Joseph E Kerschner

Medical College of Wisconsin | MCW · Department of Otolaryngology & Communication Sciences

Significance Endotracheal intubation is a common approach for airway management in critically ill patients. However, the position of the endotracheal tube (ETT) may be altered during the procedure due to head movements. Accidental displacement or dislodge of the ETT may reduce the airflow, leading to moderate to severe complications, and in some ca...

Objectives 17β‐estradiol (E2) is a steroidal hormone with immunomodulatory functions that play a role in infectious and inflammatory diseases. E2 was recently identified as the leading upstream regulator of differentially expressed genes in a comparative RNA sequencing study of pediatric patients with otitis media (OM) versus OM‐free counterparts a...

Accidental endotracheal tube (ETT) displacement can cause moderate to severe complications or fatality. Timely ETT position monitoring and correction is crucial. We present a near-infrared (NIR) and visible dual-camera device for continuous monitoring of ETT.

Objective Otitis media (OM) is among the most frequently diagnosed pediatric diseases in the US. Despite the significant public health burden of OM and the contribution research in culture models has made to understanding its pathobiology, a singular immortalized human middle ear epithelial (MEE) cell line exists (HMEEC‐1, adult‐derived). We previo...

Objectives: The goal of this study was to assess the feasibility of the implementation of a mentoring network program based on expressed interest and the diverse composition of the otitis media research community in order to address attrition of the scientific workforce. Methods: An online survey was sent to basic, translational, and clinical re...

Otitis media (OM), a common ear infection, is characterized by the presence of an accumulated middle ear effusion (MEE) in a normally air-filled middle ear cavity. While assessing the MEE plays a critical role in the overall management of OM, identifying and examining the MEE is challenging with the current diagnostic tools since the MEE is located...

Objective: Otitis media (OM) is a common inflammatory disease spectrum in children and a leading cause of pediatric physician visits, antibiotic prescriptions and surgery. Tobacco exposure is associated with increased risk of OM recurrence, chronicity and surgeries. Tobacco products have changed dramatically in recent years with the advent of elec...

Equity, in broad terms, is a critical issue and has been identified as an area that needs particular attention in academic medicine. Gender equity, as a subset of overall equity, has equally been shown to be lacking in academic medicine, and most medical schools and academic health systems are involved in substantive journeys to improve all dimensi...

Otitis media (OM) is an extremely common disease that affects children worldwide. Optical coherence tomography (OCT) has emerged as a noninvasive diagnostic tool for OM, which can detect the presence and quantify the properties of middle ear fluid and biofilms. Here, the use of OCT data from the chinchilla, the gold-standard OM model for the human...

Objective: To understand the effect of the COVID-19 pandemic on the volume, quality, and impact of otolaryngology publications. Methods: Fifteen of the top peer-reviewed otolaryngology journals were queried on PubMed for COVID and non-COVID related articles from April 1, 2020 - March 31, 2021 (pandemic period) and pre-COVID articles from the yea...

Objective Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal reflux (EER), specifically pepsin, triggers inflamm...

Objectives Otitis media (OM) is the most common pediatric diagnosis in the United States. However, our understanding of the molecular pathogenesis of OM remains relatively poor. Investigation of molecular pathways involved in OM may improve the understanding of this disease process and elucidate novel therapeutic targets. In this study, RNA sequenc...

Studying the impact of antibiotic treatment on otitis media (OM), the leading cause of primary care office visits during childhood, is critical to develop appropriate treatment strategies. Tracking dynamic middle ear conditions during antibiotic treatment is not readily applicable in patients, due to the limited diagnostic techniques available to d...

Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW)...

Proper ventilation of a patient with an endotracheal tube (ETT) requires proper placement of the ETT. We present a sensitive, noninvasive, operator-free, and cost-effective optical sensor, called Opt-ETT, for the real-time assessment of ETT placement and alerting of the clinical care team should the ETT become displaced. The Opt-ETT uses a side-fir...

Objectives/Hypothesis Cell culture models are valuable tools for investigation of the molecular pathogenesis of diseases including otitis media (OM). Previous study indicates that age‐, sex‐, and race‐associated differences in molecular signaling may impact disease pathophysiology. Currently, a singular immortalized middle ear epithelial (MEE) cell...

