To identify patient factors associated with improper restraint usage and worse trauma outcomes for pediatric patients involved in motor vehicle collisions (MVCs). Retrospective study performed at a Level I pediatric trauma center for patients (≤18 yr) evaluated after MVC between 2008 and 2018. The Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) levels based on the patient's home address. Trauma registry data was correlated to ADI and used to analyze appropriate restraint usage by NSD. Proper restraint practices were defined based on national guidelines and state laws. Demographics and clinical outcomes were also analyzed. Chi-square analysis with Bonferroni corrections was used to assess the association of ADI, race, and ethnicity with proper restraint usage. Among 1152 patients included, approximately 50% were male, the median age was 7 years [IQR 4-10], and 53% were of Hispanic ethnicity. Hispanic patients comprised 73% of children in ADI quintile 5 (greatest NSD), yet only 26% of children in ADI quintile 1 (least NSD). No differences were observed across clinical data and outcomes. Hispanic children <8 yr were significantly less likely to be in a car seat/booster seat compared to non-Hispanic children (OR 0.69, 95% CI 0.50-0.95, p = 0.025). Furthermore, those with greatest NSD (ADI quintile 5) had the largest proportion of unrestrained patients (21%, see Fig. 1). Hispanic children, especially those who require infant or booster seats (<8 yr), and children living in areas with greater neighborhood socioeconomic disadvantage demonstrated poorer restraint practices. ADI can successfully identify high-risk groups for targeted injury prevention programs and improved compliance in the most vulnerable neighborhoods. Retrospective Study.

We explored the application of a machine learning algorithm for the timely detection of potential abusive head trauma (AHT) using the first free-text note of an encounter and demographic information. First free-text physician notes and demographic information were collected for children under 5 years of age at a Level 1 Trauma Center. The control group, which included patients with head/neck injury, was compared to those with AHT diagnosed by the Child Protective Team. Differential scores accounted for words overrepresented in AHT patient vs. control notes. Sentiment scores were reflective of note positivity/negativity and subjectivity scores accounted for note subjectivity/objectivity. The composite scores reflected the patient's differential score modified by the subjectivity score. Composite, sentiment, and subjectivity scores combined with demographic information trained a Random Forest (RF) machine learning algorithm to predict AHT. Final composite scores with demographic information were highly associated with AHT in a test dataset. The control group included 587 patients and the test group included 193 patients. Combining composite scores with demographic information into the RF model improved AHT classification area under the curve (AUC) from 0.68 to 0.78, with an overall accuracy of 84%. Feature importance analysis of our RF model revealed that composite score, sentiment, age, and subjectivity were the most impactful predictors of AHT. The sentiment was not significantly different between control and AHT notes (p = 0.87), while subjectivity trended higher for AHT notes (p = 0.081). We conclude that a machine learning algorithm can recognize patterns within free-text notes and demographic information that aid in AHT detection in children. III.

Background: Since the height of the COVID-19 pandemic, there have been an increasing number of reports of incidence of otologic conditions after infection. We aim to investigate whether a history of otologic conditions was associated with elevated risk of similar or exacerbated symptoms after COVID-19 infection. Methods: Surveys were administered to patients 18 years or older who had tested positive via PCR testing for COVID-19 infection between January 2020 and September 2022. Incidence of otologic symptoms within the 10-day period after COVID-19 infection was compared between participants with a preexisting otologic condition and control participants. Results: Of 1,499 patients who tested positive for COVID-19, 63.2% were female, 87.5% were White, and the mean age was 58 years. Of these, 721 (48%) reported a preexisting otologic condition, with loss of hearing (25.5%) and history of dizziness (18.8%) being most highly represented among this subcohort. Of patients with a preexisting condition, 35.5% subjectively reported that they believed COVID-19 infection had worsened otologic symptoms of their condition. Univariable analysis revealed that individuals were more likely to report dizziness post–COVID-19 infection if they had a preexisting history of dizziness (29.1% versus 17.8%, p < 0.001) or preexisting history of vestibular neuritis (58.8% versus 19.5%, p < 0.001) than those who did not. Similarly, individuals with a history of vestibular migraine were more likely to report migraine symptoms after infection than those who did not (27.9% versus 7.2%, p < 0.001). Multivariable analysis revealed that preexisting history of dizziness, vestibular neuritis, vestibular migraine, and autoimmune conditions increased the odds of several otologic symptoms, although an exception was observed with decreased odds for changes in hearing in patients with preexisting history of dizziness. Younger age and female gender were associated with higher odds for various otologic symptoms after COVID-19 infection. Conclusions: These findings indicate that certain preexisting otologic conditions may be associated with a greater likelihood of exacerbation after COVID-19 infection and may help guide screening protocols for those at greatest risk. Level of Evidence: III. IRB: UCSD IRB #801971.

Background Many patients with neurofibromatosis type 2 (NF2) suffer from sensorineural hearing loss, and associated cochlear nerve compromise in NF2 patients makes auditory brainstem implant (ABI) an attractive treatment option. The long-term outcomes and benefits of the device are still being explored. Methods A retrospective review was conducted for 11 ABI recipients at a single-institution tertiary center between November 2017 and August 2022. Patients diagnosed with NF2 undergoing resection for concurrent vestibular schwannoma (VS) were included. Pre- and postaudiometric assessments were reviewed. Evaluation included pure-tone audiometry and speech testing. Results Our cohort included 11 patients with a median age of 34 years. All patients underwent a translabyrinthine approach for implant placement with concurrent VS resection. Average tumor size of VS was 2.87 cm. Preoperatively, 8 patients had pure-tone averages with no response at 110 dB, 2 were within mild–moderate hearing loss (25–45 dB), and one patient had a PTA of profound loss (92 dB). Postoperatively, 9 (81%) patients had improvement in PTA. In total, seven patients reported mild side effects upon ABI activation which included dizziness (n = 2), tinnitus (n = 1), and abdominal and lower extremity tingling sensation (n = 3). Of the seven patients with early speech perception (ESP) scores, five had a score >75%, indicating the auditory ability to detect pattern perception upon auditory stimulation through the ABI alone. Conclusion Nine of 11 patients derived benefits from ABI placement. These findings demonstrate that ABI placement during concurrent VS resection can provide a significant hearing benefit for NF2 patients.

One of the most common reasons a patient would see an otolaryngologist is for nasal obstruction. This article provides an overview of the physical principles related to nasal airflow as well as the critical role that the internal nasal valve plays in regulating airflow resistance. Common treatment options for internal nasal valve obstruction are discussed as well as an in-depth tutorial on an alternate lateral nasal suspension suture technique for internal nasal valve collapse.