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Otolaryngologist (ear, nose, throat)
30 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
Washington University at St. Louis (1980)
  • Currently 4 of 4 apples
Top 25%
Residency
Pennsylvania Hospital University PA Health System (1984) *
Otolaryngology
Fellowship
Children`s National Medical Center, Washington, D.C. (1985) *
Pediatric Otolaryngology
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Compassionate Doctor Recognition (2011 - 2013)
American Academy of Otolaryngology Honor Award *
American Academy of Otolaryngology-peer recognition as one of the top 10 instructors (out of 600) for Instructional Courses *
Best Doctors in America *
Gabriel F. Tucker Award by the American Laryngological Association, for outstanding contributions in Pediatric Laryngology *
San Diego Magazine- Best Doctors in San Diego *
Appointments
George Washington University (1984 - 1985)
Instructor in Otolaryngology
University of Pennsylvania (1981 - 1984)
Assistant Clinical Instructor in Otolaryngology
University of California, San Diego (1987 - Present)
Assistant Clinical Professor
American Society of Pediatric Otolaryngology
Program Committee, Annual Meeting
Society for Ear, Nose and Throat Advances in Children
Committee on Obstructive Sleep Apnea in Children
American Academy of Pediatrics, Section of Otolaryngology and Bronchoesophagology
Program Chairman ENT Section, Annual Meeting
American Academy of Otolaryngology
Pediatric Otolaryngology Committee
Blue Ribbon Consensus Panel on Antibiotic Resistance and Treatment of Ear Disease
American Academy of Otolaryngology
Alexander Graham Bell Association for the Deaf Medical Advisory Panel
Member
First International Symposium of Infectious Disease in Pediatric Otolaryngology
Program Committee
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology
California Medical Association

Affiliations ?

Dr. Pransky is affiliated with 8 hospitals.

Hospital Affilations

Score

Rankings

  • Palomar Medical Center
    Otolaryngology
    555 E Valley Pkwy, Escondido, CA 92025
    • Currently 4 of 4 crosses
    Top 25%
  • Sharp Mary Birch Hospital for Women
    3003 Health Center Dr, San Diego, CA 92123
    • Currently 3 of 4 crosses
    Top 50%
  • Southwest Healthcare Sys-Murrietta
  • Naval Medical Center - San Diego
    34800 Bob Wilson Dr, San Diego, CA 92134
  • Children's Hospital - San Diego
  • Scripps Mercy Hospital San Diego
  • Rady Children's Hospital San Diego
  • Children's Health Center
    8110 Birmingham Way, San Diego, CA 92123
  • Publications & Research

    Dr. Pransky has contributed to 51 publications.
    Title Management of Subglottic Hemangioma.
    Date February 2005
    Journal Current Opinion in Otolaryngology & Head and Neck Surgery
    Excerpt

    PURPOSE OF REVIEW: Subglottic hemangioma is a challenging congenital anomaly involving the larynx in children. Management is not uniform, and no single treatment modality has been accepted as ideal. During the last several years only a few articles have dealt with this topic. The purpose of this review is to examine the published literature and discuss the alternative treatments of SGH. The authors also describe their approach and the use of microdebrider as a new surgical tool. RECENT FINDINGS: Observation is an option for the rare case of SGH with minimal airway obstruction. However, most cases will require some additional intervention. Systemic steroids intralesional steroid injection, laser ablation with both the CO2 and KTP lasers, interferon (IFN) and open surgical excision have all been utilized. SUMMARY: The authors found few technical innovations in this field in the last 5 years. All techniques utilized have some degree of success. However, all approaches have downsides and are associated with complications, some of which can be very serious. Ideally, more structured research comparing techniques would be helpful to best determine operative and postoperative management.

    Title Long-term Follow-up of Pediatric Recurrent Respiratory Papillomatosis Managed with Intralesional Cidofovir.
    Date October 2003
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: Cidofovir is an acyclic nucleotide phosphonate antiviral medication that has been used intralesionally for the treatment of severe respiratory papillomatosis (RRP) in pediatric patients. The long-term efficacy of this medication was assessed in 11 children with severe RRP who previously required operative debulking every 2 to 6 weeks to maintain airway patency. STUDY DESIGN: Clinical case series. RESULTS: Ten of these children have completed therapy. Five are disease free over a mean follow-up period of 51.6 months. Five other patients with active RRP decreased their mean severity scores from 17.8 (range 11-26) to 4.0 (range 2-6) and no longer require cidofovir. One patient continues to receive cidofovir for recurrent disease after an initial favorable response. Throughout the 6-year observational period, no patients demonstrated any adverse effects, laboratory abnormalities, or evidence of carcinogenesis. CONCLUSION: Intralesional cidofovir is a useful adjunct for managing children with tenuous airways caused by previously uncontrolled papilloma.

