[Opacity of the left upper mediastinum and tracheal deviation].
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Biopsy↗
Biomedical subjects
P Bonfils
Publications and source records attributed to P Bonfils.
[Best clinical practices for aerosol nebulization therapy approved at the National Meeting on Nebulization, Paris 4-5 April 1997].
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Administration, Inhalation↗
[Contribution of corticosteroid treatment in neurosensorial anosomia: a series of 62 patients].
Systematic administration of corticosteroids was attempted in the treatment of olfactory loss in 41 patients with post-upper respiratory infection and 21 patients with idiopathic anosmia. In our study, anosmia failed to respond to this treatment, as no patient noted any improvement of olfaction.
Adult↗
[Analysis of olfactory disorders in aging].
AGING EFFECT: The effect of aging on the olfactory system is generally observed in subjects over the age of 65 and is the number one cause of olfactory disorders. Several studies taking into account the state of the naso-sinus system and possible early stage of developing dementia have examined the precise effects of aging on olfaction. AGE-RELATED CHANGES: Aging affects olfactory thresholds, estimation of the intensity of an olfactory stimulation, and identification and memorization of odors. The elderly subject identifies food and other odors less easily than the young subject although elderly subjects can learn to improve their performance. Changes in the nasal cavity, particularly an alteration of the processes involved in neuron distribution in the olfactory neuroepithelium, may be involved. IMPACT OF OLFACTORY DEFICIENCY: There is much morphological and experimental evidence showing the effect of aging on both peripheral and central olfactory pathways allowing a better understanding of the functional impact of the sensorial deficit. Olfactory deficiency can explain in part the eating problems encountered in elderly patients.
Aged↗
Vulnerability of the gerbil cochlea to sound exposure during reversible ischemia.
Cochlear ischemia induces a sensorineural hearing loss, in part through a fast functional impairment of outer hair cellls. Assuming that the cochlea is rendered fragile during ischemia and reperfusion and that stimulation itself can jeopardize its functional recovery, we used a model of reversible selective cochlear ischemia in Mongolian gerbils to establish what type of sound exposure can be deleterious during and immediately after reversible ischemia. Several groups of gerbils were used, with different ischemia durations and levels of sound exposure. Control groups were only exposed to tones at 80 and 90 dB SPL during 30 min, while other groups underwent complete and fully reversible blockage of the labyrinthine artery, during 5.5 or 8 min, and were exposed to 60 or 80 dB SPL tones during 30 min. The amount of ischemia and reperfusion was measured by means of laser Doppler velocimetry, whereas outer hair cells' function was continuously monitored through distortion-product otoacoustic emissions (DPOAEs). The losses of DPOAE levels after 8 min transient ischemia and 60 dB SPL exposure were as large as those induced by 80 dB SPL exposures combined with 5.5 min ischemia, or 90 dB SPL exposures without ischemia, with a maximum loss around 25-30 dB, half an octave above the stimulus frequency. These results give evidence for an extremely high cochlear vulnerability to low-level sound exposure when associated with reversible ischemia. This vulnerability may have important clinical consequences in patients with cochlear circulatory disturbances.
Animals↗
A model of cochlear function assessment during reversible ischemia in the Mongolian gerbil.
An in vivo model in the Mongolian gerbil is used to assess the auditory changes during reversible cochlear ischemia. This model allows the recordings of cochlear potentials (microphonics, summating potential and compound action potential) and otoacoustic emissions (cubic difference tones, CDTs), together with laser Doppler cochlear blood flow (CBF) measurements, over reversible cochlear ischemia. Ischemia is achieved by compression of the eighth nerve complex at the porus of the internal acoustical meatus, whereas the compression release allows the reperfusion to occur. While CBF monitoring permits to objectively determine the degree of ischemia and reperfusion, the combined analysis of cochlear potentials and CDTs makes it possible to point out the preferential site of main functional damage within the cochlea, i.e., outer hair cells (OHCs), inner hair cells, or ganglia cells. At least three ischemia-reperfusion sequences can be used on one side, and sometimes both ears can serve for experiments. This model could be applicable for testing drugs with alleged protective effects against cochlear ischemia and/or reperfusion, in treated vs. non-treated animals.
Animals↗
Auditory screening in neonates by means of transient evoked otoacoustic emissions: a report of 2,842 recordings.
