-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: Impacted cerumen in the ear canal is a common problem that can cause discomfort or prevent assessment. Cerumen removal can have deleterious side effects if performed improperly. We created an aural irrigation system which is currently not available on the market to provide a continuous flow of water at a regulated pressure and temperature. The purposes of this study were to (1) evaluate the safety and efficacy of this aural irrigation system in children and (2) determine the success rate of cerumen disimpaction when used by an allied health professional. METHODS: The following were evaluated in a nurse-run clinic: (1) referral patterns; (2) extent of canal occlusion; (3) cerumen consistency; (4) peak water pressure used; (5) patient discomfort; (6) efficacy of removal. Each ear was recorded as a separate event. RESULTS: 302 procedures were performed on 244 children (mean age 7.6±4.1years (range 0.5-18.3years)). Patients were most commonly referred by an Otolaryngologist (63%), parent (17%), hearing aid provider (10%) or audiologist (9%). The most common reasons for referral were difficulty seeing the tympanic membrane (42%), fitting a hearing aid (20%) or performing an audiogram (11%). Prior to irrigation, 98% of canals were partially or fully occluded. After irrigation (mean peak pressure=488.21±18.61mmHg (range 390-590mmHg), 92% of canals were completely free of cerumen (99% clear enough for evaluation or treatment). There was mild or no discomfort in 99% of patients and there were no incidences of trauma. CONCLUSIONS: An aural irrigation system can be effective at clearing impacted cerumen from pediatric ear canals with minimal discomfort and no trauma and can be successfully employed in a completely nurse-run clinic.
International journal of pediatric otorhinolaryngology 10/2012; · 0.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To explore whether hypoxic ventilation could allow a practical animal model of laryngotracheal injury secondary to endotracheal intubation.
Randomized controlled animal study.
Animal laboratory in a tertiary pediatric hospital.
Eight Sus scrofa piglets (15-18 kg) were anesthetized and intubated for 4 hours, with a 6-mm cuffed endotracheal tube. They were randomly assigned to either constant hypoxic ventilation (oxygen saturation under 70%) or nonhypoxic ventilation. Endotracheal tube cuff pressure was manually controlled and maintained at a constant level. After 4 hours, fluorescein dye was administered intravenously to highlight areas of hypoperfusion within the larynx. The animals were euthanized at the end of the procedure, and the larynx and trachea were harvested for gross and histological examination. The pathologist was blinded to the ventilation group. The severity of laryngeal injury was graded between 0 and 4 by a senior pathologist.
The experiment protocol was successfully completed in all animal subjects. The animals undergoing hypoxic ventilation showed a significantly higher median injury grade than the nonhypoxic animals (2 vs 1, respectively; P = .003). Damage was significantly worse in the hypoxic group at all anatomical sublevels.
Endotracheal tube-related laryngeal injury was demonstrated after only 4 hours of intubation using this animal model, and hypoxic ventilation increased the severity of injury. This study therefore provides an animal model that may be suitable for future investigation and prevention of intubation injury.
Otolaryngology Head and Neck Surgery 02/2011; 144(2):247-51. · 1.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: (1) To assess the long-term impact of thyroid ala cartilage laryngotracheal reconstruction (TAC-LTR) on health-related quality of life (QOL) in infants using 4 validated instruments: Health Utility Index version 3 (HUI3), Pediatric Voice-Related QOL (PVRQOL), Impact on Family Questionnaire, and a visual analog scale and (2) to perform acoustic and perceptual voice assessments to evaluate longterm voice quality outcomes.
Prospective study.
Tertiary academic pediatric hospital.
Eligible children who received TAC-LTR before the age of 24 months between 1995 and 2007.
Interviews with parents and children using 4 validated instruments, voice analyses, and endoscopic evaluation were performed.
