaging studies (MRI and/or CT) and investigation 

of congenital CMV infection in newborns confirmed with UHL. 

The results highlight the importance of a comprehensive physical examination 

as it will guide the medical investigation protocol, especially imaging 

studies. Those newborns confirmed with congenital CMV infection 

will benefit from longitudinal follow-up to detect progression of hearing 

loss. Future research with a larger sample is required for further recommendations.

O 079 

ABR MORPHOLOGY AND ANALYSIS IN VERY PRETERM 

NICU INFANTS 

S. Coenraad, M.S. Toll, L.J. Hoeve, A. Goedebure 

Erasmus Medical Center - Sophia children’s hospital, 

Otorhinolaryngology, ROTTERDAM, The Netherlands 

E-MAIL: s.coenraad@erasmusmc.nl 

OBJECTIVE 

Analysis of auditory brainstem response (ABR) in very preterm infants can 

be difficult due to the poor detectability of the various components of the 

ABR. We evaluated the ABR morphology and tried to extend the current 

assessment system. 

METHODS 

We included 28 preterm very low birth weight infants admitted to the 

neonatal intensive care unit (NICU) of Sophia Children’s Hospital between 

1-3-2009 and 31-8-2010. ABRs were measured between 26 and 34 weeks postconceptional 

age. The presence of the following ABR parameters was 

recorded: the ipsilateral (stimulated site) peaks I, III and V, the contralateral 

(not stimulated site) peaks III and V and the response threshold. 

RESULT 

In 82% of our population a typical “bow tie”response pattern is present as 

a sign of early auditory development. This “bow tie”pattern is the narrowest 

part of the response wave and is predominantly characterized by the 

ipsilateral negative peak III, this effect may be emphasized by the contralateral 

peak III. The “bow tie”pattern is seen approximately 0.1 ms before 

the ipsilateral peak III. From 30 weeks postconceptional age onwards a 

more extensive morphological pattern is recorded in 90% of the infants. A 

flow chart was designed to analyze the ABR morphology of preterm infants 

in an unambiguous stepwise fashion. 

CONCLUSIONS 

A typical “bow tie”pattern preceding peak III seems to be the earliest characteristic 

of the developing ABR morphology in preterm infants. ABR characteristics 

will improve with increasing age, therefore neonatal hearing 

screening should be postponed until after 34 weeks. 

O 080 

EDUCATING TOMORROW’S GPS: A WORKBOOK ON 

PAEDIATRIC OTOLARYNGOLOGY FOR GENERAL 

PRACTITIONERS 

M.M.C. Yaneza 1 , H. Kubba 2 , D. Gilmore 3 

1 West of Scotland Rotation, ENT Department, GLASGOW, 


E-MAIL: may.yaneza@nhs.net 

2 Royal Hospital for Sick Children, Yorkhill, GLASGOW, 


3 Regent Gardens Medical Centre, 18 Union Street, KIRKINTILLOCH, 


OBJECTIVES 

To improve the management of paediatric ENT problems by general practitioners 

(GPs) using a workbook. 

METHODS 

A self-directed learning workbook was developed using educational principles 

containing questions and guidelines on the management of paediatric 

ENT conditions in the community and advice on when to refer 

patients for specialist or emergency management. When completed, the 

workbook also functioned as a reference guide. It was piloted amongst GP 

trainees attending a 2-day GP paediatric update course which included 

ENT. Attendees were invited to complete a pre-workbook test (at the 

course or online), and invited to complete the same test online (and a feedback 

form for the workbook), 2 months after the course. Pre- and postworkbook 

tests were compared to determine if knowledge had improved. 

Questions were on areas of diagnostic and management difficulty in the 

community (i.e. otorrhoea, hearing loss, stridor and foreign body management). 

RESULT 

90 delegates attended the training day. 10 completed the pre-workbook 

test at the end of the day, 19 completed the test online. 10 completed the 

post-workbook test. Due to the poor response rate, particularly for the 

post-worbook test, meaningfully interpretation of the results was not possible. 

However, the feedback on the workbook was very positive; the majority 

of post-workbook test responders thought that the workbook helped 

their understanding and confidence at managing paediatric ENT problems. 

CONCLUSION 

A workbook is useful way to improve the understanding and confidence 

GPs managing paediatric ENT problems. A higher response rate is required 

to determine whether it improves their knowledge. 

99

O 081 

REGISTRAR PAEDIATRIC BRONCHOSCOPY EXPERIENCE 

I. Mckay-Davies, M. Saunders 

Bristol Royal Hospital for Children, ENT, BRISTOL, United Kingdom 

E-MAIL: imd004@gmail.com 

OBJECTIVES 

Assess Ear, Nose and Throat (ENT) Registrar familiarity and competence 

in ventilating bronchoscope use and ascertain their ability to recognise 

common airway pathology. To gain an idea of expected and realistic numbers 

of bronchoscopies required for Completion of Surgical Training (CCT). 

METHODS 

Anonymous prospective survey of ENT Registrars from three deaneries. A 

poll of Consultant Paediatric ENT surgeons was also performed. 

RESULT 

Only 39% of registrars could correctly assemble a ventilating bronchoscope 

in an emergency, yet 93% regarded this as an essential trainee skill. Those 

with prior paediatric ENT experience reported greater confidence in their 

abilities and scored higher in all domains, compared to those without. 

Registrars purported the number of ventilating bronchoscopies required 

for CCT should be in the order of 3-5; a similar number was proposed by 

Consultants. 

CONCLUSIONS 

Familiarity with essential life-saving airway equipment and its use is lacking 

in trainees across several deaneries, and potentially nationally. Other 

deficiencies highlighted include limited exposure to paediatric ENT, and 

an inadequate ability to recognise common airway pathology. Rotating 

through paediatric ENT yields greater skills, knowledge and confidence 

when dealing with paediatric airway conditions, equipment and emergencies. 

100 

O 082 

VSB IN CONDUCTIVE HEARING LOSS MANAGEMENT 

IN AURAL ATRESIA 

M. Profant, Z. Kabatova 

I. ORL FN Sv. Cyrila a Metoda, Centrum Kochlearnej Implantacie, 

BRATISLAVA, Slovak Republic 

E-MAIL: regina.dreschkai@medel.com 

A child with bilateral aural atresia requires amplification of sound to ensure 

adequate development of hearing and speech. Various surgical procedures 

have been used for this purpose. VBS implantation seems to 

become an extremely effective method in selected cases. Eight patients 

with congenital bilateral aural atresia (without any previous surgery) have 

been implanted with VSB. Half males and females, age 5-18. In all children 

the non-aided air conduction PTA was at the level of 50-60dB. The bone 

conduction PTA was normal. On the CT scans all patients had some signs 

of differentiated ossicles in the middle ear cavity and well pneumatised 

temporal bone with normal inner ear anatomy. The implantation has been 

done via mastoidectomy and posterior tympanotomy. In four patients the 

FMT has been placed against the round window membrane, in 2 patients 

the FMT was fixed on incus and in 2 patients on the head of stapes. The 

first fitting has been done 4 weeks after surgery. PTA has been done to evaluate 

the postoperative results. The PTA for air conduction has been improved 

from the non-aided level of 50-60dB to 10-25dB after VBS 

implantation.In two patients revision surgery after placement on incus 

was indicated with removal of the incus and placement on the stapes head. 

The VSB implantation in the bilateral aural atresia solves the problem of 

the hearing loss. The auditory canal remains closed without any need for 

postoperative care and toilet. The pinna reconstruction (if necessary) can 

be easily done in the later period.

O 083 

ACTIVE MIDDLE EAR IMPLANT VIBRANT SOUNDBRIDGE IN 

HIGH FREQUENCY SENSORINEURAL HEARING LOSS 

K. Boeheim, S. Pok, M. Schloegel 

Landesklinikum Sankt Poelten, ENT, SANKT POELTEN, Austria 

E-MAIL: klaus.boeheim@stpoelten.lknoe.at 

OBJECTIVES 

(1) To evaluate hearing gain and speech performance of subjects with mild 

to severe symmetrical (SNHL) with active middle ear implant (AMEI) Vibrant 

Soundbridge (VSB). 

(2) To compare two open-fitted hearing technologies for high-frequency 

sensorineural hearing loss: open-fit hearing aid (HA) and the VSB. 

METHODS 

(1) Pre- and postoperative hearing thresholds, word discrimination in 54 

adults; threshold improvement and speech recognition for unaided and 

aided conditions using the patient’s walk-in hearing aid (HA) and the VSB. 

(2) Hearing thresholds, word recognition in quiet , and 50% sentences in 

quiet and noise in 10 patients with hearing thresholds (500 through 3000 

Hz) qualifying for both VSB and open-fit HA use,l 

RESULT 

(1) Gain at threshold level was, on average, 20.9 dB at 0.5 kHz, 20.5 dB at 1 

kHz, 23.8 dB at 2 kHz, 30.2 dB at 3 kHz, 36.1 dB at 4 kHz, 37.6 dB at 6 kHz 

and 37.9 dB at 8 kHz. Monosyllabic word discrimination at 65 dB SPL improved 

from 30% (unaided) to 44% (walk-in HA) to 57% (VSB). 

(2) Both open-fit HA and VSB conditions showed significantly better 

soundfield thresholds and speech recognition in quiet and noise than in 

the unaided condition. Significantly better speech discrimination and 

hearing thresholds was observed with the AMEI than with the open-fit 

HA. 

CONCLUSION 

(1) The AMEI system VSB is an effective rehabilitation method in subjects 

with mild to severe SNHL. 

(2) Despite overlapping indication criteria, performances with the AMEI 

VSB are better than with open fitt HA . 

O 084 

BONEBRIDGE: RESULTS FROM A CLINICAL INVESTIGATION 

WITH A NEW ACTIVE BONE CONDUCTION IMPLANT 

A.L. Hinze 1 , H. Mojallal 2 , B. Schwab 1 , R. Salcher 1 , W. Burke 1 , T. Lenarz 1 

1 ENT-Clinic, MHH, German Hearing Center, HANNOVER, Germany 

E-MAIL: hinze@hoerzentrum-hannover.de 

2 Vibrant Med-El, INNSBRUCK, Austria 

OBJECTIVES 

With the Bonebridge (Med-El,Innsbruck) an active bone conduction implant 

has been introduced as a new treatment method with transcutaneous 

signal transmission. This implantable hearing system is proposed 

to treat patients with conductive and mild mixed hearing losses. The therapy 

with the Bonebridge should be efficient and secure for the patient. 

The aim of this study was to prove this hypothesis. 

METHODS 

As part of a multi-center clinical investigation, four patients with a conductive 

or mild mixed hearing loss were recruited. At the time of the implantation 

the average age was 55.7 years. The implantations were 

performed from August to October in 2011. The preoperative bone conduction 

(BC) threshold averaged 10.9 ± 7.5 dB HL and the air conduction 

(AC) threshold represented 53.8 ± 18.5 dB HL respectively. 

RESULT 

All four cases showed no complication during the implantation and no 

medical problems were reported postoperatively. The average hearing benefit 

using pure tones in sound-field condition showed 23.1 dB ± 12.6 dB 

over the frequency range 0.5, 1, 2, 4 kHz. TheFreiburg monosyllabic word 

score in sound-field condition increased from 37.5 ± 21 % preoperatively 

to 98.8 ± 2.5 % (at 65 dB) postoperatively. 

CONCLUSIONS 

The first surgical and audiometrical findings indicate that the Bonebridge 

is a secure and efficient therapy method for patients with conductive and 

mixed hearing losses. Instead of conventional and percutaneous bone conduction 

hearing aids the Bonebridge constitutes an alternative hearing 

solution for this patient group. 

101

O 085 

RESONANCE FREQUENCY ANALYSIS OF OSSEO-INTEGRATED 

IMPLANTS FOR BONE CONDUCTION IN A PAEDIATRIC 

POPULATION: A NOVEL APPROACH FOR ASSESSING STABILITY 

C. McLarnon, I. Johnson, T. Davison, J. Hill, B. Henderson, D. Leese, 

S. Marley 

Freeman Hospital, ENT, NEWCASTLE UPON TYNE, United Kingdom 

E-MAIL: clairemrennison@hotmail.com 

OBJECTIVE 

The purpose of our study was to directly measure the stability of the implanted 

abutment using Resonance Frequency Analysis (RFA) in a paediatric 

population. 

METHODS 

The principle behind RFA is to obtain a numerical value relating to stability. 

A Smartpeg (1cm commercially manufactured attachment) is 

screwed onto the abutment - its resonance in a magnetic field is measured 

with an Osstell recording device. The degree of movement (vibration) is 

inversely proportional to the stability of the abutment and a numerical 

figure, the Implant Stability Quotient (ISQ) is derived. ISQ values above 

55units may be considered stable for loading. All patients were fitted with 

the new CochlearTM Baha® BI300 series implant using a one-stage procedure 

and loaded between 8 and 12 weeks post-operatively. RFA measurements 

were obtained at surgery, 4 weeks, 16 weeks and 28 weeks post 

implant surgery. 

RESULT 

Prospectively 11 consecutive patients were recruited with age range of 3 

to 16 years, mean age of 10 years. Two patients had bilateral Baha’s fitted 

giving a total of 13 implants. Average ISQ results for the cohort gives a 

value of 59units at time of surgery. At 4 weeks = 66 units, at 16 weeks = 59 

units, and at 28 weeks = 60 units. There were no failed implants to date. 

CONCLUSIONS 

The RFA results suggest that there is immediate stability of the BI300 abutment 

at the time of surgery and the stability is maintained. This is a novel 

approach to assessing stability of the implant and provides evidence for 

safety in earlier loading in children. 

102 

O 086 

THE VIBRANT SOUNDBRIDGE FOR THE TREATMENT OF 

MIXED AND CONDUCTIVE HEARING LOSSES IN CHILDREN 

A. Wolf-Magele, V.di Koci, J. Schnabl, H. Riechelmann, G.M. Sprinzl 

Medical University Hospital Innsbruck, Otorhinolaryngology, Head and 

Neck, INNSBRUCK, Austria 

E-MAIL: astrid.wolf-magele@i-med.ac.at 

BACKGROUND 

The Vibrant Soundbridge is an Active Middle ear implant (AMEI), which 

is used for patients suffering from sensineural, conductive and mixed hearing 

loss. Since 2008 the AMEI is also approved for children. Especially in 

cases with congenital aural atresia suffering from combined malformation 

of the outer and middle ear the implantation of a Vibrant Soundbridge 

(VSB) seems to be successful treatment strategy for hearing rehabilitation 

in these patients. We show our previous experiences with the Vibrant 

Soundbridge (VSB) in children. 

MATERIALS AND METHODS 

We report about our experience in 13 children (age:2-17; median age:9,1) 

with congenital aural atresia and chronic otitis media. All patients showed 

a conductive hearing loss more than 30 dB. The average Jahresdorfer scale 

was 5,9. The Floating mass transducer (FMT) was coupled to the stapes 10 

times, once to the oval window, and two times to the round window. 

RESULT 

In all cases no peri- or postoperative medical complications appeared. Even 

no postoperative audiological complications occurred and residual hearing 

remained completely unchanged, indicating that the surgical techniques 

are safe and feasible. Audiological results under headphones and in free 

field in the unaided and aided condition with the VSB are presented. 

CONCLUSIONS 

The VSB represents an innovative treatment option for patients with 

atretic ears and chronic otitis media - also in children. Most important is, 

to observe the preoperative requirements in form of CT scan, audiological 

conditions and Jahresdorfer scale, to select the right patients and assess 

the situation for a surgical procedure realistic.

O 087 

CONGENITAL MINOR EAR ANOMALIES. OUTCOMES OF 

SURGERY AND SOME SYNDROMAL ASPECTS 

H.G.X.M. Thomeer, H.P.M. Kunst, C.W.R.J. Cremers 

Radboud University Nijmegen, Otorhinolaryngology, NIJMEGEN, 


E-MAIL: h.thomeer@kno.umcn.nl 

OBJECTIVES 

To report on a consecutive series of congenital minor ear anomalies, based 

on classification into 4 classes and to report on the surgical results, the 

postoperative outcome and possible impact of a syndromal diagnosis. 

METHODS 

A retrospective analysis of charts collected between 1986 and 2001. 

RESULT 

In 89 patients (107 ears) a congenital ossicular chain anomaly was encountered. 

In about 25% of cases a syndromal diagnosis is made. An exploratory 

tympanotomy for a congenital ossicular chain anomaly showed in the majority 

of class 1-3 minor ear anomalies (according to the Cremers classification), 

a closure of air-bone gap to within 20dB. No inner ear deafness or 

facial nerve damage were encountered direct postoperatively. In class 4 the 

risk of facial nerve or inner ear damage may be high. 

CONCLUSION 

In patients with a non-syndromal congenital ossicular chain anomaly, exploratory 

tympanotomy seems most worthwhile in the majority of class 

1-3 minor ear anomalies. In class 4 anomalies alternatives for microsurgery 

like implantable devices (i.e. Bone Conduction Devices, Vibrant Soundbridge) 

are promising and might be a viable option in these patients. 

O 088 

REGIONAL AND LOCAL VARIATION OF VENTILATION TUBE 

INSERTION IN ENGLAND: A QUANTITATIVE ANALYSIS 

N. Bohm 1 , S. Swift 2 , M.Birchall 1 

1 UCLP, ENT, LONDON WC1X 8DA, United Kingdom 

E-MAIL: nbohm@doctors.org.uk 

2 East Midlands Quality Observatory, NOTTINGHAM, 


OBJECTIVES 

To analyse regional and local variation of ventilation tube (grommet) insertion 

in England to compare variation for acute otitis media (AOM) and 

otitis media with effusion (OME). To understand impact national guidance 

has had on level of variation. 

METHODS 

Hospital Episode Statistics (HES) data for 2009 - 2011 were analysed. Elective 

episodes with myringotomy with insertion of ventilation tubes (OPCS-4 

code D15.1) were identified. Population age/sex directly standardised intervention 

rates (DSR) were calculated for OME and AOM, which were 

identified using diagnosis (ICD) code sets. The data were analysed at three 

degrees of granularity: the levels of region: Strategic Health Authority 

(SHA), locality: Primary Care Trust (PCT) and the General Practice (GP). 

RESULT 

At SHA level variation in population rate of grommet insertion for OME 

was 284% in 2010/11. At PCT level it was 851%. Variation in the same year 

for AOM was 306% and 3933% for SHA and PCT respectively. In 2009/10 for 

OME rates were 292% and 875% at SHA and PCT, for AOM it was 377% and 

5896% at SHA and PCT. GP level variation for both procedures and both 

years is many thousand percent. 

CONCLUSIONS 

Rates of grommet insertion have wide international variation. Despite 

publication of 2008 OME guidelines by the UK’s National Institute for 

Clinical Excellence (NICE), this study shows that wide variation in practice 

remains. Variation for OME is less than for AOM, reflecting that guidelines 

might have had an impact, but is still large, indicating effective implementation 

requires further research and effort. 

103

O 089 

UNILATERAL AUDITORY NEUROPATHY SPECTRUM 

DISORDER IN CHILDREN 

A. Mansbach 1 , A. Vandevoorde 2 , T. Marquet 1 , I. Delpierre 1 , P. Deltenre 3 

1 University Children’s Hospital Reine Fabiola, ENT, BRUSSELS, 

Belgium 

E-MAIL: alm@skynet.be 

2 Erasme University Hospital, BRUSSELS, Belgium 

3 Brugmann University Hospital, BRUSSELS, Belgium 

OBJECTIVE 

To highlight the anatomic characteristics of children with unilateral auditory 

neuropathy spectrum disorder (UANSD). 

METHODS 

Retrospective review of the assessment of 22 children diagnosed with 

ANSD between 2005 and 2011 and comparison of the etiology of unilateral 

and bilateral cases. Personal and familial history, pure tone and vocal audiometry, 

tympanometry, ABR, petrous bone CT-scan and/or cerebral and 

internal auditory canals MRI have been analysed. 

RESULT 

Amongst 22 children diagnosed with ANSD between 2005 and 2011, five 

(23%) presented a UANSD. A complicated medical history was found in all 

children with bilateral ANSD but only in 2 of the 5 UANSD. Amongst the 

5 children with UANSD, 4 presented an absent cochlear or cochleo-vestibular 

nerve on MRI and 1 presented a narrow internal auditory canal on CTscan 

suggesting an abnormal cochleo-vestibular nerve. Four of the 5 

children presented several associated labyrinthine malformations. 

CONCLUSION 

Cochlear nerve abnormalities seem to be particularly frequent in UANSD. 

Further studies are needed to determine whether the frequency of these 

anatomic abnormalities is higher in children presenting UANSD than in 

bilateral cases. These findings suggest that precise CT-scan and MRI are 

highly recommended for all children diagnosed with ANSD, including 

those presenting a unilateral form, in order to spare the parents unnecessary 

anxiety about any further extension of their child’s disorder. 

104 

O 090 

VIIITH NERVE ANOMALIES AND CONGENITAL DEAFNESS 

N. Loundon, B. Thierry, I. Rouillon, S. Marlin, M. Lenoir, 

E.N. Garabedian 

A. Trousseau Children’s Hospital, ENT, PARIS, France 


OBJECTIVE 

Analyze the clinical context of children with congenital sensorineural 

hearing loss (SNHL) and VIIIth nerve dysplasia. 


Retrospective analysis of 26 children with abnormal VIIIth nerve at MRI 

(hypoplastic or absent); SNHL was bilateral in 12 cases and unilateral in14 

cases (38 ears). Characteristics of audiometric thresholds, imaging, otoacoustic 

emissions (OAE), auditory brainstem (ABR), and promontory stimulation 

(PS) responses were analyzed. 

RESULT 

The VIII nerve was described as absent in 34/38 and hypoplastic in 4/38 of 

cases. SNHL was profound (n=33), severe (n=2), moderate (n=2) and mild 

(n=1). All cases with cochlear nerve hypoplasia had profound SNHL (4/38). 

At CT scan, internal auditory canal (IAC) was stenotic in 37.9% (11/29). 

OAE were present in 7/21 cases. No ABR response at 100 dB was found in 

89.7% of cases (26/29). In 6/16 cases the PS showed a neural response at 

O 091 

OUTCOME OF COCHLEAR IMPLANTATION IN 

ASYMPTOMATIC CONGENITAL CYTOMEGALOVIRUS 

DEAFENED CHILDREN 

V. Malik 1 , I. Bruce 1 , L. Henderson 2 , K. Green 2 , R. Ramsden 2 

1 Royal Manchester Children’s Hospital, ENT, BOLTON, 


E-MAIL: malikvik@yahoo.com 

2 Manchester University, MANCHESTER, United Kingdom 

BACKGROUND 

Congenital Cytomegalovirus (cCMV) infection is a common cause of sensorineural 

hearing loss (SNHL). The incidence of SNHL is higher in symptomatic 

cCMV infants than in asymptomatic cCMV children and the 

hearing loss can be delayed in onset and progressive in asymptomatic 

cCMV children. 

OBJECTIVES 

To compare the outcome of cochlear implantation in children deafened 

by cCMV with a control group of implanted children who do not have the 

condition. 

METHOD 

Retrospective review of 14 children with asymptomatic cCMV who underwent 

cochlear implantation. Their outcomes measured were compared 

with those from a control group of 45 children who were matched for sex 

and age at the time of implantation. These children did not have CMV infection 

and the hearing loss in most cases was of idiopathic aetiology. 

RESULT 

In the study group the Modified Categories of Auditory Performance (M- 

CAP) score (range 1-7) ranged from 2 to 7 (mean 4.2). In the control group 

the MCAP ranged from 5-7 (mean 6.0). In the study group The Manchester 

Spoken Language Development Scale (MSLDS) score (range 1-10) ranged 

from 1 to 9 (mean 5.4). In the control group the MSLDS ranged from 3 to 

10 (mean 8.1). 

CONCLUSION 

Children deafened by asymptomatic cCMV benefit from cochlear implantation 

but perform less well than a comparable group of implanted children 

who do not have cCMV. There is a wide range of performance in this 

which may relate to the degree of cognitive or motor disabilities. 

O 092 

IMPACT OF MIDDLE EAR EFFUSION ON AUDITORY 

BRAINSTEM RESPONSE (ABR) THRESHOLD IN NEONATES 

TESTED DURING NATURAL SLEEP 

I.M.P. Schatteman, M. Verstreken, N. Verstraeten, A. Zarowski, 

F.E. Offeciers 

Sint Augustinus Hospital, ENT, WILRIJK, Belgium 

E-MAIL: isabelle.schatteman@gza.be 

OBJECTIVE 

Audiological diagnostics in neonates with OME is hampered by uncertainty 

about the impact of middle ear effusion on hearing level. To increase 

accuracy, we used to conduct ABR under general anesthesia after myringotomy 

with aspiration of glue. In 2007 we abandoned this strategy because 

of doubts on safety, namely possible neurotoxicity of pediatric anesthesia. 

As an alternative we performed ABR during natural sleep without 

myringotomy. The aim of this study was to evaluate the validity of this 

change of strategy. 

METHODS 

ABR was performed during natural sleep in 129 neonates with OME who 

were referred after failing neonatal hearing screening with automated 

ABR around the age of 1 month. ABR threshold and impact of OME on diagnostics 

of hearing loss in these neonates were evaluated. 

RESULT 

An increased ABR threshold >40dBnHL was found in 92% of the tested ears. 

In 89% the increased ABR threshold was temporary, finally reaching normal 

hearing levels. Even in the group with ABR threshold >60dBnHL, 80% 

finally had normal hearing. In these cases a combination of OME and delayed 

maturation of the auditory pathways was probably the cause. A permanent 

congenital hearing loss needing rehabilitation was only found in 

2%. This diagnosis could be made before the age of 3 months. 

CONCLUSIONS: 

ABR performed during natural sleep is a good option for diagnosis and 

follow up of hearing loss in neonates with OME. An increased ABR threshold 

is often found, but in the majority this is a temporary condition. 

105

O 093 

BILINGUAL REHABILITATION STRATEGY IN COCHLEAR 

IMPLANTED NON NATIVE ITALIANS 

N. Nassif, A. Bettoni, M.G. Barezzani, F. Predolini, D. Zanetti 

Spedali Civili Brescia, ENT, BRESCIA, Italy 

E-MAIL: nadernassif@alice.it 

OBJECTIVE 

The aim of this study is to evaluate the results of bilingual code rehabilitation 

strategy in cochlear implanted (CI) non native Italians compared to 

their Italian peers. 

METHODS 

Between 2003 and 2010 71 children suffering from profound sensorineural 

hearing loss underwent CI where 25 of them (35%) were non native Italians. 

Their age ranged from 11 months to 13 years coming from 12 different 

countries. The rehabilitation strategy applied was the bilingual code 

within the audio-verbal therapy approach. The evaluation of auditory perception 

and production skills development included all 25 patients. The 

comparison is done between 10 of these CI non native Italians with 10 native 

CI and 10 native normal hearing children. The tests applied were 

MUSS, MAIS, LIP, CAP, and TAU obtained pre and postoperatively at 

3,6,12,24 and 36 months. 

RESULT 

Speach perception and production tests showed a significant difference in 

performance in the first 24 months between the first 2 groups. Tangible 

improvement was noticed afterwards but never reached the level of the 

native CI. The results pre-post CI non native vs pre post CI native at 36 

months were the followings: MAIS: 0-39 vs 0-40, MUSS: 0-33.5 vs 0-36.5, LiP: 

0-41 vs 0-42, CAP: 0-5 vs 0-6.5, TAU: 0-85 vs 0-100,. 

CONCLUSIONS 

Bilingualism should not be considered a contraindication in CI non native 

children. Although at the short run implanted bilingual children demonstrate 

slow progress in perceptive capacity w.r.t. their Italian peers but 

gradually the gap is significantly reduced without reaching equivalent results. 

106 

O 094 

AUDITORY MATURATION IN PREMATURE INFANTS, A 

POTENTIAL PITFALL FOR EARLY COCHLEAR IMPLANTATION. 

J.R. Hof, E. Wix, R.J. Stokroos, M. Chenault, E. Gelders, J. Brokx 

Maastricht University Medical Center, The Netherlands, Department of 

Otorhinolaryngology, Head and Neck Surgery, MAASTRICHT, 


E-MAIL: janny.hof@mumc.nl 

OBJECTIVE 

This investigation describes considerable spontaneous hearing improvement 

in a number of preterm neonates, during the first year of their life. 

The implications for cochlear implant candidacy are described. 

METHODS 

Evaluation of hearing levels of 14 preterm neonates (mean gestational age 

at birth 29 weeks) after refer by the neonatal hearing screening. The mean 

initial hearing thresholds were mean 85 dB HL (range 40-105). 

RESULT 

In 9/14 neonates the hearing level improved overtime, of whom in 5/14 

hearing thresholds finally normalized up to (sub-)normal levels. Most 

neonates (6/7) born before 29 weeks gestational age showed normalized 

hearing thresholds overtime. This improvement was mainly seen before 

the 80th week gestational age. In 5/14 neonates hearing thresholds did not 

improve and cochlear implantation was recommended. 

CONCLUSION 

Delayed maturation of an immature auditory pathway is a cause for refer 

by neonatal hearing screening. In premature infants early cochlear implantation 

should be recommended with caution.

O 095 

DOG BITES TO THE HEAD AND NECK IN CHILDREN: 

AN INCREASING PROBLEM IN THE UK 

G. Narasimhan, A. Kasbekar, H. Garfitt, C. Duncan, K. Davies, A. Donne 

Alder Hey Childrens Hospital Liverpool, ENT, ALTRINCHAM, 


E-MAIL: drgopient@gmail.com 

INTRODUCTION 

Dog bite injury to children is an emotive topic especially when involving 

the head and neck (H&N). In the UK, hospital episode statistics (HES) has 

shown significantly increasing numbers of all dog related injuries within 

the last decade. 

METHODS 

We conducted the largest UK retrospective review of dog bite injuries involving 

the H&N of children up to the age of 16 that presented to the Regional 

Children’s Emergency Department in two time periods: 2001-2003 

and 2008-2010. 

RESULT 

The rate of H&N injuries increased four fold from 2001 to 2010 (17 in 2001 

and 65 in 2010). Injuries in 1-9 year-olds increased 7 fold which differs from 

overall UK HES data which showed a reduction. In the 9-16 year-olds, injuries 

increased 4 fold in line with HES. The average age at injury was 7 

years (median 6). The lip was 3 times more likely to get injured than any 

other location in the H&N and few injuries occurred away from this site. 

Almost half the injuries required a general anaesthetic to treat. 77% occurred 

at the child’s home and over 90% occurred by a dog known to the 

child (eg. family/friends pet). 62% of children were ‘playing’ with the dog. 

CONCLUSIONS 

This largest UK series of dog bites to the paediatric H&N region illustrates 

that the responsible dog is usually known to the child and therefore there 

are major implications for guardians supervising their children. Most head 

& neck dog bites affect the lips in younger children. 

O 096 

NON ACCIDENTAL INJURY SHOULD BE CONSIDERED IN 

CHILDREN PRESENTING WITH OROPHARYNGEAL INJURIES 

G. Odoch 1 , H. Ismail-Koch 1 , S. Blaney 1 , G.A. Morrison 1 , A.Burgess 2 , 

I. Hore 1 

1 Guy’s and St Thomas’ NHS Trust, LONDON, United Kingdom 

E-MAIL: jodoch@hotmail.com 

2 Southampton General Hospital, SOUTHAMPTON, United Kingdom 

INTRODUCTION 

Child abuse is a sensitive topic. ENT Surgeons may be the first speciality 

children present to. 

OBJECTIVES 

To identify cases where children suffering from non-accidental injury presented 

with ENT complications to help guide future patient care. 

METHODS 

We describe the presentation and management of four children whom 

presented to hospital with oropharyngeal injuries and where non-accidental 

injury was later considered to be present by child protection teams. 

RESULT 

Two children (aged 10 days and 6 weeks respectively) presented with hypopharyngeal 

ulceration. Following a detailed history child abuse was suspected 

in the former case. In the latter case the child was otherwise well 

and was discharged pending further investigations, but represented with 

a fracture of the humerus 10 weeks later, being taken into care at that 

point. The third case involved a 5-month-old infant whom presented with 

a floor of mouth haematoma, torn lingual frenulum and respiratory compromise 

requiring emergency intubation. In the final case a 9-month-old 

child presented with respiratory compromise requiring an emergency intubation, 

Subsequently a torn frenum, palatal injuries and a baby wipe in 

the postnasal space were found. 

CONCLUSION 

Physical abuse affects 7-9% of children in the UK. When a child presents 

with an oropharyngeal injury, non accidental injury must be included in 

the differential diagnosis, in order to prevent escalation of abuse. 

ETHICAL APPROVAL 

Not applicable. 

107

O 097 

OSAS IN DOWN CHILDREN: COMPARISON OF RHINO- 

PHARINGO-LARYNGEAL FIBROSCOPIC FINDINGS AND 

POLYSOMNOGRAPHY RESULTS 

M. Romagnoli 1 , F. Rossi 2 , R.M. Gaini 3 , C. Fossati 2 , A. Selicorni 2 , 

C. Lombardi 4 

1 Milano- Bicocca University, U.O. otorinolaringoiatria A.O. S.Gerardo 

Monza, PESSANO (MI), Italy 

E-MAIL: ma_romagnoli@tiscali.it 

2 Milano-Bicocca university, MONZA, Italy 

3 Milano-Bicocca University, MILANO, Italy 

4 S. Luca Hospital, MILANO, Italy 

OBJECTIVES 

Evaluate the reliability and predictive significance of the upper airways 

tract fibroscopy in the diagnosis of OSAS in children with Down syndrome 

by comparing endoscopic data with those obtained with Polysomnography 

(PSG). 

METHODS 

42 children with average age of 7.3 years (range 0-16) and with a history of 

sleep-disordered breathing have been investigated. All were submitted to 

an upper airways tract fibroscopy and PSG with continuous monitoring 

of these parameters: oronasal flow, chest and abdominal respirogram, 

snoring, ECG, pulse oximetry, body position. 

RESULT 

21.4% of the sample presented a PSG pattern compatible with severe OSAS 

(AHI > 30), 19% with mild severity of OSAS (AHI 15-30) and 54.8% was normal. 

82% of patients with moderate to severe OSAS presented hypertrophic 

tonsils in contact with epiglottis and/or a base tongue hypertrophy with 

an epiglottis in contact with the posterior wall of the pharynx.87% of patients 

with negative PSG showed various levels of tonsillar hypertrophy 

not in contact with epiglottis, which was well-built and far from the posterior 

pharyngeal wall. 

CONCLUSIONS 

Sleep disorders can result from an obstruction in more than one level in 

the upper airways tract, but our observations suggest that the most frequent 

anatomical conformations associated with OSAS are hypertrophic 

tonsils in contact with epiglottis and base tongue hypertrophy, that 

pushes the epiglottis in the back.The structure that collapse during the 

obstructive phase seems to be epiglottis, whose function is essential for 

the airway patency.Further investigation is already started using druginduced 

sleep endoscopy in order to validate these suggestions. 

108 

O 098 

HEARING IMPAIRMENT IN CHILDREN WITH STICKLER 

SYNDROME: REVIEW OF PHENOTYPE AND CORRELATION 

WITH GENOTYPE 

F. Acke, I. Dhooge, E. De Leenheer 

Ghent University Hospital, Otorhinolaryngology, GHENT, Belgium 

E-MAIL: frederic.acke@ugent.be 

OBJECTIVES 

Stickler syndrome is a connective tissue disorder characterized by ocular, 

skeletal, orofacial and auditory defects. Autosomal dominant Stickler syndrome 

is caused by mutations in different collagen genes, namely COL2A1, 

COL11A1 and COL11A2. In light of our own future study concerning hearing 

impairment and the link with mutated gene and mutation type in 

Stickler patients, a review of the literature on the subject is presented. 

METHODS 

English-language literature was reviewed through searches of PubMed 

and Web of Science, in order to find relevant articles describing auditory 

features in Stickler children aged 0-17, along with genotype. 

RESULT 

103 patients (68 families) described in 34 articles were included. Hearing 

loss was found in 69 patients (67.0%), mostly mild to moderate when reported. 

Hearing impairment was predominantly sensorineural (52.5%), 

followed by mixed (27.1%) and conductive (20.3%). All patients with conductive 

and most with mixed hearing loss (78.6%) had a palatal defect, 

while this was 42.3% in children with sensorineural hearing impairment. 

Defects in COL11A1 (81.3%) en COL11A2 (100.0%) are more frequently associated 

with hearing loss than mutations in COL2A1 (56.9%). 

CONCLUSIONS 

Hearing impairment in children with Stickler syndrome is common. As 

in adults, sensorineural losses predominate. However, in children, a conductive 

component is also frequently observed (47% vs. 22% estimated in 

adults), especially in patients with a palatal defect, prone to develop 

chronic otitis media. Strict follow-up of young Stickler patients is strongly 

advised. The distinct disease-causing collagen genes lead to a different risk 

of hearing impairment, but still large phenotypic variation exists.

O 099 

DFNA54: CANDIDATE GENE ANALYSIS THROUGH SEQUENCE 

CAPTURE AND NEXT-GENERATION-SEQUENCING 

N. Gürtler, B. Röthlisberger, K. Ludin 

Kantonsspital, Department of Otolaryngology, AARAU, Switzerland 

E-MAIL: nicolas.guertler@ksa.ch 

INTRODUCTION 

Hereditary hearing loss is characterized by a high heterogeneity. Over 100 

loci and 50 genes have meanwhile been discovered and identified. A Swiss 

family with low-frequency hearing loss has been linked to chromosome 5 

and published as DFNA54. The search for mutations in a few candidate 

genes by classic sequencing method, which is time- and labour intensive, 

was without results. New methods based on higher through-put and array 

technology offer a much higher yield. 

OBJECTIVE 

Mutation mapping in DFNA54 by targeted genome capture in combination 

with next-generation sequencing. 

METHODS 

First, a possible larger pathogenic deletion is investigated with a customdesigned 

region specific high-density Roche NimbleGen CGH array. Second, 

a custom Sequence Capture 385K Human Array is designed and 

manufactured by Roche NimbleGen. One array with a total of 385,000 

unique, overlapping probes 60-90 nucleotides in length can be designed 

covering all exons within the DFNA54 target region. After capturing the 

targeted regions the DNA is eluted, amplified and then sequenced on a 

Roche GS Junior instrument. Variants are detected with the GS Reference 

Mapper Software and possible pathogenic mutations (nonsense and missense) 

will be verified by Sanger Sequencing in the patient and further 

family members. 

RESULT 

The results of the molecular-genetic analysis are presented. 

CONCLUSIONS 

The search for genes in hereditary hearing loss can be facilitated by novel 

methods such as targeted genome capture in combination with next-generation 

sequencing. 

O 100 

SURGICAL EXCISION AS PRIMARY TREATMENT FOR 

PAEDIATRIC LYMPHATIC MALFORMATIONS 

Y. Bajaj, S. Ifeacho, K. Kapoor, D. Tweedie, B. Hartley 



INTRODUCTION 

The aim of this study was to evaluate surgical excision as the primary treatment 

for cervicofacial lymphatic malformations in children. 

METHODS 

Prospectively collected database with additional information from clinical 

records of children with this condition treated over 10 years at a tertiary 

paediatric referral centre. 

RESULT 

Fifty three patients, who underwent surgical excision as the primary treatment 

were included in this study. The majority of the patients (41, 77.3%) 

underwent only a single surgical procedure (36- surgical excision, 5- laser 

excision). At the first follow up, the result was complete resolution of 

symptoms in 29 patients, near complete resolution in 13 patients (together 

79.3%) and partial response in 11 (19.7%) patients. Twenty three patients 

with disease localised only to the neck, all (100%) had a complete or near 

complete resolution of the disease after the primary surgery. Complete/ 

near complete response was achieved in 98% cases with macrocystic disease, 

regardless of the location. Minor complications occurred in 11.3% patients. 

No permanent nerve weaknesses occurred. 

CONCLUSION 

Cervicofacial Lymphatic malformations in children should be managed 

in a multidisciplinary setting. The majority of patients (80%) in this study 

had complete or near complete resolution with one surgical procedure. 

Isolated neck lesions have best outcomes (100% resolution in this study). 

Patients with macrocystic disease, achieved complete or near complete resolution 

in 97% of cases, regardless of the location. Surgical excision as the 

primary treatment modality in selected cases is safe and reliable technique 

and has good aesthetic and functional outcomes in experienced hands. 

109

O 101 

TREATMENT OF INFANTILE HEMANGIOMAS WITH 

ATENOLOL OR PROPRANOLOL: COHORT STUDY WITH 

HISTORICAL CONTROL GROUP 

M.F. Raphael, M. De Graaf, J.M.P.J. Breur, C.C. Breugem, 

S.G.M.A. Pasmans 

Wilhelmina Childrens Hospital, University Medical Center Utrecht, 

Pediatric Hematology & Oncology, UTRECHT, The Netherlands 

E-MAIL: m.f.raphael@umcutrecht.nl 

BACKGROUND 

Propranolol, a lipophilic non-selective beta-blocker, has proven to be effective 

in the treatment of infantile hemangioma (IH). However several 

side effects have been reported. The use of the hydrophilic selective beta- 

1 blocker atenolol could reduce these side effects. 

OBJECTIVE 

To compare the effects and side effects of atenolol with propranolol in patients 

with IH. 

METHODS 

30 consecutive patients with IH were treated with atenolol between June 

2010 and May 2011. This cohort was compared with a previously described 

cohort of 28 patients treated with propranolol between July 2008 and December 

2009. The therapeutic effect was judged by clinical assessment and 

with a quantitative scoring method performed by two blinded clinicalinvestigators 

using digital photographs. Side effects were evaluated. 

RESULT 

Clinical involution was present in 90% (27/30) of the IH treated with 

atenolol and in 100% (28/28) treated with propranolol (p=0.09). Quantitative 

improvement of the IH in the propranolol group (n=24) was (after adjustment 

for differences in baseline characteristics) not statistically significant 

compared to the atenolol group (n=27) (p=0.16). Mild side effects occurred 

in 20% (6/30) of patients treated with atenolol and in 36% (10/28) of patients 

treated with propranolol (p=0.18). Severe side effects occurred in 3% (1/30) 

of patients treated with atenolol and in 21% (6/28) treated with propranolol 

(p=0.04). 

CONCLUSIONS 

This observational study indicates that atenolol has similar effects as propranolol 

in the treatment of IH, but is less frequently associated with side 

effect. 

110 

O 102 

ANALYSIS OF GENE EXPRESSION PROFILES IN TYMPANIC 

MEMBRANE FOLLOWING PERFORATION USING CDNA 

MICROARRAYS 

E.K. Hassmann-Poznanska 1 , A. Taranta 1 , H. Zajaczkiewicz 1 , 

M. Poznanska 2 , M.M. Winnicka 1 

1 Medical University, Pediatric Otolaryngology, BIALYSTOK, Poland 

E-MAIL: hassmann@umb.edu.pl 

2 J. Sniadecki District Hospital, BIALYSTOK, Poland 

OBJECTIVES 

The morphologic features of tympanic membrane (TM) repair have been 

well described but the precise mechanisms involved in the process are far 

from being elucidated. The technique of microarrays allows simultaneous 

assessment of expression of several genes. 

METHODS 

In 20 rats in both ears perforations in upper-anterior quadrant of TM were 

created while the rats were under general anesthesia. Rats were allocated 

into groups to be sacrificed at either 1, 2, 3, 5 and 10 day after perforation. 

Four rats with non-perforated ears served as a control group. Immediately 

after death the TM were dissected and frozen in liquid nitrogen. Total 

TM”s RNA of each rat was isolated and reversely transcribed for cDNA 

which was used for the study. qPCR was performed using ready to use Rat 

Wound Healing RT2 Rrofiler PCR Array (QIAGEN) containing primers for 

84 tested genes. 

RESULT 

Statistically significant changes in expression of 42 genes were found on 

various stages of healing of TM. Increased expression of genes taking part 

in inflammatory reaction (interleukin 6, granulocyte and macrophage 

chemotactic proteins) was observed starting from day 2. Expression of several 

genes of extracellular matrix components and their remodeling enzymes 

was changed. Among growth factors VEGF , IGF1 and HbEGF 

showed increased expression at the beginning of healing process but HGF 

expression was highest on day 3. 

CONCLUSIONS 

Several changes in the expression of genes involved in remodeling of extracellular 

matrix points to higher than expected role of connective tissue 

in the process of healing of TM.

O 103 

TYMPANIC MEMBRANE RETRACTION POCKETS 

(CLASSIFICATION- MONITORING -EVOLUTION-TREATMENT) 

M. Graziadio 1 , M. Negri 2 , D. Farneti 3 , C. Cola 3 

1 Ospidale di Carpi, COSENZA, Italy, 

E-MAIL: marilena.graziadio@gmail.com 

2 Ospedale di Carpi (MO), CARPI, Italy 

3 Ospedale “Infermi” Rimini, RIMINI, Italy 

OBJECTIVES 

Retraction pockets are medial invaginations of the tympanic membrane. 

They are often considered pre-cholesteatomatous conditions that occur as 

a result of middle ear negative pressure and other disventilatoty mechanisms. 

Several classifications are proposed and described in the literature 

which take into account the localization (pars tensa - pars flaccida - mixed), 

the motility, the property of self-cleaning and the explorability. 

METHODS 

The long-term results of a sample of 250 spontaneous retraction pockets 

were examined under the microscope and through otoendoscopy during 

the period 1997- 2008, with the purpose of observing their clinical evolution. 

The status of the controlateral ear was systematically examined. All 

the patients underwent pure tone audiometry and tympanometry, and 

follow-up audiograms were performed periodically. Ossicular damage, potentially 

acquired cholesteatoma, uncontrollable and fixed retraction 

pockets were also examined using High Resolution Computerized Tomography 

(HRCT). Long-term otoscopic observations supported by the collection 

of digital images permitted the periodic comparative study of the 

pathology and the constant monitoring of its evolution. 

RESULT 

Good audiological pure tone thresholds (air-bone gap less than or equal 

to 20 dB) were discovered in 88% of cases. In only 5%, we have clearly observed 

an evolution in small cholesteatoma with in-growth of squamous 

epithelium through marginalis and fixed retraction pockets. In these cases, 

a planned closed tympanoplasty was performed with optimal functional 

results. 

CONCLUSION 

Our findings show that constant monitoring is required for the retraction 

pockets. Surgical treatment is needed in few instances; long-term followup 

is however essential. 

O 104 

HAVE NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE 

GUIDELINES ON MANAGEMENT OF OTITIS MEDIA WITH 

EFFUSION CHANGED PRACTICE? 

M. Daniel 1 , T. Kamani 2 , S. El-Shunnar 2 , M.C. Jaberoo 3 , A. Harrison 4 , 

S. Yalamanchili 3 , L. Harrison 5 , W.S. Cho 2 , N. Fergie 2 , R. Bayston 6 , 

J. Birchall 6 

1 Children’s Hospital Westmead, Paediatric Otolaryngology, SYDNEY, 

Australia 

E-MAIL: m-daniel@runbox.com 

2 Nottingham University Hospital, NOTTINGHAM, United Kingdom 

3 Royal Free Hospital, LONDON, United Kingdom 

4 Royal Derby Hospital, DERBY, United Kingdom 

5 King’s Mill Hospital, MANSFIELD, United Kingdom 

6 University of Nottingham, NOTTINGHAM, United Kingdom 

OBJECTIVES 

UK National Institute for Clinical Excellence (NICE) guidelines on surgical 

management of OME in children call for an initial 3 month period of observation, 

with ventilation tubes (VTs) considered for children with persistent 

bilateral OME with a hearing level in better ear of 25-30dBHL or 

worse (‘core criteria’), or for children not meeting those audiologic criteria 

but when OME has significant impact on developmental, social or educational 

status (extenuating circumstances). We aimed to establish whether 

VTs are being inserted in accordance with NICE guidelines, and whether 

guidelines have changed practice. 

METHODS 

Retrospective case-notes review in five centres, analysing practice in all 

children having first VT insertion before (Jul-Dec06) and after (Jul-Dec08) 

guidelines’ introduction. 

RESULT 

Records of 316 children were analysed, 172 before and 144 after guidelines’ 

introduction. There were no significant differences in practice before and 

after guidelines with respect to having 2 audiograms 3 months apart (57.8 

v 54.8%), OME persisting ≥3 months (93.6 v 91.1%), or fulfilment of 25dB 

audiometric criteria (68.2 v 61.0%). Whereas 43.9% of VT insertions met the 

‘core criteria’ prior to guidelines’ introduction, this fell to 32.2% after 

(p=0.032); however, if VTs inserted for extenuating circumstances were included 

there was no significant difference (85.5 v 87.0%) because the proportion 

of VTs inserted for extenuating circumstances increased after 

guidelines. 

CONCLUSIONS 

Most children have VTs inserted in accordance with NICE guidelines providing 

the extenuating cases are included, but fewer than a third meet the 

‘core criteria’. Guidelines do not appear to have changed practice. 

111

O 105 

TREATMENT OF ACUTE OTITIS MEDIA - NEW SWEDISH 

GUIDELINES FROM 2010 

K. Gisselsson Solén, K. Hermansson 

Lund University Hospital, Dpt of Otorhinolaryngology, Head and 

Neck Surgery, LUND, Sweden 

E-MAIL: marie.solen@gmail.com 

In Sweden, the first guidelines on the treatment of acute otitis media that 

included watchful waiting as an alternative was issued in 2000. In 2010, 

these guidelines were revised. The current Swedish recommendations are 

to treat all children below one year of age and everybody older than twelve 

years with antibiotics. Children between one and twelve years shall be 

subject to watchful waiting as long as complicating factors, either of the 

host or of the infection, are not present. The new guidelines are also accompanied 

by stricter recommendations on follow-up of the disease. 

112 

O 106 

PATTERNS OF INTERNET USE BY PARENTS OF CHILDREN 

ATTENDING A PAEDIATRIC OTOLARYNGOLOGY SERVICE 

R.W. Glynn, F. O’ Duffy, M. Colreavy, H. Rowley 

Childrens University Hospital Temple Street, ENT, DUBLIN, Ireland 

E-MAIL: ronanglynn@doctors.net.uk 

OBJECTIVES 

To assess internet use by parents of children with ENT conditions, to indicate 

where it fits within their information sources, how they have used 

it, and how they might use it in future. 

METHODS 

A questionnaire (n=630) was circulated to parents in the out-patient and 

day-ward settings. 

RESULT 

79.5% (n=501) of questionnaires were returned. 149/501(29.7%) had consulted 

the internet; 67.8% had found the information understandable, 59.4% had 

found it helpful, but just 26.4% felt that it had influenced the medical decisions 

they had made for their child. 50.1% had previously or intended to 

discuss the online information with their surgeon. 9.2% had searched online 

for information regarding their child’s surgeon; 19.5% of these said 

that this had been a factor in choosing that particular surgeon. 48.5% of 

respondents or their partners had an iPhone or similar; 62.9% said they 

would definitely use an iPhone app regarding their child’s condition if one 

was available. When asked to rate information sources in terms of importance(scale 

1-5), respondents rated their ENT surgeon most important (average 

4.63), followed by their general practitioner (4.14), their pediatrician 

(4.09), and ENT nurse (4.06); the internet was rated least important at 3.09. 

35.5% reported they would definitely use the internet in the future. 

CONCLUSIONS 

Whilst online sources must increasingly be considered in the dialogue 

with parents, it is clear that parents still rate the clinical team as most important 

for information gathering. Clinician-provided websites and 

smartphone applications may be the key to ensuring the provision of quality 

information into the future.

O 107 

PATIENT REPORTED OUTCOME MEASURES (PROM) AFTER 

TONSILLECTOMY PERFORMED IN PATIENTS WITH 

OBSTRUCTIVE RESPIRATORY PROBLEMS 

M. Bogaerts, P. Lemkens, N. Lemkens, W. Schrooten 

Hospital Oost Limburg, Otorhinolaryngology, Head and Neck Surgery, 

GENK, Belgium 

E-MAIL: marie_bogaerts@hotmail.com 

OBJECTIVE 

To assess the effect of tonsillectomy on quality of life in children with obstructive 

respiratory problems, as reported by their parents, by using an 

electronic questionnaire based on the Pediatric Sleep Related Breathing 

Disorder Questionnaire designed by Sproson et al. The questionnaire 

scores symptoms in 5 different subdomains (snoring, sleepiness, behaviour, 

eating, apnoea). Higher scores indicate more pronounced symptoms. 

METHODOLOGY 

The electronic questionnaire was administered on the day of the surgery 

(T0) to the parents of children undergoing tonsillectomy. The measurement 

on T0 scores the pre-operative symptoms. At 2 weeks (T1) and 6 

months (T2) postoperatively, the same questionnaire was sent by e-mail. 

The main outcome measure (the change in scores between the post-operative 

measurements and the pre-operative measurement) was analysed 

using the Wilcoxon signed-rank test. 

RESULTS 

In total, 69 questionnaires were completed on the day of the surgery (T0), 

57 at 2 weeks postoperatively (T1), and 55 at 6 months postoperatively (T2). 

The total scores at T1 and T2 were significantly lower than the total scores 

at T0, p

O 109 

THE PRESENTATION AND DIAGNOSIS OF LARYNGOMALACIA 

IN CHILDREN AGED OVER TWO YEARS 

J. Lawrence, S. Thevasagayam, D. Bateman, N. Middle Kontorinis 

Sheffield Children’s Hospital, ENT Department, SHEFFIELD, 


E-MAIL: rachael.lawrence@hotmail.co.uk 

OBJECTIVES 

Laryngomalacia (LM) is characterised by collapse of the supraglottic structures 

on inspiration. The most common symptom is stridor that is present 

at or shortly after birth but generally disappears by 2 years of age. The aim 

of this retrospective study was to identify the symptoms of children that 

present with LM after the age of 2 years in order to facilitate diagnosis of 

the condition in this cohort of patients. 

METHODS 

We reviewed a database of 234 children who underwent an isolated 

aryepiglottoplasty or supraglottoplasty for LM in the last 13 years from 

May 1998 to December 2011 at Sheffield Children’s Hospital. We then reviewed 

the cases of those children aged 2 years and older. 

RESULTS 

Fourteen children aged over 2 years old when diagnosed with LM were 

identified. The youngest was aged 2 years and 5 months and the eldest 13 

years. Seven patients had sleep-disordered breathing (SDB) as their main 

presenting symptom, 3 of these children remaining symptomatic despite 

adenotonsillectomy. Two patients presented with dysphonia and poor exercise 

tolerance. Of the remaining 5 patients, 1 presented with poor exercise 

tolerance alone and 4 with recurrent or persistent stridor. All children, except 

2 had normal neurological development. 

CONCLUSIONS 

Late onset LM should be considered a potential diagnosis in children aged 

older than 2 years presenting with respiratory symptoms, especially SDB 

that is commonly unresponsive to adenotonsillectomy. Younger children 

tend to present with persistent or recurrent stridor, whereas teenagers 

more commonly experience dysphonia and poor exercise tolerance. 

114 

O 110 

PREVENTION OF AIRWAY FIRES: ENDOTRACHEAL TUBES 

AND SURGICAL DEVICES 

L.P. Smith 1 , S. Roy 2 

1 NSHS, Otolaryngology, NEW HYDE PARK, USA, 

E-MAIL: lsmith8@nshs.edu 

2 University of Texas—-Dept of Otorhinolaryngology, HOUSTON, USA 

OBJECTIVES 

This study was designed to assess the ability of carbon dioxide (CO2) lasers 

and radiofrequency ablation devices (Coblator) to ignite either a non-reinforced 

(polyvinylchloride) endotracheal tube (ETT) or an aluminum and 

fluoroplastic wrapped silicon (‘laser safe’) ETT at varying titrations of oxygen 

in a mechanical model of airway surgery. At the conclusion of this 

presentation, the participants should be able to understand the risk factors 

for intraoperative fire during endoscopic airway surgery and list strategies 

for the reduction of intraoperative fires. 

METHODS 

Non-reinforced and laser safe ETTs were suspended in a mechanical model 

imitating endoscopic airway surgery. A CO2 laser set at 5-30 watts was fired 

at the ETT at oxygen concentrations ranging from 21%-88%. The process 

was repeated using a radiofrequency ablation (RFA) device. All trials were 

repeated to ensure accuracy. 

RESULTS 

The CO2 laser ignited a fire when contacting a non-reinforced ETT in 

under 2 seconds at oxygen concentrations as low as 44%. The CO2 laser 

could not ignite a laser safe ETT under any conditions. With the RFA, a 

fire could not be ignited with either reinforced or non-reinforced ETTs. 

CONCLUSIONS 

RFA presents no risk of ignition in simulated airway surgery. CO2 lasers 

should be utilized with a reinforced ETT or no ETT, as fires can easily ignite 

when lasers strike a nonreinforced ETT. Decreasing the fraction of inspired 

oxygen reduces the risk of fire. Compelling video will be provided.

O 111 

SUPRAGLOTTIC OBSTRUCTION: A NEW OPERATION FOR 

PROLAPSE OF THE EPIGLOTTIS 

K. Amonoo-Kuofi, H. Ismail-Koch, P. Philips, G. Morrison 

The Evelina Children’s Hospital, Otorhinolaryngology, LONDON, 


E-MAIL: entkwamena@gmail.com 

INTRODUCTION 

Supraglottic collapse and prolapse of the epiglottis affecting the laryngeal 

inlet may lead to an unsafe airway, necessitating tracheostomy and can 

result in failure of decannulation. Previous reports describe the use of endoscopic 

and laser techniques, suturing or trimming of the epiglottis or 

an external technique involving division of the epiglottis above the anterior 

commissure and attaching it to the superior border of the thyroid cartilage. 

These procedures may result in scarring, stenosis and aspiration. 

Osteogenic manibular distraction is another, more invasive approach. 

METHODS 

We describe a novel epiglottic repositioning technique that we have found 

useful in patients with Treacher Collins and Goldenharr Syndromes, and 

a grade 3-4 larynx lying high and abutting the posterior hypopharyngeal 

wall. This combined external and endoscopic surgical technique entails 

an external suprahyoid laryngeal release, resection of the central body of 

the hyoid and using simultaneous endoscopic control suturing the 

epiglottis to the tongue base. 

RESULT 

Three children underwent the procedure at our centre. All patients presented 

with respiratory distress and two were tracheostomy dependent. 

On Microlaryngoscopy and bronchoscopy the epiglottis was found prolapsed 

towards the posterior pharyngeal wall in all cases. Post-operatively 

the view became grade 1 and decannulation was achieved. There were no 

postoperative complications. The follow-up ranged from 3 months to 3 

years. 

CONCLUSION 

This technique has proved useful in the management of these challenging 

cases, and indeed avoided the need for a tracheostomy in one case. We advocate 

the use of this technique in select cases. 

O 112 

THE MISUSE OF RADIOGRAPHY IN DIAGNOSIS OF PEDIATRIC 

AIRWAY FOREIGN BODIES 

L.A. Makoshi 1 , M.M.S. AlSubaie 2 , H.M. AlEid 2 

1 National Gaurd Hospital, RIYADH, Saudi Arabia, 

E-MAIL: latifahmak@gmail.com 

2 King Saud University, RIYADH, Saudi Arabia 

Foreign body aspiration poses an important cause of accidental death 

among children; its diagnosis constitutes a continuous problem in the 

clinical practice. Radiological examination was shown to be neither 

mandatory nor contributing to the diagnosis. With the aim of highlighting 

the importance of having clear guidelines regarding radiography as a 

diagnostic tool of airway foreign bodies in children, a chart review of 55 

patients over the past 5 years was retrospectively studied. These patients 

presented to the Pediatric Emergency Department of National Guard Hospital 

in Riyadh, Saudi Arabia. Patients ages ranged from 5 months to 14 

years, 76% were 3 years and below. Foreign bodies were found in 86% of patients, 

with watermelon seeds (organic material) as the most common 

finding (21%). The majority was lodged in the right main bronchus (42%). 

A witness to the aspiration was present in 85%, and the symptoms were 

mainly: choking (82%), coughing (78%), and dyspnea (73%). Ninety eight 

percent of patients underwent radiological examination, 55% had negative 

findings. Of those with negative results, 86% were taken for a Rigid Bronochoscopy 

procedure. Half of the patients found to have a foreign body in 

the operating room had revealed no radiological findings. We conclude 

that children are being exposed to radiation at a young age, when their 

history alone was an indication for bronchoscopy, the ultimate procedure 

of choice, regardless of radiology findings. A clear practical approach is still 

needed to minimize this unnecessary radiation and avoid diagnostic delay. 

115

O 113 

BRONCHOSCOPIC ASSISTED RECURRENT CONGENITAL 

TRACHEOESOPHAGEAL FISTULA REPAIR 

E. Reindorp-Kfir, Hagit Nagar Gadi Fishman, A. DeRowe 

Sourasky Tel Aviv Medical Center, Otolaryngology Head & Neck 

Surgery & Maxillofacial Surgery Pediatric Otolaryngology, NIRIT, Israel 

E-MAIL: efratrk@gmail.com 

INTRODUCTION 

Recurrent tracheoesophageal (TEF) fistula is a serious complication that 

occurs in 3-15% of surgical repairs. Revision surgery and intra-operative 

identification of the fistula in these cases is difficult. 


20 children with TEF were treated during years 2010-2011. Four of which 

were due to recurrent fistula. Intra-operative identification of the fistula 

was performed with a rigid bronchoscope and insertion of fogarty catheter 

into the tracheal opening. The catheter is than delivered through the 

esophagus by rigid bronchoscopy. With the catheter thus placed, identification 

and excision is facilitated during thoracotomy. 

RESULT 

Revision TEF repair was successful in all 4 cases. Ease of intraoperative fistula 

identification was noted by the pediatric surgeons. 

CONCLUSION 

Cooperation between pediatric surgeon and otorhinolaryngologist is useful 

in intra-operative identification of recurrent TEF and can aid in the 

surgical excision . 

116 

O 114 

HIGH RATE OF HEARING LOSS IN ANGOLAN CHILDREN 

WITH SICKLE-CELL DISEASE 

A. Taipale 1 , T. Pelkonen 1 , H. Peltola 1 , L.P. Bernardino 2 , A. Pitkäranta 1 

1 Helsinki University Central Hospital, Otorhinolaryngology, 

HELSINKI, Finland 

E-MAIL: anni.taipale@fimnet.fi 

2 Pediatric Hospital of Luanda, LUANDA, Angola 

OBJECTIVES 

To assess the prevalence of hearing loss and otorhinolaryngological (ORL) 

findings, especially otitis media, among children with sickle-cell disease 

(SCD) in Luanda, Angola. 

METHODS 

ORL examination, tympanometry, and, at age > 5 years, pure-tone audiometry 

were performed in 61 outpatients of the SCD clinic and 61 

healthy controls in the Pediatric Hospital of Luanda. 

RESULT 

Bilateral hearing loss of > 25dB occurred in 9 (36%) SCD- vs. 3 (11%; p=0.047) 

control children. The hearing loss in the SCD group was predominantly 

mild (26-40dB), involved low and middle frequencies, and lacked age- or 

gender-dependency. Acute otitis media occurred in 2 (3%) SCD- vs. 4 (6%; 

p=0.68) control children, chronic otitis in 0 vs. 2 (3%; p=0.50), and middleear 

effusion in 1 vs. 1 (2%; p>0.99). No significant differences occurred in 

the ORL profiles of the study groups. 

CONCLUSIONS 

The high rate of hearing impairment among the present study’s SCD children 

suggests a need for hearing screening among the SCD children of the 

developing countries. The actual prevalence of otitis media and its role in 

the etiology of SCD children’s hearing loss remain subjects for further research.

O 115 

IS THE HEARING LANGUAGE LINK REALLY PRE-DOMINANT 

IN THE DEVELOPMENTAL IMPACT OF OME ? 

M. Zirk-Sadowski, H. Spencer, M. Haggard 

University of Cambridge, Centre for Neuroscience in Education, 

CAMBRIDGE, United Kingdom 

E-MAIL: jmz27@cam.ac.uk 

BACKGROUND 

Precedents from profound childhood deafness have made the pathway 

[hearing speech/ language development] the foremost hypothesis for OME 

impact, but such hypotheses rarely receive rigorous test. We tested alternatives 

via differently summarised correlation patterns (structural equation 

modelling - SEM) for OME’s cascades of impact. 

METHODS 

For 592 cases in baseline assessment for TARGET (UK randomised trial) we 

had HL, reported severity scores for URTI, Zsum disease severity (RAOM 

plus reported hearing difficulties), sleep disturbance, and quality of life 

(QoL). Development was formulated in reference model (a) as a latent factor 

combining speech/language, balance, anxiety, and inappropriate behaviour. 

In model (b), speech/language was instead interposed as an extra 

stage between hearing and development, not just one development 

marker as in (a). 

RESULT 

With a deletion criterion for links at p > 0.03, satisfactory SEM fit was obtained 

for (a) (RMSEA < 0.08). Fit of the focal model (b) (hearing speech/language 

development) was materially inferior, in the ‘poor’ range (RMSEA 

> 0.11). Permutation of variable values around model positions found no 

better solution in 6 million than (a). 

CONCLUSIONS 

1 Inferiority of the hearing speech/language development model (b) to the 

multiple marker model (a) is due to poor prediction by fluctuating measured 

HL, and to two structural properties: the less economical extra stage, 

and the entailed break-up of the Zsum index of disease severity, (also reverting 

to poorer raw distributions.) 

2 The importance of the URTI sleep disturbance pathway corrects four 

decades of over-narrow emphasis in the developmental impact from OME. 

O 116 

GOOD AGREEMENT BETWEEN PARENTS AND PHYSICIAN IN 

THE ASSESSMENT OF EAR DISCHARGE IN CHILDREN 

T.M.A. van Dongen, A. Schilder, L. Manders, E.L. van der Veen, 

G. van der Heijden 

University Medical Center Utrecht, UTRECHT, The Netherlands 

OBJECTIVE 

To determine the interobserver agreement between parents and physicians 

regarding the presence of ear discharge in children after treatment 

of acute or chronic otorrhea. 

MATERIAL AND METHOD 

Datasets of 2 randomized trials were used including 191 children treated 

for acute tympanostomy tube otorrhea (ATTO) and 100 children treated 

for active chronic mucosal otitis media (COM). Parents documented symptoms 

of ear discharge in a diary. These diaries were compared to the assessment 

by physicians at planned follow-up visits. 

RESULT 

At 2-weeks follow-up for children with ATTO the kappa value was 0.69 and 

at 6-weeks follow-up for those with COM the kappa value was 0.68, indicating 

a substantial level of agreement between parents’ and physician’s 

assessments according to the criteria of Landis and Koch. Positive predictive 

values at these visits were 0.95 for ATTO and 0.90 for COM and negative 

predictive values were 0.87 for ATTO and 0.85 for COM. 

CONCLUSION 

Parents’ assessment of the presence of ear discharge after initial treatment 

of children with ATTO or COM agrees well with that of the physician, suggesting 

that the need for further treatment can be based on parents’ judgement. 

117

O 117 

OME; AIMING THE RIGHT THERAPY AT THE RIGHT PATIENT 

J.A. De Ru 

UMC Utrecht, ENT department, UTRECHT, The Netherlands, 

E-MAIL: j.a.deru@umcutrecht.nl 

OBJECTIVE 

Otitis media with effusion (OME) is highly prevalent among young children. 

It often follows an episode of acute otitis. Although it is correlated 

with various patient characteristics and socio-economic factors, none of 

these has been identified as the sole causative factor. So, the precise pathophysiological 

mechanism and the long-term consequences of this clinical 

picture remain unclear.The objective is to support the hypothesis that 

OME might protect the middle and inner ear against invading bacteria, 

and to state that OME is merely a symptom instead of the classic view of 

OME being a disease. 

METHODS 

A descriptive review of the literature.Results: Many references show evidence 

of an infectious aetiology of OME. But, the most important factor 

to overcome OME seems to be maturation of a child’s immune system.The 

thick glue that is actively secreted by the middle ear mucosa ensures that 

for the time being an antimicrobial milieu is constantly present and may 

act as a barrier to ascending infections from the nasopharynx. 

CONCLUSIONS 

OME might be seen as a local defence mechanism.Since OME is in general 

self-limiting and resolves with age, a restrictive management of OME and 

careful counselling is indicated. It seems apparent that the surgical or 

medical therapy of OME often is a form of ‘over’ treatment. When confronted 

with OME in children the focus, more than ever, is a matter of 

aiming the right therapy at each individual child. 

118

poster presentations

P 001 

CHOLESTEATOMA SURGERY IN CHILDREN: 

A 10 YEAR REVIEW 

V. Visvanathan, H. Kubba, S.C. Morrissey 

Royal Hospital for Sick Children, GLASGOW, United Kingdom 

E-MAIL: vikranth@hotmail.co.uk 

OBJECTIVE 

To review the outcomes following paediatric cholesteatoma surgery between 

1999 and 2009 in a tertiary paediatric ENT unit. 

STUDY DESIGN 

Retrospective case series review 

RESULTS 

137 mastoid procedures were recorded. 54% children were observed to have 

disease involving the entire middle ear cleft and mastoid complex. We report 

a revision rate of 25%. Time to recurrence was 1 to 3 years in 17 patients, 

3 to 6 years in 5 patients and 6 to 9 years in 3 cases. 8/25 children demonstrated 

spontaneous improvement in air conduction thresholds following 

initial surgery. Initial disease extent and ossicular chain erosion correlated 

highly with disease recurrence (p=0.013). 

CONCLUSIONS 

Children tend to present with aggressive disease. Disease extent and ossicular 

chain involvement are associated with a higher risk of recurrent 

disease. Spontaneous improvement in hearing thresholds following 

cholesteatoma surgery should alert the clinician to recurrent disease. 

P 002 

INNER EAR LESIONS IN CONGENITAL CYTOMEGALOVIRUS 

INFECTION OF HUMAN FETUSES 

N. Teissier 1 , A.L. Delezoide 1 , A.E. Mas 2 , S. Khung-Savatovsky 1 , 

B. Bessières 3 , J. Nardelli 4 , C. Vauloup-Fellous 2 , O. Picone 2 , 

T. van den Abbeele 1 , P. Gressens 4 , H. Adle-Biassette 4 

1 Hopital Robert Debré, Pediatric ENT, PARIS, France 

E-MAIL: natacha.teissier@rdb.aphp.fr 

2 Béclère Hospital, APHP, CLAMART, France 

3 Institut de puériculture de Paris, PARIS, France 

4 Inserm U676, PARIS, France 

OBJECTIVES 

Congenital cytomegalovirus (CMV) infection is the leading cause of nonhereditary 

congenital sensorineural hearing loss (SNHL). The natural 

course and the pathophysiology of inner ear lesions during human fetal 

CMV infection have not yet been reported. 

METHODS 

Inner ear lesions were investigated in 6 CMV-infected fetuses aged 19 to 

35 postconceptional weeks and correlated with central nervous system 

(CNS) lesions. 

RESULTS 

All the fetuses had high viral loads in the amniotic fluid and severe visceral 

and CNS lesions visible by ultrasound. Diffuse lesions consisting of both 

cytomegalic cells containing inclusion bodies and inflammation were 

found within all studied structures including the inner ear, brain, other 

organs, and placenta, suggesting hematogenous dissemination. Cochlear 

infection was consistently present and predominated in the stria vascularis 

(5/6), whereas the supporting cells in the organ of Corti were less often involved 

(2/6). Vestibular infection, found in 5/6 cases, was florid; the nonsensory 

epithelia, including the dark cells, were extensively infected. The 

endolymphatic sac was infected in 1 of 3 cases. The severity of inner ear infection 

correlated with the CNS lesions, confirming the neurotropism of 

CMV. 

CONCLUSIONS 

This study documenting infection of the structures involved in endolymph 

secretion and potassium homeostasis in fetuses with high amniotic-fluid 

viral loads suggests that potassium dysregulation in the endolymphatic 

compartment of the inner ear may lead to secondary degeneration of the 

sensory structures. In addition, the occurrence of SNHL depends on the intensity 

and duration of the viral infection and inflammation. 

P 003 

ASSESSMENT OF EUSTACHIAN TUBE FUNCTION 

WITH EMG RECORDINGS OF LEVATOR AND TENSOR VELI 

PALATINI MUSCLES 

C.M. Alper, J.D. Swarts, W.J. Doyle 

University of Pittsburgh School of Medicine, Children’s Hospital of 

Pittsburgh, Otolaryngology, Division of Pediatric Otolaryngology, 

PITTSBURGH, USA 

E-MAIL: cuneyt.alper@chp.edu 

OBJECTIVES 

Assess the EMG recordings of the Tensor (mTVP) and Levator (mLVP) veli 

palatini muscle activities and Eustachian tube (ET) openings during swallowing 

in adults with (VT+) and without (VT-) a history of ventilation tube 

(VTs) insertion(s). 

METHODS 

Total of 35 subjects were enrolled. For each subject, topical anesthetic and 

decongestant were applied to the nasal passages. Then, using a 0º telescope, 

27 gauge EMG needle electrodes were inserted trans-nasally into 

the mTVP and mLVP on the test side. A microphone was placed into the 

ipsilateral ear canal and the probe from a sound generator was introduced 

into the contralateral nostril. A 45º telescope with attached videocamera 

121

was used to record soft palate and ET movements. Results for these 

tests/exams during swallowing for groups were compared. 

RESULTS 

During swallowing, the average peak voltages recorded by sonotubometry 

were higher, the average peak EMGs for mTVP were lower and for mLVP 

were much lower for the VT- group compared to the VT+ group. The variability 

in most sonotubometric and EMG parameters for both muscles as 

well as in the patterns of soft palate elevation and ET opening assessed by 

videoendoscopy was greater in the VT+ group. 

CONCLUSIONS 

Compared to VT- subjects, VT+ subjects may have less efficient ET openings 

but greater and more variable mTVP and mLVP activities during swallowing. 

The inability of the greater peritubal muscle activity to open the 

ET effectively may reflect an abnormal contraction pattern or obstruction 

of the ET lumen. 

P 004 

ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE IN 

CHILDREN WITH ACUTE OTITIS MEDIA 

F. Kudo 1 , N. Yamanaka 2 , N. Hotomi 2 

1 Chiba Prefecture University, Faculty of Health Care Science, 

CHIBA, Japan 

E-MAIL: fumiyo.kudo@cpuhs.ac.jp 

2 Wakayama Medical University, WAKAYAMA CITY, Japan 

OBJECTIVE 

Otitis media is one of the most common disorders in childhood and may 

have a considerable impact on quality of life (QOL) of children and their 

guardians. To describe how AOM influences the QOL, we conducted questionnaire 

suffered from AOM. 

STUDY DESIGN 

Prospective study of children with acute otitis media more than once in 

recent 6 months. 21 otolaryngologists all over Japan cooperated in this survey. 

The QOL questionnaire was given and answered by guardians using 

VAS (visual analog scale). Furthermore, the impact on six daily activities 

of guardians such as sleep, work, mental status, etc was also asked to describe. 

The relationship among the impact on guardians’ daily activities 

and child QOL, the frequency of AOM, and so on was statistically investigated 

using statistical analysis software, JMP v8. 

RESULT 

We enrolled 249 families of guardian and child with AOM. The average 

number of AOM episodes was 3.2 times. The average mark of VAS of QOL 

was 4.72. (VAS 10 is the best condition and VAS 0 is the worst one.) On the 

analysis of the AOM impact on guardians’ daily activities, we found significant 

relationship between ‘sleep’ and child QOL. 

122 

P 005 

ACUTE MASTOIDITIS: THE ROLE OF IMAGING FOR 

IDENTIFYING INTRACRANIAL COMPLICATIONS 

R. Shihada, A. Brodsky, K. Bartal, M. Luntz 

Bnai Zion Medical Center, Otolaryngology-Head and Neck Surgery, 

HAIFA, Israel 

E-MAIL: dr.shihada@gmail.com 

OBJECTIVES 

Brain CT is performed in patients presenting with acute mastoiditis (AM) 

in order to identify intra-cranial complications (ICC). Recently, however, 

the need for CT scans in such patients has been questioned owing to concerns 

regarding long-term effects of brain irradiation, with some clinicians 

claiming that the decision to scan should be based on a patient’s clinical 

presentation. This study was aimed at characterizing the typical clinical 

presentation of patients who already have ICCs when diagnosed with AM, 

and to compare it to that of AM patients presenting without ICCs. 

METHODS 

All patients hospitalized with AM between July 1997 and December 2009 

in an otologic tertiary referral center were divided into those with and 

those without ICCs on presentation. Pre-referral clinical characteristics 

and the signs, symptoms, and inflammatory indexes at presentation were 

compared between the two groups. 

RESULTS 

Of 71 patients presenting with AM, 10 had at least one ICC (sigmoid sinus 

thrombosis [9 patients], perisinus empyema [5], subdural abscess [1], and 

epidural abscess [1]). Patients with and without ICCs did not differ regarding 

most clinical characteristics or presenting signs and symptoms. None 

presented with neurological signs or cranial nerve deficits. 

CONCLUSIONS 

It is not possible to define an evidence-based index of suspicion for ICCs 

in patients with AM. Diagnostic imaging at presentation accordingly remains 

mandatory. 

P 006 

ASSOCIATION BETWEEN FOOD ALLERGY AND OTITIS MEDIA 

L. Hafrén, E. Kentala, P. Mattila 

Helsinki University Central Hospital, Department of 

Otorhinolaryngology, HELSINKI, Finland 

E-MAIL: lena.hafren@helsinki.fi

OBJECTIVE 

The objective of this study was to investigate the association between common 

food allergies and recurrent acute otitis media (RAOM) as well as 

chronic otitis media with effusion (COME). 

MATERIAL 

Children coming for surgery due to RAOM or COME (years 2007-2011) were 

recruited to the study together with their siblings and parents. A total of 

3004 subjects, from 718 families, answered a questionnaire concerning their 

OM history and treatment, food allergies, and oth-er medical conditions. 

RESULTS 

The frequency of egg, milk, and wheat allergy was 5.0% (51/1014), 8.5% 

(86/1012) and 4.6% (47/1014) among patients with RAOM as compared to 

2.9% (36/1248), 4.1% (51/1235), and 0.9% (11/1238) among the unaffected (OR 

1.78, 95% CI 1.13-2.84, p=0.011; OR 2.16, 95% CI 1.49-3.15, p

P 009 

DOES DIFFUSION-WEIGHTED MAGNETIC RESONANCE 

IMAGING (DW-MRI) CHANGE THE STRATEGY OF 

TREATMENT IN PAEDIATRIC CHOLESTEATOMA? 

A. Koitschev 1 , P. Behringer 1 , P. Amrhein 1 , D. Bögner 1 , T. von Kalle 2 , 

P. Winkler 2 

1 Klinikum Stuttgart, Division pediatric ORL and Otology, ORL-Dept., 

STUTTGART, Germany 

E-MAIL: a.koitschev@klinikum-stuttgart.de 

2 Radiology Institute, Olgahospital, Klinikum Stuttgart, STUTTGART, 

Germany 

OBJECTIVES 

Primary removal of cholesteatoma in children is usually associated with 

middle ear reconstruction. In this setting residual cholesteatoma remains 

obscured at follow up and therefore second stage surgery appears unavoidable 

in most cases. Parents regularly question the reason for revision surgery 

and ask for alternatives. 

METHODS 

This prospective comparative study evaluates the diagnostic accuracy of 

half-Fourier-acquisition single-shot turbo-spin-echo (HASTE) diffusionweighted 

magnetic resonance imaging (DW-MRI) in detection of chole - 

steatoma in 20 paediatric cases comparing intraoperative findings with 

immediate preoperative imaging. 

RESULTS 

In 19 of 20 cases cholesteatoma was successfully detected or excluded. In 

the only case of false-negative imaging a small size residual cholesteatoma 

(< 3 mm) was obscured by surrounding fluid collection. The exact localisation 

of small suspicious lesions within the temporal bone can be challenging 

and requires fusion techniques correlating diffusion with 

anatomical imaging. 

CONCLUSIONS 

The routine preoperative DW-MRI widens the surgical view on paediatric 

cholesteatoma and provides valuable information for preoperative planning. 

Two-stage tympanoplasty remains, however, the ‘safety first’-concept 

of cholesteatoma eradication in children. 

124 

P 010 

EFFICACY OF NEWLY DEVELOPED ORAL 

FLUOROQUINOLONE AND CARBAPENEM FOR PEDIATRIC 

INTRACTABLE ACUTE OTITIS MEDIA 

N. Yamanaka 1 , M. Hotomi 1 , R. Sugita 2 , A. Togawa 1 , Y. Ikeda 1 

1 Wakayama Medical University, Otolarynogology-Head & Neck 

Surgery, WAKAYAMA, Japan 

E-MAIL: ynobi@wakayama-med.ac.jp 

2 Sugita ENT Clinici, CHIBA, Japan 

High prevalence of drug-resistant S. pneumoniae and H. influenzae has 

been a worldwide problem while amoxicillin is recommended for drug of 

first choice. In Japan, drug-resistant microbes have been frequently detected 

in children less than 2 years of age and caused intractable AOM. In this 

study, we evaluated the clinical efficacy of two newly developed oral antimicrobial 

agents, tebipenem-pivoxil (TBPM-PI) and tosufloxacin (TFLX), for 

children with severe AOM based on the clinical scoring system and/or who 

showed no improvement after the 1st or 2nd line antibiotic treatments. 

We evaluated 104 children for TFLX and 61 children for TBPM-PI. They were 

treated with TFLX at 6mg/kg/twice daily for 5 days or TBPM-PI at 

4mg/kg/twice daily for 7 days. H. influenzae was detected in 42-46% as 

causative pathogen and S. pneumoniae was detected in 25-52%. Drug-resistant 

strains in both pathogens were 82-88% and 62-96%, respectively. TFLX 

showed 100% efficacy rate and no recurrence in 84 %. Clinical efficacy rate of 

TBPM-PI was 82% and recurrence rate after the treatment was 12%. 

Our current study showed superior efficacy of TFLX and TBPM-PI for severe 

and/or recurrent/prolonged AOM. Both agents will be drugs of choice 

for severe and/or recurrent/prolonged AOM. 

P 011 

STANDARDISED SHORT-FORM CLINICAL ASSESSMENT IN 

OME: DEVELOPMENT AND VALIDATION 

N. Femic 1 , M. Chakar 2 , S.A. Filipovic 3 , D. Djeric 3 , H. Spencer 4 , 

M.P. Haggard 5 

1 Trifun Panovski Hospital, ENT, BITOLA, Macedonia 

E-MAIL: geonatf@yahoo.com 

2 University Clinic, SKOPJE, Macedonia 

3 Clinical Centre of Serbia, BELGRADE, SERBIA 

4 Experimental Psychology, CAMBRIDGE, United Kingdom 

5 University of Cambridge, CAMBRIDGE, United Kingdom 

OBJECTIVES 

The 14 items (OMQ-14) within OM8-30 were recently shown as best mapping 

child quality of life; it would be convenient if these also supported standardised 

improved routine assessment, especially for treatment eligibility.

METHODS 

The Eurotitis-2 database standardising OM8-30 has 32 questionnaire items 

supporting 9 facets, also tympanometry, HL and basic demographics. On 

2308 hospital ENT cases from 12 countries, having full data on the OMQ- 

14 subset, we ran factor analyses. On Serbia data, we compared scores between 

contexts: new OMQ-14 questionnaire (‘solo’, N=52), versus within 

standard OM8-30 item context (N=223). 

RESULTS 

A 4-factor summary (a-d) explained 59% of variance, with weakest factor 

(d) explaining 8%. Minimal cross-loading favoured clinical interpretability 

as (a) RAOM - 3 highly-loading items; (b) reported hearing difficulties 

(RHD - 3); (c) behaviour plus parent impact - 6; and (d) speech/language - 

2. Between contexts, only 1 item (overall hearing) differed in response distribution 

(Chi-sq 15.1; 3 df; Bonferroni-adjusted p= 0.024). The 3 preceding 

items were identical between contexts and the difference weakened on adjustment 

for season and sample severity. 

CONCLUSIONS 

1) The OMQ-14 supports standardised clinical elicitation of 4 main facets 

in OM(E) presentation. The radial pentagram 5-D graphical summary, 

adding HL, is clinically attractive. 2) Up to four mapping formulae might 

be needed to equate OMQ-14 scores in data pooling between solo and 

OM8-30 contexts. In the light of only minor evident differences, a larger 

sample is needed to show for which, if any, scores this is really necessary, 

and the precise formulae. 

P 012 

CLINICAL EVALUATION OF ENZYME-LINKED 

IMMUNOSORBENT ASSAY (ELISA) (ODK-0901) FOR DETECTION 

OF STREPTOCOCCUS PNEUMONIAE ANTIGEN IN 

NASOPHARYNGEAL SECRETIONS AND MIDDLE-EAR FLUIDS 

S. Takeda 1 , M. Hotomi 1 , R. Sugita 2 , A. Togawa 1 , G. Sugita 1 , M. Kono 1 , 

S. Takei 1 , Y. Ikeda 1 , N. Yamanaka 1 

1 Wakayama Medical University, Otolaryngology - Head & Neck 

Surgery, WAKAYAMA, Japan 

E-MAIL: ynobi@wakayama-med.ac.jp 

2 Sugita ENT Clinic, CHIBA, Japan 

There has been an alarming increase in penicillin resistant Streptococcus 

pneumoniae (PRSP) worldwide. For treatments of acute otitis media 

(AOM), it is important to determine S. pneumoniae as a causative pathogen 

accurately and rapidly. We developed a novel immunochromatographic 

antigen detection kit (ODK-0901) for detecting C-polysaccharide antigen 

of S. pneumoniae in middle ear fluids (MEFs) and nasopharyngeal swabs 

from AOM. A total 523 samples, 257 MEFs and 265 nasopharyngeal swabs 

were obtained from patients with AOM. S. pneumoniae were identified 

by immunochromatographic antigen detection, real-time PCR and con- 

ventional bacterial culture. The sensitivity and specificity of ODK-0901 

based on the culture as standard were 81.4 % (48/59) and 80.5% (165/205) in 

the middle ear fluids, and 75.2 % (121/161) and 88.8 % (95/107) in the nasopharyngeal 

secretion, respectively. The ODK-0901 test provides a rapid 

and highly sensitive evaluation of the presence of S. pneumoniae and thus 

will be a promising method of identifying pneumococci in MEFs and 

NPSs. 

P 013 

ACUTE MASTOIDITIS: AN INCREASING CHALLENGE? 

V.J. Possamai, C. Panagamuwa, M.J. Kuo 

Birmingham Children’s Hospital, ENT, BIRMINGHAM, 


E-MAIL: victoriapossamai@mac.com 

OBJECTIVE 

Following the publication of a BMJ study in 2005 suggesting that admission 

rates for acute mastoiditis were rising, a retrospective review of cases 

of acute mastoiditis admitted to Birmingham Children’s Hospital in the 

preceding six years was performed. This study was then repeated for the 

six year period since the previous study to compare trends. 

METHODS 

All cases of mastoiditis were identified by searching discharge summaries 

and outpatient letters. A retrospective review of case notes, electronic imaging 

and laboratory databases was then performed. 

RESULTS 

There were 47 cases in the first six years (1999 - 2005, cohort 1 (C1)), compared 

to 55 cases in the following six years (2005-2011, cohort 2 (C2)). Two 

patients in C1 were admitted for greater than 20 days, compared to seven 

in C2. In C1 22 patients had antibiotics alone and 25 surgical treatment 

compared to C2 where18 patients had antibiotics alone and 37 surgical 

treatment. Intracranial complications occurred in three patients in C1 and 

22 in the C2 (p

P 014 

LEVELS OF SUBSTANCE P, AND VASOACTIVE INTESTINAL 

PEPTIDE IN MIDDLE EAR EFFUSIONS OF CHILDREN WITH 

OTITIS MEDIA 

H. Eyigor 1 , U. Osma 1 , M.D. Yilmaz 1 , M. Eyigor 2 , M. Gultekin 2 , N. Erin 3 

1 Antalya Training and Research Hospital, ANTALYA, Turkey 

2 Akdeniz University Medical Faculty Department of Medical 

Microbiology, ANTALYA, Turkey 

3 Akdeniz University Medical Faculty, Central Research Lab, ANTALYA, 

Turkey 

OBJECTIVE 

Etiology of otitis media with effusion (OME) is multi-factorial, and neurogenic 

inflammation may play a significant role. Substance P (SP) is a 

mediator of neurogenic inflammation which released from capsaicin-sensitive 

sensory neurons. Vasoactive intestinal peptide (VIP), is a mediator 

of sensory neurons which inhibits inflammation. Levels and possible contribution 

of SP and VIP was not previously evaluated in middle ear effusions 

(MEE) of children with OME. 

METHODS 

Fifty patients 2-12 years old age (mean age: 5,24±2,64, 20 female, 30 male) 

were included in the study. MEE were collected after myringotomy. Samples 

were classified as a mucoid or serous MEE based on the gross appearance. 

SP and VIP levels were determined using ELISA. 

RESULTS 

Majority of the samples (%64) were mucoid while % 36. were serous in apparence. 

High levels of SP were detected in MEE. In addition the levels 

were significantly higher (t-test) in serous samples (2910,55±307,96 vs 

2218,55±262,30 pg/ml). There were also age-dependent changes in SP levels 

such that it was significantly higher in 2-3 years old children compared 

to 4-5 and 6-12 years old. VIP levels were undetectable in %30 patients and 

mean VIP level was 50,91±16,01 in serous MEE and was 54,86±15,91 pg/ml 

in mucoid MEE. Surprisingly there was a inverse correlation between VIP 

and SP levels. 

CONCLUSION 

This is the first reported demonstrating high levels of SP which inversely 

correlated with VIP levels in MEE of patients with OME. Increased SP and 

decreased VIP levels might be an etiological factor in chronic OME. 

126 

P 015 

MIRINGOPLASTY IN CHILDREN: A RETROSPECTIVE 

ANALYSIS IN 50 PATIENTS, SELECTION, SURGICAL 

TECHNIQUE AND RESULTS 

C. Cola 1 , M. Negri 1 , D. Farneti 2 , M. Graziadio 2 

1 Ospedale di Carpi (MO), CARPI, Italy 

E-MAIL: colaclaudio@libero.it 

2 Ospedale ‘Infermi’ Rimini, RIMINI, Italy 

OBJECTIVES 

The selection criteria, the surgical technique and the anatomic and functional 

results of Miringoplasty in children in our experience will be presented. 

The operation can be performed on children aged 3 years and older 

and for some authors the procedure is a necessity, especially due to the 

problem of recurrent infections of the ear and hearing. 

METHODS 

Fifty children who underwent surgery between 1997 and 2007 were studied. 

The operations were performed after an average wait of one year, and 

the following cases were excluded: children with post-traumatic perforations, 

retraction pockets, cholesteatoma, tympanosclerosis and possible 

coexisting pathologies of the ossicular chain. 

RESULTS 

The sample included 28 males and 22 females, 39 patients aged between 5 

and 8 years and 11 aged between 9 and 12 years; in 2 cases the perforation 

was due to the prior placement of trans-tympanic drainages. Antibiotic 

prophylaxis and coverage were performed before and after surgery, and 

patients’ dismissal occurred the following day. In all patients, the Minimum 

Posterior Approach (MPA) was followed, and a temporalis fascia graft 

with underlay technique was used. Success (air-bone gap < 20 dB ) was 

achieved in 97%. 

CONCLUSIONS 

The surgical treatment of simple chronic otitis media in children remains 

a controversial and debated topic in the scientific community. Many surgeons 

believe that the results of miringoplasty in children can be affected 

by the increased incidence of upper respiratory tract infections and the 

possible co-existing dysfunction of the Eustachian tube.

P 016 

FACIAL NERVE PALSY IN PEDIATRIC POPULATION: 

NATURAL HISTORY AND INFLUENCING FACTORS 

A. Wolfovitz, N. Yehudai, M. Luntz 

Bnai-Zion Medical Center, Otolaryngology - Head and Neck Surgery, 

HAIFA, Israel 

E-MAIL: amit.wolfovitz@gmail.com 

OBJECTIVES 

To analyze factors influencing diagnosis and outcome of facial nerve palsy 

in children. 

METHODS 

A prospective study of 73 consecutive children treated for facial nerve palsy 

between 2005 and 2011. All children were treated with oral Prednisone 

(those treated until June 2009 received also oral Acyclovir), and followed 

for 2 months after their discharge. 

RESULTS 

Mean age at diagnosis was 12.09±4.51 years (range, 1-18 years). Etiology 

was defined as infection related in 20.5%, trauma related in 1.4% or idiopathic 

in 78.1% of the cases. Polyneuropathy was observed in 28.8% of cases, 

mainly of the Trigeminal and the Cochlear nerves. Complete resolution 

within two months was observed in 70.2% of children, the remainders were 

left with mild facial dysfunction. The yield of adjunct diagnostic assessments 

was found to be low. Oral Prednisone alone proved to be as adequate 

as Oral prednisone combined with Acyclovir, resembling results in adults. 

CONCLUSIONS 

Recovery rates in the pediatric population are similar to those reported for 

adults. Most pediatric cases are idiopathic followed by infection related. Commonly 

used diagnostic modalities have limited benefit in children. Recovery 

rates with oral Prednisone are as good as with oral Prednisone and Acyclovir. 

P 017 

SURGICAL TIMING FOR PEDIATRIC CONGENITAL 

CHOLESTEATOMA 

A. Shinnabe, M. Hara, M. Hasegawa, S. Matsuzawa, H. Kanazawa, 

N. Yoshida, Y. Iino 

Jichi Medical University, Saitama Medical Center, SAITAMA, Japan 

E-MAIL: aknewpan@yahoo.co.jp 

OBJECTIVES 

To discuss watchful waiting and early intervention for pediatric congenital 

cholesteatoma. 

METHODS 

We retrospectively reviewed 24 ears with pediatric congenital chole - 

steatoma (younger than 15 years). We followed a strategy of watchful waiting, 

especially for small cholesteatomas which did not surround the 

incudostapedial (I-S) joint. We performed tympanoplasty in cases with a 

growing or massive cholesteatoma which surrounded the I-S joint. We 

used cartilage to perform ossiculoplasty and scutumplasty. 

RESULTS 

The cholesteatoma resolved spontaneously in four cases (4/24, 16.7%). We 

performed tympanoplasty in 19 cases (19/24, 79.2%). Four cases underwent 

type I tympanoplasty; in one of these cases the cholesteatoma had resolved 

spontaneously but the parents requested surgery. In 15 cases a decision 

was made to perform staged tympanoplasty, and these cases underwent 

initial tympanoplasty without ossiculoplasty. The last case was waiting 

for surgery at the time of writing because she was still too young (aged 1.0 

years). 

CONCLUSIONS 

Watchful waiting may be appropriate for small congenital cholesteatomas 

which do not surround the I-S joint. If computed tomography does not 

show residual cholesteatoma after initial tympanoplasty, staged tympanoplasty 

and ossiculoplasty seem to be more successful when the patient 

is older than 10 years. 

P 018 

SPEECH IN NOISE TESTING PRE AND POST GROMMET 

INSERTION 

V.J. Possamai, G. Kirk, A. Scott, D.W. Skinner 

Royal Shrewsbury Hospital, ENT Surgery, SHREWSBURY, 


E-MAIL: victoriapossamai@mac.com 

OBJECTIVES 

In the UK funding for grommet insertion is under debate. Current evidence 

for the benefits is limited, with Cochrane reviews in 2005 and 2010 

suggesting improvements as little as 9dB on pure tone audiometry. Speech 

in noise testing is a better test of real life hearing and therefore more accurately 

reflects auditory disability. We designed a study to assess speech 

in noise in children prior to and after grommet insertion. 

METHODS 

Twelve children aged 6-9 years undergoing grommet insertion had speech 

in noise testing performed within three weeks pre and 6-11 weeks post 

grommet insertion. This was tested using Arthur Boothroyd word lists in 

four listening conditions. Firstly quiet, followed by 50dB, 60dB and 70dB of 

background noise, which was provided by a six-talker babble recording. 

Each word list consists of 30 phonemes giving a score out of 30 for each list. 

127

RESULTS 

The mean phoneme score under quiet conditions was 28.1 pre-op and 30 

post-op (p=0.04). The mean score in 50dB background noise was 24.2 preop 

and 29 post-op (p

serotype distribution among children with AOM before and after 7-PCV 

in Japan. All isolates were serotyped by quelling reaction with capsulespecific 

antisera (Statens Serum Institut), multiplex inhibition-type immunoassay 

or multiplex PCR-based assays. 

175 pneumococcal isolates were collected from middle ear fluids (MEFs) 

of children with AOM during pre-vaccine periods (2006 to 2007). The predominant 

serotype was 19F (19.4%) followed by 23F (14.9%), 14 (11.4%), 6B 

(11.4%), 6A (9.1%), and 3 (9.1%). They represented about 95.7% of the strains 

identified as PRSP. 

The 7-PCV covers most of PRSP isolated from AOM children, especially 

those

P 024 

CONGENITAL CHOLESTEATOMA IN CHILDREN: 

RECOGNITION, SURGICAL MANAGEMENT AND 

POSTOPERATIVE CARE 

M. Mrowka, H. Skarzynski, M. Porowski, P. Mlotkowska-Klimek 

Institute of Physiology and Pathology of Hearing, Int. Center of Hearing 

and Speech, WARSAW, Poland 

E-MAIL: m.mrowka@ifps.org.pl 

OBJECTIVE 

Congenital cholesteatoma is relatively rarely recognized, specially in children. 

Its etiology is different than in acquired cholesteatoma. Development 

of the disorder is probably associated with involution of embryonic epithelial 

cells, growing slowly and transforming in the macroscopically visible 

tumor. The objective was to analyze hearing and anatomical results 

obtained after surgical treatment of congenital cholesteatoma in children 

and to discuss the possibilities of early recognition of the condition. 

METHODS 

A group of 42 patients aged 2-18 y.o. diagnosed with congenital chole - 

steatoma whose follow-up lasted minimum of 3 years was chosen. Patients 

were divided in two groups - A the youngest patients, feasible only with 

objective hearing tests, and - B including older children who could perform 

subjective hearing tests. Most of the children were exclusively operated 

through the external auditory canal. Postoperative results were 

evaluated as in our standard at 1, 6, 12, and 36 months. 

RESULTS 

A noticeable improvement in hearing was achieved in most of the children 

who underwent the conductive apparatus reconstruction. In B group the 

air-bone gap closure to 10 dB was obtained in 94.8% of cases. In 11 cases surgery 

was performed scheduled ‘second - look’ and recurrent cholesteatoma 

was found in 4 operated children. 

CONCLUSIONS 

In cases of congenital cholesteatoma, successful surgery and postoperative 

results depend on early diagnosis. In early diagnosed cases very good results 

can be obtained. All children who had undergone the congenital 

cholesteatoma surgery must be supervised. Despite the good equipment 

and surgical techniques, cholesteatoma recurrence is possible. 

130 

P 025 

EFFECTS OF SURGICAL TREATMENT OF SECRETORY 

OTITIS MEDIA 

L. Rovcanin 1 , L.J. Vlaski 2 

1 Institute for Children’s deseases, Clinical Centar of Montenegro, 

Podgorica, Mo, ENT department, PODGORICA, Montenegro 

E-MAIL: lejla.orldhk@gmail.com 

2 ENT Clinic Novi Sad, Serbia, NOVI SAD, Serbia 

OBJECTIVE 

To evaluate place of surgery in medical treatment of secretory otitis. 

METHODS 

Children who were hospitalized for surgical treatment of secretory otitis. 

All those were taken data from their parents, about episodes of acute inflammation 

of the middle ear, child’s behavior, development of speaking 

with obligatory logoped’s opinion. Otomictoscopic research, timpanometry 

and tonal liminary audiometry were dones. The first post-operative 

control was done 6 weeks after operation. The second post-operative control 

was 6 months after surgical treatment. 

RESULTS 

51 children were examined, from 1-6 years. There is 78,4% children who 

used antibiotics during treatment of acute inflammation of the middle 

ear, decongestants 66,7%, even mucolytics 31,4%. Post-operativly there was 

decrease of physical symptoms which follow episodes of acute otitis, less 

number of episodes of pains in ears out of episodes of acute otitis, improvement 

of the morpho-functional state of the middle ear (Chi-square, 

MANOVA). According to logoped’s evaluation 17,6% of children had, preoperatively, 

delay of speaking language status. Post-operatively, six 

months after operation, statistically did not make an important improvement, 

so there was still a great number 13,7% of those who lagged in development 

of speaking. 45,1% of children have hyperactivity. Six months 

after operation 41,2% of them still have hyperactivity. 

CONCLUSION 

There is positive effects of surgical treatment, which is reflected in prolonging 

period of 6 months after operation. 

P 026 

OUR EXPERIENCE IN THE TREATMENT OF PEDIATRIC 

CHOLESTEATOMA 

B. Sergi 1 , J. Galli 2 , G. Paludetti 2 

1 Università Cattolica, ENT Clinic, ROME, Italy 

E-MAIL: bruno.sergi@rm.unicatt.it 

2 Catholic University, Rome, Italy

OBJECTIVES 

To assess the outcomes and the functional results in pediatric chole - 

steatoma surgery considering the extension of the disease and the surgical 

techniques (intact canal wall and canal wall down; ossiculoplasty). 

METHODS 

Between January 2003 and December 2009, 33 patients (range 6-14 years) 

were operated on for cholesteatoma. We considered sites of cholesteatoma 

(mastoid, antrum, attic, middle ear, Eustachian tube), surgical techniques 

(ICW vs CWD) used and how our habits changes through the years; moreover 

we evaluated the ossicular chain conditions and how we managed 

the ossiculoplasty. As outcomes we considered the percentage of residual 

and recurrent cholesteatoma for each technique and the hearing function 

(air bone gap - ABG - closure) at the follow up. 

RESULTS 

ICW was performed in 20 patients and a CWD was performed in 13 patients 

and in 9 of them as first surgery. In both groups we observed an improvement 

of the ABG and a not significant high frequencies bone conduction 

worsening. In the ICW group a residual cholesteatoma was observed in 4 

patients whereas, during the follow up, 2 patients who underwent a CWD 

showed a recurrent cholesteatoma which was treated in clinic. 

