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Resume Introduction Les anti-inflammatoires non steroidiens (AINS) sont connus pour inhiber le chimiotactisme, l’explosion oxydative et la phagocytose, la bactericidie dans les granulocytes et pour inhiber l’agregation ou la degranulation des neutrophiles et perturber la fonction des lymphocytes. D’autre part, l’ibuprofene est largement prescrit en pediatrie pour ses puissants effets analgesiques et antipyretiques. A notre connaissance, aucune publication anterieure ne decrit la relation entre l’ibuprofene et un risque accru de complications intracrâniennes et/ou orbitaires dans les sinusites fronto-ethmoidales aigues chez l’enfant. Objectif Rechercher une relation entre l’ibuprofene et l’apparition de complications intracrâniennes et/ou orbitaires de sinusite fronto-ethmoidale aigue en pediatrie. Patients et methodes Les dossiers medicaux des patients de moins de 18 ans admis dans les services ORL de 4 CHU pendant 2 annees consecutives pour sinusite fronto-ethmoidale ont ete revus retrospectivement. La prise d’ibuprofene, l’apparition de complications (orbitaires ou intracrâniennes) ainsi que les donnees demographiques habituelles ont ete notees. Une analyse statistique a ete effectuee afin de determiner s’il existe une relation entre la prise d’AINS et l’apparition d’une complication intracrânienne et/ou orbitaire. Resultats La prise d’ibuprofene semble etre un facteur de risque de complications intracrâniennes ou de complications orbitaires et surtout intracrâniennes en cas de sinusite fronto-ethmoidale aigue chez l’enfant. Ni le sexe, ni l’âge, ni l’intensite initiale de la douleur n’etaient statistiquement lies a l’apparition des complications. Conclusion Cette etude retrospective multicentrique semble suggerer que l’ibuprofene augmente le risque de complications orbitaires et/ou intracrâniennes en cas de sinusite fronto-ethmoidale aigue dans la population pediatrique. Par consequent, nous recommandons de ne pas prescrire d’ibuprofene si l’on soupconne une sinusite aigue chez un enfant ou un adolescent.

International audience; Importance: Non-steroidal anti-inflammatory drugs (NSAIDs) are known to inhibit chemotaxis, oxidative burst and phagocytosis, bacterial killing in granulocytes as well as inhibiting neutrophil aggregation or degranulation, thereby interfering with the function of lymphocytes. On the other hand, ibuprofen is widely prescribed in pediatrics for its powerful analgesic and antipyretic effects. To our knowledge, no previous publication outlines the relationship between Ibuprofen therapy and an increased risk of intracranial and/or orbital complications of acute fronto-ethmoidal sinusitis in childhood. Objective: To look for a relationship between ibuprofen and occurrence of intra-cranial and/or orbital complications of acute fronto-ethmoidal sinusitis in pediatrics. Setting and methods: The medical charts of patients younger than 18 years admitted into the E.N.T. departments of 4 academic care centers during 2 consecutive years for fronto ethmoidal sinusitis were reviewed retrospectively. The history of ibuprofen intake, the occurrence of complication (orbital or intracranial) as well as the usual demographic data were noted. A statistical analysis was performed in order to ascertain whether a relationship between taking NSAIDs and the onset of an intracranial and/or orbital complication exists. Results: Intake of ibuprofen appeared to be a risk-factor of intracranial complications or associated orbital and intracranial complications of acute fronto-ethmoidal sinusitis in children. Neither gender nor age nor initial pain intensity were statistically related to the onset of complications. Conclusion and relevance: This retrospective multicenter cohort study appears to suggest that ibuprofen increases the risk of orbital and/or intracranial complications of acute fronto-ethmoidal sinusitis in childhood. Therefore, we recommend not prescribing ibuprofen if one suspects an acute sinusitis in a child or adolescent.

Purpose The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. Methods This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. Results Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). Conclusion Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. Level of evidence IV.

