Arch Otolaryngol
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Patients with sickle cell disease are recognized as having a relatively higher risk for postoperative complications, including fever, atelectasis, pneumonia, or sickle cell vas-occlusion. ⋯ Children with sickle cell disease presenting for elective tonsillectomy should be given a transfusion to a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. Additional factors, such as age and presence of obstructive sleep apnea, only increase the potential risks.
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To assess whether a correlation exists between the degree of pars flaccida (PF) retraction and the degree of mastoid pneumatization. ⋯ This study lends further support to the possibility that the mastoid pneumatic system functions as a middle ear pressure buffer. This possibility gives further explanation as to why ears with poorly pneumatized mastoids tend to develop tympanic membrane retractions and perforations, incus necrosis, or retraction pocket cholesteatoma, while ears with a large pneumatic system are rarely at such risk.
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Several approaches to the internal auditory canal and cerebellopontine angle for acoustic neuroma removal have been described. We prefer the translabyrinthine approach in patients with tumors larger than 2 cm or poor preoperative hearing, since both factors predict poor hearing preservation. Many surgeons perceive this approach as confining and consider it contraindicated in large tumors or contracted mastoids. ⋯ E. H.), no cases required a modification of the approach because of anatomic constraints within the mastoid. We describe our techniques for the management of the low-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb, alone or in combination, during translabyrinthine removal of acoustic neuromas.
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To describe a condition identified in the pediatric population that narrows the supraglottic larynx. This condition has been termed supraglottic stenosis/collapse. To discuss common factors present in these children and to examine potential causes of this specific condition. ⋯ Supraglottic stenosis/collapse is a distinct entity that may be related to prior laryngeal or tracheal surgery. This diagnosis should be considered when evaluating and treating patients with chronic upper airway obstruction following laryngeal and/or tracheal surgery.
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To evaluate the diagnostic algorithms leading to minimal-access surgery in unilateral sinonasal disease without evidence of bone destruction. ⋯ In differentiating untreated unilateral sinonasal disease without evidence of bone destruction, we conclude that CT is the first modality of diagnostic imaging and MRI is more sensitive than CT in identifying fungal disease and angiofibroma. Furthermore, MRI is helpful when neoplasm is indicated, but it is not an accurate diagnostic tool. The endonasal endoscopic approach for obtaining pathologic specimens is a qualitative diagnostic tool in the diagnosis of sinonasal neoplasm.