PubMed Health⌕ Search

Biomedical subjects

D H Hunsaker

Publications and source records attributed to D H Hunsaker.

11 recordsLinked to original sources
PubMed1999

Safety of home-based and office allergy immunotherapy: A multicenter prospective study.

During a 1-year period, 27 otolaryngic allergy practices recorded all systemic reactions to immunotherapy resulting from 635,600 patient visits and 1,144,000 injections. Sixty percent of injections were given at home. Major systemic reactions were observed after 0. 005% of injections. There were no hospitalizations or deaths. Eighty-seven percent of major reactions began within 20 minutes of injection. Frequently observed risk factors for major reactions were buildup phase of immunotherapy, active asthma, and first injection from a treatment vial. Home and office injections had similar rates of total systemic reactions, but home-based immunotherapy had far fewer major reactions. Home-based immunotherapy was found to be safe. The methods and precautions used to treat patients with this degree of safety are specified and discussed.

Adult↗
PubMed1998

Approaches to otolaryngic allergy emergencies.

The otolaryngic allergist should take every measure possible to prevent reactions during testing and treatment of the allergic patient. Because the risk of this rare complication cannot be completely eliminated, however, it is essential to be prepared for prompt recognition and proper treatment of an anaphylactic emergency. An emergency set, including airway management tools, oxygen, intravenous materials, and proper medication, is essential. The entire office staff should be educated to cope with the emergency. Finally, a medication history must be repeated at intervals to detect patients who are receiving beta blockers to either remove them from the patients' treatment regimen or to prepare for the special treatment of the patients on beta blockers.

Adrenergic beta-Antagonists↗
PubMed1998

A new anesthetic system for microlaryngeal surgery.

Anesthesia for microlaryngeal surgery creates many obstacles for the anesthesiologist and otolaryngologist. Anesthetic techniques developed to improve surgical exposure have been met with significant limitations and are difficult for the anesthesiologist to monitor. A new subglottic jet ventilation anesthesia system is introduced that meets the needs of the otolaryngologist and the anesthesiologist. This new system is made up of two components: (1) The Hunsaker Mon-Jet tube is a laser-safe, subglottic jet ventilation tube constructed of a nonflammable fluoroplastic material. It allows monitoring of tracheal pressure and end tidal carbon dioxide, and it is designed with a basket-shaped distal extension to align the jet port away from the tracheal mucosa and to prevent trauma and submucosal injection of jetted gas. (2) An automatic jet ventilator, which has an adjustable respiratory rate, inspiratory/expiratory ratio, and flow rate, also monitors expiratory end peak airway pressures and has an automatic shutdown feature if either of these pressures are exceeded. This system was successfully used in 36 patients undergoing microlaryngeal surgery.

Adult↗
PubMed1998

Steroid use in rhinoplasty: an objective assessment of postoperative edema.

The objective of this study was to measure the effect of a single, preoperative 10 mg dose of dexamethasone on postoperative edema associated with rhinoplasty. This was a randomized, double-blind prospective study conducted in a military academic tertiary referral center. Twenty men, aged 18 to 45 years, were enrolled in the study over 28 months. All 20 men underwent rhinoplasty with osteotomy. Preoperative magnetic resonance imaging scans were obtained on the morning of surgery and postoperative scans were obtained within 48 hours. Postoperative edema was quantified as the difference in soft tissue thickness (mm) between the pre- and postoperative scans. Contrary to our expectations, the rhinoplasty patients who received dexamethasone had increased postoperative edema (p < 0.02) when compared to patients not receiving dexamethasone. This is the first objective, double-blind study that shows an increase in postoperative edema after rhinoplasty with a single preoperative dose of dexamethasone.

Adolescent↗
PubMed1997

Reliability of disposable intraoperative facial nerve stimulators.

Facial nerve injury is one major morbidity of surgery performed along the course of this nerve. Surgeons frequently employ stimulators to identify and protect the nerve. Both disposable devices as well as larger, reusable stimulators are available. Despite their common use, relatively little documentation exists regarding the safety and reliability of these devices. We tested the electrical output of the four disposable, single-use motor nerve stimulators that are marketed in the United States. We found that each produced consistent stimulus output over time. One stimulator slightly exceeded the manufacturer's listed output while three devices produced significantly less voltage and current than specified by the manufacturer.

Disposable Equipment↗
PubMed1994

Anesthesia for microlaryngeal surgery: the case for subglottic jet ventilation.

