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D L Wohl

Publications and source records attributed to D L Wohl.

10 recordsLinked to original sources
PubMed2001

Intraoperative pediatric laryngeal electromyography: experience and caveats with monopolar electrodes.

We report our experience with intraoperative laryngeal electromyography (L-EMG) using direct laryngoscopy and placement of monopolar electrodes under general anesthesia in the evaluation and management of laryngeal dysfunction in pediatric patients. In this series of case studies, we present clinical data on 30 pediatric patients with known or suspected anatomic or neurologic laryngotracheal disorders evaluated with placement of shielded monopolar electrodes into the thyroarytenoid muscles during direct laryngoscopy under general anesthesia. Diagnoses included congenital vocal fold paralysis (VFP), laryngotracheal stenosis, cerebral palsy, laryngeal tumors, traumatic vocal fold dysfunction, and postsurgical VFP. The impact of L-EMG on patient management was assessed. We found that L-EMG objectively supported clinical findings, but provided new objective data relevant toward management recommendations in only a few selected pediatric patients with new-onset vocal fold paralysis or paresis or infiltrative laryngeal tumors, and in selected postsurgical cases involving decannulation decisions. The prognostic utility of L-EMG in newborns with congenital VFP has not been established. A normal L-EMG recording indicates an intact neuromuscular axis, but does not guarantee vocal fold mobility or guarantee muscle function in a partially denervated or deconditioned muscle. The potential for false-negative recordings is the major limitation of this technique.

Action Potentials↗
PubMed2001

Diagnosis of recurrent intermittent airway obstruction ("recurrent croup") in children.

Children with a history of recurrent intermittent airway obstruction can present with a constellation of signs and symptoms labeled by their primary care physician as "recurrent croup." Recurrent croup, however, is not a diagnosis and should alert the clinician to the potential for intrinsic or extrinsic laryngotracheal pathology. This study was undertaken to evaluate referral patterns, diagnostic algorithms, and diagnoses for children with a history of recurrent intermittent airway obstruction initially characterized as "recurrent croup." We performed a retrospective analysis of office and operative records of children with a history of recurrent intermittent airway obstruction characterized as "recurrent croup." The setting was a university-based pediatric otolaryngology practice with both urban and suburban referral patterns. The medical records of 53 children (median age, 2 years) with a history of mild to severe recurrent intermittent airway obstruction characterized as "recurrent croup" were evaluated with respect to referral source, duration of signs and symptoms, diagnostic algorithm, and findings. We conclude that recurrent intermittent airway obstruction in children is an underappreciated clinical scenario. Upper aerodigestive tract endoscopy is a key component in a diagnostic evaluation to ascertain the cause. The decision for an endoscopic evaluation is best determined after analysis of the patient's age, past medical history, clinical severity, and suspected diagnosis. By virtue of his or her knowledge of aerodigestive tract anatomy and endoscopy skills, the otolaryngologist can take a proactive role in arriving at an accurate diagnosis in these children.

Airway Obstruction↗
PubMed2000

Nasal foreign body: removal of an open safety pin from the left nostril.

We describe the case of a woman who presented with an open safety pin lodged in her left nostril. An attempt to remove the pin with the patient under local anesthesia was not successful. Removal was eventually accomplished in the operating room with the patient under general anesthesia.

Adult↗
PubMed1999

Vocal fold granuloma induced by rigid bronchoscopy.

Vocal fold granulomas secondary to endotracheal intubation, vocal abuse, and laryngopharyngeal reflux are a well-described cause of hoarseness, generally in the adult population. The mean age of onset is usually in the fourth or fifth decade, and the position is most commonly on the vocal process or one of the arytenoids. We present an atypical case involving a pediatric patient with a large, anterior, true vocal fold granuloma following rigid endoscopy of the upper conductive airway.

Bronchoscopes↗
PubMed1996

Learning disability in children with postmeningitic cochlear implants.

OBJECTIVE: To determine the effects of learning disability on measures of auditory perception, receptive language development, and sequential organization in children with postmeningitic cochlear implants. DESIGN: Retrospective study. Follow-up ranged from 12 months to 7 years. SETTING: Tertiary care center. PATIENTS: Ten pediatric patients with cochlear implants, 5 with documented learning disability. MAIN OUTCOME MEASURE: Pediatric cochlear implant test battery performance. RESULTS: Children with learning disability showed slower progress, more inconsistencies, and lower test scores than their partners without learning disability. CONCLUSION: Learning disability is not a contraindication to cochlear implantation, but preoperative counseling must be available to families and support personnel about preoperative achievements and expectation for these children.

Child↗
PubMed1996

Traumatic vocal fold avulsion injury in a newborn.

A full-term newborn developed respiratory compromise in the immediate postparturition period requiring urgent intubation. Evaluation of post-extubation stridor later the same day revealed an avulsion injury extending from the left vocal fold into the lateral glottic musculature. Primary repair was accomplished with anatomic realignment of the torn vocal fold and muscle. Endotracheal intubation was utilized for stenting and the patient was extubated following 3 days of paralysis with sedation. Follow-up examination revealed a reparative granuloma, which was lasered. Eight-week follow-up examination revealed normal vocal fold architecture. At 18 months the patient continues to have a normal voice and normal laryngeal development.

Granuloma, Laryngeal↗
PubMed1995

Airway obstruction in children with infectious mononucleosis.

Epstein-Barr Virus (EBV) infection generally has a benign clinical course. Upper airway obstruction is a known complication requiring the otolaryngologist's attention. EBV is usually associated with adolescence but has been increasingly documented in younger children. We review 36 pediatric admissions for infectious mononucleosis over a 12-year period at our institution, 11 of which required consultation for airway obstruction. Airway management was based on clinical severity and ranged from monitored observation, with or without nasopharyngeal stenting, to prolonged intubation or emergent tonsilloadenoidectomy. A rare case of a four-year-old with near total upper airway obstruction secondary to panpharyngeal and transglottic inflammatory edema prompted this review and is reported. The otolaryngologist must recognize the potential severity of EBV-related airway compromise and be prepared to manage it.

Adolescent↗
PubMed1992

Infant botulism: considerations for airway management.

Infant botulism is a national problem with over 1000 confirmed cases in the United States since it was first recognized as a distinct clinical entity in 1976. The disease is characterized by a progressive, symmetrical descending paralysis of cranial nerves with eventual involvement of axial and trunk muscle innervation. Most infants progress to complete respiratory failure. An initial report in 1979 recommended early tracheotomy for avoidance of long-term intubation complications. However, over the past 10 years at St. Christopher's Hospital for Children, analysis of airway management in 11 patients with infant botulism revealed a median intubation time of 16 days. Following extubation, all patients progressed to complete respiratory recovery without adverse laryngotracheal sequelae. Otolaryngologists consulted for the airway management of infants with botulism should adopt a conservative approach with meticulous monitoring of endotracheal tube sizes and leak pressures. Tracheotomy is rarely required.

Botulism↗
PubMed1982

Water content of equine articular cartilage: effects of enzymatic degradation and "artificial fibrillation".

A method is described for accurate and reproducible determination of wet and dry weights of small articular cartilage samples. The water content of the articular cartilage samples before and after treatment with selective degradative enzymes and "artificial fibrillation" was determined. It was found that the water content of articular cartilage can be altered by changing the physical and chemical composition of articular cartilage. The combination of protein polysaccharide degradation and "fibrillation" causes an increase in articular cartilage water content, while collagenase and the combination of collagenase and "fibrillation" causes a decrease. The relationship between these findings and function of normal and osteoarthritic cartilage is discussed.

Animals↗