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

Education ?

Medical School Score Rankings
University of California at Los Angeles (1972)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Nervous System Tumor (Neurilemmoma)
Tonsillectomy
Tracheotomy
2001-2002, The Best Doctors in America
1987, Top Doctors, Philadelphia Magazine
2005-2006, The Best Doctors in America
1992, Top Doctors, Philadelphia Magazine
2002, Top Doctors List, Center for Study of Services
2003-2004, The Best Doctors in America
2005, Top Physicians of South Jersey, South Jersey Magazine
1996-1997, The Best Doctors in America
1993-1995, The Best Doctors in America
1999-2000, The Best Doctors in America
2003, Delaware Valley Consumers Checkbook Outstanding Physicians
1999, Top Doctors, Philadelphia Magazine
2001, Top Doctors, Philadelphia Magazine
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Handler is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Kingsbrook Jewish Medical Center
    Otolaryngology
    585 Schenectady Ave, Brooklyn, NY 11203
    • Currently 3 of 4 crosses
    Top 50%
  • North Shore University Hospital
    Otolaryngology
    300 Community Dr, Manhasset, NY 11030
    • Currently 2 of 4 crosses
  • Children's Hospital of Philadelphia
    324 S 34th St, Philadelphia, PA 19104
    • Currently 2 of 4 crosses
  • New York Downtown Hospital
    Otolaryngology
    170 William St, New York, NY 10038
    • Currently 1 of 4 crosses
  • Hospital of the University of Pennsylvania
  • Hospital Of The Univ Of Penn, Philadelphia, Pa
  • Chop Clinical Associates
  • Forest Hills Hospital
  • Choppa
  • Childrens Hosp Of Philadelphia, Philadelphia, Pa
  • Publications & Research

    Dr. Handler has contributed to 100 publications.
    Title Auricular Injury with Deformity Following Delivery by Cesarean Section.
    Date May 2008
    Journal Ear, Nose, & Throat Journal
    Title Management of Hypopharyngeal and Esophageal Perforations in Children: Three Case Reports and a Review of the Literature.
    Date April 2008
    Journal Ear, Nose, & Throat Journal
    Excerpt

    We report 2 cases of pediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed during nasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tube feedings, and none experienced further sequelae. Perforations of the hypopharynx and esophagus in children during endoscopy or insertion of endotracheal and nasogastric tubes are not uncommon. Many affected children can be managed conservatively without surgical drainage, depending on the cause and specific location of the perforation and the timing of the diagnosis. We discuss the clinical criteria for various management options, and we offer an algorithm that outlines important clinical considerations in the decision-making process. Our aim in presenting these cases is to increase awa reness of the management options for children with hypopharyngeal and esophageal perforations and to demonstrate the effectiveness of nonsurgical management in selected cases.

    Title Sialorrhea: a Management Challenge.
    Date July 2004
    Journal American Family Physician
    Excerpt

    Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.

    Title Choanal Atresia: a Twenty-year Review of Medical Comorbidities and Surgical Outcomes.
    Date February 2003
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: To review medical comorbid conditions and surgical outcomes for children treated for choanal atresia (CA). STUDY DESIGN: Retrospective review (1979-1998). METHODS: Participants included 78 children, aged newborn to 18 years, in the setting of an academic pediatric hospital. Main outcome measures were type and number of procedures and airway patency. RESULTS: Seventy-eight children (48 female and 30 male patients) were treated and followed for CA, with an average follow-up of 35 months. Thirty-five children (45%) had unilateral CA, and 43 children (55%) had bilateral CA. There was no statistically significant sex difference between unilateral and bilateral CA. Concomitant medical problems were common, mostly otitis media with effusion (32%), upper and lower airway diseases (32% and 23%, respectively), cardiac anomalies (19%), and gastrointestinal tract disorders (18%). Statistically significant correlations were found for bilateral CA and cardiac disorders (P =.04), CHARGE syndrome ( P=.002), obstructive sleep apnea ( P=.003), hematological problems (P =.001), and prematurity or failure to thrive (P =.006). Surgery was effective in establishing a patent airway in all cases. Average ages at first surgery were 25.2 months for unilateral and 2.4 months for bilateral CA. Unilateral CA required, on average, 2.7 total procedures, including dilation and removal of stents, compared with bilateral CA, which required 4.9 procedures. Nearly all children underwent correction by means of the transnasal approach. CONCLUSIONS: To the knowledge of the authors, the present report encompasses the largest series of children treated for CA. The high incidence of comorbid conditions mandates thorough medical evaluation, particularly for otological, airway, cardiac, and gastrointestinal tract diseases.

    Title Pilomatrixoma of the Head and Neck in Children.
    Date December 2001
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: Pilomatrixomas are benign skin neoplasms of hair follicle origin. They are one of the most common superficial masses of the head and neck excised in children. Although the entity has been well studied in the literature, few studies have been undertaken to evaluate the clinical characteristics of head and neck pilomatrixomas specifically in children. The purpose of this study was to review the clinical characteristics and management of children presenting with pilomatrixomas of the head and neck at a large tertiary care pediatric hospital. STUDY DESIGN: A retrospective chart review was performed of all patients with histologically confirmed pilomatrixoma of the head and neck excised during a 6-year period (1992-1997) at the Children's Hospital of Philadelphia. RESULTS: Ninety-one cases of pilomatrixoma were confirmed in 86 patients. The age range was 5 months to 17 years. The median age at time of excision was 6.0 years. The most common sites of occurrence were the cheek (36%), neck (20%), periorbital region (14%), and scalp (9%). The male to female ratio was 1:1.5. Multiple lesions were found in 8.2% of patients. Surgical excision was curative in all cases. CONCLUSION: Pilomatrixoma is a cutaneous neoplasm that is one of most common causes of superficial head and neck masses in children. Although the presurgical diagnosis may be difficult in some cases, pilomatrixoma must be kept in the differential of superficial head and neck masses in children. Surgical excision is almost always curative.

    Title Traumatic Perilymphatic Fistulas in Children: Etiology, Diagnosis and Management.
    Date October 2001
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Post-traumatic perilymphatic fistulas have been described following ear and temporal bone injury, particularly in the setting of temporal bone fractures. However, indications for exploratory surgery in cases of trauma without temporal bone fracture are vague and not well described. We describe three children who presented with symptoms suggestive of perilymphatic fistula (PLF) without an associated temporal bone fracture: two with penetrating tympanic membrane injuries and one with blunt temporal bone trauma. All had symptoms of hearing loss and vestibular disturbance. Two of the children cooperated with ear-specific audiologic assessment, which demonstrated sensorineural hearing loss (SNHL) on the traumatized side. The third child showed audiometric evidence of a SNHL on the injured side, but due to his age, the degree of severity of the SNHL was unable to be appropriately addressed prior to the patient being surgically managed. All three children underwent exploratory surgery and were found to have bony defects in the region of the oval window. All were repaired with fascial grafts to the oval and round windows with complete resolution of vestibular symptoms. However, two of the three patients with documented post-operative audiograms suffered from persistent SNHL on the injured side. We conclude that exploratory middle ear surgery is indicated in patients suffering from blunt or penetrating temporal bone or middle ear trauma who demonstrate persistent vestibular symptoms, sensorineural hearing loss or radiographic evidence of oval window pathology. As this is a limited number of patients, a larger series may be warranted to study the actual incidence of post-traumatic PLF in the child with persistent hearing loss and vertigo after head or ear trauma.

    Title Medial Medullary Injury During Adenoidectomy.
    Date July 2001
    Journal The Journal of Pediatrics
    Excerpt

    We report medullary injury during adenoidectomy in two children who received injections of local anesthetic agents into the operative bed. Initial manifestations included hemiparesis, nystagmus, and ataxia. Magnetic resonance imaging showed hemorrhagic, paramedian medullary lesions in both patients. The mechanism of injury is likely to be injection of fluid into the medulla.

