Otolaryngologist (ear, nose, throat)
21 years of experience
Video profile
Accepting new patients
Metro West
Children's Ear Nose & Throat Associates
1507 S Hiawassee Rd
Ste 103
Orlando, FL 32835
407-253-1000
Locations and availability (1)

Education ?

Medical School Score Rankings
University of Pittsburgh (1989)
Surgery
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2013)
Patients' Choice Award (2011)
Compassionate Doctor Recognition (2011)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Kosko is affiliated with 13 hospitals.

Hospital Affilations

Score

Rankings

  • Arnold Palmer Medical Center
    1414 Kuhl Ave, Orlando, FL 32806
    • Currently 4 of 4 crosses
    Top 25%
  • Florida Hospital Orlando
    Otolaryngology
    601 E Rollins St, Orlando, FL 32803
    • Currently 4 of 4 crosses
    Top 25%
  • Florida Hospital
    Otolaryngology
    601 E Rollins St, Orlando, FL 32803
    • Currently 4 of 4 crosses
    Top 25%
  • Orlando Regional Medical Center
    Otolaryngology
    1414 Kuhl Ave, Orlando, FL 32806
    • Currently 4 of 4 crosses
    Top 25%
  • Orlando Health South Seminole Hospital
    Otolaryngology
    555 W State Road 434, Longwood, FL 32750
    • Currently 2 of 4 crosses
  • Lucerne Medical Center
    Otolaryngology
    818 Main Ln, Orlando, FL 32801
    • Currently 2 of 4 crosses
  • Florida Hospital Kissimmee
    Otolaryngology
    2450 N Orange Blossom Trl, Kissimmee, FL 34744
    • Currently 2 of 4 crosses
  • Columbia Same Day Surgicenter Of Orlando
  • Dr. P. Phillips Hospital, a part of Orlando Health
    9400 Turkey Lake Rd, Orlando, FL 32819
  • Orlando Heatlh
  • Arnold Palmer Hosp For Childre, Orlando, Fl
  • Arnold Palmer Hospital for Children & Women
    92 W Miller St, Orlando, FL 32806
  • Orlando Regional Healthcare System
  • Publications & Research

    Dr. Kosko has contributed to 8 publications.
    Title Effectiveness of Laser-assisted Myringotomy for Otitis Media in Children.
    Date May 2004
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: To evaluate the effectiveness of OtoScan CO2 laser-assisted myringotomy (OtoLAM ESC/Sharplan) for acute otitis media and chronic otitis media with effusion (COME) in children. STUDY DESIGN: Retrospective review of 47 children with refractory acute otitis media (RAOM) or COME more than 3 months in duration in a pediatric otolaryngology practice. METHODS: Laser-assisted myringotomy was performed on 47 patients (79 ears) using the OtoLAM device. There were 28 children (ages 0.50-3 years) with RAOM and 19 children (ages 0.58-15 years) with COME. RESULTS: A total of 57.4% of procedures were considered treatment failures. Failures occurred in 53.6% of patients with RAOM on average +/-SD 3.89 +/- 2.16 weeks after the procedure and in 63.2% of patients with COME on average +/-SD 7.25 +/- 5.57 weeks after the procedure. Age, sex, microorganism isolated, myringotomy size, wattage, and laterality did not predict outcome. Ventilation tube insertion was performed in 27 (57.4%) patients. Two patients have persistent tympanic membrane perforations at 2 years. CONCLUSIONS: Laser-assisted myringotomy in children with RAOM and COME was associated with a high incidence of recurrence or persistence of disease and with perforation of the tympanic membrane. Recommendations for use of the OtoLAM should include discussion of high failure rates and the strong likelihood of subsequent ventilation tube insertion. The OtoLAM remains an option for office-based ventilation of the middle ear for families and patients where general anesthesia is a concern.

    Title Differential Diagnosis of Dysphagia in Children.
    Date July 1998
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Dysphagia in children often presents a difficult diagnostic challenge. A systematic approach in each individual can help with diagnosis and treatment. An overview of the differential diagnosis and the diagnostic and treatment options available is provided.

