Bio

Clinical Focus


  • Pediatric
  • Otolaryngology/Head&Neck
  • Otolaryngology

Academic Appointments


Administrative Appointments


  • Pediatric Otolaryngology Fellowship Director, Department of Otolaryngology/Head & Neck Surgery (2010 - Present)
  • Otolaryngology residency program director, Dept of Otolaryngology/Head & Neck Surgery (2002 - Present)
  • Vice Chair, Department of Otolaryngology/Head & Neck Surgery (2004 - Present)
  • Chief of Pediatric Otolaryngology/Head & Neck Surgery, Lucile Packard Children's Hospital at Stanford (2013 - Present)

Honors & Awards


  • 2013 Kaiser Award for outstanding and innovative contributions to medical education, Stanford University (2013)
  • American Academy of Otolaryngology/Head & Neck Surgery Distinguished Award for Humanitarian Efforts, American Academy of Otolaryngology/Head & Neck Surgery (2011)
  • Honor Award, American Academy of Otolaryngology/Head & Neck Surgery (2007)
  • Otolaryngology Resident Advocate Award, Stanford Dept of Otolaryngology (2004, 2006)
  • Stanford Otolaryngology Resident Teacher of the Year Award, Stanford Dept of Otolaryngology (1997, 1998, 1999, 2000, 2008)
  • AOA, Alpha Omega Alpha (1988)

Boards, Advisory Committees, Professional Organizations


  • Member, American Society of Pediatric Otolaryngology (1999 - Present)
  • member, The Triological Society (2008 - Present)
  • member, American Academy of Otolaryngology-Head & Neck Surgery (1995 - Present)
  • member, Society for Ear, Nose & Throat Advances in Children (1996 - Present)
  • Member, American College of surgeons (2011 - Present)
  • Member, American Academy of Pediatrics (2005 - Present)
  • Member, Society of University Otolaryngologists (2004 - Present)
  • member, Otolaryngology Program Directors Organization (2009 - Present)

Professional Education


  • Residency:Wake Forest Medical Center (1994) NC
  • Board Certification: Otolaryngology, American Board of Otolaryngology (1995)
  • Fellowship:Hospital for Sick Children (1995) Canada
  • Internship:Wake Forest Medical Center (1994) NC
  • Medical Education:Wake Forest University (1989) NC
  • A.B., Duke University, Economics (1982)
  • M.D., Wake Forest University SOM, Medicine (1989)

Research & Scholarship

Current Research and Scholarly Interests


Dr. Anna Messner's academic focus is on the care of children with common pediatric disorders who are undergoing surgery. Specifically she has research projects in the area of post-tonsillectomy care, obstructive sleep apnea and ankyloglossia. Dr. Messner is also pursing projects in the area of education of medical professionals at all levels.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Cricopharyngeal achalasia in children: indications for treatment and management options. Current opinion in otolaryngology & head and neck surgery Huoh, K. C., Messner, A. H. 2013; 21 (6): 576-580

    Abstract

    Cricopharyngeal achalasia (CPA) is an infrequently encountered but important diagnosis in pediatric dysphagia. This disorder is characterized by difficulty in feeding, regurgitation of feeds, and recurrent aspiration episodes. In this review, we discuss the current understanding of the pathophysiology of the disease and the recent developments in the diagnosis and therapeutic management of CPA.Because of the rarity of the disease, the literature reporting the treatment of CPA is limited to small case series. Although open surgical treatments including cricopharyngeal myotomy have been reported in the past, recent studies advocate less-invasive endoscopic approaches, including balloon dilation, endoscopic cricopharyngeal myotomy, and botulinum toxin injections.When CPA is suspected as a cause of dysphagia in a child, the diagnosis can be confirmed with videofluoroscopic swallow studies that demonstrate narrowing at the region of the cricopharyngeus muscle. Treatment should be initiated for children who are unable to feed orally. Current options for treatment include botulinum toxin injections, endoscopic balloon dilation, and open or endoscopic cricopharyngeal myotomy. All techniques have shown success in the treatment of the disease. Further studies comparing treatment modalities are needed before a clear recommendation can be made.

    View details for DOI 10.1097/01.moo.0000436789.29814.62

    View details for PubMedID 24240134

  • Pediatric plastic bronchitis: case report and retrospective comparative analysis of epidemiology and pathology. Case reports in pulmonology Kunder, R., Kunder, C., Sun, H. Y., Berry, G., Messner, A., Frankovich, J., Roth, S., Mark, J. 2013; 2013: 649365-?

    Abstract

    Plastic bronchitis (PB) is a pathologic condition in which airway casts develop in the tracheobronchial tree causing airway obstruction. There is no standard treatment strategy for this uncommon condition. We report an index patient treated using an emerging multimodal strategy of directly instilled and inhaled tissue plasminogen activator (t-PA) as well as 13 other cases of PB at our institution between 2000 and 2012. The majority of cases (n = 8) occurred in patients with congenital heart disease. Clinical presentations, treatments used, histopathology of the casts, and patient outcomes are reviewed. Further discussion is focused on the epidemiology of plastic bronchitis and a systematic approach to the histologic classification of casts. Comorbid conditions identified in this study included congenital heart disease (8), pneumonia (3), and asthma (2). Our institutional prevalence rate was 6.8 per 100,000 patients, and our case fatality rate was 7%.

    View details for DOI 10.1155/2013/649365

    View details for PubMedID 23662235

  • High Prevalence of Hearing Impairment in HIV-Infected Peruvian Children OTOLARYNGOLOGY-HEAD AND NECK SURGERY Chao, C. K., Czechowicz, J. A., Messner, A. H., Alarcon, J., Kolevic Roca, L., Larragan Rodriguez, M. M., Gutierrez Villafuerte, C., Montano, S. M., Zunt, J. R. 2012; 146 (2): 259-265
  • The use of botulinum toxin for pediatric cricopharyngeal achalasia (vol 75, pg 830, 2011) INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Barnes, M. A., Ho, A. S., Malhotra, P. S., Koltai, P. J., Messner, A. 2011; 75 (9): 1210-1214

    Abstract

    Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, postoperative need for nasogastric tube placement, and swallow studies.A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.

    View details for DOI 10.1016/j.ijporl.2011.07.022

    View details for Web of Science ID 000295116400033

    View details for PubMedID 21972448

  • High Prevalence of Hearing Impairment in HIV-Infected Peruvian Children. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Chao, C. K., Czechowicz, J. A., Messner, A. H., Alarcón, J., Kolevic Roca, L., Larragán Rodriguez, M. M., Gutiérrez Villafuerte, C., Montano, S. M., Zunt, J. R. 2011

    Abstract

    Objectives. To measure the prevalence and to identify risk factors of hearing impairment in human immunodeficiency virus-infected children living in Peru.Study design. Cross-sectional observational study.Setting. Two public hospitals and 1 nonprofit center in Lima, Peru, between August 2009 and April 2010.Subjects. A total of 139 HIV-infected children, ages 4 to 19 years.Methods. Hearing impairment and otologic health were assessed with pure tone audiometry, tympanometry, and otoscopy. The primary outcome was hearing loss, defined as average threshold >25dB for 0.5, 1, 2, and 4 kHz, in one or both ears. Historical and socioeconomic information was obtained through parental survey and medical chart review. Statistical analysis included univariate analysis and multivariate logistic regression.Results. Fifty-four (38.8%) of 139 children had hearing impairment. On multivariate analysis, risk factors included: tympanic membrane perforation (odds ratio [OR] 7.08; 95% confidence interval [CI], 1.65-30.5; P = .01), abnormal tympanometry (OR 2.71; 95% CI, 1.09-6.75; P = .03), cerebral infection (OR 11.6; 95% CI, 1.06-126; P = .05), seizures (OR 5.20; 95% CI, 1.21-22.4; P = .03), and CD4 cell count <500 cells/mm(3) (OR 3.53; 95% CI, 1.18-10.5; P = .02).Conclusions. The prevalence of hearing impairment in HIV-infected children in Lima, Peru was 38.8%. Middle ear disease, prior cerebral infection, and low CD4 cell count were significantly associated with hearing impairment. The high prevalence of hearing impairment emphasizes the need for periodic hearing assessment in the routine clinical care of HIV-infected children.

