Ari Goldsmith - Academia.edu (original) (raw)

Papers by Ari Goldsmith

Archives of Otolaryngology-head & Neck Surgery, Oct 1, 1997

To evaluate changes in health-related quality of life for children with otitis media. Cohort stud... more To evaluate changes in health-related quality of life for children with otitis media. Cohort study using a 6-item quality-of-life survey (OM-6) representing the domains of physical suffering, hearing loss, speech impairment, emotional distress, activity limitations, and caregiver concerns. Hospital-based pediatric otolaryngology practice in a metropolitan area. One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media. The OM-6 was completed at entry by the child's caregiver and again at least 4 weeks after routine clinical care. Otoscopic findings, static admittance, tympanometric width, audiometric thresholds, and ear-related global quality of life (10-point visual scale) were recorded concurrently. Test-retest reliability, construct validity, and responsiveness to longitudinal change of the OM-6 survey score (mean value of the 6 items). Excellent test-retest reliability was obtained for the survey score (R=0.87) and individual survey items (R> or =0.71). The median survey score was 2.8 (95% confidence interval, 2.7-3.0) of a maximum 7.0, with higher values indicating poorer quality of life. Construct validity was shown by significant correlations between the survey score and global ear-related quality of life (R=-0.64), between physical suffering and physician visits in the past month (R=0.47), and between caregiver concerns and antibiotics consumed in the past month (R=0.26). The mean change in survey scores after tympanostomy tubes was 1.7, with a standardized response mean of 1.7 (95% confidence interval, 1.4-2.0), indicating large responsiveness to change. The change score was reliable (R=0.82) and correlated well with the degree of reported clinical change (R=0.66). The OM-6 is a valid, reliable, and responsive measure of quality of life for children with otitis media. The brevity and ease of administration make the OM-6 ideal for use in outcomes studies, clinical trials, and routine clinical care.

Clínicas pediátricas de Norteamérica, 2003

International Journal of Pediatric Otorhinolaryngology, Oct 1, 2012

International Journal of Pediatric Otorhinolaryngology, Mar 1, 1999

Sternocleidomastoid tumor of infancy (SCMTI), also known as fibromatosis colli or muscular tortic... more Sternocleidomastoid tumor of infancy (SCMTI), also known as fibromatosis colli or muscular torticollis, is the most common cause of congenital torticollis. It is present in approximately 0.4% of live births, and usually 90% of patients will have a good prognosis if therapy is initiated and continued for the appropriate period of time. This paper presents two cases of SCMTI and explains the diagnostic modalities and treatment options for this entity. SCMTI should be diagnosed early in the infant's life, since early detection and initiation of conservative treatment leads to resolution of the disease in the majority of patients.

Ear, nose, & throat journal, May 1, 2006

Laryngomalacia, the most common congenital laryngeal anomaly, is not a single disease entity but ... more Laryngomalacia, the most common congenital laryngeal anomaly, is not a single disease entity but rather a variety ofentities along a spectrum of underlying pathophysiologies. Based on our study of 10 children who weresurgically treatedfor laryn gomalacia in an urban tertiary carecenter; we have developed a system of classifying laryngomalacia on the basis of its different underlying pathophysiologic processes. Type I laryngomalacia is characterized by a fo reshortened or tight aryepiglottic fo ld. Type 2 disease is defined by the presence of redundant soft tissue in the supraglottis. The type3 designationapplies to cases caused by other etiologies, such as underlying neuromuscular disorders. While the three types are not mutually exclusive, each should be considered as a separate disease entity with a final common clinical presentation. Each type requires a specific approach to surgical repair:

Pediatric Clinics of North America, Apr 1, 2003

Otolaryngology-Head and Neck Surgery, Aug 1, 1997

Objective: k humanitarian mission to Kiev Ukraine to assess the possibility of creating a compreh... more Objective: k humanitarian mission to Kiev Ukraine to assess the possibility of creating a comprehensive treatment center to help manage the epidemic of children with thyroid cancer from the Chernobyl explosion (April 26, 1986). Meetings with health officials and humanitarian organization heads allowed the examination of 22 children with advanced thyroid cancers requiring further treatment not available in Ukraine. Methods: A travel grant allowed a head and neck surgeon and an otolaryngology chief resident fluent in Ukrainian to spend 2 weeks at a screening clinic and perform examinations and flexible fiber-optic endoscopy on 22 children with airway complications from their treated thyroid cancers. In addition, arrangements were made for observations at the national otolaryngology research institute to become familiar with the local medical environment.

