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Biomedical subjects

K M Grundfast

Publications and source records attributed to K M Grundfast.

At least 73 records · Page 4Linked to original sources
PubMed1983

Cerumen removal. How necessary is it to diagnose acute otitis media?

We evaluated the consistency and appearance of aural cerumen and the degree to which such cerumen obscured the view of the eardrum in 279 children with unilateral acute otitis media with effusion (AOME). Mechanical removal of cerumen was necessary overall in 29% of the patients. Cerumen removal was inversely proportional to age, and we found it necessary to remove such cerumen to visualize most of the eardrum in 35 (57%) of 61 infants with AOME. Some physicians believe that the heat generated from an intensely inflamed middle ear will invariably cause sticky, honey-colored cerumen to liquefy. Only 29 children (11%) in this study had aural cerumen with a soft cheesy or semiliquefied consistency.

Cerumen↗
PubMed1982

Adenotonsillar hypertrophy and upper airway obstruction in evolutionary perspective.

Primary care physicians have become increasingly reluctant to refer children for tonsillectomy and adenoidectomy (T and A) during the past years while antimicrobial therapy for pharyngotonsillitis and otitis media has become more common. Consequently, more children retain tonsils and adenoids throughout the childhood years. Airway compromise from adenotonsillar hypertrophy is reported in 11 cases-8 with insidious onset, 3 with acute onset. Typical symptoms occurring during sleep include snoring, snorting, enuresis and obstructive apnea. Daytime symptoms included hyponasal speech, oral respiration and morning cephalgia. Methods of assessing children with adenotonsillar hypertrophy and airway compromise included polysomnography and acoustic analysis of respiratory sounds. It appears that airway compromise from adenotonsillar hypertrophy is more common now that fewer children are undergoing T and A, is being more commonly recognized because of improved methods of assessment, or both.

Adenoidectomy↗
PubMed1981

Acute otitis media: toward a more precise definition.

Eighty-five infants and children presenting with acute otitis media who had normal tympanic membrane landmarks and mobility within 1 month before entry into the study were studied. These criteria were used in order to avoid including children with prior otitis media with effusion (secretory otitis media). A diagnosis of suppurative otitis media was made in each case based on pneumo-otoscopic findings of diminished mobility, contour, and color of the tympanic membrane. The diagnosis was validated by myringotomy and positive culture of the middle ear fluid. A poorly mobile, bulging, yellow, opacified tympanic membrane was the most common type of tympanic membrane visualized; whereas a poorly mobile, bulging, red tympanic membrane was seen in ony 19%. The color of the tympanic membrane did not correlate with a specific pathogen isolated from the middle ear exudate. Sixty-seven per cent of children had no fever; 28% had no pain or querulous behavior.

Acute Disease↗
PubMed1981

Pharmacologic compliance with antibiotic therapy for acute otitis media: influence on subsequent middle ear effusion.

The frequency of otitis media with effusion (serous otitis media, secretory otitis media) detected after conventional antibiotic treatment of acute otitis media is approximately 50%. The relationship between pharmacologic compliance and the frequency of otitis media with effusion was studied. A Micrococcus lutea bioinhibition test was used to detect the presence of a substances in the urine that inhibited the growth of this antibiotic-sensitive organism. On the fourth, seventh, and tenth days of antibiotic treatment for acute otitis media urine specimens were collected. Otitis media with effusion was detected in 53% of 66 children who had positive results for M lutea bioinhibition compliance test for all three urine specimens. Electro-acoustic impedance measurements (tympanograms) confirmed the presence of effusion in all children in the effusion group tested by this method. The M lutea bioinhibition assay is a practical, in-office method to validate periodically, during treatment, pharmacologic compliance with antibiotics used for treatment of acute otitis media. Pediatrics 68:619-622, 1981.

Acoustic Impedance Tests↗
PubMed1979

Cefaclor compared with amoxycillin acute otitis media with effusion: a preliminary report.

A double-blind, randomized clinical trial comparing cefaclor with amoxycillin in the treatment of acute otitis media with effusion (OME) in infants and children is being conducted at Children's Hospital of Pittsburgh. Although the randomization code has not yet been broken, the results of treating the first 55 children are reported, since they appear to be of interest. Of the 62 ears with acute OME on which an initial tympanocentesis was performed, 41 positive cultures were isolated from the middle ear aspirates. Of the 10 ears from which Haemophilus influenzae was isolated, one had a type b strain, and of the remaining unencapsulated strains, one was resistant to both penicillin G and ampicillin. In the one ear from which Staphylococcus aureus was isolated, the organism was found to be resistant to ampicillin. However, all of the organisms were sensitive in vitro to cefaclor. In 88% of all subjects observed for the first 2 weeks, the initial symptomatic response was excellent. Six children had persistent signs and symptoms of acute OME and received a second tympanocentesis; however, none of the effusions from the repeat aspiration revealed an organism. An effusion was still present in 97% of the ears after 3 days, in 69% after 2 weeks, and in 48% 6 weeks after initiation of the study. Tympanocentesis did not appear to affect either the initial clinical response or the persistence of effusion. There were no adverse reactions to either drug in this study. Because an apparent increase in the incidence of ampicillin-resistant strains of H. influenzae is being reported, and because of the presence of ampicillin-resistant S. aureus in some ears with acute OME, a new antimicrobial effective against all the common pathogens causing acute middle ear disease would be desirable. In this respect, the preliminary findings of treatment with cefaclor from this study appear promising.

