Antibiotic prophylaxis of otitis media.
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Anti-Bacterial Agents↗
Biomedical subjects
A Morgon
Publications and source records attributed to A Morgon.
Long-term airway considerations after treatment of severe pediatric laryngotracheal stenosis in five children.
After initial treatment of severe laryngotracheal stenosis (LTS), we evaluated subsequent airway function. Five children between 2 and 11 years were treated previously for severe LTS by T-tube stenting. One case underwent subsequent laryngotracheal reconstruction. All patients demonstrated dyspnea, the severity of which increased with age and duration of time after completion of stenosis treatment. In the most severe cases, magnetic resonance imaging and endoscopy revealed secondary subglottic stenosis. Ventilatory function tests disclosed obstruction of both extrathoracic and pulmonary origin. These findings raise questions regarding the treatment of the initial stenosing tissue and of the secondary stenoses.
Airway Obstruction↗
Spontaneous and evoked otoacoustic emissions in pre-term and full-term neonates: is there a clinical application?
In neonates and infants, hearing impairment leads to impaired language and cognitive development. For that reason, early detection of this sensory deficit is of outstanding importance, particularly in pre-term neonates, who constitute a high risk population in regard to very early acquired hearing loss. Evoked (EOAE) and spontaneous otoacoustic emission (SOAE) recording in 93 pre-term and full-term neonates revealed that this technique is potentially useful for auditory screening in neonatology units. EOAEs and SOAEs can be recorded successfully from 30 weeks of conceptional age. SOAEs were found to be prevalent in females and presented higher peak numbers in right than in left ears. Furthermore, SOAE incidence in pre-term and full-term neonates was found to be high in EOAE positive ears, associated with strong and robust EOAEs.
Acoustic Stimulation↗
Auditory cortex activity changes in long-term sensorineural deprivation during crude cochlear electrical stimulation: evaluation by positron emission tomography.
We studied three right-handed human volunteers who have been prelingually deaf for 16 to 26 years. We measured cerebral regional activity (rA) using 15O labelled water and positron emission tomography (PET) during rest and during electrical cochlear stimulation of the right ear. The stimulus consisted of crude constant current squared pulses, it is currently employed in cochlear implant screening. Two subjects described a subjective auditory sensation under cochlear stimulation, the third did not. An increment of the rA (which is linked to the regional cerebral blood flow) in the auditory cortex was observed in all subjects, activation was ipsilateral to stimulation in one subject and contralateral in two subjects. These findings suggest 1) that auditory pathways to the cortex can remain functional a long time after prelinguistic auditory deprivation, 2) that the auditory cortex can be activated by a crude electrical stimulation of the cochlea in the absence of perception of the auditory stimulus, 3) that PET does not seem to offer any advantage for screening patients who have been prelingually deaf for a long time.
Adult↗
Management of subglottic haemangioma.
Between 1980 and 1993, 10 infants underwent endoscopic treatment and/or open surgical excision of a subglottic haemangioma. Of the eight children treated with the laser, four showed simple evolution following a single laser treatment, one required repeated laser treatments and two needed tracheotomy despite repeated laser treatments. The last three children developed moderate subglottic stenosis. Laser treatment was followed by open surgical excision in one child. Two children underwent primary surgical excision, allowing extubation between 8 and 10 days post-operatively. After a period in which we systematically treated subglottic haemangiomas with the laser, these findings have led us to employ open surgery in children with large subglottic haemangiomas or when airway obstruction requires a tracheostomy.
Airway Obstruction↗
The normality of the voice of cochlear implant children.
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Child↗
Mucocele of the sphenoid sinus in a child.
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Child↗
Use of costal cartilage graft as external stent for repair of major suprastomal collapse complicating pediatric tracheotomy.
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Airway Obstruction↗
Contralateral suppression of evoked otoacoustic emissions and detection of a multi-tone complex in noise.
Although some findings suggest that auditory efferent fibers are involved in perception in noise, their function remains controversial. The contralateral suppression of evoked otoacoustic emissions (EOAEs) has recently provided a means of exploring the medial olivocochlear system (MOCS) in humans. In an experiment based on this paradigm, the present study examined the relationships between variations of both EOAEs and detection-in-noise thresholds, induced in the same subjects by a contralateral 50-dB-SPL broad-band noise masker. EOAEs were recorded in response to a burst of a multitone complex composed of 1, 1.5 and 2-kHz components. The detection thresholds of this 3-component complex were measured at 2 ipsilateral noise levels: 50 and 70 dB SPL. The main finding was a significant correlation between EOAE suppression and threshold variations under contralateral masking. A relationship was also found between the contralateral suppression of EOAEs and threshold variation induced by the increase in ipsilateral noise level. These findings support the notion that the MOCS is involved in the detection of multicomponent stimuli in noise.
Adult↗
Physiopathological investigations in a family with a history of unilateral hereditary deafness.