Objectives Nasal obstruction is a highly subjective symptom. It can be evaluated by combining clinical examination, imaging and functional measurements such as active anterior rhinomanometry (AAR). In pediatrics, AAR is often impossible because it requires the participation of the child. Airflow modeling by Computational Fluid Dynamics (CFD) has been developed since the early 1990s, mostly in adults. This study is the first to describe a methodology of “numerical rhinomanometry” in children using CFD and to evaluate the feasibility and the clinical interest of this new tool. Materials and methods Five children aged from 8 to 15 years, complaining of nasal obstruction, underwent routine management including clinical evaluation, AAR, and CT-scanning. CT acquisitions were used for CFD calculations and numerical rhinomanometry. Results and conclusions In the 5 children, the results of CFD were concordant with clinical complaints and examination. In 3 children, AAR and CFD were concordant. In one patient, CFD corrected the results of AAR. In one patient, AAR was not feasible, unlike CFD, which contributed to diagnosis. This study highlighted the feasibility of CFD in children and that it can support or refute diagnosis of nasal obstruction with good reliability. These results indicate that CFD modeling could be widely used for functional exploration in pediatric rhinology.

Resume Objectifs L’obstruction nasale est un symptome tres subjectif. Son evaluation repose sur l’association de l’examen clinique, de l’imagerie et d’explorations fonctionnelles comme la rhinomanometrie anterieure active (RAA). En pratique pediatrique, la RAA est souvent impossible a realiser car elle necessite la participation de l’enfant. La modelisation des flux aeriens par Computational Fluid Dynamics (CFD) a ete developpee depuis le debut des annees 1990, principalement chez l’adulte. Cette etude est la premiere a decrire la methodologie pour creer des « rhinomanometries virtuelles » chez l’enfant en utilisant la CFD, a evaluer la faisabilite et l’interet clinique de cette nouvelle technique. Materiels et methodes Cinq enfants âges de 5 a 15 ans, presentant une obstruction nasale subjective ont ete evalues selon notre protocole habituel, incluant l’examen clinique, la RAA et un scanner. Ces acquisitions tomodensitometriques ont ete utilisees pour realiser les calculs de CFD instationnaires et creer les rhinomanometries virtuelles. Resultats et conclusions Chez les 5 enfants, les resultats de la CFD etaient concordants avec l’interrogatoire et l’examen physique. Dans 3 cas, la RAA et la CFD etaient concordantes. Dans un cas, la CFD a permis de rectifier la RAA. Dans un cas, la RAA etait impossible a realiser, contrairement a la CFD, qui a ete utile pour poser le diagnostic. Cette etude souligne la faisabilite de la CFD chez l’enfant et la CFD a demontre son interet pour confirmer ou rejeter le diagnostic d’obstruction nasale avec une bonne fiabilite. Ces resultats indiquent que les modelisations en CFD peuvent devenir des explorations fonctionnelles couramment utilisees en rhinologie pediatrique.

Objective The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation. Methods Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement. Results Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P = 0.03). The odds ratio for risk of > 14 procedures in 3-level involvement was 20.43 (P = 0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P = 0.16). Conclusions RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.

Resume Objectifs L’objectif de cette etude etait de definir les facteurs de risque de severite de la papillomatose respiratoire recidivante (PRR) juvenile lors de la premiere evaluation endoscopique. Materiels et methodes Il d’agit d’une revue de tous les cas operes pour PRR juvenile dans deux centres d’oto-rhino-laryngologie pediatrique situes aux Etats-Unis et en France. Le nombre d’etages larynges atteints, l’extension sous-glottique et la bilateralite des lesions ont ete analyses comme facteurs de risque de severite. Resultats Trente-deux patients ont ete inclus, pour un total de 571 procedures endoscopiques. Le nombre d’endoscopies par patient etait different selon l’extension initiale de la maladie : 30,67 procedures quand les 3 etages larynges etaient atteints, 15,57 procedures quand 2 etages etaient atteints et 14,08 quand un seul etage etait atteint (p = 0,03). L’odds ratio du risque de subir plus de 14 procedures etait de 20,43 (p = 0,047) quand les 3 etages etaient atteints. Les patients presentant une extension sous-glottique des lesions avaient tendance a necessiter plus de procedures (23,67 contre 15,56, p = 0,16). Conclusions La severite de la PRRJ est correlee a l’extension initiale des lesions papillomateuses lors de la premiere endoscopie. Cette observation a permis de creer une echelle d’evaluation rapide composee de 3 items, complementaire de l’echelle de Derkay.

