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Partial cricotracheal resection using a 3D-exoscopic visualization in children (with video). Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 1:16-18. [PMID: 34119453 DOI: 10.1016/j.anorl.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022]
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Recurrent laryngeal nerve monitoring in children using cricothyroid membrane needle electrodes. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:427-430. [PMID: 32646748 DOI: 10.1016/j.anorl.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Thyroid pathology is rare in children and the rate of malignancy is higher than in adults. Thyroid surgery in children is therefore particularly at risk of causing recurrent laryngeal nerve (RLN) palsies. The classical technique for monitoring the RLN is not always adapted to children due to the large size of the dedicated endotracheal tubes. MATERIAL AND METHODS Double-needle electrodes (NIM 3.0) were placed medially or paramedially through the cricothyroid membrane and carefully kept submucosal just below the level of the vocal folds. Before identification of the RLN, the vagal nerve was dissected on the side of the concerned lobe and stimulated. The thyroid surgery was then performed with the routine identification of the RLN. The response of the RLN is periodically checked using a stimulating probe. The main outcomes were the identification and stimulation of the RLN, quality of the voice in post-operative time. OBJECTIVE The main objective of our study is to present a simple and efficient method, available for children of all ages, in order to perform monitoring of the recurrent laryngeal nerves during thyroid surgery. RESULTS We present the results of our retrospective series, in a tertiary-care university pediatric hospital. We included nine children, corresponding to 15 nerves. In all cases, the RLN was identified, stimulated and a positive response was obtained via monitoring. CONCLUSIONS This technique of monitoring is safe, feasible at any age, even in neonates, and, as the electrode stays in the operation field, its position is easily controlled.
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Recurrent laryngeal nerve monitoring during thyroidectomy and parathyroidectomy in children. Int J Pediatr Otorhinolaryngol 2020; 131:109846. [PMID: 31935629 DOI: 10.1016/j.ijporl.2019.109846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Injury of the recurrent laryngeal nerve (RLN) is the most frequent complication of thyroid and parathyroid (TP) surgery. Monitoring of the RLN in children is not widely studied as this is not a common disease in the pediatric population. The aim of our study was to evaluate the reliability, feasibility and benefits of RLN monitoring during TP surgery in children. METHODS We analyzed all children who underwent TP surgery in our department between January 2009 and March 2018. Patients were classified into three groups: without monitoring (group 1), monitoring with an endotracheal tube (group 2) and monitoring with a double-needle electrode placed through the cricothyroid ligament (group 3). RESULTS We performed 53 surgeries (77 RLNs at risk) on 47 patients aged between 6 months and 18 years. Fourteen RLNs were in group 1, 47 in group 2 and 16 in group 3. We found one transient lesion of the RLN in group 1, three in group 2 and two in group 3. Seven patients in group 3 could not undergo monitoring with the tube because they need an orotracheal tube smaller than the smallest monitoring tube size available. The sensitivity and specificity values of the monitoring methods were 33% and 97% in group 2 and 67% and 100% in group 3, respectively. The positive and negative predictive values were 50% and 95% in group 2 and 100% and 92% in group 3, respectively. No complications arose during insertion of the electrode through the cricothyroid ligament. CONCLUSION Monitoring of the RLN with a double-needle electrode inserted through the cricothyroid ligament is a reliable method with no associated complication, which is achievable at any age.
