By William Macnee

This medical reference for practitioners deals a brand new and entire examine persistent obstructive lung illness. worldwide in scale and value, it's a massive explanation for morbidity and mortality. Bringing jointly a roster of across the world popular individuals from front traces of pulmonary drugs and examine, persistent Obstructive Lung illnesses is aimed toward practitioners in pulmonary drugs, pathology, thoracic radiology and epidemiology. Its concentration is at the pathobiology of power obstructive pathology ailment and emphysema and its exacerbation of persistent obstructive pulmonary affliction and on treatment plans.

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48 Surgical Atlas of Pediatric Otolaryngology When a fat-plug graft is used to repair the perforation: • The graft is inserted tightly into the perforation (Figure 3–11A), with half of the fat in the middle ear and half on the outer surface of the tympanic membrane (Figure 3–11B). • No Gelfoam is needed in the middle ear, but a Steri-Strip is applied to the outer surface of the graft and antibiotic ointment is instilled into the ear canal similar to that shown in Figure 3–10. Postoperative Care • Postoperative care is similar to that described in Chapter 1 under Removal of Tympanostomy Tube and Myringoplasty.

When the perforation is larger and in one or both posterior quadrants, especially when it is a “marginal perforation,” a postauricular approach is employed with a medial fascia graft. When a retraction pocket is in this portion of the tympanic membrane, the same approach is used, but a cartilage graft is placed medial to the fascia graft to “batten” the tympanic membrane. • When the perforation is in the anterosuperior quadrant, an endaural approach is used with a medial fascia graft. The same approach is used for a retraction pocket in this quadrant, but a medial cartilage graft is also employed to “batten” the eardrum.

However, removal of the tube in select younger children may be beneficial, for example, in cases of unilateral recurrent otorrhea through a tube (apparently owing to reflux of nasopharyngeal secretions into the middle ear) that is not medically controlled. Tube removal may also be beneficial when the contralateral tympanic membrane is intact (no tube is present) and that ear has been free of middle-ear disease for 1 year or more. Indications • Presence of a retained unilateral tympanostomy tube in children who are 6 years of age or older, when the contralateral tympanic membrane is intact and the middle ear has been free of disease for 1 year or more • Select children younger than 6 years of age, depending on the factors listed above Tympanostomy Tubes and Related Procedures 17 • Presence of retained bilateral tympanostomy tubes in children in whom eustachian tube function is now considered within normal limits owing to either growth and development, nonsurgical management (eg, allergy control or treatment), or surgery (eg, adenoidectomy, repair of cleft palate) • Presence of frequently recurrent otorrhea through a tympanostomy tube that is not prevented by antimicrobial prophylaxis • Important factors in decision-making are frequency, severity, and duration of the episodes; age of the patient; and duration that the tube has been in place.

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