When considering tracheotomy in VLBW infants, the total number of intubation events should be monitored as well as the total duration of intubation. The relatively high incidence of laryngotracheal stenosis argues for earlier endoscopy and possibly earlier tracheotomy in infants with developing stenoses.

Objective: The COVID-19 pandemic has introduced a period of social isolation that has challenged the ability of providers to uphold in-person patient care. Although commonplace in pediatric otolaryngology, multidisciplinary clinics pose a unique challenge during this time due to increased infection risk from multiple patient-provider interactions. Guidance on the application of telemedicine for multidisciplinary clinics in pediatric otolaryngology is limited. Methods: We provide comprehensive guidance on best practices for conducting telemedicine visits for a number of multidisciplinary otolaryngology clinics using our experiences at a single tertiary care children’s hospital. A review of literature to support the adoption of telemedicine in multidisciplinary pediatric otolaryngology is also incorporated. Results: Telemedicine was successfully adopted for 7 multidisciplinary pediatric clinics with a variety of specialists: aerodigestive disorders, congenital hearing loss, microtia/aural atresia, orofacial clefting, sleep disorders, tracheostomy care, and velopharyngeal dysfunction. Conclusions: Telemedicine is feasible for a variety of multidisciplinary clinics and its optimization is critical for providing care to complex pediatric otolaryngology patients during the COVID-19 pandemic and beyond.

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AIM Association of language impairment with neonatal brachial plexus palsy (NBPP) has not been reported in the literature. The current treatment paradigm for NBPP focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with NBPP and potential NBPP-related factors involved. METHOD Twenty toddlers with NBPP were consecutively recruited (12 males, 8 females; mean age 30 mos). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. NBPP-related factors such as palsy side, treatment type, Narakas grade, muscle MRC score, and Raimondi hand score were reported. Student t test, chi-square, or Fisher exact test were applied. Statistical significance level was established at p<0.05. RESULTS Of study participants, 30% were diagnosed with language delay, while the prevalence of language delay in the population with normal development in this age range was approximately 5-15%. INTERPRETATION We observed high language delay prevalence among toddlers with NBPP. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population.

Recently, some attention has been focused on acquired stuttering, disfluencies that begin in adulthood. The nature of acquired stuttering differs in several respects from developmental stuttering. A case of acquired stuttering following drug overdose is presented and contrasted with previously reported cases. The case is noteworthy in that, while many characteristics of acquired stuttering are evidenced, several symptoms associated with developmental stuttering are also observed. The findings are discussed in terms of a possible link between developmental and acquired forms of stuttering.

The initial delay in speech acquisition observed following decannulation, along with the presence of a postsurgical canonical stage in all study subjects, supports the hypothesis that babbling is necessary for speech and language development. Furthermore, the presence of babbling is universally evident regardless of the age at which speech develops. Finally, there is no demonstrable correlation between preoperative sign language and rate of speech development.

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