We examined several members of the same family with unilateral sensorineural hearing loss. The defect showed dominant inheritance. Clinical examination and auditory tests, including high-definition audiogram and otoacoustic emission recording, were done to characterize the physiopathological process of hearing loss, and to investigate possible asymptomatic auditory features in the normal ear of affected subjects and nonaffected siblings. Hypotheses as to the underlying mechanisms are discussed, eg, variable expression of bilateral isolated hereditary deafness, incomplete Klein-Waardenburg syndrome with stria vascularis anomalies and highly variable gene expression, or unilateral cochlear aplasia. The phenomenon may also be related to the delayed progressive unilateral loss in patients with bilateral hereditary deafness, involving perhaps unilateral vascular disorders or a genetically induced degeneration of cochlear cells or auditory neurons.
Adult↗
Effectiveness of musculus palatopharyngeus resection in uvulopalatopharyngoplasty for snoring.
Sixty-eight patients with annoying snoring were included in a prospective randomized control study. Thirty-two (group 1) were subjected to classical uvulopalatopharyngoplasty (UPPP) technique; 36 (group 2) underwent a modified "extended UPPP technique" comprising the bilateral resection of the palatopharyngeal muscles. All patients were free of obstructive sleep apnea syndrome (OSAS) as documented by an overnight polysomnography. The two groups were homogeneous for age, preoperative and postoperative body mass index, and duration of follow-up. We recorded the subjective preoperative and postoperative symptoms as evaluated by the patient and the bed partner, and the immediate postoperative complaints. The only statistically significant difference between the two groups was pain. Thus, in this series, the "extended UPPP technique" showed no better results in the surgical approach to snoring, and its morbidity rate is higher.
Adult↗
Analytic importance of the coding features for the discrimination of vowels in the cochlear implant signal.
The present study considers the analytic importance of the excitation pulse features delivered by a Nucleus cochlear implant using the F0F1F2 strategy. Four cochlear implant patients and 10 speakers uttering two 48-item lists constructed from four basic French vowels participated in this study. Patterns were presented to the patients and played at the input of an acquisition system in order to record the pulse features. Confusion matrices obtained with the patients and with automatic recognition procedures were then compared in order to find out the best-matching models simulating the patients' performances, out of 255 possibilities. The automatic recognition was carried out according to fuzzy logic based on the elementary features of the pulses coding the vowels. Results show that the essential features strongly depended on the subject.
Adult↗
Chronic tympanic membrane perforation: an animal model.
Acute perforations in the tympanic membranes (TM) of animals are not good models for assessment of materials used as graft membranes or of substances with the potential to activate tympanic membrane healing mechanisms for closing perforations. Most acute TM perforations heal spontaneously, in both animals and humans. Acute TM perforation models are not analogous to the pathologic human problem of long-standing TM perforation. Bilateral subtotal symmetric perforations, with each animal serving as its own control provide a suitable model. Fourteen dogs were operated. Subtotal perforation of TM in right ears were soaked with 2% glutaraldehyde to develop an animal model for persistent tympanic membrane perforation. Subtotal myringectomy was performed on left ears, without chemical treatment of the rim. Perforations were standardized in size. The healing pattern was evaluated weekly for a 15-week period. Six of the right ears and 14 of the left ears completely healed within 15 weeks. Statistically, the mean delay of closure was higher in the treated group than in the non-treated group, and the two groups were different according the closure rate criterion. Histologic analyses of persistent TM perforations and of healed cases were performed.
Animals↗
Influence of aging on active cochlear micromechanical properties and on the medial olivocochlear system in humans.
Transiently evoked otoacoustic emissions (TEOAEs) without and with contralateral acoustic stimulation (CAS), as well as distortion product otoacoustic emissions (DPOAEs), were recorded on 60 subjects divided into 2 groups, the first constituted by 38 normally hearing young subjects and the second by 22 subjects aged from 70 to 88 years and with normal hearing levels in view of their age. TEOAEs and DPOAE 'audiograms' were recorded in a third group constituted by 15 subjects with ages ranging from 6 to 57 years and with hearing levels not significantly different from those of the second group for frequencies above 500 Hz. TEOAEs were present in 100% of the subjects in the first group and in 91% in the second group, although with smaller amplitude. The fall in TEOAE amplitude under CAS was smaller in the second group. Concerning DPOAE audiograms, in the first group, a response was found in 71 to 95% of cases for frequencies ranging from 1 to 6.35 kHz, and in 7 to 37% of cases in the second group. Mean amplitudes were significantly lower in the second group for frequencies ranging from 2.83 to 5.04 kHz. group for frequencies ranging from 2.83 to 5.04 kHz. Mean 'thresholds' ranged from 38.55 to 43.57 dB SPL for frequencies ranging from 1 to 6 kHz in the first group and from 50 to 58 dB SPL in the second group. No significant difference was found between the second and third groups concerning the amplitude and spectrum of the TEOAEs and DPOAE audiograms. Thus, age influences TEOAEs, DPOAEs and the effect of CAS on TEOAEs.(ABSTRACT TRUNCATED AT 250 WORDS)
Acoustic Stimulation↗
A clinical study of human type IV collagen as tympanic membrane grafting material. Preliminary noncomparative study.
