Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been "prolonged" intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of "safe" periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.

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\s=b\Questionnaires designed to assess attitudes and use of headgear were completed by 537 Division I collegiate wrestlers. Only 35.2% of the wrestlers wore headgear all of the time during practice as opposed to 92.4% during competition, which was a statistically significant difference. The most common reason for not wearing headgear was discomfort (35%). There were 482 participating in nonschool team events, and 203 (42%) described headgear use as "seldom or never." However, there was a statistically significant difference of developing auricular hematoma while wearing headgear (26%) vs not wearing headgear (52%). There were 208 (39%) who reported a permanent auricular deformity resulting from an injury that occurred with (10.6%) or without (26.6%) headgear. These results suggest that headgear provides only partial protection and that nonuse is widespread, causing a surprisingly high frequency of permanent auricular deformities. Auricular injuries are commonplace -t\. in both high school and collegiate wrestlers. Blunt trauma to the auricle can cause subcutaneous bleeding. In the past, there has been some disagree¬ ment about the pathophysiology of the injury.1"5 It has been clearly estab¬ lished that the bleeding occurs deep to the auricular cartilage peri¬ chondrium.2 This hematoma or seroma creates a layer that separates the car¬ tilage from the perichondrium, which represents the only blood supply to that cartilage.2 If the injury is not treated, excessive fibrosis can occur, creating the so-called cauliflower de¬ formity. In addition, the separation of the cartilage from its blood supply can predispose the wrestler to infection and necrosis of the auricular cartilage. This injury actually represents a two¬ fold problem: one in treatment and the other in prevention.The problem in treatment is based primarily on the propensity for the fluid to reaccumulate following aspi¬ ration or drainage unless some type of extrinsic pressure dressing is applied. The application of an extrinsic pres¬ sure dressing oftentimes prevents the athlete from continuing to train and compete. For this reason, it is usually associated with a high degree of noncompliance by the wrestler with such a problem. In the literature, there are numerous approaches to the treatment of this problem.610 However, a recent article11 has described the effective¬ ness of a treatment program that al¬ lows the athlete to continue to train and compete without compromising the quality of the treatment.The other major problem is in the development of an effective preventive program that would effectively eradi¬ cate the chance for auricular injury while wrestling. A variety of different types of headgear have been developed to protect the auricles. In fact, the Na¬ tional Collegiate Athletic Association and most state high school athletic as¬ sociation regulations require the use of such headgear during wrestling com¬ petition. But there are no require¬ ments for headgear usage during prac¬ tice. Two observations motivated this evaluation. We first recogn...

1. Kleinman LC, Kosecoff J, Dubois RW, Brook RH. The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States. JAMA. 1994;271:1250-1255. 2. Kleinman LC, KosecoffJ, Dubois RW, Brook RH. Clinical characteristics of children proposed to receive tympanostomy tubes. AJDC. 1992;146:489. Abstract. 3. Bailar JC. The practice of meta-analysis.