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P118 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010

Predictors of Surgery in Pediatric Orbital Cellulitis cultured with PA for four days and treated with gentamicin to
Aditya Mahalingam-Dhingra (presenter); Rahul kill planktonic PA. Biofilm formation was assessed with bac-
Shah, MD, FAAP; Diego Preciado, MD, PhD; terial counts.
Jonathan Taylormoore, MD; Lina Lander, ScD RESULTS: TTs treated with ciprofloxacin three mg/ml had
lower HI counts than TTs treated with ten mcg/ml (p 0.001),
OBJECTIVE: To identify predictors of surgery in pediatric but viable HI persisted. PA biofilm formation on TTs with
orbital cellulitis.
prior HI biofilm and treated with ciprofloxacin ten mcg/ml or
METHOD: Analysis of the Kids Inpatient Database 2006 for gas sterilization was not different than TTs without HI. Less
patients admitted with a diagnosis of orbital cellulitis; univar- PA biofilm formed on TTs with HI treated with three mg/mL
iate and multivariate analysis was performed. ciprofloxacin (p 0.002).
RESULTS: Of 5440 admissions, 672 (12%) underwent sur- CONCLUSION: HI biofilm does not promote PA biofilm
gical intervention. Patients that had surgery were older with a
formation on TTs. Use of high dose ciprofloxacin to clear HI
mean age of 10.15 years (SE 0.29), compared to 6.07 years (SE
infection may reduce subsequent PA biofilm formation. The
0.10) for non-surgical patients (p0.001). Mean length of stay
clinical significance of this finding warrants examination.
(LOS) for all sampled patients was 3.8 days, and 90.4% were
routinely discharged. For surgical patients, cost of care (mean
$41,009) and LOS (mean 7.11 days) were higher compared to QOL and Voice Outcome after Laryngotracheal
non-surgical patients (mean cost $16,401; mean LOS 3.39 Reconstruction
days). Mean age and LOS differed significantly between the Neil Chadha, MBChB, MPH, FRCS (presenter);
surgical and non-surgical groups (p0.001). Predictors of sur- Jennifer Allegro, MSc; Vito Forte, MD; Paolo
gery include male gender, admission source, type of admis- Campisi, MD
sion, and hospital location. With the exception of gender, these
variables remained significant in a multivariate model. Clinical OBJECTIVE: 1) To asses long-term impact of thyroid alar
predictors of surgical intervention include diplopia, ethmoidal cartilage laryngotracheal reconstruction (LTR) on health-re-
sinusitis (odds ratio 4.8) or maxillary sinusitis (odds ratio 3.7).
lated quality of life (QOL) in infants using three validated
CONCLUSION: This study is the first to report on the na- instruments: Health Utility Version 3 (HUI3), Pediatric Voice-
tional resource utilization in the surgical and medical treatment Related Quality of Life Instrument (PVRQOL), and Impact on
of pediatric orbital cellulitis. Predictors of surgical intervention Family questionnaire; 2) To perform acoustic and perceptual
include older age, presentation with diplopia, involvement of
voice assessments to evaluate long-term voice quality out-
ethmoid and maxillary sinuses, and admissions via the emer-
gency department. These results can enable critical analysis of
resource utilization for pediatric orbital cellulitis and can be METHOD: Eligible children had all undergone an anterior
used to optimally triage patients, reducing costs and lengths of thyroid alar cartilage graft LTR before the age of 24 months,
stay. between 1995 and 2007. Recruitment occurred over a 6-month
period using validated QOL instruments and acoustic and per-
ceptual voice analyses.
Pseudomonas Biofilm Formation after RESULTS: Thirteen patients (eight male, five female, median
Haemophilus Infection 10 years) were enrolled. The mean age at LTR was five months
Carolyn Ojano-Dirain, PhD (presenter); Gregory
(range 0-20) and the mean study follow-up period was 9 years
Schultz, PhD; Patrick Antonelli, MD
(range 2-14). The average speech HUI3, PVRQOL and Impact
on Family scores were 0.84 (SD-0.31), 0.83 (SD-0.22) and
OBJECTIVE: Tympanostomy tube (TT) biofilm formation
may lead to refractory otorrhea and occlusion. Biofilms are 0.67 (SD-0.28), respectively. The acoustic scores were either
typically composed of multiple microbial species. The pres- within the normal range or mildly abnormal for the variables:
ence of one species may promote or inhibit biofilm formation jitter, shimmer, noise-to-harmonic ratio, peak amplitude vari-
by other species. The aim of this study was to determine if ation and fundamental frequency variation. The CAPE-V over-
Haemophilus influenzae (HI) biofilm promotes the develop- all severity perceptual score was in the mildly abnormal range
ment of Pseudomonas aeruginosa (PA) biofilm on TTs. for 8 of 10 patients.
METHOD: Fluoroplastic TTs were exposed to plasma, al- CONCLUSION: This is the first study to explore and quantify
lowed to dry, then cultured with HI for seven days. TTs were long-term QOL and voice function in children following LTR
either gas-sterilized or treated for 24h with ten mcg/ml or three with thyroid alar graft at a very young age. The vast majority
mg/ml of ciprofloxacin. Half of the TTs from each treatment of patients had a very good functional voice outcome as evi-
group underwent bacterial counts or scanning electron micros- denced by the HUI3 and PVRQOL scores. This was corrob-
copy. The remainder, as well as TTs not exposed to HI, were orated by acoustic and perceptual voice assessments.

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