Concerns with bupivacaine injection.
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Anesthetics, Local↗
Biomedical subjects
W S Gibson
Publications and source records attributed to W S Gibson.
Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis.
OBJECTIVE: To explore the possible role of gastroesophageal reflux (GER) in children with chronic sinus disease (CSD). DESIGN: A descriptive prevalence study of the frequency of GER and nasopharyngeal reflux in children with CSD. SETTING: Pediatric otolaryngology and gastroenterology outpatient clinics of a regional medical center. PATIENTS AND OTHER PARTICIPANTS: Consecutive children aged 2 to 18 years referred for evaluation of CSD from December 1, 1996, through April 30, 1998. INTERVENTIONS: Participants underwent 24-hour monitoring with dual pH probes, and participants (or their parents) completed questionnaires before treatment and at specific intervals after treatment. MAIN OUTCOME MEASURES: Prevalence of GER and nasopharyngeal reflux in children with CSD, and the response of sinusitis to treatment in those diagnosed with GER. RESULTS: Nineteen (63%) of 30 patients demonstrated esophageal reflux, which is well above the expected prevalence of GER in the healthy general population. Six (32%) of these 19 patients demonstrated nasopharyngeal reflux. Fifteen (79%) of 19 patients improved after treatment for GER. CONCLUSIONS: The children in this population had a prevalence of GER that was significantly higher than expected. Furthermore, most children with GER demonstrated improvement of sinus disease after treatment of GER. We recommend that children with CSD refractory to aggressive medical management be evaluated for GER and, if GER is present, be treated accordingly, before sinus surgery is considered.
Adolescent↗
Encounters with challenging bronchial foreign bodies: impromptu adaptation of technique.
We present a retrospective review of 2 cases of unusual foreign bodies and discuss methods needed for successful removal of the objects. The review stresses the need for preparation in managing difficult and unexpected situations. Specific instrumentation as well as surgical resourcefulness provided for successful removal of a carrot fragment in one instance and a plastic bead in the other. The need to individualize tracheobronchial foreign body extraction is stressed, as is the importance of keeping some of the "old-time" instruments in one's instrument cabinet.
Bronchi↗
The effect of topical ciprofloxacin on postoperative otorrhea after tympanostomy tube insertion.
OBJECTIVE: This study aimed to evaluate the effectiveness of prophylactic ciprofloxacin drops in decreasing the incidence of otorrhea after tympanostomy tube insertion. STUDY DESIGN: The study design was a single-blind, randomized clinical trial. SETTING: The study was conducted at a tertiary care referral center. PATIENTS: One hundred fifty-four patients aged 6 months to 14 years undergoing tympanostomy tube insertion participated. INTERVENTION: For each subject, one ear was randomly assigned to receive topical ciprofloxacin, placed in the middle and external ear after surgery, while the contralateral ear served as a control. MAIN OUTCOME MEASURE: Posttympanostomy otorrhea occurring during the period from 24 hours after surgery until 2 weeks after surgery was measured. RESULTS: Topical ciprofloxacin application after tympanostomy tube insertion was associated with a significantly lower incidence of early posttympanostomy otorrhea. The rates of otorrhea for control and treatment ears were 9.1% and 3.9%, respectively (p = 0.029). CONCLUSIONS: The topical administration of a single dose of ciprofloxacin solution after surgery is an effective treatment for the prevention of early posttympanostomy otorrhea.
Administration, Topical↗
Congenital esophageal webs.
Congenital esophageal webs are rare entities. These lesions generally occur in the upper one third of the esophagus and present symptomatically in early childhood. Dysphagia and 'feeding' difficulties are characteristic presenting symptoms. Radiographic studies generally reveal a normal appearing esophageal lumen with the exception of a single thin indentation of the esophageal lumen that is located either anteriorly or circumferential in nature. We describe two children with congenital esophageal webs and review the pathophysiology, diagnosis and management of these unusual lesions.
Adolescent↗
Isolated congenital internal auditory canal atresia with normal facial nerve function.