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WS10.1 Measuring the angulation of the uncinate process: a new specific tool for cystic fibrosis diagnosis? J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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CNTN6 mutations are risk factors for abnormal auditory sensory perception in autism spectrum disorders. Mol Psychiatry 2017; 22:625-633. [PMID: 27166760 PMCID: PMC5378808 DOI: 10.1038/mp.2016.61] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/12/2016] [Accepted: 02/17/2016] [Indexed: 12/11/2022]
Abstract
Contactin genes CNTN5 and CNTN6 code for neuronal cell adhesion molecules that promote neurite outgrowth in sensory-motor neuronal pathways. Mutations of CNTN5 and CNTN6 have previously been reported in individuals with autism spectrum disorders (ASDs), but very little is known on their prevalence and clinical impact. In this study, we identified CNTN5 and CNTN6 deleterious variants in individuals with ASD. Among the carriers, a girl with ASD and attention-deficit/hyperactivity disorder was carrying five copies of CNTN5. For CNTN6, both deletions (6/1534 ASD vs 1/8936 controls; P=0.00006) and private coding sequence variants (18/501 ASD vs 535/33480 controls; P=0.0005) were enriched in individuals with ASD. Among the rare CNTN6 variants, two deletions were transmitted by fathers diagnosed with ASD, one stop mutation CNTN6W923X was transmitted by a mother to her two sons with ASD and one variant CNTN6P770L was found de novo in a boy with ASD. Clinical investigations of the patients carrying CNTN5 or CNTN6 variants showed that they were hypersensitive to sounds (a condition called hyperacusis) and displayed changes in wave latency within the auditory pathway. These results reinforce the hypothesis of abnormal neuronal connectivity in the pathophysiology of ASD and shed new light on the genes that increase risk for abnormal sensory perception in ASD.
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Fetal airway management on placental support: limitations and ethical considerations in seven cases. J OBSTET GYNAECOL 2014; 33:787-94. [PMID: 24219714 DOI: 10.3109/01443615.2013.823924] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the paediatric and maternal outcome after ex utero intrapartum treatment (EXIT). A retrospective review was carried out of the medical charts (gestational age, circumstances of diagnosis, multidisciplinary prenatal decision, date of surgery, paediatric and maternal outcome) of all the fetuses eligible for/delivered via the EXIT procedure in our paediatrics and obstetrics tertiary care and teaching centre, between October 2004 and May 2011. Seven fetuses with cervical teratoma, epignathus tumour or congenital high airway obstruction syndrome (CHAOS) were included in our study. Two pregnancies were terminated and five fetuses were delivered alive. The airway was secured in all five cases (two endotracheal intubations and three tracheostomies). No maternal complications were observed. On average, babies were delivered at 32 gestational weeks, and spent 31 days in the intensive care unit. All but one baby were ventilated for 18 days. Long-term paediatric outcome was favourable. It is concluded that airway management by the EXIT procedure has become an efficient technique. A multidisciplinary prenatal assessment is essential in order to select appropriate cases.
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Atteinte de l’oreille interne par infection congénitale par le CMV Dépistage et prise en charge. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Implants cochléaires dans les surdités après méningite bactérienne : suivi audiologique de 16 enfants. Arch Pediatr 2013; 20:616-23. [DOI: 10.1016/j.arcped.2013.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 01/26/2013] [Accepted: 03/10/2013] [Indexed: 10/26/2022]
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Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 130:15-21. [PMID: 22835508 DOI: 10.1016/j.anorl.2012.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 04/02/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
Abstract
Laryngomalacia is the most common laryngeal disease of infancy. It is poorly tolerated in 10% of cases, requiring assessment and management, generally surgical. Surgery often consists of supraglottoplasty, for which a large number of technical variants have been described. This surgery, performed in an appropriate setting, relieves the symptoms in the great majority of cases with low morbidity. However, few data are available concerning the objective results: preoperative and postoperative objective assessment of these infants is therefore necessary whenever possible. Noninvasive ventilation (NIV) may be indicated in some infants with comorbid conditions or failing to respond to surgical management.
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Long term results of ossiculoplasties with partial and total titanium Vario Kurz prostheses in children. Int J Pediatr Otorhinolaryngol 2010; 74:1226-9. [PMID: 20800298 DOI: 10.1016/j.ijporl.2010.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/16/2010] [Accepted: 07/21/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess and compare the efficacy of the Kurz titanium prostheses for total or partial ossicular reconstruction in children. PATIENTS AND METHODS Retrospective chart review was performed for 71 consecutive children who underwent 74 ossicular reconstructions with Kurz prostheses between December 1999 and October 2007 (27 PORP and 47 TORP). Audiological parameters using four-frequency averages (0.5, 1, 2 and 4 kHz) were assessed pre- and postoperatively. Clinical and audiometric follow-up times were respectively 33±18.6 and 30±17.7 months (mean±SD). RESULTS Fifty-two percent of all patients achieved an air bone gap (ABG) ≤20 dB, 53.8% in the PORP group and 51.1% in the TORP group. The improvement of the mean ABG was 13.3 dB, 9.4 dB for PORP and 14.6 dB for TORP. Overall mean pure tone averages improved 13.2±1.8 dB (mean±SEM) with 10±2.7 dB for PORP and 15±2.4 dB for TORP. The sensory neural hearing loss rate was 1.4% (one TORP) and the extrusion rate was 2.7% (n=2/74). CONCLUSION The success rate (ABG≤20 dB) and the pure tone averages were not different between PORP and TORP. Kurz titanium ossicular prostheses offer high biocompatibility and high stability with low complication rates in pediatric ossicular reconstruction.