CONCLUSION 

Eradication of cholesteatoma and restoration of hearing function in the 

pediatric age group present unique surgical challenges. Our experience 

showed an increased choice of ICW through the years. It is, therefore, important 

for the surgeon to counsel the parents regarding the probable need 

for multiple surgeries, especially if an ICW mastoidectomy is performed. 

P 027 

MEET OUR CHILDREN: THIRTEEN YEARS IN AN AUDITORY 

REHABILITATION CLINIC 

J. Araújo Martins, I. Correia, R. Ferreira, P. Brazão Santos, R. Gonçalves, 

S. de Almeida, L. Nunes, L. Monteiro 

Centro Hospitalar de Lisboa Central, Otorrinolaringologia, LISBOA, 

Portugal 

E-MAIL: jmartinsmed@yahoo.com 

OBJECTIVES 

To characterize our population (baseline characteristics, diagnosis, hearing 

loss type and rehabilitation status); to correlate clinical presentation, diagnosis 

and rehabilitation variables with each other; to apply new knowledge 

to improve our practice. 

METHODS 

Setting - auditory rehabilitation clinic in a tertiary referral centre in Lisbon; 

Study design - retrospective cohort study using data retrieved from 

the clinical files. Population - all files from children born since 1998 (437 

in total) were reviewed resulting in the selection of 322 children who met 

the inclusion criteria: documented persistent hearing loss of at least moderate 

severity. The study was submitted to the Ethics Committee, informed 

consent was obtained and standard statistical methods were used. 

RESULTS 

Average age at referral has been declining from 55 months (1998-2000) to 

12 (2007-2009). Hypoacusis and neonatal screening programs account for 

3/4 of referrals. Around 43,5% of children had established diagnosis. Most 

(2/5) had genetic causes. Seventeen had cochlear implants. Although highly 

variable, the average delay between referral and hearing aid use was 5,2 

months. Average tonal gain was 31dB. Only etiologic diagnosis and hearing 

loss severity influence language development. Patients with genetic disease 

and congenital cytomegalovirus infection tend to have progressive 

disease more often. Infections cause the most severe hearing loss. 

CONCLUSION 

Better data recording and diagnosis guidelines are required. Neonatal 

screening allows us to begin rehabilitation of children with hearing loss 

sooner. Most cases have genetic causes. Genetic diagnosis together with 

congenital cytomegalovirus infection, should be considered when hearing 

loss worsens over time. 

P 028 

ARTERIA LUSORIA: A RARE CAUSE FOR RECURRENT 

AIRWAY INFECTIONS 

T. Marom 1 , C. Kellenberger 2 

1 Edith Wolfson Medical Center, Otolaryngology-Head and Neck 

Surgery, HOLON, Israel 


2 Kinderspital Zürich, Zürich, Switzerland 

Arteria Lusoria is a congenital vascular anomaly of the aortic arch, which 

is consitent with a rare anatomical variant of the origin of the right or left 

subclavian artery. While normally right subclavian artery arises from brachiocephalic 

trunk and courses towards the arm. The aberrant vessel arises 

from the aortic arch or proximal descending aorta distal to the left subclavian 

artery. It then crosses in the posterior part of the mediastinum, 

usually behind the esophagus on its way to the right upper extremity. 

Such course of this aberrant vessel may cause a vascular ring around the 

trachea and esophagus. Symptoms include dysphagia, dyspnea and recurrent 

airway infections. Diagnosis is done by contrast CT scan or by endoscopic 

ultra-sound. We present a 4 year-old girl who was investigated for 

recurrent airway infection. Imaging studies revealed arteria lusoria. Her 

symptoms improved following a surgical procedure. 

131

P 029 

ODONTOGENIC MYXOMA OF THE MAXILLA: 

REPORT OF AN EARLY PEDIATRIC CASE 

R. Marianowski, E. Mornet, C. Lacroix, G. Valette, G. Potard 

CHU de Brest, Otolaryngology Head Neck Surgery, BREST, France 

E-MAIL: r.marianowski@free.fr 

OBJECTIVES 

to report a case of odontogenic myxoma which is an uncommon benign 

neoplasia of slow and infiltrative growth, usually assymptomatic. 

SETTING 

Tertiary referral center, university hospital, case report. 

RESULTS 

A 8-month-old girl presented with a 1-month history of jaw swelling associated 

with a palpebral edema. The head and neck examination showed 

a painless cystic mass of the left hemiface with swollen nasolabial cleft. 

The skin overlying the area was intact. She did not have any adenopathy 

or neurological defect. The rhinologic examination showed a left deviation 

of the nasal septum. Computed tomography scan revealed a 5 cm smooth 

unilocular mass that invaded the left maxilla. Under general anesthesia, 

a sublabial approach for access was placed in the maxillary vestibule. The 

entire tumor mass was degloved in a subperiosteal plane. The infraorbital 

nerve was identified and protected. Histologically, a myxoma consisting 

of basophilic, stellate shaped cells with thin, interwoven cytoplasmic projections 

was found. The ground substance was amorphous, avascular and 

hypocellular and composed primarily of glycosaminoglycans, hyaluronic 

acid, and chondroitin sulphate. Despite the fact that odontogenic myxoma 

showed aggressive local growth, it is believed that it never undergoes malignant 

transformation or gives rise to metastasis. The recommended 

treatment modality is either radical resection or conservative tumor excision 

depending on tumor size. Recurrence rates average about 25% and 

typically occur during the first 2 years after excision. 

CONCLUSION 

Myxoma is a benign tumor but locally aggressive causing bony erosion 

with invasion of soft tissues. 

P 030 

INNER EAR MALFORMATION IN MAYER ROKITANSKY 

KUSTER HAUSER SYNDROME 

R. Marianowski, E. Mornet, C. Lacroix, C. Clodic, Y. Gauvin, G. Potard, 

G. Valette 



132 

INTRODUCTION 

Mayer Rokitansky Kuster Hauser (MRKH) syndrome is rare. Its frequency 

is reported to be one in 4500 female newborns. It is characterized by congenital 

aplasia of the uterus and the upper part of the vagina in women 

showing normal development of secondary sexual characteristics and a 

normal 46, XX karyotype. Isolated utero-vaginal aplasia is referred to as 

Rokitansky sequence or to type I (isolated) MRKH syndrome. Incomplete 

aplasia and/or associated with other malformations,is referred to as MURCS 

association (or type II MRKH syndrome). Other associated malformations 

include: - Renal - Vertebral - Hearing defects. Auditory defects are associated 

with 10 to 25% of MURCS patients. They often concern conductive deafness 

due to middle ear malformations, such as stapedial ankylosis, or sensorineural 

defects of varying severity. Hearing loss associated with dysplasia 

of the auditory meatus and/or malformed ears have been reported. We report 

the first case of bilateral inner ear anomalies in MRKH syndrome. 

SETTINGS UNIVERSITY HOSPITAL, RETROSPECTIVE CASE REPORT 

Case report RC was adopted in 1988 right after birth. She was followed up 

because of bilateral mixed hearing loss with bilateral retraction pockets. 

After many tube insertions, she underwent bilateral Tympanoplasty with 

cartilage. During surgery no ossicular malformation was noted. The hearing 

level was not improved. High resolution CT scan showed a bilateral 

enlargement of the vestibular aquaduct without any ossicular anomalies 

.She was found to have a type II MRKH syndrome. 

CONCLUSION 

We report the first case of bilateral inner ear anomalies in MRKH syndrome. 

P 031 

MALFORMATIONS OF THE FIRST BRANCHIAL CLEFT: 

A CASE REPORT 

D. Radaljac 

General Hospital Loznica, Otorhinolaryngology, LOZNICA, Serbia 

E-MAIL: dradaljac@yahoo.com 

OBJECTIVES 

First branchial cleft anomalies are extremely rare and account for less than 

8% of all branchial anomalies. In 1972 Work classified first branchial cleft 

anomalies into two types: Type I, ectodermal cysts, is a duplication of the 

external auditory duct; Type II, originate in both ectodermal and endodermal 

components and contain cartilage. Their presentation may be similar 

to other conditions. 

METHODS AND RESULTS 

A healthy 16-year-old girl presented with cystic swelling, localized to the 

left postauricular area. Since,CT and otological examination were negative, 

surgery was performed to completely excise the cystic mass. Histological 

examination confirmed the diagnosis of the first cleft cyst.

CONCLUSIONS 

There are potential difficulties in the diagnosis and menagement of first 

cleft anomalies. Incorrect diagnosis and mismenagement lead to persistence 

or recurrence lesion and secondary infection. 

P 032 

ENT MANAGEMENT OF PATIENTS WITH THE RARER 

CRANIOFACIAL ANOMALIES 

E. Phelan 1 , C. Heffernan 1 , D. Murray 2 , H. Rowley 1 

1 Childrens University Hospital, Paediatric ENT, DUBLIN, Ireland 

E-MAIL: eimearphelan@hotmail.com 

2 Children’s University Hospital, Dept of Craniofacial & Plastic, 

National Craniofacial Unit Dublin, Ireland 

OBJECTIVES 

Highlight the ENT issues that are commonly associated with these rarer 

craniofacial syndromes. Highlight the role of the paediatric ENT surgeon 

in assessing and managing airway issues as part of a multidisciplinary 

team approach. Discuss surgical options including distraction osteogenesis 

of the mandible in managing airway issues. 

METHODS 

The ongoing Craniofacial Database maintained at the Children’s University 

Hospital, a tertiary referral centre, was analysed. Children diagnosed 

with the rarer craniofacial syndromes were identified. 

RESULTS 

Twelve children with Crouzons, one child with Hallerman Streiff syndrome, 

three children with Pfieffers syndrome and one child with Saethre 

Chotzen syndrome were identified. All of these identified children had 

significant airway issues requiring paediatric ENT assessment and surgical 

management. 

CONCLUSION 

These rarer craniofacial syndromes are a very interesting subgroup and 

present a significant challenge particularly with regards to managing airway 

issues. The ENT surgeon plays a vital role as part of a multidisciplinary 

team in assessing and managing airway issues. 

P 033 

EFFICACY OF CLOSED REDUCTION IN PEDIATRIC NASAL 

FRACTURE PATIENTS 

M.S. Yilmaz, M. Guven, A.F. Varli, S.S. Elicora 

Ministry of Health Sakarya Training and Research Hospital, 

Otorhinolaryngology, SAKARYA, Turkey 

E-MAIL: yilmazms@gmail.com 

OBJECTIVE 

This study aims to evaluate efficacy of closed reduction and effects of timing 

and fracture types on satisfaction rate in pediatric nasal fracture patients. 


Only the patients with isolated nasal fracture were included to study. The 

patients with additional maxillofacial fractures and whose age above 16 

were excluded. Patients were classified into five type according to their 

fracture. All the patients underwent closed reduction and external fixation 

under local anaesthesia. Patients and parents were asked their satisfaction 

survey on controls of 28th day after the surgery. Patients were divided into 

groups according to fracture type and intervention time, and evaluated 

the results of the survey. 

RESULTS 

The total number of cases were 10 with an average age of 13.5 (7-15). Of the 

10 patients included the study, 8 (80%) patients were satisfied with the result 

whereas 2 (20%) patients were not happy with their operation. Only 1 

patient and parents affirmed that they would consider second operation 

for better esthetic outcome in the future. 

CONCLUSION 

Closed reduction is easy and sufficient treatment for nasal fracture especially 

in mild nasal fracture in pediatric patients. Early intervention raises 

the patients satisfaction rate. 

P 034 

STENSTRÖMS OTOPLASTY IN CHILDREN: EVALUATION OF 

98 DAY-CARE SURGERIES 

T. Skov Randrup 1 , D. Gustaityte Larsen 1 , V. Egsgaard Nielsen 2 

1 Regional hospital Viborg, ENT, Head and Neck Surgery, AARHUS C, 

Denmark 

E-MAIL: dr.skov.madsen@gmail.com 

2 Regional hospital Holstebro, HOLSTEBRO, Denmark 

OBJECTIVES 

Surgical correction of protruding ears (otoplasty) is performed on cosmetical 

indications. Protruding ears rarely causes functional problems, but 

often give rise to peer ridicule, especially in school. Hence the operation is 

often performed on children, and usually the rate of complications is low 

and patients very satisfied. Results of paediatric otoplasty in our department 

from 2009 - 2011 are presented. 


Patients included had otoplasty performed as on bilateral protruding ears. 

Retrospective evaluation on variables: age, gender, surgical approach, 

anaesthesia, early complications (14 days), 

cosmetic results, revision surgery and satisfaction. 

133

RESULTS 

N=98 included, age: mean 10,6 years [5-17yrs], gender: n=53 (54%) female 

and n=45 (46%) male, surgical approach: n=61 (62%) a.m. Stenström and Furnas 

combined, n=18 (19%) a.m. Stenström, n=12 (12%) a.m. Stenström with 

reduction of the concha, n=5 (5%) a.m. Furnas, n=1 (1%) a.m. Mustarde with 

reduction of the concha, n=1 (1%) reduction of the concha. 

ANAESTHESIA 

local infiltration n=37 (38%) mean age 12,1 years [5-17yrs], general n=61 (62%) 

mean age 12,1 [7-17yrs]. Early complications: n=2 (2%) bleeding, n=2 (2%) 

infection, n=1 (1%) wound dehiscence. Cumulated early complications: 5%. 

Late complications: n=10 (10%) hypersensitivity, n=1 (1%) asymmetry, n=2 

(2%) re-protrusion, n=1 (1%) other unsatisfactory cosmetic result. Cumulated 

late complications: 14%. Revision surgery: n=4 (4%) unsatisfactory cosmetic 

result, n=2 (2%) other cause. Patient satisfaction: 100%. 

CONCLUSION 

Our evaluation show low rate of complications, good cosmetic results and 

a high degree of patients satisfaction after otoplasty a.m. Stenström with 

individual adaptions. 

P 035 

AUDIOLOGICAL PROFILE OF CHILDREN AND YOUNG ADULTS 

WITH SYNDROMIC AND COMPLEX CRANIOSYNOSTOSIS 

T. de Jong, M.S. Toll, H.H.W. de Gier, I.M.J. Mathijssen 

ErasmusMC, ENT department, ROTTERDAM, The Netherlands 

e-mail: m.toll@erasmusmc.nl 

Although craniosynostosis is associated with high prevalence of hearing 

loss, details are limited. In this survey study we analysed the syndrome 

specific prevalence, type, severity and configuration of the hearing loss to 

facilitate follow-up and treatment. 

From 132 of 149 patients with complex or syndromic craniosynostosis 

treated at the craniofacial clinic of our tertiary paediatric hospital we received 

information on hearing status and incidence of otitis media. Their 

parents were asked to answer the HUI questionnaire. 

Mild or moderate hearing loss was found in 44% of patients with Apert 

syndrome, in 29% with Crouzon syndrome, in 62% with Muenke syndrome, 

in 29% with Saethre-Chotzen syndrome and in 7% with complex craniosynostosis. 

Hearing loss was conductive in most patients with Apert, Crouzon, 

and Saethre-Chotzen syndromes and was predominantly sensorineural in 

patients with Muenke syndrome. This sensorineural hearing loss had a 

low frequency character. The hearing and speech scores of the questionnaire 

correlated only weakly with audiometric results. 

Most patients with complex or syndromic craniosynostosis have recurrent 

otitis media with effusion, causing episodes of conductive hearing loss 

throughout their lives. A sensorineural hearing loss predominantly at low 

frequencies is the primary cause of hearing loss in children and young 

adults with Muenke syndrome. For patients with these syndromes, we 

134 

recommend routine visits to the general practitioner or otolaryngologist, 

depending on national standards of care, to screen for otitis media with 

effusion throughout life. We also advise early screening for sensorineural 

hearing loss among children and young adults with these syndromes. 

P 036 

OTOLARYNGOLOGICAL MANIFESTATIONS OF 

ARTHROGRYPOSIS MULTIPLEX CONGENITA 

G. Kontorinis 1 , N. Bateman 2 , F. Goetz 3 , M. Thevasagayam 2 , 

R. Lawrence 2 , A.M. Giesemann 3 

1 Sheffield Children's Hospital, SHEFFIELD, United Kingdom 

E-MAIL: gkontorinis@gmail.com 

2 Hanover Medical School, HANOVER, Germany 

OBJECTIVES 

Arthrogryposis multiplex congenital (AMC) is a rare complex of symptoms 

of congenital joint contractures associated with neurogenic and myopathic 

disorders, which may additionally involve the head and neck region. Our 

objective was to examine the otolaryngological findings in children with 

AMC 

METHODS 

A retrospective review was performed in two tertiary, referral centres. The 

children with AMC were identified and their medical files were examined 

for any otolaryngological manifestations. Any diagnostic procedures and 

therapeutic interventions were documented. 

RESULTS 

Three children with AMC and otolaryngological involvement were found, 

two females and one male. The average age at the time of the last review was 

1.4 years (range 0.5-3 years). One infant had micrognathia and severe laryngomalacia, 

which caused significant airway obstruction. The child was 

treated with a tracheostomy; its hearing screening was normal. Two children 

had a cleft palate, which was treated surgically, but no laryngeal or tracheal 

involvement. Additionally, the last two patients had moderate to profound, 

bilateral sensorineural hearing loss, which was in one case treated with 

cochlear implantation. The radiological assessment of the temporal bones 

in the two hearing impaired children revealed an absent bony modiolus. 

CONCLUSIONS 

The upper airway tract may be involved in children with AMC. Although 

such cases have been described, this is, to our knowledge, the first report 

on sensorineural hearing loss in AMC. Children with AMC should be referred 

to the otolaryngologist and undergo routine audiological evaluation.

P 037 

SURGICAL MANAGEMENT OF MICROTIA AND 

AURAL ATRESIA 

H. Skarzynski, K. Lazecka, M. Mrowka, W. Ciesla, P.H. Skarzynski 

Institute of Physiology and Pathology of Hearing, International Center 

of Hearing and Speech, WARSAW, Poland 

E-MAIL: skarzynski.henryk@ifps.org.pl 

OBJECTIVES 

Microtia with primary aural atresia is one of most common congenital defects. 

Incidence of outer ear malformations is estimated by different authors 

between 1:7000 and 1:20000 of live-births. In about 68% of cases there 

are malformations of the middle ear related to incorrect development in 

the foetal phase. All patients with outer and middle ear defects have hypoacusis, 

most cases conductive, but in 15-20% cases it may be accompanied 

by sensorineural hearing loss.The objective is to assess the choice of the 

surgical method in patients with outer and middle ear defects. 

METHODS 

Patients were treated in the IPPH between 1999-2011 using one of three 

surgical methods: reconstruction of the external acoustic duct, middle ear 

surgery with the VSB implant, BAHA. Material consists of 156 children, 

including cases of microtia and aural atresia. They underwent two-stage 

procedure of auricle reconstruction (Brent and Nagata type surgery using 

autogenous cartilage). CT scan of petrous pyramid for assessment of the 

middle ear was performed in all cases. After reconstruction of auricle one 

of the three possible surgical strategies improving hearing were implemented. 

Surgical and audiological results were evaluated in three groups 

depending on the applied method. 

RESULTS 

Authors show audiological results of patients operated with three presented 

methods. They compare ultimate effects depending on audiological 

results, number of undergone operations, patient satisfaction. 

CONCLUSIONS 

Depending on the grade of aural atresia and middle ear defect we have 

three optimal solutions aimed at hearing improvement and achievement 

of socially efficient hearing. 

P 038 

CHARGE SYNDROME IN OTORHINOLARYNGOLOGY 

J. Byckova 1 , E. Gradauskiene 2 , V. Sakalinskas 2 , E. Stasiene 2 , 

V. Zukovskaja 2 , A. Matuleviciene 3 , P. Willems 4 

1 Children’s Hospital, Affiliate of Vilnius University Hospital 

Santariskiu Klinik, ENT Department, VILNIUS, Lithuania 

E-MAIL: jekaterina.byckova@gmail.com 


Santariskiu Klinik, VILNIUS, Lithuania 

3 Centre for Medical Genetics at Vilnius University Hospital 

Santariskiu Klinikos, VILNIUS, Lithuania 

4 Genetic Diagnostic Network, ANTWERP, Belgium 

OBJECTIVES 

To present the clinical findings and results of CHD7 gene sequencing in 

children with CHARGE syndrome. CHARGE is an acronym standing for 

Coloboma, Heart malformation, choanal Atresia, Retardation of growth 

and/or development, Genital anomalies and Ear anomalies. 

METHODS 

Clinical and molecular studies in 4 children with CHARGE syndrome. 

RESULTS 

A 3-year old boy presented with ventricular septal defect, bilateral osseous 

choanal atresia, cranial nerves dysfunctions, genital hypoplasia, horseshoe 

kidney, retarded growth and development, dysplastic ears and deafness. 

A heterozygous de novo insertion of 1 nucleotide CHD7:c.1803insG was 

identified in exon 3 of the CHD7 gene. Several choanal surgeries and 

cochlear implantation were performed. A 4-year old boy presented with 

coloboma, microphtalmos, congenital heart disease, cranial nerves dysfunctions, 

tracheoesophageal fistula, genital hypoplasia, retarded growth 

and development, dysplastic ears and hearing loss. A heterozygous de novo 

c.6775+1G>C splice site variant was identified in intron 31 of the CHD7 

gene. Correction of tracheoesophageal fistula, tympanostomy and tonsillotomy 

were performed. A 5-year old girl presented with microphtalmos, 

coloboma, congenital heart disease, unilateral choanal stenosis, cranial 

nerve dysfunctions, tracheoesophageal fistula, retarded growth and development, 

hearing loss. Heart surgery, correction of tracheoesophageal 

fistula, tracheostomy, adenoidectomy and tonsillotomy were performed. 

A 8-year old boy presented with all classical features. 

CONCLUSIONS 

The clinical spectrum of CHARGE syndrome is very wide, with many ‘atypical’ 

cases. Molecular testings are necessary for confirmation of the diagnosis. 

Early confirmation of the diagnosis, treatment and rehabilitation 

help children with this syndrome to improve their psychomotoric development 

and quality of life. 

135

P 039 

TREACHER COLLINS SYNDROME: POSSIBILITIES IN THERAPY 

M. Mrowka, M. Porowski, K. Lazecka, P.H. Skarzynski, L. Olszewski, 

H. Skarzynski 




OBJECTIVE 

The Treacher Collins Syndrome (TCS) is the effect of developmental disorders 

of the branchial arch, characterized by facial bones dysplasia and 

disorders of the organs of sight and hearing. This paper is intended to systematize 

the contemporary approach to treatment of patients with TCS 

taking into account scientific and technical progress. 

METHODS 

The paper is based on the extensive literature research and own experience 

of our Clinic comprising the material of 31 patients aged 1-16 y.o.. The 

management included early audiological diagnostics, surgical correction 

of defects and application of hearing aids. With consideration to the type 

of hearing loss were applied headband hearing aids and later, at age 3-6 

y.o. Baha device. In selected microtia cases there were performed reconstructions 

of auricles from autogenous rib cartilage, also artificial auricles, 

fixed on titanium osteointegrated attachments, were proposed. 

RESULTS 

All patients after the application of BAHA device achieve lower hearing 

thresholds in free field audiometry and considerably better speech understanding 

results than with the aid or using a headband aid. Results of microtia 

treatment are satisfactory. 

CONCLUSIONS 

Based on our results and observations of TCS patients we reached following 

conclusions: 1. Baha hearing aids enable effective stimulation of the cochlea 

in these patients 2. After application of Baha device on the titanium attachment, 

patients achieved lower hearing thresholds comparing to typical 

bone-conduction hearing aids. 3. In treatment of microtia in TCS patients 

application of the silicone prosthesis with titanium attachments is alternative 

to the two-stage auricle reconstruction using autogenous material 

136 

P 040 

APPLICATION OF MIDDLE EAR IMPLANT VIBRANT 

SOUNDBRIDGE IN CONGENITAL EAR DEFORMATIONS 

IN CHILDREN 

H. Skarzynski, M. Porowski, M. Mrowka, L. Olszewski, J. Serafin-Jozwiak, 

P.H. Skarzynski 




OBJECTIVE 

Middle ear implants are the alternative In the treatment of hearing impairment 

for the patients with middle ear diseases where classic hearing 

aids cannot be used or surgical reconstruction cannot be performed. These 

devices can also be used in congenital deformations of external or middle 

ears also in younger patients. The objective of the study was to analyze 

hearing results obtained after surgical treatment of hearing impairment 

of congenital deformations of the external and middle ears in selected 

group of patients below 18 years of age. 

METHODS 

The selected group of patients are the children and adolescents at the age 

not exceeding 18 years, with congenital deformations of the external 

and/or middle ears. In these patients Vibrant Soundbridge was used as the 

method of hearing improvement. Surgical approach included posterior 

atticotomy or facial nerve recess. Various methods of fixation of the FMT 

on the ossicles were introduced. We discussed the indications, contraindications 

and limitations of use of Vibrant Soundbridge in this group of patients. 

VSB implantation was preceded by auricle reconstruction or in some 

cases was the first surgical procedure. 

RESULTS AND CONCLUSIONS 

In majority of cases the benefits of Vibrant Soundbridge use are significant 

hearing results in the cases of congenital deformations of the external 

and/or middle ears are very encouraging. 

P 041 

AMELOBLASTOMA IN CHILDERNS, OUR 5 YEARS EXPIRIENCE 

V. Ljubic 

Clinical Center of Montenegro, Institute for Childerns health, ENT 

Deparment, PODGORICA, Montenegro 

E-MAIL: vladimirlj@yahoo.com 

OBJECTIVE 

Ameloblastoma is one of the most common odontogenic tumors. It is benign 

tumor with destructive, invasive growth and recurrence nature, often

after inadequate primary surgical treatment, which make his treatment 

very hard. Ameloblastoma in all jaws tumors occurs in only about 1% of 

cases. It can occur with all ages but it is most common in 2 to 5 decade of 

life. There is no significant difference in prevalence between the sexes. 

Ameloblastoma grows very slowly and invasive. After the destruction of 

the bone penetrates and infiltrate surrounding soft tissue. There are tree 

types of these tumors: unicistical, multicistical and periferical. Also there 

is two ways of surgical treatment, one is conservative, with enucleation of 

tumor and curettage and second is radical, with bone resection. 

METHODS 

In 5 year retrospective study, we had 10 cases, age between 8 and 14 years, 

both sexes equal. In all cases lesion was in mandible bone. In 8 cases (80%) lesion 

were unicistical and in 2 cases (20%) there was solid (multicistical) lesion. 

RESULTS 

In all cases we performed conservative surgical treatment, enucleation 

with curettage, all done without radical bone resection. Until now we 

don’t have any case of recurrence, but we are planning to follow up our 

patient for longer period. 

CONCLUSIONS 

Our decision for less radical surgery depended on extent of tumor and 

young age of patients. Results are encouraging so far, but remind us that 

for complete and safe healing need many years of postoperative follow-up. 

P 042 

CUSTOMISED EAR MOULDS: AN ALTERNATIVE TREATMENT 

OF CUP EAR AND OTHER PINNA DEFORMITIES 

T.S. Ahmed, A. Hall, D. Mehta, H. Daya 




OBJECTIVES 

To outline an effective non-surgical treatment modality for the management 

of ‘cup ear’ deformity. 

METHODS 

Case report of identical twin brothers with ‘cup ear’ deformity where parents 

sought treatment at 6 months of age. The cup ear deformity was accentuated 

by a bar of cartilage extending transversely across the conchal 

bowl. Audiological assessment was normal and there were no associated 

abnormalities. Condensation-cure silicone moulds were created for each 

twin to create a normal pinna contour. 

RESULTS 

Following use of the silicone moulds over a 6 month period, an excellent 

cosmetic result was obtained in each twin thereby avoiding the need for 

surgical intervention. This correction proved to be sustained. 

CONCLUSIONS 

Pinna deformities including ‘cup ear’ are relatively common in paediatric 

otolaryngological practice. Classically otoplastic surgical methods were 

used to treat these including zig-zag incision of the cartilage to enable expansion, 

V-Y plasty at the helical root with undermining of adjacent skin 

and the use of carved costal cartilage frameworks. These were often delayed 

until later in childhood and with often unsatisfactory results. In recent 

years a number of non-surgical splintage techniques have been described 

particularly for prominent ears secondary to loss of the antihelical fold. 

The use of silicone moulds adds to the non-surgical options for treatment 

of cosmetic ear abnormalities. These are most effective when initiated 

shortly after birth before cartilage fully matures. Early referral from paediatricians 

and neonatologists is recommended to facilitate their use. 

P 043 

EARLY DETECTION OF SECRETORY OTITIS´ SYMPTOMS 

IN NEWBORNS WITH CLEFT DEFECT OPERATED ON IN 

THE EARLY POST PARTUM PERIOD 

M. Jurovcik 1 , D. Karmanova 2 , J. Borsky 3 , P. Dytrych 4 , K. Bláha 5 , M. Cerny 6 , 

Z. Kabelka 3 

1 Anesthesiology and Resuscitation Clinic, 2nd Medical Faculty and 

Faculty Hospita, PRAGUE, Czech Republic 

E-MAIL: jurovcik@volny.cz 

2 Plastic Surgery Clinic, 3rd Medical Faculty and Faculty Hospital 

Kralovske Vinoh, PRAGUE, Czech Republic 

3 ENT Clinic of the 2nd Medical Faculty, Charles University, Motol, 

Prague (2MF CU, PRAGUE, Czech Republic 

4 Biochemistry Clinic of the 2nd Medical Faculty, Charles University, 

Motol, Pragu, PRAGUE, Czech Republic 

5 Obstetric and Gynecology Clinic, Department of Newborns with 

Intensive Care Unit, PRAGUE, Czech Republic 

6 ENT Dpt. of the 2nd Med. Fac. Charles University, Motol, Prague, 

PRAGUE, Czech Republic 

INTRODUCTION 

Almost all patients with facial-cleft defect suffer from dysfunction of the 

Eustachian tube with development of the secretory otitis. The aim is to 

detect the first symptoms of the middle ear´s pathology in newborns with 

cleft defect that were operated on in the early post partum period . 

METHODS 

The first objective examination of hearing and middle ear´s structures is 

performed one or two days prior the actual procedure - multifrequency 

tympanometry and OAE. The first phase of the procedure is initiated by 

137

ENT specialist who inserts flexible optics and evaluates conditions around 

the adit to the Eustachian tube. This phase is followed by examination 

using ear microscope and paracentesis. If secretion is found in the middle 

ear, it is evacuated and sent for biochemical examination. Actual procedure 

that is performed by a plastic surgeon follows . 

RESULTS 

Pilot prospective study which proceeded from 1.5.2010 to 19.12.2011 included 

52 patients. 23 patients with cleft lip and palate were diagnosed 

with pathology secretion in the middle ear and pathological tympanometric 

curve was established in 30 patients. 22 patients with isolated cleft 

lip had normal middle ear parameters. 

CONCLUSIONS 

Although it is a very small sample population, it can be presumed that results 

are not random. Quality improvement of the early diagnostics of 

middle ears pathology in newborn patients with cleft defect will presumably 

improve results of treatment, quality incorporation of patients in 

collective as it will eliminate procedures required to manage serious conditions. 

P 044 

TEMPOROMANDIBULAR JOINT ANKYLOSIS AS SEQUELAE OF 

PAEDIATRIC ACUTE MASTOIDITIS - CASE SERIES 

G. Narasimhan, D. Richardson, K. Davies, A. Kasbekar, S. de 




OBJECTIVE 

To present three cases of temporomandibular (TMJ) ankylosis that occurred 

following acute mastoiditis between 24-36 months of age. 

METHODS 

Three children were referred from a secondary care Orthodontic setting 

to the tertiary care Supraregional Craniofacial unit at Alder Hey Children’s 

Hospital, Liverpool for management of unilateral TMJ ankylosis. A retrospective 

review of their case notes, imaging, and surgical management 

was performed. 

RESULTS 

All the children had a preceding documented episode of acute mastoiditis, 

confirmed by temporal bone imaging. They also had needed incision and 

drainage of the abscess with or without a Cortical Mastoidectomy. Subsequently 

they had slowly progressive ipsilateral TMJ symptom over the 

next five years. Two of these children required surgical correction of their 

TMJ ankylosis. 

138 

CONCLUSION AND DISCUSSION 

These cases illustrate a lesser known risk of acute mastoiditis in children. 

TMJ ankylosis should be considered as a possible long term sequelae for a 

child with acute mastoiditis. The mechanisms of spread of infection to the 

TMJ from acute mastoiditis can occur by direct extension, thrombophlebitis 

and haematogenous dissemination. It is thought that the presence 

of open sutures as the petrosquamosal, petro tympanic fissure in the 

Glenoid fossa, could explain the increased risk of spread of middle ear and/ 

or mastoid infection to the TMJ in younger children. Maxillofacial referral 

needs to be considered to enable planning of surgical treatment if necessary 

within an appropriate time frame, thus optimising the potential for 

subsequent normal growth and function of the TMJ. 

P 045 

CEREBRO-COSTO-MANDIBULAR SYNDROME: WHAT THE 

PEDIATRIC OTOLARYNGOLOGIST SHOULD KNOW 

C. Roehm 1 , T.A. Valdez 2 

1 University of Connecticut Health Center, Otolaryngology, 

FARMINGTON, USA 

E-MAIL: corrie.roehm@gmail.com 

2 Connecticut Children’s Medical Center, HARTFORD, USA 

INTRODUCTION 

Cerebro-costo-mandibular syndrome is a rare condition with multiple 

congenital anomalies with a low survival rate. The disorder is characterized 

by various degrees of cerebral maldevelopment, micrognathia and rib abnormalities. 

Most cases are sporadic with only a handful of cases reported 

being autosomal dominant. 

SETTING 

Tertiary Care Pediatric Hospital, case report. 

METHODS 

We discuss two cases of CCMS of cerebro-costo-mandibular syndrome presenting 

in a neonate and her father. Both had multiple anomalies including 

brain calcifications, severe microganthia with cleft palate, glossoptosis 

and multiple abnormal ribs. Complete description of the work-up including 

respiratory evaluation, diagnostic imaging, genetics and airway management 

will be presented. 

CONCLUSION 

Cerebro-costo-mandibular syndrome is an extremely rare syndrome with 

fewer than 75 cases reported in the English literature. Less than 7 of the 

reported cases were autosomal dominant. We present a case of a neonate 

and her father diagnosed with this rare syndrome and a review of cerebrocosto-mandibular 

syndrome in the English literature.

P 046 

CONGENITAL MIDLINE CERVICAL CLEFT: 

A RETROSPECTIVE SERIES OF 7 CASES 

P. Fayoux, S. Achard, G.H. Hosana, P.M. Duval, P. Fayoux 

University Hospital of Lille, Pediatric Otolaryngology Head Neck 

Surgery, LILLE, France 


OBJECTIVES 

Congenital midline cervical cleft is a rare developmental abnormality of 

the ventral neck with unclear etiology. It consists of a midline skin defect 

that is present at birth. We present a monocentric series of 7 cases. 


After IRB approval, a retrospective review chart was performed including 

all infant referred for congenital midline cervical cleft between 2007 and 

2012. The analysis focused on the presence of associated malformations, 

type of associated cysts, and type of surgery. In case of associated cyst, a 

histological study was systematically performed in order to determinate 

its embryological origin. A long term followed up was proposed to evaluate 

the scarf evolution. 

RESULTS 

Patients were from 3days to 5years old at first consultation. A complete 

malformative assessment was performed for each child. No other facial or 

laryngeal cleft was found, two had microgenia . One had a minor kidney 

malformation. All children had surgical excision, at 14,4 months old (average, 

from 1 to 70months old). A Z-plasty closure was used in four patients. 

Two had cervical midline cyst associated which after histological 

analysis were not thyreoglossal cysts. 

CONCLUSION 

Midline cervical cleft is a rare and generally isolated congenital malformation. 

The thyreoglossal origin of associated cyst may be questioned. It 

has no other consequences that aesthetic issue and cervical contracture. 

During surgical procedure a Z-plasty closure may be proposed in order to 

reduce cervical contracture. 

P 047 

PYRAMIDAL POCKET AND AUTOLOGOUS BONE GRAFT IN 

THE TREATMENT OF ALVEOLAR CLEFT 

V. Pinto, E. Fabbri, L. Negosanti, P.G. Morselli 

Sant’Orsola - Malpighi University Hospital, Plastic Surgery, BOLOGNA, 

Italy 

E-MAIL: valepinto@yahoo.it 

OBJECTIVES 

Alveolar cleft repair is a debated topic in cleft lip and palate treatment. 

Many surgical techniques have been described, but controversies exist 

about the adequate therapy, the better material and the correct age to perform 

surgery. The repair can be achieved by inserting different materials 

in the alveolar cleft (autologous, allogenical or alloplastic) or without any 

grafting. The aim of this paper is to analyze the evolution and to expose 

our method and our experience in the surgical treatment of alveolar clefts. 

METHODS 

We have evaluated outcomes and advantages of the autologous bone grafting 

performed on 472 alveolar clefts between 1981 and 2011. According to 

our protocol, the timing for the closure of the alveolar cleft ranged from 7 

to 11 years. Donor sites for autologous bone were the skull (45%), the iliac 

crest (35%) and the chin (20%). 

RESULTS 

The surgical technique of creating a pyramidal pocket to secure the bone 

graft was the key point for achieving good results. The postoperative evaluation 

was made by clinical criteria and imaging. The results allow us to 

confirm satisfactory outcomes. Major post-operative complications, such 

as the complete failure of the bone graft, occurred in 4 patients. No severe 

complications in the donor site occurred. 

CONCLUSIONS 

Autologous bone grafting using pyramidal pocket represents in our experience 

the treatment of choice for alveolar cleft treatment; this technique 

allows good results in terms of functional and aesthetic outcomes, in short 

and long term evaluation, without major complications and donor site 

morbidity. 

P 048 

NASAL DEFORMITY IN UNILATERAL CLEFT LIP AND PALATE: 

OUR PROTOCOL 

E. Fabbri, V. Pinto, A. Firinu, P.G. Morselli 

Sant’Orsola-Malpighi University-Hospital, Plastic and Reconstructive 

U.O., BOLOGNA, Italy 

E-MAIL: erifabbr@tin.it 

OBJECTIVE 

We want to show our therapeutic protocol for surgical correction of nasal 

deformity in cleft lip and palate, with particular attention to usefulness 

of nasal alveolar molding (NAM), before and after primary rhinoseptumplasty. 

METHODS 

Currently, our protocol includes three steps: 1) pre-operative modeling 2) 

primary rhinoseptumplasty 3) post-operative modeling. During pre-operative 

step we use a palatal splint with a nasal modeling branch in order 

139

to expand tip tissues to facilitate surgical correction; it’s applied from 1 

month of life to rhinoseptumplasty. During cheiloplasty we performed 

primary rhinoseptumplasty. After rhinoseptumplasty we use a nasal modeling 

device without a palatal splint, in order to stabilize and optimize the 

surgical outcomes. A comparison is made between a group of patients in 

which NAM is used before and after surgical treatment (group A) and a 

group of patients who underwent only surgical procedure (group B). 

RESULTS 

In our experience not surgical treatment is very important to obtain better 

morphological and functional results in nasal deformity correction in patient 

with cleft lip and palate. Comparing the two groups of patients we 

observed that nasal modeling allows better results, reducing the necessity 

of further surgical revisions before adult age. 

CONCLUSION 

Our analysis demonstrates that pre-surgical modeling facilitates nasal 

correction and post-surgical modeling allows to maintain nasal shape reducing 

the necessity of other surgical correction of nasal deformity before 

definitive rhinoseptumplasty. 

P 049 

CONGENITAL FACIAL PARALYSIS: 10 CLINICAL CASE-REPORTS 

A.S. Esschendal, F. Gordts 

Universitair Ziekenhuis Brussel, Dienst KNO, Hoofd- en 

Halsheelkunde, BRUSSEL, Belgium 

E-MAIL: annemarie.esschendal@uzbrussel.be 

OBJECTIVES 

Overview of children affected with a congenital facial paralysis. 

METHODS 

Evaluation of 10 children (University Hospital of the Vrije Universiteit 

Brussel, from 1992 to 2011, 6 out of 10 after 2009) aged from 1 day to 6 years 

affected with a congenital facial paralysis: clinical presentation, clinical 

characteristics, associated deformities, diagnostics and follow-up. 

RESULTS 

Outlining of the complex diagnostic pathway of congenital facial paralysis 

illustrated by means of photographs, audiological test results and radiology 

findings. Background information of the genetic etiology (CHARGE 

association, Oculoauriculovertebral spectrum, Trisomy 18 syndrome, BOR 

syndrome, microduplication 22q11.21, Möbius andPolandsequence) of congenital 

facial paralysis and follow-up results. 

CONCLUSIONS 

In case of a congenital facial paralysis: do not underestimate the paralysis, 

make use of high quality radiologic examinations and determine the right 

moment for surgical intervention. 

140 

P 050 

PERI-OPERATIVE COMPLICATIONS AFTER 

ADENOTONSILLECTOMY IN A PAEDIATRIC TERTIARY 

REFERRAL CENTRE. 

J. Tweedie, Y. Bajaj, M.D. Elloy, C.G. Jephson, N.E. Jonas, L.A. Cochrane, 

B.E.J. Hartley, D.M. Albert, M.E. Wyatt 




OBJECTIVES 

ENT-UK produced a consensus statement for the management of high 

risk patients requiring adenoidectomy and/or tonsillectomy (AT), including 

tertiary referral criteria. But this is based on limited evidence, with no 

large published UK case series. We present our experience of peri-operative 

management and complications in children undergoing AT at this centre. 

METHODS 

Patients were identified and reviewed using prospectively-collected departmental 

and hospital databases, and casenotes. 

RESULTS 

1735 consecutive admissions for AT (1627 individual patients aged 4-197 

months, median 46 months) were included between 2003 and 2010, 

comprising 998 adenotonsillectomies, 182 tonsillectomies and 555 adenoidectomies. 

999/1627 had a diagnosis of OSA, including 360 who had 

polysomnography. 407/1627 had no other major co-morbidities. High risk 

factors included age less than 24 months (292 cases), Down syndrome (99), 

neuromuscular problems (314), craniofacial abnormalities (94), storage diseases 

(23), morbid obesity (20), cardiovascular disease (133), respiratory disease 

(261, 109 with asthma), haemoglobinopathy (76) and coagulopathy 

(34). 300/1735 admissions were day cases and 1082/1735 were observed 

overnight. 353/1735 required more than one night in hospital (294 for two 

to three nights). 7/1735 had primary post-tonsillectomy haemorrhage necessitating 

return to theatre. 41/1627 (36 with major co-morbidities) required 

intensive care (PICU), mostly for respiratory support. Of these, 5 

were admitted pre-operatively to PICU, 17 were planned and 19 unplanned. 

There were no peri-operative mortalities. 

CONCLUSIONS 

The peri-operative course was uneventful for the majority of children 

undergoing AT during this period, even in high risk cases. Few suffered 

complications requiring PICU admission, most of whom had major comorbidities.

P 051 

USE OF A NASOPHARYNGEAL PRONG AIRWAY 

POST-OPERATIVELY AFTER ADENOTONSILLECTOMY 

IN CHILDREN WITH OBSTRUCTIVE SLEEP APNOEA 

J. Tweedie, Y. Bajaj, M.D. Elloy, A. Lloyd-Thomas, D.M. Albert 




OBJECTIVES 

Children undergoing adenoidectomy and/or tonsillectomy (AT) for obstructive 

sleep apnoea (OSA) are at risk of post-operative respiratory compromise. 

It remains difficult to predict which children will require 

intensive care (PICU) after surgery. We present our routine ward-based 

post-operative use of the nasopharyngeal prong airway (NPA) in high risk 

cases, as an alternative to elective PICU admission. 

METHODS 

High risk patients are identified via clinical and polysomnographic findings. 

After AT, an NPA is fashioned from an endotracheal tube and tube 

holder. Typically customised and inserted prior to recovery, it remains in 

situ overnight, facilitating suctioning and oxygenation. 

RESULTS 

Of 1447 consecutive admissions for AT during 2005-2010, 183 cases with 

OSA had post-operative NPA insertion (aged 6-194 months, median 35 

months). 145/183 had co-morbidities. 87/183 had had prior polysomnography. 

High risk factors included those under two years (total 58, 17 without 

co-morbidities), Down syndrome (14), craniofacial (37), neuromuscular 

(17), cardiac (9) and respiratory (15) problems. 25 had been born prematurely. 

135/183 tolerated NPA removal on the following day, with a further 

night of observation. 12/183 pulled out the NPA early; one suffered respiratory 

failure. 24/183 required more than two nights on the ward. 12/183, 

all with co-morbidities, required PICU admission (three pre-operatively, 

three electively and six unplanned). 

CONCLUSIONS 

The NPA has altered our management of children undergoing AT. PICU 

admissions are rarely pre-booked, but remain occasionally required. This 

technique could be applied in similar centres, and selectively in non-specialist 

centres, particularly in the event of unanticipated post-operative 

respiratory compromise. 

142 

P 052 

RISK FACTORS FOR PERI-OPERATIVE COMPLICATIONS AFTER 

ADENOTONSILLECTOMY IN CHILDREN WITH OBSTRUCTIVE 

SLEEP APNOEA DIAGNOSED BY POLYSOMNOGRAPHY 

J. Tweedie, A. al-Reefy, M.D. Elloy, C. Pepper, C.G. Jephson, 

L.A. Cochrane, D.M. Albert, B.E.J. Hartley, M.E. Wyatt 




OBJECTIVES 

We examine the peri-operative course of complex children undergoing 

adenoidectomy and/or tonsillectomy for obstructive sleep apnoea (OSA) confirmed 

by pre-operative polysomnography (PSG). Complications, particularly 

respiratory compromise, and intensive care (PICU) admissions are 

discussed in the context of comorbidities and the severity of obstruction. 

METHODS 

Patients were identified from prospectively-collected hospital, departmental 

and sleep laboratory databases. Data were obtained from computerised 

records and casenote review. 

RESULTS 

258 consecutive patients were identified who underwent adenoidectomy 

and/or tonsillectomy between 2003 and 2010 after pre-operative PSG (age 

range 6 months to 15 years, median 46 months). 233 patients (90%) had significant 

comorbidities relevant to their peri-operative management. Of 

215 with confirmed OSA, 49 were classed as mild, 73 moderate and 93 severe, 

respectively. 43 had no recorded apnoeic events on PSG. A total of 177 

patients (68%) were discharged within 24 hours, 57 (22%) required two 

nights in hospital, and 24 (9%) required a more prolonged admission, for 

sequelae including obstructive symptoms, post-operative pain and poor 

oral intake. Longer admissions correlated well with the severity of OSA. 13 

patients (5%) required PICU admission for respiratory compromise, all with 

major comorbidities and OSA diagnosed pre-operatively. 

CONCLUSIONS 

The severity of OSA diagnosed pre-operatively by polysomnography correlates 

well with the likelihood post-operative sequelae, particularly obstructive 

symptoms, and prolonged admission after adenotonsillectomy. 

In our experience, a small number of children require PICU admission in 

this context, the great majority of whom have both moderate or severe 

OSA and major comorbidities.

P 053 

LIFE THREATENING RESPIRATORY TRACT INJURIES IN 

PEDIATRIC OTOLARYNGOLOGY. CASE REPORTS 

B. Pucher, J. Szydlowski, J. Kolasinska-Lipinska, M. Grzegorowski 

Poznan University of Medical Sciences, Pediatric ENT Dept., POZNAN, 

Poland 

E-MAIL: bpucher@poczta.onet.pl 

OBJECTIVES 

Authors present 2 case reports of different respiratory tract injuries that 

can be life threatening conditions in pediatric laryngology. The first patient 

is 12 years old girl who suffered from tracheal rupture - a rare iatrogenic 

complication of post tracheal intubation. The second case is a 

2-year-old boy who aspirated a piece of metal (metal food clip) and required 

a tracheostomy to remove it. 


In both cases endoscopic evaluation of respiratory tract and radiology imaging 

methods were performed to confirm the diagnosis. In one case temporary 

tracheostomy was necessary to remove the foreign body and the 

patient required hospitalization in the ICU. The detailed documentation 

and treatment is presented with the literature review. 

CONCLUSIONS 

1. Two therapeutic strategies are advised for post-intubaton tracheal rupture: 

a non-surgical strategy for small ruptures presented in this case and 

surgical strategy for larger injuries. 2. Removal of the respiratory tract foreign 

body can be challenging even for an experienced ENT specialist especially 

when the aspiration was unnoticed by child’s mother 

P 054 

ANESTHESIA AND COMPLICATIONS IN RIGID 

BRONCHOSCOPY DURING FOREIGN BODY REMOVAL 

B. Rybojad 1 , A. Niedzielski 2 , G. Niedzielska 2 

1 Children’s University Hospital of Lublin, Department of Pediatric 

Anesthesiology and Intensive Care, LUBLINL, Poland 

E-MAIL: brybojad@wp.pl 

2 Medical University of Lublin, LUBLIN, Poland 

OBJECTIVES 

Foreign body aspiration (FBA) may cause a respiratory distress syndrome 

causing dangerous complications. The aim of this study was to present 

anesthetic treatment during rigid bronchoscopy and to evaluate complications 

concerning FBA. 

METHODS 

A retrospective chart review of the patients with suspicion of FBA, hospitalized 

in an eleven-year period in a tertiary referral center was done. In 

each case a rigid bronchoscopy under total intravenous anesthesia (TIVA) 

with muscle relaxants and jet ventilation was performed. After a procedure, 

every patient was administered a steroid and theophylline to prevent 

or treat wheezing, edema, and respiratory distress. 

RESULTS 

The study included 139 patients aged 1 month to 17 years. A FB was removed 

in 68 % of cases. Complications occurred in 78 % of children. Most 

of them were: inflammatory edema of the mucosa and purulent secretion 

(54 %). A few patients (5 %) under 2 years old required prolonged ventilation 

in the intensive care unit. In 12 % of the children bronchitis or pneumonia 

was the only symptom and a complication of a long-term FB lodged in a 

tracheobronchial tree. Neither deaths nor severe damage to the central 

nervous system were stated. 

CONCLUSIONS 

Full cooperation between otorhinolaryngologist and anaesthesiologist ensures 

maximum safety for the patient. TIVA with muscle relaxants and jet 

ventilation, followed by intravenous steroids and theophylline minimize 

complications. 

P 055 

COMPLICATIONS AFTER ADENOTONSILLECTOMY 

FOR PAEDIATRIC OBSTRUCTIVE SLEEP APNOEA: 

A REVIEW OF THE LITERATURE 

J. Lawrence, D. Bateman, G. Kontorinis 

Sheffield Children’s Hospital, ENT Department, SHEFFIELD, 


E-MAIL: rachael.lawrence@hotmail.co.uk 

OBJECTIVES 

To establish the rate of complications after adenotonsillectomy (T&A) for 

children with obstructive sleep apnoea (OSA) and to identify paediatric 

subgroups at increased risk of such complications. 

METHODS 

Relevant medical literature was identified from searches of Ovid Medline 

and The Cochrane Library and references cited in appropriate articles. 

Search terms used were paediatric, adenotonsillectomy, obstructive sleep 

apnoea and complications. 

RESULTS 

The search returned 67 papers. 7 studies met our criteria for inclusion. This 

incorporated 3,864 patients overall. T&A carries an overall complication 

rate of 2-10% with a reported mortality rate of approximately 1 in 16,000. 

Vomiting and fever are the most common complications. Children un- 

143

dergoing T&A for OSA are less likely to experience post operative haemorrhage 

than children undergoing the procedure for other indications. However, 

they are more likely to experience postoperative respiratory 

complications. Reported respiratory complications ranged from 2.3% to 

24.1% with an overall rate of 13.3%. Children with severe OSA, those aged 

younger than 3 years and those with associated co-morbidity are at an increased 

risk of respiratory complications. 

CONCLUSIONS 

Children undergoing T&A for OSA are at increased risk of post-operative 

respiratory complications. Clinicians should identify children at further 

increased risk of such complications by assessing for associated co-morbidity. 

This is essential not only because it enhances the parental consent 

and counselling process but also maximises safety and the standard of perioperative 

care. 

P 056 

AIRWAY MANAGEMENT IN CHILDREN WITH 

MUCOPOLYSACCHARIDOSES UNDERGOING CERVICAL 

SPINE STABILISATION 

A. Pal 1 , A. Bruce 1 , W.M. Walke 2 , P. Rothera 3 , A. Cowie 3 , S. Jones 3 , G. Gill 3 

1 Royal Manchester CHildren’s Hospital, Otolaryngology, 

144 

MANCHESTER, United Kingdom 

E-MAIL: rickypal 1 00@gmail.com 

2 Dept. of Anaesthesia, The Royal Manchester Children’s Hospital, 

MANCHESTER, United Kingdom 

3 The Royal Manchester Children’s Hospital, MANCHESTER, 


INTRODUCTION 

The mucopolysaccharidoses (MPS) represent a group of progressive hereditary 

lysosomal storage disorders. The characteristic phenotype of this condition 

results from the deposition of glucosaminoglycans within the tissues 

of the body. A subset of these children present with cervical spine instability 

requiring surgical stabilisation and spinal cord decompression. A combination 

of cervical spine fixation, skeletal deformity, obstructive sleep apnoea 

and tracheal glucosaminoglycan deposits provides a significant challenge 

in the management of the airway in the peri-operative period. 

METHODS 

A retrospective case series review was undertaken assessing the airway 

findings and management of 15 children with MPS undergoing cervical 

spine stabilisation and decompression at the Royal Manchester Children’s 

Hospital over a seventeen year period between 1994 to 2011. From our experience 

we present an algorithm that has evolved with the aim of providing 

a strategy for safe airway management. 

RESULTS 

Patients require a thorough airway assessment pre-operatively. This has 

evolved to include computer tomography of the trachea with three-dimensional 

reconstruction. The majority of patients undergo tracheal intubation. 

However, a variety of anaesthetic techniques are required in 

those patients presenting with a difficult airway. In a proportion of cases, 

tracheostomy or Montgomery T-tube insertion provides a surgical adjunct 

that secures the airway. 

CONCLUSION 

A multidisciplinary approach involving an anaesthetist, otolaryngologist, 

neurosurgeon and metabolic physician is required in the management of 

this complex cohort of patients. We demonstrate an algorithm that provides 

a strategy to ensure the safe and secure management of the airway 

in children with MPS undergoing cervical spine surgery. 

P 057 

PERI-OPERATIVE CONSIDERATIONS WHEN UNDERTAKING 

ENT SURGERY IN CHILDREN WITH INBORN ERRORS OF 

METABOLISM 

F. O’Duffy, E. Treacy, H. Rowley 

Temple Street Childrens Hospital, ENT, DUBLIN, Ireland 

E-MAIL: fergaloduffy@hotmail.com 

OBJECTIVES 

Inborn errors of metabolism cause hereditary metabolic diseases and classically 

they result from the lack of activity of one or more specific enzymes 

The aim of surgery is to address the repetitive infections seen in inborn errors 

of metabolism and while doing so to avoid anticipated problems in 

peri-operative and intra-operative spheres. The objectives of this study were 

to identify children with metabolic disease requiring ENT surgical procedures 

and audit management practices in order to identify best practice. 

METHODS 

We reviewed the surgical and anaesthetic records of all children with underlying 

metabolic conditions who required ENT surgical procedures. 

RESULTS 

79 children required ENT surgical intervention at the Children’s University 

Hospital. The most common metabolic diseases encountered include; 

disorders of amino acids, glycogen storage disorders, mucopolysaccharidosis 

and mitochondrial disorders. Peri-operative and anaesthetic considerations 

relating to the specific metabolic diseases were identified. 

CONCLUSION 

We present the common disease specific issues encountered and best practice 

to safely manage these children through surgical intervention. Basic 

recommended interventions in the pre-operatively period include; optimising 

1) calorie intake to meet new requirements 2) hydrate with glucose

enriched fluid and 3) oxygenate. An impaired stress response to surgery is 

also commonly found and must be minimised and managed according to 

the underlying metabolic disease. The ENT surgeon should identify specific 

risks associated with varying metabolic diseases in order to safely 

manage the high risk child for elective ENT surgery. 

P 058 

VIBRANT SOUND BRIDGE IN CHILDREN WITH 

TREACHER-COLLINS-FRANCESCHETTI SYNDROME: 

ANESTHETIC CONSIDERATIONS 

L. Radulescu, N. Andrioaie, G. Damean, C. Gege 2 , C. Cozma 

ENT Clinic - Rehabilitation Hospital, IASI, Romania 

E-MAIL: lmradulescu@yahoo.com 

OBJECTIVE 

Treacher-Collins-Franceschetti syndrome (TCFS) is a rare autosomal dominant 

congenital disorder found in about 2 in 100 000 births. The conductive 

hearing loss with an air-bone gap of 50 to 60 dB impose an early 

treatment of these children in order to develop a normal speech. 

METHODS 

The majority of the patients present external auditory meatus atresia combined 

with malformation of the ossicles. One treatment possibility of the 

hearing loss in TCFS is round window vibrant sound bridge (VSB) implantation. 

In these cases the surgery must be done under general anesthesia. 

TCFS poses some potential airway problems- beginning with difficulties 

and often impossibility of endotracheal intubation and ending with difficulties 

in extubation. 

RESULTS 

We report a case of 6 years old child with TCFS who required general anesthesia 

for implantation of VSB prosthesis. 

CONCLUSION 

Recognition of potential airway problems in a patient with TCFS may prevent 

various anesthetic complications. 

P 059 

DOES VELOPHARYNGEAL INSUFFICIENCY IN CHILDREN 

AFTER CLEFT PALATE SURGERY INTERFERE WITH THE 

QUALITY OF LIFE ? 

R. Marianowski, C. Clodic, E. Mornet, Y. Gauvin, G. Valette, G. Potard 



OBJECTIVE 

The success of cleft palate (CP) surgery is determined by the subsequent 

speech characteristics. The main purpose of this study was to assess long 

term speech outcome after one-stage Wardill-Kilner (W-K) palatoplasty 

and to determine if quality of life (QOL) was affected in children with 

velopharyngeal insufficiency (VPI). 

SETTING 

University pediatric center, interview and prospective study. 

PARTICIPANTS 

This population-based sample included 34 children, aged 4 to 12 years, and 

their parents; 17 of the children having had one-stage W-K palatoplasty 

for CP and 17 were age and sex-matched normal controls. 

METHODS 

Each participant (child and parent) completed the standardized Pediatric 

QOL KINDL questionnaire that assesses perception of health-related QOL 

in pediatric patients with chronic health conditions. VPI was assessed 

using nasometry. 

MAIN OUTCOME MEASURES 

The Pediatric KINDL questionnaire assessed patients’ and parents’ perceptions 

of speech, swallowing and emotional difficulty, activity limitations. 

Each child was assessed with phonation of vowels, pronunciation of various 

(oral, nasal, mixed type) sentences and evaluation of the nasalance 

score in continuous speech with nasometry. 

RESULTS 

In the group with CP, 76.4% of children had a profile of VPI after one-stage 

W-K palatoplasty. There was more nasal loss in girls than in boys. Children 

who received speech therapy had significantly better voice outcomes. The 

quality of life scores were satisfactory for both children and parents. The 

score for QOL was higher among younger children with a cleft lip and palate. 

There was no correlation between the score of QOL and the VPI profile. 

P 060 

OTOLARYNGOLOGICAL ASPECTS OF SUDDEN INFANT 

DEATH SYNDROME 

T. Marom 1 , U. Cinamin 1 , P. Castellanos 2 , C. Cohen 3 

1 Edith Wolfson Medical Center, Otolaryngology-Head and Neck 

Surgery, HOLON, Israel 


2 University of Alabama at Birmingham, BIRMINGHAM, USA 

3 Sheffield Children’s NHS Foundation Trust, Western Bank, 

SHEFFIELD, United Kingdom 

145

INTRODUCTION 

Sudden infant death syndrome (SIDS) is characterized by the sudden death 

of an apparently otherwise healthy infant during a sleep period. There is 

growing evidence of head and neck organs pathology involvement in SIDS 

cases. 

OBJECTIVE 

To review the problem from the otolaryngologist’s perspectives, review 

relevant pathologies and to critically discuss current related controversies 

to present. 

DISCUSSION 

Laryngeal, oropharyngeal, maxillofacial, otologic and cervical vascular 

pathologies are thoroughly described. In agreement with the ‘triple-risk 

model’, head and neck abnormalities serve as the anatomical ground in 

selected SIDS cases. A future area of interest is the hyposlossal nucleus, 

which dominates the movement of the tongue. Otolaryngolosists should 

be aware of these relevant pathologies, as some are treatable if identified 

soon in infancy. 

P 061 

SURGICAL SITE INFECTIONS IN PAEDIATRIC 

OTOLARYNGOLOGY OPERATIONS 

S.N. Ifeacho, Y. Bajaj, R. Talwar, C. Jephson, D.M. Albert 


E-MAIL: sonna@doctors.org.uk 

INTRODUCTION 

Surgical site infections (SSIs) account for a significant proportion of Healthcare 

associated infections National Institute for Health & Clinical Excellence 

published its own evidence-based review in October 2008 and made 

recommendations to reduce SSI rates. There is little published literature 

on surgical site infections in paediatric otolaryngology. 

METHODS 

Prospective data collection for 3 weeks on all children undergoing surgery 

where mucosa/skin was breached. Parents were given a questionnaire to 

complete at 30 days post-surgery. 

RESULTS 

Data collected on 80 consecutive cases. Majority of the cases were admitted 

on the day of the procedure. The procedures included Adenotonsillectomy 

(24), Grommets (12), Cochlear implantation (6), BAHA (2), submandibular 

gland excision (1), branchial sinus excision (1), cystic hygroma excision (3), 

excision of nasal glioma (1), Microlaryngobronchoscopy (13), tracheostomy 

(3) and other procedures. Nearly half the cases had more than one operation 

performed at the same time. 26/80 (32.5%) patients had a foreign object 

inserted at the time of operation (grommet, BAHA, cochlear implant). Of 

these 55/80 (68.7%) operative fields were classed as clean contaminated and 

146 

25/80 as clean operations. The duration of the operation varied from 6 minutes 

to 142 minutes. Hospital antibiotics protocol was followed in 69/80 

(86.3%) patients and not followed in 11/80 patients. Amongst this group, 

3/80 (3.7%) patients had an infection in the postoperative period. 

CONCLUSION 

Surgical Site Infections are uncommon in paediatric otolaryngology. However, 

given the potentially serious consequences, reduction in the risk of 

Surgical Site Infections is important. 

P 062 

CONGENITAL CYSTS OF THE INFANT LARYNX 

S. Prowse, L.C. Knight 

The General Infirmary at Leeds, Paediatric Otorhinolaryngology, 

LEEDS, United Kingdom 

E-MAIL: sjprowse@me.com 

OBJECTIVES 

Congenital laryngeal cysts are a rare cause of neonatal airway obstruction. 

Two varieties can be distinguished. Ductal cysts arise from obstructed submucosal 

glands and commonly present in the vallecula, whilst saccular 

cysts develop secondary to atresia of the ventricular orifice. Treatment remains 

controversial, with some believing that traditional approaches including 

cyst marsupialisation or endoscopic excision are more prone to 

recurrence. We reviewed our management of these cases to determine the 

most effective intervention. 

METHODS 

A review of all children treated by our unit for congenital laryngeal cysts 

between 2001and 2011. Demographic data, age at and mode of presentation 

were noted. Operation notes were reviewed to determine the nature of 

each laryngeal cyst and treatment methodology. 

RESULTS 

Ten children were identified, six with a ductal cyst of the vallecula and 

four with a saccular cyst, giving an overall incidence of 3.49 cases per 

100,000 live births. Children of Pakistani ancestry were disproportionately 

represented, accounting for 40% of cases. Saccular cysts presented earlier 

with symptoms of more severe airway compromise, whilst vallecular cysts 

tended to present later with feeding difficulties and failure to thrive. Twothirds 

of children with vallecular cysts had co-existing laryngomalacia. 

Treatment by single-stage endoscopic marsupialisation was effective in 

all cases at a mean follow-up of nine months. 

CONCLUSION 

Congenital laryngeal cysts are rare, although they appear to be more common 

in the British-Pakistani population. Presentation depends on cyst 

size and proximity to the glottis and can be associated with laryngomalacia. 

Endoscopic marsupialisation is an effective means of treatment.

P 063 

BRANCHIAL ANOMALIES IN CHILDREN: OUR EXPERIENCE 

V. Kapoor, Y. Bajaj, S. Ifeacho, D. Tweedie, C.G. Jephson, D.M. Albert, 

L.A. Cochrane, M.E. Wyatt, B.E.J. Hartley 

Great Ormond Street Hospital, ENT, LONDON, United Kingdom 

E-MAIL: dr.k.kapoor@gmail.com 

INTRODUCTION 

This study analyzes all the cases of branchial cleft anomalies operated on 

at Great Ormond Street Hospital over the past ten years. 

METHODS 

All children who underwent surgery for branchial cleft, sinus or fistula 

from January 2000 to December 2010 were included in this study. 

RESULTS 

In this series, we had 80 patients. Amongst this group, 15 patients had first 

branchial cleft anomaly, 62 had second branchial cleft anomaly and 3 had 

fourth branchial pouch anomaly. All the first cleft cases were operated on 

by a superficial parotidectomy approach with facial nerve identification. 

Complete excision was achieved in all these first cleft cases. In this series 

of first cleft anomalies, we had one complication (temporary marginal 

mandibular nerve weakness. In the 62 children with second branchial cleft 

anomalies, 50 were unilateral and 12 were bilateral. Majority of these cases 

were operated on through an elliptical incision around the external opening. 

Complete excision was achieved in all second cleft cases except one who 

required a repeat excision. In this subgroup, we had two complications one 

patient developed a seroma and one had incomplete excision. The three patients 

with fourth pouch anomaly were treated with endoscopic assisted 

monopolar diathermy to the sinus opening with good outcome. 

CONCLUSION 

Branchial anomalies are relatively common in children. Correct diagnosis 

is essential to avoid inadequate surgery and multiple procedures. The surgical 

approach needs to be tailored to the type of anomaly of origin of the 

anomaly. Complete excision is essential for good outcomes. 

P 064 

REPAIR OF NASOPHARYNX TO SKULL BASE FISTULA 

A. Gómez Torres, A. Mochón Martín, A. Abrante Jimenez, 

M. Rivero García, J. Márquez Rivas, F. Esteban Ortega 

Virgen del Rocio University Hospital, Otolaryngology, CORDOBA, Spain 

E-MAIL: gotoa83@hotmail.com 

OBJECTIVES 

Adenoidectomy is a common procedure performed in all otorhinolaryngology 

departments. The complications that may occur are varied, being bleeding 

the most frequent. Other common complications include odynophagia, 

throat infection, otalgia, nausea and vomiting and damage to teeth. The 

presence of this kind of fistula has not been described yet in the literature. 

METHODS 

A three-year old patient was referred to our hospital with a history of 

meningitis, 48 hours later of an adenoidectomy. A CT scan showed a pneumocephalus 

and an ulcerated area in nasopharynx. The patient was initially 

treated conservatively, but 24 hours later, her condition worsened 

and a CSF leak was noticed through the nasopharynx. The defect was repaired 

with a musculomucosal pharyngeal flap, Duragen®, Tissucol® 

and Tachosil®. 

RESULTS 

Two transoral approaches were performed, the placement of a lumbar 

drain, parenteral feeding, intravenous antibiotics, oral intubation and 14 

days in an Intensive Paediatric Care Unit were also necessary. After that, 

the patient was discharged and has had an uneventfully recovery, without 

any sequelae. 

CONCLUSIONS 

Dissection deeper than normal may create a discontinuity that favours 

the passage of air; this process is enhanced by air over pressured situations 

(manual ventilation, vomiting, coughing, etc.). The purpose of this oral 

communication is to analyse the mechanism, morbidity, treatment and 

prevention of this condition. 

P 065 

EMBRYONAL RHABDOMYOSARCOMA OF THE SOFT PALATE - 

REPORT OF TWO PATIENTS 

V. Ubarevic, K. Stankovic, M. Novkovic, I. Baljosevic, R. Simic 

Mother and Child health care Institute of Serbia, Pediatric ENT 

Department, BELGRADE, Serbia 

E-MAIL: kattja3@gmail.com 

The aim of this paper is to present two cases of rhabdomyosarcoma in a 

ten-year girl and a three-year old boy with a rare localization on the soft 

palate, which were surgically successfully treated. Both patients were 

treated at the ENT department of the Mother and Child Health Care Institute 

of Serbia in Belgrade. 

After diagnostic procedures, we performed radical excision of the tumor 

which has been located in the girl only on the soft palate and the boy had 

tumor localized on at the joint of frontal and posterior palatinal arcus, infiltrating 

the soft palate and uvula. Postoperatively, after histopathological 

verification of embryonal rhabdomyosarcoma, both children were treated 

with chemotherapy and radiotherapy. Five years after surgery girl is well 

147

and there was no clinical or CT/NMR diagnosed local recurrence of the 

disease while the boy is still in the stage of finishing chemotherapy, but 

local findings in the area of surgical intervention is clear. They did not 

have problems with swallowing and speech 

Rhabdomyosarcoma is an aggressive malignant tumor derived from embryonic 

mesenchymal tissue of skeletal muscle. It is very difficult for the 

surgical treatment because of the: functional importance of local structures 

and the tumor characteristics . All this may limit tumor excision, 

and impact on postoperative speech and swallowing. Embryonal rhabdomyosarcoma 

treatment and prognosis in the head and neck region 

depend on the child’s age, speed and accuracy of diagnosis, tumor localization, 

local and regional expansion, opportunities for radical surgical removal 

and histopathological type of the tumor. 

P 066 

PEDIATRIC TRACHEOTOMY: 

ARE THE INDICATIONS CHANGING? 

A. Lawrason 1 , K. Kavanagh 2 

1 University of Connecticut, Surgery, Division Otolaryngology, 

WEST HARTFORD, USA 

E-MAIL: alawrason@gmail.com 


OBJECTIVE 

The most common indications for tracheotomy in pediatric patients include 

upper airway obstruction, prolonged ventilator dependence, and hypotonia 

secondary to neurologic impairment. In this study we review the 

indications and airway endoscopy findings for patients undergoing tracheotomy 

at a tertiary care children’s hospital. 

METHODS 

A retrospective chart review of patients undergoing tracheotomy at a tertiary 

care pediatric hospital from January 2000 to April 2011 was performed. 

165 patients were identified and complete data was available on 158 patients. 

Age, sex, pre-operative diagnosis, post-operative diagnosis, and direct 

laryngoscopy and bronchoscopy findings were examined. Patients 

were divided into six groups based on their indication for tracheotomy. 

In order to assess for a change in indications, an early (2000-2005) and a late 

(2006-2011) patient group were formed. 

RESULTS 

There was no significant difference in age between the early and late 

groups, with patients in the early group only slightly older than those in 

the later group, 4.73 +/- 6 years vs. 3.6 +/- 5.5 yrs. Additionally, the indications 

for tracheotomy between the early and late group showed no significant 

change, however there was an insignificant decline in the number 

of patients referred for prolonged ventilation, 38% vs. 28% and an increase 

in the number of patients referred with neurologic impairment and craniofacial 

anomalies. 

148 

CONCLUSION 

A review at our institution showed stability with regards to indications for 

tracheotomy over the last 10 years. Prolonged ventilator requirement remained 

the most common indication with upper airway obstruction second. 

P 067 

DIFFICULT MANAGEMENT OF AN UNUSUAL 

INFLAMMATORY PAEDIATRIC NECK CONDITION: 

ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA 

VERSUS KIMURA’S DISEASE 

G. Narasimhan, A. Kasbekar, A. Donne, G. Kokai, K. Davies 




INTRODUCTION 

Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura’s Disease 

are rare causes of paediatric neck masses. The two distinct entities are 

histologically similar making the diagnosis difficult, which must be correlated 

to the clinical picture. Treatment is varied and controversial. 

METHOD 

Case report A 3-month-old girl presented with inflammatory right neck 

lymph nodes that developed into an abscess requiring drainage. The 

wound was slow to heal and required primary closure 4 months later including 

excision biopsy of a protruding wound granuloma. MRI after primary 

wound closure displayed persisting cervical lymphadenopathy. The 

retroperitonium demonstrated enlarged lymph nodes of uncertain significance. 

The thorax, abdomen and pelvis were unremarkable. Investigations 

were negative for tuberculosis. Serum Immunoglobulin E levels were 

raised but there was no eosinophilia. Renal involvement was excluded 

which is a common association. The child remains clinically well with an 

intermittently tender fluctuating mass beneath the healing scar. 

RESULT 

Initial specimens displayed appearances consistent with a chronic abscess 

wall. Biopsy of the wound granuloma revealed characteristics of ALHE including 

prominent hobnail-type, ‘histiocytoid’ endothelial cells within 

the vessel walls along with numerous eosinophilic granulocytes. 

CONCLUSION AND MANAGEMENT 

Although histologically the diagnosis was ALHE, the clinical picture was 

one of Kimura’s disease. The child’s wound eventually healed satisfactorily. 

Conservative management continues until the mass becomes sufficiently 

symptomatic. We recommend early imaging and biopsy for histological 

diagnosis. Recurrences can be treated with systemic steroids and is a common 

first line treatment in both diseases. Unfortunately all potential 

treatments have a high rate of recurrence.

P 068 

ANALYSIS OF LARYNGOTRACHEAL SEPARATION 

IN CHILDREN 

Y. Sasamura 1 , K.S. Ichimura 2 

1 Jichi Children’s Medical Center Tochigi, Otokaryngology, TOCHIGI, 

Japan 

E-MAIL: sasamura@jichi.ac.jp 

2 Jichi medical University, TOCHIGI, Japan 

We studied 11 children aged 15 years or younger (six males and five females) 

who had undergone laryngotracheal separation to prevent recurrent aspiration 

pneumonia. The primary disease was hypoxic encephalopathy in 

nine children, spinal muscular atrophy in one, and mucopolysaccharidosis 

in one. In addition to laryngotracheal separation, five children underwent 

gastrostomy and fundoplication, and four underwent preoperative tracheotomy. 

Anastomotic leak and tracheo-brachiocephalic artery fistula 

was developed in one patient respectively as a postoperative complication. 

Gastrostomy was performed in nine children to facilitate postoperative 

feeding. Two children were able to resume oral feeding. In all children, 

the respiratory status stabilized, and endotracheal suctioning markedly 

decreased in number. 

P 069 

HOW MUCH DOES PAEDIATRIC RECURRENT RESPIRATORY 

PAPILLOMATOSES COST - THE ALDER HEY PERSPECTIVE 

G. Narasimhan, A. Donne, R. Clarke 




OBJECTIVE 

To determine the cost burden of Paediatric Recurrent Respiratory Papillomatosis 

(RRP), in a tertiary health care setting in the United Kingdom. 

METHOD 

We identified 18 RRP cases in the preceding 6 years from proven histological 

reports. Comprehensive clinical coding was carried out for 14 patients to reflect 

accurately their entire clinical management journey within our hospital. 

Costs were calculated using standard National Health Service tariffs. 

RESULTS 

The summative cost of RRP to our Trust since 2005 was £225,000 for 14 patients. 

We calculated the cost per patient per annum, cost per year for 

group and tracheostomy costs. We determined the age of onset, duration 

of disease, frequency and type of surgical intervention for our RRP patients. 

CONCLUSION AND DISCUSSION 

RRP is a relatively rare condition in Paediatric Otolaryngology, albeit an 

expensive one to treat. The Department of Health in the UK have announced 

that the quadrivalent vaccine has now been selected for the National 

vaccination program. It is hoped that this will mean a reduction in 

new cases of RRP in the years to come. However, as there is no Healthcare 

Resource Group code for RRP it is very difficult to evaluate the extent of 

the problem and therefore the benefit of the vaccine in monetary terms. 

Our study presents an actual costing of RRP management in a tertiary referral 

hospital, which we feel will help towards clarifying the cost benefit 

of the Human Papilloma Vaccine in RRP, for health care providers. 

P 070 

PREDICTIVE FACTORS IN CHILDREN WITH OSA 

REQUIRING HDU IN A PAEDIATRIC HOSPITAL 

FOR ADENOTONSILLECTOMY 

A.J. Kinshuck, M.L. Schober, R.K. Sharma, S. de, R.W. Clarke, A.J. Donne 

NHS, ENT Deparment, LIVERPOOL, United Kingdom 

E-MAIL: akinshuck@gmail.com 

OBJECTIVE 

High Dependency Units (HDU) beds are often requested for post-tonsillectomy 

patients with known Obstructive Sleep Apnoea (OSA). Lack of 

HDU beds can result in cancellation of elective cases. The purpose of this 

audit was to assess the appropriate utilization of the HDU by the Paediatric 

Ear Nose and Throat Department and investigation of any predictive factors 

necessitating an HDU bed. A retrospective study was performed to assess 

the utilization of the High Dependency Unit at Alder Hey Children’s 

Hospital for elective adenotonsillectomy. 

METHODS 

The case notes were reviewed to identify the rationale for HDU admission 

and to determine whether the HDU bed proved to be required. 

RESULTS 

There were 82 admissions to the HDU for patients undergoing elective 

adenotonsillectomy between 2008 and 2010. 66 patients met the inclusion 

criteria and had a full data set. 31 patients had desaturations confirmed 

on pre-operative pulse oximetry. 7 patients had desaturations intra-operatively 

and 15 patients had significant post-operative desaturations. 

3 patients required continuous positive airway pressure (CPAP) post-operatively 

and 2 of these had previously required CPAP. From the 15 patients 

who had significant post-operative desaturations this was predicted in all 

but 1 of the cases on pre-operative pulse oximetry. 

CONCLUSION 

In this study only 5% (3/66) of patients required CPAP and 2 of these patients 

were known to be CPAP dependent pre-operatively. Pre-operative 

149

pulse oximetry was a good indicator for post-operative desaturations and 

may aid appropriate utilization of HDU. 

P 071 

TRACHEOBRONCHIAL FOREIGN BODY (TFB) IN CHILDREN: 

EXPERIENCE OF 163 CASES 

M. Kotoula 1 , A. Kioutsouki 2 , A. Dritsoula 2 , A. Magganaris 2 , N. Mpenis 2 , 

G. Kontzoglou 2 

1 Hippokratio General Hospital, E.N.T. Department, THESSALONIKI, 

Greece 

E-MAIL: mariakotoula5@hotmail.com 

2 ENT Department, Hippokratio General Hospital, THESSALONIKI, 

150 

Greece 

OBJECTIVE 

Foreign body aspiration (FBA) is one of leading causes of death in children, 

especially among those younger than 3 years of age. In that age, more than 

3000 sudden deaths caused by foreign body inhalation are reported each 

year worldwide. 

METHODS 

A retrospective study was conducted in 163 children (96 male and 67 female) 

were admitted to the ENT Department of our hospital between 1995-2011. 

Most of them were presented with a history of an acute episode of choking. 

All the patients underwent in radiological evaluation and explorative rigid 

endoscopy bronchoscopy under general anesthesia. Also parents were 

asked to respond to a questionnaire evaluating various socio-economic 

parameters which could potentially have lead to the unfortunate event. 

RESULTS 

Their ages ranged from 1 month to 13 years (the majority were 18-24 

months (63,8%)). 40% of all patients had normal radiological screening. Of 

the 163 bronchoscopies, 122 (74,7%) showed FB which are commonly located 

in the right mainstem bronchus. azelnuts were the most common FB. 

Mean hospital stay was 1 day. No mortality was observed in relation with 

bronchoscopy. The majority of the families were of Greek origin and were 

living in rural areas. 

CONCLUSIONS 

FBA is a life threating situation with high impact in childhood, which requires 

special attention from parents and health care providers. Rigid endoscopy 

bronchoscopy usually gives good results in detecting airway 

foreign bodies and the extraction can be performed safely with minimum 

risks and complications if it is performed by specialized medical staff. 

P 072 

STRIDOR AND CONGENITAL LARYNGEAL ANOMALIES 

S. Tzellas, G. Peltekis, A. Manganaris, G. Kontzoglou, N. Benis, 

E. Berovali, A. Dritsoula, S. Skouras 

Hippokrateio General Hospital, THESSALONIKI, Greece 

E-MAIL: tzellas80@hotmail.com 

INTRODUCTION 

Congenital laryngeal anomalies are relatively rare. They may present with 

hoarseness, difficulty in feeding and life-threatening respiratory problems. 

The most common presenting symptom is stridor, the sound caused by 

the abnormal air flow during breathing. Differential diagnosis of stridor 

includes a variety of clinical entities, such as laryngomalacia, vocal cord 

paralysis, subglottic stenosis and haemangiomas, laryngeal cysts, laryngeal 

cleft, bifid epiglottis, and laryngeal webs. The golden standard in the evaluation 

of congenital stridor is direct laryngoscopy under general anaesthesia. 

This procedure will define if further surgical intervention is required. 

OBJECTIVES 

The aim of this study is to discuss the presentation, assessment and management 

of the common causes of congenital laryngeal abnormalities, as 

they were recorded over the last 3 years in our hospital. 

METHODS 

103 patients presenting with inspiratory stridor were investigated and the 

records were retrospectively reviewed. 

RESULTS 

Direct laryngoscopy established laryngomalacia (37%) as the most frequent 

cause of stridor, followed by vocal cord paralysis (21%), and to a lesser extent 

by other anomalies. In many cases, airway management required a tracheostomy. 

CONCLUSION 

Evaluation of congenital inspiratory stridor with direct laryngoscopy is of 

paramount importance in the diagnosis of congenital laryngeal anomalies. 

Furthermore, it enables direct and safe surgical management of the respiratory 

distress and the feeding difficulties. 

P 073 

STRIDOR: AN UNUSUAL MANIFESTATION OF | 

TUBERCULOSIS IN AN INFANT 

W. Ahmed 

St George’s Hospital, ENT, LONDON, United Kingdom 

E-MAIL: docwazza@gmail.com

OBJECTIVE 

We report a case of tuberculosis presenting as stridor in an infant. 

METHOD 

Retrospective case note review. 

CASE REPORT 

A 4 month old child presented with a 4 week history of increasing stridor. 

Airway endoscopy revealed an external compression of the left main 

bronchus and an exophytic lesion in the proximal left main bronchus. 

Computerised Tomography post-operatively demonstrated a mediastinal 

mass compressing the left main bronchus, hilar adenopathy and a left 

lower lobe pulmonary mass. Biopsy of the exophytic lesion was reported 

as acid fast bacilli positive granulomatous inflammation. The patient was 

commenced on antituberculosis treatment to which there has been a good 

clinical response with resolution of the airway symptoms. 

CONCLUSION 

Whilst mediastinal masses in this age group are usually neoplastic in origin, 

tuberculous lympadenopathy should be included in the differential 

diagnoses. 

P 074 

TRANSNASAL ENDOSCOPIC REPAIR OF CONGENITAL 

CHOANAL ATRESIA: FACTORS FOR RESTENOSIS 

P. Brihaye 1 , A.L. Mansbach 2 

1 MPR - HUDERF, ENT, BRUXELLES, Belgium 

E-MAIL: dr.brihaye.orl@hotmail.com 

2 University Children’s Hospital Queen Fabiola, BRUSSELS, Belgium 

OBJECTIVE 

To evaluate factors involved in restenosis after surgical repair of choanal 

stenosis or atresia (CA) . 


Retrospective medical record review of 24 children operated between 1999 

and 2011 at an age of 3 days to 9 years, with a mean follow-up time of 5 

years. Fifteen had bilateral and 9 unilateral CA. There were 15 secondary 

and 9 primary surgery, all of them performed by the the first author. Fourteen 

children had associated neonatal development disorders (NDD). The 

surgical technique consisted of endonasal endoscopic resection of atretic 

choanal plate and posterior vomer with septal mucoperichondrial flap. 

No stents and Mitomycine were used. A uniform post-operative management 

was applied. 

RESULTS 

A wide choanal lumen was obtained by resecting the pterygoïd process in 

all bilateral and in 4 out of 9 unilateral cases. In 3 children with NDD a 

narrow rhinopharynx was surgically widened by submucosal partial re- 

section of clivus bone. Early surgical complication were nasal synechiae 

in 1 child and nares stenosis in one child. Choanal restenosis appeared in 

3 children. Two of them had to be reoperated. 

CONCLUSION 

One stage resection of the vomer and the pterygoid process, widening of 

the rhinopharynx, and covering with mucoperichrondral flap is an effective 

technique. Neither stenting nor Mitomycine is needed to obtain good 

long term functional results. Associated trisomy 21 and multiple previous 

transpalatal attempts appears to be risk factors for restenosis. 

P 075 

MODELING IN PAEDIATRIC OTOLARYNGOLOGY: 

PENETRATING OROPHARYNGEAL TRAUMA 

D.S. Leonard 

Children’s University Hospital, Otolaryngology, DUBLIN, Ireland 

E-MAIL: leonarddavid@eircom.net 

OBJECTIVE 

Management of penetrating oropharyngeal trauma varies widely. The risk 

of extremely rare, potentially catastrophic complications must be balanced 

against the potential complications, and cost, associated with investigation. 

Using decision analysis modeling we aim to clarify this clinical dilemma. 

METHODS 

Using conservative estimates drawn from published data, we developed a 

stochastic model of paediatric oropharyngeal traumamanagement, incorporating 

all protocols discussed in the medical literature. Using this model 

we ranked the strategies based on probability of any adverse outcome and 

probability of mortality. We then performed an incremental cost benefit. 

RESULTS 

Stochastic simulation reveals CT Angiogram plus treatment with aspirin, 

when indicated, as the optimal management strategy for paediatric 

oropharangeal injury when considering in terms of both probability of 

adverse outcomes and probability of mortality. When compared with the 

next best strategy, the number needed to treat (NNT) to avoid one adverse 

outcome was at least 3425 and 7247 to avoid one death. Using US Medicare 

2011 data this corresponds in excess of $3.1 million (€2.4 million) per adverse 

event prevented and $4.3 million (€3.4 miilion) per life saved. 

CONCLUSION 

In considering rare clinical conditions, or clinical situations where the 

outcome of interest is rare, use of simulation can help guide clinical decision-making. 

In the case of paediatric orpharyngeal trauma, our stochastic 

model suggests that CT Angiogram coupled with appropriate anti-platelet 

therapy is the optimal management strategy. However, in a environment 

of limited medical resources, the incremental cost associated with implementing 

this treatment strategy may be prohibitive. 

151

P 076 

INDEPENDENT RISK FACTORS FOR AUDITORY NEUROPATHY 

SPECTRUM DISORDER (ANSD) IN NICU INFANTS 

S. Coenraad 1 , A. Goedebure 1 , J.B. van Goudoever 2 , L.J. Hoeve 1 

1 Erasmus Medical Center - Sophia Children’s Hospital, 

Otorhinolaryngology, ROTTERDAM, The Netherlands 

E-MAIL: s.coenraad@erasmusmc.nl 

2 VU Medical Center, AMSTERDAM, The Netherlands 

OBJECTIVE 

Infants admitted to the neonatal intensive care unit (NICU) have a higher 

incidence of auditory neuropathy spectrum disorder (ANSD). We evaluated 

independent etiologic factors associated with ANSD in NICU infants compared 

to normal hearing NICU controls 

METHODS 

We included all infants (n=9) with the ANSD profile admitted to the NICU 

of Sophia Children’s Hospital between 2004 and 2009. Each patient was 

matched with four normal hearing controls of the same gender and postconceptional 

age. The following possible risk factors were studied: birth 

weight, dysmorphic features, APGAR scores (at 1, 5 and 10 minutes), respiratory 

distress (IRDS), CMV infection, sepsis, meningitis, cerebral bleeding, 

hyperbilirubinemia requiring phototherapy, peak total bilirubin level, 

furosemide, dexamethason, vancomycin, gentamycin and tobramycin administration. 

RESULTS 

Nine infants met the ANSD criteria in one or both ears. IRDS (P=0.02), 

meningitis (P=0.04) and vancomycin administration (P=0.009) were significantly 

increased in infants with ANSD compared to controls. 

CONCLUSIONS 

In high-risk NICU infants IRDS, meningitis and vancomycin administration 

are associated with auditory neuropathy spectrum disorder. 

P 077 

SENSORINEURAL HEARING LOSS IN CHILDREN: 

THE ASSOCIATION WITH APGAR SCORE 

E. Kvestad, B. Engdahl, A. Eskild 

Norwegian Institute of Public Health, Division of Mental Health, 

OSLO, Norway 

E-MAIL: ellen.kvestad@fhi.no 

OBJECTIVE 

Sensorineural hearing loss is diagnosed in 1-2 per 1000 children in the 

Western world. Apgar score is a measure of vitality of the newborn infant, 

152 

based on heart rate, respiratory effort, colour, muscle tone and reflex irritability. 

Aim of the study was to estimate the association between Apgar 

score and sensorineural hearing impairment in a population based sample. 

METHODS 

The source population included was all children born in Norway 1978-98. 

The cases were children with sensorineural hearing loss diagnosed before 

the age of five (n = 327). The controls (n = 392 044) were all other children 

born in the same counties and same time period. Hearing loss was defined 

as mean hearing loss ≥ 35 dB hearing level in the better hearing ear averaged 

over the pure-tone hearing thresholds at 500, 1000 and 2000 Hz. The 

association between Apgar score and sensorineural hearing loss was estimated 

as odds ratios with 95% confidence interval by applying logistic regression 

models. 

RESULTS 

Among children with sensorineural hearing loss 0.9 % (3/327) had Apgar 

score < 3, and that was true for 0.1 % (304/392 044) of children without hearing 

loss (p=0.001, chi square test). The crude OR for sensorineural hearing 

loss was 11.7 (95% CI 3.7, 37.0) comparing Apgar score 35 weeks’ gestation born between 1.1.2011 and 31.5.2011 were 

evaluated. OAE was performed in all infants prior to discharge. Data regarding 

perinatal and neonatal variables and results and timing of OAEs 

was collected.

RESULTS 

1170 infants (70%) were born by VD and 483 by CS (30%). Univariate analysis: 

CS, male gender, Gestational age (GA):35-37 weeks, BW≤2500g, Small GA 

(SGA) and early age at first OAE were significantly associated with failed 

first OAE. In multivariate analysis, variables that were independently significantly 

associated with failed first OAE were male gender [OR 1.42 (1.02- 

1.98)], birth by CS [emergency CS: OR 3.18 (2.21-4.57), elective CS: OR 3.32 

(2.04-5.42)], early age (

P 081 

A HOME MADE PORTABLE SCREENING AUDIOMETER FOR 

INFANT AND CHILDREN IN INDONESIA 

W.D. Hartanto 1 , P. Yusuf 2 , R.A. Poerwana 1 

1 Universitas Padjadjaran - Hasan Sadikin Hospital, 

Otorhinolaryngology - Head and Neck Surgery, BANDUNG, 

Indonesia 

E-MAIL: weehart@yahoo.com 

2 Universitas Indonesia, JAKARTA, Indonesia 

Diagnostic audiometer is not always available in clinical settings especially 

in developing countries rural areas. There is a need to develop a low cost, 

simple, and easy to use but effective audiometer for developing countries. 

Portable screening audiometer is a home made device to assess the hearing 

sensitivity in 500, 1000, 2000, 4000 Hz warbles with intensity of 30 and 60 

dB HL which are simple, less expensive, brief, easy to use and has shorter 

examination time but has not been measured its accuracy for hearing 

screening in infant and children. The objective of this study is to measure 

the accuracy of portable screening audiometry for detecting hearing loss 

in infant and children. A diagnostic test study with cross-sectional method 

was conducted at Sejahtera Elementary School and at Out-patient Clinic 

Otorhinolaryngology-Head and Neck Department Hasan Sadikin Hospital 

period June 2010 until August 2011. Thirty infants and children age

P 084 

THE OXFORD EXPERIENCE OF TREATING CONGENITAL CMV 

WITH GANCYCLOVIR AND VALGANCYCLOVIR 

T.A. Mawby, J. Ramsden 

John Radcliffe Hospital, ENT, OXFORD, United Kingdom 

E-MAIL: tommawby@hotmail.com 

OBECTIVES 

To determine the benefit to hearing of treating confirmed congenital CMV 

with valgancyclovir and/or gancyclovir. 

METHODS 

A retrospective review of cases of treated congenital CMV at The John Radcliffe 

Hospital, Oxford. All confirmed cases of congenital CMV were identified 

through the paediatric infectious diseases database and national 

CMV register and this was cross referenced with our ENT departmental 

records. The notes were reviewed to identify age of age of diagnosis, if antiviral 

therapy was prescribed and the regime used and audiology. 

RESULTS 

7 children were identified with treated congenital CMV over a three year 

period from 2008 to 2011. Four children had normal hearing, three of these 

hearing remained normal but one deteriorated. One child had a profound 

loss that failed to improve and underwent cochlear implant insertion. One 

child had a deteriorating loss managed with hearing aids and the remaining 

child is currently undergoing treatment. All the children tolerated 

their regime with no adverse events. 

CONCLUSION 

There are still controversies regarding treatment for congenital CMV. Our 

experience has shown that treatment with valgancyclovir and gancyclovir 

to be well tolerated with no adverse events but further studies are needed 

to determine who is most likely to benefit and the best regime to use. 

P 085 

THE EFFICACY OF OTOACOUSTIC EMISSIONS IN THE 

DIAGNOSIS OF HEARING LOSS IN HIGH RISK NEONATES 

A. Skouras, G. Peltekis, S. Tzellas, A. Manganaris, I. Katasmanis, 

M. Kotoula, A. Kioutsouki, G. Kontzoglou 

Hippokratio General Hospital, THESSALONIKI, Greece 

E-MAIL: skourtha@otenet.gr 

INTRODUCTION 

Otoacoustic Emissions (OAE) are an objective, cost-effective, non-invasive 

and rapid method of determining the function of the outer cochlear hair 

cells. The implementation of OAE has lead to early diagnosis of hearing 

loss in neonates. 

AIM 

To determine the efficacy of OAE in the diagnosis of hearing loss in ‘high 

risk’ children. 

METHODS 

The study group included neonates with high risk of developing sensorineural 

hearing loss. It included premature infants, neonates with 

hereditary history of hearing loss, neonates with a history of requiring 

ventilation for more than 5 days and those with syndromes associated with 

sensorineural hearing loss. During a four-year period (2007 - 2011) we performed 

223 Transient Evoked Otoacoustic Emissions (TEOAE), in high risk 

neonates hospitalized in Intensive Care Units (I.C.U.), and to infants and 

children with delayed speech development or mutism. 

RESULTS 

108 children failed the test at least in one ear (48.43%) and were reexamined 

in one month. 50 of them passed the test (46.29%). The rest were tested with 

Auditory Brainstem Response (ABR). 37 passed the test (34.25%), and 21 

failed (19.44%). 10 of them were diagnosed with a syndrome, and 11 were 

premature with very low body weight. All of them were retested with ABR, 

and finally 5 of them failed (2.24%). A hearing aid was applied. 

CONCLUSION 

OAE are the method of choice for diagnosing hearing loss in children. One 

should focus primarily on high risk neonates, where the rates are much 

higher and then broaden the study groups. 

P 086 

13 YEARS OF UNIVERSAL NEWBORN HEARING SCREENING IN 

FLANDERS: NEW INSIGHTS IN SOCIO-DEMOGRAPHIC RISK 

FACTORS 

E. van Kerschaver 

Kind en Gezin, BRUSSEL, Belgium 

E-MAIL: erwin.van.kerschaver@kindengezin.be 

OBJECTIVE 

Since 1998 an integrated universal newborn hearing screening programme 

based on the guidelines of the American Academy of Paediatrics and using 

AABR has been implemented in Flanders. The purpose of this presentation 

is to report on the results and the detailed examination of the results of 

114,000 screening tests. 

155

METHODS 

This study concerns the neonatal non-NICU population of Flanders between 

1999 and 2008. The UNHSP, organized by Kind en Gezin (K&G), uses 

a 2-stage protocol: children with a refer result in the first screening test 

are retested, and those with a refer at the retest are referred to a certified 

centre. Screening and referral centres communicate their data to a central 

database at K&G. 

RESULTS 

The screening was offered to 95.60% of babies in Flanders using the Algo® 

Portable and the Algo3i®. Two-thirds of the referred babies had a confirmed 

hearing loss, in 57.5% bilateral. Some babies had a temporary hearing 

problem. The false positive rate after two tests was 0.57%. All 

ascertained babies started early intervention, mostly before the age of 4 

months. Detailed investigation of the results and outcome of 114,000 

screening tests learns that results differ with gender, birth order and age 

of the baby at screening, and age and origin of the mother. Sensitivity 

yields 94.02% and specificity 99,96%. 

CONCLUSIONS 

K&G has succeeded in organizing a well-structured community-based 

UNHSP according to the guidelines of the AAP. In-depth analysis provides 

new insights into the prevalence and environmental factors. Further 

analysis on a large scale is indicated. 

P 087 

SENSORINEURAL HEARING LOSS AFTER NORMAL NEONATAL 

HEARING SCREENING IN VERY PRETERM INFANTS 

I.L. van Noort-van der Spek, N. Weisglas-Kuperus, A. Goedegebure 

Erasmus Medical University Center, Otorhinolaryngology, 

ROTTERDAM, The Netherlands 

E-MAIL: i.vanderspek@erasmusmc.nl 

OBJECTIVE 

To determine the prevalence of sensorineural hearing loss (SNHL) measured 

by auditory brainstem response (ABR) at 2 years of corrected age in 

very preterm (VPT) infants with normal neonatal hearing screening (NHS). 

METHODS 

85 VPT infants (gestational age 20 dB HL for at least one ear, measured 

by ABR at 2 years of corrected age. Of these VPT infants, 5 (6%) had SNHL. 

VPT infants with SNHL had significantly more sepsis as compared to VPT 

infants without SNHL (P

limitation of the current method in screening this specific population 

where ABR may be essential even as a first line test. 

P 089 

MANAGEMENT AND PROBLEMS OF HEARING EVALUATION 

OF EXTREMELY-LOW-BIRTH-WEIGHT INFANTS 

H. Sakamoto, M. Ohtsu 

Kobe Childrens Hospital, Otolaryngology, KOBE, Japan 

e-mail: GED02037@nifty.com 

OBJECTIVES 

To describe the outcome of hearing using objective audiometry such as 

auditory brainstem response (ABR )and auditory steady-state response 

(ASSR )and the subjective audiometric test in extremely-low-birth-weight 

infants less than 1,000 g of birth weight. 

METHODS 

The subject is hearing ability evaluation infants 15 whom we followed up 

from 2002 through 2011.ASSR test using MASTER system (Bio-logic system 

Inc). Children were tested with ASSR (air and/or bone conduction) and ageappropriate 

behavioral tests. Some children tested with click-evoked auditory 

brainstem response (ABR) and otoacoustic emission (OAE). 

RESULTS 

A reaction less thing was nine of 15 cases by ABR screening 80dB clickevoked 

during the NICU hospitalization. As for the hearing ability threshold 

that became clear by follow-up, four moderate degrees sensorineural 

hearing loss was normal ranges five in nine that were reactionless by ABR 

screening.One of four cases that a response was seen in by ABR screening 

is moderate degree sensorineural hearing loss. Three cases were normal 

ranges.As a result of having observed the threshold change of nine ABR 

screening no response cases, one case was improved, and four patients 

showed estrangement of the threshold between threshold of ABR,ASSR 

and subjective audiometric tests such as pure tone audiometry. 

CONCLUSIONS 

When we use ABR and ASSR for the hearing management of extremelylow-birth-weight 

infants, it is necessary to consider the presence of the 

estrangement case with the subjective audiometric test.When we examine 

early cochlear implant, this fact shows that it is necessary to observe it 

more carefully. 

P 090 

EUROPEAN CONSENSUS STATEMENT ON HEARING 

SCREENING OF PRE-SCHOOL AND SCHOOL-AGE CHILDREN 

A. Piotrowska, H. Skarzynski, P. Kamyk, P. Skarzynski 

Institute of Physiology and Pathology of Hearing, Epidemiology and 

Screening Department, WARSAW, Poland 

E-MAIL: a.piotrowska@ifps.org.pl 

OBJECTIVES 

To present European Consensus Statement of Hearing Screening of Preschool 

and School-age children. The Consensus was brought before the 

European Union’s Member States as one of the documents welcomed during 

preparing and discussion of the Council conclusions “Early detection 

and treatment of communication disorders in children, including the use 

of e-Health tools and innovative solutions” 

METHODS 

A distinguished panel of experts discussed hearing screening of pre-school 

and school-age children during the 10th Congress of European Federation 

of Audiology Societies (EFAS), held in Warsaw, Poland, in 2011. The panel 

included experts in audiology, otolaryngology, communication disorders, 

speech language pathology, education and biomedical engineering. 

RESULTS 

Consensus was reached on thirteen points. Key elements of the consensus, 

are: 1) defining the role of pre-school and school screening programs in 

the identification and treatment of hearing problems; 2) identifying the 

target population; 3) recognizing the need for a quality control system in 

screening programs; 4) encouraging the appropriate authorities of the various 

countries involved to initiate obligatory hearing screening programs 

of pre-school and school-age children. 

CONCLUSION 

The European Consensus Statement on Hearing Screening of Pre-school 

and School-age Children is aimed to encourage the appropriate authorities 

of the various countries to initiate hearing screening programs of preschool 

and school-age children. 

P 091 

SCHOOL ACHIEVEMENTS IN CHILDREN WITH MINIMAL 

HEARING LOSS 

A. Piotrowska, A. Pilka, K. Kochanek, A. Lorens, J. Serafin-Józwiak, 

H. Skarzynski 

Institute of Physiology and Pathology of Hearing, Epidemiology and 

Screening Department, WARSAW, Poland 

E-MAIL: a.piotrowska@ifps.org.pl 

157

OBJECTIVES 

To assess the hearing status and it’s impact on educational problems of 

first and six grade children. 


Hearing pure tone threshold screening was performed in the group first 

and six-grade students from primary schools in the villages and small 

towns in western Poland and in Warsaw. School achievements were assessed 

with the use of the questionnaire administered to parents and 

teachers. The positive result of screening was defined as air conduction 

thresholds equal or more than the minimal hearing loss (MHL). MHL was 

defined as: unilateral sensorineural hearing loss (snhl), with average AC 

threshold (.5, 1, 2 kHz) of more than 20 dB in impaired ear; bilateral snhl, 

with average air AC thresholds between 20 and 40 dB (1, 2, 4 kHz) or highfrequency 

snhl, with AC thresholds greater than 25 dB at two or more frequencies 

above 2 kHz in one or both ears. 

