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It is clear that infrared transmitting fibers of high quality, with many uses in IR optical systems, can be fabricated from silver halide crystals. The process requires ultrapure starting material and control of extrusion parameters such as temperature and pressure. Under laboratory conditions, fibers have been produced that are usefully transparent from 2-25 /spl mu/m and have a loss coefficient of less than O.2 dB/m at 10.6 /spl mu/m. These fibers are flexible, and can be repeatedly bent into small radii circles without loss of transmission. The material is nontoxic, insoluble in water, and has an adequate shelf life. It is also of low cost and can be considered as a "disposable" if necessary. Lengths of several meters have been extruded, and with larger preforms and couplers, length is not a limitation. Further, much is now known of the optical and mechanical properties, and the possibility of laser-fibers is envisaged. These MIR fibers will be useful in many medical procedures, such as laser surgery, noncontact fiber-optic thermometry, and fiber-optic spectrometry. Fiber-optic medical tools based on MIR fibers will be used for diagnosis, therapy, and surgery in minimally invasive systems.

A 2-year-old boy presented with varices and a neck mass. Imaging studies revealed internal jugular vein aneurysm. Gradual increasing of the mass, potential thrombus formation and cosmetical considerations were indications for surgery. At surgery aneurysms of both the external and internal jugular veins were found and resected.

The variability of the normal velopharyngeal (VP) closure mechanism was studied by investigating VP anatomy in relation to its closure mechanism in 60 patients. The axial configuration of the VP isthmus, as observed in axial CT scans at rest, was found to be correlated with VP function in terms of its closure patterns in speech as observed by nasendoscopy. A flat VP isthmus was found to be closed mainly in the anteroposterior direction, forming the coronal closure pattern. A deep VP isthmus is closed by movement of the velum and medial movement of the lateral pharyngeal walls, forming the circular closure pattern. A flat VP isthmus occurs when the hamuli are posteriorly located and the muscular slings, therefore, open more posteriorly. We conclude that posterior insertion of the velar muscles on to the skull base results in a flatter, larger VP axial configuration, whereas an anterior insertion results in a VP axial configuration that is deeper and less flat. A flat VP isthmus contracts mainly in an anteroposterior direction, exhibiting a coronal closure pattern, while a deep or round VP isthmus contracts centripetally, exhibiting a circular closure pattern. Variability of the VP valving mechanism is of anatomic and not of functional origin.

CO2 laser myringotomy has previously been proven effective in patients with serous otitis media for short-term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. The advantage of CO2 laser energy is the high absorption coefficient in biological tissue, meaning minimal damage surrounding the desired lesion. The disadvantage is that conventional optical fibers do not transmit CO2 laser energy (lambda = 10.6 microns). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 microns. Using a hand-held otoscope coupled to a fiberoptic delivery system, CO2 laser myringotomies were performed in guinea pigs. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a "dose-dependent" relationship was found between the total energy used and the duration of a patent myringotomy. However, conventional histological studies failed to show a difference in circumferential damage with different energy parameters. CO2 laser myringotomy utilizing a hand-held otoscope coupled to an optical fiber capable of transmitting CO2 laser energy may prove simple and effective. The relationship between energy parameters and myringotomy patency may be instrumental in deciding on the optimal duration of aeration of the middle ear in secretory otitis media.

Adenoid hypertrophy is the most common cause of upper airway obstruction and sleep-disordered breathing in children, yet its pathogenesis remains unclear. The identification of the novel helper T cell subsets, Th17 cells and regulatory T cells (Tregs) could provide new insight into our understanding of the mechanisms involved in the development of this condition. The purpose of this study is to evaluate the adenoidal lymphocyte subsets to describe the percentage of various lymphocyte subsets in hypertrophied adenoids and correlate them with symptom severity. Twenty consecutive children undergoing adenoidectomy were included, and lymphocytes were isolated from their adenoids. T cell subpopulations were detected by flow cytometry using a fluoresceinated monoclonal antibody directed against a number of cell markers (CD4+, CD8+, CD25+, FOXP3 IL17+, and others). We found a significant negative linear correlation between the Th17/Treg ratio and the patients' clinical scores (R = -0.71 p < 0.005). The correlation was independent of age and gender. Decreased ratios of Th17/Treg subpopulations may play a role in the pathogenesis of adenoid hypertrophy.

