Clinical Practice Guidelines
Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, Jones S, Robertson P. Otolaryngol Head Neck Surgery 2011 Jul;145(1 Suppl):S1-S15.
Clinical practice guideline: hoarseness (dysphonia) Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O’Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM.Otolaryngol Head Neck Surgery 2009 Sep;141(3 Suppl 2):S1-S31.
Clinical practice guideline: cerumen impaction Roland PS, Smith TL, Schwartz SR, Rosenfeld RM, Ballachanda B, Earll JM, Fayad J, Harlor AD Jr, Hirsch BE, Jones SS, Krouse HJ, Magit A, Nelson C, Stutz DR, Wetmore S. Otolaryngol Head Neck Surgery 2008 Sep;139(3 Suppl 2):S1-S21.
Clinical practice guideline: acute otitis externa Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS, Shiffman RN, Stinnett SS, Witsell DL; American Academy of Otolaryngology—Head and Neck Surgery Foundation. Otolaryngol Head Neck Surgery 2006 Apr;134(4 Suppl):S4-23.
Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA, Lieberthal AS, Mahoney M, Wahl RA, Woods CR , Yawn B; AAP Subcommittee on Otitis Media with Effusion; American Academy of Family Practice; AAO-HNS. Otolaryngol Head Neck Surgery 2004; May;130(5 Suppl): S95-118.linical practice guideline: Otitis media with effusion Rosenfeld RM,
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media.
Pediatrics. 2004 May;113(5):1451-65.
The Cochrane Collaboration: reviews on many OHNS subjects.
Head & Neck
Coutinho-Camillo CM, Brentani M, Nagai MA. Genetic alterations in juvenile nasopharyngeal angiofibromas. Head Neck 2008;30:390-400.
This paper discusses the fibrous and vascular origins of JNAs, angiogenic markers associated with JNAs, the role of androgens in JNA biology, and potential genes involved in JNA development.
Thomason TS, Brenski A, McClay J, Ehmer D.. The rising incidence of methacillin-resistant Staphylococcus aureus in pediatric neck Otolaryngol Head Neck Surgery (2007) 137, 459-464.
Duggal P, Naseri I, and Sobol SE. The Increawed Risk of Community-Acquired Methicillin-Resistant Staphylococcus aureus Neck Abscesses in Young Children. Laryngoscope. 2011; 121:51-55.
Both the MRSA Neck abscess papers show that the incidence of MRSA is increasing in pediatric neck infections, it more common in young children, and is usually a lateral neck abscess
Neri I, Balestri R, and Patrizi A. Hemangiomas: new insight and medical treatment. Dermatologic Therapy 2012; 24:322=334.
This paper discusses the need for a multidisciplinary management approach, when to treat with propranolol and for how long, adverse effects, and suggested overall management.
Richter GT and Friedman AB. Hemangiomas and Vascular Malformations: Current Theory and Management. Int J Pediatr 2012; 2012:645678.
This paper discusses the nomenclature and treatment of hemangiomas and vascular malformations.
Chang LC, Haggstrom AM, Drolet BA et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008; 122:360-367.
This paper discusses the growth characteristics of IH to help with decision making.
James A, Stewart C, Warrick P, Tzifa C, Forte V. Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope. 2007;117:1920-1924.
This paper discusses the anatomy of third and fourth branchial anomolies and that they do not follow the hypothetical courses as determined by embryology. They may be a derivation of the thymopharyngeal duct.
Perkins JA, Manning SC, Rempero RM, Cunningham MJ, et al. Lymphatic malformations: review of current treatment. Otolaryngol Head Neck Surgery 2010;142:795-801.
This paper discussed a review of the lymphatic malformation literature and the current treatment. They discuss medical therapy, sclerotherapy and surgery and the controversies.
Steigman SA, Nemes L, Barnewolt CE et al. Differential risk for neonatal surgical airway intervention in prenatally diagnosed neck masses. J Pediatr Surg 2009;44:76-79.
This paper discusses the tumors that increase the risk for airway intervention, often by the EXIT procedure.
Derkay CS, Wiatrak B. Recurrent respiratory papillomatosis: a review Laryngoscope. 2008 Jul;118(7):1236-47. Review.
