Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P271

Methods: Children who met the American Academy of
Otolaryngology-Head and Neck Surgery Guidelines for ventilation tube insertion had WBT performed after anesthesia
induction but before tympanotomy. MEE was categorized into
1 of 4 comparison groups: serous effusion, mucoid effusion,
purulent effusion, or no effusion. Measurements were averaged to 16 one-third octave frequency bands, and comparison
of the absorbance patterns for each MEE type was performed
using a linear mixed-effects model.
Results: A total of 118 children (211 ears) were included; 47
were female (39.8%), and 71 were male (60.2%). The mean
age was 2.73 years (95% CI, 2.25-3.22), the mean weight was
14.35 kg (95% CI, 12.85-15.85), and the mean Z-score was
1.13 (95% CI, −0.64 to 2.33). Effusions included 61 mucoid
(28.9%), 30 purulent (14.2%), 14 serous (6.6%), and 106 no
effusion (50.2%). No significant differences were found for
sex, race, age, weight, or Z-score between the 4 types of effusion (P < .05). WBT showed a significant difference in median
among the effusion groups (P < .001) with a medium effect
size of 0.35.
Conclusions: WBT has potential use to differentiate types of
MEE and should be studied further as a tool for investigating
how natural history and management of serous and mucoid
effusions may differ.
Association of Recurrent Tonsillitis With
Vitamin D Deficiency: A Systematic Review
and Meta-analysis
Feras Mohammed Alkholaiwi, MD (Presenter)
Objectives: Tonsillopharyngitis is a major health issue that
affects children in all age groups during childhood. It is 1 of the
causes that lead to frequent hospital visits during childhood. It
is an important health problem that adversely affects the quality of life of the children and their parents because of its frequently recurrent symptoms and its potential to develop
suppurative and nonsuppurative complications.
Methods: This is a systematic review study, in which
PubMed, Embase, MEDLINE, Scopus, and Cochrane Library
were searched using the terms "vitamin D" OR "calcifediol" OR "25(OH)vitamin D" OR "25-hydroxylvitamin D"
OR "25-hydroxyvitamin D" OR "25(OH)D" combined
with tonsillitis, pharyngitis, tonsillopharyngitis, and tonsillar hypertrophy.
Results: Thirty-three published articles were reviewed,
and 13 studies fit our inclusion criteria; 1 of the studies
showed that 78% of Auckland children undergoing (adeno)
tonsillectomy had a 25(OH) vitamin D level <75 nmol/L, a
level that is associated with an increased incidence of upper
respiratory tract infection. Low 25(OH) vitamin D levels
were related to a darker skin, increased body mass index,
and larger assessed tonsil size (vitamin D and tonsil disease
preliminary observations); also, 1 study showed a higher
significant positive correlation between vitamin D levels
and the frequency of group A streptococcus (the association
between vitamin D and frequency of streptococci), while

P271
another prospective cohort study did not show an association between serum vitamin D and the need to have
adenotonsillectomy.
Conclusions: Further studies are needed to confirm an association in children with recurrent tonsillitis and relation with
vitamin D level. Larger clinical trials are needed.
An Atypical Cause of Asymmetric Tonsils:
Pediatric Tonsillar Clear Cell Sarcoma
Clare Richardson, MD (Presenter); Nicole M. Fowler, MD
Objectives: Clear cell sarcoma is an extremely rare malignancy of the head and neck. This typically presents in the base
of tongue in patients older than 50 years. Tonsillar clear cell
carcinoma is even more scarcely described and has never been
reported in a pediatric patient.
Methods: We present a case of a 10-year-old girl who presented for recurrent sore throat. On physical examination, the
left tonsil appeared enlarged compared with the right, and a
decision was made to proceed with tonsillectomy. During the
procedure, the left tonsil was firm and friable. Surgical pathology returned as a malignant neoplasm with EWSR1/ATF1
fusion, most closely resembling clear cell sarcoma of soft tissue
or clear cell sarcoma-like tumor of the gastrointestinal tract/
malignant gastrointestinal neuroectodermal tumor. She underwent further workup, including magnetic resonance imaging
and positron-emission tomography scan, which revealed a
tumor at the inferior tonsillar pole and neck metastasis at level
2. No distant metastasis or primary site was identified. Further
treatment was pursued, including surgery and adjuvant
radiation.
Results: The patient successfully underwent a left transoral
robotic radical tonsillectomy and neck dissection. Pathology
returned consistent with the prior diagnosis. Tumor was present on the deep margin as well as in 4 of 64 cervical lymph
nodes. She underwent postoperative radiation with a total of
61.2 Gy. Posttreatment imaging showed no evidence of disease. At 1-year follow-up, she remained disease free.
Conclusions: We describe a case of the unusual pathology of
EWSR1/ATF1 fusion clear cell carcinoma of the tonsil in a
pediatric patient. This is the first of such cases reported in the
literature. Our patient was successfully treated with surgical
resection and adjuvant radiation.
Case Report: Malignant Peripheral Nerve
Sheath Tumors in Pediatric Population
Nima Vahidi, MD (Presenter); Rajanya S. Petersson, MD
Objectives: Malignant peripheral nerve sheath tumors
(MPNSTs) are very rare neoplasms. The incidence is thought
to be roughly 0.001% of the population, and they generally
indicate a poor prognosis. They are regarded as high-grade
sarcomas, with only about 8% to 16% occurring in the head
and neck. They are commonly associated with neurofibromatosis type 1 (NF1); however, they can arise from spontaneous mutations as well. Like most soft-tissue sarcomas,

Pediatric

Poster Presentations

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

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