A 7-months-old female presented with coughing spells while feeding. Flexible laryngoscopy revealed a round bluish mass, emanating from the postcricoid area when the child cried or strained and disappeared when she relaxed. She was treated with systemic steroids for a month and was doing well. There was no change in the lesion. On examination at age 18 months the lesion disappeared. In a review of the literature, the authors found 6 articles describing 19 children with postcricoid vascular lesions. Seven children did not have significant related problems and did well without any treatment. Eight cases had significant co-morbidity. Treatment for symptomatic children included systemic or intralesion steroids, laser ablation and open resection. Postcricoid vascular lesion is a rare entity with a typical appearance. The recommended workup includes flexible laryngoscopy and videofluoroscopy. There are several treatment options for symptomatic children.

Using an experimental fiberoptically guided CO2 laser system, we produced lesions on fresh bovine retinas. These lesions were shown to achieve immediate measurable chorioretinal adhesion. This model provides preliminary data on the use of a fiberoptic CO2 laser probe to produce chorioretinal lesions and possible future use in intraocular surgery for retinal detachment. The advantages of using CO2 laser energy are minimal damage surrounding desired lesion and its versatility as a coagulator and cutter. With modifications, CO2 endolaser may have a role in intraocular surgery. © 1992 Wiley-Liss, Inc.

Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development. We present nine children, ages 4–16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. A continuous lumbar drainage was kept for several days, and prophylactic antibiotics and anti-convulsive medications were routinely given. A multidisciplinary approach including discussion before surgery about other surgical options (endoscopic extracranial and intracranial alone) were performed. None of the operated children had episodes of meningitis/leak after the combined approach, suggesting that appropriate sealing of the base of the skull has been achieved. There was no mortality, and the long-term follow-up showed good developmental and cosmetic results. Most of the children had significant brain contusions prior to surgery; however, these did not progress as minimal retraction was enabled by the extensive subcranial and intracranial approach. Child’s age, anatomy of the bone, extent of cranial injury, and clinical parameters should be seriously considered when choosing the technical methods as for sealing base of skull and reconstruction of facial/cranial bones. Young age does not seem to be a contraindication to the combined approach, thus, we recommend considering it in extensive base of skull fractures when concomitant cranial, maxillofacial, and orbital fractures coexist, as alternative options may not suffice in these cases.

Objective Eustachian tube dysfunction and sleep-disordered breathing (SDB) share common pathophysiologic mechanisms. Our objective was to investigate whether children referred for isolated TTI (tympanostomy tube insertion) are at increased risk for snoring and upper airway procedures. Methods Telephone interviews to parents of children who underwent isolated TTI and to age- and gender-matched controls were conducted. Results Four hundred fifty-seven children were included in the study; 352 had isolated TTI (study group) and 105 children were controls. Twenty-two percent of children in the study group were reported to snore compared with 7.6% in the controls ( p =0.001). Eighteen percent of children in the study group were reported to have undergone adenotonsillectomy compared with 4.8% in the controls ( p =0.0005). Future SDB, i.e., either snoring or adenotonsillectomy following TTI, was found in 34% of children in the study group compared with 11% in the controls ( p =0.0004). Children who underwent isolated TTI were at increased risk for future snoring (OR=3.4, CI: 1.6–7.2) and future adenotonsillectomy (OR=4.4, CI: 1.7–11.2). Conclusions Children who undergo isolated TTI are at increased risk for snoring and for adenotonsillectomy. We suggest that these children be followed for symptoms of SDB on a scheduled basis to allow for early diagnosis and intervention.