    Title Nasal Wash Technique for Nasal Foreign Body Removal.
    Date December 2000
    Journal Pediatric Emergency Care
    Title Communication Disorders in the 22q11.2 Microdeletion Syndrome.
    Date November 2000
    Journal Journal of Communication Disorders
    Excerpt

    The 22q11.2 microdeletion syndrome is a genetic disorder that is being recognized with increasing frequency. Confirmation of the diagnosis can be made using fluorescence in situ hybridization. Many medical and developmental problems are present in children with this syndrome. Communication disorders are among the most common features of this syndrome and include articulation, language, resonance, and voice problems. The purpose of this paper is to provide a description of the communicative and developmental features in a sample of children with the 22q11.2 microdeletion syndrome seen for evaluation. Because communication and feeding disorders may be presenting features of this syndrome, speech and language pathologists must be familiar with this syndrome and its various characteristics. Awareness of these features and a multidisciplinary approach are necessary for the identification and treatment of the complex communicative and medical problems present in this population.

    Title Melanotic Neuroectodermal Tumor of Infancy (mnti) of the Hard Palate: Presentation and Management.
    Date October 2000
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    OBJECTIVE: To discuss the presentation and management of melanotic neuroectodermal tumor of infancy (MNTI) of the hard palate. METHOD: Case presentation and literature review. CASE: A 6-month-old girl presented with a slow growing, non-tender anterior oral hard palate mass. Radiologic imaging revealed a well-circumscribed cystic lesion containing teeth. After excision, histopathologic and electron microscopic evaluation revealed MNTI. No recurrence was seen at 12-month follow-up. CONCLUSIONS: This case and a review of the literature reveal MNTI to be a rare, benign hard palate tumor, which may present as a smooth, firm, painless, slow-growing anterior palatal lesion. Imaging reveals a well-circumscribed cystic lesion. Complete excision should be curative. Management requires attention to the potential need for palatal reconstruction, orthodontic care and correction of secondary nasal deformities.

    Title Doxycycline Sclerotherapy of Benign Lymphoepithelial Cysts of the Parotid: a Minimally Invasive Treatment.
    Date June 2000
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Benign lymphoepithelial cysts (BLCs) of the parotid gland are associated with human immunodeficiency virus infections in both children and adults. These cysts may become painful and unsightly, often initiating a request for therapeutic intervention. There are several treatment options described in the literature. We report the use of doxycycline sclerotherapy in the treatment of a child with BLCs of the parotid.

    Title Airway Compromise Caused by Disk Battery Ingestion.
    Date September 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Pathologic Quiz Case 2. Cervical Thymus.
    Date June 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Nontuberculous Mycobacterial Cervical Adenitis.
    Date August 1997
    Journal Clinical Pediatrics
    Excerpt

    Granulomatous inflammation is a common finding in pathologic evaluation of surgically excised chronic lymphadenopathy in children. Confusion exists regarding diagnosis and management of these lesions. Over a 10-year period at The Children's Hospital of Philadelphia, a total of 81 children were identified with biopsy-confirmed granulomatous lesions of the head and neck, with nontuberculous mycobacteria (NTM) accounting for 67 of the cases. The typical presentation was that of a nontender mass in the cervicofacial area present for weeks to months, unresponsive to antimicrobials. All underwent surgical excision, which was curative in 54 patients; 13 children required additional procedures. This paper reviews NTM, its typical clinical presentation, difficulty in diagnosis, and the methods of treatment.

    Title The Effects of Gelatin Film Stents in the Middle Meatus.
    Date August 1997
    Journal American Journal of Rhinology
    Excerpt

    Controversy exists regarding the management of the middle meatus after pediatric functional endoscopic sinus surgery (FESS). To prevent adhesions following pediatric FESS, gelatin film stenting of the middle meatus has been recommended. The effects of stenting, however, have not been established. Fifty-one children with similar degrees of bilateral sinus disease had a gelatin film stent placed in one middle meatus on completion of FESS, while the opposite meatus was not stented. Two to three weeks later at the time of a second, staged procedure, the sides were compared for the presence of the stent, adhesions, granulaion tissue, and patency of the maxillary sinus ostia. In 11 children the postoperative findings were more severe in the side without the stent, whereas in 29 children they were more severe in the stented side. There was no difference between the sides in 11 children. Although gelatin film stenting benefits some children, it should not be used routinely following pediatric FESS but should be reserved for children who are predisposed to develop adhesions or have poor prognostic factors, such as immunodeficiency and ciliary dyskinesia.

    Title Periauricular Cysts and Sinuses.
    Date August 1997
    Journal The Laryngoscope
    Excerpt

    Periauricular cysts, sinuses, and fistulas occur commonly in the pediatric population. They arise from developmental defects of the first branchial cleft and first branchial arch. In most instances the diagnosis and management of these conditions are straightforward, but exceptional presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, and even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular congenital lesions is reviewed, of which three cases illustrating a diagnostic or surgical challenge are presented. The embryology, presentation, and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the literature, and our paper uniquely discusses first branchial cleft anomalies and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.

    Title Effect of Otitis Media with Effusion on Gross Motor Ability in Preschool-aged Children: Preliminary Findings.
    Date March 1997
    Journal Pediatrics
    Excerpt

    OBJECTIVE: To investigate whether gross motor skills in preschool-aged children 24 to 60 months old with otitis media with effusion (OME) are different from those of preschool children without OME. CHILDREN AND METHODS: The gross motor portion of the Peabody Developmental Motor Scales (PDMS-GM) was used to compare 13 children with OME before and after tympanostomy tube placement to 12 children without OME. RESULTS: The children with OME had significantly reduced scores preoperatively compared to those without OME on the PDMS-GM. After surgery, the children with OME had higher scores than those without OME, indicating an accelerated rate of development. CONCLUSIONS: Balance and motor development are additional factors to be considered in the medical and surgical management of the young child with chronic OME. Chronic OME may represent an additional problem for young children with existing motor deficits or other disabilities.

    Title Imaging of Granulomatous Neck Masses in Children.
    Date February 1997
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Non-tuberculous mycobacterial (NTM) infection is the most common cause of granulomatous inflammation in pediatric neck masses. Diagnosis relies upon culture, acid-fast bacilli (AFB) staining, chest radiograph, purified protein derivative (PPD) test, and clinical features. Computed tomography (CT) and magnetic resonance (MR) imaging may provide valuable information in the work-up of children with cervical masses. We reviewed 11 CT and 5 MR studies of children with a clinical diagnosis of NTM infection. Specific findings included stranding of the subcutaneous fat, thickening and enhancement of the overlying skin, obliteration of the tissue palnes, and multichambered masses. One patient had calcifications within the mass. MR with contrast better demonstrated the soft tissues and is our recommended imaging modality, although CT is more likely to detect calcifications within the neck mass.

    Title Maturational Influences on Suppression of Vocal Cord Function by Anesthesia.
    Date October 1995
    Journal The Laryngoscope
    Excerpt

    Vocal cord abduction is a complex action that occurs with inspiration and is controlled by the respiratory center in the brainstem. A study was conducted to evaluate the maturational influences on the effect of anesthesia on vocal cord movement. Rabbits aged 15, 30, 45, and 60 days were used to study this problem. The animals were equilibrated to varying concentrations of halothane, and vocal cord movements were documented. In all age groups the vocal cord motion increased with increasing concentration of halothane. The amount of vocal cord movement also increased with the increasing age of the animal. These effects, however, were independent of each other. There did not appear to be any interaction between the concentration of halothane and the age of the animal. These findings are discussed in light of the apparent absence of active vocal cord motion observed in some children under a general anesthetic.

    Title Direct Laryngoscopy in Children: Rigid and Flexible Fiberoptic.
    Date May 1995
    Journal Ear, Nose, & Throat Journal
    Excerpt

    Examination of the child's larynx is mandatory in the management of pediatric airway problems. The techniques used to perform this examination have evolved over time and now present the airway specialist with choices that can be tailored to each specific situation. Traditionally, rigid direct laryngoscopy (RDL) has been used to evaluate the pediatric larynx. More recently, flexible fiberoptic laryngoscopy (FFL) has been used to visualize the child's airway. RDL and FFL each play a role in the evaluation of the pediatric larynx. Expertise with both techniques is mandatory for the otolaryngologist managing respiratory disorders in children. FFL has become our technique of choice to evaluate the pediatric larynx especially when airway dynamics are of concern. RDL remains the preferred technique when laryngeal/tracheal surgery is planned or establishment and protection of the airway with intubation or bronchoscopy is required.

