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Biomedical subjects

D R Edelstein

Publications and source records attributed to D R Edelstein.

18 recordsLinked to original sources
PubMed1997

Concurrent functional endoscopic sinus surgery and rhinoplasty.

Traditionally surgeons have avoided performing rhinoplasty in conjunction with sinus surgery for rhinosinusitis. With advances in rhinoplasty and endoscopic sinonasal surgery and its added benefits of precision, minimal trauma, and hemorrhage, the combined procedure is now feasible. The indications, management, and results are discussed in 40 patients who underwent the combined procedure. Patients were divided into three categories based on the location and severity of the sinus disease: mild, moderate, or severe. The majority of patients had mild or moderate sinus disease. The most common presenting symptoms were nasal obstruction and postnasal drip. All patients had a history of sinusitis recalcitrant to conservative medical management. Results demonstrate the combined treatment modality to be safe and effective in patients with mild to moderate sinus disease and in selected patients with severe sinus disease.

Adolescent↗
PubMed1996

Aging of the normal nose in adults.

Like other organs, the nose changes as the body ages. A review of the literature reveals a basic understanding of the aging process in the nose but a paucity of documentation and few organized studies. This study was designed to identify systematically the agerelated changes in the normal, nondiseased adult nose. A nasal-sinus laboratory was created, and a computerized patient database was developed. Four separate investigations were conducted. First, 111 subjects ranging in age from 21 to 94 years of age were studied prospectively using 135 variables. The following data were collected: history, symptoms, physical examination, rhinomanometry, ciliary beat frequency, smell testing, and incentive spirometry. Second, photographs of a separate group of 105 subjects 20 to 86 years of age were studied to ascertain the facial cephalometric changes that occur with aging. Third, a histopathologic examination of the nasal septum was performed in 20 additional subjects to evaluate the cellular changes that accompany aging. Finally, an epidemiologic study analyzing the prevalence of various nasal complaints by age was conducted, based on a review of more than 11,000 patient charts from surgeries and office visits. A number of specific age-related changes in the nose were identified, including an increased likelihood of certain nasal complaints, a pattern of increasing airflow resistance, and a decrease in physical abnormalities in the nasopharynx. The appearance of the nose, as measured by the nasolabial angle and the height/length ratio, was also found to change with age.

Age Distribution↗
PubMed1994

Microfiberoptic evaluation of the middle ear cavity.

Endoscopic instruments have revolutionized surgical diagnosis and treatment. Recently, a high resolution microfiberoptic endoscope has been developed that has vast potential for otologic use. This microfiberoptic endoscope was used in cadaver and human studies to visualize the middle ear cavity. The technique used involved placing a 1.0-mm or smaller microfiberoptic scope into the middle ear via a tympanic membrane perforation, through a myringotomy tube or up the eustachian tube. Using the scope, the mesotympanum and hypotympanum can be well visualized. Similarly, the round window, oval window, ossicular chain, and related structures can be clearly demonstrated and recorded photographically. This technique has great potential to enhance diagnosis without open surgery.

Adolescent↗
PubMed1993

Evaluation of cefixime in the treatment of bacterial maxillary sinusitis.

The efficacy and safety of cefixime, the first oral third-generation cephalosporin, were evaluated in a multicenter clinical trial involving 118 adult patients with acute sinusitis or acute exacerbations of chronic sinusitis. Patients received a single daily dose of 400 mg of cefixime for a mean duration of 10 days; 106 patients completed a course of therapy. Clinical cure and improvement were achieved in 90% of these patients (61% cured and 29% improved). Among the patients evaluated again 2 weeks after therapy, 91% had a sustained clinical cure or improvement. Sinus exudate specimens were obtained from all patients by transantral puncture before therapy. Pathogens were isolated from 76 patients (66%), the most common pathogens being Haemophilus influenzae, alpha-hemolytic streptococci, and Streptococcus pneumoniae. Eighty-six percent of pathogens were presumed eradicated. Three patients discontinued therapy because of side effects. The most frequently reported adverse effects were gastrointestinal, with 20% of patients reporting diarrhea. Cefixime was effective in the treatment of bacterial sinus infections in adults and was well tolerated.

Acute Disease↗
PubMed1993

Once-a-day therapy for sinusitis: a comparison study of cefixime and amoxicillin.