    View details for PubMedID 22128111

  • Propranolol for the treatment of airway hemangiomas: A case series and treatment algorithm INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Truong, M. T., Perkins, J. A., Messner, A. H., Chang, K. W. 2010; 74 (9): 1043-1048

    Abstract

    (1) To present six patients with symptomatic airway hemangiomas treated with oral propranolol. (2) To review the diagnostic and treatment options for airway hemangiomas and propose a new management protocol.Retrospective review.Tertiary care children's hospital.Pediatric patients diagnosed with obstructive airway hemangiomas treated with oral propranolol. Patients were followed for symptomatic improvement and relief of airway obstruction on imaging or laryngoscopy.Seven patients presenting with airway obstruction were treated with propranolol. One patient had a focal hemangioma confined to the subglottis. Four patients had airway hemangiomas that extended beyond the confines of the larynx and trachea. A sixth patient had a bulky supraglottic hemangioma. A seventh patient with an extensive maxillofacial lesion failed propranolol therapy and was found to have a pyogenic granuloma on final pathology after excision. Six patients had failed standard medical therapy and/or surgical interventions and were treated successfully with oral propranolol with improvements in airway symptoms and oral intake, requiring no further surgical intervention. Treatment was initiated as early as 1.5 months of age, and as late as 22 months. No adverse side effects of propranolol were noted.Oral propranolol was successfully used to treat airway hemangiomas, resulting in rapid airway stabilization, obviating the need for operative intervention, and reducing the duration of systemic corticosteroid therapy while causing no obvious adverse effects. These outstanding results enable the possibility of use of a standardized diagnostic and treatment algorithm for airway hemangiomas that incorporates systemic propranolol.

    View details for DOI 10.1016/j.ijporl.2010.06.001

    View details for Web of Science ID 000281615300015

    View details for PubMedID 20674045

  • Histopathologic and immunophenotypic profile of subglottic hemangioma: Multicenter study INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Badi, A. N., Kerschner, J. E., North, P. E., Drolet, B. A., Messner, A., Perkins, J. A. 2009; 73 (9): 1187-1191

    Abstract

    Subglottic hemangioma (SGH) is a rare tumor of childhood often associated with airway compromise. Recently, the possibility that many SGH may be congenital hemangiomas rather than classical infantile hemangiomas (IH) has been raised, with important diagnostic and therapeutic implications. We present the largest, multi-institutional study, to date, with immunophenotypic characterization of SGH.Biopsy proven SGH samples were retrieved from the archived files of three tertiary referral children's hospitals. Relevant demographic and clinical data corresponding to each of the specimen was collected. Standard hematoxylin and eosin staining (H&E) and glucose transporter protein isoform 1 (GLUT 1) immunohistochemical staining was used to confirm the histological diagnosis and evaluate the immunophenotypic profile of the specimens.19 cases of SGH were reviewed, 18 of these with tissue blocks available for histological and GLUT1 immunohistochemical staining, and the remaining case with GLUT1 immunostaining previously reported. There was a female to male ratio of 3.75:1. Stridor was the presenting feature of all the patients. Concomitant cutaneous lesions were noted in 9 of 19 patients; with three of the PHACES variety. 16/19 specimens were histologically diagnostic of classical IH by H&E staining and also demonstrated strong GLUT 1 positivity; 1/19 was too small for histological diagnosis, but contained GLUT1-positive capillaries; 1/19 was inflamed granulation tissue by histology and was GLUT1-negative; the final 1/19 was inflamed fibrous tissue, negative for GLUT1.This multi-institutional pathologic assessment confirms that most subglottic hemangiomas examined were histologically and immunohistochemically confirmed to be IH and similar to IH located in other anatomic locations. GLUT-1 immunohistochemical staining is a valuable tool for confirmatory diagnosis in these patients.

    View details for DOI 10.1016/j.ijporl.2009.03.024

    View details for Web of Science ID 000269224900002

    View details for PubMedID 19524305

  • Otorrhea in Infants With Tympanostomy Tubes Before and After Surgical Repair of a Cleft Palate ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Curtin, G., Messner, A. H., Chang, K. W. 2009; 135 (8): 748-751

    Abstract

    To compare the incidence of otorrhea in a group of infants with cleft palate (CP) and tympanostomy tubes before and after surgical repair of the CP.Prospective observational study.Otolaryngology clinic at a tertiary care children's hospital.Thirty-three infants with CP and middle ear effusions who underwent tympanostomy tube placement. Subjects were observed from the time of tube placement until 6 months after CP repair.Incidence of otorrhea before and after CP repair.Subjects were observed a mean of 6.3 months before CP repair and 6 months after CP repair. Before CP repair, 11 of 33 infants (33%) had no episodes of otorrhea, compared with 22 of 33 (67%) after CP repair (P = .007). Fourteen infants (43%) had 2 or more episodes of otorrhea before CP repair compared with 2 (6%) after CP repair (P = .001). Before CP repair, significantly fewer tubes were patent at the time of the audiologic evaluation compared with after CP repair (39 of 62 [63%] vs 52 of 66 [79%]; P = .048). Average speech reception threshold for the infants with tympanostomy tubes before CP repair was 18.1 dB compared with 12.6 dB after CP repair (P = .01).The incidence of otorrhea after tympanostomy tube placement before CP repair is higher than the incidence after CP repair, although more than half of all infants (19 [58%]) had either 1 or no episodes of otorrhea before CP repair.

    View details for Web of Science ID 000269022600003

    View details for PubMedID 19687392

  • Pediatric Laryngeal Dimensions: An Age-Based Analysis ANESTHESIA AND ANALGESIA Dalal, P. G., Murray, D., Messner, A. H., Feng, A., McAllister, J., Molter, D. 2009; 108 (5): 1475-1479

    Abstract

    In children, the cricoid is considered the narrowest portion of the "funnel-shaped" airway. Growth and development lead to a transition to the more cylindrical adult airway. A number of airway decisions in pediatric airway practice are based on this transition from the pediatric to the adult airway. Our primary aim in this study was to measure airway dimensions in children of various ages. The measures of the glottis and cricoid regions were used to determine whether a transition from the funnel-shaped pediatric airway to the cylindrical adult airway could be identified based on images obtained from video bronchoscopy.One hundred thirty-five children (ASA physical status 1 or 2) aged 6 mo to 13 yr were enrolled for measurement of laryngeal dimensions, including cross-sectional area (G-CSA), anteroposterior and transverse diameters at the level of the glottis and the cricoid (C-CSA), using the video bronchoscopic technique under general anesthesia.Of the 135 children enrolled in the study, seven patients were excluded from the analysis mainly because of poor image quality. Of the 128 children studied (79 boys and 49 girls), mean values (+/-standard deviation) for the demographic data were age 5.9 (+/-3.3) yr, height 113.5 (+/-22.2) cm and weight 23.5 (+/-13) kg. Overall, the mean C-CSA was larger than the G-CSA (48.9 +/- 15.5 mm(2) vs 30 +/- 16.5 mm(2), respectively). This relationship was maintained throughout the study population starting from 6 mo of age (P < 0.001, r = 0.45, power = 1). The mean ratio for C-CSA: G-CSA was 2.1 +/- 1.2. There was a positive correlation between G- and the C-CSA versus age (r = 0.36, P < 0.001; r = 0.27, P = 0.001, respectively), height (r = 0.34, P < 0.001; r = 0.29, P < 0.001, respectively), and weight (r = 0.35, P < 0.001; r = 0.25, P = 0.003, respectively). No significant gender differences in the mean values of the studied variables were observed.In this study of infants and children, the glottis rather than cricoid was the narrowest portion of the pediatric airway. Similar to adults, the pediatric airway is more cylindrical than funnel shaped based on these video bronchoscopic images. Further studies are needed to determine whether these static airway measurements in anesthetized and paralyzed children reflect the dynamic characteristics of the glottis and cricoid in children.