    Title Familial Occurrence of Pleomorphic Adenoma.
    Date February 1995
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Pleomorphic adenoma is the most common neoplasm found in the parotid gland. The familial occurrence of any salivary gland neoplasm is rare. There are 8 previous reports in the literature of familial occurrence of salivary gland tumors. Two of these report the occurrence of pleomorphic adenoma of the parotid gland in siblings; all 4 patients were adults. We report here an 11-year-old male who presented with a left parotid mass and underwent parotidectomy. The mass proved to be a pleomorphic adenoma. His sister presented 9 years later at the age of 15 years with a similar mass also in the left parotid area. She underwent superficial parotidectomy which revealed the mass to be a pleomorphic adenoma. We believe these are the youngest siblings reported to date in which familial pleomorphic adenoma has occurred.

    Title Vocal Cord Injection in Children with Unilateral Vocal Cord Paralysis.
    Date January 1995
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Unilateral vocal cord paralysis (UVCP) in children is uncommon and rarely leads to serious sequelae. However, on rare occasions, it can present with severe aspiration and dysphonia. Several therapeutic techniques have been used in adults with UVCP, but the reported alternatives in children have been much more limited. Observation and speech therapy are the standard treatment. We describe three children with UVCP and severe aspiration who were treated with vocal cord injection. The treatment indications, clinical courses, and outcomes of the three cases are detailed. The injection of vocal cords in children is discussed, with an emphasis on those aspects unique to the management of UVCP in pediatric patients. Alternative surgical treatment modalities are also presented. Vocal cord injection is an effective and viable therapeutic option for the management of UVCP in certain pediatric patients with severe aspiration and dysphonia.

    Title Salivary Gland Neoplasms in Children: a 10-year Survey at the Children's Hospital of Philadelphia.
    Date September 1994
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Fifteen salivary gland tumors were treated at The Children's Hospital of Philadelphia between 1982 and 1991. Eight of these lesions were malignant and 7 were benign. All of the benign tumors were pleomorphic adenomas. For these, superficial parotidectomy or excision of the submandibular gland was the treatment of choice. One child had recurrence 2 years after her initial surgery. Among the malignant lesions, mucoepidermoid carcinoma was diagnosed in 5 children, and acinic cell carcinoma in 3. Six malignant tumors involved the parotid gland, while 2 originated in the submandibular salivary gland. Superficial or total parotidectomy, or excision of the submandibular gland was performed, according to the nature and the location of the lesion. The facial nerve was sacrificed in one patient because of extensive involvement of the nerve. A 2-year survival rate of 100% was achieved, and all the patients were free of disease at the end of the follow-up period. Successful management of salivary gland lesions in children requires a high index of suspicion of possible malignancy and complete surgical removal as the initial treatment. Radiation therapy is recommended in the management of those patients with microscopic residual tumor and/or nodal involvement.

    Title Current Indications for Tympanostomy Tubes.
    Date June 1994
    Journal American Journal of Otolaryngology
    Excerpt

    Current indications for TT placement are (1) persistent SOM that has not responded to a 6 to 12-week course of medical treatment. This includes full and prophylactic doses of antimicrobials (and corticosteroids, as indicated); (2) recurrent AOM (at least three episodes in 6 months or four episodes in 12 months) that does not respond to, or recurs after, antimicrobial prophylaxis; (3) complications of AOM such as meningitis, facial nerve paralysis, coalescent mastoiditis, or brain abscess; and (4) complications of eustachian tube dysfunction such as tympanic membrane retraction with hearing loss, ossicular erosion, and/or retraction pocket formation. It must be emphasized that TT placement in children does not "cure" the condition that led to the surgical intervention. Rather, the TT maintains aeration of the middle ear until the child grows and his eustachian tube function normalizes. These recommendations for TT placement are to be regarded as guidelines, not as absolute requirements. They must be applied individually to each patient and his/her unique situation. Certain factors may influence timing of TT placement and lead to modification of the guidelines as they apply to each child.

    Title Congenital Tracheal Stenosis. The Otolaryngologist's Perspective.
    Date May 1994
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Congenital tracheal stenosis is a rare congenital anomaly, with less than 70 reported cases in the literature. The presenting signs and symptoms of stridor, recurrent pneumonia, and respiratory distress are commonly seen in other conditions. The rarity of congenital tracheal stenosis and the diverse presentations make accurate early diagnosis difficult and frequently lead to inappropriate treatment. We treated three patients with congenital tracheal stenosis who presented with different sites of stenosis. Each patient displayed different symptoms and required individualized management. The treatment of congenital tracheal stenosis depends on identifying the site and extent of the stenosis. We reviewed the embryogenesis and treatment of this abnormality and developed a new classification system that will aid in the management of congenital tracheal stenosis.

    Title Laryngeal Involvement in Neurofibromatosis.
    Date March 1994
    Journal Ear, Nose, & Throat Journal
    Excerpt

    Neurofibromas of the larynx are an uncommon component of neurofibromatosis, but should be considered in the differential diagnosis of patients with a submucosal supraglottic mass. Complete surgical excision is the treatment of choice; however, incomplete excision may be preferable to aggressive debilitating surgery. Plexiform neurofibroma differs from non-plexiform neurofibroma in that it is poorly circumscribed and highly infiltrative. Tracheostomy may be necessary. Sarcomatous degeneration is reported and carries a poor prognosis.

    Title Tracheobronchomalacia in Children.
    Date March 1994
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Tracheobronchomalacia (TBM) is an important cause of airway distress during infancy, but it generally resolves as the airway enlarges. To assess the origin and natural history of TBM, a chart review and telephone survey were conducted for 50 patients with TBM at the Children's Hospital of Philadelphia (Pa). This study revealed that TBM is a relatively common airway abnormality and is found on 15% of all diagnostic bronchoscopies. Prematurity, low birth weight, bronchopulmonary dysplasia, and prolonged ventilation predispose patients to the most severe symptoms. In our study, a tracheotomy with continuous positive airway pressure was required by 75% of the premature infants and 25% of the full-term infants with TBM. Seventy-one percent of all patients underwent decannulation without any other surgical intervention and remained nearly asymptomatic. Some patients could not undergo decannulation because of other airway lesions. In most instances, TBM is a self-limited disease that resolves without surgery.

    Title Second Branchial Cleft Anomalies Presenting As Pharyngeal Masses.
    Date December 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Endoscopic Assessment in Children with Tracheotomies.
    Date March 1993
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Pediatric tracheotomy is a safe procedure, and the tube can be maintained for a prolonged period. There are, however, few guidelines regarding the endoscopic assessment of the airway following tracheotomy. From January 1988 through December 1989, the Division of Otolaryngology of The Children's Hospital of Philadelphia (Pa) performed tracheotomies on 81 patients. Thirty-two children had direct laryngoscopy and bronchoscopy at the time of the procedure, 1 week later, and at 6-month intervals for a minimum of 18 months. Four children had normal airways while 21 had intraluminal stomal granulomas, 16 had development of subglottic stenosis, nine had collapse of the anterior tracheal wall, and three had development of distal tracheal granulations. Sixteen children had multiple lesions. Anatomic changes occur in the airways of the majority of children with long-term tracheotomies, and endoscopic evaluation is an essential part of their care.

