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Biomedical subjects

G Isaacson

Publications and source records attributed to G Isaacson.

At least 19 recordsLinked to original sources
PubMed2000

First branchial cleft cyst excision with electrophysiological facial nerve localization.

OBJECTIVE: To assess the safety and efficacy of surgical excision of selected first branchial cleft cysts using electrophysiological rather than anatomical location of the facial nerve. DESIGN: Retrospective review of consecutive surgical procedures by a single surgeon, using a consistent technique during a 9-year period. SETTING: Tertiary pediatric medical center. PATIENTS: Eleven children with first branchial cleft cysts. INTERVENTIONS: Selected first branchial cleft cysts were removed using a smaller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotidectomy and identification of the nerve trunk and branches. MAIN OUTCOME MEASURES: Successful removal of the lesion, avoidance of facial nerve injury, incidence of Fry syndrome, and cosmesis. RESULTS: Eleven patients underwent surgical excision of first branchial cleft cysts during a 9-year period. Ten lesions were removed without the need for anatomical localization of the facial nerve trunk. There was no facial weakness, recurrence of the lesions, or Fry syndrome during a follow-up of 6 months to 7 years. Cosmesis was superior. CONCLUSION: Electrophysiological location of the facial nerve may, in the appropriate setting, replace anatomical localization for first branchial cleft cysts that are (1) superior to the stylomastoid foramen and (2) not previously infected or surgically violated.

Branchioma↗
PubMed2000

Adenoidectomy with laser or incisional myringotomy for otitis media with effusion.

OBJECTIVE: To compare the effectiveness of CO2 laser myringotomy to incisional myringotomy at the time of adenoidectomy for refractory otitis media with effusion (OME). STUDY DESIGN: Controlled retrospective consecutive case series. METHODS: All children undergoing myringotomy and adenoidectomy for OME in the spring of 1999 had 1.7-mm-diameter perforations created in their tympanic membranes using a CO2 laser and conventional microslad. Their ears were evaluated at first postoperative visit (mean, 16.65 days after surgery) by a validated otoscopist to determine the presence or absence of perforations and middle ear effusions. These patients were compared with historical controls comprising all children undergoing incisional myringotomy and adenoidectomy in 1998. A chi2 analysis was performed to compare the results of these two myringotomy techniques. RESULTS: Twenty-three children (39 ears) underwent laser myringotomy and adenoidectomy in 1999, compared with 26 children (48 ears) who underwent incisional myringotomy and adenoidectomy in 1998. In the laser myringotomy group, 8 of the 39 ears had a persistent opening at first follow-up; 4 of the 39 ears showed evidence of effusion. In the incisional myringotomy group, all 48 ears had healed; 7 of these ears showed evidence of effusion. CONCLUSION: Myringotomies created using the CO2 laser are more likely to be patent at first postoperative visit than those made with incisional technique (P < .01). However, this prolonged middle ear ventilation does not significantly decrease the prevalence of effusion (P > .1).

Adenoidectomy↗
PubMed2000

Universal newborn hearing screening in an inner-city, managed care environment.

OBJECTIVES/HYPOTHESIS: Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the first months of life. Several states have mandated UNHS for all newborns. Such programs have been successful in small, homogeneous populations. As larger states attempt to implement such programs, important obstacles have arisen, particularly in sparsely populated rural environments and in the inner city, where poverty, unstable living situations, and inadequate access to health care make follow-up of infants failing initial testing difficult. STUDY DESIGN: We performed a prospective longitudinal study examining the effects of increasingly complex and expensive interventions designed to ensure that children failing initial hearing screening returned for complete evaluation and habilitation. METHODS: A UNHS program based on transient evoked otoacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was assessed and modifications in follow-up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect of these interventions was reassessed 6 months later. RESULTS: In its first 12 months, the Temple University Infant and Young Child Hearing Intervention Initiative successfully screened 95% (2,031) of all newborns using transient evoked otoacoustic emissions. Collecting a complete database profile for each newborn, establishing rapport with the family, and offering immediate follow-up appointments yielded a 61% return rate after discharge. The addition of a dedicated project secretary, free day-care for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow-up yield to 75%. CONCLUSION: Given adequate resources and planning, UNHS can be successful, even in economically depressed environments.

Audiometry, Pure-Tone↗
PubMed2000

Bilateral laryngoceles in a young trumpet player: case report.