    Title Nontuberculous Mycobacterial Infections of the Head and Neck.
    Date July 2003
    Journal Pediatric Clinics of North America
    Excerpt

    Nontuberculous mycobacteria are ubiquitous in the environment. Immunocompetent children are commonly infected by these resilient organisms. Cervical lymphadenitis, the most frequent head and neck manifestation of NTM infection, often presents as chronic, unilateral lymphadenopathy with characteristic violaceous overlying skin changes. Diagnosis is ultimately dependent on culture or histopathologic examination of specimen obtained through excisional lymph node biopsy or FNA. The principal treatment of NTM infection remains the surgical excision of diseased tissue. Antibiotics augment surgical therapy and their potential role as a single-modality therapy continues to be investigated.

    Title Unilateral Choanal Atresia in Identical Twins: Case Report and Literature Review.
    Date May 2002
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Choanal atresia is postulated to be secondary to an abnormality of the rupture of the buccopharyngeal membrane during the embryological period. This condition usually occurs sporadically, but has been described in siblings and successive generations. The genetics remain unclear. We present monozygotic twins with identical findings of unilateral choanal atresia and no other associated anomalies. To our knowledge, this is the first report of such an occurrence.

    Title Clinical Update on 10 Children Treated with Intralesional Cidofovir Injections for Severe Recurrent Respiratory Papillomatosis.
    Date October 2000
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVES: To continue assessment of the benefits and risks of intralesional administration of cidofovir, an acyclic nucleoside phosphonate, for treating severe recurrent respiratory papillomatosis (RRP) in pediatric patients, and to discuss guidelines for larger prospective multi-institutional studies of the use of cidofovir. DESIGN: Prospective case series. SETTING: Tertiary care children's hospital. PATIENTS: A total of 10 patients with severe RRP (defined as requiring debulking procedures to maintain airway patency at least once a month) underwent intralesional cidofovir therapy. The original 5 patients have received more than 1 year of follow-up since their last cidofovir injection, and 5 subsequent patients have been treated with a revised injection protocol. INTERVENTION: Microsuspension laryngoscopy with intralesional injection of cidofovir after repetitive carbon dioxide laser treatments and mechanical debulking of papillomas. MAIN OUTCOME MEASURES: Papilloma stage at the time of serial laryngoscopies. Histologic examination of biopsy specimens of laryngeal tissue obtained 1 year or more after last cidofovir injection. RESULTS: There was evidence of marked improvement in the 4 of the 5 new patients enrolled under the revised injection protocol, continuation of a disease-free state in 1 of the original 5 patients, and sustained improvement in 4 of the 5 original patients, resulting in a significantly reduced interval of intervention. CONCLUSIONS: Intralesional cidofovir therapy continues to show benefit in the treatment of severe RRP in pediatric patients. Safety profiles have not been fully established, but current histologic data are reassuring.

    Title Intralesional Cidofovir for Recurrent Respiratory Papillomatosis in Children.
    Date October 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To assess the potential benefit of intralesional administration of cidofovir, an acyclic nucleoside phosphonate with activity against several DNA viruses, for treating severe respiratory papillomas in pediatric patients. DESIGN: Prospective case series. SETTING: Tertiary care children's hospitals. PATIENTS: Five pediatric patients with severe recurrent respiratory papillomatosis requiring laryngoscopy with carbon dioxide laser therapy more frequently than once a month to maintain airway patency. Each patient underwent between 12 and 33 laryngoscopies with laser treatment prior to being injected with cidofovir. INTERVENTION: Microsuspension laryngoscopy with intralesional injection of cidofovir (Vistide) in conjunction with mechanical debulking and carbon dioxide laser of papillomas. MAIN OUTCOME MEASURE: Papilloma stage at time of serial laryngoscopies. RESULTS: One patient was disease free and 3 patients demonstrated a dramatic response to adjuvant therapy with cidofovir at the 9-month follow-up visit after the last injection of cidofovir. One patient showed an improvement in papilloma stage that was possibly related to concurrent therapy with interferon. CONCLUSIONS: Intralesional injection of cidofovir seems to be of benefit in the treatment of severe respiratory papillomatosis in pediatric patients. Larger prospective studies with longer follow-up will be required before cidofovir can be considered an accepted means of managing this difficult disease.

    Title Adenotonsillectomy in the Very Young Patient: Cost Analysis of Two Methods of Postoperative Care.
    Date August 1999
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was based on length of stay in the recovery room and as an inpatient. Expense of postoperative care was based on cost calculation for the recovery room and overnight hospitalization. Of the 307 patients, 194 went home the day of surgery and 113 were observed overnight in the hospital. Average hospital cost was higher in the outpatient group than in the inpatient group (P < 0.001). This difference reflects longer recovery room stay (350 min) in the outpatient group compared to the inpatient group (108 min) (P < 0.001). Outpatient adenotonsillectomy in the patient under 36 months may be safe; however, prolonged recovery room stays may actually make outpatient surgery less cost-effective than overnight admission. Recovery room costs are significantly higher per unit time than costs of inpatient hospitalization. Further investigation of cost-effective outpatient observation units may improve cost containment in the outpatient surgical setting.

    Title Documentation of the Prevalence of Penicillin-resistant Streptococcus Pneumoniae Isolated from the Middle Ear and Sinus Fluid of Children Undergoing Tympanocentesis or Sinus Lavage.
    Date August 1999
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    With increasing pneumococcal resistance to penicillin and other antibiotics, use of antibiotic therapy for children with upper respiratory tract infections such as otitis media and sinusitis has become difficult. Selecting an appropriate treatment regimen has become more challenging due to frequent concomitant microbial resistance to multiple antibiotics. In a prospective, nonrandomized study, we obtained middle ear and sinus aspirate specimens from all children undergoing outpatient tympanocentesis or sinus lavage for any indication at our institution over two 4-week periods. One hundred fifty-four specimens were obtained. Of these, 12 grew Streptococcus pneumoniae, 7 of which were resistant to penicillin. A 6-month retrospective review of these patients' medical histories evaluated their antibiotic use prior to surgical intervention. An association between penicillin resistance and recent use of 2 or more antibiotics in children with positive S pneumoniae cultures was confirmed, as has been documented in prior reports. Those with penicillin-resistant S pneumoniae also demonstrated a higher incidence of multidrug-resistant organisms.

    Title Surgical Strategies for Otitis Media.
    Date February 1999
    Journal The Journal of Otolaryngology
    Excerpt

    OBJECTIVE: As we enter the new millennium, Otitis Media remains the most common cause for an acute care visit to the pediatrician. This paper discusses the various surgical approaches to children who do not respond to medical management for acute otitis, recurrent acute otitis and for chronic otitis media. In addition to discussing the relevant alternatives of intervention, attention is directed to special populations of patients who are likely to demand a great deal of care, the problems that are encountered with typanostomy tubes and the concept of a new era of a "post-tympanostomy tube legacy." CONCLUSION: Suggestions are offered as to how we can alter our approach to these patients requiring surgical intervention and thereby reduce long term sequelae.

    Title Air in the Vestibule: Computed Tomography Scan Finding in Traumatic Perilymph Fistula.
    Date February 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Acute Coalescent Mastoiditis in an Infant: an Emerging Trend?
    Date November 1998
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    There is some evidence to suggest that the incidence and complications of ACM may be increasing. However, in the current era of widespread access to health care and broad-spectrum antibiotics, an intratemporal or intracranial complication from acute otitis media may not initially be suspected. The reported case is significant in that the patient was very young, had no underlying disease or immunocompromise, and did not have a known antecedent acute otitis media. With the emergence of resistant streptococcal species and prolonged survival in immunocompromised patients, the relative incidence of complications caused by acute otitis media will probably continue to rise, making it imperative that we raise our index of suspicion for previously rare infectious complications of relatively common diseases.

    Title Discoordinate Pharyngolaryngomalacia.
    Date May 1997
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheostomy was necessary in 13 children. Bi-level positive airway pressure (BiPAP) was used successfully in 2 children and tracheotomy was avoided. Treatment still needs to be better defined.