RESULTS 

Positive results of pure tone threshold screening were obtained in 17% of 

tested children. Majority of this group constitutes individuals with minimal 

hearing loss. In the group educational problems were observed twice more 

frequently than in children with normal hearing as reported by parents. 

CONCLUSIONS 

The results indicate the substantial prevalence of the hearing problems 

and its negative consequences in school-aged children. 

P 092 

A CANDIDATE GENE APPROACH TO IDENTIFY MODIFIERS OF 

THE PALATAL PHENOTYPE IN 22Q11.2 DS PATIENTS 

J.C.C. Widdershoven 

Maastricht University Medical Center, Otolaryngology, MAASTRICHT, 


E-MAIL: josine.widdershoven@mumc.nl 

OBJECTIVE 

Cleft palate is one of the identifying features of 22q11.2 deletion syndrome 

(22q11.2DS) affecting about one third of patients. To identify genetic variants 

that increase the risk of cleft palate in 22q11.2DS patients, we performed 

a candidate gene association study in 101 patients with 22q11.2DS 

genotyped with the Affymetrix genome-wide human SNP array 6.0. 

METHODS 

Patients from Children’s Hospital of Philadelphia, USA and Wilhelmina 

Children’s Hospital Utrecht, The Netherlands were stratified based on 

palatal phenotype (overt cleft, submucosal cleft, bifid uvula). SNPs in 21 candidate 

genes for cleft palate were analyzed for genotype-phenotype association. 

In addition, TBX1 sequencing was carried out. Quality control and 

association analyses were conducted using the software package PLINK. 

158 

RESULTS 

Genotype and phenotype data of 101 unrelated patients (63 non-cleft subjects 

(62.4%), 38 cleft subjects (37.6%)) were analyzed. 39 SNPs on 10 genes 

demonstrated a p-value ≤0.05. The most significant SNPs were found on 

FGF10. However none of the SNPs remained significant after correcting 

for multiple testing. 

CONCLUSION 

Although these results are promising, analysis of additional samples will 

be required to confirm that variants in these regions influence cleft palate 

risk in 22q11.2DS patients. 

P 093 

PRENATAL DETECTION OF CLEFT LIP AND PALATE IS RISING 

W. Maarse, C.C. Breugem, A.B. Mink van der Molen 

Wilhelmina Kinder Ziekenhuis, Plastische Chirurgie/Schisisteam, 

UTRECHT, The Netherlands 

E-MAIL: w.maarse@umcutrecht.nl 

OBJECTIVES 

To systematically review the diagnostic accuracy of second-trimester transabdominal 

ultrasound in detecting orofacial clefts and additionally to evaluate 

detection in the region of Utrecht. 

METHODS 

Medline and Embase were searched to identify cohort studies and randomized 

trials in order to assess the detection rate by prenatal ultrasound 

of cleft lip and palate. In Utrecht a non-selected population was prospectively 

evaluated, namely all pregnant women who underwent routine second-trimester 

prenatal ultrasound screening in the Utrecht region during 

the 2-year period from January 2007 to December 2008. 

RESULTS 

In the selected studies there was considerable variety in the diagnostic accuracy 

of 2D ultrasound, with prenatal detection rates ranging from 9% to 

100% for cleft lip with or without cleft palate, 0% to 22% for cleft palate only 

and 0% to 73% for all types of cleft. In Utrecht a total of 38.787 pregnant 

women underwent ultrasound screening. Orofacial clefts were present in 

62 cases, an incidence of 1:624. The distribution of clefts was as follows: 29% 

cleft lip, 40% cleft lip with cleft palate, 27% cleft palate only. 39% per cent 

had associated anomalies, with most chromosomal defects found in the 

cleft lip with cleft palate and cleft palate only groups. Sensitivity was 88%. 

CONCLUSIONS 

The detection of cleft lip and palate by prenatal ultrasound is rising. Ultrasound 

screening has a high sensitivity in Utrecht. This has implications 

for counselling but also on our advice about karyotyping during pregnancy 

and cases of termination of pregnancy because of orofacial cleft.

P 094 

LONG TERM CLINICAL OUTCOMES IN CLEFT 

PALATE PATIENTS 

H. Kobayashi, T. Sakuma, N. Yamada, H. Suzaki 

Showa University, Otorhinolaryngology, TOKYO, Japan 

E-MAIL: hitomek@med.showa-u.ac.jp 

OBJECTIVE 

The purpose of this study was to investigate the long-term clinical outcomes 

in cleft palate patients. 

METHODS 

One hundred eight patients with cleft palate (CP) were investigated. If otitis 

media with effusion (OME) was diagnosed at 1 year of age, ventilation 

tube (VT) placement was performed with palatoplasty. The mastoid air 

cell area was checked by X-ray at 1 and 5 years. The clinical course from 

age 6 to the final examination (average 9.42 years) and the language development 

at 5 years were analyzed. 

RESULTS 

VT placements were performed in 41 CP patients (82 ears, 38 %) at 5 years 

of age or under. About 30% of patients treated by VT placement required 

myringotomy or VT re-placement at 6 years of age or over. Ninety-five percent 

of patients who had not been treated by VT insertion showed a favorable 

clinical course. Patients treated by VT insertion had significantly 

smaller mastoid air cell areas as measured at 1 and 5 years of age. No difference 

was found between the presence/absence of VT placement in language 

development. 

CONCLUSIONS 

VT placement should be positively undertaken in CP patients who have 

small mastoid air cell areas as measured at 1 years of age. It is considered 

that patients treated by VT placement at 5 years of age or under should be 

carefully followed up for OME even after 6 years of age. Measurement of 

the mastoid air cell area at the age of 1 year is useful for determining the 

therapeutic program. 

P 095 

OBSTRUCTIVE SLEEP APNOEA IN CLEFT PATIENTS: 

USE OF SLEEP STUDIES TO MODIFY RISK OF RESPIRATORY 

COMPROMISE IN THE PERI-OPERATIVE PERIOD 

J.E. Reilly, C. Russell, N. Gibson, T. Moores, A. Ray, M. Devlin, 

D.M. Wynne 

Royal Hospital for Sick Children Yorkhill, GLASGOW, United Kingdom 

E-MAIL: justicereilly@yahoo.com 

OBJECTIVES 

Children with cleft palate (CP) are at risk of obstructive sleep apnoea due 

to altered nasopharyngeal anatomy and upper airway resistance; however 

there are no current methods to accurately predict pre- and post-operative 

respiratory distress. This study investigates breathing patterns and cleft 

characteristics indicative of pre- and post-operative respiratory intervention 

in patients undergoing primary CP repair. 

METHODS 

A prospective analysis of all children presenting for primary repair in 2010 

compared pre- and post-operative sleep studies. We also evaluated the need 

for pre-operative airway adjuncts and post-operative High Dependency 

Unit (HDU) respiratory support. 

RESULTS 

Thirty-nine consecutive patients were studied (25 Female: 14 Male). Mean 

age at operation 9.2 months (range 6-24 months). Increased desaturation 

indexes were most common, but not exclusive to, Pierre Robin Sequence 

(PRS) both preoperatively (p=0.043) and postoperatively (p=0.045). PRS was 

also associated with greater need for pre-operative nasopharyngeal airway 

and/or tracheostomy (p=0.009), respiratory compromise in post-operative 

HDU (p=0.002), but not longer HDU stay. 

CONCLUSIONS 

Our experience is consistent with a recent UK Royal College of Paediatric 

Child Health report on disordered sleep physiology which recommends 

sleep study evaluation on craniofacial patients. As patients with PRS have 

a more unpredictable sleep breathing physiology, we recommend postoperative 

sleep studies to guide on-going therapy as breathing disturbances 

persist beyond cleft repair. Serial sleep studies may be used to 

indicate safer operating windows and support informed consent by highlighting 

patients likely to require post-operative respiratory support. 

P 096 

DOES PALATAL REPAIRTECHNIQUE AFFECT HEARING 

OUTCOMES IN CLEFT CHILDREN: A COMPARISON OF FURLOW 

PALATOPLASTY AND MID-LINE INTRAVELAR-VELOPALASTY 

D.M. Wynne 1 , C.J.H. Mccahill 2 , J. Macfie 2 , C.J.H. Russell 1 , 

M.F. Devlin 1 , A.K. Ray 1 

1 Royal Hospital For Sick Children, West of Scotland Cleft Service, 

GLASGOW, United Kingdom 

E-MAIL: david.wynne@nhs.net 


Cleft Palate results in abnormalities of anatomical orientation/function of 

the palatal muscles (levator and tensor palatini) arising form the cartilaginous 

portion of the Eustachian Tube(ET). It is hypothesized that differences 

in muscle dissection and repair techniques in the Furlow and Intra-velar 

159

veloplasties (IVVP) may result in altered ET function and audiological outcome. 

This study sought to investigate this issue. 

All patients with CP that were born between 2006 and 2010 were identified 

form the departmental database. After exclusions for syndromes and incomplete 

data 68 patients were available for study (35 IVVP, 33 Furlow). Retrospective 

review of hospital notes and audiological audit forms were 

undertaken. Data were recorded/analysed using commercially available software 

(Microsoft Excel). Continuous data were compared by student’s T-test. 

Audiometric thresholds were assessed at 500, 1000, 2000 and 4000Hz. No differences 

in mean age at palatoplasty (both 8 months) or audiological testing 

(both 17 months) were observed between the two groups. No differences in 

distribution of hearing loss across the tested thresholds or mean minimal 

response threshold (-31 to -34dB) were observed in this study (p = 0.27-0.91) 

Practicing cleft surgeons can reassure patients that no gross difference in audiological 

outcomes exist between these two palate repair methods. That 

said outcome form cleft repair is multi-factorial with speech being a major 

component. Currently in the UK hearing thresholds of less than -25dB are 

considered normal. No data exists to indicate whether hearing impairment 

below -25dB affects speech outcomes in cleft children. 

P 097 

ALLERGIC RHINITIS AND DENTAL CARIES 

M. Bakhshaee 1 , S. Sehatbakhsh 1 , S. Jafari Ashtiani 1 , 

M. Seyed Hossainzadeh 1 , F. Jabbari 2 , O. Saffari 1 

1 Ear Nose & Throat Research Center, MASHHAD, Iran 

E-MAIL: mehbakhsh@yahoo.com, 

2 Immunology Department, MASHHAD, Iran 

OBJECTIVES 

Dental caries is highly prevalent condition among children. Allergic rhinitis 

may cause mouth breathing and decrease mouth hygiene that subsequently 

leads some dental problems. In this study; we investigate the 

association between allergic rhinitis and dental caries, missing, and filling 

(DMF) among children with primary dentition. 

METHODS AND MATERIALS 

A cross-sectional study on 171 children was performed. The children also 

had a physical examination by an allergist and dentists. Allergic rhinitis 

was diagnosed according standard (ISSAC) questionnaire. DMF were obtained 

from dental examination by expert dentist through direct mouth 

examination. Children were classified as having dental caries if one or 

more teeth had decayed and/or had been filled or missed. Outcomes measures 

were feeding and oral habits, fluoride therapy, toothbrushing, passive 

smoking, socioeconomic status. Logistic regression analysis assessed the 

association between dental caries and independent variables. 

RESULTS 

171 children (84 boys and 87 girls) with mean age of 5.25±0.83 (range 4-6 

years old) were entered into the study. Thirty six of them had allergic rhini- 

160 

tis while 108 cases did not show any symptom of rhinitis. The mean DMF 

in children with AR was 5.06±3.77 and for those without this disorders was 

4.51±3.58; however DMF in AR was higher than normal children but this 

difference was not significant (P=0.339). 

CONCLUSIONS 

The present findings do not support the hypothesis that allergic rhinitis 

caused dental caries. However, more widespread studies need to perform 

for definite conclusion. 

P 098 

SNORING IN KINDERGARTEN CHILDREN AND 

DOMESTIC ENVIRONMENT 

D. Vicheva 

E-MAIL: dilyanav@yahoo.com 

INTRODUCTION 

The aim of this study was to investigate domestic environmental factors 

associated with snoring in kindergarten children. 

METHODS 

A respiratory survey was administered during March and April of 2011. 

One hundred and twenty five children from five kindergarten were recruited 

for the study. A sub-group of 69 children aged 4-6 years were further 

selected from this sample for domestic air pollutant assessment. 

RESULTS 

The prevalences of infrequent snoring in kindergarten children were 25.3% 

and 16.1% respectively. Passive smoking was found to be a significant risk 

factor for habitual snoring (odds ratio (OR) = 1.69; 95% confidence interval 

(CI): 1.28-2.54), while having pets at home appeared to be protective against 

habitual snoring (OR = 0.62; 95% CI: 0.36-0.89). 

CONCLUSION 

Snoring is common in kindergarten children. Domestic environments may 

play a significant role in the increased prevalence of snoring in children. 

P 099 

WHAT EFFECT HAS PNEUMOCOCCAL VACCINATION HAD 

ON ACUTE MASTOIDITIS? 

M. Daniel 1 , S. Gautam 2 , C. Meller 2 , B. Levin 2 , J. Curotta 2 

1 Children’s Hospital Westmead, Paediatric Otolaryngology, SYDNEY, 

Australia 

E-MAIL: m-daniel@runbox.com 

2 CHW, SYDNEY, Australia

OBJECTIVES 

Streptococcus pneumoniae is a frequent cause of acute mastoiditis (AM), 

but despite recent (2005) introduction of pneumococcal vaccination it has 

been suggested that incidence and severity of mastoiditis is increasing. 

We sought to determine whether incidence, severity, and microbiology of 

AM have changed over last 11 years. 

METHODS 

Retrospective review of AM children at our institution (2000-2010), comparing 

patients prior to introduction of vaccination (period 1, 2000-2004), 

around time of vaccine introduction (period 2, 2005-2007) and post-vaccination 

(period 3, 2008-2010). 

RESULTS 

84 children were reviewed, with average annual incidence of 8.4, 5 and 9 

children during time periods 1, 2 and 3. Pneumococcal isolates were seen 

in 40.5% in period 1, falling to 6.7% during period 2 but rising again to 29.6% 

during period 3. Highest recorded fever was 38.7, 38.8, and 38.2°C during 

the three periods, with leukocyte counts of 19.0, 14.4 and 15.5.x109/L. Incidence 

of intracranial complications was 11.9%, 0%, and 7.4% during the 

three periods. With respect to treatment, a trend towards shorter inpatient 

stays and shorter courses of intravenous antibiotics was noted in later years 

(5.9, 3.8 and 4.2 days during the three periods), with a reduction in number 

of children undergoing surgery (71.4%, 60.0% and 48.2%). 

CONCLUSION 

Incidence of pneumococcal mastoiditis appears to have fallen when vaccination 

was introduced, with a concomitant fall in overall incidence of 

mastoiditis and its intracranial complications. However, this appeared not 

to be sustained. Overall, there was no evidence of acute mastoiditis becoming 

more frequent or increasing in severity. 

P 100 

POPULATION-BASED STUDIES OF INVASIVE PNEUMOCOCCAL 

DISEASE IN DENMARK: CHILDHOOD RISK FACTORS 

T. Hjuler 1 , J. Wohlfarht 2 , A. Koch 2 , M.E. Melbye 2 

1 Rigshospitalet, ENT dept., COPENHAGEN, Denmark 

E-MAIL: Hjuler@dadlnet.dk 

2 Statens Serum Institut, COPENHAGEN, Denmark 

OBJECTIVES 

Invasive pneumococcal disease (IPD) is a serious health problem worldwide 

causing substantial morbidity and mortality. The main results from three 

epidemiological studies on IPD in Danish children are presented. 

METHODS 

Studies were conducted as registry-based nationwide epidemiological 

studies. Data were obtained from laboratory surveillance of IPD and other 

registries during 1977 to 2004. 

RESULTS 

Perinatal and crowding-related risk factors for IPD in young children were 

studied. Infants born preterm or with low birth weight were at increased 

risk of IPD. Having older siblings increased the risk of IPD in infants aged 

less than 6 months. In contrast, children aged 6-23 months who had older 

siblings were at reduced risk of IPD, indicating that they had obtained 

natural immunization from infection. Likewise children were at increased 

risk of IPD the first months after day care enrollment, but subsequently 

at a reduced risk. Children with cancer or chronic renal disease and those 

undergoing splenectomy or transplantation were particularly susceptible. 

IPD risk increased with the number of hospital contacts. An increased risk 

of IPD was observed the following 30 days after an RSV- or non-RSV respiratory 

hospitalization in children below two years. IPD did not increase 

the risk of RSV hospitalization. 

CONCLUSION 

Infection with S. pneumoniae occurs at an early age, IPD being a rare, but 

serious outcome. Naturally acquired immunization from infection occurs 

rapidly after exposure, but the primary infection may cause IPD. Young 

children with coincident upper respiratory tract infection or children with 

repeated hospitalizations are particularly susceptible. 

P 101 

SIALOENDOSCOPIC MANAGEMENT OF JUVENILE 

RECURRENT PAROTITIS 

G.A. Marciante, P. Capaccio, P.E. Sigismund, N. Luca 

IRCCS Ca’ Granda Ospedale Maggiore Policlinco di Milano, ENT, 

RHO, Italy 

E-MAIL: giuliaanna.marciante@gmail.com 

INTRODUCTION 

We aimed to evaluate the efficacy of sialoendoscopy in diagnosis and therapy 

of juvenile recurrent parotitis on the basis of our experience in 14 patients. 

METHODS 

14 children with at least 2 episodes/year of unilateral (8 patients) and bilateral 

(6 patients) JPR were enrolled for the study. All the patients underwent 

parotid sialoendoscopy (sialoendoscope of 0.8 mm) under general 

anesthesia. US and Dynamic MR sialography were also performed. Each 

patient underwent periodic follow-up evaluations (mean follow-up 30 

months; range 12-55). 

RESULTS 

Sialoendoscopy was effective in 9 cases; 5 patients experienced recurrence 

of symptoms, but only 3 subjects underwent a second sialoendoscopy. 

There were no complications. Interestingly, 6 children previously underwent 

adenotonsillectomy and 3 patients adenoidectomy; adenotonsillar 

hypertrophy was observed in the remaining 5 subjects, and cervical lym- 

161

phadenopathy occurred in all patients. During sialoendoscopy, main duct 

strictures and dilatation were found in all patients, Stensen kinks in 6 subjects 

and mucous plugs in 12 glands. 

CONCLUSION 

Compared to non invasive diagnostic tools, sialoendoscopy provides further 

information about morphology and causes of ductal obstruction; dilation 

of the restricted duct system and intraductal injection of steroids, 

which modulates the local immune response supposed to be involved in 

the pathogenesis of JRP, helps decreasing its recurrence. 

P 102 

THE EFFECTIVENESS OF VACCINATION PREVENAR IN 

CHILDREN WITH ALLERGIC DISORDERS 

S. Gubanova 1 , T. Polunina 2 , M. Galitskaya 2 

1 Scientific Center of Children’s Health, Russian Academy of Medical 

Sciences, MOSCOW, Russian Federation 

E-MAIL: svetlanagub@gmail.com 

2 Scientific Center of Children’s Health, MOSCOW, Russian Federation 

METHODS 

The study involved 42 children aged 1 to 5 years with allergic diseases: 35 

(83.3%) children with atopic dermatitis, 1 (2.3%) children with asthma, 6 

(14.4%) children with allergic rhinitis. Among children with allergic disorders 

in 20 (47.6%) children was diagnosed acute otitis media once, and 7 children 

(16.6%) - twice. Control group consisted of 34 children without allergic 

disease. Among them acute otitis media was observed in 15 (44.1%) children. 

OBJECTIVE 

To evaluate the effectiveness of vaccination Prevenar against acute otitis 

media and acute rhinopharyngitis in children with allergic disorders. 

Acute rhinopharyngitis diagnosed in both groups with equal frequency. But 

in children with allergic rhinopharyngitis proceeded more long-term (average 

10 days) than in the control group (mean 7 days). Children from 12 to 

23 months vaccinated twice with an interval of at least 2 months. Children 

from 2 to 5 years vaccinated once. The observation time averaged 12 months. 

RESULTS 

During the observation against the background of vaccination in children 

with allergic rhinitis decreased frequency (up to 1-2 cases per year) and duration 

(5-7 days) acute rhinopharyngitis. In the group of children with allergic 

disorders in the year after vaccination Prevenar acute otitis media was 

diagnosed in 1 child (2.3%). Local and general reaction to the vaccine in children 

with allergic disorders did not differ from that in the control group. 

CONCLUSIONS 

The high efficiency with respect vaccine Prevenar and its safety in children 

with allergic disorders. 

162 

P 103 

A RETROSPECTIVE OBSERVATIONAL STUDY ON THE 

CLINICAL USEFULNESS OF NASAL NITRIC OXIDE IN THE 

ASSESSMENT OF CHILDREN WITH ALLERGIC RHINITIS 

G. Rotiroti 1 , K. Coppens 2 , G. Scadding 1 , J. Gardner 2 , S. Deiratany 2 

1 Royal National Throat Nose and Ear Hospital, Allergy, LONDON, 


E-MAIL: grotiroti@yahoo.com 


BACKGROUND 

Nasal nitric oxide (nNO) measurement is a non-invasive method for assessing 

nasal inflammation. Few studies have been performed to address the clinical 

usefulness of nNO measurement in children with allergic rhinitis (AR). 

OBJECTIVES 

Obtain data in this population and explore the clinical utility of measuring 

nNO. The aim was to ascertain if severity of AR correlates with nNO-levels 

and evaluates the correlation between nNO, exhaled (e) NO and history 

of asthma. 

METHODS 

Retrospective analysis of 37 medical records of children (age 6-16) with AR, 

attending a paediatric Allergy-Rhinology clinic. 

RESULTS 

nNO level either below or above the normal range was recorded in 67 % of 

the studied patients; no correlation between nNO and severity of disease 

(classified according to ARIA) was found. Significant correlation was detected 

between nasal obstruction and nNO levels (p= 0.012), with lower 

levels recorded in children with significant obstruction. nNO-levels and 

Nasal Inspiratory Peak Flow (NIPF) measurement did not correlate. A significant 

correlation between nNO and eNO levels was found in children 

with associated asthma (p=0.0089, r=0.13). 

CONCLUSION 

nNO alone is not a sufficient tool to assess AR severity in children. It can 

however give additional information on the presence of inflammation with 

nasal obstruction. Our data confirms a strong association between the upper 

and lower airways and supports the united airway concept. Evaluating both 

the nasal and exhaled NO may provide a promising tool to assess the presence 

of both upper and lower airway inflammation in children with AR.

P 104 

THE USE OF BIPOLAR RADIOFREQUENCY INDUCED 

THERMOTHERAPY IN ALLERGIC RHINITIS IN CHILDHOOD 

D. Vicheva, M. Milkov 


Bipolar Radiofrequency Induced Thermotherapy (RFITT) started its development 

in 2000 year. A large number of surgical interventions are done 

during the last years using this therapy.Treatment of nasal breathing disorders 

due to allergic rhinitis in children is held successfully with this 

technique.Method and materials:32 reductions of the nasal inferior 

turbinate in children between 12 and 17 years old were done.The patients 

were examined with: rhinomanometry - 32 cases before and after the treatment, 

acoustic rhinomanometry - 32 cases (before and after), timpanometry 

in 32 cases. In 5 of the patients serous otitis was found. 

RESULTS 

The method is very useful for the treatment of allergic rhinitis in childhood. 

The authors found excellent results in 76% of the cases. The rhinomanometry 

and acoustic rhinometry shown improvement of the nasal 

obstruction. Discussion: Celons RFITT provides an effective,safe and user 

friendly solution for the treatment of hypertropfy of the turbinates. We 

found precise and reproducible results. 

CONCLUSIONS 

RFITT is a successful method of treatment of allergic rhinitis in coming 

generation. In all of the children we treat with antiallergic drugs. 

P 105 

WHAT CAN BE THE ROLE OF A PEDIATRIC 

OTORHINOLARYNGOLOGIST IN PRENATAL DIAGNOSIS? 

R. Nicollas 1 , R. Desbriere 2 , M. Capelle 1 , H. Heckenroth 1 , C. Chau 1 , 

S. Roman 1 , A. Farinetti 1 , J.M. Triglia 1 

1 Aix Marseille Universite, Pediatric Otolaryngology, Head and Neck 

Surgery, MARSEILLE, France 

E-MAIL: richard.nicollas@ap-hm.fr 

2 Fondation Hôpital Saint Joseph, MARSEILLE, France 

Prenatal diagnosis is being more accurate allowing the identification of 

smaller malformations. The goal of this work is to appreciate through our 

experience what can be the role of the otolaryngologist in a staff of prenatal 

diagnosis and the consequences of his advices and decisions. 

Over a 2-years-period, all the charts of pregnant women who were seen in 

prenatal otorhinolaryngological clinic were studied.15 women from 20 

through 39 weeks-term (wt) were referred to our prenatal clinic. In each 

case, complete information was provided to parents. In 13 cases, our advice 

was required for the prenatal and neonatal management of a malformation. 

All of them underwent US screening. 5 out of them underwent a fetal 

MR for a lymphatic malformation (n=4) or for an arhinia (n=1). In one case, 

the fetus had a moderate unilateral diaphragmatic hernia and the fetal 

MR supposed that he would have an important associated retrognathia 

with a potential very difficult intubation. The last case was that of a fetus, 

with a tracheal plug for a diaphragmatic hernia, whom mother had premature 

rupture of the amniotic sac at 34 wt. The malformations found in 

these fetuses were lymphatic malformations (n=4), bilateral dacryocystoceles 

(n=4), oropharyngeal teratoma (n=1), arhinia (n=1), thyroglossal duct 

cyst (n=1), choanal atresia with CHARGE association (n=1), and dermoid 

cyst of the medial canthus (n=1).In this it appears that our knowledge is 

required not only for congenital malformations by themselves but also to 

determine the best delivery strategy in non otolaryngological problems 

such as diaphragmatic hernia. 

P 107 

TWO CASES OF LARYNGEAL EDEMA AFTER ASPIRATION: 

ACCIDENTAL INGESTION OF CAUSTIC SUBSTANCES & 

THERMAL EPIGLOTTITIS AFTER SWALLOWING MILK 

S. Suto 

Okinawa chubu hospital, Otolaryngology and Head and Neck Surgery, 

URUMA CITY, Japan 

E-MAIL: qq2k5mcd@wish.ocn.ne.jp 

We often experience respiratory tract injury resulting from the inhalation 

of hot air and toxins. However, it is rare to encounter patients whose upper 

airway is compromised after the aspiration of caustic substances or hot 

beverages. We experienced two pediatric cases of laryngeal edema after accidental 

ingestion of caustic substances and hot milk. 

Case 1 was a two-year-old boy who ingested caustic substances accidentally. 

On arrival at the emergency department, he was not in acute distress, 

and wheeze and stridor were not auscultated. Sixty minutes after ingestion, 

emergency laryngoscope showed a markedly enlarged epiglottis. Tracheal 

intubation was performed, and glucocorticoid and cefotaxime were 

administered. Ten days after admission, follow-up laryngoscope revealed 

improvement of his swollen epiglottis, and he was successfully extubated 

without airway complication. 

Case 2 was a two-year-old boy who swallowed near-boiling milk. Soon 

after the ingestion, he began to vomit repetitively and visited the emergency 

department. On arrival, he was not in acute distress, and wheeze 

and stridor were not auscultated. Eight hours later, he developed hoarseness 

and emergency laryngoscope showed severe laryngeal edema and enlarged 

epiglottis. Tracheal intubation was performed, and he was 

transferred to the ICU. Three days later, follow-up laryngoscope revealed 

improvement of his swollen epiglottis, and he was successfully extubated 

without airway complication. 

163

CONCLUSION 

These two cases illustrates the potential for severe laryngeal edema after 

the aspiration of caustic substances or hot beverages. Recognition of the 

relationship between aspiration and laryngeal edema is critically important 

to initiate proper management for preventing airway obstruction. 

P 108 

PLASTIC BRONQUITIS DEBUTING AS A BRONCHIAL FOREIGN 

BODY FOREIGN BODY 

I. Gutiérrez González, A. Gómez Torrez, A. Mochon Martin, 

F.J. Sanchez Malagon, F. Esteban Ortega 

Hospital Universitario Virgen del Rocio, SEVILLA, Spain 

E-MAIL: ingermang@hotmail.com 

OBJECTIVE 

The aim of this clinical case was to show the clinical features and the management 

of plastic bronchitis in a 10 year old boy without any of the classical 

risk factor where the diagnosis was not easy 

METHODS 

We present the case of 10 year old boy with clinical picture characterized 

by persistent dry cough and left thorax pain, with an unclear episode of 

foreign body ingestion .The PA chest radiograph shows a left hemithorax 

veiling. A CT scan revealing massive pulmonary atelectasis evident on that 

side. Suspicion of bronchial foreign body is present. 

RESULT 

A rigid bronchoscopy is performed and compact material drawn fibrinopurulent 

left main bronchus. The patient clinical picture reappeared 3 

times, requiring 3 new rigid bronchoscopy. Pathologic examination 

showed eosinophils mucofribinoide material. The diagnosis of plastic 

bronchitis is made and the patient is treated with steroid, mucolytics, 

there hasn´t been new atelectasis. 

CONCLUSION 

Plastic bronchitis is a challenging pathology where you got to have a high 

index of suspicion specially in children with risk factor such as heart diseases, 

this is an atypical case without any important risk factor , is essential to point 

out the role of rigid bronchoscopy in the management of this disease. 

164 

P 109 

A CASE REPORT OF LYMPHANGIOMA OF TONSILS 

IN CHILDREN 

F. Ramirez, I. Arruti, J. Bonaut, P. Rodriguez, J. Zubicaray 

Otorrinolaringologia, PAMPLONA, Spain 

E-MAIL: fernandoalbertoramirez@hotmail.com 

Most of the palatine tonsil tumors are squamous cell type. A tumor in a 

child suggests tonsillar lymphoma. Lymphangioma is a benign tumor of 

lymphoid tissue characterized by the formation of cysts growing rapidly. 

Symptoms depend on the size, the most common are dysphagia, airway 

obstruction and pain. 

9 Year old girl who presented dysphagia 9 months of evolution, nasal respiratory 

failure and nocturnal snoring with a break of apnea. To explore 

and hypertrophic tonsils in the lower pole of the amygdala right is a cystlike 

tumor mass, not ulcerated. Is performed by dissection tonsillectomy 

tonsils, removing the right amygdala with the tumor in its entirety. The 

histopathological diagnosis was cystic lymphangioma tonsil simple. The 

outcome was favorable, without remission of the tumor. 

We present a rare case of a benign tumor of the right palatine tonsil, caused 

respiratory obstructive dysphagia. We consider this case of great importance, 

because in the world there are very few published cases, and in children 

has been even rarer. Unlike other parts of the body, where lesions 

frequently recur in our patient has not relapsed. When compared to the 

only published case in the world of this disease symptoms were the like, 

except that in our case the growth was faster and had more respiratory 

symptoms. As in the published cases, the postoperative patient was good. 

The tonsil Lymphangioma is a rare clinical entity, more common in adults, 

which presents with dysphagia and respiratory obstruction. Their treatment 

is tonsillectomy, with excision of the lesion. 

P 110 

FACIAL AND HYOID CHARACTERISTICS IN PRE-SCHOOL 

CHILDREN WITH OSAS 

C.P. Valera 1 , B. Vieira 2 , E. Itikawa 2 , A. Almeida 1 , S. Sander 1 , 

T. Anselmo-Lima 1 

1 School of Medicine of Ribeirão Preto - University of São Paulo, 




2 School of Dentistry of Ribeirão Preto - University of São Paulo, 

RIBEIRÃO PRETO, Brazil 

OBJECTIVES 

To evaluate the facial and hyoid characteristics inpre-school children with 

Obstructive Sleep Apnea Syndrome (OSAS) by lateral cephalography.

METHODS 

15 nasal breathing children were compared to 14 children with OSAS, all 

of them with ages ranging from 03 to 06 years and with deciduous dentition. 

Exclusion criteria included previous or simultaneous otorhinolaryngologicsurgery 

and orthodontic and myofunctional treatments. Inclusion 

criterion was otorhinolaryngologic evaluation. All children with OSAS also 

underwent to a nocturnal polysomnographic exam. 

RESULTS 

Facial bony characteristics did not differ between groups in such a young 

age range. In regard to hyoid bone, it was significantly in a more inferior 

position in OSAS group when compared to controls. 

CONCLUSIONS 

These results suggest that hyoid position is altered in OSAS patients in 

even such young group. This finding reinforces the importance of hyoid 

bone position and OSAS, either through direct relationship between these 

two conditions, or through facilitating OSAS persistence in adulthood. 

P 111 

WHAT DO PARENTS DO WITH THEIR CHILDREN’S SORE 

THROAT BEFORE CONSULTING A DOCTOR? 

N. Argyriou 1 , I.B. Bardanis 2 

1 Hippokratio General Hospital of Thessaloniki, ENT, 

NEAPOLI THESSALONIKI, Greece 

E-MAIL: nektarios_argyriou@yahoo.com 

2 General Hospital of Ikaria, IKARIA, Greece 

INTRODUCTION - OBJECTIVE 

Usual medical papers refer to treatments proposed by doctors to parents 

for their children’s sore throat. This paper aims at searching what parents 

do before medical consultation. 


Every parent who visited the outpatient ward of our ENT department accompanying 

a child suffering from sore throat through the last two years 

is included in this study. Each parent was personally asked by an ENT doctor 

what he/she had already done with his/her child’s sore throat before 

visiting us. 

RESULTS 

Seventy-six parents and consequently 76 children are included in this study. 

Fourteen did nothing before visiting us. Forty-six children were administered 

paracetamol. Hot beverages of different kinds were offered as relief to 

21 children. Throat soothing candies were used by 11 children. An antibiotic 

(amoxicillin) prior to medical consultation was administered only to one kid. 

CONCLUSION 

Though politicians and journalists, as well as some doctors, often speak 

about the overuse of antibiotics, parents, at least on the island of Ikaria, 

do not use antibiotics for their children unless prescribed by physicians. 

P 112 

COMPLEMENTARY MEDICINES FOR THE TREATMENT 

OF CHILDREN’S ALLERGIC RHINITIS 

F. Macrì, M. Moretti, V. Massaccesi, I. Peparini, E. Rotunno, V. Tromba 

‘Sapienza’ University of Rome, Pediatrics, ROME, Italy 

E-MAIL: profmacri@gmail.com 

GOALS 

Illustrating therapeutic opportunities of Complementary Medicines in 

children’s ORL. 

METHODS 

All the available literature is examined: Colin and Launso showed a good 

clinical response in patients affected by allergic respiratory diseases who 

have been treated with homeopathic therapy. Reilly published positive outcomes 

which had resulted from patients affected by allergic rhinitis and 

treated with homeopathic allergen dilutions by documenting their improvement 

through rhinomanometry. Furthermore, personal data about 

children’s allergic rhinitis treatment are displayed. Two groups of children, 

suffering from allergic rhinitis (A and B) have been assessed. The A group 

has been treated with conventional therapy according to recent Guidelines, 

whereas the B group has undergone complementary therapies (fitotherapy 

and homeopathy). Fitotherapy products comprise Rosa Canina and Ribes 

Nigrum, disguised as a glyceric compound, whilst homeopathic remedies 

have been chosen according to the individualization’s rules. 

RESULTS 

With a 6-to 12-month follow up, the A group showed a remarkable improvement 

in symptoms in 80% of cases as to 6 months, and in 70% of cases 

as to 12 months. Within the B group, percentages have been equal to 68% 

and 52%, respectively. An important result was also a 50% reduction of expenses 

for the National Health Service. 

CONCLUSIONS 

Complementary Medicines are effective in the treatment of children’s allergic 

rhinitis, and imply noticeable savings in pharmaceutical expenditure. 

This confirms data shown by Christopher Smallwood, reporting an 

expenditure savings at 30-40% within those Hospitals where Complementary 

Medicines are used in UK. 

165

P 113 

FOREIGN BODY ASPIRATIONS IN GEORGIA: 

RESULTS OF 30-YEAR EXPERIENCE 

D. Gregori 1 , P. Gvetadze 2 , I. Chkhaidze 2 

1 University of Padova, PADOVA, Italy 

166 

E-MAIL: dario.gregori@unipd.it 

2 M.Iashvili Central Children Hospital, TBILISI, Georgia 

OBJECTIVE 

Foreign body aspirations are the cause of the majority of accidental deaths 

in childhood. Diagnostic delay will cause an increase in mortality and morbidity. 

METHODS 

Bronchoscopy was performed in 2896 patients with the diagnosis of foreign 

body aspirations in Tbilisi M.Iashvili Central Children Hospital from 1980 

to 2011. Diagnosis was made on history, physical examination, radiology 

and bronchoscopy. 

RESULTS 

There were 61% of patients younger than 3 years of age. In 53 children (1.8%) 

foreign bodies were localized in larynx, in 150 patients (5.2%) in trachea 

and in 2693 patients (93%) in bronchus (of which the 59% in the right main 

bronchus). The majority of aspirated objects (86%) were organic in nature, 

mainly food (nuts, walnuts, sunflowers, watermelon and pumpkin seeds, 

bones parts, etc.). The rest were non organic (parts of plastic toys, beads, 

small nails and needles). Foreign bodies were removed with rigid bronchoscopy 

in 2841 cases (98.1%), in 34 patients (1.1%) the first bronchoscopy 

was unsuccessful, so it became necessary to perform procedure second time 

and in 21 (0.7%) patients with severe complications surgery was done. In 

these 21 patients lodgments lasted longer than 1 month, occurring foreign 

body migrations, bronchiectasis and abscess. In these patients foreign objects 

were needles (11), bones (6) and grains (4). No significant differences 

were observed comparing above figures with those of the Susy Safe International 

Registry (www.susysafe.org). 

CONCLUSIONS 

Distribution of FB in Georgia is overlapping international patterns. Longer 

lodgment time is associated with complications and requires more invasive 

extraction procedures. 

P 114 

EVALUATING OF THE EFFECTIVENESS OF 

ADENOTONSILLECTOMY IN CHILDREN WITH 

OBSTRUCTIVE SLEEP APNEA 

C.S. Miura, C. Brotto, L. de Azevedo, H. Sander, F.C.P. Valera, 

W.T.A. Lima, E. Tamashiro 

Hospital das Clínicas de Ribeirão Preto, RIBEIRÃO PRETO, Brazil 

E-MAIL: carolinamiura@yahoo.com.br 

OBJECTIVE 

To evaluate the effectiveness of adenotonsillectomy in the treatment of 

OSAS in children and clarify factors that may be associated with the presence 

of residual OSA after surgery. 


A prospective study with 15 children in the average age of 6.21 ± 2.19 years, 

with clinical and polysomnographic OSA who underwent adenotonsillectomy. 

Preoperative assessment and postoperative follow-up with clinical 

history, nasal endoscopy and polysomnography. 

RESULTS 

There was significant improvement of symptoms and polysomnography 

with adenotonsillectomy (OAHI preoperative average of 11.66 and OAHI 

postoperative average of 1.64, P

Acute parotitis is a rare disease in the neonatal period. Risk factors implicated 

in its pathogenesis are prematurity and dehydration. Staphylococcus aureus 

is the most common bacterial agent. The diagnosis is clinical. Treatment 

consists of intravenous antibiotics and surgery is reserved for complications. 

The prognosis is favorable with rare recurrence.The authors describe a case 

of a term newborn, male, with 8-day-old, diagnosed with acute parotitis. 

P 116 

THE EVOLVING ROLE OF THE PAEDIATRIC ADVANCED 

NURSE PRACTITIONER 

J. Williams, K. Tzifa 

Birmingham Children’s Hospital, ENT, BIRMINGHAM, 


E-MAIL: jo_williams 2 @sky.com 

METHODS 

There are very few paediatric nurse specialists/practitioners in the United 

Kingdom. Historically, they have been heavily involved in tracheostomy 

care. At Birmingham Children’s Hospital, this is not the case. The Advanced 

Nurse Practitioner (ANP) runs her own nurse led clinics on a daily basis. 

Some of the clinics are general clinics, such as general dressing clinics and 

skin prick testing for allergy clinics. As the ANP role has evolved, nurse led 

clinics for patients with Bone Anchored Hearing Aids and also aural care 

clinics have been established. As her skills and experience have improved 

the ANP has been able to offer an aural care service to patients whose primary 

condition may not be an Otorhinolarngological disease. She has a cohort 

of patients who present with the skin condition Ichthyosis. 

RESULTS 

Establishing these nurse led clinic for children with Ichthyosis supports 

the general well being of the child. 

CONCLUSIONS 

The role of the paediatric Advanced Nurse Practitioner has many opportunities 

and is always evolving. 

P 117 

WEBB-BASED INFORMATION FOR TONSILLAR SURGERY 

E. Ericsson 1 , C. Hemlin 2 , A.C. Hessén Söderman 3 , E. Hultcrantz 4 , 

K. Roos 5 , O. Sunnergren 6 , J. Stalfors 7 

1 Nursing Science Faculty of Health Sciences Linköping, Department 

of Medical and Health Sciences, LINKÖPING, Sweden 

E-MAIL: elisabeth.ericsson@liu.se 



4 Division of ENT, LINKÖPING, Sweden 


6 County Hospital Ryhov, JÖNKÖPING, Sweden 

7 Sahlgrenska University Hospital, GÖTEBORG, Sweden 

OBJECTIVES 

The National Tonsil Surgery Register in Sweden shows that a large proportion 

of patients operated with tonsillectomy (20%) or tonsillotomy (5%) 

have had unplanned contacts with the healthcare after surgery. Improved 

patient information might decrease this need for postoperative consultations. 

The aim of this presentation is to present a structured work process 

to create and assess the effect of patient information. 

METHODS 

Already existing patient information pamphlets regarding tonsil surgery 

were collected from 55 clinics offering tonsil surgery. A national patient 

information was created thereafter from evidence based literature and 

common praxis. This information sheet was tested and adjusted in 3 clinics. 

A webpage was also created, where the information aimed to children 

is told through a narrative story with illustrations. Information to parents 

and adults is mainly in writing with illustrations. Through the National 

Tonsil Surgery Register in Sweden, 80% of all operated patients answer a 

questionnaire after 30 days where one question is if they have used the internet-based 

patient information. 

RESULTS 

The patient information can now be found on www.tonsill.se in the 

Swedish language. Whether the internet-based information will reduce 

the frequency of postop contacts with healthcare is now possible to assess 

year by year through the National Tonsil Surgery Register in Sweden. Work 

is underway to translate the information to additional languages so as to 

reach those living in Sweden who need a translator in connection with 

tonsil procedures. 

167

P 118 

MUCOPOLYSACCHARIDOSES TYPE II: AIRWAY 

MANIFESTATIONS AND PROBLEMS WITH TRACHEOSTOMY 

V. Malik, J. Nichani, M.T. Rothera, J.E. Wraith, S. Jones, I.A. Bruce 

Royal Manchester Children’s Hospital, ENT, BOLTON, United Kingdom 

E-MAIL: malikvik@yahoo.com 

INTRODUCTION 

Mucopolysaccharidoses type II (MPS II) is a rare lysosomal storage disorder 

characterised by cellular deposition of the gylcosaminoglycans (GAGs) 

within the respiratory, nervous, cardiovascular and musculoskeletal systems. 

Affected children have normal physical appearance at birth and are 

often seen by otolaryngologists before definitive diagnosis is made. Upper 

airway obstruction is present in majority of these patients and is often 

progressive involving multiple levels. The tracheostomised MPS II children 

reported here are the largest such series described to date. 

OBJECTIVES 

To describe airway manifestations and discuss the ascending ladder of 

treatment modalities in progressive airway compromise in MPS II patients. 

We also discuss the indications and complications of tracheostomy tube 

insertion in MPS II patients. 

METHODS AND MATERIAL 

Retrospective study of 8 MPS II patients who required tracheostomy to 

manage progressive airway compromise. 

RESULTS 

The mean age at which tracheostomy was performed was 9 years 8 months 

(range 4years 6months to 28years 10months). Non-invasive ventilation 

(CPAP) was used in three patients. Six patients underwent adenotonsillecotmy 

to improve upper airway obstruction. Infratip and suprastomal 

granulations were the most common complications of tracheostomy and 

the management will be discussed. 

CONCLUSION 

Progressive upper airway obstruction is a common feature of MPS II. These 

children should be managed in specialist units, but an awareness of the 

anatomical features and potential difficulties accompanying general 

anaesthesia is mandatory for all otolaryngologists. Tracheostomy is a very 

effective way of managing airway obstruction when less invasive interventions 

are no longer adequate, but it is not without complications. 

168 

P 119 

CONVENTIONAL TONSILLECTOMY: 

WORTH KEEPING IN MIND? 

A.S. Araujo Da Costa, J.M. Meléndez García, M.I. Hamdan Zavarce, 

T. Rivera Schmitz, J. Araujo, E. Pallas, D. Alonso Parraga 

Hospital Xeral-Cies, VIGO, Spain 

E-MAIL: anaaraujocosta@hotmail.com 

OBJECTIVES 

In our experience cold steel dissection followed by diathermy electrocautery 

is an old but effective and non expensive, approach that should 

not become obsolete. Our goal is to put in evidence the importance of cold 

blade dissection in management protocols that ENT residents are taught. 

METHODS 

A retrospective study with 1358 pediatric patients submitted to tonsillectomy 

with or without adenoidectomy between 2005 and 2011. We distributed 

the patients in two groups according to age: five years old or younger 

in group one (1002 patients) and ages from six to fifteen years old in group 

two (358 individuals). Data of each patient was carefully reviewed analyzing 

the incidence of bleeding post intervention requiring surgical revision 

under general anesthesia, risk factors involved and pain visual analog scale. 

We compare our results with those found in literature concerning other 

surgical techniques outcomes. 

RESULTS 

The incidence of post tonsillectomy hemorrhage in our study was of 0, 

66%, and the mean pain score was 2.2 ±1.1. Postoperative bleeding was 

mostly secondary (78%) and higher incidence in group one (73, 7%). More 

frequent with recurrent tonsillitis as the indication for surgery (78%) and 

the right side being the most affected (56%). 91% of the procedures were 

performed by residents. 

CONCLUSIONS 

Cold dissection is a safe procedure with low incidence of post tonsillectomy 

hemorrhage and good results concerning post operative pain. It’s important 

to learn and practice this technique not only for its results but also 

because it remains available in any tertiary academic setting. 

P 120 

THROAT-RELATED SYMPTOMS AND CHRONIC TONSILLITIS 

HISTOLOGY 

R. Pribuisiene, A. Kuzminiene, I. Rasteniene, I. Minkeviciene, V. Sarauskas 

Lithuanian University of Health Sciences, Otolaryngology, KAUNAS, 

Lithuania 

E-MAIL: rutaprib@yahoo.com

OBJECTIVES 

To assess the dependancy of throat-related symptoms and histological 

changes in chronic tonsillitis children. 

METHODS 

Histological examination of removed palatal tonsilla, throat -related complaints, 

tonsillitis range, pharyngeal signs (tonsillar hypertrophy, pus and 

debris in crypts, enlargement of regional lymphonodes) as well as values 

of ASO titre of consecutive 24 children aged 2-14years (mean 7.8, SD 3.7) 

was analysed in ENT departament of Lithuanian University of Health Sciences. 

Tonsillitis index was calculated according K. Fujihara. 

RESULTS 

Tonsillitis episodes ranged from 0 to 6( mean range 2.7 (SN 2.1) times per 

year. Mean tonsillitis index 13.2 (SD 7.5) was detected as pathological (> 8) 

in 57 % of cases. Snoring (87.5%) was predominant complaint. Regional lymphadenopathy 

(58.3%) and tonsillar hypertrophy II-III grade (87.5%) were 

most common pharyngeal signs of chronic tonsillitis. Type II (chronic inflammation) 

and III (chronic inflammation and lymphoid tissue hyperplasia) 

of histological finding according to T. Ripplinger were predominant, 

respectively 29.2 and 66.8 %. The mean of ASO was 226.9 (SD 275.1) u/L. No 

statistical significant correlations between histological findings and throat 

-related complaints, tonsillitis range, pharyngeal signs and ASO value was 

found. Logistic regression showed that tonsillitis range more 3 times per 

year, snoring, tonsillar hypertrophy and regional lymphadenopathy are 

the most important throat-related symptoms justifying chronic tonsillitis 

in children (p

CONCLUSION 

Combined topical (2% solution of Protargolum) and systemic antifungal 

(Fluconazole) therapy is effective for fungal eradication in children with 

chronic fungal adenoiditis. 

P 123 

A NEW INDICATION FOR TONSILLECTOMY? 

PFAPA SYDROME: REVIEW OF OUTCOMES AND 

EFFECTIVENESS OF TREATMENT 

C.A. Paul, J.D. Ramsden 

John Radcliffe Hospital, Department of Otolaryngology & Head & Neck 

Surgery, OXFORD, United Kingdom 

E-MAIL: cibapaul@gmail.com 

INTRODUCTION 

PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and 

cervical adenitis syndrome) is a rare clinical syndrome of unknown cause 

usually identified in children. Its incidence is unknown. Evidence for its 

treatment with tonsillectomy exists. 

METHODS 

6 patients have been diagnosed prospectively with PFAPA syndrome. They 

have all been treated with tonsillectomy. The outcomes were analysed and 

compared to the literature. 

RESULTS 

The 6 patients ranged in age from 3 to 11 at the time of surgery. All had 

complete resolution of periodic fevers following surgery. No abnormalities 

were identified on histopathological analysis of the tonsils. 

CONCLUSION 

PFAPA syndrome is a rare cause of regular, repeated episodes of fever, sore 

throat and swollen neck glands in children. It is a diagnosis that needs 

confirmation by paediatricians working in centres with expertise in this 

condition and most children who suffer from a lot of sore throats and tonsillitis 

will not have it. However, tonsillectomy is an effective treatment 

for PFAPA syndrome. 

P 124 

POST TONSILLECTOMY AND/OR ADENOIDECTOMY 

HEMORRHAGE 

M. Iovanescu, G. Marin, S. Ruja, I. Horhat, F. Gidea, G. Vintila, 

C. Anglitoiu, F. Cotulbea 

University of Medicine and Pharmacy, TIMISOARA, Romania 

E-MAIL: giovanescu@gmail.com 

170 

OBJECTIVES 

Adenoidectomy and amigdalectomy continues to be the most executed surgical 

procedures in otolaryngology practice. Episodes of post-adenotonsillectomy 

hemorrhage are unpredictable and potentially life-threatening. 

Primary hemorrhage (24 hr). In 

this cohort study we evaluated the occurrence of post-operatory hemorrhage 

in adenoidectomy and amigdalectomy performed in the ENT Clinic 

Bega. 

METHODS 

We retrospectively analyzed 1120 patients submitted to adenoidectomy 

and/or tonsillectomy in our clinic between 2006 to 2011, who had been 

hospitalized for at least 3 days. 

RESULTS 

In this study, 5 out of 1120 patients presented post-operative hemorrhage 

(0,53%), of which 3 occurred mainly after the first 24 hours of the surgical 

procedure and required diathermy bipolar application for hemostasis, (one 

post-tonsillectomy, one post-adenoidectomy and one post- adenotonsillectomy) 

and 2 occurred in the first 24 hours after surgery required posterior 

packing.(post-adenoidectomy). 

CONCLUSION 

We observed that the incidence of post-operatory hemorrhage was 0,53% (25% 

of which were primary hemorrhage and 75% were secondary hemorrhage). 

P 125 

TONSILLAR BIOFILM-PRODUCING BACTERIA IN CHILDREN 

WITH CHRONIC TONSILLITIS: RELATIONSHIP WITH THE 

GRADE OF TONSILLAR HYPERTROPHY 

S. Torretta 1 , L. Drago 2 , P. Marchisio 3 , S. Bianchini 3 , E. Nazzari 3 , 

L. Pignataro 1 

1 University of Milan, Dept. of Specialistic Surgical Sciences, 

MILAN, Italy 

E-MAIL: sara.torretta@gmail.com 

2 University of Milan, Dept. of Clinical Sciences, MILAN, Italy 

3 University of Milan, Dept. of Maternal and Pediatric Sciences, MILAN, 

Italy 

OBJECTIVES 

It has been suggested that bacterial biofilms are involved in chronic tonsillar 

disease, but there is a lack of strong evidence concerning their 

etiopathogenic role in childhood chronic tonsillar infections. The aim of 

this study was to assess the presence of biofilm-producing bacteria (BPB) 

in tonsillar bioptic specimens taken from children with chronic tonsillitis, 

and to evaluate the possible relationship between them and the patients’ 

demographic and clinical characteristics.

METHODS 

The presence of tonsillar BPB was assessed by means of the spectrophotometric 

analysis of tonsillar bioptic specimens taken from 22 children (68.2% 

males; median age 6.5 years, range 3-13) with chronic tonsillitis during 

tonsillectomy between episodes of tonsillar infection. 

RESULTS 

BPB were found in 50.0% of the 44 tonsillar specimens, and S. aureus was 

the most frequent pathogen (81.8%). The only significant relationship was 

between the grade of tonsillar hypertrophy (GTH, assessed according to 

Brodsky) and the presence of tonsillar BPB (p = 0.02, Fisher’s exact probability 

test), with an increased relative risk (RR 4.27, standard error 4.57, p 

neck masses. Our study shows no statistical differences between US and 

CT in diagnosing deep neck space abscess. Further, based on lesion location, 

US may improve diagnostic accuracy. 

P 128 

AUDIT TO EVALUATE THE DISCHARGE TIME AFTER 

TONSILLECTOMY IN CHILDREN 

J. Sooby, J. Jones, T. Kamani, E. Rea 

University Hospitals of Leicester, Accident and Emergency, 

LEICESTER, United Kingdom 

E-MAIL: paulsooby@doctors.org.uk 

OBJECTIVES 

The aim of this audit was to measure the number of children requiring 

an overnight admission following (adeno)tonsillectomy, and to identify 

the reasons for admission. 

METHODS 

Data was collected retrospectively from operations performed between 

January 2011 and August 2011. Whole population figures were obtained 

and 50 case notes were reviewed (25 day cases and 25 requiring over-night 

stay), 

RESULTS 

59.7% (163/273) patient having tonsillectomy/adenotonsillectomy discharge 

same day. 40.3% (110/273) had an overnight stay, 3 patients staying 

for two nights. All patients going home the same day were planned as day 

case procedures. Of the 25 notes reviewed for overnight stays, the reason 

for admission were identified as; Surgical preference 16% (4/25), Co-morbidity 

16 % (4/25), Nursing concerns 30% (7/25), pain 16% (4/25), other 16% 

(4/25) No reason identified 8 %(2/25). 

CONCLUSIONS 

There remains the potential for a greater number of day case tonsillectomies 

to be performed. The most common nursing concerned raised was 

patients not eating and drinking postoperatively, possibly linked to pain 

control. We note significantly non-consistent analgesic regimens between 

the day case and overnight groups, especially with respect to perioperative 

medications. Identifying poor pain control early could lead to a reduction 

in the number of children requiring overnight admission. Further analysis 

of surgical preference and no reason identified cases could yield further 

opportunities to reduce over-night admissions. We recommend a standardised 

pain control regimen for children undergoing tonsillectomy and 

the creation of an escalation protocol for inadequate pain control. We intend 

to re-audit in 6 months time. 

172 

P 129 

RISK FACTORS FOR UPPER RESPIRATORY INFECTION IN THE 

FIRST YEAR OF LIFE IN A BIRTH COHORT 

V. Vedantam, R. Isaac, A. Manoharan, R. Jalagandeeswaran, 

K. Thenmozhi 

Christian Medical College, Vellore, ENT, VELLORE, India 

E-MAIL: rupavedantam@cmcvellore.ac.in 

OBJECTIVES 

Upper respiratory infection (URI) in infants is one of the commonest 

causes of morbidity among infants and older children. We studied the incidence, 

risk factors and association between URI and nasopharyngeal colonization 

with S.pneumoniae in the first year of life in a rural South Indian 

population. 

METHODS 

A birth cohort of 210 babies was evaluated at monthly intervals for 1year 

to note the incidence of URI and nasopharyngeal colonization with S. 

pneumoniae. 

RESULTS 

The incidence of URI increased with age peaking at 72% in the 9th month. 

URI incidence was maximum in winter (65%). Nasopharyngeal colonization 

with S.pneumoniae increased with age peaking at 46.3% in the 7th 

month of life. There were 3 major risk factors for URI in the first year of 

life, viz., winter season (p

OBJECTIVE 

To report epidemiological data on the prevalence of malocclusion among 

a group of children, consecutively admitted at a referral mouth breathing 

otorhinolaryngological (ENT) center. We assessed the association between 

the severity of the obstruction by adenoids/tonsils hyperplasia or the presence 

of allergic rhinitis and the prevalence of class II malocclusion, anterior 

open bite and posterior crossbite. 

METHODS 

Cross-sectional, descriptive study, carried out at an Outpatient Clinic for 

Mouth-Breathers. Dental inter-arch relationship and nasal obstructive 

variables were diagnosed and the appropriate cross tabulations were done. 

RESULTS 

Seven hundred and forty two patients were included. Mean age was 6.6±2.6 

years, ranging from 2 to 12 years. Adenoid/tonsil obstruction was detected 

in 69% of this sample, regardless of the presence of rhinitis. Allergic rhinitis 

alone was found in 24.1% of the children. Non-obstructive mouth breathing 

was diagnosed in 6.9% of this sample. Posterior crossbite, anterior open 

bite and class II malocclusion were detected in almost 30% of the children 

during primary and mixed dentitions. More than 50% of the mouth 

breathing children carried a normal inter-arch relationship in the sagital, 

transversal and vertical planes. Univariate analysis showed no significant 

association between the type of the obstruction (adenoids/tonsils obstructive 

hyperplasia or the presence of allergic rhinitis) and malocclusions. 

CONCLUSIONS 

Prevalence of class II malocclusion, anterior open bite and posterior crossbite 

were higher than in general population. The obstructive size of adenoids 

or tonsils and the presence of rhinitis are not risk factors to the 

development of such malocclusions. 

P 131 

DENTOFACIAL VERTICAL CHANGES FOLLOWING 

ADENO/-TONSILLECTOMY: CHANGING CONCEPTS? 

H.M. Becker 1 , L.P. Franco 1 , C.L. Pereira 2 , M.M. Tinano 2 , J.A. Pinto 1 , 

M.L. Ribeiro 1 , B.Q. Souki 2 

1 Federal University of Minas Gerais, Otolaryngology, 

BELO HORIZONTE, Brazil 

E-MAIL: leticiafranco@uol.com.br 

2 Pontifical Catholic University of Minas Gerais, BELO HORIZONTE, 

Brazil 

OBJECTIVE 

The aim of this study was to investigate one year prospectively, in mouth 

breathing children, the impact on dentofacial vertical growth of adeno/tonsillectomy 

(T&A) to normalize the mode of respiration in comparison 

to untreated mouth breathing controls. 

METHODS 

Linear and angular cephalometric measurements, as well as superimposing 

tracings of serial lateral cephalograms of 39 patients in the treatment 

group were compared with those of the 31 untreated mouth breathing 

controls. Cephalometric record in the treatment group comprised registrations 

made at baseline before surgery (T0), and then at approximately 

1 year post-operatively (T1). Corresponding registrations were available 

for the control group, with a baseline cephalometric radiograph taken approximately 

1 year before the second one (T0 and T1, respectively). 

RESULTS 

Statistically significant growth (p

symptoms persisted. Subsequent CT scan indicated a large thin walled 

parapharyngeal / retropharyngeal abscess, hence formal incision and 

drainage was performed. During this procedure three large level II lymph 

nodes were excised. The abscess did not yield pus and an incisional biopsy 

was taken. Concurrent trans-oral aspiration was also negative. Post-operatively 

MRI demonstrated a thick walled deflated abscess cavity. On H&E 

staining Reed-Sternberg cells suggested lymphoma and DNA in-situ hybridisation 

(DISH) identified EBV. Further immunohistochemical stains 

allowed differentiation between lymphoma and infection. Retrospectively 

EBV blood serology was found to be positive for both IgM and IgG. 

CONCLUSIONS AND LESSONS LEARNED 

EBV infection can be difficult to differentiate from lymphoma unless the 

pathologist is a specialist in this field. Correct diagnosis is essential to prevent 

inappropriate treatment with chemotherapy. In this case DISH and 

immunohistochemical stains PAX-5, CD15 and EMA allowed for an accurate 

diagnosis 

P 133 

MANDIBULAR ROTATION AND ANGULAR REMODELING 

CHANGES IN MOUTH BREATHING CHILDREN WITH 

ADENO/-TONSILLAR HYPERTROPHY 

H.M. Becker 1 , L.P. Franco 1 , C.L. Pereira 2 , M.M. Tinano 2 , J.A. Pinto 1 , 

T.B. Pereira 2 , B.Q. Souki 2 

1 Federal University of Minas Gerais, Otolaryngology, 

BELO HORIZONTE, Brazil 

E-MAIL: leticiafranco@uol.com.br 

2 Pontifical Catholic University of Minas Gerais, BELO HORIZONTE, 

174 

Brazil 

OBJECTIVE 

The aim of this study was to investigate the mandibular rotation pattern 

in untreated mouth breathing children, with severe obstruction of the 

upper airways by adeno/-tonsillar hypertrophy, comparing to the 

mandibular rotation in nasal breathing children. 

METHODS 

Linear and angular cephalometric measurements, as well as superimposing 

tracings of serial lateral cephalograms of 31 children in the mouth 

breathing group (MBG), with surgical indication (adeno/-tonsillectomy), 

were compared with those of the 55 nasal breathing controls (NBG). The 

age of the children in both groups was matched. Cephalometric record in 

the MBG comprised registrations made at baseline and then at approximately 

1 year (T1), with no treatment during this period. Corresponding 

registrations were available for the control group (NBG), with a baseline 

cephalometric radiograph taken approximately 1 year before the second 

one (T0 and T1, respectively). The 31 mouth breathing children had severe 

adeno/-tonsillar hypertrophy and were waiting for surgical authorization 

by the public health system. 

RESULTS 

After 1 year observation, by superimposing tracings of the cephalograms, 

the true mandibular rotation was -0.97 , the apparent rotation was -0.65 

and the angular remodeling was 0.32 in the MBG. In the NBG, the true 

mandibular rotation was -1.40 , the apparent rotation was 0.32 and the 

angular remodeling was 1.07 . There was no statistically difference between 

the mandibular rotation in both groups. 

CONCLUSION 

The results indicate that in this group of mouth breathing children, with 

severe obstruction of the upper airways, the mandibular rotation was similar 

to the one of the nasal breathing children. 

P 134 

CLINICAL SYMPTOM CORRELATES OF ASSESSED ADENOID 

PATHOLOGY IN OME 

K. Trzpis 1 , M. Haggard 2 , H. Spencer 2 , E. Hassmann 1 

1 Medical University of Bialystok, Pediatric Otolaryngology, 

BIALYSTOK, Poland 

E-MAIL: Krzysztof_trz@op.pl 

2 University of Cambridge, CAMBRIDGE, United Kingdom 

OBJECTIVES 

Past studies relating dimensions of the adenoid tissue to clinical severity 

have given inconsistent results. We tested the idea that simple first-order 

relationships could exist but may have been obscured by inappropriate 

measures, or complex relationships not adequately tested. 

METHODS 

We adapted an existing assessment proforma to give a 7-level category scale 

for degree of obstruction of choanae by adenoid and a yes/no category for 

abutting eustachian tube (ET). Initially 58 cases were assessed under anaesthetic 

by two surgeons producing high inter-observer agreement, then a 

further 46 cases were assessed in this way by a single surgeon. We concentrate 

on two reliable outcome markers: HL, and the score from 6 items on 

severity and frequency of recent URTI history in OM8-30. Each of these 

measures was modeled with multiple linear regression. 

RESULTS 

For URTI, ET alone gave a significant relationship univariately (p = 0.013), 

but this was displaced by the much stronger adenoidal obstruction effect 

(p < 0.0000005). The overall regression slope was 0.5 of sample SD in URTI 

score per unit of 1/6th whole scale, flattening slightly over high obstruction 

values. For HL, we failed to confirm an initial suggestion of abutting 

ET as predictor and found no systematic linear prediction of HL at all. 

CONCLUSIONS 

Adenoid size relates strongly to strength of recent URTI history so may be 

assumed to be aetiologically related; its prediction of several related health

outcomes and selection for adenoidectomy benefits to URTI provides a coherent 

account. Optimal indicators can now be addressed. 

P 135 

SUPPURATIVE COMPLICATIONS OF UPPER RESPIRATORY 

TRACT INFECTIONS IN CHILDREN: 12 YEAR EXPERIENCE 

AT SINGLE INSTITUTION 

I.J. Fernandez, I. Pelligra, O. Piccin, G. Macrì, C. Bergonzoni, D. Saggese 

Otorhinolaryngology Department of the University of Bologna, 

BOLOGNA, Italy 

E-MAIL: ignafernandez@yahoo.it 

OBJECTIVE 

To review our experience with suppurative complications of upper respiratory 

tract infections (URIs) in children, given a perceived increase in both 

the incidence and the number of cases requiring surgical intervention in 

recent years. 

METHODS 

Retrospective analysis of medical records of pediatric patients (0-18 years) 

discharged from our hospital with diagnosis of suppurative complications 

of URIs. Cases from 2000 to 2005 were compared with those from 2006 to 

2011. Outcome measures included the frequency of infections, site of infection, 

microbiology and type of treatment. 

RESULTS 

A total of 195 patients with complicated URIs were retrieved. We observed 

orbital and intracranial complications of acute sinusitis (n 24), otomastoiditis 

(n 41), peritonsillar abscesses (n 68) and neck spaces abscesses (n 

62). The frequency of infections has increased in the second six years, controlling 

for cases volume. The greatest increase was in otomastoiditis and 

orbital complications of acute sinusitis. The number of neck abscesses has 

not changed, but surgical interventions have doubled in the second six 

years. No changes in bacteriology was noted between the two periods. 

CONCLUSION 

Recent data suggest that complications of URIs in children are increasing. 

Antibiotic restriction policy, antibiotic resistance and spread of more invasive 

pathogens have been advocated to explain this trend. Our experience 

seemed to confirm the increasing incidence, but it does not clarify the role 

of the antibiotic resistance and bacteriological changes because of the 

paucity of organisms isolated. Population-based studies and a regular surveillance 

of local microbiological data are required to verify these issues. 

P 136 

ROSAI-DORFMAN DISEASE (SINUS HISTIOCYTOSIS WITH 

MASSIVE LYMPHADENOPATHY) CAUSING MASSIVE TONSILS 

MANIFESTING WITH OBSTRUCTIVE SLEEP APNOEA 

A. Yassin, T.A. Mawby, L. Penny, K. Shah 

John Radcliffe Hospital, ENT, OXFORD , United Kingdom 

E-MAIL: anharyassin@hotmail.com 

OBJECTIVES 

We present a case of Rosai-Dorfman disease manifesting with massive tonsils 

causing obstructive sleep apnoea. 

METHODS 

A two year old boy presented with hearing impairment and a history of 

obstructive sleep apnoea (OSA). A sleep study confirmed OSA and audiometry 

showed a persistent conductive hearing loss and type B tympanometry 

consistent with glue ear. He subsequently proceeded to an adenotonsillectomy 

and bilateral grommet insertion. He was also noted to have small 

bilateral cervical lymphadenopathy. Intra-operatively his tonsils were 

noted to be firm and were sent for histology. 

RESULTS 

Histology confirmed Rosai-Dorfmen disease. This is only the seventh reported 

case of Rosai-Dorfmen disease within the tonsil and the first associated 

with massive tonsils causing obstructive sleep apnoea. 

CONCLUSION 

Rosai-Dorfman disease is a rare finding in the tonsils especially in the absence 

of significant cervical lymphadenopathy. However extra-nodal manifestations 

are commonly seen within the head and neck. Management is 

often conservative but needs to be tailored to the site and extent of the disease. 

In this case following surgery the patients snoring has resolved and he 

has no other clinically apparent manifestations of Rosai-Dorfman Disease. 

P 137 

OCCURRENCE OF STREPTOCOCCUS PNEUMONIAE IN 

ADENOID TISSUE IN PRESCHOOL CHILDREN WITH 

RECURRENT UPPER RESPIRATORY INFECTIONS IN POLAND 

A. Niedzielski, I. Korona-Glowniak, A. Malm, G. Niedzielska 

Medical University of Lublin, Department of Pediatric Otolaryngology, 

LUBLIN, Poland 

E-MAIL: arturniedzielski@wp.pl 

OBJECTIVES 

Streptococcus pneumoniae (SP) is one of the major bacterial pathogens colonizing 

nasopharynx, and often cause upper respiratory tract infections 

175

in children. We investigated prevalence of SP in nasopharynx in children 

aged 3-5, who had gone adenoidectomy for recurrent pharyngotonsilitis; 

serotypes and antibiotic resistance patterns of the isolated pneumococci 

were determined. 

METHODS 

Nasopharyngeal swabs were obtained before adenoidectomy and after the 

surgery, the adenoid was swabbed with sterile alginate-tipped applicator. 

Swabs were inoculated on selective Mueller-Hinton agar with 5% sheep 

blood and gentamicin. SP were identified by colony morphology, susceptibility 

to optochin and bile solubility, and confirmed by slide agglutination 

test. Serotyping was determined by Quellung reaction, while 

antimicrobial susceptibility - according to EUCAST. 

RESULTS 

SP colonization was observed in 40 (70.2%) children. SP from nasopharynx 

and adenoid core was obtained from 29 children, only from adenoid core 

- in 8 children and only from nasopharynx - in 3 children. The most frequent 

was serotype 19F (25.5%). Serotypes belonged to pneumococcal conjugated 

vaccines - PCV13 and PCV10 constituted 59.6% and 51.9% of isolates, 

respectively. SP resistance to co-trimoxazole (52.9%), tetracycline (43.1%), 

erythromycin (52.9%), clindamycin (51.0%) or chloramphenicol (43.1%) was 

found; 45.1% of isolates had decreased susceptibility to penicillin. Multidrug 

resistance was present in 52.9% of isolates. 

CONCLUSIONS 

High SP carriage rate in children with recurrent pharyngotonsilitis was 

observed. The isolated peumococci showed high level of non-susceptibility 

to antibiotics. Good vaccine coverage among the isolated pneumococci 

confirmed the validity of the introduction of PCVs in the national immunization 

programme. 

P 138 

A NEW INDICATION FOR TONSILLECTOMY? 

PFAPA SYNDROME - REVIEW OF OUTCOME AND 

EFFECTIVENESS OF TREATMENT. 

C.A. Paul, J.D. Ramsden 

John Radcliffe Hospital, Department of otolaryngology & head & Neck 



OBJECTIVES 

PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and 

cervical adenitis syndrome) is a rare clinical syndrome of unknown cause 

usually identified in children. Its incidence is unknown. Evidence for its 

treatment with tonsillectomy exists. 

176 

METHODS 

6 patients have been diagnosed prospectively with PFAPA syndrome. They 

have all been treated with tonsillectomy. The outcomes were analysed and 

compared to the literature. 

RESULTS 

The 6 patients ranged in age from 3 to 11 at the time of surgery. All had 

complete resolution of periodic fevers following surgery. No abnormalities 

were identified on histopathological analysis of the tonsils. 

CONCLUSION 

PFAPA syndrome is a rare cause of regular, repeated episodes of fever, sore 

throat and swollen neck glands in children. It is a diagnosis that needs 

confirmation by paediatricians working in centres with expertise in this 

condition and most children who suffer from a lot of sore throats and tonsillitis 

will not have it. However, tonsillectomy is an effective treatment 

for PFAPA syndrome. 

P 139 

STUDY OF TONSILLECTOMY TECHNIQUES AND 

COMPLICATIONS AT A TERTIARY CHILDREN’S HOSPITAL 

G. Narasimhan 




OBJECTIVES 

To identify the different techniques adopted by surgeons for tonsillectomy, 

identify complications according to technique adopted and the rates of 

complications. Also to identify rates of day case surgery from this data and 

to compare day case rates according to the technique adopted. 

METHODS 

A prospective case series of all children admitted for tonsillectomy (with 

or without adenoidectomy), from August 2010- 2011. Database created to 

gather information from case notes for each patient relating to procedure 

performed, technique used, complications, and day case rate. Comparisons 

studied between techniques used and complication rates. The day surgery 

outcome correlated to different techniques. 

RESULTS 

The total number of tonsillectomies entered into the database during this 

period was 325. The three techniques for tonsillectomy used at our hospital 

are coblation, cold steel dissection and bipolar diathermy. The number of 

patients for each technique corresponded to 96, 188 and 34 respectively. 

The complications documented in this study were bleeding (44), poor feeding 

(14) and desaturation episodes (23). Of the 325 procedures undertaken, 

137 achieved day case (42%). Of these, 48 (51%) were post Coblation, 80 (43%) 

post cold steel, and 9 (26%) after bipolar Diathermy.

CONCLUSIONS 

Cold steel dissection was the most common tonsillectomy technique performed, 

with bipolar diathermy being undertaken the least. Bleeding complication 

rates were highest for bipolar diathermy (21%) and lowest for cold 

steel dissection (9%) with coblation coming in between at 

Day case surgery was highest in coblation (51%) followed by cold steel dissection 

(43%) and bipolar diathermy (26 %). 

P 140 

INCIDENCE AND TREATMENT OF SUBGLOTTIC LARYNGITIS 

IN CHILDREN TREATED IN THE PEDIATRIC 

OTOLARYNGOLOGY CLINIC IN POZNAN, POLAND, 

BETWEEN 1972 - 2011 

M.W. Grzegorowski, J. Kolasinska-Lipinska, J. Szydlowski, P. Beata 

Medical University Poznan, Pediatric ENT, POZNAN, Poland 

E-MAIL: grzegorowski@esculap.pl 

After the second World War in Poland a lot of children died of laryngeal 

croup caused by Corynebacterium diphtheriae. And then in regions with 

great air pollution some children died of laryngotracheobronchitis maligna.These 

diseases are no longer present. 

The third very severe laryngeal disease today is acute epiglottitis. A significant 

drop in this disease is related to the introduction of vaccines. However, 

the most common disease in children is subglottic laryngitis. No 

child admitted to our department since the second half of the 1970s presenting 

with this disease required intubation. There are many factors 

which promote this disease, among others: viral infections(in the influenza 

season), variable atmospheric conditions, especially their sudden 

change, a child’s gender, age, socio-economic status, allergy, family histiory 

of the disease, individual features e.g.the adrenals working patterns. 

Apparently, atmospheric pressure significantly affects the respiratory mucosa 

of infants and small children. Our experience shows high atmospheric 

pressure to cause a marked decrease in subglottic laryngitis incidence. 

Moreover, the disease is also less common in children living away from 

the cities. 

One thousand eight hundred fifty six children hospitalized in our Clinic 

in the years 1972-2011 entered the study. The ratio of boys to girls was 2:1. 

Seventy five per cent of the children were younger than 3 years. The 

youngest boy was 6 months, the oldest 11.5 years old, the youngest girl 

was 4 months old and the oldest was 8 years old. 

P 141 

PREVALENCE OF RESPIRATORY VIRUSES IN CHILDREN WITH 

CHRONIC TONSILLITIS 

C.P. Valera, L. Proença-Modena, G. Jacob, P. Buzatto, T. Saturno, J. Souza, 

F.E. Paula, E. Tamashiro, E. Arruda, T. Anselmo-Lima 

School of Medicine of Ribeirão Preto - University of São Paulo, 




OBJECTIVES 

Little is known about the role of respiratory viral infections in the development 

of adenotonsillar chronic inflammation. 

METHODS 

We detected the common respiratory viruses by TaqMan real time PCR 

(qPCR) in nasopharyngeal secretions, peripheral blood, and in theadenotonsillar 

tissues of children who were undergoing adenotonsillectomy. 

Exclusion criterion included symptoms of acute respiratory infections on 

the previous month. 

RESULTS 

Of 121 patients analyzed, 118 (97.52%) had at least one viral agent detected. 

The viral co-infection rate was 67.77%. The viruses most detected were: 

human adenovirus (HAdV) in 47.11%, human enterovirus (HEV) in 40.49%, 

human rhinovirus (HRV) in 38.02%, human bocavirus (HBoV) in 29.75%, 

human metapneumovirus (HMPV) in 17.35% and human respiratory syncytial 

virus (HRSV) in 15.70%. Results of qPCR varied widely between sample 

sites. HAdV, HBoV and HEV were predominantly detected in tissues 

(80% of HAdV- HBoV- and HEV-positive patients had theirs virus detected 

in tonsils and adenoids).Eleven out of 49 HEV-positive patients had HEV 

detectable exclusively in palatine tonsil tissue, but not in nasopharyngeal 

secretion or the adenoid. Viruses were not detected in peripheral blood. 

We also observed an almost significant association between viral detection 

and the size of adenoids and tonsils lymphoid tissues. While persistence/ 

latency of DNA viruses in adenotonsillartisues is already known, such has 

not been the case for respiratory RNA viruses, as HEV and HRV. Persistence 

of viruses in tonsils may stimulate chronic inflammation and play a role 

in the pathogenesis of chronic adenotonsillar diseases. 

P 142 

RHINOSCLEROMA: A CASE REPORT 

C. Loh, A. Kinshuck, J. Mcpartland, A.C. Swift, A.J. Donne 

Alder Hey Children’s NHS Foundation Trust, LIVERPOOL, 


E-MAIL: vv@fissure.org 

177

OBJECTIVES 

Rhinoscleroma is a rare, chronic, granulomatous disease of the upper respiratory 

tract that is caused by Klebsiella rhinoscleromatis infection. 

The majority of cases reported have been mainly from countries in Africa, 

the Middle East, India, south-east Asia, and Central and South America. 

METHODS 

We report a rare case of rhinoscleroma in a 12 year old girl in the United 

Kingdom who presented with a history of nasal obstruction, nasal discharge 

and episodes of epistaxis. Flexible nasoendoscopy revealed a mass 

in the post nasal space. The patient had an examination under anaesthetic 

where a mass was found which was attached to the posterior edge of the 

nasal septum. This lesion was removed en-masse transorally. 

RESULTS 

Histopathological analysis of the lesion showed it to consist of stroma covered 

by respiratory-type epithelium. The underlying stroma showed a 

prominent infiltrate of large CD68 positive histiocytes with granular 

eosinophilic cytoplasm that is occasionally vacuolated. The histiocytes 

were S100 negative, ruling out a diagnosis of Rosai Dofrmann disease. The 

histiocytes had the characteristics of Mikulicz cell of rhinoscleroma. 

DISCUSSION 

The diagnosis of rhinoscleroma requires a high index of suspicion and clinicopathological 

correlation. Our patient did not travel to any endemic areas 

and did not have any evidence of immunodeficiency. The patient was treated 

with oral ciprofloxacin for 3 months post-operatively. As rhinoscleroma is 

known to relapse, our patient continues to be followed-up and there is no 

endoscopic or radiological evidence of relapse 12 months post-operatively. 

P 143 

BODY WEIGHT STATUS AND OBSTRUCTIVE SLEEP APNEA 

IN CHILDREN 

H. Hsu 1 , K. Kang 2 , W. Weng 1 , L. Lee 1 

1 National Taiwan University Hospital, Otolaryngology, TAIPEI, 

Taiwan 

E-MAIL: hsuwc@ntu.edu.tw 

2 Taipei Hospital, Department of Health, TAIPEI, Taiwan 

OBJECTIVES 

To evaluate the relationship between body weight status and obstructive 

sleep apnea in children. 

METHODS 

Children younger than 18 years old with sleep disturbances were divided 

into four groups: underweight, normal weight, overweight and obese by 

using the age and gender corrected body mass index (BMI). Sleep parameters 

from over-night polysomnography (PSG) and surgical outcomes between 

different weight statuses were analyzed. 

178 

RESULTS 

Total 197 children were included from 2006 to 2011. Children in obese and 

underweight status had a significantly higher apnea-hypopnea index (AHI) 

than children with normal weight. There was a negative correlation between 

BMI z scores and lower minimum oxygen saturation (MinSaO 2 ). The risk of 

having OSA was significantly higher in obese children and underweight children 

than in those with normal weight. Among children received surgeries 

(adenotonsillectomy), despite different weight status, improvements in AHI 

and lower minimum oxygen saturation (MinSaO 2 ) were observed in all these 

four groups post-operatively. There were 30 children (26.8%, 30/112) with 

residual OSA. The proportion of residual OSA in obese group was 52% and 

was significantly higher than all other three groups. Weight changes after 

surgery were documented while half of underweight children shifted to normal 

weight status within 6 months after surgery. 

CONCLUSIONS 

Obesity and underweight status are associated with children having OSA. 

Sleep parameters improved in all weight status but obese children had 

higher incidence of residual OSA post-operatively. About half of underweight 

children showed weight status changes to normal weight after 

surgery. 

P 144 

PULSE OXIMETRY STUDIES IN THE MANAGEMENT OF 

PAEDIATRIC SLEEP RELATED BREATHING DISORDERS 

BEFORE AND AFTER ADENOTONSILLECTOMY 

O. Olaleye 1 , M. Zolotar 2 , R. Mugdal 2 , N. Calthorpe 2 , M. Weller 2 , 

N. Molony 2 

1 West Midlands Otolaryngology Rotation, Otolaryngology, 

Head & Neck Surgery, WARWICK, United Kingdom 

E-MAIL: dejolaleye@yahoo.com 

2 Russells Hall Hospital, DUDLEY, United Kingdom 

INTRODUCTION 

Sleep related breathing disorders (SRBD) are very common in children. 

Pulse oximetry studies can be used to manage these children with possible 

sleep apnea peri-operatively. 

OBJECTIVES 

To demonstrate the usefulness of sleep studies in the management of children 

with SRBD as well as adenotonsillectomy outcomes. 

METHODS 

Retrospective review of sleep studies and clinical notes of children with 

SRBD seen in a UK ENT department between 2008 and 2010 (inclusive). 33 

children with SRBD that had both pre- and post-operative sleep studies 

were included in the study (total 66 sleep studies). The cohort was stratified 

using the validated McGill oximetry scoring system into inconclusive, 

mild, moderate and severe OSA groups before surgery and compared with

their post-operative scores for improvement. Data was recorded on Excel 

spreadsheets and analysis performed using SPSS v.17. 

RESULTS 

Pre-operatively the cohort was classified successfully based on the McGill 

oximetry scores into normal/inconclusive (8), mild (14), moderate (6) and 

severe (5) groups. 20 of the 33 children (60.6%) with OSA had improved postoperatively 

shown by a change in their pre-operative McGill oximetry classification 

to a better grade e.g. severe to normal. There was ‘no change’ in 

grade for 5 children and a less favourable grade in 8 children. 29 of the 33 

children (87.9%) had symptomatic improvements reported by parents postoperatively. 

Significantly, even among the 8 children who had worse 

McGill scores post-operatively, 7 reported symptomatic improvement. 

CONCLUSION 

This study demonstrates objective improvement on sleep studies following 

adenotonsillectomy which correlates with subjective improvements 

reported by parents. 

P 145 

AIR-GUN PELLET INJURY OF THE NECK LEADING TO 

MEDIASTINITIS 

T. Erdag, E. Dogan, T. Koroglu, A. Ikiz 

Dokuz Eylul University School of Medicine, IZMIR, Turkey 

E-MAIL: taner.erdag@deu.edu.tr 

Air-gun pellet injuries of the neck are rare but dangerous events. 

Here we report a 9-year old boy transferred to our unit after 24 hours following 

tracheotomy performed in an other hospital because of a shot in 

the left side of lower neck. Neck exploration revealed a small perforation 

of nearly 5 mm, 1 cm inferior of the left pyriform sinus. After it was repaired, 

the pellet was removed from the anterior wall of the 7th vertebra. 

Although drains were placed in neck for irrigation and aspiration besides 

intense antibiotherapy, a fistula leading first a retropharyngeal infection 

and then mediastinitis developed a few days later. The neck was explored 

again after one week from the first operation as the drains were obliterated 

with thick pus. The changed drains were obliterated again after 2 days and 

open wound care under sedation was begun and continued for 46 days. 

The patient who had gastrostomy was started oral feeding after 70 days 

and discharged 92 days after the injury. In this case report, we reviewed 

the management of this kind of injury leading to deep neck infection and 

mediastinitis. 

P 146 

PFAPA SYNDROME: THE ROLE OF TONSILLECTOMY 

D.L. Grasso, A. Degrassi, G. Pelos, E. Orzan 

IRCCS ‘Burlo - Garofolo’ Children Institute, ENT, TRIESTE, Italy 

E-MAIL: grasso@burlo.trieste.it 

PFAPA syndrome (Periodic fever, aphthous stomatitis, Pharyngitis and 

Adenitis) was described for the first time by Marshall in 1978. Usually, fever 

lasts some days up to a week. In the free of disease period, patients show 

no pathological feature. The syndrome arises around the first year of life 

and it is self limiting when the child is six years old. The causes are unknown. 

Diagnosis is based upon responsiveness to the steroid therapy. 

Tonsillectomy has been advocated as alternative and effective therapy for 

symptoms resolution, even though the debate is still open. The authors 

present 102 cases with PFAPA who underwent tonsillectomy, in order to 

evaluate the clinical outcomes 

Clinical and genetic data from 102 patients with periodic fever were collected. 

All patients did not show any mutation for the mevalonatekinase deficiency, 

Tumor Necrosis Factor receptor associated periodic fever and Mediteranean 

familiar fever. Diagnostic criteria for PFAPA were applied. All patients underwent 

tonsillectomy and a two year follow up. Patients affected by PFAPA 

rarely show symptoms as abdominal pain, diarrhoea, vomiting, arthralgia 

and skin rash. Tonsillectomy was effective in 97 patients with total resolution 

of symptoms, elongation of the free period between the crisis occurred in 4 

patients, while only in one patient no benefit was evident. 

PFAPA syndrome is a very clear clinical entity, easily recognizable from the 

other periodic fever syndromes. Tonsillectomy represents the therapeutic 

option with the highest probability to stop the recurrence of symptoms. 

P 147 

EXHALED BIOMARKER PATTERN IN CHILDREN WITH 

OBSTRUCTIVE SLEEP APNEA 

P. Benedek 1 , Z. Lazar 2 , A. Bikov 2 , L. Kunos 2 , I. Horvath 2 , G. Katona 1 

1 Heim Pal Childrens Hospital, ENT, BUDAPEST, Hungary 

E-MAIL: dr.benedek.palma@gmail.com 

2 Semmelweis University, BUDAPEST, Hungary 

OBJECTIVES 

Postoperative respiratory complications occur in 5% to 25% of children with 

OSAS undergoing adenotonsillectomy. Airway inflammation was investigated 

in children with OSAS only in a limited number of studies. The 

non-invasive analysis of exhaled volatiles by sensor arrays such as electronic 

noses offers a novel method to assess inflammation-related metabolic 

changes and oxidative stress. We aimed to study the exhaled volatile 

organic compound (VOC) pattern by an electronic nose in children with 

OSAS and healthy controls. 

179

METHODS 

Twenty children with OSAS (age 7.9 ± 2.1 yrs) and thirteen control subjects 

(10.4 ± 2.9 yrs) were recruited. Exhaled breath VOC pattern was recorded 

with Cyranose 320 (Smiths Detection) and analyzed off-line using principal 

component analysis. Mahalanobis-distance classification method and logistic 

regression analysis with receiver operating characteristic (ROC) curve 

were performed on principal components. 

RESULTS 

Exhaled biomarker pattern in OSAS patients discriminated from that of 

control subjects using the Mahalanobis method (Wilks’ lambda=0.825; 

p=0.02, cross-validation accuracy: 67%). Logistic regression analysis yielded 

73% classification accuracy and ROC curve analysis (area under the curve: 

0.78) showed 80% sensitivity, 67% specificity and the positive and negative 

predictive values were 67% and 76%, respectively. 

CONCLUSIONS 

In this first preliminary study, we show that the analysis of exhaled 

volatiles by electronic nose is feasible in children. Exhaled biomarker pattern 

is altered in children with OSAS suggesting enhanced lower airway 

and/or systemic inflammation in OSAS. Electronic nose analysis of exhaled 

volatiles could provide additional information for the clinicians about 

lower airway inflammation in children with OSAS. 

P 148 

T14 VERSUS CHQ PF28 FOR CHILDREN WITH 

ADENO-TONSILLAR PATHOLOGY 

Z. Awad 1 , C. Rennie 2 , M. Vatrika 3 

1 Imperial College, ENT, LONDON, United Kingdom 

E-MAIL: zaid.awad@gmail.com 

2 GOSH, LONDON, United Kingdom 

3 Whipps Cross Hospital, LONDON, United Kingdom 

The 14-item Paediatric Throat Disorders Outcome Test (T14) is a diseasespecific, 

parent-reported outcome measure for children with throat disorders. 

It has not been tested as a quality of life measure for these 

conditions. The Child Health Questionnaire, Parent Form 28 (CHQPF28) 

is a popular, generic quality of life measure that has been validated and 

used for many paediatric conditions including adenotonsillar pathology. 

Parents of 146 children undergoing tonsillectomy or adenotonsillectomy 

at three London hospitals completed both T14 and CHQPF28 questionnaires. 

We also inquired about the number of episodes of acute tonsillitis 

a child suffers from each year. Their scores were analysed to measure correlation 

between the two tests and investigate the usefulness of the T14 

as a measure of the impact of adenotonsillar pathology on children’s 

health. 

While the T14 score, especially its infective part, correlated well with the 

number of episodes of tonsillitis children have (Spearman rs=0.5 p

P 150 

A SINGLE BLIND CONTROLLED STUDY COMPARING BIPOLAR 

ELECTROCAUTERY TONSILLECTOMY TO COLD DISSECTION 

METHOD IN PEDIATRIC AGE GROUP 

S.T. Chetri, S. Bhandary, A. Nepal, R.R. Joshi, S. Koirala 

Institute of Health Sciences, DHARAN, Nepal 

E-MAIL: dr_shyamtha@yahoo.com 

BACKGROUND 

Tonsillectomy is one of the most frequently performed pediatric operations 

in otorhinolaryngology.There are many proven methods of tonsillectomy 

including bipolar electrocautery and cold dissection method.In 

spite of all the new surgical tools and techniques haemorrhage is still a 

significant complication during and after tonsillectomywhich become 

more so important in controlling haemostatsis in pediatric age group. 


This was a prospective single blind controlled study conducted at ENT 

Department of B.P.Koirala institute of health science,Dharan from august 

2010 to august 2011. Results of the two groups i.e. tonsillectomy using cold 

dissection method and bipolar electrocuatery were studied. 

RESULTS 

In one site of tonsil, cold dissection technique were used whereas in the 

other tonsil bipolar electrocautery was used to performed tonsillectomy 

in 40 pediatric patients.There were 22 male and18 female. The mean operation 

time for electrocautery was 12.04 minutes as compared to 16.57 minutes 

for cold dissection. The average amount of bleeding on electrocautery 

side was 4.07ml and on the cold dissection side was 14.58 ml.The frequency 

of pain recorded during 2 post op day was slightly more in electrocautery. 

In the present study post operative haemmorrhage was not observed. 

CONCLUSION 

In the present study, bipolar diathermy tonsillectomy had advantages in 

having less post operative time and blood loss intraoperatively but pediatric 

patients experienced slightly more pain than cold dissection 

P 151 

IS THERE ANY INDICATION FOR CURETTAGE 

ADENOIDECTOMY IN THE 21ST CENTURY 

H. Coates 

University of Western Australia, PERTH, Australia 

E-MAIL: info@congresservice.nl 

OBJECTIVE 

The objective was to review the literature on methodologies for adenoidectomy 

which included curettage with or without cautery, micro debrider, 

suction electrocautery and laserMethodA meta analysis of 64 articles. 

RESULTS 

This meta analysis suggested the published data supported the use of electrocautery 

over curette adenoidectomy. A summary of the evidence is also 

reviewed. 

DISCUSSION 

The results of this review suggest that there are no indications for curettage 

adenoidectomy except to debulk massive adenoids prior to suction 

diathermy. The advantages and disadvantages of the methods are also discussed. 

P 152 

ENT PRACTICE IN CHILDREN WITH INBORN ERRORS 

OF METABOLISM 

F. O’Duffy, E. Treacy, H. Rowley 

Temple Street Childrens Hospital, ENT, DUBLIN, Ireland 

E-MAIL: fergaloduffy@hotmail.com 

OBJECTIVES 

Inborn errors of metabolism cause hereditary metabolic diseases and classically 

they result from the lack of activity of one or more specific enzymes. 

There is a notably high number of patient with in born errors of metabolism 

in Ireland with over 1800 patients are currently being treated for 

metabolic disorders at National Centre for Inherited Metabolic Disorders. 

The objectives of this study were to assess the frequency of referral, range 

of ENT complaints and range of ENT surgical procedures as well as surgical 

challenges presented by children with metabolic disease. 

METHODS 

We examined the metabolic database and identified all children referred 

to ENT/audiology services. A subsequent review of their case notes and 

surgical records was undertaken. 

RESULTS 

We found that 289 of these children were seen by ENT/audiology services 

with a wide range of ENT conditions ranging from recurrent otitis media, 

hearing loss, recurrent tonsillitis and chronic rhinosinusitis. In addition 

79 required ENT surgical intervention at the Children’s University Hospital 

including grommet insertion, adenoidectomy and tonsillectomy. 

The metabolic conditions most likely to require ENT care were; disorders 

of amino acids, glycogen storage disorders, mucopolysaccharidosis and 

mitochondrial disorders. These four subgroups accounted for almost half 

of all metabolic patients requiring ENT intervention. 

181

CONCLUSIONS 

A significant proportion of these children required ENT intervention. 

ENT procedures represent some of the most frequent surgical interventions 

in this patient cohort necessitating carrying out elective surgery in 

high risk patients and accordingly an knowledge of the underlying disease 

state is imperative for the otolaryngologist. 

P 153 

CASE SERIES: ENDOSCOPIC MANAGEMENT OF FOURTH 

BRANCHIAL POUCH FISTULA 

G.J. Watson 

Royal Manchester Children’s Hospital, ENT, MANCHESTER, 


E-MAIL: glen_watson74@yahoo.co.uk 

INTRODUCTION 

Fourth branchial arch anomalies represent 1-2% of all branchial anomalies 

and present as recurrent neck infections or suppurative thyroiditis. Traditionally, 

management has comprised treatment of the acute infection 

followed by hemithyroidectomy, surgical excision of the tract and obliteration 

of the opening in the pyriform fossa. Recently, it has been reported 

that endoscopic obliteration of the sinus tract alone using laser, or chemoor 

electro-cautery is possibly an alternative to open surgery, with a similar 

recurrence rate of 15%. 

OBJECTIVES 

To determine the success of endoscopic obliteration of fourth branchial 

arch fistula in children 

METHODS 

Retrospective case review of all children undergoing endoscopic treatment 

of fourth branchial arch anomalies at the Royal Manchester Children’s 

Hospital. Patient demographics, presenting symptoms, surgical technique, 

complications and outcome were analysed. 

RESULTS 

In total 5 cases were identified (4 females and 1 male) aged between 3-12 years. 

All presented with recurrent left sided neck abscesses. Imaging (2 MRI, 1 ultrasound) 

was performed on three children. All children underwent a diagnostic 

laryngo-tracheo-bronchoscopy which identified a sinus in the apex 

of the left pyriform fossa. This was obliterated using silver nitrate chemocautery 

in 1 patient, CO2 laser/silver nitrate chemocautery in 3 patients and 

electrocautery in 1 patient. To date there has been no recurrence of infections. 

CONCLUSION 

In our institute we have found endoscopic obliteration of pyriform fossa 

fistula to be a safe method of treatment of fourth branchial arch anomalies 

and is now our first line management. The embryology of such branchial 

abnormalities will be discussed. 

182 

P 154 

OUTCOME OF TRACHEOTOMY AFTER PEDIATRIC 

CARDIAC SURGERY 

A. Almazrou 1 , M. Alibrahim 2 , S. Kabbani 2 , M. Abu- Sulaiman 3 

1 King Saud University, ORL, RIYADH, Saudi Arabia 

E-MAIL: kalmazrou@gmail.com 

2 King A/Aziz Medical City, RIYADH, Saudi Arabia 

3 KING A/Aziz Medical City, RIYADH, Saudi Arabia 

INTRODUCTION 

Pediatric patients with heart disease may require prolong intubation and 

ventilation. When weaning from mechanical ventilation cannot be 

achieved, transforming the artificial airway from a trans-laryngeal to a 

tracheostomy will facilitate extubation and liberation from the ventilator. 

In this study, we aimed to investigate the incidence, timing, indications 

and outcomes of tracheostomies in pediatric cardiac patients. 

METHODS 

We reviewed all of the pediatric cardiac patients who required tracheostomies 

from Nov 2000 to Nov 2010. All of the patients under 14 years 

of age who underwent tracheostomies after cardiac surgery were included. 

The data were collected and reviewed retrospectively. 

RESULTS 

Sixteen children underwent tracheostomies after cardiac surgery. Fifteen 

of these cases followed surgery for congenital heart disease, and one followed 

surgery for an acquired rheumatic valve. The mean +/- SEMs of the 

durations of ventilation before and after tracheostomy were 60.4 +/- 9.8 

days and 14.5 +/- 4.79 days respectively. The means +/- SEM of the lengths 

of stay in the pediatric cardiac intensive care unit (PCICU) before and after 

tracheostomy were 63.31 +/-10.15 days and 22+/- 5.4 days respectively. After 

the tracheostomies 12/16 patients (75%) were weaned from their ventilators 

and 10/16 were discharged from the PCICU. Six patients were discharged 

from the hospital and 3 were successfully decannulated. The overall survival 

was 9/16 (56%). 

CONCLUSION 

Tracheostomy shortens the duration of mechanical ventilation and facilitated 

discharge from the ICU. The mortality of tracheostomy patients is 

still significant but is mainly related to the primary disease.

P 155 

ACINIC CELL CARCINOMA OF THE PAROTID GLAND 

IN A CHILD 

D. Markov-Glavas, I. Makovac 

University Hospital Zagreb, ORL, Head and Neck Surgery, ZAGREB, Croatia 

E-MAIL: duska.markov@gmail.com 

OBJECTIVES 

Based on this case report we discuss extension of diagnostic procedures and 

treatment modalities for acinic cell carcinoma of parotid gland in children. 

METHODS 

We report the case of a 11-yr-old girl who was referred to our clinic, complaining 

of a painless swelling in the left parotid gland that had been gradually 

enlarging over the course of 12 months. Ultrasonography revealed 

the presence of a hypoechoic mass in the tail of the left parotid gland. 

The patient underwent superficial parotidectomy. Histologic examination 

revealed acinic cell carcinoma with no metastasis in lymph nodes found 

inside the specimen. 

DISCUSSION 

Acinic cell carcinoma as a differential diagnosis in children presented with 

painless swelling in parotid area should be taken in consideration even if 

FNAC is negative for malignant lesion. 

CONCLUSION 

On regular follow-up of our patient, three years after the initial diagnosis, 

there is no clinical evidence of tumor recurrence or metastasis. To our best 

knowledge, when tumors are completely encapsulated, and histologically 

classified as a well-differentiated low-grade malignancy, superficial paroti - 

dectomy is the best surgical treatment in children with no need for intensive 

treatment modalities. 

P 156 

THYROID NODULES IN CHILDREN: 

CASE STUDY AND LITERATURE REVIEW 

A. Aubin 1 , J.P. Trijolet 2 , S. Pondaven 1 , E. Lescanne 1 

1 CHRU Clocheville, ENT, TOURS, France 

E-MAIL: aubinalexandra@ahoo.fr 

2 CHRU Bretonneau, TOURS, France 

OBJECTIVE 

Thyroid nodules in children require most often surgical treatment. The 

purpose of this study is to evaluate the management before treatment, the 

type of surgery and postoperative follow-up in case of thyroid nodules in 

children. 

METHOD 

The records of all children operated on for thyroid nodules between December 

2001 and December 2011 in our ENT department, were retrospectively 

analyzed. In this consecutive series, epidemiological data, the 

pre-therapeutic, surgical treatment, pathological results and postoperative 

follow-up were studied. 

RESULTS 

In the study period, 27 children (20F/7M) mean age of 7 years had thyroid 

nodules requiring surgical treatment. A fine needle aspiration (FNA) cytology 

was performed in 11 cases. Results were correlated with final diagnosis 

in 10 cases. It was vesicular adenoma (14 cases), multinodular (4), 

ectopic thymic tissue (1) and immature teratoma (1). In 7 cases the tumor 

was malignant. It was papillary carcinoma (4) or follicular carcinoma (3). 

The lobo-isthmectomy was performed in 18 cases, supplemented by a summation 

in 3 cases after diagnosis of a malignant tumor. Total thyroidectomy 

was immediately performed in 9 cases. In 26 cases, laryngeal mobility 

was normal after surgery. In one case (invasive papillary carcinoma, 

metastatic), bilateral recurrent laryngeal nerve paralysis in paramedian 

position was noted. These results were compared with literature data. 

CONCLUSION 

The management of thyroid nodules in children is surgical. FNA of the 

nodule provides very useful Results to guide the indication for surgery, 

especially as the incidence of malignant tumors is high at this age. 

P 157 

THYROID CANCER IN CHILDREN A CHALLENGING DISEASE 

A.S. Araujo Da Costa 1 , M.I. Hamdan Zavarce 2 , J.M. Meléndez García 2 , 

T. Rivera Schmitz 2 , J. Araujo Nores 2 , M.J. Gonzalez Cortes 2 , 

G. Espiña Campos 2 



INTRODUCTION 

Thyroid gland carcinoma has an incidence of 1, 5% in pediatric age being 

more frequent in girls and ages between 7 to 12 years old. Major risk factor 

remains history of radiation exposure. 

METHODS 

We report a case of an 11 years old girl with nodular thyroid enlargement 

as presenting symptom and family history of goiter. Evaluation, thyroid 

ultrasound and fine needle aspiration were performed although the malignant 

diagnosis was only reached after thyroidectomy, revealing papillary 

thyroid carcinoma. 