Although the techniques for surgery on the endolarynx using suspension and the operating microscope have been fully developed, the safest, and least obtrusive anesthetic technique has yet to be manifested, as evidenced by more than 200 references to anesthesia for microlaryngoscopy in the world literature. This study reviews the physiology, physics, and problems of each anesthetic technique. In light of this review, animal and human studies are reported demonstrating the utility and safety of subglottic ventilation when provided with proper monitoring using an automatic ventilator. A modified Ben-Jet tube is reported, which has a 1-mm ID channel to monitor PCO2 and tracheal pressure. This self-centering 3.0-mm tube, which extends 6 to 8 cm below the glottis, is unobtrusive for the surgeon. The subglottic tube, which is much less likely to be malaligned, is much more acceptable to the anesthesiologist. Anesthesia, by intravenous sedation, utilizes neuromuscular blockade while ventilating through the jet tube powered by an automatic ventilator with an automatic shutdown feature attached to the monitor tube to prevent inadvertent barotrauma. The third phase of this study compared fluoroplastic, used in a prototype jet ventilation tube, with 6-mm Silastic, Red Rubber, and polyvinyl chloride (PVC) tubes when struck by maximum power of CO2, Nd-YAG, and K-532 lasers. The test was performed in a closed chamber in which concentrations of oxygen and nitrogen were controlled. Although damaged by the CO2 laser beam, the fluoroplastic tubes did not continue burning when the laser was turned off in 100% oxygen, even when coated by blood. The other three tubes continued to burn in 23% oxygen. Neither the KTP nor Nd-YAG laser damaged the Teflon tube, while they ignited a sustained flame in 30% oxygen. This study supports the use of fluoroplastic for a laser safe jet ventilation tube. It also demonstrates the danger of tube fires, even in low oxygen concentrations, when using Silastic, rubber, and PVC tubes in laser laryngeal surgery. There was no difference in the flammability of Silastic, rubber or PVC when struck by these lasers in this study. For these reasons, subglottic ventilation using a fluoroplastic, monitored, self-centering, subglottic, jet ventilation tube driven by an automatic ventilator with a shutdown feature, in the event of excessive pressure buildup, is proposed for anesthetizing healthy patients undergoing suspension microlaryngoscopy, and who have no airway obstructing lesion. A large tube with inflatable cuff is indicated when a supraglottic lesion may obstruct the airway.

Anesthesia, General↗
PubMed1991

Pseudohypacusis in a military population.

Pseudohypacusis, or non-organic hearing loss, was investigated as a possible marker for poor adaptation within the military environment. Eighteen active duty military patients who demonstrated pseudohypacusis were identified retrospectively from among all patients who underwent audiological evaluation at Naval Hospital, San Diego, during 1988. A control group of 33 patients with normal hearing was also randomly selected from the same population. Age, rank and military status one to two years later were compared, showing a significant difference between the groups in the rates of premature separation from the military. The results suggest that pseudohypacusis in a new recruit is a strong indicator that the subject may be separated prematurely from active duty in the military; this implies that it may be cost-effective for these patients to be separated from duty as soon as the diagnosis is made. Other trends in the data are discussed, and the literature is reviewed. The problem of pseudohypacusis as a method of increasing Veterans Association benefits is discussed. The signs of pseudohypacusis are important for all clinicians involved in audiological testing in order to make a correct diagnosis, avoid costly medical workup and refer affected patients for psychiatric evaluation when indicated.

Adolescent↗
PubMed1988

Conchomeatoplasty for chronic otitis externa.

Chronic moisture is a major cause of chronic otitis externa (COE). Moisture combined with inadequate lubrication of the stratum corneum and retention of keratin debris promote bacterial and fungal growth. In most cases of COE, creating a well-aerated, dry, self-cleaning external auditory canal prevents further infection. This can usually be accomplished by medical treatment that includes suction and swabbing. Antibiotic-steroid ear drops control infection and inflammation. Alcohol flush and warm-air ventilation dry the canal, and a hydrophobic cream lubricates and seals the stratum corneum from moisture, fungus, and bacteria. An anatomic variation, a narrow external auditory meatus leading to poor ventilation, is frequently associated with COE, which does not respond to conventional therapy. A previously unreported simple lateral conchomeatoplasty is presented. No other described meatoplasty corrects both the conchal cartilage projection and inadequate meatal skin circumference which, together, cause the small meatus. The lateral conchomeatoplasty has been used by this author for over 20 years on 35 ears. All patients showed improvement; most had complete control.

Chronic Disease↗