Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Jan 1999
Selection of antibiotics after incision and drainage of peritonsillar abscesses.
Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial. One element of controversy is the choice of antibiotics after drainage of the abscess. In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage. ⋯ Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients. The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature. These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.
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Otolaryngol Head Neck Surg · Jan 1999
Utility of portable chest radiographs as a predictor of endotracheal tube cuff pressure.
Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. ⋯ Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure.
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Otolaryngol Head Neck Surg · Jan 1999
Early diagnosis and treatment of laryngeal injuries from prolonged intubation in adults.
Prolonged endotracheal intubation can cause injuries to 1 or more regions of the larynx, making safe extubation impossible and leading to tracheostomy in many patients. Unfortunately, a considerable number of these patients do not benefit from early laryngeal evaluation, which may reveal potentially treatable soft, obstructive tissue before it undergoes irreversible fibrosis. Between July 1992 and December 1995, we performed immediate direct telelaryngoscopy on 142 adults who required tracheostomy because of failed extubation. ⋯ The 2 main reasons for failure of early decannulation were intractable granulation (in patients with insulin-dependent diabetes) and coexisting tracheal stenosis. Immediate telelaryngoscopy is recommended in all patients who require tracheostomy because of failed extubation. Flexible laryngoscopy is not adequate for thorough assessment of laryngeal damage from prolonged intubation.
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Temporal bone trauma can be disastrous for the individual and his or her family. With the increase in violent crime throughout our society, the number of intracranial complications associated with temporal bone injury has increased significantly. Although multiple reports concerning the diagnosis and management of temporal bone trauma have been published, few studies on its intracranial complications have been addressed. ⋯ Seven patients required further institutional care after discharge. Four patients died (9% mortality); all the deaths were neurologically related. Mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994.