Peter J. Koltai MD is Professor of Otolaryngology and Pediatrics in the in the Department of Otolaryngology Head and Neck Surgery. He has been a member of the Stanford University School of Medicine faculty since 2004.

Born in Hungary and educated in the New York City schools, Peter graduated Albany Medical College in 1975, completed his otolaryngology residency at the University of Texas Medical Branch (1980) and did a fellowship in Pediatric Otolaryngology in London’s Great Ormond Street Hospital for Sick Children (1989). Before coming to Stanford, Peter was Professor of Surgery and Pediatrics in the Division of Otolaryngology at Albany Medical College and then Head of the Section of Pediatric Otolaryngology at the Cleveland Clinic. He served as Division Chief of Pediatric Otolaryngology at LPCH from 2004 – 2013. He served as Medical Staff President of Lucile Packard Children’s hospital from 2012 – 2014. Peter has held multiple leadership positions in organizations within the scope of his interest and is past President of the American Broncho-Esophagological Association and of the American Society of Pediatric Otolaryngology,

Author of several books, many chapters, and over a hundred publications, many self-illustrated, Peter’s academic and clinical interests have focused primarily on creative solutions to difficult surgical problems. These have included establishing new techniques for the management of pediatric facial fractures, a novel method of tracheostomy, refinements in laryngotracheal reconstruction and approaches to choanal atresia, the development of microdebrider shaver blades for “powered” adenoidectomy and “partial” tonsillectomy, and the design of high pressure balloons for airway dilation. Peter’s current focus is secondary sleep apnea surgery in children having pioneered pediatric sleep endoscopy and developed endoscopic techniques of pediatric tongue base surgery. Peter has several current advocacy interests. One is the multi-organizational Task Force that he established as ABEA president and which is devoted to the prevention of button battery ingestion by young children. Peter recently became a Senior Fellow in Stanford’s Center for Innovation in Global Health and has been working with colleagues at the University of Zimbabwe in Harare, establishing a Pediatric Otolaryngology clinic at the Harare Children’s Hospital.

Academic Appointments

  • Emeritus Faculty - University Medical Line, Otolaryngology (Head and Neck Surgery)

Administrative Appointments

  • Secretary, American Society of Pediatric Otolaryngology (2002 - 2006)
  • Trustee, AO/ASIF (2002 - 2006)
  • Chief, Pediatric Otolaryngology Service, Lucile Packard Children's Hospital (2004 - Present)
  • Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Head & Neck Surgery, Stanford University (2004 - Present)
  • Secretary, American Broncho- Esophagologic Association (2005 - 2009)
  • President Elect, American Society of Pediatric Otolaryngology (2009 - 2010)
  • President, American Society of Pediatric Otolaryngology (2010 - 2011)
  • Vice President, Medical Staff, Lucile Packard Children's Hospital (2010 - 2012)
  • President Elect, American Broncho- Esophagologic Association (2011 - 2012)
  • President, American Broncho- Esophagologic Association (2012 - 2013)
  • President, Medical Staff, Lucile Packard Children's Hospital (2012 - 2014)
  • Past President, Medical Staff, Lucile Packard Children's Hospital (2014 - 2016)

Honors & Awards

  • Presidential Citation, American Academy of Otolaryngology, Head and Neck Surgery (2018)
  • Senior Fellow, Stanford 's Center for Innovation in Global Health (2016)
  • 4th Trevor McGill Lecture, Harvard University (2015)
  • Keynote Lecture, 13th Asia – Oceania ORL-HNS Congress (2015)
  • Porubsky Keynote Lecture,, Medical College of Georgia (2015)
  • Top Doctors, Castle Connolly (2015)
  • 25th Hollinger Lecture, Northwestern University (2014)
  • Keynote Lecture, European Society of Pediatric Otolaryngology (2014)
  • Keynote Lecture, 44th Brazilian Congress of Otolaryngology and Cervico Facial Surgery (2014)
  • Best Doctors in America, 12th Edition, Woodward/White (2012 - 2013)
  • Keynote Lecture, Albany Medical College (2012)
  • Schloss Keynote Lecture, McGill University (2012)
  • Best Doctors in America, 11th Edition, Woodward/White, Inc (2011-2012)
  • Board of Governors Chair Award, AAO-HNS (2010)
  • Honorary Lecturer, Royal College of Physicians and Surgeons of Canada (2010)
  • Best Doctors in America, 10th Edition, Woodward/White, Inc. (2009-2010)
  • Chevalier Jackson Award, American Broncho – Esophagological Association (2009)
  • Distinguished Service Award,, American Academy of Otolaryngology, Head & Neck Surgery (2009)
  • Honorary Member, Israeli Society of Otolaryngology (2009)
  • Honorary Member, Hungarian Academy of Otolaryngology (2008)
  • Steven Grey Memorial Keynote Lecture, University of Utah (2008)
  • Best Doctors in America, 9th Edition, Woodward/White, Inc. (2007-2008)
  • Best Doctors in America, 8th Edition, Woodward/White, Inc. (2005-2006)
  • Keynote Speaker, Australo-Asian Society of Pediatric Otolaryngology (2005)
  • Invited Guest Speaker, National Congress of the Hungarian Society of Otolaryngology (2004)
  • Top Doctors in Cleveland, Cleveland Magazine (2004)
  • Annual Achievement Award in Medicine and Health, Northern Ohio Live Magazine (2003)
  • Best Doctors in America, 7th Edition, Woodward/White, Inc. (2003)
  • Invited Principal Speaker, Annual meeting of the Japanese Society of Stomato-Pharyngology (2003)
  • Top Doctors in Northern Ohio, Northern Ohio Live Magazine (2003)
  • Best Doctors in America, 6th Edition, Woodward/White, Inc. (2002)
  • Invited Guest Speaker, 4th Congress of the Argentinean Association of Pediatric Otolaryngology (2002)
  • Top Doctors in Cleveland, Cleveland Magazine (2002)
  • Best Doctors in America, 4th Edition, Woodward/White, Inc. (1999)
  • Invited Guest Speaker, 5th National Congress of the Egyptian ORL Society (1999)
  • Senior Author: Charles F. Ferguson Clinical Research Award, American Society of Pediatric Otolaryngology (1999)
  • Senior Author: Charles F. Ferguson Clinical Research Award, American Society of Pediatric Otolaryngology (1998)
  • Community Service Award: Annual Humanitarian Awards, Capital District Center for the Disabled (1997)
  • Guest of Honor, Annual Meeting of French Association of Pediatric Otolaryngology (1996)
  • Best Free Paper of Conference, Interamerican Association of Pediatric Otolaryngology Buenos Aires, Argentina, (1995)
  • Certificate of Honor, American Academy of Otolaryngology B Head & Neck Surgery (1995)
  • Best Doctors in America, 2nd Edition, Woodward/White, Inc. (1994)
  • Alumni Member, AOA Honor Medical Society (1993)
  • Schaffer Faculty Development Scholar, Albany Medical College (1988)
  • Wiggers Travel Award, Faculty Organization, Albany Medical College (1988)
  • Commencement Speaker, Graduating Class, Albany Medical Center Nurse Anesthetists Program (1987)
  • Commencement Speaker, Graduating Class, Hudson Valley Albany Medical College Physicians Assistant Program (1985)
  • First Place Award, Annual Alumni Day Resident Presentation, Department of Otolaryngology, UTMB (1980)
  • First Place Award, Annual Alumni Day Resident Presentation, Department of Otolaryngology, UTMB (1979)
  • Third Place Award, Annual Alumni Day Resident Presentation, Department of Otolaryngology, UTMB (1978)
  • Annual MVP: Captain of Swim Team, Queens College, New York (1971)
  • Member, National Honor Society (1967)

Professional Education

  • BA, Queens College, Biology (1971)
  • M.D., Albany Medical College, Medicine (1975)
  • Board Certification, UTMB, Otolaryngology (1980)
  • Fellowship, Great Ormond Street Hospital, Pediatric Otolaryngology (1989)

Community and International Work

  • Establishing Pediatric Otolaryngology in Zimbabwe, Harare


    clinical pediatric otolaryngology

    Partnering Organization(s)

    University of Zimbabwe

    Populations Served

    Children of Zimbabwe



    Ongoing Project


    Opportunities for Student Involvement


  • Swallow Disorders Clinic, Albany NY


    Maximizing the safety and efficiency of swallowing in children with disabilities

    Partnering Organization(s)

    Center for the Disabled, Albany NY

    Populations Served

    Children with neurodevelopmental delay



    Ongoing Project


    Opportunities for Student Involvement


  • President of Board, Albany NY


    Curating and exhibiting contemporary art of the Hudson - Mohawk region of New York State

    Partnering Organization(s)

    Albany Center Gallery

    Populations Served

    Population of Upstate New York



    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

It has been well-recognized that tonsillectomy and adenoidectomy is the primary treatment for pediatric obstructive sleep disordered breathing. However, it is also recognized that approximately 15-20% of the children will continue to have problems with obstructive sleep disordered breathing, despite having their tonsils and adenoids out. The primary problem of sleep apnea in children who have had their tonsils and adenoids out was identifying the site of obstruction. Since fiberoptic laryngoscopy is a routine part of our office exam in our evaluation of children with sleep apnea, it seemed like a natural evolutionary step to perform a similar type of examination while the children are under anesthesia. Clearly an anesthetic induced sleep is not real sleep; on the other hand, it is about the closest model to real sleep that we have.
Based on this insight, we began to offer sleep endoscopy to the parents of children who we were seeing who had failed tonsillectomy and adenoidectomy and had persistent sleep apnea. What we found out during sleep endoscopy was that there can be multiple levels of obstruction. However, the two most consistent sites of obstruction were due to enlarged lingual tonsils, where the lingual tonsils caused a prolapse of the epiglottis up against the posterior pharyngeal wall during recumbent sleep and from an occult form of laryngomalacia, where the soft tissues of the posterior glottis prolapsed into the laryngeal introitus on inspiratory effort during sleep.

Lingual tonsillar hypertrophy is recognized as a cause of obstructive sleep apnea in children, however, the form that was typically seen prior to our current work was in children who had grossly enlarged lingual tonsils, easily seen on an office exam. What we were seeing on our sleep endoscopies was a more subtle form of lingual tonsillar hypertrophy which was obvious only on the sleep endoscopy but was not readily discernible on fiberoptic laryngoscopy in the office.

Similarly, while laryngomalacia is an airway problem that is well recognized in new born infants, it has not been previously demonstrated to be a cause of sleep apnea in older children, especially without any daytime manifestation of the obstruction. We now have many video recordings demonstrating the phenomenon in older children. Our experience with infant laryngomalacia provided a means of treating this form of obstruction.

We also observed other types of obstruction on sleep endoscopy not related to lingual tonsillar hypertrophy or to occult laryngomalacia,. These obstructions were from hypotonia, due to excessive relaxation of the pharyngeal musculature during sleep, obesity with a marked narrowing of the entire oropharyngeal space probably as a consequence of fatty deposition in the surrounding musculature.

2023-24 Courses

Graduate and Fellowship Programs

All Publications

  • Sleep surgery in syndromic and neurologically impaired children. American journal of otolaryngology Ali, N., Alyono, J. C., Kumar, A. R., Cheng, H., Koltai, P. J. 2020; 41 (4): 102566


    PURPOSE: To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities.MATERIAL AND METHODS: Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi.OUTCOME MEASURES: Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings.RESULTS: 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p=0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI.CONCLUSIONS: Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.

    View details for DOI 10.1016/j.amjoto.2020.102566

    View details for PubMedID 32504854

  • Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis. International journal of pediatric otorhinolaryngology Ali, N., Alyono, J. C., Koltai, P. J. 2019; 126: 109613


    OBJECTIVE: To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA).METHODS: Retrospective chart review was performed, and literature reviewed.RESULTS: We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species.CONCLUSIONS: Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.