The cat eye syndrome is a congenital malformation usually associated with anal atresia, ocular coloboma, downward slanting eyes, microphthalmia, hypertelorism, strabismus, preauricular tags or fistulas, congenital heart defect particularly septal defect, urinary tract abnormalities, skeletal anomalies and frequently mental and physical retardation. A small supernumerary chromosome (smaller than chromosome 21) is present, frequently has 2 centromeres, is bisatellited and represents an inv dup 22 (q11). A two years old female presented to our department with an association of cat eye syndrome with preauricular tags and a first branchial arch anomaly. This article discusses the surgical management and the association between the cat eye syndrome and first branchial cleft anomaly.

Fiberoptic flexible laryngoscopy (FFL) is the diagnostic procedure of choice in patients with laryngomalacia. Two techniques can be applied, either when the infant is awake or using anesthesia/sedation. The choice of technique may effect the diagnosis.To compare the two techniques for diagnosing laryngomalacia.A total of 42 infants who underwent awake fiberoptic laryngoscopy for congenital stridor, in whom either laryngomalacia was diagnosed or no cause for stridor was found, underwent a repeat laryngoscopy using anesthesia/sedation. The 84 video recordings of the supraglottic portions were copied onto a videotape along with 25 recordings of normal upper airways without stridor and 31 duplicate cases with stridor. A total of 140 recordings was mixed at random on a videotape. Sound was not included.Three investigators (Y.S., J.B.A., and A.D.) independently scored each recording using a laryngomalacia scoring system (scoring range, 0 to 8).A threshold score of 2 was the optimal cutoff point for discriminating laryngomalacia from normal condition. The awake technique (WT) missed three cases of laryngomalacia and overdiagnosed one healthy control subject. The anesthesia technique was superior with a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100% compared with 93%, 92%, 97%, and 79%, respectively, for the WT.The diagnosis of laryngomalacia with FFL is more accurate using anesthesia/sedation. The WT may be appropriate for screening or for patients with mild cases having a characteristic presentation.

Summary We report a rare case of acute otitis media (AOM) complicated by arterial brain infarction, meningitis and orbital cellulitis. Computed tomography (CT) initially showed suspected epidural abscess, coalescent mastoiditis, and orbital cellulitis. Further clinical deterioration occurred following mastoidectomy and evacuation of the abscess. Magnetic resonance imaging (MRI) revealed subacute brain infarction and an extra-axial brainstem abscess. Revision of the initial CT revealed subtle signs suggestive of arterial brain infarction. Although CT with contrast is the standard of care for suspected AOM complications, MRI should be considered as an adjunct when CT is not definitive and neurological signs are present.

OBJECTIVE To evaluate the long-term results of fat graft myringoplasty in adult and pediatric populations. DESIGN Prospective case series study. MAIN OUTCOME MEASURES Patients with chronic tympanic membrane perforations were considered candidates for fat graft myringoplasty. Excluded were patients with purulent discharge, suspected ossicular disease, suspected cholesteatoma, or a perforation diameter greater than 6.5 mm. Fat was harvested from the ear lobule or subcutaneous tissue just posterior-inferior to the lobule. RESULTS The study population comprised 27 adults and 11 children. Twenty-eight perforations were small (73.7%) and 10 were large (26.3%). Altogether, 31 of 38 perforations were successfully repaired (81.6%), including 22 of 28 small perforations (78.6%) and 9 of 10 large perforations (90%). Assessment by age showed that 23 of 27 perforations of the adults (85.2%) and 8 of 11 perforations of the children (72.7%) successfully closed (p = .648). Follow-up ranged from 25 to 53 months (mean 40.6 +/- 8.3 months). No recurrence of the perforation during the follow-up period was recorded if the initial results were successful. The speech reception threshold improved significantly (18.5 +/- 7.7 dB vs 23.5 +/- 8 dB; p = .043). No significant sensorineural hearing loss occurred. CONCLUSIONS Fat graft myringoplasty is a reliable technique for the closure of small- and medium-sized perforations. The grafting results showed excellent long-term durability. Given the simplicity of the technique, its short duration, and the favourable hearing results, fat graft myringoplasty should be considered the procedure of choice in patients with suitable perforations and when not otherwise contraindicated.