    Title Minimal Endoscopic Approach to Subperiosteal Orbital Abscess.
    Date April 1997
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To limit endoscopic abscess drainage to the opening of the ethmoid cells involved, adjacent to the subperiosteal orbital abscess. DESIGN: Prospective study. PATIENTS: Twenty children with subperiosteal orbital abscess complicating acute sinusitis. INTERVENTION: Endoscopic opening of the medial wall of the bulla ethmoidalis and of the lamina papyracea. RESULTS: The limited endoscopic approach allowed subperiosteal orbital abscess drainage in all patients with positive clinical outcomes. Extensive ethmoidectomy was not necessary to achieve drainage. CONCLUSIONS: Endoscopic subperiosteal orbital abscess drainage does not require complete ethmoidectomy as was previously performed and can be limited to the opening of the bulla ethmoidalis and the lamina papyracea through the bulla ethmoidalis.

    Title Nager Acrofacial Dysostosis: Management of a Difficult Airway.
    Date December 1996
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Nager acrofacial dysostosis, first described by Nager and deReynier in 1948, is a rare syndrome characterized by mandibulofacial dysostosis with associated radial defects. The facial features include downward slanting palpebral fissures, absent eyelashes in the medial third of the lower lids, mandibular and malar hypoplasia, dysplastic ears with conductive deafness, and variable degrees of palatal clefting. Upper limb malformation is a constant feature of Nager syndrome and ranges from thumb hypoplasia to absence of the radial ray. The maxillo-mandibular hypoplasia and associated retroplaced tongue set the stage for early and significant upper airway obstruction. The craniofacial anomalies and associated trismus make emergent airway intubation challenging. We present a case of Nager syndrome with life threatening airway obstruction unresponsive to conservative management. This case and a review of the literature emphasize the importance of early tracheotomy for these patients.

    Title One-stage Tracheal Reconstruction of Congenital Tracheal Stenosis.
    Date December 1996
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.

    Title Pediatric Ethmoidectomy.
    Date December 1996
    Journal Otolaryngologic Clinics of North America
    Excerpt

    The ethmoid sinuses play a key role in the health or disease of the entire paranasal sinus complex. Multiple underlying inflammatory processes may easily obstruct the narrow ostia of each ethmoid air cell, leading to infection. By virtue of its unique anatomic position and relationship to the ostiomeatal complex, the ethmoid labyrinth becomes the key to treatment of acute and chronic sinusitis. Surgical intervention for sinus disorders in children has grown in popularity. This article reviews the anatomy and pathophysiology of ethmoid sinusitis and discusses the role of surgery for these disorders.

    Title Open Surgical Excision of Subglottic Hemangioma in Children.
    Date October 1996
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Subglottic hemangioma is an unusual entity which may involute spontaneously without aggressive surgical intervention; although tracheotomy is sometimes necessary. The actual time course for involution is not clear by reviewing the literature [1,14]. Numerous treatment modalities are described for the treatment of this condition, including tracheotomy, CO2 laser ablation and intralesional steroid injection with or without endotracheal intubation. Surgical resection of subglottic hemangioma is an option which is described in the literature and may be utilized in certain selected cases. We present seven cases of subglottic hemangioma treated at three institutions which were resected via a crico-tracheotomy approach. Postoperative follow-up for these patients range from 6 months to 4.5 years. Although conservative measures are still advocated as the treatment of choice for subglottic hemangioma, open surgical resection may be indicated in selected cases resulting in a satisfactory outcome.

    Title Coccidioides Immitis Subperiosteal Abscess of the Temporal Bone in a Child.
    Date July 1996
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    A destructive granulomatous lesion of the temporal bone caused by Coccidioides immitis disseminated from a pulmonary lesion was found in a 4-year-old immunocompetent child. To our knowledge, it is the first case of coccidioidomycosis of the temporal bone reported in the world literature. The child presented with pain in her right ear and a 6-month history of intermittent fever, which partially responded to multiple courses of antibiotics. A tender erythematous postauricular swelling consistent with a subperiosteal abscess subsequently developed over 1 month. A mastoidectomy showed granulation tissue with pockets of purulence, and histologic evaluation of the specimen revealed spherules of C immitis, later verified by culture. The patient responded to intravenous amphotericin B therapy, without evidence of disease recurrence. Coccidioides immitis is endemic in regions of the Southwestern United States, with extremely infectious characteristics and relative resistance to medical therapy. Coccidioidomycosis should be considered in the differential diagnosis of a granulomatous lesion of the temporal bone.

