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D Ayache

Publications and source records attributed to D Ayache.

At least 19 recordsLinked to original sources
PubMed2006

[Middle ear cholesteatoma].

Cholesteatoma is a serious form of chronic otitis media. The aim of this paper is to present the state of the art of disease management, including recent data from the literature and the authors' derived from their Mentors' teaching, Professor Pierre Roulleau (Paris, France) and Professor Robert Charachon (Grenoble, France). The main recent advances concern the use of cartilage grafts to reconstruct the canal wall and/or tympanic membrane (allowing a significant reduction in residual cholesteatoma) and progress in medical imaging allowing more acute preoperative determination of extension of the cholesteatoma (in order to propose an optimally designed surgical technique) and a less invasive postoperative follow-up.

Cholesteatoma, Middle Ear↗
PubMed2006

[Useful imaging of the ear].

Good anatomical knowledge is necessary to make an effective diagnosis in ear pathology. The purpose of this article is to summarize the main landmarks of the ear. Anatomic definitions of the external ear, middle ear, and bony labyrinth are described on routine spiral CT, and the anatomic definition of the membranous labyrinth and the cochleovestibular nerve on MRI is reviewed.

Auditory Pathways↗
PubMed2006

[Imaging in adult chronic otitis].

Chronic otitis media (COM) can be divided into two subtypes: COM with cholesteatoma (including precholesteatomatous states) is an aggressive form of otitis. Surgical treatment is mandatory because of the risk for labyrinthine or cerebromeningeal complications. CT is very important in the preoperative work-up (extension of cholesteatoma, anatomic variants). In patients who have undergone middle ear surgery, CT and presently MRI play an increasing role in the detection of recurrent or relapsing cholesteatoma. COM without cholesteatoma does not have an osteolytic potential, but may leave auditive sequelae that in selected cases may warrant surgical treatment to improve hearing. CT is useful in the etiological work-up of patients with severe hypoacusis. CT also plays an important role in cases of surgical failure, to detect a dislocation of the ossiculoplasty or impairment of the middle ear caused by fluid effusion. The objective of this paper is to specify the indications, the results and the limits of pre- and postoperative imaging in COM.

Adult↗
PubMed2006

[MRI of the temporal bone].

Lesions arising within the temporal bone, where audition and balance receptors are located, are multiple. Beginning with a short clinical and technical overview, this presentation aims to review the most common temporal bone lesions, according to their location. Tumors and malignant otitis externa are the most common lesions of the external auditory canal. MRI features of cholesteatoma redux, transtegmental masses, and paragangliomas are described in the middle ear MRI study. The diagnosis of petrous apex abnormalities is emphasized: cholesterol granuloma, malignant tumor, epidermoid cyst, cholesteatoma, and petrositis. The diagnostic value of CT scan associated with MRI is stressed. This study also includes the main aspects of facial nerve lesions and vascular abnormalities of the area on MRI. The conclusion summarizes the main indications of temporal bone MRI.

Anticoagulants↗
PubMed2006

[Far-advanced otosclerosis].

OBJECTIVES: The aim of this study was to report a series of patients with far-advanced otosclerosis who were unable to benefit from hearing aids. Among patients with profound hearing loss, it is particularly useful to diagnose far-advanced otosclerosis even if relatively rare, because stapes surgery can improve hearing to a level allowing conventional hearing aid use (sometime the only choice before cochlear implant). MATERIAL AND METHODS: We retrospectively reviewed the charts of 7 patients (9 operated ears) in order to highlight diagnostic criteria, surgical indications and results of stapes surgery (stapedectomy or stapedotomy). RESULTS: Diagnosis of far-advanced otosclerosis was based on clinical presentation, course of hearing loss, positive family history of otosclerosis, and results of CT scan which was helpful in all the cases. Obliterative otosclerosis was found in 55% of the cases. Success of stapes surgery was observed in 89%, with no significant difference between stapedectomy or stapedotomy. CONCLUSION: Although rare, far-advanced otosclerosis must be diagnosed because patients can benefit from stapes surgery (and subsequently fitting of appropriate hearing aids).

Aged↗
PubMed2005

[Imaging of postoperative failures and complications in stapes surgery for otosclerosis].

Otosclerosis (OS) is a dysplasia of the otic capsule located in most cases on the anterior margin of the oval window or fissula ante fenestrum. Progressive conductive hearing loss is the major clinical symptom, due to stapedovestibular ankylosis. Stapes surgery is the only effective treatment of OS, with excellent functional results in more than 90% of cases. However, failures and complications of the surgery may be observed. In theses cases, the etiologic work-up includes imaging evaluation (CT and MRI). Imaging findings are extremely useful in the therapeutic decision. Surgical failure represents 80% of the causes for surgical revision. The main causes of failure are: displacement of the prosthesis, fibrosis of the oval window, erosion of the long process of the incus, incudo-mallear dislocation, obliterative otosclerosis. CT is essential for diagnosis. MR imaging is rarely indicated in the work-up of surgical failures. Labyrinthine complications account for less than 20% of surgical revisions. Etiologies of labyrinthine complications are: intravestibular penetration of the prosthesis, perilymphatic fistula, intra-vestibular granuloma, labyrinthitis and intravestibular bleeding. CT and MRI are complementary for the work up of these complications.

Adult↗
PubMed2005

Usefulness of delayed postcontrast magnetic resonance imaging in the detection of residual cholesteatoma after canal wall-up tympanoplasty.

OBJECTIVES/HYPOTHESIS: Imaging takes an increasing place in the follow-up of patients who have undergone surgery for cholesteatoma, with computed tomography (CT) as the first line imaging technique. However, in case of complete opacity of the tympanomastoid cavities, CT is not able to differentiate residual cholesteatoma from postoperative scar tissue. The aim of this study was to assess the usefulness of magnetic resonance imaging (MRI) using delayed postcontrast T1-weighted images for the detection of residual cholesteatoma after canal wall-up tympanoplasty (CWU) in cases where CT was not conclusive. STUDY DESIGN: Prospective study. METHODS: MRI, with delayed postcontrast T1-weighted images (30-45 minutes after contrast injection), was performed before revision surgery in 41 consecutive patients who had undergone CWU for cholesteatoma and presenting with a nonspecific complete opacity of the mastoid bowl on CT. In all the cases, imaging results were compared with operative findings at surgical revision. RESULTS: A residual cholesteatoma was found in 19 of 41 patients at revision surgery and was correctly detected on MRI in 17 patients. In the two remaining cases, cholesteatoma pearls smaller than 3 mm were not seen. There was no false-positive case. Statistics were as follows: sensitivity 90%; specificity 100%; positive predictive value 100%; negative predictive value 92%. CONCLUSION: When postoperative CT is not conclusive because of complete opacity of the tympanomastoid cavities, MRI with delayed postcontrast T1-weighted images is a reliable additional technique for the detection of a residual cholesteatoma when its diameter is at least 3 mm.

Adolescent↗
PubMed2003

[Laryngeal dystonia].

Laryngeal dystonia alters phonatory and respiratory functions in ways that may differ according to the various clinical forms. Spasmodic dysphonia, however, is the most usual clinical consequence; it is characterized either and most often by an raucous, strained, jerky voice and dotted by vocal short stops, or, more rarely, by a breathed, murmured hardly audible voice. Laryngeal dystonia may also express itself by a permanent inspiratory dyspnea witch will increase with effort. The authors describe the principal diagnostic data with are provided essentially by laryngeo-video-fibroscopy and laryngeal electromyography. Treatment of laryngeal dystonia by botulinium toxin is spectacularly efficient, with 66.7 to 100p.100 of good results in literature. Injection techniques are described as well as combined surgical treatments. In adductor spasmodic dysphonia and permanent inspiratory dyspnea, each thyro-arytenoids muscles are injected with 20 to 40 Dysport units or 5 to 10 Botox units, bilaterally; in abductor spasmodic dysphonia, we inject uni or bilaterally, 60 to 80 Dysport units or 15 to 20 Botox units in each posterior crico-arytenoïds muscles. Endoscopic or external laryngeal surgery is proposed to improve functional results when the effects of botulinium toxin injection are disappointing.

Dystonia↗
PubMed2002

[Atelectasis of the maxillary sinus: report of a case of acute onset].

INTRODUCTION: Maxillary sinus atelectasis is a rare pathology, characterized by a retraction of the maxillary sinus walls associated with tenacious mucus secretions filling the antrum. The disease usually develops in a chronic fashion, leading progressively to enophthalmos. This is sometimes associated with diplopia and midfacial depression. In these typical forms, maxillary sinus ventilation (via a middle meatal antrostomy) stops progression to retraction, but usually cannot reverse the phenomenon, resulting in a specific surgical procedure on the orbital floor or on the anterior wall of the sinus. MATERIALS & METHODS: We describe a case of maxillary sinus atelectasis with enophthalmos and midfacial depression, which appeared suddenly in one week, without nasal or sinus related symptoms. A middle meatal antrostomy performed rapidly enabled us to observe a reversal of the atelectatic process with recovery of the sinus volume, correction of the enophthalmos and disappearance of the associated diplopia, without the necessity for an additional surgical procedure. It is, to our knowledge, the first case described with such a rapid evolution.

Acute Disease↗
PubMed2001

[Fistula of the fourth branchial pouch: apropos of a case treated by endoscopic cauterization].

Fistula of the fourth branchial pouch is a rare congenital cervical malformation. It typically affects child and occurs in the left side of the neck. Surgical removal of the entire fistulous tract through an external cervical approach is the treatment traditionally performed. We report a case of a right 4th branchial pouch in an adult managed through an endoscopic approach. Endoscopic cauterization of 4th branchial pouch may be considered as an attractive alternative procedure for the management of this congenital anomaly.

Adult↗
PubMed2000

Microangiopathy of the inner ear, retina, and brain (Susac syndrome): report of a case.

Microangiopathy of the inner ear, retina, and brain was first described in 1979 by John O. Susac. Since then, approximately 60 cases have been reported. Otolaryngologists must be aware of this syndrome, in which cochleovestibular symptoms are an important part of the diagnosis. In this article, we report a new case of Susac syndrome and discuss the diagnosis, physiopathologic characteristics, and treatment of this disease.

Adult↗
PubMed2000

Use of the carbon dioxide laser for tracheobronchial pathology in children.

The carbon dioxide (CO2) laser has been used to treat tracheobronchial pathology for more than 20 years. It was initially employed in adults and now has been found to be useful in the treatment of certain lesions in children. We present our experience with this technique in 30 patients treated with a CO2 bronchoscopic laser from 1987 to 1995 in the Ear, Nose, and Throat Department of Armand Trousseau Hospital. Four different types of pathologies have been successfully treated with the laser: selective cases of tracheobronchial stenosis following trauma and/or secondary to neonatal ventilation, posttraumatic tracheobronchial granuloma (due to foreign bodies or tracheotomies), tracheobronchial granulomas of infectious origin (tuberculosis), and selective cases of tracheobronchial tumor.

Adolescent↗
PubMed2000

[Assessment of perilymphatic pressure using the MMS-10 tympanic membrane displacement analyzer (Marchbanks' test) in patients with Meniere's disease: preliminary report].

OBJECTIVES: The aim of this study was to investigate non-invasive measurement of perilymphatic pressure using the MMS-10 tympanic displacement analyzer (Marchbanks' test) in patients with Meniere's disease. METHODS: We performed measurements in 20 patients with Meniere's disease and in 9 normal subjects with normal hearing. Data were collected in three groups: healthy ears of normal-hearing patients, healthy and affected ears in patients with Meniere's disease. RESULTS: We found no significant differences between the 3 groups for the types of the graph. Measurements of the tympanic membrane displacement test variables (Vi and Vm) showed large inter-subject variations. No significant difference was found between the 3 groups for cochlear aqueduct patency. CONCLUSION: Preliminary results of this short series show that assessment of perilymphatic pressure using the MMS-10 procedure does not seem to be useful in Meniere's disease.

