Otologic referral: indications and expectations.
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Adenoidectomy↗
Biomedical subjects
G A Gates
Publications and source records attributed to G A Gates.
Change in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy.
The pharyngoesophageal high pressure zone (PE-HPZ) was measured prelaryngectomy and postlaryngectomy with a new force-summing probe that accounts for sphincter pressure asymmetry. A total of 31 patients were studied six times each. Postoperatively, pressures dropped from 130+/-24 mm Hg to 66+/-9 mm Hg. After a standardized, intensive laryngectomy rehabilitation program, 12 of 19 postoperative patients acquired acceptable esophageal speech and 7 did not. Speakers and nonspeakers were found to have nearly identical PE-HPZ pressures (speakers = 70+/-10 mm Hg, nonspeakers = 59+/-18 mm Hg). Differences in sphincter length or relaxation likewise did not discriminate between these two groups. We conclude that PE-HPZ pressure is not a critical determinant of the acquisition of esophageal speech.
Aged↗
Effect of anesthetic gases on middle ear pressure in the presence of effusion.
Halothane, randomly with or without nitrous oxide (N2O), was administered by face mask to 69 children (selected by tympanometric and otoscopic evidence of chronic otitis media with effusion) for pressure equalization (PE) tube insertion in one or both ears. Tympanograms were obtained from 127 ears prior to and soon after the induction of a satisfactory level of anesthesia. The effect of anesthesia was identical whether N2O was used or not: 85% (75/88) of ears with flat tympanograms (B) remained B (all contained fluid); 15% (13/88) became peaked and 62% (8/13) of those contained fluid. All but two ears with peaked tympanograms showed substantial increases in middle ear pressure (mean: 179 mm H2O, range: -70 to +550 mm H2O) regardless of the presence of fluid. We conclude the N2O is not responsible for aerating the middle ear in the usual surgical setting, and that assisted ventilation used in mask inhalation anesthetic techniques will inflate all normal middle ears, most ears with a peaked tympanogram regardless of fluid, and 15% of ears with a nonpeaked tympanogram. It is unlikely that inhalation of anesthetic gases is responsible for displacement of middle ear fluid down the eustachian tube within the time constraints of the usual operating room setting.
Anesthesia, Inhalation↗
Predicting esophageal speech.
Patients undergoing laryngectomy in the 1980s have a low rate of acquisition of esophageal speech. The interaction of the factors of postoperative physical performance status, preoperative phonation duration, postoperative dysphagia, site of lesion, patient income, and postoperative radiation therapy correctly predict the acquisition of esophageal speech in 83% of cases and the failure to acquire esophageal speech in 96%. Such information may be helpful in selecting patients for alternative forms of postlaryngectomy speech rehabilitation.
Humans↗
Effect of beta blockade on singing performance.
The symptoms associated with performance anxiety, or the so-called stage fright syndrome, are similar to those of alpha and beta adrenergic stimulation. Suppression of symptoms and improvement in instrumentalist's performance after beta blockade suggest that this modality would be of benefit for singers as well. To evaluate the dose-effect relationship of beta blockade upon singing performance and the possible effect of these agents upon performance maturation, we studied 34 singing students during end of semester juries, using a double-blind crossover paradigm. Students performed once with either placebo, 20, 40, or 80 mg of nadolol, and again 48 hours later, with placebo. There was a significant dose-related, limiting effect upon intraperformance cardiac rate. A small, but statistically significant, dichotomous effect upon performance rating was noted: low-dose nadolol tended to enhance performance, whereas larger doses impaired performance. We conclude that the effects of low dose beta blockade upon singing are minimally helpful and high doses may detract from performance ability.
Adolescent↗
Predictive value of tympanometry in middle ear effusion.
The presence of middle ear effusion may be inferred from a tympanogram by the configuration of the pressure compliance curve. Not infrequently, however, effusion is absent at the time of surgery when strongly indicated by preoperative tympanometry. We evaluated this discrepancy by contrasting preoperative tympanograms with the findings at surgery in 462 children, aged 4 to 8 years, with clinical evidence of persistent effusion in 909 ears. Based on these results we can classify tympanograms as to high risk for effusion, intermediate, and low risk. The proportion of ears with effusion was 83%, 47%, and 34%, respectively. The proportion of ears with fluid in the high risk tympanogram group did not change appreciably over a 1- to 8-week period, ie, no trend toward spontaneous resolution occurred. The high incidence of effusion at surgery in our low risk group is far higher than expected and is presumably due to reinfection of these ears during the time between examination and operation.
Acoustic Impedance Tests↗
Efficacy of acoustic reflectometry in detecting middle ear effusion.
The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.
Acoustic Impedance Tests↗
Acute mastoiditis and cholesteatoma.
Acute coalescent mastoiditis is an uncommon sequela of acute otitis media. It occurs principally in the well-pneumatized temporal bone. The findings of fever, pain, postauricular swelling, and otorrhea are classic. Cholesteatoma, on the other hand, being associated with chronic infection, usually occurs in the sclerotic temporal bone. The signs and symptoms are isidious in nature and consist of chronic discharge and hearing loss which result from its mass, bone erosion, and secondary infection. Of 17 consecutive cases of acute mastoiditis over a six-year period, four were atypical because they were complications of chronic otitis media and cholesteatoma, yet they had the physical findings of acute mastoiditis-subperiosteal abscess and purulent otorrhea, plus radiographic evidence of mastoid coalescence.
Acute Disease↗
Panel discussion on management of inflammatory airway obstruction in children.
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Child↗
Rabies: otolaryngologic manifestations.
Rabies is a rare, fatal viral infection, usually transmitted by the bite of an infected animal. Some 30,000 Americans are immunized annually, however, so public health considerations are common. The development of a new vaccine, grown in human diploid cell culture, is discussed. It appears to have high antigenicity with no serious morbidity. A case of a patient with fatal rabies who had fever, delirium, dysphagia, and cervical and pectoral subcutaneous emphysema is presented.
Adolescent↗
Mucoceles of the sphenoid sinus.
Mucoceles of the sphenoid sinuses are uncommon; 60 cases have been reported in the world literature to date. Signs and symptoms are caused by local expansion of the mucocele and include headache (the most common symptom), ocular field deficits, external ophthalmoplegia (particularly the sixth cranial nerve), and proptosis. Radiologic correlation in the form of plain films and polytomorgraphy is the most reliable guide in the diagnosis of sphenoid sinus disease. Therapy of these lesions is surgical, and drainage can be achieved via the external ethmoid or sublabial transseptal route. Three cases are presented: two had classical findings and the third was conspicuous by the presence of aseptic meningitis in the absence of local findings.
Adult↗
Unilateral tonsillar enlargement.
Unilateral tonsillar enlargement may result from infection, chronic inflammatory response, or neoplasm. Neoplasms that commonly produce a unilaterally enlarged tonsil include lymphomas (lymphocytic and histiocytic types) and squamous cell carcinomas. Rarer tumors include extramedullary plasmacytomas, Hodgkin's disease, leukemia, and metastatic neoplasms. Sixteen cases of unilateral tonsillar enlargement owing to causes other than squamous cell carcinoma are reviewed. When examining a patient with unilateral tonsillar enlargement, diagnosis of a neoplastic disease must be considered.
Adolescent↗
Current status of radiosialography in tumor diagnosis.
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Adenocarcinoma↗
Pulmonary edema as a complication of acute airway obstruction.
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Adult↗