RESULTS 

Ultrasound was reported as benign nodule and fine needle aspiration was 

described as follicular benign nodule with cystic degeneration. After car- 

183

ying out hemithyroidectomy for a thyroidal pathology presumed to be 

benign, we found a definitive anatomopathological diagnosis of malignancy, 

differentiated follicular papillary carcinoma of 2,3cm. Total thyroidectomy 

was then performed followed by radioiodine 131( I) ablation 

and thyroid supplementation. 

CONCLUSION 

Palpable thyroid abnormalities in pediatric groups should be viewed with 

suspicion. Careful investigation must be performed to rule out malignancy 

even when facing negative diagnostic procedures. 

P 158 

JUVENILE LARYNGEAL PAPILLOMATOSIS MANAGEMENT 

M. Poenaru 

University of Medicine and Pharmacy Victor Babes Timisoara, 

TIMISOARA, Romania 

E-MAIL: marioara.poenaru@gmail.com 

OBJECTIVES 

The aim of this study was to evaluate the results of combined treatment 

with CO2 laser microsurgery and interferon (IFN 2b) in laryngeal papillomatosis. 

METHODS 

In the study were included during a 3 years period (2009-2011) 8 patients 

aged from 3 to 35 years, diagnosed with laryngeal papilomatosis. All patients 

underwent biopsy and establishing of the HPV subtype before the 

initiation of the treatment in the ENT Clinic Timisoara. When establishing 

treatments and the evolution of the patients, studiing the biomarkers 

expression and the changes they are responsible for had an important role. 

All the patients underwent at least one ablation by cold surgery until the 

inclusion in the study. 

RESULTS 

Only one patient in the study group presented both HPV types, 6 respectively 

11, the rest of the patients presented only HPV type 6. All the patients 

in the study group needed one ablation with CO2 laser followed by adjuvant 

treatment with interferon with very good evolution. The patient with 

both subtypes needed 3 series of treatment with interferon and the rest 1 

or 2 series. 

CONCLUSIONS 

We consider that establishing the HPV subtype is absolutelly necessary 

for the therapeutical conduct and appreciating the prognosis of the disease. 

184 

P 159 

EVIDENCE BASED CARE PATHWAY FOR MANAGING ACUTE 

UPPER AIRWAY OBSTRUCTION IN CHILDREN. 

K. Bhargava, D. Bhargava 

Sultan Qaboos University, Family and Community Medicine, 

AL KODH MUSCAT, Oman 

E-MAIL: drkamlesh@gmail.com 

AIMS 

To study the current best evidence for managing upper airway obstruction 

in children. 

METHODS 

A Literature search was conducted in various databases; Medline, embase, 

Cochrane etc. The various diagnosis were defined, clinical assessments 

were quantified. The studies were evaluated for their levels of evidence 

and grades of recommendation. A care pathway including diagnosis to 

management steps was constructed based on the literature search. 

RESULTS 

32 studies including Randomized control trials(RCT), Meta-analysis, and 

systematic reviews were identified. The pathway is being presented. 

SUMMARY OF EVIDENCE BASED TREATMENT OPTIONS 

No pharmacological treatment is recommended for mild croup. There is 

no level 1 (RCT, meta-analysis or systematic reviews) to support the use of 

mist. Moderately severe croup usually involves use of adrenaline nebulization 

with systemic steroids. Children with croup who have accompanying 

stridor and signs of chest retraction should receive corticosteroids. 

Various routes can administer the corticosteroids; oral, intramuscular, Intravenous, 

However oral administration is easier and economical. For the 

primary care physician the decision to transfer to specialized care would 

depend on the degree of croup, presence of respiratory distress, age of patient, 

presence of predisposing factors, associated co morbidities, response 

to treatment and experience of the primary care physician. 

P 160 

CONGENITAL NECK CYSTS AND FISTULAS 

S. Lupescu 1 , N. Balica 1 , C. Doros 1 , G. Iovanescu 1 , R.U.J. Andreea 2 , 

S. Cotulbea 1 

1 ENT Department Timisoara, ENT Department Timisoara, 


E-MAIL: stelian_lupescu@yahoo.com 

2 Odontotherapy and Endodonty Department, TIMISOARA, Romania

OBJECTIVES 

Congenital masses are the most common noninflammatory neck lesions 

in children. Usually present at birth they can appear at any age. These include 

brachial cleft cysts (BCC), thyroglossal duct cysts (TDC). TDC are 

remnants of the embryonic thyroglossal duct that may occur from the 

base of the tongue to the thyroid gland. 

METHODS 

Between 2000 and 2011, 86 patients with BCC (41 patients) and TDC (45 patients) 

were treated. 11 patiens presented branchial fistulaes, 30 patients with 

branchial cleft cysts, 22 patients were children and 19 patients were adults, 

23 patients were males, 18 patients were females. From TDC 45 patients, 8 

patients presented thyroglossal duct fistulas; 37 patients with thyroglossal 

duct cysts; 35 patients were children; 10 patients were adults; 31 patients 

were males; 14 patients were females. Recurrences occurred in 2 cases. 

RESULTS 

For first branchial anomalies,the potential for facial nerve involvement 

was considered in all the cases. For all the remainig branchial anomalies 

surgical technich was considerd by anatomic locations. For thyroglossal 

duct cysts the hioide bone was removed in all the cases by Sistrunk procedure. 

Recurrences occurred in 2 cases: S.A. 1 years old and D.S. 12 years old, 

recurrences occurred after 5 and 4 months. 

CONCLUSIONS 

The positive diagnosis should include a complete clinic and paraclinic evaluation. 

Each of the branchial cleft types has special considerations. A thyroglossal 

duct cyst has the chance of regrowing after surgery ( 10%).. 

Sistrunk procedure - removing the whole thyroglossal tract and cyst - represents 

the efficient surgical treatment. 

P 161 

INTRAOPERATIVE RECURRENT LARYNGEAL NERVE 

MONITORING FOR PEDIATRIC THYROID SURGERY 

J. Cheng, K. Kazahaya 

Division of Pediatric Otolaryngology, The Children’s Hospital of 

Philadelphia, PHILADELPHIA, USA 

E-MAIL: chengj 1 @email.chop.edu 

OBJECTIVE 

Review our experience and describe our technique of intraoperative recurrent 

laryngeal nerve (RLN) monitoring (IONM) in pediatric thyroidectomy 

with endolaryngeal hookwire electrodes. 

METHODS 

Retrospective chart review of pediatric patients ( 12 months postoperatively. 

RESULTS 

All 17 patients who were identified had thyroid surgery with IONM by the 

senior surgeon. 19 procedures were performed - 4 hemithyroidectomies, 2 

completion thyroidectomies, and 13 total thyroidectomies - with 32 nerves 

at risk. There were 5 males and 12 females. The average age was 11.7 years 

(range 4 - 15 years). The RLN injury rate was 3.1% (1/32). 13 (76.4%) patients 

underwent surgery for preoperatively confirmed or suspected thyroid malignancy, 

2 (11.8%) for Graves disease, and 2 (11.8%) for benign thyroid disease. 

CONCLUSION 

Thyroid nodules and surgery in children consist of higher rates of malignancy 

and potentially higher risks for recurrent laryngeal nerve (RLN) complications. 

IONM with endolaryngeal hookwire electrodes in pediatric 

thyroid surgery may be helpful in nerve identification but cannot be used 

as a substitute for knowledge of surgical anatomy and cannot necessarily 

prevent RLN transection and/or injury. This technique is very sensitive and 

can be used in situations in which endotracheal tubes with surface electrodes 

cannot be accommodated by the smaller size of the pediatric airway. 

P 162 

PAEDIATRIC AIRWAY OBSTRUCTION REQUIRING 

INTERVENTIONAL DELIVERY - THE YORKHILL EXPERIENCE. 

M.M.C. Yaneza 1 , H. Kubba 2 , D. Wynne 2 , C. Best 2 , P. Bolton 2 , 

A. Cameron 3 , W.A. Clement 2 , J. Coutts 2 , M.A. Ledingham 4 , T. Moores 2 , 

J. Simpson 2 , M. Morrissey 2 






3 Ian Donald Fetal Medicine Unit, GLASGOW, United Kingdom 

4 Southern General Hospital, GLASGOW, United Kingdom 

OBJECTIVES 

To present the Yorkhill experience of managing complex neonatal airways 

using an interventional delivery. 

METHODS 

Retrospective review of complex airway cases presenting in the antenatal 

period or at birth. 

RESULTS 

Five cases were identified that required an interventional delivery (such 

as an ex utero intrapartum treatment (EXIT procedure) to manage the 

neonatal airway obstruction. In three cases the potential airway obstruction 

was identified in the antenatal period and an elective Caesarean 

Section performed at between 35 to 38 weeks. All five cases had polyhydramnios 

during the pregnancy. Three patients were intubated by the 

ENT surgeon, one patient was intubated by the neonatologist and one pa- 

185

tient required a tracheostomy by the ‘tracheostomy’ENT consultant after 

the ‘intubating’ENT consultant was unable to intubate the patient. Three 

cases had a tracheostomy after the patient was intubated and all have been 

successfully decannulated. Four cases had their airway obstructing lesion 

excised. One child died, three months after birth, due to respiratory failure. 

CONCLUSIONS 

Early recognition in the antenatal period of a potential airway obstruction 

enables a multi-disciplinary discussion and detailed plan for the delivery. 

We advocate a multi-disciplinary discussion involving foetal medicine, obstetrics, 

a maternal anaesthetist and separate paediatric anaesthetist, neonatology, 

ENT and to consider paediatric surgery involvement if ECMO is 

required. An elective Caesarean Section is recommended with two ENT consultants 

involved; an ‘intubating’consultant, and a ‘tracheostomy’consultant 

who performs the tracheostomy if intubation is unsuccessful. Early and detailed 

planning leads to a successful outcome for both mother and baby. 

P 163 

BEST MANAGEMENT OF ULTRA-SMALL TRACHEOBRONCHIAL 

FOREIGN BODIES IN NEONATES 

J.P. Ludemann 1 , J. Tin 2 , A. Thamboo 3 , H. Osiovitch 2 , L. Scheepers 1 , 

R. Ashley 1 

1 BC Children’s Hospital, VANCOUVER, Canada 

E-MAIL: jludemann@cw.bc.ca 

2 University of British Columbia, VANCOUVER, Canada 

3 Unversity of British Columbia, VANCOUVER, Canada 

INTRODUCTION 

Tracheobronchial foreign bodies (TFBs) in neonates are extremely rare and 

usually iatrogenic, secondary to breakage of an endotracheal suction 

catheter or shearing of the plastic sheath off an endotracheal intubation 

stylet. Endoscopic management of such cases may be challenging and urgent; 

but usually there is sufficient time to prepare ideal instrumentation 

and discuss strategies with the operating room team. 

OBJECTIVES 

To develop (1) a practical and comprehensive algorithm of instruments 

and techniques available to treat neonates with tracheobronchial foreign 

bodies (TFBs), depending on the patient’s subglottic diameter and (2) primary 

and secondary prevention strategies for neonatal TFBs. 

METHODS 

(1) Analysis of the case of a severely premature infant who presented with 

the incidental radiological finding of a 2cm suction catheter tip, which, 

over a two week period, had migrated between her main bronchi; the TFB 

was removed with a previously unreported combination of instruments: 

a 3 French flexible urological forceps through the side port of a 2.5mm 

rigid bronchoscope. (2) In vitro testing of typical foreign bodies and readily 

available endoscopic instruments. 

186 

RESULTS 

We have developed a practical and comprehensive algorithm for the treatment 

of neonates with TFBs, as well as primary and secondary prevention 

strategies. 

CONCLUSIONS 

The treatment algorithm and prevention strategies may reduce morbidity 

and mortality from neonatal TFBs. 

P 164 

NATIONAL GUIDELINES FOR TONSILLOTOMY IN 

CHILDREN IN SWEDEN 

E. Hultcrantz 1 , C. Hemlin 2 , E. Ericsson 3 

1 Linköping Universitet, Otorhinolaryngology, LINKÖPING, Sweden 

E-MAIL: elisabeth.hultcrantz@liu.se 


3 Linköping University, LINKÖPING, Sweden 

OBJECTIVES AND METHOD 

The Swedish Association for Otorhinolaryngology together with the 

Swedish Association of Local Authorities and Regions and the National 

Board of Health and Welfare have issued national guidelines for tonsillotomy 

developed by an expert cross-professional work group. The indications 

are based on an analysis of all available scientific literature and 

clinical data registered in the National Tonsil Register in Sweden. 

RESULTS/INDICATIONS 

Tonsillotomy, as opposed to tonsillectomy, is appropriate to offer under 

following circumstances: Patient related conditions. The Tonsils relative 

size is judged to cause obstructive breathing during sleep with or without 

snoring in combination with oral breathing and notable apneas or chest 

indrawings or restless sleep with many arousals and frequent anomalous 

sleeping position or disturbed function during daytime (for example, 

EDS=excessive daytime sleepiness and downward sloping weight gain 

curve), explainable as due to poor quality of sleep or oral-motor problems 

such as eating, swallowing, or speech problems or deviant facial or orthodontic 

development. Healthcare process related conditions: Judgment has 

been that the tonsils can be diminished enough with available techniques 

for tonsillotomy tonsil infections in a number and degree motivating a 

full tonsillectomy has been excluded. If the indication is deviant facial or 

orthodontic development, a cross-professional assessment has been done. 

Healtcare givers’ related premises. The ENT-surgeon has sufficient experience 

with the technique to be used. 

CONCLUSION 

The new guidelines will make it easier for clinicians to make decision to 

change from tonsillectomy to tonsillotomy in cases where the primary 

cause for surgery is obstruction.

P 165 

CHOOSING A PAEDIATRIC TRACHEOSTOMY TUBE: 

AN UPDATE OF CURRENT PRACTICE 

J. Tweedie, J. Cooke, C. Pepper, M.D. Elloy, L.A. Cochrane, M.E. Wyatt 




OBJECTIVES 

A variety of paediatric tracheostomy tubes are available. We review the 

plastic and metal tubes in current use at Great Ormond Street Hospital, 

which provides one of the largest tertiary paediatric airway services in Europe. 

We present an updated sizing chart for tracheostomy tubes and other 

airway devices, and a quick reference guide to assist with tube selection. 

METHODS 

We outline our current preferences and the particular indications for the 

different tubes, speaking valves and other attachments. 

RESULTS 

Our preferred range of tubes has undergone significant design changes. 

A selection of new tracheostomy tubes are now available, while others are 

no longer manufactured. We also report further experience with certain 

tubes which may be useful in particular circumstances. Our updated sizing 

chart takes these developments into account. 

CONCLUSIONS 

The appropriate choice of paediatric tracheostomy tube remains largely 

determined by individual clinical requirements. Although we still favour 

a small range of tubes for use in the majority of our patients, there are circumstances 

in which other varieties are indicated. 

P 166 

THE MULTI-DISCIPLINARY PAEDIATRIC 

TRACHEOSTOMY CLINIC 

M.M.C. Yaneza 1 , H. Kubba 2 , D. Wynne 2 , W.A. Clement 2 , P. Davies 2 , 

S. Harrison 2 






OBJECTIVES 

To review the problems seen and managed in a multidisciplinary tracheostomy 

clinic by a paediatric otolaryngologist, respiratory physician 

and tracheostomy specialist nurse. 

METHODS 

Retrospective review of clinic letters from the multidisciplinary tracheostomy 

clinic since its inception (February 2009 to May 2011). 

RESULTS 

44 different patients have attended the clinic. The male to female ratio is 

1:0.91, with an age range at the first visit of 3 months to 16 years. Each condition 

is reviewed at the clinic appointment. Over 100 different conditions 

and clinical problems were reviewed. Active conditions that are outside 

the expertise of ENT and Respiratory are addressed by seeking an opinion 

during the appointment or by arranging a review. Each patient is assessed 

for; 1) On-going requirement for the tracheostomy, 2) Secretions, 3) Recent 

or current respiratory tract infections, 4) Oxygen requirement and 5) Vocalisation 

and requirement of a speaking valve. Ventilated patients have 

their settings and requirements reviewed. 

CONCLUSIONS 

The multidisciplinary tracheostomy clinic enables the patient and carers to 

be seen by both physicians and surgeons with specialist nurse input. This 

set-up allows a holistic approach to the patient with a tracheostomy. It empowers 

the patient and carers with an ‘at home’management plan, and identifies 

long and short term goals such as increasing vocalization, aiming for 

decannulation, decreasing oxygen requirements and preventing community 

acquired respiratory infections. It is an efficient set-up for reviewing 

the patient as surgeon, physician and nurse are present in one clinic appointment 

thus prevents multiple appointments for interlinked problems. 

P 167 

CRYOEXTRACTION FOR FOREIGN BODY REMOVAL 

IN A CHILD 

H.R. Rakow, G. Rehmert, M. Engelhardt 

HELIOS Kliniken Schwerin GmbH, Department of Anaesthesia and 

Intensive Care, SCHWERIN, Germany 

E-MAIL: heike.rakow@helios-kliniken.de 

A foreign body aspiration is dangerous. Successful extraction depends on: 

type of aspirated foreign body (FB), location in the bronchial system, experience 

of the physician and instrumentation available. Due to the small 

airway in children high skills and special equipment are mandatory. 

We report on the management of a 17 month old boy who presented with 

aspiration. At home he had aspirated an apple piece. His mother had noticed 

the event, had heard cough and had seen the respiratory failure with 

cyanosis. She had slapped him on the back and had called the ambulance. 

Because of positive history of aspiration, acute respiratory symptoms, the 

187

history of hyper-responsiveness of the bronchial-system and the positive 

experience with the application of cryotherapy our plan was to use the 

classic laryngeal mask as a safe airway device, flexible bronchoscope (Olympus 

Type BF-P180, ED 4.9 mm, length 870 mm, working channel ID 2 mm) 

and the commercially available flexible cryoprobe ERBOKRYO® CA 

(ERBE, Tübingen, Germany, length 780 mm, diameter 1.8 mm) 

Anaesthesia induction with sevoflurane and oxygen was performed. After 

insertion of a laryngeal mask #2 the FB was visualized by bronchoscopy. 

It was frozen to the tip of the probe and removed by pulling on the probe 

together with the bronchoscope. The recovery was uneventful. Bronchoscopy 

with cryoextraction is required for treatment, and with experience, 

this procedure can be simple and safe. Flexible bronchoskopy and 

cryotherapy can be recommended in many indications, especially in children 

with foreign body aspiration. 

P 168 

CLINICAL OUTCOMES OF DIFFERENT SURGICAL 

APPROACHES IN MANAGEMENT OF BENIGN 

NASOPHARYGEAL LESIONS IN ADOLESCENTS: 

A RETROSPECTIVE ANALYSIS 

S. Mohanty, M. Maraignanam, J. Samuel 

Sri Ramachandra University & Hospital, ENT, Head & Neck Surgery, 

CHENNAI, India 

E-MAIL: drsanjeevmohanty@gmail.com 

OBJECTIVES 

Benign lesions of nasopharynx presents a surgical challenge because of the 

relatively inaccesible anatomical location. A good surgical approach is vital 

in the management of these lesions. Transpalatal approach has been the 

workhorse in the management of these lesions. Endoscopes have added a 

different dimension to the management. Small circumscribed lesions can 

be managed by endoscopic approach. However, endoscopes are complementary 

to the conventional surgical techniques too. In this study we assess 

the outcome of endoscopic transnasal, transpalatal and combined 

surgical approaches to identify the ideal management protocol for these 

pathological entities. 

METHODS 

Retrospective analysis of patients in the age group of 8 - 16 yearswho underwent 

management of benign nasopharyngeal lesions over a period of 

5 years in a tertiary care hospital. All the subjects underwent a digital substraction 

angiography as a pre operative protocol. Those lesions exhibiting 

tumour blush were embolised prior to surgery. 

RESULTS 

34 patients were included in this analysis according to the study criteria. 

8 patients underwent transnasal endoscopic approach, 12 patients underwent 

transpalatal and 14 subjects underwent combined approaches. 2 patients 

who underwent transpalatal approach had recurrence of lesion. 

188 

CONCLUSION 

In this era of minimally invasive surgical techniques the use of high resolution 

endoscopes have revolutionized post operative results, especially 

with regards to lesions in relatively inaccessible anatomical zones. The use 

of rigid telescopes is paramount in endoscopic techniques and also a good 

tool as an adjunct to conventional surgical techniques too. 

P 169 

IMPACT AND WORKLOAD IMPLICATIONS ON SERVICE 

PROVISION WITH ESTABLISHMENT OF A NEONATAL 

COMPLEX AIRWAY SERVICE IN SCOTLAND 

C.L. Harry 1 , C. Trivers 2 , H. Kubba 3 , W. Clement 3 , J.H. Simpson 2 

1 Royal Hospital of Sick Children, GLASGOW, United Kingdom 

E-MAIL: christina_harry@hotmail.com 

2 Neonatal Unit, Royal Hospital for Sick Children, GLASGOW, 


3 ENT Department, Royal Hospital for Sick Children, GLASGOW, 


OBJECTIVE 

To assess if any changes have occurred in the utilisation of neonatal services 

with referral for neonatal airway assessment and how this is related to the 

establishment of a National Complex Airway Service at our institution. 

METHODS 

A retrospective case note review was performed for neonates referred for 

airway assessment from 2004-2010 inclusive. 

RESULTS 

79 neonates were referred from throughout Scotland; 10 in 2004-2006, 24 

in 2007-2008 and 45 in 2009-2010. The mean gestational age was 35 weeks; 

39% were preterm. The commonest indication for referral was stridor (46%). 

The commonest diagnosis was airway malacia (38%). 53 procedures were 

performed on the ward. 64 microlaryngobronchoscopies (MLB) were performed;45 

were diagnostic and 19 were interventional. The most common 

intervention was supraglottoplasty for airway malacia. 35 separate airway 

procedures were undertaken, including tracheostomy insertion(12), cricoid 

split(4), repair of piriform stenosis(4) and laryngeal reconstruction(2). Most 

procedures were definitive however some children required further intervention. 

Additional investigations were frequently requested and co-morbidities 

were common, especially ones relating to prematurity. 38 neonates 

(48%) were discharged home and 37 (46%) were discharged to their referring 

hospital. One child died of respiratory failure. 

CONCLUSIONS 

Since the establishment of the Scottish National Complex Airway Service 

in 2006, referrals for neonatal airway assessment have increased significantly. 

The reasons for this include a greater awareness of the service, improved 

treatment options and increased preterm survival. These neonates

frequently have associated co-morbidities and require a repertoire of specialist 

input. This increase in workload has significant implications for 

further service provision. 

P 170 

MODERN FOETAL MRI TO GUIDE ESTABLISHING A SECURE 

AIRWAY IN CHILDREN ANTICIPATED TO HAVE AIRWAY 

OBSTRUCTION AT BIRTH 

S. Phillips 1 , H. Ismail-Koch 2 , S. Blaney 2 , A. Morrison 2 , S. Patel 3 , 

S. Connor 2 , I. Hore 2 

1 Guy’s and St Thomas’ NHS Trust, Otolaryngology, BROMLEY, 


E-MAIL: seamusphillips@hotmail.com 

2 Evelina Children’s Hospital, LONDON, United Kingdom 

3 King’s College Hospital, LONDON, United Kingdom 

OBJECTIVE 

Modern foetal MRI has improved the accuracy and detail of antenatal information 

that can be gained prior to birth in foetuses with potential 

causes of airway obstruction. We wished to review how foetal MRI has 

helped guide mode of delivery, and means of establishing a secure airway 

at birth, where airway obstruction is anticipated. 

METHODS 

Retrospective review of cases identified in past 2 years. 

RESULTS 

Four cases were identified. In one foetus extensive intra-oral teratoma that 

was protruding from the mouth was identified on foetal MRI. He was successfully 

intubated, over a rigid scope, during an EXIT (ex utero intrapartum 

treatment) procedure. Another foetus was found to have cervical 

cystic hygromas that, though they were very extensive, were not within 

the airway itself. He was successfully intubated in a parallel theatre following 

planned caesarean section. A third case had extreme cervical hyperextension. 

Again successful intubation was achieved in a theatre parallel 

to one in which a planned caesarean section was carried out. A fourth case 

had a large cystic component to a cervical teratoma identified on foetal 

MRI. When respiratory distress developed 10 minutes after birth by emergency 

caesarean section, fifty millilitres of fluid was aspirated from the 

teratoma to facilitate successful intubation. 

CONCLUSIONS 

Modern foetal MRI is extremely helpful in guiding perinatal management 

in children anticipated to have airway obstruction at birth. 

P 171 

THE USE OF BARE METALLIC STENTS IN THE AIRWAY 

FOR TRACHEOBRONCHOMALACIA 

H. Ismail-Koch, N. Hayes, N. Jonas, I. Hore, S. Blaney, A. Durwood, 

G. Morrison 

The Evelina Children’s Hospital, ENT, LONDON, United Kingdom 

E-MAIL: hasnaakoch 252 @hotmail.com 

OBJECTIVES 

The Palmaz stent is a useful tool in the management of life-threatening tracheobronchomalacia 

to prolong life, as a final resort in a difficult patient 

population. Metallic stents are preferred in children because of less stent 

migration and better epithelial growth, but may stimulate ingrowth of 

granulation tissue and are prone to fracture. Their use must be carefully 

considered as they may result in haemorrhage and death. The aim of this 

study was to report our experiences with Palmaz stents over the last 10 years. 

METHODS 

A retrospective analysis of patient records was undertaken for children 

that had undergone tracheal or bronchial Palmaz stent insertion at a tertiary 

care children’s hospital. The technique of insertion of the Palmaz 

stent was altered following difficulties in stent removal. Initially Palmaz 

stents were fully expanded endoluminally under direct vision, subsequently 

the stents were expanded so that they were not in tight contact 

with the tracheal or bronchial wall and did not migrate. 

RESULTS 

We describe our experiences and outcomes for a series 16 children who underwent 

the procedure at our centre. 

CONCLUSION 

The vast majority of tracheobronchial stents were inserted for tracheobronchomalacia 

secondary to vascular compression, rather than primary 

tracheobronchomalacia. Palmaz stent insertion is useful in life-threatening 

cases, however stent removal is required as the airway grows and also 

due to the risk of stent fracture. The technique of insertion of the stents 

adapted by our unit has reduced complications associated with removal 

of the stents. 

189

P 172 

SELECTIVE BALLOON OCCLUSION OF THE RIGHT MAIN 

BRONCHUS FOR PERSISTENT BRONCHOPLEURAL FISTULA 

IN A PREMATURE NEONATE 

T.S. Ahmed, H. Daya 




OBJECTIVES 

Bronchial laceration is a recognised complication of intubation in premature 

neonates. Contributing factors include small airway size, hurried and 

repeated attempts at intubation and improper assembly and placement 

of the endotracheal tube. Cases can be difficult to manage and are associated 

with an increased risk of perinatal mortality. This presentation describes 

a novel, relatively non-invasive strategy for managing this 

condition. 

METHODS 

Case report of a 745g infant born at 25 weeks gestation who required intubation 

shortly after birth and who developed pulmonary haemorrhage 

and a right-sided pneumothorax on day 4 of life. 

RESULTS 

The pneumothorax proved difficult to manage despite needle thoracocentesis, 

insertion of multiple chest drains and high frequency oscillatory 

ventilation. A decision was made for selective fibreoptic intubation of the 

left main stem bronchus but attempts were unsuccessful. Cardiac balloon 

occlusion of the right main stem bronchus was subsequently performed 

and maintained for 8 days. Following removal there was no recurrence of 

the pneumothorax and ventilatory pressures and oxygen requirements 

were improved. 

CONCLUSIONS 

We postulate that diversion of positive pressure ventilation away from the 

injury site allowed the natural healing process to occur, creating a seal 

closing the defect in the tracheobronchial tree. Only surgical repair has 

been previously reported as a viable option for more penetrating lesions 

in extremely premature infants but is not without significant risk. Balloon 

occlusion of a main stem bronchus has not previously been reported and 

may be an appropriate alternative in this extremely frail patient group. 

190 

P 173 

AN UNUSUAL CASE OF NEONATAL STRIDOR WITH 

ASSOCIATED CYANOSIS 

T.S. Ahmed, E. Hannon, B. Okoye, H. Daya 




OBJECTIVES 

Cyanosis may be associated with stridor and can indicate tracheal pathology. 

Bronchogenic cysts are congenital lesions of primitive foregut origin 

and may present with these symptoms. This report describes a case with 

these symptoms and illustrates the need for multidisciplinary management 

for this condition. 

METHODS 

Case report of a 3 week old baby who initially had intermittent stridor 

since birth which subsequently became constant and had been associated 

with cyanotic episodes on feeding. The infant presented acutely to hospital 

with respiratory distress requiring intubation and transfer to paediatric 

intensive care. 

RESULTS 

Microlaryngoscopy and bronchoscopy showed indentation and narrowing 

of the posterior tracheal wall with partial luminal collapse and oesophagoscopy 

showed compression of the anterior wall of the cervical oesophagus. 

Computed tomography imaging showed a large partially 

septated fluid-filled cyst in the right side of the neck passing into the superior 

mediastinum between the trachea and oesophagus extending inferiorly 

to the right main bronchus. The lesion was excised via a transverse 

neck incision, delivering the thoracic component into the neck. The child 

was subsequently successfully extubated with resolution of the stridor. 

He initially had a hoarse cry indicating right recurrent laryngeal nerve 

damage but on subsequent follow up this improved. Histology showed a 

cyst lined with respiratory epithelium with cartilaginous, smooth muscle 

and mucous glandular components in keeping with a bronchogenic cyst. 

CONCLUSIONS 

This case illustrates the need to consider this diagnosis in infants presenting 

with stridor and cyanotic episodes. Surgical excision is recommended 

and should be curative.

P 174 

EFFICACY OF ENDOSCOPY DURING RIGID BRONCHOSCOPY 

FOR THE SUSPICION OF TRACHEOBRONCHIAL FOREIGN 

BODY IN CHILDREN 

S. Özdemir, O. Tarkan, U. Tuncer, M. Kiroglu 

Cukurova University School of Medicine, ADANA, Turkey 

E-MAIL: drsozdemir@gmail.com 

OBJECTIVE 

We aimed to report our experience by using rigid endoscope through the 

rigid bronchoscope for the suspicion of tracheobronchial foreign body aspiration 

in children. 

METHOD 

From January 2006 to December 2011, we observed 249 children (153 male 

and 96 female; median age, 2 years; age range, 7 months-10 years). Patients 

were divided into 2 groups according to the treatment method: group I, 

endoscopy during rigid bronchoscopy; group II, only rigid bronchoscopy. 

RESULTS 

There were 73 patients in group 1, and 176 patients in group 2. Foreign body 

was identified in 79,4%, 73,2% of patients in group 1 and 2, respectively. In 

Group 2, during the operation, 5 patients showed transient hypoxia, which 

was alleviated by oxygen supplement and 6 patient had a small amount of 

bleeding. These numbers were 2 and 3, respectively in group1. There was 

one patient died because of cardiopulmoner arrest in group 2. 

CONCLUSION 

Rigid bronchoscope is an important tool in the airways of children because 

of increasing the ventilation safety and handling during the treatment 

procedure. Our experience shows that the distal bronches and also the foreign 

body can be seen more effectively by rigid endoscope during rigid 

bronchoscopy. After this procedure the surgeon can imagine the foreigm 

body more properly in his mind and can use the forceps without any damage 

to the bronches. We postulate that the complication rates and the operation 

time of rigid bronchoscopy can decrease by this procedure 

especially in children under the age 3. 

P 175 

A RARE MASS OF TONGUE IN THE NEWBORN: 

INFANTILE FIBROMATOSIS 

S. Özdemir 1 , O. Tarkan 2 , L. Soylu 3 , U. Tuncer 2 , U. Uguz 2 , 

A. Avci Açikalin 2 , Ö. Sürmelioglu 2 

2 Cukurova University School of Medicine, ADANA, Turkey 


3 Galleria ENT Hospital, Adana, Turkey 

OBJECTIVE 

We report an extremely rare case of infantile fibromatosis in the tongue. 

Also, to our knowledge, there is no published infantile fibromatosis case 

which had fine needle aspiration biopsy used in the diagnosis. 

METHOD 

A one-month-old baby with a mass measuring 26x20 mm and covering 

the anterior and left part of the tongue since birth, diagnosed with infantile 

fibromatosis is presented. 

RESULTS 

Diagnosis was confirmed by fine needle aspiration biopsy and incisional 

biopsies. The mass was totally excised with partial glossectomy and there 

was no finding compatible with recurrence at 1-year follow-up postoperatively. 

CONCLUSION 

The tumor is locally aggressive and has high recurrence rates, and the patients 

should be monitored as closely as possible after surgery. We discuss 

the symptoms, diagnosis and surgical treatment techniques in the light 

of the literature. 

P 176 

INDICATIONS OF DRUG INDUCED SLEEP ENDOSCOPY (DISE) 

IN NEONATAL AND PEDIATRIC AGE: 5 YEARS EXPERIENCE 

M. Romagnoli, R.M. Gaini, P.M. Ingelmo 

Milano-Bicocca University, S.Gerardo Hospita, ORL, MONZA, Italy 

E-MAIL: ma_romagnoli@tiscali.it 

DISE is a well-known technique used almost since 20 years in study and 

diagnosis of snoring and OSAS in adult patients. Little had been write 

about its employement in pediatric age. 

During the last 5 years about 80 DISE procedures was performed in ORL 

Department of S.Gerardo Hospital, Monza, in collaboration with Anesthesia 

and Intensive Care Unit, Neonatal Intensive Care unit (NICU), Pediatric 

Department and Maxillo-facial Surgery Department. 

Indications to prescribe DISE evaluation in neonatal and pediatric age differ 

from those established for adult patients. This paper will show and 

comment some videos of DISE concerning main indications, that, in our 

experience are the following: severe OSAS in Down Syndrome (DS) children, 

with multiple levels airways obstruction (AO); OSAS recurrence in DS or 

with cranio-facial malformations children before adenotonsillectomy; airways 

patency evaluation in children with Mucopolysaccaridosis, even 

without clinic evidence of AO, before they went submitted to any surgical 

procedure; Airways patency evaluation in children with cranio-facial malformations 

before surgical procedure; children with deep sleep desaturations 

and border-line polysomnographic findings; newborns with sleep 

191

desaturations or acute AO; failed extubation in newborns because acute 

obstructive AO. Before DISE, awake fibroscopy is always performed: nasal 

decongestants are not utilized; patency of nose cavities, adenoids, patency 

of oro- and hypo-farynx (lateral walls), base tongue, epiglottis, larynx, presence 

of GER, vocal folds, tracheal and bronchial patency are assessed in 

every patient. A second pediatric fibroscope with naso-tracheal tube is 

ready for use in emergency case. 

P 177 

A MINIMALLY INVASIVE METHOD OF MANAGING THIRD 

BRANCHIAL CLEFT SINUSES 

P.Y. Wong, A. Moore, H. Daya 

St George’s Hospital, Ear, Nose and Throat Department, LONDON, 


E-MAIL: Phuiyee_wong@yahoo.co.uk 

OBJECTIVES 

Third branchial cleft sinuses are rare and constitute less than 1% of all 

branchial cleft anomalies. Children present with a painful left anterior 

neck swelling. Ultrasound and axial imaging of neck will reveal an anterior 

neck cyst containing locules of air, with a tract running medial to the 

carotid sheath. We present three interesting cases of children with third 

branchial cleft sinuses and describe a minimally invasive technique for 

their management. 

METHODS 

A large Parsons laryngoscope is introduced into the piriform fossa and 

placed on suspension. The left piriform fossa sinus opening is cauterised 

using monopolar diathermy suction. The cyst is drained percutaneously 

using a 14G needle and syringe. A two week course of broad spectrum antibiotics 

is completed. 

RESULT 

Three children, two male and one female, of mean age 9.6 years presented 

with a painful left anterior neck swelling. Endoscopic diathermy of the 

sinus opening in combination with percutaneous aspiration of the cyst 

was successfully used to treat these third branchial cleft sinuses. 

CONCLUSIONS 

The diagnosis of a third branchial cleft cyst should be considered in a child 

presenting with an anterior neck swelling. Ultrasound and axial imaging 

can aid diagnosis with the findings of a tract containing air locules being 

highly suggestive of a third branchial cleft sinus. This case series demonstrates 

how it is possible to diagnose and definitively treat this condition 

on the same acute admission using a minimally invasive technique. In 

this way the physical and psychological morbidity of open surgery can be 

avoided. 

192 

P 178 

PAEDIATRIC LARYNGEAL CHONDROMETAPLASIA: 

A CASE REPORT 

R.F.D. Sykes, A. Moore, P. Wong, H. Daya 

St. George’s Hospital, ENT, LONDON, United Kingdom 

E-MAIL: richard.sykes@doctor.org.uk 

Chondrometaplasia is the de novo growth of benign cartilaginous tissue 

unconnected to any pre-existing cartilage. It is a relatively common finding 

in larynges at autopsy, but symptomatic cases are rare and usually associated 

with laryngeal trauma or prolonged intubation. No paediatric 

cases have been documented below the age of 14. 

We present the case of a 16 month boy, the surviving child of twins born 

at 23+5 weeks. He presented with a weak cry after prolonged intubation; 

nasendoscopy and subsequent MLB was performed. An abnormal partly 

polypoid laryngeal lesion was excised which demonstrated a loose hypocellular 

stromal area with accumulation of matrix material reminiscent of 

immature fibrocartilage, consistent with chondrometaplasia. 

Perioperative course was unremarkable and vocal quality normalised postop. 

It was not possible to fully excise the lesion and therefore the child is 

being followed up for monitoring. 

This case is the first report of neoatal vocal chord chondrometaplasia and 

adds to the body of evidence that suggests that development of symptomatic 

nodules of chondrometaplasia is usually associated with vocal cord trauma. 

What predisposes patients to develop these nodules remains unclear. 

P 179 

MANAGING THIRD BRANCHIAL POUCH ANOMALIES: 

AN EVOLUTION OF A TRULY MINIMALLY INVASIVE 

APPROACH 

P.Y. Wong, A. Moore, H. Daya 

St George’s Hospital, Ear, Nose and Throat Department, LONDON, 


E-MAIL: Phuiyee_wong@yahoo.co.uk 

OBJECTIVE 

Management of third branchial pouch anomalies has evolved in recent 

times with the popularisation of the endoscopic diathermy technique to 

sclerose the pyriform fossa sinus opening. We present our experience in 3 

children with third branchial pouch anomalies and propose a minimally 

invasive management algorithm avoiding open surgery. 

METHODS 

Retrospective case review of patient demographics, mode of presentation, 

investigations, management and complications.

RESULTS 

Three children, two male and one female, of mean age 9.6 years presented 

with a painful left anterior neck swelling. The diagnosis was confirmed 

by endoscopic examination of the pyriform fossa revealing a sinus opening 

anterolaterally. Two patients underwent open excision; one combined 

with cautery to the pyriform fossa sinus. The last patient was diagnosed 

at his initial presentation and was managed with percutaneous needle aspiration 

of the neck abscess combined with cautery of the sinus opening 

at the same setting. One patient had 2 recurrences, the first after initial 

open surgery and the second after the first cautery. Two patients developed 

temporary hoarseness after the procedure which resolved within 2 weeks. 

All patients were free from recurrences at follow up. 

CONCLUSION 

Introduction of the technique of endoscopic diathermy to the sinus opening 

in children with third branchial pouch anomalies has transformed 

their management avoiding open and potentially morbid surgery. By taking 

this approach further in treating the infective component with percutaneous 

needle aspiration and diathermising the pyriform sinus 

opening at the first presentation, we have been able to achieve the ideal 

minimally invasive management algorithm. 

P 180 

MEDIALIZATION LARYNGOPLASTY USING CARTILAGINOUS 

IMPLANT IN YOUNG CHILDREN 

P. Fayoux, G.H. Hosana, N.X. Bonne 




OBJECTIVE 

Laryngeal incompetence is a rare but potentially life-threatening situation 

in children with vocal cord paralysis that may require surgical management. 

The aim of this study was to evaluate the medialization laryngoplasty 

in this young children. 

METHODS 

Institutional review board-approved retrospective study of 7 patients with 

unilateral vocal cord paralysis undergoing surgical rehabilitation medialization 

laryngoplasty between 2003 and 2009. The procedure was performed 

under general anesthesia using laryngeal mask. The true vocal 

cords were localized by insertion of a needle through the thyroid cartilage 

the medialization was performed using a cartilage graft and the vocal cord 

placement was assessed endoscopically. Functional results was assessed 

using analogic scale 

RESULTS 

The mean age was 31 (8 to 89) months. The etiology of paralysis was iatrogenic 

in all cases, with a delay of evolution ranges between 6 to 19 months. 

Patients were discharged home after 2.7 days (2 to 5). Clinical symptoms 

improved dramatically with a quasi disappearance of aspiration, disappearance 

of bronchic infection, vocal impairment and no increase of dyspnea. 

Long term results remained stable based on clinical, endoscopic and 

sonographic exam, showing a stability of vocal cord placement and lake 

of clinical relapse with a mean follow-up of 43 months (12 to 82). 

CONCLUSION 

Laryngeal incompetence associated with vocal cord paralysis is a rare but 

life-threatening situation in infant. Thyroplasty with cartilaginous implant 

may be proposed in order to reduce inhalation and improved voice 

quality. Long term evolution and growth of cartilaginous graft may be 

evaluated on a longer study 

P 181 

PEDIATRIC LARYNGEAL CHONDROID TUMORS: A RARE 

OCCURRENCE WITH A LIFETIME OF FOLLOW-UP 

J.R. Levi 1 , R. Mcspadden 2 , P. Barth 1 




2 Jefferson Medical College, PHILADELPHIA, USA 

OBJECTIVE 

Chondroid tumors (chondrometaplasia, chondroma, and chondrosarcoma) 

of the larynx make up only 1% of all tumors with a laryngeal origin. 

When they do occur, they typically arise from hyaline cartilage such as the 

cricoid, thyroid, epiglottis, or arytenoids in order of occurrence. Additionally, 

their peak incidence is in the 7 th decade of life. Here, we present a case 

of a chondroid tumor arising from the right true vocal fold in a pediatric 

patient who presented with dysphonia and dyspnea. A discussion of both 

the role of MRI IDEAL (Iterative Decomposition of water and fat with Echo 

Asymmetry and Least-squares estimation) sequencing in diagnosis and of 

patient follow-up will take place. 

METHODS 

Case report and literature review 

RESULTS 

The patient was successfully treated using a transoral microlaryngoscopic 

approach. An incision on the superior-lateral surface of the right true vocal 

fold allowed for complete excision of the chondroid tumor, diagnosed only 

by surgical pathology. Although the tumor had the typical appearance on 

MRI T1 and T2 weighted imaging, use of MRI IDEAL sequencing caused 

difficulty with pre-op diagnosis. A literature review does reveal rare instances 

of laryngeal chondroid tumors in the pediatric population but no 

reports of one arising from the vocal fold. 

193

CONCLUSIONS 

Laryngeal chondroid tumors, although rare in the pediatric population, 

can occur and should be treated with conservative surgery. Furthermore, 

these patients should receive lifelong follow-up to monitor for recurrence 

due to the difficulty of distinguishing chondrometaplasia from chondromas 

and chondrosarcomas that can metastasize many years later. 

P 182 

ENDOSCOPIC DEBRIDEMENT TONSILLECTOMY IN 

CHILDREN WITH SEVERELY IMPAIRED MOUTH OPENING 

G. Kontorinis, R. Lawrence, M. Thevasagayam 

Sheffield Children’s Hospital, SHEFFIELD, United Kingdom 


OBJECTIVES 

Tonsillectomy is one of the commonest surgeries performed in children 

worldwide. Although different methods such as cold or bipolar dissection 

and thermal welding technique can be used, the limited access to the tonsils 

in children with craniofacial malformations and inadequate mouth 

opening may still make a tonsillectomy challenging. We present the endoscopic 

debridement tonsillectomy as an alternative method for children 

with impaired mouth opening. 

METHODS 

Tonsillectomy was planned in two patients, a 2.8 year old girl with global 

development delay, unknown severe neurological disorder with hypotonia, 

swallowing difficulties, snoring and nocturnal need for oxygen and a 

five year old girl with hemifacial microsomia (Goldenhar syndrome) and 

obstructive sleep apnoea as shown by the sleep studies. Because of the restricted 

mouth opening and the craniofacial malformation, safe access to 

the tonsils was not possible in either of the cases. A partial tonsillectomy 

was performed using a 2.7 mm 0º rigid endoscope and the microdebrider. 

RESULTS 

Partial endoscopic debridement tonsillectomy was performed without any 

difficulties in both children. The suction monopolar diathermy was used 

for haemostasis. The surgery time was not extended compared to conventional 

tonsillectomy, while the endoscope and the microdebrider provided 

us with ideal access to the tonsils. Postoperative haemorrhage did not 

occur in any case and both children improved significantly (no snoring, 

overnight need for oxygen or obstructive sleep apnoea, improved sleep 

study results). 

CONCLUSIONS 

Endoscopic debridement tonsillectomy is a safe and effective alternative 

tonsillectomy method in selected cases with craniofacial malformations 

and significantly impaired mouth opening. 

194 

P 183 

THE PAEDIATRIC SPEECH PATHOLOGY VOICE CLINIC: 

A NEW MODEL OF SERVICE DELIVERY 

C.J. Madill 1 , J. Warhurst 1 , D. Curotta 2 , G. Tzannes 2 

1 University of Sydney, Speech Pathology, LISCOMBE, Australia 

E-MAIL: cate.madill@sydney.edu.au 

2 The Children’s Hospital at Westmead, WESTMEAD, Australia 

OBJECTIVES 

To evaluate the efficacy and utility of a student assisted Speech Pathology 

Voice Assessment Clinic. The Speech Pathology Department at The Children’s 

Hospital at Westmead, NSW, Australia has run a specialist voice assessment 

clinic (SPVC) since 2009. To deal with long waiting lists for 

endoscopy in the ENT Voice Clinic, a new model of functional assessment 

and triage, based on Connelly, Clement and Kubba (2009), was created. 

Consideration was given as to the necessity of endoscopy to differentially 

diagnose patients due to the distress caused by the endoscopy procedure 

in children (Hay, Oates, Giannini, Berkowitz and Rotenberg, 2009). 

METHODS 

A review of all cases seen in the clinic was conducted and the value of the 

learning experience was documented by the students. Efficacy of the functional 

assessment model was also evaluated. 

RESULTS 

The SPVC saw 52 new patients and 9 review assessments. Only 3 of the new 

patients required laryngoscopy. Over the last three years, 131 students have 

participated in the SPVC. All reported the value of the learning experience 

and participation in a multidisciplinary team process. The case history 

and functional assessment procedures accurately predicted category of 

voice disorder in nearly all cases. 

CONCLUSIONS 

The incorporation of the student learning experience and the development 

of a functional assessment to differentially diagnose paediatric voice disorders 

is a new innovation in paediatric voice.

P 184 

LOOKING BACK AT CYTOMEGALOVIRUS: AN EMERGING 

CAUSE FOR CONGENITAL HEARING IMPAIRMENT 

J. Araújo Martins 1 , I. Correia 1 , L. Monteiro 1 , P. Brazão Santos 1 , 

P. Paixão 2 , O. Campos 2 , L. Vilarinho 3 , S. Almeida 4 , T. Marques 2 

1 Centro Hospitalar de Lisboa Central, Otorrinolaringologia, LISBOA, 

Portugal 


2 CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 

LISBOA, Portugal 

3 Genetics Institute Jacinto de Magalhães, PORTO, Portugal 

4 Centro Hospitalar da Cova da Beira, COVILHÃ, Portugal 

Congenital cytomegalovirus (CMV) infection has been implicated as one 

of the main causes of sensorioneural hearing loss in children. A previous 

study by some of the authors estimated prevalence to be 1,05% of all 

neonates. Other european studies have estimated congenital CMV to account 

for up to 20% of children with hearing impairment. 

OBJECTIVES 

To determine the prevalence of congenital CMV infection as the cause of 

hearing impairment in children; to compare clinical characteristics of infected 

children against the general population of our clinic; to identify criteria 

that should prompt congenital CMV infection testing. 

METHODS 

A retrospective cohort study was conducted. First, clinical files were reviewed. 

Children with unknown diagnosis and bilateral sensorioneural 

hearing loss of at least moderate severity were selected. After obtaining informed 

consent, dried blood spots (DBS) stored in a national reference laboratory 

were sent to Faculdade de Ciências Médicas for analysis. They were 

submitted to a heat-induced extraction method and nested polymerase 

chain reaction to amplify CMV deoxyribonucleic acid. 

RESULTS 

Of 83 DBS tested, 8 (9,6%) were positive. In our cohort, 11 patients have confirmed 

congenital CMV infection, accounting for 8,1% of cases with known 

diagnosis but only 3,4% cases overall. Hearing impairment was more severe 

in infected children and tended to be progressive more often. 

CONCLUSION 

Congenital CMV infection is a significant cause of hearing impairment in 

our population. Children with more severe or progressive disease are better 

candidates for CMV testing and should be followed-up more closely for 

proper rehabilitation. 

P 185 

PEDIATRIC OTOGENIC LATERAL SINUS THROMBOSIS: 

OUR 12 YEARS EXPERIENCE 

D. Ulanovski, J. Yacobovich, L. Korenreich, V. Shkalim, N. Buller, E. Raveh 

Schneider Children’s Medical Center, Pediatric ENT Unit, 

PETAH TIKVA, Israel 

E-MAIL: ulanovski@yahoo.com 

OBJECTIVES 

Otogenic lateral sinus thrombosis (LST) is a rare complication of acute otitis 

media and presents a controversial treatment especially regarding the 

extent of surgical intervention. We reviewed our experience with the treatment 

of LST. Our working hypothesis was that conservative surgical intervention, 

without drainage of the sinus is the preferred approach. 

METHODS 

A retrospective study of children with otogenic LST in tertiary referral pediatric 

center. 

RESULTS 

LST was diagnosed in 39 children ,aged 1-164 months. All had sigmoid sinus 

thrombosis. Transverse sinus was also involved in 11 patients and jugular 

vein in 8. Acute otitis media with mastoiditis was the causing factor in 37 

children and cholesteatoma in other two. Subperiostal abscess was diagnosed 

in 35 patients and one had otitic hydrocephalus. The treatment included 

broad spectrum antibiotics, ventilation tube insertion, and cortical 

mastoidectomy with removal of bone covering the sigmoid sinus enabling 

to drain pus and remove granulations from the epidural cavity. Drainage 

of the sinus was not performed. Thirty patients received low molecular 

weight heparin for 3-6 months after the surgery. There were no neurologic 

sequellae or hematologic complications. Follow up imaging was performed 

in 22 children. Partial or full recanalization was observed in 82%. 

CONCLUSIONS 

Surgery and antibiotic therapy are the cornerstones of the management 

of LST. We found no need to drain the sinus in order to receive complete 

clinical recovery. We believe that drainage of the sinus should be kept for 

severe cases of distant septic emboli. 

P 186 

HEARING LOSS IN CHILDREN WITH CLEFT PALATE 

A.J. Kinshuck 1 , B. Gani 2 , R.K. Sharma 1 

1 NHS, ENT Deparment, LIVERPOOL, United Kingdom 

E-MAIL: akinshuck@gmail.com 

2 University of Liverpool, LIVERPOOL, United Kingdom 

195

OBJECTIVE 

Cleft palate is associated with recurrent otitis media with effusion and 

hearing loss. Numerous studies have confirmed this, yet there is still indecision 

as to what could be the optimum management plan of such high 

risk patients. This study analysed the way these patients’ hearing is managed 

in Alder Hey Children’s Hospital. 

METHOD 

A retrospective audit was carried out on 260 children under the care of the 

cleft palate team at Alder Hey Children’s Hospital. These patients attended 

one of 14 audiology centres in North West England, North Wales and the 

Isle of Man between the dates of 24/10/2009 to 04/10/2011. Comparisons 

were made between the use of ventilation tubes (VT)s and hearing aids 

(HA)s. The types of cleft, types of hearing loss and the management output 

of the audiology regions were also reviewed. 

RESULTS 

The audiology assessments of 260 patients were examined. The incidence 

of VT insertion in this group of patients was 18.8%. The hearing aid incidence 

rate was 9.1%. The VT related complication rate was 25.0% and the 

HA related complication rate was 9.1%. Although the hearing outcomes of 

the interventions (HA/VT) didn’t vary significantly, secondary variables 

such as whether the different audiology centres preferred HA/VTs (p=0.02) 

all returned with positive results. 

CONCLUSION 

The data demonstrates both treatments are viable and a new protocol 

which combines the short term benefit of VT insertion with the lower 

complication rate of HA is required. 

P 187 

THE IMPORTANCE OF PINNA HAEMATOMAS IN SUSPECTED 

NON-ACCIDENTAL-INJURY 

G. Narasimhan, K. Davies, A. Donne, M. Abedghane 




OBJECTIVES 

Pinna haematomas in children have always aroused a high index of suspicion 

for NAI as it is an unusual injury without feasible explanation; however 

there is very limited research or documentation to highlight common 

presentations and areas of concern. Our aim was to review children with 

pinna haematomas, suspicious of NAI, which had been referred to our 

local child protection department. 

METHODS 

We retrospectively analysed the notes of children presenting to the centre 

with pinna haematomas from June 2009 until February 2011. We evaluated 

196 

the nature and extent of the injuries with categorisation of the pinna 

haematoma. 

RESULTS 

18 cases were examined with equal gender distribution. The age of presentation 

ranged from 2 months to 15 years with a median age of 2 years 4 

months. 12/18 of the injuries were unilateral. 15/18 had history of other 

injuries. 16/18 cases had involvement of the upper half of the pinna. The 

lateral surface was involved in 16/18 cases. 

CONCLUSIONS 

This work represents the largest case series of pinna haematoma due to 

suspected NAI on pubmed review. Proving NAI is difficult and ultimately 

depends upon interpretation of the medical evidence however it is accepted 

that injury without a convincing history of genuine accident 

should be cause for concern. Pinna haematoma may first present to the 

ENT surgeon and so appropriate management of potential NAI must be 

considered. We found that the majority of cases were unilateral and almost 

all had other injuries therefore pinna haematoma must not be considered 

in isolation. 

P 188 

ANTI-OXIDANT EFFECT OF PYRROLIDINE 

DITHIOCARBAMATE IN REDUCING ACUTE INFLAMMATION 

DUE TO MYRINGOTOMY 

A. Meric 1 , R. Dogan 2 , V. Kahya 2 , B. Veyseller 2 , O. Ozturan 2 

Bezmialem University ENT Department, ISTANBUL, Turkey 

E-MAIL: aysenurmeric@yahoo.com 

OBJECTIVE 

Myringotomy is most often used to treat recurrent acute otitis media and 

chronic effusion otitis media in children. The most common sequela of 

myringotomy is myringosclerosis. It has recently been shown that the development 

of myringosclerosis after myringotomy occurs concomitantly 

with an increased concentration of reactive oxygen species in the middleear 

cavity and an inflammatory reaction in the tympanic membrane. To 

assess the effect of pyrrolidine dithiocarbamate on acute inflammation 

due to myringotomy. 

METHODS 

This is prospective randomised study. Thirty Sprague-Dawley rats were 

divided into three groups. Group one constituted controls. Group two underwent 

myringotomy. Group three underwent myringotomy and also 

received 100 mg/kg pyrrolidine dithiocarbamate intraperiteonaly two days 

after surgery. Following sacrifice 48 hours after myringotomy, the animals’ 

right ears were used to determine the concentration of reactive oxygen 

species, using the chemiluminescence method; left ears were used for histological 

study.

RESULTS 

Reactive oxygen species levels were significantly decreased in group three 

compared with group two (p < 0.001). The density of inflammatory cells 

in group three was significantly less than that in group two (p

198 

P 191 

MIDDLE EAR PRESSURE REGULATION REVISITED: THE 

RELEVANCE OF MASTOID OBLITERATION 

Z. Csakanyi 1 , G. Katona 1 , D. Konya 2 , F. Mohos 3 , I. Sziklai 4 

1 Heim Pal Children’s Hospital, ENT Department, BUDAPEST, 

Hungary 

E-MAIL: csakanyi.zsuzsanna@gmail.com 

2 Budapest University of Technology and Economics, BUDAPEST, 

Hungary 

3 University of Szeged, Faculty of Engineering, SZEGED, Hungary 

4 Department of Otorhinolaryngology and Head and Neck Surgery, 

Health Science Cen, DEBRECEN, Hungary 

OBJECTIVES 

Gas pressure balance is crucial for normal middle ear (ME) function. However, 

mechanisms involved in ME pressure control are still not fully 

understood. The role of Eustachian tube (ET) function and mastoid 

pneumatization in ME gas pressure balance was examined and the possible 

clinical relevance of the mathematical model predictions was interpreted 

with particular attention to cholesteatoma and mastoid obliteration. 

METHODS 

A mathematical description and MatLab® modeling of the ME pressure 

balance is presented in the function of different ME volumes, considering 

normal and malfunctioning ET, applying published data as input values 

and comparing with our 3D ME reconstruction data in children. 

RESULTS 

ME pressure can be considered as permanent with small fluctuations in 

healthy ears due to equalization of ME gas volume (VME) changes through 

the ET. Substantially larger ME total pressure (METP) fluctuations can be 

observed in smaller MEs with malfunctioning ET. In the case of mastoid 

obliteration, METP fluctuations become very similar to those found in a 

VME = 10 ml. 

CONCLUSION 

Mastoid obliteration can be curative against larger pressure decrease in 

the MEs with poor ET function. Elimination of mucosal surface serving 

for ME gas exchange is a possible alternative for improving ME gas pressure 

balance in the case of impaired ET function and may contribute to a 

more favorable long-term outcome in cholesteatomatous otitis media. 

P 192 

CLINICAL STUDY OF PEDIATRIC ACQUIRED 

CHOLESTEATOMA :OUR EXPERIENCE IN 37 CASES 

Y. Esu 

E-MAIL: yoshihiko0712@yahoo.co.jp 

OBJECTIVE 

We report our experience with pediatric Acquired Cholesteatoma before 

the age of 15. 

METHODS 

We conducted a retrospective review of patients with Acquired 

Cholesteatoma who underwent surgical treatments from 2004 through 

2011 in the Department of Otorhinolaryngology of Seireiyokohama Hospital 

and Seireihamamatu Hospital. 

RESULTS 

37 patients with acquired cholesteatoma were identified; 22 Boys and 11 

Girls. Four patients had a bilateral disease. Patients mean age was 9.4 years 

and the mean observation term was 36 months. Cholesteatoma were classified. 

23 cases were Attic cholesteatoma, 10 cases were Tensa or Tensa retraction 

Cholesteatoma and 4 cases were Secondly Cholesteatoma. The 

surgical methods most utilized were Canal wall down tympanoplasty with 

Canal reconstruction using cymbal cartilage. This was performed in 33 

cases. Planned Stage Tympanoplasties were performed in 13 cases. Besides 

acquired cholesteatoma, we also discovered 3 cases with Congenital 

Cholesteatoma, during the surgery. Ossicular reconstructions were performed 

except in 2 cases. We performed tympanoplasty type㈵, ㈼c, ㈽c 

and ㈿c in 6,2,22,and 5 cases, respectively. Postoperative audiogram was 

obtained and the hearing results were evaluated. Hearing Level had been 

improved or preserved in most cases. A 

CONCLUSION 

Canal wall down tympanoplasty with Canal reconstruction using cymbal 

cartilage was performed on patients with Acquired Cholesteatoma across 

all age groups in our facilities. In adult, operation resulted in successful 

hearing level and completely negated Recurrent Cholesteatoma. In pediatric 

patients, the outcome was excellent similar to the adult patients, 

however keeping the patient under routine observation is critical.

P 193 

FAILURE OF TYMPANOPLASTY IN CHILDREN: 

PREDICTIVE FACTORS 

I. Alpoim Moreira, R. Moreira Ferreira, A. Casas Novas, J.M. Colaço, 

L. Monteiro 

Hospital Dona Estefânia, Otolaryngology, ALCABIDECHE, Portugal 

E-MAIL: inesvieiramendes@gmail.com 

OBJECTIVES 

To find predictive factors of failure of timpanoplasty in children. 


Period study: 5 years. Inicial patient selection: 254 (patient clinical records 

codified as Simple Timpanoplasty - ICD: 9). Patients excluded: 161 (cole - 

steatoma/atelectasy; no clinical data available; follow up inferior to 6 months; 

childrens older than 15 years old). Final study population: 93. Comparative 

study between: surgical sucess grou p and the surgical failure group. 

RESULTS 

(N=93) Age: 4 - 15 years old; average= 10 years old. Follow up: average= 24 

months. Sucess group: 71% (N= 66), Failure Group: 29% (N=27). Reperfuration= 

20 cases; Residual perfuration= 2 cases: Middles ear otitis with efusion= 

3 cases; Atelectasy= 2 cases. The proportional rate of boys in the failure group 

was bigger and this is statistical significant (Pearson Qui-Square Test: r=0.1). 

The contralateral ear condition was not different in the success and failure 

group (Pearson Qui-Square Test: 0.08). Other caracteristics of the failure 

group were: 50% of anterior perfurations, 38% of large perfurations; 43% of 

children with 4 to 7 years old; 42% with pre-surgical timpanometric volume 

inferior to 3.5 cc; and 34% of cases without associated mastoidectomy time. 

The pre-surgical timpanometric volume (N=53) was 3.05 cc in the failure 

group, and 3.48 cc in the success group, and this was statistical significant 

(p=0.13) 

CONCLUSIONS 

Bad prognostic factors: male gender; anterior perfuration; large perfuration; 

children younger than 7 years old; timpanometric volume inferior 

to 3.5 cc. Some factors are age dependent but age alone in not a contraindication 

for treatment. 

P 194 

INVESTIGATION OF PEDIATRIC CASES OF THE TYMPANIC 

MEMBRANE CHOLESTEATOMA 

K. Matsui, T. Takayuki, K. Kure, Y. Esu, K. Kinoshita, W. Kubota 

Seirei Yokohama Hospital, Otorhinolaryngology, YOKOHAMA, Japan 

E-MAIL: kmatsui@hotmail.co.jp 

Congenital cholesteatoma generally occurs in the middle ear cavity, discontinuous 

with the normal tympanic membrane. Acquired chole - 

steatoma occurs from retaction pocket of the tympanic membrane or the 

lesion progresses from an adhesion to within the middle ear. It is very rare 

to find a cholesteatoma localized to the tympanic membrane. Between 

three years, from June 2007 to May 2010, we report three cases in which a 

white spherical mass thought to be congenital cholesteatoma formed and 

was localized on the tympanic membrane.In the three cases where a 

closed-type cholesteatoma thought to be congenital was seen on the tympanic 

membrane, the mass was present in the posterior superior quadrant 

(PSQ) part of the tympanic membrane of a two-year-old girl and in the 

umbo of the tympanic membrane in a six-year-old boy. In a two-year-old 

boy, a round, white mass was seen in the flaccid part of the tympanic membrane.Tympanic 

membrane findings for these three cases are presented.All 

cases surgically were removed from external auditory canalCongenital 

cholesteatoma of the tympanic membrane is very rare. 

It may be that a type localized on the tympanic membrane should be added 

to the classifications of congenital cholesteatoma of the middle ear. 

P 195 

A STUDY ON COMPLICATIONS AFTER VENTILATION 

TUBE PLACEMENT 

A. Kanei 1 , H. Kobayasi 1 , M. Naito 2 , H. Suzaki 1 

1 Showa University, Otorhinolaryngology, TOKYO, Japan 

E-MAIL: ak-color@live.jp 

2 Naito otolaryngology clinic, SHIZUOKA, Japan 

OBJECTIVES 

Ventilation tube placement is the most effective treatment for chronic otitis 

media with effusion (OME) and recurrent acute otitis media (r 

AOM). The aim of this study is to investigate the complications of ventilation 

tube placement retrospectively. Also, we report a rare case in which 

the removal of ventilation tube was relatively difficult. 

SUBJECTS 

A total of 60 patients (108 affected ears; average 4.3 years, range 1-10 years; 

34 boys and 26 girls) were investigated. They were treated from 2007 to 2011 

at Showa University Hospital. Children with cleft palate (26 cases, 50 ears) 

and Down syndrome (1 case, 1 ear) were included. 

RESULTS 

The duration of ventilation tube placement ranged from 4 to 23 months (average 

14.0 month). The number of ventilation tube placement ranged from 

1 to 6 times (average 3.2 times) for the patients with cleft palate. The number 

of ventilation tube placement ranged from 1 to 4 times (average 2.5 times) 

for the patients without cleft palate. Incidence of complications was 20.3% 

(22 ears) of the ears; infection 12.0%, perforation 6.5%, obstruction 1.9%. 

199

CONCLUSIONS 

Infection was the most common complication of ventilation tube placement. 

For prevention of these complications, a crust or the granulation of 

the tube circumference should be eliminated periodically. If otorrhoea is 

detected, antibiotics and antibiotic ear drop may be used. If otorrhoea is 

not improved, the withdrawal of the tube should be considered When ear 

drum perforation remains, myringoplasty is considered at10 years old 

P 196 

CURRENT BACTERIOLOGICAL STRAINS IN MIDDLE EAR 

EFFUSION FLUID: IS TREATMENT STILL APPROPRIATE? 

T. Rivera Schmitz 1 , M.I. Hamdan Zavarce 2 , J.M. Meléndez García 2 , 

A.S. Araujo Da Costa 2 , G. Espiña Campos 2 

1 Hospital Xeral Cies, VIGO, Spain 

E-MAIL: teresarivera84@hotmail.com 

2 Hospital Xeral-Cies, VIGO, Spain 

OBJECTIVE 

Chronic Otitis Media with Effusion (OME) is a polimicrobial illness caused 

by bacteria, virus or both in combination. In literature we find that bacteria 

is commonly the most frecuent factor for chronic OME being found 

in middle ear fluid samples in up to 50% of children with middle ear infection. 

Children with chronic OME are frequently treated without determining 

the microbiology of the effusion. In our era with increasing 

antibiotic resistence we asked ourselves if the treatment we use nowadays 

is still usefull. Our aim was to specify the bacterial etiology of chronic OME 

by examining the middle ear fluid obtained during timpanotomy. Antibiotic 

sensitivity tests were performed after bacterial identification. 

METHODS 

Subjects were young children between 0 and 14 years of age with chronic 

OME, excluding those who already had grommets. We obtained the middle 

ear fluid samples by aspiration during timpanotomy in the operating 

room. Samples were analysed by bacterial culture and antibiogram. 

RESULTS 

The most commonly found pathogens in our study, in order of frequency, 

were Streptococcus pneumoniae, Haemofilus influenzae and Moraxella 

catarrhalis. These results agree with those of previous studies. We could 

also conclude that amoxicillin is still effective as a treatment for these patients. 

CONCLUSIONS 

We found that S. pneumoniae was the most frequently found pathogen 

in chronic OME and that if antibiotics should be necessary, we will most 

probably find to be efficient by treating empirically with amoxicillin. 

P 197 

ACUTE MASTOIDITIS IN CHILDREN WITH CONGENITAL 

AURAL ATRESIA 

G. Kontorinis 1 , D. Terzakis 2 , I. Plioutas 2 , C. Carabinos 2 , I. Psarommatis 2 

1 Sheffields Children’s Hospital, SHEFFIELD, United Kingdom 


2 Athens Children’s Hospital ‘P&A Kyriakou’, ATHENS, Greece 

OBJECTIVES 

Congenital aural atresia (CAA) represents a rare ear malformation, occurring 

approximately once in every 20,000 live births. Middle ear infections 

in aural atresia require a high suspicion index and may even remain undiagnosed 

until they cause further complications. We present the diagnostic 

keys and the therapeutic approach in children with CAA and acute 

mastoiditis. 

METHODS 

The medical notes of 85 children admitted to a tertiary, paediatric, referral 

centre with acute mastoiditis were retrospectively examined; patients with 

CAA were identified. 

RESULTS 

Two children with CAA and acute mastoiditis were found; one three year 

old male and one six year old female. The main presenting clinical signs 

were otalgia, tenderness and erythema of the ipsilateral mastoid. The computed 

tomography (CT) scans of the temporal bones apart from the bony 

external ear canal atresia showed filled mastoid with erosion of the mastoid 

cells. Both children were successfully treated with limited cortical 

mastoidectomy under facial nerve monitoring, and intravenous antibiotics. 

There were no peri-operative complications and both children were 

discharged after a short time period. 

CONCLUSIONS 

Although CAA is rare, the Otolaryngologist working in a tertiary paediatric 

centre may face complicated ear infections in such patients. Apart from 

the clinical signs, CT scans are helpful in setting the diagnosis and necessary 

for planning the surgery. As no evaluation of the middle ear through 

otoscopy or treatment with myringotomy is possible, intravenous antibiotics 

and limited cortical mastoidectomy with facial nerve monitoring are 

recommended to control the infection with safety. 

201

P 198 

THE ROLE OF COMPUTED TOMOGRAPHY IN ACUTE 

MASTOIDITIS: OUR PRACTICE 

G. Kontorinis 1 , I. Psarommatis 2 , C. Tsami 2 , E. Kalpaktsoglou 2 , 

M. Tsakanikos 2 

1 Sheffields Children’s Hospital, SHEFFIELD, United Kingdom 

202 


2 Athens Children’s Hospital ‘P&A Kyriakou’, ATHENS, Greece 

OBJECTIVE 

There is a considerable variability among ENT pediatric centers about the 

use of computed tomography (CT) in the acute mastoiditis (AM). In some 

of them a preoperative CT for all children suffering from AM is employed. 

In other centers, CTs are performed in those children who require surgical 

intervention. Finally, some surgeons order a CT only in cases with present 

or suspected complications. This report is aimed at presenting our practice 

of the use of CT in pediatric AM. 

PATIENTS AND METHOD 

The medical records of all children (n=155) admitted consecutively to our 

department with the diagnosis of AM between Jan/2002 and Dec/2010 were 

retrospectively reviewed. Diagnostic imaging was performed only in children 

with suspected intracranial complications, recurrent AMs and nontypical 

presentations of AM, when diagnosis was in doubt. Initial 

management included myringotomy and parenteral antibiotics to all children, 

associated with abscess drainage and/or simple mastoidectomy when 

necessary. 

RESULTS 

Imaging studies revealed 9 children with intracranial complications, three 

of whom showed multifocal intracranial lesions. CT was performed in 23 

(15%) children. No child developed additional complications while in-hospital 

and under treatment or after discharge. All children were cured after 

a mean hospitalization of 9.8 days. 

CONCLUSIONS 

It seems that a wise use of preoperative CT in selected children suffering 

from AM can be safe and effective. We do not employ a routine brain CT 

in all cases of AM and suggest its use in children with suspected intracranial 

complications, chronic otitis media, recurrent AM and atypical presentations. 

P 199 

THREE YEARS EXPERIENCE IN DETECTION OF DIFFICULT 

DIAGNOSIS CHOLESTEATOMA IN CHILDREN WITH 

NON/ECHO PLANAR DIFFUSION-WEIGHTED MAGNETIC 

RESONANCE IMAGING 

M. Bartolomé, J. Cervera, M.A. Lopez Pino, R. Lopez Meseguer 

Hospital Niño Jesús, MADRID, Spain 

E-MAIL: mbartolomeb@terra.es 

OBJECTIVE 

The aim of this study was to analyze the role of non echo-planar imaging 

(nonEPI) based diffusion-weighted (DW) magnetic resonance imaging 

(MRI) for the detection of cholesteatoma in children when it is suspected 

by the clinic but not clearly visualized by computed tomography, also to 

confirm the absence of cholesteatoma when in doubt, and lastly for the 

detection of residual cholesteatoma after canal wall-up or wall-down mastoidectomy 

before eventual second-look surgery. 

PATIENTS AND METHOD 

Children between 4 and 16 years old were studied in our tertiary referral 

centre during a three years period with clinic cholesteatoma suspected before 

or after mastoid surgery in order to prepare or avoid a new intervention. 

Patients in the study underwent TSE DW MRI prior to surgery for 

cholesteatoma or exploratory timpanostomy. The MRI findings were then 

correlated with the intraoperative findings at surgery and TC studies. 

RESULTS 

Non EPI DW MRI sequences depicted residual cholesteatomas and not 

clearly visualized cholesteatomas in children in TC studies and clarify the 

ears without cholesteatoma: the cases with negative preoperative DW MRI 

for cholesteatoma were all confirmed to be disease free at surgery. 

CONCLUSION 

Non EPI-DW MRI has the capability of selecting children patients for mastoid 

surgery and avoid unnecessary exploratory timpanostomy and second-look 

surgery after first-stage surgery or open timpanoplasty in 

children. DW MRI imaging is evolving into a noninvasive alternative to 

surgery for detection and screening for cholesteatoma in pediatric patients.

P 200 

ENDOTOXIN INDUCED ELECTROPHYSIOLOGICAL EFFECTS 

TO THE AUDITORY PATHWAY IN LAMBS 

A.L. Smit 1 , V. Lambermont 2 , L.J.C. Anteunis 2 , B. Kremer 2 , B.W. Kramer 2 , 

R.J. Stokroos 2 

1 MUMC, KNO, MAASTRICHT, The Netherlands 

E-MAIL: dianesmit@hotmail.com 

2 Maastricht University Medical Centre, MAASTRICHT, 


OBJECTIVES 

By discovering lipopolysaccharide (LPS) endotoxin in middle ear effusions 

attention was drawn to its potential role in the onset of sensorineural hearing 

loss (SNHL). Experimental studies already demonstrated a negative effect 

to hearing levels after application into the middle or inner ear. The 

objective of this study is to evaluate the effects of this endotoxin to the auditory 

function in case of a chronic intra-uterine infection in a lamb model. 

METHODS 

Pregnant ewes were randomized according to intra-uterine injection of 

E.coli endotoxin (n=26) or sham treated control group (n=23). After spontaneous 

term delivery bone-conducted auditory brainstem response (ABR) 

measurements were made under general anesthesia 1 and 5 months after 

birth to obtain ABR thresholds, absolute peak and interpeak latencies 

which were compared between treatment groups using multivariate statistical 

analysis. 

RESULTS 

The ABR thresholds demonstrated a significantly elevation of 9.3 dB 

(p=0.009) after endotoxin exposure in comparison to sham treatment at 5 

months after birth. Analysis of latency time showed significantly increased 

values of peak I (p=0.027),II (p=0.007), III (p=0.016) and V (p=0.000) in the endotoxin 

group compared to the sham group at 1 month after birth. This 

resulted in a similar effect on the III-V interpeak interval at 1 (p=0.031) and 

5 months (p=0.028). 

CONCLUSIONS 

Our study confirms the hypothesis of a potential damaging effect of an 

intra-uterine endotoxin infection on the auditory function of the lamb 

after birth. These results could be an explanation for the finding of mild 

sensorineural hearing loss in childhood. 

P 201 

OTITIS MEDIA WITH EFFUSION. MICROBIOLOGY AND 

BACTERIAL BIOFILMS 

P.I. Giannakopoulos 1 , K. Kesanopoulos 2 , D. Terzakis 3 , A. Radiotis 3 , 

G. Tzanakaki 2 , G. Kalogeras 4 , E. Lebessi 4 , J. Kremastinou 2 , M. Tsolia 5 , 

S. Chatzipanagiotou 6 , M. Tsakanikos 7 

1 P.A. Kyriakou, Athens Children Hospital, ENT, ATHENS, Greece 

E-MAIL: polyviosgiannakopoulos@yahoo.gr 

2 National Meningococcal Reference Laboratory, National School 

of Public Health, ATHENS, Greece 

3 ENT Dept. ‘P&A Kyriakou’ Children’s Hospital of Athens, ATHENS, 

Greece 

4 Microbiology Department, ‘P&A Kyriakou’ Children’s Hospital, 

ATHENS, Greece 

5 2nd Department of Paediatrics, ‘P&A Kyriakou’ Children’s Hospital, 


6 Laboratory of Biopathology and Clinical Microbiology, Aeginition 

Hospital, ATHENS, Greece 

7 ENT Dept. ‘P&A Kyriakou’ Children’s Hospital, ATHENS, Greece 

OBJECTIVE 

To study the microbiology of OME in Greek children and the ability of 

these bacteria to form biofilms in vitro. 


Our study includes 124 children with OME during the period 2010-mid 

2011. Myringotomy was performed under general anesthesia. By the use 

of a sterile suction device, samples were sent for culture and PCR. All the 

isolated culture positive bacteria were further studied for their ability to 

form biofilms in vitro with the silicone disk method. 

RESULTS 

Out of 124 samples, 54 were PCR positive (43,5%). Out of those, 25 were 

Haemophilus infuenzae (HI)(46%), 8 were Streptococcus pneumoniae 

(SP)(15%) , 10 Streptococcus species (18,5%), 5 were co-infection of SP-HI (9%) 

3 were Staphylococcus aureus (5,5%), 2 were co-infection of HI-Streptococcus 

species (4%) and 1 was co-infection of HI-Staphylococcus aureus (2%). 

All the co-infection cases were HI associated (n=8, 15%). 71 samples were 

sent for culture. Of those, 40 were positive (57%), 13 HI (32,5%), 4 Moraxella 

catarrhalis and 2 SP. Out of the culture positive bacteria that were sent for 

biofilm studies in vitro, Haemophilus infuenzae (40%, n=4/10), Moraxella 

catarrhalis (75%, n=3/4) and Staphylococcus aureus (100%, n=1/1) were found 

to be positive. 

CONCLUSIONS 

The pathogenesis of OME is multifactorial and seems to be related also with 

the ability of bacteria to survive in the middle ear in the form of biofilms. 

Further studies are awaited for treatment modalities in the future. 

203

P 202 

STREPTOCOCCUS PNEUMONIAE 19A IN COMPLICATED 

ACUTE OTITIS MEDIA IN GREECE 

P.I. Giannakopoulos 1 , A. Xirogianni 2 , D. Terzakis 3 , A. Radiotis 3 , 

G. Tzanakaki 2 , D. Hatzaki 4 , E. Lebessi 4 , J. Kremastinou 2 , M. Tsolia 1 , 

M. Tsakanikos 5 

1 P.&A. Kyriakou, Athens children hospital, ENT, ATHENS, Greece 

204 

E-MAIL: polyviosgiannakopoulos@yahoo.gr 

2 National Meningococcal Reference Laboratory, National School of 

Public Health, ATHENS, Greece 

3 ENT Dept. ‘P&A Kyriakou’ Children’s Hospital of Athens, ATHENS, 

Greece 

4 Microbiology Department, ‘P&A Kyriakou’ Children’s Hospital, 


5 ENT Dept. ‘P&A Kyriakou’ Children’s Hospital, ATHENS, Greece 

OBJECTIVES 

To study the impact of the heptavalent conjugated pneumococcal vaccine 

(7PCV) and the increasing occurance of serotype 19A especially in complicated 

cases of AOM. 


Fourty-five children that were admitted to our department (2010-mid 

2011) because of AOM refractory to p.o. antibiotics (>10 days) showing complications 

such as: mastoiditis with or without subperiosteal abscess, facial 

nerve paresis etc. Samples were taken with myringotomy and were sent 

for culture and PCR. 

RESULTS 

From these 45 children, those with AOM refractory to p.o. antibiotics (n=20, 

44.5%), 5 samples of Haemophilus influenzae (HI, 25%) were isolated and 8 

samples of Strpeptococcus pneumoniae (SP, 40%) serotype 19A (n=2, 25%), 

19F (n=1, 12.5%), 1 (n=1, 12.5%), 4 non-typable (NT, 50%) with PCR, while 

there was 1 case of co-infection SP and HI (5%). From the mastoiditis cases 

(n=19, 42.5%), 16 samples of SP were isolated (84%) serotypes 19A (n=10, 

62.5%), 19F (n=1, 6.25%), 6 (n=1, 6.25%), 3 (n=1, 6.25%), NT (n=3, 18.75%), while 

there were 3 cases with -I (16%). There was 1 case of co-infection SP-HI (5%). 

In those cases with otorrhea refractory to p.o. antibiotics (n=2), 2 samples 

of SP serotype 19A (n=2, 100%) were isolated. 

CONCLUSIONS 

Despite the use of 7PCV, SP remains the most common causative agent of 

complicated AOM. SP-19A seems to be invasive and resistant to common 

wide spectrum antibiotics. After the introduction of 7PCV in 2003 in 

Greece, there seems to be an increase in the frequency of SP-19A, one that 

was not common in the pre-vaccine era. 

P 203 

BACTERIOLOGY AND MANAGEMENT OF 

ACUTE MASTOIDITIS 

R. Martinkiene 1 , E. Gradauskiene 2 , E. Kavaliunaite 2 , F. Cerkauskiene 2 , 

V. Vaivockaite 2 , G. Reklaitiene 2 , V. Sakalinskas 2 , J. Byckova 2 , 

I.J. Sruogiene 2 , R. Simkiene 2 , J. Jakiuniene 2 , H. Alisauskas 2 , 

G. Manikiene 2 


Santariskiu Klinik, ENT, VILNIUS, Lithuania 

E-MAIL: rasamart@gmail.com 

2 Childre ‘s Hospital, Affiliate of Vilnius University Hospital 

Santariskiu Klinik, VILNIUS, Lithuania 

OBJECTIVES 

The objective of this study was to determine most frequent bacteria and 

their sensitivity to antibiotics of acute mastoiditis (AM), assess the conservative 

treatment and obtain comparison data for children up to 2 years 

and above of 2 years of age. 

METHODS 

A retrospective chart review of children admitted to the ENT Department 

over the 5 years period. Criteria for the diagnosis of AM were co-existing 

or recent signs of AOM, erythema or/and swelling of postauricular area, 

protrusion of auricle. Statistical analysis was done with SPSS software. 

RESULTS 

Fifty eight patients had AM during 2004-2009 years. Patient’s age varied 

between 0.1 and 17.9: 21 patients were up to 2 years of age and 37 were above 

2 years. For 49 patients we could identify bacterial cultures from medical 

charts. In 10 patients bacterial culture was negative and in 39 was positive. 

Most common organisms were S.pyogenes in 10 cases (up to 2 years only 

in 2 cases) and S. Pneumoniae in 8 cases. For 37 patients was performed 

myringotomy with/without tympanostomy. Cortical mastoidectomy was 

performed for 23 patients, in 11 cases up to 2 years patients. 

CONCLUSIONS 

AM continues to be a potentially dangerous infection despite the antibiotic 

treatment. The most common organism for children with AM up to 2 years 

of age was S. Pneumoniae and for children over 2 years group- S.pyogenes. 

Antibiotic treatment with myringotomy is the treatment choice for acute 

mastoiditis, but not always sufficient.

P 204 

RISK FACTORS FOR OTITIS MEDIA WITH EFFUSION 

L.J. Cvorovic 1 , M. Jovanovic 1 , S. Stankovic 1 , P. Vasiljevic 2 

1 Faculty of Medicine, University of Belgrade, BELGARDE, Serbia 

E-MAIL: cvorcica@yahoo.com 

2 Clinical Hospital Centre Zvezdara, BELGRADE, Serbia 

OBJECTIVES 

To identify the socio-demographic factors, comorbidity and child risk factors 

for otitis media with effusion (OME) in children and analyze the results 

with reference to the review of the literature. 

METHODS 

Associations of possible risk factors with prevalence of otitis media with effusion 

(OME) were studied in a cohort of 56 children, aged 1.5-13 years. In 

order to determine OME, otoscopy and tympanometry were performed at 3monthly 

intervals beginning at term date. The questionnaire, comprising the 

questions regarding certain risk factors relevant to the disease and characteristics 

of this particular, was completed by parents of the diseased children. 

RESULTS 

OME was most strongly associated with recurrent infections of the upper 

respiratory tract (82.1%) and the stay in day-care groups (75.0%). No significance 

was found for economic status of the family, family size, family history 

of presence of allergy and of ear disease, mother’s work status, 

smoking parents, breastfeed and birth history. Moreover on multivariate 

logistic regression analysis it resulted that positive URTI’s history and 

smoking exposure were found to be significant (P

tients underwent surgery due to recurrence and three had known residual 

cholesteatoma. In patient with congenital aural atresia. a congenital 

cholesteatoma was associated with brain temporal lobe abscess. 

CONCLUSION 

Clinical and surgical findings suggest that congenital cholesteatoma 

showed various characteristics depending on the location and stage of development. 

Appropriate imaging technique ( CT, MR) is useful to diagnose 

and delineate the extent cholesteatoma, but also in planning the surgery 

of the ear, specially in congenital aural atresia 

P 207 

APLLICATION OF DIAGNOSTIC AND OPERATIVE 

ENDOSCOPIC PROCEDURES IN MIDDLE EAR DISEASES 

IN PAEDIATRIC AGE 

N. Nassif, L.O. Redaelli de Zinis, M. Brelucchi, S. Mangili, D. Zanetti 

Spedali Civili Brescia, ENT, BRESCIA, Italy 

E-MAIL: nadernassif@alice.it 

OBJECTIVE 

Evaluate the benefits of endoscopic approach in middle ear surgery treating 

otitis media with effusion, perforations of tympanic membrane (TM) 

and cholesteatomas. 

METHODS 

Between 2010 and 2011 otoendoscopy was applied in 4 different approaches. 

Ventilation tube VT placement in 35 patients (56 VT: 21 pts in both ears 

and 14 pts in one ear) suffering from otitis media with effusion or acute 

otomastoiditis (age 1 months to 14 years). 5 patients underwent transcanal 

myringoplasty TCMP (with tympanomeatal flap) for anterior quadrants 

perforation (age between 6 and 10 years). Another 5 patients 

underwent endo-canal myringoplasty ECMP (without tympanomeatal 

flap) for paracentral perforation of TM (age 7-12 years). 4 patients underwent 

second look tympanoplasty for recurrent cholesteatoma. 

RESULTS 

Placement of 56 VT were easier to handle by endoscopy especially in both 

curved and narrow external auditory canals. Follow up of 3 months to 24 

months resulted in 2 re-perforations of TM: 1 TCMP approach and 1 ECMP. 

Trans-canal removal of cholesteatoma was successfully accomplished from 

middle ear in all 4 patients (follow up 4-12 months). 

CONSLUSION 

Otoendoscopy is a more conservative approach w.r.t. traditional techniques. 

It’s a valid alternative for grommet placement especially in narrow 

and curved external canals. Post-auricolar approach for anterior TM perforations 

could be avoided by endoscopy. Strictly selected cases of 

cholesteatomas can be handled endoscopically. In bloody fields surgery 

206 

becomes demanding and troublesome. Adequate surgical training in necessary 

in order to have good results. 

P 208 

ACQUIRED CHOLESTEATOMA IN PRE-SCHOOL AGED 

CHILDREN 

J.W. Rainsbury, A. Acharya, C. Panagamuwa, K. Tzifa 

Birmingham Children’s Hospital, BIRMINGHAM, United Kingdom 

E-MAIL: j_rainsbury@yahoo.co.uk 

OBJECTIVE 

It is a widely held opinion that acquired cholesteatoma in very young children 

behaves differently to the same disease in older children and adults. 

We present our experience of patients aged 5 and under with acquired 

cholesteatoma and discuss their presentation and outcomes in relation to 

published data on general paediatric and adult patients. 

METHOD 


RESULTS 

15 cases were identified over a seven year period. Typical presentation was 

with persistent unilateral otorrhoea. The disease was often extensive and 

in many cases required revision surgery. A number of children who had 

canal wall down surgery did not tolerate aural toilet in the outpatient 

clinic and needed to have this performed under anaesthetic. Long term 

hearing outcomes and disease recurrence rates will be discussed. 

CONCLUSION 

There are aspects of the surgery and post-operative care of cholesteatoma 

in very young children that differ from that in older patients, in particular 

the surgical approach; the need for increased vigilance for detection of recurrence, 

and the problems with doing so, either in the outpatient clinic 

or radiologically; and their hearing rehabilitation. There was frequently 

a significant delay in referral for treatment; because recurrent acute otitis 

media is relatively common in this age group, we suspect that primary 

care physicians may not suspect cholesteatoma as a cause for a chronically 

discharging ear in a preschool child. Our experience of cholesteatoma in 

these children is of an aggressive disease whose management deserves special 

consideration.

P 209 

RETROSPECTIVE REVEW OF CHOLESTEATOMA IN CHILDREN 

M.I. Hamdan Zavarce 

Hospital Xeral, Otolaryngology, VIGO, Spain 

E-MAIL: miriamhamdan@gmail.com 

OBJECTIVE 

Acquired cholesteatoma is an abnormal growth of squamous epithelium in 

the middle ear and mastoid. Incidence account for 5 to 15 per 100,000 children 

and 1% in children who had undergone tympanostomy tube placement. 

Cholesteatoma can enlarge and destroy temporal bone and ossicles, resulting 

in conductive hearing loss. We present eighty five cases of cholesteatoma in 

children treated in our hospital during a fifteen year period. 

METHODS 

We perform a retrospective review of children, patients with seventeen years 

old and younger, undergoing surgical intervention for cholesteatoma at our 

hospital. Medical history, type of cholesteatoma, age of diagnosis, air-bone 

gap improvement, type of treatment, osicular reconstruction, recurrence 

rate comparing type of surgery, were reviewed. 

RESULTS 

Eighty five patients diagnosed of Cholesteatoma that underwent surgical 

resection. Younger patient had two years old (one patient). Mean average 

of the air-bone gap recovery 12 dB. Beneficial results when evaluating air 

bone gap depending surgery type and reconstruction if present. Patients 

with ages up to ten years old represent 30% of cases and from eleven to seventeen 

years old represent 70% of cases. Recurrence rate was 14% and intact 

canal wall most frequent type of tympanoplasty performed. 

CONCLUSION 

Surgical therapy is required for most cholesteatomas. The extent and effectiveness 

of surgery depends upon the size of the cholesteatoma, experience 

and complications. Early diagnosis is crucial to successful outcome. 

Management, type of surgery and approach depend on anatomic and clinical 

factors. A careful study required in pediatric population. 

P 210 

STREPTOCOCCUS PNEUMONIAE STRAINS ISOLATED FROM 

PATIENTS WITH ACUTE OTITIS MEDIA 

M. Poenaru, V. Mocanu 

University of Medicine and Pharmacy Victor Babes Timisoara, 


E-MAIL: marioara.poenaru@gmail.com 

OBJECTIVES 

We conducted a study of infants and children with acute otitis media to 

identify pathogens and susceptibility patterns. 

METHODS 

During the winter of 2010 to 2011, middle ear fluid samples were collected 

from 914 patients with acute otitis media in the ENT Clinic in Timisoara, 

Romania. Specimens were obtained by tympanocentesis or from the discharge 

from ruptured tympanic membranes. Isolation on conventional 

culture media and identification of germs were performed at the hospital 

laboratory. Identification of Streptococcus pneumoniae and extensive antimicrobial 

tests (by dilution antimicrobial susceptibility tests) were performed 

with the help of the automatic Vitek2 System (bioMerieux France), 

using Vitek 2 GP and Vitek 2 AST P533 cards. 

RESULTS 

Pathogens were isolated from 68,12% of the patients. From 1214 samples 

we isolated 363 strains of Streptococcus pneumoniae, 182 strains of nontypable 

Haemophilus influenzae, 109 strains of Moraxella catarrhalis, 84 

strains of Streptococcus pyogenes and mixtures of pathogens in 89 middle 

ear fluid samples. More isolates of S. pneumoniae were susceptible to 

amoxicillin (98,62%) than to penicillin (68,59%). Decreased sensitivity plus 

resistance to other antimicrobials were: erythromycin-40,78%, trimethoprim/sulfamethoxazole-30,01%, 

tetracycline-47,39% and chloramphenicol 

-12,40%. The prevalence of resistant S. pneumoniae was highest in patients 

more than 12 months of age. 

CONCLUSIONS 

Amoxicillin remains the antibiotic of choice for initial empiric treatment 

of acute otitis media although the dosage should be increased in patients 

at risk for drug-resistant S. pneumoniae. 

P 211 

UNILATERAL CONDUCTIVE HEARING LOSS IN CHILDREN 

R. Zielinski, A. Zakrzewska 

Medical University of Lodz, Department of Pediatric 

Otorhinolarynology, LODZ, Poland 

E-MAIL: rafalziel@gmail.com 

INTRODUCTION 

Hearing loss in children is a serious diagnostic and therapeutic problem. 

Children with conductive hearing loss form the biggest group of patient 

hospitalized because of hypoacusis. Unilateral hearing loss in a child is 

often not even noticed by the parents or tutors, but it may affect both 

stereophonic hearing and hearing in noise. 


The group of 25 patients treated with adenectomy in years 2006-2012 was 

evaluated because of unilateral abnormality in otoscopy examination. At 

207

the examination both videootoscopy and audiologic examination (tympanometry 

and pure-tone tresholds of air and bone conduction) was performed. 

Nasopharyngoscopy was the procedure which was evaluated in 

all patients. 

RESULTS 

In examined group 18 children or their parents reported hearing loss. Lack 

of focusing was the most common complain. The videootoscopy abnormalities 

were: effusion in tympanic cavity, focal atropy, myringosclerosis 

and retraction pockets. 

RESULTS 

of mean pure tone audiometric threshold and tympanomtetry were significantly 

worse in ears with tympanic membrane abnormalities. Most 

common abnormality in endoscopic examination were: nasal septum abnormalities, 

unilateral eustachian tube pharyngeal orifice abnormalities, 

asymetric hypertrophy of an adenoid. 

CONCLUSION 

Although ventilation tubes insertion is recommended procedure in otitis 

media with effusion all of disorders affecting nasal breathing are important 

for good function of Eustachian tube. The chance of spontaneous resolution 

in otitis media with effusion depends on good state of nasal cavity 

and nasopharynx. Seeking for the problem in the area is especially important 

in unilateral conductive hearing loss in children. 

P 212 

EXTERNAL EAR CANAL (EEC) CHOLESTEATOMA 

A. Mileshina, V. Kurbatova 

National Research Center for Audiology and Hearing Rehabilitation, 

MOSCOW, Russian Federation 

E-MAIL: bakhshinyan@yahoo.com 

OBJECTIVES 

The objective of this study was to study the sources of the cholesteatoma, 

and also to estimate correlation between the temporal bone computerized 

tomography data and the surgical findings. 

METHODS 

16 patients with cholesteatoma of the EEC at the age from 6 to 16 years were 

included in this study, including 2 children with Tricher Kollins & Goldenhar 

syndroms.In 13 children the disease has been revealed on one side, 

in 3 children - was bilateral (19 cases). In 17 cases cholesteatoma was congenital, 

in 2-developed after ear surgeries, and 3 patients hadn’t EEC atresia. 

RESULTS 

19 temporal bones CT-scans analysis had shown that the stenosis of a bone 

part of EEC was found in 16 cases.In the majority of cases there was good 

pneumatisation of the mastoid (13 cases), destruction of the EEC walls was 

208 

confirmed in 3 patients, the ossicullar and middle ear structures abnormalities 

were revealed in 14 cases. The mild conductive hearing loss was 

diagnosed in 8 cases, mild-to-moderate - in 2 and severe - in 7 cases. In 13 

cases canaloplasty was performed, in 1 case - emergency mastoidectomy 

due to the acute mastoiditis, in 1-a plasty of the EEC walls defects.In 3 cases 

cholestestoma was removed without EEC plasty. Canal wall-down mastoidectomy 

was executed in 1 case. 

CONCLUSIONS 

The temporal bone CT-scans provided information necessary to diagnose 

the EEC cholesteatoma in case of EEC stenosis at the age of 6-7, and were 

helpful for planning the type and time of surgical intervention. 

P 213 

DEVELOPING, IMPLEMENTING AND AUDITING EVIDENCE 

BASED CARE PATHWAY FOR ACUTE OTITIS MEDIA, AND 

OTITIS MEDIA WITH EFFUSION IN CHILDREN 

D.R.D. Bhargava, K. Bhargava 

Sultan Qaboos University, ENT Surgery, AL KODH MUSCAT, Oman 

E-MAIL: deepaent@gmail.com 

AIM 

To develop, implement and audit an Evidence based care pathway for acute 

otitis media and otitis media with effusion. This pathway has been developed 

to guide primary care physicians to specialists, through a systematic 

process by implementing evidence based protocols for the change to evidence 

based Practice (EBP) and improved quality of care. 

METHOD 

A model has been developed as an organized framework based on theoretical, 

research literature related to evidence based practice, Information 

mastery, and research utilization. In this model general physician, residents, 

specialists are guided through the entire process of developing; implementing 

and auditing evidence-based care pathways. The care pathway 

was developed for acute otitis media and otitis media with effusion. 

Sources include Medline searches, systematic reviews, and guidelines. The 

other sources included clinical expertise and quality improvement information. 

The quality outcomes have been predefined these will be audited 

later date. 

CONCLUSION 

Pre appraised evidence with its level of evidence and grades of recommendation 

in the form of evidence-based care pathways are needed at point of 

care. Outcome based research and audits are needed to study the degree 

of improvement of quality of care after implementing the described EBP 

Model of care

P 214 

MIDDLE EAR IMPLANT IN CHILDREN AND ADOLESCENTS 

S. Roman, J.M. Triglia, R. Nicollas 

APHM-Hopital de Timone, ENT Pediattic Department, MARSEILLE, 

France 

E-MAIL: sroman@ap-hm.fr 

PURPOSE 

Active middle ear implant can be used in children and adolescents with 

congenital hearing loss. The authors report an experience of the semi implantable 

Medel Vibrant Soundbridge ® (VSB) in the audiologic rehabilitation 

for such patients. 

METHODS 

In this retrospective study, audiological and surgical data of 6 children 

(10.5 +/- 4 years) implanted with 8 VSB were analysed. 

RESULTS 

4 children presented microtia (pinna atresia) associated with external auditory 

canal (EAC) atresia, bilaterally (n=3) and unilaterally (n=1). 2 children 

presented bilateral EAC atresia and were bilaterally implanted. 4 of them 

had a conductive hearing loss (mean AC = 58.75 dB preoperatively), and 2 

of them had a mixed hearing loss (mean AC = 65 dB). The FMT was crimped 

on the long process of the incus in the all cases. There was no intra- or 

postoperative surgical complications. All the children wore their implant 

after 3 weeks. Postoperative bone conduction thresholds were unchanged. 

The mean aided thresholds with VSB (f4 = 0.5, 1, 2, 4 kHz warble tones) were 

28 dB (+/- 10). Speech discrimination in quiet conditions in free field with 

the VSB unilaterally activated was 50 % at 35 dB SPL (+/- 8). 

CONCLUSION 

The results indicate that satisfaction of the children and their parents is 

very encouraging. 

P 215 

THE USE OF THE VIBRANT SOUND BRIDGE IN POST- 

TRAUMATIC HEARING LOSS: U.S. MILITARY PROSPECTIVE 

M.E. Hoffer 

Spatial Orientation Center, Otolarynology, SAN DIEGO, USA 

E-MAIL: michael.hoffer@med.navy.mil 

OBJECTIVES 

To examine a large series of young people who have suffered head trauma 

and associated hearing loss and determine the factors that predict better 

hearing outcomes with a vibrant sound bride (VSB) than conventional 

hearing aids(HA). 

METHODS 

We retrospectively reviewed a series of young patients who presented to 

our clinic with head trauma associated hearing loss. We examined the cases 

for the following issues: 1) Percentage of individuals who were candidates 

for hearing rehabilitation, 2) Audiometric characteristics of these individuals, 

and 3) Percentage of individuals whose audiometric profile, hearing 

aid experience, or local ear factors would profit from a VSB. 

RESULTS 

A surprisingly high percentage of young individuals who suffer mild head 

trauma present with audiometric characteristics that qualify for hearing 

rehabilitation. A higher than expected number of these individuals would 

perform poorly with conventional HA. Factors that influence poor performance 

include degree/configuration of hearing loss, status of the ear, 

and the social stigma of conventional HA. Since, most of these factors could 

be overcome with a VSB we describe what percentage of our population 

who would profit from the use of a VSB. 

CONCLUSIONS 

A surpassingly high percentage of young individuals with head trauma 

have associated hearing issues. Aggressive management of hearing concerns 

is critical in this age group. Nevertheless, conventional HA are far 

from an ideal rehabilitation solution in many individuals. Our large series 

allows us to examine this issue and argues for the use of the VSB as a rehabilitative 

solution for many of these patients. 

P 216 

A NEW BONE CONDUCTION IMPLANT 

G.M. Sprinzl, A.M. Wolf-Magele, J. Schnabl, P. Zorowka, V. Koci 

Medical University Hospital Innsbruck, Otorhinolaryngology, Head and 

Neck, INNSBRUCK, Austria 

E-MAIL: georg.sprinzl@i-med.ac.at 

INTRODUCTION 

Since three decades bone conduction hearing aids (BAHA) have been used 

widely as an alternative treatment option for the rehabilitation of patients 

with mixed and conductive hearing losses. Especially for those cases where 

conventional reconstruction failed and conventional hearing aids could 

not be used, BAHA was the only option for the treatment of hearing impairment 

for many years. In the last years reports were noted where active 

middle ear implants were used successfully to overcome the well known 

problems of BAHA. However, not all candidates can be treated with active 

middle ear implants due to challenging surgical and technical problems. 

We present for the first time a new improved bone conduction implant, 

which is partially implantable transcutaneous system. 

METHODS 

Four female patients (Age 21-28 years, Median 23,3 years) suffering from 

unilateral and bilateral atretic malformations of the ear were implanted 

209

with a new bone conduction implant. The system consists of a receiving 

coil, a retention magnet and a transducer which is transferring the vibratory 

energy to the mastoid bone. The transducer was placed in the mastoid 

of the recipient. 

RESULTS 

Audiologic - free field audiometry - speech recognition tests in quite and 

noise - and clinical results of the first three patients will be presented. 

There were no postoperative complications. All patients are using the audioprocessor 

on a daily basis. 

DISCUSSION 

With the new bone conduction implant (BCI), which is a transcutaneous 

system,the shortcomings of classical BAHA can be solved and a stable audiologic 

rehabilitation is possible. 