To compare the effect of preoperative high-dose systemic corticosteroids on the radiographic and endoscopic appearance of allergic fungal rhinosinusitis (AFRS) and chronic rhinosinusitis with nasal polyposis (CRSwNP).Eight AFRS and 10 CRSwNP patients underwent computed tomographic (CT) scans and then received preoperative 1 mg/kg prednisone for 10 days. CT scans were repeated 1 day before surgery and compared with pretreatment scans (Lund-MacKay radiologic scoring system). The endoscopic appearance was recorded intraoperatively.The score dropped from 16 (66.4%) to 4.75 in the AFRS group and from 18.4 (23%) to 14.1 in the CRSwNP group (P=0.0064). Intraoperatively, most sinus mucosal surfaces appeared normal in the AFRS patients but were markedly edematous in the CRSwNP patients.Radiographic response of AFRS to systemic corticosteroids is significantly greater compared with CRSwNP. This finding is supported by endoscopic observation.

Background. This study aimed to examine the sur- gical, oncologic, and developmental results of infants and chil- dren undergoing extirpation of skull base tumors. Methods. Sixty-seven children aged 0.5 to 18 years (mean, 11 years) who were operated on during a 6-year period made up the study cohort. Eighteen cases (27%) involved malig- nant tumors, and 49 (73%) involved benign tumors. The most common benign tumors were craniopharyngioma (n = 10) and juvenile nasopharyngeal angiofibroma (n = 8). The most common malignant tumor was sarcoma (n = 5). Thirty-six tumors (55%) involved the anterior skull base, and the rest involved the lateral (n = 24) and posterior (n = 7) skull base. Subcranial, transfacial, and subfrontal approaches were used for extirpation of anterior skull base tumors. Voluminous or malignant tumors were excised by use of combined approaches (subcranial-transfacial, subcranial-degloving, or pterional-degloving). Twenty-two children underwent adjuvant therapy (chemotherapy, radiation, or both). Postoperative follow- up was 3 to 60 months. Results. No severe postoperative complications (ie, menin- gitis, cerebrospinal fluid leak, tension pneumocephalus) and no perioperative mortality occurred. Two and a half years later, 54 of the children (80%) are alive and well. Five children, two with optic glioma and one each with squamous cell carcinoma, ependymoma, and germinoma, have died of their disease. The subcranial approach had no cosmetic impact on the craniofacial development of the patients. Conclusion. The extirpation of skull base tumors by use of conventional surgical techniques is feasible and safe among infants and children. The complication and mortality rates are lower than those in adults. The long-term cosmetic effect of the subcranial approach is negligible. A 2005 Wiley Periodicals, Inc. Head Neck 27: 682 - 689, 2005

Resection of a segment of the trachea is a procedure applied for the removal of cervical tumors invading the trachea, or for the treatment of severe tracheal stenosis. The current method of anastomosis is based on multiple sutures. The main drawbacks of this method are: 1) A long procedure time, 2) An air leakage, and 3) An inflammatory response to the sutures. In this study we evaluated the feasibility and effectiveness of the use of temperature controlled CO2 laser soldering of incisions in pig tracheas in vitro. A transverse incision was made in a separated pig trachea. A flexible albumin band was prepared and was laser soldered with albumin solder to the outer surface of the trachea, covering the incision. The soldered trachea ends were sealed and the burst pressure was measured. In a series of in vitro experiments, the mean burst pressure was found to be 230 mm Hg. These preliminary results demonstrated that laser soldering using a flexible albumin band may be a useful method for sealing an incision in the trachea.

