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Biomedical subjects

J P Bent

Publications and source records attributed to J P Bent.

At least 19 recordsLinked to original sources
PubMed2001

A comparison of cortisporin and ciprofloxacin otic drops as prophylaxis against post-tympanostomy otorrhea.

Myringotomy and tube insertion, a common pediatric surgical procedure, is frequently complicated by purulent otorrhea. Many otolaryngologists routinely use topical antibiotics as prophylaxis against post-tympanostomy otorrhea. The aminoglycosides (neomycin sulfate, tobramycin and gentamicin) contained in commonly used topical antibiotics as well as components of the solutions have been shown to be ototoxic in animal studies. Although little reported evidence of ototoxicity in humans exists, sporadic reports of sensorineural hearing loss linked to topical antibiotic use do exist, and the potential for sensorineural hearing loss must be considered. The purpose of this study is to compare the rate of post-tympanostomy otorrhea in a double-blinded randomized trial using either topical Ciprofloxacin, with no reported ototoxicity, or Cortisporin as prophylaxis. One hundred patients (200 ears) between ages 7 months and 11 years with a diagnosis of recurrent otitis media or chronic otitis media undergoing tympanostomy tube insertion were randomized into two equal groups. Three drops of either drop A or B were placed into each ear at the time of tube insertion and then three times daily for 3 days. Patients were examined at 3 weeks and details of otorrhea were obtained. The rate of otorrhea was analyzed using chi-square. The overall rate of otorrhea was 39 ears (19.5%), 17 (17%) ears for the Cortisporin group and 22 (22%) for the Ciprofloxacin group. The difference in rate of otorrhea was not statistically significant (P=0.372, 95% confidence interval equals -6-16%). Our data suggest that topical Cortisporin offers no benefit over Ciprofloxacin for post-operative otorrhea prophylaxis. Therefore we recommend topical quinolone prophylaxis, which should eliminate concerns about ototoxicity, without sacrificing efficacy.

Administration, Topical↗
PubMed2001

Congenital nasal pyriform aperture stenosis: non-surgical management and long-term analysis.

Congenital nasal pyriform aperture stenosis is a rare cause of airway obstruction in the newborn. Immediate recognition and therapy are essential for this potentially life-threatening condition. After initial management, which includes establishment of an oral airway, surgical repair of the stenotic bony inlet has been traditionally considered. We present a long-term follow-up of two patients with congenital pyriform aperture stenosis, who were managed expectantly. Pertinent embryology, clinical presentation, and general treatment strategies for these patients are also discussed.

Follow-Up Studies↗
PubMed2001

Atypical indications for OtoScan laser-assisted myringotomy.

OBJECTIVE: To describe the role of OtoScan laser-assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media. STUDY DESIGN: Cross-sectional review. METHODS: Twenty-seven office-based OtoLAM procedures were performed in 21 patients for "atypical" reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1). RESULTS: In each of the 20 cases available for follow-up, middle ear disease resolved with closure of the laser-assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction. CONCLUSIONS: Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.

Acute Disease↗
PubMed2000

Nasally inhaled dornase alfa in the postoperative management of chronic sinusitis due to cystic fibrosis.

OBJECTIVE: To determine the benefit of nasally inhaled dornase alfa in cystic fibrosis (CF) sinusitis. DESIGN: Retrospective chart review comparing postsurgical course, radiographic studies, and pulmonary function test results in patients who were treated with nasally inhaled dornase alfa with those in patients who were not treated with dornase alfa. PATIENTS: Twenty consecutive patients with CF who underwent functional endoscopic sinus surgery from 1993 to 1997 were included in the study. Treatment with nasally inhaled dornase alfa was initiated in 5 of the 20 patients after they underwent functional endoscopic sinus surgery. SETTING: Tertiary care academic center. RESULTS: The dornase alfa-treated patients had less mucosal edema and no polyps at serial endoscopy over 3 years compared with the non-dornase alfa-treated patients. The patients who received nasally inhaled dornase alfa also underwent fewer revision functional endoscopic sinus surgical procedures (1.6 vs 3.2), even though there was essentially no change in pulmonary function test results in these patients. CONCLUSIONS: Sinusitis continues to be a major cause of morbidity in patients with CF. Symptomatic patients frequently require multiple drug regimens, including long-term systemic antibiotic therapy, topical and systemic steroid therapy, and antibiotic nasal irrigations. This preliminary study indicates the potential impact of nasally inhaled dornase alfa in controlling postoperative symptoms in CF sinusitis.

Administration, Inhalation↗
PubMed2000

Tympanostomy tubes and otic suspensions: do they reach the middle ear space?