Objectives To evaluate the efficiency of in‐house genetic testing for mutations causing the most common types of inherited, nonsyndromic, sensorineural hearing loss (SNHL). Methods Retrospective cohort study of 200 patients at a single, pediatric medical center with suspected or confirmed hearing loss who underwent either send out vs in‐house gene...

Background: Gel-forming mucins (GFMs) play important roles in otitis media (OM) pathogenesis. Increased mucin expression is activated by pathogens and proinflammatory cytokines. Bacterial biofilms influence inflammation and resolution of OM and may contribute to prolonged mucin production. The influence of specific pathogens on mucin expression an...

Objective To characterize otitis media–associated structures affixed to the mucosal surface of the tympanic membrane (TM) in vivo and in surgically recovered in vitro samples. Study Design Prospective case series without comparison. Setting Outpatient surgical care center. Subjects and Methods Forty pediatric subjects scheduled for tympanostomy...

Inflammation of the middle ear, knownclinicallyas chronic otitis media, presents in different forms, such as chronic otitis media with effusion (COME; glue ear) and chronic suppurative otitis media (CSOM). These are highly prevalent diseases, especially in childhood, and lead to significant morbidity worldwide. However, much remains unclear about t...

Objectives: Calgranulins (calcium-binding proteins S100A8, S100A9 and S100A12) are predominant cytoplasmic proteins of neutrophils and produced by various cells, playing multiple functions in innate immunity and the inflammatory process. Although up-regulated expression of S100A8 and S100A9 genes were observed in an animal model of otitis media (O...

Importance Persistent, viscous middle ear effusion in pediatric otitis media (OM) contributes to increased likelihood of anesthesia and surgery, conductive hearing loss, and subsequent developmental delays. Biomarkers of effusion viscosity and hearing loss have not yet been identified despite the potential that such markers hold for targeted therap...

Objectives/hypothesis: Laryngomalacia is a common cause of newborn stridor. Laryngopharyngeal reflux (LPR) has been associated with laryngomalacia. Although pepsin, a component of LPR, has been associated with inflammatory diseases of the aerodigestive tract, its presence in the airways of laryngomalacia patients is unknown. Study design: Prospe...

In 2016, the Association of American Medical Colleges projected a physician shortage in the United States of approximately 90,000; in the same year, the Wisconsin Hospital Association projected a shortage of 2,000 physicians in Wisconsin. The Medical College of Wisconsin has begun to address these shortages in three ways: 1) creation of immersive r...

Objective: Toll-like receptor signaling activated by bacterial otitis media pathogens in the middle ear has been shown to play a key role in OM susceptibility, pathogenesis and recovery. Recent studies implicate microRNA 146 (miR-146) in regulation of inflammation via negative feedback of toll-like receptor signaling (TLR) in a wide variety of tis...

Importance Sensorineural hearing loss (SNHL) is commonly caused by conditions that affect cochlear structures or the auditory nerve, and the genes identified as causing SNHL to date only explain a fraction of the overall genetic risk for this debilitating disorder. It is likely that other genes and mutations also cause SNHL. Objective To identify a...

OBJECTIVES: To investigate the role of the inflammatory cytokine interleukin-1β (IL-1β) in the regulation of mucin secretion by middle ear epithelia. STUDY DESIGN AND SETTING: Primary chinchilla middle ear epithelial cultures were established and exposed to IL-1β in a dose- and time-dependent manner. Mucin secretion was characterized by exclusion c...

The long-tailed chinchilla (Chinchilla lanigera) is an established animal model for diseases of the inner and middle ear, among others. In particular, chinchilla is commonly used to study diseases involving viral and bacterial pathogens and polymicrobial infections of the upper respiratory tract and the ear, such as otitis media. The value of the c...

Objectives/hypothesis: To examine the effect of dexamethasone on basal and proinflammatory cytokine-induced gel-forming mucin expression in human middle ear epithelial cell line (HMEEC-1). Methods: HMEEC-1 was exposed to proinflammatory cytokines, tumor necrosis factor-alpha (TNF-), and interleukin-1 beta (IL-1β) to identify optimal mucin induct...

Purpose: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children. Results: Since 20...

Health care conversion foundations, such as the Advancing a Healthier Wisconsin Endowment (the endowment) at the Medical College of Wisconsin (MCW), result from the conversion of nonprofit health organizations to for-profit corporations. Over the past several decades, nearly 200 of these foundations have been created, and they have had a substantia...