    Title Neck Masses and the Airway.
    Date January 1993
    Journal International Anesthesiology Clinics
    Title Gelfilm Myringoplasty.
    Date November 1992
    Journal The Laryngoscope
    Title Nasopharyngeal Malignancies in Children.
    Date June 1992
    Journal The Laryngoscope
    Excerpt

    A retrospective analysis identified 29 children with nasopharyngeal malignancies who were evaluated at the Children's Hospital of Philadelphia from 1970 through 1989. Rhabdomyosarcoma (15) and carcinoma (9) were the most common tumor types, and there were distinct differences in the clinical presentations of these two malignancies. Patients with rhabdomyosarcoma were generally younger than those with carcinoma and enjoyed longer survival. Six (67%) of the children with carcinoma were black; all of the patients with rhabdomyosarcoma were white. Patients with carcinoma were also more likely to present with cervical metastases. The presentation, evaluation, and methods of treatment for pediatric nasopharyngeal malignancies are discussed.

    Title Ventilation Tube Removal. Indications for Paper Patch Myringoplasty.
    Date May 1992
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Paper patch myringoplasties are commonly performed in children at the time of ventilation tube removal, yet no series documenting their efficacy appears in the otolaryngology literature. Over an 18-month period at the Children's Hospital of Philadelphia (Pa), 163 ventilation tube removals were performed on 131 children aged 1 to 18 years. In 95 of these ears, a paper patch myringoplasty was performed after tube removal. No significant difference (87% vs 85%) in the overall healing rate at 6 months was shown between these two groups. An analysis of the variables potentially affecting outcome revealed that healing following simple tube removal was influenced by the frequency of tube placement and by tube size. Paper patch myringoplasty significantly improved outcome (93% vs 61%) in ears with more than three previous tube placements.

    Title Usefulness of Computed Tomographic Scan in the Evaluation of Sensorineural Hearing Loss in Children.
    Date May 1992
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    A retrospective chart study was conducted to determine the diagnostic yield of temporal bone imaging for children with sensorineural hearing loss of unknown cause. Seventy consecutive cases, spanning 4.5 years, were identified and individual computed tomography films reviewed. Cases were analyzed with respect to patients' age, duration of hearing loss, sudden onset vs progressive loss, unilateral vs bilateral, and other symptoms. Of the 70 computed tomographic scans, nine showed temporal bone or other intracranial abnormalities. The majority of these findings were localized to structures in the posterior and middle cranial fossae. No eight nerve tumors were identified. Congenital hearing loss and hearing loss secondary to viral infections are the most common cause of sensorineural hearing loss when discovered in early childhood and, often, have no radiographic abnormality. The decision to explore an ear for a presumed perilymph fistula is based almost exclusively on the history and physical examination, and not on the demonstration of any radiographic findings. For the children presenting with stable hearing impairment in the absence of other findings, computed tomographic scans were either negative or did not contribute to diagnosis. Since tumors of the eighth nerve are rare in children under 16 years of age (without neurofibromatosis), and radiologic studies have a low yield in identifying perilymph fistulas, the routine use of computed tomographic imaging in such children may be unjustified.

    Title Preoperative History and Coagulation Screening in Children Undergoing Tonsillectomy.
    Date May 1992
    Journal Pediatrics
    Excerpt

    To evaluate the usefulness of preoperative screening for coagulation disorders in children, we prospectively studied laboratory and bleeding histories in 1603 children undergoing tonsillectomy. All patients had preoperative laboratory screening with a complete blood count, prothrombin time, activated partial thromboplastin time, and bleeding time. Persistent abnormalities on repeat testing 1 week later were investigated further by a standardized schema. A subset of 129 patients, including all those who bled perioperatively or had laboratory abnormalities, completed a standard historical questionnaire. Thirteen patients had persistent laboratory abnormalities diagnostic of lupus inhibitor (5), non-lupus inhibitor (6), mild hemophilia A (1), and vonWillebrand disease (1). Two patients had persistently prolonged activated partial thromboplastin times of undefined cause. Fourteen patients (10.8%) interviewed reported positive bleeding histories. Of these, five, including the patient with vonWillebrand disease, had persistent laboratory abnormalities. History alone failed to detect the patient with hemophilia A. For patients with inhibitors or prolonged activated partial thromboplastin times of unknown cause, surgery was delayed until the coagulation abnormalities resolved, and there was no perioperative bleeding. The patient with vonWillebrand disease had severe postoperative bleeding despite treatment with cryoprecipitate. In predicting perioperative bleeding, history and laboratory screening had a high specificity but a very low positive predictive value due to poor sensitivity and a low prevalence of bleeding. Some children with bleeding disorders may be identified first during routine preoperative coagulation testing, and replacement therapy or delay or cancellation of surgery may reduce or prevent perioperative hemorrhage. However, the large number of false positive laboratory tests and bleeding histories, coupled with the relative rarity of inherited and acquired coagulopathies, raises doubts about the overall value of routine screening.

    Title Is Outpatient Tonsillectomy Appropriate for Young Children?
    Date April 1992
    Journal The Laryngoscope
    Excerpt

    The current literature suggests that outpatient tonsillectomy is a safe, cost-effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedure.

    Title Granular Cell Tumors of the Head and Neck in Children: the Experience at the Children's Hospital of Philadelphia.
    Date September 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Granular cell tumors are rare, usually benign tumors of controversial histogenesis. These tumors are uncommon in children. Granular cell tumors in adults have a predilection for the head and neck, but this was not noted in our experience with children. Of the 22 granular cell tumors diagnosed and managed at the Children's Hospital of Philadelphia from 1960 to 1988, 7 were from the head and neck. One child with a subglottic granular cell tumor is of particular interest and is presented in detail.

    Title Radial Versus Circumferential Incision in Myringotomy and Tube Placement.
    Date September 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Pressure equalization tubes are a well-recognized treatment for persistent otitis media with effusion and recurrent acute otitis media. Ideally, the tube should remain in place until the Eustachian tube function returns. Efforts to improve the functional life expectancy of tubes have concentrated on tube design with little attention directed at modification of the surgical technique. Some authors have noted that a radial incision offers theoretical advantages over a circumferential incision. A randomized study comparing radial and circumferential incisions in myringotomy with tube placement was conducted. Two hundred and twenty-eight patients had a circumferential incision performed in one ear and a radial incision in the opposite ear. On follow-up examinations the tube position and time to extrusion were noted. Using the sign test, there was no statistical difference in extrusion rates between the two groups. This study does not support the theoretical advantages espoused in the literature.

    Title Mandibular Fractures in the Pediatric Patient.
    Date June 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Seventy-three patients were admitted to the Children's Hospital of Philadelphia (Pa) between January 1979 and June 1989 with a diagnosis of mandibular fracture. Data were obtained through a retrospective review of these cases. The cases were divided into three age groups that reflected the developing structure of the mandible and the maturation of the dentition. A trend toward a greater number of fractures and a predominance of males is shown with increasing age. Child abuse is a relatively frequent cause of fractures throughout all groups. Associated injuries are more common in young children, except in cases where abuse has been documented. The high osteogenic potential of the pediatric mandible allowed conservative management to be successful in 25% of younger patients and was responsible for a low complication rate overall.

    Title Hearing Impairment in Ventilator-dependent Infants and Children.
    Date May 1991
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Bronchopulmonary dysplasia is a complication of prematurity that can require months or years of ventilatory support. Among a cohort of 12 such ventilator-dependent patients, half had auditory brainstem response thresholds of 40 dB nHL or worse in the better ear. In 10 of 23 ears the threshold was 50 dB or worse. This incidence of hearing impairment is much greater than for other high-risk premature infants. Although conductive impairment was implicated in many cases, the degree of impairment is greater than that ordinarily seen with middle ear effusion.

    Title Why Pediatric Otolaryngology?
    Date January 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Vocal Cord Paralysis in Children.
    Date December 1990
    Journal The Laryngoscope
    Excerpt

    Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.

