International Journal of Pediatric Otorhinolaryngology Extra, 2011
Reported is a case of cervical atypical mycobacterial infection treated with an extended course o... more Reported is a case of cervical atypical mycobacterial infection treated with an extended course of clarithromycin in a 23-month-old child who developed sensorineural hearing loss. While no subjective change in hearing was reported, hearing loss was identified through audiologic ototoxicity monitoring. Audiometric changes encompassing frequency specific threshold shifts and changes in distortion product otoacoustic emissions are shown during the use
International journal of pediatric otorhinolaryngology, 2014
To assess physicians' knowledge and beliefs regarding vestibular evoked myogenic potential (V... more To assess physicians' knowledge and beliefs regarding vestibular evoked myogenic potential (VEMP) testing in children. A survey was delivered via email in html format to 1069 members of the American Academy of Otolaryngology--Head and Neck Surgery who identified as pediatric otolaryngologists. Study data were collected and managed using the Research Electronic Data Capture (REDCap) tools. 443 (41.4%) physicians opened the email. 190 (42.9% of opens) initiated the survey, of which 117 (61.9%) fully completed the survey of the physicians who responded to a question regarding knowledge of VEMP, 16% of respondents had never heard of the test. 16% of participants would use it in the setting of diagnosing pediatric conductive hearing loss. Responses regarding the youngest age at which VEMP is possible ranged from younger than 6 months through greater than 13 years of age. Beliefs regarding utility and reliability of VEMP varied, with 'unsure' as the most frequent response. Add...
A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass... more A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass became larger, and the overlying skin turned purple. There was no clinical response to a course of either cephalexin or clarithromycin. The remainder of the head and neck examination was normal including normal facial nerve function. Lyme titers and a computed tomographic (CT) scan with contrast of the facial region were obtained. The CT scan demonstrated the lesion to be superficial to the parotid gland. The lyme titer was elevated and doxycycline was begun. The mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous. The lesion was surgically excised and was vascular with calcification and cheesy inclusions. The mass was quite close to the skin and the clinical diagnosis at the time of surgery was a pilomatrixoma, which was corroborated on pathological evaluation.
Described is a case series of clinical findings in children with persistent conductive or mixed h... more Described is a case series of clinical findings in children with persistent conductive or mixed hearing loss following tympanostomy tube placement for serous otitis media. Retrospective chart review. Tertiary pediatric hospital. Medical records of thirty-nine children who were referred for either conductive or mixed hearing loss post-tympanostomy tube placement were reviewed for clinical histories, physical examinations, audiological evaluations, diagnostic studies, consultations, and surgical findings. Approval was obtained from the Boston Children's Hospital Institutional Review Board. Causes of hearing loss included ossicular abnormalities, cochlear abnormalities, 'third window' effects, cholesteatomas, genetic syndromes, and unknown causes. In four patients with isolated mild low-frequency conductive hearing loss, the cause was the presence of functional tubes. All patients diagnosed with a genetic syndrome had bilateral hearing loss. Patients with mixed hearing loss were diagnosed with cochlear abnormalities, 'third window' effects, or genetic syndromes. Computed tomography led to diagnosis in sixteen of twenty-five patients. Vestibular-evoked myogenic potential testing suggested a diagnosis in three of four patients. In children with persistent hearing loss following tympanostomy tube placement, identifying the laterality and type of hearing loss appears to be of importance in diagnosis. Patients with bilateral hearing loss should be considered for genetic testing, given the possibility of a syndrome. Patients identified with a mixed hearing loss should be evaluated for inner ear anomalies. Patients with mild, low-frequency hearing losses should be monitored audiologically and investigated further only if the hearing loss progresses and/or there is no resolution following tube extrusion.
tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airwa... more tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airway. Historically, patients have often required urgent invasive airway support, and have been treated with broad-spectrum antibiotics, often combined with direct laryngoscopy and bronchoscopy. Retrospective chart review. Six patients between the ages of 10 months and 16 years were treated at Children's Hospital, Boston, Massachusetts, for bacterial tracheitis between January 2009 and March 2009. All patients underwent urgent direct laryngoscopy and bronchoscopy for debridement of mucopurulent debris and tissue culture. Broad-spectrum intravenous antibiotics were administered, and patients were kept on acute cardiopulmonary monitoring for 48 to 72 hours, after which time the airway was re-evaluated by direct laryngoscopy and bronchoscopy in five of the patients, and by fiberoptic nasolaryngoscopy in one patient. All of the patients were transitioned to oral antibiotic therapy for 10 to 14 days after discharge. Following debridement, all of the patients did well with aggressive medical management. None of the patients required urgent intubation, although one patient was kept on ventilator support for 48 hours until disease resolution was confirmed. No patients required tracheotomy, and there were no cardiopulmonary arrests. The mean hospital length of stay was 4.8 days (range, 3-8 days). This study highlights the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis. It also demonstrates an approach with the potential to improve patient outcomes from this dangerous condition.
The contribution of the middle ear air spaces to sound transmission through the middle ear in can... more The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall-up and canal wall-down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall-up procedures, canal wall-down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262-8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall-down procedure. We conclude that as long as the middle ear air space...
Laser Doppler vibrometry was used to measure the sound-induced tympanic membrane (TM) velocity, a... more Laser Doppler vibrometry was used to measure the sound-induced tympanic membrane (TM) velocity, assessed near the umbo, in 56 normal hearing human subjects at nine sound frequencies. A second series of measurements was made in 47 subjects with sensorineural hearing loss (SNHL). Each set of measurements has features in common with previously published results. The measured velocity magnitude (normalized by the stimulus sound pressure) at any one frequency ranged among subjects by factors of 3-0.3 (+/-10 dB) from the mean and the phase angle of the normalized velocity ranged from +/-15 degrees around the mean at low frequencies to more than +/-200 degrees around the mean at 6 kHz. Measurements repeated after intervals of minutes to months were generally within 40% in magnitude (+/-3 dB) and 20 degrees in phase. Sources of variability included the effect of small differences in the location of the measurement on the TM and small static middle-ear pressures. No effects of stimulus level, ear sidedness (right or left), gender, age or the presence or absence of SNHL were found. These results provide a baseline normal response for studies of TM velocity with conductive hearing losses of different etiologies.
International Journal of Pediatric Otorhinolaryngology Extra, 2011
Reported is a case of cervical atypical mycobacterial infection treated with an extended course o... more Reported is a case of cervical atypical mycobacterial infection treated with an extended course of clarithromycin in a 23-month-old child who developed sensorineural hearing loss. While no subjective change in hearing was reported, hearing loss was identified through audiologic ototoxicity monitoring. Audiometric changes encompassing frequency specific threshold shifts and changes in distortion product otoacoustic emissions are shown during the use
International journal of pediatric otorhinolaryngology, 2014
To assess physicians' knowledge and beliefs regarding vestibular evoked myogenic potential (V... more To assess physicians' knowledge and beliefs regarding vestibular evoked myogenic potential (VEMP) testing in children. A survey was delivered via email in html format to 1069 members of the American Academy of Otolaryngology--Head and Neck Surgery who identified as pediatric otolaryngologists. Study data were collected and managed using the Research Electronic Data Capture (REDCap) tools. 443 (41.4%) physicians opened the email. 190 (42.9% of opens) initiated the survey, of which 117 (61.9%) fully completed the survey of the physicians who responded to a question regarding knowledge of VEMP, 16% of respondents had never heard of the test. 16% of participants would use it in the setting of diagnosing pediatric conductive hearing loss. Responses regarding the youngest age at which VEMP is possible ranged from younger than 6 months through greater than 13 years of age. Beliefs regarding utility and reliability of VEMP varied, with 'unsure' as the most frequent response. Add...
A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass... more A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass became larger, and the overlying skin turned purple. There was no clinical response to a course of either cephalexin or clarithromycin. The remainder of the head and neck examination was normal including normal facial nerve function. Lyme titers and a computed tomographic (CT) scan with contrast of the facial region were obtained. The CT scan demonstrated the lesion to be superficial to the parotid gland. The lyme titer was elevated and doxycycline was begun. The mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous. The lesion was surgically excised and was vascular with calcification and cheesy inclusions. The mass was quite close to the skin and the clinical diagnosis at the time of surgery was a pilomatrixoma, which was corroborated on pathological evaluation.
