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Biomedical subjects

H R Muntz

Publications and source records attributed to H R Muntz.

At least 19 recordsLinked to original sources
PubMed1992

Pediatric transbronchial lung biopsy.

A retrospective review of 25 transbronchial lung biopsies in 19 pediatric patients is reported. Nineteen of these procedures used a rigid ventilating bronchoscope and a small cup biopsy forceps. The indications included diffuse pulmonary infiltrates in the immunocompromised patient, severe hyaline membrane disease, tumor, and lung transplant. In 84% of the procedures, adequate tissue was obtained. There was a 12.5% incidence of pneumothorax and no significant pulmonary hemorrhage.

Adolescent↗
PubMed1992

Adenoidectomy and otitis media.

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.

Adenoidectomy↗
PubMed1992

Comparison of vasoconstrictors for functional endoscopic sinus surgery in children.

Three different vasoconstricting agents were evaluated during functional endoscopic sinus surgery (FESS) in 57 children. Oxymetazoline hydrochloride 0.05%, phenylephrine hydrochloride 0.25%, or cocaine 4% was applied to the nasal mucosa in a prospective, randomized, double-blind fashion. Heart rate and blood pressure changes were recorded 5 and 10 minutes after application of the study vasoconstrictor to each nostril. The surgeon's subjective impressions of bleeding and visualization were recorded for each side of the nose, as were total blood loss and anesthesia time. Although all three vasoconstrictors were tolerated well by the children, there was a suggestion that heart rate decreased more at 5 minutes with phenylephrine than with oxymetazoline or cocaine (P = .08) and that blood pressure increased more at 10 minutes with phenylephrine than with oxymetazoline or cocaine (P = .1). No arrhythmias were noted. Subjective scoring for bleeding showed that children receiving oxymetazoline were less likely to receive scores of "more" bleeding than usual (3/38 vs. 10/34 for phenylephrine and 10/35 for cocaine, P less than .02). Subjective scoring for visualization showed that children receiving oxymetazoline were also less likely to receive scores of "worse" visualization than usual (3/38 vs. 12/38 for phenylephrine and 9/35 for cocaine, P less than .01). There was no difference in surgical bleeding or visualization between children receiving phenylephrine and children receiving cocaine. In our institution, 0.05% oxymetazoline is the preferred vasoconstrictor for FESS in children.

Blood Pressure↗
PubMed1991

Endoscopic ethmoidectomy and maxillary antrostomy in immunodeficient patients.

The efficacy of endoscopic sinus surgery was evaluated in 11 patients with diverse types of primary immunodeficiency disease and symptoms of chronic sinusitis. The postoperative symptoms and ability to eliminate antibiotics were used as outcome parameters. In two patients, the follow-up time was too short to assess therapeutic effectiveness. Five of the remaining nine patients had total or significant resolution of symptoms. Patients with transient immunodeficiency had the best resolution of symptoms. Eight of the total 11 patients were treated with intravenous immunoglobulin preoperatively, and in five patients, the treatment was continued postoperatively. The ability to terminate gamma-globulin reflects not the success of the surgery, but the transient nature of some of the immunodeficiencies.

Acute Disease↗
PubMed1991

Single-stage laryngotracheal reconstruction.

The mainstay for repairing subglottic and tracheal stenosis has been the rib graft with prolonged stenting. A refinement of this treatment was the use of the anterior cricoid decompression (split). We present single-stage reconstruction of the airway as an additional refinement of the laryngotracheoplasty. This article describes the experience of two institutions with single-stage reconstruction and offers some observations on the principles of the technique.

Adult↗
PubMed1991

Bacteriology of the ethmoid bullae in children with chronic sinusitis.

Cultures from 105 children with chronic sinusitis who had failed aggressive medical management were retrospectively studied. Patients with immunodeficiency and cystic fibrosis were excluded from the study. Because the most common sites of disease were the infundibula and anterior ethmoid sinuses, samples of mucosa removed from the anterior ethmoid bullae during endoscopic ethmoidectomy were routinely cultured for aerobic and anaerobic organisms. Fungal cultures were performed for 55 bullae. The principal organisms isolated were alpha-hemolytic Streptococcus, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pneumoniae, and Haemophilus influenzae non-type B. Only 12 anaerobic organisms and four fungi were isolated. Of the 204 bullae cultured, multiple organisms were found in 61 bullae and 40 showed no growth. Isolates of other less common organisms were also found. These data are analyzed on the basis of age and duration of symptoms, and antibiotic treatment is described.

Adolescent↗
PubMed1990

Embedded earrings: a complication of the ear-piercing gun.

