Biomedical subjects

Ellen S Deutsch

Publications and source records attributed to Ellen S Deutsch.

7 recordsLinked to original sources

PubMed2005

Penetrating middle ear trauma: a report of 2 cases.

Penetrating middle ear injury can result in hearing loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia; in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.

Child, Preschool↗

PubMed2004

Traumatic supraglottitis.

Traumatic supraglottitis may occur after mechanical, thermal, chemical, or other airway injury. It can be managed following the principles used for managing the airways of patients with infectious supraglottitis. A protocol for evaluation and management is described.

Airway Obstruction↗

PubMed2003

Analysis of efficiency of common otolaryngology operations: comparison of operating room vs short procedure room in a pediatric tertiary hospital.

OBJECTIVE: To compare the operative times of routine otolaryngologic procedures performed with 2 different operating room staffing models: the traditional model with 2 staff, a scrub nurse and a circulator, and the short procedure room (SPR) setting, with a circulator only. DESIGN: Retrospective comparison of operative procedure times. Data were extracted from a prospectively maintained database of electronic medical records. SETTING: All data were from procedures performed at a tertiary care children's hospital operating room suite. PATIENTS OR OTHER PARTICIPANTS: Data for the year 2000 were extracted for all outpatient otolaryngology cases of bilateral myringotomy and tube placement (BMT), tonsillectomy and adenoidectomy (TA), and adenoidectomy alone. MAIN OUTCOME MEASURES: The mean +/- SD operative time intervals (operative procedure times and total operative procedure time), anesthesia start times, surgical preparation times, and anesthesia end times of the 2 sites were compared. These time intervals were also compared for the 3 surgeons performing TAs in both settings. RESULTS: Total operative procedure times were significantly shorter in the SPR setting for TA and BMT, but not for adenoidectomy. For TA procedures, operative procedure times and anesthesia end times were significantly shorter in the SPR setting (P<.05). For BMT procedures, all operative times were significantly shorter in the SPR setting. All 3 surgeons who performed TAs in both settings had significantly shorter total operative procedure times in the SPR setting than in the traditional setting. CONCLUSIONS: Despite fewer assisting staff, the SPR setting showed a statistically significant reduction in total operative procedure times for TA and BMT, and results were similar for adenoidectomy. Reducing operating room personnel costs is possible in addition to achieving modest gains in efficiency.

Age Factors↗

PubMed2003

Duration of patency of laser-assisted tympanic membrane fenestration.

BACKGROUND: Laser-assisted tympanic membrane fenestration (LTMF) provides intermediate-duration middle ear ventilation, which benefits selected children with acute otitis media (AOM) and otitis media with effusion (OME). OBJECTIVE: To evaluate clinical and technical factors that may affect duration of LTMF patency. DESIGN: Prospective clinical cohort effectiveness trial. SETTING: Four tertiary care children's hospitals. PATIENTS: Volunteer sample of 251 children (430 ears) followed up at 1, 2, 3, 4, 8, and 12 weeks; time to fenestration closure was evaluable in 201 ears, and assessment of cure at study conclusion was evaluable in 128 ears. INTERVENTIONS: Laser-assisted tympanic membrane fenestration for prospectively defined AOM or OME. The surgeon determined spot size, wattage, and concurrent adenoidectomy based on clinical judgment. MAIN OUTCOME MEASURES: Cure of AOM/OME with effusion at 90 days and duration of LTMF patency relative to spot size (1.8-2.8 mm), fenestration location on tympanic membrane, power (7-22 W), concurrent adenoidectomy, age, diagnosis (AOM vs OME), type of effusion, and preoperative tympanogram characteristics. Results are based on the number of ears that could be evaluated at each data collection interval. RESULTS: Fenestrations remained patent for 2 to 4 weeks (mean = 2.52, median = 2.0, SD = 1.4, n = 201); 97.4% were closed at 6-week follow-up. Spot sizes of 2.4 and 2.6 mm had a higher rate of patency than 2.0-mm spot size at 3 weeks following LTMF. Cure at 90 days was related to duration of patency for all patients combined and for patients treated for AOM and OME, but not for those undergoing adjunctive adenoidectomy. Cure at 90 days was related to larger spot size for all patients combined and those treated for AOM. Other investigated factors did not achieve statistical significance. CONCLUSIONS: Spot size of 2.4 mm or greater results in improved duration of LTMF patency, persisting for up to 3 weeks after LTMF, especially for treatment of AOM. Increased duration of LTMF patency correlates with greater incidence of cure of middle ear effusion at 90 days. Additional investigation is indicated to determine optimum spot size and optimum duration of patency for disease- severity-adjusted populations.

