Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection.

Congenital cytomegalovirus (CMV) infection is a major public health problem because 30,000 to 40,000 neonates with the infection are born each year in the United States. Although 90% of the congenitally infected infants are asymptomatic at birth, evidence is accumulating that these infants are at risk for audiologic, neurologic, and developmental sequelae. The current study describes the audiologic outcome of 59 infants with asymptomatic congenital CMV infection compared with 26 control infants.

cis-platinum ototoxicity in children.

Despite the recognized ototoxicity of cis-platinum, a clinical outline for the audiologic evaluation of patients receiving this drug has not been clearly defined. In a practical approach to this problem, the audiograms of 48 pediatric patients referred for monitoring during planned cis-platinum therapy were reviewed. Eleven patients tested with auditory brain-stem response (ABR) audiometry demonstrated several limitations of this modality.

The effect of steroid therapy on recovery from tonsillectomy in children.

A prospective, randomized, double-blind study to determine the postoperative effects of steroids in tonsillectomy was performed on 25 children from 4 to 12 years of age. A single intravenous dose of dexamethasone or a placebo was administered at onset of surgery. Other preoperative and postoperative medications, including antibiotics, anesthesia, and surgical techniques were standardized as noted in this article.

Ossifying fibroma of the mid-face and paranasal sinuses: diagnostic and therapeutic considerations.

Ossifying fibroma is benign, usually slow-growing tumor that may behave in an unpredictably aggressive fashion. Most of these unusual tumors affect the mandible. Their behavior in the mid-face and paranasal sinuses is not well documented.

Laryngotracheal stenosis: a 5-year review.

Twenty-seven children with varying degrees of laryngotracheal stenosis were treated at Texas Children's Hospital (TCH) from January 1984 to January 1989. Nineteen children had a residual airway demonstrable preoperatively, and following laryngotracheoplasty, 18 (95%) were successfully decannulated; all but 1 had a normal voice. Eight children had complete stenosis.

Asymptomatic congenital cytomegalovirus infection. Audiologic, neuroradiologic, and neurodevelopmental abnormalities during the first year.

Twenty-eight infants with asymptomatic congenital cytomegalovirus infection and 13 control infants were followed up prospectively. Congenital sensorineural hearing loss was documented by auditory brain-stem responses in four infected infants (two had mild bilateral loss, one had mild unilateral loss, and one had extreme unilateral loss) but in no controls. Four infected infants had diffuse periventricular radiolucencies on computed tomographic scan; none had calcifications or ventriculomegaly.

Choanal atresia and associated anomalies: the CHARGE association.

Over the past few years there has been increasing awareness of the association of choanal atresia with other congenital defects. Thirty-one cases of choanal atresia were reviewed and other congenital anomalies were documented in 19 patients. These other anomalies were identified in 75% of the 20 patients with bilateral choanal atresia but in only 36% of the 11 patients with unilateral choanal atresia.

Cystic fibrosis--an otolaryngologic perspective.

Cystic fibrosis (CF) is the most common lethal genetic disorder in white patients. The protean manifestations of the disease result from exocrine gland dysfunction and include chronically debilitating pulmonary and pancreatic compromise and clinically inconsequential (although diagnostically extremely important) sweat electrolyte abnormalities. The subject of this article is the otolaryngologic manifestations of the disease, based on a retrospective analysis of 450 cases.

Acquired subglottic stenosis in children.

Subglottic stenosis is a disorder characterized by narrowing of the airway below the glottis or apposing edges of the true vocal cords. In a broad definition, the term may be used to describe airway compromise in the regions of the larynx or the trachea or both. In children, the stenosis is usually due to scar formation secondary to prolonged airway intubation, rather than to external trauma.

Temporomandibular joint dysfunction in infancy.

Temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders.

Noise-induced hearing loss.

Hearing loss affects 30 million people in the United States; of these, 21 million are over the age of 65 years. This disorder may have several causes: heredity, noise, aging, and disease. Hearing loss from noise has been recognized for centuries but was generally ignored until some time after the Industrial Revolution.

Management of subglottic stenosis in children.

We treated 21 children for subglottic stenosis at the Texas Children's Hospital from 1975 to 1983. Ages ranged from newborn to 14 years. Fifteen (71%) were younger than 13 months of age.

