Digital oral photography for pediatric tonsillar hypertrophy grading

Background

Tonsillar hypertrophy contributes to pediatric disorders, including obstructive sleep apnea. The goal was to determine the utility of digital photographs for pediatric tonsillar grading.

Methods

Using Brodsky's grading scale, 41 children (3.0-14.6 years) had in-person tonsil grading during a routine pediatric ENT physical examination. Oral photographs were obtained with a standard single-lens reflex digital camera and graded by the same ENT physician and by an independent Pediatrician.

Results

In-person and photograph gradings were highly correlated, but also differed significantly. Yet photograph gradings did not differ between physicians, suggesting that photographs provide unique, consistent information to different clinicians. Discrepancies between in-person and photograph gradings were not explained by child age.

Conclusion

Static images may provide experts more time for mental calculations and may therefore provide a superior estimation of tonsil size. Photographs should be considered for remote use, as well as a potentially better alternative to current in vivo estimates.     

Appropriate hearing screening in the pediatric patient with head trauma

Purpose

To develop an algorithm for the appropriate audiologic screening of in children with head trauma.

Methods

Participants were the first consecutive 50 children admitted to a children's hospital trauma service after October 1, 2005, whose injuries resulted in a Glasgow Coma Scale (GCS) score ≤13 and/or loss of consciousness (LOC) but no history of hearing loss. Screening tympanometry, otoacoustic emissions testing, and/or routine audiometric evaluation were performed as soon as possible after admission. Age, GCS score, Pediatric Trauma Score, Injury Severity Score, presence of head and neck soft tissue injury, temporal bone fracture, skull fracture not involving the temporal bone, midface/mandible fractures, intracranial abnormality on computed tomography, and cervical fracture were analyzed as risk factors for hearing loss.

Results

Seventeen (34%) of the 50 children had abnormal hearing test results. Fischer's exact test showed abnormal test results were most strongly related to temporal bone fracture (p = 0.0041), non-temporal bone skull fracture (p = 0.0211) and younger age (p = 0.0638).

Conclusions

Any child with head trauma and clinical or radiologic evidence of temporal bone fracture should have early hearing evaluation. Using the proposed algorithm to test children with head trauma and GCS ≤13 and/or LOC and age <3 years or any type of skull fracture may help identify children with hearing loss in a more cost effective manner.     

The otolaryngologic manifestations in children with eosinophilic esophagitis

Objectives

(1) To describe the incidence of eosinophilic esophagitis (EoE) in the population of patients undergoing esophagoscopy with biopsy by a pediatric otolaryngology service. (2) To elucidate the demographics, presenting symptoms, and endoscopic findings in children with EoE.

Design

Case series.

Patients/methods

The reports of esophageal biopsy specimens taken over 5 years in 2429 patients were reviewed. Ninety-two patients who received their initial diagnosis of EoE by the pediatric otolaryngology service with specimens showing 15 or greater eosinophils per high power field (HPF) were included.

Interventions

The demographic data, history, presenting symptoms, and endoscopic findings were reviewed retrospectively for the patients.

Main outcome measure

The percentage of children diagnosed with EoE of all children undergoing esophageal biopsy.

Results

A total of 92 children were diagnosed with EoE (3.8% of total children biopsied). The mean age at biopsy was 4.4 years, much lower than previously reported in the literature (approximately 8 years); 73% were boys and 27% girls. The main presenting symptom was cough (46%) followed by hoarseness, throat clearing, burping/vomiting, and abdominal pain. Forty three percent had a history of asthma and 17% a history of GERD. Half of patients had esophageal edema, a third were normal, and only a quarter had mucosal furrowing on endoscopic examination.

Conclusions

EoE is increasingly diagnosed as a clinical entity with a distinct symptom profile and etiology. Increased understanding of EoE and its predisposing factors requires a multidisciplinary approach to diagnosis and management involving the pediatric otolaryngologist.     

Pediatric otogenic lateral sinus thrombosis recanalization

Objective

To describe the recovery outcomes in pediatric patients with otogenic lateral sinus and internal jugular vein thrombosis.