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula...

Objective To implement and review a database for children with a diagnosis of otitis media (OM) to facilitate comparative outcomes and long-term prospective follow up of surgical outcomes. Specific aim is to review presenting symptoms, risk factors, tympanostomy tube outcomes and complications, and need for further procedures. Methods A web-based...

To analyze factors associated with progression of an original scientific presentation at the American Society of Pediatric Otolaryngology (ASPO) Annual Meeting to publication in a peer-reviewed journal. A dataset of presenters was created to enable prospective follow-up to assess early impressions regarding publication success with longer-term publ...

Background: Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to...

Objective: To assess the differential response of the secretory gel forming mucins (GFM) to the most common bacterial pathogens causing otitis media, Streptococcus pneumoniae (SP), nontypeable Haemophilus influenza (NTHi), and Moraxella catarrhalis (Mcat), in a culture model of human middle ear epithelium (HMEEC). Methods: In vitro cultured HMEE...

Importance: The numbers of pediatric otolaryngology fellowship programs and applicants have increased over the past 5 years. However, the qualities desired in programs and applicants have not been explored. Objective: To determine the factors that fellowship program directors and applicants believe to be most important in choosing a fellow and t...

This case report demonstrates neurologic sequela following treatment with doxycycline sclerotherapy. A six-week-old child presented with respiratory distress from a macrocystic lymphatic malformation, extending from the skull base to the anterior mediastinum. Following doxycycline sclerotherapy, the airway symptoms resolved; however, the child deve...

Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck m...

Background and objectives: The pathogenesis of otitis media (OM) involves a number of factors related to the anatomy, pathology, and cell biology of the middle ear, the mastoid, the Eustachian tube, and the nasopharynx. Although some issues of pathogenesis are fairly well established, others are only marginally indicated by current knowledge, and...

Streptococcus pneumoniae (SP) and nontypeable Haemophilus influenzae (NTHi) are common commensals of the human airway and major bacterial pathogens of otitis media (OM) and other upper airway infections. The interaction between them may play an important role in the pathogenesis of polymicrobial infections. Although previous studies suggested NTHi...

Objective Office-based lower airway endoscopy (OLAE) is not a widespread practice in children due to concerns about its safety and efficacy. In 2003, we reported on OLAE in 105 children presenting with airway symptoms and found it both safe and effective as a diagnostic tool. The current study is a follow-up to the 2003 study that reports on an add...

Objective: A novel mouse model with a specific genetic mutation in a G protein coupled receptor (GPCR) encoded by the Oxgr1 gene results in a predisposition to spontaneous otitis media with effusion. As a primary component of interest in OME, mucin expression was examined in this model to assess expression as compared to wild type animals and suit...

Otitis media (OM) with mucoid effusion, characterized by mucous cell metaplasia/hyperplasia in the middle ear cleft and thick fluid accumulation in the middle ear cavity, is a subtype of OM which frequently leads to chronic OM in young children. Multiple factors are involved in the developmental process of OM with mucoid effusion, especially disord...

To report our experience with surgical management of auricular infantile hemangiomas and reconstruction of the affected ear. Retrospective case series. Dedicated Birthmarks and Vascular Anomalies Center in a tertiary pediatric hospital. Ten patients with surgically treated, histopathologically confirmed auricular infantile hemangiomas. Outcomes of...

To determine whether laryngeal electromyography (LEMG) can predict recurrent laryngeal nerve function return in children and whether LEMG can aid in the management of vocal fold immobility (VFI). Prospective case series. Tertiary pediatric aerodigestive centers. Twenty-five children aged 14 days to 7 years at the time of first LEMG (mean age, 21.4...

We describe the clinical presentation of a 7 1/2-year-old boy with a history of mild intermittent asthma who presented with left lung collapse and was found to have plastic bronchitis. We reviewed the patient chart and imaging results and performed a literature review of plastic bronchitis and its management. Bronchoscopy in our patient demonstrate...

Objective: 1) Present outcomes of surgically treated infantile hemangioma, and describe changes in surgical management with the advent of changes in medical therapy. 2) Highlight the role of imaging in surgical planning. 3) Identify risk factors for surgical complications. Method: Retrospective chart review of patients in a multidisciplinary clinic...

