Biomedical subjects
Publications and source records attributed to F Disant.
To compare the ototoxicity of amikacin and netilmicin, tone audiometry, high-frequency audiometry, early auditory evoked potentials, and evoked otoacoustic emission testing were used to evaluate 30 patients (15 under amikacin and 15 under netilmicin). Ototoxicity was not significantly different in the two groups.
Tracheotomy in children has two main fields of indication: 1) obstructions of the upper respiratory tract, the main cause being today the post-intubation stenosis; 2) long term mechanical ventilation. When performed in good conditions, with adapted care, there are few complications, among them the accidental denaculation being the most worrying. When long-term tracheotomy is needed, parent-education, together with special equipment and adapted environment may allow the return of the tracheotomised child at home in secure conditions. Special attention with preventive measures during intubation is recommended in order to reduce the number of tracheotomies for post-intubation stenosis.
Chronic hoarseness is frequent among children, as shown by 64 cases observed over an 18-month period in a specialized phoniatric outpatients clinic. Age at the first consultation for these 64 patients was 3-14 year although the hoarseness was already known for more than 1 year in 40 patients (62.5%). The main findings at laryngoscopy were an edematous vocal cord (33%), a unilateral or bilateral nodular lesion (26%), and an epidermoïd cyst (17%). The larynx was normal in 2 patients only. Orthophonic re-education was prescribed for 45 patients (70%); it was followed by laryngeal microsurgery in 3 patients: 9 patients were completely cured, 26 were improved, 4 showed no improvement, 16 could not be located for follow-up. Chronic hoarseness in children has numerous etiologies which can be divided into 5 main groups. The 2 more frequent are the hyperkinetic or hypokinetic laryngeal dysfunctions and the congenital lesions. The 3 other groups are much less frequent: juvenile laryngeal papillomatosis, recurrent palsy and pithiatic aphonia. Laryngoscopy is important for the diagnosis. Orthophonic re-education represents the main treatment; it completes the surgical treatment when microsurgery of the larynx is necessary.
The authors review the embryological, clinical and therapeutic aspects of congenital facial and cervical cysts (C) and fistulae (F), based on a personal series of 85 cases (facial: 18, latero-cervical: 29, mediocervical: 38) observed during a 5-year period. The facial forms are the result of an incomplete coalescence of the facial buds and most often present as helical F (17/18). Laterocervical C and F are due to abnormal evolution of branchial clefts; the main clinical forms are related to anomalies of the 2nd branchial cleft (24/29), usually presenting as sinus localized at the anterior border of the lower third of the sternocleidomastoid muscle (8) and amygdaloid cysts. Thyroglossal duct cysts are the most frequent of the medio-cervical C and F (35/38); they usually present as a mediocervical cyst in the thyro-hyoid space which may be revealed by an infection or a fistulization. The only appropriate treatment of congenital facial and cervical C and F is surgery providing that the resection is meticulous with complete resection of the fistula in order to avoid relapse. Complete resection also suppresses the risk of secondary malignant degeneration of amygdaloid and thyroglossal duct cysts.
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The authors recall the importance of collagen in the ultrastructure of the lamina propria and the properties of the type IV collagen concerning epidermic healing. Tympanomeatic graft composed of reticulated type IV collagen was used as a graft in rats. This experimental study demonstrated a good stability of the graft 40 days after operating. A new non toxic cross linking technique has been developed to stabilise of the biomaterial. The type IV collagen film shows good properties for the growth and the differentiation of epithelial cell like keratinocytes.
The relation between Minnesota Multiphasic Personality Inventory (MMPI) and tinnitus was examined in 100 subjects with tinnitus disorders. The overall profile of tinnitus sufferers on the MMPI was normal. Higher scores on the depression scale were obtained in males. High hypochondria scores were related to long duration of tinnitus. High psychoasthenia scores were associated with hearing loss. Despite an analogy previously described between chronic pain and tinnitus, the psychometric parameters of tinnitus and of headaches are quite different.
This experimental study involving dogs tested type IV human collagen as a biomaterial for use in the tympanic membrane reconstruction. A loss of substance was induced for the two tympanic membranes, and a type IV collagen graft made to one side. The kinetics of receiver fibroblast colonisation of the graft, as well as in the case of resorption, were studied. Anatomopathological examination revealed the process of reconstitution. This animal study prepares the way for studies on man.
The use of rib cartilage graft in ear reconstruction gives good cosmetic results after the age of 8. However three main conditions must be taken into account: 1) a perfect framework sculpture; 2) good quality of the skin in order to provide a soft tissue free of scars and able to drape the framework in all the details of the sculpture; 3) a soft but useful succion system allowing a good coaptation between the framework and the skin without vascular damage. Most of the surgical failures are due to skin scars which compromise the elasticity of the cutaneous pocket. The authors recommend to wait until the age of 8 before any surgery in order to keep the skin intact and to let the ribs grow. The problem of hearing can be treated as secondary.
This study presents the use of human type IV collagen film in myringoplasty in dogs. Evaluation criteria were clinical (repeated otoscopies) and histological (histological analysis of cicatrised membranes). This new biomaterial should seem to be a technological advance on temporal bone aponevrosis or perichondria auto-grafts. This study constitutes the necessary preliminary research to any application in man.
Following Kemp's original studies, several others have confirmed the existence of otoacoustic emissions. Their clinical relevance remains, however, to be clarified. The various published studies have concerned small series. This study sought to specify otoacoustic emission characteristics in relation to sensorineural hearing loss (148 ears of 76 subjects). The results show that the presence of otoacoustic emissions drops as a function of hearing loss and that there is a highly statistically significant correlation between otoacoustic emission threshold and hearing loss at the 1000-Hz frequency. Otoacoustic emissions are never found when hearing loss at 1000 Hz exceeds 40 dB hearing level and when the mean audiometric hearing loss (at 500, 1000, 2000, and 4000 Hz) exceeds 45 dB hearing level. The main practical conclusion is that otoacoustic emission presence indicates middle frequency functional integrity of the outer hair cells of Corti's organ. Absence of otoacoustic emissions is harder to interpret.
The aim of this work was to study the age-effect on otoacoustic emissions (OAE) (93 subjects, 166 ears). The results show that when age increases the presence of OAE by age group decreases as well as the frequency peak in spectral analysis. The OAE threshold increases with age. So there is an effect of age upon OAE. The effect seems linked with alteration hair cell loss and/or alteration of cochlear biomechanics.
Cholesteatoma is characterized by the accumulation of a desquamating epithelium within the middle ear. Its development and spreading are favoured by chronic inflammatory and suppurative processes. The main clinical manifestations are persistent or episodic, frequently fetid purulent discharge, hearing impairment, vertigo and rarely complications (mastoiditis, labyrinthitis or meningitis). Therapy is preventive: careful management and follow-up of children with recurrent or chronic otitis media with effusion. Surgical treatment is mandatory once cholesteatoma is constituted.
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We used transcutaneous electrotherapy to treat 27 patients with persistent tinnitus. Each patient was tested with the short form of the Minnesota Multiphasic Personality Index test (MMPI) prior to the commencement of treatment. The "unimproved" group of patients (n = 15) showed higher pretreatment scores for depression (P less than 0.05), psychasthenia (P less than 0.05) and schizophrenia (P less than 0.02). Our findings indicate that patients having significantly pathological scores on at least one of these three scales will fail to benefit from treatment. These findings also show that there appear to be psychological prognostic factors that can be used to evaluate patients receiving transcutaneous electrotherapy for persistent tinnitus.
Mastoiditis remains relatively frequent in children. The main clinical forms are recalled. Surgical treatment is mandatory.
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