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Biomedical subjects

C S Derkay

Publications and source records attributed to C S Derkay.

At least 37 records · Page 2Linked to original sources
PubMed1996

Water precautions in children with tympanostomy tubes.

OBJECTIVE: To compare the effectiveness of antibiotic ear drops (suspension of polymyxin B sulfate, neomycin sulfate, and hydrocortisone [Pediotic]), prefabricated ear molds, or no precautions in decreasing the incidence of posttympanostomy water-related otorrhea. DESIGN: Five-year prospective controlled study. SETTINGS: University referral center. PATIENTS: Five hundred thirty-three pediatric patients who were undergoing tympanostomy tube placement (including those who were undergoing tonsillectomy, adenoidectomy, or both) were self-selected into four groups. INTERVENTIONS: The use of antibiotic ear drops that contained polymyxin B, neomycin, and hydrocortisone and the use of prefabricated ear molds. Group 1 comprised patients who were not given any water precautions with swimming regardless of the depth or type of water; group 2 comprised patients in whom antibiotic ear drops were applied after all forms of swimming; group 3 comprised patients who used ear molds with all forms of swimming (all children were advised against diving and swimming more than 180 cm below the surface, and parents were cautioned to avoid the entrance of soapy water into their child's ears during bathing); and group 4 comprised patients who were selected not to swim at all (they served as a control group). RESULTS: No statistically significant difference was observed in the incidence of posttympanostomy swimming-related otorrhea among the three swimming groups (11%, 14%, and 20% of children in groups 1, 2, and 3, respectively, reported swimming-related otorrhea [P=.26, df-2, chi-square=2.66]). Children who did not swim at all (group 4) did not differ significantly in their overall incidence of otorrhea (59%) from the three swimming groups combined (68%) during the follow-up period (P=.11, df=1, chi-square=2.54). CONCLUSION: Young children with tympanostomy tubes who surface swim and do not dive receive no additional benefit from the taking of water precautions in the form of earplugs or antibiotic ear drops.

Administration, Topical↗
PubMed1996

Role of cesarean section in prevention of recurrent respiratory papillomatosis--is there one?

Recurrent respiratory papillomatosis (RRP) is a benign yet aggressive neoplasm that produces considerable morbidity in children. Previous studies have linked RRP in children to mothers with genital tract human papillomavirus infections (HPV). Risk factors for vertical transmission have not been well identified. Controversy exists among obstetricians and otolaryngologists regarding the role of cesarean section in preventing the transmission of HPV disease from mother to child. We address this issue by presenting the results of a national survey of otolaryngologists, the American College of Obstetrics and Gynecology position statement, the relevant literature regarding the association between RRP and maternal HPV, and the proposed mechanisms for HPV transmission at birth. We postulate a very limited role for cesarean section in preventing transmission of RRP, given our present knowledge of this disease.

Cesarean Section↗
PubMed1995

Task force on recurrent respiratory papillomas. A preliminary report.

OBJECTIVE: To obtain pilot data about the incidence, need for surgical intervention, and demographics of recurrent respiratory papillomas in the United States. DESIGN: Otolaryngologists were surveyed using a questionnaire with structured and open-ended questions. PARTICIPANTS: One thousand board-certified otolaryngologists practicing in the United States as of January 1, 1993, through a random mailing list provided by the American Academy of Otolaryngology-Head and Neck Surgery and all active US members of the American Society of Pediatric Otolaryngology and the American Bronchoesophagological Association. A total of 1346 questionnaires were distributed. MAIN OUTCOME MEASURES: Physician's responses to questions about their current patient load of children and adults with recurrent respiratory papillomas, their surgical and anesthetic management of the disease, and their clinical experiences with risk factors for developing recurrent respiratory papillomas. RESULTS: Projected totals for recurrent respiratory papillomas among children were 2354 new cases (95% confidence interval [CI], 1448 to 3260) and 5970 active cases (95% CI, 3465 to 8474), requiring 16,597 surgical procedures (95% CI, 6938 to 26,255) at a cost of $109 million (95% CI, $45 to 172 million) for March 1, 1993 to March 31, 1994. Projected totals for adult recurrent respiratory papillomas were 3623 new cases (95% CI, 2359 to 4887) and 9015 active cases (95% CI, 6435 to 11,591) requiring 9284 surgical procedures (95% CI, 6003 to 12,565) at a cost of $42 million (95% CI, $27 to $59 million) for March 1, 1993 to March 31, 1994. The incidence of recurrent respiratory papillomas among children is estimated at 4.3 per 100,000; among adults, 1.8 per 100,000. The carbon dioxide laser was favored by 92% of respondents. No consensus was reached on the role for cesarean section. Forty-six percent of respondents favored the use of a laser-safe endotracheal tube for anesthetic management. CONCLUSION: A registry of patients with recurrent respiratory papillomas would benefit future research protocols and provide long-term follow-up of patients.