The treatment of patients with tympanostomy tubes (TTs) and otorrhea with medicated otic suspensions is well known, but confirmation of penetration into the middle ear is difficult. To address this question, we created an in vitro model of the human head and ear and then tested it with 5 different types of liquid exposure: tap water, soapy water, polymyxin B sulfate (Cortisporin), tobramycin and dexamethasone (TobraDex), and ciprofloxacin (Cipro) suspensions. A positive test result corresponded to liquids entering the middle ear through the TT. No positive test result was elicited with tap water (0/20), but soapy water did enter the middle ear (10/40) and was statistically significant (P = 0.0112). Without the use of slight tragal pressure, Cortisporin, TobraDex, and Cipro drops did not consistently pass through the TT (0/20, 1/25, 1/25). By placing the drops with the addition of tragal pressure, a statistically significant difference was obtained for each solution (20/20, 20/20, and 20/20, respectively [P < 0.0001]). We conclude that with a clean external auditory canal, patent TT, and no middle ear fluid, medicated otic suspensions enter the middle ear only when combined with slight tragal pressure.

Administration, Topical↗
PubMed2000

Is tracheotomy decannulation possible in oxygen-dependent children?

OBJECTIVE: The goal was to determine whether decannulation can be safely achieved in children with persistent oxygen requirements. DESIGN: The study was a prospective evaluation of 12 oxygen-dependent children at a tertiary care academic children's medical center. METHODS: Twelve tracheotomy-dependent children with persistent oxygen requirements were evaluated for decannulation. Patients requiring more than 35% FiO(2) were not considered. Direct laryngoscopy and bronchoscopy were performed in all patients. Two required single-stage laryngotracheoplasty to correct subglottic stenosis, 1 required tracheal resection, and 7 required removal of suprastomal granulation tissue. Oxygen was administered after decannulation through a nasal cannula. RESULTS: Decannulation was successful in 92% (11 of 12) of patients. At final follow-up, oxygen requirements decreased in 58% of patients after decannulation. CONCLUSIONS: Decannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to reducing or eliminating their oxygen demand.

Bronchopulmonary Dysplasia↗
PubMed2000

Role of otoscan-assisted laser myringotomy in hyperbaric oxygen therapy.

Patients undergoing hyperbaric oxygen (HBO2) therapy often experience middle ear barotrauma. Not infrequently this disrupts therapy and may require myringotomy tube placement. A new, simple, office-based procedure known as OtoScan Laser Assisted Myringotomy (OtoLAM) provides temporary middle ear ventilation, which offers significant potential benefis for HBO2 patients. Five patients whose middle ear disease complicated their HBO2 therapy have undergone nine OtoLAM procedures in 11 ears. All patients tolerated the procedure without complications and immediately returned to HBO2 treatment. Based on this preliminary experience, we recommend OtoLAM for selected HBO2 patients with problematic middle ear dysfunction.

Adolescent↗
PubMed1999

Canalplasty.

An essential requisite for successful ear surgery is a patent external ear. A number of anatomic variants or abnormalities may obstruct its lumen, resulting in conductive hearing loss, hampering access for routine ear cleansing, or obscuring underlying pathology. This article reviews a surgical technique for canalplasty that can be modified to successfully treat either bone or soft tissue blockages of the external auditory canal.

Child↗
PubMed1999

Glial choristoma of the tongue: a case report and review of the literature.

Heterotopic brain tissue is an extremely rare developmental malformation. It is considered to be one of the very rare choristomatous lesions involving the oral cavity. We present a case of glial choristoma located on the dorsal surface of the tongue, midline area, in an 8-month-old African-American female baby. The clinical, histologic, and immunohistochemical features are presented. In addition, a review of previously reported cases and their probable embryogenesis are analyzed.

Choristoma↗
PubMed1999

Complications resulting from treatment of severe posterior epistaxis.

Recent advances in nasal endoscopy and arterial embolization have improved the treatment of severe posterior epistaxis. This report reviews the therapeutic options, including a case of epistaxis that did not respond to nasal packing but was successfully controlled with superselective arterial embolization. The discussion includes an outline of potential complications of epistaxis treatment, including a case of nasal septal perforation.

Aged↗
PubMed1999

Cochlear implantation in children with enlarged vestibular aqueducts.

OBJECTIVES: This report details our experience with cochlear implantation in children with both profound sensorineural HL (SNHL) and enlarged vestibular aqueducts (EVAs). It seeks to determine if the abnormal anatomy of EVA predisposes to any adverse events during or after cochlear implantation. STUDY DESIGN: A retrospective review. METHODS: Charts were reviewed for details of the procedure, complications, and audiologic outcome. RESULTS: Between 8/25/93 and 9/16/98, 10 children with EVAs received cochlear implants, of whom 8 children (5 males, 3 females; mean age 7.8 y) had audiologic follow-up of at least 6 months. The implant was inserted without difficulty in all patients. Pulsatile clear fluid via the cochleostomy was observed in five patients, but was easily controlled in each instance. There have been no major complications, although two patient had short-lived postoperative vestibular symptoms and one child has experienced an intermittent pulsing sensation in her head. Speech perception measures were obtained using a battery of tests that assessed the children's ability to perceive speech in both open- and closed-set formats. Two patients were excluded because the implant was placed within the last 6 months. Of the remaining eight children identified with EVAs, seven (86%) demonstrated open-set word recognition. CONCLUSIONS: These favorable results may be attributed in part to HL that occurs relatively late in childhood, allowing implantation in postlingual candidates. Cochlear implantation can be safely and effectively performed in children with SNHL associated with EVAs.

