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The Effect of Developmental Delay and Autism Spectrum Disorder on External Auditory Canal Foreign Body Extraction
Justin D Nguyen1, Michael C Shih2, Shaun A Nguyen2
1From the Baylor College of Medicine, Houston, TX.
Insights
Children with developmental delay (DD) and autism spectrum disorder (ASD) present differently for external auditory canal foreign body (EAC FB) removal, often requiring operating room intervention and experiencing more frequent FB episodes. Vigilance in evaluation is key for better outcomes.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Developmental Pediatrics
Background:
- Pediatric external auditory canal foreign body (EAC FB) retrieval outcomes can be influenced by underlying neurodevelopmental conditions.
- Developmental delay (DD) and autism spectrum disorder (ASD) are increasingly recognized as factors affecting healthcare encounters in children.
Purpose of the Study:
- To investigate the impact of DD and ASD on the outcomes of pediatric EAC FB retrieval.
- To compare presentation, management, and recurrence rates of EAC FB in children with and without DD/ASD.
Main Methods:
- Retrospective chart review of 1467 pediatric patients undergoing EAC FB removal from January 2018 to December 2019.
- Analysis of demographics, symptoms (otalgia), complications, number of episodes, and need for operating room (OR) removal.
- Stratification of patients based on the presence of DD and ASD.
Main Results:
- Children with DD and ASD were older at presentation and more likely to require OR removal (36.5%) compared to non-DD/ASD (NDD) peers (16.7%).
- Patients with DD/ASD experienced significantly more EAC FB episodes (1.6-1.8) versus NDD (1.1), with hazard ratios of 4.5 for DD and 5.6 for ASD for multiple episodes.
- DD patients reported less otalgia (26.3%) than NDD patients (37.4%), while complication rates remained low across all groups.
Conclusions:
- Physicians must maintain heightened vigilance for EAC FB in children with DD and ASD due to atypical presentations.
- A lower threshold for referral to otolaryngology specialists may improve management and outcomes for these vulnerable pediatric populations.
- Understanding the unique clinical characteristics of DD and ASD patients is crucial for effective EAC FB management.
Objectives:
To determine the effect of developmental delay (DD) and autism spectrum disorder (ASD) on pediatric external auditory canal foreign body (EAC FB) retrieval outcomes.
Methods:
A retrospective chart review of children presenting with EAC FB at a tertiary children's hospital was performed between January 2018 and December 2019. Charts were reviewed for demographics, presence of otalgia, complications, number of EAC FB episodes, indications for operating room removal, DD, and ASD status.
Results:
A total of 1467 patients underwent EAC FB removal. One hundred thirty-seven children (9.3%) had DD, and, of those with DD, 63 (46%) had ASD. Children with DD were 1.76 years older compared with children with non-DD (NDD) ( P < 0.0001) at the time of presentation, whereas children with ASD were 1.45 years older than children with NDD ( P = 0.0023). Children with DD and ASD were more likely to require removal of FB in the operating room (OR) compared with the NDD group (36.5% vs 16.7%, P = 0.0001). This was not true for children with DD without ASD. Patients with DD reported significantly less otalgia when compared with NDD patients (26.3% vs 37.4%, P = 0.0097). A similar trend, although not statistically significant, was observed when comparing children with ASD with NDD patients. The NDD patients (1.1) had fewer EAC FB episodes than patients with DD (1.6, P < 0.0001) and ASD (1.8, P < 0.0016). Hazard ratios for multiple episodes of FB were 4.5 (95% confidence interval, 2.9-6.8) for DD, and 5.6 for ASD (95% confidence interval, 3.2-9.9). The complication rate for all groups was low.
Conclusions:
Due to the different ways that children with DD and ASD present compared with NDD children, physicians should be vigilant when evaluating symptoms and conducting physical examinations for EAC FB in those patients. A lower threshold for referral to otolaryngologists may result in more favorable outcomes.
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