Adult↗
PubMed1995

Uvulopalatopharyngoplasty: treatment of obstructive sleep apnea in neurologically impaired pediatric patients.

Bona fide obstructive sleep apnea is rare in the pediatric age group. Traditional surgical management for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy alone, however, severely affected children may require uvulopalatopharyngoplasty (UPPP) or tracheostomy to relieve their obstruction. Children with OSA along with other medical maladies (e.g. cerebral palsy, down syndrome) pose an additional challenge to the otolaryngologist due to poor muscular tone and other medical problems which may complicate postoperative management. We report on 15 children (aged 23 months-13 years, mean 7.4 years), 12 with severe mental insufficiency, with documented OSA who underwent classical or modified UPPP. Twelve of 15 had clinical and/or objective improvement. We conclude that UPPP has a role in the management of neurologically-impaired children with OSA.

Adenoidectomy↗
PubMed1995

Pediatric tonsillectomy and adenoidectomy procedures.

The most common pediatric surgical procedures performed in the United States today are tonsillectomies and adenoidectomies (T&A). Surgical team members must be highly trained and efficient to ensure optimal patient outcomes, reduce surgical costs, and decrease the risk and potential complications inherent in T&A procedures. The authors review current surgical indications for T&A procedures; recommended preoperative, intraoperative, and postoperative patient care; and the management of potential complications.

Adenoidectomy↗
PubMed1995

The effect of very early cleft palate closure on the need for ventilation tubes in the first years of life.

The otologic consequences associated with cleft palates are well known. Closure of palatal clefts within the first weeks of life has many potential benefits, including improved feeding and cosmesis. The potential otologic benefits of very early closure are not known. Eighteen newborns have undergone closure of their palatal clefts within the first month of life with subsequent otolaryngology follow-up through our craniofacial center. Thirteen (72%) of the 18 still required placement of ventilation tubes during their first 3 years of life because of persistent effusion (for more than 120 days) or recurrent infection (more than four episodes in 6 months or more than six episodes in 12 months). Very early cleft palate closure may not significantly alter the need for ventilation tubes in children with palatal clefts.

Cleft Palate↗
PubMed1994

Retrieving foreign bodies from upper aerodigestive tracts of children.

Ingestion is foreign body lodgment in the esophagus, whereas aspiration is lodgment of foreign bodies in the larynx, trachea, or bronchi. Foreign bodies constitute an emergency when actual or potential airway obstruction occurs, when there is an esophageal perforation, or when disc batteries are ingested and lodged in the esophagus. A ventilating bronchoscope of appropriate size is essential to the removal of a foreign body in the airway or esophagus. Successful management of foreign bodies in the upper aerodigestive tracts of children is directly proportional to the time and effort spent in preoperative preparation.

Child↗
PubMed1993

Pediatric otolaryngology procedures in the United States: 1977-1987.

Common pediatric otolaryngology inpatient procedures for the years 1977 through 1987 are analyzed utilizing data provided by the National Hospital Discharge Survey (NHDS) of the National Center for Health Statistics. The data available reveal that adenotonsillar surgery remains the most frequent inpatient surgical procedure performed on all children under age 15 in spite of a decline in both the total number of adenotonsillar procedures and the rate per 100,000 population of greater than two-fold over this 11 year period. The total number of myringotomies with and without insertion of ventilation tubes and the rate per 100,000 children also decreased by greater than threefold during the same time span. Although representative of inpatient, non-institutionalized health care, the NHDS suffers from its lack of data concerning surgery performed in freestanding, ambulatory surgical facilities and military hospitals.

Adenoidectomy↗
PubMed1992

Kawasaki disease: five-year experience at Children's National Medical Center.

Kawasaki Disease (KD) is an acute multisystem disease that predominately affects infants and children. Coronary artery aneurysms or ectasia may develop in 15-25% of children with the disease and may lead to myocardial infarction or sudden death. Head and neck manifestations are often the presenting symptoms, thus the otolaryngologist may be asked to evaluate a child early in the course of the disease. Otolaryngologist need to be familiar with the early symptoms of this disease so that prompt diagnosis may be made and appropriate therapy instituted. Recent therapeutic advances have been shown to be effective in reducing the prevalence of coronary artery abnormalities. The authors retrospectively reviewed cases of KD seen at Children's National Medical Center over a 5-year period. Sixty-nine cases were included in the reviews and all children exhibited head and neck manifestations upon admission. Our data and review of the relevant literature underscore the need for heightened awareness among our profession in regards to KD.

