Timing of Tympanostomy Tube Placement and Efficacy of Palatoplasty Technique on the Resolution of Chronic Otitis Media: A Cross-sectional Analysis.

BACKGROUND: Chronic otitis media with effusion is a persistent complication essentially universal in children with cleft palate. The prevalence of chronic otitis media with effusion is hypothesized to be a result of Eustachian tube dysfunction secondary to the anomalous insertion of the palatal musculature. This study was designed to evaluate the timing of tympanostomy tube placement and the effect of primary palatoplasty technique on the recovery of Eustachian tube function and resolution of chronic otitis media with effusion. METHODS: We performed a retrospective, cross-sectional analysis of the previous 99 consecutive patients who underwent a palatoplasty at our institution. Variables included timing of initial tympanostomy tube placement, palatoplasty technique, cleft type, and gender. These were then evaluated to assess their impact on the resolution of chronic otitis media with effusion. Resolution was established as an inverse function of the number of tympanostomy tubes placed in correlation with available audiometric/tympanographic data. For all models, a generalized linear mixed model was applied using a Poisson distribution and a log-link function where the outcome variable was the total number of tympanostomy tubes. For all tests, a P = .05 level of significance was used. RESULTS: Of 99 palatoplasties performed, 94 patients were included in the study. Ninety-one percent of patients had documented chronic otitis media with effusion at the time of palatoplasty. Forty-four percent underwent straight-line repair with aggressive intravelar veloplasty, 36% had Furlow double z-plasty, 20% had straight-line repair without intravelar veloplasty. There was a statistically significant difference (F 2,83 = 5.36, P = .0065) between the 3 types of repair. The mean number of tubes placed was 0.6000 ± 0.1225, 0.8519 ± 0.1776, and 1.4737 ± 0.2785 for intravelar veloplasty, Furlow double z-plasty, and straight line without intravelar veloplasty, respectively . With regard to the timing of tympanostomy tube placement, there was a trend toward statistical significant (F 2,83 = 3.02, P = .0540) in the mean number of tube insertions was 1.4286 ± 0.4518, 0.6964 ± 0.1115, and 1.1304 ± 0.2217 when the initial set was placed before palatoplasty, at the time of palatoplasty, and after palatoplasty, respectively. CONCLUSIONS: Despite its inherent limitations, this study suggests that palatal musculature reconstruction via intravelar veloplasty or reorientation via Furlow double z-plasty may improve Eustachian tube function and lower the need for tympanostomy tubes in this population. In comparison with other time points, patients who underwent initial tympanostomy tube placement at the time of palatoplasty trended toward improved chronic otitis media with effusion.

Coarsening kinetics of a spinodally decomposed vicinal Si(111) surface.

The coarsening kinetics of the stepped-and-terrace groove structure formed on a vicinal Si(111) surface was investigated by in-situ synchrotron x-ray scattering. The time evolution of the groove period L at various temperatures below the (1 x 1)-to-(7 x 7) transition falls onto a universal curve when the annealing time is scaled by a scale factor. Distinctive stages of spinodal decomposition, coarsening, and saturation are identified in the evolution of the groove period. L increases following a power law, L approximately t;{n} with n = 1/6 and 0.29 in the initial stage and the late stage of coarsening, respectively. The initial coarsening proceeds via collective motion of step bunches while the late stage is dominated by the diffusion of individual steps.

Kinetic roughening of ion-sputtered Pd(001) surface: beyond the Kuramoto-Sivashinsky model.

We investigate the kinetic roughening of Ar+ ion-sputtered Pd(001) surface both experimentally and theoretically. In situ real-time x-ray reflectivity and in situ scanning tunneling microscopy show that nanoscale adatom islands form and grow with increasing sputter time t. Surface roughness W(t) and lateral correlation length xi(t) follow the scaling laws W(t) approximately t(beta) and xi(t) approximately t(1/z) with the exponents beta approximately 0.20 and 1/z approximately 0.20, for an ion beam energy epsilon=0.5 keV, which is inconsistent with the prediction of the Kuramoto-Sivashinsky (KS) model. We thereby extend the KS model by applying the coarse-grained continuum approach of the Sigmund theory to the order of O(inverted Delta(4),h(2)), where h is the surface height, and derive a new term of the form inverted Delta(2)(inverted Delta h)(2) which plays a decisive role in describing the observed morphological evolution of the sputtered surface.

Acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis. Prevalence and significance of negative smears pretreatment and positive smears post-treatment.

We studied 977 patients with culture-proved pulmonary tuberculosis retrospectively to determine the frequency with which patients were sputum smear negative but culture positive (S-C+) prior to treatment, the frequency with which patients developed the smear positive but culture negative (S+C-) status during treatment, and the implication of these 2 phenomena to the success of treatment. One fourth (25.6%) of the patients were repeatedly S-C+ prior to treatment; the frequency of this phenomenon was inversely proportional to the extent of disease and the presence of cavities. Patients who were S-C+ prior to treatment, and whose organisms were drug-sensitive, had the fastest sputum culture conversion rate. Patients who were S+C+ without far-advanced cavitary disease had a significantly slower conversion rate after 1 month of treatment, and those with far-advanced cavitary disease had the slowest conversion rate. Patients with drug-resistant organisms had slower conversion rates than did their counterparts with drug-sensitive organisms, but in all but 4 of these, sputum smears and cultures ultimately converted to negative. The S+C- phenomenon was observed in 20.4% of patients; its frequency was related to the extent of disease and to treatment regimens that contained rifampin. In all patients who exhibited the S+C- phenomenon, sputum smears converted to negative with continuation of the same treatment regimen.

Atypical mycobacterial infections: a clinical study of 92 patients.

Between July 1970 and December 1979, 92 patients with atypical mycobacterial infections of the lung were hospitalized 110 times at Blue Ridge Hospital (Charlottesville, Va). These patients comprised less than 3% of all patients hospitalized for active mycobacterial disease. Sixteen had Mycobacterium kansasii or group I disease, three had group II disease (two M scrofulaceum, one M szulgai), 70 had group III disease (68 M avium-intracellulare, two M xenopi), and three had M fortuitum or group IV disease. M kansasii infections comprised 23% of the total during the first five years, but only 6% during the second half of the decade. Clinical and roentgenographic findings were similar to those in patients with tuberculosis. As anticipated, most of the M kansasii organisms were sensitive to antimycobacterial drugs, and these patients generally responded well to chemotherapy. In contrast, most of the group III organisms, including one of the M xenopi, exhibited resistance to several drugs. Despite the high incidence of resistance, 59% of the patients with group III infections who were treated for at least three months in the hospital had sputum cultures converted to negative.

Paragonimus westermani: a cause of cavitary lung disease in an Indochinese refugee.

A Laotian immigrant with persistent cough and hemoptysis was found to have multiple small cavities on chest roentgenogram. Ova of the lung fluke Paragonimus westermani were found in the sputum, and the patient responded to bithionol therapy. Pulmonary paragonimiasis should be considered in the differential diagnosis of cavitary lung disease in Indochinese refugees entering the United States.