The efficacy and safety of a once-a-day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once-a-day cefixime, a third generation cephalosporin, or amoxicillin three times a day. One hundred and fourteen patients were evaluated with antral punctures, microbiologic evaluation, and radiographic studies. Cultures revealed 40% gram-negative organisms, 48% gram-positive, and 12% anaerobes. The most common bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and viridans group streptococci. Ninety-four percent of the cefixime group were cured compared with 96% of the amoxicillin group. Staphylococcus resistance was a problem in both groups, necessitating an occasional change to amoxicillin-clavulanate potassium in the amoxicillin group. Once-a-day antibiotics offer the potential for improved compliance in the treatment of sinusitis. Cefixime offers an additional benefit of covering beta-lactamase producing strains of bacteria which are increasing in incidence and resistant to many penicillins.

Administration, Oral↗
PubMed1992

Surgery for recurrent and residual cholesteatoma.

One hundred twelve patients (116 ears) were treated for recurrent and residual cholesteatoma. A retrospective review revealed that 66% had undergone canal wall down mastoidectomy at the previous surgery. The surgical procedure at revision was selected on the basis of an intraoperative assessment of the extent of disease, and clinical prediction of eustachian tube function. The average period of follow-up was 3.4 years. Revision surgery was successful in providing the patient with a safe, dry ear in 105 (91%) of 116 cases. Surgical principles and hearing results are presented.

Adult↗
PubMed1991

Management of labyrinthine fistulas caused by cholesteatoma.

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall-down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long-term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.

Adolescent↗
PubMed1990

Assessment of clinical skills using videotapes of the complete medical interview and physical examination.

Complete medical interviews and physical exams were performed on two stimulated patients by a class of medicine interns. These interviews and examinations were videotaped and were then scored using a rating scale developed by the authors. This system of videotaping and rating complete interviews and physical examinations is called the The Northwestern Evaluation & Training System (NETS). Selected findings are presented and discussed. It is shown how the NETS can be used for educational feedback to the individual student and for quality assurance feedback to training programs regarding the effectiveness of their instruction in interview and physical examination skills.

Clinical Competence↗
PubMed1989

The large vestibular aqueduct syndrome in children. A review of 12 cases and the description of a new clinical entity.

The large vestibular aqueduct as an isolated anomaly of the temporal bone has been previously identified radiologically, and its association with sensory neural hearing loss has been recognized. It has not, however, been defined as a distinct clinical entity in children. We studied 12 children, ages 3 to 9 years, with downward-fluctuating progressive high-frequency neurosensory hearing losses whose symptoms were thought to be related to the isolated enlargement of the vestibular aqueduct identified by high-resolution computed tomographic scanning. Previously it had been assumed that a large vestibular aqueduct is a temporal bone dysplasia that is a variant of the Mondini type of deformity and that the associated hearing loss is congenital in nature. Our clinical observations, however, indicate that the hearing loss in children with an isolated enlargement of the vestibular aqueduct is acquired during childhood. The natural history of this progressive deafness is reviewed, and a pathophysiologic hypothesis is presented.

Audiometry↗
PubMed1989

Acquired cholesteatoma in the pediatric age group.

Successful treatment of cholesteatoma in children is based on the same principles of therapy used in adults. A clinical profile of children with acquired cholesteatoma is compared with that of adults. Issues related to aggressiveness of disease, pathophysiology, diagnostic problems, and treatment approaches are discussed.

Adolescent↗
PubMed1989

Surgical techniques and recidivism in cholesteatoma.

Cholesteatoma is a difficult disease to treat as demonstrated by the relatively high recidivism rate attained by the best of surgeons. The concept of recidivism encompasses all reoccurrence of the disease, regardless of the theorized origins. This is a term that should be accepted so that some uniformity may be introduced into the evaluation of this disease. A standard reporting format that includes the extent of the disease, the eustachian tube function, the integrity of the ossicles, and a uniform description of the surgical procedure would enhance future evaluations of this disease. The future of otology still lies in finding new ways to eradicate this disease and to avoid recidivism.

Adult↗
PubMed1989

Management of congenital pediatric cholesteatomas.

