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Biomedical subjects

Glenn Isaacson

Publications and source records attributed to Glenn Isaacson.

At least 19 recordsLinked to original sources
PubMed2006

The mechanical reduction of early acquired cholesteatomas in children: indications and limitations.

The standard treatment for acquired cholesteatoma involves surgical removal of the lesion and reconstruction of the tympanic membrane. In some children, these lesions can be treated more conservatively. We conducted a retrospective study of 29 ears in 24 children who had been treated for early acquired cholesteatoma with mechanical reduction and a tympanostomy tube. Outcomes measures included hearing status, the postoperative appearance of the tympanic membrane, and the need for additional surgery. We found that anterior and inferior pars tensa lesions, with or without squamous debris, can be successfully reduced, but that posterosuperior retractions respond less well when the ossicular chain has been eroded. None of the children who responded to mechanical reduction required major reconstructive surgery later. We conclude that mechanical reduction of retraction pocket cholesteatomas with tympanostomy tube placement is sufficient to restore normal hearing and a normal tympanic membrane appearance in selected children with early lesions. We also identified several important prognostic features, including the patient's age, the specific location of the retraction pocket on the tympanic membrane, the extent of the pocket, ossicular chain involvement, and the patient's adenoid status.

Adenoidectomy↗
PubMed2005

Oxymetazoline is equivalent to ciprofloxacin in preventing postoperative otorrhea or tympanostomy tube obstruction.

OBJECTIVE: To compare the effectiveness of ciprofloxacin and oxymetazoline solutions instilled after tympanostomy tube placement in the prevention of postoperative otorrhea and tube occlusion. STUDY DESIGN: Prospective cross-sectional series. METHODS: We reviewed all bilateral myringotomy and tube placement operations performed by two full-time attending pediatric otolaryngologists during a 9 month period. Data from 488 patients who underwent surgery for otitis media were collected. Demographic and clinical variables including age, sex, number of tube insertions in the past, previous adenoidectomy, type of effusion present at surgery, and type of drop prescribed postoperatively were recorded. All patients were evaluated in the office 2 to 4 weeks postoperatively. Multivariate logistic regression analysis was used to estimate the relationship of these variables with the occurrence of otorrhea and tube patency. Odds ratios were calculated. RESULTS: No significant differences in postoperative otorrhea or tube patency were found between ciprofloxacin (Ciloxan) and oxymetazoline solutions (Afrin, Visine LR). CONCLUSION: Oxymetazoline and ciprofloxacin solutions are equivalent in the prevention of postoperative otorrhea and tube occlusion after tympanostomy tube placement. The implications for medication cost and potential adverse reactions are discussed.

Administration, Topical↗
PubMed2005

Oxymetazoline solutions inhibit middle ear pathogens and are not ototoxic.

OBJECTIVES: This study was performed to explore the antimicrobial activity of two commercially available oxymetazoline hydrochloride preparations against the common pathogens of otitis media and to demonstrate the lack of ototoxicity of these agents and of United States Pharmacopeia (USP) oxymetazoline in a standard animal model. METHODS: Disc diffusion assays and minimum inhibitory concentration studies against American Type Culture Collection reference strains of common middle ear pathogens were used to evaluate the antimicrobial activity of oxymetazoline solutions and fluoroquinolone drops, and outer hair cell counts were performed on scanning electron micrographs of guinea pig basal cochlear segments after chronic exposure to oxymetazoline solutions and positive and negative controls. RESULTS: Oxymetazoline nasal spray and eyedrops had activity against all species tested except Haemophilus influenzae and Pseudomonas aeruginosa. The USP oxymetazoline had limited antimicrobial activity. Oxymetazoline nasal spray, oxymetazoline eyedrops, and USP oxymetazoline had ototoxicity profiles indistinguishable from that of the saline solution control. CONCLUSIONS: Commercially available oxymetazoline solutions are active against several of the common pathogens of otitis media. This antimicrobial activity is not due to oxymetazoline, and is more likely due to preservatives present in the solutions. The solutions tested are not ototoxic to guinea pig outer hair cells. Oxymetazoline solutions are potential substitutes for broad-spectrum antibiotic drops after tympanostomy tube placement.

Adrenergic alpha-Agonists↗
PubMed2005

Inside-out complete tonsillectomy: extended intracapsular tonsillectomy for severe sore throat.

