[Are non-steroidal anti-inflammatory agents justified in the treatment of acute otitis media in children?].
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Acute Disease↗
Biomedical subjects
P Narcy
Publications and source records attributed to P Narcy.
Gastropharyngeal reflux in infants and children. A pharyngeal pH monitoring study.
Gastroesophageal reflux has been shown to play an important role in chronic and acute inflammatory disorders of the airway. In particular, gastroesophageal reflux has been suggested to be the cause of pharyngolaryngeal problems, according to the literature, at any age. However, to our knowledge, the presence of acid in the pharynx in pathological cases has not yet been proved. A series of eight patients (aged 2 months to 7.5 years) with recurrent acute laryngotracheitis underwent a two-channel pH monitoring for 23 to 24 hours. One pH probe was placed in the lower esophagus, the other in the pharynx, at the level of the epiglottis. Acid gastroesophagopharyngeal reflux was demonstrated in every patient. A significant difference with a series of six control subjects was noted in terms of esophageal and pharyngeal pH monitoring. The most significant item is the total time the pH in the pharynx was below 6. Despite the limited number of patients, this study suggests the role of gastroesophageal reflux in recurrent laryngotracheitis in infants and children.
Acute Disease↗
Bacteremia during tonsillectomy.
To determine the risk of bacteremia during tonsillectomy, we cultured blood specimens that were taken from 32 children during surgery and tonsillar swabs that were obtained just before excision, and compared the results with quantitative cultures of the excised tonsillar tissue. Twenty-five children had Haemophilus influenzae within the tonsillar tissue (density range, 10(3) to 10(8) colony-forming units per gram), and seven had Streptococcus pyogenes (density, 10(3) colony-forming units per gram in one case, 10(5) colony-forming units per gram in one case, and 10(6) colony-forming units per gram in five cases). Twelve perioperative blood cultures were positive; H influenzae was found nine times, and Micrococcus species was found one time, and alpha-hemolytic streptococci were found two times. Haemophilus influenzae was always present in the corresponding tonsillar specimens, although there was no apparent relationship between the density of colonization of the tonsillar tissue and a positive blood culture.
Bacteremia↗
Laryngeal ultrasonography in infants and children: a new way of investigating. Normal and pathological findings.
Ultrasound of the larynx appears as a new way of imaging the larynx in infants and children. The normal sonographic anatomy is briefly described. The pathological findings of this method, its advantages and its drawbacks are discussed. It appears to be a very interesting method for functional disorders and space-occupying lesions.
Adolescent↗
Contribution of MR in the diagnosis of 'occult' posterior laryngeal cleft.
This paper reports three cases of 'occult' submucous posterior laryngeal cleft in which MR examination has visualized the deficiency of the posterior cricoid lamina. Laryngeal cleft is an uncommon anomaly, and its clinical and endoscopic diagnosis is always difficult. To our knowledge, the role of MR in this diagnosis has not yet been emphasized.
Cricoid Cartilage↗
Tracheal rupture in a newborn during a complicated delivery. Diagnosis and surgical repair.
Rupture of the trachea is an exceptional obstetrical lesion. The infant reported in this paper, at 1 hour of age, developed respiratory distress with pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema. This resulted from the fact that the trachea had ruptured, within 1 cm of the carina, during the difficult delivery. When the child was 23 days old, operation proved necessary because extubation was not feasible. The stenotic portion of the trachea was resected and continuity restored by end-to-end anastomosis. The tracheal lumen at the site of the anastomosis proved normal by bronchoscopic examination 4 months after the operation. There is only one similar case in the literature. The etiology of this rupture is discussed.
Birth Injuries↗
Chiari malformation type I in a child with velopharyngeal insufficiency.
A five-year-old girl was referred for chronic and stable velopharyngeal insufficiency. Pharyngoplasty was performed, without significant improvement, and further neurological investigation was undertaken. Clinical examination and electromyography led to a suspicion of denervation of the IX, X and XI cranial nerves. Magnetic resonance imaging revealed a type 1 Chiari malformation.
Arnold-Chiari Malformation↗
Bacteriology of tonsils in children: comparison between recurrent acute tonsillitis and tonsillar hypertrophy.
