Biomedical subjects

Ken Kazahaya

Publications and source records attributed to Ken Kazahaya.

9 recordsLinked to original sources

PubMed2006

Canal atresia: "surgery or implantable hearing devices? The expert's question is revisited".

OBJECTIVES: (1) Evaluate hearing results in patients managed with external auditory canal reconstruction; (2) compare results to the expectations from treatment with surgical; placement of an osteo-integrated bone-conduction device (BAHA system); (3) assess complications of both interventions; (4) evaluate the medical cost-effectiveness of each avenue of management at 2005 rates for billings based upon relative value units (RVUs). METHODS: (1) Retrospective chart review for 36 ears in 29 pediatric patients who underwent surgical canal reconstruction at a tertiary-care pediatric hospital in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (2) Retrospective chart review of six pediatric patients who underwent BAHA placement in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (3) Cost reassessment at 2005 billings rates based upon RVUs for canal reconstruction versus BAHA system and comparative analysis. RESULTS: (1) The average post-operative hearing loss in the right ear was 34.3 dB left ear was 31.6 dB. The average gain per ear was 17.3 dB. (2) Twenty-seven (93%) of EAC reconstruction patients required some form of amplification post-operatively. (3) Data available for three of the BAHA patients reflected the predicted average gain in dB (predicted 34.3 dB, observed 31.8 dB). (4) Early complications of canal reconstruction included removal of the packing by the patient, post-operative bleeding and post-operative hematoma. (5) Late complications included recurrent canal stenosis, recurrent otitis externa, canal prolapse and canal cholesteatoma. (6) Uncomplicated external auditory canal reconstruction cost $51,505.98 or $2909.94/dB of hearing gain based upon billings fro RVUs. (7) Uncomplicated two-staged BAHA system placement cost $42,448.85 or $1237.57/dB of hearing gain based upon billings for RVUs. (8) Uncomplicated single-staged BAHA system placement cost $28,341.00 or $826.27/dB of hearing gain based upon billings for RVUs. CONCLUSIONS: Study results indicate that even with significant investments in EAC reconstruction, most patients still required some form of amplification. There are also significant risks of early and late complications from the reconstructive procedure. Studies indicate and our results support that the osteo-integrated bone-conduction device (BAHA system) can achieve truly acceptable hearing (<or=15 dB) in school-aged children with normal bone curves, and it can match the bone-curves for children with sensorineural hearing loss. The two-staged BAHA system placement may be provided at almost one-third the cost to the medical system, on a decibel-for-decibel basis. The single-stage BAHA system placement yields even greater cost savings at just over one-quarter of the cost of surgical EAC reconstruction on a decibel-for-decibel basis. Additionally, there are fewer complications and fewer follow-up visits for the care of the implant system. This is an added value to the parents and patient for the savings in opportunity costs related to the lost time at work and school for office visits and peri-operative care. Overall, it appears that osteo-integrated bone-conduction devices may provide a higher quality of outcome for patients while resulting in significant economic savings.

Bone Conduction↗

PubMed2005

Trends in the management of pediatric chronic sinusitis: survey of the American Society of Pediatric Otolaryngology.

BACKGROUND: The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. METHODS: A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. RESULTS: A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. CONCLUSIONS: The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.

Adenoidectomy↗

PubMed2004

Diagnosis of middle ear disease using tympanograms and digital imaging.

OBJECTIVE: The study investigates the ability of physicians with different levels of training to accurately identify middle ear (ME) pathology using tympanograms and tympanic membrane (TM) digital photographs. STUDY DESIGN AND SETTING: Groups of medical students, internal medicine residents, and attending and resident otolaryngologists were presented with a set of 50 matched tympanograms and photographs of TMs. The physicians were asked to differentiate between a normal and an abnormal-appearing TM. The sensitivity and specificity of diagnosis of ME pathology by physicians were compared with the gold standard, examining the ME cavity for pathology during myringotomy. RESULTS: The sensitivity did not vary among physicians with different levels of training; however, specificity improved with an increase in physician experience. CONCLUSIONS AND SIGNIFICANCE: This study establishes a baseline for accuracy of diagnosis of ME pathology using tympanograms and photographs of TMs as compared with binocular otomicroscopy and the gold standard, myringotomy. EBM RATING: B-2.

Acoustic Impedance Tests↗

PubMed2004

Endolymphatic sac tumor in a 4-year-old boy.

INTRODUCTION: Endolymphatic sac tumors (ELST) are rare, low-grade, locally aggressive papillary neoplasms. We present a case of a 4-year-old boy with an ELST, the youngest described in the literature. CASE: A boy presented with a right-sided serous otitis media and sudden-onset right facial nerve palsy. An audiogram revealed right-sided profound sensorineural hearing loss. Radiographic imaging demonstrated a 3-cm expansile lytic lesion along the posterior face of the petrous bone. INTERVENTION/RESULTS: The patient initially underwent a right transmastoid-infralabyrinthine biopsy. Pathologic examination revealed a papillary lesion suspicious for an ELST. Subsequently, a transtemporal-transcochlear approach with intra-and extradural resection of the tumor was performed. The facial nerve was dissected and transposed anteriorly and preserved. Histopathologic and immunohistochemical studies confirmed the ELST. At his 6-month follow up, there is no evidence of recurrence and the facial nerve function has returned to Grade II palsy. CONCLUSION: ELST are rare tumors of the temporal bone. This is the youngest case of ELST reported. Presentation, evaluation, and management of ELST is discussed.