Ear-piercing techniques include needles, safety pins, sharpened studs, and self-piercing kits. Complications from ear piercing are well documented and may involve local infection, sepsis, keloid scar formation, sarcoid granulomas, cyst formation, bifid ear lobe deformity, and organizing hematoma. The use of the spring-loaded ear-piercing instrument has resulted in an increased frequency of the complication of the earring backing becoming embedded in the ear lobe and helix. The embedded earring complication may result from improper aseptic technique, insufficient training of personnel at ear-piercing centers, or piercing the ears of young. To diminish the risk of embedded earrings we recommend aseptic technique, proper training, limiting ear piercing to the lobe, frequent cleansing of the lobe, and removal of the earring if signs of infection develop.

Adolescent↗
PubMed1990

A comparison of the cartilaginous rib graft and Evans-Todd laryngotracheoplasties for subglottic stenosis.

Cartilaginous rib graft interposition and Evans-Todd laryngotracheoplasties were compared in 21 patients with similar degrees of subglottic stenosis. The ultimate success of the repair was similar, but complications were more frequent with the Evans-Todd laryngotracheoplasty. Stent removal and decannulation were accomplished earlier with the cartilage graft laryngotracheoplasty--an average of 21 days to decannulation after stent removal versus 66 days for the Evans-Todd procedure. Granulation tissue was almost universal in the Evans-Todd procedure, and accounted for the long decannulation time. This retrospective study is used as a basis to discuss the relative merits of the two procedures.

Cartilage↗
PubMed1990

Nasal antral windows in children: a retrospective study.

A retrospective study of 39 patients with 46 sets of bilateral nasal antral windows was undertaken to assess the effect of this procedure on chronic sinusitis in children. All patients had symptoms of sinusitis for at least 3 months with plain radiographic documentation of maxillary sinus disease. Only medical failures were surgical candidates. Forty percent of the patients were improved at 1 month, but the success rate at 6 months decreased to 27%. It was necessary to repeat the nasal antral window procedure because of recurrent or persistent sinusitis in 7 of 39 patients. An additional 11 patients required endoscopic ethmoidectomy and maxillary antrostomy. Based on this experience, the nasal antral window procedure does not appear to be effective in treating chronic sinusitis in children.

Adolescent↗
PubMed1990

Endoscopic sinus surgery in children with chronic sinusitis: a pilot study.

This pilot study assessed the safety and preliminary data on the efficacy of endoscopic ethmoidectomy in children with chronic sinusitis. A total of 168 patients were evaluated for chronic sinusitis, and 31 were deemed appropriate candidates for ethmoidectomy. All patients were medical management failures. Twenty-six percent of the patients had asthma, 23% had some immune deficiency, 23% had allergies, and 2 patients (1%) had cystic fibrosis. All patients were followed for at least 1 year postoperatively. The only surgical complication was minor middle meatal scarring that developed in two patients. Overall, 71% of the patients were considered normal by their parents 1 year postoperatively. Of the 24 patients who did not have an underlying systemic disease (immune deficiency or cystic fibrosis) postoperatively, 80% were considered normal by their parents, 12% were improved but continued to have some symptoms, and 8% had unsatisfactory results. Seven children with underlying systemic disease had to undergo revision ethmoidectomy for persistent symptoms.

Child↗
PubMed1989

HIV protocol for the pediatric otolaryngology office.

With the increasing awareness and concern over the transmission of human immunodeficiency virus (HIV) to health care providers, the development of a reasonable approach to patient care is necessary with those suspected of or documented as being HIV-positive. Children are all too frequently the innocent victims of this deadly disease and will often require the services of the otolaryngologist for evaluation, diagnosis, and treatment. In order to provide appropriate care for these children and reduce the risk of possible contamination of health care professionals or other patients a protocol was established for the Pediatric Otolaryngology Division of Children's Hospital at Washington University. This protocol is discussed in detail with explanation of rationale and alternatives.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The diagnosis and treatment of recurrent and chronic sinusitis in children.

Pediatricians, allergists, family practitioners and otolaryngologists are all very aware of the increasing problem of recurrent and chronic sinusitis in children. This article details the diagnosis and management of the disease process and outlines steps for its future management.

Anti-Bacterial Agents↗
PubMed1989

Comparison of plain radiographs and coronal CT scans in infants and children with recurrent sinusitis.

