Steven Handler - Academia.edu (original) (raw)

Papers by Steven Handler

Genetic counseling (Geneva, Switzerland), 1999

A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients w... more A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes, and in some patients with the Opitz G/BBB and Cayler cardiofacial syndromes. We have been involved in the analysis of DiGeorge syndrome and related diagnoses since 1982 and have evaluated a large number of patients with the deletion. We describe our cohort of 250 patients whose clinical findings help to define the extremely variable phenotype associated with the 22q11.2 deletion and may assist clinicians in providing genetic counseling and guidelines for clinical management based on these findings.

Archives of Otolaryngology-head & Neck Surgery, May 1, 1992

A retrospective chart study was conducted to determine the diagnostic yield of temporal bone imag... more 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.

Archives of Otolaryngology–Head & Neck Surgery, 1998

To describe the clinical presentations and discuss the guidelines for surgical management of pilo... more To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. Design: Retrospective study. Setting: A tertiary care center. Patients: Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n = 38) between 1989 and 1997. Intervention: All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n = 11) or without (n = 23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. Results: In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twentynine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). Conclusions: Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.

Archives of Otolaryngology - Head and Neck Surgery, 1979

We discuss our experience in the diagnosis and management of seven cases of neurogenic sarcomas o... more 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.

International journal of pediatric …, 2001

Post-traumatic perilymphatic fistulas have been described following ear and temporal bone injury,... more 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 ...

Granular cell tumors are rare, usually benign tumors of controversial histogenesis. These tumors ... more 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.

Journal of the American Medical Directors Association, Jan 11, 2016

There is growing evidence that Health Information Technology (HIT) can play a role in improving q... more There is growing evidence that Health Information Technology (HIT) can play a role in improving quality of care and increasing efficiency in the nursing home setting. Most research in this area, however, has examined whether nursing homes have or use any of a list of available technologies. We sought to develop an empirical framework for understanding the intersection between specific uses of HIT and clinical care processes. Using the nominal group technique, we conducted a series of focus groups with different types of personnel who work in nursing homes (administrators, directors of nursing, physicians, mid-level practitioners, consultant pharmacists, and aides). The resulting framework identified key domain areas that can benefit from HIT: transfer of data, regulatory compliance, quality improvement, structured clinical documentation, medication use process, and communication. The framework can be used to guide both descriptive and normative research.

Saliva and serum electrolyte concentrations were monitored in 30 patients given a course of xeros... more Saliva and serum electrolyte concentrations were monitored in 30 patients given a course of xerostomia-producing cancer radiotherapy. The mean flow rate of stimulated whole saliva decreased 83.3% during a 6-week treatment period. The striking reduction in saliva output was accompanied by significant increases in saliva Na+, Cl-, Ca++, Mg++ and Prot.- concentrations and by a decrease in saliva HCO3- content. The xerostomic saliva was more concentrated and had a greater salinity than the pretreatment saliva in each instance. In contrast, none of the serum electrolytes measured was significantly altered by the subtotal salivary shutdown.

Oral surgery, oral medicine, and oral pathology, 1973

Archives of Otolaryngology - Head and Neck Surgery, 1977

Brachial plexus neoplasms are uncommon. When this diagnosis is suspected, the functional and anat... more 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.

Annals of Emergency Medicine, 1982

Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus p... more Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus pneumoniae was the predominant organism recovered (63%). Three cases of Hemophilus influenzae, alone or in combination with S pneumoniae, were identified. Other organisms found were Staphylococcus albus, Neiserria species, Group A B-hemolytic Streptococcus, and anaerobes. In four patients (I3%) no organism was recovered. All isolates were ampicillin susceptible. No relationship was found between WBC, temperature, or age and the organism recovered. Tympanocentesis did not provide any information resulting in an alteration of therapy. Tympanocentesis may he indicated for relief of pain or for periodic surveillance of organism sensitivities, but is not justified in the emergency department for uncomplicated acute otitis media.

Archives of Otolaryngology Head and Neck Surgery, May 1, 1992

A retrospective chart study was conducted to determine the diagnostic yield of temporal bone imag... more 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.

Transactions of the Pacific Coast Oto-Ophthalmological Society annual meeting

Otolaryngology Head and Neck Surgery

A prospective controlled pilot study was undertaken in which Biolite (carbon-coated) ventilation ... more 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.

American family physician, 2004

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired chil... more 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, rad...

International journal of pediatric otorhinolaryngology, Jan 15, 2000

Benign lymphoepithelial cysts (BLCs) of the parotid gland are associated with human immunodeficie... more 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.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1999

International journal of pediatric otorhinolaryngology, 1996

Non-tuberculous mycobacterial (NTM) infection is the most common cause of granulomatous inflammat... more 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.

The Annals of otology, rhinology, and laryngology

A retrospective review of a decade of experience with pediatric tracheostomy encompassed 420 chil... more 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.