    Title Use of Costal Cartilage Graft As External Stent for Repair of Major Suprastomal Collapse Complicating Pediatric Tracheotomy.
    Date August 1995
    Journal The Laryngoscope
    Title Airway Compromise Secondary to Vascular Compression in a Neonate.
    Date May 1994
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Respiratory distress in the neonate may be due to extrinsic tracheobronchial compression. We recently observed a neonate with left mainstem bronchus obstruction resulting in respiratory distress and mediastinal shift. Initial management required intubation and positive pressure ventilation. Bronchoscopic evaluation demonstrated compression of the proximal left main bronchus. The distal bronchus appeared normal. Bronchography, echocardiography and an MRI of the chest confirmed proximal compression of the bronchus and suggested that the cause was an aneurysmal left pulmonary artery and patent ductus arteriosus. With medical therapy there was resolution of the bronchial compression. Re-evaluation by bronchoscopy and echocardiography revealed a normal left main stem bronchus, a normal left pulmonary artery and a closed ductus arteriosus. This clinical scenario suggests that transient pulmonary hypertension may result in significant airway compression due to the proximity of the left main stem bronchus to the left pulmonary artery.

    Title Nasal Hamartoma: Case Report and Review of the Literature.
    Date March 1994
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Nasal masses in the pediatric population present with nasal obstruction, epistaxis and chronic rhinorrhea. We report on a 6-year-old boy with long-standing nasal obstruction. A large left nasal mass was evident on physical examination and CT scan. Techniques of functional endoscopic sinus surgery were used to resect the mass, which, on pathologic examination, proved to be a hamartoma. Hamartomas are non-neoplastic malformations, or inborn errors of tissue development. They are characterized by an abnormal mixture of tissues indigenous to that area of the body. Review of the literature revealed 5 previously reported cases of nasal hamartomas, only 2 of these in children. Our case is unique in that the hamartoma arose from the ethmoid and maxillary sinuses; previously reported cases arose from the septum and vestibule. This is the first reported case treated using a functional endoscopic sinus surgery approach.

    Title Neonatal Otitis Media. An Update.
    Date June 1993
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Neonatal otitis media may be an isolated infection or part of a more complex sepsis syndrome. Because early studies suggested that the microbiologic characteristics of neonatal otitis media included a high risk of gram-negative coliforms and Staphylococcus aureus, tympanocentesis was recommended routinely. Subsequent studies have supported empiric medical therapy in selected patients, reserving tympanocentesis for patients in whom medical treatment fails. Because of these conflicting recommendations, records from 37 neonates with otitis media who underwent tympanocentesis from 1986 through 1991 were studied retrospectively. Cultures in one outpatient (11%) and four inpatients (13%) yielded Escherichia coli, all of which were sensitive to amoxicillin. No cultures of S aureus were identified. Sterile cultures and pneumococcus isolates were found most frequently. No septic or intracranial complications were noted. All patients were discharged on regimens of routine antibiotics for otitis media.

    Title The Open Surgical Approach to Subglottic Hemangioma.
    Date April 1993
    Journal International Journal of Pediatric Otorhinolaryngology
    Title Fibrous Hamartoma of Infancy Presenting As a Perspiring Neck Mass.
    Date April 1993
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    An unusual case of fibrous hamartoma of infancy is reported. This lesion presented as a gradually enlarging, perspiring left neck mass in an eight month old male. Histologic examination revealed the characteristic features of this entity, with the additional finding of eccrine gland hyperplasia. In a review of the literature, we found no other reports of this unique histologic finding or clinical presentation.

    Title Practical Aspects of Managing Non-malignant Lumps of the Neck.
    Date March 1993
    Journal The Journal of Otolaryngology
    Excerpt

    The etiologies of pediatric neck masses are legion. Optimal management depends upon making the correct diagnosis. A detailed history to ascertain the duration of the illness, presence of systemic symptoms, animal exposures, tuberculous contacts, medications ingested, recent trauma, dental work or upper respiratory infection (URI), as well as a travel history, may yield important clues to establishing the diagnosis. The work-up for neck masses must be individualized based upon history and physical examination. Common diagnostic studies often obtained are listed in Table 1, and will be further clarified as individual diagnoses are discussed.

