Dr. Sidell is Associate Professor of Otolaryngology -Head and Neck Surgery at the Stanford University Medical Center, where he is a member of the Division of Pediatric Otolaryngology. Dr. Sidell's surgical practice focuses on the management of children with complex airway and pulmonary disorders, with a special interest in complex and revision airway reconstruction. His clinical interests also include the management of children with voice and swallowing disorders as well as congenital or acquired abnormalities of the larynx and trachea. He is the Director of the Pediatric Aerodigestive Center and the Pediatric Voice and Swallowing Clinics at Lucile Packard Children's Hospital Stanford.

Dr. Sidell received his medical degree from The George Washington University School of Medicine and completed his internship and residency with the Department of Head and Neck Surgery at the University of California, Los Angeles. He completed his fellowship in Pediatric Otolaryngology with an emphasis on airway reconstruction at Cincinnati Children's Hospital Medical Center.

Dr. Sidell has authored or co-authored multiple peer-reviewed articles and abstracts which appear in top-tier medical publications. He is board-certified by the American Board of Otolaryngology and is a fellow of the American College of Surgeons and the American Academy of Pediatrics. He is a member of numerous organizations and societies, including the Stanford Maternal and Child Health Research Institute, the American Academy of Otolaryngology, American Broncho-Esophagological Association, and the American Society of Pediatric Otolaryngology.

Clinical Focus

  • Pediatric Otolaryngology
  • Airway and Aerodigestive Disorders
  • Airway Reconstruction
  • Pediatric Voice Disorders
  • Pediatric Swallowing Disorders
  • Otolaryngology

Academic Appointments

Administrative Appointments

  • Director, Pediatric Aerodigestive Clinic (2014 - Present)
  • Director, Pediatric Voice and Swallowing Clinic (2014 - Present)

Honors & Awards

  • Distinction of Honor, Bachelor of Science, Marine Biology University of California, Santa Cruz (2002)
  • Goddard Prize in Pharmacology, George Washington University School of Medicine and Health Sciences (2004)
  • Alpha Omega Alpha Honors Society, The George Washington University School of Medicine and Health Sciences (2006)
  • Distinction of Honor, Medical Doctor The George Washington University School of Medicine and Health Sciences. (2007)
  • Triological Society Annual Meeting Award, Triological Society (2007)
  • Triological Society Resident Travel Award, Triological Society (2008)
  • AAO-HNSF Resident Leadership Grant, American Academy of Otolaryngology-Head and Neck Surgery (2010)
  • Best Research Presentation Award, American College of Surgeons (2011)
  • Teacher of the Year, University of California, Los Angeles; Department of Head and Neck Surgery (2012)
  • Ellen M. Friedman Foreign Body Management Award, ABEA (2017)
  • Robert Howard Next Step Award, GFIT Biodesign (2018)

Boards, Advisory Committees, Professional Organizations

  • Member, Alpha Omega Alpha Honors Society (2007 - Present)
  • Member, American Academy of Otolaryngology-Head and Neck Surgery (2010 - Present)
  • Member, American Society of Pediatric Otolaryngology (2014 - Present)
  • Fellow, American Academy of Pediatrics (2016 - Present)
  • Member, International Pediatric Otolaryngology Group (IPOG) (2016 - Present)
  • Fellow, American College of Surgeons (2017 - Present)
  • Member, American Bronco-Esophagological Association (2017 - Present)
  • Executive Committee Member, Aerodigestive Research Consortium (2018 - Present)
  • Member, Otolaryngology Representative-elect, Aerodigestive Research Society (2018 - Present)
  • Candidate Member, Triological Society (2019 - Present)

Professional Education

  • Residency: UCLA General Surgery Residency (2012) CA
  • Internship: UCLA David Geffen School Of Medicine Registrar (2008) CA
  • Fellowship: Cincinnati Children's Medical Center (2014) OH
  • Board Certification: American Board of Otolaryngology, Otolaryngology (2013)
  • Medical Education: George Washington University Medical School (2007) DC
  • Fellowship, Cincinnati Children's Hospital Medical Center, Pediatric Otolaryngology-Head and Neck Surgery (2014)
  • Board Certification, The American Board of Otolaryngology, Otolaryngology--Head and Neck Surgery (2013)
  • Residency, The University of California Los Angeles, Head and Neck Surgery (2012)
  • Internship, The University of California Los Angeles, Surgery (2008)
  • MD, The George Washington University School of Medicine and Health Sciences, Medicine (2007)

Current Research and Scholarly Interests

Dr. Sidell's clinical interests include the management of children with voice and swallowing disorders, and congenital or acquired airway abnormalities. Examples of ongoing or upcoming prospective trials include an investigation into the utility of acid suppression in children with laryngomalacia, the management of vocal cord paralysis following cardiac surgery, and the management of type 1 laryngeal clefts in children. Additional interests include novel material applications in laryngotracheal reconstruction.
He has a strong interest in multi-institutional collaboration, and an open-door policy for discussing research concepts that may culminate in enhanced care for children.

Clinical Trials

  • In Infants With Laryngomalacia, Does Acid-Blocking Medication Improve Respiratory Symptoms? Recruiting

    All neonates, ages 0 to 4 months, presenting to LPCH pediatric ENT clinic for airway difficulties or stridor will be screened for inclusion. As is consistent with an acceptable standard of medical care, these children will undergo a flexible nasal endoscopic exam to make the diagnosis of laryngomalacia, as well as be weighed and a breastfeeding history taken. If laryngomalacia is present, the study staff with then administer the Infant Gastroesophageal Reflux Questionnaire (IGERQ) and an airway symptoms questionnaire (ASQ). Those babies with an IGERQ score of less than sixteen (no more than mild reflux) and an ASQ score greater than six will be eligible for randomization. The patient will then be randomly placed in the control group (placebo) or the intervention group (ranitidine 2mg/kg every 12 hours or famotidine 0.5 mg/kg daily). Patients will stay on medication for a minimum of 6 months, or until symptoms resolve. Patients will be seen in follow up at 1, 2, 3, 4, 5, 6, 8 and 10 months. At which time I-GERQ, ASQ and weights will be taken. The primary outcome measure will be the time for the ASQ score to drop to normal on ranitidine or famotidine versus placebo. A secondary outcome will be weight gain in percentile. If the patient's I-GERQ score goes above 16 at any time in the study, the patient will be crossed over to the treatment arm and started on medical treatment.

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  • Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) Use in Pediatric Procedures Recruiting

    THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) refers to the use of high-flow nasal cannula to augment the ability to oxygenate and ventilate a patient under general anesthesia. The use of high-flow nasal cannula oxygen supplementation during anesthesia for surgical procedures has been a recent development in the adult population, with limited data analyzing the pediatric population. This study will determine whether high flow nasal cannula oxygen supplementation during surgical or endoscopic procedures can safely prevent desaturation events in children under anesthesia.

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2020-21 Courses

Graduate and Fellowship Programs

All Publications

  • Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in pediatric bronchoscopy: A prospective pilot study. Journal of clinical anesthesia Caruso, T. J., O'Connell, C., Qian, J., Menendez, M., Fonseca, A., Lawrence, K., Sidell, D. R., Darling, C., Tsui, B. 2020; 68: 110086

    View details for DOI 10.1016/j.jclinane.2020.110086

    View details for PubMedID 33075630

  • Using Augmented Reality to Reduce Fear and Promote Cooperation During Pediatric Otolaryngologic Procedures. The Laryngoscope Caruso, T. J., Madill, M., Sidell, D., Meister, K., Wang, E., Menendez, M., Kist, M. N., Rodriguez, S. 2020


    This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 2020.

    View details for DOI 10.1002/lary.29098

    View details for PubMedID 32886794

  • The Relationship between Croup and Gastroesophageal Reflux: A Systematic Review and Meta-Analysis. The Laryngoscope Coughran, A., Balakrishnan, K., Ma, Y., Vaezeafshar, R., Capdarest-Arest, N., Hamdi, O., Sidell, D. R. 2020


    The mechanism by which recurrent croup occurs is unknown. Gastroesophageal reflux is commonly implicated, although this relationship is only loosely documented. We conducted a systematic review with a meta-analysis component to evaluate the relationship between recurrent croup and gastroesophageal reflux disease (GERD), and to assess for evidence of improvement in croup symptoms when treated.Systematic Review and Meta Analysis.We searched five separate databases. Studies were included if they discussed the relationship between croup and GERD in children, >5 subjects, and available in English. Literature retrieved was assessed according to pre-specified criteria. Retrieved articles were reviewed by two independent authors and decisions mediated by a third author. If there was a difference of opinion after first review, a second review was performed to obtain consensus. Heterogeneity was calculated and summarized in forest plots.Of 346 initial records, 15 met inclusion criteria. These were two retrospective cohort and 13 cross-sectional studies. Thirteen of 15 articles support an association between recurrent croup and GERD. Although heterogeneity is high among studies that reported prevalence of GERD, there is less uncertainty in results for improvement to recurrent croup after GERD treatment. Most studies lacked a control group and all carry a moderate-to-high risk of bias.There is limited evidence linking GERD to recurrent croup; Further research is needed to assess for causality as most studies are retrospective, lack a control group, and have a study design exposing them to bias. Patients treated with reflux medication appear to demonstrate a reduced incidence of croup symptoms.1 Laryngoscope, 2020.

    View details for DOI 10.1002/lary.28544

    View details for PubMedID 32040207

  • Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes OTOLARYNGOLOGY-HEAD AND NECK SURGERY Meister, K. D., Johnson, A., Sidell, D. R. 2019; 160 (3): 540–45
  • Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement LARYNGOSCOPE Balakrishnan, K., Sidell, D. R., Bauman, N. M., Bellia-Munzon, G. F., Boesch, R., Bromwich, M., Cofer, S. A., Daines, C., de Alarcon, A., Garabedian, N., Hart, C. K., Ida, J. B., Leboulanger, N., Manning, P. B., Mehta, D. K., Monnier, P., Myer, C. M., Prager, J. D., Preciado, D., Propst, E. J., Rahbar, R., Russell, J., Rutter, M. J., Thierry, B., Thompson, D. M., Torre, M., Varela, P., Vijayasekaran, S., White, D. R., Wineland, A. M., Wood, R. E., Wootten, C. T., Zur, K., Cotton, R. T. 2019; 129 (1): 244–55


    Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies.Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria.Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable.This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient.5 Laryngoscope, 129:244-255, 2019.

    View details for PubMedID 30152166

  • Application-Based Translaryngeal Ultrasound for the Assessment of Vocal Fold Mobility in Children. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sayyid, Z., Vendra, V., Meister, K. D., Krawczeski, C. D., Speiser, N. J., Sidell, D. R. 2019: 194599819877650


    To compare the evaluation of vocal fold mobility between flexible nasal laryngoscopy (FNL) and a handheld application-based translaryngeal ultrasound (TLUS) platform.Prospective analysis included patients with unknown vocal fold mobility status who underwent FNL and TLUS.Tertiary referral center.TLUS was performed on 23 consecutive children (<18 years old) presenting for laryngoscopy due to unknown vocal fold mobility status. After the recording of three 10-second TLUS videos as well as FNL, the study was divided into 2 parts: parental assessment of laryngeal ultrasound at the time of patient evaluation and random practitioner assessment of ultrasound videos.We describe 23 patients who underwent TLUS and FNL. Ten patients (43.5%) had normal vocal fold function bilaterally, and 13 (56.5%) had either left or right vocal fold immobility. Family members and physicians correctly identified the presence and laterality of impaired vocal fold mobility in 22 of 23 cases (κ = 0.96). The sensitivity, specificity, positive predictive value, and negative predictive value of FLUS in diagnosing vocal fold immobility were 92.3%, 100%, 100%, and 90.9%, respectively. Random practitioners accurately identified the presence and laterality of vocal fold immobility under all circumstances.A handheld application-based ultrasound platform is both sensitive and specific in its ability to identify vocal fold motion impairment. Portable handheld TLUS has the potential to serve as a validated screening examination, even by inexperienced providers, and in specific cases may obviate the need for an invasive transnasal laryngoscopy.