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Neural plasticity of the auditory pathway after cochlear implantation in children. Cochlear Implants Int 2009; 6 Suppl 1:56-9. [PMID: 18792360 DOI: 10.1179/cim.2005.6.supplement-1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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102 Cellulite orbitaire bilatérale associée à une thrombose des veines faciales et de la veine centrale de la rétine : à propos d’un cas. J Fr Ophtalmol 2008. [DOI: 10.1016/s0181-5512(08)70698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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[Subglottic hemangioma in the infant]. ACTA ACUST UNITED AC 2008; 125:72-7. [PMID: 18280458 DOI: 10.1016/j.aorl.2007.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 06/28/2007] [Indexed: 11/28/2022]
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Sédation au pentobarbital par voie rectale pour enregistrement des PEA chez l'enfant. ACTA ACUST UNITED AC 2007; 124:61-5. [PMID: 17434138 DOI: 10.1016/j.aorl.2006.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 10/12/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of our study was to determine if rectal sedation with pentobarbital sodium provides safe and effective sedation for children undergoing auditory brainstem response (ABR) testing. MATERIAL AND METHODS A prospective study was conducted in the ENT pediatric department of Robert Debre's hospital (APHP, Paris). 68 children under 8 years of age were given rectal pentobarbital for ABR testing at a dosage of about 5 mg/kg. RESULTS 61 children of 68 (89.7%) were adequately sedated with rectal pentobarbital. The mean elapsed time from drug administration to full sedation was 36,1 minutes. No adverse event was reported in 84.1% of children. CONCLUSION Pentobarbital provides safe and effective sedation. Rectal administration is easy, painless and with brief duration of action. It's a good alternative to general anesthesia for young children undergoing ABR testing.
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Abstract
Temporal bone imaging in children shows radioanatomical aspects and diseases distinct from the imaging and pathology results found in adults. Imaging modalities such as CT and MR bring out these differences. The aim of this study is to present the CT and MR particularities of the temporal bone during postnatal growth. The mastoid air cells form mostly in the postnatal period and the course of pneumatization is directly correlated with middle ear successive inflammatory episodes. The most frequent etiologies of hearing loss in children are reviewed, emphasizing their specificities in clinical presentation, radiological aspects, and treatment. In children, conductive hearing loss with normal tympanic membrane is mostly caused by minor aplasia rather than otosclerosis. Sensorineural hearing loss, even when unilateral, is predominantly due to malformation or infection and in rare cases to posterior fossa tumor.