Pediatric Research, Apr 1, 1996

Operative Techniques in Otolaryngology-head and Neck Surgery, Jun 1, 1999

The transpalatal approach to the nasopharynx is well suited for juvenile nasopharyngeal angiofibr... more The transpalatal approach to the nasopharynx is well suited for juvenile nasopharyngeal angiofibroma limited to the nasopharynx, with minimal extension to the sinuses or pterygopalatine fossa. It offers excellent exposure to this region, with minimal morbidity and excellent cosmetic results. This article will describe the indications for the transpalatal approach, as well as the surgical technique and possible complications.

Archives of Otolaryngology - Head and Neck Surgery, 1997

Laryngoscope, Apr 1, 2003

Objective To determine the current practices of preoperative evaluation, surgical techniques, and... more Objective To determine the current practices of preoperative evaluation, surgical techniques, and postoperative treatment of pediatric adenotonsillectomy.Study Design Forty‐one‐item survey measuring the frequency of different evaluations, procedures, and treatments performed, including selected case scenarios, with all items scored on a five‐point ordinal scale ranking frequency.Methods The entire membership of the American Society of Pediatric Otolaryngology (ASPO) and active fellows and members of the American Academy of Otolaryngology—Head and Neck Surgery (AAO–HNS) residing in New York state were anonymously surveyed through mail‐in questionnaires.Results History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea. The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count; ASPO members ordered fewer preoperative laboratory tests than AAO–HNS members. Unipolar cautery is the most frequently used tonsillectomy technique, and curettage followed by cautery is the most popular adenoidectomy technique. Steroids are the most common intraoperative medication administered during an adenotonsillectomy, and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively.Conclusions Although there are statistically significant trends uncovered by the survey, the results reflect a lack of consensus regarding adenotonsillectomy management. Further randomized controlled trials or large‐scale outcomes projects are much needed to evaluate critically the current practices of pediatric adenotonsillectomies. Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns, moving us toward a more evidence‐based paradigm of treating pediatric adenotonsillar disease.

International Journal of Pediatric Otorhinolaryngology, 1999

Archives of otolaryngology--head & neck surgery, 1992

Although many children with otolaryngologic (ENT) symptoms are being treated for gastroesophageal... more Although many children with otolaryngologic (ENT) symptoms are being treated for gastroesophageal reflux (GER), how to diagnose GER in children with primarily or exclusively ENT symptoms has yet to be determined. This study compares the incidences of pathologic GER in the upper verses the lower esophagus in a cohort of children with ENT symptoms that were screened for GER. The results of extended dual channel intraesophageal pH probe monitoring obtained from 14 infants and 14 children with ENT symptoms were retrospectively analyzed. The percent of total monitoring time that the pH was less than 4, reflux index (RI) was determined. The upper limits of normal distal and proximal esophageal RI were based on published data. To evaluate our results, upper esophageal reflux (UER) was also determined in 27 infants and children without ENT or pulmonary symptoms, who had normal lower esophageal reflux (LER) values. Mean upper esophageal RIs in the infants and children with normal LER were similar to previously published values for control infants and adults. Four (29%) of the ENT infants, 11 (79%) of the older ENT children, and 54% of the entire cohort had increased esophageal acid exposure. However, nine (60%) of the 15 pediatric ENT patients with GER had pH abnormalities limited to the upper esophagus. Standard distal pH probe monitoring alone gives a false negative result in a substantial proportion of the infants and children with ENT symptoms being evaluated for GER. Beyond its value in clinical practice, UER testing should be employed in research studies that evaluate the impact of GER therapy on ENT symptoms.

International Journal of Pediatric Otorhinolaryngology, 2012

Archives of Otolaryngology–Head & Neck Surgery, 1998

Setting: Hospital-based pediatric otolaryngology practice in a metropolitan area. Patients: One h... more Setting: Hospital-based pediatric otolaryngology practice in a metropolitan area. Patients: One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media enrolled in a quality-of-life study. Intervention: Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audiometric thresholds were recorded concurrently. Fifty children were reassessed to monitor changes in hearing. Main Outcome Measure: Correlation of parent hearing assessments with baseline hearing status (pure tone average for the better hearing ear) and with changes in hearing status. Results: The hearing loss questions had good test-retest reliability (R = 0.79) but did not correlate with audiometric results (R = −0.13; P = .09). Only when caregivers reported hearing to be an "extreme problem" were median hearing levels (31 dB) significantly greater than the median response (20 dB). Conversely, static admittance and tympanometric gradient were significant predictors of hearing levels (2-way analysis of variance, PϽ.01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predictive value for hearing loss (20-dB hearing level or poorer), and normal immittance measures in both ears had a 76% predictive value for normal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R = 0.07; P = .65). Conclusions: Caregiver assessments of child hearing do not accurately predict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.