    View details for DOI 10.1177/0194599819877650

    View details for PubMedID 31547773

  • Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Meister, K. D., Johnson, A., Sidell, D. R. 2018: 194599818813002


    OBJECTIVE: Vocal fold immobility with resultant dysphagia is a known cause of morbidity in the pediatric population. Herein we evaluate the efficacy and adverse events of injection laryngoplasty in children.STUDY DESIGN: Case series with chart review.SETTING: Tertiary academic children's hospital.SUBJECTS AND METHODS: Patients <12 years of age with unilateral vocal fold immobility, dysphagia, and objective swallow study data were included. Primary outcome measures included perioperative adverse events and the ability to advance the diet, as defined by initiation of oral feeds or reduction in thickener following postoperative swallow study.RESULTS: The mean age of the cohort (N = 41) was 43.83 months (range, 0.5-144 months), and 46.3% of patients were <18 months old. Perioperative adverse events included increased oxygen requirement (n = 3), prolonged operating room time secondary to tenuous cardiopulmonary status (n = 2), and postoperative readmission within 30 days (n = 1). A total of 63.63% (n = 21 of 33) of patients safely advanced their diet following objective improvement on swallow study. Patients undergoing injection laryngoplasty ≤6 months of the onset of vocal fold immobility were more likely to advance their diet following surgery.CONCLUSION: Injection laryngoplasty has the potential to advance or initiate an oral diet for children with vocal fold immobility, including those in the first months of life. It is relatively free of adverse events, but certain limitations in the pediatric population must be considered. Preoperative characteristics, including timing of injection and premorbidity diet, may guide clinicians in predicting those patients most likely to advance their diet following injection laryngoplasty.

    View details for PubMedID 30453837

  • Revision Thoracic Slide Tracheoplasty: Outcomes Following Unsuccessful Tracheal Reconstruction LARYNGOSCOPE Sidell, D. R., Hart, C. K., Tabangin, M. E., Bryant, R., Rutter, M. J., Manning, P. B., Meinzen-Derr, J., Balakrishnan, K., Yang, C., de Alarcon, A. 2018; 128 (9): 2181–86

    View details for DOI 10.1002/lary.27145

    View details for Web of Science ID 000446523700040

  • Revision thoracic slide tracheoplasty: Outcomes following unsuccessful tracheal reconstruction. The Laryngoscope Sidell, D. R., Hart, C. K., Tabangin, M. E., Bryant, R. 3., Rutter, M. J., Manning, P. B., Meinzen-Derr, J., Balakrishnan, K., Yang, C., de Alarcon, A. 2018


    OBJECTIVES/HYPOTHESIS: Over the past decade, thoracic slide tracheoplasty (TST) has become the principal operation in the management of congenital tracheal stenosis. The purpose of this report was to describe our experience with revision TST following unsuccessful prior tracheal reconstruction.STUDY DESIGN: Retrospective analysis at an academic children's hospital.METHODS: Patients undergoing TST on cardiopulmonary bypass between January 2005 and May 2014 were reviewed. Patients with a history of prior airway surgery were extracted for further analysis. Preoperative patient variables and postoperative outcomes were evaluated and compared between patients undergoing revision slide tracheoplasty (RTST) and a control group of 26 matched patients undergoing primary surgery TST.RESULTS: Twenty-six revision patients (25 referrals, one primary patient) of 162 patients reviewed over the study period met inclusion criteria. Twenty-three patients had a history of complete tracheal rings, and three patients had cartilaginous deficiency. A total of 41 airway reconstruction procedures had been performed prior to RTST. When compared to primary TST, patients undergoing RTST required fewer cardiac procedures intraoperatively, and fewer mean ventilator hours (P=.01) postoperatively. There was no significant difference in the median length of stay, requirement of >48 hours ventilation, or postoperative complications between groups. There was one nonsurgical postoperative mortality following RTST.CONCLUSIONS: Despite some differences in the postoperative management when compared to nonrevision cases, revision TST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.LEVEL OF EVIDENCE: 4. Laryngoscope, 2018.

    View details for PubMedID 29729016

  • Enhancing pediatric airway safety using the electronic medical record. The Laryngoscope Rameau, A., Wang, E., Saraswathula, A., Pageler, N., Perales, S., Sidell, D. R. 2018


    Difficult intubations are not uncommon in tertiary care children's hospitals, and effective documentation of the difficult airway is a fundamental element of safe airway management. The primary goal of our quality improvement initiative was to improve access to airway information via an alert and documentation system within the electronic medical record (EMR).We created a difficult airway alert within the EMR, linking common airway evaluation templates used by specialists involved in airway management. We assessed the time required for different specialists to answer an airway information questionnaire using the electronic charts of patients before and after the EMR modification. Satisfaction with the EMR modification was also surveyed.Questionnaires were administered to 12 participants before the Epic (Epic Systems Corp., Verona, WI) changes were implemented and to 19 participants after they were implemented. Each participant was asked to answer the airway data questionnaire for two patients, for a total of 24 questionnaires before the EMR changes and 38 questionnaires after the changes. Respondents averaged 7.24 minutes to complete the entire airway data questionnaire before the EMR changes and 3.16 minutes following modification (P < 0.0001). Correct airway information was more consistently collected with the modified EMR (98.6% vs 51.4%, P < 0.00001). Satisfaction surveys revealed that participants found the accessibility of airway data to be significantly improved following the EMR changes.An EMR airway alert that provides rapid access to relevant airway information critical tool during urgent and emergent events. Based on our preliminary data, further use of this instrument is expected to continue to improve patient safety and practitioner satisfaction.4. Laryngoscope, 2018.

    View details for PubMedID 30195274

  • Conservative management of pediatric tracheal rupture. Pediatric pulmonology Sidell, D. R., Wood, R. E., Hart, C. K. 2017; 52 (1): E1-E3


    Traumatic injuries to the pediatric trachea are uncommon events that require prompt diagnosis and management. When they do occur, tracheal injuries often arise in the setting of high impact trauma and are accompanied by major injuries to other organ systems. In this report, we present the diagnosis and conservative management of tracheal rupture at the carina in an 11-year-old female with severe intracranial injuries. Pediatr Pulmonol. 2016; 9999:1-3. © 2016 Wiley Periodicals, Inc.

    View details for DOI 10.1002/ppul.23507

    View details for PubMedID 27333290

  • Surgical Management of Posterior Glottic Diastasis in Children. The Annals of otology, rhinology, and laryngology Sidell, D. R., Zacharias, S., Balakrishnan, K., Rutter, M. J., de Alarcón, A. 2014


    The purpose of this study was to report our clinical experience in the surgical management of patients with posterior glottic diastasis (PGD) secondary to prolonged intubation and/or laryngotracheoplasty (LTP) during childhood.We reviewed the charts of patients with a history of prolonged intubation and/or LTP who had undergone surgical correction for PGD at our institution between 2010 and 2014. We documented demographic data and pertinent information regarding medical and surgical histories. The Pediatric Voice Handicap Index (pVHI) and/or the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were used to assess patients both before and after undergoing treatment for voice disorders.Six patients met our inclusion criteria. With 1 exception, all patients with complete voice data demonstrated improvements in perceptual, patient-reported, and acoustic voice measures. There were no perioperative complications.Our case series demonstrates that operative intervention can lead to improved voice in carefully selected patients with PGD secondary to prolonged intubation and/or LTP during childhood. Patients exhibited postoperative improvement in loudness and vocal endurance; however, they also exhibited a degree of compromise in voice quality.

    View details for DOI 10.1177/0003489414543100

    View details for PubMedID 25063682

  • Pediatric Exercise Stress Laryngoscopy following Laryngotracheoplasty: A Comparative Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sidell, D. R., Balakrishnan, K., Hart, C. K., Willging, J. P., Knecht, S. K., de Alarcon, A. 2014; 150 (6): 1056–61


    Exercise-induced airway obstruction in pediatric patients is a unique phenomenon with multiple potential etiologies. An accurate diagnosis can be challenging to establish in pediatric patients because they are frequently asymptomatic at rest. Exercise stress laryngoscopy (ESL) is a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study was to demonstrate (1) the diagnostic effectiveness of pediatric ESL and (2) the ability of ESL to guide treatment for "normal" and post-airway reconstruction patients with exercise intolerance.Case series with chart review.Tertiary care children's hospital.Patients undergoing ESL for exercise intolerance were reviewed. Demographics, surgical history, examination findings, and management recommendations were extracted.Thirty-seven patients (average age, 13.5 years; range, 5-21 years) were included. There were 14 male and 23 female patients. Airway abnormalities became evident in 56% of patients. Of these, 24% had focal supraglottic collapse, 43% had evidence of paradoxical vocal fold motion, 24% had combined supraglottic and glottic dysfunction, and 9% had distal airway abnormalities. Overall, 18 patients had changes in management after ESL. Twelve patients in this review had histories of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 10 (83%) received focal diagnoses after ESL.ESL is a contemporary modality by which complex patients with undiagnosed exercise intolerance can be effectively evaluated. ESL can be an important tool used to guide treatment in pediatric patients with exercise-induced dyspnea after airway reconstruction.

    View details for DOI 10.1177/0194599814528097

    View details for PubMedID 24671463

  • Food choking hazards in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Sidell, D. R., Kim, I. A., Coker, T. R., Moreno, C., Shapiro, N. L. 2013; 77 (12): 1940-1946


    To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods.A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July-September 2010 with publication dates ranging from 1966 to 2010.Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series).For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A "majority" of patients for each study was predetermined arbitrarily to be 2/3 of the studied population.The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies).Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.

    View details for DOI 10.1016/j.ijporl.2013.09.005

    View details for Web of Science ID 000328870800007

    View details for PubMedID 24113156

  • Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus. The Laryngoscope Faucett, E. A., Wolter, N. E., Balakrishnan, K., Ishman, S. L., Mehta, D., Parikh, S., Nguyen, L. H., Preciado, D., Rutter, M. J., Prager, J. D., Green, G. E., Pransky, S. M., Elluru, R., Husein, M., Roy, S., Johnson, K. E., Friedberg, J., Johnson, R. F., Bauman, N. M., Myer, C. M., Deutsch, E. S., Gantwerker, E. A., Willging, J. P., Hart, C. K., Chun, R. H., Lam, D. J., Ida, J. B., Manoukian, J. J., White, D. R., Sidell, D. R., Wootten, C. T., Inglis, A. F., Derkay, C. S., Zalzal, G., Molter, D. W., Ludemann, J. P., Choi, S., Schraff, S., Myer, C. M., Cotton, R. T., Vijayasekaran, S., Zdanski, C. J., El-Hakim, H., Shah, U. K., Soma, M. A., Smith, M. E., Thompson, D. M., Javia, L. R., Zur, K. B., Sobol, S. E., Hartnick, C. J., Rahbar, R., Vaccani, J., Hartley, B., Daniel, S. J., Jacobs, I. N., Richter, G. T., de Alarcon, A., Bromwich, M. A., Propst, E. J. 2020


    OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal.STUDY DESIGN: Blinded modified Delphi consensus process.SETTING: Tertiary care center.METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items.RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus.CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated.LEVEL OF EVIDENCE: 5. Laryngoscope, 2020.

    View details for DOI 10.1002/lary.29126

    View details for PubMedID 33034397

  • International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction. International journal of pediatric otorhinolaryngology Puricelli, M. D., Rahbar, R., Allen, G. C., Balakrishnan, K., Brigger, M. T., Daniel, S. J., Fayoux, P., Goudy, S., Hewitt, R., Hsu, W., Ida, J. B., Johnson, R., Leboulanger, N., Rickert, S. M., Roy, S., Russell, J., Rutter, M., Sidell, D., Soma, M., Thierry, B., Trozzi, M., Zalzal, G., Zdanski, C. J., Smith, R. J. 2020; 138: 110281


    OBJECTIVE: To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery.METHODS: Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses.RESULTS: Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure.CONCLUSIONS: Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

    View details for DOI 10.1016/j.ijporl.2020.110281

    View details for PubMedID 32891939

  • The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Smith, J. D., Chen, M. M., Balakrishnan, K., Sidell, D. R., di Stadio, A., Schechtman, S. A., Brody, R. M., Kupfer, R. A., Rassekh, C. H., Brenner, M. J. 2020: 194599820936615


    The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.