The principal goal of an early identification program is to identify hearing impairment present at birth, in order to effect appropriate intervention as early as possible. Although recent research provides some evidence for the value of transient evoked otoacoustic emissions (TEOAEs) in neonate hearing screening, data are needed from large-scale clinical evaluations about the value of using TEOAEs for screening not only high-risk but also healthy neonates. A cohort of 1,421 neonates (2,842 ears) from the well-baby nursery was screened with TEOAEs in a 2-stage process. Neonates were referred from the first test prior to being discharged from the hospital. Those who failed were rescreened before the end of the first month. Those who did not pass the second-stage TEOAE screening were referred for diagnostic audiological evaluation for confirmation of hearing loss. Neonates transferred to a neonatal intensive care unit were not included in this study. Two neonates with bilateral sensorineural hearing loss of >40 dB hearing level were identified from this cohort. This study demonstrates the feasibility and the limitations of using TEOAEs as a universal hearing screening tool for all neonates. It confirms that the prevalence of hearing impairment in neonates has to be taken into account, even in a group of children without high-risk criteria. In France, a prevalence of 1.4 per 1,000 would represent 1,000 deaf children born every year, with reference to about 700,000 births per year. This study suggests that such universal screening programs would substantially increase the rate of early-identified infants with significant hearing impairment.
Acoustic Stimulation↗
[A clinical study of chronic perennial and permanent rhino-sinusal dysfunction. II. Clinical pattern of different pathologies].
Following a univariate analysis of the clinical features of chronic perannual and permanent rhinosinus dysfunction, the aim of this work was to complete the study by a multivariate analysis. The analysis was based on the three main pathologies retained (chronic sinusitis, bilateral symmetrical pansinusitis, anterior facial sinusitis). Each pathological situation was divided into subgroups, Phadiatop positive or negative chronic rhinitis, bilateral symmetrical chronic panethmoiditis or stage I, II or III naso-sinus polyposis, maxillary sinusitis or anterior facial pansinusitis. The clinical features of these different entities were detailed (number, quality and laterality of the symptoms, results of the physical examination). This clinical description was compared with paraclinical findings, particularly computed tomography of the face.
Cerebrospinal Fluid Rhinorrhea↗
[Semiology and etiology of anosmia: apropos of 306 patients].
Chemosensory dysfunction is relatively common. This article describes a series of 306 patients who presented with anosmia. We divided olfactory disorders into those associated with interruption of the transport of stimulus and those associated with damage to either peripheral or central nervous system structures. Nasal and paranasal sinus disease (transport interruption) was found to be causative in 67% of patients presenting with anosmia. These patients are generally 45 years old, the loss of olfaction is progressive and associated with additional nasal symptoms. Upper respiratory infection was found to be causative in 18% of patients. They are generally older, with a mean age of 58 years and are predominantly female (78%). The loss of smell is sudden and anosmia is often accompanied by troublesome parosmias (50%). CT-scan is necessary for the evaluation of a smell dysfunction.
Adult↗
[Anosmia secondary to acute rhinitis: clinical signs and course in a series of 118 patients].
We report here a series of 118 patients (79% women) who developed dysomia after acute rhinitis. Mean age was 59 years. Mean follow-up after the initial rhinal episode was 36 months. The dominant olfactory disorder was anosmia (71% of the patients) and dysgeusia in 71%. The prognosis of anosmia was poor as it persisted in 50% of the patients. Six patients (5%) recovered normal olfaction after a delay of 11 months. Partial recovery was observed in 45% of the patients with a mean 14-month delay. Recovery of olfaction was thus observed within the first year. Parosmia was also frequent (59% of the patients). In two out of three cases, parosmia persisted. Improvement generally occurred during the first 18 months. These olfactory disorders have an impact on the patients' psychic equilibrim since a depressive syndrome was observed in 60% of the cases.
Acute Disease↗
[Good clinical practice in nebulization].
A meeting on nebulization held in April 1997 defined good clinical practices. Guidelines that were proposed pertained to the following: pneumatic and ultrasonic nebulizers; delivering circuit, occluded or not, the choice of the tip being done according to the disease to treat and to the drugs to be delivered; various functions, depending on the type of nebulizer; the particle size, as it will indicate which disease may be treated: between 2 and 6 microns for bronchi, between 0.5 et 3 microns for lung, > 5 microns for ear, nose and throat diseases; compatibility between the type of nebulizer and drugs. Ten drugs are currently registered in France. Nebulization has multiple clinical indications, such as asthma, cystic fibrosis, chronic obstructive pulmonary disease, Pneumocystis carinii pneumonia, acute laryngitis, and in infants, acute bronchiolitis. The prescription must be detailed, and the physician should make sure that the medical staff put it into application.
Administration, Inhalation↗
Characteristics of the acoustic distortion product 2f2-f1 from the normal human ear.