Methods

An inpatient database from a tertiary care pediatric hospital was queried from 1999 to 2010 for the diagnosis code [325] thrombosis of intracranial venous sinus. Demographics, extent of thrombosis, surgical intervention, use of anticoagulation, and the presence of recanalization on follow-up imaging was collected.

Results

Fifteen patients (10 male, 5 female) were identified with otogenic lateral sinus thrombosis. Eleven patients (73.3%) had evidence of thrombus in the transverse sinus, while 10 patients (66.7%) had thrombus in the internal jugular vein, and one patient (6.7%) had thrombus in the cavernous sinus. Five patients (33%) had otitic hydrocephalus. Twelve patients (80%) underwent operative manipulation of the lateral sinus including: three decompressions 20%, three needle aspirations 20%, and six venotomies with evacuation of clot or pus 40%. Twelve patients were anticoagulated with low molecular weight heparin, and three patients were not anticoagulated. Ten of fourteen patients (71.4%) who underwent follow-up magnetic resonance venography had evidence of partial (57.1%) or complete (14.3%) recanalization of the lateral sinus. All five patients with otitic hydrocephalus recovered as determined by a normal fundoscopic exam and recovery of abducens paresis.

Conclusion

Recanalization of the lateral intracranial venous sinus occurred in the majority of the patients in this series. The role of operative intervention and/or anticoagulation remains unclear.     

Mandibular osteomyelitis in children mimicking juvenile recurrent parotitis

Objective

To describe pediatric cases with mandibular osteomyelitis initially diagnosed and treated as juvenile recurrent parotitis.

Methods

We reviewed the patient data of all our pediatric patients treated at Helsinki University Central Hospital, a tertiary care hospital, between 1998 and 2010 who had the initial diagnosis of recurrent parotitis which in fact was osteomyelitis.

Results

Over a period of 12 years, six children (aged 5-17 years, five girls) presented with mandibular osteomyelitis primarily diagnosed as recurrent parotitis. Diagnostic delay ranged from 1.5 months to 6.0 years before the final diagnosis of mandibular osteomyelitis confirmed in MRI. Of the six cases undergoing biopsies, bacterial culture showed Actinomyces or Streptococcus viridans in four cases. All patients received antimicrobial treatment. Two received hyperbaric oxygen therapy with no resolution of symptoms. Debridement was performed in these two cases as well, and in the second case persistent symptoms led to bisphosphonate treatment.

Conclusions

Juvenile parotitis is in most cases a clinical diagnosis, and treatment is symptomatic. In contrast, mandibular osteomyelitis is a severe disease requiring lengthy treatment. Because symptoms of these two entities may mimic each other, unclear cases require MRI.     

Trends in blunt laryngotracheal trauma in children

Objective

To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.

Design

Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.

Setting

Tertiary medical center.

Patients

Thirty-five patients were identified with major laryngotracheal trauma.

Main outcome measures

Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.

Results

Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.

Conclusions

In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.     

Vitamin D levels in children undergoing adenotonsillectomies

Objective

Because of the recent data supporting an immunoregulatory role for vitamin D, we evaluated levels of vitamin D in children undergoing adenotonsillectomies (T&A) and controls.

Methods

We prospectively collected data from 47 children undergoing T&As and 15 undergoing unrelated elective procedures at a tertiary care children's hospital. Demographic and disease specific data was obtained in addition to a blood sample for the measurement of 25-hydroxy (OH)-vitamin D.

Results

There were no differences in vitamin D levels between the groups and levels did not correlate to any disease parameters in the children undergoing T&A. The only significant differences were related to race in that African American children had significantly lower vitamin D levels compared to Caucasians.

Conclusion

This pilot study did not show an association between serum vitamin D and the need to have adenotonsillectomy.     

The value of fine-needle aspiration cytology in the evaluation of pediatric head and neck tumors

Objective

To study the efficacy of fine-needle aspiration cytology (FNAC) of head and neck masses in pediatric patients.

Study design

Of the 128 cases studied, FNAC was performed in 74 patients and their cyto-histological correlation done. Sensitivity and specificity of cytological diagnosis was then computed.

