摘要:

AbstractThe incidence of Down's syndrome is estimated at 1.5 per 1000 births, or 7,000 newborns annually in this country. Mounting financial considerations in the delivery of medical care, as well as humanitarian considerations, fostered this in‐depth prospective, multidisciplinary study. One hundred and seven patients comprised the initial group, and 83 met the criteria established for documentation of otorhinolaryngological parameters. All patients were home based and given scheduled, routine pediatric care. Otolaryngology care, when indicated, was by consultation. The uniqueness of this study exists in the fact that children were followed from the first year of life, in what must be considered an enhanced environmental setting for Down's syndrome patients.Otologic, rhinologic and laryngologic parameters were explored in‐depth with the following resultant data. Patients with stenotic ear canals had a markedly increased incidence of associated middle ear effusion. In addition, patients with an increased frequency of upper respiratory tract infections in association with stenotic canals had an even greater incidence of effusion. When stenotic canals were present, the diagnosis of fluid proved difficult for the primary care physician. The total incidence of conductive middle ear pathology was shown to be significantly lower than in most reported studies. Equally important was the fact that at the time of data computation, none of the children had active, chronic middle ear pathology and cholesteatoma had not been identified.Adenoidectomy was shown clinically to have little apparent effect on the course of otologic pathology, nasal respiration or rhinorrhea in Down's syndrome. Previously unreported surgical correlates of the nasopharyngeal anatomy were related to upper respiratory obstructive symptoms manifest by many of these children. Apparent, spontaneous resolution of the latter, in most instances with age, correlated well with anticipated changes in the growth of the involved structures. Low dose antibiotic therapy was shown to be of benefit in controlling early rhinorrhea.Isolated congenital abnormalities of the lower respiratory tract were discussed with the findings that symptoms related to the respiratory tract must not be assumed to be inherent to the syndrome until other potential etiologies have been thoroughly considered.Factors relating to intelligence in Down's syndrome were explored with the conclusion that a direct and favorable comparison could be made in this study between improved hearing and improved intell

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00001

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractA clinical‐pathological discussion of three lymphoreticular neoplastic diseases is presented, with illustrative case histories. These are 1. malignant rnidline reticulosis; 2. extra‐medullary plasmacytom; 3. histiocytic lymphoma. Responsibility for exact diagnosis rests with the otolaryngologist to provide accurate and representative biopsy material for the pathologist. Because of the rarity of the disorders, the pathologist is entitled to repeat biopsies and consultations as needed. Although treatment is at the hands of others — oncologists and radiation therapists — the examining expertise of the otolaryngologist is essential in the care of these p

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00002

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractA comparison of pertinent features of three types of rhinitis, with emphasis on etiology and immunologic factors, is made. Separation of nasal allergy from vasomotor rhinitis and from nasal polyposis is attempted. The ambiguity of terms used by various authors, which has caused confusion in the classification of rhinitis, is noted. It is the author's opinion that allergic rhinitis, vasomotor rhinitis and nasal polyposis are nasal diseases with their own identity in the majority of instances. However, this identity is not always clearly evident. Too often, allergic principles of treatment, particularly immunotherapy, are advised, and not found to be helpful.

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00003

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractStudies of the effects of nasal respiration on the lower respiratory tract, and on metabolic processes generally, have largely been confined to those occurring during inspiration. Expiration through the nose has equally profound effects and has been studied in detail in some animals.Under certain circumstances both heat and water loss from the body can be altered by changes in the nasal mucosa. These changes appear to be under the control of the autonomic nervous system and are influenced by the need to balance heat loss with heat production.The clinical and ecogeographical significance of these findings are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00004

