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Biomedical subjects

P Narcy

Publications and source records attributed to P Narcy.

At least 37 records · Page 2Linked to original sources
PubMed1997

Hearing impairment in infants after meningitis: detection by transient evoked otoacoustic emissions.

OBJECTIVE: To evaluate the feasibility and cost-effectiveness of using transient evoked otoacoustic emissions (TEOEs) to assess hearing in infants recovered from meningitis. METHODS: Recordings of TEOEs and visual reinforcement audiometry (VRA) were performed in a prospective study of 39 children aged 6 to 24 months recovering from a purulent meningitis. Patients with no TEOEs, or whose VRA findings were abnormal, were also tested by impedance audiometry and recording of auditory brain-stem responses (ABRs) after treatment of any secretory otitis media. Costs were compared with those of a previous protocol including VRA, impedance audiometry, and ABR for all children. RESULTS: A total of 29 children had TEOEs in both ears and normal VRA findings. Ten children lacked TEOEs in one or both ears; 9 of them had otitis media with effusion. Further examination by VRA and ABR led to the diagnosis of bilateral sensorineural hearing loss in 2.6% (1/39) of patients and unilateral sensorineural hearing loss in 7.7% (3/39) of patients. Cost analysis revealed that this protocol costs about half the previous one. CONCLUSION: Recording TEOEs appears to be a feasible and cost-effective hearing screening test for infants recovered from meningitis. If TEOEs are absent, impedance audiometry, ABR recordings, and audiometric evaluation techniques are needed to distinguish between conductive and sensorineural hearing loss and to assess hearing thresholds precisely.

Acoustic Impedance Tests↗
PubMed1997

[Mode of presentation of fistula of the first branchial cleft].

BACKGROUND: The rarity and diverse presentations of first branchial cleft anomalies lead to misdiagnosis and inadequate treatment. POPULATION AND METHODS: We report 21 cases of such anomalies in children aged 7 months to 8 years whose diagnosis was presumed on clinical presentation and confirmed at surgery. RESULTS: The symptoms were intractable otorrhea, periauricular, cervical and parotid suppuration, which were present in two, 12, five and three cases, respectively. Two children had an abnormal eardrum and three an epidermic cyst in the external ear canal. CONCLUSION: The diagnosis of a first branchial cleft anomaly must be considered in any patient with a history of recurrent periauricular swelling, a sinus located high in the neck, or a mass in the external auditory canal.

Branchial Region↗
PubMed1997

Human immunodeficiency virus-1 infection in neonates: correlation of plasma and cellular viremia and clinical outcome. French Pediatric Cohort Study Group.

Among human immunodeficiency virus-1 (HIV-1) vertically infected children, two patterns of disease progression have been observed: about 25% develop a severe immunodeficiency within the first 2 years of life; the rest experience a slower progression, like adults. We have assessed infectious viral burden in infected neonates through the French National Prospective Study. Plasma and cell-associated viremia were assayed by endpoint-dilution cultures in samples from 46 infants followed prospectively from birth. Plasma and cell-associated viral burden were found to be significantly higher in rapid progressing infants than in non-progressing infants in the first months of life: before the age of 2 months, between 2 and 4 months of age and by the age of 6 months. Moreover, among the non-progressing children, the infectious viral burden before the age of 4 months was predictive of the viral burden measured after the age of 12 months. In conclusion, this work demonstrates that infectious viral load is a reliable predictive marker for rapid progression to AIDS in infants and could be useful for initiating antiretroviral therapy.

Age Factors↗
PubMed1996

Outcome of laryngeal paralysis in neonates: a long term retrospective study of 113 cases.

Between 1985 and 1990, 113 children were diagnosed as having congenital vocal cord paralysis. Most of them were still being followed up in June 1994. Fifty two had bilateral paralysis, 61 had unilateral paralysis: 41 were on the left side and 20 on the right side. Forty two were idiopathic, 29 were associated with neurologic disorders, six were associated with heart malformations. Fifteen children were born after difficult delivery. Among the newborns with unilateral paralysis that occurred after an abnormal delivery, 73% recovered spontaneously; likewise 70% of the neurologic group and 74% of the idiopathic group recovered spontaneously. The prognosis of bilateral paralysis was worse with only 52% of spontaneous recovery in the neurologic disorders group and the idiopathic group. Seven percent of the children underwent a surgical procedure. They were all decanulated or extubated. In view of our experience the prognosis is poor for bilateral idiopathic laryngeal paralysis or those with neurological context.

