Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.
One hundred consecutive cases of orotracheal intubation in the premature and term newborn at the Hersehy Medical Center were studied retrospectively. The reason for intubation was for respiratory failure most commonly associated with hyaline membrane disease. The duration of intubation ranged from six hours to 63 days. Seventy-nine percent required intubation for more than 24 hours and 28 percent required intubation for more than one week. No tracheotomies were performed. There were 56 survivors, 50 of which were seen in follow-up examination at three, six or 18-month intervals. There were no cases of clinically evident upper airway damage or obstruction in this group. Post mortem examinations were carried out on 35 infants with tracheal necrosis found in one case. The authors feel that orotracheal intubation is superior to nasotracheal intubation and tracheotomy in this age group. This method of management should be carried out where there is adequate trained personnel and professional staff and equipment capable of proper orotracheal tube placement and management.
A series of 15 ears were explored for perilymph fistulas. Fifteen fistulas were found in 13 ears. Two cases are presented which developed hydrops-like symptoms only after closure of their fistulas. Closure of the other patients' fistulas was successful in relieving vertiginous symptoms, although hearing seldom improved. There were no significant complications of surgery. Fat failed as a graft material 4 of 10 times, whereas vein and perichondrium were not associated with recurrence of symptoms. The ENG-fistula test, as described by Daspit and associates, correctly predicted the presence or absence of a fistula in 7 of 8 ears tested. Hennebert's sign correctly predicted fistulae in 2 ears, and Hennebert's symptom was associated with proven fistulae in 9 of the 10 times it was present. Because of the low morbidity and the high success rate of surgery, a patient with a history suggestive of a perilymph fistula should have exploratory tympanotomy, particularly if the ENG-fistula test is positive.
One hundred seventy-four consecutive cases of newborn infants who required orotracheal intubation for longer than three days were studied retrospectively. The duration of intubation varied from 3 to 211 days with an overall mortality rate of 22.9%. There was one complication directly related to orotracheal intubation. One tracheotomy was performed. Orotracheal intubation is felt to be superior to nasal tracheal intubation and tracheotomy in managing infants in this age group who require prolonged assisted ventilation.
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