Results

Benign lesions were found to be more common than the malignant variety, the commonest being soft tissue tumors (46.87%). Lymphomas were the commonest tumors (22.6%) in the malignant category. Cytology was done in 74 patients of whom smears from 21 patients were unsatisfactory for diagnosis. There was one false positive and two false negative cases resulting in the specificity and sensitivity of FNAC in pediatric head and neck tumors to be 95.65% and 93.3% respectively.

Conclusion

FNAC is a useful and reliable tool in the diagnosis of head and neck masses with no contraindications and minimal complications even in children.     

Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis

Objectives

To analyze the outcome of a new endoscopic approach for the treatment of pediatric subglottic stenosis.

Study design

Case series.

Setting

Tertiary care center.

Material and methods

Eighteen pediatric cases of grade II to IV subglottic stenosis (8 congenital and 10 acquired) consecutively treated at our institutions by Endoscopic Anterior Cricoid Split (EACS) and balloon dilation between 2006 and 2010. Treatment protocol encompassed systematic postoperative laryngeal stenting (7 days of intubation or 1 month of Montgomery T-tube in previously tracheotomized patients) and endoscopic controls with possible additional balloon dilation every 15 days for at least 2 months.

Results

Patients’ ages ranged from 1 to 101 months. Postoperative follow-up ranged from 4 to 45 months (median value ± SD: 15.3 ± 11.9). The mean duration of the endoscopic procedure was 35.2 ± 13.2 min. The number of days spent in PICU during the perioperative period varied between 2 and 15. Four patients (22.2%) needed one and 14 patients (77.7%) required several (from 4 to 7) additional balloon dilations during the postoperative endoscopic controls. No incident was observed during or immediately after EACS. Treatment was efficient in 83% of cases (n = 15), with no residual respiratory symptoms and grade 0 to 1 SGS at the end of follow-up.

Conclusion

EACS is a safe and efficient technique to treat pediatric subglottic stenosis, regardless of their grade and length, provided to associate it with postoperative laryngeal stenting and regular endoscopic follow-up with possible additional balloon dilations. In our teams, it has become the first line treatment for most grades II to IV SGS. Its indications can be extended to congenital stenosis with cartilaginous involvement and to long-lasting acquired stenosis with firm fibrosis.     

Day-case pediatric middle ear surgery: From myringoplasty to bilateral cochlear implantation

Objective

In the English speaking literature there is very little evidence demonstrating safe and effective tympanomastoid day case surgery in pediatric practice. At a time when there is ongoing pressure for trusts to meet financial government targets and our care provision revolves around a patient centred approach, could otolaryngologists perform more pediatric middle ear surgery on a day case basis? We report our experience with a series of 52 pediatric middle ear day cases.

Method

Prospective study from a London tertiary referral centre of 52 consecutive children undergoing tympanomastoid surgery. There were 6 categories of surgical procedure, ranging from myringoplasty to cochlear implantation. Post-operative recovery was monitored. The duration of anaesthesia was compared with the length of post-operative ward stay.

Results

The correlation co-efficient r = −0.2203, showing that there was no association between length of anaesthetic and duration of post-operative ward stay.

Conclusions

Despite minor post-operative problems including pain, bleeding, and nausea and vomiting all patients in this series were discharged on the day of surgery. For tympanoplasty our series adds weight to already available evidence. It is the first series showing that mastoid surgery, whether combined approach, traditional mastoidectomy or cochlear implantation can be performed safely as day cases in a pediatric population.     

Endoscopic optic nerve decompression for traumatic optic neuropathy in children

Objectives

To discuss the necessity of nasal endoscopic surgery for pediatric traumatic optic neuropathy and its therapeutic effect.

Methods

We retrospectively reviewed the cases of 41 children (involving 43 eyes) with traumatic optic neuropathies who were treated in our department by endoscopic optic nerve decompression and postoperative corticosteroid in large doses from Feb. 2000 to Apr. 2010. A 6-month follow-up study was performed for each patient in order to observe the postoperative eyesight recovery and analyze the therapeutic effect.