Derkay CS, Malis DJ, Zalzal G et al. A staging system for assessing severity of disease and response to therapy in recurrent respiratory papillomatosis. Laryngoscope. 108, 935-937. (1998)
Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope. 2007 Jun;117(6 Pt 2 Suppl 114):1-33. The epidemiology of juvenile onset recurrent respiratory papillomatosis derived from a population level national database.
Campisi P, Hawkes M, Simpson K; Canadian Juvenile Onset Recurrent Respiratory Papillomatosis Working Group. Laryngoscope. 2010 Jun;120(6):1233-45.
Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenza Type B Vaccine Era: Changing Trends. Laryngoscope. 2004 114:557-560.
Lim J, Hellier W, Harcourt J, Leighton S, Albert D. Subglottic cysts: the Great Ormond Street experience. Int J Pediatr Otorhinolaryngol. 2003 May;67(5):461-5
Ransom ER, Antunes MB, Smith LP, Jacobs IN. Microdebrider resection of acquired subglottic cysts; Case Series and review of the literature: Int J Ped Oto 2009;73:1833-36.
White DR, Bravo M, Vijayasekaran S, Rutter MJ, Cotton RT, Elluru RG. Laryngotracheoplasty as an alternative to tracheotomy in infants younger than 6 months. Arch Otolaryngol Head Neck Surg. 2009 May;135(5):445-7
Miyamoto RC, Cotton RT, Rope AF, Hopkin RJ, Cohen AP, Shott SR, Rutter MJ Association of anterior glottic webs with velocardiofacial syndrome (chromosome 22q11.2 deletion) Otolaryngol Head Neck Surg. 2004 Apr;130(4):415-7
Ikonomidis C, George M, Jaquet Y, Monnier P. Partial cricotracheal resection in children weighing less than 10 kilograms. Otolaryngol Head Neck Surgery 2010; 142(1):41-7.
Monnier P, Lang F. Savary M: Treatment of subglottic stenosis in children by criocotracheal resection for pediatric subglottic stenosis: A single institution’s experience in 60 cases. Eur Arch Otorhinolaryngol. 2003;260.295-297.
Elliot M, Hartley BE, Wallis C, et al. Slide tracheoplasty. Curr Opinion Otolaryng. Head Neck Surgery 2008;16:75-82.
Hartnick CJ, Hartley BE, Lacey PD et al. Surgery for pediatric subglottic stenosisDisease specific outcomes. Ann Otol Rhinol Laryngol 2001:110:1109-1113.
Rizzi MD, Thorne MC, Zur KB. Laryngotracheal reconstruction with posterior costal cartilage grafts:outcomes at a single institution. Otolaryngol Head Neck Surgery 2009;140:348-353.
Wetmore, R, Thompson M, Marsh R. etal. Pediatric Tracheotomy: a changing procedure. Ann Otol Rhinol Laryngol 1999;108:695-699.
Bogdasian RS Olson NR. Posterior Glottic stenosis. Otolaryngology Head Neck Surg. 1980;88:765-772.
Myer III CM, O’Conner, DM, Cotton RT. Proposed grading system for shubglottic stenosis based upon endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319-323:
Schroeder JW, Bhandarkar ND, holinger LD. Syndhronous airway lesions and outcomes in infants with seere laryngomalacia requiring supraglottoplasty. Arch Otolaryngol Head Neck Surg 2009; 135(7):647-51.
Froehlich P. Seid A, Denoylle F. et al. Discoordinate pharyngolaryngomalacia. Int J Pediatric Otolaryngology 1997;39:9-18.
Marie JP, Dehesdin D, Ducastelle. T. et al. Selective reinnervation of the abductor and adductor muscles of the canine larynx after recurrent nerve paralysis. Ann Otol Rhinol Laryngol 1989;98:530-536
Inglis, Jr. AF, Perkins JA, Manning SC. Et al Endoscopic posterior cricoid split and rib-grafting in 10 children. Laryngoscope. 2003;113:2004-2009.
Lichtenberger G Reversible lateralization of paralyzed vocal cords without tracheotomy. Ann Otol Rhinol Laryngol 2002;111:21-26.
Javia LR, Zur Jacobs IN Evolving treatments in the management of laryngotracheal hemangiomas: Will propanolol supplant steroids and surgery. Int J Ped Otolaryngology 2011
Dyce O. McDonald-McGinn D, Kirschner RE et al. Otolaryngologic manefestions of 22 q 11.2 deletion syndrome. Arch Otolaryngol Head Neck Surg 2002:128:1408-1412.
