Paul R. Cook

University of Missouri, Columbia, Missouri, United States

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Publications (19)31.9 Total impact

  • TIMOTHY M. HERR · PAUL R. COOK · GARY HIGHFILL
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    ABSTRACT: Food allergies are an important cause of morbidity in the pediatric population. We used a questionnaire to assess the value of in vitro testing in evaluating children for food allergy. The patient population was divided into two groups: those who tested positive (Class I or greater) for food allergy (combined food/inhalant allergy or food allergy alone) and those who tested negative for food allergy (inhalant only or negative test). Although we recognize that a significant proportion of food allergies may not be IgE-mediated, for the purposes of this study we considered a patient food allergy--positive if in vitro testing was positive and food allergy--negative if testing was negative. Thirty-eight of 77 patients tested (49%) were positive for food allergies. Those with food allergies did not have pretreatment scores significantly different from those of patients negative for food allergies (55 vs. 65, p = 0.11). Similarly, we detected no statistically significant difference between the symptom-improvement scores of the two groups (37 vs. 40, p = 0.57). We conclude that in vitro testing for food allergies is warranted in children with allergic symptoms, for several reasons: The prevalence of IgE-mediated food allergy in children may be higher than previously thought, and children with food allergies experience the same severity of symptoms as those without. It must be remembered that in vitro testing only detects IgE levels, and therefore a negative test does not mean that the patient does not have food allergies. However, when positive, in vitro testing gives the physician the opportunity to modify the treatment plan, helping avoid time-consuming and demanding oral food challenges. Our questionnaire also showed that food allergy and non-food allergy patients had similar pretreatment and posttreatment symptom scores.
    No preview · Article · Mar 1999 · Otolaryngology Head and Neck Surgery
  • Paul R. Cook · Timothy M. Herr · Gary Highfill
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    ABSTRACT: Allergy is a significant problem in as much as 60% of patients seeking care at an otolaryngologist's office. This raises the issue of the most effective means of diagnosing allergy, especially in pediatric patients, who often may not tolerate skin testing. The RAST and CAP (Pharmacia) tests have been shown to be quite comparable with skin testing in diagnosing allergy. This study was undertaken to assess the effectiveness of treatment of children with allergies who had undergone in vitro testing. This was done by obtaining subjective symptom scores both before and after treatment. These were obtained from patients with different in vitro results, including some with negative testing. Overall, 77 of 155 mailed questionnaires were returned. Results showed overall improvement of 38.81 points in 12 symptoms (p = 0.001; n = 62). Each symptom was rated on a visual scale of 1 to 10. A small portion of the patient population received surgical treatment (tympanostomy tube placement with or without adenoidectomy) in addition to medical treatment and avoidance. These patients did not have significantly higher pretreatment scores and did not have a higher improvement rate for all symptoms. We believe this study shows the validity of in vitro testing and treatment of allergy in children.
    No preview · Article · Mar 1998 · Otolaryngology Head and Neck Surgery
  • Paul R. Cook
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    ABSTRACT: Recent scientific studies have demonstrated the efficacy of various forms of immunotherapy for the treatment of allergic diseases. Traditional subcutaneous immunotherapy, sublingual, oral, and intranasal immunotherapy have been shown to significantly reduce symptoms and favorably modulate the immune response. Outcome studies that use patient response data from standardized surveys represent the next challenge to all practicing allergists.
    No preview · Article · Feb 1998 · Otolaryngologic Clinics of North America
  • Paul R. Cook
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    ABSTRACT: Allergen-specific immunotherapy has been used empirically for many years to effectively treat allergic disease. As knowledge of immunology has grown, greater effort has been made to determine effective immunotherapeutic techniques and discover the mechanisms of action of immunotherapy. Recent studies have demonstrated the efficacy of various forms of immunotherapy. Traditional subcutaneous or injective immunotherapy has been fairly well investigated, although too little emphasis has been placed on the outcome of therapy and the effect of therapy on health status. In efforts to improve safety, efficacy, and economy, modified or new forms of immunotherapy have recently been developed and tested. Modified extracts and alternative delivery techniques, such as those used in sublingual and intranasal immunotherapy, present promising alternatives to current standard subcutaneous techniques.