    View details for DOI 10.1016/j.ijporl.2019.109613

    View details for PubMedID 31382216

  • Harare children's hospital airway symposium and pentafrica conference 2018 INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Chidziva, C., Dzongodza, T., Nyamarebvu, C., Peer, S., Prescott, C., Matinhira, N., Koltai, P. J. 2018; 113: V-VI

    View details for PubMedID 30086998

  • Utility of concurrent direct laryngoscopy and bronchoscopy with drug induced sleep endoscopy in pediatric patients with obstructive sleep apnea INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Bliss, M., Yanamadala, S., Koltai, P. 2018; 110: 34–36


    The goal of this report was to find the frequency of synchronous airway lesions (SAL) identified during microdirect laryngoscopy and bronchoscopy (MDLB) that influenced treatment decisions beyond the information provided by drug induced sleep endoscopy (DISE) alone in children with obstructive sleep apnea (OSA) at a tertiary care pediatric hospital.This was a retrospective chart review of all pediatric patients who underwent drug induced sleep endoscopy in conjunction with direct laryngoscopy and bronchoscopy as part of a comprehensive airway evaluation for obstructive sleep apnea at a tertiary care pediatric hospital.Three hundred thirty-five patients with obstructive sleep apnea were evaluated with both sleep endoscopy and direct laryngoscopy with bronchoscopy. Five percent of patients had SAL identified on MDLB contributing to airway obstruction. Three patients (0.9%) who underwent MDLB for OSA required surgical correction of SAL that was identified.In a limited subset of patients, direct laryngoscopy with bronchoscopy provides additional positive findings to aid with treatment planning for obstructive sleep apnea.

    View details for PubMedID 29859583

  • Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis. JAMA otolaryngology-- head & neck surgery Kang, K., Koltai, P. J., Lee, C., Lin, M., Hsu, W. 2017


    Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted.To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA.The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016.The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child.Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA.Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5.This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia.Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.

    View details for DOI 10.1001/jamaoto.2016.4274

    View details for PubMedID 28208178

  • It Is Just Attention-Deficit Hyperactivity Disorder…or Is It? Journal of developmental and behavioral pediatrics Won, D. C., Guilleminault, C., Koltai, P. J., Quo, S. D., Stein, M. T., Loe, I. M. 2017; 38 (2): 169-172


    Carly is a 5-year-old girl who presents for an interdisciplinary evaluation due to behaviors at school and home suggestive of attention-deficit hyperactivity disorder (ADHD). Parent report of preschool teacher concerns was consistent with ADHD. Psychological testing showed verbal, visual-spatial, and fluid reasoning IQ scores in the average range; processing speed and working memory were below average. Carly's behavior improved when her mother left the room, and she was attentive during testing with a psychologist. Tests of executive function (EF) skills showed mixed results. Working memory was in the borderline range, although scores for response inhibition and verbal fluency were average. Parent ratings of ADHD symptoms and EF difficulties were elevated.Carly's parents recently separated; she now lives with her mother and sees her father on weekends. Multiple caregivers with inconsistent approaches to discipline assist with child care while her mother works at night as a medical assistant. Family history is positive for ADHD and learning problems in her father. Medical history is unremarkable. Review of systems is significant for nightly mouth breathing and snoring, but no night waking, bruxism, or daytime sleepiness. She has enlarged tonsils and a high-arched palate on physical examination.At a follow-up visit, parent rating scales are consistent with ADHD-combined type; teacher rating scales support ADHD hyperactive-impulsive type. Snoring has persisted. A sleep study indicated obstructive sleep apnea. After adenotonsillectomy, Carly had significant improvement in ADHD symptoms. She developed recurrence of behavior problems 1 year after the surgery.

    View details for DOI 10.1097/DBP.0000000000000386

    View details for PubMedID 28079611

  • The Current State of Pediatric Drug-Induced Sleep Endoscopy LARYNGOSCOPE Friedman, N. R., Parikh, S. R., Ishman, S. L., Ruiz, A. G., El-Hakim, H., Ulualp, S. O., Wootten, C. T., Koltai, P. J., Chan, D. K. 2017; 127 (1): 266-272


    The purpose of this investigation was to assess current drug-induced sleep endoscopy (DISE) practice patterns at centers that have published on the technique, to identify areas of agreement, and to identify areas of disagreement that may represent opportunities for improvement and standardization.Multi-institutional survey.A survey was designed in two phases to evaluate preoperative assessment, intraoperative performance, and postoperative management of patients undergoing DISE. The survey was constructed iteratively in consultation with the all of the coauthors, each selected as an expert owing to their previous publication of one or more articles pertaining to pediatric DISE. In the first phase of survey creation, each expert was asked to provide narrative answers to questions pertaining to DISE. These responses served as the basis for a second survey. This second survey was then administered to all pediatric otolaryngologists at each respective institution.Overall, there was a low rate of agreement (33%) among the respondents; however, there was substantial agreement within institution, particularly for the use of anesthetic medications, the use of cine magnetic resonance imaging, and performance of bronchoscopy along with DISE. There was strong agreement among all respondents for performing DISE in a child with severe obstructive sleep apnea following adenotonsillectomy, regardless of comorbidities.This multi-institutional survey demonstrated a lack of consensus between experts and multiple opportunities for improvement. In general, there was agreement regarding the workup prior to DISE performance and the endoscopic protocol but disagreement regarding anesthetic protocol and management decisions.4. Laryngoscope, 127:266-272, 2017.

    View details for DOI 10.1002/lary.26091

    View details for PubMedID 27311407

  • Comparison of treatment outcomes between intracapsular and total tonsillectomy for pediatric obstructive sleep apnea INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Chang, D. T., Zemek, A., Koltai, P. J. 2016; 91: 15-18


    Intracapsular tonsillectomy (IT) has been advocated as a treatment for pediatric obstructive sleep apnea (OSA). However, evidence in the literature utilizing polysomnography (PSG) is limited.To examine the experience at a tertiary children's hospital to evaluate the effectiveness and risks of intracapsular tonsillectomy compared to total tonsillectomy (TT) for treating pediatric OSA.A retrospective study was undertaken of pediatric tonsillectomy cases performed for OSA at a tertiary children's hospital from 2005 to 2010. Patients with recurrent tonsillitis, craniofacial abnormalities, chromosomal abnormalities, neuromuscular disease, and congenital malformations were excluded. Main outcome measures were apnea-hypopnea index (AHI), minimum oxygen saturation (minO2), and surgical complications.Of the 1583 patients reviewed in this study, there were 75 IT and 93 TT patients with pre- and post-operative PSG results. The IT patients were younger, had lower BMI, larger tonsil size, lower pre-operative (AHI) and lower post-operative AHI (p < 0.05). There was a similar percentage of patients that showed improvement in AHI and minimum oxygen saturation between the IT and TT groups. There were statistically similar average change in AHI and minimum oxygen saturation between the IT and TT groups at 5.6 ± 8.6 and 8.6 ± 12.9, respectively (p = 0.8) as well as similar improvement in minimum oxygen saturation between the two groups at 3.3% ± 4.3% and 3.0% ± 5.2%, respectively (p = 0.66). Of TT patients, 2.9% experienced post-operative bleeding with 1.6% requiring OR for control of hemorrhage. Of IT patients, 2.2% were found to have tonsillar regrowth with 2.0% returning to the OR for secondary tonsillectomy.Intracapsular tonsillectomy, like total tonsillectomy, is effective in improving polysomnogram results in appropriately selected children. Intracapsular tonsillectomy is a suitable option for the surgical treatment of pediatric OSA consequent to its demonstrated efficacy in relieving OSA and its favorable safety profile.

    View details for DOI 10.1016/j.ijporl.2016.09.029

    View details for Web of Science ID 000389108100004

    View details for PubMedID 27863630

  • Gizmo Is a Mean Word! OTOLARYNGOLOGY-HEAD AND NECK SURGERY Koltai, P. J. 2015; 152 (4): 581–82


    The editorial titled "Gizmos" in the April issue of Otolaryngology-Head and Neck Surgery was unfortunate. Intracapsular tonsillectomy is a rational surgical option for managing tonsillar hypertrophy causing obstructive sleep apnea in selected children. It is performed routinely by surgeons across the globe and has become the standard of care across northern Europe due to the high safety profile of the operation. The semirigid, dartlike design of the sinuplasty devices suggested the idea for an airway-specific set of high-pressure balloons. We began working on these in 2007 and had FDA approval in 2009. They are in wide use by many airway surgeons. Lingual tonsils are a frequent cause of obstructive sleep apnea, and there is no tool that manages this as effectively as endoscopic plasma ablation. We are all engaged in an honorable effort to improve care; surgical and creative skills are as important as analytical skills. Both are necessary for the continuous improvement of our work. Both are worthy of respect.

    View details for PubMedID 25833921

  • Pediatric Teratoma and Dermoid Cysts OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Paradis, J., Koltai, P. J. 2015; 48 (1): 121-?


    Teratomas and dermoid cysts are germ cell neoplasms. This article focuses on cervical and craniofacial teratomas. Presentation of these neoplasms varies in degree of severity, from cosmetic deformities to airway distress requiring emergent intervention. Nasal lesions (particularly if suspicious for a nasal dermoid) require imaging before biopsy to assess for intracranial extension. Treatment consists of airway management if respiratory distress is present, and early surgical intervention. Postoperative follow-up is required to monitor for recurrence.

    View details for DOI 10.1016/j.otc.2014.09.009

    View details for PubMedID 25439551

  • The Transpalatal Approach to Repair of Congenital Basal Skull Base Cephaloceles JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Hoff, S. R., Edwards, M. S., Bailey, C. M., Koltai, P. J. 2014; 75 (2): 96-103


    Basal skull base herniations, including meningoceles and encephaloceles, are rare and may present with characteristic facial and neurologic features. The traditional craniotomy approach has known morbidity, and nasal endoscopy may not allow for control of large posterior basal defects, especially in newborns. We present two cases of successful repair of basal transsphenoidal meningoceles using an oral-transpalatal approach. The first patient with an intact palate presented with respiratory distress, and a palatectomy was performed for access to the skull base. The second patient had a large basal herniation that was reduced through a congenital midline cleft palate, and a calvarial bone graft was used to repair the defect. A literature search revealed 10 previous successful cases using the transpalatal repair, which allows for excellent access, low morbidity, and a team-oriented method to skull base surgery.

    View details for DOI 10.1055/s-0033-1358374

    View details for PubMedID 25072006

  • Pediatric button battery injuries: 2013 task force update INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Jatana, K. R., Litovitz, T., Reilly, J. S., Koltai, P. J., Rider, G., Jacobs, I. N. 2013; 77 (9): 1392-1399


    Over the last 10 years, there has been a dramatic rise in the incidence of severe injuries involving children who ingest button batteries. Injury can occur rapidly and children can be asymptomatic or demonstrate non-specific symptoms until catastrophic injuries develop over a period of hours or days. Smaller size ingested button batteries will often pass without clinical sequellae; however, batteries 20mm and larger can more easily lodge in the esophagus causing significant damage. In some cases, the battery can erode into the aorta resulting in massive hemorrhage and death. To mitigate against the continued rise in life-threatening injuries, a national Button Battery Task Force was assembled to pursue a multi-faceted approach to injury prevention. This task force includes representatives from medicine, public health, industry, poison control, and government. A recent expert panel discussion at the 2013 American Broncho-Esophagological Association (ABEA) Meeting provided an update on the activities of the task force and is highlighted in this paper.

    View details for DOI 10.1016/j.ijporl.2013.06.006

    View details for Web of Science ID 000324363400003

    View details for PubMedID 23896385

  • Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: Inter-observer correlation and comparison with awake endoscopy INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Fishman, G., Zemel, M., DeRowe, A., Sadot, E., Sivan, Y., Koltai, P. J. 2013; 77 (5): 752-755


    Evaluate the inter-observer correlation of sleep endoscopy findings in children with persistent obstructive sleep apnea (OSA) with awake office fiber-optic endoscopy.retrospective case series; blinded review.tertiary care children's hospital.Children with persistent obstructive sleep apnea.Both awake and drug induced sleep endoscopy were performed. Endoscopy video recordings were mixed at random on a DVD. Two pediatric otolaryngologists and two pediatric pulmonologists independently scored each recording using an upper airway endoscopy scoring survey.reviewers scored the following parameters: each structure's contribution (nose, nasopharynx, lateral pharyngeal walls, tongue base, supraglottis) to the obstruction, the main site in which the obstruction occurs, the severity of OSA (mild, moderate, severe), the level of confidence of endoscopy findings (poor, fair, good).When reviewing sleep endoscopy recordings for the upper airway obstruction site, the highest correlation among the four observers was found for the nasopharynx and the supraglottis (Kappa score: 0.6 and 0.5, respectively). Compared to awake endoscopy, sleep endoscopy demonstrated more cases of airway obstruction caused by collapse of lateral pharyngeal walls and base of tongue (McNemar test for symmetry, P value<0.05). Level of confidence among the four observers was higher in older children and lower in children with severe OSA.Sleep endoscopy is a consistently reliable tool for identifying the site of obstruction in children with persistent OSA. Though anesthetic induced sleep is not a perfect model for real sleep, the technique demonstrably guides further therapy better than awake endoscopy.