P 217 

COCHLEAR REIMPLANTATION IN CHILDREN 

M.N. Calmels, J. Lajoie, B. Baladi, N. Cochard, M. Marx, O. Deguine, 

B. Fraysse 

Purpan hospital, ENT, TOULOUSE, France 

E-MAIL: calmels.mn@chu-toulouse.fr 

OBJECTIVES 

To review a series of children that have undergone revision cochlear implant 

surgery 

METHODS 

Retrospective study of 15 reimplanted children from 1999 to 2011 in our 

department. Each case was analysed from the time implant failure was 

suspected to the last performance after reimplantation. We describe the 

aetiology of the failure, analyse surgical difficulties and compare audiological 

performances and the evolution of results before and after reimplantation. 

RESULTS 

13 patients were reimplanted in the same ear, 2 in the opposite one: 5 with 

the same implant device, 8 with an upgraded implant and 2 using a different 

type of implant . Aetiologic research found 5 hard failures, 8 soft 

failures based on performance decrements with normal integrity test, and 

2 wound infections. Mean duration between date of implant failure and 

reimplantation was 167 days (7-630). This delay was greater in cases of soft 

failure (230 days versus 14 days in hard failures cases). No surgical difficulty 

was encountered for reimplantation except for 2 partial electrode insertions. 

Speech perception scores were the same or better one year after reimplantation 

for all children except for one contralateral reimplantation. 

Performances increase faster after reimplantation for children with hard 

failure. Coding strategy modifications appear to slow down performances 

without long term negative impact. 

210 

CONCLUSION 

Reimplantation surgery is a success in the majority of cases. Reimplantation 

decisions can be difficult in soft failure cases but must be as fast as 

possible in order to avoid initial speech performances impairments after 

reimplantation. 

P 218 

THE ROLE OF BAHA IN CHILDREN WITH CONGENITAL 

CONDUCTIVE HEARING LOSS 

F. Ball, A. Bruce, J. Nichani, S. Jarvis, M.J. Green, P. Sheehan, P. Rothera 

Royal Manchester Children’s Hospital, ENT, MANCHESTER, 


E-MAIL: jessica.ball@student.manchester.ac.uk 

OBJECTIVE 

Long term hearing rehabilitation in children with congenital conductive 

hearing loss in the presence of external and middle ear abnormalities and 

normal inner ear function may be achieved using a BAHA. We evaluated 

the long-term outcome of BAHA in these children. 

METHOD 

A retrospective analysis was performed of children with congenital conductive 

hearing loss fitted with BAHA between June 2006 and February 

2011 at Royal Manchester Children’s Hospital. 

RESULTS 

We identified 28 children of whom 22 had an underlying syndrome, 5 had 

auricular malformations and 1 had congenital cholesteatoma. Mean age 

at implantation was 9.9 years (range 3.3 - 16.1). Unilateral implants were 

performed in 9 children; bilateral in 19, of which 8 were sleeper implants. 

In total 47 fixtures were inserted, 10 single stage and the rest 2 stage procedures. 

We were able to use 4mm fixtures in all except one child. There 

was 1 intra-operative complication secondary to bleeding. In 11 children 

significant soft tissue overgrowth was seen, 7 were managed with longer 

abutment and 4 had revision surgery. 3 children required re-implantation. 

25 children are using their BAHA with continuing benefit. 2 had the abutment 

removed and long-term follow-up is not available in 1. 

CONCLUSION 

BAHA is a safe and effective intervention in children with congenital conductive 

hearing loss secondary to either a syndrome or auricular malformation. 

Soft tissue complications may necessitate the use of longer 

abutments or revision surgery. The evolving role of BAHA in the rehabilitation 

of childhood hearing loss will be discussed.

P 219 

NEW CLOSED-SKIN BONE-ANCHORED IMPLANT ALPHA1: 

PRELIMINARY RESULTS IN 6 CHILDREN WITH EAR ATRESIA 

F. Denoyelle 1 , C. Coudert 2 , O. Mazzaschi 1 , N.L.B. Leboulanger 1 , 

N. Loundon 1 , E.N. Garabédian 1 

1 Trousseau Children’s Hospital, Pediatric Otolaryngology, PARIS, 

France 

E-MAIL: f.denoyelle@trs.aphp.fr 

2 Audionova, PARIS, France 

OBJECTIVE 

To report the results of the Alpha-1 closed-skin bone-anchored implant 

with a 6 months follow-up in 6 children with ear atresia. 

METHODS 

Prospective study in a tertiary care center; cross-over comparison with a 

soft band BAHA. Evaluations used pure-tone and speech audiometry, 

speech discrimination tests in noise. Quality-of-life was assessed before 

surgery and at six months (M6) using a questionnaire adapted from the 

Meaningful Auditory Integration Scale (MAIS). 

RESULTS 

Patients’ ages ranged from 6 to 10 years at surgery. Patients were implanted 

because of a high grade ear atresia with a pre-operative mean pure-tone 

average (PTA) loss of 71.5 ± 6.6 dB on air conduction and 14 ± 5,5 dB on bone 

conduction. Contralateral mean air conduction PTA +/- SD and bone conduction 

PTA were respectively 28.3 ± 20.6 dB and 10 ± 5.2 dB. At M6, free 

field with contralateral masking showed a mean aided PTA of 28.5 ±1.8 

with the Alpha 1 and 29.2 ± 5.6 with BAHA on soft band. The Speech Recognition 

Threshold (SRT) in noise was 58,2 ± 14.2 without Alpha 1 and 50.2 ± 

15.2 dB with Alpha 1 activated. At M6, all children used the implant 5 to 

12 hours daily without pain or cutaneous complications. Quality of life 

score increased in the 5/6 patients at M6, and all children and parents declared 

to be ‘satisfied’ or ‘very satisfied’. 

CONCLUSION 

These preliminary results show satisfactory functional gain, cutaneous 

tolerance, and quality of life. 

P 220 

OUTCOMES OF OSSICULOPLASTY IN THE PAEDIATRIC 

POPULATION 

N.C. Seymour 


United Kingdom, 

E-MAIL: m0702101@sgul.ac.uk 

OBJECTIVES 

To investigate clinical outcomes following paediatric ossiculoplasty and 

identify factors which may predict hearing results. 

METHODS 

All paediatric (age 18 or below) patients undergoing ossiculplasty between 

2000 and 2011 at St George’s Hospital, London were identified from clinical 

coding databases. A retrospective chart review was performed and data including 

operative findings, prosthesis type used, and pre and post-operative 

pure tone audiometric thresholds were extracted. 

RESULTS 

Twenty-two children (mean age 10.8, range 3 18) underwent a total of 28 

ossiculoplasty procedures. The majority (19 patients) had undergone treatment 

for cholesteatoma. Twelve patients (54.5%) underwent ossicular reconstruction 

at the same sitting as cholesteatoma surgery. Thirteen 

individuals were fitted with a total ossicular replacement prosthesis 

(TORP) and 9 were fitted with a partial ossicular replacement prosthesis 

(PORP). Seventeen ossiculoplasties (60.7%) resulted in hearing improvement 

with a mean 5.5 dB (SD 14.1 dB): in 15 (89%) this improvement was 

deemed to be ‘useful’ as assessed with the Glasgow benefit plot. Hearing 

improved following eight TORP procedures (7 patients). Three ossiculoplasties 

(10.7%) resulted in no hearing change and 8 procedures (28.6%) resulted 

in audiometric threshold worsening. 

CONCLUSIONS 

Ossicular reconstruction following mastoid or tympanoplasty surgery is 

helpful in improving hearing outcomes. Those patients who underwent 

reconstruction with a PORP were more likely to have an improvement. 

There appears to be some association between absence of the stapes suprastructure 

and a less favourable hearing outcome. Patients with recurrent 

cholesteatoma do not appear to be at risk from poorer hearing outcomes 

in this series. 

P 221 

APPLICATION OF MIDDLE EAR IMPLANT VIBRANT 

SOUNDBRIDGE FOR AURAL ATRESIA IN PATIENTS WITH 

TREACHER COLLINS SINDROME 

E. Lesinskas, V. Beleskiene 

Vilnius University Hospital, Department of Otolaryngology, 

VILNIUS, Lithuania 

E-MAIL: eugenijus.lesinskas@santa.lt 

OBJECTIVES 

The objective of this report was to present resuts of the auditory rehabilitation 

of Vibrant Soundbridge middle ear implantation in patients with 

Treacher Collins syndrome with bilateral osseous atresia and a poor preoperative 

radiologic score. 

211

METHODS 

3 patients with Treacher Collins syndrome (6-19 years old, mean age 11,7± 

6,6) undergoing vibroplasty for aural atresia and moderate to severe conductive 

hearing loss. The preoperative Jahrsdoerfer radiologic score was 4 

for every patient. Intervention: active middle ear implant Vibrant Soundbridge, 

oval window implantation,and audiological analysis as a follow-up. 

RESULTS 

For all the patients the coupling of FMT to the rudimentary stapes or the 

footplate was performed. The mean threshold with the VSB activated in 

the free field tone audiometry was 22,8± 5,5 db HL. The mean functional 

gain was 44,5 dB. The speech understanding scores of bisyllablic words at 

65 dB SPL increased from 7% to 96%, and the mean SRT decreased to 46,6 dB 

SPL with the device activated. There were no intra- or postoperative surgical 

complications in any of the patients. 

CONCLUSION 

Vibrant Soundbridge implantation is a safe and effective hearing rehabilitation 

procedure for patients with Treacher Collins syndrome with severe 

middle ear malformation and a poor preoperative radiologic score. Since 

the VSB is a versatile instrument, even in cases of severe middle ear malformation, 

similarly to what can be expected in cases of craniofacial disorders, 

technical possibilities of coupling of FMT exist. 

P 222 

EFFECTIVENESS OF COCHLEAR IMPLANTS IN CHILDREN: 

LONG TERM RESULTS 

M.C. Peixoto 1 , J. Spratley 1 , G. Oliveira 2 , J. Martins 3 , J. Bastos 3 , 

C. Ribeiro 3 

1 Medical Faculty of Oporto, PORTO, Santa Maria de Lamas, Portugal 

E-MAIL: saopeixoto@gmail.com 

2 Medical Faculty of Coimbra, Coimbra, Portugal 

3 Centro Hospitalar de Coimbra, Coimbra, Portugal 

OBJECTIVES 

Define effectiveness of Cochlear Implants (CI) after ten years of use. 


From all children submitted to a cochlear implantation in our department 

were selected those who were implanted for ten years or more. Retrospectively 

speech understanding and audiometric results were analyzed. Free 

field pure tone and speech audiometry were evaluated. Speech understanding 

was analyzed by using word recognition and sentence test accuracy, 

percentage of recognition of phonemes, numbers, Categories of Auditory 

Perception, Speech Intelligibility, Meaningful Auditory Integration Scale 

and Meaningful Use of Speech Scale. 

212 

RESULTS 

Our study included 132 patients with an average age of 3 years old (range 

2 to 15) at time of implantation. The duration of deafness was variable. 

Seventy five per cent of patients presented with congenital forms, while 

17,4% presented with prelingual and 5% with postlingual deafness. It were 

identified several causes for deafness that led to the CI. The follow-up period 

was of 13,03 years (+/- 2,66), with a minimum of 10 years and a maximum 

of 19 years. Pure tone hearing threshold in free field with CI showed 

in the first assessment an average hearing threshold of 35,78 dB SPL. After 

10 years or more the same patients presented with an average hearing 

threshold of 34,63 dB SPL. 

CONCLUSIONS 

CI leads to an improved quality of life for the patients under long term 

observation. No statistically differences were found between initial evaluation 

and the after a 10 year’s evaluation. Therefore functional outcome 

seems to be stable over the years. 

P 223 

BAHA APPLICATION IN CHILDREN WITH HEARING LOSS, 

DUE TO VARIOUS ACQUIRED AND CONGENITAL EAR 

MALFORMATIONS 

M. Mrowka, M. Porowski, P.H. Skarzynski, L. Olszewski 




OBJECTIVE 

Treatment and rehabilitation of children with conductive and mixed hearing 

losses in congenital ear malforamtions (bilateral microtia with external 

auditory canal atresia), after chronic otitis media, or in single sided deafness 

(SSD) can be conducted applying Bone Anchored Hearing Aids (BAHA). 

AIM 

Of the research was to assess results of application of BAHA in children 

and to compare hearing obtained by typical bone conduction hearing aids 

(head-band, hearing aid, bone conduction glasses, or Cross) to hearing in 

BAHA system. 

METHODS 

Method of choice in treatment of hearing impairments in presented cases 

was attachment of titanium fixture to the temporal bone, and removal of 

subcutaneous tissue around attachment (with or without dermatome). 

The procedure was performed as a one-stage in older and a two-stage in 

younger children. After implantation the titanium screw was not used for 

about 3-4 months to provide good healing and proper osseointegration. 

Then a hearing aid was attached. Audiological examinations were performed 

1 and 6 months after fitting. Our material consists of 72 patients 

aged between 3 to 18 y.o.

RESULTS 

Audiological results are good and sustainable. Thresholds measured in the 

free field audiometry wearing BAHA device are on average 8,8 dB lower in 

comparison to previously used devices. Patients emphasize that the new devices 

provide better sound quality, speech understanding, are comfortable 

and are more aesthetic comparing to typical bone conduction hearing aids. 

CONCLUSIONS 

Application of BAHA in children with various hearing losses in ear malformations 

is good from audiological perspective, safe and comfortable. 

P 224 

CHALLENGES OF COCHLEAR IMPLANTATION IN CASES OF 

RARE GENETIC SYNDROMES WITH CONGENITAL 

CRANIOFACIAL DEFORMATIONS IN CHILDREN 

M. Porowski, H. Skarzynski, M. Mrowka, L. Olszewski, J. Serafin-Jozwiak, 


Institute of Physiology and Pathology of Hearing, Int. Center of 

Hearing and Speech, WARSAW, Poland 

E-MAIL: m.porowski@ifps.org.pl 

OBJECTIVE 

The aim of the study was to specify the indications and safety of cochlear 

implantation in youngest patients with rare genetic syndromes with congenital 

craniofacial deformations, coexisting external, middle and internal 

ears anomalies and assess the results obtained after surgical treatment. 

METHODS 

Children with described, very rare genetic syndromes were operated on in 

Institute of Physiology and Pathology of Hearing. Detailed preoperative 

diagnostic tests including MRI and HRCT scans were carried out. Various 

cochlear implant systems were used to each of these patients. The technique 

of cochlear implantation was in all cases facial recess. 

RESULTS 

In all cases surgical implantation was successful. No early or late serious 

complications were observed. In one case we encountered gusher after 

making the cochleostomy. Early results are encouraging but one has to 

expect the worse results the more complex is congenital deformation. 

CONCLUSIONS 

Even in cases with very complicated anatomy and congenital malformations 

there is possibility to improve hearing using implantable devices. It 

is of crucial importance to focus on hearing improvement to maintain appropriate 

hearing level and to give chance for those children to be active 

society members. 

P 225 

LONG-TIME SUCCESSFUL THIRD WINDOW VIBROPLASTY 

USING A VIBROPLASTY-RW-COUPLER 

G. Brademann 1 , M. Hey 1 , J. Müller-Deile 2 

1 Christian-Albrechts-University of Kiel, ENT-Department, KIEL, 

Germany 

E-MAIL: brademann@hno.uni-kiel.de 

2 Christian-albrechts-university of Kiel, KIEL, Germany 

The use of a Vibrant Soundbridge, connecting the Floating Mass Transducers 

(FMT) onto either the incus, stapes, the stapes footplate or the 

round window (vibroplasty) is a proven method in the rehabilitation of 

patients with low and high grade hearing loss, if (further) tympanoplasties 

would not be promising. In rare cases a coupling of the FMT to a newly 

built 3rd cochlea window is needed. 

We surgically treated a young patient suffering from osteogenesis inperfecta 

with serious alterations of the middle ear anatomy. We performed a 

vibroplasty with connection over a newly created access to the intact endosteum 

of the cochlea using a Vibroplasty-RW-Coupler, fixated with perichondrium 

and cartilage. The audiological data were documented preand 

postoperative as well as after one year. 

The operation was free of complications. The Vibroplasty-RW-Coupler 

proved beneficial in the connection of the FMT to the endosteum of the 

cochlea. Postoperative neither a change in hearing of the inner ear nor 

dizziness were to be noted. The patient was very satisfied with the hearing 

result. The postoperative data relating to the tone thresholds and speech 

intelligibility documented a clear improvement. This hearing gain was 

unchanged one year after the operation. 

In cases of complex anomalies or tympanosclerotic obliterations of the middle 

ear treated with a Vibrant Soundbridge, the direct coupling of the FMT 

onto the intact basal endosteum of the cochlea (third window vibroplasty) 

is feasible and could present a successful and long-lasting alternative 

method. The use of the Vibroplasty-RW-Coupler is to be recommended. 

P 226 

CI IN POSTMENINGITIS CASES FOLLOWING MINIMAL 

INVASIVE MODIFIED TRANS CANAL-DIRECT TUNEL 

TECHNIQUE 

N. Arsovic, B. Panovic, B. Mikic, V. Djukic, M. Miric 

Clinical Centar of Serbia, ENT, BEOGRAD, Serbia 

E-MAIL: regina.dreschkai@medel.com 

The authors have shown a series of 100 implanted patients operated by 

minimal invasive surgery. In five cases deafness was due to bacterial 

meningitis with incomplete ossification to cochlea. Preoperative radiological 

assessment on CT scan in vast majority of patients. In cases of sus- 

213

pected ossification MSCT(multi slice CT scan) and MRI were performed in 

order to get finer details of ear anatomy. Trans canal and modified transcanal 

direct tunel technique was performed in all of the patients. No perioperative 

or postoperative complications where met in this series. We 

found this technique feasible for cochlear implantation both in children 

and adults. This techniques enables safer access and better angle in performing 

cochleostomy in cases with normal anatomy as well as cochlear 

malformations or ossification of the basal turn. Also, modified transcanal 

technique enables physiological angle for insertion and it is extremely important 

in difficult cases.All of the patients had normal length electrodes, 

but incomplete insertion was done only once. In that patients one channel 

was out of function. Regarding postoperative auditory performance and 

speech development or restoration all of the patients had extraordinary 

results postoperative audiograms were ranging 20-30 dB. Speech intelligibility 

for open set sentences was achieved one year post-operatively 

P 227 

STABILITY AND OSSEOINTEGRATION OF BAHA IMPLANT 

SYSTEMS IN CHILDREN: A PILOT STUDY 

A. Scorpecci 1 , C. Pacifico 1 , R. d’Eredità 2 , A. Della Volpe 3 , P. Malerba 4 , 

P. Marsella 1 

1 Bambino Gesù Pediatric Hospital, Otorhinolaryngology, ROME, Italy 

E-MAIL: alessandroscorpecci@yahoo.it 

2 San Bortolo Hospital, VICENZA, Italy 

3 Santobono Pausilipon Hospital, NAPLES, Italy 

4 Cochlear Italia, S.r.l., BOLOGNA, Italy 

OBJECTIVES 

This is a multicenter, controlled, longitudinal study. The aim is to obtain 

objective data of Bone-anchored Hearing Aid (Baha) stability and osseointegration 

in children, and to compare in pediatric subjects the stability 

and osseointegration of the novel TiOblast -coated Baha implant system 

(BI300 ) to the previous-generation, as-machined model. 

METHODS 

10 child Baha candidates were enrolled and implanted ‘single-stage’ and 

with 3-mm fixtures: 5 received the previous generation, pure titanium 

Baha fixture and 5 the BI300, TiOblast -coated fixture. Processors were 

loaded 6 months post-operatively. Baha stability was measured using Resonance 

Frequency Analysis (expressed as Implant Stability Quotient, ISQ) 

intraoperatively, at 1 week, 2 weeks, 1 month and every month till 9 

months post-operatively. 

RESULTS 

The lowest intraoperative ISQ score ever measured was 44 Units. BI300 

was more stable than the control fixture, both intra- and post-operatively. 

The difference in stability was statistically significant intraoperatively 

(p=0.03), at 2 weeks (p=0.02), at 6 months (p=0.001), 7 months (p=0.0007) and 

214 

8 months (p=0.03). Over the follow-up a stability increase, albeit not significant, 

was observed with both models. 

CONCLUSIONS 

The BI300 Baha implant system has a greater primary stability as compared 

to the previous generation model, but its faster osseointegration 

could not be definitely verified. It is reasonable to assume that the BI300 

fixture will enable surgeons to perform single-stage surgery safely and 

with a very low failure rate, even with 3-mm fixtures. The possibility of 

an earlier processor loading is to be confirmed in a greater sample. 

P 228 

VSB AND PINNA RECONSTRUCTION IN A SINGLE STAGE IN 

CHILDREN WITH MICROTIA 

J.M. Hempel, A. Berghaus, J.M. Mueller, T. Braun 

Ludwig-Maximilians University of Munich, 

Prof. Dr. Alexander Berghaus, ORL, Head and Neck Surgery, MUNICH, 

Germany 

E-MAIL: john-martin.hempel@med.uni-muenchen.de 

BACKGROUND 

Both microtia reconstruction and aural atresiaplasty are challenging procedures. 

Unfortunately, functional results after atresiaplasty turned out 

to be limited. Since October 2009, the MedEl Vibrant Soundbridge (VSB) is 

CE certified for implantation in children in Germany. This active middle 

ear implant opens new possibilities for atresia cases, allowing individual 

solutions to fix the floating mass transducer. 

METHOD 

The authors combine a single stage pinna reconstruction with a porous 

polyethylene framework as introduced by Berghaus in 1982 and a temporoparietal 

fascia flap with the implantation of the Vibrant Soundbridge. 

RESULTS 

So far, six children (age 5 to 17) received a combined reconstruction of the 

pinna and VSB implantation in our department. In another four cases with 

atresia (age 5 to 6), the author only performed VSB implantation. No complications 

have been seen. Several options have been used, such as modifying 

the original clip in a way that an upside down fixation to a 

malformed stapes superstructure was possible, using couplers or round 

windows applications. After activation of the VSB, speech understanding 

for monosyllables ranged from 95 to 100% for the atretic ear. 

CONCLUSION 

Reconstruction of the auricle and implantation of the VSB can be achieved 

in a single stage around the age of 5 years. The implantation of the VSB 

leads to a normal speech understanding for the atretic ear.

P 229 

IMPACT OF VESTIBULAR LOSS ON POSTUROMOTOR AND 

COGNITIVE DEVELOPMENT IN YOUNG CHILDREN AND 

APPLICATION TO COCHLEAR IMPLANT STRATEGIES 

S.R. Wiener-Vacher, J. Jacot, M. Rouillard, T. van den Abbeele 

Hôpital Robert Debré APHP, ORL, PARIS, France 

E-MAIL: sylvette.wiener@gmail.com 

OBJECTIVES 

Showing prevalence of vestibular impairment after cochlear implant and 

its consequences on posturomotor development in young children. Promote 

a vestibular evaluation prior to any cochlear implantation (CI) to 

avoid secondary complete bilateral vestibular loss. 

METHODS 

Vestibular loss (VL) was assessed with a battery of tests adapted to children 

including: clinical vestibular tests, head impulse test, bi-caloric test, earth 

vertical axis rotation, off vertical axis rotation and vestibular evoked myogenic 

potentials (VEMP). Correlation was tested between both severity of 

VL and age at VL onset and posturomotor developmental milestones. 

RESULTS 

Hearing loss severity does not predict the status of the vestibular function: 

50% of the profoundly deaf children had normal bilateral vestibular function, 

only 20% bilateral complete vestibular loss, and 30% partial vestibular 

impairment (asymmetrical in 22.5% , 6% single functional vestibule and 

1.5% symetrical). Only complete bilateral VL was apparent because of its 

severe consequences on posturomotor performances (head and body instability, 

delays in posturomotor development) particularly if the loss occurs 

before the child has made his first independent steps. 

CONCLUSION 

CI should be preceded by vestibular functional tests to first implant the 

least functional vestibule. In very young children every effort should be 

made to avoid provoking bilateral vestibular loss and its severe developmental 

consequences. One-step bilateral CI should be reserved only for bilateral 

vestibular loss patients. Otherwise, each cochlea should be implanted 

at 2 to 3 month intervals in order to assure maintained vestibular function 

in the implanted ear. Otherwise contralateral implant is contraindicated. 

P 230 

PEDIATRIC COCHLEAR IMPLANTATION FOR RESIDUAL 

HEARING CANDIDATES 

N. Loundon, M. Gratacap, B. Thierry, E.N. Garabedian 

A. Trousseau, Children’s Hospital, ENT, PARIS, France 


OBJECTIVE 

To identify the various situations for cochlear implantation (CI) candidacy 

and results in the pediatric population with residual hearing (RH). 

SETTING 

Out of 710 implanted patients, 53 children with RH underwent a CI in our 

department. Five groups were identified: G1 with partial deafness (n=5), 

G2 severe hearing loss (HL) with low speech intelligibility rate (n=12), G3 

with asymmetrical severe to profound HL (n=9), G4 with progressive HL 

(n=15) and G5 with severe HL and fluctuations (n=12). Mean post-operative 

follow-up (FU) was 64 mo (12mo-170mo). Inner ear malformation was present 

in 54% cases (29/53). Preoperative non aided and aided pure tone average 

threshold (naPTA/ aPTA), speech recognition with open set words (OSW) 

preoperative (preop), at 12 and 24 month follow up were analysed. 

RESULTS 

In each group, mean preop naPTA/aPTA were respectively 83/54dB (G1), 

100/54dB (G2), 104/77dB (G3), 102/66dB (G4), 92/56dB (G5). Mean preop OSW 

scores were respectively: 79% (G1); 50% (G2); 59% (G3); 35% (G4); 39% (G5). 

Mean OSW scores showed 47.9% preop, 73.6% at 12 months and 80.7% at 24 

months (p0.05). In 4 children, OSW scores remained < 50%, the limitative 

factors are discussed. 

CONCLUSION 

The 5 groups show improvement in speech perception scores within the 

first year of follow up. Limited improvement in speech perception can be 

related to lengh of deprivation, residual contralateral hearing, and cognitive 

delay. 

P 231 

BENEFIT OF THE BIMODAL FITTING OF HEARING AIDS WITH 

EXTERNAL RECEIVER FOR UNILATERAL IMPLANTED CI USERS 

M. Brendel 1 , C. Baumgaertner 2 , V. Hamacher 1 , A. Buechner 3 , T. Lenarz 3 

1 Advanced Bionics GmbH, European Research Centre, HANNOVER, 

Germany 

E-MAIL: martinab@abionics.fr 

2 Auric Hoersysteme, HANNOVER, Germany 

3 Medical University of Hannover, HANNOVER, Germany 

The purpose of this clinical study is to determine the benefit of a canal receiver 

technology (CRT) hearing aid in the bimodal condition compared 

to reference systems like a high power device or the clinically used hearing 

aid. One advantage of this kind of HA is the small design and the light 

weight. 

Speech perception results for the HSM sentence test in noise could be evaluated 

for ten experienced CI users. During a baseline appointment the 

tests were conducted with and without their own hearing aid on the con- 

215

tralateral side before the Phonak Audeo S Smart (CRT system) was fitted 

with a standard fitting formula and minor modifications in the high frequencies. 

After a take-home period of two to four weeks the measures with 

the CRT system as well as with an acutely fitted Phonak Ambra SP (high 

power HA) were repeated. 

The test with the clinically used hearing aid, the Audeo S Smart as well as 

the Ambra SP showed comparable Results for the median in the speech 

perception tests. 

The subjective feedback of the subjects for the CRT system was positive 

regarding comfort of use, sound quality and the acoustical feedback of the 

hearing aid. 

Although a standard fitting was performed for the HAs, there was no influence 

on the outcomes in speech performance compared to the own HA 

after a long experience and more extensive fittings. 

Teenagers and children with full-grown ears could even more benefit from 

the small design of the CRT hearing aids. 

P 232 

COCHLEAR IMPLANTATION WITH THE CONCERTO PIN 

SYSTEM: NEW TECHNIQUES FOR MINIMAL INVASIVE 

APPROACHES 

G.M. Sprinzl, A.M. Wolf-Magele, J. Schnabl, V. Koci, H. Riechelmann 

Medical University Hospital Innsbruck, Otorhinolaryngology, 

Head and Neck, INNSBRUCK, Austria 

E-MAIL: georg.sprinzl@i-med.ac.at 

OBJECTIVE 

Minimal invasive approaches have already been described for cochlear implantation 

in adults. We present our experience with adult and pediatric 

cochlear implantation, the incision technique for the Concert-device, the insertion 

techniques for two different electrodes and the usefulness of the pin 

system, which enables an easy immobilization of the implant device itself. 

METHODS 

Among 68 cochlear implantations performed between July 2010 and December 

2011, there were 10 pediatric and 58 adult cochlear implantations 

with the MED-EL Concert pin. In our technique, standard posterior tympanotomy 

and cochleostomy were performed after 3.5 cm minimal invasive 

incisions in the postauricular region. In fifteen consecutive cases, 

suture fixations were not used for the implant receiver, nor its electrode. 

We used for the insertion of the electrode the round window approach in 

all cases. 

RESULTS 

There were 6 girls and 4 boys with a mean age of 3,6 years. The mean follow-up 

duration was 3 months. In the adult group there were 28 female 

and 30 male subjects with a median age of 45,8 years. In both groups no 

medical complications were encountered. In all cases a full electrode insertion 

was carried out. 

216 

CONCLUSION 

Minimal invasive cochlear implantation can be performed using small incisions 

without suture fixation of the receiver and its electrode in adults 

and children. However, a subtle drill out of the implant well is recommended 

in every case. The Concert Pin System enables the surgeon to use 

the most minimal invasive surgical technique with less trauma and less 

risk for the patient. 

P 233 

BIMODAL HEARING WITH FINE STRUCTURE PROCESSING: 

IMPLICATIONS FOR PEDIATRIC COCHLEAR IMPLANTATION 

C.L. Runge, K.D. Atwood, D.R. Friedland 



E-MAIL: chrunge@mcw.edu 

OBJECTIVES 

To identify whether bimodal improvements in cochlear implant performance 

are affected by processing strategy. 

METHODS 

Pediatric speech and music perception testing with cochlear implants is 

difficult due to variability in language and musical knowledge development. 

We therefore examined bimodal hearing and speech processing 

strategies in adults using a degraded programming map to eliminate effects 

of daily experience. This protocol was designed to isolate the effects 

of programming strategy and focus on the interaction with acoustic hearing. 

Tests of vowel and musical instrument identification were administered 

using fine structure processing (FSP) or high definition continuous 

interleaved sampling (HDCIS). 

RESULTS 

The addition of acoustic information significantly improved vowel recognition 

for FSP and HDCIS. In contrast, acoustic information did not provide 

a significant benefit to musical instrument identification when using 

FSP. Further, those subjects who routinely used FSP as their daily program 

performed better overall on vowel and musical instrument tests in every 

condition tested (e.g., FSP, HDCIS, bimodal, CI alone). 

CONCLUSION 

Acoustic information was not significantly beneficial in combination with 

FSP for musical tones but it did provide benefit with vowel sounds. This 

may indicate that the FSP program provides a closer approximation of 

complex non-speech stimuli and the added acoustic information was redundant. 

Those subjects who regularly used FSP performed better on every 

test and modality presented. This may indicate that chronic use of FSP 

supports central processes important for interpreting complex stimuli. 

This has important implications for pediatric cochlear implant patients 

and development of musical and environmental sound perception.

P 234 

EAS IN CHILDREN WITH PARTIAL DEAFNESS: 

THE WESTERN AUSTRALIAN EXPERIENCE 

J. Krishnaswamy 1 , G.P. Rajan 2 , J. Kuthbutheen 3 

1 Princess Margaret Hospital for Children, Audiology, SUBIACO, 

Australia 

E-MAIL: jay.krishnaswamy@health.wa.gov.au 

2 Fremantle Hospital, PERTH, Australia 

3 Royal Perth Hospital / Fremantle Hospital, PERTH, Australia 

OBJECTIVE 

Partial deafness has only recently been identified as a significant cause of 

hearing disability. Preservation of low frequency sounds is crucial for 

speech in noise perception, sound localisation and music perception. Loss 

of mid to high frequency sounds means the inability to hear consonants 

and fricative sounds which in children results in impaired speech and language 

development. Conventional hearing aids do not offer appropriate 

hearing rehabilitation in patients which mid to high frequency loss who 

have a narrow dynamic range. The aim of the study is to investigate the 

use of hearing preservation cochlear implantation in this situation. 


A total of 4 children with either drug induced or congenital partial deafness 

were enrolled in a pilot study. The patients range in age from 34 

months to 15 years (at the time of surgery). Cochlear implantation was 

performed using a hearing preservation technique. A Flex EAS electrode 

(MED-EL) was used in all patients with full insertion. Speech perception 

and hearing preservation rates were assessed. 

RESULTS 

Low frequency hearing was preserved in all patients with postoperative 

changes in bone conduction within 10dB of the preoperative hearing levels. 

These changes were preserved over the average follow up period of 18 

months with no case so far of late-onset hearing loss. There were also significant 

improvements in speech perception scores. 

CONCLUSION 

Hearing preservation cochlear implantation is new effective modality of 

hearing preservation in children with partial deafness. We look forward 

to further results from the study. 

P 235 

OUTCOME OF AUDITORY NEUROPATHY AFTER 

COCHLEAR IMPLANTATION 

A.M. Alshaikh 

King fahd hospital Jeddah, JEDDAH, Saudi Arabia 

E-MAIL: a_m_alshaikh@yahoo.com 

PURPOSE 

To record language and auditory skills development before and after 

cochlear implantation in children with Auditory neuropathy (AN), and to 

determine the outcome after cochlear implant (CI) in patients with AN in 

comparison to patients with sensorineural hearing loss (SNHL) 


Cases Included in this study were divided into two groups. Group 1: includes, 

13 children diagnosed with AN, of them 7 cases were subjected to 

CI. Group 11: includes, 20 cases of SNHL, of them 10 patients were subjected 

to cochlear implant. For all cases language therapy was given regularly for 

6 months pre operatively and 6 months post operatively. Auditory Skills 

Checklist and The Arabic language test (receptive, expressive and total language 

Quotients) were used to monitor the progress concerning auditory 

skills and language development. 

RESULTS 

There was no difference between SNHL group and AN group regarding 

auditory skills and language development both preoperatively and postoperatively. 

Also there was marked improvement in both groups post - 

operatively regarding auditory skills and language development. 

CONCLUSIONS 

Cases with AN improved markedly after cochlear implantation and No 

differences were noticed in outcome between SNHL & AN groups. 

KEY WORDS 

Hearing loss, auditory neuropathy, cochlear implant, auditory skills. 

P 236 

SENTENCE STRUCTURE IN COCHLEAR IMPLANTED 

CHILDREN 

B. Mikic 1 , D. Miric 1 , M. Mikic 2 , M. Asanovic 1 , S. Ostojic 2 , N. Arsovic 1 

1 Clinical Center of Serbia, Audiology Rehabilitation Department, 

BELGRADE, Serbia 

E-MAIL: branmi@gmail.com 

2 Faculty for Special Education and Rehabilitation, BELGRADE, Serbia 

217

INTRODUCTION 

Lack of auditory feedback affects speech and language development 

tremendously. Cochlear implantation facilitates dramatic improvement 

in speech perception and production in prelingually deaf children. The 

most dynamic progress is seen in the first 3 years following implantation, 

but speech and language continue to develop up to 6 years after surgery so 

that 50% of cochlear implant users achieve age appropriate language skills. 

OBJECTIVE OF THE STUDY 

To assess sentence structure in prelingually deaf CI users as compared to 

hearing aid users and their hearing peers. 

SAMPLE AND METHODOLOGY 

Group A consisted of 20 CI children aged 4 to 8 y; Group B - 20 profoundly 

deaf children with hearing aids and Group C - 20 hearing children of appropriate 

age. The children were asked to describe various situations 

shown on pictures. The sentences they have used were evaluated by length 

(duration), syntax and grammar. 

RESULTS 

Sentence quality and structure of cochlear implanted children (Group A) 

was much better than in profoundly deaf children with hearing aids 

(Group B), but not achieving age appropriate quality of their hearing peers 

(Group C). Average length of the sentences in CI group has been 5.7 words 

as compared to 4.2 words in HA group and 6.1 in hearing children. Syntax 

and grammar was better in CI than in HA group, although even in the 

normal hearing children of that age it was not impeccable. 

CONCLUSION 

Cochlear implantation improves speech production and sentence quality 

in prelingually deaf children dramatically. 

P 237 

INFLUENCE OF NON-OPTIMAL VALUES OF ELECTRICAL 

STIMULATION PARAMETERS ON HEARING BENEFITS 

A. Wasowski, A. Lorens, A. Obrycka, A. Walkowiak, H. Skarzynski 

Institute of Physiology and Pathology of Hearing, Auditory Implants 

and Perception Department, WARSAW, Poland 

E-MAIL: a.wasowski@ifps.org.pl 

OBJECTIVES 

To obtain hearing benefits after cochlear implantation it is crucial to optimally 

fit the system to the individual need of every patient. Great variability 

between patients and the fact, that optimal values change in time make 

this a difficult task. In the Institute of Physiology and Pathology of Hearing, 

fitting procedure that contains many psychophysics and objective measurements 

was introduced to assure optimal fitting of the system. However, 

it is still very interesting to find out, how non-optimal fitting may influence 

hearing benefits, especially when the error is relatively small. 

218 

STUDY DESIGN 

Material of the study consists of 61 patients. In 3 experiments, some characteristic 

of the patient’s program: loudness, balance, threshold were nonoptimally 

changed. The results of speech comprehension tests obtained 

on those programs were compared to those obtained on optimal map. 

RESULTS 

Unexpectedly big deteriorations of hearing benefits were observed after 

relatively small change in electrical stimulation values. In quiet, the average 

worsening in speech comprehension tests was as large as 16% when 

balance was change, and 14% when loudness changes. In noise, those values 

are respectively 16% and 18% 

CONCLUSIONS 

The results prove that it’s very important to find best possible values of 

electrical stimulation parameters. Even slight error can worsen the patient’s 

results by larger degree that it was assumed. 

P 238 

EXAMINATION OF DEPENDENCES BETWEEN ESR 

THRESHOLD AND MCL VALUE IN LARGE PATIENT 

POPULATION 

A. Wasowski, A. Lorens, A. Walkowiak, A. Obrycka, H. Skarzynski 

Institute of Physiology and Pathology of Hearing, Auditory Implants 



INTRODUCTION 

During fitting of cochlear implant system one of the most important task 

is to find optimal values of MCL. Often, especially in children during first 

months after cochlear implantation, it is difficult to estimate optimal MCL 

values using psychophysical Methods, so objective Methods were introduced. 

One of the most useful of those Methods is electrically elicited 

stapedius muscle reflex (ESR). The aim of the study was to assess the dependences 

between ESR thresholds and MCL values in numerous and diverse 

patient population. 

STUDY DESIGN 

The MCL values and ESR thresholds of 159 patients were used in the study. 

Age of patients varied between 1 years and 7 months to 72 years, and experience 

with CI system varied between 2 month and 2 years. MCL values 

were set in accordance with standard fitting procedure based on behavioral 

Methods. Then ESR measurement was performed by means of the ‘up and 

down’ procedure. Additional factors were taken into account during analysis 

of the data.

RESULTS 

High correlations between ESR threshold and MCL were found, which indicate 

the usefulness of ESR method in estimation of MCL values. Influence 

of the age of implantation and experience with CI system was 

discussed. 

CONCLUSIONS 

Postoperative electrically elicited stapedius muscle reflex seems to be a 

very good method for estimation of MCL values. Based on authors experience 

and available literature reporting correlations of other objective 

Methods like electrically elicited compound action potential (ECAP), ESR 

seems to be better method for MCL estimation 

P 239 

NATIONWIDE NETWORK OF TELEAUDIOLOGY IN 

POSTOPERATIVE CARE OVER IMPLANTED PATIENTS 

A. Wasowski 1 , H. Skarzynski 1 , P.H. Skarzynski 1 , L. Bruski 2 

1 Institute of Physiology and Pathology of Hearing, Auditory Implants 



2 Institute of Sense Organs, WARSAW, Poland 

OBJECTIVES 

‘Nationwide network of auditory telerehabilitation centers’ was introduced 

in 2009. It consist of 19 policlinics cooperating with Institute of 

Physiology and Pathology of Hearing, using state-of-the-art telemedical 

methodology and equipment. Practical considerations concerning service 

quality, patients approval, time and cost effectiveness are presented in this 

paper. 

STUDY DESIGN 

Questionnaires assessing quality and time effectiveness of teleconsultation 

were presented to over 200 patients during standard follow-up visits in 

one of selected eight remote policlinics. Additionally, differences in travel 

time and cost were estimated. 

RESULTS 

Patients approve teleconsultation as a good alternative to standard, faceto-face 

visit. However, in special cases or some parts of postoperative care 

like hook-up visits teleconsultation is not recommended. Travel time and 

cost estimation of visit in local policlinic shows significant savings compared 

to visit in implantation center. 

CONCLUSIONS 

The model of extensive use of teleconsultations performed by experienced 

specialists from implantation centre to patient in cooperating policlinic 

proved to be reliable alternative to standard models of postoperative care, 

additionally providing substantial savings in time, cost and effort for the 

patient. 

P 240 

COMPLICATIONS IN COCHLEAR IMPLANTATION 

H.E. Stefanescu, A.H. Marin, V. Draganescu, N. Balica, D. Trales, 

S. Cotulbea 


E-MAIL: hstefanescu@yahoo.com 

OBJECTIVE 

The objective of this paper is to present our experience of surgical complications 

in cochlear implantation. We present these complications in a series 

of 78 children operated on by the same surgical team and with a 

relative long follow-up period. 

METHODS 

78 patients with cochlear implants were studied from January 2003 to December 

2010. The series included only children age 1-14, implanted mostly 

with MED-EL devices. The different types of complication and their handling 

and treatment were analyzed. 

RESULTS 

The complication rate was 10.3% (n=8). The most common complications 

were: Intraoperative Complications: 3 Cerebrospinal Fluid Leaks (Gusher 

syndrome) and 2 ossifications of the cochlea that have not been discovered 

on preoperative imaging. The Late Complications included 1 case of mastoiditis 

with cholesteatoma and 2 technical failures of the implanted system. 

No alteration or migration was found in the placement of the receiver 

electrode. 

CONCLUSIONS 

Cochlear implant surgery has low morbility. In this series, no cases of 

meningitis resulted from the procedure. 

P 241 

COCHLEAR IMPLANTATION IN A TEENAGER WITH A 

VESTIBULAR SCHWANNOMA IN AN ONLY HEARING EAR 

N. Yehudai, T. Shpak, M. Luntz 

Bnai Zion Medical Center, Otolaryngology - Head and Neck Surgery, 

HAIFA, Israel 

E-MAIL: noam.yehudai@b-zion.org.il 

OBJECTIVE 

One of the most challenging problems facing a neuro-otologic surgeon is 

dealing with patients who develop a vestibular schwannoma in their only 

hearing ear, the other ear being auditory deprived since childhood. 

219

METHODS 

A case report of an eighteen years old teenager with congenital unilateral 

profound SNHL who developed a 4 cm vestibular schwannoma in the contra 

lateral normally-hearing ear. 

RESULTS 

The patient underwent tumor removal via a retro-sigmoid approach with 

no hearing preservation, which rendered him with bilateral profound 

SNHL. He was referred for hearing rehabilitation, during which he was 

fitted with a hearing aid to the left, congenitally deaf ear, for the first time 

in his life. He managed to gain some benefit, a positive sign for success 

with cochlear implantation (CI), yet no speech understanding. CI was performed 

in the congenitally deaf ear with 50% monosyllabic word discrimination 

score and 94% CID sentences in quiet score at 6 months post CI. 

Follow up MRI at one year post CI mandated removal of the magnet. MRI 

revealed a small residual tumor. He was scheduled for future CT scan follow-up. 

Hearing performance continued improving after re-insertion of 

the magnet, reaching 94% monosyllabic word discrimination score and 

100% CID sentences in quiet score at 18 months post CI. 

CONCLUSIONS 

Many patients with unilateral congenital deafness are left un-rehabilitated. 

If however later in life the only hearing ear is compromised, cochlear 

implantation may still be beneficial in the auditory deprived deaf ear. 

P 242 

EDUCATIONAL STATUS OF CHILDREN AFTER PARTIAL 

DEAFNESS TREATMENT (PDT) 

M. Zgoda, A. Lorens, J. Putkiewicz, A. Lutek, H. Skarzynski 

Institute of Physiology and Pathology of Hearing, Cochlear Implants 

and Auditory Perception Dept, WARSAW, Poland 

E-MAIL: m.zgoda@ifps.org.pl 

AIM 

Partial Deafness Treatment (PDT) in children restore the ability to perceive 

high frequency sounds, greatly improving the process of child’s language 

acquisition. The aim of the study was to investigate the educational status 

of children after PDT. 


The study group consist 34 children with Partial Deafness (PD) who underwent 

cochlear implantation with round window hearing preservation 

and was recruited from the total group of over 2500 children implanted in 

Institute. Designed for the study survey was distributed in the group of 

parents of PDT children. 

RESULTS 

Children after PDT are mainly enrolled in mainstream classrooms before 

and after implantation. 

220 

CONCLUSIONS 

Successful inclusion to the mainstream education for hearing impaired 

children is one of the main goals of cochlear implantation. Better hearing 

abilities achieved with cochlear implant in Partially Deafened children allows 

them to continue education in regular settings. Application of the 

cochlear implant system in Partially Deafened children facilitates better 

overall functioning and integration in social environment. 

P 243 

THE LITTLEARS SPEECH PRODUCTION QUESTIONNAIRE 

(LEESPQ): A VALIDATED QUESTIONNAIRE FOR VERY EARLY 

SPEECH PRODUCTION 

B. Schramm 1 , J. Brachmaier 2 , A. Keilmann 3 

1 Catholic University of Applied Sciences, Health and Care, MAINZ, 

Germany 

E-MAIL: schramm@kfh-mainz.de 

2 MED-EL, INNSBRUCK, Austria 

3 Division for Communication Disorders, University Medical Center 

of the Johannes, MAINZ, Germany 

OBJECTS 

Because of insufficient data about the early milestones of speech and language 

production, no standardized assessment tools for the first 18 

months of life, especially for German language is available. For this reason, 

we developed and validated a new tool, the LittlEARS Early Speech Production 

Questionnaire (LEESPQ). 

METHODS 

Based on data from a longitudinal study in German speaking infants with 

normal hearing and with cochlear implants, we first developed a questionnaire 

with 24 yes/no questions to assess the following stages: reflexive 

behaviours, crying, early vocalization, babbling, jargon and first words. 

In addition, each question contains an example, like: “Does your child produce 

individual syllables? Eg. “ba”or “Does your child produce vowels? 

E.g.: /a, e, i, o, u/. After the first pilot version which was critically reviewed 

by parents, speech and language therapists and phoniatricians, a final version 

with 22 questions was chosen. 

RESULTS 

Statistical analysis of the final questionnaire offered expected values and 

minimal values for children between 1 and 18 months. Within the tested 

group, we found no sex differences and a continuous growth of positive 

answers with age [r=.780 (p

P 244 

THE LONG-TERM OUTCOME AND SPONTANEOUS HEALING 

IN CHRONIC SUPPURATIVE OTITIS MEDIA 

R.G. Jensen 1 , P. Homøe 1 , A. Koch 2 

1 Rigshospitalet Univerity Hospital, Otorhinolaryngology, 

Head and Neck Surgery, COPENHAGEN, Denmark 

E-MAIL: ramon@dadlnet.dk 

2 Statens Serum Institute, COPENHAGEN, Denmark 

BACKGROUND 

Chronic suppurative otitis media (CSOM) is a frequent cause of hearing 

loss and affects 65-330 million people worldwide mainly in the developing 

part of the world and among Indigenous populations. There is a lack of 

basic epidemiological knowledge on the natural history and the long-term 

outcome of CSOM. 

OBJECTIVE 

To examine the long-term chronicity of CSOM and estimate the proportion 

of individuals affected by CSOM in a high-risk population. 

METHODS 

Follow-up study (2009) on a population-based cohort of 591 children originally 

examined 1993-94 at 3-8 years age. Follow-up was attempted among 

348 individuals still living in the study area. Video otoscopy and tympanometry 

was used. 

RESULTS 

Of 226 participants (65% of those contacted, median age 22 years) 28 persons 

(12%) had present CSOM or had been surgically treated. Eleven were new 

cases of CSOM not seen in 1993-94. Of those with CSOM in the initial study 

39% had healed spontaneously. The cumulative incidence of CSOM was 

17%. Eighty persons (35%) at follow-up had present CSOM, undergone earsurgery 

or sequlae in the form of circular atrophy or myringosclerosis. 

CONCLUSIONS 

The proportion of spontaneous healing and the findings of new cases show 

that CSOM is a dynamic disease on both the individual as well on the population 

level. The global burden of CSOM among children may be underestimated 

as previous estimations have been based on cross-sectional 

studies without follow-up. 

P 245 

COLCHICINE PROLONGS PATENCY OF MYRINGOTOMY 

IN AN ANIMAL MODEL 

A. Kessler 1 , E. Eviatar 2 , H. Gavriel 2 , H. Sohmer 3 , J. Lapinsky 2 

1 Assaf Harofeh Medical Center, ENT, TEL AVIV, Israel 

E-MAIL: akessler 33 @hotmail.com 

2 Assaf Harofeh Medical Center, TEL AVIV, Israel 

3 Hadassah Medical School, JERUSALEM, Israel 

BACKGROUND/OBJECTIVE 

Chronic otitis media with effusion (COME) is a frequently observed condition 

in childhood. The most common and effective surgical therapy for 

COME is myringotomy with insertion of a ventilation tube (VT). Our aims 

were to investigate the combined effect of myringotomy and the topical 

application of Colchicine solution to the external ear canal for the prolongation 

of patency in the treatment of patients with COME and to evaluate 

the ototoxicity of Colchicine applied directly to the middle ear. 

METHODS 

A prospective study on 47 ears in 26 fat sand rats was fashioned. In the first 

phase, solutions of different concentrations of Colchicine were applied to 

the middle ear cavity in order to determine the drug’s ototoxicity, assessing 

inner ear function with ABR. In the second phase myringotomy was performed 

and a non ototoxic concentration of Colchicine applied to 12 external 

ear canals, while Saline was applied to nine. 

RESULTS 

In the first phase, Colchicine concentration of 0.1% and higher applied to 

the middle ear cavity caused an ABR threshold elevation. In the second 

phase, the mean closure time after 0.01% Colchicine application was prolonged 

to >2.14 weeks (P

P 246 

ENDOSCOPIC EXCISION OF BILATERAL BRANCHIAL CLEFT 

FISTULA 

N. Süslü, B. Gönüldas, T. Aslan Dündar, U. Akyol 

Hacettepe University Faculty of Medicine, Otorhinolaryngology, 

ANKARA, Turkey 

E-MAIL: aesuslu@yahoo.com 

Branchial cleft anomalies are cysts, sinuses or fistulas in head and neck 

area. Bilateral fistulas are rare in literature ,incidence is %2-3 of branchial 

anomalies and may have familial origin. Usually tracts travel to the carotid 

bifurcation and open into pharyngeal pouch or go high and open to tonsillary 

fossa. Excision can be difficult and complicated because tract follows 

long way in the neck. Recurrences and infections are high if residual tissue 

is left. We present an 8- year old girl with bilateral type 2 branchial cleft 

with fistulas in the supraclavicular region. Exicision of bilateral fistulas 

with a mini- incision was performed by endoscope assistance, with a direct 

visulization of tract opening in the tonsillary fossa. Use of endoscope was 

usefull in the manner of totally excision of the branchial fistula. Endoscopic 

excision has advantages on visualizing the tract and surgeons are 

more comfortable of lefting residue. Incision is smaller and more tolerable 

in aesthetical point of view. 

P 247 

UPPER AIRWAY ABNORMALITIES DETECTED IN CHILDREN 

USING FLEXIBLE BRONCHOSCOPY 

L. Midyat 1 , E. Çakir 2 , A. Kut 3 

1 Department of Pediatric Pulmonology, Bezmialem Vakif University 

Faculty of Medic, ISTANBUL, Turkey 

2 Department of Pediatric Pulmonology, Sureyyapasa Chest Diseases 

and Thoracic Sur, ISTANBUL, Turkey 

OBJECTIVES 

Rapid anatomical evaluation is essential to establish the severity of cases 

with upper respiratory obstruction and to define the degree of respiratory 

distress. Detailed airway endoscopy is required in most patients, not only 

for diagnosis, but also to treat the condition. . In this study, as two of the 

largest paediatric pulmonology centers in Turkey, we reviewed the data 

of our bronchoscopy patients, and aimed to document the upper airway 

abnormalities that we detected during these procedures. 


A retrospective analysis was made of the records of 1076 paediatric cases 

with pulmonary/airway disease who had undergone felxible bronchoscopy 

between 2007 and 2011. 

222 

RESULTS 

Upper airway malacia disorders were the most common (79.6%, n=259) 

bronchoscopic findings detected in the patients. The other most common 

pathologies were laryngeal edema (12.9%, n=42), external tracheal compression 

(12.3%, n=40), subglottic stenosis (4.0%, n=13), tracheal stenosis (2.8%, 

n=9), and vocal cord paralysis/irregularity (2.8%, n=9). The mean duration 

of symptoms was shortest in patients with vocal cord paralysis, and longest 

in patients with tracheal nodules (p 0,05). Similiar decanulation 

success was observed in children (n=18; 34,6%) and adults (n= 33; 40,2 %). 

Mean decannulation time after tracheotomy were 317 and 69 days in the 

pediatric and adult group respectively, the difference was statistically significant 

(p =0.040). 

CONCLUSION 

Pediatric and adult tracheotomies differ in terms of indication and decannulation 

time. Complications following tracheotomy are similar in 

both pediatric and adult groups.

P 249 

CLINICAL FEATURES OF YOUNG PATIENTS WITH 

OLFACTORY DISORDERS 

M. Shino 

Showa University Yokohama Northern Hospital, Otorhinolaryngology, 

YOKOHAMA, Japan 

E-MAIL: shinomi@med.showa-u.ac.jp 

OBJECTIVES 

The aim of this study is to analyze clinical features of young patients with 

olfactory disorders. 


The patients 18 years of age or younger who complained of olfactory disorders 

were investigated retrospectively. They consulted to Showa University 

Hospital from 2000 to 2009. Olfactory functions were examined 

according to T&T olfactometry. 

RESULTS 

A total of 39 patients were identified. The mean age was 14.5 years. 21 patients 

were male and 18 patients were female. The common causes of olfactory 

disorders were congenital dysosmia (28.2%), chronic rhinosinusitis 

(20.5%) and dysosmia after head trauma (17.9%). The averaged recognition 

threshold was 4.91 and the averaged detection threshold was 4.37 in T&T 

olfactometry. After treatment, re-examinations were performed in 17 patients. 

The averaged recognition threshold was 4.04 and the averaged detection 

threshold was 2.54. Five patients showed improvement of olfactory 

functions, but 12 patients showed no improvement. 

CONCLUSIONS 

Congenital olfactory disorder and head trauma were comprised large proportion 

in the common cause of olfactory disorders. We would like to show 

the characteristics of olfactory disorders in young patients. 

P 250 

PFAPA (PERIODIC FEVER, APHTHOUS STOMATITIS, 

PHARYNGITIS, CERVICAL ADENITIS) SYNDROME: 

CLINIC CASE 

F. Moreira, R. Pratas, B. Rodrigues, N. Marçal, J. Guimarães, D. Miranda 

Hospital de Braga, BRAGA, Portugal 

E-MAIL: filipamoreira@yahoo.com.br 

INTRODUCTION 

The PFAPA syndrome characterized by recurrent episodes of high fever, aphthous 

stomatitis, pharyngitis and cervical adenitis occurring mostly in children 

younger than 5 years. The etiology is unknown and diagnosis is clinical 

and made by exclusion. This paper aims to review literature (clinical, diagnosis 

and treatment), complemented with the presentation of a clinical case. 


Literature search and document analysis conducted through the database 

of Medline, Pubmed and Ovid. 

RESULTS 

The use of antibiotics or cimetidine is ineffective, while corticosteroids 

and tonsillectomy (with or without adenoidectomy) reduce the symptoms. 

CONCLUSIONS 

PFAPA syndrome is a rare disease, whose recognition can be difficult. The 

most effective medical treatment is steroids, but does not prevent future 

recurrences. The most effective therapy in long-term resolution of symptoms 

is tonsillectomy (with or without adenoidectomy). 

KEYWORDS 

PFAPA syndrome, periodic fever, corticosteroids, tonsillectomy 

P 251 

SURGICAL TREATMENT OF OTOSCLEROSIS IN CHILDREN 

H. Skarzynski, M. Mrowka, M. Porowski, P. Mlotkowska-Klimek 

Institute of Physiology and Pathology of Hearing, International 

Center of Hearing and Speech, WARSAW, Poland 


INTRODUCTION 

Otosclerosis in children is not a rare condition, however, many authors 

recommend only assessment in those cases and no surgical treatment before 

puberty. 

AIM 

The aim of the present study was to analyze hearing Results of stapedotomy 

in children with otosclerosis and to compare the Results with those 

obtained in adults. 

MATERIAL 

The material of Oto-Rhino- Laryngology Surgery Clinic of the International 

Center of Hearing and Speech consists of 214 children and adolescents 

under 16 years of age who have been surgically treated for 

otosclerosis, and followed up for at least 3 years. Almost all the patients 

underwent stapedotomy with implantation of teflon-piston prosthesis; 

stapes mobilization was performed in 36 cases. Pre- and postoperative 

hearing assessment included frequencies: 500, 1000, 2000 and 4000 Hz. 

RESULTS 

Mean preoperative air-bone gap reached 27.4 dB. Following surgery a gap 

closure, within 10 dB was achieved in 85 ears. An overclosure effect was ob- 

223

tained in 32 patients with an average value of 3.2 dB. Mean hearing gain 

in all patients was 29.2 dB. The follow-up period (6-36 months) showed 

that the hearing Results was slightly deteriorated with time, however, 

hearing thresholds have been still better than those from before the surgical 

operation. Reoperations were performed in 6 patients in order to remove 

adhesions or to restore the connexion between the prosthesis and 

footplate. Total complications rate was 1,52 %. 

CONCLUSIONS 

Postoperative hearing results, not worse than in adults, seem to support 

the concept of employing surgical treatment in all children with recognized 

otosclerosis. 

P 252 

CONGENITAL CONDITIONS IN PAEDIATRIC 

OTOLARYNGOLOGY PRACTICE 

S. Mohanty, J. Samuel, M. Maraignanam 

Sri Ramachandra University & Hospital, ENT, Head & Neck Surgery, 

CHENNAI, India 

E-MAIL: drsanjeevmohanty@gmail.com 

OBJECTIVES 

Although congenital lesions are present at birth, certain conditions are 

detected later due to specific symptomatology or as incidental findings. 

This study aims to detect the prevalence of congenital lesions in paediatric 

otolaryngology practice in the urban setup of a developing country. 

METHODS 

A retrospective analysis of case records of paediatric patients admitted for 

otolaryngology care in a tertiary care referral hospital in South India was 

conducted covering the period from 2007 - 2011. Diagnoses like haemangioma, 

subglottic stenosis, branchial cleft and sulcus vocalis were used as 

search criteria restricting to the age group 1month to 18 years. The various 

presenting features were analysed and the overall prevalence was estimated. 

RESULTS 

A total of 1264 patients were admitted for otolaryngology care during this 

period of which 251 patients were children. A total of 8 patients (5 males 

and 3 females) in the age range 3 months to 7 years with various congenital 

conditions of the nose, larynx, head and neck were managed surgically. 

Difficulty in breathing or swallowing, change in voice and neck swelling 

were the symptoms reported by the patients. Direct laryngoscopy, CT scan 

of the neck and stroboscopy aided in the diagnosis. 

CONCLUSION 

A high degree of clinical suspicion and evidence based otolaryngology practice 

is essential for the diagnosis of congenital lesions presenting in later 

life. The prevalence of less than 4% of congenital lesions in paediatric oto 

224 

laryngology practice, as evidenced by this study, reiterates the need for 

good clinical acumen and knowledge about these conditions. 

P 253 

BJORK FLAP AND PEDIATRIC TRACHEOTOMY 

A. Alkurdi, K. Almazrou 

King Abdulaziz Medical City, RIYADH, Saudi Arabi 

E-MAIL: akuent@hotmail.com 

OBJECTIVE 

To compare use of the vertical incision technique (VIT) versus the inferiorly-based 

tracheal flap technique (IFT) in pediatric tracheotomy. 

DESIGN 

Prospective, randomized trial. 

SETTING 

Tertiary-care hospital. 

PATIENTS 

35 children (ages 1 month-16 years). Exclusion criteria were previous tracheotomy 

and tracheal anomalies. Prolonged intubation was the most 

common indication for tracheotomy. 

INTERVENTION 

35 children undergoing tracheotomy were randomized to VIT or IFT. A 

standardized surveillance brochoscopy protocol was utilized. Main Outcome 

Measures: Primary outcome measure was suprastomal collapse. Secondary 

measure was peristomal granulation tissue formation. 

RESULTS 

Sixteen children were randomized to the IFT group, while 19 underwent 

VIT tracheotomy. There was no significant difference between the two 

groups with regards to demographic features. The incidence of suprastomal 

collapse between VIT (37.5%) and IFT (12.5%) has been noticed but 

not statistically significant (p=0.569). Granulation tissue between the VIT 

and IFT groups were 26.3% and 56.3 % respectively (p

P 254 

OUTCOME AND COMPLICATIONS OF AIRWAY 

RECONSTRUCTION IN PEDIATRIC PATIENTS: 

SINGLE INSTITUTE RESULTS 

A. Alkurdi, K. Almazrou 

King Abdulaziz Medical City, RIYADH, Saudi Arabia 

E-MAIL: akuent@hotmail.com 

OBJECTIVE 

To study the outcomes and complications of pediatric airway reconstructions 

performed at king Abdul-Aziz medical city in Riyadh, kingdom of 

Saudi Arabia, over the period July 2007- November 2011. 

METHODS 

A retrospective chart review was undertaken in the otolaryngology division 

at our tertiary hospital(king Abdul-Aziz medical city) over the period 

July 2007- November 2011. Twenty pediatric patients underwent open airway 

reconstruction surgery. Information recorded presenting features, 

classification of lesion, surgery performed, surgical complications, and 

final surgical outcomes.. 

RESULTS 

Six patients had grade 2 SGS (30%) and 14 patients had grade 3 SGS (70%). 

Complications included 2 tracheocutaneous fistulas (10% ), 1 subcutaneous 

emphysema (5%), and 3 graft necrosis with displacement (15%). Fourteen 

patients underwent laryngotracheal reconstruction LTR( 70%) and 6 patients 

underwent partial cricotarcheal resection PCTR (30%). Nine patients 

had a single stage reconstructive surgery (45%) and 11 patients had a staged 

reconstructive surgery (55%). Successful decannulation was achieved in 16 

patients ( 80% ). 

CONCLUSION 

This series illustrates the efficacy of airway reconstructive surgery with 

minimal occurrence of complications at our institute. 

P 255 

PRELIMINARY RESULTS OF PROPRANOLOL TREATMENT OF 

INFANTILE HEMANGIOMAS OF HEAD AND NECK REGION 

N. Süslü, R.T. Senirli, U. Akyol, S. Ocak, C. Akyüz 

Hacettepe University Faculty of Medicine, Otorhinolaryngology, 

ANKARA, Turkey 

E-MAIL: aesuslu@yahoo.com 

Infantile hemangiomas are the most common childhood tumour, affecting 

about 4-5 % of pediatric population.They begin to proliferate at 1-2 

months of age, approximately 10% will require medical intervention. The 

aim of our study is to prospectively assess the efficacy of propranolol treatment 

in infantile hemangiomas of the ear nose and throat, head and neck 

(ent-hn) region. 

We present the early Results of an ongoing prospective study. The study 

includes ten patients with infantile hemangioma treated with propranolol 

and followed by ent-hn surgery and pediatric oncology . Five patients had 

subglottic hemangioma, four facial hemangioma and one patient had an 

extensive maxillofacial and subglottic hemangioma. Two patients, one 

with facial and one with subglottic hemangioma failed propranolol treatment. 

Eight patients showed a good response to propranolol, including 

one patient showing full regression. 

Oral propranolol appears to be an effective treatment in infantile hemangiomas. 

Considering its low rate of side effects propranolol can be used as 

a first line treatment agent. Failures necessitating surgery still can be seen. 

P 256 

CENTRAL ACTIVITY IN A YOUNG TINNITUS POPULATION: 

A QEEG ANALYSIS 

A. Gilles, S. Vanneste, D. de Ridder, P. van de Heyning 

Universitair Ziekenhuis Antwerpen - Universiteit Antwerpen, 

Otorhinolaryngology - Head & Neck Surgery, EDEGEM, Belgium 

E-MAIL: annick.gilles@uza.be 

BACKGROUND 

Electroencephalography (EEG) is a frequently used technique to study generating 

networks of tinnitus. The objective of the present retrospective 

study was to analyze source localized resting state EEG activity in young 

tinnitus patients. 

METHODS 

Data of a group of young adults (N = 42) aged 15 to 22 years old (Mean age= 

19.5) suffering from tinnitus was analyzed. Patients underwent full ENT 

investigation, audiological testing (audiometry, impedance testing and 

tinnitus analysis) and resting-state EEG. The EEG Results of the tinnitus 

patients were compared to a normative group (N = 42), homogeneous for 

age and sex. In addition, the tinnitus group was compared to an older tinnitus 

group (N = 42) homogeneous for sex, hearing loss and tinnitus type. 

RESULTS 

Young adults experiencing tinnitus showed increased beta1 and beta2 activity 

in the dorsal anterior cingulate cortex (dACC) in comparison to the 

control group. Compared to the older group (Mean age = 54.56), young 

adults showed a decrease in gamma activity in the auditory cortex as well 

as an increase of beta2, beta3 and theta synchronized activity in the supplementary 

motor area (SMA). 

CONCLUSIONS 

As the dACC is part of an emotional-related area, the increased synchronization 

in the beta1 and beta2 frequency band in young adults with tin- 

225

nitus is likely due to the tinnitus related distress in the tinnitus group. 

Brain activity differences between the younger and older group might be 

due to a difference in the conscious perception of the phantom sound and 

to changes of the local and global networks due to aging. 

P 257 

EPIDEMIOLOGY OF NOISE-INDUCED TINNITUS IN 

ADOLESCENTS 

A. Gilles 1 , G. van Hal 2 , D. de Ridder 1 , P. van de Heyning 1 

1 Universitair Ziekenhuis Antwerpen - Universiteit Antwerpen, 

Otorhinolaryngology - Head & Neck Surgery, EDEGEM, Belgium 

E-MAIL: annick.gilles@uza.be 

2 Universiteit Antwerpen, WILRIJK, Belgium 

BACKGROUND 

Adolescents are often exposed to loud music. As a consequence, noise-induced 

symptoms such as tinnitus, hearing loss and hyperacusis, increased 

tremendously. Transient (or permanent) tinnitus can be seen as a sign of 

overexposure and is therefore a valid measure for noise-induced damage. 

OBJECTIVES 

In this epidemiological study we obtained prevalence data of transient and 

permanent noise induced tinnitus (NIT) in a young Flemish population. 

In addition we assessed the attitudes towards noise and hearing protection 

(HP). 

METHODS 

A questionnaire was completed by 3892 high school students (aged 12 to 

18; mean 16.7 years old). The prevalence of transient and permanent tinnitus 

was assessed. A Dutch version of the ‘Youth Attitude towards Noise 

Scale’ and the ‘Beliefs About Hearing Protection and Hearing Loss’ were 

used. The Results of the questionnaires were compared with those of university 

students (aged 19 to 22; mean: 20.8 years old) previously obtained. 

RESULTS 

The prevalence of transient NIT and permanent tinnitus in high school 

students was respectively 74.9% and 18.3%. An increasing trend of transient 

tinnitus with age was revealed. Both groups were ‘neutral’ towards loud 

music and towards the use of HP. 

CONCLUSIONS 

Despite the very high prevalence of tinnitus in such a young population, 

the rate of HP use and the knowledge about the risks of loud music is extremely 

low. This study demonstrates that adolescents and young adults 

are not well informed and show risky behavior related to loud music exposure, 

providing new insights for future preventive measures. 

226 

P 258 

BIPOLAR DIATHERMY VERSUS COLD DISSECTION 

IN PAEDIATRIC TONSILLECTOMY 

A. Hesham 

OMAN, E-MAIL: ahesham73@yahoo.com 

OBJECTIVES 

To compare bipolar diathermy with cold dissection in paediatric tonsillectomy. 

METHODS 

One hundred and fifty children were randomized equally into bipolar 

diathermy tonsillectomy (BDT) and cold dissection tonsillectomy (CDT). 

Operative time, operative blood loss, postoperative pain, diet intake, activity 

level and complications were compared in the 2 groups. 

RESULTS 

The 2 groups were comparable in age and sex distribution. Operative time 

and blood loss was significantly less in the diathermy group. No significant 

difference in the postoperative pain except on the 3rd day in which 

the cold dissection group showed significantly lower pain score. Mean percentage 

of diet was significantly higher in the diathermy group on the 1st 

day. No significant difference between the 2 groups in terms of postoperative 

activity and complications. 

CONCLUSION 

BDT is a safe technique of tonsillectomy. There is significant less operative 

time and blood loss with similar morbidity compared to CDT, so it can be 

used safely in children. 

P 259 

PROJECT OF COCHLEAR IMPLANTATION IN BOSNIA AND 

HERZEGOVINA 

F. Brkic 1 , A. Kapidzic 2 , S. Spiric 3 , P. Spiric 3 

1 University Clinical Center Tuzla, ENT, TUZLA, Bosnia-Herzegovina 

E-MAIL: fuad.brkic@ukctuzla.ba 

2 Clinical Center Sarajevo, SARAJEVO, Bosnia-Herzegovina 

3 Clinical Center, BANJA LUKA, Bosnia-Herzegovina 

OBJECTIVES 

To show success of project of cochlear implantation in Bosnia and Herzegovina. 

METHODS 

Project of cochlear implantation started in Bosnia and Herzegovina in the 

beggining of XXI century. In three centers (Tuzla, Sarajevo, Banja Luka) up

to 100 CI implanted until 2012. In all three centers doctors performing by 

themselves implantation in standard cases, and for cases with anatomic 

anomalies consulted experienced surgeons from abroad. 

RESULTS 

Postoperative rehabilitation of implanted children is organized in these 

centers and successfful of rehabilitation is different, depending on different 

factors. Neonatal Newborn Heraing Screening Programme is also organized, 

with different approaches in centers. 

CONCLUSION 

Our opinion is that project of cochlear implantation in Bosnia and Herzegovina 

is, despite some problems, good, and it needs, ofcourse, improvenents. 

P 260 

HEARING PRESERVATION FOR CHILDREN -PARTIAL 

DEAFNESS TREATMENT (PDT): 10 YEAR’S RESULTS 

P.H. Skarzynski, H. Skarzynski, A. Lorens, A. Piotrowska 



E-MAIL: p.skarzynski@ifps.org.pl 

In our experience first cases with residual hearing possible to preserve were 

in previous century over 12 years ago. During next years observation of patients 

were provide and in 2004 the first child with PDT-EC (electric complement) 

was implanted. 

The aim of that work was to evaluate and compare effects of treatment 

children with cochlear implants in group PDT-EC. 

The age of children were from 5 to 16 years old and they had good hearing 

(up to 30 dB SPL) in low frequencies up to 1000 Hz. They had no enough 

effect from hearing aids and only electric amplification was possible to 

higher frequencies. 20 mm insertion with MEDEL Standard electrode was 

performed in each of that children. In 2004 there was 15 implantation like 

that and we include also group of next 32 from years 2005 and 2006. 

Average Results of tests - monosyllabic speech understanding in quiet 

84,2% and in noise 65,8%. That Results were better than children from PDT- 

EAS group (typical electro acoustic stimulation with need of acoustic amplification 

in low frequencies). From pure tonal audiometry point of view 

hearing was preserved. 

As summary using that method could be effective and developing of new 

electrodes allow Us to minimize electrode insertion trauma. Connection 

of electric hearing from cochlear implants and natural acoustic hearing 

gave positive Results and patient’s satisfaction. Long term observation 

presents no decreasing Results of pure tonal audiometry. 

P 261 

EXPLORING THE CLINICAL APPROACH REGARDING 

BIMODAL FITTING 

F. Scherf 

Advanced Bionics, Clinical Research, NIEL, Belgium 

E-MAIL: Fanny.Scherf@advancedbionics.com 

An international multicentre clinical survey was designed to obtain information 

on the various approaches towards bimodal hearing and device 

fitting. Questions regarding counseling, fitting and testing were presented 

to clinicians involved with bimodal fitting in key centers in Europe and 

answers were collected via an online survey or during clinic visits. 

The approaches regarding bimodal fitting differ from audiologist to audiologist, 

from centre to centre and country to country. Most audiologists 

are very much in favour of bimodal hearing and counsel the newly implanted 

patient to wear their contralateral hearing aid if it doesn’t conflict 

with the information obtained with the cochlear implant. Refitting of the 

hearing aid in the non-implanted ear is, however, usually only done by 

audiologists that do both CI and hearing aid (HA) fitting, and only if they 

suspect that the HA was not optimally fitted before the cochlear implantation. 

This refitting is usually based on ‘comfort’ and not so much on 

outcomes. Testing is done in the conventional way: tonal and speech audiometry 

in both unilateral and bimodal condition. 

P 262 

TREATING HEARING LOSS IN CHILDREN WITH APLASIA OF 

THE COCHLEA: IS COCHLEAR IMPLANTATIONSTILL FEASIBLE? 

G. Kontorinis 1 , F. Goetz 2 , A. Giourgas 2 , H. Lanfermann 2 , T. Lenarz 2 , 

A.M. Giesemann 2 

1 Sheffield Children’s Hospital,United Kingdom 


2 Hanover Medical School, Hanover, Germany 

OBJECTIVES 

To describe the radiological findings of the aplasia of the cochlea and evaluate 

the existing options for hearing rehabilitation. 

METHODS 

The medical files of patients with cochlear aplasia admitted to a tertiary, 

referral centre during a ten-year period were retrospectively examined. 

The radiological assessment involved high resolution computed tomography 

and magnetic resonance imaging scans. In cases of auditory implantation 

on the aplastic side the post-implantation performance and any 

relevant issues were recorded. 

227

RESULTS 

Twenty-eight ears with cochlear aplasia were found in 23 patients; bilateral 

in five, unilateral in 18 patients. The unilateral cases had contralaterally 

normal ears (two patients), cochlea hypoplasia (five patients), common 

cavity (six patients), incomplete partition type I (four patients) and atresia 

of the internal auditory canal (one patient). Four patients (two with bilateral, 

two with unilateral cochlear aplasia) were treated with cochlear implants 

in the ipsilateral ear. One patient underwent auditory brainstem 

implantation. All implanted patients achieved speech perception but with 

limited vocabulary. The surgery was challenging and time demanding in 

all cases but was not related to any complications. 

CONCLUSIONS 

Aplasia of the cochlea is defined the total absence of the cochlea, with a 

present, though malformed, vestibule. Although the hearing nerve cannot 

be identified, the post-implantation Results suggest the existence of functional 

hearing fibres in the remaining dysplastic inner ear structures. 

Hearing rehabilitation in such patients is very challenging and requires 

careful and individualized assessment; cochlear implantation may still be 

an option. 

P 263 

PERFORMANCE OF YOUNG CHILDREN FIRST FITTED 

WITH HIRES 120 

N. Mathias 1 , K. Niemczyk 2 , J. Attias 3 , E. Raveh 3 , N.A. Daykhes 4 , 

K. Neumann 5 , M. Sainz 6 , M. Kameswaran 7 , N. Vaid 8 , 

D. Arweiler-Harbeck 9 

1 Advanced Bionics, RIXHEIM, France 

E-MAIL: nathalie.mathias@advancedbionics.com 

2 University Clinic, WARSAW, Poland 

3 Schneider Children’s Medical Center, TEL AVIV, Israel 

4 Federal State Scientific Clinical Centre of Otorhinolaryngology, 

Ufa department, Russian Federation 

5 Klinikum der J.W. Goethe Universität, FRANKFURT, Germany 

6 Hospital Clinico San Cecilio, GRANADA, Spain 

7 Madras ENT Research Foundation, CHENNAI, India 

8 KEM Hospital and Research Center, PUNE, India 

9 Universitäts-Hals-Nasen-Ohren-Klinik Essen, ESSEN, Germany 

OBJECTIVES 

The HiRes 120 sound coding strategy from Advanced Bionics implements 

virtual channels by current steering between two adjacent electrodes. 

Therefore, the number of stimulation sites is no longer limited to the 16 

physical electrodes, but may be extended to up to 120 locations sites. The 

aim of this project was to evaluate the benefit of the HiRes 120 strategy for 

speech production, perception and music development over a 24 month 

period in children. 

228 

METHODS 

Children between seven months and five years of age were included in the 

evaluation. All subjects were first fitted with HiRes 120 using either their 

Harmony or Platinum Sound processors. Pre-implantation, baseline was 

evaluated using the Children’s Implant Profile (Nottingham Version) and 

a free field audiogram if available. The children were evaluated with a series 

of questionnaires: MUSS, (IT) MAIS, SIR, CAP, PRISE and a Musical 

Stages Profile at approximately 3, 6, 9, 12, 18 and 24 months. 

RESULTS 

40 subjects from 8 centres were included in the evaluation. The data obtained 

so far, the majority up to 12 months, showed a clear increase of the 

scores from session to session for all the questionnaires. In addition, most 

of children are within the normal hearing range for the (IT) MAIS and 

PRISE questionnaires. 

CONCLUSIONS 

Data collection is ongoing; the first outcomes are very promising in terms 

of acceptance and performance with the HiRes 120 strategy. 

P 264 

NEPTUNE, THE FIRST SWIMMABLE SOUND PROCESSOR 

FOR COCHLEAR IMPLANTS RECIPIENTS: 

PRELIMINARY FEEDBACK ON ITS DAILY USE 

N. Mathias, L. Arnold 

Advanced Bionics, RIXHEIM, France 


OBJECTIVES 

Advanced Bionics recently launched their latest generation sound processor 

called Neptune . Neptune is a freestyle design swimmable processor, 

which makes it possible to hear underwater and enjoy an active life without 

worrying about the robustness of the processor. It offers a variety of 

wearing options for different persons and situations. The objective of this 

survey was to evaluate the practicality, comfort and ease of use of the Neptune 

processor and its various wearing configurations. 

METHODS 

Two separate surveys were conducted: a short one online and a longer questionnaire 

specifically handed out to existing users who were upgraded to 

Neptune. Adults and children participated. They tested the Neptune and 

the wearing options for a minimum of four weeks before completing the 

surveys. Upgraded subjects compared their previous processor to the Neptune 

and both new and existing users answered questions on the Neptune 

processor about the wearing options, comfort, ease of use and sound quality.

RESULTS 

Data collection is still ongoing; preliminary outcomes show that the Neptune 

processor allows users to live an active life without compromising 

their hearing performance. 

CONCLUSION 

Although only preliminary Results are available so far, the Neptune 

processor appears to deliver up to its promises. More data are expected to 

confirm these preliminary observations on a larger scale. 

P 265 

EVALUATION OF THE CLEARVOICE STRATEGY 

IN CHILDREN 

N. Mathias 1 , N. Noël-Petroff 2 , C. Ulmann 2 , T. van den Abbeele 2 

1 Advanced Bionics, RIXHEIM, France 


2 Hôpital Robert Debré, PARIS, France 

OBJECTIVES 

ClearVoice has been designed to improve speech understanding in difficult 

listening environments without compromising performance in quiet 

situations. The aim of the study was to evaluate the benefits of ClearVoice 

in children. 

METHODS 

Children between six and fourteen years of age using the HiRes 120 sound 

coding strategy for at least one year were asked to randomly test two modalities 

of ClearVoice (‘medium’ and ‘high’) during one month each. The baseline 

program, HiRes 120, and both ClearVoice programs were then 

evaluated with a sentence test in quiet and noise. Parents and teachers were 

asked to complete a questionnaire related to everyday noisy situations. 

RESULTS 

Nine children were included. The switch-over to ClearVoice was uneventful 

for both modalities of ClearVoice. Seven out of nine children preferred 

a ClearVoice program compared to their usual program. Some difficulties 

were encountered with the test material, particularly in younger children. 

Nevertheless, among the five subjects where speech test Results were usable, 

a significant improvement in scores in noise was observed for both 

ClearVoice modalities after one month of use compared to the HiRes 120 

program. In addition, ClearVoice had no impact in quiet as the scores obtained 

with both ClearVoice programs were similar to the score with HiRes 

120. Very positive comments were obtained through the questionnaires. 

CONCLUSIONS 

ClearVoice improved speech understanding in noise in these children and 

showed clear benefit of using ClearVoice in their daily life as described by 

comments of both parents and children. 

P 266 

LISTENING HABITS OF PERSONAL MUSIC PLAYER USERS AND 

POTENTIAL RISK OF NOISE INDUCED HEARING LOSS AMONG 

SCHOOLCHILDREN 

A. Vidraite, E. Lesinskas, A. Klivickas 

Vilnius University Hospital Santariskiu Clinics, ENT Department, 

VILNIUS, Lithuania 

E-MAIL: austeja.vidraite@gmail.com 

AIM 

To evaluate listening habits of MP3 users among teenagers and potential 

risk of hearing damage. 

METHODS 

519 schoolchildren aged 13-19 responded to a specially designed questionnaire, 

reflecting listening habits of MP3, tinnitus symptoms. We also estimated 

the music intensity reaching the drum using sound analyser 

SVAN 958, artificial model of ear channel and ordinary MP3 player. Participants 

listened to 4 songs of different music style in the quiet environment 

and chose the acceptable sound level. The data was processed with 19.0 

SPSS program. 

RESULTS 

We estimated our MP3 to generate sound up to 109-112 dB, the average 

sound level of 4 songs was 92 (±11) dB. 314 (%) girls and 205 (%) boys responded 

to the questionnaire. 365 (70%) of schoolchildren listen MP3 at 

80dB and higher sound level. 239 (46%) listen at 95 dB and higher sound 

level. 515 (99%) uses MP3 2,03 (±1,69) hours a day, 52 (10%) approximately 5 

and more hours a day. 429 (82,7%) usually in a noisy environment. 176 (56%) 

of girls and 119 (58%) boys sometimes experience tinnitus after using MP3 

player. 174 (33, 4%) consider using expensive earphones or MP3 player to 

be safe from causing hearing damage at any sound level. 

CONCLUSIONS 

1) 99% of schoolchildren uses MP3 every day. 2) 70% listen MP3 in higher 

sound levels and longer than it is recommended what suggests most of 

children to be at risk of noise induced hearing damage. 3) More than a half 

have experienced tinnitus after using MP3. 

229

P 267 

HEARING LOSS IN CHILDREN WITH TYPE 1 DIABETES 

A.F. Qased 1 , E. Aziz 2 

1 Al Salaam Teaching Hospital, ENT, MOSUL, Iraq 

230 

E-MAIL: drawsent@yahoo.com 

2 Ibn Sina Teaching Hospital, MOSUL, Iraq 

OBJECTIVE 

To examine the auditory function in a group of children with type 1 diabetes 

and to study the association between hearing impairment and duration 

of illness, metabolic control and diabetic complication. 

METHODS 

Sixty-three diabetic patients below the age of 18 attending AL- Salam 

Teaching Hospital, Mosul, Iraq were investigated together with 63 age and 

sex matched non-diabetic controls. Pure-tone audiometric tests were performed 

in a soundproof room. Both air and bone conduction were tested 

at frequencies between 250-8000 Hz and 250-4000 Hz respectively. 

RESULTS 

The hearing acuity was lower in the diabetic patients than in the control 

subjects in all tested frequencies, but the differences achieve statistical significance 

only at middle and high frequencies. The hearing loss was symmetrical 

and affects both sexes equally. Duration of diabetes, HbA1c 

concentration, and angiopathic complications showed positive correlation 

with the increased hearing thresholds; while, age at onset, insulin dose 

per day, presence of neuropathy, and frequency of hypoglycaemic episodes 

were not associated. 

CONCLUSIONS 

Hearing loss occurs early in diabetic children and is related to the duration 

of the disease and the degree of metabolic control. Strict glycemic control 

might prevent or delay this complication. 

P 268 

COCHLEAR IMPLANT AND THIAMINE-RESPONSIVE 

MEGALOBLASTIC ANEMIA (TRMA) SYNDROME 

A. Hagr 

King Abdulaziz University Hospital, Otorhinolaryngology, 

RIYADH, Saudi Arabia 

E-MAIL: hagr@ksu.edu.sa 

OBJECTIVE 

To present the first published cochlear implant in an individual with Thiamine 

-responsive megaloblastic anemia (TRMA) syndrome. 

METHODS 

Case report and review of the medical literature concerning Thiamine - 

responsive megaloblastic anemia (TRMA) syndrome is presented. 

RESULTS 

The child’s hearing ability significantly improved one year after receiving 

cochlear implant. 

CONCLUSION 

To our knowledge, this is the first report in the literature of cochlear implantation 

in Thiamine - responsive megaloblastic anemia (TMRA) syndrome. 

Although this study needs further research, it may serve as a guide 

what is to be expected in such syndrome 

P 269 

HEALTH-RELATED QUALITY OF LIFE IN ROMANIAN 

COCHLEAR IMPLANTED PATIENTS 

I. Necula, E. Cosgarea 

University of Medicine Cluj-Napoca, ENT Clinic, CLUJ-NAPOCA, 

Romania 

E-MAIL: neculav@yahoo.com 

INTRODUCTION 

Cochlear implant is a well established treatment method in severe to profound 

hearing loss. It is important to assess the benefits in term of healthrelated 

quality of life not only on auditory-verbal performances. 

METHOD 

We compared the HRQoL between two groups, a hearing aided group (50 patients) 

and a cochlear implant group (84 patients), spitted in two subgroups, 

according to the age of implantation. We used the Nijmegen cochlear implant 

HRQoL questionnaire. All the implanted patients had MedEl devices 

and more than 6 months of experience with the speech processor. 

RESULTS 

Although there were differences between children with hearing aids and 

implanted children in all areas of HRQoL, in the physical area these differences 

were greater than for psychological and social domains. HRQoL 

was positively correlated with auditory performance, speech intelligibility 

and negatively with implantation age. Good auditory performance and 

speech intelligibility had a positive influence on HRQoL. The correlation 

coefficient, R = 0.78 indicates a very good linear and directly proportional 

correlation between the three variables, implantation age, SIR and CAP 

and HRQoL. 59.5% of quality of life’s variation is explained by the variation 

of these three parameters. 

CONCLUSIONS 

Cochlear implant improves the auditory performance and speech production 

more than hearing aids. Children implanted at young age evolve bet-

ter than older but even older children can get good Results, good performances, 

if they are properly selected. Associated diseases had a negative effect 

on these children outcomes but cochlear implant may have an important 

impact on quality of life. 

P 270 

OUTCOMES IN ROMANIAN COCHLEAR 

IMPLANTED CHILDREN 

E. Cosgarea, I. Necula 

University of Medicine Cluj-Napoca, ENT Department, 

CLUJ-NAPOCA, Romania, 

E-MAIL: rcosgarea@yahoo.com 

OBJECTIVES 

The aim of study was to establish the correlations between the cochlear 

implant outcomes and various demographic and health-related parameters 

in order to achieve a more appropriate selection of cochlear implant 

candidates. 

METHOD 

80 patients implanted in ENT Department Cluj-Napoca, during 2003-2010, 

were included in this study. In four perilingual cases etiology was meningitis 

occurred before one year of age. In 15 cases the hearing loss was hereditary. 

Two patients were diagnosed with Usher syndrome and one with 

Pendred syndrome. We assessed the auditory performances and speech 

abilities and correlated them with some intrinsic and extrinsic factors. 

RESULTS 

Auditory threshold increased significantly in cochlear implanted children. 

Young children operated before the age of 5 years has begun to perceive 

environmental sounds and then they learn to recognize speech and to articulate 

words. Older children (older than 5 years) who had auditory training 

a long period before surgery, with hearing aids, had a real 

improvement in both perception and oral production of speech. 

CONCLUSIONS 

Overall, there is an improvement in speech perception and production no 

matter the age they have been implanted. However, age remains an essential 

factor in the further development of the patient with the cochlear implant 

but each case must be evaluated individually and must take account 

of other factors involved in the evolution of cochlear implant. 

P 271 

EFFECTS OF FINE STRUCTURE AND EXTENDED LOW 

FREQUENCIES IN PEDIATRIC COCHLEAR IMPLANT 

RECIPIENTS 

J.S. Hamzavi, D. Riss, C.H. Arnoldner 

University Hospital of Vienna, VIENNA, Austria 

E-MAIL: sasanhamzavi@me.com 

This was a prospective study investigating the upgrade to a new speech 

processor. The upgrade used a repeated measures design with an alternating 

order of conditions (A-B-A-B design). Twelve pre- and perilingually 

deaf children with MED-EL C40+ cochlear implants were enrolled in the 

study. Patients were upgraded from their Tempo+ speech processor, which 

used continuous interleaved sampling (CIS) in combination with a frequency 

spectrum of 200-8500 Hz, to an Opus speech processor, which used 

FSP with an extended frequency spectrum of 70-8500 Hz. The primary 

means of testing was an HSM (Hochmair, Schulz and Moser) sentence test 

at 65 and 80 dB in quiet. In addition, the ‘Mainzer Kindersprachtest’ (Mainz 

audiometric speech test for children) was applied at 65 and 70 dB. 

When the new FSP speech processor was used together with the extended 

low frequency range, HSM sentence tests at 65 and 80 dB resulted in scores 

indicating statistically significant improvements of 7.1 and 9.9 percentage 

points, respectively. Scores in the ‘Mainzer Kindersprachtest’ at 65 and 70 

dB indicated statistically significant improvements of 9.3 and 6.1 percentage 

points, respectively. 

The present study clearly shows that children benefit from the fine structure 

speech coding strategy in combination with an extended frequency 

spectrum in the low frequencies, as is offered by the Opus speech processors. 

This should be taken into consideration when fitting pre- and perilingually 

deaf children implanted almost a decade previously. 

P 272 

COCHLEAR IMPLANTATION IN CHILDREN DEAFENED 

BY CONGENITAL CYTOMEGALOVIRUS 

B. Philips, I. Dhooge 

Ghent University, GENT, Belgium 

E-MAIL: birgit.philips@ugent.be 

OBJECTIVES 

A retrospective study was performed on children with cochlear implantation 

(CI), deafened by congenital cytomegalovirus (cCMV). 

METHODS 

Twelve infants with cCMV infection underwent audiological assessment 

including otoscopic examination, tympanometry, auditory brainstem responses 

and behavioral pure tone audiometry. The test protocol was se- 

231

lected according to the developmental age of the child. Besides audiological 

assessment, additional disorders and sequelae are documented. 

RESULTS 

Asymptomatic cCMV children can achieve substantial auditory perceptive 

and productive skills following cochlear implantation. Also symptomatic 

cCMV children sometimes perform better than initially expected. 

CONCLUSIONS 

Early hearing rehabilitation of children with cCMV-related deafness can 

successfully increase access to oral language, even in the presence of CNS 

abnormalities. Secondly, additional hearing evaluations after universal 

newborn hearing screening will be needed to detect infants with delayedonset 

hearing loss. Long-term audiological follow-up assessment, especially 

within asymptomatic CMV children, should be taken care of. 

P 273 

EVOKED COMPOUND ACTION POTENTIALS (ECAP) 

MEASURES IN PAEDIATRIC MED-EL COCHLEAR IMPLANTEES: 

RELATIONSHIP WITH ELECTRODE PLACE, AGE AND C-LEVELS 

S. Labassi 1 , B. Philibert 1 , N. Bouchair 2 , A. Mecibah 2 , A. Saidia 2 

1 Vibrant Med-El, SOPHIA ANTIPOLIS, France 

E-MAIL: samia.labassi@medel.com 

2 Annaba University Hospital, ANNABA, Algeria 

OBJECTIVE 

To validate ECAP recordings (ART) in 71 CI children and to compare the 

responses among different electrodes (apical, medial and basal). 

METHOD 

ART responses were recorded in 71 children. For all 3 electrodes, maximum 

stimulation level, ART response amplitude measured at maximum stimulation 

level, ART threshold and C-level were determined. 

RESULTS 

Showed that ART responses amplitudes were larger for electrode 2 than 

for electrodes 6 and 10. No statistically significant differences were observed 

for maximum stimulation levels and ART thresholds. For all 3 electrodes, 

statistically significant paired correlations were reported between 

ART responses amplitudes and age of the children at the test. No correlations 

were observed with age at the implantation or with CI use duration. 

CONCLUSION 

ECAP recording was successful in most of the subjects (>86%). Differences 

among electrode places were observed showing better responses at the 

apex of the cochlea as well as with age of child. 

232 

P 274 

LOW FREQUENCY HEARING PRESERVATION BY USING CI422 

ELECTRODE IN CHILDREN 

H. Skarzynski, A. Piotrowska, P.H. Skarzynski, A. Szkielkowska, 

M. Matusiak 




OBJECTIVES 

Preservation of functional hearing in children with high and mid frequencies 

sensori-neural hearing loss is one of necessary conditions of effective 

electro-acoustic stimulation, as well as condition of complete speech rehabilitation. 

METHODS 

Preoperative and postoperative hearing in tonal audiometry was assesed 

in the group of 56 children implanted with CI422 electrode. Tests were performed 

in 3, 7, 30 days after surgery and 2, 4, 7 and 13 months after surgery. 

All patients were on steroids during surgery and up to 1o days post surgery. 

RESULTS 

Complete preservation of preoperative hearing ( increase of hearing threshold 

with 15dB for any measured frequency) was stated in 89% of treated 

children in 3rd day after surgery, 92% in 7th day after surgery, 98% in 30ieth 

day after surgery, 98% in 2nd month after surgery and 99% in any next follow 

up intervals. 

CONCLUSIONS 

It was evaluated that cochlear implant with CI422 is the tool, which gives 

full range of possibilities for preoperative hearing preservation. Another 

possibility is effective treatment of mid and high frequency hearing loss. 

P 275 

PARTIAL DEAFNESS TREATMENT IN CHILDREN BY USING 

COCHLEAR IMPLANTATION WITH CI422 ELECTRODE- 

RESULTS AFTER 1 YEAR 

H. Skarzynski, A. Piotrowska, P.H. Skarzynski, M. Porowski, M. Matusiak 




OBJECTIVES 

Mid and low frequency hearing loss in children is an impairment of farreaching 

negative influence on child development, especially development 

of speech, acquisition of communicative competences and having delaying

impact on overall level of child progress. Inclusion of child into the world of 

sound of full range of frequencies, speech rehabilitation and improvement 

of articulation disorders are the main goals of treatment of children with 

this kind of hearing loss with cochlear implantation with CI422 electrode. 

METHODS 

The level of preoperative hearing preservation was evaluated in a group 

of children included into the study. The gain of implantation with 

cochlear implant with CI422 was assessed: In terms of increase of level of 

speech understanding measured by means of AAST as well as level of hearing 

threshold measured in tonal audiometry. In studied group in 26 children 

there was 18 months observation noted. 

RESULTS 

Complete and stable preservation of preoperative hearing comparing with 

post operative ( increase in hearing threshold up to 15dB for any measured 

frequency) was observed in 99.2% of analyzed cases. 

CONCLUSIONS 

It was stated that cochlear implant with CI422 electrode is effective tool 

for treatment of sensori-neural heating loss in high and middle frequencies 

giving a realistic chance for hearing preservation. 

P 276 

DEEP INSERTION IN CHILDREN - ROUND WINDOW 

APPROACH BY USING OFT ELECTRODES: CI422 AND FLEX 

LONG 

H. Skarzynski, M. Mrowka, M. Porowski, P.H. Skarzynski, M. Matusiak 




OBJECTIVES 

Preservation of preoperative hearing is becomming a challenge and neccessity 

in perspective of treatment of sensori-neural hearing losses, especially 

in children population. Technical parameters of new types of 

electrodes - soft ones - make it possibile to minimize potenial intracochlear 

insertion trauma. 

METHODS 

Atraumaticity of insertion of CI422 and FLEX long electrodes was assessed. 

In all analysed insertions round window approach surgical technique was 

used for treatment of partial deafness. Atraumaticity was evaluated by 

means of assesement of pre- and postoperative hearing measurement by 

means of tonal audiometry and position of electrode inside cochlea by 

means of ct computed tomography. Assesed groups were: 56 with CI422 

electrode and 31 with FLEX long Electrode. 

RESULTS 

Preoperative hearing was preserved in 98,7% implanted children. In radiological 

evaluation tere was no dislocation of electrode form scala tympani 

into any other compartment of labirynth. Angular depth of insertion was 

assessed in each case, what has been correlated with level of hearing preservation. 

CONCLUSIONS 

It was stated, that these two electrodes used in surgical procedure of round 

window approach fulfill requirements of ‘ soft-surgery’ and give chances 

for complete hearing preservation. 

P 277 

TAILORED IMPLANTATION - LIFE SURGERY 

COMPLEMENTATION OF ELECTRIC STIMULATION. 

H. Skarzynski, M. Porowski, P.H. Skarzynski, M. Matusiak 




OBJECTIVES 

Treatment of high frequency hearing loss by cochlear implantation is a 

procedure dedicated for precise and atraumatic complementation of natural 

residua hearing with electric or acoustic- electric stimulation. As sensori-neural 

hearing loss is a non-homogenous group of hearing 

impairment - implantation and insertion should be individualized and 

tailored for each particular case. 

METHODS 

By using an intraoperative computed tomography (X-CAT, SYNGOVIA) 

controls of depth of insertions were performed during surgery. In each 

case angular depth of insertion was tailored for preoperative thresholds 

of hearing. 3 stage implantations with intraoperative measurements of 

depth of insertions in patients with different levels of high and mid frequencies 

of sensori-neural hearing loss were presented. 

RESULTS 

In each implanted patient postoperative hearing was measured and no serious 

alternation in this was noted. 

CONCLUSIONS 

It was assessed, that intraoperative control of angular depth of insertion 

is a effective tool for precise measurement of depth of electrode insertion 

and adjustment of its location to the level of preoperative hearing. 

233

P 278 

FAST FITTING PROCEDURES FOR CI BY ELECTRICAL 

STAPEDIUS REFLEX THRESHOLDS (ESRT) 

V. Koci, P. Zorowka 

Innsbruck Medical University, Hearing, Speech and Voice Disorders, 

INNSBRUCK, Austria 

E-MAIL: viktor.koci@uki.at 

INTRODUCTION 

Postoperative electrical stapedius reflex thresholds (ESRT) show a good 

correlation to psychoacoustic loudness scaling. This is the main reason 

why ESRTs are used for CI fitting in children for the estimation of comfort 

levels (c-levels, m-levels, MCL). The application of this objective fitting 

procedure is particularly helpful in children who cannot provide reliable 

behavioural response. Fast fitting can be performed by online and/or offline 

evaluation of the reflex recordings. 

METHODS 

By means of a new setup, ESR measurements were performed in children 

and adults. Stimuli were generated by the standard fitting software. Repetitive 

stimulation with increasing and decreasing stimulation intensities 

was applied to elicit the reflex in the vicinity of reflex threshold. Reflex detection 

was performed by impedance audiometry of the ipsi- or contralateral 

ear using a new PC-soundcard based fast response impedance meter. 

All 12 electrodes of the Med-El implants were stimulated. The median of 

the recorded ESRT was calculated offline. These values were compared to 

the MCL value subjectively set by the investigator during the fitting session 

(‘online’). 

RESULTS 

The comparison of subjectively set MCLs and offline calculated ESRTs 

shows a variability in between the normal distribution of the collected 

ESRT values. 

CONCLUSIONS 

ESRT values for online and offline evaluation show a good correlation. If 

there is no more time (approximately 15 min) for a more accurate fitting, 

ESRT values can be set directly to MCL values by a experienced investigator 

online during the fitting. Nevertheless for a high quality fitting offline 

evaluation of ESRT is recommended. 

234 

P 279 

CI IN CHILDREN: PRESERVING INTRACOCHLEAR 

STRUCUTURES 

A. Lesinski-Schiedat, L. Lahr, M. Münzel, B. Büchner, L. Lenarz 

MHH, ENT Clinic, HANNOVER, Germany 

E-MAIL: les@hoerzentum-hannover.de 

Cochlear Implantation is an established therapy concept in children and 

adults to provide profound hearing impairment. The indications were extended 

towards patients with residual hearing. Especially in children it is 

important to discuss the input of the low frequencies and the consequences 

for children with profound hearing loss. 

We have implanted about 20 children unilateral and bilateral with the so 

called electrodes perserving intracochlear structures using different products. 

Preoperative all patients underwent complete audiological and radiological 

diagnostics. 

All children underwent a special surgical technique to avoid intracochlear 

damage. Residual hearing could be sustained after CI surgery in nearly all 

patients. 

In patients using their low frequency residual hearing we could observe 

in all of them a benefit in electroacoustic stimulation. 

CI in highfrequency deafness is a challenge for surgical and audiological 

skills. While developing future electrode concepts it should be considered 

whether also in bilateral profound deaf children the surgical concept 

should follow with respect to prospective technologies. We actually recommend 

in all children at least one ear to be implanted with an electrode 

developed for electroacoustic stimulation. 

P 280 

CI IN CHILDREN - PLASTICITY OF THE COCHLEAR NERVE 

MEASURED VIA THE CI 

A. Lesinski-Schiedat, L. Lahr, M. Münzel, G. Giourgas, L. Lenarz 

MHH, ENT Clinic, HANNOVER, Germany 

E-MAIL: les@hoerzentum-hannover.de 

Cochlear Implantation is an established therapy concept in children and 

adults to provide profound hearing impairment. Still the age for implantation 

is in discussion. 

Via the CI products an E-ABR is possible. Beside measuring the hearing 

development in children it seems to be necessary, especially while observing 

multi-handicapped children to establish an objective tool. 