We performed a prospective study of 70 infants and children with recurrent sinusitis. We compared plain radiographs with coronal CT scans of the sinuses to determine if plain radiographs can be used to accurately diagnose and localize residual sinus disease amenable to endoscopic surgery. This residual disease is thought to be important in the pathogenesis of recurrences of sinusitis. The patients were taking antibiotics and were clinically well at the time of the two examinations (performed on the same day). Findings on slightly over 80% of the CT scans were abnormal. In about 75% of the patients, the findings on plain radiographs did not correlate with those on CT scans. About 45% of the patients had normal findings on plain radiographs of at least one sinus with an abnormality of that sinus shown on CT scans. Almost 35% of the patients had what was interpreted as an abnormality of at least one sinus on plain radiographs, but that sinus was normal on CT scans. Sinusitis in infants and children is often underdiagnosed or overdiagnosed on the basis of findings on plain radiographs of the sinuses. Plain radiographs cannot be used to determine the need for, or to guide, endoscopic surgery on the sinuses.

Adolescent↗
PubMed1989

Reliability of flexible fiberoptic nasopharyngoscopy for evaluation of velopharyngeal function in a clinical population.

Flexible fiberoptic nasopharyngoscopy (FFN) has become a popular clinical tool for evaluating velopharyngeal function. The literature contains numerous reports of FFN methodology and findings. However, there are few published reports that address clinical rating and reporting schemes or that evaluate viewer reliability. This study was designed to evaluate the reliability of visual perceptual ratings of FFN video images for assessing velopharyngeal structure and function in a clinical population. Ninety-five videotaped clinical evaluations were presented to and judged by three expert raters and nine novice raters from the fields of speech pathology, otolaryngology, and plastic surgery, using a standard rating form. A clinical rating scheme was used for quantifying perceptual judgments of velopharyngeal activity. Results suggest that videotaped FFN evaluations may be rated reliably, that expert raters working as a group are more reliable than novice raters working individually, and that the 125 evaluations presented without feedback are insufficient to improve the novices' reliability. The combined auditory and visual perceptual evaluation inherent in FFN may be its most significant asset for both clinical and research applications.

Adolescent↗
PubMed1988

Tracheal stenosis in the sick premature infant. Clinical and radiologic features.

Six premature infants with congenital tracheal stenosis underwent diagnostic evaluation. Clinical features and chest roentgenograms were nonspecific; difficulty with intubation was the most common clinical finding and persistent lobar collapse the more common radiologic finding. The diagnosis was established by bronchoscopy in all infants. In the differential diagnosis of the sick premature infant, problems with airway patency must be considered because early intervention may reduce morbidity and mortality.

Bronchoscopy↗
PubMed1988

Practical application of flexible fiberoptic nasopharyngoscopy for evaluating velopharyngeal function.

Flexible fiberoptic nasopharyngoscopy increasingly is recognized as a valuable tool for assessing velopharyngeal function. There are, however, few reports in the literature describing a method for routine use of nasoendoscopy, the outcome of such evaluations, the criteria for referral, and a mechanism for communicating findings. Results from a 2-year clinical nasoendoscopy data base are presented. Ninety-eight patients were referred for evaluation of velopharyngeal function during speech. Flexible fiberoptic nasopharyngoscopic evaluations were conducted in 85 patients. Patients ranged in age from 3 years to adult. Eighty-nine percent of the evaluations were completed successfully on a first attempt. A standard format has been designed to communicate the results of nasoendoscopic examinations to primary and tertiary care providers. Nasoendoscopy has become an integral part of our cleft team care and is used routinely for decisions regarding palatal management, fabrication and fitting of palatal prostheses, and treatment of resonance disorders following pharyngeal flap surgery.

Adolescent↗
PubMed1988

Laryngeal/voice findings in patients with velopharyngeal dysfunction.

It is reported frequently that individuals with palatal clefts have a high occurrence of laryngeal/voice symptoms. It has been speculated that vocal pathology in this population is the result of laryngeal compensation for abnormal velopharyngeal valving. This paper describes the prevalence of laryngeal/voice findings in a group of 85 patients referred for multimethod evaluation of velopharyngeal dysfunction. Forty-one percent of the patients had auditorily perceived voice symptoms and/or observable laryngeal abnormalities. Twenty-one percent of the patients had vocal fold nodules or thickened vocal folds. There was no clear relationship between laryngeal/voice findings and nasoendoscopic or aerodynamic assessments of velopharyngeal dysfunction. However, there was a significant relationship between laryngeal/voice findings and estimated subglottal pressure. Patients with laryngeal/voice findings (with or without nodules) had average estimated subglottal pressure values which were outside the normal range more often than patients without laryngeal/voice findings. These results suggest patients referred for assessment of velopharyngeal dysfunction should receive a comprehensive evaluation which includes screening laryngeal structure and function.

Auditory Perception↗