    View details for DOI 10.1016/j.ijporl.2013.02.002

    View details for Web of Science ID 000318384000026

    View details for PubMedID 23433922

  • Effect of Obesity and Medical Comorbidities on Outcomes After Adjunct Surgery for Obstructive Sleep Apnea in Cases of Adenotonsillectomy Failure ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Chan, D. K., Jan, T. A., Koltai, P. J. 2012; 138 (10): 891-896


    To evaluate the effect of body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and medical comorbidities on outcomes after lingual tonsillectomy and supraglottoplasty performed for obstructive sleep apnea syndrome (OSAS) caused by lingual tonsillar hypertrophy and occult laryngomalacia.Retrospective case review seriesAcademic tertiary referral centerChildren with persistent OSAS after adenotonsillectomy who underwent surgery to correct obstruction at the level of the lingual tonsils and/or supraglottis identified on sleep endoscopy.All children underwent lingual tonsillectomy, supraglottoplasty, or both.Change in polysomnographic parameters, including apnea-hypopnea index (AHI), number of nighttime apneas, and lowest oxygen saturation level.We analyzed the medical records of 84 children with persistent OSAS after adenotonsillectomy who underwent either lingual tonsillectomy (n = 68), supraglottoplasty (n = 24) or both (n = 8). Compared with children with lingual tonsillar hypertrophy, children with occult laryngomalacia were younger, had lower BMI, and were more likely to have a medical comorbidity. Overall, both operations significantly improved the AHI; however, children with comorbidities had significantly higher postoperative AHIs after supraglottoplasty than those without, and overweight children had significantly higher postoperative AHIs after lingual tonsillectomy than those of normal weight. The BMI z-score and age had direct, though weak, correlations with postoperative AHI among all children undergoing either technique of adjunct airway surgery.Lingual tonsillar hypertrophy and occult laryngomalacia are 2 important causes of residual OSAS after adenotonsillectomy. However, they tend to affect distinct populations of children, and though appropriate surgical correction can improve AHI, cure rates are significantly worse for overweight children undergoing lingual tonsillectomy and for children with medical comorbidities undergoing supraglottoplasty.

    View details for Web of Science ID 000309916600001

    View details for PubMedID 23069817

  • The "Postcricoid Cushion" Observations on the Vascular Anatomy of the Posterior Cricoid Region ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Hoff, S. R., Koltai, P. J. 2012; 138 (6): 562-571


    To describe the cyclical vascular enlargement that occurs in the postcricoid region during the expiratory phase on an infant's cry, and to consider the anatomic, physiologic, and clinical implications of this phenomenon, which we term the "postcricoid cushion."A total of 125 consecutive office fiber-optic laryngoscopic examinations in children and infants were reviewed for engorgement and vascular discoloration of the postcricoid region. Presence of a postcricoid cushion in relation to patient age was reviewed. A comprehensive literature review was also performed.Tertiary care pediatric hospital.Patients from newborns to 17 years old undergoing laryngoscopy for any reason.Sixty-one percent of the videos showed a postcricoid cushion with cyclical enlargement during crying. Eighty-eight percent of children younger than 24 months had presence of a cushion compared with only 38% of children 24 months or older (P < .001). Twenty-five percent of the cushions had violaceous discoloration that resembled a vascular malformation.Anatomic studies have demonstrated a rich venous plexus in the postcricoid region of the larynx. During the expiratory phase of an infant's cry, there is a cyclical engorgement, occasionally with vascular discoloration, in the postcricoid region at the same level of the venous plexus-the "postcricoid cushion." We propose that during crying, with acute elevation in intrathoracic pressure, there is a filling of the plexus, causing apposition of the postcricoid cushion against the posterior pharyngeal wall, which may serve as a protective barrier to emesis in infants. Our observations relate and differentiate this normal physiologic phenomenon from the rare cases of postcricoid vascular anomalies.

    View details for Web of Science ID 000305415600006

    View details for PubMedID 22710508

  • Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Truong, M. T., Woo, V. G., Koltai, P. J. 2012; 76 (5): 722-727


    Ten to twenty percent of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy (T&A). We hypothesize that sleep endoscopy, a flexible fiberoptic examination of the pharynx under anesthesia, is an effective tool for identifying sites of persistent obstruction.In this retrospective cohort study, we reviewed records of children who had symptoms consistent with OSA and a positive polysomnogram (PSG) who underwent sleep endoscopy followed by sleep endoscopy directed surgery. Data collection included age, BMI and co-morbidities. Apnea-hypopnea index (AHI) was compared to pre and post surgery for each child using a paired t-test.Of the 80 children who underwent sleep endoscopy followed by directed surgery, 65% were male, mean age was 6 years (SD 3.75 years), average BMI was 19 (SD 0.43 years) and 28% had co-morbidities. For the 51% of patients who had persistent OSA after T&A, the mean AHI after sleep endoscopy directed surgery was significantly lower then before surgery (7.9 vs. 15.7, p<.01). For the 49% of patients who had never undergone surgery for OSA, or who were surgically naïve, and underwent sleep endoscopy directed surgery, the mean AHI was significantly lower then before surgery (8.0 vs. 13.8, p<.01).Sleep endoscopy is a consistently reliable tool for identifying the sites of obstruction in both surgically naive children and those with persistent OSA after T&A.

    View details for DOI 10.1016/j.ijporl.2012.02.028

    View details for PubMedID 22421163

  • Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Chan, D. K., Mai Thy Truong, M. T., Koltai, P. J. 2012; 138 (1): 50-54


    To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia.Retrospective case series with medical chart review.Tertiary pediatric medical center.Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded.Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS.Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically.Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP.Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia.

    View details for PubMedID 22249629

  • Sleep endoscopy in the evaluation of pediatric obstructive sleep apnea. International journal of pediatrics Lin, A. C., Koltai, P. J. 2012; 2012: 576719-?


    Pediatric obstructive sleep apnea (OSA) is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible.

    View details for DOI 10.1155/2012/576719

    View details for PubMedID 22518178

    View details for PubMedCentralID PMC3299368

  • Surgical reconstruction of Tracheal Stenosis in Conjunction With Ann Thoracic Surg Mainwaring RD, Shillingford M, Davies R, Koltai PJ, Navarainam M, Reddy M 2012; 93: 1266- 1273
  • The use of botulinum toxin for pediatric cricopharyngeal achalasia (vol 75, pg 830, 2011) INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Messner, A., Ho, A. S., Malhotra, P. S., Koltai, P. J., Barnes, M. A. 2011; 75 (9): 1057
  • 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


    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 PubMedID 21972448

  • Choanal atresia: current concepts and controversies CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY Corrales, C. E., Koltai, P. J. 2009; 17 (6): 466-470


    Choanal atresia is a common and widely recognized craniofacial disorder characterized by obliteration of the posterior nasal aperture. Given the long time since its original description, controversy persists regarding pathogenesis and optimal surgical techniques. This review addresses current literature on choanal atresia and identifies areas of debate and future opportunities in research.Recent molecular mechanisms in retinoic acid receptor development have been described in the pathogenesis of choanal atresia. Whereas surgical treatment is generally believed to be effective in alleviating respiratory symptoms, consistent data confirming efficacy are scarce regarding best surgical approach with and without endoscopic sinus techniques, adjuvant use of stents, use of antiproliferative agents and laser-assisted surgery. Recent studies regarding each technique are discussed.Despite vigorous research, the pathogenesis remains elusive and unproven. Many surgical techniques have been advocated; however, there is no dominant approach. Trends in treatment are directed towards the use of highly advanced endoscopic approaches with the use of microdebriders, small drill bits and telescopes to minimize traumatic injury that leads to postoperative scarring and restenosis.

    View details for DOI 10.1097/MOO.0b013e328332a4ce

    View details for PubMedID 19779346

  • Update on hemangiomas and vascular malformations of the head and neck EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Eivazi, B., Ardelean, M., Baeumler, W., Berlien, H., Cremer, H., Elluru, R., Koltai, P., Olofsson, J., Richter, G., Schick, B., Werner, J. A. 2009; 266 (2): 187-197


    Although the current classification systems of vascular malformations and hemangiomas are increasingly accepted, there are nonetheless several aspects that show us how special and at the same time difficult it is to diagnose, evaluate, and treat some of those diseases. Close interdisciplinary cooperation of all involved disciplines is essential; the discussion of the adequate individual procedure must be performed in angioma boards, as it is already well established in the context of tumor boards. The interface of angioma therapy and tumor therapy seems to be very close, which is certainly true for the aspect of angiogenesis and of course for the inhibited proliferation as promising therapeutic approach of complex vascular malformations. This leads to another obvious necessity of intensifying experimental scientific research on vascular malformations and hemangiomas, which is a precondition for optimizing or elimination of different current problems and deficits in the mentioned field.

    View details for DOI 10.1007/s00405-008-0875-6

    View details for Web of Science ID 000261750000005

    View details for PubMedID 19052764

  • Airway management in Nager Syndrome LARYNGOSCOPE Ho, A. S., Aleshi, P., Cohen, S. E., Koltai, P. J., Cheng, A. G. 2009; 119: S179-S179

    View details for DOI 10.1002/lary.20468

    View details for Web of Science ID 000207862500179

  • Pediatric Facial Fractures PEDIATRIC OTOLARYNGOLOGY FOR THE CLINICIAN O-Lee, T. J., Koltai, P. J., Mitchell, R. B., Pereira, K. D. 2009: 91–95
  • Pediatric Tracheal Stenosis OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Ho, A. S., Koltai, P. J. 2008; 41 (5): 999-?


    Tracheal stenosis is a rare, potentially life-threatening condition described as innate narrowing of the tracheal lumen. The causes of tracheal stenosis vary widely. The most common forms result from prolonged intubation, although congenital causes usually involve complete tracheal rings or compression from cardiovascular malformations. The condition historically has harbored a poor prognosis, but significant advances in radiologic diagnosis, cardiac bypass, and endoscopic and surgical treatments have led to a range of options, better overall survival, and reduced morbidity. The complex, long-term manifestations of tracheal stenosis point to the need for individualized treatment as well as multidisciplinary care.

    View details for DOI 10.1016/j.otc.2008.04.006

    View details for PubMedID 18775347

  • Oropharyngeal atresia in a preterm infant: A case report and review of the literature INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Lee, H. C., O-Lee, T. J., Madan, A., Koltai, P. 2007; 71 (9): 1485-1489


    Oropharyngeal atresia is a rare and often fatal condition that presents soon after birth with severe respiratory distress. We present a case of a premature infant who initially was suspected to have tracheo-esophageal atresia due to prenatal ultrasound findings of polyhydramnios and absent stomach bubble, but was found instead to have oropharyngeal atresia and a complete persistent buccopharyngeal membrane. This case is the first described in which the patient was successfully intubated through a small slit in the persistent membrane.

    View details for DOI 10.1016/j.ijport.2007.05.026

    View details for PubMedID 17597231

  • Pathology quiz case 1 - Diagnosis: Foregut duplication cyst ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Leung, M., O-Lee, T. J., Koltai, P. J. 2007; 133 (9): 946-?