We have registered via the Medel CI product in 12 children the E-CAP and 

correlated this to the Results of our routine test battery. The test battery 

includes international validated tests to measure in very young children 

the hearing development before starting the active speech development

We could find the compliance for the testing is available in children, also 

in very young age. The registration is in most of the cases reliable. 

Dependent from age the registration shows a plasticity of the nerve which 

is as expected dependent from the age at implantation. Further analyses 

will show whether we can correlate the quality of E-CAP to the hearing 

development of the children. 

P 281 

MUSIC EXPERIENCE OF PRELINGUALLY DEAF CHILDREN 

WITH COCHLEAR IMPLANTS 

S.J. Brockmeier 1 , S. Kunze 2 , M. Vischer 3 , T. Stark 4 

1 University Basel, Otolaryngolgoy, BASEL, Switzerland 

E-MAIL: hbrockmeier@uhbs.ch 

2 Kinderzentrum, MÜNCHEN, Germany 

3 University Bern, BERN, Switzerland 

4 Technical University München, MÜNCHEN, Germany 

Although impaired enjoyment of music has been reported (Stordahl 2002) 

CI children participate in numerous musical activities (Gfeller 1998, 

Nakata 2005b, Vongpaisal 2006). However, the numbers of subjects in these 

studies were small. Therefore we undertook a study explore the musical 

exposition and activities of a larger group. 

In 18 questions the paediatric version of the MUMU questionnaire covers 

musical experience and exposure for ci users and normal hearing children. 

The questionnaire was filled out by parents without help. We collected 

the data of 102 Ci users and 29 normal hearing subjects. The data was 

analysed with the Chi square test in SPSS. The average age of the CI users 

was 7.3 (SD 3.9) yrs and 5.5 (SD 3.1) yrs for normal hearing children. The 

average implant experience was 3.7 (SD 2.7) yrs. 16% of the patients were 

bilaterally implanted, 84% unilaterally. Distribution of implants was 69% 

Combi 40/40+/Pulsar; 30% Nucleus 22/24; 1% ABC. 13 CI kids had additional 

handicaps. 

Families of hearing impaired rate role music plays in their live less important 

than those of the normal hearing children, however not significantly 

so. The overall exposure of music is the similar in both groups. However, 

children with ci are less actively engaged in musical activities. 

Cochlear implanted prelingually deaf children are involved in musical activities. 

However, in their families music is less important than in families 

of normal hearing kids. The implant users do not develop a spontaneous 

approach to music to the extent their normal hearing peers do. 

P 282 

FACTORS CONTIBUTING TO LIMITED/NON-USE IN 

THE COCHLEAR IMPLANT SYSTEMS IN CHILDREN: 

11 YEARS EXPERIENCE 

S. Özdemir, U. Tuncer, O. Tarkan, M. Kiroglu, F. Çetik, F. Akar 

Cukurova University School of Medicine, ADANA, Turkey 


OBJECTIVES 

The aim of this study was to analyze the incidence and etiologic factors of 

non-use and limited use of cochlear implants. The patients’ age, gender, 

duration of implantation and additional disabilities were investigated. 


Of the 462 patients implanted in our clinic between January 2000 and December 

2011, twelve limited user /non-user cochlear implanted patients 

were selected who had an age under 16 and had a follow-up of at least 24 

months. 

RESULTS 

A total of 12 patients (7 male and 5 female patients; median age, age range, 

5-13 years) reviewed in this study. The median age at implantion and median 

follow-up times were 3,5 years and 4 years, respectively. In total of 12 

(2.55 %) recipients, 4 (0.85%) patients were non-users and 8 (1.70%) patients 

were limited users. Among the limited users, the patients had some additional 

disabilities. These were classified as: autism (3 children), cerebral 

palsy (2 patients), moderate mental retardation (1 patient), attention 

deficit/hyperactivity disorder (1 patient) and learning disability and lack 

of family interst (1 patient). Among the non-users, 2 patients had ossified 

cochlea due to menengitis, 1 patient had autism and 1 patient had learning 

disability and lack of family interest. Non had experienced device failure. 

CONCLUSION 

It should always be considered in patients with additional factors like 

autism, mental-motor retardation, learning disabilities that they will 

show limited development from cochlear implantation. These patients 

are potential limited/non-users. These patients require unique rehabilitation 

and provide high family and educational interest. 

235

P 283 

RESULTS OF AUDITORY BRAINSTEM IMPLANTS ON 3 CASES 

OF COCHLEAR NERVE APLASIA 

J. Economides 1 , M. Economides 1 , M. Zarifi 2 , J. Magnan 3 

1 Children’s Hospital of Pendelis, ATHENS, Greece 

236 

E-MAIL: jacquedkrd@yahoo.gr 

2 Agia Sofia, Children’s Hospital, ATHENS, Greece 

3 CHU Hopital Nord, MARSEILLE, France 

OBJECTIVE 

We present the Results of three children who underwent auditory brainstem 

implantation. 

MATERIALS 

Three children respectively aged 6, 5 and 4,5 years old were selected with 

cochlear nerve aplasia after complete imaging assessment. The first case 

was a boy with Charge syndrome aged 5,5 years old, with bilateral dysplasia 

of the petrous bone and bony atresia on the right side. Upon radiologic 

examination absence of both internal auditory canals was found. The second 

case was a 5 year old boy with cleft lip and absence of the cochleae and 

vestibules bilaterally. The third case was a 4,5 year old girl, born with 

esophageal and anal atresia, tetralogy of Fallot, absence of radius and absence 

of two fingers on the left hand. 

METHODS 

Surgery was performed in one case via the translabyrinthine approach, in 

the two other cases the retrosigmoid approach was used. The auditory 

brainstem implant Neurelec was used with 15 electrodes. 

RESULTS 

After a 3 year follow up, the first case is progressing satisfactorily in speech 

and language development and social behavior. The second case is progressing 

moderately in language development but low in discrimination. 

The third case showed little or no improvement in communication ,speech 

or language. 

CONCLUSION 

The surgery and the electronic-audiological evaluation of young children 

with ABI is challenging. Systematic surveillance through a longer period 

of time is required in order to evaluate the precise audiological situation, 

the speech and language development of the child. 

P 284 

ELECTRO-ACOUSTIC STIMULATION UTILIZING THE MEDEL 

FLEX-EAS AND FLEX-20 ELECTRODES 

R. Schramm 1 , C. Seguin 2 , J. Chenier 2 , S. Armstrong 2 

1 University of Ottawa, OTTAWA, Canada 

E-MAIL: schramm@cheo.on.ca 

2 The Ottawa Hospital, OTTAWA, Canada 

The development of hearing preservation electrodes has allowed cochlear 

implantation to be utilized in the management of partial deafness. Using 

a soft surgery technique, the electro-acoustic stimulation (EAS) electrode 

array is inserted through either the round window or scala tympani 

cochleostomy. Low frequency hearing is generally preserved. EAS implantation 

criteria have expanded recently in several centers to include children. 

The Duet 2 speech processor with integrated acoustic unit allows users to 

access low frequency acoustic amplification combined with electrical stimulation 

for higher frequencies. If residual hearing is preserved, synergistic 

effects of combined electric and acoustic stimulation typically occur which 

is particularly beneficial for speech understanding in challenging listening 

conditions. 

Ten adults with mild to moderate thresholds in the low frequencies and 

severe to profound thresholds in the high frequencies underwent EAS implantation. 

Five individuals received the FLEX-EAS electrode and 5 received 

the FLEX-20 electrode. The round window approach was utilized in all 

cases. All subjects received both intratympanic and systemic steroids. 

Post-operative performance measures included pure tone audiometry and 

speech perception testing in both quiet and noise. Recipients completed 

the Speech, Spatial and Qualities of Hearing (SSQ) questionnaire. 

All subjects had initial preservation of auditory thresholds after implantation. 

Patients were initially fit with the Duet 2 processor. The Opus 2 

processor was later used with the one subject who lost all residual hearing 

12 months after surgery. All recipients demonstrated marked benefit of 

EAS on speech perception testing. SSQ Results demonstrated early functional 

benefit of EAS. 

P 285 

ENDOMEATAL/POSTERIOR TYMPANOTOMY COMBINED 

APPROACH IN COCHLEAR IMPLANTATION 

A. Della Volpe 1 , I. Cantore 2 , G. Nolè 2 , P. Valente 2 , A.M. Varricchio 1 , 

L. Perfido 2 , M. Santandrea 2 , V. Santandrea 2 , R. Cantore 2 

1 Santobono Pausillipon Paediatric Hospital - Otosurgery and CI Unit, 

NAPLES, Italy 

E-MAIL: antoniodellavolpe@yahoo.it 

2 S. Carlo Regional Hospital, POTENZA, Italy

Vaious alternative techniques for cochlear implant surgery have been 

described, as endomeatal or suprameatal alone approaches without traditional 

posterior tympanotomy. Authors propose a posterior tympanotomy/endomeatal 

combined approach is proposed as a way to enhance 

surgical safety and effectiveness. 

64 patients, 34 men and 30 women, mean age 28 (range 1-81 years), 26 preverbal 

and 38 post-verbal, were submitted to cochlear implantation, 32 by 

means of the described combined posterior tympanotomy/endomeatal 

approach and 32 with traditional posterior tympanotomy alone approach. 

Good anatomic and functional results were observed, with intraoperative 

improvements in visibility and accessibility of cochleostomy site in difficult 

cases without any complication such as tympanic membrane perforation, 

external canal skin lesions or extrusion at 12 months. No significant 

differences were found with traditional technique complication rates excepting 

for partial insertion data, with statistically significant better Results 

with combined access. 

The combined posterior tympanotomy/endomeatal approach facilitates 

the array insertion in conditions of bad exposition/accessibility of promontory 

and round window. Moreover, this double way access hinders an incomplete 

or incorrect positioning. It should be always considered as an 

alternative to the traditional posterior tympanotomy one way access. 

P 286 

PROGRAMMING PECULIARITIES OF THE SPEECH PROCESSOR 

OF COCHLEAR IMPLANT IN CHILDREN WITH OBLITERATION 

OF THE COCHLEA 

A.V. Zaytsev, V.V. Bereznyuk 

State Medical Academy, Otorhinolaryngology, DNEPROPETROVSK, 

Ukraine 

E-MAIL: zavdnepr@ua.fm 

OBJECTIVES 

Fitting peculiarities determination of speech processor using the Splitelectrode 

in children with cochlea obliteration after meningitis. 

METHODS 

At the ORL-clinic of Dnepropetrovsk State Medical Academy, 113 cochlear 

implantation (CI) have been made since 2006. There were 2 children aged 

of 3 and 17 years, who had cochlea obliteration because of meningitis. We 

used implants with dual Split-electrode by MEDEL. 

RESULTS 

Patient aged of 17 years had frequency scaling for subjective determination 

of stimulus frequency. According to its data, electrodes programming was 

made in a definite order.In two year after CI, a growing resistance on three 

channels was revealed and it was more than 20 kOhm, the channels were 

disconnected. Probably, it happened because of the growth of connective 

tissue around the electrode in cochlea. The resistance on six channels was 

up to 12-20 kOhm. We increased the stimulus duration on these channels 

up to 70 s (standard is 26 s) and reduced the volume of the most comfortable 

level. It permitted to obtain hearing sensations. 

CONCLUSIONS 

The Split-electrode usage allows to implant patients with cochlea obliteration. 

When there is a growing resistance and absence of auditory sensations, 

the stimulus duration should be increased and the volume of the 

most comfortable level should be reduced.In case of a significant resistance 

growth on certain channels, electrodes need to be disconnected. Obliteration 

progression can lead to total cochlea ossification and nerve degeneration 

and cochlear implant will not cause auditory sensations. The only 

alternative is brainstem implantation. 

P 287 

REVISION SURGERIES AND MEDICAL INTERVENTIONS 

IN YOUNG COCHLEAR IMPLANT RECIPIENTS 

M. Alzahrani 1 , E. Lescanne 1 , A. Robier 1 , S. Podaven 2 , D. Bakhos 1 

1 CHU de Tours, ORL, TOURS, France 

E-MAIL: musaed.alzahrani@gmail.com 

2 University of Tours, France 

OBJECTIVE 

To report devices failures and postoperative or medical complications after 

cochlear implantation in children and to discuss revision surgeries and 

medical interventions occurring during follow-up. 

STUDY DESIGN 

Retrospective study. 

SETTING 

Tertiary referral pediatric hospital. 


We included a consecutive sample of children younger than 15 years old 

who received implants between January 1994 and June 2011. Complications 

were classified according to the European Consensus Statement on 

Cochlear Implant Failures and Explantations. 

RESULTS 

One hundred and Fifty-six children were included in this study. Seven 

children received bilateral cochlear implantation. Mean age at implantation 

was 42.8 months (age ranged from 7 months to 15 years). Overall, 43 

children (27.5 %) have received implants before the age of two. Inner ear 

malformations were found in 19 children (12.1 %), while 23 children (14.7 

%) experienced complications: cochlear reimplantations (n=10), other revision 

surgeries (n=4) and medical treatment (n=9). Excluding device failures, 

15 children (9.6 %) experienced complications. Postoperative infection 

was the principal cause of these complications (11 cases). six children 

younger than 2 years at implantation suffered complication postopera- 

237

tively. In these children, there was no statistically significant increase in 

complications compared to older children (P>0.05). Complete electrode insertion 

was achieved in 8 of the 9 reimplanted children. 

CONCLUSION 

Cochlear implantation could be considered a safe and reliable rehabilitation 

for deafened young children. Reimplantation was feasible and complete 

electrode insertion was achievable. Long-term follow up was 

mandatory to minimize and control surgical complication. 

P 288 

SURGICALLY TREATED PEDIATRIC PERIPHERAL FACIAL 

NERVE PARALYSIS: TEN-YEAR RETROSPECTIVE ANALYSIS 

L.J. Vlaski, D. Dankuc, D. Dragicevic, V. Kljajic, S. Lemajic-Komazec 

ENT University Clinic, Clinical Center of Vojvodina, Pediatric ENT, 

NOVI SAD, Serbia 

E-MAIL: vlaskilj@EUnet.rs 

INTRODUCTION AND OBJECTIVE 

Facial nerve paralysis can occur in children as congenital or acquired, central 

or peripheral. When acquired, peripheral facial nerve paralysis can be 

caused by middle ear inflammation, trauma, iatrogenic, rarely it is caused 

by tumors or it is characterized as Bell`s palsy. The aim of this study is to 

analyze the cases of pediatric acquired peripheral facial nerve paralysis, to 

discuss the etiology, necessary diagnostic procedures and treatment 

modalities in these children. 


This retrospective study analyzed the clinical data of six children surgically 

treated for peripheral facial nerve paralysis during the period 2002-2011. 

at ENT University Clinic in Novi Sad, Serbia. 

RESULTS 

Causes of peripheral facial nerve paralysis in children included in this 

study were: acute middle ear inflammation (1/6), mastoiditis (3/6), chronic 

secretory otitis media (1/6) and middle ear neoplasm (1/6). Surgical treatment, 

for cases of paralysis caused by inflammation, included myringotomy 

(1/6), cortical mastoidectomy and myringotomy with ventilation 

tube insertion (4/6). In the neoplastic case (1/6), behind the intact, thickened 

ear drum, unusual polypodal masses filling the antromastoidal tract 

and tympanic cavity were found, radical tympanomastoidectomy was performed. 

Pathohistological finding in this case revealed an embryonal rhabdomyosarcoma. 

Additional chemoradiotherapy followed in this child. 

CONCLUSION 

In children with signs of peripheral facial nerve palsy, complete, serious 

diagnostics and clinical follow-ups are necessary, especially if symptoms 

are prolonged and do not respond to conservative treatment. 

238 

P 289 

STUDY OF SLC29A3 GENE IN ROSAI-DORFMAN HISTIOCYTOSIS 

ASSOCIATED WITH HEARING IMPAIRMENT: THE FRENCH 

EXPERIENCE 

S. Marlin 1 , L. Jonard 2 , V. Couloigner 3 , S. Pierrot 3 , M. Louha 2 , S. Gherbi 2 , 

R. Couderc 4 , N. Garabédian 2 , F. Denoyelle 2 

1 APHP, INSERM U587, Centre de Référence des Surdités Génétiques, 

PARIS, France 



3 Necker Hospital, Pediatric Oto-Rhino-Laryngology Department, 

PARIS, France 

4 Service de Biochimie, PARIS, France 

SLC29A3 is implicated in a syndromic form of genodermatosis: H syndrome. 

The major features encounters in H syndrome are Hearing loss, 

Hyperglycaemia, Heart anomalies, Hypertrichosis, Hyperpigmentation, 

Hepatomegaly and Hypogonadism. More recently, SLC29A3 mutations 

have been described in families presenting syndromes associating generalised 

histiocytosis to systemic progressive features: severe camptodactyly, 

hearing loss, hypogonadism, hepatomegaly, heart defect and skin hyperpigmentation. 

We have identified a homozygous missense SLC29A3 mutation 

in a patient presenting with only a progressive sensorineural 

hearing impairment and a single cervical node. The same mutation was 

revealed in another patient with Rosai-Dorfman histiocytosis, profound 

hearing impairment, chronic inflammation with pericarditis and ophthalmological 

disorders. Both patients originated from North Africa and 

their mutation may be related to a common ancestor. Our Results suggest 

that SLC29A3 should be studied in patients presenting with histiocytosis 

and hearing impairment. 

P 290 

MUSIC APPRECIATION BY BI PATIENTS USING THE FSP4 

CODING STRATEGY 

A.U.D. Modan 

SC AUDIOLOGOS SRL, Audiology and Hearing Aids, Bucharest, Romania 

E-MAIL: ancamodan 23 @gmail.com 

Recent technical performances of the cochlear implants allow the patients 

not only to orient themselves in the sound environement, but also to have 

an close to normal hearing life, including pursuing a career, social and cultural 

integration, music appreciation.We tested 10 CI Medel patients regarding 

the perceptive behaviour regarding music characteristics: timbre, 

rhythm and pitch (tonality). 

The cochlear implant systems for all the patients were fitted using the 

coding strategy FSP4.

For testing the rhythm, we used 5 different patterns, that the patients 

were asked to imitate. For testing the timbre, the patients listened to 

music pieces intrepreted by 4 different instuments, and they were asked 

to identify the right instrument (piano, guitar, trumpet and violin). For 

appreciating the capacity of the patients to discriminate the frequencial 

characteristics of the music – tonality – we presented them five combinations 

of two pure sounds. The sounds were at tone and semitone intervals. 

The patients were asked to say if the sounds are identical or different from 

the pitch point of view. 

Results show so far that with the stimulation strategy FSP4 the patients 

have the chance to better perceive the characteristics of the music concerning 

tonality and timbre, in comparison with the older strategies that 

permitted only the hearing and imitating the rhytm patterns. 

P 291 

THREE YEAR EXPERIENCE OF ENDOSCOPIC BALLOON 

DILATATION FOR PAEDIATRIC SUBGLOTTIC STENOSIS 

E.C. Toll 1 , I. Mckay-Davies 2 , M.W. Saunders 2 

1 University College London, Division of Surgery and Interventional 

Science, LONDON, United Kingdom 

E-MAIL: edtoll@gmail.com 

2 Bristol Royal Hospital for Children, BRISTOL, United Kingdom 

BACKGROUND 

Subglottic stenosis (SGS) is the most common acquired laryngeal abnormality 

in children. One treatment for SGS grade I-III is endoscopic balloon 

dilatation of the stenotic ring. This case series aims to assess the safety and 

efficacy of balloon dilatation for the treatment of SGS. 

METHODS 

Operative records of all paediatric airway endoscopic procedures performed 

within a tertiary referral centre from August 2007 to January 2011 were reviewed. 

The case notes for all those receiving balloon dilatation during 

this time period were analysed. 

RESULTS 

14 patients received balloon dilatation for SGS during the 3.5 years of the 

study. Mean patient age was 12.2 months at first dilatation. On initial dilatation 

43% had grade III SGS, 36% had grade II SGS and 21% had grade I 

SGS. 57% (8) of patients only required one dilatation procedure. Of these 

patients, balloon dilatation was unsuccessful in one patient who required 

reintubation and subsequent laryngotracheal reconstruction. One patient 

required immediate re-dilatation with a wider balloon. 36% (5) required a 

further balloon dilatation procedure subsequently. Balloon dilatation was 

unsuccessful in one of these patients who went on to tracheostomy. 21% 

of patients required 3 dilatation procedures in total but did not have any 

further problems. No direct complications of balloon dilatation were observed. 

CONCLUSIONS 

Balloon dilatation for subglottic stenosis is a well tolerated and safe procedure 

with few complications. Balloon dilatation appears to be a successful 

strategy for management of subglottic stenosis grade I-III with the 

majority of patients only requiring one dilatation procedure. 

P 292 

CRICOID SPLIT IN THE OLDER CHILD: THE YORKHILL 

EXPERIENCE IN ACQUIRED, TRAUMATIC SUBGLOTTIC 

STENOSIS 

M.M.C. Yaneza 1 , D. Wynne 2 , H. Kubba 2 






OBJECTIVES 

To describe the Yorkhill experience of cricoid split in the older child for 

acquired subglottic stenosis secondary to chemical or thermal burns. 

METHODS 

A retrospective case series. 

RESULTS 

Two, 2-year-old children, one boy and one girl, developed subglottic stenosis 

after a chemical airway burn and skin scalding injury respectively. Both 

had normal tracheas immediately after the injury when viewed on intubation 

during initial resuscitation. The girl was extubated shortly after as 

there were no concerns regarding her airway. She developed stridor 8 days 

after the scalding injury. Bronchoscopy revealed circumferential subglottic 

stenosis which was treated with an anterior and posterior cricoid split. 

The boy had stridor and respiratory distress at presentation thus was 

immediately intubated. He was noted to have an inflamed epiglottis but 

normal trachea. He remained intubated for 7 days and underwent laryngoscopy 

and bronchoscopy. This revealed a normal supraglottis but 

oedema of the anterior commissure. A soft stenosis was present at two levels 

in the subglottis, each narrowing to a pinhole. Balloon dilation was 

performed but the stenosis recurred within seconds. An anterior cricoid 

split and microdebrider removal of vocal cord granulations was performed 

11 days after the chemical burn. Both children were successfully extubated 

within 7 days of surgery and have had no further airway intervention. 

CONCLUSIONS 

Cricoid split is classically described for neonates with subglottic stenosis. 

We advocate that a cricoid split should be considered as a management 

option in carefully selected older children with acute subglottic injury. 

239

P 293 

SINGLE STAGE LARYNGOTRACHEAL RECONSTRUCTION 

USING ENDOSCOPIC POSTERIOR GRAFTING IN CHILDREN 

V. Kapoor, Y. Bajaj, D. Tweedie, S. Ifeacho, A. Lloyd-Thomas, D.M. Albert 

Great Ormond Street Hospital, ENT, LONDON, United Kingdom 

E-MAIL: dr.k.kapoor@gmail.com 

INTRODUCTION 

Posterior glottic stenosis is a well recognised though rare condition. A wide 

range of treatment options have been proposed including endoscopic laser 

techniques and open techniques with grafting. The objective of this study 

was to present our experience of single stage laryngotracheal reconstruction 

with endoscopic technique of placement of posterior graft in isolated 

posterior glottic stenosis. 

METHODS 

The senior authors (ALT, DMA) were involved in the management of two 

children with isolated posterior glottic stenosis operated on as single stage 

reconstruction. 

RESULTS 

The two children in this small series had isolated posterior glottic stenosis. 

The aetiology in both the cases was previous prolonged intubation. Both 

patients underwent a successful placement of the posterior graft endoscopically, 

though it was a challenging task because of space constraints. 

None of these children required an intra-operative or post-operative tracheostomy. 

There were no complications in these patients. At follow up 

endoscopic examinations, both these patients have had their airway 

widened successfully. 

CONCLUSION 

Single stage laryngotracheal reconstruction with endoscopic placement 

of posterior graft in cases with isolated posterior glottic stenosis is a good 

alternative to open surgical techniques, although is technically a challenging 

procedure. 

P 294 

TRACHEOTOMY AFTER CRICOID SPLIT: RISK FACTORS OVER 

TEN YEARS 

U.K. Shah 1 , R.A. Joseph 2 , C.R. Grindle 3 , T. Marom 4 

1 Nemours/duPont Hospital for Children, Otolaryngology, 

WILMINGTON, USA 

E-MAIL: ushah@nemours.org 

2 Christiana Care Health Systems, NEWARK, USA 


4 Wolfson Medical Center, Sackler Faculty of Medicine, TEL AVIV, Israel 

240 

BACKGROUND 

Management of subglottic stenosis remains challenging with controversy 

remaining over the role of cricoid split. 

OBJECTIVE 

To determine which children have a greater likelihood of tracheotomy 

after cricoid split. 


Retrospective review of medical records in a tertiary pediatric medical center 

over 10 years. 

RESULTS 

23 children (16 boys, 7 girls), mean gestational age of 31 weeks underwent 

cricoid split with and without interpositional grafting at median age 89 

days. 11 pts had thyroid cartilage grafts, 7 had hyoid interposition, 2 had 

auricular cartilage grafts. 10 children required tracheotomy. 10 patients 

had Myer-Cotton grade II stenosis, and 10 had grade III stenosis. Of pts 

less than 2.5 kg, 7/8 needed tracheotomy while only 1/5 weighing more 

than 5 kg needed tracheotomy. (p=0.003) Average length of stay for tracheotomy 

patients was 125 days while those without tracheotomy required 

58 days. (p=0.011). The grade of stenosis (p=0.809), gender (p=0.968), age at 

surgery (p=0.178) and gestational age (p=0.117) were not associated with 

the need for tracheotomy. Weight at surgery was correlated with likelihood 

of needing tracheotomy (p=0.003). 

CONCLUSION 

Neonates who weigh less than 2.5 kg at the time of cricoid split procedures 

are more likely to require a tracheotomy to maintain a safe airway. Children 

who required tracheotomy had longer lengths of stay. 

P 295 

ENDOSCOPIC REPAIR OF LONG-SEGMENT TRACHEAL 

STENOSES 

J. Szydlowski 1 , B. Pucher 2 , A. Pogorzelski 3 , J. Kolasinska-Lipinska 2 , 

M.W. Grzegorowski 2 

1 Karol Marcinkowski Medical University, Pediatric ENT Dept., 

POZNAN, Poland 

E-MAIL: szydlowski@ump.edu.pl 

2 Poznan University of Medical Sciences, POZNAN, Poland 

3 Instytut Gruzlicy i Chorób Pluc, RABKA, Poland 

Long-segment severe tracheal stenosis in children is extremely difficult 

because of the general condition of the child and the diameter of airways. 

The optimal type of repair is not clearly defined. Surgical approaches suggested 

for this life-threatening lesion have included resection of localized 

stenoses, tracheoplasty involving interposition of cartilage rib graft, periostium 

or pericardium via an anterior tracheal split or esophageal anastomosis 

to a posterior tracheal split.

This report summarizes our experience with endoscopic balloon dilatation 

tracheoplasty done with spontaneous ventilation. 

Two patients with critical airway obstruction underwent repair of longsegment 

tracheal stenosis between September 2010 and November 2011. 

Patients had stenosis of 50 to 70% of the tracheal length. 

Endoscopic procedure was accomplished using balloon angio-catheters 

withi topical Mitomycin C applocation resulting in great increases in airway 

lumen. 

We conclude that balloon dilatation tracheoplasty with Mitomycin C application 

for selected cases of long-segment tracheal stenosis provides excellent 

Results in short and intermediate follow-up. 

P 296 

LAMBDOID STENOSIS OF THE PEDIATRIC AIRWAY: 

INCIDENCE, PREDISPOSING FACTORS, AND MANAGEMENT 

E. Berg, I. Jacobs, K. Zur 

Children’s Hospital of Philadelphia, Department of Pediatric 

Otolaryngology, PHILADELPHIA, USA 

E-MAIL: berge@email.chop.edu 

OBJECTIVES 

To review the experience of a pediatric center in management of lambdoid 

(A-Frame) stenosis and identify the incidence, pre-disposing risk factors 

and interventions required to treat this abnormality. 

METHODS 

An IRB- approved retrospective case review was performed. Charts were 

identified through a search of procedural codes including tracheotomy 

and a variety of operative airway interventions. Pediatric patients undergoing 

one or more of these procedures with subsequent operative airway 

evaluation were included. Patients with inadequate medical records were 

excluded. For subjects with lambdoid stenosis, previous procedures, subsequent 

procedures, and outcome were determined. In order to identify 

the incidence of lambdoid stenosis following tracheotomy, serial endoscopic 

findings were reviewed. 

RESULTS 

901 charts were reviewed and 260 subjects were eligible. Lambdoid stenosis 

was identified in 46 subjects following operative airway intervention. After 

tracheotomy alone, lambdoid stenosis was noted in 14% of patients. Gender, 

age at tracheotomy, and duration of tracheotomy at time of evaluation 

did not correlate with diagnosis. Ninety-Seven percent of non-ventilator 

dependent subjects (36 of 37) were decannulated, 64% (n=23) without further 

intervention. Thirteen required operative intervention including one 

tracheal resection, 3 balloon dilations, and 9 laryngotracheal reconstructions. 

These patients had a higher grade of stenosis (p

P 298 

CHARACTERISTICS OF 79 INFANTS AND CHILDREN 

SURGICALLY TREATED FOR A LARYNGEAL STENOSIS 

AFTER ENDOTRACHEAL INTUBATION 

M. Timmerman, L.J. Hoeve, K.F.M. Joosten 

Erasmus Medical Center, Otorhinolaryngology, ROTTERDAM, 


E-MAIL: marieketimmerman@hotmail.com 

OBJECTIVES 

To describe the characteristics of infants and children with an acquired laryngeal 

stenosis after prolonged intubation and to evaluate the risk factors. 

METHODS 

We retrospectively reviewed data concerning infants and children with an 

acquired laryngeal stenosis who were treated in our hospital with a laryngotracheal 

reconstruction or a cricotracheal resection during a period of 

15 years. 

RESULTS 

Seventy nine infants and children underwent surgical repair of their acquired 

laryngeal stenosis in Sophia Children’s Hospital. Thirty five patients 

were boys, 44 girls. The observed female overrepresentation in the 

studied population was most pronounced in the subgroups prematures 

and neonates, however the difference was not statistically significant 

(p=0.7). Almost half of the population (n=39) consisted of prematurely born 

infants. Their median birth weight was 950 g. The other patients acquired 

intubation injury as neonates (n=15), infants (n=15) or as children (n=10). 

Twelve patients appeared to have a congenital syndrome of which seven a 

Down syndrome. The median duration of intubation in prematures and 

neonates was significantly different compared to infants and children (25 

vs 12 days, p=0.02). There was no significant difference between the four 

age groups in the grade of stenosis. Girls seem to have more severe stenoses 

than boys, but this difference was statistically not significant (p=0.2). 

CONCLUSIONS 

Risk groups appeared to be girls, prematures and patients with Down syndrome. 

The possible association of risk factors with laryngeal stenosis requires 

further investigation to better understand the mechanisms of 

development of laryngeal stenosis and to improve prevention. 

242 

P 299 

LARYNGOTRACHEAL RECONSTRUCTION WITH CARTILAGE 

RIB GRAFT IN CHILDREN WITH PARALYTIC LARYNGEAL 

STENOSIS: REPORT OF TWO CASES 

P.V. Pavlov, A. Savchenko 

State Pediatric Medical Academy, ENT, SAINT-PETERSBURG, 

Russian Federation 

E-MAIL: pvpavlov@mail.ru 

Surgical treatment of chronic paralytic laryngeal stenosis in children, both 

congenital and acquired, remains relevant and unsolved problem of otolaryngology 

at the present time. Endoscopic laser surgery which is widely 

used in elder patients, and gives satisfactory Results, is not always effective 

in children. It can be explained by both the narrowness of the lumen of 

larynx and higher regenerative abilities in children. Thus, the search for 

the new Methods of surgical procedures and the modification of the 

known ones is going on, including usage of the external approach in treatment 

of this pathology. 

METHODS 


RESULTS 

We have made laryngotracheal reconstruction with cartilage rib grafts in 

two patients with congenital paralytic stenosis of the larynx. 

Case 1. A 5-year-old male child, tracheostomy-dependent, had contralateral 

endoscopic chordarytenoidotomy in anamnesis. Laryngotracheal reconstruction 

with posterior cartilage rib graft and stent placement was 

performed. Stent was removed after one month, the patient was decanulated 

successfully. 

Case 2. A 9-year-old female child, tracheostomy-dependent, had congenital 

laryngeal paralysis and postintubation subglottic stenosis. Laryngotracheal 

reconstruction with anterior and posterior cartilage rib graft and 

stent placement was performed. The duration of stenting was three 

months. After that the patient was decanulated successfully. 

CONCLUSIONS 

Consequently, the laryngotracheal reconstruction with cartilage rib graft 

and stent placement has allowed to decanulate two operated patients. 

This technique can become an effective method of surgical rehabilitation 

of tracheostomy-dependent children with paralytic laryngeal stenosis.

P 300 

ENDOLUMINAL STENTS IN THE MANAGEMENT 

OF PEDIATRIC TRACHEAL STENOSIS 

B.E. Mostafa 

Faculty of Medicine/Ain-Shams University, Otorhinolaryngology - 

Head and Neck Surgery, CAIRO, Egypt 

E-MAIL: bemostafa@gmail.com 

Review of our experience in the management of pediatric tracheal stenosis 

using endoscopic techniques and self-expanding intraluminal stents. 

METHODS 

Twenty children (aged 1 week to 14 years) with various causes of tracheal 

stenosis were treated. A total of 23 stents were used, 13 self-expanding nitinol 

stents and 10 silicone self-expanding stents. Follow-up ranged from 

6 month to 12 years. 

RESULTS 

There were no stent related mortalities. Serious complications occurred 

in 6 patients [30.7%] but all were managed successfully. The most frequent 

problem was granulation tissue formation. In the short-term (18”‘24 

months) 12 stents remained patent and functional. On the longer term (5 

years) 3 stents required removal, one required replacement and another 

resulted in stenosis. Conclusion: Endoluminal stenting can have an increasing 

role in the management of selected cases pediatric tracheal stenosis 

with acceptable morbidity and stable long term results. 

P 301 

TRACHEAL ATRESIA: DIAGNOSIS AND 

MANAGEMENT:ANALYSIS OF A SERIES OF 4 CASES 

G. Hosana, N.X. Bonne, P. Fayoux 



E-MAIL: greg_hosana@yahoo.fr 

OBJECTIVES 

The aim of this study is to discuss the diagnosis and the potential management 

of tracheal atresia on a case series and a review of literature. 

METHODS 

A retrospective medical chart review was performed, including a series of 

4 patients managed in a tertiary care center. Clinical, radiological and histological 

data were analyzed. 

RESULTS 

Prenatal diagnosis by ultrasonography and MRI was performed in all fetuses, 

showing multiple malformations. Tracheal atresia was diagnosed 

in 1 case at this stage due to lung distension and abortion was proposed. 

In the 3 other cases, pregnancy went on and birth occured. All presented a 

respiratory distress and tracheal intubation was impossible. In 1 case, the 

absence of efficient ventilation followed by a failure of tracheotomy lead 

to the child death. In the 2 other cases, the intraoesophageal ventilation 

allowed an efficient pulmonary ventilation. Endoscopy found in both cases 

a laryngeal cleft without distal trachea. CT scan confirmed the absence of 

tracheal lumen up to the carena. In the first case, clipping the tracheoesophageal 

fistula at the lower end was done. After reviewing the different 

treatments and considering the associated malformations as well as the 

bad long-term functional prognosis, therapeutic abstention was decided, 

which led to the children’s death after few days. 

CONCLUSION 

The prenatal diagnosis of tracheal atresia is not often identified because 

of a tracheoesophageal fistula, which allows ventilation though. In surviving 

infants surgical management remains very heavy and must be discussed 

according to the associated malformations and clinical status. 

P 302 

BRANCHIAL CYST CAUSING LARINGEAL DYSPNEA 

IN A NEWBORN 

A. Gómez Torres, I. Tirado Zamora, A. Abrante Jimenez, 

A. Mochón Martín, F. Esteban Ortega 

Virgen del Rocio University Hospital, Otolaryngology, CORDOBA, 

Spain 

E-MAIL: gotoa8 3 @hotmail.com 

OBJECTIVES 

The third branquial arch anomalies represent less than 1% of this deformities; 

its clinical manifestation can be varied and may appear at any time 

in life. 

METHODS 

A newborn, from an uneventfully pregnancy and delivery, was admitted 

to the Neonatal Intensive Care Unit a few hours later for laryngeal dyspnoea. 

A CT scan showed a cystic lesion of 17x14x11 mm, with no enhancement 

with contrast, next to the larynx, which is shifted to the right. 

Microlaryngoscopy and removal of the cyst was performed the day after. 

RESULTS 

On examination, a cystic lesion in the left pyriform sinus was noticed and 

a complete surgical removal was performed. The newborn had an uneventfully 

recovery and was discharged four days later. 

243

CONCLUSIONS 

Cysts and fistulas are the result of lack of regression of the branquial arch. 

Lesions from the second branchial arch are the most frequent, as its embryological 

persistence is higher. According to all authors, only complete 

surgical removal is curative in these situations. 

P 303 

NEONATAL LARYNGEAL AND TRACHEAL EMBRYOLOGICAL 

ANOMALIES AT A TERTIARY REFERRAL CENTRE: A 10 YEAR 

REVIEW 

T.S. Ahmed, J. Richards, H. Daya 




OBJECTIVES 

Laryngeal and tracheal embryological anomalies presenting in the neonatal 

period are potentially fatal. Affected infants frequently have multiple 

comorbidities. This study reviews the management, morbidity and clinical 

features of congenital laryngeal and tracheal abnormalities at a paediatric 

tertiary referral centre. 

METHODS 

A retrospective chart review of neonates presenting with embryological 

laryngeal and tracheal anomalies between 2001 and 2011 was conducted. 

Patients were identified using clinical coding databases and the neonatal 

death register. This information was correlated with histopathological 

and post-mortem findings. 

RESULTS 

Five infants presenting with perinatal respiratory distress were identified. 

Underlying pathologies included tracheal agenesis, laryngeal atresia, tracheal 

stenosis and a type IV laryngeal cleft. Affected infants had associated 

medical issues including cardiac and great vessel abnormalities, renal, skeletal 

and oesophageal anomalies. In one case airway issues were anticipated 

antenatally from a cystic neck mass on maternal ultrasonography and an 

ex-utero intrapartum treatment (EXIT) procedure was performed. This 

neonate had an additional anomaly of tracheal agenesis. Antenatal polyhydramnios 

was present in all cases. Intubation was attempted for all infants. 

Two cases required emergency neck exploration and tracheostomy. All cases 

were fatal with survivals ranging between several hours and 10 days. 

CONCLUSIONS 

Congenital laryngeal and tracheal abnormalities are rare and associated 

complex comorbidities often dictate poor prognosis. The lack of anticipation 

of such significant anomalies and dismal outcome is devastating for 

families. The option of oesophageal intubation provides an opportunity 

to assess for other comorbidities and allows families time to come to terms 

with the non-viability of their newborn. 

244 

P 304 

JUVENILE ANGIOFIBROMA: REPORT OF A CASE 

M.J. Greco Machado 1 , V. Caicedo 2 , E. Hornung 3 , P. Smith 2 

1 Hospital Simon Bolivar, Emergency, MATURIN, Venezuela 

E-MAIL: marijo_greco@hotmail.com 

2 Hospital Universitario De Los Andes, MERIDA, Venezuela 

3 Hospital Dario Marquez, MATURIN, Venezuela 

INTRODUCTION 

Juvenile angiofibroma is a rare benign lesion, it is a benign vascular neoplasm 

which affects young males between 9 and 19 years of age and accounts 

for 0.05% of all head and neck tumors. In USA represents a frequent 

head and neck tumor of adolescence. In the Middle East, India and Mexico, 

the incidence seems to be much higher than in Europe. 

OBJECTIVE 

Report a descriptive case of juvenile angiofibroma in Venezuela and review 

of the literature. 

Clinic case. A ten years-old male patient who consults by a unilateral 

right epistaxis in moderate amount and sudden installation, concomitantly, 

fetid yellowish secretion out through the right nostril. The physical 

examination revealed evidence of a hypervascularized lesion like a ‘peeled 

grape’ occupying the entire Cottle area II. The patient was taken to surgery 

for dissection on the right side of the neck with reference to an external 

carotid, transpalatal approach and Caldwell Luc antrostomy that reported 

as findings a tumor with endonadal cystic appearance of 10 cm of length 

with implantation in the right maxillary antrum. 

RESULTS 

The histopathological reports juvenile angiofibroma. 

CONCLUSIONS 

Juvenile angiofibroma is a pathology that should be included in the differential 

diagnosis of unilateral nasal obstruction, associated or not with 

epistaxis, especially in young adolescent males. The finding at nasal endoscopy, 

which is the first step in the diagnostic algorithm, of a hypervascularized 

lesion occupying the posterior half of the nasal fossa should 

immediately raise suspicion.

P 305 

TYPE IV LARYNGOTRACHEOESOPHAGEAL CLEFT: 

REPORT OF A SUCCESSFUL CASE MANAGED BY A 

MULTIDISCIPLINARY TEAM 

T. Órfão 1 , J. Spratley 1 , S. Pissarra 1 , A. Azevedo 1 , J. Matute 2 , M. Santos 1 

1 Hospital São João, Otorhinolaryngology, PORTO, Portugal 

E-MAIL: tiagoorfao@gmail.com 

2 Hospital Virgen del Rocio, SEVILLE, Spain 

BACKGROUND/OBJECTIVE 

Laryngotracheoesophageal cleft (LTEC) is a rare congenital disorder that 

Results from failed posterior fusion of the cricoid cartilage and incomplete 

development of the tracheoesophageal septum. Potential complications 

are serious and surgical treatment is essential. Despite appropriate management 

overall mortality reaches 50%. 


The current report depicts a case of a 12 days-old newborn referred to our 

hospital NICU with acute respiratory distress. Emergent rigid laryngotracheoscopy 

was performed and a type IV LTEC, extending to the carina, was 

diagnosed. 

RESULTS 

Immediate endoscopic-assisted intubation of the right bronchus allowed 

to secure ventilation and respiratory stability. The left lung was temporarily 

excluded until surgery. Surgical repair with tracheoesophageal separation 

was performed via a medial sternotomy and extracorporeal circulation 

support. Few days after initial repair a tracheotomy and gastrostomy with 

fundoplication were needed due to extubation difficulties and feeding 

problems. At three months, a small bleeding granuloma near the carina 

was coagulated with YAG laser. Eleven months later, a persistent type III 

cleft was successfully operated via an external cervical approach. Definitive 

decannulation from tracheostomy was performed uneventfully at 13 

months of life. Currently, at 18 months-old, the infant shows a normal 

development, no respiratory complaints and a regular oral feeding without 

aspiration. 

CONCLUSIONS 

Type IV LTEC is the most severe form of laryngeal cleft and warrants early 

diagnosis and repair. An integrated multidisciplinary collaboration is essential 

to attain a successful outcome. Recent surgical advances and meticulous 

post-operative care give rise to better quality of life and long-term 

survival. 

P 306 

COMPLICATIONS OF UNDIAGNOZED FOREIGN BODY 

ASPIRATION IN CHILDREN 

N. Mircetic, I. Baljosevic, V.S. Subarevic, P. Minic, M. Mircetic 

Institute for Mother and Child Health Care, ENT department, 

BELGRADE, Serbia 

E-MAIL: mirceticn@ikomline.net 

INTRODUCTION 

Foreign body aspiration is a major cause of accidental death in children 

age 0 - 4. Undiagnosed and retained foreign bodies may result in serious 

complications including asphyxia, pneumonia, atelectasis, hyperinflation 

and other. 


We have retrospectively reviewed the clinical records for 92 patients between 

January 1st 2007 and Decembar 31st 2011. Diagnosis had been made 

based on anamnesis of sudden choking, coughing with or without 

cyanosis, radiological examination, auscultatory findings, flexible and 

rigid bronhoscopy.. 

RESULTS 

There had been 53 (57.6%) boys and 39 (42.4%) girls. Incidence is highest in 

children age 0 - 4; 63 (68.5%).The youngest child was 8 months old (chicken 

bone in larynx), the oldest was 13,5 (plastic toy part in trachea). The most 

common localisation of foreign body had been in right main bronchus 52 

(56.5%). Of the 92 patients, 37 (40.2 %) had aspirated peanuts. Physical findings: 

decreased breath sounds and wheezing had been present in 35 (38 ,0 

%) patients. Radiopaque foreign body had been in 8 (8,7 %) patients. Most 

common radiological findings had been mediastinal shift + hyperinflation 

in 25 (27.2 %), and pneumonia in 14 (15,2 %) patients. Hyperinflation was 

leading complication with 21 (22,8 %), and after that pneumonia with 15,2%, 

and supurative bronchitis + atelectasis with 11 (11,9 %). In the first 24h 36 

(39,1 %) patients had been diagnosed, and 13 (14,2%) were diagnosed after 

30 days. 

CONCLUSIONS 

The best form of avoiding a serious accident of a child inhaling a foreign 

body is prevention. 

245

P 307 

DOES OLFACTORY STIMULATION PROMOTE ORAL FEEDING 

IN IMMATURE NEWBORN? 

M.S. van Cao 1 , A.L. Mansbach 2 , E. Damis 3 , B.N. Landis 1 , T. Hummel 4 

1 University Hospitals of Geneva, ENT, GENEVE, Switzerland 

246 

E-MAIL: caovanln@yahoo.fr 

2 University Children’s Hospital Reine Fabiola, BRUSSELS, Belgium 

3 CHU Brugmann, BRUSSELS, Belgium 

4 University of Dresden Medical School, DRESDEN, Germany 

INTRODUCTION AND AIM 

A newborn requiring tube feeding is deprived of optimal conditions for 

the acquisition of oral feeding and effective swallowing. Numerous studies 

have shown that sensory-motor-oral stimulation and non-nutritive sucking 

are significant tools to enhance oral feeding performances. These 

Methods are currently used. Moreover, it has also been reported that children 

born at term or prematurely, have a powerful sense of smell. The purpose 

of this study is to determine if olfactory stimulation promotes oral 

feeding in immature newborn. 


In this prospective randomized study, newborns admitted to the neonatal 

non-intensive care unit of CHU Brugmann and requiring tube feeding 

(partial or exclusive), are included. 50 infants are randomized into an experimental 

and a control group. The olfactory stimulation consists in 

shaking a scented pen (anise or cinnamon) under the nose of the child during 

10 seconds before each meal. The same procedure is applied to the control 

group but with a pen without odor. 

RESULTS 

The primary outcome, the length of hospital stay, is significantly different 

between our experimental group and our control group (p

RESULTS 

A total of 45 patients underwent division of tongue-tie over the study period. 

The mean patient age was 30 months (range 3-192). The majority of 

patients were referred by a GP (71%), with delayed speech or articulation 

problems (27%), and parental concern (25%) the most common reasons for 

referral. Overt difficulty with feeding was responsible for referral in just 

4 cases. All cases were performed under general anaesthetic as day-case 

procedures; 6 patients had a second procedure performed at the same time. 

No complications, either early or late, were recorded across this cohort. 

CONCLUSIONS 

Tongue-tie division is a safe procedure with minimal associated morbidity. 

Whilst the primary indication cited in the literature is that of feeding difficulty, 

it appears that the majority of division is performed for other reasons. 

P 310 

IN TONSILLECTOMY: BE PATIENT AND GIVE EXTRA FEW 

MINUTES FOR COMPRESSION TO SAVE DIATHERMY. 

A PROSPECTIVE RANDOMIZED STUDY 

A. Behery 

Tanta University, ORL & HNS, TANTA, Egypt 

E-MAIL: behery_ent@hotmail.com 

OBJECTIVE 

Twofolds: 1) To assess the value of giving more time for compression of 

the tonsillar fossae during cold dissection tonsillectomy in minimizing 

the use of diathermy for haemostasis, 2) To validate the efficiency of not 

using diathermy in reducing postoperative (PO) morbidity. 


A total of 216 children, aged 1-8 years were included in our study. Cold dissection 

tonsillectomy was performed for all participants. Compression of 

the tonsillar fosae was maintained for 5 minutes after excision. Patients 

with haemostasis failure were offered an extension of compression for another 

5 minutes. At the end of the extension, haemostasis failure was 

treated by bipolar diathermy. On discharge, patients were offered a follow-up 

visit on 10th PO day. 

RESULTS 

After 5 minutes of compression, 122 patients had successful haemostasis 

(56%). On offering an extension of extra 5 minutes significant haemostasis 

was achieved in 156 cases (71%). During the follow-up period (10 days) patients 

and parents expressed significant increase in pain scores in 

diathermy group (p

P 312 

LOW PREDICTABILITY OF LARYNGEAL FINDINGS 

IN PEDIATRIC GERD 

A. Degrassi, S. Martellossi, D.L. Grasso, G. Pelos, G. di Leo, I. l’Erario, 

E. Orzan 

IRCCS Burlo Garofolo, Audiology and otorinolaryngology, TRIESTE, Italy 

E-MAIL: annadegrassi@burlo.trieste.it 

The purpose of this study was to explore the pathognomonic value of fibrolaringoscopy 

in case of gastroesophageal reflux disease in children.As 

part of the routine activities of the Department of Digestive Endoscopy 

dell’IRCSS Burlo Garofolo we randomly evalueted with fibrolaringoscopy 

20% of children (47 out of 225) visited in a period of 6 months between 2010 

and 2011. The ENT specialist was not aware of the gastroenterological sintoms 

or pathology. A lot of authors observed that the most significant 

findings are laryngeal edema and erythema of the vocal cords, of the anterior 

commisure and of the interaritenoideal space. 

The endoscopic laryngeal abnormalities were categorized according to an 

index of 0-4, 0 meaning as the absence of edema / erythema, and 4 as the 

highest degree. 11 of 47 patients presented abnormalities of varying severity 

(1-4) with 76% of children without signs of pharyngolaryngeal alteration. 

The comparing of findings with endoscopy gastroenterological diagnosis, 

has not shown significant correlation between the presence of endoscopic 

laryngeal abnormalities and the presence of gastroesophageal reflux. 

In conclusion the endoscopic alterations of the larynx have a low sensitivity 

and specificity in case of GERD and should not itself guide the choice 

of drug treatment for gastroesophageal reflux in children. 

P 313 

MANAGEMENT OF REACTIONARY HAEMORRHAGE AFTER 

ADENOIDECTOMY USING EPISTAXIS CATHETER 

A. Behery 

Tanta University, ENT, TANTA, Egypt 

E-MAIL: behery_ent@hotmail.com 

BACKGROUND 

Post-nasal packs are the preferred haemostatic solution for control of postadenoidectomy 

haemorrhage. 

OBJECTIVE 

To present our results of controlling post-adenoidectomy reactionary 

haemorrhage through using epistaxis catheter. 


The study has been conducted at Tanta University Hospitals during the 

period between 2005-2010 on 34 children presenting with reactionary 

248 

haemorrhage following adenoidectomy. Their ages ranged between 3-10 

years.curettage adenoidectomy after digital palpation was the method undertaken 

by surgeons.After failure of medical measures to control bleeding 

and after assurance of the child, an epistaxis catheter was introduced 

nasally without general anaethesia till its posterior cuff reached the nasopharynx. 

A suitable degree of inflation is made to keep the field dry.After 

an uneventful 4 hours, the catheter was removed nasally and the child was 

discharged next morning. 

RESULTS 

Among the 34 cases treated with this technique, only 2 cases failed where 

bleeding continued. For them standard post-nasal packing was done 

under general anaethesia.All children tolerated the catheter without sedation. 

No case bled after removal. 

CONCLUSION 

Epistaxis catheters proved to be successful in controlling post-adenoidectomy 

haemorrhage with no need to prolonged discomfort or general 

anaethesia. We hope others will find it effective in similar situations. 

P 314 

QUESTIONING THE LEGITIMACY OF RIGID BRONCHOSCOPY 

AS A TOOL FOR ESTABLISHING THE DIAGNOSIS OF A 

BRONCHIAL FOREIGN BODY 

M. Bergeron 1 , O. Cavel 2 , L. Garel 2 , P. Arcand 2 , P. Froehlich 2 

1 Laval University, Department of Otolaryngology - Head & Neck 

Surgery, QUEBEC, Canada 

E-MAIL: mathieu.bergeron.10@ulaval.ca 

2 Sainte-Justine University Hospital Center, MONTREAL, Canada 

OBJECTIVES 

Our aim is to review our experience in the routine use of rigid bronchoscopy 

(RB) for a suspected foreign body (FB) aspiration, and evaluate 

the adequacy of our current attitude in light of alternatives means of diagnosis, 

such as CT scan, fluoroscopy and flexible bronchoscopy. 

METHODS 

We performed a retrospective review of cases where bronchoscopy was used 

in the management of a suspected airway FB. We also reviewed the literature 

concerning the use of RB and alternative means of diagnosis. 

RESULTS 

Thirty-two patients underwent bronchoscopy to rule out a FB aspiration 

under general anesthesia. No FB was found in 8 cases (25%). Cough and 

history of choking were the most sensitive parameters (sensitivity 100% 

and 80% respectively). Stridor was the most specific sign (88% specificity). 

Chest radiography had a 25% sensitivity, and a 62.5% specificity. Flexible 

bronchoscopy changed the management in 22% of cases, sparing RB.

CONCLUSIONS 

Performing RB solely on the clinical findings and chest radiography entails 

at least a 25% rate of negative exams. CT scan appears to be the most accurate 

non-invasive tool for ruling out the presence of a FB. Digital substraction 

fluoroscopy is a safe and simple mean to confirm the presence of air 

trapping generated by a bronchial obstruction, but is not sensitive enough 

to definitively rule out a FB. We propose a stepwise approach using fluoroscopy 

or possibly flexible bronchoscopy, in order to reduce the number 

of negative RBs while restricting the use of the CT scan. 

P 316 

STANDARDISING REPORTING IN PAEDIATRIC NECK 

ULTRASOUND: A 2-CYCLE AUDIT 

A. Fraser, K. O’Neill, R. Locke, M. Attiae, G. Irwin, H. Kubba, 

F.B. MacGregor 

Yorkhill Hospital, Department of ENT, GLASGOW, United Kingdom 

E-MAIL: LyndsayFraser@doctors.org.uk 

OBJECTIVES 

Ultrasound can be a useful imaging tool for the initial investigation of 

neck lumps in children but is known to be operator dependent. We aimed 

to compare the quality and content of reporting in paediatric neck ultrasound 

before and after the introduction of a reporting protocol. 

METHODS 

We performed a prospective 8 month audit assessing the content of paediatric 

neck ultrasound reports requested in our tertiary referral paediatric otolaryngology 

service. We assessed reports arising from 3 different clinical scenarios: 

non- acute cervical lymphadenopathy, midline neck lumps and acute 

cervical lymphadenitis with suspected abscess formation. We found wide 

variation in report content and inconsistent reporting of certain radiological 

features. In response to this we performed a literature search to identify key, 

clinically relevant ultrasonographic features in each of the clinical scenarios 

and then in consultation with our radiology colleagues, devised a protocol 

to facilitate the reporting of these key features. Quality and content of reports 

were then prospectively reaudited over a further 8 month period. 

RESULTS 

49 reports were assessed before and 58 after introduction of the reporting 

protocol. Fisher’s exact test was used to analyze the data. We found a statistically 

significant (p

P 318 

DOCUMENTATION OF THE JOURNEY OF CONGENITALLY 

DEAF CHILDREN TO HEAR LIFE 

U. Hellmuth-Zweyer 1 , R. Popescu 2 

1 MED-EL, CEO-Team, INNSBRUCK, Austria 

250 

E-MAIL: u.hellmuth@medel.com 

2 Lucian Blaga University, SIBIU, Romania 

OBJECTIVE 

Decision aspects for CI-implantation after diagnosis and efficient postoperative 

support for congenitally deaf children and their environment. 

METHOD 

The evolution of 11 implanted children has been documented via video 

recording . From a cohort of 100 implanted children, who are members in 

a CI-users association, 11 children (6 boys and 5 girls) were selected as random 

subjects. Their age at implantation varied from 12 month to 5 years. 

Each subjects evolution process of hearing based communication skills 

was documented over a 3 year time span by performing a video documentation 

every 4 month comprising: a) an interview of parents assessment 

regarding their child’s progress in listening, speech understanding and 

speech production and b) real life situations such as speech therapy with 

a professional, home rehabilitation and every day communication. 

RESULTS 

Parents involvement is of utmost importance and ensures that rehabilitation 

training comprising communication and acoustic stimulation 

starts directly after CI implantation, omissions within the first two years 

cannot be compensated later. Independent of the age at implantation significant 

speech production (e.g. first words) will not occur before one year 

after activation of the implant. In line with other studies early CI - implantation 

supports natural language acquisition of congenitally deaf children, 

facilitating rehabilitation and increasing chances to successfully 

attend mainstream education facilities. 

CONCLUSION 

This work encourages parents and family members to be active and take 

their role as natural co-therapists and supporters. 

P 319 

BELL’S PALSY IN CHILDREN: PROGNOSTIC VALUE OF 

ELECTRONEUROGRAPHY 

J.M. Meléndez García, M.I. Hamdan Zavarce, A.S. Araujo Da Costa, 

T. Rivera Schmitz, C. Dieguez Varela, E. Pallas Pallas, G. Espiña Campos 

Complejo Hospitalario Universitario de Vigo, Hospital Xeral, 

Otorhinolaryngology, VIGO, Spain 

E-MAIL: melendezmanny@hotmail.com 

OBJECTIVE 

Bell’s palsy is a self-limiting idiopathic facial palsy that is non-life-threatening 

and has a generally favorable prognosis in children. It is a relatively 

common pediatric problem affecting children from infancy to adolescence. 

The diagnosis is predominantly one of exclusion and based on clinical 

findings. Electroneurography (ENoG) and clinical staging are currently 

the Methods of choice to indicate prognosis. 

METHODS 

Retrospective clinical study combined with long-term follow-up. We analyzed 

cases of Bell’s palsy in children. The recovery of facial nerve function 

was documented by House and Brackmann grading. 

RESULTS 

We analyzed 165 cases of Bell’s palsy in children aged below 15 years old. The 

group consisted of 76 boys and 89 girls. In most patients, ENoG was performed 

10 to 14 days after the onset of facial palsy. The time to maximal recovery 

and rate of favorable recovery was assessed. Patients whose final status 

was less than the initial status were grouped as recovery group. Electroneurography 

values of the recovery and non-recovery groups were not similar. 

CONCLUSIONS 

Facial nerve palsy has a broad differential diagnosis and possible psychological 

and anatomical consequences. Resolution and time to recovery vary with etiology, 

but overall prognosis is good. The presence of an identifiable response 

in ENoG may indicate a favorable recovery of facial movement in children. 

P 320 

PATIENT ATTITUDES TO TONSILLECTOMY 

K.M. Ubayasiri, R. Kothari, L. Mcclelland, M. De 

Royal Derby Hospital, ENT, DERBY, United Kingdom 

E-MAIL: kishan.ubayasiri@gmail.com 

INTRODUCTION 

Recent changes to the primary care trust’s (PCT) Procedures of Limited 

Clinical Value (PLCV) Policy, mean that otolaryngologist must follow policy 

rather than exercising clinical judgment.

OBJECTIVES 

To gauge perception in the general public of when tonsillectomy is acceptable, 

and to compare this to the current policy. 

METHOD 

All patients or their parents attending the adult and paediatric outpatient 

ENT departments were asked to anonymously complete questionnaires. 

RESULTS 

125 completed questionnaires were returned: 49 adult and 76 paediatric. 

44% of respondents were male and 66% female. The mean age of patients 

was 24 years (age range: 14 weeks to 83 years). 31% of respondents thought 

that tonsillectomy should be offered on patient request without previous 

tonsillitis, 19% after 1 to 3 bouts and 35% after 4 to 6 bouts of tonsillitis. 

Only 9% thought that the current guideline of 7 or more episodes was reasonable. 

Patients who had suffered recurrent tonsillitis or had undergone 

previous tonsillectomy generally thought that tonsillectomy was advisable 

after more bouts of tonsillitis (4-6 bouts) than those who had not. 14 patients 

fulfilled the SIGN guidelines for tonsillectomy after recurrent tonsillitis. 

Of these, 13 (93%) felt that suffering 4-6 bouts of tonsillitis was 

reasonable before undergoing tonsillectomy, whilst the remaining respondent 

thought 1 to 3 bouts. 

CONCLUSION 

All patients we surveyed who meet the current PLCV and SIGN guidelines 

regarding the appropriateness of tonsillectomy for recurrent tonsillitis 

perceive that they are excessive, believing that 4-6 bouts of recurrent tonsillitis 

are adequate to justify tonsillectomy. 

P 321 

PRIMARY CILLIARY DYSKINESIA IN PEDIATRIC 

OTORHINOLARYNGOLOGY: OUR EXPERIENCE 

J. Szydlowski 1 , B. Pucher 2 , J. Kolasinska-Lipinska 2 , M. Prauzinska 2 , 

M.W. Grzegorowski 2 

1 Karol Marcinkowski Medical University, Pediatric ENT Dept., 


E-MAIL: szydlowski@ump.edu.pl 

2 Poznan University of Medical Sciences, POZNAN, Poland 

Primary ciliary dyskinesia (PCD) is a rare inherited disease with a prevalence 

of about 1:20,000. The purpose of this paper is to review the clinical 

features, diagnosis and management of PCD in patients of Pediatric ENT 

Dept. in Poznan. 

In this paper we describe the clinical profile of 10 PCD patients (6 boys and 

4 girls) with typical otological manifestations and symptoms of CRS. 

In our group 7 patients had recurring problems at the paranasal sinuses 

and 6 of them needed corresponding surgical intervention. 9 patients suffered 

from recurring otitis media and, as a result, 7 of these patients underwent 

paracentesis with temporary tympanostomy tubes. 

Otorhinolaryngological manifestation, especially otitis media with effusion 

and chronic rhinosinusitis, are frequently associated with primary 

ciliary dyskinesia. Surgical intervention to treat these symptoms is common 

but in some otological cases seems to be controversial. 

P 322 

TREATMENT AND OUTCOMES OF RHINOSINUSITIS 

IN CHILDREN WITH PRIMARY CILIARY DYSKINESIA: 

WHERE IS THE EVIDENCE? 

E. Boss, S.L. Ishman, J. Benke 

Johns Hopkins University, Otolaryngology, BALTIMORE, USA 

E-MAIL: erudnic 2 @jhmi.edu 

OBJECTIVES 

There is little consensus about the treatment of chronic rhinosinusitis 

(CRS) in children with primary ciliary dyskinesia (PCD). We sought to synthesize 

the best available evidence pertaining to the treatment and outcomes 

of CRS in children with PCD. 

METHODS 

Systematic review of PubMed and Embase for studies related to treatment 

and outcomes of CRS in children with PCD from 1991 to 2011. Two reviewers 

independently extracted information on study design, setting, medical/surgical 

therapy for CRS, and treatment outcomes. 

RESULTS 

Eleven studies from 8 countries were included: 4 retrospective/1 prospective 

cohort, 1 cross-sectional, 1 case series, and 4 case reports. N of patients 

ranged from 1-78. Medical treatment included oral antibiotics, intranasal 

and oral steroids. Surgical treatment was mentioned in 8 studies, with endoscopic 

sinus surgery described in 3/8. Follow-up was reported in 4/11 

studies and ranged from 2-36 months. Outcome measures were rarely defined 

but included responses to the SNOT-20 (1/11) or a general symptom 

questionnaire (1/11), decreased mucocele/recurrent pneumonia (2/11), and 

subjective improvement in CRS symptoms(3/11). No randomized, controlled, 

or long-term prospective cohort studies were identified, and no 

study employed a disease-specific, pediatric-validated instrument to measure 

outcomes. 

CONCLUSIONS 

There is a paucity of evidence regarding CRS treatment or outcomes in 

children with PCD. Given the rare prevalence of PCD and the insufficient 

evidence concerning treatment effectiveness for CRS, we propose an international, 

multicenter database for prospective data collection. This database 

should include diagnosis, treatment, and outcomes of CRS for 

children with PCD and would encourage implementation of validated and 

standardized outcome measures. 

251

P 323 

SOME REMARKS OF SCANNING AND TRANSMISSIONAL 

ELECTROMICROSCOPIC INVESTIGATIONS OF CHRONIC 

INFLAMMATED MUSCOSA AND POLYPS OF NOSE AND 

PARANASAL CAVITIES 

M. Zivic 1 , M. Bojanovic 2 , J. Pavlovic 3 , E. Zivkovic-Marinkov 2 , 

D. Milisavljevic 2 , A. Bojanovic 4 

1 Clinical Center Nis, Medical Faculty of Nis, Nis, Serbia 

E-MAIL: milabojanovic@yahoo.com 

2 ENT Clinic, NIS, Serbia 

3 Medical Faculty, NIS, Serbia 

4 Radiology Institute, NIS, Serbia 

OBJECTIVE 

The electro microscopic scanning of the changes on the surface and morphological 

structures of the chronic inflammated of mucosa and polyps 

of paranasal cavities was performed. 

METHODS 

With the help of the transmissional electromicroscopia there were also 

observed some changes of the lamina epithealis of mucosa of paranasal 

cavities and polyps. 

RESULTS 

As the result, some electro microscopic changes of the ciliar apparatus of 

chronic inflammated mucosa and polyps of paranasal cavities were noticed 

and, as well as the changes of the quality of outer morphology of the epithealis 

were verified with the help of the scanning electromicroscopia. 

The clinical research included the 20 patient samples. All the formerly noticed 

characteristics can be defined as the phenomenon known ‘SYN- 

DROM OF THE IMMOTILIA CILIA’ mostly characterized for the recurrent 

infections of the respiratory tract. 

CONCLUSIONS 

So, the conclusion was the presence of the denudation and reduction of 

the cell rows and the goblet cell metaplasia, which reduce the barrier function 

of mucosa. 

252 

P 324 

SURVEY OF RESPIRATORY ALLERGIC DISEASES IN 6-12-YEAR 

OLD SCHOOLCHILDREN IN BUDAPEST 

M. Sultesz 1 , K. Katona 1 , A. Hirschberg 2 , G. Gálffy 3 

1 Heim Pál Hospital for Sick Children, Department of 

Oto-Rhino-Laryngology, BUDAPEST, Hungary 

E-MAIL: sultmon@gmail.com 

2 Saint John’s Hospital Budapest, BUDAPEST, Hungary 

3 Semmelweis University Budapest, BUDAPEST, Hungary 

OBJECTIVES 

To examine 155 children suffering from allergic rhinitis (AR), who were 

picked following a survey carried out among 6-12-year-old schoolchildren 

living in Budapest. To filter children having asthma with the help of a 

new questionnaire and to examine the potential risk factors of allergic 

rhinitis. 

METHODS 

In our 2007 survey with the help of a validated questionnaire from 3993 

children we detected 530 (14,9%) cases of potential AR. 155 pupils turned 

up for a second examination, which consisted of questionnaire based on 

ISAAC, relating to AR and asthma, completed with questions of our own, 

otorhinolaryngological examination and Prick-test. The data obtained 

were processed by SPSS 15 statistical program. 

RESULTS 

None of the 87 boys (56%) and the 68 girls (44%) has taken part in an allergological 

examination prior to ours. Of the 155 pupils that we examined 

we found that 25 (16%) were not allergic, 24 (15%) were diagnosed with AR 

based on the history, the symptoms and clinical picture, but the Prick-test 

did not justify it. 106 (68%) children proved to have AR. Asthma bronchiale 

was justified in 19 cases, of which 12 (63,16%) had already been known, but 

7 (36,84%) were newly discovered and justified with lung function. Significant 

risk factors in developing AR symptoms are male gender (p

P 325 

ENT PATHOLOGY IN CHILDREN AFFECTED 

BY CYSTIC FIBROSIS 

Y. Escamilla Carpintero, R.R. Rosell Ferrer, R. Aguila Artal, 

R. Cardesin Revilla, M. Bosque Garcia, J. Costa Colmer, J.M. Saiz Arnaiz, 

S. Cardelus Vidal, J.J. Diaz Arguello, A. Martinez Arias, 

R. Bargues Cardelus, L. Samara Piñol 

Hospital de Sabadell, Otorhinolaryngology, SABADELL, Spain 

E-MAIL: yescamilla@telefonica.net 

OBJECTIVES 

Review ENT pathology presented by children suffering from cystic fibrosis 

who have been referred to our service. 

METHODS 

Retrospective review of symptoms, examination, radiology and treatments 

performed for a period of 3 years. A complete examination with sinonasal 

endoscopy has been done when it has been possible, and sinus CT if necessary 

depending on clinical and exploratory findings. Patients have been 

treated medically or surgically, according to the pathology presented. 

RESULTS 

We have attended 24 children affected by cystic fibrosis and ENT symptoms. 

The most common ones are sinonasal (80%) and within these rhinorrhea 

and nasal obstruction presented in 54% of cases. Endoscopic 

abnormalities were found in 63% and radiological (CT) in 80%. Poliposis or 

sinusitis were diagnosed in 46% of the cases and mucoceles or pseudomucoceles 

in 30%. One third of the patients had previous otologic symptoms, 

most of them repeated ear infections, and one fifth of the children had 

pharyngolaryngeal symptoms. 41% of the cases have undergone surgery 

and 38% of them were endoscopic nasosinusal surgery. 55% of the endoscopic 

surgeries have recurrent poliposis at 6 months, but only one case is 

symptomatic and waiting for new surgery.. 

CONCLUSIONS 

ENT disease is a common finding in children affected by cystic fibrosis, 

mainly sinonasal pathology, with frequent occurrence of mucoceles or 

pseudomucoceles. Children undergoing surgery have improved symptoms, 

but recurrence of poliposis has been the norm. 

P 326 

OBSTRUCTIVE SLEEP APNEA SYNDROME IN PEDIATRIC 

PATIENTS. A 6-YEAR EXPERIENCE 

E.N. Fountoulakis, I. Panagiotaki, I. Papadakis, E. Koudounarakis, 

G.A. Velegrakis 

University Hospital of Heraklion, Otorhinolaryngology-Head and 

Neck Surgery, HERAKLION, Greece 

E-MAIL: emm.n.fountoulakis@gmail.com 

OBJECTIVES 

In the last years, the Obstructive Sleep Apnea Syndrome (OSAS) is the main 

indication for tonsillectomy alone or in combination with adenotomy in 

children. The efficacy of the surgical treatment is evaluated for this group 

of patients. 

METHODS 

In the present study we present the experience of the Dept. of Otorhinolaryngology 

of the University Hospital of Heraklion in Crete, Greece regarding 

the treatment of OSAS in pediatric patients in the last 6 years. In 

our series, 290 patients with an average age of 6,34 years were evaluated 

and treated. 

RESULTS 

The OSAS may be related to snoring, somnolence, disturbances of school 

performance, enuresis and cardiovascular disorders. Although the diagnostic 

criteria are well established for the adult population, this statement 

is not valid for the pediatric patients. In our series, all of our patients had 

benefit from tonsillectomy +/- adenotomy. 

CONCLUSIONS 

The complete and thorough clinical approach of the patient is priceless. 

Tonsillectomy combined with adenotomy, is effective in treating these patients 

although the ideal technique of tonsillectomy is still controversial. 

P 327 

NASAL BLEEDING IN THE PAEDIATRICS EMERGENCY UNIT: 

OUR GUIDELINES IN MANAGEMENT OF EPISTAXIS 

L. Samara 1 , A. Cardesin 2 , N. Roca 2 , R. Rosell 2 , J. Diaz 2 , J.M. Saiz 2 , 

A. Martinez 2 , R. Bargués 2 , Y. Escamilla 2 , A. Aguilar 2 

1 Hospital Sabadell, ENT, SABADELL, Spain 

E-MAIL: birka__s@hotmail.com 

2 Hospital de Sabadell, Sabadell, Spain 

Epistaxis is a common occurrence in the paediatric population. Its mean 

age incidence is around 2 to 11 years old, and it can be influenced by temperature 

and pressure changes. 

253

Our hospital attends a population of 400,000 inhabitants. A guideline on 

the management of epistaxis in children has been established between 

the ENT and the Pediatrics departments, due to the hospital does not have 

an ENT on duty 24 hour a day and pediatricians are the ones who first see 

the children in the Paediatrics Emergency Unit. 

We present a clinical guide, agreed and accepted by the 2 departments, on 

how to proceed in front of an epistaxis in children in the Emergency Unit, 

differentiating the location, quantity, and severity. 

Given that there are hospitals with similar characteristics to ours and that 

have to deal with situations like ours, we believe that this protocol can be 

useful for all of them. 

P 328 

ORBITAL ABSCESS DUE TO SINUSITIS IN A PEDIATRIC 

PATIENT: A CASE REPORT 

M.S. Yilmaz, M. Guven, S. Cesur 

Ministry of Health Sakarya Training and Research Hospital, 

Otorhinolaryngology, SAKARYA, Turkey 

E-MAIL: yilmazms@gmail.com 

Despite the availability of potent new antimicrobial agents for the treatment 

of bacterial infections, serious complications of sinusitis still occurs. 

Since it is located near to ethmoid sinuses, orbital spaces are the most common 

site where the sinusitis complications occur. Orbital complications 

due to sinusitis include preseptal cellulitis, orbital cellulitis, subperiosteal 

abscess, orbital abscess and cavernous sinus thrombosis. Classic signs of 

orbital abscess are proptosis, limitation of eye movement, chemosis, visiual 

impairment and even loss of vision. Treatment of orbital abscess due to 

sinusitis is endoscopic sinus surgery and broad-spectrum antibiotic therapy. 

In this report we aimed to present an orbital abscess due to acute sinusitis 

which is seen a 13 years old boy, and to discuss complications of 

sinusitis. 

P 329 

RECCURENT EPISTAXIS IN CHILDREN 

F. Manole 

Faculty of Medicine Oradea, ENT, ORADEA, Romania 

E-MAIL: felimanole@yahoo.com 

AIM 

Nose bleeding occur in children in different situatiation. The purpose of 

this study is to identify the most predominant cause of nasal bleeding and 

the most effectivness treatment. 

254 


We include in aour study 62 patients presenting to a single pediatric otolaryngologist 

with complaints of unilateral and bilateral epistaxis. We perform 

a general ENT examination and take into consideration the 

associated disease. We perform silver nitrat cautery folowed by topical 

treatment vit short term of A vitamin for one week after. We follow-up 2 

months later to assess control of epistaxis and complication of this therapy. 

RESULTS 

From total number of case 92% of patients have normal coagulation test 

and 8 % present with trombocitopenia because of hematological chronic 

disease. The epistaxis was unilateral in 98% of case from vasculary stain 

Kiesselbach. About 93% had total or near-total resolution of their epistaxis. 

Two percent of patients returned to the clinic after initial successful control 

for a second cauterization during the period of study. No significant 

complications of infection, perforation, long-term crusting, mucocutaneous 

or allergic reactions were identified. One case of severe leukemia 

was treated by anterior paking of unilateral nasal fose menteined in place 

for 48 hours. 

CONCLUSIONS 

Epistaxis in children can be treated at a single visit with l silver nitrate 

therapy. This treatment is highly effective, well-tolerated, and appears to 

have a low rate of complications if the associated disease is well treated. 

P 330 

INVASIVE FUNGAL RHINOSINUSITIS IN CHILDREN 

E. Carmel, A. Yakirevitch, L. Bedrin, Y. Talmi, M. Wolf 

Sheba Medical Center, Otorhinolaryngology, RAMAT-GAN, Israel 

E-MAIL: eldarcarmel@gmail.com 

OBJECTIVES 

To present children with invasive fungal rhinosinusitis (IFRS) and characterize 

and assess their endoscopic surgical management and outcome. 

METHODS 

Retrospective review of children treated for IFRS in the Sheba Medical Center 

between January 2001 and December 2011. Medical and surgical records 

of these patients were reviewed for age, gender, underlying diseases and 

immunological status, clinical and radiological findings, medical and surgical 

treatment and outcome. 

RESULTS 

Ten children were included. Diagnosis was established within 1 to 5 days 

of referral. The patients had 1 to 3 surgical interventions. They had also 

received long term treatment with amphotericin, voriconazole or both. 

Four out of ten children survived the disease but only one child died directly 

of IFRS sequela.

CONCLUSIONS 

Early diagnosis of invasive fungal rhinosinusitis is invaluable and may 

decrease the mortality rate. In our series, endoscopic surgery was found to 

be sufficient in most cases. 

P 331 

CONGENITAL DACRYOCYSTOCELE: 

SURGICAL TREATMENT OR ROUTINE FOLLOW-UP? 

A. Hitter, B. Morand, I. Atallah, S. Schmerber, C.A. Righini 

University hospital of Grenoble, ORL, GRENOBLE CEDEX , France, 

E-MAIL: ahitter@chu-grenoble.fr 

OBJECTIVES 

The aim of our study is to discuss the role of surgical treatment in the 

management of congenital dacryocystocele. 

METHODS 

Retrospective review (2009-2011) in a tertiary care center. The data of fourteen 

congenital dacryocystoceles have been analyzed. A review of literature 

had been done with medline database. 

RESULTS 

Ten children, including four cases with bilateral congenital dacryocystocele, 

were managed. The average age was 14, 6 days. Five patients had an 

episode of acute dacryocystitis. No respiratory complications were observed. 

Spontaneous drainage of the dacryocystocele was observed in 5 (35, 

7%) of cases on average 22 days of life. Transnasal endoscopic drainage was 

performed in 9 (64, 3%) of cases. No recurrence or complication was observed 

after surgery, the mean follow-up period of these patients was 11, 

3 months. After spontaneous evacuation, no recurrence was observed after 

a mean follow-up period of 9, 5 months. 

CONCLUSIONS 

Congenital dacryocystoceles are rare and often misunderstood pathologies. 

Their management is not well established and varies depending on medical 

teams. It ranges from follow-up to lacrimal catheterization and endoscopic 

surgical drainage. Spontaneous drainage is common. Given the 

incidence of infectious complications, local antibiotic treatment is necessary 

until spontaneous drainage of the dacryocystocele. In case of acute 

dacryocystitis and / or persistence of the dacryocystocele after 4 weeks of 

life, surgical drainage should be performed. CT scan or MRI should be ordered 

before any surgical treatment. Recurrence and complications are 

very rare after surgical treatment of dacryocystoceles. 

P 332 

INCIDENCE OF COMPLICATIONS OF NASAL DERMOIDS 

R. Locke, H. Kubba 

Royal Hospital for Sick Children, ENT, GLASGOW, United Kingdom 

E-MAIL: richard.locke7@ntlworld.com 

OBJECTIVE 

Congenital midline nasal dermoids may present as a cosmetic deformity 

such as midline swelling or sinus along the midline of the face from the 

philtrum of the upper lip to the nasion. They may communicate with the 

anterior skull base and can present with complications in the form of discharge, 

cellulitis, osteomyelitis or meningitis. The traditional teaching is 

that these should be excised at an early age to reduce the risk of potential 


METHOD 

We present a retrospective analysis of all nasal dermoids treated at the 

Royal Hospital for sick children, Glasgow, over a 5 year period from 2004 

till 2011 to examine age of presentation and relative risk of complication. 

RESULTS 

There were 31 cases included. They aged from 9 months to 15 years at the 

time of presentation. Most presented by 2 years of age. One case was treated 

conservatively. Sixteen presented with a swelling or punctum without complication. 

Fifteen presented with complications in the form of discharge or 

cellulitis. Five cases had intracranial extension and 1 case had a large intracranial 

dermoid cyst. Two cases presented over the age of 5 with cellulitis 

over the dorsum of the nose from an infected cyst with resultant skin loss. 

CONCLUSION 

We suggest that children presenting with a nasal dermoid sinus cyst 

should have this treated at an early age to reduce the risk of complication, 

especially skin loss as a result of an infected cyst with resultant long term 

cosmetic implications. 

P 333 

NEW PATHOPHYSIOLOGY IN A CASE OF ORBITAL CELLULITIS 

J.R. Levi 1 , R. Vincent 2 , P. Barth 1 




2 Jefferson Medical College, PHILADELPHIA, USA 

OBJECTIVE 

Review recent literature on orbital cellulitis and present an interesting 

case which represents a new pathophysiology in this disease process. We 

255

present the case of a 9-year-old girl with orbital cellulitis caused by contralateral 

frontal sinusitis. 

METHODS 

Literature review and case report. 

RESULTS 

In this case, our patient was diagnosed with post-septal right sided orbital 

cellulitis which worsened after 48 hours of IV antibiotics. A CT scan revealed 

only contralateral frontal sinusitis and subsequently a, left sided 

anterior ethmoidectomy and frontal sinusotomy were performed and revealed 

purulence. Following surgery she improved clinically, and was at 

her base line at Ophthalmology follow up 2 weeks later. 

CONCLUSIONS 

Extension of sinusitis into the orbit may result in orbital cellulitis, abscess 

formation or even vision loss. Most commonly ipsilateral ethmoiditis leads 

to infection of the orbit by direct extension. (84% of cases of orbital cellulitis 

are caused by ipsilateral ethmoiditis according to Younis et al.). Less commonly 

ipsilateral frontal sinusitis can lead to infection with several mechanisms 

proposed. This case and our review of the literature suggest that 

there are often signs, symptoms and CT findings which may stratify patients 

with oribital cellulitis and guide treatment. This case illustrates a 

new interesting pathophysiology in orbital cellulitis and illustrates the 

need for further investigation into the optimal management scheme for 

children with orbital cellulitis caused by contralateral frontal sinusitis. 

P 334 

PPPM AND FACIAL PAIN SCALE ARE USEFUL TOOLS TO 

QUANTIFY POST-TONSILLECTOMY PAIN IN CHILDREN 

C.P. Valera, C.B. Azevedo, L.R. Carenzi, D.L. Cunha, T. Anselmo-Lima, 

E. Tamashiro 

School of Medicine of Ribeirão Preto - University of São Paulo, 




OBJECTIVES 

To evaluate the applicability of clinical pain scales in the assessment of 

post-tonsillectomy pain in children. 

METHODS 

Children between 4 to 10 years-old undergoing tonsillectomy, together 

with their parents, were invited participate in the study. Parents were required 

to fill in the Parents’ Post-Operative Pain Measurement Questionnaire 

(PPPM - possible scores from 0-15) and children were required to 

self-report their pain by choosing the most representative figure in the 

Facial Pain Scale (FPS - 6 different faces) during the seven consecutive days 

after surgery. The number of times of analgesics taken on each day was 

256 

also assessed. Pearson’s test was used to evaluate the correlation between 

PPPM, FPS and the need of analgesics, considering significant when p

CONCLUSIONS 

Peri-orbital complications of sinusitis in children usually respond to medical 

therapy. In contrast, subperiosteal and orbital abscesses often require 

prompt surgical intervention. Early CT scan is mandatory in these patients 

to prevent missed diagnosis or delayed treatment. ENT and Ophthalmology 

coordination is essential to aim successful outcomes. 

P 336 

POSTNASAL DRIP SYNDROME IN CHILDREN 

D. Vicheva, M.M.M. Milkov 

Mario, VARNA, Bulgaria 


INTRODUCTION 

Discuss the clinical features and the disease curing methods for the chronic 

cough caused by postnasal drip syndrome. 

METHODS 

Twenty one children who were diagnosed with postnasal drip syndrome 

were given systemic cure such as giving antibiotics, adopt a nasal decongestant, 

part system using glucocorticoid very carefully. 

RESULTS 

All above of children follow-up three months. With subjectivity, if symptoms 

improve action appraises an index, cough of twelve children had different 

improve. Nine cases did not feel their symptom improve obviously. 

CONCLUSION 

The postnasal drip syndrome is complicated. Cough is n important clinical 

feature of postnasal drip syndrome. The treatment is difficult and requires 

combinative thinking and accurate diagnosis. 

P 337 

DETERMINANTS OF SPECIALIST REFERRALS FOR RECURRENT 

RESPIRATORY TRACT INFECTIONS INCLUDING OTITIS 

MEDIA IN YOUNG CHILDREN 

R.A.M.J. Damoiseaux, A.C. van de Poll, C.K. van der Ent, 

A.C. van der Gugten, A.G.M. Schilder, E.M. Benthem, H.A. Smit, 

R.K. Stellato, N.J. de Wit 

University Medical Center Utrecht, Julius Center for Health Sciences 

and Primary Care, UTRECHT, The Netherlands 

E-MAIL: rdamoiseaux@hotmail.com 

OBJECTIVES 

(a) To establish whether medical factors, child-related factors and physician-related 

factors are independently associated with specialist referral 

in young children with recurrent respiratory tract infections (RTI), and 

(b) to evaluate whether general practitioners (GPs) follow guidelines regarding 

referral for recurrent RTI. 

METHODS 

GP records of all children under two years of age, born 2002 through 2008, 

were reviewed for RTI episodes using ICPC codes. Characteristics of RTI 

episodes and year of graduation of the attending GP were recorded. Childrelated 

factors were extracted from the prospective ‘Wheezing Illnesses 

Study Leidsche Rijn’ (WHISTLER) birth cohort. The independent association 

between variables of interest and the outcome (recurrent RTI referral) 

was analyzed. To evaluate GPs’ guideline adherence referral data were compared 

to national guideline recommendations. 

RESULTS 

2532 RTI episodes in 1041 children were evaluated. Seventy-eight children 

were referred for recurrent RTI. Medical factors were the main determinants 

of specialist referral: number of previous RTI episodes (OR 1.7 [CI 

1.7-1.7]); severity of previous RTI episodes (OR 2.2 [CI 1.6-2.8]); and duration 

of RTI episode (OR 1.7 [CI 1.7-1.8]). The non-medical factors daycare attendance 

(OR 1.3 [CI 1.0-1.7]), and 5-10 years working experience as a GP compared 

with less than 5 years (OR 0.37 [CI 0.27-0.50]) were moderately 

associated. Fifty-seven percent of recurrent RTI referrals were made in accordance 

with national guideline recommendations. 

CONCLUSION 

Specialist referral of young children for recurrent RTI was primarily determined 

by medical factors. Yet, only just over half of referrals were made 

in accordance with guideline recommendations. 

P 338 

AERODIGESTIVE FOREIGN BODY IN CHILDREN: 

DIAGNOSIS, REMOVAL, FOLLOW-UP 

Z.S. Farkas, G. Katona 

Heim Pál Hosp., ENT Dept., BUDAPEST, Hungary 

E-MAIL: drfarkaszsolt@yahoo.com 

OBJECTIVES 

The aim of our study was to assess experiences of aerodigestive foreign 

body (FB) problems in children. Our goal was to provide a guideline of diagnostics 

and therapeutic regimen of such cases based on our 50 years’s 

experiences. Another main issue was to point out how to avoid complications 

or - if occurred - how to treat them. 

257


This is a retrospective study in a tertiary referral children’s hospital. In diagnostics, 

physical examination, X-ray, sometimes CT or MRI were used. Removal 

of FBs was performed by means of rigid endoscope, and/or rigid esophagoscope. 

Digital photo and video documentation was made in each cases. 

RESULTS 

Between 2007. and 2011. 517 bronchoscopies (517/86 FBs) and (160/66FBs) 

esophagoscopies were performed. 7 children needed repeated procedure 

due to incomplete or uncertain removal. Two cases with esophageal perforations 

are presented in details. 

CONCLUSIONS 

A mild suspicion of FB is an indication for endoscopy. Imaging can be helpful 

but can not exclude the FB. A key for a successful removal is the experienced 

team, good relation with radiologists and anesthesiologists. In case 

of perforation, immediate nasogastric tube insertion and intensive observation, 

sometimes chest surgical intervention are necessary. 

P 339 

THE MANAGEMENT OF PERI-ORBITAL AND ORBITAL 

CELLULITIS IN CHILDREN 

G. Narasimhan 1 , K. Davies 1 , V. Puranik 2 , S. Williams 2 

1 Alder Hey Childrens Hospital Liverpool, ENT, ALTRINCHAM, 



2 Ysbyty Gwynedd, RHYL, United Kingdom 

OBJECTIVE 

To audit the current management of peri-orbital cellulitis in children and 

to see where improvements could be made. 

METHOD 

We carried out a retrospective analysis of all notes for children admitted 

with suspected peri-orbital cellulitis between 2003 and 2008. We compared 

their management to previously documented guidelines and our local 

ideal practices. 

RESULTS 

There were 37 patients that were admitted with suspected peri-orbital cellulitis 

during this period. Only 24 could be included (66%) as the others 

were either mis-coded (3%) or the notes were unable to be located (32%). 

Cefuroxime and metronidazole have been shown to be the first antibiotic 

choice however this protocol was initiated on day 1 in only 4 patients (17%). 

In all 5 cases where a CT scan was indicated it was performed. In 17 cases 

(71%) the patients were referred and reviewed on day 1 by the ophthalmologist 

compared to only 5 cases (20%) who were seen by an ENT doctor. A 

specialist referral to ophthalmology was not made in 3 cases (12%) and in 

10 cases (42%) an ENT referral was not made. 

258 

CONCLUSION 

The audit shows that the management of suspected peri-orbital cellulitis 

could be improved. We have subsequently produced a protocol that will 

be used in the emergency department and paediatric ward so that we can 

improve the outcome for these patients. We will re audit the management 

after a year so that we can hopefully see that the use of the protocol has 

enhanced the management of peri-orbital cellulitis 

P 340 

CORRELATION OF ACUTE ADENOIDITIS AND 

ACUTE SINUSITIS IN CHILDREN 

F. Manole 



AIM 

The purpose of the study is to follow the association of various symptoms, 

as well as, their correlation with radiological and bacteriological changes. 


The group comprise 185 patients aged between 6 and 18 years diagnosed 

with acute adenoiditis diagnosed in Municipal Hospital of Oradea in the 

period 2009-2011. We apply clinical questionary where we collect data regarding: 

nasal obstruction unilateral or bilateral, the period of the symptoms 

and the predominance, aspects of rhinorrhea, hyposmia, presence of 

local bleeding, facial pain and cough. The lot of study was then examined 

ENT by : anterior rhinoscopy, posterior rhinoscopy, endoscopy and associated 

disease : asthma, bronchic hyperreactivity was appreciated by pediatrics. 

We perform radiological investigation in selected case and 

bacteriological culture of nasal secretion. 

RESULTS 

From total number of cases taken into consideration 45% of subjects was 

diagnosed with acute sinusitis. From this 82% have unilateral sinusitis and 

18% have bilateral siusitis.The anterior ethmoid and maxillary sinus unilateral 

was more frecvent affected in the group age 6-8 years. Just 35% of 

patients diagnosed with sinusitis complain about headache. Regarding 

the culture of nasal secretion , pneumococcus was more frequent find in 

our laboratory. 

CONCLUSION 

In children the nasopharynx pathology is predominant at the aged between 

4 and 10 years and is well correlated with paranasal sinus disease 

usualy unilateral. Thus, we can assert that the local neighbouring factors, 

namely the nasopharynx disorders are involved in the onset of the vicious 

circle of the paranasal sinus pathology.

P 341 

MOST FREQUENT ORBITAL RHINOSINUS-RELATED 

COMPLICATIONS IN CHILDREN 

V. Stojanovic Kamberovic 1 , S. Babac 2 , P. Vasiljevic 2 , A. Brankovic 1 , 

R. Kosanovic 3 , R. Sladoje 3 

1 Zvezdara Health Cnter, ENT Department, BELGRADE, Serbia 

E-MAIL: vesnanbgd@yahoo.com 

2 Clinical and Hospital Center Zvezdara, BELGRADE, Serbia 

3 Novi Beograd Health Center, Belgradeo, Belgrade, Serbia 

OBJECTIVES 

Is to show most frequent orbital rhinosinus-related complications and 

their diagnostic and therapeutic treatment. 

METHODS 

A retrospective analysis has covered 1,803 patients age between 2 and 16 

(11.33±3.38) treated for rhinosinusitis in the period between 2006 and 2010. 

The diagnosis of the orbital complications was made based on an anamnesis, 

an otorhinolaryngological, ophtalmological examination, bacteriological 

analysis (smears from nasopharynx/middle nasal passage/ aspirate 

and/or intraoperative smears), radiological diagnostics (CT and/or MR examination), 

FESS, neurological-neurosurgical checkups. 

RESULTS 

Orbital complications were diagnosed in 17 patients (0.94%). X2=1.736E3; 

df= 1; p

P 343 

INDICATION FOR ENDONASAL SURGERY BY INFANTS 

I. Slapak 

Childrens University Hospital, Pediatric ORL Dept., BRNO, 

Czech Republic 

E-MAIL: islapak@med.muni.cz 

OBJECTIVE(S) 

Endonasal endoscopic surgery in infants is a surgical technique for an experienced 

surgeon and requires skill and knowledge of child development 

and anatomy of the facial skeleton. 

METHODS 

To evaluate the results of endonasal endoscopic surgery in neonates and 

infants was carried out a retrospective analysis of a group of patients who 

were operated in the years 1991 - 2010 (20 years) in the ENT Clinic of Children’s 

Medical Faculty of Masaryk University, Brno. 

RESULTS 

In this period it was operated on this site Endonasal endoscopic technique 

of total 1033 children (0-19 years) including 627 boys (57%) and 406 girls 

(43%). From this group, you can set aside a group of 148 children (14.2%), 43 

neonates (4.1%) and 105 infants (10%) aged 1 month - 5 years. Most often 

diagnosis was maxillar cyst 307 cases, recurrent sinusitis 206 cases, nasal 

polyps 128 cases, mucosal hypertrophy 53 cases, choanal atresia 39 cases, 

lacrimal tract disorders 64 cases. 

P 344 

MICROENDOSCOPIC SURGERY OF NASAL CAVITY, SINUSES 

AND NASOPHARYNX IN CHILDREN 

I.V. Zyabkin 

RMAPE, ENT, 123 00 1 Moscow, Russian Federation 

E-MAIL: zyabkin 74 @gmail.com 

INTRODUCTION 

Last decade development of Methods of functional microendoscopic rhinosurgery 

surgery has considerably expanded opportunities in treatment 

of chronic diseases of a nasal cavity, sinuses and nasopharynx in children. 

These Methods have strongly borrowed leading positions concerning classical 

Methods. 


We have reviewed 178 children with chronic rhinosinusitis upon whom 

the microendoscopic surgical procedures were performed within the period 

from 2007 till 2010 years. In analyzing the results it was noted that 

260 

the inflammatory process within the nasal cavity and paranasal sinuses 

touches upon almost all the levels to a certain extent. 

RESULTS 

In 136 (91,9%) patients nasal endoscopy and CT-scanning revealed a combined 

patology with different anatomical localization. All patients underwent 

one-step microendoscopic procedure with 91% of good results. 

CONCLUSIONS 

The results allowed us to come to the conclusion, that one-step surgical 

procedure for correction of the endonasal structures and inflammatory 

process management in children is the method of choice. 

P 345 

SKULL BASE SURGERY IN CHILDREN AND INFANTS: 

COMBINED OTORHINOLARYNGOLOGICAL AND 

NEUROSURGICAL APPROACH 

R. Nicollas, D. Scavarda, A. Farinetti, S. Roman, J.M. Triglia 

Aix Marseille Universite, Pediatric Otolaryngology, Head and Neck 

Surgery, MARSEILLE, France 

E-MAIL: richard.nicollas@ap-hm.fr 

Minimally invasive surgery is an increasingly popular concept for several 

years. Skull base is an ideal field for the development of these techniques. 

The goal of this work is, through our experience, to appreciate how the 

otorhinolaryngologist can help neurosurgeons in the management of several 

pathologies involving the skull base.In the last 5 years, 12 patients 

were commonly operated on by pediatric otorhinolaryngological and pediatric 

neurosurgical teams. The series was composed of: 2 skull base clefts, 

2 sellar tumors, 1 intracranial-rhinopharyngeal teratoma, 4 frontal sinusitis 

with associated empyema, 1 neonatal nasal glioma, 2 ossifying fibromas. 

The clinical charts with a special focus on the surgical approach and the 

outcome of these patients were reviewed. 

With a 2-years-mean follow-up, all the patients but one are doing well. 

This patient is a teenager with a congenital anterior skull base cleft previously 

operated twice by a transcranial approach. Recurrence of the rhinorrhea 

occurred after a nasal infection 3 weeks later. 6 patients underwent 

a combined endonasal and transcranial approach (2 sellar tumors, 2 frontal 

sinusitis, 1 ossifying fibroma and the teratoma) while others were operated 

on endoscopically. If in some cases an endoscopic approach allows the 

treatment of a disease of the skull base, in other cases, a combined approach 

can be necessary. The otorhinolaryngologist has a great role to play 

collaborating with the neurosurgeon to optimize their surgical procedure 

on skull base.

P 346 

TREATMENT OF ALLERGIC AND NON-ALLERGIC RHINITIS 

WITH BIPOLAR RADIOFREQUENCY INDUCED 

THERMOTHERAPY ‘OLYMPUS - CELON’ 

D. Vicheva 


Bipolar Radiofrequency Induced Thermotherapy (RFITT) started its development 

in 2000 year. A large number of surgical interventions are done 

during the last years using this therapy.Treatment of nasal breathing disorders 

due to allergic and non-allergic rhinitis is held successfully with 

this technique. (RFITT). 

METHOD AND MATERIALS 

28 reductions of lower nasal concha in children between 11 and 16 years 

old were done with the applicators of ‘Olimpus’. In 7 cases it was combined 

with nasal septoplasty The patients were examined with: rhinomanometry 

- 18 cases, acoustic rhinomanometry - 10 cases, timpanometry - 28 cases. 

In 7 of the patients serous otitis was found. 

DISCUSSION 

Celons RFITT provides an effective,safe and user friendly solution for the 

treatment of snoring, hypertropfy of the turbinates and tonsils, and mild 

obstructive sleep apnoae. The key advantages are: Bipolar on the tip- technology:gentle 

treatment, Auto-Stop; safe application. 3D -Impedance- 

Feedback:Precise and reproducible 

RESULTS/CONCLUSIONS 

RFITT is a successful method of treatment of both allergic and non-allergic 

rhinitis. In all the cases second intervention was not necessary. 

P 347 

CONGENITAL LACRIMAL PATHWAY STENOSIS: 

15-YEARS EXPERIENCE AT A SINGLE INSTITUTE 

M. Berlucchi 1 , N. Nassif 1 , P. Rossi Brunori 2 , P. Nicolai 2 

1 Spedali Civili, Department of Pediatric Otorhinolaryngology, 

BRESCIA, Italy 

E-MAIL: marco.berlucchi@tin.it 

2 University of Brescia, BRESCIA, Italy 

OBJECTIVE 

To evaluate the application and efficacy of diagnostic-therapeutic algorithm 

in the management of congenital lacrimal pathway stenosis (CLPS). 

METHODS 

From September 1997 to December 2010, 65 children affected by CLPS were 

admitted to Department of Pediatric Otorhinolaryngology, Spedali Civili, 

Brescia - Italy. Diagnostic work-up included an ophthalmologic examination 

and nasal endoscopy. When conservative managements (i.e., lacrimal 

massage, probing, and intubation) failed, before to perform a transnasal 

endoscopic dacryocystorhinostomy (TEDCR), dacryocystography and CT 

of sinuses were carried out. 

RESULTS 

A total of 83 lacrimal pathway stenoses were observed and treated. All patients 

underwent ophthalmologic evaluation and rhinoscopy, associated 

with radiological assessment and imaging in 18 children. TEDCR was performed 

in 23 lacrimal systems. A failure of endoscopic surgery was observed 

in 3 patients. A revised TEDCR was carried out in these subjects. To date, 

(range follow-up: 13 months - 14 years), all children are symptom-free. 

CONCLUSIONS 

Conservative procedures are first therapeutic managements to perform in 

children with CLPS. Whenever these therapies fail, a TEDCR can be considered 

a valid surgical alternative to traditional approach. TEDCR is a 

safe, less invasive, efficacious, reproducible, and well-tolerated treatment. 

The meticulous application of a diagnostic-therapeutic algorithm for CLPS 

and a close cooperation with ophthalmologist are mandatory to obtain 

successful results. 

P 348 

IMAGE-GUIDED SURGERY IN PEDIATRIC SINONASAL AND 

SKULL BASE SURGERY 

A. Almomen 

King Fahad Specialist Hospital, Orl, Head & Neck Surgery, DAMMAM, 

Saudi Arabia 

E-MAIL: alihalmomen@yahoo.com 

Image-guided surgery remains a very valuble tool in pediatric sinonasal 

and endoscopic skull base surge. It enhances the intraoperative orientation, 

accurate localization and improves the clinical outcome. In this series, 

we review our experience with image-guidance in different difficult pediatric 

sinonasal and skull base lesions. Image-guidance was used in 

Pathologies like acute and chronic sinusitis, cystic fibrosis with polypsis, 

allergic rhinosinusitis w polypsis, allergic fungal sinusitis,isolated sphenoid 

sinusitis, lateral sphenoid recess fungal sinusitis, complicated fungal 

sinusitis affecting the orbit and skull base, frontal sinusitis, sphenoidal 

mucocele, fibrous dysplasia,csf leaks affecting the posterior wall of the 

frontal sinus and pediatric pituitary cyst, all will be presented and discussed. 

261

P 349 

TRANSNASAL ENDOSCOPIC REPAIR OF CHOANAL ATRESIA: 

14 YEARS EXPERIENCE 

I.J. Fernandez, P. Farneti, V. Sciarretta, G. Macrì, E. Pasquini 

University of Bologna, Otorhinolaryngology Department, BOLOGNA, Italy 

E-MAIL: ignafernandez@yahoo.it 

OBJECTIVE 

To express a 14 years experience in pediatric transnasal endoscopic repair 

of congenital choanal atresia. 

METHODS 

24 patients with a mean age of 4,2 years (range 2 days - 17 years) underwent 

endoscopic repair of choanal atresia between 1997 and 2010 at our institution. 

Patients had unilateral choanal atresia in 12 cases (50%) and bilateral 

in 12 cases. Outcome, complications and data of patients were extracted 

from prospective data base. The mean follow-up was 33 months (ranging 

from 12 to 120). 

RESULTS 

Success rate was 95,9 % after the first procedure. Two patients had mild 

partial stenosis following the first procedure, requiring surgical revision 

only in 1 case (4.1%). Synechia develops in 1 patient having two transnasal 

endoscopic surgery procedures. No complete restenosis, need for multiple 

revision surgery or other complications develop during the follow up period. 