    Title Congenital Abnormalities of the Submandibular Duct.
    Date November 1992
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Five newborns presented with cystic lesions of the floor of mouth. Four of these patients proved to have congenitally imperforate submandibular salivary gland ducts and the other newborn proved to have a duplication anomaly of the submandibular gland duct and gland. The patients with imperforate Wharton's ducts underwent marsupialization with or without ductoplasty and have been without evidence of recurrence for up to three years. The duplication anomaly of the submandibular gland duct responded to simple excision. The diagnosis of congenital anomalies of the submandibular gland and duct can be made on physical examination. Magnetic resonance imaging can be helpful in differentiating congenital imperforate submandibular duct and duplication anomalies of the ductal system. Treatment of the former consists of duct marsupialization in the floor of mouth with or without ductoplasty. Treatment of the duplicated ductal system may best be treated with excision. A failure in diagnosis and treatment may result in ranula formation or sialoadenitis requiring more extensive therapy.

    Title Tongue Gastric Choristoma: Failure to Localize by Technetium-99m Pertechnetate Scan.
    Date November 1992
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.

    Title Pediatric Airway Manifestations of Gastroesophageal Reflux.
    Date September 1992
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.

    Title Candida Laryngotracheitis: a Complication of Combined Steroid and Antibiotic Usage in Croup.
    Date May 1992
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

    Title The Open Surgical Approach to Subglottic Hemangioma.
    Date November 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The management of subglottic hemangioma in infants remains controversial. We report two patients in whom an open surgical approach was utilized to completely excise the subglottic hemangioma. Both children have been successfully extubated and have remained symptom-free since that time.

    Title Closure of the Soft Palate for Persistent Otorrhea After Placement of Pressure Equalization Tubes in Cleft Palate Infants.
    Date November 1991
    Journal The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-craniofacial Association
    Excerpt

    Four case reports of infants with cleft palate and intractable otorrhea following the placement of pressure equalization tubes are presented. In one patient, liquids taken orally were noted to reflux through her ears. Otorrhea was refractory to medical management in all cases and was controlled only after closure of the soft palate. Persistent otorrhea may be an indication for early closure of the soft palate in these infants.

    Title The Prognostic Value of Endotracheal Tube-air Leak Following Tracheal Surgery in Children.
    Date October 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    In an effort to determine if the endotracheal tube-leak pressure has prognostic value in relation to a successful outcome after one-stage laryngotracheal reconstruction or cricoid split surgery, a retrospective analysis was performed on 17 children who had undergone such surgery. The daily leak pressures, length of intubation, and ultimate outcome of attempts at extubation were noted. One hundred percent of patients with a leak pressure of less than 20 cm H2O on the day before extubation were successfully extubated. In contrast, the failure rate was 100% in children extubated with a leak of greater than 30 mm H2O. The difference between these two groups was statistically significant (chi 2, 13.03). Sixty percent of patients with leak pressures in the range of 21 to 30 cm H2O were successfully extubated. The endotracheal tube-leak pressure is a parameter that has prognostic value, and should be considered in determining when to extubate children who have undergone tracheal reconstructive surgery.

    Title Actinomycosis in Obstructive Tonsillar Hypertrophy and Recurrent Tonsillitis.
    Date October 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    A quantitative analysis of adenoid and tonsillar specimens from 460 patients was performed. The patients underwent tonsillectomy or adenotonsillectomy for either recurrent tonsillitis or obstructive tonsillar hypertrophy. Histologic preparations revealed Actinomycetes as statistically more prevalent in the obstructive population. The presence of Actinomycetes in the adenotonsillar core of this diagnostic group may indicate an etiologic role for this organism in tonsillar and adenoidal hypertrophy.

    Title Current Concepts in Pediatric Adenotonsillar Disease.
    Date August 1991
    Journal Ear, Nose, & Throat Journal
    Excerpt

    More objective thinking regarding the indications for adenotonsillar surgery has gained new respect for these operations. Better understanding of the implications of adenoid disease in chronic otitis and sinusitis, along with appreciation of obstructive airway problems secondary to adenotonsillar hypertrophy, has changed the scope of the operation. Research is ongoing to determine the etiology of chronic antigenic stimulation as a cause for hypertrophy of these organs.