Twelve patients (7 male, 5 female, median age 10 years) were enrolled over a 6-month period. The mean age at LTR was 5 months (range, 1-20 months), and the mean study followup period was 9 years (range, 2-14 years). The average speech HUI3, PVRQOL, and Impact on Family scores were 0.83 (95% confidence interval = 0.74, 0.92), 0.93 (interquartile range [IQR] = 0.81, 1.00), and 0.65 (IQR = 0.54, 0.92), respectively. All acoustic scores were either normal or mildly abnormal for the variables jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation, and fundamental frequency. The Consensus Auditory-Perceptual Evaluation of Voice overall severity score was in the normal to mildly abnormal range for 8 of 9 patients.
This is the first study to explore and quantify longterm QOL and voice quality in children following LTR with thyroid ala graft at a very young age. Most patients had very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.
Otolaryngology Head and Neck Surgery 02/2011; 144(5):770-7. · 1.72 Impact Factor
-
Waqas Ullah Khan, Paolo Campisi,
Sanjeevan Nadarajah,
Yaseer Abdul Shakur,
Nasir Khan,
Dan Semenuk,
Cathy McCann,
Lisa Roske,
Sharon McConney-Ellis,
Melissa Joseph,
Dimitri Parra,
Joao Amaral,
Philip John,
Michael Temple,
Bairbre Connolly
[show abstract]
[hide abstract]
ABSTRACT: To report (1) our experience with botulinum toxin A injections into the salivary glands of pediatric patients with sialorrhea, (2) the clinical outcomes of these interventions, and (3) the associated complication rates.
Retrospective cohort study.
Urban pediatric hospital and pediatric rehabilitation center.
Forty-five neurologically impaired children.
Patients received botulinum toxin A intrasalivary injections between January 2004 and May 2008 at the Hospital for Sick Children in Toronto, Ontario, Canada. All patients received sedation or general anesthesia for their botulinum toxin A injections, which were performed using ultrasonographic guidance.
Posttreatment assessments included the duration of effect, patient complications, saliva consistency, caregiver willingness to repeat the treatment, caregiver satisfaction with the treatment, and caregiver overall assessment of the child's posttreatment quality of life.
Forty-five subjects received a total of 91 botulinum toxin A treatments. The mean (SD) duration of effect was 4.6 (5.2) months. Duration of effect (log transformed) was significantly negatively associated with saliva quantity (P = .02), and there was a positive association with both increasing age and female sex, although neither reached statistical significance (P = .08 for each). Seven of the 24 documented complications were major, according to the Society of Interventional Radiology Classification System for Complications by Outcome scale. Thirty-six of the caregivers reported that this treatment improved the child's quality of life (80%).
Ultrasonographically guided botulinum toxin A injections into the salivary glands are safe and efficacious in the management of sialorrhea in children with neurologic disorders.
Archives of otolaryngology--head & neck surgery 01/2011; 137(4):339-44. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess whether dynamically modulating endotracheal tube (ETT) cuff pressure, by decreasing it during each ventilatory cycle instead of maintaining a constant level, would reduce the extent of intubation-related laryngotracheal injury.
Single-blind, randomized controlled animal study using a previously validated live porcine model of accelerated intubation-related tracheal injury.
Animal research facility.
Ten piglets (weight, 16-20 kg each) were anesthetized and underwent intubation using a cuffed ETT.
The animals were randomized into the following 2 groups: 5 pigs had a novel device to modulate their cuff pressure from 25 cm H₂O during inspiration to 7 cm H₂O during expiration, and 5 pigs had a constant cuff pressure of 25 cm H₂O. Both groups underwent ventilation under hypoxic conditions for 4 hours.
Laryngotracheal mucosal injury after blinded histopathological assessment.
The modulated-pressure group showed significantly less overall laryngotracheal damage than the constant-pressure group (mean grades, 1.2 vs 2.1; P < .001). Subglottic damage and tracheal damage were significantly less severe in the modulated-pressure group (mean grades, 1.0 vs 2.2; P < .001, and 1.9 vs 3.2; P < .001, respectively). There was no significant difference in glottic or supraglottic damage between the groups (P = .06 and .27, respectively).
This novel device reduces the risk of subglottic and tracheal injury by modulating ETT cuff pressure in synchronization with the ventilatory cycle. This finding could have far-reaching implications for reducing the risk of airway injury in patients undergoing long-term intubation. Further clinical study of this device is warranted.