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MESH Headings
- Adolescent
- Age Factors
- Audiometry
- Child
- Child, Preschool
- Cochlea/abnormalities
- Cochlear Implants
- Cochlear Nerve/abnormalities
- Deafness/congenital
- Deafness/diagnosis
- Deafness/etiology
- Deafness/therapy
- Ear Ossicles/abnormalities
- Ear, Inner/abnormalities
- Female
- Hearing Loss/diagnosis
- Hearing Loss/diagnostic imaging
- Hearing Loss/etiology
- Hearing Loss/therapy
- Hearing Loss, Conductive/diagnosis
- Hearing Loss, Conductive/etiology
- Hearing Loss, Conductive/therapy
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/therapy
- Humans
- Infant, Newborn
- Klippel-Feil Syndrome/complications
- Klippel-Feil Syndrome/diagnosis
- Klippel-Feil Syndrome/diagnostic imaging
- Magnetic Resonance Imaging
- Male
- Mitochondrial Encephalomyopathies/complications
- Mitochondrial Encephalomyopathies/diagnosis
- Mitochondrial Encephalomyopathies/diagnostic imaging
- Otosclerosis/complications
- Otosclerosis/diagnosis
- Temporal Bone/diagnostic imaging
- Tomography, X-Ray Computed
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Abstract
OBJECTIVE To assess the results of inlay butterfly cartilage tympanoplasty in children. STUDY DESIGN Before-and-after trial; follow-up duration, 26.6 +/- 19.9 months (mean +/- standard deviation). SETTING Tertiary referral center. PATIENTS Fifty-nine pediatric cases of tympanic membrane perforation. INTERVENTION Inlay butterfly cartilage tympanoplasty was performed under general anesthesia according to the technique originally described by Eavey and modified by Lubianca-Neto (i.e., without any associated split-thickness skin graft). MAIN OUTCOME MEASURES Percentage of perforation closures, surgical complications, preoperative and postoperative puretone hearing thresholds; the results of inlay butterfly cartilage tympanoplasty were compared with those obtained in a retrospective series of 29 underlay fascia temporalis myringoplasties. RESULTS The 71% "take rate" of inlay butterfly cartilage tympanoplasty was not significantly different from the 83% take rate obtained with underlay fascia temporalis tympanoplasty (p = 0.23, chi test). The anatomic results were improved when the graft diameter was at least 2 mm larger than the size of the perforation (81% take rate) (p = 0.009, chi test). No iatrogenic cholesteatoma was observed. Pure-tone hearing thresholds were improved at 0.5, 1, and 2 kHz, and stable at 4 kHz. Hearing levels were not different from those obtained with underlay fascia temporalis tympanoplasty. CONCLUSION Inlay butterfly cartilage tympanoplasty is a safe, efficient, time-saving, and easy technique of tympanoplasty in children. Anatomic results may be improved by associating a split-thickness skin graft and/or by trimming a tragal graft much larger than the size of the perforation.
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Neural plasticity of the auditory pathway after cochlear implantation in children. Cochlear Implants Int 2005. [DOI: 10.1002/cii.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The Auria TMBTE in children. Cochlear Implants Int 2005; 6 Suppl 1:14-6. [DOI: 10.1179/cim.2005.6.supplement-1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The Auria™ BTE in children. Cochlear Implants Int 2005. [DOI: 10.1002/cii.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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251 Anomalies oculaires et orbito-palpébrales dans les sténoses des orifices pyriformes avec anomalies endocriniennes. J Fr Ophtalmol 2005. [DOI: 10.1016/s0181-5512(05)74649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cervical presentations of thymic anomalies in children. Int J Pediatr Otorhinolaryngol 2004; 68:909-14. [PMID: 15183582 DOI: 10.1016/j.ijporl.2004.02.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2004] [Accepted: 02/10/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To better define the clinical manifestations, radiologic imaging and the surgical management of cervical thymic lesions in children. STUDY DESIGN Multi-center retrospective case review. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Abstract
La rhinopharyngite désigne une inflammation modérée des voies aériennes supérieures d’origine infectieuse. Les signes habituels en sont l’obstruction nasale, la rhinorrhée, l’éternuement, la douleur pharyngée et la toux. Le terme de rhinopharyngite est spécifiquement français. Les auteurs anglo-saxons parlent de rhume (common cold) ou de upper respiratory tract infection (URI) pour décrire une inflammation aiguë des voies aériennes supérieures, et d’adénoïdite chronique (chronic adenoiditis) pour désigner une infection chronique des végétations adénoïdes responsable de rhinorrhées fébriles itératives ou d’obstruction des voies aériennes supérieures. Les rhinopharyngites aiguës non compliquées sont d’origine virale. Leur évolution spontanée est habituellement rapide et non compliquée. Elles ne nécessitent donc ni prélèvement bactériologique ni antibiothérapie systématique. En première intention, elles relèvent exclusivement d’un traitement antalgique et antipyrétique associé à des lavages des fosses nasales au sérum salé iso- ou hypertonique. Les complications des rhinopharyngites sont infectieuses, essentiellement représentées par les otites et les sinusites, et respiratoires obstructives. Le caractère fréquemment itératif des rhinopharyngites à partir de l’âge de 6 mois reflète un processus physiologique de maturation du système immunitaire. En présence de rhinopharyngites fréquentes et invalidantes, les principaux facteurs de risque devant être recherchés et si possible éradiqués sont le tabagisme passif et la fréquentation d’une collectivité d’enfants. L’adénoïdectomie n’est pas indiquée en l’absence de complications. Le développement d’antiviraux efficaces dans la prévention et dans le traitement des rhinopharyngites fait l’objet d’intenses recherches cliniques et expérimentales.