    View details for DOI 10.1177/0194599820936615

    View details for PubMedID 32571147

  • Tracheostomy in Infants in the Neonatal Intensive Care Unit. NeoReviews Chang, J., Sidell, D. R. 2020; 21 (5): e323–e334


    Approximately half of all pediatric tracheostomies are performed in infants younger than 1 year. Most tracheostomies in patients in the NICU are performed in cases of chronic respiratory failure requiring prolonged mechanical ventilation or upper airway obstruction. With improvements in ventilation and management of long-term intubation, indications for tracheostomy and perioperative management in this population continue to evolve. Evidence-based protocols to guide routine postoperative care, prevent and manage tracheostomy emergencies including accidental decannulation and tube obstruction, and attempt elective decannulation are sparse. Clinician awareness of safe tracheostomy practices and larger, prospective studies in infants are needed to improve clinical care of this vulnerable population.

    View details for DOI 10.1542/neo.21-5-e323

    View details for PubMedID 32358145

  • Pediatric tracheostomy practice patterns. International journal of pediatric otorhinolaryngology Sioshansi, P. C., Balakrishnan, K., Messner, A., Sidell, D. 2020; 133: 109982


    OBJECTIVE: Despite recent guidelines and the frequency of pediatric tracheostomy, surgical techniques and perioperative management are variable. We aim to describe the post-operative practice patterns following tracheostomy in children.METHODS: An electronic cross-sectional survey was distributed to American Society of Pediatric Otolaryngologists (ASPO) members in academic and private practice settings. Responses were collected anonymously and analyzed by percentages of respondents who employ specific management strategies. Statistical analysis of response distributions performed using the Z test of proportions for binary questions and the Mantel-Haenszel chi-square test for questions with more than two options. For questions with ordered categorical responses, Cuzick's nonparametric test of trend was used.RESULTS: One-hundred twenty-four responses were received (22.3%). Most respondents were fellowship trained and practiced in academic medical centers. A greater number of tracheostomies were performed by respondents practicing in the Midwest region (p=0.042). There was no variability in the number of tracheostomies performed based on practitioner age, hospital setting, or fellowship training. The majority perform stoma maturation and/or stay suture techniques intraoperatively and send patients to the intensive care unit postoperatively. The routine use of postoperative paralysis was reported by a minority of respondents and 50% reported the use of sedation. There was a roughly-even distribution of respondents who reported postoperative immobilization, mobilization to a chair, and ambulation respectively. Routine; postoperative airway evaluations were reported by 35% of respondents. Clinic follow-up was; variable.CONCLUSION: These results demonstrate ongoing variability in the postoperative management strategies following tracheostomy in children and highlight areas for further study.

    View details for DOI 10.1016/j.ijporl.2020.109982

    View details for PubMedID 32171147

  • International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). International journal of pediatric otorhinolaryngology Benedek, P., Balakrishnan, K., Cunningham, M. J., Friedman, N. R., Goudy, S. L., Ishman, S. L., Katona, G., Kirkham, E. M., Lam, D. J., Leboulanger, N., Lee, G. S., Le Treut, C., Mitchell, R. B., Muntz, H. R., Musso, M. F., Parikh, S. R., Rahbar, R., Roy, S., Russell, J., Sidell, D. R., Sie, K. C., Smith, R. J., Soma, M. A., Wyatt, M. E., Zalzal, G., Zur, K. B., Boudewyns, A. 2020; 138: 110276


    To develop an expert-based consensus of recommendations for the diagnosis and management of pediatric obstructive sleep apnea.A two-iterative Delphi method questionnaire was used to formulate expert recommendations by the members of the International Pediatric Otolaryngology Group (IPOG).Twenty-six members completed the survey. Consensus recommendations (>90% agreement) are formulated for 15 different items related to the clinical evaluation, diagnosis, treatment, postoperative management and follow-up of children with OSA.The recommendations formulated in this IPOG consensus statement may be used along with existing clinical practice guidelines to improve the quality of care and to reduce variation in care for children with OSA.

    View details for DOI 10.1016/j.ijporl.2020.110276

    View details for PubMedID 32810686

  • Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study. The Laryngoscope Sioshansi, P. C., Byrne, E., Freccero, A., Meister, K. D., Sidell, D. R. 2020


    To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study.Multi-institutional survey and prospective cohort study.Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted.Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events.Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team.4 Laryngoscope, 2020.

    View details for DOI 10.1002/lary.28748

    View details for PubMedID 32438519

  • Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus. The Laryngoscope Propst, E. J., Wolter, N. E., Ishman, S. L., Balakrishnan, K., Deonarain, A. R., Mehta, D., Zalzal, G., Pransky, S. M., Roy, S., Myer, C. M., Torre, M., Johnson, R. F., Ludemann, J. P., Derkay, C. S., Chun, R. H., Hong, P., Molter, D. W., Prager, J. D., Nguyen, L. H., Rutter, M. J., Myer, C. M., Zur, K. B., Sidell, D. R., Johnson, L. B., Cotton, R. T., Hart, C. K., Willging, J. P., Zdanski, C. J., Manoukian, J. J., Lam, D. J., Bauman, N. M., Gantwerker, E. A., Husein, M., Inglis, A. F., Green, G. E., Javia, L. R., Schraff, S., Soma, M. A., Deutsch, E. S., Sobol, S. E., Ida, J. B., Choi, S., Uwiera, T. C., Shah, U. K., White, D. R., Wootten, C. T., El-Hakim, H., Bromwich, M. A., Richter, G. T., Vijayasekaran, S., Smith, M. E., Vaccani, J., Hartnick, C. J., Faucett, E. A. 2019


    OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric tracheotomy.STUDY DESIGN: Blinded, modified, Delphi consensus process.METHODS: Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items.RESULTS: The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus.CONCLUSIONS: It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure.LEVEL OF EVIDENCE: 5 Laryngoscope, 2019.

    View details for DOI 10.1002/lary.28461

    View details for PubMedID 31821571

  • Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) augments oxygenation in children with cyanotic heart disease during microdirect laryngoscopy and bronchoscopy JOURNAL OF CLINICAL ANESTHESIA Caruso, T. J., Sidell, D. R., Lennig, M., Menendez, M., Fonseca, A., Rodriguez, S. T., Tsui, B. 2019; 56: 53–54
  • Prolonged esophageal foreign body: Management strategies in the setting of complicated tracheoesophageal fistula JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Kiyosaki, K., Wall, J., Sidell, D. R. 2019; 48
  • Static endoscopic swallow evaluation in children. The Laryngoscope Meister, K. D., Okland, T., Johnson, A., Galera, R., Ayoub, N., Sidell, D. R. 2019


    OBJECTIVES: Static Endoscopic Evaluation of Swallowing (SEES) has been demonstrated to have a strong correlation with the Videofluoroscopic Swallow Study (VFSS) in adults. In children, Fiberoptic Endoscopic Evaluations of Swallow (FEES) are frequently performed to avoid repeated VFSS; however, a subset of the population does not tolerate FEES. The purpose of this study was to evaluate the utility of a modified SEES in children.METHODS: Charts of 50 consecutive patients who underwent FEES evaluations were reviewed. Patients age 3 months to 12years undergoing SEES, FEES, and VFSS were extracted. We compared a binary assessment of outcome on SEES versus VFSS as the diagnostic standard to report characteristics, including sensitivity, specificity, and positive and negative predicted value.RESULTS: A total of 36 patients met all inclusion criteria (mean age 2.8years). Using the VFSS as the diagnostic standard, residue seen on SEES had a sensitivity of 80.0%, specificity of 85.7%, a positive predictive value of 88.9%, and a negative predictive value of 75.0% for predicting deep penetration or aspiration.CONCLUSION: SEES may be helpful for developing an initial diagnostic impression and may serve as a platform for patient and caregiver counseling. In children who are unable to cooperate with FEES, SEES may provide clinical insight in predicting an abnormal swallow study; however, a normal SEES was less reliable in predicting a safe swallow on subsequent VFSS in this patient population.LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

    View details for DOI 10.1002/lary.28263

    View details for PubMedID 31448817

  • Assessment of airway abnormalities in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals CARDIOLOGY IN THE YOUNG Wise-Faberowski, L., Irvin, M., Sidell, D. R., Rajashekara, S., Asija, R., Chan, F. P., Hanley, F. L., McElhinney, D. B., Pulm Artery Reconstruction Program 2019; 29 (5): 610–14
  • The successful application of high flow nasal oxygen during microdirect laryngoscopy and bronchoscopy in patients under 7 kg JOURNAL OF CLINICAL ANESTHESIA Caruso, T. J., Gupta, A., Sidell, D. R., Darling, C., Rodriguez, S., Fonseca, A., Tsui, B. 2019; 52: 27–28
  • Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) augments oxygenation in children with cyanotic heart disease during microdirect laryngoscopy and bronchoscopy. Journal of clinical anesthesia Caruso, T. J., Sidell, D. R., Lennig, M., Menendez, M., Fonseca, A., Rodriguez, S. T., Tsui, B. 2019; 56: 53–54

    View details for PubMedID 30690312

  • Lecompte Procedure for Relief of Severe Airway Compression in Children With Congenital Heart Disease. World journal for pediatric & congenital heart surgery Greene, C. L., Mainwaring, R. D., Sidell, D., Palmon, M., Hanley, F. L. 2019; 10 (5): 558–64


    Children with congenital heart disease may present with severe airway compression prior to any surgical procedure or may develop airway compression following their surgical procedure. This combination of congenital heart defect and airway compression poses a significant management challenge. The purpose of this study was to review our experience with the Lecompte procedure for relief of severe airway compression.This was a retrospective review of ten patients who underwent a Lecompte procedure for relief of severe airway compression over the past nine years (2010-2018). Three patients with absent pulmonary valve syndrome presented with severe symptoms prior to any surgical procedure. Seven patients presented with symptoms of airway compression following repair of their congenital heart defects (one with absent pulmonary valve syndrome, three patients had repair of pulmonary atresia with ventricular septal defect, and three patients had undergone aortic arch surgery). The median age at presentation was two years (range: one day to seven years).The ten patients underwent a Lecompte procedure without any significant complications or operative mortality. The median interval between the surgical procedure and extubation was 9.5 days. No patients have required any further interventions for relief of airway obstruction.The Lecompte procedure is a surgical option for young children who present with severe airway compression. The patients in this series responded well to the Lecompte procedure as evidenced by clinical relief of airway compression.

    View details for DOI 10.1177/2150135119860466

    View details for PubMedID 31496414

  • Operative Management of Vocal Fold Avulsion Following Pediatric Laryngotracheal Separation. Ear, nose, & throat journal Chang, M. T., Schoppy, D. W., Schoppy, K. K., Sidell, D. R. 2019: 145561319866821


    Laryngotracheal disruption in children is rare but life-threatening, and endolaryngeal injuries may go overlooked. We present the case of a 10-year-old boy who sustained near-complete laryngotracheal separation, multiple laryngeal fractures, and arytenoid and vocal fold avulsion following blunt cervical trauma. These injuries were not identified radiographically and only became apparent intraoperatively. Following surgical repair, the patient was successfully decannulated, eating a normal diet, and had a serviceable speaking voice within 2 months. In children, the diagnosis of severe endolaryngeal injuries may be elusive and therefore require high degree of clinical suspicion. Surgical success requires accurate diagnosis and prompt intervention.

    View details for DOI 10.1177/0145561319866821

    View details for PubMedID 31558058

  • International Pediatric Otolaryngology Group (IPOG): Juvenile-onset recurrent respiratory papillomatosis consensus recommendations. International journal of pediatric otorhinolaryngology Lawlor, C., Balakrishnan, K., Bottero, S., Boudewyns, A., Campisi, P., Carter, J., Cheng, A., Cocciaglia, A., DeAlarcon, A., Derkay, C., Fayoux, P., Hart, C., Hartnick, C., LeBoulanger, N., Moreddu, E., Muntz, H., Nicollas, R., Peer, S., Pransky, S., Rahbar, R., Russell, J., Rutter, M., Seedat, R., Sidell, D., Smith, R., Soma, M., Strychowsky, J., Thompson, D., Triglia, J. M., Trozzi, M., Wyatt, M., Zalzal, G., Zur, K. B., Nuss, R. 2019; 128: 109697


    To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients.Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group.Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP.Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.