    View details for PubMedID 17875866

  • The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children JOURNAL OF LARYNGOLOGY AND OTOLOGY Koempel, J. A., Solares, C. A., Koltai, P. J. 2006; 120 (12): 993-1000


    Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

    View details for DOI 10.1017/S0022215106002544

    View details for Web of Science ID 000243738900002

    View details for PubMedID 16923328

  • 3.5-year follow-up of intralesional cidofovir protocol for pediatric recurrent respiratory papillomatosis INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Chung, B. J., Akst, L. M., Koltai, P. J. 2006; 70 (11): 1911-1917


    Intralesional injection of cidofovir has been described as an adjunctive treatment for pediatric recurrent respiratory papillomatosis (RRP). However, questions remain regarding the optimal dosing schedule and side-effect profile. The objective of this study was to describe patient outcomes following a standardized cidofovir protocol.Eleven pediatric patients originally treated with a standardized stepped-dose protocol of intralesional cidofovir for RRP were followed for an extended observational period. Additional interventions, disease severity, and adverse outcomes were recorded.Five of 11 patients have required no further treatments following the original cidofovir protocol. Two patients initially achieved remission but have subsequently required additional treatment for recurrent disease. Four patients never achieved remission and have undergone multiple additional interventions. Mean follow-up time for all patients from the conclusion of the original study was 30.2 months (10-45). No adverse outcomes were noted.Intralesional injection of cidofovir may have some potential as an adjunct in the treatment of RRP. Response to cidofovir is unpredictable. Further study of cidofovir is necessary to more clearly define whether the favorable responses observed represent a true treatment effect or simply reflect the natural history of the disease. Perhaps as important is to refine treatment protocols and informed consents that reflect the concern about the carcinogenic potential of cidofovir and to better characterize the drug's side-effect profile.

    View details for DOI 10.1016/j.ijporl.2006.06.018

    View details for Web of Science ID 000241932800010

    View details for PubMedID 16919339

  • Anterior and posterior cartilage graft dimensions in successful laryngotracheal reconstruction 20th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology Koltai, P. J., Ellis, B., Chan, J., Calabro, A. AMER MEDICAL ASSOC. 2006: 631–34


    To describe the dimensions of cartilage grafts used for successful laryngotracheal reconstruction, with the goal of establishing appropriate sizes for "off-the-shelf" tissue-engineered cartilage grafts.A retrospective review of prospectively maintained operative illustrations of a single surgeon's experience.Two tertiary children's hospitals.A consecutive sample of 54 patients (tracheotomized or intubated) with a diagnosis of subglottic stenosis.Each patient underwent anterior (n = 30), posterior (n = 3), or anterior and posterior (n = 22) laryngotracheal reconstruction. Rib cartilage was used in 51 patients and thyroid cartilage was used in 3 patients.Successful or failed extubation.Of the 54 patients, 48 (89%) were successfully decannulated. The mean +/- SEM length of the anterior graft was 20.7 +/- 10.3 mm, and the mean width of the anterior graft was 7.7 +/- 2.5 mm. The mean length of the posterior graft was 13.9 +/- 2.9 mm, and the mean width of the posterior graft was 4.2 +/- 0.9 mm.With the prospect of tissue-engineered cartilage implants becoming available for laryngotracheal reconstruction, the most appropriate templates for designing these implants should be based on the geometric dimensions of grafts carved from native tissues in cases that have been successfully decannulated. Based on our analysis, the use of 2-mm increments for the posterior grafts suggests a set of molds that are 2, 4, and 6 mm wide and 22 mm long. Using 2 x 2-mm increments for the anterior grafts indicates that 36 mold sizes will be sufficient for 90% of predicted cases.

    View details for PubMedID 16785408

  • Cost-effectiveness of tonsillectomy for recurrent acute tonsillitis 5th International Symposium on Tonsils and Mucosal Barriers of Upper Airways Fujihara, K., Koltai, P. J., Hayashi, M., Tamura, S., Yamanaka, N. ANNALS PUBL CO. 2006: 365–69


    We used a retrospective case series to perform a preliminary study to determine the clinical effectiveness and cost-effectiveness of tonsillectomy for recurrent acute tonsillitis.We studied 25 children and 16 adults who had tonsillectomy for recurrent acute tonsillitis. The adult patients and the children's caregivers were asked to respond to a questionnaire regarding the efficacy of their tonsillectomy. The cost of medical care and the work disability cost for tonsillitis and for tonsillectomy were calculated. We then applied the technique of break-even time analysis to assess when the total health care cost savings from surgery overtook the total cost of tonsillectomy.In children, the overall economic costs (medical costs and work-related costs) were recovered at 1.6 years after tonsillectomy (break-even point). In adults, the overall economic costs (medical costs and work-related costs) were recovered at 2.5 years after tonsillectomy (break-even point).Tonsillectomy for recurrent acute tonsillitis is both clinically effective and cost-effective for children and adults in Japan.

    View details for Web of Science ID 000237604600009

    View details for PubMedID 16739669

  • PHACE syndrome: Report of a case with a glioma of the anterior skull base and ocular malformations 15th Annual Meeting of the North-American-Skull-Base-Society Cannady, S. B., Kahn, T. A., Traboulsi, E. I., Koltai, P. J. ELSEVIER IRELAND LTD. 2006: 561–64


    PHACE syndrome consists of the constellation of manifestations including Posterior fossa anomalies of the brain (most commonly Dandy-Walker malformations), Hemangiomas of the face and scalp, Arterial abnormalities, Cardiac defects, and Eye anomalies. We present the case of a patient who presented with respiratory distress at birth secondary to a large nasal glioma. She was subsequently found to have a ventricular septal defect (VSD), a facial hemangioma, and a malformation of the eye and optic nerve head. The nasal glioma, which extended to the cribriform plate, has not been described in this syndrome. The tumor was resected through a coronal incision, midline nasal bone osteotomy, and a retrograde dissection from the nasal bones to the anterior skull base. Glioma of the skull base is a novel and serious manifestation of this uncommon condition.

    View details for DOI 10.1016/j.ijporl.2005.047.014

    View details for Web of Science ID 000235354700025

    View details for PubMedID 16144720

  • Surgical management of cervical ganglioneuromas in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Cannady, S. B., Chung, B. J., Hirose, K., Garabedian, N., Van Den Abbeele, T., Koltai, P. J. 2006; 70 (2): 287-294


    To review the experience with ganglioneuromas in the head and neck of children including presentation, diagnostic testing, treatments, and outcomes.Case series. Retrospective chart review.Tertiary care hospital.All patients with a history of ganglioneuroma of the neck in each authors practice were reviewed. All pathologically confirmed occurrences were eligible for inclusion, and five patients met these criteria.Five patients underwent surgical excision of head and neck ganglioneuromas between 1988 and 2004. There were no occurrences of secretory tumors, therefore all of the patients presented with enlarging masses. In all cases, the tumor arose from the cervical sympathetic chain, and thus, patients had subsequent ipsilateral Horner's Syndrome following resection. No synchronous tumors were noted, nor has a recurrent tumor been observed to this point. Complete excision was possible in all cases via a transcervical, or transoral approach, without mandibulotomy.Ganglioneuroma of the neck is a rare tumor that most commonly presents as an enlarging neck mass. Complete surgical excision is the treatment of choice, and in this series of children was possible with transcervical approach, and once via transoral approach. This tumor may be suspected in children who are otherwise asymptomatic, and present with long history of enlarging neck masses.

    View details for DOI 10.1016/j.ijporl.2005.06.020

    View details for Web of Science ID 000235091600015

    View details for PubMedID 16102846

  • Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Sautter, N. B., Krakovitz, P. R., Solares, C. A., Koltai, P. J. 2006; 70 (1): 99-105


    The "starplasty" technique of pediatric tracheostomy was introduced in 1990 as an alternative pediatric tracheostomy technique associated with several advantages. The only apparent drawback of this technique is the higher incidence of persistent tracheocutaneous fistula following decannulation. Several methods have been proposed for closure of persistent tracheocutaneous fistula in children, including fistulectomy with primary closure and fistulectomy with healing by secondary intent. Some authors advocate placement of a drain at the time of primary closure. We present our experience with closure of persistent tracheocutaneous fistula following starplasty in children over the past 15 years.Ninety-six starplasty procedures were performed on 96 children from 1990 to present, all by the senior author or under the guidance of the senior author. Twenty-eight of these children have been decannulated. Three fistulas closed spontaneously following decannulation. Of the remaining 25 children, 13 have undergone surgical closure of the tracheocutaneous fistula by the senior author. All tracheocutaneous fistula closures were performed as a fistulectomy with primary closure in three layers. Drains were not used in any of the patients.There were three minor complications in the postoperative period (wound infection and airway granuloma) and no major complications. None of the patients have experienced any degree of airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good."Starplasty" is a safe, reliable pediatric tracheostomy technique that has been shown to decrease the incidence of perioperative morbidity and mortality. The only drawback appears to be a high incidence of postoperative tracheocutaneous fistula. Our method of persistent tracheocutaneous fistula closure following starplasty is safe and effective, with no major complications and no incidence of postoperative airway narrowing.

    View details for DOI 10.1016/j.ijporl.2005.05.024

    View details for Web of Science ID 000234767800015

    View details for PubMedID 15979730

  • Tonsillitis index: An objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Fujihara, K., Goto, H., Hiraoka, M., Hayashi, M., Hotomi, M., Tamura, S., Kuki, K., Yamanaka, N., Koltai, P. J. 2005; 69 (11): 1515-1520


    This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TI> or =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TI> or =8 were significantly decreased compared to those with TI was less than 8 (TI<8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TI> or =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.

    View details for DOI 10.1016/j.ijporl.2005.04.007

    View details for Web of Science ID 000233098700009

    View details for PubMedID 15979731

  • Prolonged infusion of dexmedetomidine for sedation following tracheal resection PEDIATRIC ANESTHESIA Hammer, G. B., Philip, B. M., Schroeder, A. R., Rosen, F. S., Koltai, P. J. 2005; 15 (7): 616-620


    Dexmedetomidine is a centrally acting alpha-2 adrenergic agonist that is currently approved by the US Food and Drug Administration for short-term use (< or = 24 h) to provide sedation in adults in the ICU. This drug has been shown to be efficacious in adult medical and surgical patients in providing sedation, anxiolysis, and analgesia. Dexmedetomidine has been associated with rapid onset and offset, hemodynamic stability, and a natural, sleep-like state in mechanically ventilated adults. To date, there are few publications of the use of this drug in children, and prolonged infusion has not been described. We report our use of dexmedetomidine in a child during a 4-day period of mechanical ventilation following tracheal reconstruction for subglottic stenosis.

    View details for DOI 10.1111/j.1460-9592.2005.01656.x

    View details for PubMedID 15960649

  • Laryngotracheal consequences of pediatric cardiac surgery ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Khariwala, S. S., Lee, W. T., Koltai, P. J. 2005; 131 (4): 336-339


    To determine the incidence and character of clinically significant laryngotracheal anomalies in pediatric patients undergoing surgical repair of congenital cardiac defects at a tertiary care center.Single-center retrospective review.The charts of pediatric patients who required surgical treatment for congenital heart disease over a 4-year period were reviewed. Forty-eight of 1957 patients were seen in inpatient consultation by the otolaryngology service. The parameters studied included cardiac diagnosis, reason for consultation, findings on examination, and follow-up.There were 16 (33%) cases of subglottic stenosis, which were graded according to the Cotton-Myer classification system as follows: grade 1 (n=8); grade 2 (n=3); and grade 3 (n=5). Three of the 16 patients with subglottic stenosis required tracheotomy and 4 required laryngotracheal reconstruction. Nine (19%) of the 48 patients were diagnosed as having unilateral true vocal cord paralysis and 3 (6%) as having bilateral paralysis. With the exception of 1 patient, all patients with true vocal cord paralysis on the left side had undergone repair of the aortic arch.Pediatric patients with congenital cardiac disease are predisposed to laryngeal anomalies owing to (1) frequent intubation, (2) prolonged ventilatory support, and (3) recurrent laryngeal nerve injury. In our patients, subglottic stenosis was the most common laryngeal abnormality. When recognized early, in the eschar phase, most of these cases can be managed with sequential endoscopic debridement, which is conceptually similar to debridement that is performed after functional endoscopic sinus surgery. Established stenosis requires more vigorous intervention, the invasive degree of which depends on the length and circumference of the narrowing. Unilateral vocal paralysis tends to be a self-limited problem, while an elegant solution to bilateral paralysis remains elusive.