Adolescent↗
PubMed1999

The rhinology laboratory.

OBJECTIVES: This study seeks to develop a rhinology lab model and to assess its effectiveness for physicians-in-training. STUDY DESIGN: We established a rhinology lab at our institution with simple and affordable modifications to our temporal bone lab. Residents attended a seven-part lecture series and received a list of endoscopic and open procedures to perform on computed tomography (CT)-scanned, vessel-injected cadaver heads. METHODS: After 2 years we asked participating residents to rate their lab experience on a 1-to-10 (disagree-agree) scale. RESULTS: Cumulative scores indicated that residents enthusiastically perceived this additional training as worthwhile (micro=10), while increasing their efficiency (micro=9.5), safety (micro=9.875), and anatomic knowledge (micro=9.875). The lab has opened opportunities for rhinology research, as evidence by one resident publication and another project in progress. Survey feedback has helped develop guidelines for instructor participation in the lab as well as for assigned reading and independent study. CONCLUSIONS: Based on our preliminary experience, we recommend the rhinology lab to all residency programs as an important yet cost-effective means of maintaining education in step with rapidly changing technologies.

Endoscopy↗
PubMed1999

Laryngeal papillomatosis presenting as acute airway obstruction in a child.

Upper airway obstruction, regardless of cause, can masquerade or be misdiagnosed as lower airway disease in children. In such cases, therapeutic trials of antibiotics, bronchodilators, and over-the-counter medications for symptom relief routinely fail; however, the original diagnosis often goes unchallenged. If the obstructive process is progressive, then acute occlusion of the airway may occur, rapidly leading to suffocation and death if resuscitation is unsuccessful. Outlined in this report is the case of a young female with a history of asthma, poorly responsive to outpatient treatment, who presented with respiratory arrest. The cause of the respiratory collapse was later identified as a large laryngeal papilloma, a condition rarely encountered by emergency physicians.

Acute Disease↗
PubMed1998

Tympanostomy tubes and water exposure: a practical model.

OBJECTIVE: To determine whether water exposure causes middle ear contamination in patients with collar button tympanostomy tubes (TTs). METHOD AND DESIGN: An in vitro model of a human head that contained an auricle, external auditory canal, tympanic membrane with TT, middle ear, eustachian tube, and mastoid cavity was developed. Two electrodes connected to an external ohmmeter resided in the middle ear to detect water entry. The model was tested with 4 types of water exposure: showering, bathing, hair rinsing, and swimming. Statistical analysis was performed by the Fisher exact test. MAIN OUTCOME MEASURES: A positive test result corresponded to water entering the middle ear via the TT, confirmed by a resistance reading of zero on the ohmmeter. A negative test result indicated no change in the initial high resistance reading. RESULTS: No positive test results were obtained for showering (0 of 60 tests), hair rinsing (0 of 60 tests), or head submersion (12.7 cm) in clean tap water (0 of 60 tests). Ten positive test results were obtained for head submersion in soapy water (10 of 97 tests), which was statistically different from clean water (P< or =.007). Swimming pool depths of 30, 45, 60, and 75 cm elicited positive test results in 2 of 16, 3 of 18, 2 of 20, and 11 of 20 tests, respectively. A higher incidence of water entry into the middle ear occurred at depths of more than 60 cm (P< or =.001). No statistical difference between depths of 60 cm or less occurred (P= .88). CONCLUSIONS: Showering, hair rinsing, and head submersion in clean tap water do not promote water entry into the middle ear. Submersion in soapy water increases the probability of water contamination. Pool water infrequently enters the middle ear with head submersion, but the incidence increases with deeper swimming (>60 cm). These data provide further evidence that many water precautions frequently advised in patients with TTs are unnecessary.

Acrylic Resins↗
PubMed1998

Aerocele after tracheocutaneous fistula closure.

Tracheocutaneous fistulas (TCF) occasionally follow pediatric tracheotomy decannulation, often requiring surgical treatment. Complications of TCF closure are infrequent, but may include development of a cervical aerocele. A case of cervical aerocele after TCF closure is described. Based on our experience with this problem, we offer guidelines for care of TCFs.

Child↗