Publications by authors named "Andre Wineland"

Purpose Of Review: Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care.

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Objectives/hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.

Study Design: Delphi method-based survey series.

Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established.

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Article Synopsis
  • The study aimed to investigate if detectable upper respiratory infections (URIs) during adenoidectomy/adenotonsillectomy lead to more complications or unexpected hospital admissions in children.
  • A total of 164 pediatric patients were analyzed, with 82.9% testing positive for URIs, but there were no significant differences in postoperative outcomes between those with and without detectable infections.
  • The findings suggest that routine preoperative URI testing is unnecessary, as having a recent URI does not increase risks during or after outpatient surgeries in healthy children.
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The cricoid is a circular "ring" of cartilage in the airway. When the lateral walls of the cricoid approximate, it takes the shape of an ellipse. In severe cases, this also reduces the glottic aperture and causes respiratory distress, stridor, and failure to thrive.

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Acquired laryngomalacia in the pediatric population is rare, especially from a neurogenic cause. This case report describes a pediatric patient who developed laryngomalacia following a neurologic insult. A proposed physiologic pathway is reviewed.

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Objectives: Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies.

Methods: Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications.

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Objective: Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients METHODS: This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1.

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Congenital deficiency of distal tracheal rings is a rare anomaly and has been previously reported in the literature. Here we report the first case deficient tracheal rings confined to the cervical trachea. Patient was transferred to our institution for management of what was initial thought to be complete tracheal rings.

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Importance: CHARGE syndrome refers to a syndrome involving coloboma, heart defects, atresia choanae, retardation of growth and development, genitourinary disorders, and ear anomalies. However, Verloes revised the characteristics of CHARGE syndrome in 2005 to define this syndrome more broadly. Deficiency of the semicircular canals is now a major criterion for CHARGE syndrome.

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Objective: To evaluate the impact of a Mindfulness Based Stress Reduction (MBSR) program in patients with chronic bothersome tinnitus on the (1) severity of symptoms of tinnitus and (2) functional connectivity in neural attention networks.

Study Design: Open-label interventional pilot study.

Setting: Outpatient academic medical center.

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A case of balloon frontal sinuplasty in a 12-year old male with intracranial abscess from acute sinusitis is presented. The patient experienced photophobia, fever, headache, nausea and vomiting. Frontal sinusitis with intracranial abscess was diagnosed on imaging.

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Importance: Tinnitus affects more than 40 million people in the Unites States, and cognitive difficulties are among the most commonly associated symptoms.

Objective: To test the feasibility and preliminarily the effectiveness of using a putative neuroplasticity-enhancing drug, D-cycloserine, to facilitate a computer-assisted CT program for improving tinnitus bother and related cognitive difficulties.

Design, Setting, And Participants: Double-blind, randomized clinical trial at an outpatient academic medical center of 34 participants aged 35 to 65 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of at least 6 months' duration.

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Objectives/hypothesis: This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications.

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Objectives/hypothesis: The goal of this study was to determine the incidence of major complications following primary and revision functional endoscopic sinus surgery (FESS). In addition, this study aimed to determine factors associated with the occurrence of complications including patient and provider characteristics and the use of image guidance system (IGS) technology.

Study Design: Retrospective cohort analysis of California and Florida all-payer databases from 2005 to 2008.

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Importance: This research examines the impact of 4 weeks of repetitive transcranial magnetic stimulation (rTMS) stimulation to the temporoparietal junction and compares the results of this longer duration of treatment with a similar stimulus protocol of only 2 weeks' duration.

Objective: To examine the effectiveness and safety of 4 weeks of low-frequency rTMS to the left temporoparietal junction in a cohort of patients with bothersome tinnitus.

Design: Crossover, double-blind, randomized controlled trial.

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Objectives/hypothesis: Subjective, chronic tinnitus is a common but poorly understood condition. The heterogeneity within tinnitus has hindered the development of functional severity measures and effective treatment. Tinnitus at least partially results from maladaptive cortical processes that are associated with cognitive deficits.

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Objective: To assess functional connectivity in cortical networks in patients with nonbothersome tinnitus compared with a normal healthy nontinnitus control group by measuring low-frequency (<0.1 Hz) spontaneous blood oxygenation level-dependent (BOLD) signals at rest.

Design: Case-control.

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Objective: To determine changes in cortical neural networks as defined by resting-state functional connectivity magnetic resonance imaging during voluntary modulation of tinnitus with orofacial maneuvers.

Study Design: Cross-sectional study.

Setting: Academic medical center.

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Background: The objective was to examine functional connectivity linked to the auditory system in patients with bothersome tinnitus. Activity was low frequency (< 0.1 Hz), spontaneous blood oxygenation level-dependent (BOLD) responses at rest.

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Objectives: To reexamine the "Norman rule" (affected parathyroid gland would contain at least 20% radioactivity compared with background), report normative radiation data, offer alternative ratios, and explore the effect of lapsed time on minimally invasive parathyroidectomy (MIRP).

Design: Retrospective analysis.

Setting: Tertiary care academic medical center.

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Purpose Of Review: In the last year, several groups have used various methods to calculate economic costs to patients with early- and late-stage head and neck cancer, cost comparisons of palliative treatments, patient time costs associated with cancer care, and the impact of new diagnostic technologies which need formal cost-effectiveness assessment to determine their value.

Recent Findings: Late-stage oral and oropharyngeal cancer treatment is more expensive than early-stage. Photodynamic therapy is cost-effective for esophageal cancer.

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Objective: To describe an elusive case of blastomycosis involving the thyroid gland, which was ultimately diagnosed by use of ultrasound-guided fine-needle aspiration (FNA).

Methods: We present a case report, including clinical features, results of laboratory studies, and radiographic, computed tomographic, and ultrasonographic findings. In addition, the treatment and the utility of FNA of the thyroid relative to the diagnosis of blastomycosis are discussed.

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Objective: To describe the mechanical rationale and clinical application of prototype right-angle reduction forceps.

Methods: A pair of prototype right-angle reduction forceps was designed and manufactured specifically to improve the consistency and ease of fracture reduction. It was used to reduce mandible fractures of the mandible body, parasymphysis, and symphysis in 4 patients.

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