The aim of this report is to identify the current relevant literature data on myringoplasty for chronic tympanic membrane perforation in children; to expose the different surgical techniques, traditional and recent techniques and to report their indications and results; and to address controversies of age in terms of timing of surgery and as a prognostic factor among many other factors. Myringoplasty is an easy and reliable surgery when performed in children in order to repair tympanic membrane perforation. Reported success rate is classically between 32 and 95% while some series have 100% rates. Timing of surgery in terms of age is still controversial and varies among teams related to their own experience. Myringoplasty in children has high rates of anatomical and functional success when well indicated. Age has not been found to affect surgery results.

Resume Objectif Le but de cette etude est de presenter les resultats d’une serie pediatrique de tympanoplasties par la technique dite du « butterfly cartilage », et de les comparer aux resultats de la litterature. Methodes Il a ete realise une etude retrospective portant sur des patients âges de 2 ans a 12 ans operes par le meme chirurgien senior d’une tympanoplastie au sein de notre service sur une periode allant de 2003 a 2012 et qui possedaient obligatoirement une documentation iconographique tympanique en pre- et postoperatoire. Les resultats ont ete analyses, avec un recul minimal de 10 mois, sur le plan de la prise de greffe et sur le plan auditif avec des audiogrammes pre- et postoperatoires et calcul de la perte auditive moyenne. Resultats Vingt-huit tympanoplasties ont ete realisees chez 27 enfants (16 garcons, 11 filles). Chez un enfant la perforation etait bilaterale. Les perforations tympaniques etaient de localisation inferieure ou antero-inferieure pour 14 d’entre elles (50 %), antero-superieure dans 9 cas (32,1 %) et anterieure dans 5 cas (17,9 %). La taille de la perforation mesuree a partir des cliches otoscopiques se distribue entre 11,1 et 36,4 % de l’aire tympanique avec une moyenne de 26,3 %. La duree moyenne de suivi est de 25 mois. La fermeture de la perforation a ete obtenue dans 87,7 % des cas. La perte auditive moyenne preoperatoire etait de 20,2 dB (10–31,25 dB) et en postoperatoire de 14 dB (5–31,25 dB). Discussion Analyser et comparer nos resultats a ceux publies dans la litterature internationale et mieux cerner les indications de cette technique de refection tympanique. Conclusion La technique de tympanoplastie par « butterfly cartilage » est fiable et de realisation aisee et doit faire partie de l’arsenal therapeutique a proposer dans les cas de perforations tympaniques non marginales et de taille moderee. Dans cette serie, nous avons reserve cette technique aux perforations correspondant a moins de 40 % de la superficie tympanique.

Objective This study presents results for a pediatric series of tympanoplasty using the butterfly-cartilage technique, with comparison to literature reports. Methods A retrospective study included patients aged between 2 and 12 years receiving tympanoplasty performed by a single senior surgeon in our department between 2003 and 2012, for whom pre- and postoperative tympanum imaging was complete. Results were analyzed at a minimum 10 months’ follow-up in terms of graft healing and auditory data, with pre- and postoperative audiograms and calculation of mean hearing loss. Results Twenty-eight tympanoplasties were performed in 27 children: 16 males, 11 females; in 1 case, perforation was bilateral. Perforation location was inferior or antero-inferior in 14 cases (50%), antero-superior in 9 (32.1%) and anterior in 5 (17.9%). Perforation size on otoscopy ranged from 11.1% to 36.4% of tympanum area (mean, 26.3%). Mean follow-up was 25 months. Closure of the perforation was achieved in 87.7% of cases. Mean hearing loss was 20.2 dB (range, 10–31.25 dB) preoperatively and 14 dB (range, 5–31.25 dB) postoperatively. Discussion We analyze our results and compare them with the international literature to refine indications for this technique of tympanic repair. Conclusion Tympanoplasty using the butterfly-cartilage technique was reliable and easy to perform. It should be included in the therapeutic armamentarium for moderate non-marginal tympanic perforation. In the present series, the technique was reserved to perforations involving less than 40% of tympanum area.