    View details for DOI 10.1213/ane.0b013e31819d1d99

    View details for Web of Science ID 000265422300020

    View details for PubMedID 19372324

  • Subglottic Hemangioma OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA O-Lee, T. J., Messner, A. 2008; 41 (5): 903-?

    Abstract

    Subglottic hemangioma is a rare condition that can be potentially life threatening because of airway obstruction. It is common for subglottic hemangioma to be misdiagnosed as croup initially. Infants with a subglottic hemangioma and cutaneous facial hemangiomas in a "beard" distribution should be evaluated for PHACE syndrome. Endoscopic laser resection is effective for subglottic hemangioma but carries a chance of subglottic stenosis, up to 25%. Open excision of subglottic hemangioma is an excellent option, particularly in patients with bilateral or circumferential subglottic hemangioma. It is a more extensive surgery when compared with endoscopic laser resection. Surgeons who do not have access to a pediatric intensive care unit staffed by experienced pediatric intensivists should not use this procedure.

    View details for DOI 10.1016/j.otc.2008.04.009

    View details for Web of Science ID 000259874600007

    View details for PubMedID 18775341

  • Newborn hearing screening in infants with cleft palates OTOLOGY & NEUROTOLOGY Chen, J. L., Messner, A. H., Curtin, G. 2008; 29 (6): 812-815

    Abstract

    The high incidence of conductive hearing loss from serous effusion in patients with cleft palate is well known. This study investigates the results and interpretation of newborn hearing screening in infants with cleft palates.Retrospective cohort review.One hundred fourteen newborns with cleft palate, with or without cleft lip, born between 1999 and 2005 and referred to a craniofacial anomalies clinic.Tympanostomy tubes were placed in 102 newborns, and follow-up audiograms were available for 104 infants.Hearing screening outcomes were collected. Sex, gestational period, type of screening performed, the presence of hearing loss after tube placement, and the presence of associated syndromes were noted.Eighty-two (72%) of 114 of newborns with cleft palates passed their hearing screen. Of the 30 newborns who failed their hearing screen, and had tympanostomy tubes placed, 13 (43%) had persistent hearing loss after tube placement. Factors predicting persistent hearing loss include cleft palate alone, female infants, and the presence of an associated syndrome.Newborns with cleft palate are at higher risk of failing their newborn hearing screen compared with healthy neonates. Detection of sensorineural or conductive hearing loss unrelated to middle ear effusions is more difficult in this at-risk population with cleft palate because of the high prevalence of serous otitis media.

    View details for Web of Science ID 000259071900013

    View details for PubMedID 18617869

  • Letters of Recommendation to an Otolaryngology/Head and Neck Surgery Residency Program: Their Function and the Role of Gender LARYNGOSCOPE Messner, A. H., Shimahara, E. 2008; 118 (8): 1335-1344

    Abstract

    To ascertain common features and gender differences in letters of recommendation (LORs) for applicants to an otolaryngology/head and neck surgery (OHNS) residency program.Retrospective review.Seven hundred sixty-three LORs submitted to one OHNS residency program in 2006 were reviewed.All 763 letters "recommended" the applicant for OHNS residency. Ninety-one percent of letters were written by men, 68.4% by male otolaryngologists (OTOs), 4.2% by female OTOs, and 33% by OHNS department chairs or division chiefs (100% men). A comparison of female and male letter writers revealed five categories with significant differences: female letter writers were more likely to call an applicant a "team player" (P = .000), "compassionate," (P = .001) and use strings of adjectives (P = .024). In contrast, they were less likely when compared with male letter writers, to mention an applicant's personal life (P = .003), or write "letters of minimal assurance" (P = .035). Evaluation of the letters by applicant gender revealed two findings: letter writers were more likely to use a gender term in letters for male applicants (P = .004), and male letter writers were more likely to make reference to a female candidate's physical appearance (P = .040).LORs for OHNS residency universally advocate for the applicant. The letters are written predominately by the highest-ranking male OTOs in academic medicine. In the LORs, male and female applicants are described similarly. Male and female letter writers, however, often describe applicants in different ways regardless of applicant gender.

    View details for DOI 10.1097/MLG.0b013e318175337e

    View details for Web of Science ID 000260662600002

    View details for PubMedID 18596564

  • Pediatric tympanoplasty: factors affecting success CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY Lin, A. C., Messner, A. H. 2008; 16 (1): 64-68

    Abstract

    The timing of pediatric tympanoplasty is controversial despite many studies reporting on the relationship between patient age and tympanoplasty results. This update reviews the literature to examine the role of age and other factors on the success of tympanoplasty in children.Multiple studies, both recent and past, have largely reported no difference in the success rate of pediatric tympanoplasty as a function of age. In addition, these studies as a whole have offered a conflicting mix of other parameters that may or may not affect the surgical result.The rate of success of pediatric tympanoplasty is likely not a matter of age, but a matter of patient selection. Careful attention to factors such as technique, eustachian-tube function, and site and size of the perforation will likely increase the rate of an intact tympanic membrane with improvement in hearing. No one variable determines outcome. Clearly, some factors studied are age-related, but age in itself should not be an indication or contraindication to treatment.

    View details for Web of Science ID 000270375100014

    View details for PubMedID 18197025

  • Pediatric vocal fold paralysis after cardiac surgery: Rate of recovery and sequelae OTOLARYNGOLOGY-HEAD AND NECK SURGERY Truong, M. T., Messner, A. H., Kerschner, J. E., Scholes, M., Wong-Dominguez, J., Milczuk, H. A., Yoon, P. J. 2007; 137 (5): 780-784

    Abstract

    To determine the rate of recovery of pediatric vocal fold paralysis (VFP) after cardiac surgery.Retrospective case series from January 2000 to 2005 at 4 tertiary care pediatric hospitals.A total of 109 children with VFP were identified. Of 80 patients with follow-up >3 months, 28 (35%) recovered vocal fold function with a median time to diagnosis of recovery of 6.6 months. Fifty-two (65%) patients had persistent vocal fold paralysis with a median follow-up time of 16.4 months. Twenty-five (45%) of 55 patients demonstrated aspiration or laryngeal penetration with modified barium swallow. Twenty-nine (27%) of the 109 patients underwent surgical intervention for their airway, feeding, or voice.Pediatric VFP is not an uncommon complication after cardiac surgery and can result in serious sequelae. This study demonstrates a 35% rate of recovery, 45% rate of aspiration, and 27% rate of complications that require surgical intervention.

    View details for DOI 10.1016/j.otohns.2007.07.028

    View details for Web of Science ID 000250821700017

    View details for PubMedID 17967646

  • Open excision of subglottic hemangioma with microscopic dissection INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY O-Lee, T. J., Messner, A. 2007; 71 (9): 1371-1376

    Abstract

    To evaluate the efficacy of open excision of subglottic hemangioma utilizing microscopic dissection techniques.Retrospective review of case series.Tertiary care teaching children's hospital.The study included 8 patients ages 7 weeks to 8 months. All patients underwent open microscopic excision of subglottic hemangioma between 2000 and 2006.All patients underwent full pre-operative evaluation including micro-direct laryngoscopy and bronchoscopy. All resections were carried out with an anterior cricoid split and partial laryngofissure. Intra-laryngeal dissections were carried out under a cross-table binocular dissecting microscope. Mucosal preservation was practiced whenever possible. Thyroid ala cartilage graft was used to augment subglottic laryngeal framework. Patients were intubated for 3-7 days prior to reassessment and extubation.Eight patients were treated with microscopic open excision of subglottic hemangioma. All patients were successfully extubated. During the follow-up period, 2/8 patients developed early subglottic stenosis that required endoscopic laser treatment. Median follow-up time was 37 months (range 3-84 months). No recurrences have been observed.Microscopic dissection adds precision to open excision of subglottic hemangioma. Such precision enables complete excision while accomplishing maximal mucosal preservation, thus limiting the risk of recurrence and subglottic stenosis.

