Objective: To evaluate the results of our multidisciplinary approach to recurrent croup and chronic cough. Methods: Retrospective chart review of all patients with recurrent croup and chronic cough managed at a tertia...
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Objective: To evaluate the results of our multidisciplinary approach to recurrent croup and chronic cough. Methods: Retrospective chart review of all patients with recurrent croup and chronic cough managed at a tertiary care children's hospital by our Comprehensive Airway, Respiratory, and Esophageal (CARE) Team. Charts were reviewed for all patients who carried a diagnosis of recurrent croup or chronic cough. Patients were excluded if they did not receive a full workup, including micro-direct laryngoscopy, flexible and/or rigid bronchoscopy, bronchioalveolar lavage (BAL), and upper endoscopy with biopsies. We reviewed the records for the presence of gastrointestinal complaints, abdominal pain and failure to thrive (FTT) and compared the children with documented esophagitis to the remaining children. Results: Forty patients met inclusion criteria. 53% had airway abnormalities;the most common was tracheomalacia, followed by enlarged adenoids. 38% had esophagitis (group 1) while 62% had normal esophageal biopsies (group 2). Among the children in group 1, 27% met criteria for eosinophilic esophagitis (>15 eosinophils per high powered field). There was no significant difference between groups 1 and 2 based on the presence of gastrointestinal complaints, abdominal pain and/or FTT (p > 0.05). There was no significant difference between the groups based on the location or presence of an airway abnormality (p > 0.05). Conclusions: Children with recurrent croup and chronic cough may benefit from a multidisciplinary approach to management. Our CARE Team approach led to a specific diagnosis in almost 95% of patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
In human cases, visual suppression was sometimes temporarily abolished immediately after a sudden loss of unilateral inner ear function. The suppression, however, gradually recovered and reached a normal value within ...
Zur wirtschaftlichen Verordnungsweise gehört laut einem Urteil des Sozialgerichts Magdeburg nicht nur die Wahl des richtigen Arzneimittels, sondern auch die der preisgünstigsten Bezugsquelle. Sonst droht ein...
Zur wirtschaftlichen Verordnungsweise gehört laut einem Urteil des Sozialgerichts Magdeburg nicht nur die Wahl des richtigen Arzneimittels, sondern auch die der preisgünstigsten Bezugsquelle. Sonst droht ein Regress.
Objectives: Non-echo-planar diffusion weighted magnetic resonance imaging (Non-EPI DWI MRI) is commonly used for follow-up after cholesteatoma surgery. MRI has a critical role in the evaluation of residual disease, wh...
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Objectives: Non-echo-planar diffusion weighted magnetic resonance imaging (Non-EPI DWI MRI) is commonly used for follow-up after cholesteatoma surgery. MRI has a critical role in the evaluation of residual disease, where physical examination will commonly demonstrate an intact tympanic membrane. The aim of our study was to assess the timing of residual cholesteatoma identification on serial MRI scans and the yield of MRI follow up after canal wall up tympano-mastoidectomy. Methods: A retrospective chart review of children that underwent canal wall up tympano-mastoidectomy due to cholesteatoma in Schneider Children's Medical Center during 2004-2016, and were followed up both clinically and with MRI. Results: Seventy-seven children (89 ears) were included, who altogether underwent 166 surgeries (77 revisions). Average follow-up was 66 +/- 34.4 months. During follow up, 244 scans were performed;19 cases of residual disease were diagnosed by MRI and confirmed in surgery. The mean time from surgery and an MRI positive for residual disease was 29.7 +/- 16 months (range: 10-66). In 9/19 cases (47%), at least one negative MRI preceded the scan positive for residual disease, and in 4 cases at least two initial scans were negative. Conclusions: MRI plays an important role in the diagnosis of residual disease after cholesteatoma surgery. In our cohort. Almost half of the cases diagnosed with residual disease had at least one negative scan prior to the positive one, emphasizing the importance of close radiological follow-up with serial scans after surgery.
Obstructive sleep apnea (OSA) syndrome is a destructive and insidious entity mostly underdiagnosed and undertreated. It affects not only individuals but the society as a whole. The costs to the populations can be meas...
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Obstructive sleep apnea (OSA) syndrome is a destructive and insidious entity mostly underdiagnosed and undertreated. It affects not only individuals but the society as a whole. The costs to the populations can be measured not only in morbidity and mortality but also in the financial wellbeing of a society. Financial burden of this disease is staggering. The social fabric of society is also greatly impacted. Physiologic effects of OSA are far reaching. It has been shown that early intervention with treatment of OSA can often prevent and/or reverse many of the negative outcomes associated with this condition.
Puberphonia or mutational falsetto is a voice disorder seen in male adolescents. It is defined as the failure of the voice to change from the high pitch of early childhood to the low pitch of adulthood. Puberphonia is...
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Puberphonia or mutational falsetto is a voice disorder seen in male adolescents. It is defined as the failure of the voice to change from the high pitch of early childhood to the low pitch of adulthood. Puberphonia is usually treated with voice therapy (with or without adjunctive laryngeal manipulation) and psychological counseling. Small series of surgical treatments have also been described. We present the first report of bilateral in-office injection laryngoplasty with hyaluronic acid with voice therapy to treat a 22-year-old male with puberphonia that had not responded to voice therapy. The subject presented with a speaking fundamental frequency of 152 Hz, which decreased to 102 Hz immediately after bilateral injection laryngoplasty and has been maintained at 108 Hz after 24 months.
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