Objective Chronic isolated frontal sinusitis occurs infrequently. In this condition, most of the ethmoid cells are well aerated and the frontal sinus is involved secondary to anatomical obstruction or inflammatory changes confined to the frontal recess. The purpose of this study was to evaluate a targeted endoscopic technique where standard anterior ethmoidectomy is unnecessary in the treatment of chronic isolated frontal sinusitis. Study design and setting This retrospective study was conducted in a large university-affiliated hospital and included 11 patients with chronic isolated frontal sinusitis who underwent endoscopic sinus surgery limited to the frontal sinus outflow. The ethmoid bulla was untouched in all cases. Follow-up continued for 19 to 40 months (mean 28.6 months). Results Frontal sinus outflow patency was verified in 9 patients (81.8%). Nine patients, including one with an apparent nonpatent frontal ostium, reported improvement. Two patients—one of whom had a patent frontal ostium—reported no improvement. There were no complications. Conclusion Chronic isolated frontal sinusitis can be effectively treated in selected cases by a targeted endoscopic procedure, limited to reestablishment of frontal sinus outflow. EBM rating: C-4

Summary Objective: Otomicroscopic examination with suctioning of ears or other procedures is frequently uncomfortable especially for children. Anxiety and pain with lack of cooperation may result in trauma to the ear, incompletion of the examination, delayed diagnosis and treatment and need for completion of the examination under general anesthesia. The purpose of this study was to evaluate the efficacy and safety of utilizing nitrous oxide–oxygen inhalation for sedation and analgesia in otologic examination and minor surgical procedures performed on the uncooperative child at the outpatient clinic. Methods: In a prospective pilot case series study conducted at the Pediatric Otolaryngology outpatient clinic of a tertiary medical center, nitrous oxide–oxygen inhalation was administered by the examining otolaryngologist and the assisting nurse. The study group included children over 2 years old, for which an accurate diagnosis of ear pathology could not be made or a minor surgical procedure could not be tolerated because of anxiety and lack of cooperation. Results: Completion of the indicated procedure was successful in 21 of 24 patients (88%). Full cooperation, where no restraint was necessary was achieved in 20 of 24 patients (83%). The mean rank pain scores, evaluated separately by the patient, parent and staff, were in the mild pain range using a 0–10 coding for Faces Pain Rating Scale. The mean procedure time was 8.9 min. An adverse reaction, vomiting, occurred in one patient. Twenty-one of 24 parents stated that they would repeat the procedure if necessary. Conclusion: This pilot study shows the potential usefulness of nitrous oxide–oxygen inhalation administered by an otolaryngologist in the outpatient clinic. Alleviation of pain and anxiety and avoiding the need for physical restraint is an important goal that can be achieved with this form of sedation.

A 9 month old girl at the emergency room appeared with an acute onset of restlessness, drooling and suspected foreign body ingestion. An X-Ray revealed an open safety pin in the child's upper aero-digestive tract. The source of the safety pin was a "Hamsah" good luck charm that was attached to her bed. Open safety pins in the aero-digestive tract are difficult to manage and great care must be taken during removal to prevent further injury. Parents should be counseled regarding the presence of safety pins in the child's surroundings in order to prevent such hazards.