OBJECTIVE: To evaluate tolerance for this middle-ear implant and its effectiveness in eardrum healing under various pathologic conditions. SETTING: A 12- to 18-month follow-up case series at an institutional referral center offering hospitalized care. PATIENTS: Twenty-six eligible volunteers suffering from tympanic perforation or tympanic pocket retraction class II and III in Tos' classification. INTERVENTION: Patients underwent implantation with the type IV collagen film (film called "MTY" from the French membrane tympanique). The surgical procedure was similar to those using the temporal aponeurosis or the tragal perichondrium. OUTCOME MEASURE: Anatomic criteria was determined by otoscopy, and functional audiometric criteria was determined by air-borne gap measurements and by effects on cochlear function. RESULTS: Twenty-two of 26 patients were completely healed after 6 months, with no subsequent evolution. Nineteen of 26 subjects underwent a 1-year postoperative audiometric follow-up examination: 13 (68%) had an air-borne gap less than 10 dB, four (21%) had between 11 and 20 dB, and two (11%) had between 21 and 30 dB. Adverse effects included one patient whose MTY fell into the middle ear, three patients with transient myringitis, and one patient with otitis media with effusion. CONCLUSIONS: A human type IV collagen film may be a possible alternative to autologous tissue in tympanic membrane reconstruction. This new biomaterial was tested on patients with various diseases common in clinical otology, and demonstrated a good biocompatibility of MTY in the different pathologic conditions of chronic otitis media. A future randomized, controlled trial will randomly allocate patients to receive either MTY collagen film or tissue from the temporal aponeurosis.
Adolescent↗
Failures in outpatient tonsillectomy policy in children: a retrospective study in 311 children.
The literature suggests that outpatient tonsillectomy in children is a safe and cost-effective procedure. These conclusions have been based on the low rate of post-operative complications. Recent papers suggest contra-indications for ambulatory surgery in some patients. A retrospective study involving 311 children was performed in our Department. We defined two groups in which the out-patient policy had failed. The first group (43 children) comprised inpatient children scheduled because of an unhealthy preoperative state (12 patients), a sleep-apnea syndrome (5 children), a major associated procedure (3 patients), a social or family environment not reliable enough for postoperative supervision (19 patients) or because of parental refusal (4 patients). The second group (268 patients) was constituted of scheduled outpatients. In this group, the outpatient policy failed in 31 and children had to be kept overnight, because complications occurred. The main short-term complication was bleeding (13 patients). In 8, delayed complications were observed. Thus, according to the literature, children with concomitant heavy medical problems or with a poor social environment have to be managed as inpatients. For the others outpatient procedures were possible but parents should previously be informed of the possible overnight hospital supervision which is needed in 11.6% of cases. When comparing the youngest patients under 4 years of age with the others, although the preexisting medical and social conditions are important factors that may contraindicate ambulatory surgery, once the latter has been decided on, there is no significant difference between the two age groups regarding the number of children requiring overnight hospital supervision.
Adolescent↗
Lack of association between transiently evoked otoacoustic emission amplitude and experimentation linked-factors (repeated acoustic stimulation, cerebrospinal fluid pressure, supine and sitting positions, alertness level).
Changes in transiently evoked otoacoustic emissions (TEOAEs) occur during sleep and during tasks requiring attention. This can be due to a central nervous system effect on the cochlea. But, an additional or dominant influence by non-controlled factors is possible. In this paper, the effect of click-stimulus repetition, lying and sitting positions, state of alertness (awake or asleep) and CSF pressure variation on TEOAE features were studied. None of these factors affected TEOAE amplitude. In 2 subjects, TEOAE amplitude increased considerably during the night while remaining stable in 7 subjects during daytime sleep. This may be due to circadian variations of TEOAE amplitude.
Acoustic Stimulation↗
A gene responsible for a dominant form of neurosensory non-syndromic deafness maps to the NSRD1 recessive deafness gene interval.
The first localization of a gene responsible for autosomal, neurosensory, recessive deafness recently assigned NSRD1 to the centromeric region of human chromosome 13. We now report on a dominant form of neurosensory deafness found in a family of French origin. The deafness is moderate to severe, has a prelingual onset and affects predominantly the high frequencies. The gene responsible for this form of deafness was found by linkage analysis to map to the same region of chromosome 13 as NSRD1. A multipoint analysis gave a maximum lod score of 4.66 with a most likely location close to locus D13S175. This suggests that different mutations in NSRD1 may cause both dominant and recessive neurosensory deafness.
Centromere↗