Pediatric Otolaryngology

Pediatric otolaryngology research at Mayo Clinic is focused on four major areas:

Velopharyngeal insufficiency

Velopharyngeal insufficiency, the inadequate closing of the velopharyngeal sphincter often due to a congenital abnormality, can result in problems such as hypernasal speech or regurgitation of fluids through the nose when swallowing. Treatment options for velopharyngeal insufficiency include various surgical techniques or the use of injectable filler.

Basic science research at Mayo in this area includes studying the efficacy of augmenting the nasopharynx with rolled acellular dermis. Prospective clinical studies are comparing outcomes, such as voice and perceptual analysis, between people who have undergone surgery and those receiving injectable filler.

Ear disease and otitis media

Mayo is involved in the Parent Response to Ear Disease in Children With and Without Tubes (PREDICT) Study, a multi-institutional study investigating the impact that ear disease — in children ages 6 months to two years — has on the child and his or her family's quality of life.

Additionally, otolaryngology researchers have developed a questionnaire that gathers data about all children seen at Mayo who have recurrent acute or chronic serous otitis media. This data is being used to populate a database, which will be used for many future research projects.

Tonsil and adenoid disease

An adenoidectomy database is used to track characteristics and outcomes of children who have undergone adenoidectomy — surgical removal of the adenoids — at Mayo. Data from approximately 8,400 children are now in the database, which is currently being used to investigate factors that may influence the need for revision adenoidectomy.

Other tonsil- and adenoid-related studies are utilizing the Rochester Epidemiology Project (REP), a unique medical records-linkage system containing health data from residents of Olmsted County, Minn., the site of Mayo Clinic's Rochester campus.

One past study using the REP has examined trends in adenotonsillectomy¹ — surgical removal of both the tonsils and adenoids — while another has looked at the efficacy of adenotonsillectomy for recurrent strep infection.²

Aerodigestive tract disorders

Proper neurological and anatomic development of the upper aerodigestive tract is essential for normal feeding and breathing. Ongoing Mayo research into disorders of the upper aerodigestive tract includes:

• Studying breathing and swallowing symptoms in laryngomalacia, which includes maintaining a prospective database^3,4
• Evaluation of clinical outcomes of epiglottopexy for the treatment of pharyngomalacia and supraglottic collapse
• Investigating upper airway manifestations (such as hoarseness, cough, stridor, subglottic stenosis and dysphagia) of gastroesophageal reflux disease (GERD)
• Using a prospective database to identify factors (such as asthma, allergy, subglottic stenosis, eosinophilic esophagitis and GERD) that influence recurrent croup
• Studying upper airway and swallowing problems related to eosinophilic esophagitis^5,6,7, which includes maintaining the largest ongoing database of children with upper airway disease (such as sinusitis, croup, cough, hoarseness, stridor and dysphagia) related to or caused by eosinophilic esophagitis
• In collaboration with Neurosurgery and Pediatric Neurology, prospectively looking at berating airway symptoms, swallowing symptoms and surgical decompression of Chiari malformation in the improvement of upper airway and swallowing symptoms
• Evaluation of clinical outcomes of endoscopic airway reconstruction procedures compared with open airway surgery

References

1. Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg. 2009 Jun;140(6):894-901. PMID: 19467411
2. Orvidas LJ, St Sauver JL, Weaver AL. Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis. Laryngoscope. 2006 Nov;116(11):1946-50. PMID: 17075399
3. 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. PMID: 17513991
4. Thompson DM. Laryngomalacia: Factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010 Dec;18(6):564-70. PMID: 20962644
5. Dauer EH, Ponikau JU, Smyrk TC, Murray JA, Thompson DM. Airway manifestations of pediatric eosinophilic esophagitis: A clinical and histopathologic report of an emerging association. Ann Otol Rhinol Laryngol. 2006 Jul;115(7):507-17. PMID: 16900805
6. Dauer EH, Freese DK, El-Youssef M, Thompson DM. Clinical characteristics of eosinophilic esophagitis in children. Ann Otol Rhinol Laryngol. 2005 Nov;114(11):827-33. PMID: 16358601
7. Thompson DM, Orvidas LJ. Otorhinolaryngologic manifestations of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008 Jan;18(1):91-8; ix. PMID: 18061104