Adolescent↗
PubMed1991

Vocal quality of decannulated children following laryngeal reconstruction.

Laryngotracheal reconstruction with expansion surgery is a reliable method for treatment of laryngotracheal stenosis in children. It allows for decannulation of the patient and restoration of vocal communication. Previous information regarding vocal quality in these patients has been scant. Sixteen children who underwent successful laryngotracheal reconstruction were evaluated using a standardized voice assessment during each of the following: phoneme prolongation, counting, storytelling, and spontaneous conversation. Interjudge ratings were obtained to establish reliability. The location and severity of the laryngotracheal stenosis and the method of treatment were reviewed. Twelve children have a functional voice compared to six preoperatively. Overall, vocal parameters suggested a particular pattern consisting of a lower than optimal pitch and a restricted pitch range. Laryngotracheal reconstruction does make oral communication possible for children who would otherwise have persistent tracheotomy. However, vocal quality appears to be disturbed in most of the patients.

Child↗
PubMed1991

Laryngeal pathology in hearing-impaired children.

Eighty-five children enrolled in a total communication elementary school for the severe-to-profoundly hearing-impaired were evaluated prospectively to assess the incidence of laryngeal abnormalities. Direct flexible laryngoscopy and indirect mirror laryngoscopy revealed vocal cord nodules in 3 children, omega-shape infantile epiglottis in 3 children, and normal larynges in the remaining 79 children. These findings suggest that severe-to-profoundly hearing-impaired children develop detectable laryngeal pathology at approximately the same frequency as previously reported by others for normal hearing children.

Adolescent↗
PubMed1991

Adenotonsillectomy in children with sickle cell disease.

The pediatric patient with sickle cell disease risks having a vasoocclusive episode during adenotonsillectomy under general anesthesia. With proper patient selection and appropriate perioperative management, adenotonsillectomy can be accomplished safely in children with sickle cell disease. We review the management of 10 children with sickle hemoglobinopathies who had adenotonsillectomy. Indications for surgery were recurrent streptococcal infections in four and obstructive sleep apnea in six of these children. No complications resulted from any of these procedures, and the mean length of postoperative hospitalization was 2.4 days. The principal feature of preoperative management was the transfusion of red blood cells to suppress the patient's endogenous erythropoiesis and to reduce the concentration of sickle cell hemoglobin to less than 30%. Though a prospective, multi-institutional clinical trial will ultimately be required to settle the issue of the safest preoperative management of children with sickle cell disease, balancing the risks of transfusion-related complications against anesthesia-related complications, our experience supports the operative safety of hypertransfusion therapy in children with sickle cell disease.

Adenoidectomy↗
PubMed1991

Management of otolaryngic patients susceptible to malignant hyperthermia without dantrolene.

Malignant hyperthermia (MH) is an adverse reaction most frequently associated with the administration of halogenated inhalational anesthetic agents and the depolarizing muscle relaxant succinylcholine. Characteristic findings are a hypermetabolic state accompanied by extreme hyperpyrexia, acidosis, rhabdomyolysis, and generalized muscle rigidity, often involving the masseter muscles. Dantrolene sodium, which was approved in 1979 by the FDA for use in the prevention of MH in high-risk patients, has neurologic and gastrointestinal side effects. At the Children's National Medical Center (CNMC), 24 children identified as being at risk for the development of a MH reaction were anesthetized for otolaryngic procedures by using "non-triggering" anesthetics and without use of dantrolene sodium. These patients represent 56% of all patients at risk for MH or masseter muscle rigidity (MMR) reactions during an 8-year period at the CNMC. There were no complications. Concomitant muscle biopsies were performed, and caffeine/halothane contracture studies were completed in 18 of these patients, demonstrating 11 susceptible or equivocal responses. The data suggest that children undergoing common otolaryngic procedures who are at risk for development of MH may be safely anesthetized without the use of prophylactic dantrolene sodium.

Anesthesia↗
PubMed1990

Airway compromise from nasal obstruction in neonates and infants.

Nasal obstruction in neonates can cause significant airway compromise and even be life-threatening. In general, otolaryngologists are familiar with management of the neonate born with choanal atresia but there have been few reports and there are no guidelines for management of the neonate or young infant who presents with nasal obstruction and airway compromise but who does not have choanal atresia (NOWCA). This study demonstrates the difficulty in diagnosis, variability in severity of airway compromise, and delineates the problematic aspects of management.

Adenoids↗