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Acute Disease↗
Spontaneous and evoked otoacoustic emissions in preterm neonates.
Spontaneous (SOEs) and evoked otoacoustic emissions (EOEs) were recorded in a group of preterm neonates (N = 134 ears) in order to study the basic properties of SOEs and EOEs as a function of gestational age. In the study, it was found that: 1. EOEs were recorded in 93% of the tested ears; 2. SOEs were recorded in 61% of the tested ears; 3. there were no statistically significant variations of EOE amplitude with gestational age; 4. EOE spectrum did not vary with age; and 5. the two main factors influencing EOE amplitude were the SOE presence and the fast Fourier transform spectrum, especially the lower limit of the spectrum. Thus, the maturation of outer hair cell properties appears to be complete at 32 weeks of gestational age. Because a number of infants at risk for hearing loss are preterm babies, screening for EOEs, an objective, rapid, and nontraumatic technique, may prove useful in evaluating peripheral auditory dysfunction in preterm neonates.
Cochlea↗
Distortion-product otoacoustic emissions in neonates: normative data.
Distortion-product otoacoustic emissions (DPOEs) are otoacoustic emissions evoked by two pure tones and used in order to provide a frequency specific assessment of the mechanical properties of the cochlea. This paper first reports complete input-output DPOE functions for audiometric frequencies between 867 Hertz and 8 kHz in a normal neonate population (normative data). DPOE results were analyzed as a function of evoked otoacoustic emission (EOE) properties. Neonates having normal EOEs have large DPOEs. DPOE amplitudes in neonates are larger than in adults. Neonates with atypical EOE frequency spectrum without low frequency components had normal DPOE input-output functions only for high frequencies (above 2 kHz). DPOEs could be useful, in association with EOEs, to precisely evaluate the auditory peripheral function in neonates.
Humans↗
[Long-term esophageal and oropharyngeal pH-metry in ORL manifestations of gastroesophageal reflux in children].
Several studies published over the last few years have pointed out the importance of gastroesophageal reflux (GER) in the pathogenesis of certain cases of chronic or recurrent pharyngo-laryngitis. While the presence of an acid reflux at the level of the pharyngo-larynx has recently been demonstrated in certain cases, the real incidence and pathogenic impact of this reflux is not precisely known. A new technique of continuous 24 hour bi-level monitoring of endoluminal pH in the esophagus and the oro/hypopharynx has made it possible to observe the variations in acid-base balance in contact with the pathological mucosa. 21 patients, 2 months to 7.5 years old, presenting recurrent episodes of pharyngitis or laryngitis, underwent continuous pH monitoring during a 24 hour hospitalization. 6 control subjects, 1 month to 13 years old, presenting no chronic or recurrent ear, head or neck pathology and no sign or symptom of GER were subjected to the same monitoring regimen. A statistically significant difference between the 2 groups is evident for most of the parameters analysed. The most discriminative parameter is the fraction of the total recording time where the pharyngeal readings remain under ph6 (p < 0.0005). These results demonstrate that, in this clinical condition, acid of gastroesophageal origin is in contact with the pharyngeal mucosa. This suggests that the acid has a causal role in the pathological changes observed in the pharyngolaryngeal mucosa.
Child↗
[Deafness screening in children by otoacoustic emissions. Current data].
Hearing impairment should be detected in early childhood. Among available screening techniques, acoustic oto-emission testing is a rapid, reliable, noninvasive method which specifically investigates peripheral hearing but does not provide data on auditory nerve centers. This functional test should be carried out within a few days of birth in infants with risk factors for hearing impairment.
Hearing Disorders↗
[Why and how should serous otitis media be treated?].
Serous otitis media is an extremely commonplace condition in pediatric patients and tends to resolve spontaneously. Only some forms warrant treatment. Indications for treatment include frequent superinfections, lasting hearing impairment with adverse consequences on socialization, or debilitation of the tympanic membrane carrying a risk for the ear. Tympanostomy tubes are a palliative treatment for serous otitis which restores hearing within a few hours and eliminates unfixated retractions of the tympanic membrane within a few weeks. Tympanostomy tubes may lead to complications including otorrhea and perforation of the tympanic membrane and should therefore be used only in patients with severe otitis media. Etiologic treatment of serous otitis rests on restoration of satisfactory nasal ventilation (education to improve nose-blowing, adenoidectomy), improvement of eustachian tube patency (corticosteroids), and modification of the characteristics of middle ear secretions (mucolytic agents and mucomodifying agents).