We report the case of a 16-year-old trumpet player who was referred for an otolaryngologic consultation after his band leader noticed that a neck mass would protrude while the boy was playing. X-rays revealed the presence of bilateral laryngoceles, and computed tomography demonstrated bilateral, air-filled outpouchings of the laryngeal saccules during forced expiration. There was no evidence of any other intra-laryngeal or cervical pathology. Surgery was deferred while the laryngoceles remained reducible and asymptomatic, and the boy was cleared to continue playing.

Adolescent↗
PubMed1999

Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood.

OBJECTIVE: The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens. METHODS: We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure. RESULTS: We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results. CONCLUSION: An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.

Adolescent↗
PubMed1999

Ossiculoplasty in young children with the Applebaum incudostapedial joint prosthesis.

OBJECTIVE: To evaluate the performance of the Applebaum incudostapedial joint prosthesis in young children in terms of hearing results and long-term stability despite continuing eustachian tube dysfunction and otitis media. STUDY DESIGN: Retrospective review of all Applebaum prostheses placed in children at our institution from June 1993 to June 1998. RESULTS: In 1993 Applebaum proposed the use of a hydroxylapatite ossicular prosthesis as an alternative to incus interposition for the repair of incudostapedial discontinuity. We have used this prosthesis exclusively for the repair of such defects in children over the past 5 years. Among 12 operated ears, all healed, all prostheses remain in place (average duration, 2.6 y), and all children have excellent hearing (mean air-bone gap, 15 dB; range, 5-25 dB). CONCLUSIONS: The Applebaum incudostapedial joint prosthesis restores conductive hearing even in young children. It has been stable in the face of recurrent otitis media and has not interfered with revision surgery. Placement of the prosthesis at primary cholesteatoma surgery should be considered in children.

Adolescent↗
PubMed1999

Prospective application of a protocol for selective nonsurgical management of suspected orbital subperiosteal abscesses in children.

Goodwin et al (1982) and Souliere et al (1990) have proposed a protocol for the selective nonsurgical management of suspected orbital subperiosteal abscesses. This protocol has been routinely applied by the Temple Pediatric Otolaryngology and Ophthalmology services since 1990. During this period, children with computed tomography and physical examination findings consistent with orbital subperiosteal abscesses and visual acuity better than 20/60 were treated with intravenous antibiotics rather than immediate surgery. They were followed with frequent ophthalmologic examinations and operated upon if vision deteriorated or they failed to improve clinically within 48 hours. A review of patients admitted to St Christopher's Hospital for Children, the site of Temple University's pediatric activities in the years from 1991 to 1997, revealed 14 patients with clinical evidence of orbital subperiosteal abscesses. Twelve patients were treated in accordance with the Goodwin-Souliere protocol. All recovered completely without surgical intervention and without any adverse sequelae. Selective nonsurgical treatment of clinically diagnosed orbital subperiosteal abscesses in children is relatively safe and effective.

Abscess↗
PubMed1999

Otoendoscopy for improved pediatric cholesteatoma removal.

Our objective was to determine the usefulness of intraoperative rigid endoscopy in detecting incompletely removed cholesteatomas, and to learn whether "second-look" procedures are still needed in children. We used 30 degrees, 2.7-mm endoscopes to evaluate the middle ears of 14 children (29 procedures) with cholesteatomas once all visible disease had been removed under the operating microscope. If residual cholesteatoma was seen, removal continued until all disease visualized with the endoscope was removed. If the cholesteatoma was not removed intact, planned exploratory surgery was performed. The rigid endoscope detected incompletely removed cholesteatomas at surgery in 7 of the 29 cases (24%). In 2 of the 11 cases (18%) judged free of cholesteatoma by both otomicroscopy and otoendoscopy, residual disease was found at planned exploratory procedures. While otoendoscopy is clearly useful in detecting incompletely removed cholesteatoma, a substantial rate of residual disease following "complete" removal suggests the continued need for planned exploratory procedures.

Adolescent↗
PubMed1998

Electrosurgery in the head and neck.

Electrosurgery is widely used in the practice of otolaryngology-head and neck surgery. Despite its popularity, few training programs give formal education in the optimal use of electrosurgical instruments. This article reviews the history, physics, and tissue effects of these commonly used devices. Armed with this knowledge, the head and neck surgeon can take full advantage of electrosurgery's ability to dissect tissues with precision and minimal blood loss.

