Forty-three percent had serious complications involving loss of the tracheostomy airway (tube occlusion or accidental decannulation) or requiring a separate surgical procedure. Deaths directly attributable to tracheostomy complications occurred in 0.7%.

Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.

Objective: To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD). Study Design: Retrospective chart review Methods: Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy). Results: A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality. Conclusion: Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.

1. Single-neuron behavior in the cochlear nerve of neonatal (3-day-old) chicks was examined after exposure to a 120-dB SPL pure tone (0.9 kHz) for 48 h. Exposed animals were tested after 0 days or 12 days of recovery. Nonexposed chicks, age-matched to the exposed animals, formed two control groups. 2. Spectral response plots were obtained from each cell. These plots described the neuron discharge rates in response to 1,767 tone burst stimuli, each with a unique frequency-intensity combination. The tone bursts were presented at frequencies between 0.1 and 4.5 kHz and for intensities between 0 and 100 dB SPL. From these plots the characteristic frequency (CF), CF threshold, and sharpness of tuning (Q10 dB) were derived for each cell. Frequency response-area functions at selected stimulus levels and rate-intensity functions at the CF were also constructed from the spectral response plots. In addition, spontaneous activity was determined. Data were obtained from 903 cells. 3. Neuron activity in the control cells revealed no differences between CF thresholds, Q10 dB, or spontaneous activity in the two age groups. However, age differences at all frequencies were noted in the rate-intensity functions. 4. A frequency-dependent loss in CF threshold was observed in the 0-day recovered cells. The threshold shift (relative to age-matched control cells) was 55-65 dB between 0.8 and 1.5 kHz, but only 10-15 dB between 0.1-0.4 kHz and 2.5-3.5 kHz. The exposed cells showed no loss in frequency selectivity (Q10 dB) at < 0.5 kHz, whereas above this frequency an increasing deterioration in tuning was noted. Spontaneous activity in the 0-day cells was suppressed across the entire range of CFs. The rate-intensity function of exposed cells had a steeper growth rate than that of control cells. 5. At 12 days of recovery, CF threshold, Q10 dB, and spontaneous activity all recovered to the levels exhibited by age-matched control cells. However, the rate-intensity function for cells with CFs between 0.8 and 1.0 kHz showed abnormal growth and higher discharge rates at saturation than the control cells. Outside of this frequency range the rate-intensity functions of control and exposed cells were similar to each other. 6. Recovery of function in the sound-damaged chick ear is accompanied by almost complete repair of the basilar papilla. The tectorial membrane, however, retains a major defect and only the lower layer of this membrane regenerates. An important observation in this presentation was the abnormal rate-intensity functions (in the 12-day recovered cells) reported for frequencies served by that region of the sensory epithelium where the tectorial membrane defect was found. This observation may be related to sustained structural damage to the short hair cell region of the papilla and/or alterations in the efferent control of papilla function mediated by the short hair cells.

Children are vulnerable to head and neck dog bite injuries. Wound healing is excellent despite a contaminated wound. Infections occur infrequently. Pulsed dye laser improves cosmesis.