Denoyelle F, Leboulanger N, Enjolas O et al. Role of propanolol in the therapeutic treatment of infantile laryngotracheal hemangioma. Int J ped Oto 2009;73: 1168-1172
Rahbar R, Nicollas R, Roger G et al. The biology and management of subglottic hemangioma. Past, present and future. Laryngoscope. 2004;114:1880-1891.
Warner D, Brietzke SE. Topical Mitomycin C and airway surgery: how well does it work? Otolaryngol Head Neck Surgery 2008;138:700-709.
Fearon B, Cotton RT. The management of long term airway problems in infants and children. Ann Otol Rhinol Laryngol 1971;80:669-677.h
Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, Smith CG, Colborn DK, Bernard BS, Kurs-Lasky M, Janosky JE, Sabo DL, O’Connor RE, Pelham WE Jr. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007 Jan 18;356(3):248-61.
American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs Pediatrics. 2007; 120(4):898-921.
Morton CC, Nance WE. Newborn Hearing Screening—A silent revolution. N Engl J Med 2006;354:2151-64.
Lester EB, Dawson JD, Gantz BJ, Hansen MR. Barriers to the early cochlear implantation of deaf children. Otol Neurotol 2011 32(3): 406-12
Papsin BC, Gordon KA. Cochlear implants for children with severe-to-profound hearing loss. N Engl J Med. 2007 Dec 6;357(23):2380-7. Review.
Putcha GV, Bejjani BA, Bleoo S, Booker JK, Carey JC, Carson N, Das S, Dempsey MA, Gastier-Foster JM, Greinwald JH Jr, Hoffmann ML, Jeng LJ, Kenna MA, Khababa I, Lilley M, Mao R, Muralidharan K, Otani IM, Rehm HL, Schaefer F, Seltzer WK, Spector EB, Springer MA, Weck KE, Wenstrup RJ, Withrow S, Wu BL, Zariwala MA, Schrijver I. A multicenter study of the frequency and distribution of GJB2 and GJB6 mutations in a large North American cohort Genet Med. 2007; (7):413-26.
de Alarcon A, Choo DI. Controversies in aural atresia repair. Curr Opin Otolaryngol Head Neck Surg 15:310-314, 2007.
Jahrsdoerfer RA, Yeakley JW, Aguilar EA, Cole RR, Gray LC.Grading system for the selection of patients with congenital aural atresia. Am J Otol. 1992 Jan;13(1):6-12.
Jackler RK, Luxford WM, House WF. Congenital malformations of the inner ear: a classification based on embryogenesis. Laryngoscope. 1987 Mar;97(3 Pt 2 Suppl 40):2-14.
Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis.Rubin LG, Papsin B; Committee on Infectious Diseases and Section on Otolaryngology-Head and Neck Surgery. Pediatrics. 2010 Aug;126(2):381-91. Epub 2010 Jul 26.
Toner JG, Smyth GD, Kerr AG. Realities in ossiculoplasty. Acta Otorhinolaryngol Belg. 1991;45(1):99-104.
Browning GG, Gatehouse S, Swan IR. The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery. Laryngoscope. 1991 Feb;101(2):180-5.
Nelson M, Roger G, Koltai PJ, Garabedian EN, Triglia JM, Roman S, Castellon RJ, Hammel JP. Congenital Cholesteatoma. Arch Otolaryngol Head Neck Surg 2002;128:810-814
O’Reilly RC, Greywoode J, Morlet T, Miller F, Henley J, Church C, Campbell J, Beaman J, Cox AM, Zwicky E, Bean C, Falcheck S. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surgery 2011 Feb;144(2):142-8.
This is an exciting and rapidly developing field within pediatric otology. I highly commend this to students.
Lieu JE, Tye-Murray N, Fu Q. Longitudinal study of children with unilateral hearing loss. Laryngoscope. 2012 Sep;122(9):2088-95.
To me this represents the most important addition to the field of hearing loss in 3 decades and has huge implications for how we should be rehabilitating and treating our patients.
van Zon A, van der Heijden GJ, van Dongen TM, Burton MJ, Schilder AG. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev. 2012 Sep 12;9:CD009163.
This is a state of the art review of the most contentious disease in our practice. Well performed review by Anna.
