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Biomedical subjects

C D Bluestone

Publications and source records attributed to C D Bluestone.

At least 127 records · Page 7Linked to original sources
PubMed1984

Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials.

We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.

Adenoidectomy↗
PubMed1984

Eustachian tube obstruction after provocative nasal antigen challenge.

To test if allergic rhinitis is associated with abnormal eustachian tube function (ET), juvenile rhesus monkeys were passively sensitized with serum samples from patients allergic to timothy grass or ragweed pollen. Tympanostomy tubes were inserted for direct measurement of ET function by inflation-deflation and forced-response testing before and after provocative intranasal challenge. Intranasal challenge with pollen (antigen) resulted in rhinorrhea and nasal obstruction. Slight increases in passive ET function values and significantly impaired active ET function were observed after antigen challenge. No changes in nasal airway patency or active ET function resulted from control nonantigen pollen challenges. These data complement our studies in man and support the use of this model to evaluate the relationships among allergic rhinitis, ET function and middle ear disease.

Adult↗
PubMed1984

Antigen-induced eustachian tube obstruction: an intranasal provocative challenge test.

ETO and symptoms of AR have been demonstrated to develop after an intranasal provocative antigen-challenge test. To determine the antigen dose required to produce ETO, intranasal insufflations of increasing amounts of pollen (ragweed or timothy) from 0.1 to 100 mg were delivered to 29 patients, ages 20 to 31 yr with AR who were skin test positive or had elevated serum-IgE antibodies to ragweed or timothy but not pine pollen. Our results demonstrated ETO developed in four ears at 0.05 mg of pollen, in one at 0.5 mg, in four at 1 mg, in 28 at 10 mg, in 15 at 50 mg, and in two at 100 mg of pollen. ETO persisted from 2 to 120 hr. Dose responses and duration of ETO were compared to patients' serum-IgE antibodies that ranged from 3% to 36% B/T (median 26.4%). The patients with the highest serum-IgE antibody values (greater than or equal to 26.4%) required lower antigen-dose challenges (less than or equal to 10 mg) to develop ETO (p less than or equal to 0.01) that also persisted longer (less than or equal to 48 hr) p less than or equal to 0.05. Symptoms of AR developed with an antigen dose that was less than the antigen dose that resulted in the development of ETO in 22 patients and at the same antigen dose in the other seven subjects. At a later date, these same subjects were also challenged intranasally with 50 mg of pine pollen after which no symptoms of AR or development of ETO were noted. In summary, the expression of ETO after provocative intranasal pollen challenge in AR patients is an immune-mediated reaction that is antigen-dose dependent and related to serum-IgE antibody titer.

Adult↗
PubMed1984

Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor.

Maxillary sinus aspiration and quantitative culture of the aspirate were performed in 50 patients, ranging in age from 1 to 16 years, with clinical and radiographic evidence of acute sinusitis. Of 79 sinuses aspirated, at least one was found to be infected in 35 (70%) children. Streptococcus pneumoniae, Branhamella catarrhalis, and Haemophilus influenzae were the most common organisms recovered. All H. influenzae were nontypeable. Twenty percent of the H. influenzae and 27% of the B. catarrhalis organisms were beta-lactamase positive and amoxicillin resistant. The subjects received either amoxicillin or cefaclor at a dose of 40 mg/kg/day in three doses for 10 days. The clinical cure rate with amoxicillin was 81%, compared to 78% with cefaclor. Radiographic improvement was similar in both treatment groups. Antibiotic therapy failed in four patients; three had been given amoxicillin, and one cefaclor. In three of these, a beta-lactamase-positive antibiotic-resistant bacterial species was recovered from the maxillary sinus aspirate; the fourth aspirate was sterile.

Acute Disease↗
PubMed1983

Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ("secretory" otitis media) in children. Results of a double-blind, randomized trial.