    Title The Efficacy of Cefaclor Vs Amoxicillin on Recovery After Tonsillectomy in Children.
    Date May 1990
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Tonsillectomy and adenoidectomy continues to be one of the most commonly performed operations in the pediatric age group. The morbidity from tonsillectomy can be severe and includes throat and ear pain, fever, lethargy, and poor oral intake. A previous study at the Children's Hospital of Philadelphia (Pa) demonstrated the efficacy of amoxicillin therapy in minimizing some of these postoperative symptoms. However, some children continue to have a prolonged recovery even while receiving this antibiotic regimen. Because of these children and the high incidence of Staphylococcus found in tonsillar core tissue, a randomized, prospective study was undertaken at the Children's Hospital of Philadelphia to evaluate the efficacy of cefaclor vs amoxicillin in patients recovering from tonsillectomy. The patients received either ampicillin or cefazolin intravenously at the time of surgery and for 12 to 24 hours postoperatively. When oral intake was adequate, they received either amoxicillin or cefaclor orally for 7 additional postoperative days. Intraoperative cultures of the oropharynx and tonsillar tissue were obtained, as well as cultures of the tonsillar fossa 7 to 14 days postoperatively. The patients were evaluated for severity and duration of postoperative symptoms as well as complications. The results of this study showed no difference between the two groups of patients. We conclude that there is no justification for routine use of cefaclor over amoxicillin in the posttonsillectomy patient.

    Title Rhabdomyosarcoma of the Head and Neck in Children.
    Date May 1990
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Rhabdomyosarcoma is the most common soft-tissue sarcoma in infants and children, with the head and neck being the most frequent site of involvement. Treatment for this neoplasm has undergone many changes, with a much improved prognosis using a combination of surgery, radiation therapy, and chemotherapy. This retrospective analysis presents the management and outcome of 60 children (aged 3 months to 18 years) with rhabdomyosarcoma of the head and neck evaluated at the Children's Hospital of Philadelphia (Pa) between 1970 and 1987. The overall death rate for all head and neck sites decreased from 50% in 1970 to 1979 to 23% in 1980 to 1987, reflecting the improved management protocol.

    Title Adenoidectomy for Secretory Otitis Media.
    Date April 1990
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Laryngotracheoplasty in the Management of Subglottic Stenosis.
    Date October 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Laryngotracheoplasty (LTP) has revolutionized the surgical management of subglottic stenosis in children. A 10-year review of patients at the Children's Hospital of Philadelphia yielded 27 patients who had undergone a LTP. LTP with an anterior cartilage graft was utilized in over 80% of procedures. Morbidity was minimal, and there were no deaths. In this series, 78% of patients have been successfully decannulated. LTP has reduced the time necessary for decannulation in children with chronic tracheostomies as a result of subglottic stenosis.

    Title Pediatric Neck Masses: Guidelines for Evaluation.
    Date May 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Neck masses are frequent findings in the pediatric population. Unlike the adult, there are few established guidelines for evaluation of these children. The etiology of cervical masses includes many conditions. Knowledge of these conditions and their clinical presentations is essential. To elucidate the clinical characteristics which may help in establishing a correct diagnosis, the charts of 445 patients with biopsies of neck masses performed at the Children's Hospital of Philadelphia were analyzed. There were 244 (55%) congenital lesions, 118 (27%) inflammatory lesions, 23 (5%) non-inflammatory benign masses, 12 (3%) benign neoplasms, and 48 (11%) malignancies. The preoperative diagnosis was correct in 270 (61%) patients. Guidelines are established for the evaluation of the child presenting with a neck mass.

    Title Bacteriology of Tonsil Surface and Core in Children.
    Date April 1989
    Journal The Laryngoscope
    Excerpt

    The tonsils of 97 children undergoing tonsillectomy were studied to determine the correlation between surface culture swab and culture of tonsillar core. In many cases, pathogenic organisms were found in the tonsil core, despite the fact that surface cultures revealed only normal respiratory flora. The tonsil core cultures showed a high incidence of Hemophilus influenzae and Staphylococcus aureus, which was rarely reflected on surface culture. The study indicates that pharyngeal swab cultures do not reliably reflect the presence of pathogens in the tonsil core. The value of parameters such as history of recurrent bouts of tonsillitis and presence of erythema or cryptic debris on physical examination for predicting the differential bacteriology of the tonsil is studied. The implications for treatment of children with adenotonsillar hypertrophy are discussed.

    Title The Anterior Cricoid Split: the Children's Hospital of Philadelphia Experience.
    Date February 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The anterior cricoid split procedure (ACS) is an alternative to tracheotomy in selected infants with subglottic stenosis. From February 1983 to October 1987, 26 children underwent ACS at the Children's Hospital of Philadelphia. All children had subglottic stenosis. Six children had previously undergone tracheotomy. A successful outcome, allowing extubation or decannulation, correlated only with decreased pre-operative intubation time and was achieved in 73% of these patients. A failed ACS had little adverse affect on the subsequent management of these children.

    Title A Prospective Study of Titanium Ventilation Tubes.
    Date February 1989
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    A prospective controlled study was undertaken in which in 100 children a titanium ventilation tube was inserted in one ear, and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea, and early occlusion. Sixty-five patients were followed for at least one year, or until both tubes had extruded. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion, early extrusion, or infection with otorrhea. Since the titanium tube is more than twice as expensive and has no proven advantages over a silicone tube of similar design, we have no reason to recommend its use over the less costly, standard silicon ventilation tube.

    Title Microbiology of the Tonsils and Adenoids in a Pediatric Population.
    Date July 1988
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    To investigate the microbial flora of the tonsils and adenoids, the core tissue from the tonsils and adenoids of 50 children undergoing tonsillectomy and adenoidectomy for either recurrent infection or airway obstruction was cultured aerobically and anaerobically, and the number of bacterial colonies was quantitated. The most common organisms isolated were alpha-hemolytic streptococci, nonpathogenic Neisseria species, Haemophilus species, Staphylococcus aureus, and Corynebacterium species. No anaerobes were identified. Bacterial isolates from the tonsils and adenoids were similar in number and frequency of occurrence. Potential pathogenic bacteria (Haemophilus species, S aureus, beta-hemolytic streptococci, and Streptococcus pneumoniae) were identified in 40 patients. Seventy-three percent of these patients shared a common pathogen in tonsil and adenoid tissue. Haemophilus species were recovered in 54% of patients and S aureus in 46%. No significant difference exists between the type and number of pathogens in patients undergoing adenotonsillectomy for recurrent infection or obstruction.

    Title Trauma to the Larynx and Upper Trachea.
    Date June 1988
    Journal International Anesthesiology Clinics
    Title Craniofacial Surgery: Otolaryngological Concerns.
    Date June 1988
    Journal International Anesthesiology Clinics
    Title Cholesteatoma in the Pediatric Patient.
    Date March 1988
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    A review of patients with cholesteatoma at the Children's Hospital of Philadelphia from 1981 to 1986 yielded 161 children. Analysis of data from both outpatient and hospital charts revealed a higher incidence of males to females, and the peak incidence of cholesteatoma appeared to be in the 6-10 year age group. Otorrhea was the most common symptom; and on physical examination, the posterior-superior quadrant was most often affected. Both intact canal wall and open cavity procedures were employed depending upon the site and extent of disease. Seventy-six percent of patients underwent an intact canal wall or middle ear procedure initially, with the remainder requiring an open cavity procedure. Recurrent or residual cholesteatoma was found in 32% of 148 patients at the second procedure, and in 7% of 148 patients if a third procedure was necessary. Pre- and post-operative audiometric findings for 91 patients revealed 21% with decreased hearing post-surgically, 50% with no change in hearing and 29% with improved hearing. Post-operative complications were minimal.

    Title Pediatric Orbital Tumors.
    Date March 1988
    Journal Otolaryngologic Clinics of North America
    Excerpt

    The proper management of orbital tumors in children requires a knowledge of the lesions commonly seen in this area, in addition to the appropriate methods of investigation and treatment. A multidisciplinary approach is most beneficial in obtaining the desired results.

    Title The Sternocleidomastoid Tumor of Infancy.
    Date January 1988
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little attention in the otolaryngological literature. The diagnosis must be considered in any infant presenting with a lateral neck mass. Although its natural history favors spontaneous regression, the mass may initially grow in size. The purpose of treatment is the prevention of torticollis and craniofacial asymmetry. The initial treatment is non-surgical, passive and active exercises. Only when this treatment fails should surgery be performed. The disappearance of the lesion is not always a predictable sign. A small number of children will develop delayed torticollis or craniofacial asymmetry. It is important that parents be informed of this possibility and of the necessity for long term follow-up.