    View details for DOI 10.1016/j.ijporl.2019.109697

    View details for PubMedID 31698245

  • Assessment of airway abnormalities in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals. Cardiology in the young Wise-Faberowski, L., Irvin, M., Sidell, D. R., Rajashekara, S., Asija, R., Chan, F. P., Hanley, F. L., McElhinney, D. B. 2019: 1–5


    Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/MAPCAs) are at risk for post-operative respiratory complications after undergoing unifocalisation surgery. Thus, we assessed and further defined the incidence of airway abnormalities in our series of over 500 children with TOF/MAPCAs as determined by direct laryngoscopy, chest computed tomography (CT), and/or bronchoscopy.The medical records of all patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery from March, 2002 to June, 2018 were reviewed. Anaesthesia records, peri-operative bronchoscopy, and/or chest CT reports were reviewed to assess for diagnoses of abnormal or difficult airway. Associations between chromosomal anomalies and airway abnormalities - difficult anaesthetic airway, bronchoscopy, and/or CT findings - were defined.Of the 564 patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery at our institution, 211 (37%) had a documented chromosome 22q11 microdeletion and 28 (5%) had a difficult airway/intubation reported at the time of surgery. Chest CT and/or peri-operative bronchoscopy were performed in 234 (41%) of these patients. Abnormalities related to malacia or compression were common. In total 35 patients had both CT and bronchoscopy within 3 months of each other, with concordant findings in 32 (91%) and partially concordant findings in the other 3.This is the largest series of detailed airway findings (direct laryngoscopy, CT, and bronchoscopy) in TOF/MAPCAS patients. Although these findings are specific to an at-risk population for airway abnormalities, they support the utility of CT and /or bronchoscopy in detecting airway abnormalities in patients with TOF/MAPCAs.

    View details for PubMedID 31044684

  • International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care. International journal of pediatric otorhinolaryngology Moreddu, E., Rizzi, M., Adil, E., Balakrishnan, K., Chan, K., Cheng, A., Daniel, S. J., de Alarcon, A., Hart, C., Hartnick, C., Inglis, A., Leboulanger, N., Pransky, S., Rahbar, R., Russell, J., Rutter, M., Sidell, D., Smith, R. J., Soma, M., Spratley, J., Thompson, D., Trozzi, M., Ward, R., Wyatt, M., Yeung, J., Zalzal, G., Zur, K., Nicollas, R. 2019; 123: 151–55


    To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of young infants who present with signs or symptoms of choanal atresia.A two-iterative delphi method questionnaire was used to establish expert recommendations by the members of the International Otolaryngology Group (IPOG), on the diagnostic, intra-operative, post-operative and revision surgery considerations.Twenty-eight members completed the survey, in 22 tertiary-care center departments representing 8 countries. The main consensual recommendations were: nasal endoscopy or fiberscopy and CT imaging are recommended for diagnosis; unilateral choanal atresia repair should be delayed after at least age 6 months whenever possible; transnasal endoscopic repair is the preferred technique; long term follow-up is recommended (minimum one year) using nasal nasofiberscopy or rigid endoscopy, without systematic imaging.Choanal atresia care consensus recommendations are aimed at improving patient-centered care in neonates, infants and children with choanal atresia.

    View details for DOI 10.1016/j.ijporl.2019.05.010

    View details for PubMedID 31103745

  • Outcomes After Initial Unifocalization to a Shunt in Complex Tetralogy of Fallot with MAPCAs. The Annals of thoracic surgery Bauser-Heaton, H., Ma, M., Wise-Faberowski, L., Asija, R., Shek, J., Zhang, Y., Peng, L. F., Sidell, D. R., Hanley, F. L., McElhinney, D. B. 2019


    Our approach to tetralogy of Fallot (TOF) with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAs) emphasizes early single-stage unifocalization and intracardiac repair. However, a subset of patients with small native pulmonary arteries (PAs) and MAPCAs undergo unifocalization to a shunt rather than simultaneous intracardiac repair.Patients with TOF/MAPCAs who underwent unifocalization to a systemic-to-PA shunt by a single surgeon were reviewed. The decision to perform simultaneous intracardiac repair was based on an intraoperative flow study or empirical assessment of PA and MAPCA size.From 11/01-12/17, 57 patients with TOF/MAPCAs underwent unifocalization to a shunt at a median age of 6.9 months. Genetic abnormalities were documented in 60% of patients, including a chromosome 22q11 deletion in 25 and Alagille syndrome in 8. Twenty patients (35%) had undergone prior surgery elsewhere (n=16) and/or at our center (n=7). During a median follow-up of 5.4 years, 9 patients had additional surgery to revise the PA reconstruction before complete repair, and 38 patients underwent complete repair. Survival was 74±6% 5 years after unifocalization. At follow-up, the median PA:aortic systolic pressure ratio was 0.36 and was >0.50 in 2 patients.In patients with the smallest MAPCAs and PAs, single-stage unifocalization to a shunt followed by intracardiac repair yields an excellent outcome in most cases.

    View details for DOI 10.1016/j.athoracsur.2019.01.030

    View details for PubMedID 30772338

  • The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study JOURNAL OF CLINICAL PSYCHIATRY Frankovich, J., Leibold, C., Farmer, C., Sainani, K., Kamalani, G., Farhadian, B., Willett, T., Park, J. M., Sidell, D., Ahmed, S., Thienemann, M. 2019; 80 (1)
  • The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study. The Journal of clinical psychiatry Frankovich, J., Leibold, C. M., Farmer, C., Sainani, K., Kamalani, G., Farhadian, B., Willett, T., Park, J. M., Sidell, D., Ahmed, S., Thienemann, M. 2018; 80 (1)


    OBJECTIVE: To describe the longitudinal association between disease severity, time established in clinical treatment, and caregiver burden in a community-based patient population diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS).METHODS: The study included an observational longitudinal cohort design, with Caregiver Burden Inventories (CBIs) collected between April 2013 and November 2016 at the Stanford PANS multidisciplinary clinic. Inclusion criteria for this study were as follows: pediatric patients meeting strict PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) diagnostic criteria (n = 187), having a caregiver fill out at least 1 complete CBI during a disease flare (n = 114); and having family who lives locally (n = 97). For longitudinal analyses, only patients whose caregiver had filled out 2 or more CBIs (n = 94 with 892 CBIs) were included. In the study sample, most primary caregivers were mothers (69 [71.1%] of 97), the majority of PANS patients were male (58 [59.8%] of 97), and mean age at PANS onset was 8.8 years.RESULTS: In a patient's first flare tracked by the clinic, 50% of caregivers exceeded the caregiver burden score threshold used to determine respite need in care receiver adult populations. Longitudinally, flares, compared with quiescence, predicted increases in mean CBI score (6.6 points; 95% CI, 5.1 to 8.0). Each year established in clinic predicted decreased CBI score (-3.5 points per year; 95% CI, -2.3 to -4.6). Also, shorter time between PANS onset and entry into the multidisciplinary clinic predicted greater improvement in mean CBI score over time (0.7 points per year squared; 95% CI, 0.1 to 1.3). Time between PANS onset and treatment with antibiotics or immunomodulation did not moderate the relationship between CBI score and time in clinic.CONCLUSIONS: PANS caregivers suffer high caregiver burden. Neuropsychiatric disease severity predicts increased caregiver burden. Caregiver burden tends to decrease over time in a group of patients undergoing clinical treatment at a specialty PANS clinic. This decrease could be independent of clinical treatment.

    View details for PubMedID 30549499

  • Response to editor regarding "Improvement of psychiatric symptoms in youth following resolution of sinusitis". International journal of pediatric otorhinolaryngology Frankovich, J., Sidell, D., Gans, H., Brown, K., Mahony, T., Thienemann, M. 2018; 112: 208–9

    View details for PubMedID 29050812

  • Response to editor regarding "Improvement of psychiatric symptoms in youth following resolution of sinusitis" INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Frankovich, J., Sidell, D., Gans, H., Brown, K., Mahony, T., Thienemann, M. 2018; 112: 208–9
  • Impact of Phrenic Nerve Palsy and Need for Diaphragm Plication Following Surgery for Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collaterals SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY Greene, C. L., Mainwaring, R. D., Sidell, D., Yarlagadda, V. V., Patrick, W. L., Hanley, F. L. 2018; 30 (3): 318–24
  • Deletion of 22q11 chromosome is associated with postoperative morbidity after unifocalisation surgery. Cardiology in the young Koth, A., Sidell, D., Bauser-Heaton, H., Wise-Faberowski, L., Hanley, F. L., McElhinney, D. B., Asija, R. 2018: 1–4


    BACKGROUND: A 22q11 chromosome deletion is common in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals. We sought to determine whether 22q11 chromosome deletion is associated with increased postoperative morbidity after unifocalisation surgery.METHODS: We included all patients with this diagnosis undergoing primary or revision unifocalisation ± ventricular septal defect closure at our institution from 2008 to 2016, and we excluded patients with unknown 22q11 status. Demographic and surgical data were collected. We compared outcomes between those with 22q11 chromosome deletion and those without using non-parametric analysis.RESULTS: We included 180 patients, 41% of whom were documented to have a chromosome 22q11 deletion. Complete unifocalisation was performed in all patients, and intracardiac repair was performed with similar frequency regardless of 22q11 chromosome status. Duration of mechanical ventilation was longer in 22q11 deletion patients. This difference remained significant after adjustment for delayed sternal closure and/or intracardiac repair. Duration of ICU stay was longer in patients with 22q11 deletion, although no longer significant when adjusted for delayed sternal closure and intracardiac repair. Finally, length of hospital stay was longer in 22q11-deleted patients, but this difference was not significant on unadjusted or adjusted analysis.CONCLUSION: Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals and 22q11 deletion are at risk for greater prolonged mechanical ventilation after unifocalisation surgery. Careful attention should be given to the co-morbidities of this population in the perioperative period to mitigate risks that may complicate the postoperative course.

    View details for PubMedID 30160647

  • The successful application of high flow nasal oxygen during microdirect laryngoscopy and bronchoscopy in patients under 7 kg. Journal of clinical anesthesia Caruso, T. J., Gupta, A., Sidell, D. R., Darling, C., Rodriguez, S., Fonseca, A., Tsui, B. 2018; 52: 27–28

    View details for PubMedID 30153541

  • Postoperative feeding problems in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing unifocalisation surgery. Cardiology in the young Koth, A. M., Sakarovitch, C., Sidell, D. R., Schultz, L. M., Freccero, A., Rizzuto, S., Hanley, F. L., Asija, R. 2018: 1–4


    BACKGROUND: Patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals are at risk for prolonged hospitalisation after unifocalisation. Feeding problems after congenital heart surgery are associated with longer hospital stay. We sought to determine the impact of baseline, intra-operative, and postoperative factors on the need for feeding tube use at the time of discharge.METHODS: We included patients with the aforementioned diagnosis undergoing unifocalisation from ages 3 months to 4 years from 2010 to 2016. We excluded patients with a pre-existing feeding tube. Patients discharged with an enteric tube were included in the feeding tube group. We compared the feeding tube group with the non-feeding-tube group by univariable and multi-variable logistic regression.RESULTS: Of the 56 patients studied, 41% used tube feeding. Median age and weight z-score were similar in the two groups. A chromosome 22q11 deletion was associated with the need for a feeding tube (22q11 deletion in 39% versus 15%, p=0.05). Median cardiopulmonary bypass time in the feeding tube group was longer (335 versus 244 minutes, p=0.04). Prolonged duration of mechanical ventilation was associated with feeding tube use (48 versus 3%, p=0.001). On multi-variable analysis, prolonged mechanical ventilation was associated with feeding tube use (odds ratio 10.2, 95% confidence intervals 1.6; 63.8).CONCLUSION: Among patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals who were feeding by mouth before surgery, prolonged mechanical ventilation after unifocalisation surgery was associated with feeding tube use at discharge. Anticipation of feeding problems in this population and earlier feeding tube placement may reduce hospital length of stay.

    View details for DOI 10.1017/S1047951118001270

    View details for PubMedID 30070195

  • Isolated lymphatic malformation of the postcricoid space. Ear, nose, & throat journal Sidell, D., Joshi, A. S., Kieliszak, C. R., Bielamowicz, S. A. 2018; 97 (8): E52–E53

    View details for PubMedID 30138530

  • Isolated Lymphatic Malformation of the Postcricoid Space ENT-EAR NOSE & THROAT JOURNAL Sidell, D., Joshi, A. S., Kieliszak, C. R., Bielamowicz, S. A. 2018; 97 (8): E52–E53
  • Impact of Phrenic Nerve Palsy and Need for Diaphragm Plication Following Surgery for Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collaterals. Seminars in thoracic and cardiovascular surgery Greene, C. L., Mainwaring, R. D., Sidell, D., Yarlagadda, V. V., Patrick, W. L., Hanley, F. L. 2018


    Injury to the phrenic nerves may occur during surgery for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD and MAPCAs). These patients may develop respiratory failure and require diaphragm plication. The purpose of this study was to evaluate the impact of phrenic nerve palsy on recovery following surgery for PA-VSD and MAPCAs. Between 2007 and 2016, approximately 500 patients underwent surgery for PA-VSD and MAPCAs at our institution. Twenty-four patients (4.8%) subsequently had evidence of new phrenic nerve palsy. Sixteen patients were undergoing their first surgical procedure, whereas 8 were undergoing reoperations. All 24 patients underwent diaphragm plication. A cohort of matched controls was identified based on identical diagnosis and procedures but did not sustain a phrenic nerve palsy. Eighteen of the 24 patients (75%) had clinical improvement following diaphragm plication as evidenced by the ability to undergo successful extubation (5±2 days), transition out of the intensive care unit (32±16 days), and discharge from the hospital (42±19 days). In contrast, there were 6 patients (25%) who did not demonstrate a temporal improvement following diaphragm plication, as evidenced by intervals of 61±38, 106±45, and 108±46 days, respectively (P<0.05 for all 3 comparisons). The 6 patients who failed to improve following diaphragm plication had a significantly greater number of comorbidities compared to the 18 patients who demonstrated improvement (2.2 vs 0.6 per patient, P<0.05). When compared with the control group, patients who improved following diaphragm plication spent an additional 22 days and patients who failed to improve an additional 90 days in the hospital. The data demonstrate a bifurcation of clinical outcome in patients undergoing diaphragm plication following surgery for PA-VSD and MAPCAs. This bifurcation appears to be linked to the presence or absence of other comorbidities.

    View details for PubMedID 29545034

  • "Split to save": Accessing mandibular lesions using sagittal split osteotomy with virtual surgical planning ENT-EAR NOSE & THROAT JOURNAL Liu, S., Sidell, D., Huon, L., Torre, C. 2018; 97 (3): 91–96


    Large, benign intramandibular lesions are frequently removed by resection followed by extensive free tissue transfer or delayed bone grafting. We outline a protocol to remove benign mandibular lesions using sagittal split osteotomy (SSO) with virtual surgical planning (VSP) to mitigate risks involved with this effective, tissue-saving approach. Patients with benign mandibular lesions accessed by SSO with VSP during 2014 were included in this study. Computed tomographic data were imported into VSP software. Using VSP, the exact locations of mandibular lesions and the inferior alveolar nerve canal were delineated. SSO was designed virtually and provided surgeons exact measurements to gain access to lesions and to avoid vital structures intraoperatively. SSO with VSP preserved the cortical mandibular bone and the inferior alveolar neurovascular bundle in 3 patients with benign mandibular lesions. Twelve months after surgery, no patient had pathologic fracture, prolonged paresthesia (except for the patient who required inferior alveolar nerve resection), or malocclusion. No patient required bone grafting. There were no functional or aesthetic jaw deficits. SSO is an effective approach to access intramandibular lesions. The technique does not result in loss of mandibular bone, and patients return to full masticatory function compared with those who require resection and reconstruction. VSP may mitigate technical challenges associated with SSO.

    View details for PubMedID 29554403

  • Bronchoscopy in children with tetralogy of fallot, pulmonary atresia, and major aortopulmonary collaterals. Pediatric pulmonology Sidell, D. R., Koth, A. M., Bauser-Heaton, H., McElhinney, D. B., Wise-Faberowski, L., Tracy, M. C., Hanley, F. L., Asija, R. 2017


    Children with Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for developing more postoperative respiratory complications than children undergoing other types of congenital heart surgery. Bronchoscopy is used in the perioperative period for diagnostic and therapeutic purposes. In this study, we describe bronchoscopic findings and identify factors associated with selection for bronchoscopy.Retrospective case-control.All patients with TOF/PA/MAPCAs who underwent unifocalization surgery from September 2005 through March 2016 were included. Patients who underwent bronchoscopy in the perioperative period were compared to a randomly selected cohort of 172 control patients who underwent unifocalization without bronchoscopy during the study period.Forty-three children underwent perioperative bronchoscopy at a median of 9 days postoperatively. Baseline demographics were similar in bronchoscopy patients and controls. Patients who underwent bronchoscopy were more likely to have a chromosome 22q11 deletion and were more likely have undergone unifocalization surgery without intracardiac repair. These patients had a longer duration of mechanical ventilation, ICU duration, and length of hospitalization. Abnormalities were detected on bronchoscopy in 35 patients (81%), and 20 (35%) of bronchoscopy patients underwent a postoperative intervention related to abnormalities identified on bronchoscopy.Bronchoscopy is a useful therapeutic and diagnostic instrument for children undergoing unifocalization surgery, capable of identifying abnormalities leading to an additional intervention in over one third of patients. Special attention should be given to children with a 22q11 deletion to expedite diagnosis and intervention for possible airway complications.

    View details for DOI 10.1002/ppul.23732

    View details for PubMedID 28504356

  • Palatal Petechiae in the Absence of Group A Streptococcus in Pediatric Patients with Acute-Onset Neuropsychiatric Deterioration: A Cohort Study. Journal of child and adolescent psychopharmacology Mahony, T., Sidell, D., Gans, H., Cooperstock, M., Brown, K., Cheung, J. M., Farhadian, B., Gustafson, M., Thienemann, M., Frankovich, J. 2017


    Palatal petechiae are 95% specific for streptococcal pharyngitis. Despite this, and despite prior research demonstrating that Group A Streptococcus (GAS) is a common antecedent to pediatric acute-onset neuropsychiatric syndrome (PANS) episodes, we anecdotally observed a low rate of documented GAS in patients with PANS and palatal petechiae. This retrospective chart review was conducted to formally report the rate of palatal petechiae and concurrent GAS in a cohort of patients with PANS and investigate other etiologic factors.The clinical notes of 112 patients seen at the Stanford PANS Clinic who met PANS research criteria were reviewed for mention of palatal petechiae. The medical records of patients who demonstrated palatal petechiae on physical examination were reviewed for signs of infection, a clinical history of trauma, and laboratory results that could indicate other causes of petechiae.Twenty-three patients had documented palatal petechiae on physical examination (ages 5-16, 13/23 [57%] male). Fifteen patients had a rapid GAS test and GAS culture in the Stanford PANS clinic, all with negative results. Evidence of recent GAS infection was found in 8/23 (32%) patients (elevated GAS titers [n = 6] or documentation of a positive rapid GAS test at another facility [n = 2]), one of whom also had potential herpes simplex virus (HSV) infection. One patient had potential HSV infection and recent palatal trauma. No patients had thrombocytopenia. 14/23 (61%) of patients with palatal petechiae had no discernable cause of petechiae. 10/19 (53%) of patients had antihistone antibodies.Despite the established relationship between palatal petechiae and GAS, no patient with palatal petechiae in our clinic tested positive for GAS and only 32% had evidence of recent GAS. Most did not have an identifiable cause for the palatal lesions. This finding suggests the potential for alternative causes of palatal petechiae or undetectable GAS in our patient population. The high prevalence of palatal petechiae without GAS infection suggests that the pathogenesis of PANS is multifactorial and may involve disruption or inflammation of the microvasculature. Additional research is needed to further elucidate these findings.

    View details for DOI 10.1089/cap.2016.0153

    View details for PubMedID 28387528

  • Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. Laryngoscope Rutter, M. J., Hart, C. K., Alarcon, A. d., Daniel, S., Parikh, S. R., Balakrishnan, K., Lam, D., Johnson, K., Sidell, D. R. 2017


    Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI.Multicenter review.A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS.Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway.Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.4 Laryngoscope, 2017.

    View details for DOI 10.1002/lary.26547

    View details for PubMedID 28271539

  • Langerhans Cell Histiocytosis of the Maxillary Sinus. Clinical pediatrics Noel, J. E., Messner, A. H., Sidell, D. R. 2017; 56 (2): 184-186

    View details for DOI 10.1177/0009922816645522

    View details for PubMedID 27121594

  • Improvement of psychiatric symptoms in youth following resolution of sinusitis INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Mahony, T., Sidell, D., Gans, H., Brown, K., Farhadian, B., Gustafson, M., Sherr, J., Thienemann, M., Frankovich, J. 2017; 92: 38-44


    Accumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis.We reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis.10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up.Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed.

    View details for DOI 10.1016/j.ijporl.2016.10.034

    View details for Web of Science ID 000393245100008

    View details for PubMedID 28012531

  • Diagnosis and treatment of pediatric frontotemporal pits: report of 2 cases JOURNAL OF NEUROSURGERY-PEDIATRICS Bliss, M., Grant, G., Tittler, E., Loven, T., Yeom, K. W., Sidell, D. 2016; 18 (4): 471-474


    In contrast to more common nasal and cervical lesions, the frontotemporal pit is a rarely encountered lesion that is often associated with a dermoid and may track intracranially. Due to delays in diagnosis, the propensity to spread intracranially, and the risk of infection, awareness of these lesions and appropriate diagnosis and management are important. The authors present 2 cases of frontotemporal pits from a single institution. Epidemiology, presentation, and management recommendations are discussed.

    View details for DOI 10.3171/2016.5.PEDS1687

    View details for Web of Science ID 000383938500015

    View details for PubMedID 27391653

  • Inferior alveolar nerve hemangioma. Laryngoscope Vaezeafshar, R., Liu, S. Y., Sidell, D. 2016; 126 (9): 2168-2170


    A 14-year-old male presented with lower lip numbness and a slowly enlarging mandibular mass. Computed tomography demonstrated an expansile lesion centered in the marrow space of the left mandibular body, extending along the course of the inferior alveolar nerve (IAN), and expanding the mental foramen. Preoperative diagnosis was consistent with an IAN schwannoma. Surgical planning was performed using PROPLAN CMF software. The lesion was approached via a sagittal split osteotomy and excised en bloc with the IAN. Final pathology demonstrated a capillary hemangioma originating from the inferior alveolar nerve. Based on a detailed PubMed search, this is the first capillary hemangioma of the inferior alveolar nerve reported in the literature.NA Laryngoscope, 2016.

    View details for DOI 10.1002/lary.25869

    View details for PubMedID 26863892

  • Combination therapies using an intratympanic polymer gel delivery system in the guinea pig animal model: A safety study. International journal of pediatric otorhinolaryngology Sidell, D., Ward, J. A., Pordal, A., Quimby, C., Nassar, M., Choo, D. I. 2016; 84: 132-136


    High dose antivirals have been shown to cause hearing loss when applied via the intratympanic route. The aim of this study was to determine if a combination therapy using dexamethasone (DXA) with either Cidofovir (CDV) or Ganciclovir (GCV), in solution or in PLGA-PEG-PLGA (PPP) hydrogel, is innocuous to the inner ear.Cytomegalovirus (CMV)-free guinea pigs were separated into four principal study groups and treated via intratympanic injection (IT) of CDV/DXA solution, CDV/DXA Hydrogel, GCV/DXA solution and GCV/DXA hydrogel. Hearing thresholds were evaluated with pretreatment ABR and post injection weekly ABRs for a total follow up of 28 days. Temporal bone tissue was harvested and stained with Hematoxylin and Eosin for histologic analysis.ABR analysis revealed that GCV/DXA in solution and in hydrogel led to a mild hearing loss at days 7-21 but returned to baseline by day 28 When administered via PPP hydrogel, CDV/DXA demonstrated mild persistent hearing loss at 32kHz at 28 days. An inflammatory response was identified in the cochlear specimen of the CDV/DXA/PPP hydrogel group, in concert with mild hearing loss, at days 21 and 28.Results of this study support the safe intratympanic use of higher concentrations of antivirals when combined with DXA, both in solution and when applied via PPP hydrogel.