To build a pediatric clinical outcomes registry (COR) using a contemporary information system designed to support research and outcome studies and to improve patient care and quality of life. In response to physician needs, this process was implemented: 1) database needs assessment survey, 2) evaluate existing systems and vendors, 3) pilot test a C...

(1) Discuss indications for surgical treatment of infantile hemangioma (IH); (2) describe outcomes, management of complications and long term surveillance of surgically treated IH. Retrospective. The charts of children seen in a dedicated vascular anomalies center at a tertiary pediatric hospital were reviewed. Out of 1012 patients diagnosed with I...

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used as an adjunct to assess swallowing function in children with complex feeding disorders. We report the feeding outcomes of patients who underwent FEES to determine whether associations exist between clinical diagnoses or FEES findings and feeding outcomes. Retrospective review of children...

Biofilms of pathogenic bacteria are present on the middle ear mucosa of children with chronic otitis media (COM) and may contribute to the persistence of pathogens and the recalcitrance of COM to antibiotic treatment. Controlled studies indicate that adenoidectomy is effective in the treatment of COM, suggesting that the adenoids may act as a reser...

Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. The presence of mucin (MUC) genes has been correlated with patient prognosis using immunohistochemical techniques. This study was undertaken to 1) investigate the expression of newly discovered MUC genes in MEC specimens, 2) assess the correlation of this expression t...

PHACE syndrome describes a spectrum of anomalies associated with large facial infantile hemangiomas and characterized by posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. With improved recognition and imaging practices of infants with PHACE syndrome, additional assoc...

To investigate the expression of recently identified human mucin genes in an in vivo model of the chinchilla middle ear epithelium (CMEE). CMEE was harvested, RNA was extracted and primers were designed for RT-PCR to assess for expression of mucin genes Muc6, Muc17 and Muc18. Further sequencing of these genes was also accomplished. Mucin genes Muc6...

To compare levels of middle ear (ME) MUC5AC expression in patients with otitis media (OM) with patients without OM. Mucin gene 5AC has been identified as a major secretory mucin in the ME and is fundamentally important in the development of ME mucoid effusions, hearing loss and also provides ME mucosal protection and bacterial clearance. Case contr...

Objectives: To investigate the expression of recently identified human mucin genes in an in vitro model of cultured mouse middle ear epithelial cells (MMEEC). Methods: MMEEC were established, RNA was extracted and primers were designed for RT-PCR to assess for expression of mucin genes Muc1, Muc2, Muc3, Muc4, Muc5AC, Muc5B, Muc6, Muc7, Muc8, Muc...

We sought to construct and partially characterize complementary DNA (cDNA) libraries prepared from the middle ear mucosa (MEM) of chinchillas to better understand pathogenic aspects of infection and inflammation, particularly with respect to leukotriene biogenesis and response. Chinchilla MEM was harvested from controls and after middle ear inocula...

To quantify the prevalence of dysplasia and to evaluate the impact of use of cidofovir in recurrent respiratory papilloma biopsy specimens obtained from a pediatric population. Retrospective review of patient medical records and histopathologic test results from January 1, 1998, through December 31, 2008. Children's Hospital of Wisconsin. Patients...

Biofilms of pathogenic bacteria are present on the middle ear mucosa of children with chronic otitis media (COM) and may contribute to the persistence of pathogens and the recalcitrance of COM to antibiotic treatment. Controlled studies indicate that adenoidectomy is effective in the treatment of COM, suggesting that the adenoids may act as a reser...

Mucin genes MUC2, MUC5AC, and MUC5B have been identified as major gel-forming mucins in the middle ear (ME). This study compared polymorphisms in MUC2, MUC5AC, and MUC5B genes in otitis media (OM) patients and controls. Cross-sectional case-control study. Patients age 6 months to 14 years undergoing routine tympanostomy tube insertion for recurrent...

Subglottic hemangioma (SGH) is a rare tumor of childhood often associated with airway compromise. Recently, the possibility that many SGH may be congenital hemangiomas rather than classical infantile hemangiomas (IH) has been raised, with important diagnostic and therapeutic implications. We present the largest, multi-institutional study, to date,...

Mucin gene 19 (MUC19) has been identified as a major gel-forming mucin in the human middle ear (ME). The objectives of this investigation were to characterize the expression and assess the regulation of MUC19 in the ME cell culture models utilized in the study of otitis media (OM). Findings demonstrate that MUC19 is expressed in both human immortal...