    No preview · Article · Feb 1998 · Current Opinion in Otolaryngology & Head and Neck Surgery
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    ABSTRACT: There has been a recent explosion of new in vitro tests for the diagnosis of allergies. At present there is no general agreement on which type of in vitro test is best. Recently our hospital switched in vitro testing from the modified radioallergosorbent system (mRAST) to the Pharmacia CAP system (CAP). While changing in vitro testing techniques, 47 patients were tested with both the mRAST and CAP tests. Comparisons were made between the mRAST and CAP results of Alternaria tenuis and Dermatophagoides pteronyssinus allergens. These results were then compared with the results of patients who also underwent intradermal skin testing based on end point titration techniques.
    No preview · Article · Dec 1997 · Otolaryngology Head and Neck Surgery
  • Dwight M Ellerbe · David S Parsons · Paul R Cook
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    ABSTRACT: Botryomycosis is a chronic bacterial granulomatous disease often involving the skin and subcutaneous tissue. Head and neck involvement is rare. Botryomycosis presents with clinical and histological features similar to actinomycosis or mycetoma, but the causative organism is usually Staphylococcus aureus. Microscopically the organisms appear to be encapsulated in granules, which are thought to protect them from the effects of standard courses of antibiotics. Botryomycosis usually requires surgical intervention for cure. Major debilitating surgery has been required for most patients, because the infection has been unresponsive to seemingly appropriate medical therapy. We present an 8-month-old male with periorbital botryomycosis. Surgical specimens for diagnosis were obtained, but complete resection would have created debilitating functional and cosmetic defects. The lesion failed to respond to nafcillin alone or combination therapy with hyperbaric oxygen, but showed slow, steady improvement with long-term clindamycin. The patient has been disease free for more than 4 years, with minimal scarring and no functional impairment. Prolonged medical therapy for botryomycosis may be a viable alternative to the traditionally recommended surgical resection, thereby reducing cosmetic and functional morbidity.
    No preview · Article · Oct 1997 · International Journal of Pediatric Otorhinolaryngology
  • Dwight M Ellerbe · David S Parsons · Paul R Cook
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    ABSTRACT: Botryomycosis is a chronic bacterial granulomatous disease often involving the skin and subcutaneous tissue. Head and neck involvement is rare. Botryomycosis presents with clinical and histological features similar to actinomycosis or mycetoma, but the causative organism is usually Staphylococcus aureus. Microscopically the organisms appear to be encapsulated in granules, which are thought to protect them from the effects of standard courses of antibiotics. Botryomycosis usually requires surgical intervention for cure. Major debilitating surgery has been required for most patients, because the infection has been unresponsive to seemingly appropriate medical therapy. We present an 8-month-old male with periorbital botryomycosis. Surgical specimens for diagnosis were obtained, but complete resection would have created debilitating functional and cosmetic defects. The lesion failed to respond to nafcillin alone or combination therapy with hyperbaric oxygen, but showed slow, steady improvement with long-term clindamycin. The patient has been disease free for more than 4 years, with minimal scarring and no functional impairment. Prolonged medical therapy for botryomycosis may be a viable alternative to the traditionally recommended surgical resection, thereby reducing cosmetic and functional morbidity.
    No preview · Article · Sep 1997 · International Journal of Pediatric Otorhinolaryngology
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    ABSTRACT: Seventy paranasal sinus computed tomography scans of patients with cystic fibrosis were compared with those of age-matched control groups of randomly selected chronic sinusitis patients without cystic fibrosis to determine whether differences in disease patterns existed. In patients older than 10 years, frontal sinus agenesis and maxilloethmoid sinus opacification were significantly more prevalent in patients with cystic fibrosis than in chronic sinusitis patients without cystic fibrosis. Medial bulging of the lateral nasal wall was significantly greater in patients with cystic fibrosis than in chronic sinusitis patients without cystic fibrosis in patients older than 5 years. On the basis of these findings, a diagnostic triad of radiologic findings for cystic fibrosis detection is presented, as well as its clinical implications.