    View details for DOI 10.1016/j.ijport.2007.05.006

    View details for Web of Science ID 000249164000004

    View details for PubMedID 17644192

  • Radiology case quiz 2: Congenital high airway obstruction syndrome (CHAOS) ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Erickson, V., Messner, A. 2007; 133 (3): 299-301

    View details for Web of Science ID 000244935700015

    View details for PubMedID 17372091

  • Familial laryngomalacia in two siblings with syndromic features INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Chen, J. L., Messner, A. H., Chang, K. W. 2006; 70 (9): 1651-1655

    Abstract

    We present two siblings with severe laryngomalacia requiring surgical intervention during the newborn period, microcephaly, developmental delay, cleft palate, preaxial polydactyly, dysplastic nails and conductive hearing loss (persistent after tympanostomy tube placement). In addition the girl has microopthalmia and the boy was born with a patent ductus arteriosus, mild pelviectasis, and hypospadias. This combination of multiple congenital anomalies has not been described previously and may represent a previously undescribed syndrome with autosomal inheritance.

    View details for DOI 10.1016/j.ijporl.2006.04.010

    View details for Web of Science ID 000240528700022

    View details for PubMedID 16774790

  • Simultaneous multigene mutation detection in patients with sensorineural hearing loss through a novel diagnostic microarray: A new approach for newborn screening follow-up PEDIATRICS Gardner, P., Oitmaa, E., Messner, A., Hoefsloot, L., Metspalu, A., Schrijver, I. 2006; 118 (3): 985-994

    Abstract

    The advent of universal newborn hearing screening in the United States and other countries, together with the identification of genes involved in the process of hearing, have led to an increase in both the need and opportunity for accurate molecular diagnosis of patients with hearing loss. Deafness and hearing impairment have a genetic cause in at least half the cases. The molecular genetic basis for the majority of these patients remains obscure, however, because of the absence of associated clinical features in approximately 70% (ie, nonsyndromic hearing loss) of patients, genetic heterogeneity, and the lack of molecular genetic tests that can evaluate a large number of mutations across multiple genes.We report on the development of a diagnostic panel with 198 mutations underlying sensorineural (mostly nonsyndromic) hearing loss. This panel, developed on a microarray, is capable of simultaneous evaluation of multiple mutations in 8 genes (GJB2, GJB6, GJB3, GJA1, SLC26A4, SLC26A5 and the mitochondrial genes encoding 12S rRNA and tRNA-Ser[UCN]).The arrayed primer extension array for sensorineural hearing loss is based on a versatile platform technology and is a robust, cost-effective, and easily modifiable assay. Because hearing loss is a major public health concern and common at all ages, this test is suitable for follow-up after newborn hearing screening and for the detection of a genetic etiology in older children and adults.Comprehensive and relatively inexpensive genetic testing for sensorineural hearing loss will improve medical management for affected individuals and genetic counseling for their families.

    View details for DOI 10.1542/peds.2005-2519

    View details for Web of Science ID 000240959100016

    View details for PubMedID 16950989

  • Death following tonsillectomy in a child with Williams syndrome INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Monfared, A., Messner, A. 2006; 70 (6): 1133-1135

    Abstract

    Williams syndrome (WS) is an uncommon genetic syndrome due to a deletion of several genes on chromosome 7. The syndrome is associated with dysmorphic facies, neurological manifestations, idiopathic hypercalcemia, and cardiac abnormalities, particularly supravalvular aortic stenosis (SVAS). Children with Williams syndrome may have chronic serous otitis media and/or obstructive sleep apnea. Hyperacusis is also commonly seen in these children. We report a case of sudden death at the time of tonsillectomy/adenoidectomy and bilateral tympanostomy tube placement in a child with Williams syndrome. All children with Williams syndrome should have a thorough cardiac evaluation before undergoing general anesthesia for any otolaryngologic procedure.

    View details for DOI 10.1016/j.ijporl.2005.11.009

    View details for Web of Science ID 000237864100029

    View details for PubMedID 16406078

  • Perioperative steroids in tonsillectomy using electrocautery and sharp dissection techniques ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Hanasono, M. M., Lalakea, M. L., Mikulec, A. A., Shepard, K. G., Wellis, V., Messner, A. H. 2004; 130 (8): 917-921

    Abstract

    To determine the effect of preoperative dexamethasone sodium phosphate administration on posttonsillectomy morbidity for electrocautery ("hot") and sharp ("cold") dissection techniques.Prospective, randomized, double-blind study.University pediatric hospital and county teaching hospital. Subjects A total of 219 children, aged 9 months to 12 years, undergoing tonsillectomy. Intervention Participants who underwent tonsillectomy were randomly assigned to receive either intravenous dexamethasone sodium phosphate (1 mg/kg) or placebo.Pain scores, oral intake, and emesis on postoperative day (POD) 1.A total of 106 subjects (62 undergoing hot and 44 cold tonsillectomies) received preoperative steroids, and 113 (56 hot and 57 cold tonsillectomies) received placebo. On POD 1, pain scores reported by patients (P =.02), parents (P =.002), and physicians (P<.001) were significantly lower in subjects receiving steroids than in those receiving placebo. Emesis was reduced from a mean of 2.1 (placebo group) to 1.2 episodes (steroid group) (P =.02). Oral intake improved from 24.5% of normal diet (placebo) to 31.7% (steroid group) (P =.004). When all 4 groups were compared (cold placebo, cold steroid, hot placebo, and hot steroid), pain scores reported by physicians and parents were significantly lower in the cold steroid group than in the other groups.Perioperative dexamethasone use reduces posttonsillectomy morbidity in pediatric patients in the early postoperative period after hot or cold tonsillectomy. The combination of steroid and cold dissection technique provided the greatest advantage in reducing posttonsillectomy subjective pain levels.

    View details for Web of Science ID 000223138800002

    View details for PubMedID 15313860

  • Treating pediatric patients with obstructive sleep disorders: an update OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Messner, A. H. 2003; 36 (3): 519-?

    Abstract

    Obstructive sleep apnea syndrome in children continues to be an important subject for otolaryngologists because of the high prevalence of the disease. The evaluation of a child with OSAS remains controversial, although there is little controversy that T&A is the optimal treatment for these children. The search for the optimal T&A technique is ongoing, although now either "cold" tonsillectomy or "hot" tonsillectomy is standard. Quality-of-life studies confirm the significant benefit gained after a child undergoes a T&A.

    View details for DOI 10.1016/S0030-6665(02)00180-9

    View details for Web of Science ID 000183412600010

    View details for PubMedID 12956099

  • Ankyloglossia: The adolescent and adult perspective OTOLARYNGOLOGY-HEAD AND NECK SURGERY Lalakea, M. L., Messner, A. H. 2003; 128 (5): 746-752

    Abstract

    We sought to characterize examination findings and functional limitations due to ankyloglossia in adolescents and adults and to evaluate frenuloplasty in this group. Study design A prospective study was conducted of 15 individuals with ankyloglossia aged 14 to 68 years. Baseline symptoms were recorded by questionnaire, and tongue mobility measures were compared with that of 20 control subjects. Six subjects were reassessed postfrenuloplasty.Thirteen of 14 patients with uncorrected ankyloglossia (93%) noted symptoms including speech problems (50%) and mechanical limitations (57%), such as difficulty licking the lips. Mean tongue protrusion and elevation at baseline measured 15.5 +/- 6.0 mm and 13.6 +/- 8.0 mm, respectively, for patients and 32.0 +/- 3.9 mm and 30.3 +/- 4.9 mm for control subjects (P < 0.001). Postfrenuloplasty, tongue function improved both subjectively and objectively in 6 of 6 patients, with a mean gain of 9.2 mm for protrusion (P < 0.05) and 13.0 mm for elevation (P < 0.001).Symptoms related to ankyloglossia are prevalent in this age group and respond favorably to frenuloplasty.

