Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P291

Tonsillectomy Outcomes of High-risk
Pediatric Patients Treated at Teaching and
Nonteaching Hospitals
Cynthia Wang, MD (Presenter); Gopi Shah, MD; Erin
Wynings; Romaine F. Johnson, MD, MPH
Objectives: There is conflicting evidence whether outcomes
are affected by resident involvement or surgical volume. This
study compares outcomes between teaching and nonteaching
hospitals for high-risk children undergoing tonsillectomy.
Methods: We analyzed the 2016 Kids' Inpatient Database,
2016 Nationwide Readmissions Database, and 2016 Nation-
wide Ambulatory Surgery Sample for children (age <17 years)
undergoing tonsillectomy. We compared outcomes from
teaching and nonteaching hospitals, including length of stay,
cost, respiratory complications, bleeding, and readmission
among high-risk tonsillectomy patients (age <2 years, obese,
obstructive sleep apnea [OSA], Down syndrome, craniofacial
anomalies, mucopolysaccharidoses, sickle cell anemia, and
neuromuscular disorders).
Results: There were an estimated 370,000 tonsillectomies
(362,000 ambulatory and 8400 inpatients) in 2016. Forty-four
percent of the ambulatory cases occurred in teaching hospitals
compared with 80% of the inpatient cases. High-risk patients
represented 84% of inpatients in contrast to just 43% of ambulatory tonsillectomies. The most common high-risk category
was OSA (70% for inpatient and 35% for ambulatory cases).
For high-risk patients, the risk of postprocedural respiratory
failure among inpatients was higher at large teaching hospitals
(odds ratio, 1.93; P = .040). Ambulatory outcomes were similar between teaching and nonteaching hospitals when treating
high-risk patients.
Conclusions: Among high-risk patients undergoing tonsillectomy, the risk of acute postprocedural respiratory failure at
teaching hospitals is increased, although other outcomes were
similar. Despite the concerns, a significant percentage of highrisk patients have tonsillectomies in ambulatory settings.
Toradol and Post-tonsillectomy
Hemorrhage: Does Delayed Administration
Increase Bleeding Risk?
Malia S. Gresham (Presenter); Yisrael Wallach; Hayley Mann;
Adrienne L. Childers, MD
Objectives: The effect of nonsteroidal anti-inflammatory
drugs on rates of posttonsillectomy hemorrhage (PTH) has been
studied over the past 2 decades, especially as providers search
for narcotic alternatives in light of the opioid crisis. However,
the effect of ketorolac (Toradol) on PTH when administered in
a delayed fashion has yet to be investigated in the literature.
This retrospective chart review attempts to answer the question:
Is Toradol, when administered >24 hours after tonsillectomy,
associated with increased rate of PTH in children?
Methods: This is a retrospective chart review involving 2to 18-year-old patients at Cardinal Glennon Children's
Hospital who underwent tonsillectomy or tonsillectomy and
adenoidectomy between January 2015 and July 2019. Patients

P291
who presented to the emergency department with pain control
or dehydration issues within 2 weeks of their original surgery
were included. We identified those who received Toradol and
those who did not. We then compared incidence of subsequent
PTH between the Toradol and non-Toradol groups using chisquare statistics.
Results: We identified 329 patients who presented with pain
or dehydration within 2 weeks of surgery. The average age
was 6.8 years, and 52% of the sample were female. Fortyseven patients received Toradol, and 4 of these had subsequent
PTH. Fourteen patients who did not receive Toradol had subsequent PTH. We found no significant difference in incidence
of PTH between patients who received and did not receive
Toradol (P = .21). Of note, the overall PTH rate at our institution was found to be 3.3%.
Conclusions: There was no significant difference found in
the rate of PTH between the Toradol and non-Toradol groups.
This study is limited by its retrospective nature and small sample size. More investigation of this topic is warranted, including randomized controlled trials.
Tympanic Membrane Perforation and
Sensorineural Hearing Loss due to Lightning
Strike: A Case and Review of Literature
Kelly C. Landeen, MD (Presenter); Madelyn Stevens, MD;
James D. Phillips, MD
Objectives: Although tympanic membrane (TM) perforation
occurs in up to 50% of lightning strikes, sensorineural hearing
loss (SNHL) due to lightning is minimally reported in the
pediatric literature. We present a unique case of a patient
struck by lightning, resulting in TM perforation and mixed
conductive and SNHL as identified per audiometry.
Methods: This is a single-institution case report of an adolescent male struck by lightning. Patient examination and
audiometric data were collected at 4 days and 6 weeks following injury. Review of literature was performed to evaluate
incidence of otologic injury types following lightning strike.
Case: A 15-year-old boy became unresponsive following a
lightning strike, with spontaneous return of circulation after
1 minute of cardiopulmonary resuscitation. Examination
showed right-sided Lichtenberg markings, perforated TM,
and pulmonary contusion. He was intubated and transferred to
a tertiary care center.
Results: On extubation, he endorsed right-sided hearing loss
and tinnitus. Otoscopy showed a 50% TM perforation and
abnormal tuning fork tests. Audiometry demonstrated moderate conductive hearing loss on the right and mild mixed hearing loss rising to normal on the left. At 6 weeks, the right TM
was intact with a middle ear effusion and type B tympanogram, with mild mixed hearing loss. Left-sided otoscopy, tympanometry, and audiometry were normal.
Conclusions: This case demonstrates the importance of otologic and audiologic examination in lightning victims. We
examine lightning strike as an example of blast injury, which
has known SNHL sequelae. Importantly, this patient's SNHL

Pediatric

Poster Presentations

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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