    Title Malignant Fibrous Histiocytoma.
    Date June 1987
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title A Controlled Study of a 'new' Ventilating Tube. The Gold Standard?
    Date March 1987
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    A prospective controlled study of a gold ventilation tube was undertaken in which a gold tube was inserted in one ear of 88 children and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea and early occlusion. Sixty-three patients were available for a follow-up of at least 6 months. The gold tube remained in place for a shorter period of time when compared to the control tube. Episodes of otorrhea were infrequent and there was not any significant difference between the two types of tubes. The gold tube became occluded more frequently than the control tube. Since the gold tube is approximately 3 times more expensive and has no proven advantages over our conventional silicone tube, we have no reason to recommend its use in preference to any other available tube.

    Title Post-tonsillectomy Hemorrhage: Incidence, Prevention and Management.
    Date December 1986
    Journal The Laryngoscope
    Excerpt

    Tonsillectomy (with or without adenoidectomy) continues to be a commonly performed operation in the United States. Over the years, the incidence of post-tonsillectomy hemorrhage (reported between 0% and 20%) has decreased, but continues to pose serious problems. We reviewed 1,445 tonsillectomies performed over a 2-year period to study the incidence of post-tonsillectomy hemorrhage. Thirty-eight of 1,445 children (2.62%) had postoperative bleeding. The incidence of primary hemorrhage (within 24 hours) was 0.14%. Delayed hemorrhage requiring operative intervention or observation in the hospital was 1.03% and 0.76%, respectively. Ten patients (0.69%) had delayed hemorrhage of a minor nature that had stopped by the time they reached the hospital; these children were treated with observation alone and did not require hospitalization or operative intervention. The proposed reasons for this low rate of post-tonsillectomy hemorrhage include complete preoperative coagulation screening, meticulous attention to surgical technique, use of suction-cautery to obtain hemostasis and, possibly, use of postoperative antibiotics. Management of hemorrhage is discussed with respect to observation, surgical intervention, and blood transfusion.

    Title The Effect of Antibiotic Therapy on Recovery After Tonsillectomy in Children. A Controlled Study.
    Date June 1986
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Tonsillectomy continues to be a commonly performed operation in the pediatric age group. The postoperative period is often protracted and characterized by throat and ear pain, intermittent fever, foul odor from the oral cavity, and poor oral intake. Consequently, antibiotics are frequently prescribed in an effort to minimize these symptoms and/or avoid complications such as dehydration or secondary infection of the operative site. However, to our knowledge, no study to date has been performed to demonstrate the efficacy of antibiotic therapy in this setting. At the Children's Hospital of Philadelphia, a prospective, randomized, double-blind study was undertaken in which ampicillin (or placebo) was administered intravenously at the time of surgery and for 12 to 24 hours postoperatively. The children then continued to receive oral amoxicillin therapy (or placebo) for an additional seven days. The patients were then evaluated for the incidence and severity of postoperative symptoms and complications. Intraoperative cultures of the oropharynx and tonsillar tissue, as well as cultures of the tonsillar fossa, were obtained following completion of one week of therapy. Our results indicate that ampicillin sodium/amoxicillin trihydrate therapy is well tolerated and safe in the nonallergic child and is effective in minimizing fever and other troublesome postoperative symptoms, such as pain, lassitude, mouth odor, and poor oral intake after tonsillectomy.

    Title Malignant Fibrous Histiocytoma of Soft Tissue in Childhood.
    Date June 1986
    Journal Cancer
    Excerpt

    Seven children aged 6 months to 11 years with malignant fibrous histiocytoma, a type of sarcoma of soft tissues, have been treated at the Children's Hospital of Philadelphia from January 1975 through July 1983. The primary tumor arose in the head and neck region in three patients, the chest wall in two patients and the pelvis or buttock in one patient each. Operative management consisted of complete tumor removal in the two patients with chest wall tumors, and biopsy only in the remaining five children. Afterward, all seven patients were treated with a multiple-agent chemotherapy program consisting of vincristine, dactinomycin, and cyclophosphamide for two years, with or without Adriamycin (doxorubicin). The five patients with residual tumor also received radiation therapy (RT) in doses of 1500 to 5500 rad. The two children with localized, completely excised sarcoma are continuously free of tumor at 1.4 and 9 years after initiation of treatment. Of the five with residual sarcoma, three had a complete response to radiation and chemotherapy, and two of them are free of recurrence at 4 and 5 years, respectively. In the three remaining children, the tumor spread regionally into the central nervous system or distantly into the lungs, subcutaneous tissues, and liver. Childhood malignant fibrous histiocytoma of soft tissue appears to be similar to childhood rhabdomyosarcoma in its modes of spread and response to management. Operative removal is the key to successful therapy. The roles of multiple-agent chemotherapy and RT remain to be defined. Adriamycin appears to be the most promising single agent. In the absence of concrete data, it seems prudent to follow the same guidelines for irradiation as those used for other soft tissue sarcomas of childhood.

    Title Upper Airway Obstruction in Craniofacial Anomalies: Diagnosis and Management.
    Date October 1985
    Journal Birth Defects Original Article Series
    Excerpt

    Particular attention to airway problems must be paid to any child with a craniofacial anomaly. Knowledge of the potential for upper airway obstruction in children with craniofacial anomalies, early recognition of the signs of obstruction, and prompt treatment are extremely important aspects of the treatment plan for each patient. An infant with choanal atresia or a nasal glioma will need definitive repair of his specific deformity to ensure the airway prior to consideration of any other problem. Similarly, the child with severe mandibular hypoplasia may require an early tongue-lip adhesion or tracheotomy to relieve airway distress until mandibular growth or surgical advancement enlarges the natural airway. Adenotonsillar hypertrophy may present earlier and with more severe sleep apnea in a child with an already compromised pharyngeal lumen. Early tonsillectomy and/or adenoidectomy must be considered in these patients even if this may possibly lead to velopharyngeal incompetence. Sleep apnea may also occur as a complication of the creation of a pharyngeal flap. If operative intervention for the craniofacial anomaly is contemplated, the potential for airway problems increases. The anesthetic induction and intubation are extremely difficult in the child with mandibular hypoplasia. The anesthetist and otolaryngologist must have a full range of techniques available to them to accomplish this task. If intermaxillary fixation is required postoperatively, or if the endotracheal tube is in the operative field, consideration should be given to a short-term tracheotomy to protect the airway during and after the operation. Close cooperation among the members of the craniofacial team is mandatory to prevent and/or treat any upper airway obstruction that may occur in the child with a craniofacial anomaly. Anticipation of possible airway compromise, early recognition of any existing obstruction, and prompt management of the problem are imperative to the successful diagnosis and treatment of craniofacial anomalies.

    Title Massive Juvenile Ossifying Fibroma of Maxillary Sinus with Orbital Involvement.
    Date July 1985
    Journal The British Journal of Ophthalmology
    Excerpt

    A 14-year-old black girl had painless, progressive proptosis and upward displacement of the left eye for approximately six months. Computed tomography showed a massive tumour involving the maxillary sinus with extension into the sphenoid sinus, ethmoid sinus, and orbit. The mass was excised surgically and proved histopathologically to be a juvenile ossifying fibroma. The clinical and histopathological features of this uncommon orbital tumour are discussed and its place in the spectrum of fibro-osseous tumours of the orbital region is considered.