    View details for DOI 10.1016/S0194-5998(03)00258-4

    View details for Web of Science ID 000183096200019

    View details for PubMedID 12748571

  • Ankyloglossia: does it matter? PEDIATRIC CLINICS OF NORTH AMERICA Lalakea, M. L., Messner, A. H. 2003; 50 (2): 381-?

    Abstract

    Ankyloglossia is an uncommon oral anomaly that can cause difficulty with breast-feeding, speech articulation, and mechanical tasks such as licking the lips and kissing. For many years the subject of ankyloglossia has been controversial, with practitioners of many specialties having widely different views regarding its significance. In many children, ankyloglossia is asymptomatic; the condition may resolve spontaneously, or affected children may learn to compensate adequately for their decreased lingual mobility. Some children, however, benefit from surgical intervention (frenotomy or frenuloplasty) for their tongue-tie. Parents should be educated about the possible long-term effects of tongue-tie while their child is young (< 1 year of age), so that they may make an informed choice regarding possible therapy.

    View details for DOI 10.1016/S0031-3955(03)00029-4

    View details for Web of Science ID 000183417100007

    View details for PubMedID 12809329

  • The need for long-term audiologic follow-up of neonatal intensive care unit (NICU) graduates INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Yoon, P. J., Price, M., Gallagher, K., Fleisher, B. E., Messner, A. H. 2003; 67 (4): 353-357

    Abstract

    To evaluate the adequacy of newborn hearing screening in the identification of hearing loss in post-neonatal intensive care unit (NICU) infants.Eighty-two post-NICU infants who had initially passed automated auditory brainstem response (AABR) screening were studied prospectively between November 1997 and July 1999. Tympanometry and transient evoked otoacoustic emissions (TEOAE) were used to evaluate middle ear status and screen the hearing of subjects when they were seen routinely in the Mary L. Johnson Infant Development Clinic, where NICU graduates are followed at our institution. TEOAEs were not performed in subjects with abnormal tympanometry, defined as negative pressures greater than 200 daPa or flat tympanograms.Of the 82 subjects, 31 (37%) had abnormal tympanometry in at least one ear, with 24 (29%) exhibiting abnormal values bilaterally. Two subjects were identified with delayed-onset or previously undiagnosed sensorineural hearing loss. One had a history of persistent pulmonary hypertension (PPHN) and extracorporeal membrane oxygenation. The other infant had no risk factors for sensorineural hearing loss.Our data indicate that newborn hearing screening programs may not provide adequate vigilance for NICU graduates. The high incidence of abnormal middle ear status and the identification of delayed-onset hearing loss in an infant without known risk factors highlights the need for close audiologic and speech/language follow-up in the post-NICU population.

    View details for DOI 10.1016/S0165-5876(02)00400-7

    View details for Web of Science ID 000182263300007

    View details for PubMedID 12663106

  • The effect of ankyloglossia on speech in children OTOLARYNGOLOGY-HEAD AND NECK SURGERY Messner, A. H., Lalakea, M. L. 2002; 127 (6): 539-545

    Abstract

    We wanted to determine whether ankyloglossia is associated with articulation problems and the effect of frenuloplasty on speech and tongue mobility.We conducted a prospective study of 30 children aged 1 to 12 years with ankyloglossia undergoing frenuloplasty. Outcomes were assessed by measurements of tongue mobility, speech evaluation, and parent questionnaires.Mean tongue protrusion improved from 14.2 mm preoperatively to 25.8 mm postoperatively (P < 0.01). Similarly, mean tongue elevation improved from 5.2 to 22 mm (P < 0.01). Preoperative speech pathology evaluation documented articulation problems thought due to ankyloglossia in 15 of 21 children. Postoperative evaluation in 15 of these children showed improvement in articulation in 9, no change in 4 who had normal speech preoperatively, and an ongoing articulation disorder in 2. Parent perception of speech intelligibility on a scale of 1 to 5 improved from 3.4 to 4.2 (P < 0.01).Tongue mobility and speech improve significantly after frenuloplasty in children with ankyloglossia who have articulation problems.

    View details for DOI 10.1067/mhn.2002.129823

    View details for Web of Science ID 000180088700008

    View details for PubMedID 12501105

  • A phase II, double-blind, randomized, placebo-controlled clinical trial of tgAAVCF using maxillary sinus delivery in patients with cystic fibrosis with antrostomies HUMAN GENE THERAPY Wagner, J. A., Nepomuceno, I. B., Messner, A. H., Moran, M. L., Batson, E. P., DiMiceli, S., Brown, B. W., Desch, J. K., Norbash, A. M., Conrad, C. K., Guggino, W. B., Flotte, T. R., Wine, J. J., Carter, B. J., Reynolds, T. C., Moss, R. B., Gardner, P. 2002; 13 (11): 1349-1359

    Abstract

    tgAAVCF, an adeno-associated cystic fibrosis transmembrane conductance regulator (CFTR) viral vector/gene construct, was administered to 23 patients in a Phase II, double-blind, randomized, placebo-controlled clinical trial. For each patient, a dose of 100,000 replication units of tgAAVCF was administered to one maxillary sinus, while the contralateral maxillary sinus received a placebo treatment, thereby establishing an inpatient control. Neither the primary efficacy endpoint, defined as the rate of relapse of clinically defined, endoscopically diagnosed recurrent sinusitis, nor several secondary endpoints (sinus transepithelial potential difference [TEPD], histopathology, sinus fluid interleukin [IL]-8 measurements) achieved statistical significance when comparing treated to control sinuses within patients. One secondary endpoint, measurements of the anti-inflammatory cytokine IL-10 in sinus fluid, was significantly (p < 0.03) increased in the tgAAVCF-treated sinus relative to the placebo-treated sinus at day 90 after vector instillation. The tgAAVCF administration was well tolerated, without adverse respiratory events, and there was no evidence of enhanced inflammation in sinus histopathology or alterations in serum-neutralizing antibody titer to adeno-associated virus (AAV) capsid protein after vector administration. In summary, this Phase II trial confirms the safety of tgAAVCF but provides little support of its efficacy in the within-patient controlled sinus study. Various potentially confounding factors are discussed.

    View details for Web of Science ID 000177015400009

    View details for PubMedID 12162817

  • Pediatric residents' clinical diagnostic accuracy of otitis media PEDIATRICS Steinbach, W. J., Sectish, T. C., Benjamin, D. K., Chang, K. W., Messner, A. H. 2002; 109 (6): 993-998

    Abstract

    Pediatric resident physicians' clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry.Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used kappa statistics to calculate correlation of clinical findings and interpretation.A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a kappa statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (kappa statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (kappa statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a kappa statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a kappa statistic of 0.32 (fair agreement).Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.

    View details for Web of Science ID 000175907100015

    View details for PubMedID 12042534

  • Paradoxical vocal cord motion in a child presenting with cyanosis and respiratory failure. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Falco, D. A., Hammer, G. B., Conrad, C., Messner, A. H. 2002; 3 (2): 185-186

    View details for PubMedID 12780992

  • Volunteer-based universal newborn hearing screening program INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Messner, A. H., Price, M., Kwast, K., Gallagher, K., Forte, J. 2001; 60 (2): 123-130

    Abstract

    To evaluate efficacy and costs of a volunteer-based universal newborn hearing screening program.The Lucile Packard Children's Hospital at Stanford newborn hearing screening program database was reviewed. Results and costs of the hearing screens were analyzed.Hearing screens were performed on 5771 newborns treated in the well-baby nursery and nine infants from this population were identified with hearing loss, seven of whom had no risks factors for hearing loss. Using volunteers to perform the first-line screen with the automated auditory brainstem response (AABR) technology, 91% of infants registered for screening were evaluated prior to discharge. An additional 4% of infants were screened as outpatients. If an infant failed the AABR on two occasions, he or she was rescreened with the AABR or transient evoked otoacoustic emissions by a licensed audiologist, often while the infant was still in the hospital. Using this algorithm, 5% of infants tested in the well-baby nursery needed additional follow-up as an outpatient. Cost analysis of this volunteer-based program reveals a per/baby screening cost of $27.41.A volunteer-based hearing screening program is a viable option for hearing screening in well-baby nurseries but does not result in significant cost savings during the first 2 years of the program.