Objective: To define the etiology, management and prevention of iatrogenic neonatal nasal obstruction caused by intra-nasal synechia (INS). Design: Case series retrospectively reviewed, years 2001–2002. Setting: Tertiary care children’s hospital Patients: Four neonates, ages 2 weeks to 3 months, evaluated for nasal obstruction and consequent respiratory distress. Endoscopic findings were of intra-nasal synechia caused by previous intra-nasal invasive interventions. Main outcome measures: The procedures inciting the formation of synechia, possible management problems leading to synechia formation, clinical presentation, treatment and results of treatment were documented. Results: Initial incorrect diagnosis and management with an inappropriate intervention was found to be a possible cause of nasal obstruction due to synechia formation in three of these patients (two with associated craniofacial anomalies). In one patient complete nasal obstruction due to synechia was a result of continuous positive airway pressure (CPAP) intra-nasal catheters. Treatment including endoscopic synechiolysis resulted in an improved airway but not a complete cure. All patients required multiple procedures to attain a satisfactory nasal airway. Conclusion: Careful initial diagnosis and management of neonatal nasal obstruction may prevent severe complications caused by synechia in the nasal cavity.

Described is a 2-year-old child who required a tracheotomy for an obstructing laryngeal tumor. Post-operatively the child responded with extreme anxiety and refused to cooperate with tracheostomy care including suctioning, tie changing and cannula change. A novel approach was attempted. We performed a tracheotomy on the child's favorite doll and taught her to perform all the necessary tracheostomy care on the doll. Once the child became accustomed to treating the doll, it became much easier to care for her tracheostomy and compliance to treatment improved greatly to the point were restraint was no longer required. This model of mock surgery and care of a child's doll may be helpful in treating young children with tracheotomies.

Flexible nasopharyngoscopy has become an important examination of the upper airway in children. It is performed in the outpatient clinic in children of all ages under local anesthesia. We reviewed 190 consecutive examinations of children aged 3 days to 17 years, that were referred to the pediatric ENT clinic between 1999 and 2000. The following parameters were analyzed: demographic details, indications, physical findings, patient cooperation, reliability, and recommendations for further evaluation or treatment. The most common indication for endoscopy was nasal obstruction in 56 patients (30.1%). In this group 25 had an obstructing adenoid and were referred for adenoidectomy. Hoarseness was the second most common complaint in 40 patients (21.5%). Thirty-one of those patients had vocal cord nodules. The most common finding was adenoid hypertrophy in 56 patients (30.1%). No pathology was found in 34 examinations (18.3%). Although a significant correlation between patient cooperation and examination reliability was seen, in most cases good reliability was obtained even in the presence of poor cooperation. The procedure was easy to perform and had no complications. This study emphasizes the advantages of awake flexible nasopharyngolaryngoscopy in the diagnosis of upper airway pathologies in children.

Objective: To determine if children with neurological impairment are at additional risk for foreign body aspiration or impaction and if they present with a different clinical course than normal children. Design: Retrospective cohort study. Setting: Tertiary care children's hospital. Patients and other participants: A retrospective chart review of 328 consecutive procedures for aero-digestive foreign body removal over a 6 year period was performed. Of these patients 52 (15.9%) were identified with neurological impairment. Results: Compared with the non-impaired children, those with neurological impairment were older, diagnosed later, hospitalized longer and had a higher incidence of complications. Conclusion: A greater index of suspicion is needed to timely treat aero-digestive foreign bodies in children with neurological impairment. These children may not be receiving the necessary attention when presenting with non-specific symptoms.

In this study we sought to define the histologic changes produced by laser treatment of inferior turbinates.Eight inferior turbinates with prior laser treatment (mean, 26.8 months) were analyzed by light microscopy after turbinectomy for relief of refractory nasal obstruction. Histologic findings were compared with those of a group of 8 hypertrophic inferior turbinates that had no previous laser surgery.Laser-treated areas of the inferior turbinates demonstrated a histologically bland appearance, with marked diminution of seromucinous glands and relative preponderance of connective tissue matrix. Prominence of venous sinusoids was also significantly reduced in the laser-treated areas. Surface epithelium including goblet cells was reconstituted over the areas of laser application.Clinical laser surgery of the inferior turbinate produces striking long-term histologic changes.The data suggest a differential response of turbinate histologic components to application of laser energy, with the glandular component being particularly sensitive. Further correlative study is needed to clarify the clinical significance of laser-induced histologic changes in inferior turbinates.