The internal auditory canal forms as a result of mesoderm enveloping the eighth cranial nerve in the developing embryo. The mesoderm eventually transforms into cartilage and ultimately ossifies around the nerve, forming the internal auditory canal. It is theorized that atresia or stenosis of the internal auditory canal results from altered cochleovestibular nerve development secondary to faulty chemotactic mechanisms or a lack of end organ targets. Unilateral internal auditory canal anomalies are frequently seen in conjunction with other inner ear anomalies and occasionally with middle or external ear anomalies. Infrequently, it will occur as either an isolated or bilateral finding, but rarely simultaneously. The few citations of isolated, unilateral or bilateral internal auditory canal anomalies that are reported in the literature are usually associated with other systemic developmental anomalies, such as, cardiac septal defects, polycystic kidney disease, skeletal deformities and duodenal atresia. We present a case report of a patient with bilateral, congenital, internal auditory canal atresia and cochleovestibular deficits but, normal facial nerve function. A review of the literature is discussed as well as diagnostic considerations and treatment options including audiologic and communication rehabilitation.
Child, Preschool↗
Infantile subglottic hemangioma: a review and presentation of two cases of surgical excision.
Subglottic hemangioma in infants is a well-defined entity with which otolaryngologists should be familiar. Although benign lesions with a natural history of regression, they may demand the attention of an otolaryngologist to maintain a secure airway. Throughout the years, multiple treatment options have been proposed and utilized for subglottic hemangioma. As of yet, however, there is no consensus as to the best treatment. Surgical excision is one treatment option available to the otolaryngologist which has previously received less attention. We review treatment options and report two cases of surgical excision of infantile subglottic hemangioma. Both patients were extubated by postoperative day number three and have remained symptom free. We support surgical excision as a valuable treatment option.
Airway Obstruction↗
Traumatic herniation of the buccal fat pad: a report of two cases and a review of the literature.
Two cases of injury resulting in traumatic herniation of the buccal fat pad into the oral cavity are described. A review of the literature reveals that almost all reported cases of traumatic herniation of the buccal fat pad occurred in young children. The majority of cases resulted from penetration of the buccal mucosa and buccinator muscle by a foreign object in the mouth. Treatment generally consisted of excision of the mass followed by primary closure.
Adipose Tissue↗
Branchio-oto-renal syndrome.
Branchio-oto-renal (BOR) syndrome is a rare, autosomal dominant genetic disorder involving branchial cleft and renal anomalies, hearing loss, and other otologic manifestations. We report a case of a family with three generations of branchial cleft anomalies and otologic anomalies with hearing loss. A review of the literature, classic clinical presentations, associated findings, and the differential diagnosis of BOR syndrome is presented. Due to BOR syndrome's variability of both penetrance and expression and a high incidence of renal the practicing otolaryngologist should consider BOR syndrome when evaluating hearing loss and branchial cleft remnants in any child.
Abnormalities, Multiple↗
Otalgia in infants and children--a manifestation of gastroesophageal reflux.
To investigate if there is a relationship between gastroesophageal reflux and ear pain in the pediatric age group, a series of children presenting with this picture were analyzed. Infants and children are often seen in an emergency room setting because of fretfulness, irritability, and pulling on the ears. A diagnosis of otitis media is usually made, but in some cases the diagnosis may be referred otalgia secondary to gastroesophageal reflux. Six children who presented with the above picture were seen by one of the authors (W.S.G.) the following morning and noted to have a normal ear exam. These children were studied for gastroesophageal reflux by esophageal pH monitoring and in some cases esophagoscopy with biopsy. All children exhibited gastroesophageal reflux and an anti-reflux regimen eliminated the pattern of 'recurring otitis media'. This paper will review the mechanism of referred otalgia along with data supporting the concept of GE reflux as a cause of otalgia in infants and children.
Child↗
Pathologic quiz case 1. Traumatic herniated gangrenous buccal fat pad (traumatic pseudolipoma).
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Gangrene↗
Diplophonia in a neonate.