    View details for Web of Science ID 000170845700004

    View details for PubMedID 11518589

  • Lymphatic malformation with internal jugular phlebectasia OTOLARYNGOLOGY-HEAD AND NECK SURGERY Yoon, P. J., Messner, A. H. 2001; 124 (5): 579-580

    View details for Web of Science ID 000168682300020

    View details for PubMedID 11337668

  • Fungal malignant otitis externa due to Scedosporium apiospermum ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Yao, M., Messner, A. H. 2001; 110 (4): 377-380

    Abstract

    Malignant otitis externa (MOE) is an infection of the external auditory canal that invades the skull base. Aspergillus species fungi were the pathological organism in 21 of 23 reported cases of fungal MOE. We report on a 21-year-old man with end-stage acquired immunodeficiency syndrome (AIDS) and fungal MOE caused by Scedosporium apiospermum. Fungal MOE is most common in patients with end-stage AIDS and hematologic malignancies. Granulation tissue is not a common finding in these patients, and the infectious process often starts in the mastoid air cells or middle ear space, as opposed to the external auditory canal. Surgical debridement and amphotericin B are the mainstays of therapy; resolution of the infection depends greatly on the severity of the underlying disease.

    View details for Web of Science ID 000168014900015

    View details for PubMedID 11307916

  • Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy LARYNGOSCOPE Moir, M. S., Bair, E., Shinnick, P., Messner, A. 2000; 110 (11): 1824-1827

    Abstract

    To compare the effectiveness of acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy and adenoidectomy.Prospective, randomized, double-blind study.Fifty-one children ages 3 to 12 years scheduled for outpatient tonsillectomy and adenoidectomy were studied. Patients were randomly assigned to receive acetaminophen or acetaminophen with codeine in unlabeled bottles for postoperative pain control. The Wong-Baker FACES pain rating scale was used to help children quantify their level of pain after surgery. The level of pain, quantity of pain medication required, presence of side effects, and the percentage of a normal diet consumed was recorded for 10 postoperative days.There was no difference (P > .05, all time points) in the level of postoperative pain reported by the parents and children in the two groups. The acetaminophen with codeine group tended to have increased problems with nausea, emesis, and constipation, but these differences did not reach statistical significance. Children in the acetaminophen group consumed a significantly higher percentage of a normal diet on the first 6 postoperative days (P < .05, all time points).There was no difference in the level of pain control provided by acetaminophen and acetaminophen with codeine as measured by the Wong-Baker FACES pain rating scale. Postoperative oral intake was significantly higher in children treated with acetaminophen alone.

    View details for Web of Science ID 000165165200010

    View details for PubMedID 11081593

  • Impact of tympanostomy tubes on child quality of life ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Rosenfeld, R. M., Bhaya, M. H., Bower, C. M., Brookhouser, P. E., Casselbrant, M. L., Chan, K. H., Cunningham, M. J., Derkay, C. S., Gray, S. D., Manning, S. C., Messner, A. H., Smith, R. J. 2000; 126 (5): 585-592

    Abstract

    The objective benefits of tympanostomy tubes for otitis media are well established, but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied.To determine the subjective impact of tympanostomy tubes on child QOL, and to compare the variability in QOL before surgery with that observed after surgery.Prospective, observational, before-and-after trial.Fourteen referral-based pediatric otolaryngology practices in the United States.Consecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure.Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey), satisfaction with health care decision (Satisfaction With Decision Scale), and satisfaction with office visit; surveys were completed at baseline (visit 1), at surgery (visit 2), and after surgery (visit 3).Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3).Changes in QOL before surgery were mostly trivial, and were smaller than changes observed after surgery (P<.001). Large, moderate, and small improvements in QOL occurred after surgery in 56%, 15%, and 8% of children, respectively. Physical symptoms, caregiver concerns, emotional distress, and hearing loss were most improved, but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status, child age, type of otitis media (recurrent vs chronic), and office visit satisfaction were unrelated to outcome.Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal, and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.

    View details for Web of Science ID 000086907900002

    View details for PubMedID 10807325

  • Pediatric sleep-related breathing disorders AMERICAN JOURNAL OF OTOLARYNGOLOGY Messner, A. H., Pelayo, R. 2000; 21 (2): 98-107

    Abstract

    Sleep-related breathing disorders (SRBD) can occur at any age. Obstructive sleep apnea, upper airway resistance syndrome and obstructive hypopnea syndrome all lie on the pathological continuum of SRBD. These disorders can have a great impact on a child's quality of life and can progress to significant complications. The symptoms, signs, work-up, and treatment of SRBD in children are discussed.

    View details for Web of Science ID 000085933800005

    View details for PubMedID 10758994

  • Isolated large vestibular aqueduct syndrome in a family ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Nowak, K. C., Messner, A. H. 2000; 109 (1): 40-44

    Abstract

    This paper presents the second case in the literature of large vestibular aqueduct syndrome without associated cochlear anomalies in 2 members of the same family. The syndrome is frequently associated with sensorineural hearing loss presenting in childhood. The onset is commonly sudden, following an event causing increased intracranial pressure. On the basis of an emerging pattern of inheritance, we recommend screening siblings of an affected child. We also discuss the importance of characterizing the extent of disease of the inner ear.

    View details for Web of Science ID 000084767600007

    View details for PubMedID 10651410

  • Retropharyngeal abscess management in children: Current practices OTOLARYNGOLOGY-HEAD AND NECK SURGERY Lalakea, M. L., Messner, A. H. 1999; 121 (4): 398-405

    Abstract

    Retropharyngeal abscesses (RAs) in children are uncommon in the modern antibiotic era. As a result, there are few large series outlining the management of these infections in contemporary literature. The goal of this study is to determine the current standard of care for RA. The membership of the American Society of Pediatric Otolaryngology was surveyed, and the response rate was 77.5%. Seventy-two percent of practitioners reported that CT is their preferred diagnostic method. Nearly two thirds recommended a trial of intravenous antibiotics at least occasionally for suspected RA before operative drainage was considered; 51% of respondents indicated that 20% to 40% of RA may resolve with antibiotics alone. Intraoral incision and drainage is the surgical technique preferred by 83% of respondents. Tracheotomy and short-term intubation (24 to 72 hours) are rarely required. This study defines current management practices for RA in children among pediatric otolaryngologists. Results are compared with those in the existing literature.

    View details for Web of Science ID 000082961200012

    View details for PubMedID 10504595

  • Safety of pediatric short-stay tonsillectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Lalakea, M. L., Marquez-Biggs, I., Messner, A. H. 1999; 125 (7): 749-752

    Abstract

    To determine the safety of a relatively brief (<3-hour) period of postoperative observation prior to discharge in children undergoing outpatient tonsillectomy.Retrospective chart review.Tertiary care children's hospital and public teaching hospital.The records of all patients (12 years of age who underwent tonsillectomy or adenotonsillectomy from November 1995 through July 1997 were reviewed. A total of 143 patients scheduled for ambulatory treatment were identified; 9 were excluded owing to insufficient follow-up. The remaining 134 patients made up the study group.(1) Duration of observation prior to discharge; (2) complication rates.The mean age of the study population was 6.1+/-2.6 (mean+/-SD) years. Obstructive sleep apnea was an indication for surgery in 86.5%. Eleven (8.2%) of 134 planned outpatients were electively admitted from the recovery room for inpatient observation, most often because of respiratory compromise. Patients admitted from the recovery room were significantly younger (mean age, 4.0 years) than those who were discharged as planned (6.3 years, P<.001). One hundred twenty-three patients were discharged from the recovery room as anticipated, following a mean+/-SD duration of postoperative observation of 144+/-48 minutes. Overall, 5 (4.1%) of these 123 outpatients suffered complications after discharge. Two patients (1.6%) experienced primary bleeding, both at 8 hours after surgery. Four patients (3.2%) were readmitted. The complication rate did not vary significantly with the duration of postoperative observation (P= .71).A short postoperative observation period is safe, with a low rate of complications, in appropriately selected children scheduled for ambulatory tonsillectomy.