Multifocal lymphangioendotheliomatosis with thrombocytopenia is characterized by vascular skin and gastrointestinal (GI) tract lesions, thrombocytopenia, and GI bleeding. The first patient had scattered red macules and subcutaneous nodules on the skin with involvement of the lungs, liver, omentum, and right kidney. At 10 months of age he continues...

To determine the effect of a dedicated otomicroscope in the emergency department (ED) management of complex ear foreign bodies (FB). Prospective analysis of 85 patients with complex pediatric ear FB's. 65 (76%) of 85 FB's were successfully removed in the ED. 54 (63%) had previous attempted removal, 27 (31%) were less than age 4, 37 (44%) had ear FB...

Most chronic bacterial infections are associated with biofilm formation wherein the bacteria attach to mucosal surfaces, wound tissue, or medical device surfaces in the human body via the formation of an extracellular matrix. Biofilms assume complex three-dimensional structures dependent on the species, the strain, and the prevailing environmental...

Large, segmental, cervicofacial hemangiomas are often associated with anomalies of intracranial, cardiovascular, and ophthalmic systems as well as ventral development.

To investigate genetic differences in middle ear mucosa (MEM) with nontypeable Haemophilus influenzae (NTHi) infection. Genetic upregulation and downregulation occurs in MEM during otitis media (OM) pathogenesis. A comprehensive assessment of these genetic differences using the techniques of complementary DNA (cDNA) library creation has not been pe...

Otitis media continues to be an important pediatric illness and requires significant expenditures in management and treatment. Despite its prevalence and importance, clinicians often have significant knowledge deficits regarding the most up-to-date research or clinical thinking regarding this disease. The present review aims to discuss recent and i...

We sought to document the mucin gene profile in normal human laryngeal epithelium and compare it with that in patients with reflux-attributed laryngeal injury or disease. We also investigated the effect of low pH with or without pepsin on mucin messenger RNA levels in vitro. Laryngeal biopsy specimens were obtained from 3 patients with clinically d...

Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. Cidofovir, an antiviral drug, has demonstrated efficacy in slowing and/or reducing RRP recurrence. This investigation examined the differential gene expression of RPP before and after cidofovir use in vivo. Papillomas were harvested from two patients pre- and post-...

Paradoxical vocal fold dysfunction (PVFD) is a complex disorder of the larynx that primarily affects breathing. To date, no study has focused on the patient's own perception of how their quality of life related to voice is affected by the diagnosis of PFVD. The objective of this study is to characterize the self-reported voice-related quality of li...

Although several instruments have been validated to assess voice quality, the incidence and degree of impairment in normal, healthy children has not been widely reported. It is hypothesized that healthy children outside a medical setting do not demonstrate impairment as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument; in...

To compare levels of expression of mucin gene 2 (MUC2), a major secretory mucin, in the middle ear of patients with otitis media (OM) and control patients. Case-control study. Children's Hospital of Wisconsin, Milwaukee. Nineteen patients aged 6 months to 15 years undergoing routine ventilation tube insertion for recurrent OM or chronic OM with eff...

Although several instruments are available to measure voice quality in children, their application to a normal population and major demographic subgroups has not been described. It is hypothesized that there is no measurable difference in self-reported voice related quality of life between gender and age groups within a population of normal childre...

Middle ear mucins are associated with otitis media (OM), contribute to hearing loss and are regulated by cytokines. This work investigates the regulation of mucin secretion from human middle ear epithelial cells (HMEEC) by inflammatory cytokines interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and cytokine inhibitors interleuki...

To determine the rate of recovery of pediatric vocal fold paralysis (VFP) after cardiac surgery. Retrospective case series from January 2000 to 2005 at 4 tertiary care pediatric hospitals. A total of 109 children with VFP were identified. Of 80 patients with follow-up >3 months, 28 (35%) recovered vocal fold function with a median time to diagnosis...

To investigate the expression of recently identified human mucin genes in human middle ear epithelial (MEE) specimens from in vivo middle ear (ME) tissue and to compare this mucin gene expression with mucin gene expression in an immortalized cell culture in vitro source of human MEE. Human MEE was harvested as in vivo specimens, and human MEE cell...

To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI). Retrospective medical chart review. Two tertiary academic centers. All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006. Injection laryngoplasty, ansa cervicalis-recurrent laryngeal ne...