P118 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
Predictors of Surgery in Pediatric Orbital Cellulitis
Aditya Mahalingam-Dhingra (presenter); Rahul
Shah, MD, FAAP; Diego Preciado, MD, PhD;
Jonathan Taylormoore, MD; Lina Lander, ScD
OBJECTIVE: To identify predictors of surgery in pediatric
orbital cellulitis.
METHOD: Analysis of the Kids Inpatient Database 2006 for
patients admitted with a diagnosis of orbital cellulitis; univar-
iate and multivariate analysis was performed.
RESULTS: Of 5440 admissions, 672 (12%) underwent sur-
gical intervention. Patients that had surgery were older with a
mean age of 10.15 years (SE 0.29), compared to 6.07 years (SE
0.10) for non-surgical patients (p0.001). Mean length of stay
(LOS) for all sampled patients was 3.8 days, and 90.4% were
routinely discharged. For surgical patients, cost of care (mean
$41,009) and LOS (mean 7.11 days) were higher compared to
non-surgical patients (mean cost $16,401; mean LOS 3.39
days). Mean age and LOS differed significantly between the
surgical and non-surgical groups (p0.001). Predictors of sur-
gery include male gender, admission source, type of admis-
sion, and hospital location. With the exception of gender, these
variables remained significant in a multivariate model. Clinical
predictors of surgical intervention include diplopia, ethmoidal
sinusitis (odds ratio 4.8) or maxillary sinusitis (odds ratio 3.7).
CONCLUSION: This study is the first to report on the na-
tional resource utilization in the surgical and medical treatment
of pediatric orbital cellulitis. Predictors of surgical intervention
include older age, presentation with diplopia, involvement of
ethmoid and maxillary sinuses, and admissions via the emer-
gency department. These results can enable critical analysis of
resource utilization for pediatric orbital cellulitis and can be
used to optimally triage patients, reducing costs and lengths of
stay.
Pseudomonas Biofilm Formation after
Haemophilus Infection
Carolyn Ojano-Dirain, PhD (presenter); Gregory
Schultz, PhD; Patrick Antonelli, MD
OBJECTIVE: Tympanostomy tube (TT) biofilm formation
may lead to refractory otorrhea and occlusion. Biofilms are
typically composed of multiple microbial species. The pres-
ence of one species may promote or inhibit biofilm formation
by other species. The aim of this study was to determine if
Haemophilus influenzae (HI) biofilm promotes the develop-
ment of Pseudomonas aeruginosa (PA) biofilm on TTs.
METHOD: Fluoroplastic TTs were exposed to plasma, al-
lowed to dry, then cultured with HI for seven days. TTs were
either gas-sterilized or treated for 24h with ten mcg/ml or three
mg/ml of ciprofloxacin. Half of the TTs from each treatment
group underwent bacterial counts or scanning electron micros-
copy. The remainder, as well as TTs not exposed to HI, were
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cultured with PA for four days and treated with gentamicin to
kill planktonic PA. Biofilm formation was assessed with bac-
terial counts.
RESULTS: TTs treated with ciprofloxacin three mg/ml had
lower HI counts than TTs treated with ten mcg/ml (p 0.001),
but viable HI persisted. PA biofilm formation on TTs with
prior HI biofilm and treated with ciprofloxacin ten mcg/ml or
gas sterilization was not different than TTs without HI. Less
PA biofilm formed on TTs with HI treated with three mg/mL
ciprofloxacin (p 0.002).
CONCLUSION: HI biofilm does not promote PA biofilm
formation on TTs. Use of high dose ciprofloxacin to clear HI
infection may reduce subsequent PA biofilm formation. The
clinical significance of this finding warrants examination.
QOL and Voice Outcome after Laryngotracheal
Reconstruction
Neil Chadha, MBChB, MPH, FRCS (presenter);
Jennifer Allegro, MSc; Vito Forte, MD; Paolo
Campisi, MD
OBJECTIVE: 1) To asses long-term impact of thyroid alar
cartilage laryngotracheal reconstruction (LTR) on health-re-
lated quality of life (QOL) in infants using three validated
instruments: Health Utility Version 3 (HUI3), Pediatric Voice-
Related Quality of Life Instrument (PVRQOL), and Impact on
Family questionnaire; 2) To perform acoustic and perceptual
voice assessments to evaluate long-term voice quality out-
come.
METHOD: Eligible children had all undergone an anterior
thyroid alar cartilage graft LTR before the age of 24 months,
between 1995 and 2007. Recruitment occurred over a 6-month
period using validated QOL instruments and acoustic and per-
ceptual voice analyses.
RESULTS: Thirteen patients (eight male, five female, median
10 years) were enrolled. The mean age at LTR was five months
(range 0-20) and the mean study follow-up period was 9 years
(range 2-14). The average speech HUI3, PVRQOL and Impact
on Family scores were 0.84 (SD-0.31), 0.83 (SD-0.22) and
0.67 (SD-0.28), respectively. The acoustic scores were either
within the normal range or mildly abnormal for the variables:
jitter, shimmer, noise-to-harmonic ratio, peak amplitude vari-
ation and fundamental frequency variation. The CAPE-V over-
all severity perceptual score was in the mildly abnormal range
for 8 of 10 patients.
CONCLUSION: This is the first study to explore and quantify
long-term QOL and voice function in children following LTR
with thyroid alar graft at a very young age. The vast majority
of patients had a very good functional voice outcome as evi-
denced by the HUI3 and PVRQOL scores. This was corrob-
orated by acoustic and perceptual voice assessments.