Introduction Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disease presenting with neonatal respiratory distress, often associated with other anomalies. Materials and methods This study reports the clinical and radiological characteristics of the patients managed in The Department of Pediatric Otolaryngology Head and Neck Surgery of La Timone Children's Hospital in Marseille between 1988 and 2014. Pyriform aperture (PA) widths were measured on CT-scans, obtained by using hand calipers at the largest portion of the PA in a plan parallel to the Francfort plan. Results 10 patients were included. Average PA width was 6.6 mm, 5/10 patients presented with single central maxillary median incisor, 6/10 patients had associated abnormalities. 8 patients underwent a surgical intervention and 2 patients were medically managed. All the patients had satisfactory nasal airway permeability on late follow-up. A management algorithm was elaborated. CNPAS should be evoked when breathing difficulties are associated with impossibility of passing fiberscope or nasogastric tube at the nasal inlet. Craniofacial CT-scanning is necessary to make the diagnosis and look for associated abnormalities. Medical treatment associating nasal wash and decongestants should be performed. Surgical intervention is necessary when failure of the medical management. Discussion and conclusions Our results were close to those found in the literature in terms of clinical characteristics, associated abnormalities and PA width. However, no objective criterion to decide whether a surgical intervention is necessary or not, has been established so far. The algorithm we propose offers guidelines from diagnosis to treatment, but the management should be adapted based on clinical tolerance.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 133 - N° 1 - p. 29-33

Objectives The purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years. Methods We performed a retrospective observational study from 1990 to 2017 in a pediatric tertiary-care center with needing surgery for tracheal stenosis. We analyzed clinical patients' characteristics, type of stenosis, type of surgery and follow-up. Results Twenty-eight children presented with tracheal stenosis, half of them with congenital stenosis (complete tracheal rings) and the other half with acquired stenosis (neoplasic or post intubation injury). 39.3% of these stenoses were associated with a vascular ring (61.5% in case of congenital stenosis). Depending on the extent of the stenosis and its origin, the surgery could be performed endoscopically or by an external approach. Enlargement tracheoplasty with an autograft (14.3%) was replaced by slide tracheoplasty with Cardio Pulmonary By-Pass (CPBP, 28.6%) with improved results for the treatment of long segment tracheal stenosis, involving more than 30% of the tracheal length (all were congenital in our study). Slide tracheoplasty has been performed since the late 90's in our institution. 25% of children have had a resection and anastomosis of the trachea because they had a stenosis involving less than 30% of tracheal length. Endoscopic surgery was performed for membranous stenoses, which were often seen after intubation or tracheotomy (32.1% of patients). Conclusion Effective treatment of surgical tracheal stenosis was performed in 28 children between 1990 and 2015. Surgical techniques have evolved over time, leading to a better management of this rare and serious disease.

Resume Objectifs Etablir les complications postoperatoires liees a l’implantation cochleaire chez les patients implantes dans un programme d’implantation cochleaire, et discuter des differences constatees entre les populations adulte et pediatrique. Par complications, nous entendons toute manifestation pathologique survenue en periode postoperatoire, qu’elle soit liee directement ou non a la technique chirurgicale. Nous avons ainsi comptabilise l’ensemble des complications au sens large du terme, allant de l’otite moyenne aigue (OMA) a l’explantation cochleaire. Type d’etude Il s’agit d’une analyse retrospective des patients implantes cochleaires. Patients et methodes Nous avons analyse l’ensemble des interventions chirurgicales (implantation cochleaire unilaterale ou bilaterale, revision chirurgicale), entre mars 1993 et janvier 2013. Cette population comprenait 168 adultes (âge median a l’implantation de 51,9 ans), et 235 enfants (âge median a l’implantation de 4,5 ans). L’ensemble des complications postoperatoires ont ete colligees puis classees en complications majeures (necessitant une revision chirurgicale ou un traitement medical hospitalier) et mineures (necessitant un traitement conservateur). Resultats Le taux global de complications a ete de 19,9 % (80 cas sur 403), reparti en 5 % de complications majeures (20 cas) et 14,9 % de complications mineures (60 cas). Ce taux etait significativement plus eleve dans la population adulte ( p = 0,004). Conclusion L’implantation cochleaire demeure une technique chirurgicale sure de rehabilitation auditive, grevee d’un faible taux de complications qu’il faut cependant connaitre afin de les prevenir de facon optimale. Les complications mineures ont ete principalement infectieuses chez l’enfant (OMA) et cochleovestibulaires chez l’adulte (acouphenes et vertiges). Les complications majeures ont ete principalement des reimplantations suite a des revisions chirurgicales ou des pannes liees a l’implant. Seul le taux de complications mineures etait significativement superieur dans la population adulte.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 135 - N° 1 - p. 81-82