Results

The eyesight of 11 patients out of 41 patients reached 0.2-0.3 postoperatively, the eyesight of 16 patients recovered from counting fingers to 0.1 after the surgery, the eyesight of 6 patients ranged from light sensation to seeing the hand movement, the eyesight of 7 children did not recover from the operation. The prognosis in the children who underwent the decompression 7 days post-traumatically was much worse than other children.

Conclusions

The age of the patients was not the main element influencing the decision-making process for the operation. The main elements affecting the prognosis were the degree of injury and the time interval between the trauma and the time when patients underwent the surgery. The operation opportunity and plan are very important to a successful operation.     

Effects of adeno-tonsillectomy on polysomnography patterns in Down syndrome children with obstructive sleep apnea: A comparative study with children without Down syndrome

Objective

To determine if adeno-tonsillectomy (T&A) in children with Down syndrome (DS) improves breathing, measured by apnea hypopnea index (AHI), rapid eye movement AHI (REM-AHI) and the lowest oxygen desaturation (SaO₂), and sleep disruption, measured by arousal index (ArI) and time spent in stages 1-4 and rapid eye movement (REM) sleep and compare these results with a group of non-DS children with obstructive sleep apnea (OSA).

Study design

Retrospective chart review at pediatric sleep center.

Patients

Eleven DS and nine non-DS children underwent pre- and post-T&A polysomnography between 1997 and 2005.

Outcome measures

Pre- and post-T&A polysomnography parameters were compared using paired t-test and independent samples test.

Results

Mean age in DS group was 101 months and non-DS group was 80 months (64% males in DS and 88% in non-DS group). The average BMI was 29.8 and 27.6 for DS and non-DS group. The total AHI showed significant improvement after T&A but this was not as marked as the non-DS group. REM-AHI and lowest SaO₂ did not show significant change in the DS children. The non-DS group showed significant improvement in all respiratory parameters. Both groups showed mild improvement in sleep parameters. With the modest overall improvement, 27% of the DS children required no further treatment. However, 73% required CPAP, BiPAP or oxygen for persistent OSA.

Conclusion

This study supports the fact that T&A in DS children improves some parameters of OSA, however not as markedly as in non-DS children.     

Mandibular fractures in a group of Brazilian subjects under 18 years of age: A epidemiological analysis

Objective

This study showed a retrospective analysis of the etiology, incidence and treatment of maxillofacial injuries in a pediatric and adolescent population of the State of Sao Paulo.

Methods

We analyzed 2986 medical records of victims of facial trauma under 18 years, treated between 1999 and 2008 by the Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, University of Campinas, Sao Paulo - Brazil. During this period, 757 patients under 18 were victims of maxillofacial trauma, of which, 112 patients had 139 lines of fracture in the mandible. The most affected age group were male adolescents.

Results

The bicycle accidents constituted the main etiology (34.82%). The conservative treatment was used in 51% of cases, and 49% received surgical treatment. Only 5 cases of postoperative complications were identified.

Conclusion

The incidence of trauma and mandible fractures in pediatric and adolescent patients was high in the area of study. Bicycle accidents and falls being the main etiological factors. The group of adolescents was most affected. The conservative and surgical treatment was used almost in the same proportion.     

Correlation between NRT measurement level and behavioral levels in pediatrics cochlear implant patients

Objective

To determine the relationship between the electrically evoked nerve action potential (Neural Response Telemetry [NRT]) and behavioral levels (T- and C-level) for pediatric patients using the Nucleus 24 cochlear implant system.

Method

A hospital based study of pediatric cochlear implant patients in the period between June 2000 and December 2008. At King Abdul-Aziz University Hospital (KAUH) Saudi Arabia the Neural Response Telemetry was administered to 47 children (mean age at implantation: 4 years) with the Nucleus 24 cochlear implants. Four intra cochlear electrodes (numbers 5, 10, 15, and 20) were tested one-month post-implantation, the neural response threshold compared with the behavioral threshold and the maximum comfort level estimated at the same time.

Results

At all the electrode numbers, the mean for NRT level measurements was significantly higher than that for the T-level measurements and the mean for the C-level measurements was significantly higher than that for NRT level measurements The correlation analyses showed positive correlation between C-level and NRT level measurements and T-level and NRT level measurements.

