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Biomedical subjects

S E Stool

Publications and source records attributed to S E Stool.

At least 19 recordsLinked to original sources
PubMed1992

Should granulomas be excised in children with long-term tracheotomy?

We reviewed 265 rigid bronchoscopies performed in 50 children with tracheotomy-dependent subglottic stenosis (25 congenital, 25 acquired). Granulomas developed in 40 children (80%) and were unrelated to age, sex, race, gastroesophageal reflux, tracheotomy duration, or type of stenosis. The incidence of small to medium, large, and obstructing granulomas at endoscopy was 28%, 6%, and 0%, respectively. Compared with a baseline finding of no granuloma at preceding bronchoscopy, the odds of granuloma recurrence were 3.0 after an unexcised granuloma (95% confidence interval [CI], 1.1 to 8.4), 4.1 after granuloma excision (95% CI, 1.4 to 11.9), and 7.3 after expansion surgery (95% CI, 1.1 to 49.2). Considering the low incidence of large or obstructing granulomas, and the failure of granuloma excision to diminish recurrence, we do not recommend interval excision of nonobstructing granulomas in children with stable tracheotomies.

Bronchoscopy↗
PubMed1992

Assessment of otoscopists' accuracy regarding middle-ear effusion. Otoscopic validation.

Validation of otoscopic diagnostic accuracy is an important aspect of medical education and is necessary to substantiate clinical research observations. In addition, otoscopic accuracy is a prerequisite to optimal patient care. We describe an otoscopic validation program at the Children's Hospital of Pittsburgh (Pa) in which 27 physicians and three nurse practitioners participated from December 1980 to March 1990. The lowest acceptable limits for sensitivity and specificity regarding the diagnosis of middle-ear effusion were arbitrarily set at 80% and 70%, respectively. The 30 participating clinicians examined a total of 4147 ears. Mean sensitivity and mean specificity for the group as a whole were 87% and 74%, respectively. The chief benefit of the program was an improvement in diagnostic skills for some individuals. The chief limitation was the large amount of time required. We conclude that a formal validation program can document achievement of a reasonable standard of otoscopic diagnostic accuracy.

Child↗
PubMed1992

Temporal bone fractures in children: a review with emphasis on long-term sequelae.

A 10-year retrospective study of pediatric basilar skull fractures identified 120 patients with temporal bone fractures, of which 92 had otolaryngologic and audiologic evaluations. The otologic data provide documentation of the nature, common physical findings, complications, and management of these fractures. The prognosis of hearing impairment in children caused by temporal bone fractures is elucidated, as 76 of the 92 patients were available for long-term follow-up. Close interaction between involved services evaluating and treating pediatric trauma cases is mandatory for optimal patient outcome. A literature review of the presentation, complications, and management of pediatric temporal bone fractures is presented.

Adolescent↗
PubMed1990

Otitis media and hearing loss in Turner syndrome.

Twenty-two phenotypic females with Turner syndrome underwent prospective otologic evaluation including a standard history, physical examination, audiogram, and tympanogram. Eight of these patients had computed tomography of the temporal bones. Eighty-two percent of the patients had a history of chronic or recurrent ear infections. Eleven patients (50%) had previous myringotomy and tube placement and 4 (16%) had undergone tympanoplasty or tympanomastoidectomy for sequelae of otitis media. Ten patients (45%) had middle ear effusions evident on examination. Sixteen patients (73%) had hearing loss in at least one ear at the time of examination. Sensorineural losses were evident in 37% of patients. No malformations of the otic capsule were noted on computed tomography. The high prevalence of both hearing loss and otitis media in Turner syndrome warrants otologic and audiologic assessment of patients with this chromosomal anomaly.

Adolescent↗
PubMed1990

[Educational and research program on diagnosis and treatment of otitis media in Latin America].

Otitis media in Latin America is an important cause of hearing impairment and infectious complications which can be prevented without an inordinate effort or investment of resources. The Latin American Otitis Media Research and Training Program is a multidisciplinary, international project designed to improve the detection an treatment of otitis media in Latin America. Over 200 health care providers have already participated in pilot seminars presented in Brazil, Costa Rica, and Mexico. These sessions were highlighted by audiovisual presentations emphasizing pneumatic otoscopy. We conclude that this focused program of medical education can significantly contribute to improve primary health care in the region.

Adolescent↗
PubMed1989

Otologic manifestations of Langerhans' cell histiocytosis.

Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.

Child↗
PubMed1989

Otolaryngologic findings in whistling face syndrome.

