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Biomedical subjects

C D Bluestone

Publications and source records attributed to C D Bluestone.

At least 109 records · Page 6Linked to original sources
PubMed1988

Controversy over tubes and adenoidectomy.

Dr. Bluestone then summarized the panelists' discussion by stating that there is now evidence that myringotomy alone for chronic otitis media with effusion has some efficacy but is probably no better than watching the child and not performing surgery. He also stated there are now some data to show that myringotomy and tube insertion for chronic otitis media with effusion appear to be more beneficial than either watching a child over a long period of time or performing myringotomy alone. However, the panelists made a plea that each child should be individualized on the basis of the duration of the effusion, the child's response to medication, the time of the year, distance from health care providers and other factors. Dr. Gates stressed that hearing loss was an important factor, but if hearing loss is a deciding factor, then serial audiograms or at least some assessment of hearing in the clinician's office should be performed. He also stated that there is now evidence that adenoidectomy is effective in certain children, but there is still an 80% recurrence rate and a 15% rate of failure in which children require repeat surgery. Dr. Bluestone suggested that parents and the child (if old enough) should be informed of what is known about the risks, costs and benefits of these surgical procedures. He recommended the clinician discuss with the parents the pros and cons of performing or not performing surgery, including the complications and sequelae of otitis media and also of tube insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1987

Efficacy of amoxicillin with and without decongestant-antihistamine for otitis media with effusion in children. Results of a double-blind, randomized trial.

In a randomized, double-blind, placebo-controlled trial involving 518 infants and children who had otitis media with effusion ("secretory" otitis media), we evaluated the efficacy of a two-week course of amoxicillin (40 mg per kilogram of body weight per day) with and without a four-week course of an oral decongestant-antihistamine combination. Among the 474 subjects who were evaluated at the four-week end point, the rate of resolution of middle-ear effusion was twice as high in those treated with amoxicillin, either with or without the decongestant-antihistamine, as in those who received placebo (P less than 0.001), but 69.8 percent of the amoxicillin-treated subjects still had effusion. Among both the amoxicillin-treated subjects and the placebo-treated subjects, resolution was more likely in those with initially unilateral effusion, in those who had had effusion for eight weeks or less, and in those without an upper respiratory tract infection at the four-week end point. Side effects were reported more often in subjects who received decongestant-antihistamine than in those who did not. Among the subjects without effusion at the four-week end point, recurrent effusion developed in approximately half those in both the amoxicillin and placebo groups during the subsequent three months. We conclude that in infants and children with otitis media with effusion, amoxicillin treatment increases to some extent the likelihood of resolution.

Amoxicillin↗
PubMed1987

Malignant tumors of the head and neck in children: a twenty-year review.

This 20-year (1965-1985) retrospective review identified 241 children under the age of 19 years who presented with a malignancy of the head and neck. Hodgkin's disease and other malignant lymphomas predominated, accounting for 59% of the total number of cases. Soft tissue sarcomas, specifically rhabdomyosarcoma, were the next most common lesions (17.5%). Thyroid carcinomas (10%), neuroblastomas (5%), nasopharyngeal carcinomas (5%), salivary gland malignancies (2.5%), and malignant teratomas (1%) accounted for the remaining cases. The neck was the primary site of presentation, followed by the naso-oropharynx, orbit, face and scalp, salivary glands, and aural region, in descending order of frequency. Advances in the diagnosis, staging and treatment of children with malignant tumors of the head and neck have occurred since the last comprehensive survey of such lesions was published in 1973. Otolaryngologists must be aware of these advances in order to remain active members of a multi-discipline team responsible for the care of these children.

Adolescent↗
PubMed1987

Amoxicillin-clavulanate potassium compared with cefaclor for acute otitis media in infants and children.

One hundred thirty-three infants and children with documented acute otitis media (OM) were randomized to receive the oral suspension of either amoxicillin-clavulanate potassium or cefaclor. Beta-lactamase-producing bacteria were found in 10.9 and 14.5% of subjects treated with amoxicillin-clavulanate potassium and cefaclor, respectively. Subjects were reexamined at 5, 10, 30, 60 and 90 days after the initiation of therapy and whenever signs/symptoms of acute otitis media recurred. All but two children had resolution of otalgia/otorrhea during the initial treatment period. The drug groups were not significantly different in the percentage of evaluable subjects with otitis media with effusion at each scheduled follow-up visit. Recurrence of acute OM/otorrhea [corrected] developed in a similar percentage of subjects in both treatment categories. Both subjects with and those without middle ear effusion at 10 days had approximately a 50% recurrence rate of subsequent middle ear disease. Adverse side effects/complaints, which occurred in significantly more children treated with amoxicillin-clavulanate potassium, were generally mild and primarily gastrointestinal.

Acute Disease↗
PubMed1987

Autoinflation of eustachian tube in young children.

Inflation of the middle ear has long been thought to be beneficial in the treatment of otitis media. We describe a new system of autoinflation based on a modified Valsalva technique consisting of an anesthesia mask and a flowmeter which can be used successfully by children. An objective method to record eustachian tube opening during autoinflation using frequency spectrum analysis of the ear canal sounds is also presented. Tubal opening results of this method were compared to the traditional method using preinflation and postinflation tympanometry. Study subjects included 20 adults with normal otologic findings and 35 children with middle-ear effusion; all together 107 ears of children and adults with and without effusion were tested. Using the frequency spectrum analysis, tubal opening was recorded in 75% of adult ears and 56% of children's ears. Also, in both groups, a sound pressure peak with the same characteristic frequency around 2 kHz was associated with tubal openings. The methods described are incorporated into a clinical trial being conducted at the Children's Hospital of Pittsburgh.