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Rinofaringitis infantiles. EMC - OTORRINOLARINGOLOGÍA 2004; 33. [PMCID: PMC7148693 DOI: 10.1016/s1632-3475(04)41051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
La rinofaringitis designa una inflamación moderada de las vías respiratorias superiores de origen infeccioso. Sus signos habituales son obstrucción nasal, rinorrea, estornudos, dolor faríngeo y tos. Los autores anglosajones hablan de catarro (common cold) o de infección de vías respiratorias altas para describir una inflamación de las vías respiratorias superiores, y de adenoiditis crónica (chronic adenoiditis) para designar una infección crónica de las vegetaciones adenoides que produce rinorrea febril recidivante u obstrucción de las vías respiratorias altas. Las rinofaringitis agudas no complicadas son de origen vírico. Habitualmente su evolución espontánea es rápida y sin complicaciones. Por tanto, no hay que obtener muestras bacteriológicas ni hacer un tratamiento antibiótico sistemático. Como tratamiento de primera línea, sólo precisan analgésicos y antipiréticos asociados a lavados de las fosas nasales con suero salino isotónico o hipertónico. Las complicaciones de las rinofaringitis son infecciosas –representadas esencialmente por las otitis y las sinusitis– y respiratorias obstructivas. El carácter a menudo repetitivo de las rinofaringitis a partir de los 6 meses de edad refleja un proceso fisiológico de maduración del sistema inmunitario. Cuando existen rinofaringitis frecuentes e invalidantes, los principales factores de riesgo que se deben buscar, y de ser posible erradicar, son el tabaquismo pasivo y los contactos con una población infantil. La adenoidectomía ya no está indicada si no existen complicaciones. Se están realizando investigaciones clínicas y experimentales sobre el desarrollo de fármacos antivíricos eficaces para la prevención y el tratamiento de las rinofaringitis.
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[Middle ear tuberculosis extended to the skull base in a teenager: a case report]. REVUE DE LARYNGOLOGIE - OTOLOGIE - RHINOLOGIE 2004; 125:175-80. [PMID: 15602862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Tuberculosis of the middle ear and mastoid is a rare disease in our countries. Nevertheless, it still occurs and the diagnosis must be considered in the differential diagnosis, especially in particular populations, of acute or chronic ear drainage. Diagnosis is not always easy, as in this case report, where the disease is disseminated, involving the skull and the lung. The discussion highlights the difficulty of diagnosis, and the different actual aspects of treatment.
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Abstract
OBJECTIVE To assess the functional and anatomic results of cartilage grafting in children with a severe retraction pocket of the posterosuperior part of the pars tensa and operated on by pocket excision and cartilage grafting. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Fifty six children (60 ears) with severe posterosuperior retraction pockets. INTERVENTION Excision of the pocket and tympanic reinforcement with a tragal or conchal cartilaginous graft. MAIN OUTCOME MEASURES Postoperative anatomic (otoscopy, computed tomography) and functional (pure tone audiometry thresholds) outcome. The follow-up time was 27 +/- 18 months (mean +/- SD). RESULTS Retraction recurrences requiring additional surgery occurred in 5 cases (8%). The risk of recurrence was lower in children older than 10 years and when the whole surface of the pars tensa was reinforced (chi(2) test, p< 0.05 for both factors). Functionally, hearing was improved even when the ossicular chain was intact. In case of disrupted ossicular chain, direct contact between the graft and eroded incudostapedial joint gave good hearing results. CONCLUSIONS Cartilage reinforcement of the whole surface of the pars tensa is probably the best treatment of a severe posterosuperior retraction pocket. The flexibility and thinness of cartilage from the cymba conchae makes it particularly suitable in this indication.