    View details for DOI 10.1016/j.ijporl.2016.03.002

    View details for PubMedID 27063768

  • Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital PEDIATRIC NEUROLOGY Lungren, M. P., Halula, S., Coyne, S., Sidell, D., Racadio, J. M., Patel, M. N. 2016; 54: 70-75


    Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.

    View details for DOI 10.1016/j.pediatrneurol.2015.09.014

    View details for Web of Science ID 000367416400013

  • Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital. Pediatric neurology Lungren, M. P., Halula, S., Coyne, S., Sidell, D., Racadio, J. M., Patel, M. N. 2016; 54: 70–75


    Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.

    View details for PubMedID 26706481

  • Outcomes and Resource Utilization of Endoscopic Mass-Closure Technique for Laryngeal Clefts OTOLARYNGOLOGY-HEAD AND NECK SURGERY Balakrishnan, K., Cheng, E., de Alarcon, A., Sidell, D. R., Hart, C. K., Rutter, M. J. 2015; 153 (1): 119-123


    To compare resource utilization and clinical outcomes between endoscopic mass-closure and open techniques for laryngeal cleft repair.Case series with chart review.Tertiary academic children's hospital.Pediatric patients undergoing repair for Benjamin-Inglis type 1-3 laryngeal clefts over a 15-year period. All 20 patients undergoing endoscopic repair were included. Eight control patients undergoing open repair were selected using matching by age and cleft type. Demographic, clinical, and resource utilization data were collected.Twenty-eight patients were included (20 endoscopic, 8 open). Mean age, rates of tracheostomy and vocal fold immobility, and distribution of cleft types were not different between the 2 groups (all P > .2). Mean operative time (P = .004) and duration of hospital stay (P < .001) were significantly shorter in the endoscopic group. All repairs were intact in both groups at final postoperative endoscopy. Rates of persistent laryngeal penetration or aspiration on swallow study were not different between groups (P = 1.000), although results were available for only 11 patients.Endoscopic laryngeal cleft repair using a mass-closure technique provides a durable result while requiring significantly shorter operative times and hospital stays than open repair and avoiding the potential morbidity of laryngofissure. However, open repair may allow the simultaneous performance of other airway reconstructive procedures and may be a useful salvage technique when endoscopic repair fails. Postoperative swallowing results require further study.

    View details for DOI 10.1177/0194599815576718

    View details for Web of Science ID 000357297000019

    View details for PubMedID 25782984

  • Standardized Outcome and Reporting Measures in Pediatric Head and Neck Lymphatic Malformations OTOLARYNGOLOGY-HEAD AND NECK SURGERY Balakrishnan, K., Bauman, N., Chun, R. H., Darrow, D. H., Grimmer, J. F., Perkins, J. A., Richter, G. T., Shin, J. J., Shivaram, G. M., Sidell, D. R., Elluru, R. G. 2015; 152 (5): 948-953


    To develop general and site-specific treatment effect and outcome measures to standardize the reporting of head and neck lymphatic malformation (HNLM) treatments.Consensus statement/expert opinion.Multiple tertiary academic institutions.The modified Delphi method is an iterative process of collecting expert opinions, refining opinions through discussion and feedback, statistically aggregating opinions, and using these aggregates to generate consensus opinion in the absence of other data. The modified Delphi method was used by a multi-institutional group of otolaryngology and interventional radiology experts in the field of vascular anomalies to formulate a list of recommended reporting outcomes for the study and treatment of head and neck lymphatic malformations.Through 3 rounds of iteration, 10 expert panelists refined 98 proposed outcome measures and 9 outcome categories to a final consensus set of 50 recommended outcome measures in 3 global categories (general, demographics, and treatment complications) and 5 site-specific categories (orbit, oral cavity, pharynx, larynx, and neck).We propose the first consensus set of standardized reporting measures for clinical and treatment outcomes in studies of HNLMs. Consistent outcome measures across future studies will facilitate comparison of treatment options and allow systematic review. We hope that these guidelines facilitate the design and reporting of subsequent HNLM studies.

    View details for DOI 10.1177/0194599815577602

    View details for Web of Science ID 000354261400029

    View details for PubMedID 25829389

  • Comment Regarding Article "An Adolescent Found Unconscious" CLINICAL PEDIATRICS Sidell, D. R., Myer, C. M. 2014; 53 (5): 507-507

    View details for DOI 10.1177/0009922814529019

    View details for Web of Science ID 000337493000018

    View details for PubMedID 24707024

  • Epstein-barr DNA serology and positron-emission tomography imaging of the head and neck in pediatric transplant recipients LARYNGOSCOPE Sidell, D., Venick, R. S., Shapiro, N. L. 2014; 124 (5): 1236-1241


    Epstein-Barr virus (EBV) infection is a potential precursor of post-transplantation lymphoproliferative disorder (PTLD) in the pediatric transplant patient. Positron-emission tomography (PET) imaging is increasingly utilized in this population to monitor for neoplasia and PTLD. We assess the association between EBV serum titers and Waldeyer's ring and cervical lymph node PET positivity in the pediatric transplant recipient.Retrospective analysis of EBV serology and PET imaging results in pediatric orthotopic liver transplantation (OLT) recipients.Imaging results and laboratory data were reviewed for all pediatric OLT recipients from January 2005 to July 2011 at a single institution. Charts were evaluated for PET positivity at Waldeyer's ring or cervical lymphatics, and for EBV serology results. Demographic data extracted include patient sex and age at transplantation.A total of 122 pediatric OLT recipients were reviewed. Twelve patients (10%) underwent PET imaging. Overall, four patients (33%) had evidence of PET positivity at Waldeyer's ring or cervical lymphatics. Five patients (42%) had positive EBV serology. There was a significant association between PET imaging results and EBV DNA serology results (P = .01).PTLD surveillance in the pediatric transplant recipient is an important component of long-term care in this population. Although PET imaging is a new modality in monitoring pediatric transplant recipients for early signs of PTLD, an association between EBV serology and PET imaging results appears to exist. With increased implementation, PET imaging will likely prove valuable in its ability to monitor the transplant recipient at risk for PTLD.

    View details for DOI 10.1002/lary.24376

    View details for Web of Science ID 000334680500047

    View details for PubMedID 24105893

  • High-Dose Sublesional Bevacizumab (Avastin) for Pediatric Recurrent Respiratory Papillomatosis Meeting of the American-Broncho-Esophagological-Association Sidell, D. R., Nassar, M., Cotton, R. T., Zeitels, S. M., de Alarcon, A. ANNALS PUBL CO. 2014: 214–21


    We review and report the use of high-dose bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP) in pediatric patients.We included all patients with pediatric-onset RRP who underwent bevacizumab (25 mg/mL) injections by a single practitioner. A series of 5 consecutive subepithelial injections were administered at 4- to 6-week intervals with concomitant 532 nm KTP laser ablation. The lesions were staged according to the Derkay staging system. The outcomes included pretreatment and posttreatment Derkay scores, the time interval between procedures, and voice outcomes. The demographic data extracted included sex, age at diagnosis, and current age.Nine patients were included in this study, with 1 patient lost to follow-up; their median age was 8 years (range, 3 to 21 years). The mean bevacizumab dose was 14.25 mg (range, 5 to 45 mg). There was a median Derkay score of 11.5 (range, 4 to 23) at the time of diagnosis and a median 58% improvement following therapy. All patients demonstrated an increased time interval between injections, for a median improvement of 2.05× (range, 1.6× to 3.25×).Evidence exists in support of vascular endothelial growth factor as an important factor in the development of RRP. Although some variability in response is demonstrated by this study, high-dose bevacizumab appears to yield promising results for pediatric patients with RRP.

    View details for DOI 10.1177/0003489414522977

    View details for Web of Science ID 000332436700008

    View details for PubMedID 24633948

  • Role of obesity in otitis media in children. Current allergy and asthma reports Ahmed, S., Arjmand, E., Sidell, D. 2014; 14 (11): 469


    The ongoing childhood obesity epidemic has garnered significant attention among healthcare providers due to its short- and long-term sequelae. Multiple diseases have been associated with obesity, not limited to hypertension, diabetes, and attention deficit hyperactivity disorder. Over the past decade, the relationships between obesity and otologic conditions have been investigated. In this setting, otitis media has remained the focus of research, representing one of the most common pediatric illnesses. Initial studies suggesting a relationship between the two conditions have been supported with epidemiological studies controlling for socioeconomic factors. The purpose of this article is to review our current understanding of the relationship between otitis media and obesity and to discuss the healthcare implications of this association. In addition, several identifiable factors associated with each condition are discussed, as are potential pathophysiologic mechanisms that may help to elucidate the complex and multifactorial relationship between the two disease entities.

    View details for DOI 10.1007/s11882-014-0469-x

    View details for PubMedID 25183362

  • Risk Factors for Preoperative and Postoperative Hearing Loss in Children Undergoing Pressure Equalization Tube Placement. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sidell, D., Hunter, L. L., Lin, L., Arjmand, E. 2014; 150 (6): 1048–55


    Pressure equalization tube (PET) placement is the most common surgical procedure performed during childhood. Current guidelines recommend more prompt management of children with otitis media with effusion who are at greater risk for speech-language and developmental problems. This study was designed to examine risk factors for continued post-PET hearing loss in a large pediatric clinical sample.Retrospective analysis using the electronic medical record.Tertiary care children's hospital.Pediatric patients undergoing PET placement between January 2009 and October 2012 who had audiometric tests.Demographics, patient diagnoses, and hearing loss information were extracted. Multivariate binary logistic regression models were used to identify associations between patient-specific characteristics and the presence of hearing loss.In total, 3949 children with 4598 audiology visits were included (2357 males and 1592 females; mean age, 3.3 years), and 1272 preoperative and 3329 postoperative audiograms were performed. Using multivariate modeling, the only variable significantly associated with preoperative hearing loss was low tympanometric static acoustic admittance. Postoperative hearing loss was positively associated with patient age, preoperative hearing loss, lower tympanometric equivalent canal volumes, and Down syndrome. Other factors, including cranial/facial anomalies, low birth weight or prematurity, allergies, and asthma, were not determined to be risk factors for hearing loss.Our results support hearing testing to identify candidates for PET surgery and to determine treatment effectiveness after surgery, since hearing loss cannot be predicted on the basis of risk or demographic factors. These data have important preoperative counseling and postoperative management implications.

    View details for DOI 10.1177/0194599814529080

    View details for PubMedID 24705221

  • Defining the Critical-Sized Defect in a Rat Segmental Mandibulectomy Model Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation (AAO-HNSF) and OTO Expo DeConde, A. S., Lee, M. K., Sidell, D., Aghaloo, T., Lee, M., Tetradis, S., Low, K., Elashoff, D., Grogan, T., Sepahdari, A. R., St John, M. AMER MEDICAL ASSOC. 2014: 58–65


    Advances in tissue engineering offer potential alternatives to current mandibular reconstructive techniques; however, before clinical translation of this technology, a relevant animal model must be used to validate possible interventions.To establish the critical-sized segmental mandibular defect that does not heal spontaneously in the rat mandible.Prospective study of mandibular defect healing in 29 Sprague-Dawley rats in an animal laboratory.The rats underwent creation of 1 of 4 segmental mandibular defects measuring 0, 1, 3, and 5 mm. All mandibular wounds were internally fixated with 1-mm microplates and screws and allowed to heal for 12 weeks, after which the animals were killed humanely.Analysis with micro-computed tomography of bony union and formation graded on semiquantitative scales.Seven animals were included in each experimental group. No 5-mm segmental defects successfully developed bony union, whereas all 0- and 1-mm defects had continuous bony growth across the original defect on micro-computed tomography. Three of the 3-mm defects had bony continuity, and 3 had no healing of the bony wound. Bone union scores were significantly lower for the 5-mm defects compared with the 0-, 1-, and 3-mm defects (P < .01).The rat segmental mandible model cannot heal a 5-mm segmental mandibular defect. Successful healing of 0-, 1-, and 3-mm defects confirms adequate stabilization of bony wounds with internal fixation with 1-mm microplates. The rat segmental mandibular critical-sized defect provides a clinically relevant testing ground for translatable mandibular tissue engineering efforts.