OBJECTIVES: This consecutive case series is presented to describe inside-out complete tonsillectomy and to assess its effects on postoperative pain and bleeding and its initial effectiveness in controlling recurrent sore throat and peritonsillar abscess formation. METHODS: Bipolar electrosurgical scissors are used for bloodless resection of 90% of the tonsillar mass. During controlled resection, tonsil tissue is intentionally left at the superior and inferior poles and at the deepest part of the tonsillar fossa to provide coverage for nutrient arteries and the tonsillar plexus of veins. This tissue is then electrodesiccated and removed under direct vision and indirect mirror guidance to achieve complete tonsillectomy. RESULTS: One hundred eighty-three consecutive tonsillectomies were performed by a single surgeon in a 16-month period, 47 of which were for the indication of recurrent sore throat (44) or recurrent peritonsillar abscess (3). Among these 47 children, there were 2 readmissions for dehydration. There were no immediate or delayed bleeding episodes. The average child required 4 days of narcotic pain medication. The mean annualized number of severe sore throats decreased from 5.24 before operation to 0.36 after operation (p < .0001, Student's paired t-test). There were no recurrent peritonsillar abscesses. CONCLUSIONS: Inside-out complete tonsillectomy achieves the surgical goal of complete tonsillectomy with the smallest possible wound and minimal injury to the surrounding tissue. The perioperative morbidity is markedly decreased compared to that of historical controls. The initial results suggest effectiveness similar to that of extracapsular tonsillectomy.

Child↗
PubMed2004

Recurrent pneumoparotid: cause and treatment.

OBJECTIVE: To document the etiology and successful treatment of severe recurrent pneumoparotid. STUDY DESIGN: Computed tomography, ductal measurement by probe size, surgical treatment. RESULTS: We performed a superficial parotidectomy for a 13-year-old with a history of recurrent parotitis. He subsequently developed recurrent pneumoparotid in the contralateral gland with subcutaneous dissection of air into the face, neck, and mediastinum. At surgery, Stensen's ducts were measured and found to be abnormally patent bilaterally compared to standardized norms. Parotid duct ligation, commonly used for sialorrhea, was employed as a novel treatment and was curative. CONCLUSION: Insufflation of air into the parotid duct system can trouble woodwind instrument players, can complicate dental procedures, or can be self-induced. It is generally a benign condition requiring no therapy. Occasionally, pneumoparotid can be recurrent and lead to inflammation and infection of the parotid or subcutaneous emphysema. SIGNIFICANCE: In selected cases of recurrent pneumoparotid, ductal ligation may be curative.

Adolescent↗
PubMed2004

Pseudoaneurysms of the superficial temporal artery: treatment options.

OBJECTIVES: Pseudoaneurysms of the superficial temporal artery present as slowly growing masses of the face or scalp. They may arise as a result of infection or autoimmune disease but most commonly are sequelae of blunt, penetrating, or surgical trauma. We describe their clinical presentation and differential diagnosis and compare several treatment options. STUDY DESIGN: Observational case series. METHODS: We retrospectively reviewed the presentations, diagnostic evaluations, and management in three young men who presented with pseudoaneurysms after trauma. A computerized review of the world's literature revealed a variety of methods for the control of head and neck pseudoaneurysms. RESULTS: Surgical resection, ligation without resection, intravascular sclerosis, and coil embolization have all been used to treat these lesions. We treated two lesions by coil embolization and one by surgical resection. Long-term control was achieved in each case. CONCLUSIONS: Surgical resection cures pseudoaneurysms in most cases. The frontal and zygomatic branches of the facial nerve are at risk during this procedure. Local sclerosis is effective but may cause distal tissue necrosis. Coil embolization is highly effective and leaves no facial scar but carries small risks of stroke, lower extremity ischemia, and groin pseudoaneurysm.

Adolescent↗
PubMed2004

Superstition and post-tonsillectomy hemorrhage.

OBJECTIVES/HYPOTHESIS: The objective was to determine whether post-tonsillectomy hemorrhages occur more frequently in redheaded children, in patterns of threes, on Friday-the-13th days, or with the full moon. STUDY DESIGN: Case-control analysis. METHODS: The authors performed multiple statistical analyses of all children undergoing tonsillectomy at Temple University Children's Medical Center (Philadelphia, PA) during a 29-month period. Children readmitted to the hospital with or without surgical control of bleeding were compared with children who did not bleed. Relation of post-tonsillectomy hemorrhages to the phase of the moon was evaluated using a standard normal deviate. The frequency of surgery performed on Friday-the-13th days was compared with a differently dated Friday chosen at random. Clusters of three hemorrhages in a 7-day period were recorded. Families of children were contacted and asked whether their child had red hair. A chi analysis compared redheaded and non-redheaded tonsillectomy patients. RESULTS: Twenty-eight of 589 tonsillectomy cases performed required readmission for bleeding events. Twenty tonsillectomies occurred on a full-moon day, resulting in one bleeding event. One cluster of three post-tonsillectomy hemorrhages occurred in a 7-day period. Four of the children who bled had red hair. Two tonsillectomies occurred on Friday the 13th, with no associated hemorrhage. Statistical analysis revealed a random pattern to post-tonsillectomy hemorrhage. CONCLUSION: Post-tonsillectomy hemorrhages do not occur in clusters of three and are not more frequent with the full moon or on Friday the 13th. The bleeding rate among children with red hair is similar to that of non-redheaded children.