    Title Endoscopic Instrument Holder.
    Date May 1985
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title False Vocal Cord Nodules: an Unusual Case of Hoarseness.
    Date December 1984
    Journal Ear, Nose, & Throat Journal
    Title Communication Development in Young Children with Long-term Tracheostomies: Preliminary Report.
    Date April 1984
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Communication development was studied in 77 subjects with long-term tracheostomies ranging in age from two months to 7 years. Children were categorized according to tracheostomy status (cannulated or decannulated), presence of speech practice prior to cannulation, and level of language development (prelinguistic or linguistic) at the time of decannulation. All were aphonic and consequently deprived of speech experience for extended periods while tracheostomized. Twenty-three children have been studied post-decannulation. Results for the children decannulated during the prelinguistic stage revealed that speech and language skills were attained commensurate with intellectual functioning. This evidence led to the conclusion that extensive, audible prespeech practice (cooing and babbling) was not needed for later spoken language development. All children decannulated during the linguistic stage exhibited specific spoken language delays including phonological impairment at the time of decannulation. The presence of speech practice prior to cannulation did not appear to be a factor in the severity of phonological impairment. The children who were cannulated for more lengthy time periods, extending into the linguistic stage, however, demonstrated more severe phonological impairment than those who were decannulated during the prelinguistic stage. With direct speech/language therapy, 20 of the 23 decannulated children eventually compensated for these difficulties, demonstrating appropriate spoken language skills. Alternative communication modalities were felt to be crucial in reducing communicative frustrations during cannulation.

    Title Otolaryngologic Injuries.
    Date January 1984
    Journal Clinics in Sports Medicine
    Title A Trial of Biolite Ventilation Tubes in Children: is Further Use Warranted?
    Date December 1983
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    A prospective controlled pilot study was undertaken in which Biolite (carbon-coated) ventilation tubes were placed in 44 ears and a conventional silicone tube in the contralateral ear. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion or early extrusion. In addition, there were several disadvantages noted with the Biolite tubes: incomplete coating of the tube (especially within the lumen), shedding of the Biolite coating over time, "tattooing" of the tympanic membrane, poor otoscopic visibility, and the higher cost of these tubes. Since the Biolite tube has no documented advantages and, actually, several disadvantages, we believe its use in the treatment of middle ear disorders should be discontinued until significant benefits are demonstrated and present deficiencies are corrected.

    Title Difficult Laryngoscopy/intubation: the Child with Mandibular Hypoplasia.
    Date September 1983
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    The child with mandibular hypoplasia (Treacher Collins syndrome, Pierre Robin sequence, hemifacial microsomia, etc) presents the otolaryngologist and anesthesiologist with considerable problems when direct laryngoscopy and/or endotracheal intubation is attempted. In addition to the small mandible, several other features of these patients contribute to the difficult laryngoscopy: macroglossia, glossoptosis, trismus related to temporomandibular joint abnormalities, and prominent maxilla or maxillary incisors. Most of the techniques that have been described for laryngoscopy/intubation in problem cases are difficult or impossible to use in infants and young children with mandibular hypoplasia. We present a modification of the standard direct laryngoscopic procedure, utilizing the 9-cm anterior commissure laryngoscope and an optical stylet in the task of exposing and intubating the larynx of a child with mandibular hypoplasia.

    Title Melanotic Neuroectodermal Tumor of Infancy.
    Date September 1983
    Journal Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology
    Title Speech and the Child with a Long-term Tracheostomy--the Problem and the Otolaryngologist's Role.
    Date September 1983
    Journal Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology
    Title Giant Cell Tumor of the Ethmoid Sinus: an Unusual Cause of Proptosis in a Child.
    Date February 1983
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Orbital and Periorbital Cellulitis in Children.
    Date February 1983
    Journal Head & Neck Surgery
    Excerpt

    The proper management of patients with orbital and periorbital cellulitis represents a distinct challenge to the clinician. A retrospective study is presented of 165 patients with the diagnosis of orbital or periorbital cellulitis admitted to the Children's Hospital of Philadelphia (CHOP) from January 1975 through December 1980. Sinusitis, trauma, local skin inflammations, and otitis were the most common etiologies. Twenty-three of the patients had orbital cellulitis, all of which were secondary to sinusitis. There was one death in this series. No patients had permanent ocular sequelae related to orbital or periorbital cellulitis. A discussion of etiology and management is presented, with emphasis on the usefulness of computerized tomography (CT).

    Title Contributing Generator of Frequency-following Response in Man.
    Date February 1983
    Journal Scandinavian Audiology
    Excerpt

    A contributing generator of the frequency-following response (FFR) was identified in a patient with severe neurological impairment, by comparing latencies and phase shifts of the FFR to the latency of the auditory brainstem evoked responses (ABR), and by comparing the duration of the FFR to that of the acoustic stimulus. In this patient, the ABR comprised only waves I and II; activity in the inferior colliculus was not identified. Both onset and offset latencies and phase shifts of the FFR were substantially shorter than the latency of the first wave of the ABR. The duration of the FFR corresponded precisely to that of the acoustic stimulus. These results are interpreted as supporting the view that the cochlear microphonic potential (CM) contributes to the scalp-recorded FFR.

    Title Pediatric Tracheostomy. Experience During the Past Decade.
    Date January 1983
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    A retrospective review of a decade of experience with pediatric tracheostomy encompassed 420 children. Analysis was performed with respect to primary diagnosis, age, duration of tracheostomy and hospitalization, early and late complications and mortality. While the incidence of tracheostomy per hospital admission decreased over the period of review, there was substantial increase in duration of tracheotomy. Approximately half of the patients sustained complications. While overall mortality approached 28%, tracheostomy-related deaths occurred in only eight patients (2%). Almost one fifth of children with tracheostomies were discharged to home care, and 3% were involved in our home ventilator program.

    Title Membranous Laryngotracheobronchitis.
    Date December 1982
    Journal Pediatrics
    Title Hemophilus Influenzae Epiglottitis Occurring Concurrently in Two Siblings.
    Date December 1982
    Journal Clinical Pediatrics
    Excerpt

    Epiglottis (more properly supraglottitis) is a potentially life-threatening infection of the supraglottic larynx that is most often caused by Hemophilus influenzae type B (HITB). Intrafamily spread of HITB disease has been described often for meningitis, but is rarely reported in epiglottis. We describe two siblings seen concurrently with HITB epiglottitis and discuss prophylaxis of family members and close contacts.

    Title The Speech Pathologist and Management of Children with Tracheostomies.
    Date May 1982
    Journal The Journal of Otolaryngology
    Excerpt

    Troublesome airway problems necessitating the presence of a tracheostomy for extended periods of time are now not uncommon in children. To date, little attention has been devoted to the communication problems these young patients encounter. Experience with 44 children with tracheostomies, some of whom are ventilator-dependent, at the Children's Hospital of Philadelphia has enabled us to develop a therapy program that we feel would be useful to other speech professionals treating such patients. The speech pathologist must take an active role in the evaluation and management of these patients and the education of the family and hospital staff. The ultimate goal is to provide communicative and feeding skills to these handicapped children.

    Title Unsuspected Esophageal Foreign Bodies in Adults with Upper Airway Obstruction.
    Date September 1981
    Journal Chest
    Excerpt

    Esophageal foreign bodies rarely cause respiratory distress in adults. While it is well known that upper airway obstruction can occur with esophageal foreign bodies in children, the otorlaryngologic literature mentions little of this problem in older patients. Two adults with airway obstruction from unsuspected esophageal foreign bodies are described, with emphasis on the problems of diagnosis and management. The possibility of an unsuspected esophageal foreign body should be kept in mind during the evaluation of respiratory distress in an adult, especially in one who is a poor historian or has a history of a psychiatric disorder. Early endoscopic removal in the treatment of choice, although esophagotomy may be required.

    Title Management of Neoplasms of the Head and Neck in Children. Ii. Malignant Tumors.
    Date September 1981
    Journal Head & Neck Surgery
    Excerpt

    The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidisciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. This article outlines the types of malignant neoplasms that occur in childhood and discusses current approaches to therapy.

    Title Management of Neoplasms of the Head and Neck in Children. 1. Benign Tumors.
    Date August 1981
    Journal Head & Neck Surgery
    Excerpt

    The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidisciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. The purposes of this paper are to outline the types of benign and malignant neoplasms that occur in childhood and to discuss current approaches to therapy.