The aim of this study was to determine the basic properties of the 2f2-f1 distortion product otoacoustic emissions (DPOEs) in 36 normally hearing subjects and to compare their characteristics with those of the 2f1-f2 DPOEs. The influence of stimulation parameters on 2f2-f1 DPOE behaviour was examined: i) stimulation levels varied from 40 to 70 dB sound pressure level in 10 dB steps; and ii) two values of the f2/f1 ratio were used (1.12 and 1.22). The prevalence and the level of the 2f2-f1 DPOEs depended on three parameters: f2 frequency, stimulation level and f2/f1 ratio. The results showed many differences between the characteristics of 2f1-f2 and 2f2-f1 DPOEs, probably due to their being generated by different mechanisms. Thus, the 2f2-f1 DPOEs may provide different information about the cochlear status and could be of clinical interest.
Acoustic Stimulation↗
[A sinus neglected for so long...].
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Endoscopy↗
[Acute and chronic sphenoid sinusitis. Review of the literature].
Isolated involvement of the sphenoid sinus is a relatively uncommon entity. We present a review of the most important series. Acute and chronic diseases are separated. Acute sphenoid sinusitis is a potentially catastrophic infectious disease. It is frequently initially misdiagnosed, and, due to the severe intracranial complications, a genuine medical and surgical treatment is recommended. Chronic sphenoid lesions may pose a problem of etiologic diagnosis. It may be difficult to differentiate between benign and malignant lesions. The most common presenting symptom is headache, followed by visual symptoms and cranial nerves palsies. Radiographically, computed tomography is the gold standard. Treatment includes antibiotic therapy and surgical drainage. This drainage is now done through an endoscopic approach.
Acute Disease↗
[Semiologic study of chronic perennial and permanent paranasal sinus dysfunction. Prevalence of symptoms].
Rhino-sinus dysfunction is associated with several symptoms: nasal obstruction, anterior and posterior rhinorrhea, episodes of sneezing, painful or heavy feeling in the face, taste and smell disorders. Certain manifestations have an impact on the pharynx, the larynx or the tracheobronchial tree. This prospective study was conducted in 449 consecutive patients who consulted over an 18-months period from November 1995 to May 1997. The objective was to determine the symptom pattern, main disease of the nasal cavities and paranasal sinuses which were involved: chronic rhinitis, anterior sinusitis, bilateral and symmetric pansinusitis with or without nasosinus polyps. In the first part of the study, the frequency of different symptoms were determined for the main nasosinus diseases. Statistical analysis of the correlations between symptoms and diseases provided a specific approach to symptoms.
Adolescent↗
[Medical treatment of paranasal sinus polyposis: a prospective study in 181 patients].
Treatment of naso-sinus polyposis has been the subject of much controversy. The large number of reports in the literature suggest that role of surgical treatment is on the uprise. There is however general agreement that medical treatment is fundamental although an insufficient number of studies have evaluated its efficacy. The aim of this prospective study was to evaluate results 6 months, 12 months and 2 years after medical treatment of polyposis in 181 patients. Despite a well-coduced information protocol, nearly 19% of the patients were lost to follow-up. Less than 32% of the patients have been operated. Patients treated medically were given a standard regimen according to a protocol combining short-term oral corticosteroids (prednisolone) and steroid nasal spray (beclometasone). Treatment was successful in 68% of the patients given medical treatment alone. Mean symptom intensity declined by 35 to 80% at 6 months then remained unchanged to the end of the study (2 years follow-up). Mean doses of prednisolone and beclomethasone were evaluated. Doses could be tapered off progressively allowing satisfactory nasal comfort. Medical treatment should be the first line therapy for nasal polyposis. Surgery should not be proposed until corticosteroid therapy has been found to be unsuccessful over a mean 6 months of a well-conducted treatment and good patient compliance.
Adolescent↗
[Treatment of nasal obstruction with subtotal inferior turbinectomy in chronic rhinitis: a retrospective study on 50 patients].
Between January 1993 and September 1996, 50 patients underwent isolated subtotal turbinectomy (without associated septal intervention). This retrospective study analyzes the short and long-term subjective results after a mean 24-month follow-up. Surgery was successful in 80% of cases yielding good nasal repermeabilization. Rhinorrhea and post nasal drip were improved in 30% of cases. Facial pains and hyposmia were improved in 71% and 89% respectively. No cases of crusting rhinitis were observed. Subtotal inferior turbinectomy, although it has raised some controversy, is the treatment of choice for the patients suffering from chronic rhinitis related to hypertrophy of the inferior nasal conchae resistant to medical treatment.
Adult↗
[Clinical, etiologic and therapeutic aspects of chronic sphenoid opacities].
A series of 23 patients with sphenoid disease were seen between 1992 and 1997. The most common symptom was headache. This headache was found to be nonspecific. Cranial nerve abnormalities were found in two patients. The different types of radiolographic images were analyzed, and compared with the surgical diagnosis. Twenty-one patients underwent surgical exploration by intranasal endoscopic sphenoidotomy. This approach allowed drainage and inspection of the sinus.
Adult↗