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Practice Focus » TRIO Best Practices » Pediatric

Is Prophylactic Peri-Operative Antibiotic Indicated in Cochlear Implantation?

May 4, 2026

The risk of complications after CI surgery is low, but severity may impact antibiotic prescribing patterns, despite limited evidence. Studies indicate that a single intra-operative dose of antibiotics can prevent post-operative infections in both children and adults, though they have limitations such as retrospective designs and differing surgical practices. Until more randomized controlled trials are conducted, antibiotic use will likely depend on individual provider choice, especially for children who have higher rates of otitis media. Future research should focus on controlled trials at single centers to better understand the role of prophylactic antibiotics in CI surgery.

Management of Pediatric Tracheocutaneous Fistulae

May 6, 2025

Tracheocutaneous fistulae (TCF) involve a remnant skin tract that connects the external cervical skin with the anterior trachea following decannulation of a tracheostomy tube (TT). Due to the young age at insertion, length of TT dependence, and propensity for removal with aging, persistent pediatric TCF (PPTCF) are more frequent than in adults. Methods of management are varied, and ideal approaches to management are debated.

When Should We Recommend Intracapsular Tonsillectomy in Pediatric Patients? 

August 6, 2024

Intracapsular tonsillectomy is a safe and effective method for performing tonsillectomy and should be included in future clinical practice guidelines for tonsillectomy. 

Laryngeal Reinnervation Is Recommended Surgical Intervention for Pediatric Unilateral Vocal Fold Paralysis

January 5, 2024

Laryngeal reinnervation should be offered to all patients independent of patient age or duration of denervation, as it can improve voice and swallowing. Long-term denervation, however, may result in a smaller degree of improvement.

Is There a Role for Adjuvant Therapy in Patients with Large Juvenile Nasopharyngeal Angiofibromas?

October 27, 2023

Adjuvant therapy may have a limited role in select patients with advanced JNAs to achieve acceptable outcomes while minimizing serious morbidity and mortality.

Repair of Type 1 Laryngeal Cleft

October 3, 2023

There is significant debate in the literature on diagnosis and the ideal approach to treatment when sequelae are present with congenetial laryngal cleft.

Videofluoroscopic Swallow Study and Fiberoptic Endoscopic Evaluation of Swallow—Which Is Superior?

August 17, 2023

Accurate assessment of the safety of oral feeds is essential in the pediatric population to avoid the risks of unsafe feeding or unnecessary restrictions.

When is the Optimal Time to Reduce Pediatric Nasal Bone Fractures?

August 17, 2023

Historically, nasal fractures have been reduced within seven days as pediatric patients are thought to undergo rapid osseous healing. Delayed nasal fracture reduction, however, allows soft tissue edema to abate, potentially aiding intraoperative result assessment.

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Genetic Testing Is Appropriate for Some Pediatric Patients with Unilateral Hearing Loss or Single-Sided Deafness

July 19, 2023

Genetic testing should be considered when the most common nongenetic causes (congenital cytomegalovirus, negative imaging for structural inner ear, or cochlear nerve abnormality) are ruled out as subtle phenotypic manifestations of syndromic hearing loss.

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Is the Best Modality to Assess Vocal Fold Mobility in Children Flexible Fiberoptic Laryngoscopy or Ultrasound?

March 15, 2023

The gold standard in the evaluation of VFI in children is awake flexible fiberoptic laryngoscopy (FFL) but over the past decade, ultrasound (US) has gained increasing attention as a modality for assessing vocal fold mobility in children.

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