    View details for Web of Science ID 000228227100009

    View details for PubMedID 15837903

  • Safety and efficacy of powered intracapsular tonsillectomy in children: a multi-center retrospective case series INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Solares, C. A., Koempel, J. A., Hirose, K., Abelson, T. I., Reilly, J. S., Cook, S. P., April, M. M., Ward, R. F., Bent, J. P., Xu, M., Koltai, P. J. 2005; 69 (1): 21-26


    To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample.Multi-center retrospective case series.We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I. DuPont Hospital for Children, and the New York Otolaryngology Institute. For comparison, we reviewed the outpatient and inpatient records of all children who underwent conventional tonsillectomy performed by the same surgeons at the Children's Hospital at the Cleveland Clinic and Alfred I. DuPont Hospital for Children during the same period. No comparison group was available for the New York Otolaryngology Institute group. Three outcome measures were recorded: regrowth, bleeding and re-admission for dehydration rates. All statistical analyses were performed using SAS, and P < 0.05 was considered statistically significant.We identified 870 children that underwent PIT at three different institutions. In addition, 1121 children underwent conventional tonsillectomy at two of the three institutions. The mean follow-up for the PIT group was 1.2 years (range, 0.1-2.6 years) and 1.5 years (range, 0.1-3.0 years) for the conventional tonsillectomy group. The incidence of and 95% CI for the outcome measures were as follows regrowth 0.5% (0%, 1.4%), delayed post-operative bleeding 0.7% (0%, 1.9%), re-admission for dehydration 1.3% (0.05%, 2.6%), and overall major complications 0.46% (0.009%, 0.9%). When comparing conventional tonsillectomy to PIT, the bleeding rate, re-admission for dehydration, and the overall incidence of major complications were significantly lower in the PIT group (P = 0.001, P = 0.002, and P < 0.001, respectively).PIT is a safe and effective technique in the management of obstructive sleep disordered breathing in children. PIT has the advantages of decreased pain, dehydration and post-operative bleeding, and with a mean follow-up of 1.2 years, a low incidence of tonsillar regrowth thus far.

    View details for DOI 10.1016/j.ijporl.2004.07.006

    View details for Web of Science ID 000226571700003

    View details for PubMedID 15627442

  • High-frequency ultrasound in the measurement of pediatric craniofacial integrity 107th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation Knott, P. D., Hazony, D., Karafa, M., Koltai, P. J. MOSBY-ELSEVIER. 2004: 851–55


    This study evaluates the use of high-frequency ultrasound in the measurement of the material nature of the pediatric craniofacial skeleton.Three desiccated human skulls, aged 1 year, 5 years, and adult, underwent ultrasonic evaluation at 6 sites on each hemicranium.The overall mean signal reflection coefficients for the infant, child, and adult skulls are 98.8 mV (13.75 mV SD), 172 mV (24.5 mV SD), and 230 mV (23.5 mV SD), respectively. The mean signal reflection coefficient is positively correlated with increasing chronological age. Comparison of intrasubject signal patterns suggests bone density fields, which vary as a function of growth.High-frequency ultrasound provides accurate measurements of the osseous impedance of the craniofacial skeleton. Pattern analysis suggests increases in skull density with greater growth and age.Although further testing must be performed in vivo, high-frequency ultrasound may accurately measure the osseous impedance of the pediatric craniofacial skeleton.C.

    View details for DOI 10.1016/j.otohns.2004.08.010

    View details for Web of Science ID 000225725200010

    View details for PubMedID 15577779

  • Ultrasonic detection of middle ear effusion - A preliminary study Combined Otolaryngologic Spring Meeting (COSM) Discolo, C. M., Byrd, M. C., Bates, T., Hazony, D., Lewandowski, J., Koltai, P. J. AMER MEDICAL ASSOC. 2004: 1407–10


    To assess the ability to detect and characterize middle ear effusion in children using A-mode ultrasonography.Prospective nonblinded comparison study.Tertiary children's hospital.Forty children (74 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement.Before myringotomy, ultrasound examination of the tympanic membrane and middle ear space was performed on each ear. Afterward, myringotomy was performed and the type of effusion (serous, mucoid, or purulent) was recorded. Pressure equalization tubes were then placed.Comparison of ultrasound findings with the visual assessment of the type of middle ear effusion present.Of the 74 ears tested, 45 (61%) had effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished between serous and mucoid effusion with 100% accuracy (P = .04). The probe did not distinguish between mucoid and purulent effusion.Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Moreover, it can distinguish thin from mucoid fluid. Further refinements in probe design may further improve the sensitivity of fluid detection and allow differentiation of sterile vs infectious effusion.

    View details for Web of Science ID 000225606400008

    View details for PubMedID 15611400

  • Postcricoid hemangioma presenting as dysphagia - A report of 4 cases Combined Otolaryngologic Spring Meeting (COSM) Discolo, C. M., Koltai, P. J. AMER MEDICAL ASSOC. 2004: 1420–22


    Hemangiomas involving the postcricoid region of the hypopharynx are rare. This report reviews our experience with 4 cases of postcricoid hemangioma, including a set of twin siblings. All patients underwent panendoscopy. All patients were managed nonsurgically. Three patients did well with dietary modification. One patient, with multiple medical problems, remains partially dependent on her gastrostomy tube. To our knowledge this report represents the largest series in the literature and the first to describe similar lesions in twin siblings. This report highlights the importance of a complete fiberoptic office examination of children who present with symptoms of dysphagia or aspiration.

    View details for Web of Science ID 000225606400011

    View details for PubMedID 15611403

  • Cervical presentations of thymic anomalies in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Khariwala, S. S., Nicollas, R., Triglia, J. M., Garabedian, E. N., Marianowski, R., Van Den Abbeele, T., April, M., Ward, R., Koltai, P. J. 2004; 68 (7): 909-914


    To better define the clinical manifestations, radiologic imaging and the surgical management of cervical thymic lesions in children.Multi-center retrospective case review.The charts of all children with pathologically confirmed thymic lesions at six children's hospitals (1990-2002) were reviewed for demographics, physical findings, X-ray findings, operative outcomes and pathology.There were a total of 15 children, 2 of whom had ectopic cervical thymus and 13 who had thymic cysts. They ranged in age from 1 month to 18 years. Thymic lesions were more common in males. Ectopic cervical thymus was best defined by MRI whereas thymic cyst had a more consistent appearance on CT. All children had successful surgical resection with no recorded complications or recurrences.Cervical thymic lesions are rare. Ectopic cervical thymus tends to be found primarily in infants whereas thymic cysts occur in a wider age range. Radiologic imaging is important but is not histologically specific. Definitive diagnosis and cure requires complete surgical excision.

    View details for DOI 10.1016/j.ijporl.2004.02.012

    View details for Web of Science ID 000222141500007

    View details for PubMedID 15183582

  • The age dependent facial fractures and relationship between skull fractures Craniomaxillofacial Advanced Symposium Chan, J., Putnam, M. A., Feustel, P. J., Koltai, P. J. ELSEVIER IRELAND LTD. 2004: 877–81
  • The age dependent relationship between facial fractures and skull fractures. International journal of pediatric otorhinolaryngology Chan, J., Putnam, M. A., Feustel, P. J., Koltai, P. J. 2004; 68 (7): 877-881


    To provide clinical evidence to support the age dependent relationship between facial fractures and skull fractures.Retrospective chart review of all children and adults admitted with combined facial fractures and skull fractures and skull fractures alone between January 1991 and November 1997.The Albany Medical Center Hospital, a tertiary level-one trauma center.Two hundred and one children, ages 1 month to 17 years, with skull fractures (frontal, parietal, or temporal), and 41 children with concurrent facial fractures were included in this study. One hundred and thirty-nine adults, ages 18-90 years, with skull fractures, and 70 adults with concurrent facial fractures were also studied.The gender, age, skull fracture, facial fracture, Glasgow coma score (GCS), mechanism of injury, and outcome of all patients admitted with frontal, parietal, or temporal fractures with or without facial fractures.There are a significantly greater (P < 0.001) number of facial fractures associated with skull fractures among adults as compared to children. Moreover, there is an exponential rise in facial fractures associated with skull fractures between infancy and adolescence. The GCS of children with combined facial and skull fractures is significantly lower than in those with skull fractures only (P < 0.001).The spectrum of craniofacial injuries is related to the specific developmental stage of the craniofacial skeleton. This is demonstrated by the variable pattern of combined facial and skull fractures observed clinically in children and adults.

    View details for PubMedID 15183577

  • Obstructive sleep apnea in children AMERICAN FAMILY PHYSICIAN Chan, J., Edman, J. C., Koltai, P. J. 2004; 69 (5): 1147-1154


    Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenotonsillectomy is curative in most patients. Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.

    View details for Web of Science ID 000220104300012

    View details for PubMedID 15023015

  • Thyroglossal duct cysts: presentation and management in children versus adults INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Brousseau, V. J., Solares, C. A., Xu, M., Krakovitz, P., Koltai, P. J. 2003; 67 (12): 1285-1290


    To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management.We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults.Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure.There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.

    View details for DOI 10.1016/j.ijporl.2003.07.006

    View details for Web of Science ID 000187400700001

    View details for PubMedID 14643470

  • Capsule sparing in tonsil surgery: The value of intracapsular tonsillectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Koltai, P. J. 2003; 129 (12): 1357-1357

    View details for Web of Science ID 000187178500033

    View details for PubMedID 14676180

  • Infectious indications for tonsillectomy PEDIATRIC CLINICS OF NORTH AMERICA Discolo, C. M., Darrow, D. H., Koltai, P. J. 2003; 50 (2): 445-?


    Tonsillectomy is the most common major surgery performed on children in the United States. Recurrent throat infections of either bacterial or viral etiology can cause significant morbidity and decreased quality of life, and potentially lead to life-threatening complications. When performed in the proper patient, tonsillectomy can be a highly effective procedure. Recent clinical trials have sought to better define the appropriate infectious indications for surgery. Despite the improved understanding gained from these studies, the decision to operate always must be made on an individual basis with the primary care physician, surgeon, patient, and family all involved in the decision-making process.

    View details for DOI 10.1016/S0031-3955(03)00030-0

    View details for Web of Science ID 000183417100011

    View details for PubMedID 12809333

  • Nasal deformity in neonates and young children PEDIATRIC CLINICS OF NORTH AMERICA Lee, W. T., Koltai, P. J. 2003; 50 (2): 459-?


    Pediatric nasal deformities comprise a broad range of congenital and acquired pathologies. The congenital deformities are rare and often require specific surgical interventions. The acquired deformities are more common, and in the majority of cases surgical intervention is not necessary. The decision to operate is based primarily on the extent of the functional impairment and the severity of the aesthetic deformity.

    View details for DOI 10.1016/S0031-3955(03)00036-1

    View details for Web of Science ID 000183417100012

    View details for PubMedID 12809334

  • Occult supraglottic lymphatic malformation presenting as obstructive steep apnea Annual Meeting of the Academy-of-Otolaryngology-Head-and-Neck-Surgery Chan, J., Younes, A., Koltai, P. J. ELSEVIER IRELAND LTD. 2003: 293–96


    Sleep disordered breathing and obstructive sleep apnea is commonly encountered in the pediatric population. In many cases, it is the result of oropharyngeal obstruction secondary to adenoidal or adenotonsillar hypertrophy. We describe an unusual case of a child with adenoidal hypertrophy who had an occult supraglottic lymphatic malformation that manifested as obstructive sleep apnea. The management of this lesion is discussed including the use of endoscopy, carbon-dioxide laser, and the decision to avoid a tracheotomy. Occult supraglottic lymphatic malformations (LMs) are a rare cause of obstructive sleep apnea, the diagnosis of which will be missed without fiberoptic laryngeal examination. They are challenging to manage because of the airway involvement and propensity to recur.

    View details for Web of Science ID 000181722200013

    View details for PubMedID 12633931

  • Anatomical variations of the facial nerve in first branchial cleft anomalies ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Solares, C. A., Chan, J., Koltai, P. J. 2003; 129 (3): 351-355


    To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve.Case series.Tertiary care center.Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams.Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case.The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly.Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence.The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.

    View details for Web of Science ID 000181522400014

    View details for PubMedID 12622548

  • The natural history of congenital cholesteatoma ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Koltai, P. J., Nelson, M., Castellon, R. J., Garabedian, E. N., Triglia, J. M., Roman, S., Roger, G. 2002; 128 (7): 804-809


    To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions.A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral).Two tertiary care children's hospitals.Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years).Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss.Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.