    No preview · Article · Apr 1996 · Otolaryngology Head and Neck Surgery
  • G J Nishioka · P R Cook
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    ABSTRACT: The enhanced understanding of the pathophysiology of cystic fibrosis (CF) has advanced significantly the management of this disorder, resulting in both an increased longevity and an improved quality of life. Sinonasal disease is an important aspect of CF. The goal of this article is to provide a current synopsis of CF sinonasal disease with an emphasis on disease symptomatology, physical signs, characteristic radiographic features, and outcome-based management options. When indicated, functional endoscopic sinus surgery has been shown to be a safe and effective treatment option for children with CF.
    No preview · Article · Mar 1996 · Otolaryngologic Clinics of North America
  • P R Cook · G J Nishioka
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    ABSTRACT: Allergic disease is very common in the U.S. population and even more common in children seen by otolaryngologists. Allergy causes or contributes to virtually all of the diseases in the respiratory tract that otolaryngologists, particularly otolaryngic allergists, evaluate and treat. The signs and symptoms of allergic disease in the pediatric patient are reviewed to improve the appreciation of the role of allergy in pediatric otolaryngology. Recent research developments, which are reviewed in detail in this article, underscore the importance of allergic, inflammatory response in rhinosinusitis. The key to long-term therapeutic success, particularly in pediatric rhinosinusitis, is management of the underlying allergic diathesis.
    No preview · Article · Mar 1996 · Otolaryngologic Clinics of North America
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    ABSTRACT: Twenty-nine consecutive patients with cystic fibrosis were offered functional endoscopic sinus surgery. Twenty-six of these patients underwent surgery. A symptom questionnaire was obtained from the patient or parent before surgery. At the end of the study this symptom questionnaire was again administered to the same individual, and 21 completed it. There were 14 male and 7 female patients, with a mean age of 12.3 years and a median age of 8.7 years. Mean follow-up was 34.3 months. Results for the following symptoms were significant: nasal airway obstruction was improved (p < 0.0002), olfactory function was improved (p < 0.0037), purulent nasal discharge was decreased (p < 0.001), and activity level was increased (p < 0.001). Other parameters are also reported in the text. In summary, this study prospectively studies the effects of functional endoscopic sinus surgery on symptoms in patients with cystic fibrosis. The study points out several significant areas of symptom improvement and supports the selective use of functional endoscopic sinus surgery in patients with cystic fibrosis. Indications for surgery are provided.
    No preview · Article · Oct 1995 · Otolaryngology Head and Neck Surgery
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    ABSTRACT: We report the first prospective study of the effect of partial middle turbinectomy on nasal airflow and resistance as measured objectively by active anterior rhinomanometry. Our study group consisted of 31 consecutive patients who underwent functional endoscopic sinus surgery with simultaneous partial middle turbinate resections. We found that all patients had significant improvement in nasal airflow (p < 0.001) and significant decrease in nasal resistance (p < 0.001). Thus we found no deleterious effect on nasal function. Additionally, we reviewed the literature on retrospective series in which patients had received partial middle turbinectomies and found no evidence that nasal function was impaired after surgery. We conclude that partial middle turbinectomy may be performed without adversely altering nasal function, as measured by active anterior rhinomanometry.
    No preview · Article · Oct 1995 · Otolaryngology Head and Neck Surgery
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    ABSTRACT: Anaphylaxis may be defined as a systemic, immunoglobulin E-mediated (Gell-Coombs type I) hypersensitivity reaction triggered by exposure to an antigen in a previously sensitized patient. Anaphylaxis may occur in a variety of circumstances; however, when it occurs as the result of immunotherapy, it is of great concern to the practicing allergist. When describing or reporting anaphylaxis relating to immunotherapy, most allergists speak in terms of the types of reactions, local vs. systemic. Germane to this discussion is the use of the term systemic reaction, which can mean anything from mild allergy symptoms resulting from an allergy injection to bradycardia and hypotension (shock). In this article we report serious or significant systemic reactions, which are characterized by any of the following symptoms: urticaria, sneezing or nasal obstruction, throat tightness or congestion, wheezing, and shock (bradycardia or hypotension). There were no fatalities reported from the survey group. The overall reaction rate was 0.3%.