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Cochlear electrical stimulation: influence of age of implantation on Fos immunocytochemical reactions in inferior colliculi and dorsal cochlear nuclei of the rat. J Comp Neurol 2001; 438:226-38. [PMID: 11536190 DOI: 10.1002/cne.1311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The influence of age at the time of implantation of a stimulating electrode unilaterally in the inner ear on central auditory pathways was investigated in rats deafened shortly after birth. Immunoreactivity for Fos served as a functional marker of neuronal activity. Electrodes were implanted in the left cochlea of rats aged 3 weeks or 4 months. Stimulation lasted 45 minutes, then rats were sacrificed and tissues processed for immunocytochemistry. The younger animals showed significantly more neurons with Fos immunoreactivity bilaterally in the dorsal cochlear nuclei (DCN) and inferior colliculi (IC) than the older rats or control animals with normal hearing receiving the same stimulation. Activity was more prominent in the left DCN and right IC. The results show that electrical stimulation of the inner ear is more effective in younger animals in eliciting gene expression associated with development of a functional network in the auditory pathways. This suggests that deaf children should be provided with cochlear implants as early as possible.
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Abstract
Congenital malformations of the tracheobronchal tree and the related arterial blood supply are a complex group of lesions in which there are abnormalities of the venous drainage and lung parenchyma. These malformations are examples of congenital pulmonary venolobar syndrome (CPVS). Tracheal trifurcation is an extremely rare anomaly associated with CPVS. We report on an unusual case of lower right extralobar sequestration connected to the trachea, plus a type I posterior laryngeal cleft, an aberrant systemic artery, and an anomalous route of the phrenic nerve. This paper discusses the place of this unusual abnormality in the spectrum of congenital bronchopulmonary vascular malformations.
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Abstract
The objective of this study was to review the characteristics of congenital nasal pyriform aperture stenosis (CNPAS) in a series of 20 children seen between 1993 and 1996. The diagnosis was made by physical examination and computed tomography scan. A single central maxillary incisor was detected in 12 cases (60%). Three children had morphological abnormalities of the pituitary gland shown on magnetic resonance imaging. One child had an antidiuretic hormone deficiency, and another child had a growth hormone deficiency. Two children had craniosynostoses, 1 of which was Apert's syndrome. All patients underwent operation by a sublabial approach, and 1 was referred for a columellar necrosis after nasal stenting. After surgery, all patients showed improvement, and the nasal stenting was usually removed 1 week after surgery. Follow-up revealed normal breathing. In conclusion, CNPAS was previously considered to be an unusual cause of nasal obstruction in neonates and infants. The number of cases treated recently in our department suggests that this newly recognized entity is more common than expected.
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Expression of NMDA, AMPA and GABA(A) receptor subunit mRNAs in the rat auditory brainstem. I. Influence of early auditory deprivation. Hear Res 2000; 150:1-11. [PMID: 11077189 DOI: 10.1016/s0378-5955(00)00166-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impact of early post-natal deafening on auditory pathways was investigated in newborn rats deafened by daily amikacin injections from P7 to P16 inducing a complete destruction of the organ of Corti. The expression of mRNAs encoding N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazole (AMPA) and gamma-aminobutyric acid type A (GABA(A)) receptor subunits was then studied by in situ hybridization in the dorsal and ventral cochlear nucleus and in the central nucleus of the inferior colliculus (CNIC). Early post-natal deafening decreased bilaterally the expression of mRNAs encoding NR1, NR2a, NR2b and flop isoforms of AMPA receptors. On the contrary, it increased the expression of mRNAs encoding some GABA(A) subunits (alpha1, beta1, gamma2) and flip isoforms of AMPA receptors. These changes were more pronounced in cochlear nuclei than in CNIC. They suggest that auditory sensation is essential in the normal development of central auditory pathways.