Acoustic Impedance Tests↗
[Neonatal laryngeal paralysis. Apropos of 116 cases].
The following study is based on a retrospective survey of 116 cases of neonatal vocal cord paralysis referred to out department over a period of 5 years. The purpose of this study is to better define the etiology, the evolution, and the prognosis of this affection in the newborn. The principal prognostic factors are: 1) unilateral versus bilateral involvement, 2) the etiological factors associated with the paralysis. Among 21 newborns with unilateral paralysis occurring after an abnormal or difficult delivery, 90% recovered spontaneously. In this form of vocal cord paralysis and in brachial plexus or facial nerve paralysis of obstetrical origin, the etiopathogenesis and prognosis are comparable. Unilateral vocal cord paralysis as the result of other etiological factors and bilateral paralysis as a group have a worse prognosis (76% and 74% spontaneous recoveries, respectively).
Cranial Nerve Diseases↗
[Must we implicate the primary treatment of acute otitis media in children?].
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Acute Disease↗
Maternally inherited duplication of the mitochondrial genome in a syndrome of proximal tubulopathy, diabetes mellitus, and cerebellar ataxia.
Two sisters in the first year of life presented with a proximal tubulopathy of unknown etiology. They subsequently developed a pluritissular disorder including diabetes mellitus, skin abnormalities, mitochondrial myopathy with ragged-red fibers, and cerebellar ataxia. Their mother had ptosis, ophthalmoplegia, and muscle weakness. Analysis of the mitochondrial respiratory chain showed a complex III deficiency in both skeletal muscle and lymphocytes of the second girl. Southern blot analysis provided evidence for a heteroplasmic partial duplication of the mtDNA (26 kb), involving one full-length and one partly deleted mitochondrial genome and with one single abnormal junction between the genes for ATPase 6 and cytochrome b. Using PCR amplification of lymphocyte DNA, we were able to detect minute amounts of duplicated molecules in the mother, which provided evidence for maternal inheritance of the partial duplication. While maternal transmission of point mutations have been reported in Leber disease, retinitis pigmentosa, and MERRF disease, this observation is, to our knowledge, the first example of a maternally inherited duplication of the mitochondrial genome in man.
Adenosine Triphosphatases↗
[Dimensions of the pharynx in function of the posture, in neonates and infants].
The authors measured the pharyngeal patency of 25 wakeful newborns and infants on X-ray films of the lateral upper airway. The upper airway patency depends on the head position. The velopharyngeal and the posterior tongue space are smaller in supine position than in ventral position. In supine position the airway space behind the base of the tongue is significantly greater when the head is extended than when the head is in neutral position (p less than 0.007).
Head↗
[Variations of nasopharyngeal pH in nasopharyngitis in children].
In view of the well-known relationship between gastro-oesophageal reflux (GOR) and inflammatory diseases of the bronchi, trachea and larynx, the possibility of a pathogenic acid reflux reaching the pharynx has sometimes been suspected but never demonstrated. Paediatric E.N.T. specialists are often confronted with chronic inflammatory rhinopharyngitis of no obvious origin. In order to test the hypothesis of rhinopharyngeal contamination by gastric acid, the nycthemeral local pH was recorded in children presenting with chronic rhinopharyngitis and gastro-oesophageal reflux, and in two groups of controls without rhinopharyngitis and with or without GOR. Falls in rhinopharyngeal pH were found to be more frequent and to last longer in the 18 patients than in controls. The most significant criterion was the time during which the pH was lower than 6 compared with the total time of recording in these cases where pharyngeal pH measurements were recorded over 15 to 26 hours. It seemed most probable that this acidity resulted from the gastro-oesophageal reflux. Such variations in acid-base balance at the surface of a respiratory mucosa might be instrumental in the genesis or maintenance of the nasopharyngeal inflammatory reaction. However, these two hypotheses must be confirmed or infirmed by further studies.
Child↗