Introduction: The goal of this retrospective study is to compare the management and outcome of surgical treatment of laryngotracheal stenosis in children and infants with and without an associated neurological disorder. Patients and Method: In a series of children operated on for subglottic stenosis (SGS), patients with an associated neurological disorder were identified. The following criteria were compared in children with and without neurological disease: grade of stenosis, age, technique (Crico-Tracheal Resection (CTR), Laryngo-Tracheo-Plasty (LTP) in single and 2 stage, laser), analyzing duration, preoperative tracheostomy, decannulation rate, preoperative gastrostomy, and number of days in intensive care unit and in hospital. Results: Two hundred twenty-three children were operated on for subglottic stenosis, of whom 68 (30.5%) had an associated neurological disorder. Some criteria were found to be statistically different between the 2 populations: mean age of 43 months in neurological population versus 13 months ( P < .001). The distribution of the grades of SGS appeared similar in the 2 groups ( P = .088), and the mean duration of stay in hospital and in ICU were not statistically different (respectively, P = .186 and P = .056) between the 2 groups; a 2-stage procedure was performed more frequently than 1-stage in the cases with associated neurological disorder—66.6% versus 36.5% ( P = .013); the median duration of stenting was 20 days in those with neurological disease versus 12 ( P = .021). Preoperative tracheotomy was noted in 75% of neurological patients versus 47.7% of the others ( P < .001). The outcome was considered to be good (decannulation and no further treatment) following a single procedure in 82.4% of patients with neurological disorder, as against 86.5% of neurologically unimpaired subjects. The difference in outcome of surgery was not statistically different ( P = .392) between the 2 groups. Discussion and Conclusion: It appears that subglottic stenosis in children with associated neurological disorder is not more severe than in neurologically normal patients. In three-quarters of the neurologically impaired cases, a preoperative tracheostomy was needed, but the rates of failure of postoperative decannulation are not statistically significant between the 2 groups. In our experience, 2-stage techniques are more often performed than single stage in this population in order to allow airway safety, for example after feeding. If properly managed, the final results are similar in the 2 populations.

Objectives The aim of this study was to assess quality of life in children fitted with cochlear implants, using combined self- and parental assessment. Materials and methods Thirty-two children, aged 6 to 17 years, with prelingual hearing loss and receiving cochlear implants at a mean age of 22 months, were included along with their families. The KIDSCREEN-27 questionnaire was implemented, in face-to-face interview, in its parents and children-adolescents versions, with 27 items covering physical well-being (“physical activities and health”), psychological well-being (“general mood and feelings about yourself”), autonomy & parents (“family and free time”), peers & social support (“friends”) and school environment (“school and learning”). Parent and child responses were compared with a general population database, and pairwise. Results Global scores were compared against the general population on Cohen d effect-size. For child self-assessment, the results were: physical well-being, 72.81 ( d = 0); psychological well-being, 78.13 ( d = −0.4); autonomy & parents, 63.84 ( d = −0.2); peers & social support, 61.72 ( d = −0.4); and school environment 73.83 ( d = 0). For parent assessment, the respective results were 62.66 ( d = −0.8), 74.89 ( d = −0.3), 57.37 ( d = −1.2), 51.56 ( d = −0.8), and 68.95 ( d = −0.4). Half of the children could not answer the questionnaire, mainly due to associated disability. Schooling and language performance were poorer in non-respondent than respondent children. Quality of life was comparable between implanted and non-implanted children: Cohen d , 0 to 0.4. Early cochlear implantation in children with pre-lingual hearting loss provides quality of life comparable to that of the general population.