Craniocarpotarsal dysplasia or whistling face syndrome is rare with only 60 cases having been reported in the literature. More than 60 anatomic anomalies of the head, hands, and feet, in addition to the face, have been noted. Although the literature contains numerous case reports describing in detail the various features and abnormalities of the syndrome, the otolaryngologic findings in these patients have yet to be summarized. We present two additional cases in a mother and daughter with an extended follow-up period of 30 and 17 years, respectively, and summarize the otolaryngologic findings in all previously reported cases of this rare syndrome. Also, the principal clinical features and associated features are described.

Abnormalities, Multiple↗
PubMed1989

Evolution of pediatric otolaryngology.

A historical overview of the evolution of the field of pediatric otolaryngology is presented in this article. The author recounts his own experiences in the field, and details the development of this rapidly expanding specialty.

Child↗
PubMed1989

Posttracheotomy granulation tissue managed by carbon dioxide laser excision.

The problem of accumulation of granulation tissue and scar at the superior edge of the tracheostoma is a frequent problem in the management of chronic tracheotomy patients. This traditionally has been managed by cup forceps excision or by eversion through the tracheostoma with a skin hook and blind resection. These methods often lead to hemorrhage, and incomplete removal in a bloody field. We have used the carbon dioxide laser via a bronchoscope for ablation of the granulation tissue and/or scar at the stomal edge and at the tracheotomy tube proximal tip without morbidity in 13 pediatric cases. With experience, removal with the laser often proceeds more quickly than conventional methods. The scar and granulation tissue are excised under direct vision with minimal hemorrhage. We believe this to be a reasonable alternative in the management of this recurring problem.

Adolescent↗
PubMed1989

The role of tympanocentesis in the management of infants with sepsis.

Tympanocentesis is a procedure that can identify pathogenic organisms in otitis media. However, the clinical value of this diagnostic method in the management of infants who have sepsis has not been previously reported. Although otitis media is a significant source of sepsis in infants, tympanocentesis is not routinely employed in the work-up of infants with sepsis who have abnormal otoscopic findings. Charts of 40 consecutive infants who had sepsis and were undergoing tympanocentesis as part of their emergency room work-up were reviewed. Results of middle-ear aspirations from these infants, the bacteriology of middle-ear effusions, and the role of this information in their clinical management is presented. In 80% of these patients, clinical management was directly affected by tympanocentesis data. Tympanocentesis is a safe, effective diagnostic and therapeutic procedure with which otolaryngologists can provide important bacteriologic information to the pediatricians who are managing infants with sepsis.

Bacterial Infections↗
PubMed1989

The impact of otitis media.

Otitis media is one of the most worldwide prevalent diseases that affects children. The socioeconomic costs may exceed 3.5 billion dollars a year in the United States alone in direct and indirect costs. If a vaccine can be developed that will decrease 1% of the illness this would be significant in this country and probably even more valuable in less developed countries.

Anti-Bacterial Agents↗
PubMed1989

The role of the otolaryngologist in managing suicidal adolescents.

From 1978 to 1987, 18 suicidal children were cared for by the otolaryngology service at Children's Hospital of Pittsburgh. The evaluation and treatment of these patients are reviewed, and factors resulting in these self-destructive acts discussed. Pertinent risk factors and warning signals that may enhance the otolaryngologist's ability to make the diagnosis of attempted suicide and avert potential further harm are also presented.

Adolescent↗
PubMed1988

Malignant external otitis in children.

Malignant external otitis in the pediatric population is primarily a disease of children with chronic illness or immunosuppression. The presence of severe, unrelenting otalgia, otorrhea with isolation of Pseudomonas aeruginosa, a markedly elevated erythrocyte sedimentation rate, and evidence of bone destruction on computed tomography scan should alert the clinician to the diagnosis. Unlike adults, children have a higher incidence of seventh nerve paralysis earlier in the course of the infection. They also manifest more frequent involvement of the middle ear with tympanic membrane destruction. The short interval between the onset of symptoms and facial nerve dysfunction highlights the necessity of prompt diagnosis and institution of anti-Pseudomonas therapy. Our review suggests that this destructive bacterial infection is an emerging clinical entity in children; 73% of the cases have been reported since 1980. Pediatricians should therefore be familiar with the clinical presentation of this treatable infection. Substantial morbidity could be alleviated by prompt diagnosis and early antibiotic treatment.

Child↗
PubMed1988

Stridor.

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Child↗