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThe diagnosis of rhinitis medicamentosa was made in 130 patients seen over a 10 year period from July 1967 to June 1977. There was an incidence of 1% in our otolaryngological practice. Patients had been taking the causal medication for an average of 21.4 months. There were 73 males and 57 females with the peak incidence in young and middle‐age adults. The primary offending medications were decongestant nasal sprays in 85 patients, decongestant drops in 33, and a combination of these drugs in 12 patients. The major reasons for self‐medication were 1. deviated nasal septum in 40 patients, 2. an acute upper respiratory infection in 33, 3. allergy in 18, 4. miscellaneous causes in 24 and 5. unknown in 15 patients. The initial management in addition to avoidance of the medication consisted of systemic antibiotics, decongestants, antihistamines, and sedatives depending on the severity of the rhinitis and the presence of secondary infection. Later treatment consisted of correction of the deviated septums, allergic management, and supportive care. Eight patients were considered to have complications of the disease by development of chronic ethmoiditis and nasal polyposis. The pharmacologic properties of the causal agents are thoroughly reviewed as they relate to the pathogenesis of this disease. It is felt that the ready commercial availability and limited clinical value of the topical nasal sprays and drops represents a certain risk to all patients using t

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00005

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThere is a dearth of factual information relating to the effect of the external gaseous environment on the mucosa of the upper respiratory tract. This paper is an attempt to gather some factual information in this regard. It is suggested that the mucus transport time is a meaningful index of the ability of the ciliated nasal mucosa to cope with the environmental challenges. Further, it is suggested that a depressed transport time may be one step in nasal disease induction.

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00006

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThe purpose of this paper is to present a technique of endonasal puncture and stenting for bilateral choanal atresia in the neonate that is easily performed and may be definitive. The procedure described is original only in its details, its broad principles are well known. A method of placing the nasal stent is reported that is particularly applicable in the premature, even as small as five pounds. No antibiotics or steroids are given in the postoperative period. Three months is the recommended duration of stenting.Four patients were operated on using this technique, between July 1978 and August 1979; 3 were complete successes; 1 was a bilateral failure, but was re‐operated on and was then a unilateral success. Shortest follow‐up was 16 months.We feel endonasal puncture and stenting of bilateral choanal atresia in the neonate can be definitive, and is the first procedure of cho

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00007

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractExcellent exposure of the structures of the middle third of the face can be obtained without external skin incisions by combining the basic incisions of rhinoplasty with a wide sublabial incision. In this way the bony structures of the middle third of the face can be completely uncovered. The interior of the nose and sinuses can be exposed simultaneously in the same field, and the perpendicular process of the palatine bone can be removed to provide unusually good access to the nasopharynx. Compared to lateral rhinotomy it is quicker both to open and to close, exposure is better, blood loss is less and there is no visible scar.

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00008

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractIntranasal as well as external nasal repair is desirable in the total repair of the unilateral cleft palate nose and in many instances can be achieved concurrently. Carefully performed septal reconstruction will correct the nasal obstruction due to the severe septal deviation to the cleft side and the usual caudal dislocation to the uninvolved side. Since a minimal amount of cartilage is removed, good support is Mayntained for the cartilaginous dorsum. Appropriate management of the turbinates, including extraction, infraction, submucous intramural electrocoagulation, or partial submucous resection will improve the functional result. Because of the better positioning of the septum, some of the alar and columellar abnormalities may be cosmetically improved, and repositioning of the ala or columella will enhance the esthetic appearance.

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00009

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractA review of the medical and surgical management of 195 patients with Meniere's disease is presented. In order to avoid a piecemeal approach to the problem of Meniere's disease, the “whole” patient must be treated. Psychological counseling, medical management, and when indicated selective surgical management is advocated. The diagnosis of Meniere's must be confirmed through careful history, physical, neurotological evaluation and selective testing.The majority of patients can be controlled medically; however, in this study 52 (26%) patients underwent surgical therapy. Twenty‐eight patients underwent some type of saccus surgery for Meniere's disease with overall relief of 71%; however, better relief of vertigo was seen with labyrinthectomy and nerve section. The most common indication for surgery was disabling vertigo. However, fluctuating progressive sensorineural loss, may be an important reason to advise surgery.Surgical techniques for Meniere's disease continue to evolve. A graduated approach is preferred, starting with endolymphatic‐mastoid shunt, proceeding to middle fossa vestibular nerve section when medical status and hearing are adequate. When hearing is socially inadequate, labyrinthectomy with or without yestibular nerve section is preferred. A good working relationship with a neurosurgeon is advised for otolaryngologists performing middle fossa

ISSN:0023-852X    

DOI:10.1288/00005537-198110000-00010

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY