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Biomedical subjects

F Denoyelle

Publications and source records attributed to F Denoyelle.

At least 55 records · Page 3Linked to original sources
PubMed1995

Role of modern imaging technology in the implementation of pediatric cochlear implants.

Since 1989, 40 patients have received cochlear implants in our institution. Over the past 2 years, 17 children among these patients have undergone radiographic assessment combining magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) scanning. Imaging is not essential, and is only used after assessment by a multidisciplinary team. However, the imaging results influence the choice of implant, and sometimes the side to be implanted. The first study is always CT, as it detects congenital abnormalities, and for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification that contraindicates or complicates cochlear implantation. These signs are not always visible with tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for postoperative confirmation of implant position in case of failure or complication. Over the past 3 years, MRI has been combined with tomodensitometry, especially with children having a history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A GE Signa 1.5-T unit was used by the authors, employing sequences of volumetric acquisition (steady state free precision with 1.5-mm image slices and an angle of 15 degrees to 35 degrees). Hence, modern imaging plays an important role when the decision to implant has already been made, particularly in the case of profoundly deaf children. We always use MRI in combination with a CT scanner in children with a history of meningitis.

Adolescent↗
PubMed1995

Severe laryngomalacia: surgical indications and results in 115 patients.

Between 1987 and 1993, 115 children were operated on for severe forms of laryngomalacia in two pediatric ear, nose, and throat (ENT) departments. The criteria used to determine the severity of the illness were selected following short hospitalization periods during which the children received both pediatric and ENT checkups. Based on clinical manifestations and/or the results of pH monitoring gastroesophageal reflux was found to be present in 68% of the children in the study. Detailed analysis and endoscopy were used to differentiate the symptoms that were related to laryngomalacia from those that were caused by other conditions, including mixed-breathing, swallowing, and sucking difficulties. Endoscopic resection of the aryepiglottic folds, with or without the use of a carbon dioxide laser, resulted in rapid improvement of both ventilation and swallowing. The success rate of this simple and effective procedure, which has no inherent morbidity, was 98% in an average follow-up period of 30 months. Only seven children required an additional similar procedure. The procedure failed in only two children, who needed to be tracheotomized. Given these excellent results, endoscopic resection can be considered an effective technique for the management of severe laryngomalacia.

Acute Disease↗
PubMed1995

[Clinical and surgical aspects of cysts and fistulae of the nose in children. Apropos of 37 cases].

Thirty-seven children with nasal midline masses and/or sinus ostia were surgically treated in the pediatric ENT and cervicofacial surgery department of Trousseau children hospital in Paris, from 1974 to 1994. The patients presented with midline cysts (11 cases), sinus ostia (8 cases) or both (18 cases). Various surgical techniques were used ranging from transcolumellar approach (25 cases) to direct midline approach (8 cases) or paracanthal approach. Preoperative imagery and surgery showed in 6 patients an intracranial extension to the base of the foramen cecum, without intracranial mass. Histologic examination demonstrated 33 dermoïds, 1 lipoma, 1 hamartoma, 1 glioma ans 1 hemangioma. 2 recurrences occurred after surgery. In children, the transcolumellar approach provides an enhanced exposure with a few percentage of recurrences and good cosmetic results.

Adolescent↗
PubMed1995

[Predictive factors of residual cholesteatoma in children].

The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).

Child↗
PubMed1994

[Clinical and endoscopic aspects of laryngeal dyskinesia in the infant].

Laryngeal dyskinesia, also called function stridor or stridor by cordal dysfunction, has been described in older children and in adults as episodes of acute dyspnea sometimes induced by exertion and in a particular psychological context. We report 5 cases of infants with stridor due to defective abduction of the vocal cords and normal laryngeal opening which occurred at rest or at awakening after anaesthesia. The common point was the clinical course of the stridor comparable with stridor which occurs during rapid respiration (crying) seen at birth then disappearing during the first 18 months of life, and also clinically observed gastro-oesophageal reflux which was confirmed by oesophageal pH measurements. Two infants had malaise with vagal hyperactivity. Disappearance of the stridor had no times relationship with the initiation of anti-reflux treatment and disappeared progressively near the end of the first year of life.