Adolescent↗
PubMed2000

[Susac's syndrome: improvement with combined cyclophosphamide and intravenous immunoglobulin therapy].

We report a case of Susac's syndrome characterized by subacute encephalopathy, bilateral hearing loss and multiple bilateral branch retinal artery occlusions in a forty-year-old-white-woman. Brain Magnetic Resonance Imaging showed on T2-weighted images multiple, punctate areas of increased signal intensity in periventricular white matter, gray matter and brainstem most of them being enhanced by gadolinium. Cerebrospinal fluid was acellular but with an increased protein level (1.66 g/l). Treatment with cyclophosphamid and intravenous immmunoglobulin resulted in dramatic improvement of the clinical status over the following months and CSF normalization.

Adult↗
PubMed2000

[Revision surgery of otosclerosis: a review of 26 cases].

OBJECTIVES: The aim of this study was to identify causes of primary stapedectomy failures and to evaluate hearing results in revision stapes surgery. MATERIAL AND METHODS: We retrospectively reviewed a series of 26 revision stapedectomies. Patient characteristics, preoperative findings, causes of failure and complication of primary stapedectomy and postoperative hearing results were noted. RESULTS: Conductive hearing loss was the most common reason for revision surgery (77 %). Leading causes of stapedectomy failure included prosthesis malfunction (42 %), fibrous adhesions (37,5 %), incus erosion (12,5 %) and otosclerotic regrowth (12,5 %). When revision was indicated because of cochleo-vestibular complication, middle ear exploration revealed 3 problems: oval window granuloma or excessively long prosthesis or perilymphatic fistula. In this series, postoperative air-bone gap was closed to less than 10 dB in 57 % of cases, to less than 20 dB in 71 % of cases and we did not observed any sensorineural hearing loss. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but the risk of sensorineural hearing loss does not appear to be higher than in primary surgery. Revision surgery is a challenging problem that must be performed by an experienced surgeon.

Adult↗
PubMed1999

Head and neck infantile myofibromatosis--a report of three cases.

Infantile myofibromatosis (IM) is a proliferative disorder characterized by the development of single or multiple nodular lesions arising from cutaneous, subcutaneous, muscular, bone or visceral structures. This proliferation may occur at any anatomical site, but in 30% of the cases it involves the head and neck. We report here three cases of head and neck IM occurring in young children and presenting as solitary lesions. The clinical heterogeneity and the misleading histopathological appearances can make the diagnosis difficult. The treatment is surgical but the low rate of recurrence and the possibility of spontaneous tumoral regression may lead to conservative surgery or therapeutic abstention.

Child↗
PubMed1999

Obliterative otosclerosis.

From January 1990 to December 1996, 293 primary stapedectomies for otosclerosis were performed, among which 14 had obliterative otosclerosis (4.7 per cent). Probability of bilateral obliterative disease was 50 per cent. With this particular condition, a drill-out procedure was used to perform either a stapedectomy or a stapedotomy. In two patients with bilateral 'far-advanced otosclerosis', surgery was effective in enabling the patient to benefit from hearing-aids. In patients with a measurable hearing-loss, an air-bone gap closure to within 10 dB was achieved in 62.5 per cent of the cases and to within 10-20 dB in 37.5 per cent of the cases, with no deterioration of air-conduction thresholds at 8 kHz. A mild sensorineural hearing loss at 4 kHz was observed in 25 per cent of the cases. There was no statistical difference between stapedectomy and stapedotomy. According to these results, the drill-out technique is a safe and effective procedure in cases of obliterative otosclerosis.

Adolescent↗