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Biomedical subjects

P A Clement

Publications and source records attributed to P A Clement.

At least 19 recordsLinked to original sources
PubMed2000

Reference data for DPOAE in healthy newborns.

Distortion Product Otoacoustic Emissions (DPOAE) can be used as an alternative to Transient Evoked Otoacoustic Emissions (TEOAE). This study aims to establish normal values for DPOAE in healthy newborns. DPOAE were determined with the Madsen Celesta 503 at 0.5, 1, 2, 4 and 8 kHz with an unequal stimulus level of the primaries (L1 = 65 dB SPL, L2 = 50 dB SPL). DPOAE were present in 92.4% of the ears of the 185 babies tested at 4 days after birth. The 5% quantile and the median of the DPOAE of the right and left ears were calculated for the five frequencies tested. At 4 kHz there was a significant sex effect (mean amplitude of DPOAE was higher in female than in male babies) and at 2 kHz a significant interaction effect was found between sex and side. The calculated reference limits are open to comparison with data obtained using other commercial equipment.

Acoustic Stimulation↗
PubMed2000

Microbiology of the middle meatus: a comparison between normal adults and children.

Middle meatal samples were obtained from 52 carefully selected healthy adults. In 75 per cent of the test subjects bacterial organisms were cultured. However, growth was often poor and the predominant species suggest a commensal flora: coagulase-negative staphylococci were retrieved from 35 per cent, Corynebacterium sp. from 23 per cent and Staphyloccus aureus from eight per cent of the adults. These data are very different from those previously obtained among children where--even in the absence of obvious ENT pathology--the most frequently cultured organisms were typical sinusitis pathogens: Haemophilus influenzae present in 40 per cent, Moraxella catarrhalis in 34 per cent and Streptococcus pneumoniae in 50 per cent of children. Furthermore, Streptococcus viridans and Neisseria sp., both organisms that might be able to inhibit colonization by some of the pathogens and found commonly among children, are virtually absent in healthy adults.

Acute Disease↗
PubMed2000

Endoscopic endonasal surgery in choanal atresia.

Twenty-seven cases of choanal atresia operated between 1979 and 2000 have been reported from 4 different institutions (19 females, 8 males, age of first surgical procedure ranging from 2 days to 35 years). Of these 27 cases, 22 were previously untreated. The outcomes for 19 of these new cases were available for the present report. Bilateral atresias were somewhat more frequent (15 versus 12) and associated anomalies were present in 10 out of 27 patients. Details about the types of atresia, associated anomalies, surgical techniques, duration of stenting and outcomes are given together with a theoretical review on choanal atresia.

Adolescent↗
PubMed1999

Management of rhinosinusitis in children.

The authors provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs. They also provide the indications for CT scan examination and microbiological investigations. In addition, they emphasize the importance of concomitant systemic disease, such as allergy and immunological disorders. The adequate medical management, which is mandatory before any surgery, is considered and discussed, and the indications for surgery are provided.

Child↗
PubMed1999

Bacteriology of the middle meatus in children.

Little is known about the bacteriology of the middle meatus in children. Therefore, middle meatal samples were obtained from 50 children who underwent adenoidectomy or adenotonsillectomy, while a group of 50 children submitted to minor non-ENT surgical procedures, were used as a control group. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the most frequent cultured organisms, not only in the ENT group (in 68, 50 and 60% of the children respectively) but also in the control group (40, 34 and 50%). These three potential pathogens were more frequently seen among the children of the ENT group but only for H. influenzae was the observed difference statistically significant (P = 0.009). On semiquantitative analysis, there seemed to be more negative cultures or cultures with only a few colonies in the control group, while the richer cultures were obtained from the ENT group. Again, only for H. influenzae, these differences reached a statistical significance (P = 0.003). Streptococcus viridans and Neisseria species, both organisms that might be able to inhibit colonisation by some of the pathogens, were more frequently cultured in the control than in the ENT group: Strep. viridans 30 vs. 10% (P = 0.025) and Neisseria species 14 vs. 2% (P = 0.069).

Child, Preschool↗
PubMed1999

Microbiology of the middle meatus in children requiring adenotonsillectomy.

Middle meatus samples were cultured in 120 children undergoing adenotonsillectomy with, or without, insertion of ventilation tubes. Every child (except one) had positive cultures. Haemophilus influenzae (62 per cent of the children), Moraxella catarrhalis (53 per cent) and Streptococcus pneumoniae (48 per cent) were the most commonly isolated bacteria. The presence of Moraxella catarrhalis and (to a lesser extent) Streptococcus pneumoniae was higher in younger children, while Haemophilus influenzae was cultured independently of age. Culture results of these middle meatal samples, carefully taken in order to avoid any contamination, probably reflect some ongoing sinus infection in these children requiring adenotonsillectomy. The problems inherent in the interpretation of surface cultures are addressed.

Adenoidectomy↗
PubMed1999

Distortion product oto-acoustic emissions as objective audiometry in a group of children with ventilation tubes.

The aim of this study was to evaluate distortion product oto-acoustic emissions (DPOAEs) as a means of objective audiometry in a population of children with ventilation tubes. We measured DPOAEs at two different stimulus levels--recorded transient evoked oto-acoustic emissions (TEOAEs) and obtained pure-tone audiometry (PTA). DPOAEs were compared with the normal range proposed by the Madsen company: the CELESTA 503 provides a 'normalized' distortion-product-gram which we compared with the pure-tone threshold of the test group. DPOAEs at 60 dBSPL were more easily obtained in the test group than TEOAEs and PTA. Correlation between 'normalized' DPOAEs and pure-tone thresholds was the strongest at 2 and 4 kHz. Surprisingly, DPOAEs at 60 dBSPL showed significant differences also at 2 and 4 kHz compared with the Madsen data. DPOAEs at 60 dBSPL might be an easy, objective test for evaluating auditory function and for determining hearing threshold at 2 and 4 kHz.