Archives of otolaryngology--head & neck surgery 01/2011; 137(1):30-4. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To retrospectively review trends in clindamycin resistance among Staphylococcus aureus head and neck abscesses between January 2000 and June 2008.
Between January 2000 and June 2008, inpatient and out-patient S aureus isolates were reviewed for antibiotic susceptibility. In particular, cultures from 153 abscesses in the head and neck region were assessed for clindamycin and methicillin resistance patterns.
Annual clindamycin resistance rates for all S aureus isolates, and specifically for S aureus head and neck abscesses, revealed concerning levels of clindamycin and methicillin resistance. After 2002, the mean clindamycin resistance rate in head and neck abscesses was approximately 27%. The number of new cases of methicillin-resistant S aureus per year increased from four cases in 2000 to 44 cases in 2007.
Antibiotic resistance should be considered following failed empirical therapy of head and neck abscesses with clindamycin.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 01/2011; 22(2):49-51. · 1.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In this study we 1) measured the impact of juvenile-onset recurrent respiratory papillomatosis on health-related quality of life, voice-related quality of life, and family psychosocial well-being; and 2) compared these different measures, exploring their intercorrelation and their correlation with clinical disease severity.
Cross-sectional qualitative study.
Tertiary academic pediatric hospital.
Twenty consecutive children with active juvenile-onset recurrent respiratory papillomatosis (JoRRP) were included. Standardized interviews were performed on parents and children with the use of four validated tools: the Health Utilities Index version 3; the Pediatric Voice-Related Quality of Life survey; the Impact on Family Scale; and a visual analogue health preference measure. Clinical disease severity and demographic data also were collected.
Subjects (13 male, 7 female) had a median age of 9.2 years, median age of JoRRP onset of 3.8 years, and averaged four procedures per year of disease. Mean health utility was 0.76 (95% confidence interval 0.68-0.84) on a scale of 0 (death) to 1 (perfect health). Marked impact on voice-related quality of life and family psychosocial health also was identified. Health burden correlated poorly with existing methods of severity scoring.
This is the first study to use validated measures of health utility, voice-related quality of life, and psychosocial impact. This information has public health implications, providing essential parameters for accurate modeling studies and cost-utility analysis of future interventions, including different human papilloma virus vaccination strategies.
Otolaryngology Head and Neck Surgery 11/2010; 143(5):685-90. · 1.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Congenital bilateral vocal fold paralysis (BVP) is a rare but serious condition often requiring a tracheostomy to temporize the airway. In cases of idiopathic BVP, studies suggest waiting twelve months prior to laryngeal surgery because of a high rate of spontaneous recovery. Therefore a less invasive and reversible intervention would be optimal. A prospective study in a piglet model was undertaken to evaluate the efficacy of a novel spring-loaded stenting device designed to maintain laryngeal patency in an in vivo animal model of BVP.
Eight Yorkshire piglets had BVP induced by surgical division of the recurrent laryngeal nerves. Stents were endoscopically deployed between the arytenoid vocal processes. Animals were recovered and monitored for stridor, dietary intake, and weight gain. Animals were sacrificed after five days. Airway resistance using a calibrated manometer was measured at four time-points: baseline, BVP induction, stent insertion, and pre-sacrifice.
Six of eight animals survived greater than five days with an average weight gain of 1.9kg (p=0.003). Relative inspiratory resistance increased from baseline after inducing BVP (1.00 vs. 1.468, p=0.0315) and decreased to baseline levels with stent insertion (1.468 vs. 1.092, p=0.0238). Expiratory resistance was not significantly influenced by stage of measurement (p=0.236). Of the two animals not surviving the protocol, one had an unrelated anesthesia complication and the other a malpositioned stent.
The novel stent was successful in relieving the inspiratory resistance associated with BVP, without compromising swallowing and daily function. This may hold promise in temporarily securing the pediatric airway in the setting of BVP.
