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Biomedical subjects

S C Manning

Publications and source records attributed to S C Manning.

At least 19 recordsLinked to original sources
PubMed1997

Immunotherapy in the treatment of allergic fungal sinusitis.

Recommendations to withhold immunotherapy with fungal antigens from patients with allergic fungal sinusitis (AFS) have been based primarily on retrospectively reviewed, anecdotal case reports and theoretical considerations. A study that was approved by the investigational review board of our institution is ongoing in our department to administer immunotherapy with relevant fungal antigens to patients with histologically proven AFS. After 1 year, no instances of worsening of symptoms as a result of this therapy have been observed. Objective measurement of improvement has been difficult, but our initial clinical impression is that this treatment regimen has resulted in significant reduction in the reaccumulation of crusts and allergic mucin within the sinuses, has led to a reduction in the use of topical nasal steroids, and has made systemic steroid therapy unnecessary, thereby improving the quality of life of the patient. A further study of immunotherapy for patients with AFS is recommended, and suggestions for modification of the current protocol are presented.

Allergens↗
PubMed1997

Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis.

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.

Adolescent↗
PubMed1996

Tonsillar tissue penetration of dirithromycin after multiple doses.

Dirithromycin is a new macrolide antibiotic that is effective against group A beta-hemolytic streptococcal pharyngotonsillitis. This prospective, multicenter, randomized study compared the serum and tonsil tissue concentrations of erythromycylamine (to which dirithromycin is rapidly converted by nonenzymatic hydrolysis during absorption) and erythromycin after 5- and 10-day regimens of dirithromycin and erythromycin, respectively. Thirty-nine patients undergoing elective tonsillectomy but without active tonsillitis were assigned in randomized fashion to receive dirithromycin 500 mg orally once daily (n = 22) or erythromycin base 250 mg orally four times daily (n = 17). Data from 12 patients receiving dirithromycin and 10 receiving erythromycin were eligible for analysis. Mean serum concentrations (+/-standard deviation) of erythromycylamine and erythromycin were 0.20 +/- 0.07 microgram/mL and 0.12 +/- 0.25 microgram/mL, respectively, after the 5-day regimen and 0.17 +/- 0.10 microgram/mL and 1.57 +/- 3.16 micrograms/mL, respectively, after the 10-day regimen. The mean serum concentration of erythromycin after 10 days was skewed by the data for one of the six patients in the group (concentration of > 8 micrograms/mL). Mean concentrations of erythromycylamine in tonsil tissue were 4.62 +/- 0.97 micrograms/ g after 5 days and 3.47 +/- 2.84 micrograms/g after 10 days. Concentrations in tonsillar tissue were undetectable in all patients given erythromycin for 5 days and in 4 of the 6 patients given erythromycin for 10 days. The high concentrations of erythromycylamine in tonsillar tissue agree with the clinical efficacy seen in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitis with dirithromycin.

Adolescent↗
PubMed1996

Microbial flora of the subglottis in intubated pediatric patients.

Infection of the intubated subglottis is felt to be one of the many factors involved in the pathogenesis of acquired cicatricial subglottic stenosis. The precise role of infection is unclear and the microbial flora has not been established. An analysis of subglottic culture material, from 22 intubated pediatric patients undergoing tracheotomy, has been performed to establish the nature of the subglottic microbial flora. Fifty-nine isolates were found, including 19 types of organisms. The number of isolates per patient ranged from one to eight, with an average of 2.7 isolates per patient. The most common isolates in the 22 patients were alpha-hemolytic Streptococcus viridans (17 isolates-77%), Neisseria sp. (6 isolates-27%), Pseudomonas sp. (5 isolates-22%), and coagulase negative Staphylococcus sp. (5 isolates-22%). This data indicates that colonization of the subglottis in intubated pediatric patients is polymicrobial in nature. alpha-Hemolytic Streptococcus viridans and Neisseria sp. were most common, with a shift in cultured flora towards Pseudomonas sp. in patients intubated for more than 10 days. In view of this, antimicrobial therapy may be of benefit in preventing acquired cicatricial subglottic stenosis.

Adolescent↗
PubMed1996

Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients.

The purpose of this study was to determine the correlation between signs and symptoms of upper respiratory tract disease and sinus images in a convenience sample of sixty pediatric patients scheduled for computed tomography or magnetic resonance imaging of the head for non-sinus diagnoses over a 2-year period. The study was carried out in a tertiary pediatric referral center. Each patient underwent rhinoscopy and otoscopy just prior to imaging, and each patient's parent was asked to fill out a questionnaire regarding recent symptoms of upper respiratory tract infection; a blinded comparison was then made between respiratory signs and symptoms and images of the paranasal sinuses. Forty-seven percent of patients had abnormalities of their sinus images, and a significant (P < 0.05) correlation was found between the presence of absence of respiratory signs and symptoms and the presence or absence of abnormalities of sinus images, especially in younger patients. In conclusion, a large percentage of pediatric patients undergoing imaging procedures of the head for non-sinus diagnoses have sinus image abnormalities. In the population studied these imaging abnormalities appear to reflect ongoing or resolving upper respiratory tract viral or allergic inflammation.