    No preview · Article · Jul 1994 · Otolaryngology Head and Neck Surgery
  • P R Cook · G J Nishioka · W E Davis · J P McKinsey
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    ABSTRACT: Eighteen patients were operated on by functional endoscopic sinus surgery who had no ostiomeatal unit obstruction on computed tomography scan and had unremarkable paranasal sinuses. These patients also had no apparent ostiomeatal unit obstruction on diagnostic nasal endoscopy. Data were collected on these patients regarding the impact of very limited functional endoscopic sinus surgery on their principal complaint of recurrent sinusitis with facial pain/headache thought to be of sinogenic origin. Sixteen patients (88.9%) had a reduction in the number of sinus infections requiring antibiotic therapy. This reduction was significant at p < 0.0001. Twelve of 14 patients whose facial pain/headache was believed to be of sinogenic origin had a significant reduction in severity (95% confidence interval, 49.2% to 95.3%). We discuss the role of reversible nasal mucosal disease in the pathophysiology of recurrent rhinosinusitis in this patient population. This was a very small, select group of patients who had specific complaints and had had medical treatment failures. This therapy is not recommended for every patient, but only a select few with classic complaints of sinus headaches or recurrent sinusitis and negative computed tomography scans.
    No preview · Article · Jun 1994 · Otolaryngology Head and Neck Surgery
  • G J Nishioka · P R Cook · W E Davis · J P McKinsey
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    ABSTRACT: Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% (p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.
    No preview · Article · Jun 1994 · Otolaryngology Head and Neck Surgery
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    ABSTRACT: A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.
    No preview · Article · May 1994 · Otolaryngology Head and Neck Surgery
  • P R Cook · W E Davis · R McDonald · J P McKinsey
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    ABSTRACT: We report on a series of 33 consecutive cases of antrochoanal polyp (ACP) treated by endoscopic sinus surgery over a five-year period. All but one patient was treated by endoscopic sinus surgery alone. This method of treatment was quite effective for ACPs. These 33 patients represent 22.3% of all nasal polyp patients on whom we operated during the same period. This incidence of ACP is greater than that generally reported in the literature. Some authors have attempted to distinguish ACPs from common nasal polyps primarily on the basis of morphology, histology, and the clinical behavior of the ACPs. In our series, a multivariate analysis, including histopathologic correlation, did not support the notion that ACPs are clearly distinct from common nasal polyps. Some interesting differences between the polyp groups did, however, become evident in our data analysis. Generally, ACPs are not thought to be associated with allergic disease; however, in our series we found the association of allergic disease with ACPs to be statistically significant (Chi-square = 4.575, p < .05).
    No preview · Article · Jun 1993 · Ear, nose, & throat journal
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    ABSTRACT: Although anaphylactic reactions resulting from immunotherapy rarely occur, when they do occur they can be life-threatening. The literature reveals more than 30 deaths attributed to immunotherapy but numerous reports of anaphylaxis. We reviewed a 5-year experience of immunotherapy in a University practice and their experience with systemic reactions is presented. More than 125,000 injections were given in this time period. Of the 550 patients receiving immunotherapy, 14% experienced anaphylactic reactions, the majority of which were mild.
    No preview · Article · Aug 1992 · Otolaryngology Head and Neck Surgery

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Publication Stats

374 Citations
31.90 Total Impact Points

Institutions

  • 1998
    • University of Missouri
      • Department of Surgery
      Columbia, Missouri, United States
  • 1997
    • Columbia College Missouri
      Columbia, South Carolina, United States
  • 1996
    • Palm Drive Hospital
      Себастопол, California, United States