Otitis media and sinusitis are clinically identifiable infections of the middle ear and sinuses. Both conditions should be regarded as dynamic processes with a clinical spectrum, which may extend from a self-limiting condition to a prolonged and sometimes complicated disease. With the advent of antibiotics, the natural course of these diseases has changed significantly. Severe complications once characterized by high mortality and morbidity have become rare. This has led to a generation of general practitioners, otolaryngologists, and pediatricians trained in an atmosphere of complacency in the treatment of otitis media and sinusitis. However, several recent publications report an increasing incidence of serious complications associated with otitis and sinusitis, probably due to rising antibiotic resistance. A high index of suspicion, based on clinical grounds, is therefore warranted. The ultimate goal in the approach of these conditions is pharmacotherapeutic management, resorting to surgery for the restoration of function rather than for the eradication of the infectious disease. As new information becomes available on the etiology, pathogenesis, and bacteriology of these conditions, new strategies are being used to improve treatment and to prevent complications. These measures should include a more appropriate choice of antibiotics, the determination of the role of adjuvant therapy and surgical procedures, and the development of new vaccines.

Clinical diagnosis of acute otitis media (AOM) in children is not easy. It was assumed that there is a difference ΔT between the Tympanic Membrane (TM) temperatures in the two ears in unilateral AOM and that an accurate measurement of ΔT may improve the diagnosis accuracy. An IR transmitting fiber, made of AgClBr, was coupled into a hand held otoscope and was used for the non-contact (radiometric) measurements of T T , the TM temperature. Experiments were carried out, first, on a laboratory model that simulated the human ear, including an artificial tympanic membrane and an artificial ear canal. Measurements carried out using commercially available tympanic thermometers shown that the temperature T c of the ear canal affected the results. T c did not affect the fiberoptic radiometer, and this device accurately measured the true temperature, T T of the tympanic membrane. A prospective blinded sampling of the TM temperature was then performed on 48 children with suspected AOM. The mean temperature difference between the ears, for children with unilateral AOM was ΔT = (0.68 ± 0.27)°C. For children with bilateral AOM it was ΔT = (0.14±0.10)°C (p

A novel infrared (IR) transparent optical fiber coupled to a hand held otoscope and a radiometer was constructed and used to measure the temperatures of the tympanic membrane (TM) and to distinguish between diseased and healthy middle ears. A greater temperature difference between TM readings was found when Acute Otitis Media (AOM) existed in one of the ears examined. This supports the hypothesis that acute inflammation of the middle ear will result in elevated local temperature when measured in such a way that the reading is taken only from the TM without interference of the external canal. The use of an optical fiber enabled temperature measurements of the TM with high spatial resolution eliminating the external ear canal interference. A small patient population was examined and the initial results were statistically significant. In the hands of the primary care physician, this tool would prevent misdiagnosis of AOM preventing indiscriminate use of antibiotics and avoiding complications by early diagnosis.

We suggest that using the sonographic examination as an integral part of the work-up may save the physician and the patient from an unpleasant and uninformative examination, and avid EUA or unnecessary surgery. The type or sonographic examination should be determined by what is known, the equipment available, and the age and past history of the patient. In our institution the transabdominal approach is the choice for any nonsexually active female and the transvaginal approach is the procedure of choice for those females who are emotionally mature and sexually active. This review is addressed to the clinicians taking care of the pediatric and adolescent population. We wish to stress the importance of the sonographic evaluation as an immediate tool for the evaluation of suspected pelvic pathology, gender identity, and sexual-development disorders. We find it convenient and accurate, and feel that in children and young women with such pelvic complaints, it should be considered an important step in the diagnostic process.

