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S D Handler

Publications and source records attributed to S D Handler.

95 records · Page 6Linked to original sources
PubMedDate not supplied

Pediatric tracheostomy. Experience during the past decade.

A retrospective review of a decade of experience with pediatric tracheostomy encompassed 420 children. Analysis was performed with respect to primary diagnosis, age, duration of tracheostomy and hospitalization, early and late complications and mortality. While the incidence of tracheostomy per hospital admission decreased over the period of review, there was substantial increase in duration of tracheotomy. Approximately half of the patients sustained complications. While overall mortality approached 28%, tracheostomy-related deaths occurred in only eight patients (2%). Almost one fifth of children with tracheostomies were discharged to home care, and 3% were involved in our home ventilator program.

Adolescent↗
PubMedDate not supplied

Difficult laryngoscopy/intubation: the child with mandibular hypoplasia.

The child with mandibular hypoplasia (Treacher Collins syndrome, Pierre Robin sequence, hemifacial microsomia, etc) presents the otolaryngologist and anesthesiologist with considerable problems when direct laryngoscopy and/or endotracheal intubation is attempted. In addition to the small mandible, several other features of these patients contribute to the difficult laryngoscopy: macroglossia, glossoptosis, trismus related to temporomandibular joint abnormalities, and prominent maxilla or maxillary incisors. Most of the techniques that have been described for laryngoscopy/intubation in problem cases are difficult or impossible to use in infants and young children with mandibular hypoplasia. We present a modification of the standard direct laryngoscopic procedure, utilizing the 9-cm anterior commissure laryngoscope and an optical stylet in the task of exposing and intubating the larynx of a child with mandibular hypoplasia.

Humans↗
PubMedDate not supplied

The effects of gelatin film stents in the middle meatus.

Controversy exists regarding the management of the middle meatus after pediatric functional endoscopic sinus surgery (FESS). To prevent adhesions following pediatric FESS, gelatin film stenting of the middle meatus has been recommended. The effects of stenting, however, have not been established. Fifty-one children with similar degrees of bilateral sinus disease had a gelatin film stent placed in one middle meatus on completion of FESS, while the opposite meatus was not stented. Two to three weeks later at the time of a second, staged procedure, the sides were compared for the presence of the stent, adhesions, granulaion tissue, and patency of the maxillary sinus ostia. In 11 children the postoperative findings were more severe in the side without the stent, whereas in 29 children they were more severe in the stented side. There was no difference between the sides in 11 children. Although gelatin film stenting benefits some children, it should not be used routinely following pediatric FESS but should be reserved for children who are predisposed to develop adhesions or have poor prognostic factors, such as immunodeficiency and ciliary dyskinesia.

Adolescent↗
PubMedDate not supplied

Predicting hearing loss from stapedial reflex thresholds in patients with sensorineural impairment.

We have demonstrated the elevated reflex thresholds and decreased bandwidth effect in listeners with sensorineural hearing loss, and we have extended this generalization to include those with hearing loss related to presbycusis. A bivariate plotting method has been described for predicting hearing loss from reflex threshold data that is characterized by a low rate of false positives, while successfully identifying those with a moderate degree of hearing loss (greater than 32 dB) more than 80% of the time. We found no evidence of decreasing reflex threshold with age. Instead, our reflex thresholds for normal hearing subjects tend to remain the same or increase slightly as age increases. It is hoped that these findings will stimulate further work to correlate reflex thresholds with hearing levels. This information should be used to test infants (especially those at high risk for hearing loss) and other subjects unable to respond to conventional audiometric testing.

Adult↗