[Acquired subglottic stenosis after heart-lung transplantation. Efficacy of treatment by inhalation of budesonide].
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Administration, Inhalation↗
Biomedical subjects
E N Garabedian
Publications and source records attributed to E N Garabedian.
[Indications and results of cochlear implants in young children].
In order to determine the criteria for patient selection and the preoperative prognostic factors for hearing recovery after cochlear implants in young totally dead children, the results of hearing rehabilitation were studied in 15 children who had undergone cochlear implantation at from 2 to 9 years of age. The choice of implant is determined by the permeability of the cochlear duct. A multi-system should be used, except when the cochlea is totally ossified. The reliability and efficacy of mono and multi system implants make it possible to offer a solution to the urgent therapeutic problems posed by total deafness in the young child.
Age Factors↗
[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↗
[Choanal atresia: management and surgical treatment. Study of 50 cases].
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.
Choanal Atresia↗
[Current therapeutic approach to cervicofacial lymphangiomas in children].
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.
Child↗
[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↗
[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↗
[Cochlear implants in children].
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Child↗
[Cervicofacial cysts and fistulas in children].
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Branchial Region↗
[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↗
[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↗
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↗
[Congenital sensorineural deafness and associated syndromes].
The etiology of perceptive deafness, especially the congenital variety, requires investigation. The presence of a variety of signs associated with deafness constitutes an "associated syndrome" and helps to define a possible genetic origin. These syndromes only represent a small percentage of overall causes of deafness in children, since at most they account for only 10% of cases. Certain syndromes are encountered more often or are well known, others are extremely rare or have only been described recently. The authors report six of these very rare syndromes discovered among their patients: a KID syndrome, a Leopard syndrome, a Norrie syndrome, a Jervell and Lange Nielsen syndrome, a recently described entity called CEE with deafness and an External Neuro-Cochleo-Pancreatic syndrome which would not appear to have been previously described.
Abnormalities, Multiple↗
[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↗
[Hereditary epidermolysis bullosa and laryngeal involvement].
Two cases of epidermolysis bullosa (EB) with laryngeal involvement are reported in 2 Algerian girls, aged 6 and 7 years. The first one with a junctional EB, received local treatment with good results. For the second, with an EB dystrophica, tracheostomy was necessary and remained so. Laryngeal involvement is rare in EB. It and remained so can be serious and life-threatening. Eight cases where previously reported. Their clinical and therapeutical particularities are discussed.
Child↗
[Protracted otitis and subacute mastoiditis in children. A prospective study apropos of 118 cases].
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.
Adenoidectomy↗
[Emergency tracheobronchoscopy in children with burns].
Smoke inhalation affects the upper airways and lung parenchyma, causing the burn victims' death rate to increase substantially. Early diagnosis is hard to obtain, as clinical signs of complications will be delayed. However, both improved chances for survival and a lower incidence of sequelae depend on how soon treatment is initiated. The smoke inhalation syndrome suspectacle from the case history cannot be confirmed without due paraclinical investigations. The authors retrace their experience with 42 children hospitalized at the Hôpital Trousseau Burn Unit. They stress the importance of emergy ENT endoscopic assessment for obtaining the diagnostic and therapeutic data necessary for taking adequate measures.
Bronchial Diseases↗
[Otorhinolaryngologic involvement in cystic fibrosis].
ENT involvement is very frequent in mucoviscidosis, particularly rhinitis and sinusitis. This prospective study, which spanned from September 1st, 1988 to August 31st, 1989 anc included 27 children with cystic fibrosis of pancreas was carried out with the intent of determining the incidence of the various associated diseases, their bacteriologic profile, and the optimal therapeutic procedure. Less than a child in 5 is symptomless when the nose and sinuses are affected. Polyposis is found to occur in 6/27 cases, and all children have sinus radio-opacities. Ear disease is rare (1/4 of cases) and is manifested by asymptomatic tubal dysfunction with minimal audiometric repercussions. Bacteriologic specimens of sputum and sinus purulent discharge show simultaneous germ positivity (10 times out of 11). Our therapeutic recommendations are based on our own experience as well as literature data, and are, in our opinion, only relevant for children with clinical signs of disease, as opposed to advocating systematic treatment of sinus foci found on X-ray.
Adolescent↗