    View details for Web of Science ID 000081416800005

    View details for PubMedID 10406311

  • Evaluation of obstructive sleep apnea by polysomnography prior to pediatric adenotonsillectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Messner, A. H. 1999; 125 (3): 353-356

    View details for Web of Science ID 000079115900018

    View details for PubMedID 10190812

  • Maxillary sinusitis as a surrogate model for CF gene therapy clinical trials in patients with antrostomies JOURNAL OF GENE MEDICINE Wagner, J. A., Nepomuceno, I. B., Shah, N., Messner, A. H., Moran, M. L., Norbash, A. M., Moss, R. B., Wine, J. J., Gardner, P. 1999; 1 (1): 13-21

    Abstract

    Assessing the biological activity and clinical efficacy of gene therapy is critically important in cystic fibrosis (CF). It is widely accepted that clinical testing using surrogate markers including pulmonary function will be useful in assessing clinical efficacy. One problem with pulmonary surrogate markers of CF disease is the large number of patients and length of time required to demonstrate clinical efficacy. An alternative to pulmonary testing of new CF treatments is use of the maxillary sinuses as a surrogate model of CF lung disease. Using CF sinusitis as a surrogate model for testing clinical efficacy of new treatments is attractive because CF upper respiratory disease is similar to the lower respiratory disease with respect to electrophysiology and microbiology.Sinusitis recurrence in untreated sinuses was analyzed during a prospective, randomized, unblinded, dose-escalation, within-subjects, phase I clinical trial of the adeno-associated virus mediated cystic fibrosis transmembrane conductance regulator (AAV-CFTR) gene transfer.Clinical symptoms combined with sinus endoscopy proved useful in the diagnosis of unilateral and bilateral sinusitis recurrence. Sinusitis recurred at a rate of 45% during one month of follow-up. IL-8 concentration rose in sinus fluids from affected sinuses. Bacterial cultures and increased sinus leukocytes corroborated recurrent sinusitis. Sinus CT scans were also useful in diagnosing recurrent sinusitis in this surrogate model of CF infectious exacerbations.CF sinusitis as a surrogate for lung disease is particularly well-suited for phase II clinical trials of gene transfer agents, with the potential for measuring clinical efficacy in relatively small numbers of patients over relatively short periods of time.

    View details for Web of Science ID 000083463500002

    View details for PubMedID 10738581

  • Post-transplant lymphoproliferative disease may present with severe airway obstruction ANESTHESIOLOGY Hammer, G. B., Cao, S., Boltz, M. G., Messner, A. 1998; 89 (1): 263-265

    View details for Web of Science ID 000074710800035

    View details for PubMedID 9667319

  • Pitfalls in the diagnosis of aerodigestive tract foreign bodies CLINICAL PEDIATRICS Messner, A. H. 1998; 37 (6): 359-365

    Abstract

    In the young child, particularly those between the ages of 1 and 3 years, aerodigestive tract foreign bodies continue to be a significant problem. Early diagnosis and treatment can decrease morbidity and length of hospital stay in these children. Three cases of delayed diagnosis in children with bronchial (2) and esophageal (1) foreign bodies are presented. In dealing with young children it is important to maintain a high clinical suspicion of a foreign body and to perform a detailed history and physical examination. Options in radiographic analysis of the patient with a suspected foreign body, probable locations of the foreign body, and the likelihood of definitive radiographic findings are discussed. Importantly, a negative radiographic analysis does not rule out the presence of an aerodigestive tract foreign body. Two flow charts for the evaluation of patients who have possibly ingested or inhaled a foreign body are presented to aid the primary care physician in diagnosis.

    View details for Web of Science ID 000074122800005

    View details for PubMedID 9637900

  • A phase I/II study of tgAAV-CF for the treatment of chronic sinusitis in patients with cystic fibrosis HUMAN GENE THERAPY Wagner, J. A., Moran, M. L., Messner, A. H., DAIFUKU, R., Conrad, C. K., Reynolds, T., Guggino, W. B., Moss, R. B., Carter, B. J., Wine, J. J., Flotte, T. R., Gardner, P. 1998; 9 (6): 889-909

    View details for Web of Science ID 000073201700014

    View details for PubMedID 9581911

  • Oral fluid intake following tonsillectomy INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Messner, A. H., Barbita, J. A. 1997; 39 (1): 19-24

    Abstract

    Children undergoing tonsillectomy surgery traditionally have been required to drink a specified amount of fluid before being discharged home. With increasing economic pressures, same-day discharge tonsillectomy has become common, and several studies have shown it to be safe for the appropriately selected child. To examine the role of required oral fluid intake following tonsillectomy, a non-randomized cohort study was performed with 200 consecutive tonsillectomy patients scheduled for same-day discharge. The first 100 patients (group 1) were required to drink 20 cc/kg prior to discharge, and the next 100 patients (group 2) were not required to drink. The mean oral fluid intake prior to discharge decreased significantly between the two groups from 524 cc in group 1 to 130 cc in group 2 (P = 0.0001). The mean length of stay also decreased significantly from 13.8 h for group 1 to 10.0 h for group 2 (P = 0.0001). Sixty percent of children in each group vomited at least once following surgery. Fewer children in group 2 had protracted vomiting (8 versus 15) although this was not statistically significant (P = 0.12). No children were readmitted to the hospital for dehydration following discharge. Overall, 71% of children in group 1 scheduled to go home the same day were discharged on time, compared to 94% of children in group 2. In conclusion, it is safe and economically efficient to discharge tonsillectomy patients home prior to the resumption of normal oral fluid intake.

    View details for Web of Science ID A1997WG53600003

    View details for PubMedID 9051436

  • Nasal growth after external septoplasty in children ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Bejar, I., Farkas, L. G., Messner, A. H., Crysdale, W. S. 1996; 122 (8): 816-821

    Abstract

    To assess the impact of external septoplasty surgery on nasal growth in children.Twelve anthropometric measurements (9 linear and 3 angular) were obtained in patients who previously underwent external septoplasty surgery for severe nasal obstruction caused by septal deviation anterior to the nasal spine. Surgery consisted of excision, refashioning, and reinsertion of the quadrilateral cartilage. From these 12 measurements, 5 proportional indexes were calculated, and then all measurements and proportions were compared with previously published norms. Follow-up measurements were taken at least 2 years after surgery (average, 3.4 years).The Hospital for Sick Children, Toronto, Ontario, a tertiary care children's hospital.Twenty-eight patients who underwent external septoplasty surgery between the ages of 6 and 15 years.The principal measurements of the face and nose were within 1 SD of the normative mean for the majority of those in the study group. This was true for nasal height, nasal tip protrusion, nasal width, columella width, columella length, upper face height, face height, face width, inclination of the upper face, inclination of the nasal dorsum, and inclination of the columella. Values for 4 of the 5 proportional indexes were also overwhelmingly in the normal range. Twenty-nine percent of nasal dorsum measurements and 57% of nasal dorsum indexes were more than 2 SDs from the mean, indicating a predominance of short nasal dorsums.External septoplasty does not affect most aspects of nasal and facial growth, but it may negatively influence growth of the nasal dorsum. Prospective studies are needed to clarify this issue.