International journal of pediatric otorhinolaryngology 11/2010; 75(2):182-5. · 0.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To develop a national database of cases of juvenile onset recurrent respiratory papillomatosis (JoRRP) in Canada, to calculate trends in incidence and prevalence of JoRRP from January 1994 to December 2007 at the national and regional level, and to mathematically model the natural history of JoRRP.
Retrospective, multicenter study.
Patient demographics, clinical presentation, human papillomavirus status, method and timing of treatment, and indicators of disease severity were captured with a standardized case report form. Operative records were retrospectively scored using the Derkay-Coltrera staging system for each operative intervention. Trends in incidence and prevalence of JoRRP from 1994 to 2007 were calculated at a national and regional level using national population census data. A multivariable mixed effects linear model was used to explore the effect of surgery-specific variables on the intersurgical interval. Nonlinear least-squares regression was used to model the natural history of JoRRP.
Development of a national database of children with JoRRP identified 243 cases who underwent 3,021 surgical procedures. The national incidence of JoRRP from 1994 to 2007 was 0.24 per 100,000 children aged 14 years and younger. The prevalence was 1.11 per 100,000 children. The natural history of JoRRP followed a nonlinear time course with 64% of cases having a decreasing annual rate of surgery over time.
A Canadian national database of children with JoRRP was successfully developed. Modeling of the natural history of JoRRP may have important clinical and research implications.
The Laryngoscope 06/2010; 120(6):1233-45. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To develop an anatomically shaped endotracheal tube (ETT) and to compare the degree of induced laryngeal injury of this ETT with that of a standard ETT using an animal model.
Randomized controlled animal study.
Eight Sus scrofa piglets (15-20 kg) randomly intubated with either a standard or a modified uncuffed ETT.
The modified ETT was handcrafted by gluing and then trimming dry polyvinyl acetate foam circumferentially to the distal end of a standard uncuffed ETT. After intubation, the foam quickly self-expanded as it absorbed the secretions of the laryngopharynx and adopted the shape of the intraluminal airway. This conforming shape also sealed the larynx to allow for positive pressure ventilation. Both groups were intubated for 4 hours under constant hypoxic conditions (mean oxygen saturation <70%) to enhance and accelerate intubation damage. They were then humanely killed, and the larynx and trachea were harvested for histologic examination.
The severity of laryngeal injury graded on a scale from 0 to 4 (0 indicates normal; 1, epithelial compression; 2, epithelial loss; 3, subepithelial and glandular necrosis; and 4, perichondrium involvement).
All of the specimens histologically demonstrated areas of inflammation and epithelial loss. The standard ETT caused substantial deep damage, with a mean (SD) severity score of 2.79 (0.74). The modified ETT caused mainly superficial damage, with a mean (SD) severity score of 1.65 (0.56) (P < .001).
The modified ETT objectively caused less laryngotracheal damage compared with the standard ETT and may be of potential clinical benefit.
Archives of otolaryngology--head & neck surgery 01/2010; 136(1):54-9. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To measure acoustic voice outcomes in children with bilateral cochlear implants and to compare these with established norms, as well as to determine whether these acoustic measures were influenced by duration of cochlear implant use, age at implantation, and overall "time in sound."
Cross-sectional study.
Pediatric tertiary care cochlear implant center.
All children using bilateral cochlear implants who were followed up during a 4-month period at our implant center were invited to participate. Twenty-seven children (17 males and 10 females) aged 3 to 15 years were enrolled. Causes of deafness included congenital (n = 8), genetic (n = 8), meningitis (n = 3), cytomegalovirus (n = 2), and unknown (n = 6). The interval between first and second implantations ranged from simultaneous to 7.8 years (mean, 4.2 years).
Children completed acoustic voice testing using a Computerized Speech Lab and a Multi-Dimensional Voice Program. Acoustic results were compared with those of children receiving unilateral implants and with normative data.
Compared with established pediatric normative data, children with bilateral implants demonstrated poor control of long-term frequency perturbation and long-term amplitude perturbation when vocalizing sustained phonations (P < .001 for both). This finding was consistent with data previously reported in children using unilateral cochlear implants. Long-term control of frequency perturbation improved as children used their bilateral cochlear implants over time and was significantly influenced by overall time in sound (P = .02).
