PubMed Health⌕ Search

Biomedical subjects

P Viala

Publications and source records attributed to P Viala.

At least 19 recordsLinked to original sources
PubMed2003

Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children.

OBJECTIVE: To assess the functional and anatomic results of cartilage grafting in children with a severe retraction pocket of the posterosuperior part of the pars tensa and operated on by pocket excision and cartilage grafting. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fifty six children (60 ears) with severe posterosuperior retraction pockets. INTERVENTION: Excision of the pocket and tympanic reinforcement with a tragal or conchal cartilaginous graft. MAIN OUTCOME MEASURES: Postoperative anatomic (otoscopy, computed tomography) and functional (pure tone audiometry thresholds) outcome. The follow-up time was 27 +/- 18 months (mean +/- SD). RESULTS: Retraction recurrences requiring additional surgery occurred in 5 cases (8%). The risk of recurrence was lower in children older than 10 years and when the whole surface of the pars tensa was reinforced (chi(2) test, p< 0.05 for both factors). Functionally, hearing was improved even when the ossicular chain was intact. In case of disrupted ossicular chain, direct contact between the graft and eroded incudostapedial joint gave good hearing results. CONCLUSIONS: Cartilage reinforcement of the whole surface of the pars tensa is probably the best treatment of a severe posterosuperior retraction pocket. The flexibility and thinness of cartilage from the cymba conchae makes it particularly suitable in this indication.

Cartilage↗
PubMed2001

[Acute external mastoiditis in children: report of a series of 48 cases].

DESIGN: To determine the impact of the emergence of penicillin-resistant strains of pneumococci on the frequency of acute mastoiditis in children, and to assess the importance of laboratory and imaging studies in the treatment of acute mastoiditis. METHOD: Retrospective review of the medical records of children with postauricular swelling and otoscopic signs of acute otitis media from January 1993 through December 2000. RESULTS: Forty-eight children aged three months to 14 years (median 17 months) were identified. The number of cases was almost the same from one year to another. All children had bacteriological examinations. The mastoid pus and the otorrhea was sterile in 22 cases. The most frequent pathogen was Streptococcus pneumoniae (17 cases), which was resistant to penicillin in 71% of cases. The initial body temperature, the number of polymorphonuclears and the CRP were not different between the group of 18 children with periostitis, which required medical treatment alone, and the group of 30 children who had a mastoid abscess which required surgery. The difference between periostitis and mastoid abscess was seen on clinical examination and CTscan.

Abscess↗
PubMed1999

Facial neuromas in children: delayed or immediate surgery?

OBJECTIVE: The objective of this study was to investigate the clinical characteristics and outcome of facial nerve neuromas in children. To date, no specific study has focused on children, and the management of these tumors is not codified. DESIGN AND SETTINGS: A review of case series treated in a tertiary care center of pediatric otolaryngology. SUBJECTS: The treatment and outcomes for 7 children (4 infants and 3 adolescents) were analyzed. RESULTS: Six patients underwent complete removal of tumor and immediate restoration of the nerve continuity. The grade of facial palsy improved in 4 of the 6 children, but did not get better than grade 3 (House classification). The remaining patient was managed conservatively and remained stable clinically and radiologically after 9 years follow-up. CONCLUSIONS: These findings support the reasonable strategy of combining conservative assessment of these slow-growing tumors with regular clinical and radiologic evaluations and radical surgery using various procedures. The choice depends on the age of the child, the extent and growth rate of the tumor, the grade of facial palsy, and the hearing function.

Adolescent↗
PubMed1999

[Surgical management of laryngeal stenosis in children].

Surgical management of children with laryngotracheal stenosis changed recently because of the procedure of single-stage approach. Between January 1992 and April 1997, 101 children underwent surgery for laryngotracheal stenosis in our department: 47 of them had a single stage procedure, and 54 a classic laryngotracheoplasty with stenting with an Aboulker's tube or silastic sheets. The majority of the cases were acquired stenosis (64%) and the others congenital. The degree of stenosis was graded into four categories according to Cotton's classification. Thirty six cases were grade 2, 44 cases were grade 3, 21 cases were grade 4. Subglottic localization of the stenosis was found in 64% of the cases and the mobility of the vocal folds was normal in 60% of the cases. The surgery was considered successful after one procedure when there was a permanent and permeable laryngotracheal lumen (no more than grade 1) not requiring a tracheotomy. Of the 47 single-stage procedures, 38 were successful (81%); of the 54 cases managed with classic methods, 30 were successful (55%). These results and the indications of the different surgical procedures are discussed.

Adolescent↗
PubMed1992

[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↗
PubMed1991

[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↗
PubMed1991

[Perilymphatic fistula].

Perilymphatic fistulae are the first cause of perceptive deafness that may be amenable to surgical treatment. After a complete study of the literature, we have made a retrospective analysis of 48 ear explorations in 37 children. These children presented with a variable degree of progressive or fluctuating perceptive deafness without any obvious etiology. Computed tomography, especially aimed at detecting an abnormality in the patency of the aqueduct of the cochlea, seems to be the most efficient criterion of selection to establish an indication for surgical exploration. The extent of the perilymphatic fistulae and their location, mainly at the level of the fissura ante fenestram, call to our mind the possibility of an arrest in the differentiation of the otic capsule, with a persistent anomalous patency of the aqueduct of the cochlea. The results of this study mainly demonstrate stabilizations of hearing, while spectacular improvements still are anecdotal. On the other hand, morbidity is very low and mainly results from insufficient surgery to fill in the fistula. Further studies are needed, especially to better understand the pathophysiology of the perilymphatic fistulae, and their results must certainly be appreciated in the longer term.

Adolescent↗
PubMed1990

Surgical treatment for laryngeal paralysis in infants and children.

Clinical and endoscopic data of 219 cases of laryngeal paralysis in newborns, infants, and children are briefly reported. The management of severe cases of persistent dyspnea then is discussed, according to the literature. Of 219 cases, 22 young patients underwent a surgical procedure because of lack of spontaneous recovery and poor tolerance of their disease after 6 to 9 months of follow-up. Arytenoidectomy technique has been used three times and arytenoidopexy 19 times, with fair to excellent results. Other possible treatments for infants are discussed. On the basis of this important series of surgical pediatric cases, the arytenoidopexy technique is advocated, besides arytenoidectomy, to avoid the risks of a long-term tracheostomy in young patients with vocal cord paralysis and severe dyspnea.

Adolescent↗
PubMed1990

Aryepiglottic fold excision for the treatment of severe laryngomalacia.

Laryngomalacia is the most common laryngeal anomaly. Clinical presentation is most often associated with stridor, which usually resolves spontaneously by the second year of life. Infrequently, laryngomalacia can be severe and cause dyspnea and feeding difficulties. These children require surgical treatment, including tracheostomy. A new procedure has been recently described for the endoscopic excision of the aryepiglottic folds. The authors report results in 39 patients who have been treated with this procedure. One failure required tracheostomy. No recurrence of dyspnea was noticed in the other children. Gastroesophageal reflux, associated with 50% of our cases, was also noted in our only failure. We advocate endoscopic treatment in children with severe laryngomalacia.

Endoscopy↗
PubMed1990

Gastroesophageal reflux and upper airway diseases.

GER can have important impacts on the upper airway passages, and in turn, upper airway obstruction can certainly aggravate reflux. This relationship should be considered in the newborn or young infant, faced with a sudden life-threatening event, and in the older child or adult presenting with chronic head and neck complaints, either unexplained or unresponsive to adequate medical therapy. A causal relationship may be difficult to establish, based first on clinical expertise as a guideline, on laboratory tests, among which pharyngeal pH monitoring could be promising, and on response to medical antireflux therapy. A better understanding of the significance of high levels of reflux and defective acid clearance, as well as a more precise knowledge of the maturation and functioning of upper airway protective mechanisms, would open the way to more accurate diagnostic procedures, to a more reliable definition of the abnormal, and to greater efficiency in the management of these patients.

Gastroesophageal Reflux↗
PubMed1989

[Congenital perilymphatic fistula in children].

We report twenty case of perilymphatic fistulae in children. A fistula was discovered in every case where the cochlear aqueduct is larger than normal on high resolution CT scan of the temporal bone. The surgical treatment of these fistulae allowed only a significant improvement of hearing in the cases were an asymmetry or a dilatation of the cochlear aqueducts and a fluctuating deafness coexisted. Unfortunately these improvements do not look permanent.

Adolescent↗
PubMed1989

[The cochlear aqueduct and congenital perilymphatic fistula. An initial report].

The authors present 3 preliminary case reports of congenital perilymphatic fistula and describe their approach, which in the presence of clinical symptoms composed of progressive or fluctuating deafness, should suggest the diagnosis of congenital perilymphatic fistula leading to examination of the cochlear aqueduct by high resolution computed tomography. An anomaly detected on the CT scan, particularly on the intermediate and internal segments, is a decisive argument in the decision to operate on these congenital perilymphatic fistulae.

Adolescent↗
PubMed1989

[Anatomic characteristics of the mastoid in children. Pneumatization of the subfacial region].

Three specific features of the mastoid in the pediatric population appeared to us to be important in view of our per-operative findings on mastoidectomy for chronic suppurative otitis, cholesteatoma or middle ear effusion with chronic persistent mastoiditis in the older child. These included the position of the facial nerve, the superficial nature of its third part being well known, but also the existence of the Körner septum and especially the pneumatization of the sub-facial region which explains the similarity between certain infectious lesions of the retro-tympanic structures and infectious lesions of the anterior portion of the mastoid process. An experimental study of staining of preserved petrous bones in the adult enabled the sub-facial permeability of the mastoid to be demonstrated in certain cases. Awareness of these small details should help to avoid per or post-operative complications in surgery for chronic otitis media in children.

Adult↗
PubMed1987

[Pathology and surgery of tumors located under the internal auditory canal. 1. Neurinoma of mixed nerves].

The schwannomas of foramen jugulare are infrequent although progress in diagnosis of these tumors have been obtained by CT scan. We report five cases of the caudal nerves that where developed into the foramen jugulare. One may suspect these tumors in presence of any minimal, unilateral defect of otological, facial and pharyngo-laryngeal functions. The surgical approach to the tumors depends of both its location and its symptomatology. The mastoid-retro-sigmoid approach allow in most cases to preserve the eight and seven nerve functions.

Adult↗
PubMed1987

[Intracranial schwannomas of the cranial nerves. The acoustic nerve excluded].

The schwannomas of the cranial nerves (except the IId and VIIIth nerves) are known to be infrequent although progress in diagnosis of these tumors have been obtained by C.T. scan. We report twelve cases involving the facial nerve and five cases of the caudal nerves that were developed into the foramen jugulare, and two cases of trigeminal schwannomas. One may suspect these tumors in presence of any minimal, unilateral defect of otological, facial, and pharyngo-laryngeal functions. The surgical approach to the tumors depends on both its location and symptomatology.

Adult↗