Female↗
PubMed1996

Evolution of transient evoked otoacoustic emissions in preterm newborns: a preliminary study.

Transient evoked otoacoustic emissions (TEOEs) were recorded in a cohort study of preterm neonates in order to study their basic properties as a function of gestational age. Their main properties were: (1) TEOEs spectrum did not vary with age; it was analogous to those of full term; (2) there was no statistically significant variation of the TEOEs amplitude with age. The maturation of outer hair cell properties appears to be complete at a gestational age of 29 weeks. Because a number of infants at risk for hearing loss are preterm babies, screening for TEOEs has to be performed in the neonatal care unit. To improve the accuracy and efficiency of the test, screening should take place as close to hospital discharge as possible, with the optimum time at 35 gestational weeks.

Analysis of Variance↗
PubMed1996

[Pneumococcal meningitis revealing dysplasia of the bony labyrinth in an infant].

BACKGROUND: Dysplasias of the bony labyrinth are frequently associated with cerebrospinal fluid fistula and are usually discovered because of recurrent meningitis. CASE REPORT: A 1 year-old infant was admitted for a pneumococcal meningitis which appeared 2 days after the occurrence of a clear otorrhea from the right ear. The same organism was isolated from the otorrhea fluid, which also contained cerebrospinal fluid as confirmed cytochemically. The meningitis rapidly resolved with antibiotic treatment. Auditory brain stem responses were abolished from the right ear. CT of the temporal bones showed a pseudo-Mondini type labyrinth dysplasia at the right ear and Mondini type dysplasia at the left one. A translabyrinthine cerebrospinal fluid fistula was discovered by surgical exploration of the right ear, occurring through a perforation in the stapedial foot plate. The leak was cured by packing the vestibule and obturating both oval and round windows. Three years after the operation, the child did not experience any further episode of otorrhea or meningitis. CONCLUSIONS: Features suggesting a translabyrinthine fistula, especially otorrhea and deafness, should be systematically searched in any child with bacterial meningitis. Closure of these fistulas can prevent severe infectious recurrences.

Cerebrospinal Fluid Otorrhea↗
PubMed1996

Bilateral evoked otoacoustic emissions in a child with bilateral profound hearing loss.

Recording of bilateral evoked otoacoustic emissions in a 3-year-old girl with bilateral profound hearing loss is presented. No component of auditory-evoked brain stem potentials was recorded. Findings on computed tomography of the inner ear were within normal limits. At retest 3 months later, these results were unchanged. Explanations for this particular condition are presented together with a review of the literature.

Audiometry, Pure-Tone↗
PubMed1996

Canal and otolith vestibulo-ocular reflexes to vertical and off vertical axis rotations in children learning to walk.

In order to determine the characteristics of the vestibulo-ocular reflexes (VORs) as a function of age and posturo-motor development, a group of 26 normal children (6 to 25 months old) were tested at three different stages of posturo-motor control: prior to as well as during the first attempts to walk without support, and during the first year of independent walking. The test consisted of electro-oculographic (EOG) recordings of the VOR responses to horizontal semi-circular canal and otolith stimulations. The canal VOR was elicited in seated subjects by rotatory impulsions about a vertical axis (acceleration and deceleration both at 40 degrees/s2, separated by a rotation at 60 degrees/s velocity). The otolith VOR was elicited by inclining the rotating chair by 9 degrees respect to gravity. For the canal VOR, the time constant and the highest initial slow phase velocity were measured. The otolith VOR was characterized by the amplitude of the modulation and the bias (offset of baseline from zero) of the slow phase velocity averaged over 10 to 20 rotation cycles, for both the horizontal and vertical components of the response. The pooled values of these data show that canal VOR parameters did not vary significantly either with age of the children or with their stage of posturo-motor control. However, the otolith VOR parameters changed during the period of learning to walk: the modulation of the horizontal component increased and the modulation of the vertical component decreased significantly. Thus the ability to walk without support is marked by a significant change in the otolith but not canal responses; since the vestibular sensory organs develop anatomically at the same rate these results indicate that central nervous system processors of canal and otolith information develop independently.

