Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P287

Poster Presentations

Prevalence of Elevated Right Ventricular
Pressure in Children With OSA Undergoing
Pulmonary Hypertension Screening
Anna Catherine Bitners (Presenter); Raanan Arens;
Nicole J. Sutton, MD; Sanghun Sin, MS; Joseph
Mahgerefteh, MD; Christina J. Yang, MD
Objectives: Obstructive sleep apnea (OSA) is linked to cardiovascular risk in children; however, the reported prevalence
of pulmonary hypertension (PH) varies. In this study, we
sought to determine the prevalence of elevated right ventricular pressure (RVP) as a surrogate marker for PH in children
with OSA undergoing echocardiography.
Methods: We performed a retrospective chart review of
children age 2 to 21 years diagnosed with OSA by an overnight polysomnogram (PSG) who underwent cardiac echocardiogram to screen for PH within 6 months of PSG in a tertiary
inner-city pediatric hospital. OSA was defined as obstructive
apnea-hypopnea index (AHI) ≥2 and/or obstructive apnea
index ≥1. The primary outcome was elevated RVP defined by
estimated RVP ≥25 mm Hg above the right atrial pressure or
ventricular septal configuration consistent with elevated RVP.
Results: We included 174 children in this study. The mean
age was 9.6 ± 4.9 years, with 59.2% male, 41.4% Hispanic, and
25.9% African American. The mean body mass index (BMI)
percentile was 84.4% ± 29.4%, and 69.0% were obese. Severe
OSA (AHI ≥10) was present in 93.1%. The median (interquartile range) obstructive AHI and oxygen nadir were 27.3
events/h (17.3-49.8 events/h) and 77.0% (68.8%-85.0%),
respectively. Seven children (4%) had elevated RVP. There
was no association between elevated RVP and age, sex, race,
BMI percentile, obstructive AHI, oxygen nadir, or severe OSA.
Conclusions: We noted elevated RVP in 4% of our cohort.
This is higher than the prevalence of PH reported in similar
studies (0%-1.8%) and may be related to differences in cohort
characteristics (ie, high BMI and severe OSA). Our findings
justify continued echocardiographic screening in obese children with severe OSA. Further effort to determine the optimal
role for cardiac screening in pediatric OSA is needed.
Proactive Ethics in Pediatric Otolaryngology
Within an Academic Tertiary Children's
Hospital: A Conceptual Content Analysis
Lulia Kana (Presenter); Marc C. Thorne, MD;
Andrew G. Shuman, MD; Janice I. Firn, PhD
Objectives: Caring for children with complex otolaryngologic issues can be ethically fraught. Although there has been a

shift toward proactively addressing ethical issues arising in the
care of hospitalized pediatric patients, the ethical issues experienced by patients with otolaryngology-related concerns have
not been identified. Thus, in this study, we aimed to explore the
types of ethical issues experienced by these patients.
Methods: We conducted a qualitative conceptual content
analysis of field notes from weekly proactive, preventive
ethics rounds discussions with health care teams occurring
between January 2017 and December 2018 in the pediatric,
cardiothoracic, and neonatal intensive care units at our academic tertiary care children's hospital. Eleven otolaryngology patients discussed on rounds were included in this
analysis.
Results: Content analysis of rounds' discussions revealed 5
ethical themes: caring for complex patients, challenging family and team interactions, the family role, working through
uncertainty, and systemic issues. Moral distress and issues
related to tracheostomies and surgical innovation were prevalent in this group.
Conclusions: Ethical issues arising in the management of
pediatric otolaryngology inpatients in the intensive care unit
share similarities to those reported in the ethics consultation
literature for the general pediatric population. However, complex health care needs and the surgical innovation inherent to
the field introduce unique nuances. Our findings have implications for pediatric health care teams, surgeons, ethicists, and
institutions.
Pyriform Aperture Stenosis and Its Surgical
Management in the Setting of Moebius
Syndrome
Connor J. O'Boyle (Presenter); Andrew R. Scott, MD;
Alexander P. Marston, MD
Objectives: Moebius syndrome classically involves palsy
of the sixth and seventh cranial nerves. However, a multitude
of diverse findings can be present in Moebius patients, and
careful workup is necessary to understand the unique presenting features. The patient presented in this case example
had significant nasal obstruction originally attributed to isolated nasal valve collapse. However, his symptoms were
later discovered to be predominately due to pyriform aperture stenosis.
Methods: A retrospective review of the patient's electronic
medical record was completed.
Results: The 12-year-old patient described in this case example had chronic nasal congestion due to presumed isolated nasal
valve obstruction. He underwent an open septorhinoplasty for
correction of these abnormalities with bilateral spreader and
batten graft placement. However, intraoperatively, he was found
to also have pyriform aperture stenosis, which allowed for limited benefit from the nasal valve surgery. In a subsequent procedure, the pyriform aperture was drilled out via a sublabial
approach in combination with surgically assisted rapid palatal
expansion (SARPE) via Le Fort 1 and midpalatal osteotomies.
The SARPE procedure facilitated optimization of his pyriform
aperture patency and allowed for correction of lateral crossbite

Pediatric

diate postoperative bleeding, which required surgical intervention. No other complications were noted in either group.
Conclusions: Our preliminary results of 33 patients demonstrate that intraoperative Toradol is safe to use and led to a
decrease the use of narcotics in a postanesthesia care unit. Our
goal sample size was 400, and we expect to have more data
regarding medication use during the first week after surgery
and overall adverse events between these 2 groups.

P287

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

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