Resume La surdite neurosensorielle represente, chez l’enfant, l’handicap sensoriel le plus frequent. L’etablissement d’un diagnostic etiologique a des implications pronostiques et therapeutiques majeures. Il est legitime de s’interroger sur le contenu du bilan etiologique en France. L’objectif de cet article etait de realiser une veritable evaluation retrospective de nos pratiques professionnelles en comparant le bilan etiologique d’enfants sourds non implantes avec celui d’enfants sourds implantes cochleaires. Patients et methodes Cent sept enfants âges de moins de 18 ans presentant une surdite neurosensorielle uni- ou bilaterale vus en consultation pour la premiere fois dans un service d’ORL pediatrique entre janvier 2007 et janvier 2009 ont ete inclus dans l’etude. L’interrogatoire et l’ensemble des examens paracliniques prescrits ont ete analyses. Resultats Les differentes etiologies des surdites ont ete ventilees selon l’origine genetique, acquise, ou inconnue dans chacune de ces deux populations. Le groupe des enfants sourds non implantes, comprenant 87 enfants, avait une origine inconnue dans 52 % des cas. Le groupe des enfants implantes cochleaires, comprenant 20 enfants, avait une origine inconnue dans 15 % des cas. Conclusion Notre etude a mis en evidence une heterogeneite dans la pratique du bilan etiologique des surdites neurosensorielles en fonction des populations cibles. Les enfants implantes cochleaires, dont la prise en charge est multidisciplinaire, ont beneficie d’un bilan etiologique plus systematique. Ce travail justifie de protocoliser un bilan etiologique pour toutes les surdites neurosensorielles de l’enfant.

Resume Introduction Apres plus de 20 ans d’experience clinique chez l’enfant, les protheses auditives a ancrage osseux representees essentiellement par la bone anchored hearing aid (BAHA®) se sont imposees comme un traitement des surdites de transmission et mixtes. Objectif Cet article tente, a partir d’une revue generale de la litterature et de notre propre experience, de faire le point sur les protheses a ancrages osseux en pediatrie. Materiels et methodes Parmi les points cles, on retiendra un âge minimal d’implantation superieur ou egal a cinq ans et/ou une epaisseur de la corticale osseuse superieure ou egale a 3 mm. Les pertes de fixtures sont de 40 % pour les enfants âges de moins de cinq ans, de 8 % pour ceux âges de cinq a dix ans et de 1 % c’est-a-dire identique aux adultes pour ceux âges de plus de dix ans. Les complications cutanees different peu de l’adulte et doivent, avant tout, etre prevenues par une education parentale et par un suivi regulier. La chirurgie s’effectue generalement en deux temps ou en un temps pour des fixtures superieures ou egales a 4 mm. Le taux de succes fonctionnel, correle au port a moyen et long terme de la BAHA est de l’ordre de 96 %. L’indication en cas de surdite profonde unilaterale est envisageable sous reserve d’un essai de port de bandeau BAHA durant quelques semaines avec la pleine participation de l’enfant. L’implantation bilaterale sequentielle necessite des evaluations complementaires et semble apporter un benefice perceptif dans le bruit. Resultats Ce type de prothese permet une amelioration de la qualite de vie des enfants ayant une surdite transmissionnelle et/ou mixte bilaterale qui devraient encore s’accroitre par les nouveaux developpements techniques.

To analyze prognostic factors in the management of patients with choanal atresia.This is a review of 114 patients operated on for choanal atresia in a tertiary care center between November 1986 and November 2016, including clinical characteristics, surgical management, and postoperative course with final nasal patency. The data were collected in a database that was updated over time.Among the 114 patients, 78 were female, 77 presented with unilateral choanal atresia, and 37 presented with bilateral unilateral choanal atresia, corresponding to 151 nasal fossae. Forty-seven patients had associated abnormalities (41.2%), including CHARGE, diagnosed in 20 children (17.5%). At the end of follow-up, 91 patients (79.8%) had normal choanal patency. The identified risk factors of surgical failure were age6 months (P = .004), weight5 kg (P = .007), and bilateral choanal atresia (P .001). The type of atresia, presence of associated abnormalities, surgical approach, stenting, and use of mitomycin were not significantly linked with the surgical results.This series highlights the importance of the timing of surgery, which is guided by the clinical ability of the infant to tolerate the procedure. Endoscopic approaches are widely performed, but a transpalatal approach, necessary in some cases of bilateral choanal atresia, does not alter the results. Unilateral choanal atresia surgery should be delayed after age 6 months and/or weight5 kg when possible.