During the past 10 years discrete middle ear congenital cholesteatomas have been detected with greater frequency in young children. The increased recognition of this condition is probably related to the pediatricians' greater awareness of this defect, their improved facility with pneumatic otoscopy, and effective audiometric and tympanometric screening procedures. This early detection while the lesions are small and localized facilitates their surgical removal. Clinically, it would appear that congenital cholesteatomas can be subdivided into two categories according to their anatomic locations. The anterior lesions present as an isolated pearl that arise from an area on the anterior surface of the malleus, are usually associated with normal hearing, and have pneumatized mastoids. The posterior lesions do not seem to originate from a clearly defined anatomic area, have a higher incidence of sclerotic mastoids, and erode the ossicular chain commonly producing a hearing loss. The anterior middle ear cholesteatoma probably arises from a persistent epidermoid formation, a structure that normally is present during fetal development of involutes by the 33rd week of gestation. The origin of cholesteatomas arising in the posterior middle ear space remains more controversial.

Adolescent↗
PubMed1988

Otitis media.

Otitis media is a disease involving the inflammation and infection of the middle ear. Despite modern medical therapy, its widespread incidence in all age groups makes it one of the most common illnesses seen by physicians. The advent of a wide range of antibiotics has helped to decrease the number of complications resulting from the disease. Nevertheless, the large number of missed school and work days and the hearing losses and related problems that accompany otitis media make it a perpetual menace to public health.

Humans↗
PubMed1987

Fibrous dysplasia involving the temporal bone: report of three new cases.

Monostotic fibrous dysplasia, an unusual disease that can involve the temporal bone, will frequently cause an acquired stenosis of the external auditory canal. Three patients with this disorder who presented with occluded canals are described. Two individuals developed external canal cholesteatomas medial to the obstruction, one of whom eventually developed a postauricular abscess and infected draining sinus. The third patient presented with a restenosis nine months following canalplasty. The cases reported illustrate three surgical criteria necessary to manage these unusual cases successfully: removal of sufficient diseased bone to create a patulous canal; resurfacing denuded bony areas with thin split-thickness skin grafts to prevent soft tissue contractions; an adequate meatoplasty. Postoperatively, the reconstructed canals have remained patent and stable during follow-up periods ranging from one to four years. Clinical, radiographic, and pathologic features of fibrous dysplasia are discussed, the differential diagnosis is presented, and the relevant literature is reviewed.

Adolescent↗
PubMedDate not supplied

Verrucous carcinoma of the temporal bone.

Verrucous carcinoma, a familiar lesion of the oral cavity and larynx, is distinctly rare in the ear. We report five cases of verrucous carcinoma of the temporal bone, each of which fulfills Ackerman's histologic and biologic criteria. Only three cases of verrucous carcinoma of the ear have been previously reported. Most cases of verrucous cancers of the head and neck demonstrate a lack of nodal involvement, relatively slow growth potential, local invasiveness, and responsiveness to surgical treatment. In our five cases of verrucous carcinoma of the temporal bone, three had a biologic behavior similar to other verrucous tumors, while two cases were unusually aggressive. Three patients were treated surgically and had favorable outcomes, while the remaining two were treated with combination therapy. These cases highlight the difficulty in diagnosis and treatment as well as the lack of understanding of the biologic behavior of this rare otologic entity.

Aged↗
PubMedDate not supplied

Cholesteatoma in the pediatric age group.

The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%.

Adolescent↗
PubMedDate not supplied

The anatomic relevance of the Haller cell in sinusitis.

In current theories of sinusitis, obstruction at the ostiomeatal complex leads to localized inflammation and infection. Haller cells, an extension of ethmoid pneumatization along the maxillary antrum roof, have also been suggested as a causative factor in sinusitis because of their ability to cause narrowing of the infundibulum. Coronal CT scans were reviewed in 154 patients to evaluate the role of Haller cells in sinusitis. Haller cells were present in 34% of patients. The cells were graded as small, medium, or large, and correlated with radiologic evidence of sinusitis (e.g., mucosal thickening or opacification). A statistically significant increase in maxillary sinus mucosal disease was noted in patients with medium or large Haller cells (45.8%) versus those with small cells (28.9%, p < 0.05). Thus obstructive medium and large Haller cells may be an etiologic factor in sinusitis.

Ethmoid Bone↗