Acute Disease↗

PubMed2003

Adenotonsillectomy in the morbidly obese child.

OBJECTIVE: The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed pediatric surgical procedures in the United States. Our objective was to determine if there is an increased complication rate in morbidly obese (MO) children undergoing AT and if elective pediatric intensive care unit (PICU) admission for observation is warranted. METHODS: This retrospective study includes postoperative admissions to the PICU over a 4-year period at one hospital. Out of 957 adenotonsillectomies performed by one surgeon, 543 were admitted to the hospital. Fourteen MO children were identified. Using body mass index (BMI; weight in kg/m(2)), as calculated for age appropriate categories, postoperative outcomes of AT in MO children (>95th percentile BMI) were determined. These 14 were electively admitted to the PICU for airway observation. The indication for surgery in these 14 children was obstructive sleep apnea. Ages ranged from 4 to 15 years. There were 11 males and 3 females. RESULTS: Two patients required overnight bi-level positive airway pressure (BiPAP) for oxygen desaturation. One patient remained intubated for 10 days. Three patients required supplemental oxygen. Four of these admissions had preoperative polysomnograms (PSGs). CONCLUSIONS: Our study concluded that routine PICU admission was not warranted for most MO patients although several required supplemental oxygen, BiPAP, and one required intubation. These interventions can easily be administered in a surgical floor bed. In fact, these results imply that performing this surgical procedure in obese children is not as risky as many believe. Trends were noted for an increased need of airway interventions in children requiring preoperative BiPAP and in those with comorbidities. In this small population, sample AT was performed on the basis of history. This is to serve as a pilot review for a prospective study in which preoperative PSGs would be used to determine potential indicators for elective PICU admission.

Adenoidectomy↗

PubMed2002

The feasibility of office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion: the duPont Hospital experience.

OBJECTIVE: To determine the feasibility of inserting tympanostomy tubes in children using office-based laser-assisted tympanic membrane fenestration. METHODS AND MATERIALS: Study consisted of a retrospective review of the charts of all children who underwent office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion from July 1, 1998 to August 31, 2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel). RESULTS: Of the 127 patients (185 ears) who underwent laser-assisted tympanic membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears were treated for otitis media with effusion, 43 for recurrent acute otitis media, and eight for acute otitis media not responding to antibiotics. Fifteen ears had purulent effusion, five had a serous effusion, and 23 had mucoid middle ear fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all tested ears had hearing of 20 dB or better. Two children had tubes that were blocked. Blockage occurred in ears that required more than one laser firing to penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea occurred exclusively in ears with purulent or mucoid middle ear fluid. CONCLUSIONS: Office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion is a safe and effective alternative to tube placement in the operating room. The outcome compares favorably with previously published data.

Ambulatory Surgical Procedures↗

PubMed2002

A pilot survey of vocal health in young singers.

The objective of this study was to determine the incidence of vocal problems in young choir singers and to correlate vocal problems with demographic and behavioral information. A questionnaire addressing vocal habits and hygiene was offered to 571 young choir singers, up to 25 years of age, who sing at least weekly; 129 (22.6%) responded. More than one-half of the respondents had experienced vocal difficulty, particularly older adolescents. Detrimental behaviors and circumstances surveyed were not reflective of the incidence of vocal difficulty, except for morning hoarseness, chronic fatigue, insomnia, and female gender after puberty. Voice care professionals should be aware that self-reported voice difficulties are common among young choral singers, especially postpubescent girls, and children with symptoms consistent with reflux (morning hoarseness) and emotional stress (insomnia). Laryngologists should communicate with choral conductors and singing teachers to enhance early identification and treatment of children with voice complaints, and to develop choral educational strategies that help decrease their incidence.

Adolescent↗