Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: May endoscopy reasonably be omitted in completely negative pediatric patients?

90 three main types of procedure were castellated laryngotracheoplasty, anterior cartilage rib grafting, and anterior and posterior cricoid cuts with or without grafting. All cases but 1 (44/45) of congenital subglottic stenosis have been successfully decammlated, 7 requiring a second procedure. The decannulation rate for acquired SGS was 89% (62/70), but 14 patients required multiple procedures. Current trends in subglottic stenosis management in our institution are presented. Evaluation of otoacoustic emissions in high-risk infants by using an easy and rapid objective auditory screening method Plinkert P.K.; Sesterhenn G.; Arold R.; Zenner H.P. EUR. ARCH. OTO-RHINO-LARYNGOL. (1990) 247/6 (356-360) Ninety-five ears of 53 infants at high risk for hearing impairment were examined using branstem-evoked response audiometry (BEBA), stapedial reflex audiometry (SRA) and click-evoked otoacoustic emissions (EOAEs). By taking BEBA as a reference, the results obtained were compared in order to evaluate the significance of EOAEs for auditory screening. E0AE.s were present in more than 90% of the ears when the BEBA threshold was below 30 dB. In this group of infants, the stapedial reflex was positive in about 80% of the ears examined. In contrast, EOAEs were never observed with BERA thresholds exceeding 40 dB. In several cases with BEBA thresholds above 30 dB, elevated SBA values could also be recorded. A further advantage of EOAEs and SBA was a recording time of less than 3 min. Since the non-invasive recording of EOAEs was fast and easy to perform and the results obtained were reproducible, we conclude that click-evoked otoacoustic emissions are a reliable technique for demonstrating normal cochlear function. Predictive valw of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: May endoscopy reasonably be omitted in completely negative pediatric patients? Previtera C.; Giusti F.; Guglielmi M. PEDIATR. EMERG. CARE (1990) 6,‘3 (176-178) The relationship between absence or presence of grossly visible lesions in the cheeks, lips, and oropharynx (C.L.O. bums) and the incidence, site, and degree of visceral bums was evaluated in all children referred to our hospital for a suspected caustic ingestion during a IO-year period. All children underwent eso-gastro-duodenoscopy within 24 hours. Of the 156 children, 96 (61.6%) showed no visible signs of contact with the caustic substance; however, in 36/96 (37.5X), endoscopy revealed bums in one or more visceral sites. Eight of 36 children (22.2%) sustained potentially dangerous lesions (second to third degree). Sixty of 156 children (38.4%) showed visible lesions; in 30/60 (50%), endoscopy revealed other bums in one or more visceral sites. Fourteen of 30 patients (46.6%) sustained potentially dangerous lesions (second to third degree). A total of 50 esophageal bums have been recorded: first degree (El), 32; second degree (E2), 12; third degree (E3), 6. Two of 12 patients with E2 lesions and 6/6 with E3 lesions developed esophageal stenosis. One patient in this latter group died because of complications related to a tracheostomy. A total of 31 gastric bums have been recorded: Gl (22) G2 (6), G3 (3). One gastric perforation was observed in the G3 group, whereas the remaining two lesions healed with residual asymptomatic scarring. Minimal scarring was observed in two of six patients with G2 bums. A total of eight lesions have been recorded in the larynx (Ll (3), L3 (l)] and in the duodenum [Dl (2), D2 (2)]. Analysis of our data shows that: 1. Absence of visible lesions cannot exclude the occurrence of visceral bums. 2. In the patients showing C.L.O. lesions, the risk of dangerous visceral bums (second to third degree) is higher than in those without C.L.O. lesions. 3. Higher than fist degree C.L.O. lesions almost invariably are associated with dangerous visceral bums. 4. Signs or symptoms do not adequately predict the presence or the severity of visceral lesions, even if spontaneous vomiting is associated with a high incidence of second to third degree visceral burns. Eso-gastro-duodenoscopy, with extremely wide indications, is mandatory in all children referred for obvious or suspected caustic ingestion. Comparison of hearing aids and cochlear implants in profoundly and totally deaf persons Spillmann T.; Dillier N. BRJ. AUDIOL.. (1990) 24/4 (223-227) Cochlear implants are increasingly used in the rehabilitation of the profoundly and totally deaf. Usually, insufficient gain of speech discrimination with a powerful conventional hearing aid is considered as a prerequisite for a cochlear prosthesis. With recent improvements of electronic systems, the criterion for