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Biomedical subjects

N W Todd

Publications and source records attributed to N W Todd.

At least 55 records · Page 3Linked to original sources
PubMed1990

Head shape and abnormal appearance of tympanic membranes.

We examined 187 males to evaluate the hypothesis that short-headed persons more often have otitis media than long-headed persons. The subjects were seen as part of routine health screening before attending recreational summer camp. The photographic appearance of each tympanic membrane was judged on two separate occasions by an otolaryngologist who categorized them as "normal", "abnormal", or "cannot determine". The repeatability of the categorizations was fair: kappa = 0.44. Only the tympanic membranes categorized identically twice were used for data analysis. The left-right symmetry of the tympanic membrane categorizations was fair: correlation coefficient phi = 0.42. Subjects categorized as having bilaterally normal tympanic membranes were considered to have not had previous otitis media (N = 95). In contrast, subjects categorized as having at least one abnormal tympanic membrane were considered to have had previous otitis media (N = 13). Head length and width, measured by calipers, and the cephalic index (width divided by length) x 100 were determined for each person. On the average, the cephalic index of the normal subjects was lower than that for the subjects with otitis media (t = 3.06, p less than 0.005). These data support the suggestions of Pautow (1925) and Worley et al. (1987): dolichocephalic persons have otitis media less often than do brachycephalic persons. Though this association is not useful in clinical care of the individual patient, it may be considered a weak external manifestation of the different cranial base and eustachian tube anatomy found in persons with otitis media.

Adolescent↗
PubMed1990

Autoimmune hypothesis of acquired subglottic stenosis in premature infants.

Acquired subglottic stenosis is a devastating additional burden for nearly 4% of premature infants receiving neonatal intensive care. The duration of endotracheal intubation is considered the most important etiologic factor. Surprisingly, most premature infants do not acquire subglottic stenosis. Infants with similar clinical characteristics and care have varying laryngeal outcomes. We hypothesized an autoimmune mechanism to type-II collagen to explain the varying laryngeal outcomes of these infants. A retrospective study of premature infants of comparable birth weight, gestational age, and duration of endotracheal intubation was conducted. The eight control children, who did not manifest symptoms of airway obstruction, had longer durations of intubation than did the infants who developed subglottic stenosis. Three of five affected infants had serum antibodies to type-II collagen, in contrast to none of the control infants (P = .035). This finding warrants additional study, and might lead to new diagnostic and therapeutic measures for these patients.

Airway Obstruction↗
PubMed1988

Congenital cardiac outflow tract anomalies and otitis media.

The neural crest is involved in the differentiation of the cardiac outflow tract and branchial arches. Branchial arches one and two give rise to the eustachian tubes. Anatomically different eustachian tubes (e.g., short length) are found in persons prone to otitis media. We hypothesized a relationship between outflow tract anomalies and eustachian tube anomalies. The medical records of 238 children with a catheterization diagnosis of congenital heart disease were reviewed for otitis diagnoses. Children with syndromes known to be associated with recurring otitis media were excluded. Recurrent otitis media was recorded in 32.2% of those with outflow tract anomaly, significantly (P less than 0.03) higher than the 18.9% rate in children with a cardiac anomaly not involving the outflow tract. Neither race, sex, nor cyanosis seemed to account for the differing rates of otitis. These data may support the concept of a field defect arising from neural crest cells that influences the development of the cardiac outflow tract and eustachian tubes.

Adolescent↗
PubMed1988

Jugular bulb position and shape are unrelated to temporal bone pneumatization.

The position and shape of the jugular bulb are undependable, and thus can add difficulty to temporal bone surgery. The present study addresses the hypothesis that position and shape of the jugular bulb correlate with the extent of temporal bone pneumatization. Systematic study was done in 25 unilateral cadaver specimens. Pneumatization was determined using both the classic Runström II radiograph, and computed tomography. Jugular bulb shape and position were determined by anatomic dissection and computed tomography. No association of jugular bulb shape or position, with pneumatization, was found. However, the dissection-determined distance from the plane of the lateral semicircular canal to the roof of the jugular bulb (2 to 15 mm), had a good correlation (r = 0.70, p less than .001) with the distance from the internal auditory canal to the apex of the jugular bulb (1.5 to 15.0 mm).

Humans↗
PubMed1988

Temporal bone pneumatization in cystic fibrosis patients.

Cystic fibrosis patients commonly have nasal polyps and sinusitis, but surprisingly are spared from an increased occurrence of otitis media. Twenty cystic fibrosis patients whose ages ranged from 13 to 26 years were studied. Only one of these patients had a history of otitis. Minimal temporal bone pneumatization, as determined by computed tomography, was used as an indicator of childhood otitis. The computed tomography had been done as part of the medical evaluation of their symptomatic paranasal sinusitis. On the average, pneumatization volume was larger for the cystic fibrosis patients than for the normal population (p = 0.033, Student's t-test). That is, these data indicate that cystic fibrosis patients had significantly less otitis than the normal population. Assuming that these cystic fibrosis patients are representative, the data may imply that the gene for good musculoskeletal eustachian differentiation is linked with the gene for cystic fibrosis. The data also imply that poor mucociliary transport does not necessarily induce otitis media.

Adolescent↗
PubMed1987

Lack of association of cleft uvula with otitis media in Apache Indian children.

Cleft uvula occurs in approximately 20% of Athabaskan Indians. The association of cleft uvula with otitis media was examined in a cohort of 175 Apache Indian children followed up prospectively from birth. No association was found between the occurrence of cleft uvula and the rate, frequency, or timing of otitis media attacks.

Arizona↗
PubMed1987

Familial predisposition for otitis media in Apache Indians at Canyon Day, Arizona.