    View details for Web of Science ID 000176714300014

    View details for PubMedID 12117340

  • Congenital cholesteatoma - Classification, management, and outcome 15th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology Nelson, M., Roger, G., Koltai, P. J., Garabedian, E. N., Triglia, J. M., Roman, S., Castellon, R. J., Hammel, J. P. AMER MEDICAL ASSOC. 2002: 810–14


    To assess whether a classification system for congenital cholesteatoma (CC) can be derived from analysis of a large clinical sample of cases and to assess whether such a classification system is a reliable guide for surgical intervention, reexploration, and hearing outcome.A retrospective review of clinical and surgical records of 119 patients with CC.Four tertiary care children's hospitals.One hundred nineteen children with CC (age range, 2-14 years).Congenital cholesteatomas in the anterior mesotympanum were treated successfully with exploratory tympanotomy. Congenital cholesteatomas involving the posterior superior quadrant and the attic usually had concurrent involvement of the incus and stapes and often required a canal wall up tympanomastoidectomy and a second look for its control. Congenital cholesteatoma involving the mastoid usually involved all of the ossicles, was inconsistently controlled with canal wall up tympanomastoidectomy, and had a poor prognosis for restoration of conductive hearing loss. The mean +/- SD age of children with CC was 5.6 +/- 2.8 years, while that of children with acquired cholesteatoma was 9.7 +/- 3.3 years.The sequence of spread of CC, involving 3 sites, suggests a natural classification system. The CC usually originates in the anterior superior quadrant, but does not consistently remain there, and may variably occupy the middle ear and mastoid and result in ossicular destruction and conductive hearing loss. The location of CC and the involvement of the ossicles is an accurate predictor of the type of surgery necessary for its control and for the success of hearing restoration.

    View details for Web of Science ID 000176714300015

    View details for PubMedID 12117341

  • The impact of airbags and seat belts on the incidence and severity of maxillofacial injuries in automobile accidents in New York state ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Mouzakes, J., Koltai, P., Kuhar, S., Bernstein, D. S., Wing, P., Salsberg, E. 2001; 127 (10): 1189-1193


    To evaluate the effect driver-side and passenger-side airbags have had on the incidence and severity of maxillofacial trauma in victims of automobile accidents.Retrospective analysis of all automobile (passenger cars and light trucks) accidents reported in 1994.New York State.Of the 595910 individuals involved in motor vehicle accidents in New York in 1994, 377054 individuals were initially selected from accidents involving cars and light trucks. Of this subset, 164238 drivers and 62755 right front passengers were selected for analysis.Each case is described in a single record with approximately 100 variables describing the accident, eg, vehicle, safety equipment installed and utilized or deployed, occupant position, patient demographics, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses, and procedural treatments rendered. A maxillofacial trauma severity scale was devised, based on the ICD-9-CM diagnoses.Individuals using airbags and seat belts sustained facial injuries at a rate of 1 in 449, compared with a rate of 1 in 40 for individuals who did not use seat belts or airbags (P<.001). Those using airbags alone sustained facial injuries at the intermediate rate of 1 in 148, and victims using seat belts without airbags demonstrated an injury rate of 1 in 217 (P<.001).Use of driver-side airbags, when combined with use of seat belts, has resulted in a decrease in the incidence and severity of maxillofacial trauma.

    View details for Web of Science ID 000171444100005

    View details for PubMedID 11587598

  • Comparison of power-assisted adenoidectomy vs adenoid curette adenoidectomy 14th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology Stanislaw, P., Koltai, P. J., Feustel, P. J. AMER MEDICAL ASSOC. 2000: 845–49


    To compare the safety and efficacy of power-assisted adenoidectomy (PAA) vs adenoid curette adenoidectomy (ACA).A prospective randomized study.Children's hospital of a tertiary care medical center.Ninety patients (aged 1-13 years) underwent PAA, and 87 patients (aged 1-12 years) underwent ACA.The parameters evaluated were operative time, blood loss, completeness and depth of resection, injuries to surrounding structures, short- and long-term complications, surgeon satisfaction with the procedure, and parents' assessment of the patient's postoperative recovery period.The PAA was 20% faster (P<.001) and had 27% less blood loss (P<.001) than the ACA. It provided a more complete resection(P<.001) and better control of the depth of resection (P<.05). Surgeon satisfaction was greater with PAA (P<.001). There was no difference in the recovery period or parent satisfaction. One patient in the PAA group returned to the operating room for control of postoperative bleeding, and 1 child in the ACA group returned to the hospital for postoperative dehydration.The PAA provides a faster, dryer, more complete, and more surgically satisfying resection than the ACA.

    View details for Web of Science ID 000088105000004

    View details for PubMedID 10888996

  • Familial occurrence of acinic cell carcinoma of the parotid gland ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE Depowski, P. L., Setzen, G., Chui, A., Koltai, P. J., Dollar, J., Ross, J. S. 1999; 123 (11): 1118-1120


    We report the familial occurrence of acinic cell carcinoma involving the parotid gland, the first such report of which we are aware. The familial occurrence of any salivary gland neoplasm is rare. Several reports are present in the literature, including pleomorphic adenoma, Warthin tumor, carcinoma of the submandibular gland, and malignant lymphoepithelial lesion. We report the case of a 35-year-old man who underwent excision of a left parotid gland acinic cell carcinoma. Eight years later, his daughter presented at the age of 16 years with a nontender parotid gland mass that was excised and found also to be acinic cell carcinoma. The histologic features of both neoplasms were typical of acinic cell carcinoma. While this may represent a coincidental event, the possibility that this familial occurrence is a manifestation of common genetic or environmental risk cannot be excluded.

    View details for Web of Science ID 000083584000031

    View details for PubMedID 10539921

  • Evaluation of orbital stress dissipation in pediatric and adult skulls using electronic speckle pattern interferometry 13th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology Mouzakes, J., Koltai, P. J., Simkulet, M. D., Castracane, J. AMER MEDICAL ASSOC. 1999: 765–73


    To measure and quantitatively compare the degree of force dissipation in pediatric and adult skulls subjected to similar dynamic forces.An anatomical study using electronic speckle pattern interferometry, which allows generation of displacement vectors after application of a force.Five human skulls (3 pediatric and 2 adult).Each skull was subjected to a reproducible and quantifiable force created by a steel ball pendulum striking a precise periorbital focus: (1) infraorbital foramen, (2) supraorbital notch, (3) malar eminence, and (4) nasofrontal suture. Electronic speckle pattern interferometry was used to construct interferogram fringe patterns to determine skull regions with the greatest degree of displacement.Interferogram analysis revealed that the adult skull has a tendency to dissipate force with minimal resultant displacement. In contrast, the pediatric skulls demonstrated greater displacements (ie, increased fringe density) at the same periorbital foci.The pediatric skull dissipates periorbital stress differently than the adult skull, as illustrated by quantitative interferogram analysis. This finding parallels clinical data that demonstrate a varying pattern of fractures in pediatric and adult skulls related to craniofacial development.

    View details for Web of Science ID 000081416800008

    View details for PubMedID 10406314

  • Safety of powered instrumentation for adenoidectomy INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Heras, H. A., Koltai, P. J. 1998; 44 (2): 149-153


    A recent study established the utility of an endoscopic shaver for adenoidectomy in children by the transoral approach and showed that power assisted adenoidectomy (PAA) was significantly faster with a trend toward decreased blood loss. The purpose of this study was to demonstrate the safety of power assisted adenoidectomy in a large cohort of patients. A retrospective review was performed of 329 patients who had adenoidectomy by powered instrumentation. Postoperative complications were documented and compared with a similar group that had curette adenoidectomy. Complications watched for included prolonged recovery, postoperative hemorrhage, readmission for dehydration, velopharyngeal insufficiency, and nasopharyngeal stenosis. No postoperative complications were seen in the power assisted adenoidectomy group. This review confirms the safety of power assisted adenoidectomy.

    View details for Web of Science ID 000075284200007

    View details for PubMedID 9725531

  • First branchial cleft anomalies - A study of 39 cases and a review of the literature 12th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology Triglia, J. M., Nicollas, R., Ducroz, V., Koltai, P. J., Garabedian, E. N. AMER MEDICAL ASSOC. 1998: 291–95


    To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft.Retrospective study.Three tertiary care centers.Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996.All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed.Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases.Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.

    View details for Web of Science ID 000072607600007

    View details for PubMedID 9525513

  • Pediatric mandibular fractures. Facial plastic surgery Schweinfurth, J. M., Koltai, P. J. 1998; 14 (1): 31-44


    Over the last 20 years, a revolution in the management of facial fractures has taken place. Refinements in biocompatible materials of great delicacy and strength along with advances in our understanding of biomechanics of the face, have rendered complex injuries consistently amenable to accurate 3-dimensional reconstruction. Furthermore, with the availability of education in the techniques of internal rigid fixation, these advanced techniques have become routine practice in adults. However, the suitability of rigid internal fixation for children remains controversial. There are many concerns about the effect of implanted hardware in the mandible of a growing child. In addition, some evidence suggests that the elevation of functional matrix off of bone may result in alterations in development. The goal is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. However, in children the treatment of bony injuries is most easily accomplished by techniques that may adversely effect craniofacial development. While it is not entirely possible to resolve this dilemma, there exists an extensive body of experimental and clinical information on the appropriate management of pediatric mandibular fractures which can be used to formulate a rational treatment plan for most cases. This paper presents an overview of the contemporary understanding and application of these treatment principles.

    View details for PubMedID 10371892

  • Power-assisted adenoidectomy 11th Annual Meeting of the American-Society-of-Pediatric-Otolaryngology / American-Rhinologic-Society Combines Otolaryngologic Spring Meeting Koltai, P. J., Kalathia, A. S., Stanislaw, P., Heras, H. A. AMER MEDICAL ASSOC. 1997: 685–88


    To quantify that the use of powered instrumentation for adenoidectomy is an improvement over traditional techniques.Retrospective case series of 40 consecutive children undergoing power-assisted adenoidectomy compared with 40 consecutive children undergoing conventional transoral adenoidectomy with a curet.Tertiary care center.Operative time, blood loss, length of hospitalization, and complications.With power-assisted adenoidectomy, the mean operative time was significantly faster (11 minutes vs 19 minutes for the conventional method), mean blood loss was not significantly different (22 mL vs 32 mL for the conventional method), mean length of hospitalization after the procedure was not significantly different (2.95 hours vs 2.8 hours for the conventional method), and there were no surgical complications with either technique.In comparison with conventional techniques, power-assisted adenoidectomy provides significant advantages that are subjectively apparent but can also be objectively measured.

    View details for Web of Science ID A1997XL47900003

    View details for PubMedID 9236585

  • p53 protein expression in benign lesions of the upper respiratory tract ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Ingle, R. R., Setzen, G., Koltai, P. J., Monte, D., Pastore, J., Jennings, T. A. 1997; 123 (3): 297-300


    p53 is a tumor suppressor gene that is lost or mutated in most forms of human malignancy. There are, however, very few studies evaluating p53 expression in normal epithelium or benign lesions.We screened for p53 protein expression in a variety of benign epithelial lesions of upper respiratory tract using monoclonal antibody DO-1 on paraffin-embedded material.We studied a total of 109 cases: 16 cases of juvenile and 36 cases of adult laryngeal papillomatosis, 10 cases each of laryngeal nodules and laryngeal polyps, 17 cases of inverted papilloma, and 20 cases of nasal polyps.Nuclear immunoreactivity for p53 protein was demonstrated in 14 (88%) of 16 cases of juvenile laryngeal papillomatosis, 33 (92%) of 36 cases of adult laryngeal papillomatosis, 4 (40%) of 10 cases of laryngeal nodules, 8 (80%) of 10 cases of laryngeal polyps, 7 (41%) of 17 cases of inverted papilloma, and 2 (10%) of 20 cases of nasal polyps. These results pertained only to the basal epithelial layer in all cases of laryngeal nodules, laryngeal polyps, and nasal polyps. Intermediate layer cells were also positive for p53 in the majority of the cases of both juvenile (69%) and adult (75%) laryngeal papillomatosis and in a minority of the cases of inverted papilloma (18%).Overexpression of p53 protein is commonly demonstrable in benign epithelial lesions of the upper respiratory tract. This observation suggests that p53 protein accumulation may occur in the absence of mutation of the p53 gene and may correlate with epithelial proliferative activity.

    View details for Web of Science ID A1997WN50200008

    View details for PubMedID 9076236

  • Management of facial trauma in children PEDIATRIC CLINICS OF NORTH AMERICA Koltai, P. J., Rabkin, D. 1996; 43 (6): 1253-?