Acoustic Impedance Tests↗
PubMedDate not supplied

Vocal cord paralysis in children studied by monopolar electromyography.

Twelve children with symptoms of vocal cord paralysis were studied by monopolar needle electromyography. Recordings were used to verify complete or partial paralysis as well as to evaluate the etiology of the problem, paralytic or mechanical. These results then were useful in patient management. The monopolar electromyographic technique is of value in evaluating and treating vocal cord problems.

Adolescent↗
PubMedDate not supplied

Management of middle ear hemangiomas.

Hemangioma rarely presents as an isolated middle ear lesion. Because congenital hemangiomas usually regress spontaneously, surgical excision is not always necessary. However, a hemangioma in the middle ear can be complicated by infection and hearing impairment. We present 2 cases to show contrasting management strategies, both with successful outcomes. Two children who presented with unilateral otitis media were found to have concomitant mesotympanic hemangiomas on examination. The first child was asymptomatic and subsequently had an incisional biopsy, confirming the suspected diagnosis. The residual tumor then involuted over the following year. The second child, however, developed chronic otitis media refractory to medical therapy and required surgical removal of the entire hemangioma. Once a tissue diagnosis is made, middle ear hemangiomas can be managed expectantly (ie, wait for spontaneous resolution) or surgically. If growth of a middle ear hemangioma appears to be causing complications refractory to conservative therapy, then early surgical excision may be indicated.

Biopsy↗
PubMedDate not supplied

The role of the audiologist and otologist in the identification of the dysmorphic child.

Definitive diagnosis of hearing impairment may represent the first objective evidence of physiologic dysfunction in an infant or child with undetected associated abnormalities. The audiologist and otologist should be able to recognize many genetic abnormalities and dysmorphic syndromes. Six case summaries illustrate the importance of total evaluation of the hearing-impaired child. As an aid to eliciting important information, an associated system abnormalities questionnaire is provided.

Abnormalities, Multiple↗
PubMedDate not supplied

Sore throats in adolescents.

The approach to the adolescent with sore throat requires few diagnostic tools: an accurate history, a good physical examination and the ability to perform simple laboratory tests such as complete blood count, a test for heterophile antibody and a throat culture. The majority of adolescent patients with a sore throat require only symptomatic relief for what is probably a short lived viral infection of the upper respiratory tract.

Adolescent↗
PubMedDate not supplied

Duration of middle ear effusion after acute otitis media.

In approximately 50% of young children persistent otitis media with effusion (POME) is found by otoscopic examination or by tympanometry 10 to 14 days after the physician institutes antimicrobial treatment for acute otitis media. Over a 180-day period the course of persistent otitis media with effusion was studied in predominantly middle class, otherwise healthy white children under 3 years of age. One month after POME was first diagnosed, 22 (29%) of the children still had POME. By the second month 11 (14%) of these children still had POME. Only 5 (6%) of the study population had POME which persisted for more than 90 days. The mean duration of POME was 40 days; (median 14 days). These data suggest that in most cases POME is a self-limiting condition when found in young, otherwise healthy, middle class white children.

Child, Preschool↗
PubMedDate not supplied

Sudden or fluctuating hearing loss and vertigo in children due to perilymph fistula.

Five cases are presented of children with rapid onset of sensorineural hearing loss, disequilibrium, or both, who were found at exploratory tympanotomy to have a perilymph fistula. Four of the children had histories suggesting that antecedent barotrauma or physical exertion contributed to the development of the fistula. One child with congenital unilateral craniosynostosis had a residual temporal bone abnormality on the same side as the perilymph fistula. Two children had identifiable anatomic abnormalities in the middle ear. A classification of perilymph fistula is proposed that describes a congenital, an acquired, and a combined type of fistula. Inner ear fluid dynamics and patency of the cochlear aqueduct appear to be important factors in pathogenesis. Children with unexplained fluctuating or sudden onset of sensorineural hearing loss, and children with unexplained disequilibrium or vertigo should be suspected of having a perilymph fistula. The history can be singularly important in raising the suspicion that a perilymph fistula may be present. Although audiometric, vestibular, and radiographic studies can be helpful, there is no way to prove the presence or absence of a fistula without directly viewing the middle ear. Tympanotomy with repair of the fistula does not assure improvement in hearing.

Adolescent↗
PubMedDate not supplied

Tracheomalacia in an infant with multiplex congenita (Larsen's) syndrome.

An infant born with multiplex congenita (Larsen's) syndrome developed respiratory distress 30 days following tracheostomy for relief of upper airway obstruction. The infant had structural and functional abnormalities of the thoracic cage. Tracheobronchoscopy revealed excessive compliance of the trachea with a tendency for collapse of the tracheal rings and obliteration of the tracheal lumen. Continuous positive airway pressure in the range of 20-25 cm H2O was used to maintain patency of the tracheal lumen and assure adequate ventilation. Hemodynamic and pulmonary barometric complications often observed when high levels of positive airway pressure are utilized in infants were not observed.

Abnormalities, Multiple↗