2017 Sec 1 Green Book

Katzel EB, Shakir S, Naran S, et al. Speech outcomes after clinically indicated posterior pharyngeal flap takedown. Ann Plast Surg . 2016; 77(4):420-424. EBM level 4............41-45

Summary : This is a retrospective review of 64 patients who had pharyngeal flap takedown due to hyponasality and obstructive sleep apnea. The authors primarily took down the pharyngeal flap, but occasionally also performed a Furlow palatoplasty at the time of flap take down. The speech results after flap take down were compared using objective speech analysis, which demonstrated that 90% of patients who have their pharyngeal flap taken down will not suffer from poorer speech. Pawar SS, Koch CA, Murakami C. Treatment of prominent ears and otoplasty: a contemporary review. JAMA Facial Plast Surg . 2015; 17(6):449-454. EBM level 5..................................................................................................................................46-51 Summary : This is a comprehensive review of the development, anatomy, and surgical considerations for surgery for the prominent ear. The authors review the specific physical findings and their relevance to the surgical approach, and then provide a reconstructive paradigm for addressing the specific ear deformity. The article includes wonderful diagrams illustrating the most common surgical approaches, which give very specific details about the surgery. Adenotonsillar Disease and Sleep Disorders Dahl JP, Miller C, Purcell PL, et al. Airway obstruction during drug-induced sleep endoscopy correlates with apnea-hypopnea index and oxygen nadir in children. Otolaryngol Head Neck Surg . 2016; 155(4):676-680. EBM level 4.....................................................52-56 Summary : This article correlates drug-induced sleep endoscopy (DICE) scores using the Chan-Parikh (C-P) scoring system with the preprocedural polysomnogram apnea-hypopnea index (AHI) and oxygen nadir in 127 children with obstructive sleep apnea. Fifty-six patients were syndromic and 21 had previous adenotonsillectomy. The mean C-P score positively correlated with the mean AHI and negatively correlated with mean oxygen nadir. The study provides further evidence that DICE is a useful tool to identify the location and severity of obstruction in pediatric obstructive sleep apnea. Summary : This is a systematic review of the treatment for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) focusing on tonsillectomy, antibiotic treatment/prophylaxis, intravenous immunoglobulin, and cognitive- behavioral therapy with or without selective serotonin reuptake inhibitors. A paucity of high- level studies was identified. Overall, tonsillectomy was not found to be an effective treatment modality. Antibiotics remain an option, although their efficacy is uncertain. Cognitive behavior therapy is a low-risk option for management of symptoms. Two studies support the use of intravenous immunoglobulin, but additional trials are needed given its potential risks. Farhood Z, Ong AA, Discolo CM. PANDAS: a systematic review of treatment options. Int J Pediatr Otorhinolaryngol . 2016; 89:149-153. EBM level 3............................................57-61

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