    Title The Impact of Technique and Conditions of the Tympanic Membrane Upon Infrared Tympanic Thermometry.
    Date June 1991
    Journal Clinical Pediatrics
    Title One-stage Laryngotracheoplasty.
    Date April 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    This article documents the evolution of our approach to the repair of subglottic stenosis in infants. With increasing experience in the management of subglottic stenosis using the anterior cricoid split procedure, we extended our procedure to include older children. This then led to the use of the one-stage procedure for repair of severe and mature subglottic stenosis. We present the results of surgical repair in 13 patients. Extubation was accomplished in 12 of 13 patients using one-stage laryngotracheoplasty.

    Title Catheterization of Branchial Sinus Tracts. A New Method.
    Date January 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The complete surgical extirpation of branchial cleft abnormalities is essential in avoiding recurrent disease. The most technically difficult maneuver is often the localization and excision of associated sinus tracts and fistulae. The authors communicate a simple yet effective technique for dealing with this difficulty utilizing the Fogarty embolectomy catheter.

    Title Early Home Management of Patients with Pierre Robin Sequence.
    Date January 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Robin Sequence is a well-described disorder with a reported incidence of 1 in 2000 births. It is characterized by glossoptosis and micrognathia often associated with a cleft palate. Respiratory obstruction at the level of the tongue occurs in many affected children. Prior to routine intensive care unit management, it was the primary factor in the mortality reported in patients with moderately severe to severe deformity. Treatment of this obstruction is controversial and may include a long stay in an intensive care setting. We report two cases that demonstrate properly placed and constructed nasopharyngeal tubes allow a non-surgical treatment with early discharge of the patient and without the risks and morbidity of surgery or the complications of tracheostomy.

    Title Cervicofacial Mycobacterial Adenitis in Children: Endemic to San Diego?
    Date October 1990
    Journal The Laryngoscope
    Excerpt

    Nontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.

    Title Do Angiomas of the Nasal Septum Exist?
    Date August 1990
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Juvenile nasopharyngeal angiofibromas (JNA) by definition originate in the nasopharynx. Vascular tumors arising in the nasal cavity can easily be mistaken for JNA, when the correct diagnosis is hemangioma or angiofibromatous polyp. We present a case that illustrates this problem, an 11-year-old boy with a unilateral anterior nasal cavity mass associated with recurrent epistaxis. At surgery, the mass was found to arise from the anterior nasal septum and was removed easily with minimal bleeding. The initial pathologic interpretation was JNA. After extensive review of the specimen, however, the diagnosis of hemangioma was made. Similar tumors have been reported as being JNA that have been simple to remove with minimal blood loss. JNA is associated with more severe blood loss, is more difficult to expose surgically and has a higher risk of recurrence than other nasal tumors. Therefore, JNA needs to be distinguished from anterior nasal cavity masses.

    Title The Otolaryngologic Manifestations of Pelizaeus-merzbacher Disease.
    Date May 1990
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Pelizaeus-Merzbacher disease is a condition of central nervous system dysmyelination. We describe a familial series in which both otologic and laryngologic abnormalities were present. The diagnosis of this invariably fatal disorder can be made on a clinical and/or pathologic basis. As the otolaryngologic manifestations are often the first to appear, the consulting head and neck surgeon may be essential in the initial diagnosis of this hereditary disease.

    Title Surgical Therapy of Obstructive Sleep Apnea in Children with Severe Mental Insufficiency.
    Date May 1990
    Journal The Laryngoscope
    Excerpt

    Obstructive sleep apnea is the underlying cause of a variety of pediatric maladies, including pulmonary hypertension and failure to thrive. In children, unlike adults, obstruction secondary to lymphoid hyperplasia is often encountered; adenotonsillectomy restores airway patency. Patients who fail this procedure, such as children with cerebral palsy and associated muscular hypotonia, may face tracheotomies. We report on 10 pediatric patients with severe mental insufficiency and obstructive sleep apnea in whom palatal hypotonicity and lack of adenotonsillar hypertrophy was identified. Uvulopalatopharyngoplasty was performed in conjunction with adenotonsillectomy to enlarge the diameter of the nasopharyngeal inlet with successful resolution of the obstructive symptoms in eight patients. The remaining two children required more surgery. This procedure is presented as a possible alternative to tracheotomy in selected patients.