No significant association between possible risk factors (CHARGE, 

other associated syndrome, bilateral atresia, gender, age, stent use) and 

restenosis were encountered. 

CONCLUSIONS 

Transnasal endoscopic approach is a safe and successful procedure for the 

repair either unilateral or bilateral choanal atresia. There were no significant 

predictors for restenosis in our series. Therefore the authors believe that a 

correct surgical technique, with precise repositioning of mucosal flaps after 

the resection of the atretic plate, is of paramount importance in avoiding 

restenosis of the neochoana and in reducing the need for stenting. 

P 350 

NEUROFIBROMA OF THE NASAL DORSUM 

IN A PEDIATRIC PATIENT 

T. Erdag 1 , E. Dogan 2 , E. Ozer 2 

Dokuz Eylul University School of Medicine, IZMIR, Turkey 

E-MAIL: taner.erdag@deu.edu.tr 

262 

We present a case of neurofibroma of the nasal dorsum treated by an external 

rhinoplasty approach. A 2-year old boy had suffered progressive 

swelling of the left side of the nasal dorsum since birth. Examination of 

the patient revealed a painless solid mass with a diameter of 1 cm at the 

left side of the nasal dorsum. Nasal cavities were normal. Magnetic resonance 

imaging showed a nodular solid mass just under the skin with a 

low signal intensity both on T1 and T2 images without intranasal and intracranial 

connection. The mass was resected using an external rhinoplasty 

approach and the pathologic examination revealed a neurofibroma. Neurofibromatosis 

was excluded with pediatric consultation and additional 

radiologic examinations. No postoperative complication or recurrence of 

the tumor was observed during a follow-up period of 14 months. Here, we 

present this case and discuss the clinical and pathological aspects of neurofibroma 

arising in the nasal dorsum. 

P 351 

CONGENITAL GIANT LOWER TURBINATES HYPERTROPHY 

IN TWO SIBLINGS 

D.L. Grasso, G. Pelos, A. Degrassi, E. Orzan 

IRCCS ‘Burlo - Garofolo’ Children Institute, ENT, TRIESTE, Italy 

E-MAIL: grasso@burlo.trieste.it 

Nasal obstruction caused by extensive hypertrophy of the inferior 

turbinates is a relatively common disease in the pediatric population. Such 

hypertrophy may be due to various causes including allergic reaction, vasomotor 

rhinitis or drug-induced rhinitis. 

Two siblings (7 and 4 years old respectively) were referred to Otolaryngologic 

Unit of the IRCCS ‘Burlo - Garofolo’ Children Hospital, Trieste, Italy 

for suffering of chronic nasal obstruction. The history was positive for bilateral 

inferior turbinates hypertrophy at birth in both children. Nasal 

breathing was completely excluded and bilateral stent positioning was required 

to allow feeding in both children. In the following months, after 

the stents were removed, a follow -up was adopted and topical therapy 

saline solution irrigation was prescribed. Allergy test and sweat test for 

cystic fibrosis were negative. Rhinoscopy showed a wide enlargement of 

the head of the lower turbinates in both children protruding through the 

nostrils. Fiberoptic evaluation of the nasal fossae confirmed the involvement 

of the entire lower turbiantes bilaterally in both children. The lower 

turbinates tail enlargement occupied the rhynopharynx. Surgical reduction 

of the lower turbinates was performed in both children under general 

anaesthesia and under endoscopic control. Relief form symptoms occurred 

and children were free of recurrence after a two years of follow - up period. 

Even though hypertrophy of the inferior is frequently detected in the 

childhood, no case of familiar congenital obstruction due to this disease 

has been reported.

P 352 

COMPUTATIONAL FLUID DYNAMICS MODELING 

OF THE PEDIATRIC AIRWAY UTILIZING COMPUTED 

TOMOGRAPHY IN PIERRE ROBIN SEQUENCE 

C. Zdanski 1 , J. Kimbell 1 , R. Superfine 1 , S. Davis 2 

1 University of North Carolina at Chapel Hill, Otolaryngology/ 

Head and Neck Surgery and Pediatrics, CHAPEL HILL, USA 

E-MAIL: zdanski@med.unc.edu 

2 Riley Hospital for Children, Indiana University Health, 

INDIANAPOLIS, USA 

OBJECTIVES 

To develop a method for Computational Fluid Dynamic (CFD) modeling 

of the airway in neonates with Pierre Robin Sequence (PRS) from existing 

CT scans. 

METHODS 

Airway geometries were reconstructed in 3D from CT scans using medical 

imaging software (Mimics, Materialise, Inc., Plymouth, MI), converted 

to stereolithography (STL) file format, and meshed with tetrahedral elements 

using ICEM-CFD (ANSYS, Inc., Lebanon, NH). Minimal crosssectional 

area and anatomic obstructions were determined. Pressure drop 

and wall pressure were estimated using steady-state airflow simulations 

with Fluent (ANSYS, Inc.,Lebanon,NH). 

RESULTS 

Five neonates with PRS had CT scans available for evaluation. CFD models 

of the airways were successfully created in all. Two neonates had pre- and 

post-surgical scans, though one had an airway adjunct present during the 

post-operative scan which precluded optimal modeling. The other had a 

post-surgical scan with an unsupported airway which showed improvement 

in minimal cross sectional area and airflow. 

CONCLUSIONS 

Computational fluid dynamic modeling is a method for simulating and 

predicting air flow in 3D geometries derived from medical images of the 

human airway. We successfully developed CFD models of the airway from 

CT scans of neonates with PRS which were originally obtained to evaluate 

the craniofacial skeleton. Post-operative improvement in the airway was 

observed both in the CFD models and clinically in the one patient with 

an available appropriate scan. Successful creation of CFD models of the 

airway is the first step in the development of an airway model with possible 

predictive value in children with airway obstruction. 

P 353 

MEASURING VOICE QUALITY MADE EASY WITH OPERAVOX: 

THE ‘ON PERSON RAPID VOICE EXAMINER’ 

O.R. Hughes 1 , O. Forth 2 , A. Alexander 2 

1 Institute of Child Health, Otolaryngology, LONDON, 


E-MAIL: owainrhyshughes@gmail.com 

2 Oxford Wave Research Ltd, Oxford, United Kingdom 

OBJECTIVE 

At present, objective analysis of voice quality using acoustic parameters is 

only possible in the voice laboratory to which the patient has to travel. We 

aim to develop an application that allows patients to easily record and have 

their voice analysed away from hospital, making it possible to collect much 

more data. 

METHODS 

We developed an application to run on the Apple iPhone and iPad, called 

OperaVOX. We tested how well members of the public use OperaVOX 

to record and have their voice analysed acoustically in their own 

environment. Using feedback we made incremental changes to the user 

interface. Furthermore we compared analyses performed on OperaVOX 

with those obtained through the gold-standard system. 

RESULTS 

After a brief introduction, volunteers were able to use OperaVOX to 

record their voice. Volume between recordings was standardised using a 

volume meter represented on screen. By prompting the patient to perform 

a sustained vowel, OperaVOX could measure relevant acoustic parameters 

including the fundamental frequency (F0) and formants (F1-F4) - and 

was comparable to results obtained using gold-standard system. An electronic 

version of the Paediatric Voice Handicap Index questionnaire was 

implemented. Furthermore, OperaVOX could automatically send these 

data either via email or directly into an electronic patient record system. 

CONCLUSIONS 

By allowing patients to record, analyse and share data on their voice 

hourly, daily or weekly and longitudinally over a long period of time and 

at their convenience, OperaVOX may make it possible to collect data 

on a patient’s voice quality away from the hospital. 

263

P 354 

CHARACTERISING THE LARYNGEAL MUCOSAL IMMUNE 

RESPONSE IN PATIENTS WITH RECURRENT RESPIRATORY 

PAPILLOMATOSIS 

O.R. Hughes 1 , D. Albert 2 , M. Wyatt 2 , C. Jephson 2 , S.O. Burns 1 

1 Institute of Child Health, Otolaryngology, LONDON, 


E-MAIL: owainrhyshughes@gmail.com 

2 Great Ormond Street Hospital, London, United Kingdom 

OBJECTIVES 

Lesions caused by the human papillomavirus (HPV) are seen to spontaneously 

regress when lymphocytes and antigen presenting cells infiltrate 

the mucosa. Very little is known, however, about the immune response to 

HPV lesions in patients with Recurrent Respiratory Papillomatosis (RRP). 

We aimed to characterise the immune infiltrate into HPV induced lesions 

in patients with RRP. 

METHOD 

Biopsies were taken from six patients. Sections from these lesions were 

first stained with antibodies against the viral proteins E4, L1 and the cell 

proliferation marker MCM-7. Using the expression of these markers, we 

were able to localize within each section where viral proteins were being 

expressed. Subsequently, adjacent sections were stained with antibodies 

against CD3, CD4, CD8, (lymphocytes) CD14, (monocytes) and CD1a (dendritic 

cells). Expression of each antibody per unit area was quantified separately 

for the epithelium, its basal cells, and lamina propria. In addition, 

biopsies were taken from macroscopically normal false vocal fold from the 

same patients. These biopsies were sectioned and stained with the same 

antibodies as above and the immune cell infiltrate was quantified and 

compared with the RRP lesion. 

RESULTS 

We identified that in patients with RRP there is a significant reduction in 

the amount of CD4 lymphocytes and antigen presenting cells within a lesion 

expressing HPV proteins when compared to adjacent macroscopically 

normal tissue. 

CONCLUSION 

The reduced immune cell infiltration within a virally induced lesion is 

unexpected and may possibly be due to the presence of T-regulatory cells 

or the effects of HPV on antigen presenting cells. 

264 

P 355 

COMBINED ERLOTINIB AND CELECOXIB TREATMENT 

FOR SEVERE JUVENILE RECURRENT RESPIRATORY 

PAPILLOMATOSIS IN CHILDREN: 3 CASES 

O. Haag 

Hospital Sant Joan de Deu, Pediatric Otolaryngology, BARCELONA, Spain 

E-MAIL: ohaag@hsjdbcn.org 

Juvenile-onset recurrent respiratory papillomatosis (JRRP) is still an unsolved 

problem. Patients, caregivers and doctors suffer during many years, 

before often leading to pulmonary complications or malignancies with 

fatal consequences. 

There is desperate need for new adjuvant treatment options, since surgical 

treatment alone is not enough to control the disease and established adjuvant 

treatment options often seem to fail. 

Based on recent publications showing in-vivo and in-vitro effectiveness 

of combined erlotinib and celecoxib treatment in adult-onset recurrent 

respiratory papillomatosis, we decided to initiate a clinical trial treatment 

with one patient, 8 years old. After receiving an excellent initial response 

we included 2 more patients, 14 and 15 years old, for a 4 month trial. 

All three children showed a clearly positive response to the treatment, 

measured by decrease in the Derkay severity scale for RRP, increased voice 

quality and increased time interval between surgical interventions. 

Two of the three children experienced a strong regrowth after stopping 

the combinatioin treatment, which lead us to reintroduction of the treatment 

in these cases. After one year of follow-up we still treat two of the 

three children with much better control of the disease. We conclude that 

we found a clear improvement after starting the treatment a clear deterioration 

after stopping the combination treatment with erlotinib and celecoxib. 

However, until any meaningful conclusions can be drawn, further 

studies are needed to determine the long-term effectiveness, dosing strategies 

and side-effect profile of erlotinib and celcoxib in combination for the 

treatment of severe JRRP. 

P 356 

CLINICAL OBSERVATIONS ON PROPANOLOL USE FOR 

PAEDIATRIC HEAD AND NECK HAEMANGIOMAS 

R. O’Connell 

University College Hospital, Glaway, Otolaryngology, NIL GALWAY, 

Ireland 

E-MAIL: rohana.oconnell@gmail.com 

INTRODUCTION 

Recent reports on the experience of propanolol use in the treatment of paediatric 

subglottic haemangiomas suggest favourable reasons for this use 

due to rapid improvement and its lack of severe side effects.


Retrospective review of children with subglottic haemangiomas who were 

treated with propanolol as the main therapeutic option, seen in the paediatric 

airway service in Children’s University Hospital since 2009 was carried 

out. 

RESULTS 

Eight patients were included in this observation. We described the clinical 

characteristics of these patients and studies carried out prior to starting 

treatment with propanolol, pre-treatment endoscopic findings, clinical 

evolution and incidences during treatment. 

CONCLUSION 

Propanolol use in the treatment of subglottic haemangiomas appears to 

show a high degree of efficiency in improving clinical symptoms without 

the disadvantage of severe side effects. Further studies are still required to 

confirm safety and results, but so far this drug appears to be an acceptable 

alternative in the treatment of subglottic haemangioma . 

P 357 

SYMPLASTIC HAEMANGIOMA OF NASOPHARYNX 

I. Baljosevic, S. Djuricic, G. Samardzija, V. Subarevic, N. Mircetic 

Mother and Child Health Institute, ORL Department, BELGRADE, 

Serbia 

E-MAIL: ivan.baljosevic@gmail.com 

OBJECTIVE 

Presenting the case of rare benign tumour located in nasopharynx we 

point out the clinical situation, importance of correct diagnosis and treatment 

method. 

METHOD 

We are presenting the case of girl, 12 years old, that checked in hospital 

because obstruction in the nose, sleeping disorder and problems in eating. 

In order to establish diagnosis we have performed ORL examination and 

CT of skull basis. 

RESULTS 

Tumour was located at the back wall of nasopharynx. We have completely 

removed it surgically. Tumour tissue was cut into three uneven samples of 

total mass of 8,56 grams, the largest was of 3,4 cm. Basis of tumour was 

mixoid, diffused imbued with lymphocytes and rare eosinophils, and within 

there were places lobular organized, altered blood vessels of cavernous haemangioma-like, 

lumens filled with blood and partly thrombosis. 

CONCLUSION 

Symplastic haemangioma is benign vascular tumour significant for the 

differential diagnostic similarity to angiosarcoma and it’s usually located 

in the skin. Localized in the nasopharynx at our patient suggest possibility 

that skin localization is not the only possible anatomic location of this variety 

of vascular tumour. 

P 358 

LARYNGEAL LYMPHATIC MALFORMATIONS: A PROPOSED 

STAGING SYSTEM AND REVIEW OF TREATMENT 

E. Berg, S.E.S. Sobol, I. Jacobs 

Children’s Hospital of Philadelphia, Department of Pediatric 

Otolaryngology, PHILADELPHIA, USA 

E-MAIL: berge@email.chop.edu 

OBJECTIVES 

The primary objective is to propose a staging system for congenital lymphatic 

malformations involving the larynx. The secondary objective is to 

review a series of congenital lymphatic malformations involving the larynx 

and attempt to correlate the staging system with clinical outcome, specifically 

in relation to need for tracheotomy and likelihood of decannulation. 

METHODS 

A four-part staging system (grade I-IV) for congenital lymphatic malformations 

involving the larynx is proposed based upon clinical experience. 

Grade I lesions do not cause compressive endolaryngeal obstruction while 

grade IV lesions cause complete obstruction. A series of patients with lymphatic 

malformations involving the larynx are then retrospectively reviewed 

and staged according to the proposed system. Clinical management 

and outcomes are then assessed and correlated with stage of disease. 

RESULTS 

16 patients with laryngeal lymphatic malformations were identified. 

Eighty-one percent (13/16) received sclerotherapy and 50% (8/16) underwent 

operative intervention. Fifty-seven percent (4/7) of grade I lesions, 50% (1/2) 

of grade II lesions, 100% (4/4) of grade III lesions, and 100% (3/3) of grade IV 

lesions required tracheotomy. Of the patients requiring tracheotomy, all 

patients with grade I and II lesions were subsequently decannulated while 

only 50% (2/4) of grade III lesions were decannulated. No patients with 

grade IV lesions have been successfully decannulated. 

CONCLUSIONS 

Lymphatic malformations of the larynx require a careful and often staged 

management approach. A proposed staging system, which will be detailed 

in the paper, helps to predict the need for tracheotomy and the likelihood 

of long-term tracheotomy dependence. 

265

P 359 

RADIOFREQUENCY PLASMA ABLATION OF LYMPHATIC 

MALFORMATIONS OF THE LARYNX AND HYPOPHARYNX 

S.P. Smith, M.J. Gibber 

Albert Einstein College of Medicine, BRONX, NY, USA 

E-MAIL: lsmith8@nshs.edu 

OBJECTIVE 

To describe the removal of lymphatic malformations of the larynx and hypopharynx 

using bipolar radiofrequency plasma ablation. 

METHODS 

We report a retrospective case series at a tertiary care academic children’s 

hospital. Two children with lymphatic malformations of the larynx and 

post-cricoid region respectively were treated with bipolar radiofrequency 

plasma ablation (Coblation). One child was tracheotomy dependent secondary 

to a transglottic lymphatic malformation and complex glottic and 

subglottic stenosis. One child had symptomatic dysphagia and a postcricoid 

lymphatic malformation. Both children underwent a staged approach 

for endoscopic removal of their lymphatic malformation. 

RESULTS 

Both children tolerated the procedures without complication. Both children 

were able to return to an oral diet and were discharged from the hospital 

post-operative day 1. Six months after successfully addressing the 

lymphatic malformation, the child with the laryngeal lymphatic malformation 

underwent double-stage laryngotracheal reconstruction with anterior 

and posterior costal cartilage grafting to address his posterior glottic 

and grade 3 subglottic stenosis. He was successfully decannulated several 

months later. The child with the post-cricoid lymphatic malformation 

had resolution of his dysphagia and no evidence of recurrence on surveillance 

esophagoscopy 6 months following the initial intervention. 

CONCLUSIONS 

Bipolar radiofrequency plasma ablation (Coblation) may provide a safe, 

simple and effective technique for endoscopic removal of lymphatic malformations 

of the larynx and hypopharynx. 

266 

P 360 

CUTANEOUS HAEMANGIOMAS OF THE HEAD AND NECK: 

A CYCLE OF CHANGE 

E. Phelan, P. Lenenan, H. Rowley 

Childrens University Hospital, Paediatric ENT, DUBLIN, Ireland 

E-MAIL: eimearphelan@hotmail.com 

OBJECTIVES 

Review paediatric cutaneous head and neck haemangiomas Highlight the 

role of the paediatric ENT surgeon as part of a multidisciplinary team approach 

in the management of this condition. Assess response of head and 

neck haemangiomas treated with oral propanolol 

METHODS 

The ongoing prospective Paediatric Head and Neck Cutaneous Haemangioma 

database maintained at the Children’s University Hospital, a tertiary 

referral centre was reviewed. All children referred with cutaneous head 

and neck haemangiomas to the ENT service had serial photographs performed 

and response to oral propanolol documented. 

RESULTS 

Forty children referred to the ENT service with cutaneous head and neck 

haemangiomas over a 2 year period were indentified. The size, location 

and number with associated airway haemangioma were analysed. Children 

who were treated with oral propanolol and who had serial photographs 

had their response to treatment assessed. 

CONCLUSION 

Propanolol is effective in the treatment of problematic head and neck haemangiomas 

that may cause significant functional and cosmetic issues. 

The vast majority of our patients treated had a good response to treatment 

with no significant side effects. 

P 361 

BILATERAL ARTERIOVENOUS MALFORMATIONS 

OF MANDIBLE TREATED BY COMBINED ENDOVASCULAR 

AND TRANSCUTANEOUS ANGIO-EMBOLIZATION 

M. Bergeron 1 , M. del Pilar Cortes Nino 2 , Y. Dolev 3 , L. Hp Nguyen 3 

1 Laval University, Department of Otolaryngology - Head & Neck 

Surgery, QUEBEC, Canada 

E-MAIL: mathieu.bergeron.10@ulaval.ca 

2 Montreal Neurological Institute and Hospital, McGill University, 

MONTREAL, Canada 

3 McGill University, MONTREAL, Canada

OBJECTIVE 

We report a unique case of extensive bilateral arteriovenous malformations 

(AVMs) in a child’s mandible successfully treated with endovascular and 

transcutaneous angio-embolization. 

CASE REPORT 

A healthy 8 year-old girl presented with bright blood found on her pillow 

and no apparent source of bleeding. Examination revealed a bluish gingival 

discoloration around a loose left lower premolar tooth, as well as a 

mesh-like subcutaneous plexus of veins on her left anterolateral neck. 

Three large AVMs involving the symphyseal region and bilateral mandibular 

bodies were found on angiography. Due to the extent of surgical resection 

required and its negative consequences, the patient instead 

underwent a series of endovascular and transcutaneous angio-embolization. 

These procedures were performed within a period of 8 months. A year 

after her first embolization, a CTA confirmed the complete obliteration of 

the lesion. 

CONCLUSIONS 

AVMs are rare and unusual lesions representing only 5% of all vascular 

malformations of the mandible. In cases of extensive intraosseous AVMs, 

serial embolization procedures can be successful, thereby avoiding the 

negative consequences of surgical resection. A multidisciplinary approach 

for both diagnosis and management by otolaryngologists and neurointerventional 

radiologists can lead to optimal results for the patients 

P 362 

A CASE SERIES OF COBLATION TO TREAT LYMPHATIC 

MALFORMATIONS OF THE TONGUE 

M.D. Elloy, C. Pepper, D.J. Tweedie, S. Pal, B.E.J. Hartley 

Great Ormond Street Hospital, Paediatric ENT, LONDON, 

United Kingdom, 

E-MAIL: mdelloy@yahoo.com 

OBJECTIVES 

Coblation to lymphatic malformations of the tongue was introduced to 

our department in 2011. This study aims to determine whether coblation 

is a safe and effective method of treating lymphatic malformations of the 

tongue and to assess symptom control as perceived by the parents of each 

patient. 

METHOD 

Patients were identified from a prospectively collated database, from which 

a retrospective review of the case notes was undertaken. A parental questionnaire 

was carried out a minimum of three months after surgery, enquiring 

about symptoms in the immediate post-operative period and the 

effect on longstanding symptoms. 

RESULTS 

During the study period of 7 months, 6 patients underwent coblation of a 

lymphatic malformation of the tongue. No complications were documented, 

and all patients made an uneventful recovery from surgery. 

CONCLUSION 

This series reveals coblation to be a safe, effective means of reducing the 

size and improving symptoms of lymphatic malformations of the tongue, 

while requiring less analgesia than alternative techniques. 

P 363 

RESOLUTION OF OPISTHOTONUS IN RESPIRATORY 

DISTRESS BY AORTOPEXY 

M. Trozzi 1 , V. Briganti 2 , S. Bottero 1 

1 Bambino Gesu’ Children’s Hospital, Otolaryngology, ROME, Italy 

E-MAIL: marilena.trozzi@opbg.net 

2 S. Camillo-Forlanini Hospital, ROME, Italy 

We report a case of worsening respiratory distress associated to opisthotonus 

secondary to tracheomalacia, investigating physio-pathological insight. 

A 2-months-old male baby was referred to our Hospital for respiratory distress 

syndrome. Clinical examination on arrival revealed severe respiratory 

failure, requiring O2 supplementation, failure to thrive and a noticeable 

opisthotonus. Neurological impairment was also present as the baby presented 

facial syndromic features. Bronchoscopy and 3D-CT scan showed 

the presence of an aberrant innominate artery bulging toward the trachea 

and tightening its lumen in the lower third. The infant was submitted to 

aortopexy and presented a dramatic post-operative recovery. Noteworthy, 

opisthotonus vanished soon after operation. 

Clinical manifestation of tracheomalacia may widely vary ranging from 

unspecific cough to severe respiratory distress syndrome with apparent 

life treatening events. Our patient presented opisthotonus secondary to 

tracheal compression, as demonstrated by the complete resolution soon 

after arterial suspension. The hyperextension of neck muscles with 

opisthotonus has to be considered an automatic adaptation to increase 

airway section when tracheomalacia is present. However, hyperextending 

neck muscles, the trachea may be pinched between the innominate artery 

and the spine at the level of the thoracic inlet. As a result, the upper mediastinal 

space became overcrowded by airway, artery and thymus, with 

a vicious circle occurrin. 

The suspension of the innominate artery may interrupt this auto-renewing 

cycle, with resolution of respiratory symptoms. 

Opisthotonus not always is related to neurological impairment, and it 

may be the warning sign of mediastinal overcrowding in those patients 

with respiratory distress syndrome secondary to vascular compression. 

267

P 364 

SCHWANNOMA OF THE CERVICAL SYMPATHETIC CHAIN: 

A RARE AETIOLOGY OF NECK TUMOUR IN CHILDREN 

G. Kontorinis, A.B. Jebreel 

Sheffield Children’s Hospital, SHEFFIELD, United Kingdom 


OBJECTIVES 

Schwannoma of the cervical sympathetic chain is a rare neck tumour. To 

date approximately 250 cases have been reported; to our knowledge only 

one case has for certain been described in children. Our objective was to 

present the diagnostic and therapeutic approach in a young girl with a 

cervical mass. 

METHODS 

A 14 year old girl with a large, progressively growing mass on the right 

side of the neck was prospectively followed-up. Apart from the bulging 

lump there were no further symptoms. The magnetic resonance imaging 

scans and the angiography showed a well defined tumour posterior to the 

carotid bifurcation, with good vascularization. The tumour blood markers 

came back negative. Surgical intervention was performed through an external 

approach and histological studies were conducted. 

RESULTS 

The tumour was well capsulated and separate from the carotid artery and 

the vagus nerve, deriving from the floor of the neck and the small nerve 

branches of the sympathetic chain. There were no surgical complications. 

Horner syndrome was not observed postoperatively. However, the child 

presented with first-bite syndrome six weeks after the surgery. The histology 

confirmed the diagnosis of benign schwannoma and the child was 

referred for genetic and radiologic investigation to rule out neurofibromatosis 

II (NF 2). 

CONCLUSIONS 

Sporadic sympathetic schwannomas are very rare pathologies in paediatric 

population. Surgical excision remains the standard treatment, while additional 

imaging studies and genetic screening for NF 2 mutations will 

be needed; first-bite syndrome may occur in such cases, postoperatively. 

P 365 

STRIDOR AND LINGUAL THYROGLOSSAL DUCT CYST 

IN A NEWBORN 

A. Aubin 1 , D. Bakhos 2 , S. Pondaven 1 , E. Lescanne 1 

1 CHRU Clocheville, ENT, TOurs, France 

E-MAIL: aubinalexandra@ahoo.fr 

2 CHRU Bretonneau, TOURS, France 

268 

INTRODUCTION 

Lingual thyroglossal duct cyst (LTDC) is an uncommon etiology of dyspnea 

in newborns. 

CASE REPORT 

A one month old girl had presented an inspiratory stridor with accessory 

muscles effort. This child was referred to our department for the management 

of a laryngomalacia. The dyspnea increasing with hypoxia, the child 

required endotracheal intubation and transfered in an intensive care unit 

(ICU). A round cyst with smooth surface was found at the base of the 

tongue with laryngoscopy. A cervical computed tomography revealed a 

well-circumscribed, round cyst with low intensity located at the base of 

the tongue. We had decided to perform marsupialization of the cyst by endoscopic 

management under general anesthesia. The histologic examination, 

had confirmed a LTDC. One year after the endoscopic treatment, 

there was no recurrence. 

CONCLUSION 

According to the literature the endoscopic management with marsupialization 

or puncture is an alternative to this rare cyst in newborns. 

P 366 

CONGENITAL NASAL PIRIFORM APERTURE STENOSIS: 

OUR EXPERIENCE 

V. Visvanathan, D.M. Wynne 

Royal Hospital for Sick Children, Glasgow, United Kingdom 

E-MAIL: vikranth@hotmail.co.uk 

INTRODUCTION 

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of 

neonatal upper airway obstruction. This study is to review the presentation 

and management of this uncommon condition in a tertiary paediatric 

ENT centre in Scotland, United Kingdom. 

METHODS 

Retrospective case series review. 

RESULTS 

A total of 10 cases were identified and 50% of cases were managed surgically. 

Surgical widening of the pyriform aperture was performed at an average 

14 days at birth. Associated malformations include holoprosencephaly, hypopituitarism, 

cardiac and urogenital malformations. 

CONCLUSION 

CNPAS is a treatable cause of upper airway obstruction. Early recognition 

is vital to appropriate management. Treatment is either conservative or 

surgical and depends on the severity of symptoms.

P 367 

AN UNUSUAL PRESENTATION OF ATRAUMATIC NASAL 

SEPTAL ABSCESS WITH COMMUNITY ACQUIRED MRSA 

G.H. Alokby 1 , M.M. Almohizea 2 , A.K. Alkurdi 3 , H.E. Aleid 3 

1 Riyadh Military Hospital, ENT, RIYADH, Saudi Arabia 

E-MAIL: galokby@hotmail.com 

2 King Saud University, RIYADH, Saudi Arabia 

3 King Abdulaziz Medical City, RIYADH, Saudi Arabia 

OBJECTIVE 

Nasal septal abscess usually forms following trauma and can cause multiple 

serious complications if not identified and treated urgently. Few cases 

of atraumatic nasal septal abscess are reported in the literature. We present 

a case of a neonate who presented with atraumatic nasal septal abscess and 

that had unusual presentation and complications. We aim to delineate 

the importance of recognizing nasal septal abscess as a possible cause of 

life threatening airway obstruction in neonates and we present a literature 

review of the management of this condition. 

METHODS 

A case report of a 50 day old boy who had a complicated course of atraumatic 

nasal septal abscess. The case report is followed by literature review 

about septal abscess and its possible complications in pediatric age group. 

RESULT 

The patient presented with signs of orbital cellulitis and had a rapidly deteriorating 

course that lead to upper airway obstruction due to nasal septal 

abscess. The patient was treated by incision and drainage of the abscess 

and Intravenous antibiotics and had a favorable course there after. 

CONCLUSION 

Nasal septal abscess is a rare medical entity with dire consequences. It is 

usually overlooked when no history of trauma exists. Therefore to prevent 

the development of functional, cosmetic and septic complications, nasal 

septal abscess should be suspected in all pediatric patients presenting with 

acute fever and nasal obstruction, with or without history of trauma. 

P 368 

SHOULD WE TREAT NEONATAL NASAL BIRTH TRAUMA? 

T. Deitmer 1 , A. Kiebler 2 

1 Klinikum Dortmund, Dept. ORL-HNS, DEITMER, Germany 

E-MAIL: deitmer@t-online.de 

2 Dept. Pediatrics, KLinikum Dortmund, DORTMUND, Germany 

OBJECTIVES 

Publications dealing with neonatal septal and/or nasal deviations are scarce. 

The overwhelming opinion is the recommendation of early treatment 

within the first days of life, whereas only few studies tend to a conservative 

treatment. Deviation may be only manifest to the septum, to the cartilagenous 

nose, or the the complete nose including the osseous parts. The deviation 

may be congenital or the circumstances of a complicated delivery and 

possible signs of hematoma or swelling point to trauma during delivery. 

An important aspect for therapeutic decision is nasal breathing of the 

neonate, who has obligate nasal breathing. With a child in respiratory distress 

due to nasal patency correction of the nasal airway is mandatory. 

METHODS 

Case report on a child after a complicated non-surgical delivery. The pediatrician 

saw a significantly deviated nose with swelling and hematomas 

obviously due to perinatal trauma to the nose. As there was no impaired 

nasal breathing and no difficulties in feeding we advised no surgical correction 

and could document during the next weeks an impressive spontaneous 

straightening of the complete cartilagenous nose. 

CONCLUSION 

The case report proves a high capability of the nasal structures of a newborn 

to help itself. Taking into account publications on this issue, we 

should tend to conservative treatment of neonatal nasal deviation, if the 

nasal function is not impaired. 

P 369 

NASOPHARYNGEAL ANGIOFIBROMA: CLINICAL FEATURES, 

TREATMENT AND OUTCOMES 

M. Iovanescu, G. Marin, S. Ruja, I. Horhat, F. Gidea, G. Vintila, 

C. Anglitoiu, F. Cotulbea 

University of Medicine and Pharmacy, TIMISOARA, Romania 

E-MAIL: giovanescu@gmail.com 

INTRODUCTION 

Nasopharyngeal angiofibroma (NAF), occurring mostly in young men, is 

histologically a benign tumor with aggressive clinical behaviour that includes 

repeated epistaxis and intractable nasal obstruction. 

MATHERIALS AND METHODS 

This paper reviews our experience regarding clinical features and the treatmentof 

NAF at ENT Department Timisoara. Nineteen patients with 

diagnosis of NAF from 1996- 2007 were included, and their clinical presentations, 

imaging studies, treatments and outcomes were retrospectively 

analyzed. The duration of symptoms in the current study was 8- 9 months. 

The current treatment modality was in all cases surgery. All patients underwent 

combined transpalatal or retropalatal and lateral rhinotomy approach. 

269

RESULTS 

in present series there were 3 recurrences due to failure in complete removing 

of the tumor. They were all reoperated by lateral rhinotomy approach 

and they are now free of disease. The follow up period was at least 

18 months for all patients, even for recurrences. 

CONCLUSIONS 

CT, MRI improve the patient evaluation and provide essential informations 

for the surgeon regarding the approach to use and improve the postoperative 

results. 

P 370 

FROM PURPURA TO A NASAL MASS: A NEW ASSOCIATION 

BETWEEN ROSAI-DORFMAN DISEASE AND HENOCH- 

SCHONLEIN-PURPURA 

G. Narasimhan, K. Davies, S. de, J. Mcpartland 




OBJECTIVES AND METHODS 

Rosai-Dorfman Disease(RDD) is a rare disorder characterised by an increased 

production of histiocytes. The most common accumulation is in 

the nodes of the neck however extra-nodal disease has been reported and 

is most prevalent in the upper respiratory tract and sinuses. We report the 

case of a 3-year-old girl who presented to her local hospital with Henoch- 

Schonlein-Purpura(HSP). Over the next six weeks she deteriorated with 

left nasal discharge and an expanding nasal mass. She had a CT scan and 

was referred to ourselves. We carried out a biopsy and the diagnosis of RDD 

was made. We carried out a thorough literature search to identify the current 

ideal management plan. 


MRI showed a mass occupying the left nasal space, extending into the 

maxillary antrum and the lamina papyracea which remained intact. It lay 

against the nasal septum causing deviation to the right. The left inferior 

turbinate had been destroyed. Histologically, there was a diffuse infiltrate 

of large histiocytic cells. Many cells were multi-nucleate and occasional 

emperipolesis was seen of both lymphocytes and granulocytes. Immunohistochemistry 

revealed the histiocytes to be positive for S100 and CD68. 

These findings were consistent with a diagnosis of Rosai-Dorfman disease. 

On discussion with the radiology department we organised an ultrasound 

scan to exclude any other lymphadenopathy. We then performed debridement 

of the nasal mass to improve her airway and symptoms. RDD has 

been reported to have links with other auto-immune conditions but an 

association with HSP has never been documented. 

270 

P 371 

UNEXPLAINED NEONATAL RESPIRATORY DISTRESS 

G. Narasimhan, R. Clarke, A. Kinshuck, J. Mcpartland 




Congenital tumours in neonates are rare and it is even more unusual to 

be found in the nasopharynx, however it still needs consideration as a possible 

cause of airway obstruction. A five day old girl presented with airway 

obstruction and noisy breathing and oxygen desaturation from birth. After 

ruling out choanal atresia, her irritable neurological signs, led to her having 

a Magnetic Resonance scan of the brain, which incidentally picked up 

a large nasopharyngeal mass as the possible cause. 

RESULTS 

Magnetic resonance scans revealed a Nasopharyngeal mass with high signal 

on T1 weighted images suggestive of a teratoma; it also clearly confirmed 

the absence of any intracranial connection. There were ischaemic 

changes noted in both cerebral hemispheres. An examination under anaesthetic 

of the nasopharynx was performed under mirror vision Trans orally; 

the mass was found attached to the posterior septum and was carefully 

removed with blunt dissection in toto. The procedure was uneventful; she 

was discharged home the following day. She was reviewed six weeks hence, 

and is making excellent progress. On histopathological examination, complete 

removal was confirmed; the mass included the presence of ectoderm, 

mesoderm, and endoderm components, without immature or malignant 

elements, consistent with a benign congenital teratoma. 

CONCLUSION 

This case report reminds us of rare causes of airway obstruction in 

neonates. In the reviewed literature congenital hairy polyps which are dermoids 

of the nasopharynx are considered to be more common than teratomas 

although both are very rare, the most common presenting feature 

is respiratory distress 

P 372 

EXPERIENCE IN NASAL PIRIFORM PERTURE STENOSIS 

TREATMENT 

G.E. Marrugo Pardo 

Universidad Nacional de Colombia-Fundacion Hospital de la 

Misericordia, Cirugia-ORL, BOGOT, Colombia 

E-MAIL: gemarrugop@hotmail.com

OBJECTIVES 

Review the diagnosis and treatment of patients with Nasal Piriform Aperture 

Stenosis at the Fundación Hospital de la Misericordia - Universidad 

Nacional de Colombia. 

METHODS 

Revision of medical history of patients with this condition between July 

2009 and November 2010. 

RESULTS 

The youngest of the six treated patients, was ten days old when diagnosed 

and the oldest one three months. Three male patients, two had other associated 

conditions. Breathing and feeding difficulty where the main 

symptoms. The Paranasal Sinuses computed tomography (CT) was the test 

that best showed the disease. The surgical technique used is described and 

a follow-up is done between two and twenty-seven months after surgery. 

CONCLUSIONS 

Nasal Piriform Aperture Stenosis is an infrequent disorder which diagnosis 

and successful treatment are challenging for the Paediatric Otorhinolaryngologist. 

P 373 

CONGENITAL NASAL MASS: NASAL POLYP 

B. Kapucu, M. Keles, A. Bolat, G. Ozkan 

Tatvan Military Hospital, ORL, BITLIS, Turkey 

E-MAIL: burakkapucu@yahoo.com 

A new-born boy presented at our hospital with inspiratory stridor during 

feeding and nasal block. Endoscopic examination revealed congenital nasal 

mass in both nasal cavity which were pinkish globular with smooth surface. 

Right nasal cavity was completely closed and there was almost complete 

obstruction on the left side. Nasal continuous positive airway 

pressure (CPAP) had used for the respiratory care of the patient. Nervous 

system connection was considered because of the presence of congenital 

intracranial central pathologies in his sister. Computed tomography (CT) 

study of the basal cranium found no apparent bony defect at the base of 

the anterior cranial fosse or the sellar floor and revealed mass lesions located 

in the anterior region of both nasal cavities. Prednisolone (1 mg\kg) 

was used to relieve possible edema and respiratory distress and thus provided 

partially relaxation of the patient’s complaints. Surgical resection 

planned under the guidance of a pediatric endoscope but the mass on the 

left was thrown out with sneezing and the patient showed remarkable 

improvement in respiratory function. Histopathological examination was 

consistent with nasal polyp. Regression of the mass located in the right 

nasal cavity was observed within 1 week. At the end of 6-month followup, 

no sign of nasal polyp recurrence was noted. 

P 374 

NASAL GLIOMA. A CASE REPORT 

M. Kotoula 1 , A. Magganaris 1 , A. Kioutsouki 1 , E. Berovali 1 , N. Mpenis 2 , 


1 Hippokratio General Hospital, ENT Department, THESSALONIKI, 

Greece 

E-MAIL: mariakotoula 5 @hotmail.com 


Greece 

OBJECTIVE 

Congenital midline nasal masses are rare congenital anomalies, estimated 

to occur in 1:40,000. Nasal gliomas account for approximately 5% of all congenital 

nasal swellings. They usually manifest either as an extranasal (60%), 

an intranasal (30%), or a combined (10%) lesion. 

METHODS 

We present a case of a thirteen-month-old male baby with unilateral nasal 

obstruction since birth. The mother had also noticed a progressively increasing 

distance between both medial canthi. The patient underwent 

nasal endoscopy and MRI. 

RESULTS 

Clinical examination revealed a reddish, polypoidal mass medial to the 

middle turbinate and an MRI confirmed the presence of a relatively homogeneous 

intranasal mass in the left nasal cavity causing lateral displacement 

of the left middle turbinate and medial displacement of the nasal 

septum, without any intracranial connections. The mass was completely 

resected through a limited lateral rhinotomy approach (Moore incision). 

Histopathology of the specimen indicated a nasal glioma. MRI at 6 months 

follow-up revealed an intranasal mass with similar radiographic characteristics 

to the primary lesion. Subsequently, the patient underwent a 

more extended lateral rhinotomy (Ferguson).However, the histopathology 

report ruled out the presence of recurrent or residual disease. 

CONCLUSION 

Nasal gliomas are rare clinical entities, which necessitate detailed radiological 

evaluation pre-operatively. MRI is considered the test of choice for 

determining intracranial soft tissue connections as well as for identifying 

residual disease or recurrence on post-operative follow-up. Although MRI 

provides better soft tissue detail, it requires experience and deep knowledge 

in order to distinguish normal from pathological tissue at the early 

follow-up. 

271

P 375 

CONGENITAL LOBULAR CAPILLARY HEMANGIOMA 

OF THE NASAL CAVITY OF AN INFANT: CASE REPORT 

OF A RARE PRESENTATION 

I. Correia 1 , H. Sousa 1 , I. Cunha 1 , V. Sousa 2 , L. Monteiro 1 

1 Dona Estefânia Pediatric Hospital, Centro Hospitalar Lisboa Central, 

Otorhinolaringology, LISBON, Portugal 

E-MAIL: isabelmcorreia@gmail.com 

2 S. José Hospital, Centro Hospitalar Lisboa Central, LISBON, Portugal 

OBJECTIVES 

To report an occurence of a lobular capillary hemangioma of the nasal cavity 

in a 54-days-old child. 

METHODS 

A retrospective case review of an infant presenting at our tertiary care pediatric 

hospital with a mass of the nasal cavity. 

RESULTS 

This is a review of the history of a 54-days-old child with severe nasal obstruction 

caused by a mass of right nasal cavity. He had difficulty breathing 

since birth, which had been progressively worsening. The right nasal 

cavity mass had increased in size since birth and was responsible for 

bulging of the right side of nasal pyramid and periorbital edema. After removal 

of the mass through endonasal surgery with endoscopic control, it 

was diagnosed as lobular capillary hemangioma. 

CONCLUSIONS 

Lobular capillary hemangioma of the nasal cavity is rare, and even rarer 

in children. The authors found very few reports in the literature of this 

histological diagnosis in the nasal cavity in children, and only one was 

congenital. Although rare, lobular capillary hemangioma must be included 

in the differential diagnosis of nasal cavity masses in the infant 

population. 

P 376 

NASOPHARYNGEAL HAMARTOMA IN A FIVE MONTHS OLD 

PREMATURE PATIENT: A CASE REPORT 

N. Snovak, D. Markov Glava , E. Kli eska 

University Hospital Center Zagreb, Otorhinolaryngology, Head and 

Neck Surgery Department, ZAGREB, Croatia 

E-MAIL: natalija.snovak@gmail.com 

OBJECTIVES 

The term hamartoma refers to an excessive, focal overgrowth of cells and 

tissues native to the organ in wich it occurs. Nasopharyngeal hamartoma 

272 

is uncommon benign developmental malformation and can be divided 

into two types based on the histologic presentation. A more common type 

is composed predominantly of mesodermal tissues (bone, cartilage, muscle, 

connective tissue etc.) while a less common type is composed of a spectrum 

of mucosal epithelial, serous/mucinous gland, and stromal elements. 


We present a case of nasopharyngeal hamartoma in a five months old premature 

patient. The patient was born on 28th week of pregnancy and was 

treated in neonatology department. Because of unexplained respiratory 

insufficiency, further investigation was necessary. Nasal endoscopy 

showed a mass which partially obstructed nasopharynx. MR and CT scan 

were performed preoperatevely. The mass was resected endoscopically and 

confirmed histologically as a hamartoma. 

CONCLUSIONS 

Nasopharyngeal hamartoma is rare, but benign lesion and in this particular 

case was hard to diagnose it because the patient was premature with 

respiratory distress and was mechanically ventilated immediately after 

birth which was leading us to search for the cause of hypoxia at the other 

level. Thorough clinical evalutation is necessary in every patient with unclear 

respiratory insufficiency. 

P 377 

ADENOIDECTOMY IN CHILDREN UNDER 12 MONTHS: 

A 10 YEAR REVIEW 

P. Doody, T.S. Ahmed, H. Daya 



E-MAIL: m1002183@sgul.ac.uk 

OBJECTIVES 

To identify characteristics of children aged 12 months or below requiring 

adenoidectomy and examine post-operative patient outcomes. 

METHODS 

All children aged 12 months or below undergoing adenoidectomy between 

2001 and 2011 at St George’s Hospital, London were identified from clinical 

coding databases. A retrospective chart review was performed and data including 

patient demographics, mode of presentation, clinical investigations 

and underlying diagnoses were extracted. Information was also collected regarding 

their perioperative hospitalisation and clinical outcome. 

RESULTS 

Nine children (mean age 9.4 months, range 7-11 months) underwent adenoidectomy 

over this period for significant nasal obstruction. All patients 

were male and the majority (44.4%) were of Black Caribbean origin. Mean 

weight was 8.95 Kg. Two patients had other comorbidities (Sickle cell disease 

and Down syndrome). Most of the children were referred electively

to outpatient clinics by their general practitioner. Examination of the postnasal 

space with a paediatric nasendoscope was performed in clinic in 

5 cases (55.5%). All adenoidectomies were performed using suction 

diathermy. Post-operatively two thirds of the group were hospitalised 

overnight on a ward, one patent was admitted to a paediatric intensive 

care unit and two were discharged home on the same day. 

CONCLUSIONS 

Adenoidectomy is an effective treatment of a number of upper respiratory 

tract conditions in children aged 12 months or below (67% improvement 

rate in this series). Our results would suggest that there is no significantly 

increased risk of perioperative morbidity or complications in this age 

group in appropriately-selected individuals. 

P 378 

BILATERAL CHOANAL ATRESIA AND MCADD, AN 

ASSOCIATION OR COEXCISTENCE: A CASE REPORT 

C.A. Paul, J.D. Ramsden, P. Mazaheri 

John Radcliffe Hospital, Department of Otolaryngology & Head & Neck 



OBJECTIVES 

Congenital choanal atresia is a rare malformation with an incidence of 1 

in 7000 to 8000 live births and was first described by Johann Roederer in 

1755. Most cases of choanal atresia are isolated malformations, but association 

with other congenital deformities is not an exception, as in the 

CHARGE association. Medium Chain Acyl Dehydrogenase Deficiency 

(MCADD) is a rare inherited disorder dictated during neonatal screening. 

METHODS 

Female baby born at 35 weeks of gestation to non-consanguineous Caucasian 

parents developed respiratory distress needing resuscitation and 

was found to have bilateral chaonal atresia and CT scanning confirmed 

the diagnosis. Patient was also found to have MCADD on neonatal screening 

test. 

RESULTS 

Baby had endoscopic repair of choanal atresia with bilateral stenting. 

MCADD was managed conservatively by the Paediatricians. 

CONCLUSION 

Congenital chaonal atresia has been described in association with various 

congenital anomalies. In this report we present a case of isolated choanal 

atresia with MCADD, an association that has not been reported previously. 

P 379 

MANAGEMENT OF CHOANAL ATRESIA CORRECTION. 

10 YEARS OF EXPERIENCE 

A. Kioutsouki 1 , M. Kotoula 2 , H. Karasmanis 1 , A. Dritsoula 2 , A. Skouras 2 , 


1 Hippokratio General Hospital, ENT Department, THESSALONIKI, 

Greece 

E-MAIL: mariakotoula5@hotmail.com 


Greece 

OBJECTIVE 

Choanal atresia is a congenital anomaly that occurs in about 1:7000 livebirths 

with a female predominance.It can be unilateral or bilateral but the 

second one considered life threating disorder. Anatomically, atresia can 

be bony and/or membranous. 

METHODS 

A retrospective review was conducted in 20 children who underwent 

choanal atresia correction between 2001 and 2011. A CT scan of the choanae 

was requested routinely. A 0°and a 120° Hopkins rod telescope used to visualize 

the atretic plate from the nasopharynx. Straight urethral sounds 

were used to perforate the thin central component of the atresia followed 

by use of an air drill to remove the bony component . After completion of 

surgery, mitomycin was applied to the neochoanae and Portex endotracheal 

tube was inserted into each nostril. The stents were removed 4-6 

weeks after surgery. 

RESULTS 

Fourteen had bilateral lesions and six were unilateral. For both groups, 

females were more likely to be affected [bilateral: 57,14%, unilateral: 83,3%). 

A review of CT examinations revealed that the majority of atresias are 

mixed bony/membranous.The mean age at time of initial surgery, for 

bilateral and unilateral atresia patients was 8.2 days and 15.25 years respectively. 

The average number of procedures necessary to reach an asymptomatic 

state was 2.56. No severe complications was observed in relation with 

operation. 

CONCLUSION 

For choanal atresia patients, a standard management protocol does not 

exist. The transnasal approach under endoscopic control , in combination 

with the perioperative use of mitomycin, have a satisfactory outcome in 

most of the cases. 

273

P 380 

RESPIRATORY DISTRESS SYNDROME OF NASAL ORIGIN IN 

NEONATE: A RETROSPECTIVE REVIEW 

S. Pondaven Letourmy, A. Aubin, M. Chenebaux, M. Al Zahrani, 

E. Lescanne 

Hopital Clocheville CHU de Tours, Paediatric ENT, TOURS, France 

E-MAIL: pondaven@med.univ-tours.fr 

OBJECTIVE 

To examine the aetiology of respiratory distress of nasal origin in newborn 

taken care in our paediatric ENT unit during the last 10 years. 

METHODS 

It’s a retrospective review of all neonate referred to our paediatric ENT department 

from January 2001 to December 2011. Neonate rhinitis is excluded. 

RESULTS 

A total of 17 cases were identified (9boys and 8 girls). The causes of respiratory 

distress were as follows: bilateral choanal atresia in 8 cases (4 

CHARGE association), congenital nasal pyriform aperture stenosis in 5 

cases (3 with single maxillary central incisor), nasal cavity stenosis in 2 

cases, one case of nasolacrimal duct cyst and one tumor (glioma). sixteen 

babies needed a surgical treatment. The bilateral choanal atresias were all 

done transnasally while the congenital nasal pyriform aperture stenosis 

by sublabial approach. The mean age of the surgical procedure is 4 days 

for bilateral choanal atresia and 4 weeks for congenital nasal pyriform aperture 

stenosis. Babies with CHARGE syndrome needed more surgical procedure 

than non-CHARGE babies. 

CONCLUSION 

In our experience the most common nasal aetiology of respiratory distress 

in neonate (excluding rhinitis) is bilateral choanal atresia. Fifty percent of 

them were CHARGE association. These results are in accordance with the 

data of literature. Four out of five congenital nasal pyriform aperture 

stenosis required surgery. We believe that only severe cases were referred 

to us and probably some cases were misdiagnosed because they improved 

with medical treatment of nasal rhinitis. 

274 

P 381 

MIDDLE EAR MUCOSA EXPRESSION OF TLR 2 AND TLR 4 IN 

CHILDREN WITH ACUTE MATOISDITIS AND CHRONIC OTITIS 

S. Jesic 1 , A. Jotic 2 , N. Tomanovic 1 

1 School of Medicine,University of Belgrad, Clinic for 

Otorhinolaryngology and MF surgery, Clinical Centre of Serbia, 

BEOGRAD, Serbia 

E-MAIL: xeniam@sezampro.rs 

2 Clinic for Otorhinolaryngology and MF surgery, Clinical Centre of 

Serbia, BEOGRAD, Serbia 

OBJECTIVE 

To investigate expression of Toll like receptors (TLR) 2 and 4 in inflamed 

middle ear mucosa of children with acute and chronic middle ear disease. 

METHOD 

Middle ear mucosa paraffin tissue section of 21 children operated due to 

acute mastoiditis, cholesteatoma and tubotympanic otitis underwent immunohistochemical 

evaluation using policlonal antibodies for TLR 2 and 

4, dilution 1: 100, and specific blocking peptides.Cytoplasmic immunohistochemical 

reaction was considered as positive. Cappillary leukocytes 

served as positive control. Negative control was performed by leaving out 

the primary antibody during the staining procedure. Semiquantitative 

method for determination the percentage of positive cells on a x 100 magnification 

was used; negative: up to 3% (0), slight: 3-33% (1), moderate: 34- 

66% (2) and strong: more than 66% (3) of cells in the examined area. Median 

and Wilcoxon tests were used in statistical analysis. 

RESULTS 

There was no difference in mucosa TLRs expression between acute and 

chronic ear inflammation (Chi=.02, p>.05). The expression of both TLRs 

was lower in edema and polyps as less intensive mucosal changes than in 

granulation tissue (Chi =14.09, p.05). 

CONCLUSION 

Middle ear mucosa in acute and chronic infection showed similar characteristic 

in immunologic recognition of bacterial antigens. The expression 

of TLR2 and 4 receptors is the highest in cholesteatoma perimatrix and 

granulation tissue of acute mastoiditis. Is it reflection of intensive or depressed 

mucosal immunoreactivity has to be investigated?

P 382 

ETIOLOGICAL FACTORS IN THE ORIGIN OF CONGENITAL 

ABNORMALITIES OF THE EXTERNAL EAR 

L. Paput 1 , D. Dános 2 , F. Bánhidy 2 , A.E. Czeizel 3 

1 Military Hospital - State Health Centre, ORL - Head and Neck 

Surgery, DISD, Hungary 

E-MAIL: paputlaszlo@freemail.hu 

2 Semmelweis University, BUDAPEST, Hungary 

3 Foundation for the Community Control of Hereditary Diseases, 

BUDAPEST, Hungary 

OBJECTIVES 

The aim of this study was to scrutinize the origin of congenital abnormailities 

(CAs) of the external ear - in order to advence their prevention. 

METHODS 

We intended to describe the etiological factors of the Hungarian cases born 

with isolated or multiplex-syndromic external ear abnormalities on the 

basis of our case-control studies relying on the internationally outstanding, 

population-based, homogenous dataset of Hungarian Case-Control 

Surveillance of Congenital Abnormalities (from 1980 to 1996). We evaluated 

the unspecified multiplex congenital abnormalities comprising micotia/ 

anotia in order to define the characteristic patterns of other (associated) 

CA components. We studied the possible genetic and teratogenic causes 

of external ear abnormalities, as well as the coherence between diseases of 

mothers as well as their medication during pregnancy and the increased 

risk of external ear CA formation in their children. 

RESULTS 

Isolated external ear CAs are more frequent in the children with higher 

birth order and of mothers with worse social status. Isolated external ear 

CAs have a multifactorial origin (interaction of polygenic dispositions and 

inducing noxas). Maternal diseases associated with high fever - mainly 

seasonal influenza and coryza with secondary complications play role in 

the origin of isolated external ear CAs. Oral hydroxyethylrutosidea therapy 

during the critical period of ear CAs raised 9 times greater the risk of specific 

multiplex CAs. Moreover, pregnancy planning women who did not 

have chicken-pox before, should be advised to be given varicella-vaccination 

in order to prevent multiplex ear CAs caused by diseases during the 

pregnancy. 

P 383 

A COMPREHENSIVE INTRODUCTION TO THE GENETIC 

BASIS OF NON-SYNDROMIC HEARING LOSS IN THE SAUDI 

ARABIAN POPULATION 

K.H. Taibah 1 , F.I. Imtiaz 2 , M. al Owin 2 

1 ENT Medical Center, Otolaryngology, RIYADH, Saudi Arabia 

E-MAIL: ktaibah@gmail.com 

2 King Faisal Specialist Hospital & RC, RIYADH, Saudi Arabia 

OBJECTIVES 

Hearing loss is a clinically and genetically heterogeneous disorder. Mutations 

in the DFNB1 locus have been reported to be the most common cause 

of autosomal recessive non-syndromic hearing loss worldwide. Apart from 

DFNB1, many other loci and their underlying genes have also been identified 

and the basis of our study was to provide a comprehensive introduction 

to the delineation of the molecular basis of non-syndromic hearing 

loss in the Saudi Arabian (SA) population. This was performed by screening 

DFNB1 and to initiate prioritized linkage analysis or homozygosity mapping 

for a pilot number of families in which DFNB1 has been excluded. 

METHODS 

Individuals from 130 families of SA tribal origin diagnosed with an autosomal 

recessive nonsyndromic sensorineural hearing loss were screened 

for mutations at the DFNB1 locus by direct sequencing. 

RESULTS 

Our results strongly indicate that DFNB1 only accounts for 3% of non-syndromic 

hearing loss in the SA population of ethnic ancestry. Prioritized 

linkage analysis or homozygosity mapping in five separate families established 

that their hearing loss was caused by five different known-deafness 

causing genes thus confirming the genetic heterogeneity of this disorder 

in the kingdom. 

CONCLUSION 

The overall results of this study are highly suggestive that underlying molecular 

basis of autosomal recessive non-syndromic deafness in SA is very 

genetically heterogeneous. In addition, we report that the preliminary results 

indicate that there does not seem to be any common or more prevalent 

loci, genes or mutations in patients with autosomal recessive 

non-syndromic hearing loss in patients of SA tribal origin. 

275

P 384 

GENETIC HEARING IMPAIRMENT IN A PORTUGUESE 

PEDIATRIC COHORT 

J. Araújo Martins, I. Correia, R. Ferreira, P. Brazão Santos, R. Gonçalves, 

S. de Almeida, L. Nunes, L. Monteiro 

Centro Hospitalar de Lisboa Central, Otorrinolaringologia, LISBOA, 

Portugal 


AIM 

The burden of genetic hearing impairment and prevalence of specific 

causes varies greatly among populations. Genetic diagnosis is important 

for treatment plans, follow-up and counseling. Optimized testing protocols 

are critical for proper resource management. 

OBJECTIVES 

To determine the prevalence of genetic causes of hearing impairment in 

children followed in an auditory rehabilitation clinic in Lisbon; to determine 

the best genetic testing sequence. 

METHODS 

A retrospective cohort study using data obtained from clinical files of children 

followed in the auditory rehabilitation clinic and genetics clinic in 

Hospital Dona Estefânia (Lisbon). Informed consent was obtained for all 

children tested and a step-by-step genetic testing protocol was used. 

RESULTS 

From a total of 322 children, 134 (41,6%) were tested for genetic causes of 

hearing impairment. In 73 cases (54,5%) it was not possible to find any genetic 

cause for the hearing loss, 32 (23,9%) had non-syndromic genetic hearing 

impairment and 29 (21,6%) had syndromic hearing impairment. The 

c.35delG mutation in GJB2 gene was the most frequent finding (17 patients) 

and Down and CHARGE syndromes accounted for almost half of 

syndromic cases. 

CONCLUSION 

In selected children, genetic testing offers a high diagnostic yield. In our 

cohort, c.35delG mutations makes GJB2 the best target for genetic testing. 

The prevalence of syndromic cases justifies the need for multidisciplinary 

centers when providing care for hearing impaired children. 

276 

P 385 

IDENTIFICATION OF A LARGE DELETION OF THE GENE KAL1 

IN TWO BROTHERS WITH SENSORINEURAL HEARING LOSS 

S. Marlin 1 , S. Chantot 2 , N. Loundon 3 , A. David 4 , F. Denoyelle 3 , 

M.F. Portnoi 3 , L. Jonard 3 , M. Louha 3 , S. Gherbi 3 , C. Bonnet 3 , J.P. Siffroi 3 , 

N. Garabédian 3 


PARIS, France 


2 Hôpital Trousseau, PARIS, France 


4 CHU, NANTES, France 


Two brothers, aged 9 and 14, have a sensorineural hearing loss associated 

with signs that suggest a Kallmann syndrome: unilateral renal agenesis, 

cryptorchidism, hyposmia and mirror movements. 

RESULTS 

The deafness found in both boys is sensorineural and prelingual but vary 

in severity from one form to profound unilateral bilateral. Temporal CTscan 

is normal. A wide KAL1 gene deletion was identified by array CGH in 

both cases and a somatic mosaicism was diagnosed in their asymptomatic 

mother. 

CONCLUSION 

Kallmann syndrome usually diagnosed in case of an anosmia associated 

to a hypogonadotropic hypogonadism. To date, five genes have been identified 

in Kallmann syndrome: KAL1, located on chromosome X and FGFR1, 

FGF8, PROKR2, PROK2 involved in the autosomal forms of the disease. 

The X-linked form of this syndrome appears to be the most common. Several 

clinical signs allow suspecting this diagnosis in case of a boy with a 

sensorineural hearing loss: renal aplasia, cryptorchidism, mirror movements, 

abnormal eye movements, hyposmia and a delayed puberty. The 

absence of malformations of the semicircular canals can differentiate a 

Kallmann syndrome a syndrome CHARGE association to deafness and agenesis 

of the olfactory bulbs. The evidence of the mosaic deletion in the 

mother of two boys modifies the genetic counseling in of a case ‘sporadic’ 

Kallmann’s syndrome with abnormal KAL1 gene.

P 386 

IDENTIFICATION OF TWO NOVEL MUTATIONS IN GATA3 

GENE IN PATIENTS WITH HDR SYNDROME 

S. Marlin 1 , M. Louha 2 , L. Jonard 2 , V. Drouin Garraud 3 , B. Letavernier 4 , 

A. David 5 , S. Gherbi 2 , R. Couderc 6 , N. Garabédian 2 , F. Denoyelle 2 


PARIS, France 



3 Service de Génétique, ROUEN, France 

4 Unité de Néphrologie, PARIS, France 

5 CHU, NANTES, France 

6 Service de Biochimie, PARIS, France 

HDR is a rare autosomal dominant congenital disorder characterized by 

hypoparathyroidism, sensorineural deafness and renal dysplasia. This 

triad of symptoms does not occur in all patients. Indeed, renal abnormalities 

are heterogeneous with variable penetrance. HDR is caused by mutations 

in the GATA3 gene that belongs to a family of dual zinc-finger 

transcription factors that play a critical role in embryonic development. 

So far, various HDR-associated GATA3 mutations occurring throughout 

the gene have been reported. 

We have investigated two HDR probans and their families for GATA3 abnormalities 

and have identified two novel intragenic deletions. 

The first patient was born with upper eyelid agenesis and was diagnosed 

as having hypoparathyroidism, bilateral sensorineural deafness and kidney 

hypoplasia. Sequence analysis of GATA3 demonstrated a heterozygous 

deletion c.807_812del (p.Ser271_Thr272del) in the zinc finger1 (ZnF1), 

which is essential to stabilize the C-terminal zinc finger2 (ZnF2) DNA 

binding and interacts with other zinc finger proteins, such as the friends 

of GATA (FOG). Both parents did not have the mutation suggesting that 

the p.Ser271_Thr272del arose de novo. 

The second patient was diagnosed with PTH-deficient hypoparathyroidism, 

bilateral sensorineural deafness and cataract. Direct sequencing 

of GATA3 revealed the presence of a frameshift deletion, c.630_636del, that 

introduces a premature stop codon (p.Ala211Argfs*53) and resulting in the 

loss of the nuclear localization signal of GATA3. This mutation was present 

in his two affected children as well. 

In conclusion, we have identified two novel mutations of the GATA3 gene, 

associated with HDR syndrome, widening the spectrum of GATA3 mutations 

that cause this disease. 

P 387 

CONGENITAL DISORDERS OF THE MIDDLE EAR: 

TWO CASES OF OVAL WINDOW APLASIA 

C. Reis 1 , M. Coutinho 2 , J. Gameiro Dos Santos 3 , C. Almeida E Sousa 3 

1 Oporto Hospital Center, PORTO, Portugal 

E-MAIL: Claudiapintoreis@gmail.com 

2 Maria Pia Children’s Hospital - CHP, PORTO, Portugal 

3 Hospital Santo António, PORTO, Portugal 

OBJECTIVES 

Conductive hearing loss in children is in most cases acquired, being the 

otitis media with effusion the most common etiology. However, in some 

cases the cause is congenital, ranging from severe deformities of the external 

and middle ear to isolated ossicular abnormalities. The latter are 

very uncommon and their diagnosis is often delayed. 

METHODS 

The purpose of this presentation is to describe two cases of bilateral oval 

window aplasia, the most infrequent congenital anomaly of the ossicular 

chain according to Cremers’ classification. The literature respecting middle 

ear malformations and their management is also reviewed in this presentation. 

RESULTS 

In both cases, the diagnosis was made at age six and confirmed by high 

resolution computed tomography scanning. The absence of oval window 

was associated with a hypoplastic stapes and facial nerve anomaly, which 

suggests a deficiency in second branchial arch development. One of the 

children was otherwise healthy and with no relevant medical history. The 

other child presents a variety of malformations, including tracheal stenosis, 

cervical aortic arch and interauricular communication. They were both 

successfully rehabilitated by hearing aids (in one case conventional and 

in the other bone-anchored). 

CONCLUSION 

Congenital disorders of the middle ear are rarely the cause of a conductive 

hearing loss in children but are frequently overlooked, especially if not associated 

with external ear malformations, which may delay the diagnosis 

and proper management of these children. 

277

P 388 

CONDUCTIVE HEARING LOSS IN BETA-THALASSEMIA 

A. Pereira Da Silva 1 , M. Coutinho 2 , T. Feliciano 1 , C. Almeida E Sousa 1 

1 Centro Hospitalar do Porto, Serviço de Otorrinolaringologia e 

278 

Cirurgia Cérvico-facial, PORTO, Portugal 

E-MAIL: anacostapsilva@gmail.com 

2 Hospital de Crianças Maria Pia, Centro Hospitalar do Porto, PORTO, 

Portugal 

OBJECTIVES 

Beta-thalassemia is an autossomic recessive disorder characterized by a reduced 

or absent synthesis of the hemoglobin subunit beta, resulting in a 

microcytic hypochromic anemia. Chronic anemia is known to increase ineffective 

erythropoiesis with resultant bone deformities. This paper aims 

to discuss the possibility of conductive hearing loss caused by these bony 

alterations. 

METHODS 

Discussion of 2 case reports of beta-thalassemia patients with conductive 

hearing loss along with a review of the published literature on auditory 

involvement in beta-thalassemia. 

RESULTS 

This study describes the clinical cases of 2 young individuals with betathalassemia 

minor and intermedia presented with a conductive hearing 

loss. CT scans showed a possible osteolyses of the incus long crus on the 

first case and no relevant abnormalities on the second case. In the scarce 

existent literature we can found other case reports that reveal conductive 

hearing loss despite a normal tympanogram. 

CONCLUSION 

More research on this topic is necessary to identify the real effects of bony 

alterations caused by beta-thalassemia in the middle ear ossicular chain. 

P 389 

THE P.V37I EXCLUSIVE GENOTYPE OF GJB2: A GENETIC 

RISK-INDICATOR OF POSTNATAL PERMANENT CHILDHOOD 

HEARING IMPAIRMENT 

L. Li 

Xinhua hospital,Otolaryngology Head & Neck Surgery, SHANGHAI, 

China 


OBJECTIVES 

To identify a genetic indicator of risk for permanent childhood hearing 

impairment (PCHI). 

METHODS 

45 unrelated Chinese subjects with confirmed or suspected postnatal PCHI 

and 1677 subjects from all stage of hearing screen were recruited. GJB2 mutation 

screening of the subjects was performed by PCR amplification and 

bidirectional sequencing as previously described. 

RESULTS 

The p.V37I exclusive genotype (V37I/V37I, V37I/del) of GJB2 was present in 

3 (21.4%) of 14 children with confirmed postnatal PCHI and in 6 (19.4%) of 

31 children with suspected postnatal PCHI. In contrast, this genotype was 

present in only 6 (0.4%) of the 1516 control Chinese newborns; In the hearing 

screen group, the p.V37I exclusive genotype present: 0.14% (2/1405) of 

control newborns who passed the initial screen; 2.0% (2/99, P = 0.024) of 

newborns who failed the initial screen but passed a repeat screen; and 5.8% 

(10/173, P = 1.7 10-8) of newborns who failed both screens but were diagnosed 

with normal hearing on the referral evaluation. 

CONCLUSIONS 

Based on our studies, we propose that genetic testing for the GJB2 p.V37I 

exclusive genotype is warranted in Asian newborns who fail at least one 

newborn hearing screen. Continued audiologic monitoring should be offered 

to children who carry this genetic variant to facilitate prompt detection 

and intervention of postnatal PCHI. 

P 390 

ETHICAL CONSIDERATIONS ON NEONATAL GENETIC 

HEARING SCREENING 

L. Radulescu 

ROMANIA 

E-MAIL: lmradulescu@yahoo.com 

OBJECTIVE 

The present paper would like to open a debate concerning the recent opportunities 

which have made possible the early genetic diagnosis and the 

treatment of deafness with the cochlear implant, the use of cochlear implant 

leading to the eradication of deafness (as a disability) and therefore, 

to the disappearance of the deaf culture. 

METHODS 

The paper discusses the ethical problems linked to the use of genetic 

screening in the diagnosis of the hearing loss. 

RESULTS 

Development of speech was one of the elements which determined the 

evolution of the human being as an individual and as a member of a society. 

Normal hearing at birth is a prerequisite to acquire speech.

CONCLUSIONS 

To forbid or determine (at request) the birth of a deaf child, to consider 

deafness to be a culture or a disability, to require the informed agreement 

for genetic screening are the ethical dilemmas approached in this paper; 

it is also an analysis of these facts from the point of view of the deaf community 

and of the people with normal sense of hearing. 

P 391 

SAFETY OF COBLATION TONSILLECTOMY AFTER COCHLEAR 

IMPLANTATION 

S.L. Ishman 1 , J.R. Benke 1 , H.W. Francis 1 , S.P. Bowditch 1 , J.K. Niparko 1 , 

D.J. Brown 2 

1 Johns Hopkins School of Medicine, Department of Otolaryngology - 

Head and Neck Surgery, BALTIMORE, USA 

E-MAIL: sishman1@jhmi.edu 

2 University of Michigan, ANN ARBOR, USA 

OBJECTIVE 

While a cadaveric animal study has suggested that coblation can be safely 

used in patients with cochlear implants, no in vivo studies have been published 

to confirm that coblation does not alter the integrity of the cochlear 

implant device. 

METHODS 

Cochlear prosthesis function and subject performance was studied 

through prospective case series of 16 or 22 channel impedance testing 

(kOhms) in five children with six functioning multichannel implants before 

and after a coblation adenotonsillectomy. 

RESULTS 

There were 4 female and 1 male patient, aged 6 to 10 years (mean 8.5 years, 

sd 1.95) with 6 functioning implants. The overall mean impedance was 

unchanged following tonsillectomy at 8.90 before and 8.90 kOhms after 

surgery (p= 0.10). Paired evaluation of each implant before and after adenotonsillectomy 

revealed no significant difference (p= 0.052-0.999) in 4 of 

6 implants. For the last 2 implants, the impedance values were significantly 

improved after surgery but the changes were not clinically significant 

(mean change of 0.5-0.6KOhms) and were well within the range of 

normal values (p=0.009 & p

P 393 

RECONSTRUCTION OF THE INCUDO-STAPEDIAL JOINT 

IN CHILDREN 

M. Porowski, H. Skarzynski, M. Mrowka, P. Mlotkowska-Klimek, 




E-MAIL: m.porowski@ifps.org.pl 

OBJECTIVE 

Postimflammatory damages of the middle ear conductive apparatus in 

the area of the incudostapedial joint are one of the largest and, in spite of 

the age diversification (younger or older children) the group is rather homogenous. 

The aim of this paper is analysis of results of hearing improving 

surgeries in cases of hearing loss caused by damages of conductive 

apparatus in the incudostapedial joint area in children. 

METHOD 

Analysis was performed in the group of 1,536 ears with changes in the incudostapedial 

joint, operated in years 1999-2011. Most damages was resulting 

from chronic otitis media. Reconstructive surgeries were 

performed using autogenous (incus interposition) or allogenous (glassionomer 

cement, various prostheses) materials. Auditory results were assessed 

following the standard of the Institute after 1, 3, 6 months, 1 year 

and after 2 and 3 years, in some cases also after 4 and 5 years. 

RESULTS 

Observed results confirm that an isolated damage of the auditory ossicles 

within the incudostapedial joint allows, in most cases, to achieve stable 

reconstruction or connection of the damaged chain, resulting in improvement 

of hearing, measured as decrease or total closing of the air-bone gap, 

verified in our material in 91,3% of operated ears. 

CONCLUSIONS 

In spite of the certain, small group of failures demanding reoperation, good 

and very good results achieved in the large percent of ears after surgery 

confirm that the technique and materials applied may be a correct approach 

in this type of damages of the conductive apparatus of the middle ear. 

P 394 

SURGICAL TREATMENT OF AUDITORY OSSICULAR 

MALTIFORMATIONS 

W. Kubota 1 , K. Matsui 2 , T. Ota 2 , K. Kure 2 , Y. Esu 2 , Y. Hayashi 1 , K. Kinosita 1 

1 Seirei Hamamatu Hospital, HAMAMATSU, Japan 

E-MAIL: watarukubota771213@gmail.com 

2 Seirei Yokohama Hospital, YOKOHAMA, Japan 

280 

OBJECTIVES 

We reported the postoperative hearing results of 26 cases who underwent 

an auditory ossicular malformation in the Department of Otorhinolaryngology, 

Seireihamamatsu Hospital and the Department of Otorhinolaryngology, 

Seireiyokohama Hospital between January 2004 and September 

2010. Their mean age was 9.6 years. Defects in the incudostapedial joint 

was found in 13 ears, fixation of the malleus and incus in 5 ears, fixation 

of stapes in 3 ears, and multiple malformations in 5 ears. 

METHODS 

Ossicular reconstructions were performed with tympanoplasty type ㈽c 

(12 ears),modified tympanoplasty type ㈽i (2 ears),modified tympanoplasty 

type ㈿c (5 ears), modified tympanoplasty type ㈿i (1 ear). Total stapedectomy 

was performed in 3 ears. Stapedotomy was performed in 1 ear. 

RESULTS 

The hearing results were classified as successful rate when the postoperative 

hearing level met at least one of these three conditions :1) air bone gap 

less than 15 dB, 2) hearing gain more than 15 dB, 3) hearing level above 30 

dB . Hearing was evaluated in 1 year after surgery. Successful hearing results 

were obtained in 96.1 %. 

CONCLUSIONS 

High rate of hearing improvement encouraged us to operate on auditory 

ossicular malformation. 

P 395 

QUALITY OF LIFE OF OUR PEDIATRIC COCHLEAR IMPLANT 

USERS 

J.M. Meléndez García, M.I. Hamdan Zavarce, A.S. Araujo Da Costa, 

T. Rivera Schmitz, E. Pallas Pallas, G. Espiña Campos 

Complejo Hospitalario Universitario de Vigo, Hospital Xeral, 



OBJECTIVE 

To examine the results of health-related quality-of-life questionnaire 

scores from children who wear cochlear implant. 

METHODS 

We used a generic quality-of-life questionnaire designed to be completed by 

both parents and children. Twelve families participated in the study. Their 

responses were compared with those of normal-hearing mates of similar age 

and their parents. Every family completed questionnaires at home. Normalhearing 

participants all belonged to the same educational institution. 

RESULTS 

Cochlear implant users scored similarly to their normal-hearing peers and 

their parents. Comparisons were made to the findings of other studies.

CONCLUSIONS 

Cochlear implants can help young children to acquire speech, language, 

and social skills. Children with cochlear implants experience quality of 

life similar to that of normal-hearing peers. As an institution that started 

performing cochlear implants more than twenty years ago, we are concerned 

of the adjustment problems that our deaf children may experience. 

P 396 

HEADACHE, VERTIGO AND UNILATERAL HEARING LOSS. 

AN UNCOMMON PRESENTATION OF FIBROMUSCULAR 

DYSPLASIA 

M.R. Rosell Ferrer 1 , Y. Escamilla Carpintero 1 , J.M. Saiz Arnaiz 2 , 

S. Cardelus Vidal 2 , L. Samara Piñol 1 , J. Perendreu Sans 1 , 

A. Martinez Arias 1 , A. Cardesin Revilla 1 , R. Bargues Cardelus 1 , 

J.J. Diaz Arguello 1 , A.F. Aguila Artal 1 

1 Hospital de Sabadell, Otolaryngology, SABADELL, Spain 

E-MAIL: rrosell@tauli.cat 

2 Hospital de Sabadell, SABADELL, Spain 

INTRODUCTION 

Fibromuscular dysplasia (FMD), is a noninflammatory nonatherosclerotic 

vascular disease of unknown etiology. It can affect any gender and age, 

mostly women between 30 and 50. We present the case of a child referred 

for vertigo. 

CASE REPORT 

Boy, 7 years old, consulted for two days cervical pain, headache and vomiting. 

At exam presented cervical stiffness. Lumbar punction was practiced 

obtaining normal CSF. On next day appeared rotatory vertigo, he could be 

seated but instability did not allow standing or walking, he had nistagmus 

with rapid movement to the left. Otoscopy was normal. Audiometry: deafness 

of the left ear. Cranial-RMI imaging showed multiple focal chronic 

left cerebellar right thalamic and acute left thalamic ischemic injuries. Selective 

cerebral angiography showed hypoplasia of right vertebral and 

stenosis of left vertebral artery, suggestive of FMD. Balloon angioplasty 

was performed. Evolution was good with normalisation of neurological 

symptoms, but audiometry shows persistent hearing loss. 

DISCUSSION 

FMD affects mainly renal and carotid arteries but has been observed everywhere 

of the body. Cervicocranial FMD prevalence is estimated to be about 

2/1000. Symptomatic cervicocranial FMD manifests with nonspecific 

headache and complications like arterial dissection, aneurysm, subarachnoid 

or intracerebral hemorrhage and infarction. Image tests (ultrasonography, 

RMI and CT-angiography) showing a classic ‘string-of-beads’ pattern 

are diagnostic. Treatment is prophylactic anticoagulation in asymptomatic 

patients and transluminal balloon angioplasty when indicated. 

CONCLUSIONS 

FMD is often asymptomatic and discovered as an incidental finding. It is 

probably underdiagnosed and should be considered in differential diagnoses 

of headache, in children. 

P 397 

OUTCOME FROM OUT-PATIENT TONGUE-TIE DIVISION 

PROCEDURES; PARENTAL SATISFACTION SURVEY 

A. Espeso 1 , S.C. Toynton 2 

1 University Hospitals Bristol NHS Foundation Trust, Otolaryngology, 

TAVISTOCK, United Kingdom 

E-MAIL: espesoangeles@hotmail.com 

2 Plymouth Hospitals NHS Trust, PLYMOUTH, United Kingdom 

OBJECTIVES 

To assess the outcome of performing tongue tie release procedures for infants 

in the ENT out-patient department at Derriford Hospital. Assess our 

performance following the National Institute of Clinical Excellence UK 

guidelines on ‘Division of ankyloglossia (tongue tie) for breastfeeding’ 

published 14th December 2005 (IP Guidance Number: IPG149). Discuss the 

practice of performing tongue tie division in Derriford Hospital (Plymouth) 

and several other South West country hospitals. 

METHODS 

Retrospective, questionnaire-based audit of 101 parental responses regarding 

their satisfaction for the treatment of their infants ankyloglossia in 

the ENT department at Derriford Hospital. 

RESULTS 

This study shows that 94 per cent of infants with a tongue tie had a complete 

resolution of symptoms such as feeding difficulties, wind problems 

and drooling while feeding, after frenulotomy. This improvement was reported 

in 75 per cent of cases within one week. Parents reported no complications 

in 78.2 per cent of cases and nearly 20 per cent reported 

immediate post-intervention bleeding which resolved within 5 minutes. 

The average number of procedures performed was 1.5 per week in our unit. 

In the other contributing ENT departments, the average of procedures per 

week varied from ‘no procedures performed’ to 4 procedures. 

CONCLUSION 

Tongue tie division (frenulotomy) is a mostly complication free procedure 

which when performed by trained health professionals can be safely provided 

in the outpatient clinic setting. 

281

P 398 

SPEECH-LANGUAGE DISORDERS IN CHILDREN 

WITH HEARING LOSS CONNECTED WITH OTITIS MEDIA 

WITH EFFUSION 

J. Broz Frajtag, J. Handzic 

University Hospital Center Rebro, Audiology, ZAGREB, Croatia 

E-MAIL: brozfrajtag@gmail.com 

OBJECTIVES 

Otitis media with effusion is characterized with conductive hearing loss 

which affects a child’s ability to recognize and memorize spoken language 

and develop auditory working memory and tectal mapping. The aim of 

the study is to find out if peripheral hearing deficit with particularly restrictive 

frequencies compromise temporal processing and thus predict 

speech and language disorders in childhood. 

METHOD 

Prospective study group included 18 female (mean age 7, 8 year) and 27 

males (mean age 6,5 year)with hearing loss associated with otitis media 

with effusion. Tonal audiometry, tympanometry and speech audiometry 

sound field discrimination and with earphones for each side of ears respectively 

performed in all study groups. All of the children undergo 

speech/language screening tests. 

RESULTS 

Threshold and 100% of speech recognition showed no ear side effect in females 

and right ear advantage in males. Females showed smaller rate and 

earlier central auditory processing disorder from the age of first three years 

while process of the language and verbal acquisition is most intensive. Males 

showed later than females language and speech disorder at the age of 7 years 

motorical immaturity, undeveloped articulation, poor vocabulary, lack of 

syntax in sentences, substitution of ‘r’ and ‘l’, unable to focus on school tusk. 

CONCLUSION 

Children with conductive hearing loss associated to otitis media with effusion 

are pronounced for left hemisphere auditory processing and 

speech/language discrimination disturbance. Associative thinking and 

solving of abstract problems are more affected in females than males. 

P 399 

CENTRAL AUDITORY PROCESSING IN CHILDREN 

WITH CONDUCTIVE HEARING LOSS ACCOMPANIED 

WITH OTITIS MEDIA WITH EFFUSION 

J. Handzic 

University Hospital Center Rebro, audiology, ZAGREB, Croatia 

E-MAIL: jadranka.handzic-cuk@usa.net 

282 

OBJECTIVES 

Otitis media with effusion accompanied with conductive hearing loss is 

the most common disease in childhood and communication disorders in 

preschool children The aim of the study is to explore correlation of the 

conductive hearing loss to the central auditory processing: possible ear 

side and gender differences and their influence on further cognitive disturbances. 

METHOD 

Prospective study group included 18 female (mean age 7, 8 year) and 27 

males (mean age 6, 5 year) with hearing loss associated with otitis media 

with effusion. Tonal audiometry, tympanometry and speech audiometry 

performed in all study groups. 

RESULTS 

Hearing level of conductive hearing loss was higher for 500Hz and 1000Hz 

(p=0.008) in males and for 4000Hz (p 0.078) in females. Females have higher 

level of hearing loss than males and no ear side effects (p=0.0052). Males 

showed on speech discrimination test right ear advantage for threshold 

and for reaching a 100% of speech recognition (p=0.169 (p=0.016). Females 

reached 100% of speech recognition on higher level than males (p=0.016, 

p=0.799) with no ear side advantage. 

CONCLUSION 

Study showed right ear advantage of conductive hearing loss in males and 

no advantage of ear sides in females. Males showed lateralization and advantage 

of right ear in peripheral hearing for lower frequencies and .Central 

auditory processing disorder started in older age than in females. 

Females showed no lateralization of hearing loss. 

P 400 

AUDITORY NEUROPATHY SPECTRUM DISORDER: 

AN EVIDENCE BASED PROTOCOL FOR CLINICAL EVALUATION 

AND MANAGEMENT 

C.L. Runge, S. Mleziva, D.R. Friedland 



E-MAIL: chrunge@mcw.edu 

OBJECTIVES 

To describe our evidence-based clinical program for the evaluation of auditory 

neuropathy spectrum disorder (ANSD). 

METHODS 

A combination of evidence from the literature and results from an integrated 

research program were used to develop an algorithm for the evaluation 

and management of children with ANSD.

RESULTS 

A formal multi-disciplinary ANSD program consisting of otolaryngology, 

audiology, neurology, radiology and speech-language pathology was implemented 

using evidence from internal studies and published results. 

Because of the detailed support for proposed clinical interventions, this 

comprehensive program was endorsed by the administration and supported 

by participating clinicians. This resulted in more consistent and 

efficient evaluation and follow-up for affected patients. Protocols such as 

fitting contralateral hearing aids in unilaterally implanted children with 

ANSD were implemented based on our studies demonstrating a bimodal 

advantage across subjects. To continually advance our program 

OBJECTIVES 

We are currently investigating objective measures for early behavioral evaluation 

for candidacy for cochlear implantation. 

CONCLUSION 

Developing a comprehensive program for the care of children with ANSD 

was facilitated by the use of evidence to support each clinical intervention. 

This process provides useful information for developing other multidisciplinary 

programs. Specifically, the treatment of complex clinical entities 

can be improved by a combination of careful review of the literature and 

well-directed research endeavors. Evidence-based programs are more likely 

to be supported by clinicians, administrators and affected families. Protocols 

must remain flexible and reflect current findings and new developments 

in the field. 

P 401 

THE GALKER-35 TEST: A SPEECH RECEPTION IN NOISE TEST 

FOR 3 TO 6 YEAR-OLD DANISH CHILDREN. 

J. Lous 1 , M.G. Lauritsen 2 , E. Galker 3 

1 Institute of Public Health, Research Unit of General Practice, 

ODENSE, Denmark 

E-MAIL: lous@oncable.dk 

2 Research Unit of General Practice, Department of Public Health, 

COPENHAGEN, Denmark 

3 Privat, COPENHAGEN, Denmark 

AIM 

The third version of the Danish speech reception in noise test (GALKER- 

35) is developed for identifying children with problems in understanding 

verbal communication. 

METHOD 

The test has 35 test words presented by a speaker under heavy background 

noise. The child has to point at one of two alternative pictures on the 

screen. The child uses hearing, vision, lip-reading, knowledge about the 

used words, and interpretation of the drawings of which one illustrate the 

spoken word. The Galker-35 has been validated on 370 children in kinder- 

gartens in Hillerød municipality and is standardized to children between 

three and six years. These results were presented at ESPO 2010, Pamplona. 

In Aarhus County 469 children between 3 and 7 years with and without 

learning or linguistic problems have been tested. This presentation will 

concentrate on children from Aarhus County and the results will be compared 

with standardization material from Hillerød. 

RESULTS 

Children found the test interesting and only a few in the youngest group 

have problems completing the test. After controlling for age and type of 

day care (normal/not normal) in a regression model, we found no significant 

relation between Galker-35 and gender or other than Danish language 

spoken at home and we found a better correlation to the day care teacher’s 

expectation than the parents’. 

PERSPECTIVE 

The test is available on DVD and takes 6 minutes. We are working on an 

internet version of the test both for professional and parental use with 

data collection and possible feed-back. 

P 402 

AUDIOLOGICAL COMPLICATIONS OF CHILDREN WITH 

DISTAL RENAL TUBULAR ACIDOSIS 

J. Economides, A. Klimentopoulou, K. Parpounas, M. Choulakis, 

J. Economides 

Agia Sofia, Children’s Hospital, ATHENS, Greece 

E-MAIL: jacquedkrd@yahoo.gr 

OBJECTIVE 

To assess the treatment methods of children suffering from audiological 

complications of distal renal tubular acidosis, a condition of hyperchloremic 

metabolic acidosis with a normal anion gap in the blood. It’s a 

hereditary disease with an autosomal recessive type of inheritance. Transformation 

of ATP6B1 on the gene of the B1 subtype if the H+ ATPase on 

the chromosome 2p13 that is translated to the kidneys and the cochlea. 

METHODS 

After the diagnosis of distal renal tubular acidosis, regular audiological 

surveillance is performed. The appearance of primary audiological symptoms 

as neurosensory hearing loss is treated with hearing aids, but in the 

case of profound hearing loss cochlear implantation is performed. 

RESULTS 

5 children suffering from distal renal tubular acidosis were assessed systematically. 

The first child has a normal hearing. 2 cases have been diagnosed 

with mild or moderate hearing loss and wore conventional hearing aids. 2 

cases (sisters) presented with moderate hearing loss after their 3rd year of 

age and wore conventional hearing aids but the hearing loss progressed to a 

profound degree and both of them underwent cochlear implantation. 

283

CONCLUSION 

The children who wear conventional hearing aids show a satisfactory progression 

of speech and language. The 2 sisters who underwent cochlear 

implantation, 1 year after surgery their speech and language capabilities 

remained unchanged. The early detection of the disease is essential as is 

the control by the pediatric geneticians. Surveillance should also be carried 

out by the pediatric nephrologists and systematic audiological assessment 

from the otorhinolaryngologists. 

P 403 

THE INFLUENCE OF PARENTAL ATTITUDES ON 

REHABILITATION OF HEARING-IMPAIRED CHILDREN 

WITH AND WITHOUT COCHLEAR IMPLANT 

S. Ristic 1 , M. Zivic 1 , B. Kocic 2 , M. Bojanovic 1 , E. Z.Marinkov 1 

1 ENT Clinic, CC Nis, Medical Faculty of Nis, NIS, Serbia 

E-MAIL: snezanaristic018@gmail.com 

2 Medical Faculty of Nis, NIS, Serbia 

INTRODUCTION 

The rehabilitation of children with hearing impairments is a long-term 

and complex process. Apart from the individual characteristics of each 

child, the environment he/she lives in, the attitudes of parents confronted 

with their child’s defect, and the consequences the defect implies are all 

of vital importance. 

OBJECTIVES 

The aim of our study was to determine to what extent parents’ attitudes 

towards their children affect the rehabilitation process. An additional objective 

was to determine differences in parents’ role in the rehabilitation 

of children with and without cochlear implants. 

METHODS 

Methods used in the study include a semi-structured interview and a questionnaire 

(Parental Attitudes Scale, PAD). The participants were 60 parents 

with children aged 4 to 15 years. The children who participated in this 

study were included in the rehabilitation process for a minimum of three 

months. For better analysis, this study applied descriptive and inferential 

statistical techniques. 


The research indicates that parental attitudes significantly affect the rehabilitation 

process of children with hearing and speech impairments. 

There are indications that parents’ attitudes are especially important for 

children with major hearing loss. The results demonstrate that fostering 

close cooperation and qualitative interactive relationships with the parents 

of these children is a precondition for successful treatment. 

284 

P 404 

TRANSCUTANEOUS APPLICATION OF BONE CONDUCTION 

DEVICES: FIRST RESULTS IN SIX CHILDREN WITH THE 

ALPHA-1 SYSTEM 

M.K.S. Hol 1 , R. Nelissen 2 , M.A. Agterberg 3 , A.F.M. Snik 2 

1 RAdboud UMCN, ENT, NIJMEGEN, The Netherlands 

E-MAIL: m.hol@kno.umcn.nl 

2 Department of Otorhinolaryngology, Radboud University Nijmegen 

Medical Center, NIJMEGEN, The Netherlands 

3 Department of Biophysics, Donders Institute for Brain, Cognition 

and Behaviour, NIJMEGEN, The Netherlands 

OBJECTIVES 

Although results on osseointegration and limited skin reactions with percutaneous 

bone conduction devices (BCD’s) are good especially in children 

adverse events with percutaneous BCD’s are identified relatively frequent. 

Transcutaneous BCD’s are expected to minimize adverse events as implant 

loss and skin reactions. This study compares the first results of a new transcutaneous 

BCD, the Alpha-1, with the conventional BCD Baha system. 

METHODS 

11 patients (age 5-12), with congenital unilateral conductive hearing loss, 

were divided in 2 groups: 6 patients received the Alpha-1 system (study) 

and 5 received a Baha (control). Outcome measurements were skin reactions/implant 

loss, audiological data, directional hearing tests, and patient 

satisfaction questionnaires for Alpha-1. Complementary objective audiological 

comparisons between both systems were obtained with the skull 

simulator. 

RESULTS 

All control children underwent 2-stage surgery, in the study group a single 

stage surgery was sufficient. Baseline pure tone audiology (PTA) showed 

average conductive loss of ~60 dB and average speech understanding at 

70dB was ~0%. With the Alpha-1 device PTA was ~45 dB, and speech understanding 

at 70dB of ~82%. With the Baha PTA ~34 dB, and speech understanding 

at 70dB of ~91%. Skin reactions were favourable for the 

Alpha-1 system, with an average follow-up time of 11 months. Questionnaires 

for Alpha-1 use showed subjective improvement of hearing and 

overall satisfaction. 

CONCLUSION 

The transcutaneous application has advantages with regard to adverse 

events however preliminary audiological results show more benefit with 

the Baha.

P 405 

BONE ANCHORED HEARING AIDS: BACK TO BASICS 

J. Williams, K. Tzifa 

Birmingham Children’s Hospital, ENT, BIRMINGHAM, United Kingdom 

E-MAIL: jo_williams 2 @sky.com 

OBJECTIVE 

To present our findings 

METHODS 

The Internet is available in many homes and workplaces. Social networking 

websites such as Facebook and Twitter are more and more widely used. 

The Internet is not only a means of communication, but it is also a tool to 

obtain information and advice. Over the last 6 months, I have been invited 

to become the Nurse Advisor on the Ear Foundation Website, and also two 

Facebook Forums; namely the ‘BAHA - Bone Anchored Hearing Aids (UK)’ 

forum and also the ‘Microtia and Atresia UK’ forum. These are all UK based 

Forums, but they are used by patients and families all over the world. 

RESULTS 

There is evidence when visiting these Forums that we are not informing 

our patients about day to day living with these devices. Often they ask 

what we would suggest are basic questions which have not be addressed 

by the hospital or clinic where they have been fitted. 

CONCLUSIONS 

As practitioners working with patients who have bone anchored hearing 

aid surgery, we have a responsibility to ensure that we impart our knowledge 

and experience to these patients so they can go about their daily lives. 

P 406 

DEVELOPMENT OF A MIDDLE EAR IMPLANT PROGRAM 

IN A US ARMY HOSPITAL 

J.V. Crawford 

Madigan Army Medical Center, ENT, TACOMA, USA 

E-MAIL: jvcrawford@me.com 

OBJECTIVE 

To describe the process of initiating a middle ear implantable device program. 

METHODS 

Aside from organizing equipment and arranging for approval to use the 

device, the critical component is education. It begins with education of 

the surgeon. Once the surgeon understands the potential applications of 

the device, and identifies a patient population that would benefit - then 

the work begins. Potential referral sources need to be educated as well. 

That means residents (in training programs), audiologists, and potential 

referral sources in the community. Education of the audiologists is also a 

key effort. The audiologist is often the point of entry into the health care 

system for patients with hearing loss and they need to be able to help the 

physicians ensure that the selected patients are truly the best candidates. 

Once you’ve found a way to get patients into the program, it becomes essential 

to build a team. Like every other implantable device, there needs 

to be a team to help the parents and the patients prepare to make use of 

the device. In addition you will need to educate your billing/procurement 

staff. The final step is to be sure that your operating room staff has been 

educated on the instruments and set-up for the new devices. 

RESULTS 

We have successfully built a middle ear implant program by following 

these steps. 

CONCLUSION 

Initiating a middle ear implant device program takes some initial effort. 

Apart from getting some mechanics in place, education is the essential 

component to the whole process. 

P 407 

RECENT APPROACHES TO REHABILITATION OF PATIENTS 

WITH EXTERNAL EAR CANAL ATRESIA 

A. Mileshina, V. Kurbatova, V. Bakhshinyan, A. Tavartkiladze 




OBJECTIVES 

To investigate the possibilities of canaloplasty and Baha in rehabilitation 

of patients with the external ear canal (EEC) bilateral atresia. 

METHODS 

29 patients with bilateral microtia and atresia of the EEC were operated.25 

children had severe conductive hearing loss,2 - profound hearing loss and 

2-mixed severe-to-profound hearing loss.ABR thresholds were estimated 

with bone conduction stimulation in 12 cases at the age of 3-4 years, and 

the conventional tonal audiometry - in 17 older patients. 

RESULTS 

Patients were divided to 2 groups:1st group consisted of 11 children after 

canaloplasty, 2nd group-of 18 children after Baha implantation in the 1st 

stage. In the 2nd group children with the congenital severe syndromes were 

dominated.After the 12 months follow-up speech level and quality was estimated 

in both groups. The patients from the 1st group were not reached the 

speech age normal level. Half of them used conventional hearing aids. The 

patients from the 2nd group had good vocabulary and fluid speech. 

285

CONCLUSION 

For patients with bilateral microtia and atresia of the EEC the rehabilitated 

with Baha from the early age on the soft bandage or Baha implantation is 

recommended.The implantation of Baha could be performed in patients 

from the age of 3-4 years.Canaloplasty and otoplasty is recommended to 

start in 7-8 years old patients.The results after canaloplasty in these patients 

depend on the character of the middle ear abnormalities revealed 

by the CT.Patients with multiple severe syndromes are not the best candidates 

for the canaloplasty. 

P 408 

STUDY OF SPONTANEOUS REGRESSION OF MIDDLE EAR 

CHOLESTEATOMA IN CHILDREN 

O. Okaniwa, H. Kobayashi, M. Shino, H. Suzaki 

Department of Otorhinolaryngology, Showa University School of 

Medicine, TOKYO, Japan 

E-MAIL: a_okani@yahoo.co.jp 

OBJECTIVES 

We report three cases of reduced or disappearing masses in children with 

middle ear cholesteatoma, along with a review of the literature. This study 

was conducted retrospectively by reference to patients’ clinical records. 

Case 1. A boy aged 1 year and 6 months had a white mass on the tympanic 

membrane and a circular soft tissue density was detected by CT scan. Congenital 

cholesteatoma was suspected. Exploratory tympanotomy was performed, 

but no cholesteatoma was observed. 

Case 2. A boy aged 1 year and 7 months had a white mass in the right tympanum, 

observed on the upper part of a ventilation tube. A circular soft 

tissue density adjacent to the ventilation tube was detected by CT scan, 

and acquired cholesteatoma was suspected. In the follow-up period, the 

mass gradually decreased in size. 

Case 3. A boy aged 8 years underwent CT scan for further examination of 

conductive hearing loss in his right ear, which revealed a soft tissue density 

around the right auditory ossicles and loss of a part of the auditory ossicles. 

He was followed-up because of suspected cholesteatoma, during which 

time the density disappeared. 

DISCUSSION 

Inflammation or apoptosis may be considered as a factor contributing to 

the reduction or disappearance of cholesteatoma. Follow-up is considered 

to be one of the therapeutic options for the treatment of uncomplicated 

cholesteatoma which is confined to the tympanum. 

286 

P 409 

PREVENTION OF POSTOPERATIVE TYMPANIC MEMBRANE 

RETRACTIONS AFTER SURGERY FOR ATTIC AND PARS TENSA 

RETRACTION POCKETS 

D. Jesic 1 , D. Jotic 2 , H. Rovcanin 3 , D.J. Jovicevic 3 

1 School of Medicine, University of Belgrad, Otorhinolaryngology and 

Maxillofaial Surgery, BEOGRAD, Serbia 

E-MAIL: xeniam@sezampro.rs 

2 Clinic for Otorhinolaryngology and MF surgery Clinical Centre of 

Serbia, BEOGRAD, Serbia 

3 Clinic for Children Diseases, ENT, PODGORICA, Montenegro 

OBJECTIVE 

To compare tympanic membrane postoperative outcome after different 

treatment approach of retraction pockets. 

METHOD 

Retrospective study of 76 children ears operated for retraction pockets; 40 

with tensa retraction classified according to Erasmus classification and 36 

with attic retraction classified according to Tos. Cholesteatoma from both 

groups were treated in two stage procedure with period of a year between. 

Attic retraction pockets were treated with lateral attic wall reconstruction 

(LAR), with aeration tubes (16) or without aeration tubes insertion (6), 

using cartilage graft (14). Pars tensa retractions were treated with aeration 

tubes (2), together with fascia graft (24), only cartilage graft (14), depending 

of retraction stage. Main outcome measure was postoperative retraction 

during the follow up of 18 months. 

RESULTS 

Attic retractions were mostly grade IV (91.7%), with cholesteatoma 77.8% 

and pars tensa retractions in 63.9%. Pars tensa retractions were grade II and 

III (32.5%), grade I (20.0%), IV (17.5%) and V (30%), with cholesteatoma in 

42.5%. Postoperative retraction of pars tensa in attic retraction group was 

significantly lower in ears with cartilage graft (23.7%) than in ears treated 

with LAR and tubes insertion (66.7%) (t=2.234, p

P 410 

BAROTRAUMA IN PEDIATRIC ENT 

F. Manole 



PURPOSE 

Analyze clinical aspects related to barotrauma in children. I analyze 

symoptoms- feeling of fullness or , discomfort or pain in the ear, hearing 

loss, ringing in the ear, dizziness, epistaxis- results the treatment and tympanic 

membraine status post treatment. 


The study was retrospective. The medical records od 19 patients with 

barotitis media were reviewed from 2009-2011. All patients were examined 

by rhinoscopy, otoscopy and tympanometric findings were saved. Otomicroscopy 

classified patients according to the findings describen in Teed 

clasification middle ear barotrauma. 

RESULTS 

Of the 19 patients, 8 were boys and 11 girls, aged from 6 to 16. All of the 

rest complaind of ear pain during the descent phase of the flight prior to 

land. Before the flight 8 patients have acute rhinitis symptoms. Most of 

childrens were attendat with barotitis grade 1 and grade 2. Two patientswith 

grade 3. In most childrens symptoms resolve spontaneously . 7 patients 

were treated . Treatment was conservative in all cases. The patients 

were treated with oral decongestants associated and with antibiotics just 

in case of hemorrhage and fluid level presents into the middle ear and trophyc 

vascular. In two case of patients seven and eight years old we find 

anamnestic anterior epistaxis remited spontaneously in the time of descent 

of airplane. 

CONCLUSION 

Special attention must be spending to prevention of ear barotrauma. The 

efects of barotrauma can be decreased by using topical or sistemic nasal 

decongestants and encouraging children to swallow during periods of 

presure changing. 

P 411 

OTOLARYNGOLOGY INVOLVEMENT IN THE RARER 

CRANIOFACIAL SYNDROMES 

C.B. Heffernan, D. Murray, H. Rowley 

Children’s University Hospital, Otolaryngology, DUBLIN, Ireland 

E-MAIL: Heffernan_colleen@hotmail.com 

OBJECTIVES 

The Children’s University Hospital Dublin is the national craniofacial 

unit. Many craniofacial syndromes have associated otolaryngology features 

due to their common embryological origin; therefore these patients are 

frequently managed by both the craniofacial and otolaryngology departments. 