Acoustic Impedance Tests↗
PubMed1998

Management of rhinosinusitis in children: consensus meeting, Brussels, Belgium, September 13, 1996.

OBJECTIVES: To (1) provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs; (2) provide indications for microbiological, allergic, and immunologic assessment as well as for imaging studies; (3) suggest standard medical management with judicious use of antimicrobial agents; and (4) discuss indications for surgery. DATA SOURCES: Clinical studies and literature data relevant to the different topics of pediatric rhinosinusitis. CONCLUSIONS: Rhinosinusitis in children is a multifactorial disease in which the importance of several predisposing factors changes with increasing age. Continued study to obtain a better understanding of the disease and carefully controlled comparative evaluations of medical and surgical therapies are suggested.

Child, Preschool↗
PubMed1998

Nasal mucosal sarcoidosis: a case report.

The authors present a case of nasal mucosal sarcoidosis. Its low incidence may be due to unawareness of this sometimes forgotten entity. Crusting and nasal obstruction may be the first symptoms of this multisystemic disease. With the nasal endoscope, today's most helpful tool for examining the nose and its adjacent structures, the otolaryngologist can diagnose this disease at an early stage.

Humans↗
PubMed1997

Rhinomanometry.

The importance of nasal obstruction is stressed as one of the cardinal symptoms in allergic rhinitis and the major symptom of the late phase reaction; therefore the objective measurement of this symptom is of the utmost importance. The international committee on objective assessment of the nasal airway advocated rhinomanometry as a reliable method for measuring this symptom. The author's experience with this method after nasal challenge during the early and late phase, in 18 patients and 10 normal volunteers, is discussed. If total nasal resistance is considered then 41% of the patients showed a late phase. When considering unilateral nasal resistance a late phase was observed in 82% of the patients.

Humans↗
PubMed1997

The hummer, shaver or microdebrider.

The major goal in functional endoscopic sinus surgery (F.E.S.S.) is the precise and delicate removal of diseased tissue in order to prevent trauma to healthy mucosa, bleeding and scar formation. One of the advantages in this field is the use of the microdebrider. The authors describe the use of this instrument, as well as their own experience for nasal polypectomy, prior to the F.E.S.S. procedure.

Blood Loss, Surgical↗
PubMed1997

Unusual choanal polyps.

Four children with choanal polyps are presented. Their age and/or the site of origin of the polyps are unusual. At the time of diagnosis, the two boys were respectively 3 years 9 months and 4 years 6 months. The two girls were aged 9 and 10. In one of the patients the polyp originated from the sphenoidal sinus, in another from the inferior turbinate. The age of the child complicates diagnosis, endoscopic sinus surgery and postoperative care.

Child↗
PubMed1997

Definitions of sinusitis.

Following an international consensus in 1996 on sinusitis the author reports the definitions, signs and symptoms of acute, chronic and recurrent sinusitis in adults and children.

Acute Disease↗
PubMed1997

Chronic rhinosinusitis in cystic fibrosis (mucoviscidosis).

The authors present two clinical studies performed in the ENT departments of two Belgian Universities. A total of 248 patients with mucoviscidosis (cystic fibrosis, CF) were assessed by means of nasal endoscopy. One hundred eighteen underwent computed tomography of the paranasal sinuses (CT) and 55 were endoscopically operated. This allowed the observation of different clinical patterns of rhinosinusitis: mucopyosinusitis (pseudomucocele) of the maxillary antrum with bulging of the lateral nasal wall (LNW), nasal polyposis with erosion of the LNW, and chronic purulent rhinosinusitis with an isolated prominent uncinate process. The treatment of those patients could be tailored to the individual clinical pattern. Medical therapy consisted of systemic antibiotics and topical drugs delivered by sprays or by lavages with a nose can. Surgery was mainly aimed at removing the massive polyposis when it interfered with the daily life activities. The use of the endoscope enabled to perform safely more extensive procedures resulting in a lower recurrence rate. In patients with chronic rhinosinusitis without polyposis, yet presenting ostiomeatal obstruction, a limited and more functional endoscopic surgery was indicated in order to restore some drainage and to improve the penetration of topical drugs into the affected sinus. A short addendum presents two studies: one about genetics and the other about prevalence of middle ear disease in CF. The first concluded that no clear correlation was found between DF508 (the most common CF mutation) and nasal polyposis. The second revealed that in contrast with the extremely high prevalence of sinus problems, there was no clear evidence of an increased prevalence of middle ear disease in CF.

Administration, Intranasal↗
PubMed1997

Prevalence of sinusitis signs on MRI in a non-ENT paediatric population.

In a population of 100 children with suspected intracranial neurological disease, the overall prevalence of sinusitis signs on magnetic resonance images (MRI) is 45%. This figure exceeds the adult prevalence of 39%, while the nature of the lesions is more severe in children. Furthermore, paediatric sinuses seem to be affected according to a different pattern: adults have mainly maxillary and anterior ethmoidal lesions, whereas in children the sphenoidal and posterior ethmoidal sinuses are frequently involved too. Among children, the overall prevalence increases in the presence of a history of nasal obstruction (prevalence: 50%) and recent upper respiratory tract infection (prevalence: 81%) as well as when bilateral mucosal swelling (prevalence: 80%) or purulent secretions (prevalence: 100%) are seen on anterior rhinoscopy.

Adolescent↗