    Title Malignant Schwannoma of the Neck.
    Date July 1981
    Journal Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology
    Title Hemangiomas of the Head and Neck in Children - a Guide to Management.
    Date March 1981
    Journal The Journal of Otolaryngology
    Excerpt

    Hemangiomas are the most common benign tumor of childhood occurring in the head and neck. The vast majority of these lesions are noted in the neonatal period and are a frequent cause for parental concern. Appropriate management requires familiarity with the varied types of lesions and syndromes, their natural histories, and their proven treatments. In general, treatment should remain conservative except when there is mechanical obstruction of the airway, hemorrhage, infection, tissue loss, or threatened cardiovascular decompensation. A review of the literature is presented with anatomic descriptions, classification, and discussion of treatment modalities. Special emphasis is placed on the diagnosis and treatment of the often life-threatening subglottic hemangioma.

    Title Chemotherapy in the Management of Childhood Cancer of the Head and Neck: Indications and Results.
    Date February 1981
    Journal Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology
    Title Neonatal Submandibular Sialadenitis.
    Date February 1981
    Journal American Journal of Otolaryngology
    Excerpt

    Abscess of the salivary glands in the neonatal period is a rare occurrence and almost always involves the parotid gland. A case of suppurative sialadenitis and abscess involving the submandibular gland in a neonate is presented. The diagnosis and management of this uncommon disease are discussed. A review of the literature revealed only three cases of isolated submandibular sialadenitis in neonates.

    Title Peritonsillar Abscess: a Complication of Corticosteroid Treatment in Infectious Mononucleosis.
    Date January 1981
    Journal International Journal of Pediatric Otorhinolaryngology
    Title Hemoptysis in Children.
    Date January 1981
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Hemoptysis is uncommon in the pediatric age group. There is little mentioned regarding this problem in either the pediatric or the otolaryngologic literature. A review of the past ten years' experience at the Children's Hospital of Philadelphia identified 40 patients whose presenting symptoms included hemoptysis. Causes of the hemoptysis included tumor, infection, trauma, and foreign bodies, as well as a variety of other conditions. Based on these findings, a systematic approach to the diagnostic evaluation of the pediatric patient with hemoptysis has been developed. A thorough endoscopic examination of the upper aerodigestive tract is essential in most cases, and can have both diagnostic and therapeutic value. Particular attention is directed toward airway management in patients with massive hemorrhage. Close cooperation among the bronchoesophagologist, pediatrician, and anesthesiologist is mandatory for optimal care of the child with hemoptysis.

    Title Epiglottitis: Evolution in Management During the Last Decade.
    Date February 1980
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    In the past decade, changes have occurred in the management of epiglottis. A ten-year retrospective study of 64 patients admitted to the Children's Hospital of Philadelphia with the diagnosis of epiglottis was performed. An evolution in the management of epiglottitis was demonstrated in this series of patients. The morbidity and mortality of currently employed modes of airway management (medical observation, endotracheal intubation or tracheostomy) were complication than treatment with tracheostomy. A small, select group was conservatively managed with close observation. The use of antibiotics and steroids was analyzed. Suggested guidelines for management of epiglottitis are presented.

    Title Ewing's Sarcoma Metastatic to the Sphenoid Sinus.
    Date October 1979
    Journal Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology
    Title Oncocytoma of the Maxillary Sinus.
    Date June 1979
    Journal The Laryngoscope
    Excerpt

    A case of oncocytoma of minor salivary gland origin of the left maxillary sinus is presented. No previous reports of oncocytoma confined entirely to the maxillary sinus were found in an extensive computerized search (Medline and Cancerline) of the world literature. The diagnosis and management of these histologically benign but locally aggressive tumors occurring in the head and neck are discussed.

    Title Neurogenic Sarcoma of the Head and Neck.
    Date June 1979
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    We discuss our experience in the diagnosis and management of seven cases of neurogenic sarcomas of the head and neck. These uncommon tumors, which affect all ages, arise most frequently from the brachial plexus, sympathetic chain, and the cranial nerves or their branches. An enlarging mass is the most common initially appearing symptom. Diagnosis may be difficult and rests heavily on gross evidence of a relationship between the tumor and its nerve of origin. Histologically, the lesions are composed of spindle cells with varying degrees of pleomorphism in a pattern that is frequently undistinguishable from fibrosarcomas. Ultrastructural studies may be helpful in establishing the neurogenic origin of these tumors. Neurogenic sarcoma of the head and neck has an extremely poor prognosis. Surgery remains the cornerstone of treatment, although radiotherapy is important for palliation.

    Title Neurilemoma of the Brachial Plexus.
    Date June 1979
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Title Airway Management in the Repair of Craniofacial Defects.
    Date March 1979
    Journal The Cleft Palate Journal
    Excerpt

    The operative repair of craniofacial defects presents the surgeon with critical problems regarding airway management. Thirty-seven per cent of our series of 100 children operated upon for a variety of cranofacial deformities had some difficulty in airway management. Those patients with mandibular dysostoses and those requiring midface advancement (Le Fort III) had the highest incidence of airway problems. Our suggested management of the airway is described with emphasis upon the importance of close cooperation between the plastic surgeon, otolaryngologist and anesthesiologist.

    Title Complications of Orbital Floor Implants.
    Date September 1978
    Journal Transactions of the Pacific Coast Oto-ophthalmological Society Annual Meeting
    Title Management of Brachial Plexus Tumors.
    Date December 1977
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Brachial plexus neoplasms are uncommon. When this diagnosis is suspected, the functional and anatomical integrity of the brachial plexus and cervical spinal cord must be carefully assessed. A thorough search for other signs of neurofibromatosis (von Recklinghausen's disease) must also be completed. The distinction between neurilemoma and neurofibroma is an important and useful one to know. Evaluation by a pathologist who is well versed in neural tumors is mandatory for appropriate treatment of these usually benign lesions. Surgical intervention, adequately prepared on the basis of the patient's age, the amount of neural impairment, and the extent and histology of the tumor requires a surgeon who is experienced in peripheral nerve surgery and in microdissection techniques. Long-term follow-up is necessary to monitor the growth of known tumors, the detection of malignant change, and the appearance of other stigmata of von Recklinghausen's disease.

    Title Predicting Hearing Loss from Stapedial Reflex Thresholds in Patients with Sensorineural Impairment.
    Date October 1977
    Journal Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology
    Excerpt

    We have demonstrated the elevated reflex thresholds and decreased bandwidth effect in listeners with sensorineural hearing loss, and we have extended this generalization to include those with hearing loss related to presbycusis. A bivariate plotting method has been described for predicting hearing loss from reflex threshold data that is characterized by a low rate of false positives, while successfully identifying those with a moderate degree of hearing loss (greater than 32 dB) more than 80% of the time. We found no evidence of decreasing reflex threshold with age. Instead, our reflex thresholds for normal hearing subjects tend to remain the same or increase slightly as age increases. It is hoped that these findings will stimulate further work to correlate reflex thresholds with hearing levels. This information should be used to test infants (especially those at high risk for hearing loss) and other subjects unable to respond to conventional audiometric testing.

    Title Quinidine Hepatitis.
    Date August 1975
    Journal Archives of Internal Medicine
    Excerpt

    Long-term administration of quinidine was associated with persistent elevation of serum concentrations of SGOT, lactic acid dehydrogenase, and alkaline phosphatase. Liver biopsy showed active hepatitis. Discontinuance of quinidine therapy led to normalization of liver function tests. A challenge dose of quinidine caused clinical symptoms and abrupt elevation of SGOT, alkaline phosphatase, and lactic acid dehydrogenase values. We concluded that this patient had quinidine hepatotoxicity and believe that this is the first case reported with liver biopsy documentation. This report also suggests that, even after long-term administration, the hepatic toxicity is reversible.

    Title Persistent Circadian Rhythmicity of Protein Synthesis in the Liver of Starved Rats.
    Date January 1972
    Journal Experientia
    Title Attempts to Augment Thyrotropin Secretion. Effects of Methimazole, Methimazole-iodide, Vasopressin, and Glucagon.
    Date August 1970
    Journal Metabolism: Clinical and Experimental
    Title Diurnal Incorporation of 3h-leucine into Liver Protein.
    Date
    Journal Febs Letters

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