The case of a 7-year-old boy with multifocal eosinophilic granuloma, initially presumed to be chronic otitis media, is presented. A review of other similar cases in the literature reveals that a delay in diagnosis is not uncommon, and a high index of suspicion is necessary to avoid an unfavourable outcome. Early in the evaluation of an aural polyp, sufficient biopsies should be performed and computerized tomography scanning should be considered.

Functional endoscopic sinus surgery (FESS) utilizing laser energy delivered by optical fibers shows promising results. Due to high absorbance in tissue, pulsed CO2 laser energy (10.6 micrometers ) has the theoretical advantage of causing minimal damage to the area surrounding the spot of vaporized tissue. However, conventional optical fibers are not capable of transmitting in this mid IR region. Unclad optical fibers made by extrusion of silver halide crystals are capable of transmitting CO2 laser energy but their 0.9 mm diameter and output beam divergence results in less than desirable power density. We recently developed a silver halide optical fiber consisting of core and cladding, which can transmit CO2 laser energy with lower divergence and an increase in the power density delivered to tissue. This preliminary study presents the histological effects on tissue of CO2 laser energy, delivered through a clad silver halide optical fiber. Higher ablation rate and less circumferential damage to tissue have been observed.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Purpose: Suspected impaction of esophageal foreign bodies may at times pose a diagnostic problem as to the decision to perform esophagoscopy. It is not unusual to perform a rigid esophagoscopy following a diagnostic work-up for an impacted foreign body and not to find one. This study attempts to delineate the clinical situations where negative esophagoscopies are more likely to occur. Materials and Methods: In a retrospective analysis of 98 rigid esophagoscopies performed for suspected foreign bodies in our department, an attempt was made to delineate the clinical and radiologic findings characteristic of the patients who had no foreign body at esophagoscopy compared with the patients in whom a foreign body was found. Results: Negative esophagoscopies were associated with suspected bone (mostly fish) impaction in 20 of the 22 negative esophagoscopies. Other parameters associated with negative findings were prolonged duration of symptoms and a positive finding at the physical examination. In suspected bone impaction, barium studies and neck x-rays were not helpful in determining the presence of a foreign body. Conclusion: Clinical history is the main indicator in the decision to perform esophagoscopy for suspected foreign bodies.

CO 2 laser myringotomy has previously been proven effective in patients with serous otitis media for short term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. Also, conventional optical fibers do not transmit CO 2 laser energy ((lambda) equals 10.6 micrometers ). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 micrometers . Using a hand held otoscope coupled to a fiberoptic delivery system CO 2 laser myringotomies were performed first in guinea pigs and then in humans. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a `dose dependent' relationship was found between the total energy used and the duration of a patent myringotomy. This system was used to perform CO 2 laser myringotomies under local anesthesia in five patients with serous otitis media and conductive hearing loss. None of the patients complained of discomfort and no scarring was noted. All patients had subjective and audiometric documentation of hearing improvement. The average duration of a patent myringotomy was 21 days. In two patients the effusion recurred. CO 2 laser myringotomy utilizing a hand held otoscope coupled to an optical fiber capable of transmitting CO 2 laser energy may prove simple and effective in the treatment of serous otitis media.

We have developed an otoscope which contains an optical fiber capable of transmitting CO2 laser energy. Such a hand-held unit may prove useful in the treatment of acute otitis media and otitis media with effusion. We used crystalline fibers (0.9 mm diameter) capable of transmitting CO2 laser energy. Four guinea pigs were anaesthetized. In one ear a laser myringotomy was performed using 7.5 watts for 0.1 seconds. The diameter of the myringotomy was 1.5 mm. In the other ear a similar conventional myringotomy was performed. After three weeks three laser and three conventional myringotomies were closed. On the average conventional myringotomies closed 50% sooner than laser myringotomies. Temporal bones from three guinea pigs were removed and sectioned according to accepted methods. No histological differences were found between ears. This experiment has proven the feasibility of using an otoscope for fiberoptically guided CO2 laser myringotomy.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.