Electrooculography↗
PubMed1996

Is nasal polyposis in cystic fibrosis a direct manifestation of genetic mutation or a complication of chronic infection?

Cystic fibrosis (CF) is the most common autosomal recessive disease among Caucasians. It is characterized by abnormal transepithelial sodium and chloride transport. The clinical expressions of the disorder are highly variable including nasal polyposis. Some authors have found that CF children with nasal polyposis form a distinct subgroup of patients within the clinical heterogeneity of the disease with milder gastrointestinal and pulmonary symptoms. The aim of this prospective study was to verify whether the clinical manifestations in CF children with nasal polyposis are different from control CF patients, and to identify any correlation between a phenotype of nasal polyposis and a genotype. Sixty-six CF children, aged 1-25 years, consecutively underwent ENT examination including nasal endoscopy. Twenty-one had nasal polyposis. The remainder formed the control group. There was no statistical difference in the mode and age of presentation of the disease between the two groups. The clinical manifestations (Schwachman and Kulczycki score, colonization by Staphylococcus aureus and Pseudomonas aeruginosa) were comparable between the two groups. We found no statistical difference in the repartition of genotypes between the polyposis and the control groups. Nasal polyposis does not seem to be genetically dependent, but a larger sample of patients is needed to reach an accurate conclusion.

Adolescent↗
PubMed1995

Screening for neonatal and infant deafness in Europe in 1992.

Many methods of screening for hearing impairment are available. The aim of our study was to determine which ones were really used in 1992. At the request of the British Audiology Society, we conducted an inquiry into the organization of screening for deafness in neonates and infants in Europe. In practice all 6-9 month-old infants are tested with behavioural tests in every country. For the neonates, generally only those at risk for hearing-impairment (about 5%) were tested. The most widely used tests were behavioural ones. Only specialized centers used transient evoked otoacoustic emissions (TEOAEs). This last test assesses the active mechanical properties of the cochlea and allows detection of even mild or unilateral sensorineural deafness.

Audiometry↗
PubMed1995

[Deafness in the neonatal period: basis for screening].

Deafness must be recognized in infancy in order to reduce auditory disability to a minimum. To achieve this, it is important to implement screening programmes as soon after birth as possible. In the United States, the Joint Committee on Infant Hearing recommended in 1982 that identification of hearing loss should be screened in the neonatal period. This early detection is now considered critical for optimal rehabilitative outcome. This paper presents the "state of art" neonatal screening principles and procedures. In France, neonatal screening programs for auditory dysfunction are not consistent with these principles. Evoked otoacoustic emissions represent an important advance in screening for hearing loss in normal neonates and babies from neonatal intensive care units. This method records very low intensity sound energy released by the cochlea in response to a brief sound stimulation. These otoacoustic emissions show promise as a rapid, cost-effective means of quickly discharging all babies with normal peripherical auditory systems.

Deafness↗
PubMed1995

[Conservative otoplastic modelling: early operative indication].

The authors presents their philosophy and their experience in the field of otoplasty in young children. The modelling and conservative characteristic of the surgical procedure, used for over 6 years, allows surgery on children as young as 3 years old. They detail the different operative steps underlining the rarity of the complications, the natural results achieved and the stability of these results with the child growth.

Ambulatory Surgical Procedures↗
PubMed1995

[Tonsillectomy in a day care hospital. A socioeconomic study at the Robert Debré Hospital in Paris].

Tonsillectomy as an outpatient procedure in children is a common practice in the United States and many other countries. In French public hospitals, it remains quite rare. A 6-month prospective study was conducted in order to check the procedure's feasibility in a large Paris university children's hospital, to describe the involved population and to search for the possible benefits which could be made by a public hospital from an increase in day surgery practice for tonsillectomy. In terms of quality of postoperative outcome, this study confirms the absence of major complications related to this procedure if the proper criteria are met for day surgery. In fact, medical and social findings from the involved patients tend to limit here a large extension of this procedure. For example, in the inpatients group, more than 43% of children had a tonsillar hypertrophy with significant airway obstruction and 47% did not have lodging conditions which would allow day surgery with the required safety. Only 20% of patients could be transferred to ambulatory surgery which leads to 2-3 additional cases each week here. Finally, the cost analysis shows no benefit in human resources at this hospital because the requested differential activity threshold would not be reached.

Ambulatory Surgical Procedures↗