International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Jan 1995
Case ReportsDiagnosis and management of laryngeal obstruction in childhood pachyonychia congenita.
Pachyonychia congenita is a genetic syndrome of epithelial dysplasia. In infants and young children, laryngeal involvement can present a life threatening complication: obstruction of the patient's airway due to leukokeratosis can lead to severe respiratory distress. This report concentrates on the diagnosis and successful microsurgical management of laryngeal obstruction in the first female case, a 19-month-old girl with pachyonychia congenita.
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Int. J. Pediatr. Otorhinolaryngol. · Nov 1994
ReviewFactors that influence successful decannulation after surgery for laryngo-tracheal stenosis in children.
The process to decannulation requires attention to details from the time of initial tracheostomy, through the pre- and peri-operative period up until the decannulation event. Important points to consider during this process are: a formal tracheostomy rather than a tracheotomy; other potential sites of obstruction than the laryngeal stenosis; gastroesophageal reflux; prevention and control of infection and the use of prophylactic antibiotics; method and type of suture material; stenting; movement and method of feeding. Decannulation itself requires attention to removal of granulation tissue and control of tracheomalacia and tracheostenosis.
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Int. J. Pediatr. Otorhinolaryngol. · Nov 1994
Chronic otitis media requiring ventilation tubes in tracheotomized ventilator dependent children.
The occurrence of sinusitis and middle ear effusions has frequently been attributed to the obstruction of the sinus ostia and/or eustachian tube. In the intensive care unit setting, edema caused by the irritation from nasogastric, nasotracheal and orotracheal tubes has been associated with this pathology and has been responsible for occult sepsis in this population. Our investigation was performed to determine the risk of chronic otitis media with effusion necessitating myringotomy with tympanostomy tubes among tracheotomized, ventilator dependent children in a consecutive series of children admitted to our recently created stable ventilator unit. ⋯ Ventilation tubes for chronic otitis media with effusion were not required in 3 patients. Using a case control study design, we examined the need of myringotomy tubes for children requiring continuous mechanical ventilation versus those requiring night-time only ventilation. The risk of myringotomy tubes in the continuously ventilated group (9/9) was significantly greater than the risk in the intermittently ventilated group (0/3) P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)
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Int. J. Pediatr. Otorhinolaryngol. · Aug 1994
Outpatient tonsillectomy and adenoidectomy: complications and recommendations.
An example of cost-effective alternatives in medical care is the increasing use of out-patient surgery for those children requiring tonsillectomy, or tonsillectomy with adenoidectomy rather than an in-patient procedure. Two studies were carried out to answer questions about the complications, in addition to post-operative hemorrhage, and also the questions about the parental views and concerns relating to providing at-home care for their children following surgery. A triad, including recent history of upper airway infection, knife dissection technique, and increased intra-operative blood loss of 100 ml or more should be used to help identify the risk of post-operative hemorrhage.
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Int. J. Pediatr. Otorhinolaryngol. · Jul 1994
Comparative StudyMiddle ear measures as predictors of hearing loss in Australian aboriginal schoolchildren.
This study sought to establish the value of tympanometry and otoscopy for predicting significant conductive hearing loss in remote-area Aboriginal children, and also to measure the range of hearing loss which can be expected with middle ear disease, with or without a tympanic membrane (TM) perforation. A field study is reported of 255 Aboriginal children aged up to 16 years who were examined with pneumotoscopy and tympanometry and whose hearing was tested under controlled acoustic conditions. Results showed that pneumatic otoscopy for detection of middle ear effusion and identification of perforations resulted in the best rate of prediction of significant conductive hearing loss. ⋯ D. 9.6), and both differed significantly from ears showing normal tympanograms (mean pure-tone average 11.2 dB; S. D. 5.9). Implications for community-based hearing screening and classroom management of affected children are discussed.