    In today's fast-paced society, many children sustain severe maxillofacial injuries that require surgical reconstruction. The factor that differentiates the treatment of pediatric facial fractures from those of adults is facial growth. Anticipation of mandibular growth facilitates repair because most injuries can be treated with intermaxillary fixation. Midfacial injuries, on the other hand, may be more sensitive to alterations of facial growth, and complex cases require more sophisticated correction. The techniques of three-dimensional reconstruction of complex facial fractures has been facilitated greatly by the use of a rigid plating system, wide craniofacial exposure, and bone grafting. These techniques have sound theoretic and practical applications in severe pediatric facial trauma.

    View details for Web of Science ID A1996VY94300008

    View details for PubMedID 8973512

  • ORBITAL FRACTURES IN CHILDREN ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Koltai, P. J., Amjad, I., Meyer, D., Feustel, P. J. 1995; 121 (12): 1375-1379


    To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium.Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures.The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center.The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992.Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8 +/- 3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0 +/- 4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1 +/- 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger.Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses.

    View details for Web of Science ID A1995TJ64500006

    View details for PubMedID 7488366



    Acoustic features of expiratory cry vocalizations were studied in 125 pre-term infants prior to being discharged from a level-3 neonatal intensive care unit. The purpose was to describe various phonatory behaviors in infants in whom significant hearing loss could be ruled out. We also compared these results with normal-hearing full-term infants, and evaluated whether linkage exists among acoustic cry features and various anthropometric, diagnostic and treatment variables obtained throughout the peri- and neonatal periods. Our analysis revealed that cry duration was significantly related to total days receiving respiratory assistance. The occurrence of other complex spectral and temporal aspects of acoustic cry vocalizations including harmonic doubling and vibrato also increased in infants receiving some form of respiratory assistance. The presence of harmonic doubling also depended on weight and conceptional age at test. The discussion focuses on the implication of these relationships and directions for future research.

    View details for Web of Science ID A1995TC77800003

    View details for PubMedID 8557478

  • Rigid fixation of facial fractures in children. The Journal of cranio-maxillofacial trauma Koltai, P. J., Rabkin, D., Hoehn, J. 1995; 1 (2): 32-42


    This article presents a retrospective analysis of a selective use of rigid fixation among 62 children with facial fractures, treated at a Level I trauma center over a 5-year period (1986-1991). There were 21 mandible fractures, 11 orbital fractures, 11 zygomaticomalar complex fractures, 7 nasal fractures, 5 maxillary fractures, 3 pan-facial fractures, 2 nasal-orbital-ethmoidal complex fractures, and 2 frontal sinus fractures. Only 18 children had rigid fixation of their injuries. Complications of Le Fort upper facial fractures repaired with rigid fixation involved perioperative sinusitis; one case required oral antibiotics, the other ethmoidectomy and maxillary antrostomy. One child with a Le Fort fracture had delayed exposure of a zygomaticomalar buttress plate, which required surgical removal. Permanent enophthalmos occurred in two children with Le Fort fractures. The authors conclude that traditional conservative management is appropriate in most cases. However, in children aged 13 and older with mandible fractures and children with complex mid- and upper facial fractures, a judicious use of rigid fixation has advantages over the traditional techniques.

    View details for PubMedID 11951461



    To compare the therapeutic effects of systemic pentoxifylline and topical aloe vera cream in the treatment of frostbite.The frostbitten ears of 10 New Zealand white rabbits were assigned to one of four treatment groups: untreated controls, those treated with aloe vera cream, those treated with pentoxifylline, and those treated with aloe vera cream and pentoxifylline.Tissue survival was calculated as the percent of total frostbite area that remained after 2 weeks.The control group had a 6% tissue survival. Tissue survival was notably improved with pentoxifylline (20%), better with aloe vera cream (24%), and the best with the combination therapy (30%).Pentoxifylline is as effective as aloe vera cream in improving tissue survival after frostbite injury.

    View details for Web of Science ID A1995RC17400015

    View details for PubMedID 7772322

  • TRANSSPHENOIDAL HYPOPHYSECTOMY THROUGH THE EXTERNAL RHINOPLASTY APPROACH 1993 Annual Meeting of the American-Academy-of-Otolaryngology - Head-and-Neck-Surgery Koltai, P. J., Goufman, D. B., Parnes, S. M., Steiniger, J. R. MOSBY-YEAR BOOK INC. 1994: 197–200


    The external rhinoplasty approach is a refinement of the well-recognized sublabial transseptal technique for transsphenoidal hypophysectomy first introduced by Cushing in 1910. This article relates our experience with 111 cases of transsphenoidal hypophysectomy performed during a 10-year period (1982-1992) and includes a detailed description of our use of the external technique. Fifty-one patients were male, and 60 were female. Ages ranged from 12 years to 80 years, with an average of 46 years. One hundred one patients had pituitary adenomas, four had craniopharyngiomas, two had inverting papillomas, and there was one each of lymphoma, metastatic prostate cancer, pituitary abscess, and posttraumatic cerebrospinal fluid leak. Nine of the operations were for recurrent adenomas. Complications included 8 symptomatic anterior septal perforations and 13 asymptomatic posterior perforations. Five had transient cerebrospinal fluid rhinorrhea, five had perioperative hemorrhages, two had minor postoperative columellar deformities, and one had injury to the internal carotid artery requiring embolization. We have found the external technique for transsphenoidal hypophysectomy to be a reliable and facile means for nasal exposure of the sphenoid sinus and pituitary gland without loss of nasal tip projection or significant cosmetic deformity.

    View details for Web of Science ID A1994PG59700005

    View details for PubMedID 8084625

  • Lateral cervical radiographs and adenoid size: do they correlate? Ear, nose, & throat journal Cohen, L. M., Koltai, P. J., Scott, J. R. 1992; 71 (12): 638-642


    Clinicians have questioned the value of lateral soft tissue neck x-ray (LSTN) in assessing adenoid size. Elaborate cephalometric assays have been devised to measure degree of nasopharyngeal obstruction secondary to adenoid hypertrophy. This study prospectively studied 73 children, aged 11 months to 13 years, with clinical evidence of adenoid hypertrophy to assess how well a LSTN correlates with direct intraoperative observation of adenoid size and nasopharyngeal obstruction. We found a relatively weak correlation (Pearson coefficient r = 0.34) between x-ray and operative observations. We conclude that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy. However, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.

    View details for PubMedID 1483401

  • The external rhinoplasty approach for rhinologic surgery. Ear, nose, & throat journal Reese, B. R., Koltai, P. J., Parnes, S. M., Decker, J. W. 1992; 71 (9): 408-412


    The technique of external rhinoplasty has enjoyed a renaissance over the last ten years, primarily for cosmetic and functional septorhinoplasty, and we have found this to be an effective method for nasal reconstruction. Moreover, we have recognized the versatility of this approach for a variety of rhinologic problems and have utilized it for transsphenoidal hypophysectomy, sphenoidotomy, unilateral choanal atresia, septal perforation, nasal valvuloplasty and rhinophyma. We describe our technique and the rationale for employing it. We conclude that the enhanced exposure provided by the cutaneous decortication of the nose facilitates surgery of both the soft tissues and the supportive architecture of the nose.

    View details for PubMedID 1425380



    One of the disabilities in patients with cerebral palsy (CP) is dysphagia. To establish the prevalence of dysphagia in a population of children with CP, and to determine if any factors are related to dysphagia, we studied 56 CP patients, 5-21 years, enrolled in a primary school for the disabled. Fifteen patients (27%) had either radiographic or clinical evidence of dysphagia. These 15 patients were compared to the remaining 41 patients without dysphagia. Using data obtained from chart review and interviews with speech pathologists, several factors that contributed to dysphagia were found. These included: bite reflexes, slowness of oral intake, poor trunk control, inability to feed independently, anticonvulsant medication, coughing with meals, choking, and pneumonia. We also noted trends in the following factors: presence of tongue thrusting, presence of drooling, severity of CP, poor head control, severity of mental retardation, seizures, and speech disorders. Factors not related to the presence of dysphagia include: subject age, cause of CP, and type of CP. Early, aggressive work-up and identification in CP patients with the risk factors outlined above can reduce the associated pulmonary complications.

    View details for Web of Science ID A1992JG39000008

    View details for PubMedID 1399305



    The external rhinoplasty is a versatile approach for exposing nasal anatomy in children and has been utilized for a variety of rhinologic problems (N = 35). These have included septal deviation (11), cleft lip nasal deformity (10), unilateral choanal atresia (five), nasal dermoids (four), and problems of the sphenoidal sinus (five). For children with septal deformities, the external approach allows complete intranasal visualization, providing access for careful and conservative reconstruction. In children with cleft lip nasal deformity, decortication allows for direct sculpting of the alar cartilages. For unilateral choanal atresia, the external technique provides exposure of the posterior vomer as in the transpalatal approach, but without the risk to palatal growth. For nasal dermoids, the open rhinoplasty offers wider exposure with more control over the medial osteotomies, a better view of the cribriform plate, and enhanced cosmesis. For problems of the sphenoid, the external route utilizes the guiding midline intranasal structures for rapid and direct entry into the sinus. In our study, the age range of the children was between 7 months and 18 years. The range of follow-up was between 6 months and 5 years. The techniques for the individual procedures are described, along with a rationale for their employment. There were no postoperative complications, and no long-term problems associated with the use of the external technique. In conclusion, the enhanced exposure provided by the external rhinoplasty approach in children facilitates rhinologic procedures on the soft tissues of the nose and the nasal architecture, as well as in the central core of the face.

    View details for Web of Science ID A1992HN29900011

    View details for PubMedID 1554470



    In an effort to show that Chlamydia trachomatis (CT) may be involved in the causation of acute otitis media (AOM), we performed three experiments. In the first, we inoculated the tympanic bullae of 6 chinchillas with CT. Five of the 6 inoculated animals developed CT AOM. In the second experiment, we sprayed the nasopharynx of 10 chinchillas with CT. Of these, 8 developed both pharyngitis and AOM, and in 6, live CT was cultured from the middle ear and pharynx. In the third experiment, 5 chinchillas had their conjunctiva inoculated with CT. Three developed CT conjunctivitis. Of these, 2 developed CT pharyngitis and 1 developed CT AOM. We concluded that CT will cause AOM in the chinchilla by direct inoculation into the middle ear as well as indirectly by infection of the nasopharynx and conjunctiva.

    View details for Web of Science ID A1991GA48900003

    View details for PubMedID 1872510

  • External rhinoplasty approach to transsphenoidal hypophysectomy. Ear, nose, & throat journal Parnes, S. M., Koltai, P. J. 1991; 70 (7): 438-440


    The external rhinoplasty approach is a modification of the well recognized transseptal transsphenoidal hypophysectomy technique first introduced by Cushing in 1910. Our approach has been used successfully in 75 cases over a six year period, demonstrating its efficacy and safety. It provides a simple, reliable, rapid technique for exposing the septum and the floor of the nose with excellent exposure to the sphenoid sinus and pituitary gland. There has been no loss of nasal tip projection or other cosmetic deformity.

    View details for PubMedID 1914964

  • Applied nasal anatomy & embryology. Ear, nose, & throat journal Lanza, D. C., Kennedy, D. W., Koltai, P. J. 1991; 70 (7): 416-422


    The embryology & anatomy of the nose as it is applied to rhinoplasty is surveyed so that the surgeon in training can develop a basis from which to review the literature. This review demonstrates the need for the consolidation and clarification of the nomenclature associated with the complex anatomy of the nasal pyramid.

    View details for PubMedID 1914961

  • The external rhinoplasty for the correction of unilateral choanal atresia in young children. Ear, nose, & throat journal Koltai, P. J. 1991; 70 (7): 450-453


    The external rhinoplasty approach has been utilized in three young children for the correction of unilateral choanal atresia. It has been demonstrated to be technically feasible to utilize this technique in young children. It provides excellent exposure of the atresia plate with the ability to correct the atresia in a precise and confident way. This technique is an elegant alternative to transnasal puncture and transeptal resection.

