Julina Ongkasuwan

Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19A isolates.

OBJECTIVE. We review the impact of pneumococcal conjugate vaccine on pneumococcal mastoiditis in children at Texas Childrens Hospital. METHODS. The medical charts (including the number of pneumococcal conjugate vaccine doses) for children with pneumococcal mastoiditis treated at Texas Childrens Hospital between January 1995 and June 2007 were reviewed retrospectively. Isolates were serotyped with the capsular swelling method. Pulsed-field gel electrophoresis was performed on the 19A isolates and multilocus sequence typing on selected 19A clones. RESULTS. Forty-one pneumococcal mastoiditis cases were identified, and 19A (n = 19) was the most common serotype. Before the introduction of pneumococcal conjugate vaccine (from 1995 to December 1999), 0 of 12 cases were 19A. Between April 2000 and October 2006, 15 cases of pneumococcal mastoiditis occurred, and 5 were 19A. Fourteen cases of pneumococcal mastoiditis occurred between November 2006 and June 2007, all of which were 19A. Mastoiditis caused by 19A isolates was more likely to present with subperiosteal abscess and was more likely to need intraoperative mastoidectomy than was mastoiditis caused by non-19A isolates. Multidrug resistance was also common among the 19A isolates; 13 (68%) of the 19A isolates were resistant to all antibiotics tested routinely. Pulsed-field gel electrophoresis analysis placed 14 (74%) of the 19 serotype 19A isolates into a highly related group; 12 isolates were classified as closely related, and 2 were possibly related. Multilocus sequence typing analysis placed the pulsed-field gel electrophoresis cluster isolates into clonal complex 271 (sequence types 320 and 1451). CONCLUSIONS. At Texas Childrens Hospital, 19A has become the predominant serotype causing pneumococcal mastoiditis, partly related to the emergence of multidrug-resistant clonal complex 271 strains. Subperiosteal abscesses and the need for mastoidectomy were more common in children with mastoiditis caused by serotype 19A isolates, compared with isolates of other serotypes.

Oral Lactoferrin Results in T-cell Dependent Tumor Inhibition of Head and Neck Squamous Cell Carcinoma in vivo.

Purpose: Human lactoferrin is a naturally occurring glycoprotein that inhibits cancer growth. Our purpose was to evaluate recombinant human lactoferrin as a chemotherapeutic agent against head and neck squamous cell carcinoma. Experimental Design: Controlled experiments both in vitro and in the murine model evaluating both the effect and mechanism of lactoferrin on cancer growth. Results: In both human and murine cell lines, lactoferrin induced dose-dependent growth inhibition. Using flow cytometric analysis, lactoferrin was shown to induce G1-G0 growth arrest. This arrest seemed to be modulated by down-regulation of cyclin D1. In the in vitro model, luminex data revealed that lactoferrin inhibited cellular release of proinflammatory and prometastatic cytokines, including interleukin-8, interleukin-6, granulocyte macrophage colony-stimulating factor, and tumor necrosis factor-α. Lactoferrin up-regulated the cellular activation of nuclear factor-κB within 4 h of cellular exposure. In C3h/HeJ mice implanted with SCCVII tumors, orally delivered lactoferrin inhibited tumor growth by 75% compared with control mice. Immunohistochemical analysis of harvested tumors revealed up to 20-fold increases of lymphocytes within treated animals. When mice were depleted of CD3+ cells, all lactoferrin-induced tumor inhibition was abrogated. Conclusion: We conclude that human recombinant lactoferrin can inhibit the growth of head and neck squamous cell carcinoma via direct cellular inhibition as well as systemically via immunomodulation. Our data support the study of human lactoferrin as an immunomodulatory compound with therapeutic potential.

Causes and consequences of adult laryngotracheal stenosis

Laryngotracheal stenosis (LTS) is largely considered a structural entity, defined on anatomic terms (i.e., percent stenosis, distance from vocal folds, overall length). This has significant implications for identifying at‐risk populations, devising systems‐based preventive strategies, and promoting patient‐centered treatment. The present study was undertaken to test the hypothesis that LTS is heterogeneous with regard to etiology, natural history, and clinical outcome.

Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis

Idiopathic subglottic stenosis (iSGS) is a rare and potentially life‐threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes.

The physiologic impact of transnasal flexible endoscopy.

Diagnostic transnasal flexible endoscopy (TNFE) is a commonly used office procedure in otolaryngology. Currently there is a paucity of data on the impact of TNFE on physiologic parameters. This is relevant with the advent of office‐based endoscopic procedures. The goal of this study is to measure the impact of topical decongestion, anesthesia, and diagnostic TNFE on vital signs: systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and oxygenation (O2 sat).

The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis.

Purpose of reviewThe management of a patient with bilateral vocal fold motion impairment (BVFMI) can be challenging for the otolaryngologist. The treatment traditionally involves tracheotomy, which can be very distressful for some patients. Alternatively, there are endoscopic procedures, which irreversibly sacrifice voice in order to improve airway. The optimal treatment of BVFMI still eludes us. The purpose of this review is to highlight an alternate management strategy for bilateral vocal fold paralysis using botulinum toxin (BTX). This procedure is predicated on the premise that vocal fold immobility is related to synkinetic reinnervation of the vocal fold. Eliminating any thyroarytenoid/lateral cricoarytenoid (LCA) activity during respiratory gestures should allow greater unopposed posterior cricoarytenoid abduction. Recent findingsThere have been several case reports and series, the largest of which involved 11 patients, describing the successful use of BTX for this application. SummaryThe best candidates for this adductor chemical denervation are those patients who have undergone trauma to the recurrent laryngeal nerve without evidence of cricoarytenoid joint fixation. Patients should have evidence of voluntary thyroarytenoid/LCA laryngeal electromyography activity, though true synkinesis cannot always be reliably identified. The procedure can be another management option for patients with BVFMI.

Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit

Vocal fold motion impairment (VFMI) is a known sequela of cardiovascular surgery. The gold standard for the evaluation of vocal fold movement is flexible nasolaryngoscopy (FNL). Although safe, FNL does cause measurable physiologic changes. Noxious stimuli in cardiovascular intensive care unit (CVICU) neonates may cause imbalance between the pulmonary and systemic circulations and potentially circulatory collapse. The goals of this project were to determine the accuracy of laryngeal ultrasound (LUS) compared to FNL to identify VFMI in CVICU neonates and compare their physiologic impact.

The progression of thyroid cartilage calcification as it relates to the utilization of laryngeal ultrasound

The purpose of this study is to review the computed tomography (CT) scans of infants, children, and adults to assess the degree of calcification of the thyroid cartilage at various ages in order to understand in which age group laryngeal ultrasound can be utilized.

Juvenile recurrent respiratory papilloma: variable intersurgical intervals.

To analyze the patterns of surgical frequency in pediatric patients undergoing surgery with CO2 laser ablation for juvenile onset recurrent respiratory papillomatosis (JORRP). The hypothesis is that over time there is a high variability in surgical frequency independent of the use of an adjuvant therapy.

Is voice therapy effective in the management of vocal fold nodules in children

BACKGROUND The term ‘‘vocal fold nodules’’ refers to bilateral thickening of the membranous folds, with minimal impairment of the vibratory properties of the mucosa. They are considered to be related to repetitive mechanical stress, typically related to voice use patterns. Diagnosis is made in the office via either rigid or flexible laryngeal stroboscopy. The reported incidence of vocal fold nodules in school age children is 17% to 30%, with reported resolution in most cases by puberty. Traditionally, conservative management has been recommended for these lesions, although voice hygiene approaches, voice therapy techniques, and surgery also have been advocated. Voice hygiene typically includes education about healthy voice care, increased hydration, and elimination of abusive habits. Voice therapy encompasses a variety of behavioral techniques including, but not limited to, progressive relaxation, yawn-sigh, laryngeal massage, vocal intensity reduction, pitch elevation, vocal function exercises, and confidential and resonant voice therapy. Children with voice disorders often are seen as more aggressive and are viewed more negatively than their peers. Given the negative social and academic effects that can result from pediatric voice disorders, should voice therapy be used to treat children with vocal fold nodules?