Similar to unilateral cochlear implant users, children using bilateral implants have difficulty controlling long-term frequency perturbation and long-term amplitude perturbation during sustained phonations. These measures improved as the duration of usable hearing increases.
Archives of otolaryngology--head & neck surgery 01/2010; 136(1):17-21. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: 1) To apply perceptual and acoustic voice assessments to children treated for juvenile-onset recurrent respiratory papillomatosis (JORRP); 2) to compare voice outcomes following treatment for JORRP using microdebrider versus carbon dioxide (CO(2)) laser.
Prospective cohort study.
This study was conducted at a tertiary pediatric academic center (March 2008-March 2009).
Children with active JORRP were assessed using perceptual and acoustic voice analysis following treatment with either CO(2) laser or microdebrider. Outcome measures included overall severity rating, jitter, shimmer, and noise-to-harmonic ratio (NHR). The unpaired Student t test and Pearson correlation tests were used to explore the statistical significance of hypothesis tests.
Eleven patients (8 male, 3 female) aged three to 17 years were enrolled. There were six children in the CO(2) laser cohort and five children in the microdebrider cohort. The immediate postoperative scores were significantly lower in the microdebrider cohort (vs the CO(2) cohort) for jitter, shimmer, NHR, and perceptual scores (P < 0.05), indicating a better voice quality in the microdebrider group. Jitter, shimmer, and NHR showed a significant positive correlation with the proportion of CO(2) laser procedures (P < 0.05).
This is the first study to use perceptual and objective acoustic evaluations to compare voice outcomes following microdebrider or CO(2) laser treatment of JORRP. The results of this study suggest that treatment with the microdebrider results in a better immediate and early postoperative voice outcome. Moreover, the data demonstrate a correlation of worsening voice quality with increased exposure to the CO(2) laser.
Otolaryngology Head and Neck Surgery 10/2009; 141(4):522-6. · 1.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Congenital narrowing of the nasal airway at the posterior choanae, which can be uni- or bilateral, is an uncommon condition in pediatric patients. The surgical management of choanal atresia varies widely in different centers. This article discusses the different surgical strategies including: dilation and stenting; trans-palatal repair; and transnasal resection utilizing endoscopic sinus surgery (ESS) techniques. The merits of stents, lasers, CT-guided surgery, and the use of additional agents including mitomycin C are reviewed, as well as the particular problems associated with managing bilateral choanal atresia in neonates.
Otolaryngologic Clinics of North America 05/2009; 42(2):339-52, x. · 1.65 Impact Factor
-
Pediatric emergency care 04/2009; 25(3):196-9. · 0.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine (1) the molecular angiogenic relationship between endothelial and stromal cells of angiofibromas and how this may elucidate the pathogenesis of angiofibromas and (2) the effects of embolization on the expression of angiotrophic factors and proapoptotic and antiapoptotic factors within the tumor.
The expression of mesenchymal and endothelial stem/progenitor cell-associated proteins (MECAPs) such as proangiogenic cytokine vascular endothelial growth factor (VEGF), VEGF receptors (VEGFR1, VEGFR2, and VEGFR3), angiopoietin receptors (Tie-1 and Tie-2), and stem cell subset marker CD133 was assessed by immunohistological staining in 7 embolized angiofibroma specimens. Expression of proapoptotic Bax, antiapoptotic Bcl-2 and Bcl-xL, nuclear proliferation protein MiB-1, and hypoxia-inducible factor 1alpha (Hif-1alpha) in peri-ischemic areas of the embolized angiofibromas was also assessed.
A single pediatric institution.
Seven patients (identified from medical records, January 1, 2001, through December 31, 2005) who were diagnosed as having juvenile angiofibroma and who underwent surgical treatment. Archival tissues were retrieved for immunostaining.
The immunostaining results were evaluated by microscopy and the staining intensities were also recorded.