Case-Control Studies↗
PubMed2004

Pediatric intracapsular tonsillectomy with bipolar electrosurgical scissors.

This article describes the benefits of performing intracapsular tonsillectomy with bipolar electrosurgical scissors as an alternative to the powered microdebrider These scissors are used to excise approximately 90% of the tonsillar mass en bloc. The remaining tonsillar tissue is electrodesiccated by monopolar suction cautery, while the anterior and posterior pillars are completely preserved. The procedure leaves a smaller surgical wound than do extracapsular techniques. Surgical time averages 6 minutes. There is typically no intraoperative blood loss. Bipolar electrosurgical scissors are an efficient and low-cost tool for performing pediatric intracapsular tonsillectomy.

Blood Loss, Surgical↗
PubMed2003

Metastatic intracranial abscesses of bronchopulmonary origin.

Intracranialabscesses are serious, life-threatening infections despite recent advances in diagnosis and treatment. We report the case of a child with metastatic brain abscesses and a chronic, sharp foreign body of the bronchus. Its presentation and endoscopic appearance and the microbiology of the abscesses are detailed. The detection of bacteria of respiratory origin should lead to a search for a bronchopulmonary source of contamination.

Brain Abscess↗
PubMed2003

Natural history of sigmoid sinus thrombosis.

To demonstrate the evolution of sigmoid sinus thrombosis, we performed a prospective observational study on a 6-year-old girl who presented with mastoiditis, epidural abscess, and occipital osteomyelitis from multiple drug-resistant Streptococcus pneumoniae. She underwent mastoidectomy and partial occipital craniectomy. This procedure produced a window in the occipital bone that allowed serial ultrasonography of the sigmoid sinus during medical treatment. Computed tomography was performed, followed by weekly Doppler ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The natural history of a treated episode of sigmoid sinus thrombosis was illustrated. Venous occlusion resolved over a 4- to 6-week period without surgical drainage or venous anticoagulants. Collateral flow, reversal of normal venous flow, and ultimate return to normal venous transport characterized the period of resolution. We conclude that an occluded sigmoid sinus from mastoiditis can naturally recanalize. Aberrant venous flow can be demonstrated during the period of resolution. This case supports a conservative approach to management of the occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal of perisinus infection is sufficient for cure.

Anti-Bacterial Agents↗
PubMed2003

Worldwide distribution of Waardenburg syndrome.

To clarify the multiracial occurrence of Waardenburg syndrome, we present a case series and literature review. A computerized review of the English-language literature was conducted to assess the distribution of reported occurrences of Waardenburg syndrome in populations around the world. We detail the clinical features of 2 family cohorts: one of Western European origin and the other from South Asia. A computerized literature review found sporadic cases of the syndrome in many ethnic groups, including Japanese, Taiwanese, and Middle Eastern families. The highest reported incidence is among Kenyan Africans. Waardenburg syndrome accounts for between 2% and 5% of cases of congenital deafness. It was first described in Northern European cohorts and is widely identified in fair-skinned populations. We hope to raise awareness of the worldwide distribution of this important cause of hearing loss.

Asia↗
PubMed2003

Congenital salivary gland anlage tumor of the nasopharynx.

OBJECTIVE: Nasal and upper respiratory tract obstruction in the neonatal period can result from a variety of conditions, and may present with variable symptoms. In the absence of dysmorphic features or other abnormalities, causes of nasal obstruction may be difficult to differentiate on initial examination. We report an unexpected and potentially life-threatening condition arising during the work-up of this common neonatal complaint. DESIGN: Case report with literature review. RESULTS: A male neonate presented with complaints of nasal obstruction and feeding difficulties. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. Cannulation of the nasal cavity to rule out choanal atresia resulted in a burst of bleeding from the nose and mouth. A finger sweep of the oropharynx produced a dislodged mass lesion. Pathology revealed a salivary gland anlage tumor of the nasopharynx. CONCLUSIONS: The diagnosis of a nasopharyngeal mass lesion should be considered in neonates with nasal obstructive symptoms. It is wise to place an index finger in the oropharynx when passing catheters to rule out choanal atresia to feel a dislodged mass lesion before it can become an airway foreign body. Should passage of nasal catheters result in bleeding and/or respiratory distress, the possibility of a displaced mass lesion must be considered immediately to institute prompt intervention.

Adenoma, Pleomorphic↗