Conclusion

There was a positive correlation between NRT value measurements and both T and C value measurements. Therefore, it is useful to use the NRT values to predict the behavioral T and C values in prelingual children.     

Sialendoscopy in children

Background

The definitive cause of most cases of recurrent salivary gland inflammation in children remains unknown. Relatively little has been written about the use of sialendoscopy as a diagnostic and therapeutic tool in children.

Objective

To evaluate the safety and efficacy of sialendoscopy as a diagnostic and therapeutic tool for recurrent salivary gland inflammation in children.

Study Design

Retrospective case series.

Methods

Medical records of all patients who underwent sialendoscopy for recurrent salivary gland inflammation from a single tertiary-care pediatric otolaryngology practice were reviewed. Comparison of pre-procedure vs. post-procedure frequency and severity of disease was reviewed. Operative reports, images, and video were analyzed for causes of inflammation.

Results

Six patients (aged 3-16 years old) underwent sialendoscopy (3/6 bilateral parotid, 2/6 unilateral parotid, 1/6 unilateral submandibular). There were no complications. No post-operative recurrence was noted in 3/6 patients; decreased frequency of recurrence was noted in 2/6 patients; repeat sialendoscopy was required in 1/6. Operative findings from sialendoscopy from 10 parotid glands showed fibrinous debris (7/10), mucoid debris (1/10), purulent debris (1/10), or duct stenosis (1/10). No stones were noted.

Conclusions

Sialendoscopy is a safe, minimally invasive procedure that may decrease the frequency of recurrences for salivary gland inflammation in children. In contrast to previously published work, the most common cause of salivary gland obstruction in this series was debris, rather than stones. Increased use of sialendoscopy as a diagnostic and therapeutic tool will allow for improved understanding of the causes of and management for recurrent salivary gland inflammation in children.     

A systematic review of concomitant interventions to prevent persistent perforations following the removal of long-term ventilation tubes

Objective

To review the current evidence for the use of concomitant interventions to reduce the persistent perforation rate following the removal of long-term ventilation tubes.

Type of review

A systematic review of the literature and meta-analysis of randomised controlled trials on this topic.

Search strategy

Medline (1952-2008), EMBASE (1974-2008) and the Cochrane Central Register of Controlled Trials. A combination of search terms were used in a search strategy derived from guidance from the Cochrane collaboration.

Evaluation method

A review of all trials by two authors with grading of the level of evidence.

Results

Fifteen studies using a variety of interventions were identified.

Conclusion

A multi-centre randomised controlled trial is indicated to validate findings of previous studies and elucidate any optimum intervention to reduce the persistent perforation rate.     

The Sluder method in the Netherlands and the incidence of postoperative haemorrhage in a pediatric hospital

Objective

Analysis of the method of tonsillectomy in use in the Netherlands and the incidence of postoperative haemorrhage in an academic tertiary pediatric referral hospital.

Study design and setting

(A) An explorative study of the Sluder tonsillectomy method in the Netherlands and (B) a retrospective case file review at the Sophia Children's Hospital in Rotterdam.

Methods

(A) A telephone and e-mail survey amongst 107 hospitals in the Netherlands. (B) A review of patients younger than 16 years who underwent a tonsillectomy or adenotonsillectomy between January 1, 1998, and February 22, 2008. This part of the study surveyed the intubated Sluder method and analyzed the incidence of primary and secondary haemorrhage in an academic tertiary pediatric referral hospital.

Results

(A) The Sluder method was commonly used in 102 (95.32%) hospitals; the traditional dissection technique was exclusively used only in five hospitals (4.67%). Of the 102 hospitals using the Sluder method, 67 (65.68%) report using only inhalation mask anaesthesia, while the remaining 35 use intubation. (B) Of 1797 patients studied, 40 patients experienced postoperative tonsillar haemorrhage (2.23%), with 35 (1.95%) patients primary haemorrhage of which 32 (1.78%) within 6 h after the surgery. Secondary haemorrhage occurred in five (0.28%) patients.

Conclusions

The Sluder method is still generally used in the majority of hospitals in the Netherlands today. Because of the low incidence of especially secondary haemorrhage and most of the primary haemorrhages occurring within 6 h after the surgery, this technique is ideally suited for day care tonsillectomy.     

