Rise of Subspecialties in Pediatric Otolaryngology Has Changed Practice

There is also some evidence suggesting that the greater the amount of time between implants, the less benefit. Also the people who seem to benefit are those who don’t have a lot of a lot of motor issues, Dr. Kenna said.

Another factor to take into account with bilateral implants is that the cost-effectiveness of the second implant is reduced if a second surgery is required, said Dr. Papsin.

How to Manage Benign Laryngeal Tumors

Panelists were challenged with a sample case of a recurrent respiratory papillomatosis of the larynx that presented in childhood and caused some airway obstruction. Many cases are resolved but we’re now managing cases graduating to adulthood and developing to significant secondary disease as a result of papilloma of the larynx, said Dr. Papsin. The question presented was: What is the best way to treat recurring papillomatosis in a 4-year-old child?

Different centers tend to treat the problem differently, according to Christopher Hartnick, MD, Assistant Professor of Otology and Laryngology at the Massachusetts Eye and Ear Infirmary in Boston. A committee with the American Society of Pediatric Otolaryngology is working on developing a protocol for this sort of problem.

He described his experience in using pulsed dye laser in a series of children whose lesions were difficult to treat with a microdebrider. The laser treatment was very effective in dealing with this particular lesion, he said. The pulsed dye laser has an advantage over CO₂ lasers in that it doesn’t promote epithelial scarring, can be used in the office, and can be used for tracheal lesions.

On the other hand, Joseph Haddad, Jr., MD, Associate Professor of Otolaryngology at Columbia University in New York City, reported that in his experience, the CO₂ laser was effective in most cases he’s worked on.

However, there are significant voice issues, especially in the children who get regular treatments. I’ve also had good results with the microdebrider, he said. However, there are children who have recurrences and need procedures close to every month. For these kids, he suggested the use of cidofovir to try to reduce the need for surgery-though there are significant side effects parents should be made aware of.

Dr. Myer added that he has had good experience with microdebriders. He also suggested that when treating papillomas, doing a biopsy should be considered. Over a 21 year period, he has had four young patients have malignancies develop. It’s a benign disease until it’s not, he reminded the audience.

Team Approach to Complex Cases

The next topic addressed was how to manage infants with a large lymphatic malformation below the mylohyoid muscle. The overall message from panelists was that this is a complex problem that requires a team approach, and that it is important to develop a team that can work together well.