Airway Obstruction↗
PubMed1994

[Role of modern imaging (tomodensitometry and MRI) in cochlear implantation in children].

Since 1989, 40 patients have received implants in the O.R.L. ward of the Hôpital d'Enfants Armand Trousseau (Paris). Over the past 2 years, 17 children have undergone radiological assessment combining M.R.I. anf high resolution C.T scanning. Imagery is not the essential stage, and is only used after assessment by a multidisciplinary team. However, the imagery results influence the choice of implant, and sometimes the side to be implanted. C.T is always the first stage as it detects congenital abnormalities, and, for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification which contraindicate cochlear implantation. These signs are not always visible using tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for post-operative confirmation of implant position in case of failure or complication. Over the past 3 years, Magnetic Resonance Imagery has been combined with tomodensitometry, especially with children having a past medical history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A G.E. Sygna 1.5 T was used by the authors, employing sequences of volumetric acquisition (S.S.F.P. with 1.5 mm image slices and an angle of 15 to 35 degrees). Hence, modern imagery plays an important role when the decision to implant has already been taken, particularly in the case of profoundly deaf children. M.R.I. is always used in combination with a scanner in cases involving children with a past medical history of meningitis.

Adolescent↗
PubMed1994

[Value of magnetic resonance imaging associated with x-ray computed tomography in the screening of residual cholesteatoma after primary surgery].

Several recent studies have described the magnetic resonance imagery (MRI) of cholesteatomas. For certain authors the MR images are specific after Gadolinium injection. This radio-surgical study included 16 patients who underwent a tympanoplasty with supra and retromeatic masto-attictomy for a cholesteatoma and for whom a second operation was planned. Computed tomography (CT) and MRI was performed before operation in all patients with and without injection of Gadolinium. Images were then correlated with peroperative observations. Based on the CT and MRI diagnostic criteria of cholesteatoma reported in the literature, the radio-surgical correlation was false in 8 out of 16 cases (false negatives, false positives, partial errors). Among the 8 true correlations, 5 were normal images confirmed by the absence of cholesteatomy on operation. MRI with and without Gadolinium cannot be used to screen for small residual cholesteatomas or to determine the characteristics of an opacity of the middle ear seen on computed tomography.

Adolescent↗
PubMed1994

[Audiophonologic aspects of the decision and follow-up of cochlear implants in children].

Based on the audiologic, audioprosthetic, psychological and orthophonic criteria involved in the decision for a cochlear implant in 16 children (age 5 to 18), a protocol including 10 criteria was developed for children with severe deafness and a low to very low level of oral language acquisition. The importance of the motivation of the family, their capacity to become implicated and their desire to listen to the child and communicate orally with him, as well as the role of the specialist teachers were emphasized. In this series of 16 children the results of the implantation work-up lead to only 9 cases of implantation.

Adolescent↗
PubMed1993

[Pharmacokinetic study of antibiotics in otitis].

Antibiotic concentrations in middle ear fluid can be determined in the purulent effusions of acute otitis media or in chronic effusions at the time of myringotomy with tympanostomy tube insertion. Measurements are usually made using microbiological methods. The concentration of betalactamines in middle ear fluid is 20 to 40% serum concentrations. Therefore, in the treatment of otitis media, it is necessary to use high doses of antibiotics, so that the concentration in the middle ear fluid is higher than the minimum inhibitory concentration (MIC) for the most frequent infecting organisms. Sulfamides penetrate well into the middle ear. On the other hand, the concentration of macrolides is not significant until two or three doses have been delivered and a steady state is reached. While direct measurements of the antibiotic concentrations in middle ear fluid can provide information concerning the effectiveness of the antibiotic relative to the MIC, they do not replace clinical trials in confirming the indications of new antibiotic molecules in the treatment of otitis media. In addition, direct measurements are delicate and show great interindividual variations.

Anti-Bacterial Agents↗
PubMed1992

[Cochlear implants in children].