Marchioni D, Piccinini A, Alicandri-Ciufelli M, Presutti L. Endoscopic anatomy and ventilation of the epitympanum. Otolaryngol Clin North Am. 2013 Apr;46(2):165-78.
Whether you like these approaches or not, the endoscopic otologic principles and understanding of the ear is revolutionizing our thinking just “functional” endoscopic sinus surgery made us rethink our approach to the ear.
Tonsils & Adenoids & Palate & Pharynx
Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics, 110 Number 1, pgs 7-15, 2002
In a previous trials on children severely affected with recurrent tonsillar infection, tonsillectomy and adenoidectomy (T&A) was justified. However, current publication by the same authors demonstrated only modest benefit in mild to moderately affected children and claim that risk of surgery is not justified.
Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J, Yung M, Brown P.Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope. 117:717-24, 2007.
A national audit in England and northern Ireland on post-operative hemorrhage after T&A revealed 0.6% primary and 3% secondary hemorrhage. Diathermy methods had increased risk of bleeding compared to cold steel dissection and stitch method.
Muzumdar H, Arens R. Diagnostic Issues in Pediatric Obstructive Sleep Apnea. Proc Am Thorac Soc, 5:263-73, 2008.
A thorough review of diagnostic issues from history and physical examination to the testing, including detailed information on polysomnogram (PSG) variables and its interpretation in children.
Goldstein NA, Pugazhendhi V, Rao SM, Weedon J, Campbell TF, Goldman AC, Post JC, Rao M. Clinical Assessment of Pediatric Obstructive Sleep Apnea. Pediatrics,114:33-43, 2004
This study was to assess the role of surgery on children with a positive clinical assessment of obstructive sleep apnea (OSA) but negative PSG and demonstrated significant improvement after T&A as compared with observation alone, thus validating the clinician’s role in diagnosing upper airway obstruction.
Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics, 122:149-55, 2008.
This study demonstrated an improvement in OSA as per PSG and reduction of adenoid size with 6 week course of budesonide in children with mild SDB, and recommended that topical steroids should be the initial therapeutic option.
Friedman M, Wilson M, Lin H-C, Chang H-W. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surgery 140:800-08, 2009
A meta-analysis of 23 studies on the treatment of pediatric OSA with T&A using PSG as metric of cure was conducted, which demonstrated that although complete resolution is not achieved in most cases, T&A offers significant improvement in OSA making it valuable first-line treatment.
Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK,Marcus CL, Guire KE. Sleep-Disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics, 117, Number 4, e769-e778, 2006
Ths study compares the pre-operative and 1-year post-operative assessment of behavioral, cognitive and psychiatric morbidity in children undergo T&A. Results indicate that pre-operatively, children with sleep sleep disordered breathing (SDB) have significant neurobehavioral morbidity that improves after the surgery.
Lin AC, Koltai, PJ. Persistent pediatric obstructive sleep apnea and lingual tonsillectomy Otolaryngol Head Neck Surgery 2009 141: 81
Persistent OSA after T&A is discussed in this article, with the experience on endoscopic assisted coblation lingual tonsillectomy improving the SDB in pediatric population.
Campbell A, Costello BJ, Ruiz RL. Cleft lip and palate surgery: an update of clinical outcomes for primary repair. Oral Maxillofac Surg Clin North Am. 2010 Feb;22(1):43-58. Review.
This article provides an update on current primary cleft lip and palate outcome data and helps the reader in understanding outcome data and when making clinical decisions for patients with clefts
Abyholm F, D’Antonio L, Davidson Ward SL, Kjøll L, Saeed M, Shaw W, Sloan G, Whitby D, Worhington H, Wyatt R; VPI Surgical Group. Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1 year postoperatively: Results of a randomized trial. Cleft Palate Craniofac J. 2005 Sep;42(5):501-11.
An international multicenter randomized trial to study the outcome of two surgical procedures (flap and sphincter pharyngoplasty) for speech, incidence of sleep apnea, and surgical complications demonstrated no significant differences 1 year postoperatively.
Rhinology & Sinus Surgery
Zanation AM, et al. Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope. 2010. 120:1730-1737.
This CT cross-sectional survey highlights the important anatomic limits that must be considered in pediatric sinus and skull base surgery. It is extremely important to appreciate these differences, as the use of endoscopic sinus and skull base techniques continues to increase in young children.
