Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P286

P286
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
diphosphate-related platelet defect and 2 diagnoses of von
Willebrand disease.
Conclusions: Obtaining coagulation panels in pediatric
patients presenting with PTH is rarely useful, and diagnosing
a coagulopathy is uncommon. However, among children with
a second PTH, a referral to hematology is reasonable because
this group has a significantly higher, albeit small, incidence of
undiagnosed bleeding disorders.
Practical Management Approach to Ear
Foreign Bodies in Children
Shayanne Lajud, MD (Presenter); Gabriel D. Pujol, MD;
Edgar Del Toro, MD; Carlos Gonzalez Aquino, MD

Pediatric

Objectives: Ear foreign bodies (FBs) commonly occur in
children. Although most ear FBs are managed uneventfully,
short-term and long-term complications can occur. To date,
there is no established step-by-step approach to manage ear
FBs. The purpose of our study was to evaluate our experience
in managing ear FBs in children. In addition, we evaluate
potential complication risk factors and propose a practical
management algorithm.
Methods: A retrospective chart review of patients presenting to the emergency department (ED) at the University
Pediatric Hospital with an ear FB between January 2018 and
December 2019 was performed. Data collected included
demographics, type of FB, symptoms, otoscopy, number of
attempts, method of removal, and complications.
Results: A total of 67 patients were identified. Most patients
were male with a mean age of 6.7 years. Eighty-five percent
were successfully treated in the ED without the use of microscopy. Most of these patients received intravenous sedation for
removal. Ten patients (14%) required removal of the FB in the
operating room with an operating microscope. Most of these had
undergone at least 2 attempts at removal and had a spherical type
of FB located in the medial external auditory canal (EAC). Most
patients had minor trauma to the EAC, and approximately 17%
had small tympanic membrane perforations.
Conclusions: Our results indicate that multiple previous
attempts at removal, spherical FBs, and medial location were
the main contributors to failure of removal in the ED. Based
on our findings, we propose a practical treatment algorithm to
maximize patient safety and guide management in the treatment of ear FBs in children.
Predictors of Sinonasal Disease Onset,
Progression, and Severity in Pediatric Cystic
Fibrosis Patients
Michael S. Weinstock, MD (Presenter);
Amber Dianne Shaffer; Amanda L. Stapleton, MD
Objectives: Pediatric cystic fibrosis (CF) patients have a
variable onset, severity, and progression of sinonasal disease.
The goal of this study was to identify genotypic and phenotypic factors associated with CF that are predictive of early
onset sinonasal disease, recurrent nasal polyposis, and failure
to respond to standard medical and surgical management.

Methods: This is a retrospective case series of 30 patients
with CF chronic rhinosinusitis with and without polyps.
Patient-specific mutations were divided by class and categorized into high risk (classes I-III) and low risk (classes IV-V).
Severity of pulmonary and pancreatic manifestations of CF,
number of sinus surgeries, nasal polyposis and recurrence, age
at presentation to otolaryngology, and Pediatric Sinonasal
Symptom Survey (SN5)/Sino-Nasal Outcome Test (SNOT22) scores were examined.
Results: Twenty-seven of 30 (90%) patients had high-risk
mutations (classes I-III, including 15 patients who were
homozygous for the delta F508 mutation). Twenty-one of 30
(70.0%) patients had nasal polyposis, and 10 of 30 (33.3%)
had recurrent nasal polyposis. Dependence on pancreatic
enzymes (23/27; 85.2% vs 0/3; 0.0%; P = .009) and worse
forced expiratory volumes (FEV1%; mean, 79; SD, 15 vs
mean 105; SD 12; P = .009) were more common in patients
with high-risk mutations. Interestingly, insulin dependence
was more common in those with recurrent polyposis (5/10;
50% vs 2/20; 10%; P = .026). There was no statistical difference in polyposis presence, recurrence, or extent of sinus surgery based on high-risk vs low-risk classification.
Conclusions: Cystic fibrosis-related diabetes was associated
with nasal polyposis recurrence. Patients with more severe
extrapulmonary manifestations of CF may also be at increased
risk for sinonasal disease.
Preliminary Results on a Randomized
Control Trial on Use of Intraoperative
Ketorolac in Pediatric Tonsillectomy
Samuel Dudley (Presenter); Madhu Poornima Mamidala, PhD;
Ladd Caballero; Elijah Debroux; Kayla Bryan, MD; Timothy
Head, MD; Anthony Sheyn, MD
Objectives: The use of ketorolac during adenotonsillectomy
remains controversial because of the potential risk of hemorrhage. Previous studies have been equivocal and generally
retrospective on the safety of ketorolac in pediatric tonsil surgery. Our hypothesis is that ketorolac is safe to use in pediatric
tonsil surgery and may decrease the use of narcotics perioperatively in these patients.
Methods: Institutional review board approval was obtained.
A randomized control study was designed to include healthy
patients age 2 to 18 years undergoing tonsillectomy. Patients
were randomized to receive intraoperative ketorolac or placebo based on a random computer algorithm. The surgeons
were not aware of what medications were administered. Data
were collected on demographics, surgical indications, rate of
bleeding, rate of postoperative narcotic medication, and postoperative pain diary. Univariate analysis was then performed.
Statistical significance was set at P < .05.
Results: Thus far, 33 patients have been enrolled; 19 of 33
patients received Toradol, and 14 of 33 did not. Patients
receiving Toradol had statistically significant decreased utilization of narcotics postoperatively (P value of .04; odds ratio,
0.157). One of 19 patients in the Toradol study had an imme-

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

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