    View details for DOI 10.1001/jamaoto.2013.5669

    View details for Web of Science ID 000331369700010

    View details for PubMedID 24232293

  • Safety of cidofovir by intratympanic delivery technique ANTIVIRAL THERAPY Ward, J. A., Sidell, D. R., Nassar, M., Reece, A. L., Choo, D. I. 2014; 19 (1): 97-105


    Congenital cytomegalovirus (CMV) infection is one of the most common infectious causes of congenital sensorineural hearing loss. To date, a safe and effective therapy for CMV-induced hearing loss does not exist. We hypothesize that the antiviral cidofovir (CDV) can be delivered to the inner ear via intratympanic (IT) injections to safely and effectively mitigate CMV-induced hearing loss.To evaluate the safety of CDV IT injections, weanling guinea pigs with normal hearing were injected intratympanically with 3 mg or 5 mg concentrations of CDV and compared to control animals injected with sterile saline. A separate group of weanling guinea pigs were inoculated with CMV and a subset of this group was treated with CDV following inoculation.The 3 mg/ml and 5 mg/ml CDV concentrations resulted in hearing loss following IT injection into uninfected animals. No signs of inflammation or toxicity were noted on histologic analysis and there was no evidence of systemic toxicity in serology. Hearing loss induced as a result of guinea pig CMV infection recovered by day 21 in animals treated with IT injections of 5 mg/ml CDV.We provide promising evidence demonstrating both the efficacy and safety of IT CDV in the guinea pig animal model. This research further establishes a sound framework upon which ongoing investigations into drug delivery mechanisms for CMV-induced hearing loss will be based.

    View details for DOI 10.3851/IMP2693

    View details for Web of Science ID 000335231800010

    View details for PubMedID 24153022

  • Obesity and the Risk of Chronic Rhinosinusitis, Allergic Rhinitis, and Acute Otitis Media in School-Age Children LARYNGOSCOPE Sidell, D., Shapiro, N. L., Bhattacharyya, N. 2013; 123 (10): 2360-2363


    To determine if obesity is a significant risk factor for acute otitis media (AOM), allergic rhinitis (AR), or chronic rhinosinusitis (CRS) in children and to understand the potential otolaryngological implications of childhood obesity.Cross-Sectional Analysis.The 2006 and 2008 the Medical Expenditure Panel Survey was utilized to identify school-aged children with AOM, AR, and/or CRS. Risk factors for the diagnoses extracted included standard demographics and the presence or absence of obesity. Multivariate analyses were conducted for associations between childhood obesity and AOM, AR, and CRS.42.1 million (95% CI, 40.4-44.2) school-age children (unweighted N = 10623) were sampled in 2006 and 2008. There was a slight male predominance (51.0% [95% CI, 49.8-52.2]). Of these patients, 2.2 million (95% CI 1.9-2.4) received a diagnosis of AOM, 4.0 million (95% CI 3.6-4.4) received a diagnosis of AR, and 1.7 million (95% CI 1.4-1.9) received a diagnosis of CRS. Approximately 9.3 million (95% CI 8.7-10.0) children were obese, representing 22.2% (95% CI 21.0-23.3) of the U.S. population (age 6-17). Utilizing an adjusted multivariate model, childhood obesity was found to be associated with AOM (odds ratio, 1.44; [95% CI 1.08-1.93]; P = 0.033). Significant associations between obesity and AR (OR 1.14; [95% CI 0.88-1.47]; P = 0.60) or obesity and CRS (OR0.73; [95% CI 0.48-1.10]; P = 0.79) were not identified.Childhood obesity appears to be associated with the development of AOM; however, an association between obesity and AR or CRS was not demonstrated. Given that in the United States nearly one-fourth of all children seeking health care are obese, these data may have important preventative care implications.2C.

    View details for DOI 10.1002/lary.24038

    View details for Web of Science ID 000325091100007

    View details for PubMedID 23918707

  • Bone Morphogenetic Protein-2-Impregnated Biomimetic Scaffolds Successfully Induce Bone Healing in a Marginal Mandibular Defect LARYNGOSCOPE DeConde, A. S., Sidell, D., Lee, M., Bezouglaia, O., Low, K., Elashoff, D., Grogan, T., Tetradis, S., Aghaloo, T., St John, M. 2013; 123 (5): 1149-1155


    To test the osteoregenerative potential and dosing of bone morphogenetic protein-2 (BMP-2)-impregnated biomimetic scaffolds in a rat model of a mandibular defect.Prospective study using an animal model.Varied doses of BMP-2 (0.5, 1, 0.5, 0.5 in microspheres, 5, and 15 μg) were absorbed onto a biomimetic scaffold. Scaffolds were then implanted into marginal mandibular defects in rats. Blank scaffolds and unfilled defects were used as negative controls. Two months postoperatively, bone healing was analyzed with microcomputerized tomography (microCT).MicroCT analysis demonstrated that all doses of BMP-2 induced successful healing of marginal mandibular defects in a rat mandible. Increasing doses of BMP-2 on the scaffolds produced increased tissue healing, with 15 μg demonstrating significantly more healing than all other dosing (P < .01).BMP-2-impregnated biomimetic scaffolds successfully induce bone healing in a marginal mandibular defect in the rat. Percentage healing of defect, percentage of bone within healed tissue, and total bone volume are all a function of BMP-2 dosing. There appears to be an optimal dose of 5 μg beyond which there is no increase in bone volume.NA.

    View details for DOI 10.1002/lary.23782

    View details for Web of Science ID 000320782200018

    View details for PubMedID 23553490

  • Acute tonsillitis. Infectious disorders drug targets Sidell, D., Shapiro, N. L. 2012; 12 (4): 271-276


    Acute tonsillitis is an inflammatory process of the tonsillar tissues and is usually infectious in nature. Acute infections of the palatine tonsils predominantly occur in school-aged children, but patients of any age may be affected. Tonsillitis of viral origin is usually treated with supportive care. Bacterial tonsillitis is most commonly caused by Streptococcus pyogenes. Polymicrobial infections and viral pathogens are also important sources of infection. Penicillins remain the treatment of choice for S. pyogenes tonsillitis, and augmented aminopenicillins have gained utility in concert with the increasing incidence of beta-lactamase producing bacteria. We describe the anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of history and physical examination findings, treatment recommendations, and possible complications of acute tonsillitis. Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this common pathologic process.

    View details for PubMedID 22338587

  • Composite Mandibulectomy: A Novel Animal Model 115th AAO-HNSF Annual Meeting and OTO EXPO Sidell, D. R., Aghaloo, T., Tetradis, S., Lee, M., Bezouglaia, O., DeConde, A., St John, M. A. SAGE PUBLICATIONS LTD. 2012: 932–37


    Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described.Description of an animal model.Animal laboratory at a quaternary care university medical center.We present an Animal Research Oversight Committee-approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed.A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative).This novel animal model reliably replicates the en bloc segmental mandibular defects seen in our patient population and can be manipulated to achieve a wide variety of research objectives.

    View details for DOI 10.1177/0194599811435633

    View details for Web of Science ID 000305522400010

    View details for PubMedID 22282867

  • Demographic Influences on Antibiotic Prescribing for Pediatric Acute Otitis Media OTOLARYNGOLOGY-HEAD AND NECK SURGERY Sidell, D., Shapiro, N. L., Bhattacharyya, N. 2012; 146 (4): 653-658


    To understand the epidemiologic antibiotic treatment patterns and the potential impact of race and insurance status on the medical management of acute otitis media (AOM).Cross-sectional analysis of a national database.National ambulatory care setting.Cases of isolated AOM in children ≤ 16.0 years were extracted from the National Ambulatory Medical Care Survey (2006-2008). The frequency and type of antibiotic prescribed were extracted. A multivariate logistic regression model incorporating age, sex, race, ethnicity, and insurance type was used to determine the influence of these demographic variables on antibiotic prescribing patterns.A total of 15.8 ± 1.5 million cases of AOM were studied (mean age, 3.6 ± 0.3 years; 55.1% ± 2.9% male). Of the children, 15.0% ± 2.8% were Hispanic and 10.4% ± 3.1% were black. Medicaid/State Children's Health Insurance Program and private insurance covered 30.6% ± 4.4% and 69.4% ± 4.4% of children, respectively. Overall, 83.1% ± 2.2% of children received an antibiotic prescription. The most commonly prescribed antibiotics were amoxicillin (6.5 ± 0.9 million), beta-lactamase inhibitors (2.6 ± 0.4 million), and third-generation cephalosporins (2.3 ± 0.4 million prescriptions). On multivariate analysis, insurance status, ethnicity, race, age, and sex did not influence the likelihood of an antibiotic being prescribed during the visit (P = .884, .909, .849, .102, and .931 respectively).Most children receiving medical treatment for AOM receive an antibiotic prescription during their visit. Ethnicity, race, and insurance type do not significantly influence antibiotic prescribing rates for AOM, and nearly all patients have medical insurance.

    View details for DOI 10.1177/0194599811431228

    View details for Web of Science ID 000303546600026

    View details for PubMedID 22166962

  • Hypoglossal schwannoma masquerading as a carotid body tumor. Case reports in otolaryngology Lee, M. K., Sidell, D. R., Mendelsohn, A. H., Blackwell, K. E. 2012; 2012: 842761-?


    Study Objective. To describe the clinical presentation, evaluation, and treatment of a hypoglossal schwannoma. Methods. We report an unusual case of a hypoglossal schwannoma presenting as a pulsatile level II neck mass at the bifurcation of the external and internal carotid arteries, mimicking a carotid body tumor. Radiologic findings are reviewed in detail. Results. A 59-year-old female presented to a tertiary care medical center with complaints of a pulsatile right-sided neck mass. An MRA of the neck was obtained demonstrating a 5 cm mass located at the carotid artery bifurcation and causing splaying of the internal and external carotids. Based on clinical presentation and imaging, a diagnosis of a carotid body tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the carotid artery. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion. Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a parapharyngeal space mass. As this report demonstrates, the clinical and radiologic presentation of a hypoglossal schwannoma may closely mimic that of the more common carotid body tumor.

    View details for DOI 10.1155/2012/842761

    View details for PubMedID 23213586

  • Optimal Timing of Surgical Intervention Following Adult Laryngeal Trauma 114th Annual Meeting of the Triological-Society Mendelsohn, A. H., Sidell, D. R., Berke, G. S., St John, M. WILEY-BLACKWELL. 2011: 2122–27


    Laryngeal trauma is an infrequent diagnosis with a scarcity of published data. We aim to further define the factors associated with positive surgical outcomes of adult laryngeal trauma.Multi-institution database analysis.Of the 1.9 million trauma cases from the National Trauma Database (NTDB), 564 adult trauma events were selected with ICD-9 codes specific to laryngeal trauma.Laryngeal trauma was seen predominately in white (61.5%), middle-aged (40.6 years), male (83.7%) patients experiencing blunt (70.7%) laryngeal injury with multiorgan system (92.2%) trauma. There was an overall 17.9% mortality rate. Within the 564 cases, 133 direct laryngoscopies, 185 tracheostomies, 53 laryngeal suturing, and 60 laryngeal fracture repairs were performed. In univariate negative binomial regression models, trauma severity (P ≤ .01), placement of tracheostomy (P lt; .01), and delayed tracheostomy placement (P = .04, .03, .048) were associated with increased ventilator dependence, intensive care unit (ICU) stay, and overall hospital admission duration. Multivariate regression models demonstrated significant associations between tracheostomy performed within 24 hours and shortened ICU stay (P = .03, β = -.28, SE = 1.7) and overall hospital stay (P = .009, β = -.23, SE = 3.1).The NTDB allows study of the largest laryngeal trauma cohort in modern literature. Although complexities arise in the treatment of laryngeal traumas, when indicated, surgical airway should be placed within 24 hours of presentation to improve the overall hospital course.

    View details for DOI 10.1002/lary.22163

    View details for Web of Science ID 000295228800013

    View details for PubMedID 21898446

  • Malignant Phosphaturic Mesenchymal Tumor of the Larynx LARYNGOSCOPE Sidell, D., Lai, C., Bhuta, S., Barnes, L., Chhetri, D. K. 2011; 121 (9): 1860-1863


    Phosphaturic mesenchymal tumors are rare neoplasms predominantly originating in the trunk and extremities. Malignant variants are exceedingly rare, and can present significant diagnostic challenges to the pathologist and otolaryngologist alike. This report describes the first case of malignant phosphaturic mesenchymal tumor involving the larynx, and emphasizes the importance of vigilance in both histopathologic and clinical actions so that appropriate treatment can be provided in a timely manner. The clinical presentation, radiologic and histologic features, and management are discussed.