Acoustic Impedance Tests↗
PubMed1987

Prognostic value of eustachian tube function in pediatric tympanoplasty.

Poor eustachian tube function and prevalence of infectious ear disease are thought to be the reasons for less successful outcome associated with tympanoplasty in children. Since both of these factors are related to age, identification of those patients who may benefit by delaying the surgery has been a concern to otolaryngologists. In an effort to investigate the role of eustachian tube function on the outcome, we tested the tubal function in 63 ears (56 children) undergoing tympanoplasty for central perforations. In 49 ears (78%), the graft took; of these, 33 had good middle-ear function, 8 developed persistent or recurrent otitis media, and 8 had severe retraction or atelectasis. There was a significant association (p less than 0.01) between outcome and preoperative tubal function as determined by combining the active and passive function parameters. However, the prognostic value of tubal function testing was low; predictive values for success and lack of success being 68% and 56%, respectively. Other factors, such as graft placement (medial or lateral) contralateral ear status, and child's age, were not associated with outcome. Consistent with other studies, good eustachian tube function was shown to predict good outcome, but poor tubal function was not helpful in predicting poor outcome.

Adolescent↗
PubMed1986

Medical management of chronic suppurative otitis media without cholesteatoma in children.

Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty-two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.

Adolescent↗
PubMed1986

Otitis media and sinusitis in children. Role of Branhamella catarrhalis.

Otitis media and sinusitis are among the most common diseases of childhood and various treatment approaches have been advocated. This review focuses on current experience in Pittsburgh, both in terms of our methods of patient management and the changing aetiology of the underlying diseases. Special reference is made to the role played by Branhamella catarrhalis and the emergence of beta-lactamase-producing strains. Results from recently completed clinical trials would suggest that antibacterial therapy should be administered to children with these infections, to reduce morbidity and prevent the ever-present supportive complications associated with both diseases.

Acute Disease↗
PubMed1985

Update on antimicrobial therapy for otitis media and sinusitis in children.

Acute otitis media and chronic otitis media with effusion are generally caused in children by the bacteria found in the nasopharynx. In growing numbers of young patients, beta-lactamase-producing strains of Branhamella catarrhalis and Staphylococcus aureus have recently emerged as causative organisms. The antimicrobial agent selected for treatment should be effective against whatever pathogens have been associated with failures of symptomatic treatment in the community. Acute or chronic sinusitis in children is overlooked and poorly understood because so many children have frequent episodes of upper respiratory infection. To relieve acute symptoms and prevent suppurative complications, antimicrobial treatment is indicated. Children with persistent pain or fever may require surgical intervention and/or treatment with another antimicrobial agent. Recurrent acute sinusitis needs further evaluation and may be associated with a tooth abscess or cystic fibrosis.

Acute Disease↗
PubMed1985

Current concepts in eustachian tube function as related to otitis media.

Two types of Eustachian tube dysfunction can result in otitis media: obstruction and abnormal patency. Obstruction may be either functional or mechanical. Functional obstruction can result from persistent collapse of the Eustachian tube due to increased tubal compliance, an inadequate active opening mechanism, or both. Mechanical obstruction may be the result of either intrinsic or extrinsic factors. Otitis media can result from inadequate ventilation of the middle ear or entry of unwanted nasopharyngeal secretions into the middle ear (by aspiration, insufflation, or reflux), or both. An understanding of these concepts of Eustachian tube function and otitis media can then be related to the rationale for nonsurgical and surgical management and prevention of middle-ear disease.

Adult↗
PubMed1985

Otitis media with effusion in preschool children.

The incidence, prevalence, and natural history of otitis media with effusion (OME) and middle ear high negative pressure (HNP) were investigated in a group of 2 to 6 year old preschool children. The children were examined monthly over a two year period from September 1981 to August 1983. The middle ear status was assessed using a decision-tree algorithm which combined the findings of pneumatic otoscopy, tympanometry, and acoustic reflex measurements. Fifty-three percent of the children in the first year and 61% in the second year developed OME; also during the two years, HNP was documented in 66% of the children. Eighty percent of OME episodes lasted only two months. The prevalence of OME and HNP showed a seasonal variation and a strong association with the presence of upper respiratory infections (URIs). The incidence of OME was independent of age. These data indicate that OME and HNP are prevalent conditions with a high spontaneous recovery in the preschool population.

Audiometry, Pure-Tone↗
PubMed1985

Nasal surgery in children with cystic fibrosis: complications and risk management.

Children with cystic fibrosis (CF) are predisposed to pansinusitis and nasal polyposis and, therefore, require frequent surgery by otolaryngologists. These children are at risk to have complications following surgery, both locally, at the surgical site, as well as systemically from their underlying pulmonary disease. A 20-year retrospective study of children (average census 219 per year) revealed 39 children developed nasal polyps and these children required 85 nasal polypectomies. No major complications occurred and only three minor complications (fever, minor bleeding) were noted. Over 95% of our CF children were able to return home in less than 48 hours, and extensive hospital stays appeared not to be required.

Adolescent↗