    View details for PubMedID 1914966



    We describe the technique of endoscopic diagnosis and endoscopic surgical repair used in the management of supraglottic interarytenoid laryngeal clefts in 11 children seen between 1981 and 1988 at the Hospital for Sick Children, London, England. Six of the children had primary type I clefts that required endoscopic repair. The symptoms included inspiratory stridor, choking during eating, and aspiration. Five of the children had previous transcervical repair of type II clefts that had partial breakdown in the interarytenoid area causing symptoms of aspiration, which required secondary repair endoscopically. All the patients had successful microlaryngoscopic closure; in two children, however, the breakdown of the repair necessitated repeated endoscopic correction. The only complication occurred in a case of postoperative supraglottitis, which was successfully managed with intubation and antibiotics. We conclude that endoscopic repair is a useful and reliable technique and an elegant alternative to the open transcervical approach for the closure of supraglottic laryngeal clefts.

    View details for Web of Science ID A1991FA77000004

    View details for PubMedID 1998565

  • EARLY COMPLICATIONS OF AIRWAY MANAGEMENT IN HEAD-INJURED PATIENTS LARYNGOSCOPE Lanza, D. C., Parnes, S. M., Koltai, P. J., Fortune, J. B. 1990; 100 (9): 958-961


    Head-injured patients are frequently young, healthy individuals whose excellent medical condition is suddenly altered by trauma. The purpose of this study is to evaluate the early complications of airway management which occur in head-injured patients and to determine if these are different from what has been reported in patients with chronic illnesses (i.e., diabetes, atherosclerosis, or immunosuppression). Chart review of 52 head-injured patients reveals an early complication rate of 61% for endotracheal intubation and 20% for tracheotomy. Discriminant analysis shows that increasing duration of intubation is the most significant factor in predicting airway management complications (P less than 0.008). The incidence of complications seen in head-injured patients is similar to that of the chronically ill. Complications of endotracheal intubation are judged to be more severe than those of tracheotomy. Data from this study supports the early tracheotomy of severely head-injured patients who are likely to require prolonged airway management.

    View details for Web of Science ID A1990DW72100009

    View details for PubMedID 2395405



    Otitis media with effusion is a significant cause of hearing loss in young children. We hypothesized that persistent bacterial antigens in middle ear effusions (MEEs) might act as chronic inflammatory stimuli causing release of neutrophil proteins. Concentrations of neutrophil lactoferrin and a 37-kd cationic bactericidal protein (CAP 37) were measured in 47 MEEs collected from 27 children at the time of tympanostomy tube placement. Antigens of Streptococcus pneumoniae were detected by latex particle agglutination and those of Haemophilus influenzae by dot-blot assay. Bacterial antigens were detectable in 24 (51%) of MEEs: S pneumoniae in 10 (21%), H influenzae in 12 (26%), and both antigens in 2 (4%). Concentrations of lactoferrin and CAP 37 in H influenzae antigen-positive MEEs were significantly higher than in either S pneumoniae antigen-positive or antigen-negative MEEs. We conclude that H influenzae antigen causes a greater middle-ear inflammatory response, as judged by neutrophil products, than does S pneumoniae antigen.

    View details for Web of Science ID A1990CT42600014

    View details for PubMedID 2306352



    Sternomastoid tumor of infancy (SMTI) is the most common cause of neck mass in the perinatal period. We present seven children with this disorder, six studied prospectively. Ages at presentation ranged from 1 week to 4 weeks. Five had a history of birth trauma. Torticollis with facial asymmetry was seen in two. In six the diagnosis of SMTI was made clinically, and these patients were managed conservatively with massage and controlled stretching of the neck. Resolution of the neck mass, the torticollis, and the facial asymmetry occurred in all patients. Pathologic and radiographic findings are presented. We conclude that careful clinical assessment precludes the necessity of biopsy and emphasize the importance of conservative management of this transient problem.

    View details for Web of Science ID A1989CD49300007

    View details for PubMedID 2589764



    We prospectively studied 10 patients with chronic otitis media suspected of having cholesteatoma with computed tomography and magnetic resonance imaging to assess which imaging modality would be most specific in predicting the presence of cholesteatoma. The interpretation of images was then correlated with the operative findings. In 9 of the 10 cases, computed tomography accurately predicted the extent and destructiveness of the disease but did not consistently differentiate between cholesteatoma and associated granulation tissue. In 2 of the 10 cases, the T1-weighted magnetic resonance imaging demonstrated high signal, suggestive of cholesteatoma. In one case, magnetic resonance imaging predicted cholesteatoma on the basis of bony destruction. However, in 7 of 10 cases the scan was nonspecific for cholesteatoma. We conclude that high-resolution computed tomography remains the primary imaging modality for chronic otitis media.

    View details for Web of Science ID A1989AT78600023

    View details for PubMedID 2789780

  • The story of the laryngoscope. Ear, nose, & throat journal Koltai, P. J., NIXON, R. E. 1989; 68 (7): 494-502

    View details for PubMedID 2676465

  • Three dimensional imaging in otolaryngology. ENTechnology Koltai, P. J., Wood, G. W., CaJacob, D. E., Meagher, D. J. 1988: 6-19

    View details for PubMedID 3271579

  • Otitis media in the immunosuppressed child. Ear, nose, & throat journal Koltai, P. J., MAISEL, B. O., Seskin, F., Arenson, E. 1988; 67 (2): 88-?

    View details for PubMedID 3349963



    High-resolution computed tomography (HRCT) is a noninvasive technique for evaluating the middle ear for primary and recurrent cholesteatoma. However, a limitation of HRCT is that it cannot differentiate between cholesteatoma and granulation tissue. Magnetic resonance imaging (MRI) is a noninvasive, nonradiologic technique that has been effective in demonstrating histochemical differences between various soft tissues. We present images from a normal living subject's temporal bone in the sagittal plane obtained with both HRCT and MRI. Anatomic correlates in the same cut planes are presented. The HRCT provided excellent detail of the bony landmarks within the temporal bone and was used as the reference for the MRI. The soft-tissue structures such as cranial nerves, cochlea, vestibule, and semicircular canals were identified.

    View details for Web of Science ID A1988L520200008

    View details for PubMedID 3334820



    Laryngoscopy and panendoscopy can cause airway complications. To determine the risk to the airway from reintubation following general anesthesia in otolaryngology patients, we examined recovery room and anesthesia records at the Albany Veterans Administration Medical Center covering a 10-year period. From this information we determined the incidence of recovery room reintubation and studied airway risk factors associated with otolaryngologic endoscopy. From 1975 to 1984, 10,060 surgical patients were intubated at the Albany VA Medical Center. Only 17 patients (0.17%) required reintubation. Of 1,365 otolaryngology patients intubated during the same period, 324 had laryngoscopy and 302 had panendoscopy. Significantly, four laryngoscopy patients (1.2%) and nine panendoscopy patients (3%) required recovery room intubation. Nine endoscopy patients needed reintubation within 1 hour of extubation. We conclude that the risk of postoperative airway compromise is significantly greater among patients who underwent diagnostic laryngoscopy and panendoscopy than among patients who had general anesthesia for other reasons.

    View details for Web of Science ID A1987L280800016

    View details for PubMedID 3688760



    Despite advances in radiology--including CT scanning--the three-dimensional (3D) nature of facial fractures must still be inferred by the spatial imagination of the physician. A computer system (Insight Phoenix Data Systems, Inc., Albany, N.Y.) uses CT studies as substrate for 3D reconstructions. We have used the Insight computer for the evaluation and surgical planning of facial fractures of 16 patients with complex injuries. We present five illustrative cases, directly photographed from the computer monitor. Images can also be manipulated in real time by rotating or planar sectioning (functions best appreciated on video). The ability to cybernetically extract the facial skeleton from living subjects provides precise anatomic data previously unobtainable. The images are valuable for an accurate assessment of the relationship between the injured and uninjured sections of the face. We conclude that 3D reconstruction is an important advance in the treatment of facial fractures.

    View details for Web of Science ID A1986D194500003

    View details for PubMedID 3106883

  • Vertigo and perilymph fistula. Ear, nose, & throat journal Koltai, P. J., GALOS, R. 1986; 65 (6): 264-266

    View details for PubMedID 3732107

  • Three-dimensional interactive analysis of craniofacial and spinal computed tomography. Acta radiologica. Supplementum Wood, G. W., Koltai, P. J., Meagher, D. J., Schmidt, W., Eames, F., ROBESON, G. H. 1986; 369: 703-705


    Three-dimensional interactive display of CT data from 23 cases of craniofacial and spinal pathology using a solids processing computer system was compared with conventional two-dimensional CT display. Three-dimensional display gave a more complete perspective of complex displacement patterns of facial and spinal fractures, and more clearly defined surface anatomy of osseous tumors and malformations. In 7 cases however, processing algorithms for three-dimensional display caused subtle anatomic features and non-displaced fractures to be obscured. These false negatives were clinically significant in cases of petrous bone pathology and in non-displaced spinal fractures that affected stability.

    View details for PubMedID 2980601



    The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.

    View details for Web of Science ID A1985ABH5600004

    View details for PubMedID 3968947



    Pseudomonas aeruginosa (Ps. Au.) infection of the maxillary sinus has been reported as an incidental finding on routine antrostomy; however, it has also been noted in several studies as the significant organism in the etiology of chronic sinusitis. Four case reports of culture verified Ps. Au. maxillary sinusitis are presented. The therapeutic modality used in two of the cases was a Caldwell-Luc operation and in two, an intranasal antrostomy. In all cases, multiple irrigations through the surgically created nasoantral windows were done postoperatively, as was the instillation of gentamicin ophthalmic drops intranasally. In all four cases the infection cleared with this combined surgical and medical therapy.

    View details for Web of Science ID A1985AAM4800010

    View details for PubMedID 3917521



    The history of transsphenoidal hypophysectomy demonstrates the soundness of the basic concept of approaching the sella turcica in a midline fashion through the nose. Conceptually, it has not been eclipsed since first evolved by Cushing in the early part of this century. The surgical advances since Cushing's time have been major refinements in instrumentation and minor refinements of his basic technique. The external rhinoplasty approach is such a refinement. We have used this technique in a two-year period between June 1982 and June 1984 on 14 patients. We have found this technique for transsphenoidal hypophysectomy to be a simple, reliable, rapid technique for exposing the septum and the floor of the nose. It provides excellent exposure to the sphenoid sinus and pituitary gland without loss of nasal tip projection or other cosmetic deformity.

    View details for Web of Science ID A1985AKZ8400010

    View details for PubMedID 4015499


    View details for Web of Science ID A1984TD76300022

    View details for PubMedID 6205235



    We evaluated and compared the separate effects of ethyl, isobutyl, and fluoroalkyl cyanoacrylate on the promontory mucosa and surgically disarticulated incudostapedial joint in the adult cat middle ear. The animals were sacrificed at 10-, 30-, and 60-day intervals after glue application. All three cyanoacrylates elicited a chronic inflammatory response when placed directly on the promontory mucosa. The use of ethyl and isobutyl cyanoacrylate resulted in persisting discontinuity of the incudostapedial joint with erosion of the incus. Fluoroalkyl cyanoacrylate maintained incudostapedial continuity without ossicular erosion. Ethyl and isobutyl cyanoacrylate are probably not appropriate for middle ear surgery. The less toxic fluoroalkyl cyanoacrylate may be useful as an ossicular adhesive in selected cases. Our findings are further contrasted with those obtained in similar studies with methyl and butyl cyanoacrylate. The effects of each of the five cyanoacrylates are reviewed in the continuing search for a safe and effective ossicular adhesive.

    View details for Web of Science ID A1983QC40300006

    View details for PubMedID 6824276



    We studied the effect of free buried dermal grafts to primary pharyngeal closures among 24 nonirradiated patients undergoing radical head and neck surgery to determine if this technique would reduce the incidence of postoperative pharyngocutaneous fistula. For a control group we selected 23 patients who had undergone similar operations as the patients in the study group, but who did not have dermis used for pharyngeal protection. Our results indicate that dermal grafts do not alter the incidence of fistulization following cancer surgery of the head and neck.

    View details for Web of Science ID A1981LQ10900016

    View details for PubMedID 6787522



    Although the parotid glands are affected more frequently by cysts and congenital lesions than other salivary glands, the benign multigerminal cyst arising from a duplication anomaly of the first branchial cleft within the parotid gland is extremely rare. Forty-two cases of this unusual cause of parotid swelling have been reported in the literature. An example of a first branchial cleft anomaly appearing clinically as a parotid tumor is reported.

    View details for Web of Science ID A1980JM05200011

    View details for PubMedID 7393602