Diplophonia has never been described in a neonate. An unusual case, then, of diplophonia in a neonate is described here. There is a description of the acoustic characteristics of this infant's cry and a discussion of their significance. This contributes to a review of the differential diagnosis of diplophonia. Moreover, this case further shows the essential relation between laryngoscopic findings and acoustical data.
Crying↗
Serial tomographic imaging with technetium-99m-sestamibi for the assessment of infarct-related arterial patency following reperfusion therapy.
The purpose of this study was to determine the relationship of changes in the severity and extent of hypoperfusion on serial tomographic 99mTc-sestamibi images with patency of the infarct related artery during acute myocardial infarction. We studied 109 patients with acute myocardial infarction using tomographic 99mTc-sestamibi imaging acutely and at 18-48 hr later. Perfusion defect extent and defect area, an index of defect severity, were measured on both studies. Both defect extent and defect area were significantly (p = 0.0001) greater for anterior infarctions than for inferior and lateral infarctions. By two factor analysis of variance, the change in defect area varied significantly with both infarct location (p = 0.0001) and patency of the infarct-related artery (p = 0.002). The change in defect extent also varied significantly with both infarct location (p = 0.0001) and with patency of the infarct-related artery (p = 0.004). In patients with inferior myocardial infarction, a change in defect extent or defect area of greater than 4% or 0.017, respectively, had a positive predictive accuracy of 96% and 93%, respectively, for the identification of a patent infarct artery. Therefore, sequential changes on tomographic 99mTc-sestamibi images are of potential value for the noninvasive assessment of patency of the infarct-related artery.
Adult↗
Severe dysthyroid orbitopathy.
Nineteen patients (12 women and 7 men) with severe dysthyroid orbitopathy were treated with either orbital irradiation (9 patients) or orbital decompression (10 patients) or both (1 patient). Eight of the nine patients who received orbital irradiation had a favorable response. One patient had progression of optic neuropathy despite orbital irradiation and required orbital decompression. All eleven patients who underwent orbital decompression had a favorable response.
Adult↗
Uvulopalatopharyngoplasty: postoperative management and evaluation of results.
Since the earliest report of success with the uvulopalatopharyngoplasty (UPPP) operation, several authors have reported less than optimal results in their experience with the procedure. Part of the difficulty in evaluating the objective results of postoperative sleep studies has been the variations in reporting data. In addition, no standard of postoperative care, including analgesia, and immediate postoperative monitoring has been described. Our experience with 42 UPPP patients (34 studied with preoperative and postoperative polysomnography) indicates a 76% response (56% successes, and an additional 20% with limited success) with use of the more stringent criteria described recently. We discuss our management of these cases, including postoperative oxygen saturation monitoring and avoidance of narcotic analgesia as necessary factors for success with this operation.
Female↗
The acoustic characteristics of the cry of an infant with unilateral vocal fold paralysis.
We have previously shown the acoustic similarity among well, full-term infants of the same post-conceptional and post-partum ages (Int. J. Pediat. Otorhinolaryngol., 10 (1985) 1-8). The objective of that research was to provide a template against which the cries of any given infant may be compared. This paper shows a more detailed analysis of both the normal infants' cries and the cry of an infant with a unilateral vocal fold paralysis. It is evident from this analysis that this infant's cry is not normal as it displays a spectrum not found in the cries of normal infants. What this research shows is that a technique is available with which it is possible to make a screening identification of those infants who merit further investigation. It is an objective of such research to determine if the cry of a given infant is abnormal in specifiable, and therefore diagnostic, ways. In this instance, we can conclude that the cry of this infant differs from that of one with a normal airway.
Crying↗
Congenital sublingual dermoid cyst.
Oral cavity dermoids account for less than a quarter of those dermoids occurring within the head and neck region and about 1.6% of all dermoids. The anterior floor of the mouth is the most common site within the oral cavity, but overall, it is uncommon. Most lesions are seen in young adults; congenital sublingual dermoids occurring in infancy are thus rare. Included in this report are the background literature, including definition and classification of these cysts, and the clinical characteristics of such lesions.
Dermoid Cyst↗
Hemangioma of the inferior turbinate.
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Adult↗