International journal of pediatric otorhinolaryngology, 1987

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little... more 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.

Genetic counseling (Geneva, Switzerland), 1999

A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients w... more A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes, and in some patients with the Opitz G/BBB and Cayler cardiofacial syndromes. We have been involved in the analysis of DiGeorge syndrome and related diagnoses since 1982 and have evaluated a large number of patients with the deletion. We describe our cohort of 250 patients whose clinical findings help to define the extremely variable phenotype associated with the 22q11.2 deletion and may assist clinicians in providing genetic counseling and guidelines for clinical management based on these findings.

Archives of Otolaryngology-head & Neck Surgery, May 1, 1992

A retrospective chart study was conducted to determine the diagnostic yield of temporal bone imag... more 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.

Archives of Otolaryngology–Head & Neck Surgery, 1998

To describe the clinical presentations and discuss the guidelines for surgical management of pilo... more To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. Design: Retrospective study. Setting: A tertiary care center. Patients: Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n = 38) between 1989 and 1997. Intervention: All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n = 11) or without (n = 23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. Results: In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twentynine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). Conclusions: Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.

Archives of Otolaryngology - Head and Neck Surgery, 1979

We discuss our experience in the diagnosis and management of seven cases of neurogenic sarcomas o... more 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.

International journal of pediatric …, 2001

Post-traumatic perilymphatic fistulas have been described following ear and temporal bone injury,... more 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 ...

Granular cell tumors are rare, usually benign tumors of controversial histogenesis. These tumors ... more 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.

Journal of the American Medical Directors Association, Jan 11, 2016

There is growing evidence that Health Information Technology (HIT) can play a role in improving q... more There is growing evidence that Health Information Technology (HIT) can play a role in improving quality of care and increasing efficiency in the nursing home setting. Most research in this area, however, has examined whether nursing homes have or use any of a list of available technologies. We sought to develop an empirical framework for understanding the intersection between specific uses of HIT and clinical care processes. Using the nominal group technique, we conducted a series of focus groups with different types of personnel who work in nursing homes (administrators, directors of nursing, physicians, mid-level practitioners, consultant pharmacists, and aides). The resulting framework identified key domain areas that can benefit from HIT: transfer of data, regulatory compliance, quality improvement, structured clinical documentation, medication use process, and communication. The framework can be used to guide both descriptive and normative research.

Saliva and serum electrolyte concentrations were monitored in 30 patients given a course of xeros... more Saliva and serum electrolyte concentrations were monitored in 30 patients given a course of xerostomia-producing cancer radiotherapy. The mean flow rate of stimulated whole saliva decreased 83.3% during a 6-week treatment period. The striking reduction in saliva output was accompanied by significant increases in saliva Na+, Cl-, Ca++, Mg++ and Prot.- concentrations and by a decrease in saliva HCO3- content. The xerostomic saliva was more concentrated and had a greater salinity than the pretreatment saliva in each instance. In contrast, none of the serum electrolytes measured was significantly altered by the subtotal salivary shutdown.

Oral surgery, oral medicine, and oral pathology, 1973

Archives of Otolaryngology - Head and Neck Surgery, 1977

Brachial plexus neoplasms are uncommon. When this diagnosis is suspected, the functional and anat... more 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.

Annals of Emergency Medicine, 1982

Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus p... more Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus pneumoniae was the predominant organism recovered (63%). Three cases of Hemophilus influenzae, alone or in combination with S pneumoniae, were identified. Other organisms found were Staphylococcus albus, Neiserria species, Group A B-hemolytic Streptococcus, and anaerobes. In four patients (I3%) no organism was recovered. All isolates were ampicillin susceptible. No relationship was found between WBC, temperature, or age and the organism recovered. Tympanocentesis did not provide any information resulting in an alteration of therapy. Tympanocentesis may he indicated for relief of pain or for periodic surveillance of organism sensitivities, but is not justified in the emergency department for uncomplicated acute otitis media.

Archives of Otolaryngology Head and Neck Surgery, May 1, 1992

A retrospective chart study was conducted to determine the diagnostic yield of temporal bone imag... more 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.

Transactions of the Pacific Coast Oto-Ophthalmological Society annual meeting

Otolaryngology Head and Neck Surgery

A prospective controlled pilot study was undertaken in which Biolite (carbon-coated) ventilation ... more 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.

American family physician, 2004

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired chil... more 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, rad...

International journal of pediatric otorhinolaryngology, Jan 15, 2000

Benign lymphoepithelial cysts (BLCs) of the parotid gland are associated with human immunodeficie... more 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.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1999

International journal of pediatric otorhinolaryngology, 1996

Non-tuberculous mycobacterial (NTM) infection is the most common cause of granulomatous inflammat... more 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.

The Annals of otology, rhinology, and laryngology

A retrospective review of a decade of experience with pediatric tracheostomy encompassed 420 chil... more 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.

International journal of pediatric otorhinolaryngology, 1987

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little... more 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.