In a double-blind, randomized trial of 553 infants and children who had otitis media with effusion ("secretory" otitis media), we compared the efficacy of a four-week course of an oral decongestant-antihistamine combination (pseudoephedrine hydrochloride, 4 mg per kilogram of body weight per day, and chlorpheniramine maleate, 0.35 mg per kilogram per day) with that of placebo. Among patients with initially unilateral disease, resolution of middle-ear effusion occurred at four weeks in 38 per cent of those treated with placebo and 34 per cent of those treated with drug (P = 0.74). Among patients with initially bilateral disease the corresponding proportions were 19 and 21 per cent, respectively (P = 0.67). Side effects were reported more often among drug-treated than placebo-treated patients. Decongestant-antihistamine combinations do not appear to be indicated for the treatment of otitis media with effusion in infants and children.

Child↗
PubMed1983

Effect of levator veli palatini muscle excision on eustachian tube function.

The role of the levator veli palatini (LVP) muscle in eustachian tube (ET) physiology was investigated in five juvenile rhesus monkeys (Macaca mulatta). The baseline ET function and middle ear pressures were documented longitudinally for a period of six months prior to bilateral excision of the LVP muscle, and postoperative ET function and middle ear status were assessed for a period of five months. During the postoperative follow-up period, otitis media with effusion was not observed and middle ear pressure values remained within the normal baseline values. Parameters of ET function as measured by the forced-response test did not show any significant differences in comparison with baseline values. These findings provide additional evidence that the operational biomechanics of the ET are independent of the integrity of the LVP muscle, and that the tensor veli palatini is the only paratubal muscle responsible for normal active opening of the ET.

Animals↗
PubMed1983

Treatment of ampicillin-resistant acute otitis media in the chinchilla.

The efficacy of sulbactam sodium (CP45,899-2) was investigated using the chinchilla animal model of acute otitis media with effusion (AOME). Both ears of 78 chinchillas were inoculated with beta-lactamase-producing nontypable Hemophilus influenzae. Half of the animals were treated with ampicillin sodium alone (group A) and the remaining animals received ampicillin plus sulbactam (group B). On day 14, all of the ears in group B were culture-negative whereas H influenzae was recoverable in over 70% of the effusions in group A. Similarly, the course of middle ear effusion was significantly abbreviated in group B during the two-week study period. These findings suggest that sulbactam in combination with ampicillin is effective in treating AOME secondary to infection with beta-lactamase-producing nontypable H influenzae in the chinchilla animal model.

Acute Disease↗
PubMed1983

Eustachian tube function: physiology, pathophysiology, and role of allergy in pathogenesis of otitis media.

Otitis media may be the result of Eustachian tube dysfunction or inflammation of the middle ear, or both. The Eustachian tube may be either abnormally patent (patulous or semipatulous) or, more commonly, obstructed. Functional obstruction is most likely due to either lack of tubal stiffness or an abnormal active opening mechanism, e.g., inefficient tensor veli palatini muscle. Mechanical obstruction may be secondary to extrinsic causes such as a nasopharyngeal tumor or possibly an adenoid mass. Intrinsic obstruction can result from an upper respiratory tract infection. Even though proof that allergy is causally related to otitis media is lacking, recent studies indicate that the Eustachian tube can become partially obstructed when upper respiratory allergy is present. In addition, there is now some evidence that in a small percentage of children with upper respiratory allergy, the middle ear may be a "shock organ." Future studies are needed to define the role of allergy in the pathophysiology of the Eustachian tube and the pathogenesis of otitis media. Randomized clinical trials will be required to determine the efficacy of the currently popular forms of immunotherapy and allergy control in the prevention of otitis media.

Child↗
PubMed1983

A point prevalence of otitis media in a Nigerian village.

One hundred seventy children and 103 adults from a rural Nigerian village were examined for the presence of middle and external ear pathology. Ear, nose and throat examination included: (1) pneumatic otoscopic exam, (2) tympanometry and (3) contralateral acoustic reflex. A diagnostic algorithm was applied to these 3 findings for each subject and each ear. Our data showed a point prevalence of otitis media in children (less than or equal to 15 years) to be 21.2% compared to 4% in adults (greater than 15 years). Of the 36 children with otitis media, only 3 had perforation and otorrhea; a diagnosis of otitis media with effusion behind an intact tympanic membrane was made in the other 33 children. The prevalence of otitis media varied significantly with age and evidence of upper respiratory tract infection. There was no significant difference between sexes. External ear pathology was found as an independent variable in 24% of the 170 children; three-fourths of these children had concurrent middle ear pathology. The results are discussed in relation to the current understanding of the differences that exist in the epidemiology and pathogenesis of otitis media in different racial groups.

Acoustic Impedance Tests↗
PubMed1983

Perilymph fistulas in infants and children.

During the years 1975 through 1981 we performed exploratory tympanotomies on 33 infants and children (44 ears) to verify the presumptive diagnosis of perilymph fistula (PLF). A PLF was identified at the round window, oval window, or both in 29 (66%) of the 44 ears explored. After surgery hearing was unchanged in 86%, improved in 5%, and worsened in 9% of the ears in which PLFs had been observed. Complaints of vertigo subsided in all children in whom a PLF was repaired. Preoperative factors determined to be highly suggestive of the presence of a PLF included the following: sudden onset of sensorineural hearing loss (SNHL), congenital deformities of the head, and abnormal findings on tomograms of the temporal bones, especially Mondini-like inner ear dysplasias. Middle ear abnormalities (primarily congenital) were observed in 20 of the 44 ears. Abnormal results of preoperative vestibular function studies, which included a fistula test, and sex were not consistently found to be associated with an observed PLF at tympanotomy.

Adolescent↗
PubMed1983

Treatment of otitis media with effusion.

Otitis media is the most common disease of children who seek medical care. It is estimated that over 30 million visits to physicians are made per year, and that over one billion dollars are spent annually in the United States for the treatment of otitis media. More prescriptions are written for oral antimicrobial agents for otitis media than any other disease. Antimicrobial therapy is still the mainstay of treatment for children with acute otitis media. Myringotomy (and tympanocentesis) should also be performed when acute otitis media is associated with: severe otalgia, when otalgia or fever persists or recurs in spite of antimicrobial therapy, in the very young or immunocompromised host and when a suppurative intratemporal or intracranial complication is impending or present. Antimicrobial agents should be selected according to the incidence of bacteria prevalent in the community and should be altered depending upon the results of cultures obtained from middle ear aspirates in children who are not responding to the usual antimicrobial agents. Children who experience frequently recurrent acute otitis media (without a middle ear effusion between attacks) should be considered candidates for prophylactic antimicrobial therapy or tympanostomy tube insertion, or both. A middle ear effusion that has persisted for three months or longer should be considered chronic and active treatment should be instituted. A course of antimicrobial therapy should be tried, and if not effective, then a myringotomy with aspiration of the effusion is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1983

Management of chronic otitis media with effusion.

Chronic otitis media with effusion ('secretory') is one of the most common diseases of childhood. Pathogenesis related to Eustachian tube dysfunction. Bacteria have been isolated from approximately 50 percent of chronic middle ear effusions. Diagnosis by pneumatic otoscopy or tympanometry, or both. Efficacy yet to be shown for antimicrobial therapy, decongestants, antihistamines, hydrocortisone, myringotomy with or without tympanostomy tubes, and adenoidectomy with or without tonsillectomy. However, a 10-day trial with an antimicrobial agent, such as amoxicillin (erythromycin and sulfonamide, trimethoprim-sulfamethoxazole, or cefaclor, are reasonable alternatives), should be prescribed before surgical intervention. Attendant conductive hearing loss may be related to abnormalities in cognition, language, and learning. Since the prevalence and incidence of otitis media decrease with advancing age, palliative management options would appear to be appropriate at present, reserving the more aggressive options for those infants and children who have frequently recurrent or chronic disease or the complications or sequelae of otitis media with effusion.

Acoustic Impedance Tests↗