title: First branchial cleft anomalies: otologic manifestations and treatment outcomes.
abstract: OBJECTIVE
  This study describes the presentation of first branchial cleft anomalies and compares outcomes of first branchial cleft with other branchial cleft anomalies with attention to otologic findings.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Pediatric tertiary care facility.
  
  
  METHODS
  Surgical databases were queried to identify children with branchial cleft anomalies. Descriptive analysis defined sample characteristics. Risk estimates were calculated using Fisher's exact test.
  
  
  RESULTS
  Queries identified 126 subjects: 27 (21.4%) had first branchial cleft anomalies, 80 (63.4%) had second, and 19 (15.1%) had third or fourth. Children with first anomalies often presented with otologic complications, including otorrhea (22.2%), otitis media (25.9%), and cholesteatoma (14.8%). Of 80 children with second branchial cleft anomalies, only 3 (3.8%) had otitis. Compared with children with second anomalies, children with first anomalies had a greater risk of requiring primary incision and drainage: 16 (59.3%) vs 2 (2.5%) (relative risk [RR], 3.5; 95% confidence interval [CI], 2.4-5; P<.0001). They were more likely to have persistent disease after primary excision: 7 (25.9%) vs 2 (2.5%) (RR, 3; 95% CI, 1.9-5; P=.0025). They were more likely to undergo additional surgery: 8 (29.6%) vs 3 (11.1%) (RR, 2.9; 95% CI, 1.8-4.7; P=.0025). Of 7 persistent first anomalies, 6 (85.7%) were medial to the facial nerve, and 4 (57.1%) required ear-specific surgery for management.
  
  
  CONCLUSIONS
  Children with first branchial cleft anomalies often present with otologic complaints. They are at increased risk of persistent disease, particularly if anomalies lie medial to the facial nerve. They may require ear-specific surgery such as tympanoplasty.
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Shinn
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA plpurcel@uw.edu.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Purcell
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Kathleen C Y
authors.initials: KC
authors.lastname: Sie
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Manning
mesh_terms: D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010031:Otitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods*; D010608:Pharyngeal Diseases / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: branchial cleft; congenital neck mass; otitis; pediatric otolaryngology