No abstract

Atoh1 is a transcription factor that regulates neural development in multiple tissues and is conserved among species. Prior mouse models of Atoh1, though effective and important in the evolution of our understanding of the gene, have been limited by perinatal lethality. Here we describe a novel point mutation of Atoh1 (designated Atoh1trhl) underlying a phenotype of trembling gait and hearing loss. Histology revealed inner ear hair cell loss and cerebellar atrophy. Auditory Brainstem Response (ABR) and Distortion Product Otoacoustic Emission (DPOAE) showed functional abnormalities in the ear. Normal lifespan and fecundity of Atoh1trhlmice provide a complementary model to facilitate elucidation of ATOH1 function in hearing,central nervous system and cancer biology.

The objective was to determine the incidence of exposure of the lingual branch of the glossopharyngeal nerve during tonsillectomy with a retrospective review of surgical findings in 138 children who underwent total tonsillectomy at a tertiary medical center. Age, sex, surgical indication, tonsil size, congenital abnormalities, operative time, and surgical findings indicating the presence or absence of the glossopharyngeal nerve in the tonsillar fossa were recorded. Statistical analysis was performed with z test, t test, and Fisher's exact test. Thirty-seven nerves were observed in 28 patients, with preponderance for the left fossa (24 of 37 vs 13 of 37; P = .01). In a comparison of children with and without exposed nerves, there was no statistically significant difference in mean age (6.89 vs 7.08; P = .84), proportion of males (14 of 28 vs 54 of 110; P = 1), or proportion of 3 to 4+ tonsils (20 of 28 vs 73 of 110; P = .66). In approximately 20% of children undergoing tonsillectomy, the lateral pharyngeal musculature incompletely protected the lingual branch of the glossopharyngeal nerve from the tonsil capsule.

A management protocol was developed based on the findings of this study: (I) obtain two preoperative localization studies, one of which is surgeon-performed ultrasound; (II) obtain preoperative vitamin D levels and supplement as indicated; and (III) in select patients who have two strongly corroborating preoperative localization studies, one of which is surgeon performed ultrasound, and intraoperative findings are consistent with the localizing studies, intraoperative PTH (IOPTH) may not be necessary.

Introduction: Post-operative pain control in pediatric patients is often difficult to assess. Children often cannot verbalize their level of pain control. Pain control is often accomplished with various combinations of Tylenol, Ibuprofen, and Narcotics. Narcotic medications are commonly prescribed but have a variety of complications. We propose that treating pediatric patients with Tylenol and Motrin combination is a safe and effective way to control pain in most pediatric otolaryngology procedures. Methods and Materials:Study approval was obtained from the IRB 194. patients, between the ages of 6 months and -17 years, were evaluated. Some of the procedures that were performed were adenotonsillectomy, tympanostomy tubes, tympanoplasty, sinus surgery, congenital neck masses, and thyroidectomy. Patients were all started on Tylenol and Motrin following surgery. No narcotics were prescribed unless families called stating that pain control was inadequate. Parents filled out a validated survey at their first post-operative visit to assess pain control.Results: 140/194 patients had post-operative pain that was adequately controlled by alternating Tylenol and Motrin. 27/137 required no pain medicine at all once arriving home. Nine patients requested additional pain control these include 6 adenotonsillectomies, 2 balloon dilation, and 1 PET/Adenoidectomy. Conclusion:Alternating Tylenol and Motrin provides adequate pain control for commonly performed surgeries in the pediatric population. It is safe to wait and prescribe narcotic medications at a later point if pain control is not adequate. By decreasing reliance on narcotic medication we can reduce rates of complications associated with narcotic use.