Electrosurgery↗
PubMed1997

Effect of sinus surgery on pulmonary function in patients with cystic fibrosis.

The impact of sinus surgery on the pulmonary status of cystic fibrosis patients is unknown. This retrospective study reviewed the charts of the cystic fibrosis patients presenting to our institution's cystic fibrosis center with nasal obstruction, recurrent sinusitis, and nasal polyposis. This group subsequently underwent endoscopic ethmoidectomy and antrostomy. Fourteen of the 15 patients, ages 5-24 years, received preoperative and postoperative pulmonary function testing obtained by spirometry. The data were compiled and analyzed statistically. Our results suggested no significant improvement in the pulmonary function of cystic fibrosis patients after sinus surgery.

Adolescent↗
PubMed1997

State-dependent laryngomalacia.

We have observed 5 infants who demonstrate normal breathing when awake, but develop stridor while asleep. Flexible laryngoscopy in the awake state reveals either a normal larynx or redundancy of the aryepiglottic folds or arytenoid soft tissue without prolapse into the laryngeal inlet. When these children are sedated, however, the classic signs of laryngomalacia appear. Wet inspiratory stridor with concomitant supraglottic prolapse can be demonstrated by flexible videolaryngoscopy in this state. As these findings vary with level of consciousness, we have dubbed this condition "state-dependent" laryngomalacia. We believe the appearance and disappearance of classic laryngomalacia with changes in level of consciousness adds credence to the neurogenic theory of laryngomalacia.

Consciousness↗
PubMed1997

Pediatric ethmoid mucoceles in cystic fibrosis: long-term follow-up of reported cases.

Ethmoid mucocele, a condition that usually affects adults, can be found in both children and infants with cystic fibrosis. We have cared for two patients with cystic fibrosis and ethmoid mucoceles. Because we could find no references to the prognosis or any long-term follow-up data for this disorder, we contacted the physicians and families of six of the seven patients with this condition previously reported in the English literature to determine how they were managed surgically and the incidence of recurrence. Regardless of the mode of therapy, none of the mucoceles recurred.

Child↗
PubMed1996

Care of the child with tympanostomy tubes.

More than two million tympanotomy tubes are placed annually in the United States, making this operation the most common performed on children. This article provides an overview of the applications of tympanotomy tubes for the treatment for otitis media in childhood. The indications for tube placement are discussed; a visual guide for managing children with tympanostomy tubes is presented; an approach to dealing with tube complications is outlined; and guidelines for referral to a pediatric otolaryngologist are suggested.

Child↗
PubMed1996

Sinusitis in childhood.

There is much to be learned about sinusitis in children. The appropriate choice and timing of diagnostic tests, correct type and duration of antibiotic treatment, role of allergy management and adjuvant drugs, and indications for and limits of endoscopic sinus surgery remain to be defined. Technological advances have been introduced and accepted as standard with little validation. Well-thought-out, controlled studies of diagnostic and treatment modalities are needed to address these issues and to better understand the function of the sinuses in health and illness.

Anti-Bacterial Agents↗
PubMed1996

Patterns of sinusitis in cystic fibrosis.

It has been pediatric dogma that most children with cystic fibrosis (CF) have pansinusitis and few are symptomatic. To reassess this premise, we compared symptoms, clinical examinations, radiographic and surgical findings, and results of treatment in 19 children with cystic fibrosis who had undergone computed tomography at St. Christopher's Hospital (Philadelphia) from 1991 to 1994. We found two distinct patterns of sinus disease: chronic sinusitis (n = 3) and polyposis (n = 12). Two of the patients with polyposis had ethmoid mucoceles and 1 child had no sinus disease at all. Children with chronic sinusitis had headache as a major complaint, while those with polyposis suffered nasal obstruction alone unless a mucocele was present. Surgery provided marked and lasting improvement in the 14 patients who were operated on.

Child↗
PubMed1996

Acute airway obstruction in the hospitalized infant: four hard lessons in the distal trachea.

Acute obstructing lesions of the distal (lower) trachea present a unique challenge to the pediatric otolaryngologist. The small caliber of the airway and tenuous medical status of such patients test the ingenuity of the surgeon and the limits of instrumentation. This report presents the operative findings and management of four hospitalized infants with worsening respiratory distress. Difficulties encountered in maintaining airway control while diagnosing and correcting these lesions are described.

Airway Obstruction↗