Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P121

Oral Presentations

Accuracy of Pediatric Tracheostomy Tube
Position Measurement Methods
Allison Keane, MD (Presenter); Robert A. Saadi, MD; Einat
Slonimsky, MD; Meghan N. Wilson, MD; Jason G. May, MD
Objectives: The position of a pediatric tracheostomy tube,
defined here as the distance from the tube tip to the carina, can
be measured intraoperatively by tracheoscopy and postoperatively by chest x-ray. Both methods assist in selecting the
appropriate tracheostomy tube length. The purpose of this
study was to investigate inconsistencies between tracheostomy tube position measurements.
Methods: A retrospective study of all pediatric patients
younger than 1 year at the time of procedure who underwent
tracheotomy by the otolaryngology department at our institution between 2014 and 2019 was conducted. Patients were
included if they had both intraoperative measurement of tracheostomy tube position and postoperative chest x-ray within
24 hours of the procedure. The distance from the tip of the
tracheostomy tube to the carina was measured on chest
-anterior-posterior x-ray by an attending radiologist blinded to
the intraoperative measurements.
Results: The study included 66 patients; 30 patients (14:16,
male/female) had available data. The mean distance from the tracheostomy tube tip to the carina measured by tracheoscopy was
8.88 mm (range, 3.5-20 mm) and measured radiographically was
11.71 mm (range, 2.4-23.3 mm). The mean difference between
the measurements was 2.82 mm (95% CI, 0.56-5.086). A paired t

test revealed t = 2.55 (P = .016), which was statistically significant. A Wilcoxon signed-rank test revealed S = 115 (P = .015).
Conclusions: Significant discrepancy exists between intraoperative measurement and x-ray evaluation of tracheostomy tube
position in the pediatric population. Clinical decisions should
mostly rely on intraoperative measurement, and awareness of
overestimation of the distance from the tracheostomy tube tip to
the carina by imaging should be taken into consideration.
Analysis of the Clinical Course of Children
With Initial Negative Polysomnography
Arman Maqsudlu (Presenter); Elizabeth Abraham, MS;
Jessica R. Levi, MD
Objectives: Physicians often obtain polysomnography (PSG)
to rule out positional obstructive sleep apnea (POSA), but it
is unclear whether children with negative PSG tests continue
to not have POSA. The aim of this project was to determine
the clinical course of children with initial negative PSG; we
believe a significant percentage of these children proceed to
POSA over time, and thus should continue to be monitored.
Methods: A retrospective chart review was performed on all
patients who underwent a PSG between October 2012 and
March 2019. An apnea-hypopnea index <2.0 was used as the
cutoff for a negative PSG for this study. Only patients for whom
this was their first PSG, were younger than 18 years at the time
of their initial PSG, and who did not have prior adenoidectomy
or tonsillectomy surgery were included. Data, including demographics, follow-up PSG tests, and surgeries, were collected.
Results: Of the initial 2018 patients undergoing PSG, 535
were negative for POSA and had no prior adenotonsillectomy.
Of those 535, 408 (76.26%) did not obtain follow-up testing
or surgeries, 69 (12.90%) underwent adenotonsillectomy
instead of a repeat PSG, and 58 (10.84%) obtained 1 or multiple follow-up PSG tests. Of these 58, 25 (43.10%) obtained
a repeat PSG that was positive, with 17 of those (29.31% of
58) undergoing subsequent adenotonsillectomy. Thirty-three
of the 58 patients (56.90%) had negative repeat PSG tests.
Conclusions: A sizable percentage of children who initially
tested negative for POSA tested positive on repeat PSG testing. In addition, several other children who tested negative
went on to receive surgery (indicating worsening disease) in
lieu of repeat PSG. A total of 127 (23.7% of 535) patients had
worsening symptoms following a negative initial PSG. Thus,
children with negative PSG should continue to be monitored
for disease progression over time.
Audiological Outcomes in Pediatric Patients
Who Underwent Mastoidectomy for Acute
Coalescent Mastoiditis
Dhruv Sharma, MD (Presenter); Brady Jay Tucker;
Kolin Rubel; William Bennett, MD; Sarah J. Burgin, MD
Objectives: Studies assessing hearing outcomes in pediatric
patients who undergo mastoidectomy for acute mastoiditis
(AM) are absent from the literature.

Pediatric

an affordable anatomic model of the sinuses for both trainee
education and preoperative surgical planning.
Methods: Eleven 3D-printed models of the pediatric sinuses
were created using resin. Six models were used for defining the
frontal outflow pathway. Five additional 3D models were created of upcoming surgical procedures, which included
2 obstructing mucoceles, 2 silent sinus syndromes, and 1 recurrent juvenile ossifying fibroma of the maxilla. The models
were dissected in the laboratory to facilitate surgical planning,
technique, and instrumentation selection. Endoscopic videos
and pictures were taken while performing dissection.
Results: Eleven models were created and dissected to trial
the feasibility of using 3D models for surgical planning, training, and anatomic accuracy. All models were extremely accurate to the actual computed tomography scan that they were
created from. The ethmoid sinuses were the easiest to dissect
and remove bony septations. The consistency of the 3D-printed
models was firmer than true anatomic specimens. The ability
to paint sinonasal pathology and the frontal outflow pathway
was extremely helpful in identifying these structures in the
laboratory and subsequently in the operating room.
Conclusions: The 3D-printed models are a useful tool to
study and plan for uncommon sinonasal pathology. They can
also serve as a useful trainee instrument for learning frontal
sinus anatomy. This feasibility study shows that 3D sinus
models are affordable and accurate in preserving and identifying important anatomic landmarks.

P121

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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