The familial occurrence of otitis media was studied in White Mountain Apache Indians at Canyon Day, Arizona. Of the 760 residents, 366 persons were seen during a village survey for otitis media. There were 133 first-degree relatives involving 113 first-degree relative pairs. Of these, there were 38 children involving 19 separate sibling pairs, for whom age- and sex-matched controls could be assigned. Tympanic membrane scarring was assumed to be a marker of prior otitis media. The findings suggested (P less than .01 for the nonindependent first-degree relative pairs, and P less than .05 for the independent sibling pairs) a familial predisposition. With the additional assumption that the severity of tympanic membrane scarring can be ranked, no association of severity of otitis media was apparent in the first-degree relatives.

Arizona↗
PubMed1987

Association of abnormal appearance of tympanic membrane with minimal temporal bone pneumatization. A cadaver study.

The association of abnormal tympanic membrane appearance with minimal pneumatization of the temporal bone was studied in 28 unilateral formalin-fixed cadaver specimens. The photographic appearance of each tympanic membrane was judged by seven otolaryngologists, and a normalcy score determined. The normalcy score of the tympanic membranes had a weak association (tau = 0.27, p less than 0.05) with pneumatization volume, as determined by computed tomography. The same trend, though not statistically significant, was found with pneumatization area determined by lateral radiographs. For cross-sectional surveys, the otitis media condition is probably best identified by a combination of indicators: bilateral extent of pneumatization as assessed by computed tomography, bilateral appearance of the tympanic membranes, and a history of otitis media.

Adult↗
PubMed1986

Bifid uvula and otitis media in Apache Indians.

The association of bifid uvula with otitis media and scarred tympanic membrane was studied in White Mountain Apache Indians at Canyon Day, Arizona. Of 349 persons seen during a survey for otitis media, 13.5 percent had clinical otitis media, and 64.2 percent had scarring of the tympanic membrane of the otoscopically worse ear; 20.3 percent had bifid uvula. Bifid uvula was not associated with clinical otitis media or scarred tympanic membrane.

Arizona↗
PubMed1985

Otitis media at Canyon Day, Ariz. A 16-year follow-up in Apache Indians.

A 16-year follow-up survey of native Americans living in Canyon Day, Ariz, did not show improvement in the 9.3% rate of clinically significant otitis media. However, the manifestations were more benign, especially in children, and included the spectrum of otitis media. A genetically determined eustachian tube difference may explain the high rate of occurrence of otitis media in these Apache Indians. Improvements in living conditions and health care may explain the change to less severe manifestations.

Adolescent↗
PubMed1985

Otitis media and language performance in a cohort of Apache Indian children.

Language performance was evaluated in 167 healthy Apache Indian children aged 6 to 8 years, who had contrasting histories of otitis media and who had been followed since birth. All children received pneumatic otoscopy, tympanometry, pure tone audiometry, and a battery of language measures. Groups were similar with respect to age, sex, school experience, family income, housing, primary language spoken, and nonverbal intelligence. No statistically or clinically significant differences in language performance were observed between groups of children with frequent episodes of otitis media and those from the same cohort with infrequent otitis. While frequent otitis media was associated with abnormalities on tympanometry and otoscopy, bilateral hearing loss (greater than 25 dB) was observed in only 1% of the children.

Acoustic Impedance Tests↗
PubMed1985

Allergic airway disease and otitis media in children.

The occurrence of allergic rhinitis, asthma and otitis media was examined in 395 Indian children living on two separate reservations in Arizona. The children were followed from birth to age 5 years in a study of otitis media. On retrospective review of medical records, 45% of the children at Parker had a clinical diagnosis of allergic airway disease, in contrast to only 6% at San Carlos. At each site, about 55% had recurring otitis media in infancy; of these otitis-prone infants, 40% at Parker and 36% at San Carlos persisted to have 3 or more episodes of otitis media after age 2 years. The only allergic airway disease correlate with otitis media was allergic rhinitis in children age 2-4 years.

Arizona↗
PubMed1984

Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis.

Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.

Adolescent↗
PubMed1983

Otitis media and eustachian tube caliber.

Clinical data supported the hypothesis that most otitis media requiring surgery is part of a life-long bilateral process that correlates with small mastoid air system, and with a bougie-assessable large eustachian tube. Cleft palate, even in the microform of cleft uvula, was an indicator of large eustachian tube (p less than 0.001). The 1.48 mm mean eustachian tube caliber of the otitis patients was larger (p less than 0.001) than the 0.73 mm mean of the reference eustachian tubes. Eustachian tube caliber was not a correlate of age or sex. Comparatively small caliber eustachian tubes were associated with trauma-caused tympanic membrane perforation (p less than 0.01), and middle ear effusion in allergic airway disease patients (p less than 0.05). Large eustachian tube caliber seemed a reliable correlate of the spectrum of manifestations of chronic otitis media.

Adolescent↗
PubMed1976

The application of a semiautomated postoperative care program in a community hospital: early results.

The clinical involvement of computer technology in medical center environment has been successfully utilized in the postoperative care of patients following open intracardiac operations. This report describes the initial experience in a community hospital with the adaptation and evaluation of such a system in the postoperative care of critically ill patients. The early experience with this noncomputerized system suggests the clinical usefulness of the approach, the potential increase in manpower utilization, and the greater utilization of the nursing staff in true patient care. The early results of the study do not indicate that this approach to patient care is necessarily economically feasible or technically applicable in all community hospitals.

Aged↗
PubMed1976

Penetrating injuries of the laryngotracheal area.

Penetrating injuries of the laryngotracheal area require immediate maintenance of an adequate airway and prompt surgical exploration and repair. Two basic principles are illustrated by case reports: repairing major vessels before doing the laryngotracheal repair and using adjacent tissues to repair traumatic defects. We suggest a team approach at operation.

Adolescent↗