    View details for DOI 10.1002/lary.21916

    View details for Web of Science ID 000294219900009

    View details for PubMedID 21721013

  • CO2 Laser Ablation and Balloon Dilation for Acquired Nasopharyngeal Stenosis: A Novel Technique Annual Combined Sections Meeting of the Triological-Society Sidell, D., Chhetri, D. K. WILEY-BLACKWELL. 2011: 1486–89


    Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results.Retrospective review of case series.An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation.Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months.Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.

    View details for DOI 10.1002/lary.21843

    View details for Web of Science ID 000292425300026

    View details for PubMedID 21647909

  • Diagnostic Accuracy of Ultrasonography for Midline Neck Masses in Children Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation and OTO EXPO Sidell, D. R., Shapiro, N. L. SAGE PUBLICATIONS LTD. 2011: 431–34


    To evaluate the diagnostic accuracy and to assess the utility of preoperative ultrasonography in the pediatric patient with a midline neck mass.Diagnostic test study.Tertiary care university hospital.An institutional review board (UCLA Office of the Human Research Protection Program)-approved retrospective review of pediatric patients undergoing excision of a midline neck mass between 1999 and 2010 at a tertiary care institution was performed. The preoperative imaging modality, imaging diagnosis, and pathologic results were evaluated.Forty patients were included in this review. This study failed to demonstrate an association between preoperative ultrasound-based diagnoses and postoperative pathologic results (P > .99).Ultrasonography is commonly used in the workup of a midline neck mass in the pediatric population. Despite the utility of preoperative ultrasonography, the diagnostic accuracy of this imaging modality may have significant limitations.

    View details for DOI 10.1177/0194599810391743

    View details for Web of Science ID 000293997400017

    View details for PubMedID 21493208

  • Spurious decline in intraoperative parathyroid hormone: false positives in parathyroid surgery AMERICAN JOURNAL OF OTOLARYNGOLOGY Sidell, D., Wang, J., Sercarz, J. 2010; 31 (6): 479-481


    The aims of this study were to (1) describe a false-positive result using a highly sensitive intraoperative parathyroid hormone (PTH) assay in an adult patient with primary hyperparathyroidism and (2) discuss the potential pitfalls of revision parathyroid surgery and the implication of various localization techniques described in the literature.A case report is described from a tertiary care university hospital. A literature review detailing diagnostic tools used to improve outcomes in parathyroid surgery is presented. The potential inaccuracies of intraoperative PTH assays are discussed.We present a 71-year-old woman with primary hyperparathyroidism who was referred to our institution for revision surgery. The patient had preoperative sestamibi imaging that localized a right inferior parathyroid lesion. Intraoperatively, a specimen consistent with parathyroid tissue was removed and sent for frozen section. The intraoperative PTH levels were noted to decrease from 154 pg/mL (preincision) to 28 pg/mL (20 minutes postexcision). The frozen section results were consistent with a lymph node. This stimulated a 4-gland exploration, which confirmed normal left superior and inferior parathyroid glands. A 1.5-cm right retroesophageal parathyroid was subsequently discovered and excised. Final intraoperative PTH levels were 20 pg/mL.Rapid PTH assays have become the mainstay of parathyroid surgery at many institutions; however, despite their accuracy, false-positive results are known to occur. We present a case of an inaccurate decline in intraoperative PTH and use this case report as a means to highlight some potential pitfalls of the test.

    View details for DOI 10.1016/j.amjoto.2009.07.003

    View details for Web of Science ID 000283977700014

    View details for PubMedID 20015796

  • Unsedated office-based tracheoesophageal puncture using a novel guidewire technique 113th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation-and-OTO-EXPO Sidell, D., Ghadiali, M., Chhetri, D. K. SAGE PUBLICATIONS LTD. 2010: 284–85

    View details for DOI 10.1016/j.otohns.2009.09.030

    View details for Web of Science ID 000276574500025

    View details for PubMedID 20115990

  • Improved Tracheoesophageal Prosthesis Sizing in Office-Based Tracheoesophageal Puncture 89th Annual Meeting of the American-Broncho-Esophagological-Association Sidell, D., Shamouelian, D., Erman, A., Gerratt, B. R., Chhetri, D. ANNALS PUBL CO. 2010: 37–41


    Tracheoesophageal puncture (TEP) for postlaryngectomy speech is increasingly being performed as an office-based procedure. We review our experience with office-based TEP and compare outcomes with those of operating room-based TEP. Our hypothesis was that office-based TEP results in improved prosthesis sizing, reducing the number of visits dedicated to prosthesis resizing.A retrospective chart review was performed of all patients who underwent secondary TEP at our institution from 2001 to 2008. The primary dependent measure was the change in the length of the voice prosthesis. We also evaluated the number of visits made to the speech-language pathologist for resizing before a stable prosthesis length was achieved, and the number of days between voice prosthesis placement and the date a stable prosthesis length was observed.Thirty-one patients were included in this study. There was a significant difference in prosthesis length change between patients who had office-based TEP and patients who had operating room-based TEP (p < 0.001). In addition, the office-based cohort required fewer visits to the speech-language pathologist for TEP adjustments before a stable TEP length was achieved (p < 0.001).Voice prosthesis sizing was better in patients who had office-based TEP than in patients who had operating room-based TEP. This outcome is likely due to the lesser degree of swelling of the tracheoesophageal party wall in the office-based procedure.

    View details for Web of Science ID 000273680600007

    View details for PubMedID 20128185

  • The Use of Ultrasonic Shears for the Harvest of Perforator Free Flaps ARCHIVES OF FACIAL PLASTIC SURGERY Ahmed, S., Sidell, D., Blackwell, K. E., Sercarz, J. A., Abemayor, E., Nabili, V. 2009; 11 (5): 343-346


    A retrospective chart review was performed at a university medical center to evaluate the use of ultrasonic shears for the harvest of perforator free flaps over an 18-month period. The anterolateral thigh (ALT) was the perforator free flap site selected for the study. The site of origin and the number of musculocutaneous perforator vessels that were dissected using ultrasonic shears were recorded, and ALT flap viability and wound-healing complications were evaluated to assess safety. Seventeen patients underwent harvest of ALT perforator free flaps. Successful dissection of musculocutaneous perforators was achieved in 96% (27 of 28) of the descending branch perforators and in 100% (9 of 9) of the transverse branch perforators. Flap viability was 100% (17 of 17). We found that ultrasonic shears were effective and safe to use for harvesting perforator free flaps. According to these preliminary findings, the use of ultrasonic shears appears promising, yet further prospective analysis is needed.

    View details for Web of Science ID 000270041600011

    View details for PubMedID 19797098

  • Pediatric Squamous Cell Carcinoma: Case Report and Literature Review Annual Meeting of the Western Section of the Triological-Society Sidell, D., Nabili, V., Lai, C., Cheung, G., Kirsch, C., Abemayor, E. JOHN WILEY & SONS INC. 2009: 1538–41


    Describe a rare pediatric malignancy. Discuss the clinical, diagnostic, and therapeutic differences between squamous cell carcinoma (SCC) of the adult and pediatric population.Case report including a detailed radiological and histopathologic analysis and review of the literature.A case report is described from a tertiary care university hospital. Histopathologic assessment and radiological details are reviewed. A literature review of the background, incidence, disease course, and treatment options are presented.This case report presents a 6-year-old male with a 2-month history of an enlarging oral lesion. The patient denied dysphagia, pain, weight loss, bleeding, or loosening of the teeth. Biopsy demonstrated invasive, well-differentiated, exophytic squamous cell carcinoma with perineural and angiolymphatic invasion. Computed tomography and magnetic resonance imaging demonstrated a 2.7 x 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, primarily to the right of midline. Multiple small subcentimeter lymph nodes were also identified in the bilateral level II to V posterior cervical triangles bilaterally.Pediatric SCC of the oral cavity is indeed a rare entity; however, its presence in the pediatric population should not be ignored. This case report describes the occurrence of SCC in the oral cavity of a 6-year-old male patient, the youngest case ever reported, and is a reminder that a multidisciplinary approach tailored to pediatric individuals is essential to obtain clear diagnoses and appropriate treatment plans.

    View details for DOI 10.1002/lary.20531

    View details for Web of Science ID 000268739500013

    View details for PubMedID 19522006

  • Cystic Lymphatic Malformation of the Middle Ear ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Tanna, N., Sidell, D., Schwartz, A. M., Schessel, D. A. 2008; 117 (11): 824-826


    We review the clinical, radiologic, and histopathologic features of cystic lymphangioma of the middle ear, and discuss the developmental etiology and management of such a lesion.We present an unusual location for the development of a cystic lymphangioma with emphasis on etiology, clinical implications, and current treatment.A 10-year-old girl presented with a mass involving the medial surface of the right tympanic membrane. T2-weighted magnetic resonance imaging demonstrated a hyperintense lesion in the anterior-superior middle ear cavity without evidence of vascular abnormalities.To our knowledge, this is the only report of lymphangioma involving the middle ear represented in the English-language literature. Such a lesion has been demonstrated to arise from abnormalities in growth factors that contribute to the tightly regulated process of lymphangiogenesis. Lymphatic malformations can be diagnosed presumptively by virtue of magnetic resonance imaging in combination with a detailed physical examination. The treatment of choice for lymphangiomas located in the middle ear is surgical excision. Definitive diagnosis of the lesion is then made by identifying specific histopathologic characteristics. Although rare and histologically benign, middle ear lymphangiomas may produce significant patient discomfort and ultimately a conductive hearing loss. Therefore, these lesions warrant early recognition and treatment.

    View details for Web of Science ID 000261066800005

    View details for PubMedID 19102127

  • Adult intralesional cidofovir therapy for laryngeal papilloma Combined Otolaryngological Spring Meeting Tanna, N., Sidell, D., Joshi, A. S., Bielamowicz, S. A. AMER MEDICAL ASSOC. 2008: 497–500


    To assess the long-term efficacy of intralesional cidofovir therapy in a previously reported cohort of adult subjects with laryngeal papilloma.Retrospective review.Tertiary care medical center.We previously reported on the favorable clinical response to intralesional cidofovir therapy in 13 adult subjects. The subjects were enrolled in an open-trial prospective study (1997-2001) and completed the injection-only treatment protocol, and all subjects achieved a disease remission after a mean of 6 injections. In the present study, we review the clinical course of these subjects during an extended observational period (2001-2006).Patients with documented relapse of disease underwent additional intralesional cidofovir injections.Additional interventions, disease severity, and adverse outcomes are reported.Following the original cidofovir protocol, 6 patients (46%) received no further interventions. The remaining 7 patients (54%) required further treatment for disease relapse, with a mean duration of remission before relapse of 1.05 years. Of the 7 patients who experienced disease relapse, 2 continued to have stable disease with regular injections, 2 were lost to follow-up during relapse treatment, and 3 achieved disease remission again. For this latter cohort, the mean number of injections per year necessary to achieve a second remission was 3.82. This compares with a mean of 1.77 injections per year that these patients received on an as-needed basis prior to the original study.Intralesional cidofovir injections have been shown to be an effective therapy for adult laryngeal papilloma and should be considered in those patients who experience disease relapse.

    View details for Web of Science ID 000255905300006

    View details for PubMedID 18490570

  • Adolescent tracheobronchomalacia - Double aortic arches revisited 34th Annual Meeting of the Society-for-Ear-Nose-and-Throat-Advances-in-Children Tanna, N., Joshi, A. S., Sidell, D., Shah, R. K., Preciado, D. A. AMER MEDICAL ASSOC. 2008: 434–36

    View details for Web of Science ID 000254797000014

    View details for PubMedID 18427012

  • Pathology quiz case 1: Plexiform neurofibroma ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Tanna, N., Joshi, A. S., Sidell, D., Misra, S., Santi, M., Collins, W. O. 2007; 133 (3): 302-?

    View details for Web of Science ID 000244935700016

    View details for PubMedID 17372092

  • Tonsillar inclusion cysts in Gorlin's syndrome. Ear, nose, & throat journal Sidell, D., Tanna, N., Preciado, D. 2006; 85 (12): 818-?

    View details for PubMedID 17240705