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Upper Airway

Topic: Risk Factors Associated with Post Tonsillectomy Hemorrhage

Principal Investigator: Dr. Eelam Adil

Summary: Tonsillectomy is one of the most common surgical procedures performed in children with obstructive sleep disordered breathing and/or recurrent tonsillitis. One potential complication of this procedure is post tonsillectomy hemorrhage. Post-operative hemorrhage can result in hospital readmission and operating room returns. Prior studies have identified clinical risk factors associated with increased bleeding risk, including demographic variables (male versus female), age of patient, medical history, surgical technique, indication of surgery, details of surgery, and pre- and post-operative medications. However, many of these studies are limited by their sample size and varying parameters of post tonsillectomy hemorrhage. Based on risk factors identified in the literature, we are querying the Pediatric Health Information System (PHIS) to analyze post-operative tonsil hemorrhage in a pediatric population.

Lower Airway

Topic: Quality of Life Before and After Laryngeal Cleft Repair

Principal Investigator: Dr. Reza Rahbar

Summary: Laryngeal clefts can cause myriad issues for patients and family, beyond medical and surgical comorbidities. Thickened diets can place added financial and social stress on the family. Concern for the child’s breathing and eating can add emotional stress, as well. The aim of our study is to better delineate how overall quality of life is affected for patients with laryngeal cleft and their families. Establishing and validating a quality of life instrument for laryngeal cleft patients are critical to provide an objective measurement that will reflect the impact of laryngeal cleft, and of treatment thereof, on patient and family quality of life.


Topic: Neurological Evaluation of Laryngeal Cleft Patients

Principal Investigator: Dr. Reza Rahbar

Summary: Laryngeal cleft is a rare clinical finding that allows food and liquids to pass from the esophageal lumen to the airway, causing aspiration. If left undiagnosed or untreated, the patient may develop severe pulmonary sequelae, including respiratory infections and lung atelectasis. With the appropriate management strategy, aspiration is often either completely resolved or significantly improved. However, recent studies have shown that, some patients continue to suffer from aspiration and swallowing difficulties despite having undergone successful surgical repair of the cleft. This suggests that laryngeal incompetence and aspiration in these patients is multifactorial, with one of the best predictors of postoperative outcomes being the presence of neurological comorbidities. It is therefore important to ask how clinicians might suspect whether a laryngeal cleft patient requires a neurological consultation to rule out contributing nervous system disorders. In this study, we perform a retrospective review of pediatric patients with laryngeal cleft, with a focus on those referred to a neurologist to learn more about the etiology of their aspiration. The purpose of our investigation is to provide guidelines that indicate when laryngeal cleft patients should be referred for a neurological evaluation and to differentiate between anatomical and neuromuscular etiologies.



Topic: Cost Analysis of Laryngeal Cleft Repair

Principal Investigator: Dr. Reza Rahbar

Summary: In recent years, laryngeal cleft repair has become a more streamlined and safe procedure thanks to advancements in surgical medicine and the development of endoscopic surgery to treat this condition. Historically, laryngeal clefts were repaired through open surgery, but now most surgeons tend to prefer the less invasive endoscopic approach. In this investigation, we hope to study the utility of endoscopic laryngeal cleft repair from a financial perspective. We will do this by reviewing patients that have undergone endoscopic laryngeal cleft repair at Boston Children’s Hospital within the last 15 years. We want to collect information regarding their surgery including the length of hospitalization, length of the operation, hospital billings, and anesthesia and ICU costs. Our belief is that the results will depict a significant decrease in costs related to this surgery over the last 15 years. In addition, we are interested in studying how the current costs associated with endoscopic laryngeal cleft repair differ from the historical costs of open repair at Boston Children’s Hospital.