Tana N, et al. Surgical treatment of subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg, 2008. 134:(7):764-767.
An excellent comparison of the different approaches in the surgical treatment of subperisoteal abscess. The study highlights the endoscopic approach, now widely considered the first line of surgical treatment.
Thottam PJ, et al. Functional endoscopic sinus surgery (FESS) alone versus balloon catheter sinuplasty (BCS) and ethmoidectomy: a comparative outcome analysis in pediatric chronic rhinosinusitis. Int J Ped Otorhinolaryngology, 2012. 76:1355-1360.
This recent study of balloon catheter sinuplasty (BCS) improves upon past papers, by directly comparing FESS to the increasingly popular technique of BCS. In children, adequate data for BCS has been lacking.
Bonne NX, et al. Endonasal endoscopic approach for removal of intranasal glial heterotopias. Rhinology, 2012. 50(2):211-217.
This recent review highlights the techniques necessary for endoscopic resection of congenital nasal glioma and encephaloceles. Management of the potential complications is also addressed.
Newman JR, et al. Operative management of choanal atresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg, 2013. 139(1):71-75.
A recent and excellent report on the management of choanal atresia over a 15 year period at the University of Alabama at Birmingham. The review addresses various approaches as well as the issues of mitomycin-C use and the recent controversy in regards to the use of stents vs. no-stenting.
Facial Plastic Surgery
Brent B. Technical advances in ear reconstruction with autologous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstru Surg. 1999 104(2):319-334.
A classic review and description on the use of autologous rib cartilage in external ear reconstruction for microtia, that every resident should read and be familiar with.
Thorne CH et al. Auricular Reconstruction: indications for the autogenous and prosthetic techniques. Plast Reconstru Surg, 2001 107(5):1241-1252
This article addresses the indications for both autogenous and prosthetics in the reconstruction of the external ear in children.
Gosain AK et al. Prominent ears in children younger than 4 years of age: what is appropriate timing for otoplasty. Plast Reconstu Surg, 2004 114(5):1042-54
This paper discusses surgery for otoplasty, including the classic Mustarde technique and the appropriate timing of surgery in younger children.
McCarthy JG et al. Hemangiomas of the nasal tip. Plast Reconstr Surg 2002 10931-40.
An excellent review of a very challenging dilemma in pediatric facial plastic surgery – i.e. watchful waiting vs. medical treatment, vs. surgical intervention.
Monasterio FO et al. Distraction osteogenesis in Pierre Robin Sequence and related respiratory problems in children. J Craniofac Surg 2002 13:79-83.
An important description of distraction for micrognathia, complicated by respiratory distress and feeding difficulties. This paper will help residents to understand the decision making process involved in choosing distraction osteogenesis vs. conservative management vs. tracheotomy when necessary.
Cunningham MJ, Lin AC. Pediatric otolaryngology: The maturation of a pediatric surgical subspecialty. Laryngoscope. 2011 Jan;121(1):194-201.
A wonderful review of the history of pediatric otolaryngology.
Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG, North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009 Oct;49(4):498-547.
This is a comprehensive guideline discussing all aspects of GERD.
Furuta, GT, Liacouras CA, Collins, MH, et al, Eosinophilic esophagitis in children and adults: A systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 133:1342-1363; 2007.
Otteson TD, Mantle BA, Casselbrant ML, Goyal A. The otolaryngologic manifestations in children with eosinophilic esophagitis. Int J Pediatr Otorhinolaryngol. 2012 Jan;76(1):116-9. doi: 10.1016/j.ijporl.2011
These 2 articles on eosinophilic esophagitis provide the learner with an excellent overview of the subject.
Sharpe SJ, Rochette LM, Smith GA. Pediatric battery-related emergency department visits in the United States, 1990-2009. Pediatrics. 2012 Jun;129(6):1111-7
Interesting information on battery injuries.
Shprintzen RJ. Velo-cardio-facial syndrome: 30 Years of study. Dev Disabil Res Rev. 2008;14(1):3-10.
Bull MJ; Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011 Aug;128(2):393-406. doi: 10.1542/peds.2011-1605
Makishima T, King K, Brewer CC, et al. Otolaryngologic markers for the early diagnosis of Turner syndrome. Int J Pediatr Otorhinolaryngol. 2009; 73(11): 1564-7.