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Expression of NMDA, AMPA and GABA(A) receptor subunit mRNAs in the rat auditory brainstem. II. Influence of intracochlear electrical stimulation. Hear Res 2000; 150:12-26. [PMID: 11077190 DOI: 10.1016/s0378-5955(00)00167-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We investigated the effects of intracochlear electrical stimulation (ICES) on auditory pathways of neonatal rat deafened by daily amikacin injections. Expression of mRNAs encoding ionotropic glutamate receptor subunits such as alpha-amino-3-hydroxy-5-methyl-4-isoxazole (AMPA) and N-methyl-D-aspartate (NMDA), and gamma-aminobutyric acid type A (GABA(A)) receptor subunits was assessed by in situ hybridization in the dorsal (DCN) and the ventral cochlear nucleus (VCN) and in the central nucleus of the inferior colliculus (CNIC). After 15 days of daily unilateral ICES, the expressions of NR1, NR2b and NR2c subunits of NMDA receptor, that of GluRA, B, C, D flop isoforms of AMPA receptor and that of some GABA(A) subunits (alpha1, beta1, gamma1, gamma2) were increased bilaterally in the DCN, VCN and the CNIC. These changes last over a week after stimulation for only NR1 and NR2c. These modifications might be related to long lasting synaptic plasticity of brainstem auditory pathways. As far as analogy to deaf children can be made, early electrical stimulation might be of interest to maintain neuronal networks.
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MESH Headings
- Animals
- Auditory Pathways/metabolism
- Auditory Pathways/pathology
- Auditory Pathways/physiopathology
- Autoradiography
- Brain Stem/metabolism
- Brain Stem/pathology
- Brain Stem/physiopathology
- Cochlear Implants
- Cochlear Nucleus/metabolism
- Cochlear Nucleus/pathology
- Deafness/metabolism
- Deafness/pathology
- Deafness/physiopathology
- Deafness/therapy
- Electric Stimulation
- Evoked Potentials, Auditory, Brain Stem
- In Situ Hybridization
- Inferior Colliculi/metabolism
- Inferior Colliculi/pathology
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptors, AMPA/genetics
- Receptors, AMPA/metabolism
- Receptors, GABA-A/genetics
- Receptors, GABA-A/metabolism
- Receptors, N-Methyl-D-Aspartate/genetics
- Receptors, N-Methyl-D-Aspartate/metabolism
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Abstract
OBJECTIVE To examine the indications and the results of surgical excision of severe subglottic hemangiomas. DESIGN Retrospective study and case series. SETTING Four academic tertiary care centers of pediatric otolaryngology. PATIENTS Twenty children were included from 1991 to 1997. All presented with severe subglottic hemangiomas resistant to classical treatments such as corticosteroids and/or CO2 laser. INTERVENTION Six children were operated on using laryngotracheal reconstruction and prolonged stenting by a reinforced Silastic roll and 14 children were operated on by a single-stage laryngotracheoplasty and postoperative intubation in a pediatric intensive care unit. RESULTS All patients were successfully decannulated or extubated and have been free from recurrent hemangiomas. CONCLUSION The surgery of severe subglottic hemangiomas is a reliable technique in selected patients and should be considered in corticoresistant or corticodependent, circular, or bilateral hemangiomas.
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Abstract
Identification of the K+ transporters located in the lateral wall of the cochlea is essential for a better understanding of the mechanisms by which a positive endocochlear potential and a high K+ concentration are achieved in endolymph. In this study, we have determined the distribution of the K+ channel rat ether à go-go (eag) mRNA in the cochlea. After reverse transcription of adult rat cochlear tissues, cDNA was amplified with primers specific to eag channel. The eag mRNA was localized in cochlear tissues by in situ hybridization using specific oligonucleotide probes tailed with digoxigenin conjugated UTP. Eag mRNA was detected in the organ of Corti but mainly in the fibrocytes of the spiral ligament but not in spiral prominence or in stria vascularis. The expression pattern of rat eag transcript in spiral ligament is complementary to the Na+,K+-ATPase distribution in the cochlear lateral wall. The localization of eag mRNA suggests that eag potassium channel may be produced in the corresponding cells. Considering the importance of the K+ gradient in the cochlea, the result reported here suggests that eag channel may play a role in the control of K+ fluxes in the spiral ligament.