    Title Anisocoria: a Rare Consequence of Endoscopic Sinus Surgery.
    Date March 1998
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Correlation of Neutrophil Activation and Skin Flap Survival in Pharmacologically Altered Pigs.
    Date October 1997
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    In inflamed tissue, neutrophils produce tissue necrosis factors such as free oxygen radicals. We investigated the role of neutrophils in random flap survival using the tissue neutrophil marker myeloperoxidase (MPO), an in whole blood using flow cytometry with the neutrophil activation marker 2'7'dichlorofluorescein diacetate. Hypopigmented pigs were treated with the experimental 21-aminosteroid lipid antioxidant U-74389G (oxygen free radical scavenger) before dorsal random skin flaps were elevated. Extent of flap survival was measured by surface planimetry 7 days after surgery. Mean flap survival was 64.1% +/- 3.4% in the 3-mg/kg-treated group, and 68.0% +/- 3.4% in the 1-mg/kg-treated group-both significantly greater than the survival in vehicle-treated controls (48.6% +/- 2.3%). We measured MPO in tissue extracts using an enzyme-linked immunoassay, which showed less MPO in treated animals than in controls. Flow cytometry results were nonspecific. These data suggest that U-74389G improves random skin flap viability by inhibiting neutrophil infiltration into the flap.

    Title Role of Cesarean Section in Prevention of Recurrent Respiratory Papillomatosis--is There One?
    Date December 1996
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Recurrent respiratory papillomatosis (RRP) is a benign yet aggressive neoplasm that produces considerable morbidity in children. Previous studies have linked RRP in children to mothers with genital tract human papillomavirus infections (HPV). Risk factors for vertical transmission have not been well identified. Controversy exists among obstetricians and otolaryngologists regarding the role of cesarean section in preventing the transmission of HPV disease from mother to child. We address this issue by presenting the results of a national survey of otolaryngologists, the American College of Obstetrics and Gynecology position statement, the relevant literature regarding the association between RRP and maternal HPV, and the proposed mechanisms for HPV transmission at birth. We postulate a very limited role for cesarean section in preventing transmission of RRP, given our present knowledge of this disease.

    Title Acquired Maxillary Sinus Hypoplasia: a Consequence of Endoscopic Sinus Surgery?
    Date December 1996
    Journal The Laryngoscope
    Excerpt

    The effects of functional endoscopic sinus surgery (FESS) on sinus and midfacial development remain unclear. The authors report five children who, at a median age of 30 months, underwent FESS for refractory sinusitis. Three of the children had cystic fibrosis, and two had asthma. Preoperative computed tomographic (CT) scanning showed symmetric maxillary sinus development with varying degrees of mucosal disease. At a mean of 42 months after surgery, CT scans were obtained to evaluate recurrent symptoms in the five children. The scans showed unilateral maxillary hypoplasia in four children and bilateral maxillary sinus hypoplasia in one child. No child had clinically apparent facial asymmetry or midfacial hypoplasia. The authors also discuss the factors involved in maxillary sinus pneumatization, the possible effects of sinus surgery on sinus development, and the clinical implications of "acquired" maxillary sinus hypoplasia.

    Title Uvulopalatopharyngoplasty: Treatment of Obstructive Sleep Apnea in Neurologically Impaired Pediatric Patients.
    Date October 1995
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Bona fide obstructive sleep apnea is rare in the pediatric age group. Traditional surgical management for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy alone, however, severely affected children may require uvulopalatopharyngoplasty (UPPP) or tracheostomy to relieve their obstruction. Children with OSA along with other medical maladies (e.g. cerebral palsy, down syndrome) pose an additional challenge to the otolaryngologist due to poor muscular tone and other medical problems which may complicate postoperative management. We report on 15 children (aged 23 months-13 years, mean 7.4 years), 12 with severe mental insufficiency, with documented OSA who underwent classical or modified UPPP. Twelve of 15 had clinical and/or objective improvement. We conclude that UPPP has a role in the management of neurologically-impaired children with OSA.

    Title Masseter Spasm and Malignant Hyperthermia: a Retrospective Review of a Hospital-based Pediatric Otolaryngology Practice.
    Date June 1992
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    It has been claimed that the combination of halothane and succinylcholine, commonly used for anesthetic induction during short pediatric otolaryngologic procedures, is associated with a 1% incidence of masseter spasm (MS) which may be an early sign of malignant hyperthermia (MH). An 18-month retrospective chart review of all patients undergoing general anesthesia at the Children's Hospital of Pittsburgh (n = 14, 112) was conducted to assess the incidence of MS and its management. In addition, a separate subgroup of patients identified as being at risk for MH was also evaluated. In the otolaryngology service, the incidence of developing MS was 2 of 206 (1%) in children who were anesthetized with halothane and received succinylcholine, patients were identified in the MH high-risk group, and none developed MH. The findings affirmed the risks of using this combination of anesthetic and neuromuscular blocking agents during induction and the need for establishing management guidelines.


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