Pediatric otolaryngologists' actions regarding secondhand smoke exposure: pilot data suggest an opportunity to enhance tobacco intervention

OBJECTIVE

To assess pediatric otolaryngologists' training, actions, and attitudes with respect to patients exposed to secondhand smoke.

STUDY DESIGN

Cross-sectional survey.

SUBJECTS

Pediatric otolaryngologists and senior residents.

METHODS

An anonymous, Web-based survey of pediatric otolaryngologists was designed to capture demographics, tobacco-specific education, actions, and attitudes. Responses were analyzed descriptively and entered into logistic regression models to determine predictors of adherence to the basic tenets of the general pediatrics secondhand smoke exposure-prevention guidelines.

RESULTS

One hundred-fifteen US physicians completed the survey. Descriptive analysis revealed low levels of training and low levels of tobacco-specific intervention among respondents. Logistic regression models showed that greater tobacco-specific knowledge/education and fewer perceived barriers predicted greater adherence to the basic tenets of the pediatrics guidelines.

CONCLUSION

Our pilot study provides preliminary evidence that can guide specific improvements in tobacco-intervention training for pediatric otolaryngologists and residents.

Staged tympanostomy tube placement facilitates pediatric cholesteatoma management

OBJECTIVES

Evaluate results of middle ear ventilation with or without adenoidectomy prior to definitive cholesteatoma surgery in children with concomitant middle ear effusion.

METHODS

Charts of 40 children seen in follow-up for acquired or congenital cholesteatoma were reviewed. Nine children underwent staged tympanostomy tube placement for concomitant middle ear effusion. Computed tomography was obtained after placement of tubes in all patients. Extent of disease by tomography was compared to disease extent at definitive surgery. Details of cholesteatoma surgeries, most recent disease status, and length of follow-up were recorded.

RESULTS

Three children had extensive congenital cholesteatoma, while six had acquired disease. All nine children underwent tube placement (four with adenoidectomy) prior to definitive surgery. Computed tomography obtained after middle ear ventilation accurately predicted extent of cholesteatoma involvement. Seven atticotomies, two tympanomastoidectomies, and one revision mastoidectomy were performed. Follow-up ranged from 9 to 99 months with a median of 54 months. All were free of cholesteatoma at latest assessment.

CONCLUSIONS

Staged tympanostomy tube placement with or without adenoidectomy prior to tympanomastoidectomy allows superior delineation of cholesteatoma extent pre-operatively and facilitates surgery in children with concomitant middle ear effusion. Adenoidectomy may improve eustachian tube function and decrease the risk of recurrent disease.

Congenital Malformations of the Oral Cavity

Congenital malformations of the oral cavity may involve the lips, jaws, hard palate, floor of mouth, and anterior two thirds of the tongue. These malformations may be the product of errors in embryogenesis or the result of intrauterine events disturbing embryonic and fetal growth. This article begins with a review of the pertinent embryologic development of these structures. After reviewing the normal embryology, specific malformations are described. Recommended management follows the brief description of each malformation. An attempt is made to point out where these malformations deviate from normal development. Finally, management recommendations are based on traditional methods and recent advances described in the literature.

Occult contralateral congenital cholesteatoma: is the epidermoid formation theory enough?

Bilateral congenital cholesteatomas are rare entities. Nine cases have been previously described in the literature. Many different etiologies for the development of congenital cholesteatoma have been proposed. The case of a five-year-old boy with bilateral congenital cholesteatoma is discussed. A lesion of the left ear was apparent clinically. However, the right-sided lesion was silent and was demonstrated only by radiologic exam. Theories of pathogenesis are reviewed.

Effects of short- and long-term wheel deprivation on running

The effects of wheel deprivation on running were explored. Eight male rats, well habituated to wheels, were each deprived of wheels for periods of 0, 1, 3, and 10 h during the night (Experiment 1) and 0, 1, 3, and 10 days (Experiment 2). In Experiment 1, as wheel deprivation lengthened, wheel running in the first 24 h of access increased. After 10 days of wheel deprivation subsequent daily running decreased (by 70%), and feeding was suppressed for several days. This temporary decline may be due to detraining and the rats physical inability to run more. Experiment 3 with 12 rats found that the running increase after 3-h wheel deprivation was proportional to the amount of running normally occurring during the deprivation period. Over the short-term, running appears to be regulated like other appetitive behaviors.

Alternate-day wheel access: effects on feeding, body weight, and running

For rats access to a running wheel results in a pronounced but temporary suppression of feeding. The reasons for the feeding suppression and its temporary nature are unclear. The effects of alternate-day wheel access were explored by comparing feeding and running in 25 male Sprague-Dawley rats given either no wheel access, continuous wheel access, or alternate-day wheel access. With alternate-day wheel access food intake was suppressed on wheel days and elevated on non-wheel days for the full 32 days of the experiment. Body weight decreased on wheel days and showed a large increase on non-wheel days. Acquisition of running over days was similar in both wheel groups and plateaued at the same level, but running was elevated, compared to continuous-access rats, for the first few hours when alternate-day rats were returned to the wheel. These results suggest that wheel-induced feeding suppression is not due to the novelty of the wheel and that this suppression can be extended by providing periods with no wheel access. The temporary nature of feeding suppression in chronic access conditions may be due to secondary longer term motivational changes.