All angiofibroma specimens expressed the stem cell subset marker CD133 and MECAPs except VEGFR3 (a few cases). In the only case tested, we found evidence of VEGF-induced angiogenic signaling as the expression of phosphorylated VEGFR2 (Tyr951). Endothelial cells expressed VEGFR1 and VEGFR2 and angiopoietin receptors Tie-1 and Tie-2 but not VEGF. In contrast, VEGF was expressed within stromal cells. Viable tumor adjacent to the ischemic areas demonstrated increased staining intensities to VEGFR2, Tie-1, Tie-2 (all cases), and VEGFR3 (2 cases) and increased nuclear proliferation (5%-20%). All cases expressed proapoptotic and antiapoptotic factors, and the expression of Hif-1alpha was unaffected by ischemia.
Stromal cells appear to be similar to mesenchymal stem cells with endothelial differentiation potential in umbilical cord blood cells. Stromal cells support endothelial growth by providing VEGF as a paracrine factor. Under ischemic stress, the embolized tumor tissues show upregulation of angiogenic receptors, retention of Hif-1alpha, and increased nuclear proliferation rates. Specific angiogenesis blockers may represent a novel treatment strategy for angiofibromas.
Archives of otolaryngology--head & neck surgery 12/2008; 134(11):1170-6. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aggressive fibromatosis in children is a rare, benign condition that is locally infiltrative and destructive. It often presents as a rapidly growing, painless lump in the head and neck region. To date, only small series and case reports have been reported, and the management of the condition remains unclear. Recently, nuclear beta-catenin expression has been suggested as a tumor-specific marker for aggressive fibromatosis (desmoid).
The aims of the study were to review our experience of the presentation, management, and treatment outcome of pediatric aggressive fibromatosis in the head and neck and to identify the presence of the desmoid tumor marker beta-catenin within this population.
The study was conducted as a retrospective case review of children diagnosed with aggressive fibromatosis in the head and neck for a period of 20 years and a review of the literature. Pathologic review of the original tumor specimens was undertaken for evidence of positive tumor margins and presence of nuclear beta-catenin expression.
A total of 10 patients (6 males, 4 females) were identified. The age at presentation ranged from 12 months to 14 years. In total, 8 patients were treated with surgery alone. This included 7 patients with extension of the tumor to the resection margin; all had good long-term outcomes with no disease progression. Two patients received chemoradiotherapy, one as primary treatment, and the other as adjuvant treatment after gross incomplete resection. Both resulted in poor outcomes requiring further treatments. Within our series of pediatric fibromatosis, only 4 cases (40%) had positive results for any nuclear beta-catenin expression, and 6 (60%) of 10 patients had negative results for beta-catenin.
Our experience is that total gross resection and preservation of form and function is of higher priority than achieving a negative resection margin. Pediatric fibromatosis though aggressive is still a benign condition, and careful thought should be taken before considering adjuvant chemoradiotherapy. Nuclear beta-catenin expression should not be considered a specific tumor marker for pediatric aggressive fibromatosis of the head and neck. Pediatric aggressive fibromatosis in this region may be a distinct subtype of desmoid tumor from its adult form.
Journal of Pediatric Surgery 10/2008; 43(9):1596-604. · 1.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the quantity and nature of undergraduate otolaryngology instruction in the Canadian medical school system and to present the management of the undergraduate otolaryngology curriculum at the University of Toronto medical school with a yearly enrolment of 224 students.
Survey questionnaire and narrative description.
A structured one-page survey was administered to the education directors of all 16 Canadian medical schools. The administration of core learning material, scheduling, patient encounter logging, and student and instructor evaluations with computerized, on-line systems at the University of Toronto was described.
Rotations in otolaryngology were highly variable across medical schools. Mandatory rotations in otolaryngology were identified in only 6 of the 16 undergraduate curricula. The average length of clinical experience in schools with mandatory rotations was 4.6 days.
The majority of Canadian medical graduates complete their undergraduate training with minimal clinical experience in otolaryngology. There is a clear discrepancy between the quantity and perceived need for training. To provide a thorough and equitable exposure to otolaryngology, a curriculum with standardized lectures and evaluation procedures is required.