Adenocarcinoma, Papillary↗

PubMed2004

Congenital cholesteatoma.

PURPOSE OF REVIEW: Congenital cholesteatomas have historically been considered a rare disorder. However, a review of the literature reveals an incidence ranging from 4 to 24%, and these values are probably underestimated. This article summarizes the general diagnostic criteria of congenital cholesteatomas, their usual presenting symptoms and findings, perioperative studies, a proposed staging system to assist with predicting postoperative outcomes, general surgical procedures, and recidivism rates. RECENT FINDINGS: Congenital cholesteatomas have been defined as evidencing no prior history of otorrhea, tympanic perforation, or previous otologic procedures; a normal pars flaccida and tensa; and a pearly white mass medial to the tympanic membrane. Their cause remains controversial; however, the epithelial rest theory is most commonly accepted. The incidence of this disorder seems to be on the rise; however, this may be a result of increased awareness and reporting. The most common sites of presentation on physical examination are the anterior-superior and posterior-superior quadrants of the tympanic membrane. Conductive hearing loss is the most common presenting symptom. There is a lack of uniformity of reporting and classifying congenital cholesteatomas. Staging systems have recently been proposed. One in particular is reported and correlates with outcomes of treatment. Treatment of congenital cholesteatomas is still surgical. A comparison is made between canal wall up and canal wall down tympanomastoidectomy for the treatment of nonlocalized cholesteatoma pearls. Postoperative hearing results are associated with the status of the ossicular chain perioperatively. SUMMARY: Heightened awareness and early diagnosis of congenital cholesteatomas is imperative. Early treatment decreases the extent of the disease and reduces the risk of recidivism and complications. Management of this disease is surgical. Preoperative computed tomography should be considered to assist in preoperative planning and prediction of postoperative issues. Consideration of a standard staging system and classification is important for consistent reporting and comparison.

Audiometry↗

PubMed2004

Cellular neurothekeoma of the maxilla.

Neurothekeomas are uncommon benign soft tissue tumors of nerve sheath origin. They occur predominately in the head and neck or upper trunk of children and young adults. A 15-month-old boy presented with an enlarging mass of the right maxilla. Radiologic imaging demonstrated an expansile lesion of the nasomalar region. An incisional biopsy resulted in the diagnosis of neurothekeoma. This lesion should be considered as part of the differential diagnosis of pediatric soft tissue head and neck masses. We discuss the presentation, evaluation, and treatment of these rare benign lesions.

Humans↗

PubMed2003

Revisiting outpatient tonsillectomy in young children.

OBJECTIVE: Postoperative same-day discharge is safe for most children undergoing tonsillectomy. However, young children with upper airway obstruction have a higher risk of postoperative complications. We review our tonsillectomy experience in children under 36 months to evaluate the safety of outpatient tonsillectomy in this population. STUDY DESIGN AND SETTING: We conducted a retrospective study of all children under 36 months who underwent tonsillectomy during a recent 2-year period at The Children's Hospital of Philadelphia. RESULTS: The indication for tonsillectomy in 96% of 421 children was upper airway obstruction. Eighteen percent required postoperative treatment to prevent respiratory compromise; 56% of these patients had no associated medical comorbidity. Patients younger than 24 months and those with medical comorbidities were more likely to require intervention. CONCLUSION AND SIGNIFICANCE: It is not possible to preoperatively anticipate which children will have postsurgical complications. We recommend planning an overnight admission for children younger than 36 months undergoing tonsillectomy.

Airway Obstruction↗

PubMed2002

A new absorbable pressure-equalizing tube.

OBJECTIVE: We investigated pressure-equalizing (PE) tubes made of biodegradable, absorbable material in an animal model. METHODS: PE tubes, made of poly-bis(ethylanate)phosphazene (PBE) were inserted in 55 ears of 28 Hartley guinea pigs, with survival times of 10, 30, and 60 days after tube insertion. In vivo reactions between the PBE-PE tube and the tympanic membrane (TM) were studied. Tubes, TMs, and middle ears were examined by scanning electron microscopy and light microscopy. RESULTS: There was neither infection nor an inflammatory reaction to the tube within the middle ear in any animal. At 30 days, 53% of the tubes had disintegrated. At 60 days, tubes were still functioning in the 25% of ears. CONCLUSION: More research must be performed before these new PBE PE tubes can be considered for clinical use. Nonetheless, these tubes are promising. The disintegration rate can be controlled by varying the formulation of the polymer, so treatment can be adjusted to the needs of each patient.

Absorbable Implants↗

PubMedDate not supplied

Routine use of the crystal device integrity testing system in pediatric patients.

Crystal Device Integrity Testing System (CITS), the first commercially available testing system of its type, allows rapid assessment of cochlear implant function by measuring averaged electrode voltages-the scalp-recorded fields generated by electrode currents. We describe our experience performing routine integrity tests on 44 pediatric cochlear implant patients using the CITS. We present our findings focusing on the monopolar and common ground scans to provide a framework from which CITS scans can be evaluated in the future. We also describe selected cases in which abnormal results using the CITS influenced clinical treatment, demonstrating the utility of performing routine integrity tests.

Child↗