Adolescent↗
PubMed1996

Choanal atresia: a new anatomic classification and clinical management applications.

The anatomic classification of choanal atresia is commonly quoted as 90% bony and 10% membranous. This incidence is from a review by Fraser in 1910 of 115 cases, "many of which were insufficiently described." We have reviewed 47 computed tomography scans of choanal atresia from the literature and 16 from our clinical experience, and classified the anatomy as bony, mixed bony-membranous, or pure membranous. Our results reveal a combined incidence of 18 (29%) pure bony, 45 (71%) mixed bony-membranous, and no pure membranous atresia. We propose a new classification of choanal atresia to include bony, mixed, and membranous to accurately reflect the anatomic abnormalities. Our series of 11 patients undergoing transnasal microsurgical repair, a critical review of the literature, and the implications of the anatomic classification on the choice of surgical procedure are presented.

Adolescent↗
PubMed1994

Incidence of sensorineural hearing loss in patients evaluated for tympanostomy tubes.

There are currently no standard guidelines for assessing hearing in pediatric patients who are evaluated for tympanostomy tubes. We describe the results of audiologic testing on 600 consecutive pediatric patients evaluated for tube placement. Six patients (1%) were found to have previously undiagnosed unilateral or bilateral moderate or severe neurosensory loss. Patients undergoing evaluation for tympanostomy tube placement have a low but significant likelihood of neurosensory hearing loss and should have age-appropriate hearing assessment as part of their overall evaluation.

Audiometry↗
PubMed1994

Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma.

OBJECTIVE: To determine the efficacy of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. SETTING: Patients were selected from the tertiary care practice of a pediatric pulmonologist (R.S.) and immunologist (R.L.W.); all underwent sinus surgery at Children's Medical Center at Dallas (Tex). PATIENTS: Fourteen pediatric patients aged 3.5 to 13 years with severe asthma requiring at least intermittent systemic steroid therapy. All patients had a history of sinusitis aggravating asthma and all had computed tomographic evidence of chronic sinus disease. INTERVENTION: All patients underwent endoscopic sinus surgery consisting of bilateral total ethmoidectomies and middle meatus antrostomies at a minimum. MAIN OUTCOME MEASURES: The period 12 months prior to surgery was compared with 12 months postoperatively with regard to total hospitalization days for asthma treatment, number of school days missed, pulmonary function test results, and systemic glucocorticoid medication requirements. Symptom scores for asthma and sinusitis were assessed via parental questionnaire both preoperatively and postoperatively. RESULTS: No significant difference was found for pulmonary function test results. Eleven of 14 patients demonstrated a significant reduction in hospitalization and school days missed. Twelve of 14 patients experienced a reduction in glucocorticoid requirements. Eleven of 14 and 13 of 14 patients experienced a significant improvement in asthma and sinusitis symptom scores. CONCLUSION: Endoscopic sinus surgery was effective in reducing sinusitis and improving the overall management of asthma in a majority of study patients.

Absenteeism↗
PubMed1994

Endoscopic resection of the intranasal frontal sinus floor.

The current accepted treatment for chronic frontal sinus disease unresponsive to medical management and endoscopic surgery is an external approach to either obliterate the sinus or restore communication to the nasal cavity. Here reported is an endoscopic approach for resection of the intranasal frontal sinus floor, a modification of a procedure first described by Lothrop in 1899. Eleven patients underwent this operation from April 1993 to December 1993. One complication, a cerebrospinal fluid leak treated successfully endoscopically, has occurred. Of the 7 patients followed up 3 months or longer after surgery, only 1 has developed symptoms of recurrent frontal sinusitis. On the basis of this limited preliminary experience, the endoscopic Lothrop procedure shows promise as an effective operation designed to establish a physiologic communication between the frontal sinus and the nasal cavity in selected patients who would otherwise be candidates for an external approach.

Adolescent↗
PubMed1993

Effects of inhalant anesthesia on the middle ear as measured by tympanometry.

This investigation examined the effects of inhalant anesthesia, nitrous oxide and halothane, on middle ear pressure. Moreover, the effect of inhalant anesthesia on the validation procedure for tympanometry was examined. Tympanometry was used to measure middle ear pressure variations. Subjects were examined with tympanometry prior to and after the administration of inhalant anesthesia. Group 1 (N = 86) received halothane and nitrous oxide. Group 2 (N = 52) received halothane only. Group 1 data were gathered in a previous investigation. The investigation was continued with subjects in group 2. Results indicated that middle ear status prior to anesthesia was not significantly different from middle ear status under anesthesia. In addition, middle ear pressure changes due to nitrous oxide were not significantly different from middle ear pressure changes due to halothane alone. Moreover, there was no effect on the tympanometry validation procedure. These findings are consistent with previous studies that indicate nonsignificant changes in middle ear pressure associated with the use of nitrous oxide and halothane.