The Laryngoscope 10/2008; 118(11):1941-50. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The present report details the case of a 13-year-old girl who presented to the emergency department with stridor. Treatment for presumed reactive airway disease was attempted with antibiotics, nebulized adrenaline masks and high-dose corticosteroids. Over the next month, she presented repeatedly in a similar fashion and was admitted to hospital on three separate occasions. Ultimately, she was referred to the Centre for Paediatric Voice and Laryngeal Function at The Hospital for Sick Children (Toronto, Ontario) for a speech-language pathology evaluation and direct laryngoscopy. The patient was diagnosed with paradoxical vocal fold dysfunction. After a brief treatment session with a speech-language pathologist, her stridor completely resolved and paradoxical inspiratory vocal fold adduction was no longer visualized on direct laryngoscopy. The present case highlights the fact that paradoxical vocal fold dysfunction can mimic other entities that present with stridor, and misdiagnosis can result in significant morbidity. Investigation into a patient's social history and stressors can facilitate the diagnosis, and can avoid unnecessary and potentially harmful medical and surgical interventions.
Paediatrics & child health 10/2008; 13(7):611-4. · 0.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To design and test a bench model of an intraluminal optical device capable of accurately measuring airway diameter.
A fresh porcine trachea divided longitudinally and affixed to a linear translation stage was used to simulate 20 tracheal diameters (18.3-30.3 mm). Tungsten-halogen light was dispersed across the luminal surface by a diffraction grating. Determination of the wavelength of diffusely reflected light of peak intensity by spectrograph analysis then allowed for the calculation of an optical distance for each simulated tracheal diameter. The criterion standard was the distance as measured by the micrometer on the translation stage. Intraclass correlation (ICC) and Bland-Altman regression analysis (BARA) were performed between the optical and micrometer measurements. Subject Trachea from a newly exsanguinated pig.
The ICC showed high correlation (0.994; 95% confidence interval [CI], 0.9860.998) (P < .001); BARA showed a small mean difference between the optical and micrometer measurements (0.052 mm; 95% CI, -0.867 to 0.762 mm) and no significant trend in bias for varying diameters (r = 0.581; 95% CI, 0.187-0.814) (P = .07).
The determination of airway diameter by means of the reflection of nonionizing radiation from the luminal surface correlates closely to actual diameter as measured by a micrometer. This bench model may be used to develop a fiberoptic intraluminal probe capable of accurately profiling airway luminal diameter and shape during flexible or rigid bronchoscopy.
Archives of otolaryngology--head & neck surgery 06/2008; 134(6):637-42. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hypernasality is a commonly perceived characteristic of speech in deaf adults and children, but the mechanism of this abnormal nasal resonance is poorly understood. The impact of cochlear implantation on nasalance measures in children with severe auditory deprivation has not been previously reported. We conducted a study of nasality in 6 deaf children who had undergone cochlear implantation. Voice recordings were obtained before surgery and 6 months after activation of the implants. The MacKay-Kummer SNAP Test--which consists of a syllable-repetition subtest and a picture-cued subtest--was used to obtain nasalance scores for oral (bilabial, alveolar, velar, and sibilant) and nasal phonemes. Before cochlear implantation, mean nasalance scores were significantly higher than normal during the production of oral phonemes for both subtests (p < or = 0.05). Six months after activation, the nasalance measures for all components of the syllable-repetition subtest had been restored to within 1 standard deviation of normal. For all oral phonemes of the picture-cued subtest, the elevated nasalance scores were consistently lower after cochlear implant activation, although the difference was statistically significant only for velar tasks. Nasalance scores for nasal phonemes were within 1 standard deviation of normal both before and after implant activation. Our study showed that cochlear implantation partially corrects elevated nasalance measures. Disturbances in nasal resonance may be caused in part by the inability of deaf speakers to monitor velopharyngeal valving with auditory feedback. The trend toward improved nasalance scores after implantation highlights the role of auditory feedback in monitoring velopharyngeal function. Visual biofeedback may be required to further normalize hypernasal speech in profoundly deaf children.
Ear, nose, & throat journal 04/2008; 87(3):138, 140-3. · 0.66 Impact Factor