Described is a case series of clinical findings in children with persistent conductive or mixed h... more Described is a case series of clinical findings in children with persistent conductive or mixed hearing loss following tympanostomy tube placement for serous otitis media. Retrospective chart review. Tertiary pediatric hospital. Medical records of thirty-nine children who were referred for either conductive or mixed hearing loss post-tympanostomy tube placement were reviewed for clinical histories, physical examinations, audiological evaluations, diagnostic studies, consultations, and surgical findings. Approval was obtained from the Boston Children's Hospital Institutional Review Board. Causes of hearing loss included ossicular abnormalities, cochlear abnormalities, 'third window' effects, cholesteatomas, genetic syndromes, and unknown causes. In four patients with isolated mild low-frequency conductive hearing loss, the cause was the presence of functional tubes. All patients diagnosed with a genetic syndrome had bilateral hearing loss. Patients with mixed hearing loss were diagnosed with cochlear abnormalities, 'third window' effects, or genetic syndromes. Computed tomography led to diagnosis in sixteen of twenty-five patients. Vestibular-evoked myogenic potential testing suggested a diagnosis in three of four patients. In children with persistent hearing loss following tympanostomy tube placement, identifying the laterality and type of hearing loss appears to be of importance in diagnosis. Patients with bilateral hearing loss should be considered for genetic testing, given the possibility of a syndrome. Patients identified with a mixed hearing loss should be evaluated for inner ear anomalies. Patients with mild, low-frequency hearing losses should be monitored audiologically and investigated further only if the hearing loss progresses and/or there is no resolution following tube extrusion.
tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airwa... more tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airway. Historically, patients have often required urgent invasive airway support, and have been treated with broad-spectrum antibiotics, often combined with direct laryngoscopy and bronchoscopy. Retrospective chart review. Six patients between the ages of 10 months and 16 years were treated at Children's Hospital, Boston, Massachusetts, for bacterial tracheitis between January 2009 and March 2009. All patients underwent urgent direct laryngoscopy and bronchoscopy for debridement of mucopurulent debris and tissue culture. Broad-spectrum intravenous antibiotics were administered, and patients were kept on acute cardiopulmonary monitoring for 48 to 72 hours, after which time the airway was re-evaluated by direct laryngoscopy and bronchoscopy in five of the patients, and by fiberoptic nasolaryngoscopy in one patient. All of the patients were transitioned to oral antibiotic therapy for 10 to 14 days after discharge. Following debridement, all of the patients did well with aggressive medical management. None of the patients required urgent intubation, although one patient was kept on ventilator support for 48 hours until disease resolution was confirmed. No patients required tracheotomy, and there were no cardiopulmonary arrests. The mean hospital length of stay was 4.8 days (range, 3-8 days). This study highlights the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis. It also demonstrates an approach with the potential to improve patient outcomes from this dangerous condition.
The contribution of the middle ear air spaces to sound transmission through the middle ear in can... more The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall-up and canal wall-down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall-up procedures, canal wall-down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262-8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall-down procedure. We conclude that as long as the middle ear air space...
Laser Doppler vibrometry was used to measure the sound-induced tympanic membrane (TM) velocity, a... more Laser Doppler vibrometry was used to measure the sound-induced tympanic membrane (TM) velocity, assessed near the umbo, in 56 normal hearing human subjects at nine sound frequencies. A second series of measurements was made in 47 subjects with sensorineural hearing loss (SNHL). Each set of measurements has features in common with previously published results. The measured velocity magnitude (normalized by the stimulus sound pressure) at any one frequency ranged among subjects by factors of 3-0.3 (+/-10 dB) from the mean and the phase angle of the normalized velocity ranged from +/-15 degrees around the mean at low frequencies to more than +/-200 degrees around the mean at 6 kHz. Measurements repeated after intervals of minutes to months were generally within 40% in magnitude (+/-3 dB) and 20 degrees in phase. Sources of variability included the effect of small differences in the location of the measurement on the TM and small static middle-ear pressures. No effects of stimulus level, ear sidedness (right or left), gender, age or the presence or absence of SNHL were found. These results provide a baseline normal response for studies of TM velocity with conductive hearing losses of different etiologies.
Uploads
Papers