Though the array of syndromes is vast, they are infrequent so the 

average specialist will have encountered relatively few of them. We aim to 

give an overview of the key features of these syndromes and their management. 

We will review the course and prognosis of airway obstruction, 

feeding difficulties and hearing abnormalities. 

METHODS 

The craniofacial surgery department has a database of all their patients. 

We have retrospectively reviewed this database to identify those who required 

input from the otolaryngology department. The HIPE department 

also compiled a list of all patients having a diagnosis of a craniofacial syndrome. 

Data regarding airway management, nutritional status and hearing 

difficulties was collected. 

RESULTS 

The patients who attended between 1990 and 2011 were identified. A review 

of their charts highlighted the specific otolaryngology issues such as hearing 

problems and airway management. 

CONCLUSIONS 

Craniofacial syndromes though complex can have excellent outcomes if 

managed in a multidisciplinary setting. Thorough airway assessment and 

management is the most important initial step. Also early audiological 

assessment is essential to prevent speech and language delay. 

P 412 

NASAL RECONSTRUCTION WITH RIB GRAFT CARTILAGE IN 

A PATIENT WITH NEUROFIBROMATOSIS 

J.M. Meléndez García 1 , M. Tomás Barberán 2 

1 Complejo Hospitalario Universitario de Vigo, Hospital Xeral, 



2 Hospital Universitari Son Espases, PALMA DE MALLORCA, Spain 

OBJECTIVE 

Neurofibromatosis is one of the most common genetic disorders, characterized 

by the formation of tumors involving nerve tissue in the skin, subcutaneous 

tissue, cranial nerves, and spinal root nerves. Abnormalities can 

develop in the skin and bones. Children with neurofibromatosis often present 

with broad, amorphous noses. To eliminate a substantial nasal deformity 

in children, confusion may exist regarding the optimal technique. 

287

METHODS 

We describe a case report of a 13-year-old boy with neurofibromatosis and 

important nasal deformity who underwent nasal reconstruction. Intraoperative 

views are presented. 

RESULTS 

Patient presented a broad nose, with an amorphous nasal tip and weak 

support. The surgery included subcutaneous tissue resection and the use 

of a rigid cartilaginous strut to provide tip projection and columellar contour. 

Patient had a satisfactory functional and cosmetic result. 

CONCLUSIONS 

When indicated, rib cartilage grafts can serve as a safe, effective and versatile 

choice as donor material in nasal surgery. The reconstruction using 

costal cartilage allowed us to perform precise modelation. 

P 413 

SECOND BRANCHIAL CLEFT SINUS - A RARE ENTITY: 

DESCRIPTION AND TREATMENT 

J.Y. Sichel 

Shaare Zedek Medical Center, Otolaryngology, Head & Neck Surgery, 

JERUSALEM, Israel 

E-MAIL: sicheljy@yahoo.com 

INTRODUCTION 

Branchial cleft cyst (BC) (neck cyst without any connection) and second 

branchial cleft fistula (BF) (tract connecting neck skin and oropharynx) are 

relatively common. However, second branchial cleft sinus (BS) (neck cyst 

connected with a tract to the pharynx) are rare. Based on two recent cases, 

we describe clinical signs, which raise suspicion, before surgery, on the existence 

of a tract in presence of a BC. 


We reviewed all the cases of second branchial cyst / sinus / fistula treated 

in Shaare Zedek Medical Center during years 2005-2011. Demographic data, 

presentation signs and surgical findings were reviewed. 

RESULTS 

During the years 2005 to 2011, 28 cases of BC, 7 of BF (one blind) and 2 cases 

of BS were surgically treated. Age of presentation: All BF were present at 

birth, the median age of diagnosis of BC was 26 years and both BS were diagnosed 

before one year of age Infections: All BF had some secretions from 

the neck opening, 6 out of 28 BC had one episode of infection, and both BS 

had several episodes of infection. Conclusion: First presentation of BC 

around the age of one year and several episodes of infections are suspicious 

for the presence of tract connecting the cyst to the pharynx (BS). In our 

opinion, early surgical treatment is mandatory to prevent avoidable neck 

infections. 

288 

P 414 

SELECTIVE REPORTING OF PRIMARY OUTCOMES 

AND SUBGROUP ANALYSES: A COMPARISON OF GRANT 

APPLICATIONS AND PUBLICATIONS 

C.W. Boonacker 1 , A.W. Hoes 1 , K. van Liere-Visser 2 , A.G.M. Schilder 1 , 

M.M. Rovers 3 

1 University Medical Center Utrecht, Julius Center for Health Sciences 

and Primary Care, UTRECHT, The Netherlands 

E-MAIL: c.w.b.boonacker@umcutrecht.nl 

2 The Health Care Efficiency Research Program, The Netherlands 

Organization for He, THE HAGUE, The Netherlands 

3 Radboud University Nijmegen Medical Center, NIJMEGEN, 


OBJECTIVE 

To assess discrepancies between primary outcomes and subgroup analyses 

specified in grant proposals and subsequent publications. 

METHODS 

We investigated all finalized research projects (n = 79) awarded by the 

ZonMw ‘Health Care Efficiency Research Program’ as from 2001, along the 

pathway from grant application to scientific publication. The main outcome 

measures were the proportions of studies in which the publications 

were completely in agreement with the grant proposal regarding the primary 

outcomes and the subgroup analyses. 

RESULTS 

In 37% of the projects, publications were in agreement with the grant application 

regarding the primary outcomes; for subgroup analyses there 

was agreement in 25% of the projects. In 36% of the projects, a primary outcome 

specified in the grant proposal was not reported. Of the subgroups 

specified in the grant application, 69% was not reported. In general, no explanation 

for the discrepancies was provided. The chance of an original 

primary outcome being included in scientific publications was 2.8 times 

higher (95% confidence interval 1.2 ; 6.6) for outcomes that were statistically 

significant. Furthermore, 71% of the subgroup analyses in the scientific 

publications was performed on a non-significant or inconclusive overall 

effect estimate; 24% became significant. 

CONCLUSION 

There is a large discrepancy between grant applications and final publications 

regarding both primary outcomes and subgroup analyses. As publication 

of all intended outcomes is the ethical obligation of researchers, 

publication guidelines need to be updated to include the statement that 

all outcomes specified in the grant proposal should be fully reported.

P 415 

ASSESSMENT OF THE ENT ORGANS IN CHILDREN BORN 

AFTER ASSISTED REPRODUCTIVE TECHNOLOGY 

E.Y.U. Radtsig, N.D. Pivneva 

The Russian State Medical University (RSMU), Paediatric ENT, 


E-MAIL: radena@rambler.ru 

OBJECTIVE 

The purpose of our study was to assess the state and frequency of ENT 

pathology in children born after assisted reproductive technologies using. 

METHODS 

208 children aged from the birth to 3 years were observed: 98 children born 

after ART application (single and twin pregnancy, a study group (SG)) and 

111 children born after natural pregnancies ensuing (control group (CG)). 

The ENT and endoscopic examination were perfomed in all cases, CT if required. 

RESULTS 

Congenital malformations were detected in 3 (3.038%) children from the 

SG and in 4 (3.6%) children from naturally become pregnant. In the SG 23 

(23.9%) children suffered from the acute otitis media, 51 (51.3%) - had from 

1 to 3 episodes, 22 (22.9%) had no evidence for the acute otitis media.In the 

CG results are as follows: 11 (10.57%) children, 76 (73.07%) children and 17 

(16.3%), respectively 7 (7.3%) children in the SG and 6 (5.7%) children in the 

CG complained of hoarseness. Laryngeal diagnostic endoscopy detected 

vocal nodules in 3 (3.1%) children in the SG and in 5 (4.8%) children in the 

CG. Adenoid vegetations hypertrophy degree 3 was detected in 5 (5.2%) children 

in the SG and 4 (4.1%)in the CG; degree 2 was detected in 17 patients 

(17.1%) children in the SG and in 13 children (12.5%) in the CG. 

CONCLUSIONS 

We can conclude that the use of ART did not significantly affect the level 

and structure of ENT diseases in children. 

P 416 

SLEEP APNEA IN CHILDREN WITH DOWN SYNDROME 

M.E. Austeng 

University of Oslo, ENT, SØF, FREDRIKSTAD, Norway 

E-MAIL: marit.austeng@gmail.com 

OBJECTIVES 

An increased risk of sleep apnea in children with Down syndrome is documented 

in the literature, but reported prevalence varies considerably. 

Unless sleep apnea is treated, these children may suffer from additional 

health risks. In Norway, no national consensus on sleep apnea screening 

or follow-up of otolaryngologic symptoms in Down children. The aim of 

the study was to assess sleep apnea prevalence and associated diseases in a 

cohort of Down children. 

METHODS 

The cohort study includes all children born in 2002 in Norway with Down 

syndrome, a total of 55 children. Children with more than one parent of 

foreign ethnicity were excluded. In all children, clinical examination, otologic 

and auditory examination was performed. A sub cohort of 29 children 

from one geographic selected area underwent polysomnography with 

video recordings. 

RESULTS 

The data collection is ongoing and preliminary results form 26 children 

will be presented. 

CONCLUSION 

Preliminary rsuggest that undiagnosed sleep apnea is frequent in children 

with Down syndrome, and that the incidence is surprisingly high. 

P 417 

MIDDLE EAR PRESSURE CHANGES OVER TIME IN CHILDREN 

WITH DOWNS SYNDROME 

S. Mitchell, N.O. Turner 

Walsall Healthcare NHS Trust, Department of Otolaryngology, 

BIRMINGHAM, United Kingdom 

E-MAIL: scottmitchell@nhs.net 

INTRODUCTION 

There is debate regarding the management of otitis media with effusion 

(OME) in children with downs syndrome. Information about the progression 

of middle ear function in this group is limited. This work aims to investigate 

this, along with any impact of interventions. 

METHODS 

A retrospective study reviewing case notes of children with downs syndrome. 

Demographic data, details of interventions and clinical findings 

was collected. Changes in middle ear pressure over time were recorded, 

using tympanograms as a measurement of this. 

RESULTS 

Overall, 24 children with an average age of 6.98 years (range 1.08-16.92 years) 

were found. Female:Male ratio was 0.7:1. Follow up time was, on average, 

46.5 months (range 5-129 months). First and last tympanograms were compared 

using Jerger’s 1970 classification along with clinical findings. 50% 

(12/24) with flat tympanograms at their initial review persisted to have 

the same trace on follow up. Of this group, 42% (5/12) had at least one intervention. 

Overall, 25% (6/24) showed a drop in pressure group, with 4/6 

289

having had interventions. 25% had improvement in tympanograms, principally 

from type B to Type C1 or C2 traces, with 5/6 having had interventions. 

One child’s tympanogram returned to Type A. 

CONCLUSION 

Changes in middle ear pressures in children with downs syndrome is a 

complex issue. Most OME will persist, with few improving on their own. 

This is in contrast to children without downs where upto 80% improve 

over a period of 3 months, depending on age and season. 

P 418 

OTITIS MEDIA, HEARING LOSS AND ASSOCIATED 

DISORDERS CHILDREN WITH DOWN SYNDROME - 

THE FORGOTTEN STORY? 

M.E. Austeng 

University of Oslo, ENT, SØF, FREDRIKSTAD, Norway 

E-MAIL: marit.austeng@gmail.com 

OBJECTIVE 

An increased risk of hearing loss in children with Down syndrome is well 

documented. In addition to cognitive retardation, the children are at risk 

of suffering additional learning- and developmental delay unless hearing 

rehabilitation take place. In Norway, no national consensus on follow-up 

of these children exists. The aim was to assess the prevalence of hearing 

loss, history of otitis media and associated diseases in a cohort of Down. 

METHODS 

The cohort study includes all children born in 2002 in Norway with Down 

syndrome, a total of 65 children. In all children, clinical examination, otologic 

and audtiory examination was performed. Hearing loss was measured 

using pure-tone audiometry, according to recommended procedures, 

using a Madsen Auricle audiometer, calibrated according to ISO standards. 

Main outcome measures were hearing ability at age 8 measured with puretone 

audiometry, otoacoustic emissions, tympanometry and history and 

clinical presence of otitis media. 

RESULTS 

Preliminary results showed that 67% had a uni- or bilateral hearing loss 

above 25 dB HL, estimated as the pure-tone air-conduction average (PTA) 

at 500, 1000, 2000 and 4000Hz. Mean PTA was of 30.5 dB HL. Otological examination 

revealed tympanogram type B in 40% of the children and 33% 

reported a history of otitis media. Symptoms of sleep apnea were present 

in almost all children. The data collection is ongoing and final results will 

be presented. 

CONCLUSION 

Preliminary results suggest that undiagnosed hearing loss and otitis 

media is frequent in Down children, and that associated sleep apnea symptomatology 

are surprisingly high. 

290 

P 420 

MINING THE GENETIC MOUSE LIBRARY IDENTIFIES 

A CRITICAL REGION FOR THE CHRONIC OTITIS MEDIA 

PHENOTYPE IN DOWN SYNDROME 

M.F. Bhutta 1 , M. Cheeseman 2 , Y. Herault 3 , Y. Yu 4 , S.D.M. Brown 2 

1 University of Oxford, Nuffield Dept of Surgical Sciences, 

OXFORD, United Kingdom 

E-MAIL: m.bhutta@doctors.org.uk 

2 MRC Harwell, OXFORDSHIRE, United Kingdom 

3 ICS, STRASBOURG, France 

4 Roswell Park, NEW YORK, USA 

OBJECTIVES 

Chronic otitis media (OM) is prevalent in Down syndrome, yet the cause 

is unknown. An understanding of aetiology may illuminate the genetic 

basis for Chronic OM in Down syndrome, and also the genetic component 

of non-syndromic chronic OM. The large library of engineered mouse 

models carrying partial trisomy for regions syntenic to human chromosome 

21 can be screened to define a critical genetic region responsible for 

the OM phenotype. 

METHODS 

Cadaveric specimens of almost the entire reported library of Down syndrome 

mouse models mice were obtained: the Ts65Dn, Ts1Cje, Ts2Yah, 

Ts1Rhr, Dp16(1)Yey, Dp10(1)Yey, Dp17(1)Yey, and the Tc1 mouse. These 

were analysed for histological presence of chronic OM, when compared to 

wild-type littermate mice. 

RESULTS 

338 ears were analysed. Only the Dp16(1)Yey mouse line developed chronic 

OM with phenotype penetrance of 0.73 (19 ears in 10 mice). Mice displayed 

thickened mucoperiosteum, neutrophil and macrophage infiltration, and 

an effusion of variable cellularity. 

CONCLUSIONS 

Genetic susceptibility to chronic OM in human Down Syndrome is determined 

by a critical region of syntenic genes on mouse chromosome 16. 

However, the failure to demonstrate OM in mice with shorter-segment 

trisomy within this region suggests a complex aetiology, with important 

gene-gene or gene-environment interactions. The critical region, containing 

92 genes can be speculatively reduced to 83 by analysis of known transcriptional 

up-regulation. Of this reduced list of genes, only 8 have a 

known role in inflammation. Further analysis of mouse models, integrating 

hypothesised phenotype modifiers, may enable any critical region or 

gene to be confirmed.

P 421 

TOPICAL MITOMYCIN C APPLICATION BEFORE 

MYRINGOTOMY AND VENTILATION TUBE INSERTION: 

DOES IT AFFECT THE FINAL OUTCOME? 

A. Hesham 

OMAN 

E-MAIL: ahesham73@yahoo.com 

OBJECTIVE 

To assess whether topical application of mitomycin C before myringotomy 

and ventilation tube insertion in cases of resistant otitis media with effusion 

will make a difference in the rate of tube extrusion and post operative 


METHODS 

55 children (2-12 years) scheduled for myringotomy and bilateral ventilation 

tube (VT) insertion for persistent otitis media with effusion were enrolled 

in this study. 

INTERVENTION 

Mitomycin C was applied over the tympanic membrane before myringotomy 

on one side and normal saline was applied over the other side. 

Myringotomy with ventilation tube insertion was done on both sides. 

MAIN OUTCOME MEASURES 

Duration of intubation and incidence of early and late post operative complications 

were compared in both sides. 

RESULTS 

No significant difference was found between the 2 groups in terms of extrusion 

rate, incidence of early and late post operative complications. 

CONCLUSIONS 

All previous studies proved efficacy of mitomycin in prolonging the patency 

of myringotomy openings without inserting ventilation tube with 

no ototoxic side effects, however we did not find any difference in the rate 

of extrusion of ventilation tubes and rate of early and late post operative 

complications , so the use of mitomycin C before myringotomy and ventilation 

tube insertion is not recommended. 

P 422 

NODULAR FASCIITIS OF THE EXTERNAL AUDITORY CANAL 

IN SIX EGYPTIAN CHILDREN 

A. Hesham 1 , M. Abdel-Aziz 2 , H. El-Bosraty 2 , H. El-Hoshy 2 , H. Khattab 2 , 

H. al-Taweel 3 

1 OMAN 

E-MAIL: ahesham73@yahoo.com 

2 Cairo University, CAIRO, Egypt 

3 Hamad Hospital, DOHA, Qatar 

OBJECTIVE 

Nodular fasciitis of external auditory canal may mimic a malignant tumor 

due to its progressive course, so it was the aim of this study to focus on a 

new etiology for aural masses to avoid unnecessary aggressive treatment. 

STUDY DESIGN 

Retrospective study on six children presented with aural masses that were 

diagnosed pathologically to have nodular fasciitis. 

METHODS 

Presentation of the cases clinically, radiologically and pathologically was 

carried out. Surgical excision of the lesions was done through the external 

canal with follow up of the cases for 1 year. 

RESULTS 

Recurrence was detected in two cases, one after 2 months and the other 

after 4 months. Re-excision was carried out without recurrence till the end 

of the follow up period. 

CONCLUSIONS 

Proper diagnosis of this lesion is mandatory to avoid aggressive treatment 

(radical surgery and/or radiotherapy) as the disease has favorable prognosis 

with local excision. 

P 423 

THE BIRTH OF EXIT AT A TERITIARY ACADEMIC 

MEDICAL CENTER 

C.F. Harbarger, J.D. Prosser, J. van Beek-King, C.A. Hughes 

GHSU Department of Otolaryngology, GHSU Department of 

Otolaryngology, AUGUSTA, USA 

E-MAIL: charbarger@gmail.com 

OBJECTIVES 

In anticipation of a difficult neonatal airway immediately following birth, 

the Ex Utero Intrapartum Treatment (EXIT) procedure has been established 

to secure the fetal airway while oxygenation is maintained through 

utero-placental circulation. This newly described procedure has been in- 

291

corporated into our institutional armamentarium. Herein we describe our 

experience in coordinating a multi-disciplinary team as well as a successful 

operative set-up and provide a helpful guideline for the implementation 

of EXIT procedures at new institutions. 

METHODS 

4 EXIT procedures were performed at a tertiary academic medical center, thus 

establishing a standardized process for this procedure. We performed a chart 

review and interviewed critical personnel involved in these procedures. 

RESULTS 

The etiologies included congenital granular cell epulus, cystic hygroma, 

Nager syndrome, and one child with both holoprosencephaly and a large 

midfacial cleft. Pre-operative imaging included high-resolution ultrasound 

in all cases and MRI in one. Mean gestational age was 38 weeks. All 

airways were endotracheally intubated at the time of the EXIT procedure, 

with a mean time to extubation of 1 day. No child experienced perinatal 

hypoxia. All cases were staged via a run-through with participating personnel 

in a fully-equipped operating room. 

CONCLUSIONS 

Although initially logistically challenging, these procedures have proven 

extremely rewarding. It is essential that an EXIT procedure be planned 

with a multidisciplinary team, including neonatology, otolaryngology, 

maternal-fetal specialists, pediatric anesthesiology, and adult anesthesiology 

teams. A trial run-through in the operating room before each procedure 

proved invaluable and is recommended for any institution 

implementing this new procedure. 

P 424 

MANAGEMENT OF LATERAL SKULL BASE TUMOR 

IN CHILDREN 

H. Wu 

Xinhua Hospital, Otlaryngology Head & Neck Surgery, SHANGHAI, 

China 


OBJECTIVE 

To explore the clinical features, diagnosis and treatment of pediatric lateral 

skull base tumors. 

METHODS 

A retrospective study of 49 children diagnosed with lateral skull base 

tumors was involved. Including 3 schwannoma, 2 nasopharygeal fibroangioma, 

2 fibromatosis, 5 teratoma. 8 temporal bone LCH, 11 rhabdomyosarcoma, 

2 melanoma, 4 neuroblastoma, 4 lymphoma, 1 PNET, 3 chordoma, 

2 NPC and 2 synovial sarcoma. Total surgical removal was achieved in 32 

cases 65.31% and subtotal removal in 8 cases 16.32% ; 9 cases 18.37%) did 

not received surgery. 28 cases of malignancy received pre- or post-operative 

292 

radiotherapy and/or chemical therapy. The surgical approaches composed 

of infratemporal fossa approach, subtotal temporal bone resection and 

transpalatine approach. 

RESULTS 

All 12 benign tumors had total removal and no tumor recurrence was 

found during the follow-up. 3 LCH lost follow-up, the other 5 were survived 

with systemic chemical therapy. 3 chordoma were died of recurrence 

and metastasis. 3 rhabdomyosarcoma died of metastasis 2 years after surgery, 

the other 8 still survived and followed up. 1 neuroblastoma died 3 

years after surgery. 2 melanoma, 1 PNET and 2 synovial sarcoma were still 

followed-up without recurrence. The total 3 years survival rate is 86.49%, 

and 78.57% for the patients who received surgery. 

CONCLUSION 

Pediatric lateral skull base tumors were a series of complicated, occult and 

untypical lesions. Early diagnosis is difficult but necessary by diagnostic 

imaging. Surgical removal combined with radiotherapy and/or chemical 

therapy can get a favorable prognosis with low motality and mobidity. 

P 425 

MANAGEMENT OF INFANT LARYNGEAL STRIDOR: 

A REPORT OF 141 CASES 

Q. Huang, H. Huang 

Xinhua Hospital, Otolaryngology Head & Neck Surgery, SHANGHAI, 

China 


OBJECTIVE 

To explore the etiology, clinical features and treatments of infant laryngeal 

stridor. 

METHODS 

The clinical data of 141 cases of infant laryngeal stridor were retrospectively 

studied. 

RESULTS 

Among 143 cases, there were 12 tongue base cysts, 8 laryngeal cysts, 31 subglottic 

angiomas, 14 laryngeal papillomas, 4 laryngeal webs, 17 subglottic 

swellings and 45 laryngomalacias. 86 cases received surgical treatment 

composed of cyst removal, bleomycin injection, microdebrider and supraglottic 

plasty. 

CONCLUSION 

The infant laryngeal stridor has complex causes and is difficult in diagnosis. 

Preoperative evaluation and surgical reconstruction of upper airway 

is the key to improve the ventilation and phonation function.

P 426 

THE MANAGEMENT OF INFANT SUBGLOTTIC 

HEMANGIOMA: A REPORT OF 24 CASES 

Q. Huang, H. Hu, H. Huang 2 

Xinhua Hospital, Otolaryngology Head & Neck Surgery, SHANGHAI, 

China 


OBJECTIVE 

To investigate the clinical features, treatment, and outcomes of subglottic 

hemangioma in infants. 

METHODS 

Retrospective analysis of 24 cases of infantile subglottic hemangioma in 

our department from April 2007 to December 2010. Average time of onset 

was within 3 months of age. Sixteen cases appear symptoms of laryngeal 

obstruction one week after birth, and 8 cases onset from one week after 

birth to three months of age. Four cases performed tracheotomy in anesthesia 

after intubation. Fifteen cases accepted local injection of bleomycin 

under microscope laryngoscope, 2 cases with powerful debrider, 2 cases 

with radiofrequency resection, 4 cases with electrocoagulation resection, 

and 1 case with tracheal split tumor resection. 

RESULTS 

Six to twelve months follow-up after injection of bleomycin, no systemic 

and local complications were observed in 15 bleomycin injection cases. 

Four of them received two injections with interval time of 2 months. Four 

tracheotomy cases were successful extubate after 2 months. The infants 

with powerful debrider, radiofrequency resection, electrocoagulation resection, 

and tracheal resection were cured with no recurrence during follow-up. 

CONCLUSIONS 

Subglottic hemangioma is a congenital disease in most cases. It will cause 

life-threatening laryngeal obstruction. As the infant’s laryngeal anatomical 

characteristics, treatment options should be minimally invasive, simple, 

less complications. Bleomycin injection treatment is a safe and 

effective method. 

P 427 

NEONATAL HEARING SCREENING: 

A REVIEW OF RECENT RESULTS 

A.S. Araujo Da Costa, J.M. Meléndez García, M.I. Hamdan Zavarce, 

T. Rivera Schmitz, E. Pallas, G. Espiña Campos 



INTRODUCTION 

Newborn hearing screening is currently performed routinely trying to 

allow early identification and intervention. Prosthetic intervention and 

speech therapy offers children with hearing problems access to oral language 

at early ages. Our aim is to analyze the rate of hearing loss and to 

evaluate our program according to recommendations of the Early Detection 

Commission in Newborn promoted in Spain. 

METHODS 

All newborns (100%) in our hospital are now screened with automated auditory 

brainstem response. If the screening is not passed, patients are referred 

for diagnostic confirmation. Every first test is performed before the 

first month of life. The results obtained with the protocol developed at 

our hospital for auditory assessment of children from January 2010 to December 

2011 were analyzed. 

RESULTS 

Each year, approximately 5000 infants are born in our hospital. In 22 children 

referred for diagnostic testing the last two years, 5 cases (23%) of severe-to-profound 

bilateral deafness were found. Demographic and clinical 

characteristics of the newborns were analyzed. Screening test, confirmation 

of the final diagnosis and further management were aspects evaluated 

quantitatively and qualitatively according to the Early Detection Commission 

in Newborn. 

CONCLUSIONS 

Auditory screening is recommended for all newborns as the only effective 

procedure for early detection of childhood deafness. In our hospital we 

work to ensure that screening, diagnostic and follow-up services are effective 

and carried out to a high standard. 

P 428 

HOW UNIVERSAL NEWBORN HEARING SCREENING 

INFLUENCES COCHLEAR IMPLANTATION (CI)? 

M. Bojanovic 1 , E. Zivkovic-Marinkov 2 , M. Zivic 2 , M. Stankovic 2 , 

D. Milisavljevic 2 , S. Ristic 2 , S. Zivaljevic 2 

1 ENT Clinic, CC Nis, Medical Faculty of Nis, NIS, Serbia 

E-MAIL: milabojanovic@yahoo.com 

2 ENT Clinic, NIS, Serbia 

UNHS has led to increased identification of infant hearing loss and evaluation 

of impact of UNHS program on managament and outcome of deaf 

children.. Early screening and cochlear implantation is associated with 

better auditory receptive skills and speech intelligibility. 

OBJECTIVES 

The aim of this study was to present the results of UNHS and to contribute 

to the implementation of a UNHS inSerbia and earlier cochlear implantation. 

293

METHODS 

We started performing UNHS at the Gynaecology and Obstetrics Clinic 

inNis in July, 2007. In first 8 months we screened 1,733 newborns and in 

first year 2421 newborns after the first day of life, using two-stage TEOAE 

screening test. The newborns who failed the first screening unilaterally 

or bilaterally were rescreened 30 days later. The newborns with risk factors 

for hearing loss as well as those who failed screening twice were rescreened 

using an ABR test. 

RESULTS 

From the total number of 2421 newborns (50.3%male and 49.7 female) examined 

in this study, 90.8% passed the first screening, while 96.6% passed 

the second screening, performed a month after. 0.75% newborns were refered 

to additional audiological testing. Hearing loss was confirmed in 3 

cases. Hearing screening significantly reduced the age of the time of diagnosis 

(7,9m vs 23,2m);age of the first fitting (9,6m vs 24,1m);age at the 

time of cochlear implantation. 

P 429 

EARLY DETECTION OF HEARING IMPAIRMENT 

IN NEWBORNS 

E. Zivkovic Marinkov, M. Bojanovic, M. Stankovic, M. Zivic, 

D. Milisavljevic, S. Ristic, S. Zivaljevic 

ENT Clinic, NIS, Serbia 

E-MAIL: emilijazm@gmail.com 

INTRODUCTION 

Hearing loss in newborns has been associated with lifelong deficits in 

speech and language acquisition, poor school performance and emotional 

and social maladjustment. The identification of hearing loss in newborns 

can prevent or reduce many of these adverse consequences, permitting 

early intervention. 

OBJECTIVES 

The aim of this study was to determine the frequency of risk factors in 

hearing impaired newborns as well as the rate of early detection of hearing 

impairment using the Transient Evoked Otoacoustic Emission (TEOAE) 

screening test. 

METHODS 

Newborn hearing screening was performed at the Neonatology ward of 

the Gynaecology and Obstetrics Clinic,ClinicalCenter inNis, from July 2007 

to February 2009. A two-stage TEOAE screening test was administered. 

The newborns who failed the TEOAE rescreening twice, unilaterally or bilaterally, 

were referred to audiological diagnostics. 

RESULTS 

3,109 newborns were screened in this study. 98 (3,15%) newborns had one 

of the risk factors for hearing impairment. The incidence of hearing im- 

294 

pairment in this group of newborns was 1.3 . Three newborns had bilateral 

and one had unilateral sensorineural hearing impairment. 

CONCLUSION 

Universal neonatal hearing screening allows of timely diagnosis, and appropriate 

intervention, habilitation and rehabilitation in newborns with 

congenital hearing impairment. Parental awareness is also an important 

factor in the early detection of hearing impairment in newborns. 

P 430 

POLISH UNIVERSAL NEONATAL HEARING SCREENING 

PROGRAM - WITH SUCCESS SINCE 2003 

M.J. Wróbel, W. Szyfter 

Poznan University of Medical Sciences, Department of Otolaryngology, 


E-MAIL: wrobmac@ump.edu.pl 

OBJECTIVES 

Universal Neonatal Hearing Screening Program is the biggest prophylactic 

program in Poland. It was organized to cover every newborn in order to 

detect individuals with hearing loss and refer them for early treatment. 

This goal was achieved owing to the initiative of the Polish citizens and 

support of the Great Orchestra of Christmas Charity Foundation. The aim 

of the presentation is to share with results and experience in running the 

Program. 

METHODS 

The Program is structured into three levels - screening (neonatal departments), 

diagnosis (laryngo-audiological departments) and intervention 

(audiological centers). Centralized database was organized to collect data 

from all centers. Implemented hearing tests comprise OAE as the screening 

tool, and ABR conducted on children, referred to the second level . 

RESULTS 

The total number of 3 422 776 children were screened for hearing impairment. 

The Program enabled to identify and refer for further treatment 9 

737 children with various types of hearing loss, 685 with profound (0.02% 

of population) and 308 with severe bilateral sensorineural hearing loss 

(0.01% of population). 3,8% of population was indentified to have risk factors. 

The mean age at diagnosis is 83 days and intervention - 211 days. 

CONCLUSIONS 

Polish Universal Neonatal Hearing Screening Program has fully achieved 

the main goal of early detection and treatment of hearing impairment in 

children. The awareness of medical environment, support of citizens and 

charity organization stays behind the success of the Program which covers 

96.6% of all delivered babies, registered in Poland.

P 431 

INFLUENCE OF POLISH UNIVERSAL NEONATAL HEARING 

SCREENING PROGRAM ON EARLY COCHLEAR 

IMPLANTATION IN POZNAN, POLAND 

M.J. Wróbel, M. Karlik, W. Szyfter, A. Sekula 

Poznan University of Medical Sciences, Department of Otolaryngology, 


E-MAIL: wrobmac@ump.edu.pl 

OBJECTIVES 

To present the influence of Universal Neonatal Hearing Screening Program 

in Poland on number of qualified and implanted small children with 

cochlear prosthesis. 

METHODS 

The cochlear implantation program in Poznan started in Jan 1994. Till now 

866 Nucleus implants were introduced in Poznan, including 526 children 

(229 under 3 years of age). The Universal Neonatal Hearing Screening Program 

began in the end of 2002 and first screened children were implanted 

in our center in 2005. 

RESULTS 

Until now 193 cochlear implants in children between 11-36 months of age 

were implanted. Between 2000-2004 only 1-9 children below 3 years of age 

were operated on per year. From 2005-2011 a number of children implanted 

below 3 increased till 16-30 per year. According to logistic procedures we 

have started to operate children below 18 months in 2008. Till now 40 babies 

were implanted (13 in 2011). Poznan Cochlear implanted program was 

sequentially adapted to work with small children after implantation. 

CONCLUSIONS 

The hearing screening program enabled early audiological intervention, including 

hearing aids fitting and early cochlear implantation, if necessary. 

P 432 

INCIDENTAL LEARNING THROUGH OVERHEARING: 

HOW TO MEASURE IT IN DEAF CHILDREN 

R. Masi, M. Vallarino, P. Marsella 

ROMA, Italy 

E-MAIL: roberto.masi@opbg.net 

OBJECTIVES 

Incidental learning through ‘overhearing’ happens when a child listens to a 

speech that is not directly addressed to him/her and learns from it. Children 

of two years of age can acquire new words from overheard language and this 

helped to improve speech perception and phonologic production. Our pur- 

pose is to verify how much the cochlear implant (CI) may allow deaf children 

to reach the ability to acquire words through overhearing. 

METHODS 

All the implant user over 18 months were tested with the Ling Sound Test 

twice; the first at 7 cm and the second at 12 meters. Then their parents 

were give a questionaire with 4 questions to analize the overhearing children 

behaviour. The same procedure was administered to a group of deaf 

children with a severe/profound hearing loss with hearing aid. 

RESULTS 

Our preliminary results can not be analized with statistical strategy. They 

show that all the CI users have the ability to acquire words through overhearing. 

This ability was lost with the hearing problems and was improved 

in some a way with the hearing aids. 

CONCLUSIONS 

This study is a proposal and it can be improved by any suggestion you may 

have. Our findings illustrate how the use of cochlear implant improve the 

ability of acquire words through overhearing. 

P 433 

TEN YEARS OF COMPLEX CASES OF AUDITORY 

IMPLANTATION IN VERY YOUNG CHILDREN 

G. Lilli, A. Della Volpe, A.M. Varricchio, I. Diomaiuto 

AORN Santobono Pausilipon, Ear Nose Throat, NAPOLI, Italy 

E-MAIL: giorgiolilli@libero.it 

The care of multiple involved hearing impaired children is one of the main 

challenge CI professionals encounter. Candidacy and surgical approaches 

have to be progressively updated in order provide good performances even 

for kids with associated pathologies or malformation. This work aims to 

describe a long run experience in auditory implantation in very young 

kids. Data concerning surgery, anesthesia, postoperative tracking, and preand 

postimplantation audiometry were collected from the CI Unit database 

and evaluated. A group of 121 kids engaged in the study underwent 

early coclear implant and B.A.H.A. implantation. We found a plethora of: 

inner ear malformations, mental retardation, poor motricity development, 

congenital cerebral infections, genetic syndromes and congenital profound 

HL. 27 patients had an abnormal position of the cochlea and concurring 

middle ear disease. A cerebrospinal fluid Gusher was encountered in 12 

patients. An aberrant facial nerve was found in a group of 18. 13 patients 

showed a slight cochlear ossification. 4 had Mondini-like syndrom. 4 children 

had a C.M.V. and Rubella congenital infection. 1 patient had a Smith- 

Lemli-Opitz syndrome. A group of 28 children showed other associated 

pathologies. Patients with mild cochlear malformation showed good performances. 

Taking in relative account the mental or neurological concerns, 

subjects with severe syndromes showed noteworthy outcomes. An early 

intervention is always mandatory. Thus, we give confidence to the broadening 

of a paediatric CI program. However, it is compulsory to gather a 

295

multiprofessional team experienced in padiatric care in order to face the 

high frequency of unexpected pitfalls. 

P 434 

HOW USING THE AGC PARAMETERS IN 5 COCHLEAR 

IMPLANTED PATIENTS WITH AUDITORY NEUROPATHY IS 

INFLUENCING THE SPEECH RECOGNITION PERFORMANCES 

M. Stamate 1 , A.U.D. Modan 2 

1 Coltea Clinical Hospital, ENT, BUCHAREST, Romania 

E-MAIL: mstamate@gmail.com 

2 SC Audiologos SRL, BUCHAREST, Romania 

INTRODUCTION 

Auditory neuropathy affects the synchronous activity of the auditory nerve, 

but not the cochlear amplification function. The aim of this study is to find 

out how modifying the compression and AGC system’s characteristics of 

the speech processors of the cochlear implanted patients that suffers of auditory 

neuropathy, is influencing the speech understanding in noisy environments. 

Patients with neuropathy that are wearing hearing aids have 

better results at speech for linear amplification or minimal compression 

settings. We know that some children benefit more from a cochlear implant 

than from hearing aids. We can have a clue on how certain settings of the 

fitting parameters can improve the speech understanding. 

METHODS 

We target a number of 5 patients wearers of MEDEL cochlear implants and 

diagnosed prior to implantation with auditory neuropathy. They are completing 

a series of speech understanding tests with different configurations 

of settings of the compression and AGC parameters. They will be 

tested in noisy listening situations. 

RESULTS 

The results will be analyzed to see if there is any statistical significant relation 

between the configuration of the AGC system and compression settings 

and speech understanding for patients with auditory neuropathy. 

CONCLUSIONS 

In CI users with auditory neuropathy, the speech understanding will tend 

to be better in one of the choosen configuration of settings for compression 

and AGC system. 

296 

P 435 

MULTICENTER UPGRADE STUDY AP 404 VS AP AMADE’ 

T. Keintzel, T. Rasse, M. Grö lbauer, P. Schmid 

Klinikum Wels-Grieskirchen, ENT, WELS, Austria 

E-MAIL: thomas.keintzel@klinikum-wegr.at 

INTRODUCTION 

The goal of the study was to compare speechrecognition and quality of life 

with the Amade’ speechprocessor and the AP 404. 

METHOD 

25 Patients with more than 3 month experience with the active middle ear 

implant VSB were included in our trial comparing the AP 404 with the 

Amade’ Speechprocessor. The testintervall with the Amade’ was 6 weeks. 

The OLSA sentence test was used for speechrecognition in the situation 

S0°N0° and S0°N180°.With the HDSS questionaire we requested individual 

satisfaction with both processors . 

RESULTS 

There was a better speechrecognition in the OLSA in both situations with 

the Amade’ speechprocessor.The HDSS questionaire showed an improvment 

with the Amade’ in most conditions. 

CONCLUSION 

The study showed the advantage of the Amade’ speechprocessor according 

to the new directional/omnidirectional microphon as well as background 

noise suppression. There was a postive judging for the Amade’ requested 

with HDSS. 

P 436 

PROGRESSIVE HEARING LOSS IN CHILDREN: 

DIAGNOSIS, REFERRAL & OUTCOMES 

C. Sylvester, A. Rafferty, D.R. Strachan, J. Martin, C. Raine 

Bradford Royal Infirmary, BRADFORD, United Kingdom 

E-MAIL: dsylvester@doctors.net.uk 

OBJECTIVES 

Children with progressive loss are often referred for CI assessment at 

thresholds worse than criteria for implantation. The aim of this study is 

to correlate pre-operative hearing with outcome of implantation. 

METHODS 

From the departmental database, 37 females 29 males, average age 7.5 years 

were referred with progressive hearing loss. Audiology at initial assessment 

was categorised into

measures used were CAP, MUSS, MAIS, SIR and age appropriate audiology. 

Post-implantation data were correlated with pre-operative hearing levels. 

RESULTS 

Aetiology was congenital in 44% (largely WVA syndrome). Other causes included 

CMV and meningitis. For group 1 (n=18), scores of CAP, MUSS, MAIS 

and SIR pre-implantation were 4, 67%, 66%, 3, at 12 months (n=13) 6, 82%, 

90.6%, 4 and 36 months (n=8) 6, 82.5%, 85.0%, 4. For group 2 (n=21), scores 

pre-implantation were 4, 64.6%, 39.4%, 3, at 12 months (n=19) 6, 77.3%, 81.7%, 

3 and at 36 months (n=14) 6, 87.9%, 96.8%, 4. For group 3 (n=9) scores preimplantation 

were 3, 40%, 46.6%, 2, for 12 months (n=7) 5, 52%, 78.3%, 2 and 

for 36 months (n=6), 6, 57.5%, 87%, 3. 

CONCLUSIONS 

This study highlights referral to our centre is often delayed. This has an 

adverse effect on long-term outcomes. Regular audiological monitoring 

is essential in moderate to severely deaf children. The education of allied 

health professionals may help reduce delay in referral. 

P 437 

AUDITORY PERFORMANCE IN CHILDREN WITH BIMODAL 

HEARING REHABILITATION - COCHLEAR IMPLANT AND 

CONVENTIONAL HEARING AID 

S. Cozma, R. Olariu, O. Manolache, C. Martu, L. Radulescu 

University of Medicine and Pharmacy ‘Grigore T Popa’, ENT, 

IASI, Romania 

E-MAIL: scozma@iasi.mednet.ro 

OBJECTIVES 

Cochlear implantation is the standard intervention for hearing and speech 

rehabilitation for children with bilateral severe to profound hearing loss. 

The aim of the study is the evaluation of the Results for concomitant usage 

of a hearing aid in the contralateral ear. 

METHODS 

The study group included twelve patients, implanted in our cochlear implant 

center, fitted with hearing aids in the opposite ear. For all the subjects 

we considered the age at the implantation, the etiology and the onset 

of the hearing loss, pre- and postimplantation audiological evaluation 

with the cochlear implant and with the hearing aid. 

RESULTS 

The free field pure tone thresholds with cochlear implant are superior to 

those with the hearing aid in the opposite ear. The cochlear implant offers 

a better audition for the high frequencies comparing to the reverse situation 

of the hearing aid. There is no evidence for different auditory quality 

input in bimodal rehabilitated children. Bilateral auditory rehabilitation 

offers a better sound localization and speech understanding in complex 

noise situation. 

CONCLUSIONS 

The results of the present study suggest an advantage of cochlear implant 

usage in conjunction with a hearing aid in the opposite ear. The cochlear 

implant alone performs better than the hearing aid alone, but the bimodal 

condition is superior to the cochlear implant alone. The bimodal hearing 

rehabilitation requires a regularly auditory reevaluation to establish the 

limit line between the benefit / less benefit of bimodal hearing. 

P 438 

COCHLEAR IMPLANTATION IN CHILDREN WITH COCHLEAR 

NERVE DEFICIENCY: REPORT OF 9 CASES 

Z. Zhang 

Xinhua Hospital, Otolaryngology Head & Neck Surgery, SHANGHAI, China 


OBJECTIVES 

To analyze effectiveness of cochlear implantation(CI) in children with 

cochlear nerve deficiency(CND). 

METHODS 

Children with radiographically documented CND undergone CI were involved 

in this retrospective study. The nerves in inner ear canal and inner 

ear malformations were evaluated by MR imaging and temporal bone 

computed tomography scans, respectively. Electrically evoked auditory 

brainstem response were measured in all patients before surgery. Meaningful 

auditory integration scale, categories of auditory performance score, 

speech intelligibility rating and aided hearing threshold with cochlear 

implant device in free field were measured for analysis of CI performance. 

RESULTS 

Nine patients with CND and bilateral prelingual profound sensorineural 

hearing loss were analyzed in this study. They underwent unilateral CI between 

2005 and 2010 after failure of traditional power hearing aid fitting. Before 

surgery, only one patient presented wave V in right side in EABR test. 

The follow-up time for patients was one year. Four patients (44.4%) performed 

a significant improvement of aided hearing threshold with cochlear implant 

device(77.5dBHL, 45dBHL, 51.3dBHL and 68.8dBHL). None of them had developped 

sufficient speech intelligibility and perception ability. 

CONCLUSION 

Making a decision of CI for children with CND must be remarkably prudent 

because of its limited effectiveness and uncertain cost-benefit. Preoperative 

detailed audiologic, neuroimaging assessment and a careful 

counsel to parents are necessary. In some effective cases, although CI performance 

showed much better audiologic outcomes than traditional 

power HA, it is nearly impossible to gain sufficient speech perception ability 

and intelligibility. 

297

P 439 

WHAT WE HAVE LEARNED IN REVISION COCHLEAR 

IMPLANT SURGERY 

L. Lassaletta, R. Perez-Mora, B. Herrán, E. Valiente, I. Rabanal, J. Gavilan 

La Paz University Hospital, Otolaryngology, MADRID, Spain 

E-MAIL: luikilassa@yahoo.com 

INTRODUCTION 

Revision cochlear implant surgery has become an important tool for the 

management of cochlear implantation complications, both in children 

and adults. The aim of this study is to review our patient series who underwent 

revision cochlear implantation surgery. This review encompasses 

both common and uncommon indications. We will illustrate the experience 

we have gained by presenting a series of lessons learned. 

METHODS 

A retrospective study of revision surgery in an academic medical center. 

Retrospective chart review of cochlear implant revision surgeries from 

1990 to 2010. An extensive review of these patients’ histories was performed. 

RESULTS 

Twenty-five patients initially implanted at this program and 3 patients 

implanted elsewhere underwent revision surgery with or without reimplantation. 

Reasons for implant revision included documented internal 

device failure (32%), scalp flap complications (7%), optimization of electrode 

placement (7%), explantation due to non user (25%) or medical reasons (3%), 

technology upgrade (14%) and intratemporal pathology (11%). Revision surgery 

typically involved only minor anatomic challenges. In 2 patients rotation 

flaps were performed in order to improve stabilization of the 

implant. Upgrading surgeries included 4 patients with Ineraid devices, 2 

of them implanted ipsilaterally and 2 implanted on the contralateral side. 

Two patients underwent subtotal petrosectomy with closure of the EAC. 

CONCLUSION 

Revision implantation is a safe procedure that should be pursued in a 

timely fashion when patients experience cochlear implant failure. Although 

rare, it is prudent to discuss the potential complications of revision 

surgery and their implications with patients and their families. 

298 

P 440 

ELECTRICALLY EVOKED COMPOUND ACTION POTENTIALS 

IN PATIENTS SUPPLIED WITH CI 

L. Lassaletta 1 , P. van de Heyning 2 , S.L. Arauz 2 , M. Atlas 2 , 

W.D. Baumgartner 2 , M. Caversaccio 2 , H. Demin 2 , J. Gavilan 1 , 

B.O. Godey 2 , J. Müller 2 , L. Parnes 2 , C.H. Raine 2 , G. Rajan 2 , J.A. Rivas 2 , 

Y. Yanov 2 , P. Zorowka 2 , H. Skarzynski 2 

1 La Paz University Hospital, Otolaryngology, MADRID, Spain 

E-MAIL: luikilassa@yahoo.com 

2 The Hearring, Network of Comprehensive Hearing Implant Centers, 

ANTWERP, Belgium 

BACKGROUND 

The measurement of Electrically Evoked Compound Action Potentials 

(ECAP) is an established method to assess cochlear implant function by an 

objective method which is implemented in all CI devices. In a multicenter 

study the ECAP performance of the standard electrode array of MED-EL 

cochlear implants was investigated using the auditory nerve response 

telemetry (ART) task of the MAESTRO software. Examining the underlying 

physiological background of neural responses from different regions, 

ECAPs elicited by stimulation in the most apical region of the cochlea were 

compared to potentials for stimulation of the basal region of the CI. 

METHODS 

The study included 150 subjects from 16 centres worldwide. The integrity 

of the implant was tested by impedance telemetry immediately before performing 

the ECAP recordings. Two different ECAP measurements were 

run in order to assess different parameters of the neural response: A) 

Amplitude growth recordings by stimulating the apical electrode 2, the 

middle electrode 5 and the basal electrode 10, B) Recovery sequences stimulating 

the same respective electrodes with ECAP recording on adjacent 

electrodes. 

RESULTS 

An analysis of ECAP amplitudes, thresholds and slope of the amplitude 

growth functions from three different regions will be presented. ECAP latencies 

for different regions as well as the presence and incidence of double 

peaks in ECAP recordings will be discussed. 

CONCLUSIONS 

The results show that nerve cells have a similar sensitivity to electrical 

stimulation throughout the entire cochlea, therefore we conclude that all 

regions are able to work with the information delivered by electrical stimulation.

P 441 

EARLY MANAGEMENT OF POSTMENINGITIC DEAFNESS 

A. Degrassi 1 , E. Orzan 1 , M. Gregori 1 , P. Bolzonello 2 , D.L. Grasso 1 , 

G. Babighian 1 , G. Pelos 1 

1 IRCCS Burlo Garofolo, Audiology and Otorinolaryngology, 

TRIESTE, Italy 

E-MAIL: annadegrassi@burlo.trieste.it 

2 Azienda Ospedaliera Santa Maria Degli An, PORDENONE, Italy 

Urgent evaluation and management of postmeningitic severe to profound 

hearing loss is necessary because of the possible occurrence of cochlear ossification, 

with resulting limitations in cochlear implant electrode insertion.We 

describe a case of rapidly progressive hearing loss in a 5 years old 

child after Neisseria Meningitidis meningitis. The patient developed tinnitus 

and bilateral profound hearing loss within a month after meningitis 

onset. A CT and MRI scan was obtained to evaluate the status of the cochlea 

revealing the presence of initial signs of lateral semicircular canal fibrosis. 

Urgent bilateral cochlear implantation was recommended and the little 

patient was simultaneously implanted, with normal electrode insertion 

on both sides. The child returned home two days after surgery with the 

external components of the device already programmed and activated. 

Dramatic auditory benefit were obtained after early cochlear implant activation, 

with 75% open set word recognition already 4 days after 

surgery.Multidisciplinary care, early surgery and very early cochlear implant 

activation are particularly advantageous in cases with postmeningitic 

deafness. Especially in such circumstances, where quick and 

important decisions are necessary, specific parental engagement and support 

should always be given priority. 

P 442 

SURGICAL FEATURES OF THE REIMPLANTATIONS AFTER 

COCHLEAR IMPLANT SURGERIES 

I. Fedoseev, A. Mileshina, V. Bakhshinyan, A. Tavartkiladze 




OBJECTIVES 

The aim of our study was to investigate the reasons and difficulties of 

reimplantations after cochlear implantations. 

METHODS 

The results of the reimplantations after 1320 cochlear implant surgeries 

in children and adults performed in our Center in 1991-2011 were analyzed.During 

this period 14 patients were reoperated -13 children and 1 

adult.In 12 cases the cause of the reimplantation was the device failure (in 

3 cases due to mechanical trauma) and in 2 patients reimplantation was 

performed due to the wrong electrode array position. 

RESULTS 

Skin cutting was done at the same place with the preservation of the periosteal 

graft which was used again.The immersion and osseointegration 

with the bone of all parts of the devices which were in the contact with 

the skull bone was obtained.Almost totally recovering of the cortical bone 

of the mastoid was found.The size of the mastoid cavity and posterior tympanotomy 

remain the same with the small number of gentle scars in the 

mastoid and tympanic cavities.The implant leads were covered by cicatrical 

capsule. For the reimplantations the electrode arrays with the same dimensions 

as during the first surgery or even smaller in the diameter were 

used.The ECAP and the EESRT were registered in all cases. 

CONCLUSIONS 

Based on our experience we can conclude that the reoperations after 

cochlear implantation is very effective and easy to perform procedure for 

qualified surgeon. 

P 443 

TRACHEAL TUMOR MISDIAGNOSED AS BRONCHIAL ASTHMA 

IN CHILD 

G. Pavlovcinova 1 , J. Jakubikova 1 , R. Stanik 1 , I. Klochanova 1 , 

S.H. Harustiak 2 

1 Pediatric ENT Department, Childrens University Hospital, 

BRATISLAVA, Slovak Republic 

E-MAIL: g.pavlovcinova@gmail.com 

2 Department of Thoracic Surgery, BRATISLAVA, Slovak Republic 

OBJECTIVES 

Tracheal tumors are very rare occurring in less than 1-2 % of lung tumors. 

They are often difficult to diagnose, because they simulate other illness 

like asthma or chronic bronchitis. The common symptoms include wheezing, 

cough, dyspnoea and haemoptysis and thus mimic asthma and are 

treated with inhaled steroids and bronchodilators without results. 

CASE REPORT 

We report a characteristic of 8-years-old boy, who has been treated as 

bronchial asthma due to stridor and wheezing of 1 year duration without 

improvement. The examination for bronchial asthma was negative. After 

further evaluation in our ENT departement tracheal mass was found, excision 

and later resection and end to end anastomosis was performed. He 

was diagnosed of mucoepidermoid carcinoma of trachea, and is followedup 

without radiotherapy. The boy is asymptomatic and no recurrence has 

been detected in the first year since diagnosis. 

299

CONCLUSIONS 

It is important to remember that delay by the physician in diagnosing tracheal 

tumours is the principal problem, and that children suffering of 

wheezing and stridor, who do not respond to accepted medical treatment 

deserve systematic radiographic and endoscopic evaluation of the entire 

air passage. 

P 444 

A RETROSPECTIVE OBSERVATIONAL STUDY ON THE 

CLINICAL USEFULNESS OF NASAL NITRIC OXIDE IN THE 

ASSESSMENT OF CHILDREN WITH ALLERGIC RHINITIS 

G. Rotiroti 1 , K. Coppens 2 , G. Scadding 1 , J. Gardner 2 , S. Deiratany 2 

1 Royal National Throat Nose and Ear Hospital, Allergy, 

LONDON, United Kingdom 

E-MAIL: grotiroti@yahoo.com 


OBJECTIVE 

This longitudinal study aimed to determine whether ETF variables discriminate 

between children with recurrent AOM (rAOM) and those with 

chronic OME (cOME) and measure the effect of growth on ETF. 

METHODS 

Children 3 years of age with a confirmed history of rAOM or OME are enrolled 

and followed with yearly ETF testing. We report here the results of 

the Forced Response Test (FRT) in children at 3 and at 4 years of age. 

RESULTS 

Correlation coefficients were high and significant (p < 0.05) with the slopes 

approaching 1.0 (no change with age) for the opening pressure, steady state 

pressure, and passive resistance. Active flow rate, log of the active resistance, 

and log dilatory efficiency were not correlated. ANOVA documented 

a significant group effect (p < 0.05) for the passive function variables opening 

pressure, steady state pressure, closing pressure and steady state 

resistance. Of interest, 89% of swallow patterns (tubal dilation vs constriction) 

were concordant at the two time points. 

CONCLUSIONS 

These results indicate that there is a significant change in the passive ETF 

variables in children from age 3 years to 4 years. However, for the active 

ETF variables no change could be documented. The continued follow up 

of the children will elucidate the effect of growth on ETF in the two groups 

and the time course to resolution of their middle ear disease. 

300

programme 

at a glance

SUNDAY 20 MAY 2012 

16:00 – 17:00 

17:00 – 18:00 

18:00 – 20:00 

09:00 – 10:15 

10:15 – 10:45 

10:45 – 12:00 

12:00 – 13:30 

12:15 – 13:15 

Grand Ballroom St. John’s Room 

OPENING CEREMONY 

UNICEF’s approach to Young Child 

Development 

Jan Bouke Wijbrandi, Executive director 

UNICEF the Netherlands 

Welcome reception at the exhibition 


302 

CORPORATE SESSION: GSK 

Otitis media – what has changed in the era of 

pneumococcal conjugate vaccines? 

Grand Ballroom St. John’s Room Amsterdam Room 


Evidence based practice in pediatric 


CHAIRMAN: John Graham 

MODERATOR: Rob Scholten 

Martin Burton: Variations on a theme; too much, 

too little, too late? 

Rich Rosenfeld: Evidence-based common sense 

Coffee 

ROUND TABLE 1 

Evidence based medicine in pediatric 

laryngology 

CHAIRMAN: Martin Bailey 

MODERATORS: Reza Rahbar & Mark Aarts 

George Zalzal: Supraglottoplasty: Evidence and 

outcome 

Craig Derkay: Management of RRP 

Patrick Froehlich: Management of bilateral 

vocal cord paralysis 

David Albert: LTR vs CTR for subglottic stenosis 

Lunch 

CORPORATE LUNCH SESSION supported by 

MED-EL 

The Bonebridge – a new era in bone conduction 

stimulation 

LION LIVE SURGERY MEETING hosted by 

MED-EL 

MODERATORS: Thomas Lenarz, Wilko Grolman 

& Christine Mühlöcker 

The surgery will be performed by Prof. dr. 

Baumgartner streamed live from Vienna, 

Austria. 

The surgical procedure will be a 

demonstration of a Bonebridge live-surgery 


ALK-ABELLO 

Allergic diseases in childhood: a journey 

through the allergic march: Is it possible to 

stop the march? 


Language as a medical/biological concern! 

CHAIRMAN: Robert Ruben 

MODERATORS: Mark Haggard & Ellen Gerrits 

Frank Wijnen: Primary language development: 

Basic processes and pathology 

Robert Ruben: Language – a basic tenet of 

pediatric otolaryngology: A determinant of 

intervention and outcome 

Martine Coene: The role of low-frequency hearing 

in the acquisition of morphology in hearing 

impaired children 

O006: A. Niedzielski: The assessment of 

phonemic hearing in school children and teenagers 

with hearing loss 

O115: J. Zirk-Sadowski: Is the hearing-language 

link really predominant in the developmental 

impact of OME?

Foyer Room Seasons Room Golden Palm Bar 


Innovations and new technologies in pediatric 

rhinology 

CHAIRMAN: Glenis Scadding 

MODERATORS: Sanjay Parikh & Wytske Fokkens 

Christos Georgalas: Endoscopic trans-nasal 

resection of pediatric skull base tumors – Has it 

come of age? 

O001: M. Cornet: Long-term results of functional 

endoscopic sinus surgery in children with chronic 

rhinosinusitis 

O002: S. Atmaca: Is it really necessary to delay 

intranasal steroid treatment after fess? An animal 

study 

O003: C. Valera: Evaluation of the nasal airway 

increase induced by rapid maxillary expansion 

(RME) by MRI 

O004: A. Wolfovitz: Orbital and peri-orbital 

infections in pediatric population: Etiology, 

clinical presentation, radiological characteristics 

and outcome predictors 

O005: P. Fayoux: Secondary rhinosinusitis in 

children treated for craniofacial malignancies 

WORKSHOP 1 

How to recognize the syndromal child 

CHAIRMAN: Rolien Free 

INSTRUCTORS: Raoul Hennekam & 

Maria Bitner-Glindzicz 

MONDAY POSTER PRESENTATIONS 

09:00 - 09:45 Poster P001 - P014 

09:45 - 10:30 Poster P015 - P027 

10:30 - 11:15 Poster P028 - P043 

11:15 - 12:00 Poster P044 - P059 

12:00 - 12:45 Poster P060 - P075 

12:45 - 13:30 Poster P076 - P091 

13:30 - 14:15 Poster P092 - P104 

14:15 - 15:00 Poster P105 - P119 

15:00 - 15:45 Poster P120 - P135 

15:45 - 16:30 Poster P136 - P151 

16:30 - 17:15 Poster P152 - P167 

17:15 - 18:00 Poster P168 - P183 

303


13:30 – 14:45 

15:00 – 16:15 

16:15 – 16:45 

16:45 – 18:00 

304 



Innovations and new technologies in pediatric 


CHAIRMAN: Wilko Grolman 

MODERATOR: Gerry O’Donoghue 

Patrick Froehlich: Surgical simulation: Towards 

minimal invasive management of the pediatric 

airway 

Thomas Lenarz: Robotic surgery and surgical 

navigation in pediatric otology 


Cutting edge pediatric laryngology 

CHAIRMAN: Carel Verwoerd 

MODERATORS: Martin Birchall & 

Bernd Kremer 

Derek Roebuck: Interventional radiology and the 

pediatric airway 

Martin Birchall: Creating airways from stem cells 

O007: S. Wang: The management of recurrent croup 

in children 

O008: J. Tweedie: Tracheostomy decannulation 

in children: experience at Great Ormond Street 

O009: C.M. Bailey: UK study of inhaled and 

ingested foreign bodies 

Tea 


URTI, the evidence! 

CHAIRMAN: Ann Hermansson 

MODERATORS: Peter Morris & 

Niels van Heerbeek 

O022: M. van Driel: Different antibiotic 

treatments for group A streptococcal pharyngitis – 

a meta-analysis 

O023: M. van den Aardweg: Effectiveness of 

adenoidectomy in children with recurrent upper 

respiratory tract infections: open randomised 

controlled trial 

O024: D. Ramsden: Tonsillectomy for periodic 

fever, aphthous stomatitis, pharyngitis and 

cervical adenitis syndrome (PFAPA) 

O025: A. Hessén Söderman: Posttonsillectomy 

haemorrhage rates related to surgical technique 

O026: J. Stalfors: Presentation of large datavolumes 

with the valuecompasses – a qualitive method 

O117: J.A. De Ru: OME; aiming the right 

therapy at the right patient 


Evidence based medicine in pediatric 

otology 

CHAIRMAN: Cuneyet Alper 

MODERATORS: Adrian James & 

Peter Paul van Benthem 

O010: C. Roehm: Analysis of tympanic and 

middle ear anatomy through multiplewavelengthlight 

otoscopy and image processing 

O011: A. Filipovic: Differing seasonal delays of 

facets of OM(E) presentation in hospital referred 

cases 

O012: W. Van Rompaey: Quality assurance for a 

sustained prospective observational study in 

middle ear surgery 

O013: P. Robinson: The management of 

tympanic membrane perforations in children 

O014: E. Westman: Myringoplasty: a Swedish 

Quality Register of Otorhinolaryngology 

O015: N. Chadha: Bilateral versus unilateral 

bone anchored hearing aids for children with 

bilateral permanent conductive hearing loss: 


ROUND TABLE 3 

Evidence based cochlear implantation at the 

edge … of an envelope? 

CHAIRMAN: Manuel Manrique 

MODERATORS: Blake Papsin & Rolien Free 

Anke Lesinski: Hearing preservation in cochlear 

implantation in children and possibilities in single 

sided deafness 

Stephen O’Leary: Cytoprotection use of 

intratympanic medication and use of neurotrophic 

medication for protection of inner ear, more 

clinically oriented 

Levent Sennaroglu: Cochlear implantation in 

cochlear malformations and when to use ABI 

Keiko Hirose: Inflammatory response of the cochlea 

ROUND TABLE 2 

Comprehensive approach to the drooling and 


CHAIRMAN: Yvan Vandenplas 

MODERATORS: Dana Thompson & 

Lucienne Speleman 

Sam Daniel: Drooling and swallowing 

dysfunction in the neurologically impaired child 

Gresham Richter: Swallowing dysfunction in 

the non-neurologically impaired child 

Yvan Vanderplas: The role of PPIs and reflux 

management of swallowing dysfunction and 

aspiration 

Mark Gerber: Surgical management of the 


ROUND TABLE 4 

Pediatric Anesthesia:Is there teamwork in the 

air(way)? 

CHAIRMAN: Andy Inglis 

MODERATORS: Markus Weiss & 

Bouwe Molenbuur 

Andreas Machotta: Red flags in pediatric 

anesthesia, sharing the airway 

Elly Vermeulen: Can intubate, cannot ventilate 

O027: J.M.Th. Draaisma: Prehospital 

endotracheal cuff pressure as risk factor for 

iatrogenic tracheal stenosis



Head and Neck surgery 

CHAIRMAN: Colin Barber 

MODERATORS: Hamid Daya & Christian Sittel 

O016: Y. Bajaj: Management of first branchial 

cleft anomalies 

O017: R. Locke: The introduction of a protocol for 

the management of Paediatric Cervical 

Lymphadenopathy 

O018: T. Ahmed: Paediatric head and neck 

pathology – a 10 year experience 

O019: J.P. Ludeman: Educating children about 

choking hazards 

O020: O. Piccin: Non tuberculous mycobacterial 

cervicofacial adenitis: a 30 years retrospective review 

O021: S. Alvi: Neonatal tracheostomies: experiences 

over the last decade at the royal Manchester 

Children’s Hospital 


Balance and vertigo; An overlooked problem in 

pediatric otorhinolaryngology 

CHAIRMAN: Margaretha Casselbrant 

MODERATORS: Sharon Cushing & Leen Maes 

Robert O'Reilly: Pediatric balance disorders: 

Prevalence and the spectrum of disease 

Sylvette Wiener-Vacher: Vestibular evaluation 

in young children: Important points and recent 

advances 

O028: F. Tjernström: Learning Postural Control in 

Children – Plasticity or Exploratory Learning? 

O029: P. De Kegel: The influence of a vestibular 

dysfunction on the motor development of deaf and 

hard of hearing children 

O031: J.R. Levi: Pediatric vestibular and balance 

disorders: risk factors and causes from 300+ pediatric 

patients 

O030: N. Loundon: Effects of Cochlear 

implantation on vestbular function 

WORKSHOP 2 

Temporal bone imaging - what the radiologist 

and surgeon should tell each other 

CHAIRMAN: Vedat Topsakal 

INSTRUCTORS: Jan Casselman & Erwin Offeciers 


OSA and tonsillectomy in children 

CHAIRMAN: Harvey Coates 

MODERATORS: Anne-Laure Mansbach & 

Khalid Al Mazrou 

O032: C. Driessen: The naturel course of OSA in 

children with syndromic craniosynostosis 

O033: M. Maris: Drug-induced sleep endoscopy for 

upper airway evaluation in children with down 

syndrome 

O034: C. Hemlin: A patient questionnaire can give 

valid information on the prescence of morbidity after 

tonsillar surgery 

O035: J. Walton: Systematic review of randomized 

controlled trials comparing intracapsular 

tonsillectomy with total tonsillectomy in a 

pediatric population 

O036: A. Zaman: Changing trends of 

tonsillectomy for obstructive sleep apnoea 

O037: O. Sunnergren: Pediatric tonsillotomy; 

a comparison of high- and low radiofrequency 

techniques with regard to postoperative bleeding, 

pain, infection and symptom relief 

MONDAY POSTER PRESENTATIONS 

09:00 - 09:45 Poster P001 - P014 

09:45 - 10:30 Poster P015 - P027 

10:30 - 11:15 Poster P028 - P043 

11:15 - 12:00 Poster P044 - P059 

12:00 - 12:45 Poster P060 - P075 

12:45 - 13:30 Poster P076 - P091 

13:30 - 14:15 Poster P092 - P104 

14:15 - 15:00 Poster P105 - P119 

15:00 - 15:45 Poster P120 - P135 

15:45 - 16:30 Poster P136 - P151 

16:30 - 17:15 Poster P152 - P167 

17:15 - 18:00 Poster P168 - P183 

305


07:45 – 08:45 

09:00 – 10:15 

10:15 – 10:45 

10:45 – 12:00 

12:00 – 13:30 

12:15 – 13:15 

306 


WORKSHOP 3 

Handling the patient load in different societies 

CHAIRMAN: Anne Schilder 

INSTRUCTOR: Seth Pranksy 

Ari Derowe: Can computer aided patient flow 

management deal with chaos in the understaffed 

clinic? 

Michael Kuo: Effective use of the extended 

working day to maximise capacity in the UK 

National Health Service 

Steve Handler: Integrating non-physician 

providers into complex pediatric otolaryngology care 


Research ethics and conflict of interest 

CHAIRMAN: Kari Kvaerner 

MODERATOR: Chris Raine 

Doug Altman: The ethical imperative of good 

reporting of research 

Frank Miedema: Management of conflict of 

interest, a Board Room perspective 

Coffee 

ROUND TABLE 5 

Conductive hearing loss in children: when do 

implantable devices come in? 

CHAIRMAN: Milan Profant 

MODERATORS: Michael Rothera & 

Emmanuel Mylanus 

Hans Thomeer: Etiology pediatric of conductive 

hearing impairment; surgical aspects? 

Henning Frenzel: Management of congenital 

atresia & active middle ear implants 

Michael Rothera: Management of conductive 

hearing loss with bone conduction devices in children 

Levent Sennaroglu: Management of congenital 

oval window pathologies, where is the limit to 

reconstructive surgery? 

Myrthe Hol: Transcutaneous bone conduction 

revisited 

Lunch 


ArthroCare: 

Coblation: Diagnosis and treatment of 

obstructive sleep apnea 

WORKSHOP 4 

Imaging the pediatric airway 


INSTRUCTORS: Ben Hartley & Alistair Calder 

O038: C. Güldner: Role of Cone-beam-CT in 

pediatric-ENT diagnostics 


Mucosal immunology and microbiology in 

otitis media 

CHAIRMAN: Noboru Yamanaka 

MODERATORS: Marie Gisselsson Solén & 

Debby Bogaert 

O045: M.R. van den Bergh: Alternative 

sampling methods for detecting bacterial 

pathogens in children with an upper respiratory tract 

infection: revisiting the gold standard 

O046: J. Langereis: Modulated lipooligosaccharide 

structure prevents non-typeable 

haemophilus influenzae from IGM-mediated 

complement killing during otitis media 

O047: N. Mills: Otitis media in New Zealand: 

Middle ear microbiology and nasopharyngeal 

carriage in A 3+1 conjugated pneumococcal 

vaccinated cohort 

O048: S.Takei: Minimal biofilm eradication 

concentration of antimicrobial agents against 

Haemophilus influenzae isolated from acute 

otitis media 

O049: M.Gisselsson Solén: Immunologic 

findings in young children with early onset of 

acute otitis media 


Cochlear: 

Performance. And more. 

WORKSHOP 5 

Nasal obstruction in the newborn and infant 

CHAIRMAN: Lucienne Speleman 

INSTRUCTORS: Jean Michel Triglia & Bob Ward 

Karin Oomen: Newborn nasal obstruction: 

Symptoms, evaluation and treatment 

Richard Nicollas: Numerical modeling: New tool 

in nasal obstruction management in children 

Bob Ward: Congenital piriform aperture stenosis: 

Diagnosis, evaluation, timing of surgery 

Max April: Choanal atresia: Towards an 

individualized treatment? 

Jean Michel Triglia: Zebras in the infant nose: 

Unusual cases of nasal obstruction 


Cleft palate & 22q11.2 deletion syndrome 

CHAIRMAN: Jetty Verwoerd-Verhoef 

MODERATORS: Gabor Katona & Ronald Admiraal 

O050: T. Marom: Head and neck manifestations 

of 22q11.2 deletion syndromes 

O051: Z. Csakanyi: Incidence of otitis media with 

effusion and its sequelae in cleft palate children at 

different age groups 

O052: N. Spruijt: In search of the optimal 

surgical treatment for velopharyngeal dysfunction in 

22Q11.2 deletion syndrome 

O053: D. Wynne: Dysphonia in a cleft population. 

Associations with cleft type, velo-pharyngeal 

dysfunction and socio-economic deprivation 

O054: N. Janssen: Pure phase ß-Tricalcium 

Phosphate as a bone substitute for alveolar cleft 

closure: A pilot study



Developments in cochlear implantation 

in children 

CHAIRMAN: Henryk Skarzynski 

MODERATORS: Nathalie Loundon & Iain Bruce 

O039: A. Gordon: Evidence supporting simultaneous 

bilateral cochlear implantation in children 

O040: Y. Bajaj: Cochlear implantation in syndromic 

children – The Great Ormond Street hospital 

O041: N. Loundon: Cochlear reimplantation in 

pediatric population 

O042: C. Jolly: Distribution of cochlear duct lengths 

and electrode choice 

O043: D. Friedland: Fine structure processing 

and music perception: Implications for pediatric 

cochlear implantation 

O044: L. De Bruyn: Sound caterpillar-assessment 

and training of sound and music perception skills 

in hearing impaired children 


Progress in otitis media with effusion 

CHAIRMAN: Pekka Karma 

MODERATORS: George Spratley & 

Michal Grzegorowski 

O057: M.F. Bhutta: Susceptibility to chronic 

otitis media with effusion is associated with 

polymorphism at the loci FBXO11 and SMAD2 

O056: M. Casselbrant: Forced response test 

age 3 and 4 years in children with recurrent Otitis 

Media or chronic Otitis Media with effusion 

O059: M. Haggard: Two separate paths to 

parent quality of life in persistent otitis media 

with effusion (OME) 

O055: A. van Zon: Antibiotics for otitis media with 

effusion in children: a Cochrane systematic review 

O058: G. Marciante: Comparison between 

microdebrider endoscopic-assisted adenoidectomy 

and traditional adenoidectomy in the management 

of otitis media with effusion in children 

O060: D.Fitzgerald: Influence of current and future 

ventilation tube design on the magnitude 

of stress imposed at the implant / tympanic 

membrane interface 

WORKSHOP 6 

Child abuse and ENT 

CHAIRMAN: Elzbieta Hassmann-Pozanska 

INSTRUCTORS: Ad Bosschaart & 


Ann Hermansson 

WORKSHOP 7 

Laryngeal cleft 

CHAIRMAN: Bas Pullens 

INSTRUCTORS: Reza Rahbar & Noel Garabédian 

TUESDAY POSTER PRESENTATIONS 

08:15 - 09:00 Poster P184 - P198 

09:00 - 09:45 Poster P199 - P213 

09:45 - 10:30 Poster P214 - P228 

10:30 - 11:15 Poster P229 - P242 

11:15 - 12:00 Poster P243 - P258 

12:00 - 12:45 Poster P259 - P274 

12:45 - 13:30 Poster P275 - P290 

13:30 - 14:15 Poster P291 - P305 

14:15 - 15:00 Poster P306 - P320 

15:00 - 15:45 Poster P321 - P335 

15:45 - 16:30 Poster P336 - P351 

16:30 - 17:15 Poster P352 - P365 

307


13:30 – 14:45 

15:00 – 16:15 

16:15 - 16:45 

16:45 – 18:00 

18:00 – 18:30 

18:30 

308 



Curative therapy of deafness: The road ahead 

CHAIRMAN: Cor Cremers 

MODERATOR: Françoise Denoyelle 

Christine Petit: Curative therapy of deafness: 

the road ahead 

Andrej Kral: Sensitive periods for therapy of 

deafness 

ROUND TABLE 6 

Open versus closed surgery for laryngotracheal 

stenosis. Experience, evidence, guidelines? 

CHAIRMAN: Noel Garabédian 

MODERATORS: John Russell & Hans Hoeve 

O061: Y. Bajaj: Paediatric laryngotracheal 

reconstruction: Great Ormond Street experience 

O062: C.E. Rennie: Balloon Dilatation of the 

Paediatric Airway: the Great Ormond Street 

experience. 

Vikash Modi: A multi-institutional experience for 

endoscopic posterior cricoid grafting in 25 children 

Alan Cheng: Building towards an algorithm for 

laryngotracheal reconstruction 

Reza Rahbar, Mike Rutter, Philippe Monnier: 

Much experience, but how much evidence? 

Tea 

ROUND TABLE 8 

Pierre Robin sequence: to distract or not to 

distract? 

CHAIRMAN: Peter Bull 

MODERATORS: Michelle Wyatt & 

Irene Mathijssen 

Koen Joosten: How badly is the airway obstructed 

in Pierre Robin sequence? 

Eppo Wolvius: How retrognathic and glossoptotic 

is the Pierre Robin patient? 

O073: Y. Bajaj: Airway management in Pierre 

Robin patients using nasopharyngeal airway 

O074: V. Couloignier: Pierre Robin syndrome: 

comparison between tracheotomy and noninvasive 

ventilation 

Corstiaan Breugem: Diagnosis and treatment of 

Pierre Robin sequence 

ESPO General Assembly 

Departure boat cruise and informal dinner 

at Fifteen Amsterdam 

OTOLOGIC LIVE SURGERY BY LION 

MODERATORS: Thomas Lenarz & 

Wilko Grolman 

The surgery will be performed by one of 

the experienced surgeons from MHH, 

Hannover, Germany. 

The Surgical procedure will be a cochlear 

implantation using the C422 device by 

Cochlear. 


Universal neonatal hearing screening: Meeting 

the goals 

CHAIRMAN: Antonio Della Volpe 

MODERATORS: Adrian Davis & 

Ingeborg Dhooge 

O076: M. Elloy: The impact of universal neonatal 

hearing screening on the timing of cochlear 

implantation in children with congenital hearing 

loss 

O078: S. Ratnayake: Yield of medical 

investigations of babies with permanent unilateral 

deafness identified via newborn hearing screening 

O079: S. Coenraad: ABR morphology and analysis 

in very preterm NICU infants 

O075: L.V. Jingrong: Screening for delayed-onset 

hearing loss in preschool children who previously 

passed the newborn hearing screening 

O077: J. Goderis: Audiological and vestibular 

findings in congenital cytomegalovirus infection: 

Results of a prospective cohort study 

ROUND TABLE 7 

Down syndrome: a challenge for the ENT 

surgeon 

CHAIRMAN: Patrick Sheehan 

MODERATORS: Sally Shott & An Boudewyns 

Ad Snik: Diagnosis and treatment of hearing loss 

in Down syndrome 

Marceline van Furth: Upper airway infections 

in Down syndrome 

Sally Shott: Sleep-disordered breathing in Down 

syndrome 

O067: M Maris: Sleep problems in children with 

Down syndrome. 

ROUND TABLE 9 

Effective teaching in pediatric 


CHAIRMAN: Seth Pransky 

MODERATORS: Umut Akyol & 

Jochen Bretschneider 

Jochen Bretschneider: Aspects of medical 

education in 2012 – an experience based approach 

O080: M. Yaneza: Educating tomorrow’s GPs – 

A workbook on paediatric otolaryngology for general 

practitioners 

O081: M. Saunders: Registrar paediatric 

bronchoscopy experience 

Mark Volk: Using medical simulation to teach 

decision making and teamwork in the operating 

room 

Umut Akyol: Pan-European assessment of 

specialist education by e-platform, UEMS 

experience can be used as an effective tool to 

harmonize pediatric ORL training



Genetics of deafness: From research to improved 


CHAIRMAN: Alessandro Martini 

MODERATORS: Guy Van Camp & Dirk Kunst 

Guy Van Camp & Dirk Kunst: Genetics of 

deafness: From research to improved diagnostics and 

clinical care 

Nicole Weegerink: Clinical otogenetics: from 

research to improved clinical care 

O063: D.C. van Trier: External ear anomalies 

and hearing impairment in Noonan Syndrome 

O064: F. Swinnen: Audiologic and genetic 

determination of hearing loss in osteogenesis 

imperfecta 

O065: S. Masuda: High prevalence of inner ear 

and/or internal auditory canal anomalies in 

pediatric unilateral hearing loss 

O066: S. Marlin: Genotype phenotype correlation in 

usher syndrome 

FREE PAPER SESSION 16: 

Surgery in conductive hearing loss 

CHAIRMAN: Erwin Offeciers 

MODERATORS: Marc Pellicer & 

Thomas Nikolopoulos 

O082: M. Profant: VSB in conductive hearing loss 

management in aural atresia 

O083: K. Boeheim: Active middle ear implant 

Vibrant Soundbridge in high frequency 

sensorineural hearing loss 

O086: A. Wolf-Magele: The Vibrant Soundbridge 

for the treatment of mixed and conductive hearing 

losses in children 

O084: A. Hinze: Bonebridge: Results from a 

clinical investigation with a new active bone 

conduction implant 

O085: C. McLarnon: Resonance frequency analysis 

of osseo-integrated implants for bone conduction in 

a paediatric population 

O087: H. Thomeer: Congenital minor ear 

anomalies. Outcomes of surgery and some 

syndromal aspects 


Complementary and integrative medicine in 

pediatric otorhinolaryngology 

CHAIRMAN: Tania Sih 

MODERATORS: Paola Marchisio & 

Ines von Rosenstiel 

O068: J.R. Levi: Evidence based complimentary and 

alternative medicine for Otitis Media 

O069: S. Bianchini: Hypertonic saline is better than 

normal saline for seasonal allergic rhinitis in 

children 

O070: L. Bellussi: Complementary and integrative 

therapies in acute and chronic inflammatory 

processes of the nose and paranasal sinuses 

O071: R. Cohen-Kerem: Use of complementary 

alternative medicine in pediatric otolaryngology 

patients 

O072: M. Popp: Treatment of acute rhinosinusitis 

with a herbal product: evidence has been reached 

WORKSHOP 8 

Improving clinical decision making: What do 

you do in OME? 

CHAIRMAN: Karin Oomen 

INSTRUCTORS: Geert van der Heijden & 

David Albert 

David Albert: Introduction of the challenge for 

clinicians 

Geert van der Heijden: Expert view on decision 

making from an epidemiologist 

O088: N. Bohm: Regional and local variation 

of ventilation tube insertion in England: 

A quantitative analysis 

Marianne Elloy: Scenarios in OME and LTR 

Mark Haggard: Implementation of guidelines 

TUESDAY POSTER PRESENTATIONS 

08:15 - 09:00 Poster P184 - P198 

09:00 - 09:45 Poster P199 - P213 

09:45 - 10:30 Poster P214 - P228 

10:30 - 11:15 Poster P229 - P242 

11:15 - 12:00 Poster P243 - P258 

12:00 - 12:45 Poster P259 - P274 

12:45 - 13:30 Poster P275 - P290 

13:30 - 14:15 Poster P291 - P305 

14:15 - 15:00 Poster P306 - P320 

15:00 - 15:45 Poster P321 - P335 

15:45 - 16:30 Poster P336 - P351 

16:30 - 17:15 Poster P352 - P365 

309


07:45 – 08:45 

09:00 – 10:15 

10:15 – 10:45 

10:45 – 12:00 

12:00 – 12:30 

12:30 – 13:00 

310 


WORKSHOP 9 

Dutch Flemish Working Group of Pediatric 

Otorhinolaryngology (NVWPO) 

Decision-making in pediatric airway 

treatment. Case discussions 


MODERATORS: Frans Gordts 

Dana Thompson 

Noel Garabédian 

Philippe Monnier 


Guidelines and patient participation 

CHAIRMAN: Anne Pitkaranta 

MODERATOR: Hendrik Verschuur 

Lester Firkins: Patient participation: Who's life is 

it anyway? 

Jako Burgers: Professionals and patients as 

partners in guidelines 

Coffee 


Guidelines in upper respiratory tract infections 

and otitis media 

CHAIRMAN: Javier Cervera 

MODERATORS: Rich Rosenfeld & 

Jet van den Akker 

O105: M. Gisselsson Solén: Treatment of acute 

otitis media – new Swedish guidelines from 2010 

O104: M. Daniel: Have National Institute for 

Clinical Excellence guidelines on management of 

Otitis Media with effusion changed practice? 

O106: R. Glynn: Patterns of internet use by 

parents of children attending a paediatric 

otolaryngology service 

O107: M. Bogaerts: Patient Reported Outcome 

Measures (PROM) after tonsillectomy performed 

in patients with obstructive respiratory problems 

O116: T. van Dongen: Good agreement between 

parents and physician in the assessment of ear 

discharge in children 

Rich Rosenfeld: Otitis Media guidelines: 

concepts and controversies 

CLOSING CEREMONY 

Lunch 

WORKSHOP 10 

How to write a systematic review? 

CHAIRMAN: Laura Meltzer 

INSTRUCTORS: Maroeska Rovers & 

Martin Burton 


The atelectatic ear: surveillance, ventilation 

tubes or surgery ? 

CHAIRMAN: Gabor Katona 

MODERATORS: Françoise Denoyelle & 

Rinze Tange 

PANEL: Keiko Hirose, Gabor Katona, 

Adrian James, Yukiko Iino, Patrick Froehlich 

Patrick Froehlich: Minimally invasive middle 

ear surgery 

Françoise Denoyelle: Tympanic membrane 

reinforcement 

O102: E. Hassmann-Poznanska: Analysis of 

gene expression profiles in tympanic membrane 

following perforation using cDNA microarrays 

O103: M. Graziadio: Tympanic membrane 

retraction pockets 


Pediatric otology 

CHAIRMAN: Richard Kuylenstierna 

MODERATORS: Zsolt Farkas & Michel Mondain 

O090: N. Loundon: VIIIth Nerve anomalies and 

congenital deafness 

O089: A.L. Mansbach: Unilateral auditory 

neuropathy spectrum disorder in children 

O092: I. Schatteman: Impact of middle ear effusion 

on Auditory Brainstem Response (ABR) threshold in 

neonates tested during natural sleep 

O094: J. Hof: Auditory maturation in premature 

infants, a potential pitfall for early cochlear 

implantation 

O091: V. Malik: Outcome of cochlear 

implantation in asymptomatic congenital 

cytomegalovirus deafened children 

O093: N. Nassif: Bilingual rehabilitation 

strategy in cochlear implanted non native Italians 


Vascular and lymphatic malformations of the 

head and neck 

CHAIRMAN: Ben Hartley 

MODERATORS: Jonathan Perkins & 


Ben Hartley: Management of lymphatic 

malformations of the head and neck in children 

Jonathan Perkins: How basic science understanding 

of LM and lymphatics have changed my 

approach and others to LM treatment 

O100: Y. Bajaj: Surgical excision as primary 

treatment for paediatric lymphatic malformations 

O101: M. Raphael: Treatment of infantile 

Hemangiomas with Atenolol or Propranolol: Cohort 

Study with historical control group



Challenging issues in pediatric 


CHAIRMAN: Craig Derkay 

MODERATORS: Palma Benedek & 

Els De Leenheer 

O095: G. Narasimhan: Dog bites to the head and 

neck in children – an increasing problem in the UK 

O096: G. Odoch: Non accidental injury should 

be considered in children presenting with 

oropharyngeal injuries 

O097: M. Romagnoli: Osas in Down Children: 

Comparison of Rhino-pharingo-laryngeal 

fibroscopic findings and polysomnography results 

O098: F. Acke: Hearing impairment in children 

with Stickler syndrome: review of phenotype and 

correlation with genotype 

O099: N. Gürtler: DFNA54: Candidate gene 

analysis through sequence capture and nextgeneration-sequencing 


Airway: an update 

CHAIRMAN: Sergio Bottero 

MODERATORS: Robert Black & Gavin Morrison 

O108: G. Hosana: Histological structure and 

development of tracheal pars membranacea in 

human 

O109: J. Lawrence: The presentation and 

diagnosis of laryngomalacia in children aged over 

two years 

O112: L. Makoshi: The Misuse of Radiography 

in Diagnosis of Pediatric Airway Foreign Bodies 

O111: K. Amonoo-Kuofi: Supraglottic 

obstruction: A new operation for prolapse of 

the epiglottis 

O113: E. Reindorp-Kfir: Bronchoscopic assisted 

recurrent congenital tracheoesophageal fistula repair 

O110: L. Smith: Prevention of airway fires: 

Endotracheal tubes and surgical devices 

WORKSHOP 11 

Intubating the difficult airway with laryngeal 

mask and flexible bronchoscope 

CHAIRMAN: George Thomas 

INSTRUCTORS: Hans Hoeve & Andreas Machotta 


Pediatric otorhinolaryngology in the 

developing world 

CHAIRMAN: Jan Grote 

MODERATOR: Hans Borgstein 

Rupa Vedantam 

Wakisa Mulwafi 

Diego Santana 

O114: A. Taipale: High rate of hearing loss in 

Angolan children with sickle-cell disease 

WEDNESDAY POSTER PRESENTATIONS 

08:15 - 09:00 Poster P366 - P380 

09:00 - 09:45 Poster P381 - P396 

09:45 - 10:30 Poster P397 - P410 

10:30 - 11:15 Poster P411 - P426 

11:15 - 12:00 Poster P427 - P442 

311

Floorplan 

GROUND FLOOR 

312 

St. Jansstraat 

Parking 

St. Johns 

Room 

Conference 

Entrance 

Conference desk 

Oudezijds voorburgwal 

Volmer 

Room 

Reflet 

Exhibition 

Warmoesstraat 

The Grand 

Ballroom 

Exhibition 

The Winter 

Garden 

Golden 

Palm Bar 

Digital 

Posterboards 

Dam Square 

Garden 

Seasons 

Room 

Hall 

Main Entrance 

Lounge 

Rest 

Room 

Front office 

Business Centre 

Landing Dock 

Pijlsteeg 

Pijlsteeg 

Damstraat

FIRST FLOOR 

St. Jansstraat 

Warmoesstraat 

Foyer 

Room 

Hall 

Hall 

Ground Floor 

The Winter 

Garden 

Winter Garden 

Balcony 

Amstel Room 

Hospitality Suite 

Med-El 

Emergency Corridor 

Dam Square 

Emergency 

Excit 

Amsterdam 

Room 

Rest Room 

313

Authors index 

a 

Aardweg, M.T.A. van den O023 

Acke, F. O098 

Ahmed, T.S. O018, P042, P172, P173, P303 

Ahmed, W. P073 

Alkurdi, A. P253, P254 

Almazrou, A. P154 

Almomen, A. P348 

Alokby, G.H. P367 

Alper, C.M.A. P003 

Alpoim Moreira, I. P193 

Alshaikh, A.M. P235 

Alvi, S. O021 

Alzahrani, M. P287 

Amonoo-Kuofi, K.B. O111 

Andric Filipovic, S. O011 

Arai, J. P020 

Araujo Da Costa, A.S.E. P119, P157, P427 

Araújo Martins, J.A-M. P027, P184, P384 

Argyriou, M.D. P111 

Arsovic, N. P226 

Aubin, A P156, P365 

Austeng, M.E. P416, P418 

Awad, Z. P148 

b 

Bailey, C.M. O009 

Bajaj, Y O016, O040, O061, O073, O100 

Bakhshaee, M. P097 

Baljosevic, I. P357 

Ball, F. P218 

Bartolomé, M. P199 

Bayraktar, C. O002 

Becker, H.M. P130, P131, P133 

Behery, A. P310, P313 

Bellussi, L.M. O070 

Benedek, P. P147 

Berg, E. P296, P358 

Bergeron, M. P314, P361 

Bergh, M.R. van den O045 

Berlucchi, M. P347 

Bhargava, K.B. P159, P213 

Bhutta, M.F. O057, P420 

Bianchini, S. O069 

Boeheim, K. O083 

Bogaerts, M. O107 

Bohm, N. O088 

Bojanovic, M. P428 

Boonacker, C.W. P414 

Boss, E. P322 

Brademann, G. P225 

Brendel, M. P231 

Brihaye, P. P074 

Brkic, F. P259 

Brockmeier, S.J. P281 

Broz Frajtag, J. P398 

Byckova, J. P038 

c 

Calmels, M. P217 

Cao, M. van P307 

Carmel, E. P308, P330 

Casselbrant, L.M. O056 

Chadha, N.K. O015 

Cheng, J. P161 

Chetri, S.T. P150 

Clement, W.A. P342 

Coates, H. P151 

Coenraad, S. O079, P076 

Cohen-Kerem, R. O071 

Cola, C. P015 

Cornet, M.E. O001 

Correia, I. P375 

Cosgarea, E. P189, P270 

Costa, L. P115 

Couloigner, V. O074 

Cozma, S. P437 

Crawford, J.V. P406 

Csakanyi, Z. P191, O051 

Cunningham, A. P126 

Cvorovic, L.J. P204 

d 

Dale, O.T. P311 

Damoiseaux, R.A.M.J. P337 

Daniel, M. O104 

De Bruyn, L. O044 

De Kegel, P. O029 

De Ru, J.A. O117 

Degrassi, A. P312, P441 

Deitmer, T. P368 

Della Volpe, A. P285 

Denoyelle, F. P219 

Djeric, D. P206 

Dongen, T.M. van O116 

Doody, P. P377 

Draaisma, J.M.Th. O027 

Driel, M.L. van O022 

Driessen, C. O032 

e 

Economides, J.E. P283, P402 

Elloy, M. P362, O076 

Erdag, T.E. P145, P350 

Ericsson, E. P117 

Escamilla Carpintero, Y. P325 

Espeso, A. P397 

Esschendal, A.S. P049 

Esu, Y. P192 

Eyigor, M.D. P014, P392 

f 

Fabbri, E. P048 

Farkas, Zs. P338 

315

Fayoux, P. P046, P180, O005 

Fedoseev, I. P442 

Femic, N. P011 

Fernandez, I.J. P135, P349 

Fitzgerald, M. A. O060 

Fountoulakis, E.N. P326 

Fraser, A. P316 

Friedland, D.R. O043 

g 

Giannakopoulos, P.I. P201, P202 

Gilles, A. P256, P257 

Gisselsson Solén, M.K. O049, O105 

Glynn, R.W. O106, P309 

Goderis, J.M. O077 

Gómez Torres, A.G.T. P064, P302 

Gordin, A. P078 

Gordon, A. O039 

Grasso, D.L. P351 

Graziadio, M. O103 

Greco Machado, M.J. P304 

Gregori, D. P113 

Grzegorowski, M.W. P140 

Gubanova, S.G. P102 

Güldner, C. O038 

Gürtler, N. O099 

Gutiérrez González, I. P108 

h 

Haag, O. P355 

Hafrén, L. P006 

Haggard, M.P. O059 

Hagr, A. P268 

Hamdan Zavarce, M. P205, P209 

Hamzavi, J.S. P271 

Handzic, J. P399 

Harbarger, C.F. P423 

Harry, C.L. P169 

Hartanto, W.D. P081 

Hassmann-Poznanska, E.K. O102 

Heffernan, C.B. P411 

Hellmuth-Zweyer, U. P318 

Hemlin, C. O034 

Hempel, J.M. P228 

Hesham, A. P258, P421, P422 

Hessén Söderman, A.C. O025 

Hinze, A.L. O084 

Hitter, A. P331 

Hjuler, T. P100 

Hof, J.R. O094 

Hoffer, M.E. P215 

Hol, M.K.S. P404 

Hosana, G. P301 

Hsu, H. P143 

Hunag, Q. P425, P426 

Hughes, O.R. P353, P354 

Hultcrantz, E. P164 

316 

i 

Ifeacho, S.N. P061 

Iovanescu, M. P124, P369 

Ishman, S.L. P391 

Ismail-Koch, H. P171 

Ivoilov, A.Y. P122, P007 

j 

Janssen, N.G. O054 

Jensen, R.G.J. P244 

Jesic, S. P381, P409 

Jolly, C. O042 

Jong, T. de P035 

Jurovcik, M. P043 

k 

Kanei, A. P195 

Kapoor, V. P063, P293 

Kapucu, B. P373 

Karpova, E.P. P149 

Keintzel, T. P435 

Kessler, A. P245 

Kinshuck, A.J. P070, P186 

Kioutsouki, A. P379 

Kobayashi, H. P094 

Koci, V. P278 

Koitschev, A. P009 

Kontorinis, G. P036, P182, P197, P198, P262 

Kotoula, M. P071, P374 

Krishnaswamy, K P234 

Kubota, W.K P394 

Kudo, F. P004 

Kvestad, E. P077 

l 

Labassi, S. P273 

Langereis, J.D. O046 

Larangeiro, J. P335 

Lassaletta, L. P439, P440 

Lawrason, A. P066 

Lawrence, R.J. P317 

Lawrence, J. P055, O109 

Leonard, D.S. P075 

Lesinskas, E. P221 

Lesinski-Schiedat, L. P279, P280 

Levi, J.R. O031, O068, P181, P333 

LI, L. P389 

Lilli, G. P433 

Ljubic, V. P041 

Locke, R. O017, P332 

Loh, C. P142 

Loundon, N. O030, O041, O090, P230 

Lous, J. P401 

Ludemann, J.P. O019, P163 

Lupescu, S. P160 

LV, J.R. O075

m 

Maarse, W. P093 

Macaj, M.M. P190 

Macrì, F. P112 

Madill, C.J. P183 

Makoshi, L.A. O112 

Malik, V. P118, O091 

Manole, F. P329, P340, P410 

Mansbach, A.L. O089 

Marciante, G.A. O058, P101 

Marianowski, R. P029, P030, P059 

Maris, M. O033, O067 

Markov-Glavas, M. P155 

Marlin, S. P289, P385, P386, O066 

Marom, T. O050, P028, P060 

Marrugo Pardo, G.E. P372 

Martinkiene, M. P203 

Martirosyan, A.M. P079 

Masi, R. P432 

Masuda, S. O065 

Masuno, A. P021 

Mathias, N. P263, P264, P265 

Matsui, N. P194 

Mawby, T.A.R. P084 

Mckay-Davies, I. O081 

McLarnon, C. O085 

Meléndez García, J.M. P319, P395, P412 

Meric, M. P188 

Midyat, L. P247 

Mikic, B. P236 

Mileshina, A. P212, P407 

Mills, N.A. O047 

Mircetic, N. P306 

Mitchell, S. P417 

Miura, C.S. P114 

Modan, A. P290 

Modi, V. P297 

Mohanty, S. P168, P252 

Moreira, F. P250 

Mostafa, B.E. P300 

Mrowka, M.M. P024, P039, P223 

n 

Nakano, A. P080 

Narasimhan, G O095, P339, P370, P371 

Narasimhan, G P044, P067, P069, P132, P139 

Nassif, N. O093, P207 

Necula, I. P269 

Nicollas, R. P105, P345 

Niedzielski, A. O006, P137 

o 

O'Connell, R. P356 

Odoch, G. O096 

O'Duffy, F. P057, P152 

Okaniwa, O. P408 

Olaleye, O. P144 

Órfão, T. P088, P305 

Özdemir, S. P174, P175, P282 

p 

Pal, A. P056 

Paput, P. P382 

Paul, C.A. P123, P138, P378 

Pavlov, P.V. P299 

Pavlovcinova, G. P443 

Peixoto, M.C. P222 

Pereira da Silva, A. P388 

Phelan, E. P032, P360 

Philips, B. P272 

Phillips, S. P170 

Piccin, O. O020 

Pinto, V. P047 

Piotrowska, A. P090, P091 

Poenaru, M. P158, P 210 

Pondaven Letourmy, S. P380 

Popp, M. O072 

Porowski, M. P224, P393 

Possamai, V.J. P013, P018 

Pribuisiene, R. P120 

Profant, M. O082 

Prowse, S.J. P062 

Pucher, B. P053 

q 

Qased, A.F.Q P267 

r 

Radaljac, D. P031 

Radtsig, E.Y. P415 

Radulescu, L. P058, P390 

Rainsbury, J.W. P208 

Rakow, H. P167 

Ramirez, F. P109 

Ramsden, D. O024 

Raphael, M. O101 

Ratnayake, S. A. B. O078 

Reilly, J.E. P095 

Reindorp-kfir, E. O113 

Reis, C. P387 

Rennie, E. O062 

Ristic, S.J. P403 

Rivera Schmitz, T. P196 

Robinson, P.J. O013 

Roehm, C. O010, P045 

Romagnoli, M. O097, P176 

Roman, S. P214 

Rosell Ferrer, R. P396 

Rotiroti, G. P103 

Rovcanin, L. P025 

Runge, C.L. P233, P400 

Rybojad, B. P054 

s 

Sakamoto, H. P089 

Samara, L. P327 

Sasamura, Y. P068 

Schatteman, I.M.P. O092 

Scherf, W.A.C. P261 

Schoem, S. P008 

317

Schramm, B. P243, P284 

Scorpecci, A. P227 

Sergi, B. P026 

Seymour, N.C. P220 

Shah, U.K. P294 

Shihada, R. P005 

Shinnabe, A. P017 

Shino, M. P249 

Sichel, J.Y. P413 

Skarzynski, H. P251, P260, P082 

Skarzynski, H. P023, P037, P040 

Skarzynski, H. P274, P275, P276, P277 

Skouras, A. P085 

Skov Randrup, T. P034 

Slapak, I. P343 

Smit, A.L. P200 

Smith, L.P. P359, O110 

Snovak, N. P376 

Sooby, J. P128 

Sprinzl, G.M. P216, P232 

Spruijt, N.E. O052 

Stalfors, J. O026 

Stamate, S. P434 

Stefanescu, H. P240 

Stojanovic Kamberovic, V. P341 

Subarevic, V. P065 

Sultesz, S.M. P324 

Sunnergren, O. O037 

Süslü, N. P246, P248, P255 

Suto, S. P107 

Swinnen, F. O064 

Sykes, R.F.D. P178 

Sylvester, C. P436 

Szydlowski, J. P295, P321 

Szydlowski, J. P321 

t 

Taibah, K.H. P383 

Taipale, A. O114 

Takeda, S. P012 

Takei, S. O048 

Teissier, N. P002 

Thomeer, H.G.X.M. O087 

Timmerman, M.K. P298 

Tjernström, F. O028 

Toll, E.C. P291 

Torretta, S. P125 

Trier, D.C. van O063 

Trozzi, M.T. P363 

Trzpis, K. P019, P134 

Tweedie, J. P050, P051, P052, P165, O008 

Tzellas, S. P072 

u 

Ubayasiri, K.M. P320 

Ulanovski, D. P185 

318 

v 

Valera, C.P. P110, P141, P334, O003 

Van Kerschaver, E. P086 

Van Noort-van der Spek, I.L. P087 

Van Rompaey, V.W.F.M. O012 

Vedantam, V. P129 

Vicheva, D.V. P098, P104, P336, P346 

Vidraite, A. V. P266 

Visvanathan, V. P001, P366 

Vlaski, L.J. P288 

w 

Walton, J. O035 

Wang, S.M. O007 

Wasowski, A. P237, P238, P239 

Waters, M.D. P127 

Watson, G.J. P153 

Weber, F.U.W P022 

Westman, E. O014 

Widdershoven, J.C.C. P092 

Wiener-Vacher, S.R. P229 

Wikstén, J.W. P121 

Williams, J. P116, P405 

Wolf-Magele O086 

Wolfovitz, A. P016, O004 

Wong, P.Y. P177, P179 

Wróbel, M.J. P430, P431 

Wu, H. P424 

Wynne, D.M. O053, P096 

y 

Yamanaka, N. P010 

Yaneza, M.M. P162, P166, P292 

Yaneza, M.M. O080 

Yassin, A. P136 

Yehudai, N. P241 

Yilmaz, M.D. P033, P328 

z 

Zaman, A. O036, P083 

Zaytsev, Z.A.V. P286 

Zdanski, M.D. P352 

Zgoda, M. P242 

Zhang, Z. P438 

Zielinski, R, P211 

Zirk-Sadowski, J. O115 

Zivic, M. P323 

Zivkovic Marinkov, E. P429 

Zon, A. van O055 

Zyabkin, I.V. P344

PHOTOGRAPHY: © Thomas Schlijper, AMSTERDAM, The Netherlands 

GRAPHIC DESIGN: MOL grafische vormgeving, UTRECHT, The Netherlands 

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