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Transnasal endoscopic repair of congenital defects of the skull base in children. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 1999; 125:580-4. [PMID: 10326818 DOI: 10.1001/archotol.125.5.580] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine imaging findings and methods of endoscopic treatment of congenital skull base defects in children. DESIGN Retrospective study and case series. SETTING Academic tertiary care center. PATIENTS Four patients (aged 12 and 14 months and 8 and 13 years) were included from 1995 to 1997. Three presented with a nasal glioma, which was recurrent in 1 case. The fourth patient presented with bacterial meningitis due to a spontaneous cerebrospinal fluid leak. Computed tomography and magnetic resonance imaging were used to locate the defect of the skull base. INTERVENTION Transnasal endoscopic resection of the glioma or the meningocele, with immediate repair of the skull base defects using free mucosal flaps and/or pediculized mucosal flaps and/or conchal cartilage together with fibrin glue and nasal packing during a 3-week period. RESULTS None of the 4 patients has experienced recurrent cerebrospinal fluid leaks or postoperative meningitis. CONCLUSIONS The transnasal endoscopic repair of congenital meningoceles is a reliable technique in select pediatric patients. Computed tomography and magnetic resonance imaging provide information that can be used to help the surgical procedure.
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Facial neuromas in children: delayed or immediate surgery? THE AMERICAN JOURNAL OF OTOLOGY 1999; 20:253-6. [PMID: 10100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the clinical characteristics and outcome of facial nerve neuromas in children. To date, no specific study has focused on children, and the management of these tumors is not codified. DESIGN AND SETTINGS A review of case series treated in a tertiary care center of pediatric otolaryngology. SUBJECTS The treatment and outcomes for 7 children (4 infants and 3 adolescents) were analyzed. RESULTS Six patients underwent complete removal of tumor and immediate restoration of the nerve continuity. The grade of facial palsy improved in 4 of the 6 children, but did not get better than grade 3 (House classification). The remaining patient was managed conservatively and remained stable clinically and radiologically after 9 years follow-up. CONCLUSIONS These findings support the reasonable strategy of combining conservative assessment of these slow-growing tumors with regular clinical and radiologic evaluations and radical surgery using various procedures. The choice depends on the age of the child, the extent and growth rate of the tumor, the grade of facial palsy, and the hearing function.
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The CHARGE association: the role of tracheotomy. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 1999; 125:33-8. [PMID: 9932584 DOI: 10.1001/archotol.125.1.33] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To evaluate the need for a tracheotomy and its timing during the evolution of an association of malformations, including coloboma, heart defects, choanal atresia, developmental and growth retardation, genitourinary malformation, and ear anomalies (CHARGE association). DESIGN Retrospective study from January 1988 through December 1997. SETTING Four academic tertiary care centers. PATIENTS AND METHODS Forty-five patients with CHARGE association having at least 3 cardinal malformations (growth retardation excluded) and review of the malformations and respiratory manifestations encountered. All the patients underwent endoscopic exploration on several occasions. We reviewed the nature and the timing of therapeutic interventions performed on the airway. RESULTS Two patients died (one patient of septicemia, the other of unknown causes). Abnormalities of blood gas levels and/or sleep were found in 30 patients (67%), were responsible for cardiorespiratory arrest in 9 (20%), and required admission to the intensive care unit in 21 (47%). Pharyngolaryngeal anomalies leading to dyspnea (discoordinate pharyngolaryngomalacia, glossoptosis, retrognathia, laryngeal paralysis, cleft, stenosis, and difficult intubation) were found in 26 patients (58%). Tracheobronchial anomalies (esophagotracheal fistula, esophageal atresia, and tracheomalacia) were present in 18 patients (40%). Resection of the aryepiglottic folds was attempted 3 times, but without success. Tracheotomy was necessary in 13 patients (29%) at a median age of 2.4 months (mean duration, 25 months). Among these infants, the posterior nasal choanae were patent in 10 patients at the time of tracheotomy. Gastroesophageal reflux was encountered in 36 patients (80%). Prolonged enteral feeding was necessary in 21 patients (47%), with gastrostomy in 16 (of whom 9 needed a tracheotomy). These feeding difficulties and airway problems were highly correlated. CONCLUSIONS We encountered multiple, complicated airway abnormalities. Resection of aryepiglottic folds was inadequate. Often, a tracheotomy could not be avoided in these patients, regardless of choanal patency. Tracheotomy needs to be performed early to avoid hypoxic events. In some selected patients, ventilation using bilevel positive airway pressure may be an alternative.
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