The development of surgically implantable hearing aids that are placed directly in the cochlea where they send electrical impulses to the cochlear nerve is a major break-through for patients whose hearing loss is so severe as to make conventional electroacoustic hearing aids ineffectual. Initially used only in adults, this method has gradually been extended to pediatric patients. To benefit from a cochlear implant, the patient must fulfill a number of criteria which are specified in this article. Following preoperative investigations, the decision is taken during a meeting of all the care providers involved, i.e., the surgeon, ENT phoniatrist or audiophonologist, hearing aid specialist, special education provider, speech therapist, psychologist, and other members of the health care staff. Team work is thus essential both before and after the procedure. The implant selected can be intracochlear or extracochlear and single-channel (one electrode) or multi-channel (several electrodes). Each team selects the implantation technique and type of implant they use according to their preferences and specific criteria. The authors use a multi-channel intracochlear system except in the rare instances where complete ossification of the cochlea requires use of an intracochlear mono-channel system. They have inserted implants in 29 patients to date. The cochlear implant has unquestionably had a significant impact of the life of these patients.

Child↗
PubMed1992

[Severe aplasia of the ear: management and surgical indications].

Severe aplasia of the ear raises both a cosmetic and a functional problem. Surgery is often performed starting at four or five years of age but early management is essential. The need for a hearing aid should be evaluated at the age of six months. At birth, the infant should have investigations for concomitant malformations, which are common, and for etiologic factors. Functional surgery to create a canal, tympanic membrane, and chain of ossicles should be performed only in bilateral forms. Satisfactory cosmetic results can be achieved by cartilage autografting according to Brent's technique.

Clinical Protocols↗
PubMed1992

[Current therapeutic indications in laryngeal stenoses in children].

Among pediatric patients with laryngeal stenosis, acquired forms are now more common than congenital forms. External surgery is not always warranted except in complete or tight obstructions. After establishing the diagnosis by endoscopy, consequences on respiration and phonation should be assessed before deciding on the most appropriate treatment: abstention, medical therapy, endoscopic treatment, or surgical treatment by the cervical route. Surgical laryngoplasty techniques have changed radically over the last twenty years. The Cotton procedure is the most widely used. Another available method is the cricoid-split technique. These laryngoplasty procedures can be performed from birth and tracheostomy is now warranted only after failure of initial surgery.

Child↗
PubMed1991

[Therapeutic strategy for cervicofacial lymphangioma in children].

The authors report a series of 22 cervicofacial lymphagiomas treated from 1984 to 1990, and try to define a therapeutic strategy. In 11 cases, facial, laryngeal or pharyngeal extension was observed, and 1 cas showed mediastinal extension. These cases are not easily treated, and it is impossible to perform complete surgery, thus leading to recurrence. Tracheotomy was necessary in two cases. In 5 cases, the extension was limited to the cervical area and surgical exeresis was considered complete. Sclerosing injections gave variable results.

Child↗
PubMed1991

[Value of cricoid split in congenital subglottic stenoses].

The authors report about the cases of two infants less than 5 weeks old, who presented with congenital subglottic stenosis and in whom a cricoid split produced good results. This procedure, which is classically reserved for difficult extubation of infants due to acquired subglottic stenosis, is compared with the other surgical techniques used in the congenital condition. It may be useful in the latter case owing to its simplicity and to the possibility of performing laryngoplasty later in case of failure.

Cricoid Cartilage↗
PubMed1990

Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases.

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital. Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation. The operative and anesthetic technique is described in detail, together with any possible adverse events. The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.

Bronchi↗
PubMed1990

[Development of tone curves in sensorineural deafness in children].

The authors reviews 239 cases of child sensorineural deafness (478 ears studied both separately and in correlation with the controlateral ear) to try and identify the evolutionary trend of the tone curves throughout the follow-up period, which spanned nearly 20 years in some cases. The difficulties encountered in this study were due to several factors, namely the problem involving very accurate assessment in very young children, the high incidence of tubotympanal disease in the very young, the hard to obtain definition and quantitative evaluation of the notion of progressiveness, as well as the need to analyze the evolutionary patterns in global terms (mean hearing loss), from one frequency to the next and from one ear to the other, since such tone loss patterns are not always symmetric. The authors state their opinion derived from a large number of cases regarding a situation, which characterizes a relatively frequent (over 25% of cases) aggravation of perceptive hearing loss in children.

Adolescent↗