    Title Laryngeal Diversion in the Treatment of Chronic Aspiration in Children.
    Date April 1990
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Chronic aspiration in children can be life-threatening, especially in patients with underlying pulmonary disorders. Numerous surgical procedures have been described to treat chronic aspiration. In patients with severe chronic aspiration, laryngeal diversion is the most effective procedure for reducing soilage of the pulmonary tract. Over a 10-year period at the Children's Hospital of Philadelphia, 14 patients with life-threatening aspiration were managed with a laryngeal diversion. Surgical correction of aspiration resulted in stabilization or improvement of pulmonary function in these patients. The surgical management of chronic aspiration in the pediatric patient is discussed.

    Title Fourth Branchial Pouch Sinus: Principles of Diagnosis and Management.
    Date March 1990
    Journal The Laryngoscope
    Excerpt

    The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.

    Title Evaluation of the Compromised Neonatal Airway.
    Date December 1989
    Journal Pediatric Clinics of North America
    Excerpt

    Differentiating upper- from lower-airway compromise in the neonate may be difficult. Knowledge of the multiple problems that affect the airway and an organized approach to assessment aid in determining the site(s) of respiratory compromise. Although endoscopy provides information about the status of the upper airway, the length of time elapsed from extubation may affect the predictive value of observations made at endoscopy. The otolaryngologist should avoid recommending surgical intervention for relief of upper-airway compromise when the major cause of respiratory insufficiency is in the lower airway. Conversely, appropriate surgical intervention at the appropriate time may obviate the need for a tracheotomy. Lastly, if the prognosis is such that continued intubation is necessary and may lead to laryngeal or subglottic damage, a tracheotomy should be performed.

    Title Technique for Costal Cartilage Harvest for Use in Laryngotracheal Reconstruction.
    Date December 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Title Actinomycosis of the Middle Ear.
    Date June 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Actinomycosis is an uncommon infection of the middle ear. Only 21 cases of actinomycosis of the middle ear have been reported in the English literature prior to this paper. The offending organism is Actinomyces israelii, which is an anaerobic, filamentous organism that is difficult to grow in culture. The infection is chronic and is seldom diagnosed prior to tympanomastoidectomy. The identification of small, yellow, glue-like masses, which are called sulfur granules, is often the key to making the diagnosis of actinomycosis of the middle ear. Following tympanomastoidectomy, penicillin is given orally for 3-6 months.

    Title An Approach to the Failed Cricoid Split Operation.
    Date March 1988
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The cricoid split operation is a well established treatment for subglottic stenosis; the success rate for this procedure is approximately 77%. The management of patients who fail this operation has traditionally involved tracheostomy followed by delayed laryngotracheoplasty. We have treated 22 patients using the cricoid split--6 required subsequent tracheostomy. Two-thirds of the patients with a tracheostomy have been unable to be decannulated, even after laryngotracheoplasty. In contrast, 3 patients had repeat cricoid split operations instead of tracheostomy. All 3 of these children have had no further problems with their airway. The authors propose that in patients who fail the cricoid split operation one consider repeating the procedure instead of performing a tracheostomy.

    Title Differentiating Upper from Lower Airway Compromise in Neonates.
    Date November 1985
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.

    Title Clinical Assessment of Flap Perfusion by Fiberoptic Fluorometry.
    Date July 1985
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.

    Title Fatal and Non-fatal Food Injuries Among Children (aged 0-14 Years).
    Date
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    OBJECTIVE: To identify and characterize food items with high risk of airway obstruction in children younger than 15 years. METHODS: This retrospective study collected injury data from 1989 to 1998 for 26 pediatric hospitals in the United States and Canada. Aspiration, choking, ingestion, and insertion injuries due to food items were analyzed. The data included 1429 infants and children. Results were compared with fatality data published by the American Association of Pediatrics in 1984. RESULTS: The 10 food objects with the highest frequency for both injuries and fatalities were identified. Peanuts caused the highest frequency of injury, and hot dogs were most often associated with fatal outcomes. The severity of respiratory distress prior to hospital evaluation varied for different foods. Age younger than 3 years was the highest-risk factor. Key characteristics such as bite size, shape, and texture were analyzed and found to demonstrate relationships with severity of clinical outcomes. CONCLUSIONS: Children younger than 3 years remain at greatest risk of food injury and death. We found that hard, round foods with high elasticity or lubricity properties, or both, pose a significant level of risk. Consideration of the key characteristics of the most hazardous foods may greatly decrease airway obstruction injuries. Food safety education can help pediatricians and parents select, process, and supervise appropriate foods for children younger than 3 years to make them safer for this highest-risk population.

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