ABSTRACT
Cholesteatoma is more destructive in the child than in the adult, but few studies have examined the outcome as a function of age. The authors evaluated retrospectively their experience in 199 cases of cholesteatomas or uncontrollable fixed retraction pouches in children under the age of 15. Mean follow-up was 2 and a half years and the anatomic and functional results are detailed. Reasons for performing first intention or second intention canal wall up or down procedures were analyzed as a function of age. Residual cholesteatomas were particularly frequent in whatever the initial surgical procedure. Cholesteatomas and retraction pouches in the child under 5 (n = 24) were particularly aggressive and destructive, often requiring a canal wall down operation. Residual cholesteatomas were also very frequent and involved both bony and functional element of the petrus. The clinical course of cholesteatoma in the young child appears to be very different, becoming less destructive as the child reaches adulthood.
Subject(s)
Cholesteatoma, Middle Ear/surgery , Adolescent , Child , Child, Preschool , Cholesteatoma, Middle Ear/pathology , Female , Humans , Infant , Male , Middle Ear Ventilation , Recurrence , Retrospective Studies , Tympanic Membrane/surgery , TympanoplastyABSTRACT
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.
Subject(s)
Cochlear Implants/standards , Deafness/surgery , Child , Cochlear Implants/classification , Deafness/diagnosis , Deafness/psychology , Humans , Otolaryngology/methods , Patient Care Team , Pediatrics/methods , Quality of LifeABSTRACT
Diagnosis of choanal atresia should lead to multidisciplinary investigations to look for other malformations which may or may not be part of the CHARGE syndrome. These concomitant defects have an adverse effect on prognosis in patients with choanal atresia. They seem to be more common in patients with bilateral choanal atresia due to a bony septum. Local investigations include nasal fiberoptic endoscopy to obtain a direct view of the atresia and a CT scan study to determine the type of obstruction. In neonates, treatment rests on transnasal perforation of the septum followed by stenting for four to six weeks. However recurrence is common and requires subsequent use of another therapeutic procedure. In patients with failed transnasal perforation or unilateral choanal atresia discovered at a later age, surgery through the palatal route seems to be virtually radical and can be carried out from eight months of age. Recently developed CO2 laser therapy is, in the opinion in of the authors, an elegant and simple means for transnasal treatment of fibrotic restenosis which, in many cases, obviates the need for transpalatal surgery.
Subject(s)
Choanal Atresia/surgery , Choanal Atresia/diagnosis , Choanal Atresia/epidemiology , Endoscopy , Female , Follow-Up Studies , Hospitals, Pediatric , Humans , Infant , Laser Therapy/methods , Male , Paris/epidemiology , Patient Care Team , Recurrence , Stents , Tomography, X-Ray ComputedABSTRACT
Twenty-four cases of cervicofacial lymphangioma treated between 1984 and 1991 are reported. The therapeutic approach is discussed. Because the therapeutic problem depends on whether or not the airways are involved, an endoscopic evaluation and a CT scan study should be included in the workup. In the five patients with limited lymphangiomas, complete surgical exeresis was feasible and yielded good results. Sclerosing injections are an alternative to surgery in this situation. In patients with pharyngeal or laryngeal infiltration or involvement of the mediastinum, the prognosis is extremely grim and surgery is still the mainstay of therapy despite the potential for recurrence due to the fact that only incomplete exeresis can be performed. Tracheostomy was required in two patients.
Subject(s)
Head and Neck Neoplasms/surgery , Lymphangioma/surgery , Child , Child, Preschool , Endoscopy , Female , Follow-Up Studies , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Hospitals, Pediatric , Humans , Infant , Lymphangioma/diagnosis , Lymphangioma/epidemiology , Magnetic Resonance Imaging , Male , Neoplasm Recurrence, Local , Paris/epidemiology , Prognosis , Sclerosing Solutions/therapeutic use , Tomography, X-Ray ComputedABSTRACT
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.
Subject(s)
Diatrizoate , Facial Neoplasms/therapy , Fatty Acids , Head and Neck Neoplasms/therapy , Lymphangioma/therapy , Propylene Glycols , Proteins/therapeutic use , Sclerosing Solutions/therapeutic use , Zein , Child , Child, Preschool , Combined Modality Therapy , Drug Combinations , Facial Neoplasms/surgery , Female , Head and Neck Neoplasms/surgery , Humans , Infant , Lymphangioma/surgery , Male , Neoplasm Recurrence, Local , Retrospective StudiesABSTRACT
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.
Subject(s)
Cricoid Cartilage/surgery , Laryngostenosis/congenital , Humans , Infant, Newborn , Laryngostenosis/surgery , Male , Methods , Postoperative ComplicationsABSTRACT
Antibiotherapy has lead to a substantial decrease in the number of infants with acute mastoiditis or complications thereof. However, the non-negligible incidence of protracted otitis currently observed has caused one to raise several pathogenid hypotheses, among which subacute mastoiditis figures as one needing to be detected early. This prospective study was conducted on 118 children treated for protracted otitis in the ENT Service at Hopital Trousseau, during the period from january 1987 to december 1988. It allowed us to develop diagnostic and therapeutic strategies to cope with the difficult problem of protracted otitis, taking into account bacteriologic findings and risk factors, among other things.
