Nearly all children born with cleft palate develop middle ear fluid requiring ear tube placement. However, the best time to place ear tubes (before or during cleft palate repair), the type of ear tubes to use (short vs. long-lasting), and whether the type of palate repair makes a difference is unknown. Currently, the otologic care of patients enrolled in the CDRC Craniofacial Disorders Clinic is being reviewed.

An article by Dr. Henry Milczuk.

Some children require brief procedures that are painful. In the past these have been done using general anesthesia in the operating room (whereas in adults they can be done using local anesthesia). Because of the easy availability of a Pediatric Sedation Service at Doernbecher Children's Hospital some of these procedures can be done in the clinic. Dr. Milczuk and Dr. Kirk Lalwani from the Division of Pediatric Anesthesiology reviewed the safety and effectiveness of doing these procedures in the Pediatric Otolaryngology Clinic at DCH. The results were presented by Dr. Samuel Shiley at the American Society of Pediatric Otolaryngology in April 2001.

For lymphatic malformations (cystic hygroma) of the head and neck in children. This therapy has been available in Japan for several years. Retrospective reports have indicated good success using OK-432 sclerotherapy for certain lymphatic malformations. This trial is designed to prospectively evaluate efficacy and determine which malformations are best treated using this modality. Inclusion criteria are children between 6 months and 18 years of age and macrocystic (>2 ml) disease. Previous surgery does not exclude patients from entry. Please call Dr. Milczuk at (503)494-5350 for further information.

Laryngomalacia is the most common cause of stridor in an infant. Much is known about the effects that laryngomalacia has on children, but little is known about how caring for such a child affects parents. A survey instrument was recently developed by Dr. Milczuk in collaboration with Dr. Stephen Johnson at Oregon Survey Research Lab. The results were presented at the American Broncho-Esophagology Association meeting in April 1999. The survey instrument is now ready for a prospective trial.

Recurrent laryngeal papillomatosis is a disease in which warts grow in a child's larynx. The warts often recur, and the course of the disease is unpredictable. Some children are severely affected requiring multiple surgeries every year to clear their airway of the warts. To date there is no reliable medical therapy for these warts. However, a new therapy has recently been advocated, Cidofovir-TM, which is injected directly into the larynx during surgery to remove the warts. Dr. Milczuk has reviewed the experience with four children with severe laryngeal papillomas, and he continues to monitor these children. The initial results were presented at the European Society of Pediatric Otorhinolaryngology meeting in Oxford, England in September 2002.

Important nerves that affect how a child can speak and swallow travel close to the heart. Rarely these nerves are stretched during surgery to repair a diseased heart. The type of problems and the potential for recovery of nerve function is unknown in children. As part of a collaborative effort with several other major children's hospitals in the Western United States, Dr. Milczuk and his colleagues in the Division of Pediatric Otolaryngology are evaluating these children. Improved treatment strategies are the goal of this research.