Subglottic stenosis: another challenge for intubation and potential mechanism of airway obstruction in Pierre Robin Sequence

Objective

To determine the endotracheal tube (ETT) size and presence of subglottic narrowing in children less than 1 year old with Pierre Robin Sequence (PRS).

Materials and methods

We performed a retrospective review from 2005 to 2009 of infants with PRS who underwent diagnostic laryngoscopy (DL) and intubation.

Results

Fifteen children with a median age of 25 days were reviewed. All patients, except one, were born full term. Subglottic narrowing was visualized in 5 patients (33%). 73% of all patients required an ETT size smaller than what is recommended by intubation guidelines in the literature in regards to normative data based on age and weight.

Conclusion

Infants with PRS may have a higher incidence of subglottic stenosis and require a smaller ETT compared to the normal population. This pilot study warrants a larger prospective investigation to validate these findings.     

Management and outcome of pediatric skull base fractures

Objective

The management of skull base fractures in the pediatric age group continues to be a major challenge even for experienced multidisciplinary teams. This retrospective study was undertaken at a tertiary care academic hospital to evaluate the management and outcome of pediatric skull base fractures.

Methods

Retrospective analysis covering a period of 13.5 years (from 1996 to 2009) and 63 patients (mean age 10.7 years; range 1-18 years) was performed.

Results

A road traffic accident was the most frequent etiological factor (38%). The most common skull base fracture type was temporal bone fracture (64%). Longitudinal temporal fractures were observed in 45% and transversal in 23% of these patients; in 10 cases (25%) the fracture was comminuted or mixed type. A fracture involving the spheno-ethmoidal complex was the second most common type of basilar skull fracture (41%) followed by fracture through the orbital bone (35%). Forty-three percent of the patients had a concomitant intracranial injury. Early neurological deficits were diagnosed in 21 patients (33%) and 10 patients (16%) had permanent neurological deficits. One patient died after 1 week of intensive care treatment. Fifty-four patients (86%) were discharged home and 8 patients (13%) were discharged for further rehabilitation. Glasgow Coma Scale score of 8 or lower correlated with moderate to poor outcome.

Conclusions

We conclude that skull base fracture is a rare injury in childhood. Mortality is uncommon, but this trauma is commonly associated with intracranial injury. Early neurological deficits are caused by traumatic brain injury and were observed in one-third of the patients. However, only less than one-sixth suffered from permanent neurological or neuropsychiatric disorders.     

Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children

Objective

Although racial/ethnic and socioeconomic healthcare disparities in pediatric primary care are widely documented, little is known regarding health disparities for common otolaryngic conditions. Pediatric sleep-disordered breathing (SDB) is highly prevalent, associated with significant physical and neurocognitive sequelae, and a common reason for pediatric otolaryngology referral. We sought to synthesize information from published findings related to racial/ethnic and socioeconomic disparities in children with SDB.

Methods

Qualitative systematic review of MEDLINE database for articles reporting on racial/ethnic or socioeconomic differences in prevalence, diagnosis or surgical treatment of SDB in children over 30 years.

Results

Of 210 abstracts identified, 33 met inclusion criteria. 24 articles directly addressed differences in race/ethnicity and socioeconomic status, and 10 had findings which identified a disparity. Differences were identified in prevalence, sleep patterns, and sequelae of pediatric SDB (24/33) and in access to care and utilization of adenotonsillectomy (10/33). Black children (12/33) and children with socioeconomic deprivation (17/33) were the most common minority groups studied. Although conclusions were broad, common study findings showed: (1) children in racial/ethnic and socioeconomic minorities may have higher prevalence and greater risk for SDB, and (2) In the U.S., white children or children with private insurance are more likely to undergo adenotonsillectomy.

Conclusions

Racial/ethnic and socioeconomic disparities are prevalent among children with SDB. Disparities in multiracial populations and disparities in access to care, treatment, and utilization of services for pediatric SDB require more detailed investigation. Given the potential negative impact of SDB in children, as well as its economic consequences, the evaluation of disparities should be prioritized in health policy research.