    View details for Web of Science ID A1996VC00900002

    View details for PubMedID 8703382

  • Otoplasty - Clinical protocol and long-term results ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Messner, A. H., Crysdale, W. S. 1996; 122 (7): 773-777

    Abstract

    To evaluate the long-term results after otoplasty on prominent ears.Between 1988 and 1993, ear protrusion was measured preoperatively and postoperatively in pediatric patients undergoing otoplasty by means of a standard protocol based on the Frankfort horizontal line. Patients were asked to return for follow-up measurements a minimum of 1 year after surgery. At the time of follow-up, a patient satisfaction survey was completed by the patients and their families.The Hospital for Sick Children, Toronto, Ontario, a tertiary care children's hospital.Thirty-one of 51 patients returned for follow-up an average of 3.7 years after surgery.One third of ears returned to their original position, one third of ears stayed in a position equal to the immediate postoperative position, and one third of ears had final positions between the preoperative and post-operative positions. At the superior rim, an average of 58% of the operative medialization was lost. Good to excellent ear-to-ear symmetry was obtained in 78% of patients who returned for follow-up. Retrospective chart review showed a revision surgery rate of 3%; stitch granulomas were removed in 9% of patients. The patient satisfaction survey found that 85% of patients were happy or very happy with their ears.With time, a substantial loss of correction can be expected in most (but not all) patients who undergo otoplasty, particularly at the upper pole. Overall, patients and their families are happy with the results of otoplasty surgery.

    View details for Web of Science ID A1996UX51300016

    View details for PubMedID 8663953

  • Mucosal lesions in severe combined immunodeficiency syndrome JOURNAL OF OTOLARYNGOLOGY Messner, A. H., MITCHELL, D. P., Roifman, C. M. 1996; 25 (3): 200-202

    View details for Web of Science ID A1996UQ51400014

    View details for PubMedID 8783087

Conference Proceedings


  • Hearing impairment and poverty: The epidemiology of ear disease in Peruvian schoolchildren Czechowicz, J. A., Messner, A. H., Alarcon-Matutti, E., Alarcon, J., Quinones-Calderon, G., Montano, S., Zunt, J. R. MOSBY-ELSEVIER. 2010: 272-277

    Abstract

    1) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2) To identify risk factors for HI and assess its impact on academic performance.Cross-sectional.Elementary schools in an asentimiento humano (shantytown) near Lima, Peru, October 2008 to March 2009.Schoolchildren (n = 335), ages six to 19 years.Audiological health was assessed with pure-tone audiometry, tympanometry, and otoscopy. The primary outcome was HI, defined as average threshold >25 dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for chi(2) values and odds ratios (ORs), and multivariate logistic regression.HI prevalence: 6.9 percent (95% confidence interval [CI] 4.2%-9.6%). Risk factors for HI (OR, 95% CI, P value): neonatal jaundice (5.59, 1.63-19.2, 0.015), seizure (7.31, 2.50-21.4, 0.0013), hospitalization (4.01, 1.66-9.68, 0.003), recurrent otitis media (5.06, 1.98-12.9, 0.002), past otorrhea (4.70, 1.84-12.0, 0.003), family history of HI at <35 years (2.91, 1.19-7.14, 0.026), tympanic membrane abnormality (13.8, 4.48-42.7, <0.001), cerumen impaction (15.8, 4.71-53.1, <0.001), and eustachian tube dysfunction (4.87, 1.74-13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15-9.82, 0.03).Impoverished Peruvian schoolchildren were four to seven times more likely to experience HI than children living in higher-income countries. Untreated middle ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.

    View details for DOI 10.1016/j.otohns.2009.10.040

    View details for Web of Science ID 000276574500022

    View details for PubMedID 20115987

  • Ankyloglossia: controversies in management Messner, A. H., Lalakea, M. L. ELSEVIER IRELAND LTD. 2000: 123-131

    Abstract

    To determine current beliefs regarding ankyloglossia and its treatment.Anonymous written survey.Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively.Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs.The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.

    View details for Web of Science ID 000089211000009

    View details for PubMedID 10967382

  • Ankyloglossia - Incidence and associated feeding difficulties Messner, A. H., Lalakea, M. L., Aby, J., MacMahon, J., Bair, E. AMER MEDICAL ASSOC. 2000: 36-39

    Abstract

    To determine the incidence of ankyloglossia (tongue-tie) in the well-baby population, and to determine whether patients with ankyloglossia experience breastfeeding difficulties.Prospective controlled study.Tertiary care children's hospital.A total of 1041 neonates in the well-baby nursery were screened for ankyloglossia. Those positively identified were invited to participate in the study. Mothers of newborns with ankyloglossia and mothers of a matched control group of unaffected newborns were contacted by telephone on a monthly basis for 6 months after their children were discharged from the hospital to determine the presence of breastfeeding difficulties.Incidence of ankyloglossia, percentage of infants successfully breastfed, and incidence of breastfeeding difficulties.Fifty newborns were identified with ankyloglossia, for an incidence of 4.8% The male-female ratio was 2.6:1.0. Of the 36 mothers of affected infants who were followed up and who intended to breastfeed, 30 (83%) successfully breastfed their infants for at least 2 months, compared with 33 (92%) of the 36 mothers of infants in the matched control group (P = .29). Breastfeeding difficulties were experienced by 9 (25%) of the mothers of infants with ankyloglossia compared with 1 (3%) of the control mothers (P<.01).Ankyloglossia, which is a relatively common finding in the newborn population, adversely affects breastfeeding in selected infants.

    View details for Web of Science ID 000084630700006

    View details for PubMedID 10628708

  • Safety and biological efficacy of an adeno-associated virus vector cystic fibrosis transmembrane regulator (AAV-CFTR) in the cystic fibrosis maxillary sinus Wagner, J. A., Messner, A. H., Moran, M. L., DAIFUKU, R., Kouyama, K., Desch, J. K., Manley, S., Norbash, A. M., Conrad, C. K., Friborg, S., Reynolds, T., Guggino, W. B., Moss, R. B., Carter, B. J., Wine, J. J., Flotte, T. R., Gardner, P. JOHN WILEY & SONS INC. 1999: 266-274

    Abstract

    The host immune response and low vector efficiency have been key impediments to effective cystic fibrosis transmembrane regulator (CFTR) gene transfer for cystic fibrosis (CF). An adeno-associated virus vector (AAV-CFTR) was used in a phase I dose-escalation study to transfer CFTR cDNA into respiratory epithelial cells of the maxillary sinus of 10 CF patients.A prospective, randomized, unblinded, dose-escalation, within-subjects, phase I clinical trial of AAV-CFTR was conducted.Ten patients with previous bilateral maxillary antrostomies were treated.Safety, gene transfer as measured by semiquantitative polymerase chain reaction (PCR), and sinus transepithelial potential difference (TEPD) were measured.The highest level of gene transfer was observed in the range of 0.1-1 AAV-CFTR vector copy per cell in biopsy specimens obtained 2 weeks after treatment. When tested, persistence was observed in one patient for 41 days and in another for 10 weeks. Dose-dependent changes in TEPD responses to pharmacologic intervention were observed following treatments. Little or no inflammatory or immune responses were observed.AAV-CFTR administration to the maxillary sinus results in successful, dose-dependent gene transfer to the maxillary sinus and alterations in sinus TEPD suggestive of a functional effect, with little or no cytopathic or host immune response. Further study is warranted for AAV vectors as they may prove useful for CFTR gene transfer and other in vivo gene transfer therapies. A prospective, randomized, double-blind, placebo-controlled, within-subjects, phase II clinical trial of the effect AAV-CFTR on clinical recurrence of sinusitis will determine the clinical efficacy of AAV gene therapy for CF.

    View details for Web of Science ID 000078432500017

    View details for PubMedID 10890777

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