Brain abscesses in the young.

Brain abscesses in the young are rare. Only 14 such abscesses have been seen at Texas Children's Hospital since 1968. Most abscesses developed in association with congenital heart disease (5), although sinusitis and mastoiditis were precipitating causes in two patients and one patient, respectively.

Prevention of hearing impairment from infection and ototoxic drugs.

Infectious diseases are a primary cause of hearing impairment and produce about 25% of profound losses. Of these, one fifth are congenital. The major infections include rubella, cytomegalovirus, measles, pertussis, meningitis, and acute otitis media.

Onset of hearing loss in children with bacterial meningitis.

Auditory brainstem responses were evaluated in 37 children with bacterial meningitis within 48 hours of admission. Four children (two with Haemophilus influenzae type b, and two with Streptococcus pneumoniae) had definite abnormalities of hearing detected at admission. Two of these children had severe-to-profound hearing losses which have persisted.

Prospective comparative trial of moxalactam versus ampicillin or chloramphenicol for treatment of Haemophilus influenzae type b meningitis in children.

In a prospective, randomized study, moxalactam in 44 children was compared with ampicillin or chloramphenicol in 47 children for the treatment of Haemophilus influenzae type b meningitis. Both groups were comparable in terms of clinical and laboratory findings at admission. The hospital course, neurologic sequelae including deafness, and number of deaths were the same for both groups.

Studies of normal hearing.

Auditory function changes continually from birth to old age. A variety of methods to assess hearing have evolved since the invention of the audiometer. Types of measurement include: electrical response in the central nervous system, cochlear acuity and speech responses.

Congenital anomalies of the larynx.

Congenital anomalies of the larynx are infrequent, though potentially life-threatening, defects with which both pediatricians and otolaryngologists should be familiar. We reviewed the basic stages in normal laryngeal embryology and outlined a scheme for the examination of a neonate with a possible laryngeal abnormality. In particular, symptoms, laryngoscopic appearance, and treatment of the more commonly encountered anomalies should be considered.

Symptomatic congenital cytomegalovirus. Disorders of language, learning, and hearing.

Seventeen patients with symptomatic congenital cytomegalovirus (CMV) were studied longitudinally, with emphasis given to disorders of language, learning, and hearing. At a mean age of 5.5 years (range, 1 go 10 years), nine children (53%) performed in the retarded range.

Ataxia and deafness in children due to bacterial meningitis.

Eight children with postmeningitis ataxia had detailed neurologic, audiologic, and neurovestibular evaluations. Prolonged fever, prolonged hyponatremia, or septic arthritis occurred in six during hospitalization. Severe to profound sensorineural hearing losses were present in seven of the children.

Pulmonary complications of tonsillectomy as originally described by Samuel J. Crowe, M.D.

The incidence of pulmonary complications of tonsillectomy is very low today in comparison to the early part of the 20th Century. Much of the credit belongs to Samuel Crowe and his colleagues who demonstrated that pulmonary complications could be prevented by the use of improved instrumentation and techniques which were based upon sound scientific principles. A historical review of anesthesia and the mouth gags of the early 1900's is included with a brief history of the development of the Crowe-Davis mouth gag.

The immotile cilia syndrome--one cause of persistent upper respiratory tract infection.

Four patients with persistent recurrent upper respiratory tract infections are presented. Electron microscopic studies of respiratory mucosal biopsies from these patients reveal ultrastructural abnormalities of cilia consisting of partial to complete loss of dynein arms, radial spoke disruption, and compound cilia. The concept of immotile cilia as an important cause of recurrent infections is receiving more attention.

Supglottic coccidioidomycosis presenting with persistent stridor.

Localized laryngeal coccidioidomycosis has been rarely reported and usually is associated with disseminated disease. This paper has described localized subglottic coccidioidomycosis in a 13-month old white boy who presented with persistent stridor. Medical management including intravenous amphotericin B resulted in complete eradication of the subglottic lesion.

Acute and chronic effects of ammonia burns on the respiratory tract.

Exposure to anhydrous ammonia can result in substantial injury to the respiratory system, eyes, and integument. In this retrospective study, we present the acute and chronic respiratory manifestations in 12 patients exposed to anhydrous ammonia as a result of the same accident. Survivors suffering significant ill effects are separated into two groups according to history and clinical course.