Acoustic Impedance Tests↗
PubMed1993

Endoscopic management of medial subperiosteal orbital abscess.

Medial subperiosteal orbital abscess is the most common serious orbital complication of pediatric sinusitis. When it is confirmed by radiograph or strongly suspected from clinical findings, most authors recommend drainage via an external ethmoidectomy. The present case review describes five pediatric patients with medial subperiosteal orbital abscesses that were successfully managed via an endoscopic ethmoidectomy approach. Potential advantages include avoidance of a scar and more rapid resolution of signs and symptoms.

Abscess↗
PubMed1993

Evidence of IgE-mediated hypersensitivity in allergic fungal sinusitis.

Despite documentation of specific immunologic hypersensitivity in a few case reports, controversy continues as to the role of allergy versus true infection in the clinical entity of allergic fungal sinusitis (AFS). Using a modified radioallergosorbent test (RAST) to multiple fungal antigens, 16 patients meeting the histologic criteria of AFS and with positive fungal cultures were compared to 5 control patients with similar preoperative clinical findings but without histologic or culture evidence of AFS. All patients were immunocompetent and none demonstrated histologic evidence of tissue invasion. All AFS patients were RAST-positive to at least one fungal antigen in the family of their cultured organism with positive defined as class 2 or greater. No control patient was RAST-positive to either dematiaceous or Aspergillus fungal antigens. Thus, modified RAST testing can aid in the routine clinical diagnosis of AFS, and it provides further serologic evidence for a type I hypersensitivity in the pathogenesis of AFS.

Adolescent↗
PubMed1993

Pediatric sinusitis.

Interest in pediatric sinusitis is growing in response to better diagnostic techniques and to the implication of better results with newer surgical techniques. In addition, sinusitis has the potential for a significant impact on overall health in growing numbers of children with chronic pulmonary disease and immunodeficiency.

Adenoidectomy↗
PubMed1992

Congenital abnormalities of the submandibular duct.

Five newborns presented with cystic lesions of the floor of mouth. Four of these patients proved to have congenitally imperforate submandibular salivary gland ducts and the other newborn proved to have a duplication anomaly of the submandibular gland duct and gland. The patients with imperforate Wharton's ducts underwent marsupialization with or without ductoplasty and have been without evidence of recurrence for up to three years. The duplication anomaly of the submandibular gland duct responded to simple excision. The diagnosis of congenital anomalies of the submandibular gland and duct can be made on physical examination. Magnetic resonance imaging can be helpful in differentiating congenital imperforate submandibular duct and duplication anomalies of the ductal system. Treatment of the former consists of duct marsupialization in the floor of mouth with or without ductoplasty. Treatment of the duplicated ductal system may best be treated with excision. A failure in diagnosis and treatment may result in ranula formation or sialoadenitis requiring more extensive therapy.

Cysts↗
PubMed1992

Surgical management of sinus disease in children.

In the past few years, interest in pediatric sinus surgery has increased in response to the introduction of new endoscopic techniques and to mounting societal pressure to resolve the problem of persistent rhinosinusitis in the day-care setting. As yet, there are no prospective controlled studies demonstrating efficacy of sinus surgery in children with uncomplicated acute or recurrent acute sinusitis, and medical management overwhelmingly remains the treatment of choice for these patients. Sinus surgery may be indicated, however, for three groups of pediatric patients: those with true chronic disease, those with serious underlying disease states aggravated by recurrent sinusitis, and those with suppurative complications of sinusitis.

Child↗
PubMed1992

Incidence of otitis media in vitamin A-deficient guinea pigs.

After observing an association between vitamin A deficiency and otitis media among children in Micronesia, we sought to develop an animal model for vitamin A-deficiency-induced otitis media. Thirty juvenile guinea pigs were screened for absence for otitis and then divided into two groups. The experimental group was placed on a vitamin A-free diet, whereas control animals were fed a standard formula. The animals were followed by means of otologic examination and serum retinol determinations. When experimental animals demonstrated vitamin A deficiency, they were killed along with one control and temporal bones were harvested and prepared for histologic examination. None of the 15 controls demonstrated middle ear abnormalities. In the experimental group, 77% of temporal bones showed middle ear pathology consisting of either of subepithelial edema (27%) or frank otitis media (50%). These results indicate that the guinea pig is a suitable species for study of otitis media in association with vitamin A deficiency. We postulate that eustachian tube dysfunction is the primary mechanism for inducing middle ear inflammation in this animal model.

Animals↗