Resume Introduction Le fibrome ossifiant est une tumeur osteo-fibreuse benigne rare de localisation essentiellement cervico-faciale. L’atteinte la plus frequente concerne la mandibule mais des cas plus rares ont ete decrits au niveau naso-sinusien. Ce sont alors des formes plus agressives localement. Cas clinique Nous rapportons le cas d’un fibrome ossifiant du cornet moyen chez un enfant de 8 ans, s’etant revele par un tableau d’ethmoidite. Une resection totale par voie endoscopique a ete realisee. Nous disposons d’un recul de 3 ans sans recidive clinique ou radiologique. A ce jour, il s’agit du plus jeune patient avec un fibrome ossifiant developpe aux depens du cornet moyen decrit dans la litterature. Discussion La presomption diagnostique des fibromes ossifiants est clinique et radiologique (localisation, masse ovalaire, delimitee par une fine coquille osseuse, contenu heterogene). Le diagnostic de certitude est, bien sur, histologique (presence de corps psammomatoides, bordure osteoblastique, os trabeculaire). Le traitement des formes naso-sinusiennes est chirurgical, par voie endoscopique si possible. Et l’exerese doit etre la plus complete possible pour minimiser le risque de recidive en particulier dans les localisations naso-sinusiennes, connues pour etre plus agressives. En cas d’ethmoidite sur un terrain atypique, l’etiologie tumorale doit etre evoquee.

Summary Introduction Ossifying fibroma (OF) is a rare benign fibro-osseous tumor, mainly located in the head and neck region. Most often, it affects the mandible but rare involvement of paranasal sinuses has been reported, associated with more locally aggressive behavior. Case report We report the case of an 8-year-old boy with OF of the middle turbinate, revealed by ethmoiditis. Total resection was performed on an endoscopic approach. The patient was free of clinical or radiological recurrence at 3 years’ follow-up. This was the youngest patient with OF of the middle turbinate so far reported in the international literature. Discussion Presumptive diagnosis is established by clinical examination and CT scan (location, oval-shaped mass, heterogeneous tumor with a thin bony rim). Definitive diagnosis is founded on histological examination (psammomatous bodies, osteoblastic rim, trabecular bone). Treatment in paranasal sinus OF is surgical, preferentially on an endoscopic approach. Resection should be as complete as possible to minimize risk of recurrence, especially in sinonasal locations, known to be more aggressive. Ethmoiditis in an unusual age-range should suggest tumoral etiology.

Objective Preliminary assessment of the efficacy of propranolol on subglottic hemangioma in children on a nation-wide scale. Methods Multicentric, retrospective study of clinical files of 14 children; pre- and post-treatment endoscopies. Results Mean age at diagnosis was 2.3 (0.7–4) months. Mean percentage of airway obstruction was 68% (15–90) before propranolol introduction. Propranolol was started at 5.2 (0.7–16) months of age. This treatment was effective in all cases with a mean regression of the stenosis to 22% after 2 weeks and 12% after 4 weeks. Other medical treatments (steroids) could be stopped. In one patient, a side effect of propranolol motivated the switch to another β-blocker. In four patients, treatment was stopped after 5.2 (1–10) months with a relapse in 2 (50%) cases. One of these two patients developed a resistance to propranolol and required a surgical procedure by external approach. Conclusion This preliminary nation-wide survey confirms propranolol high effectiveness against airways’ localization of infantile hemangiomas. Propranolol also allows alleviation or cut-off of previous medical treatments. However, recurrences are possible after early treatment interruption.

Objectives: We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws. Methods: The characteristics of this implant allow cochlear implantation using a minimal incision, a subperiosteal pocket, and fixation with two titanium screws, without drilling a custom-fitted seat or creating suture-retaining holes in the skull. The fixation system relies on two tailfins for use of osseo-integratable screws, incorporated into the cochlear implant housing. The first version of this fixation system was modified after a case of device migration: The size of the titanium insert inside the silicone tailfin was increased. Data on 156 patients (8 months to 86 years of age) from a 4-year period in 6 cochlear implantation centers were retrospectively evaluated. Ten patients have undergone bilateral implantation. Results: Of 166 implantations, 4 postoperative infections and 1 device failure after head trauma were reported. No cerebrospinal fluid leaks or epidural hematomas were reported. One device migration was observed in the first series; no device migrations occurred in the second series. Conclusions: The fixation system with screws embedded in the Digisonic SP involves a fast and simple surgical technique that seems to efficiently prevent implant migration.

Resume Objectif Le but est de rapporter les resultats de la premiere rehabilitation auditive pediatrique francaise par un implant d’oreille moyenne et de discuter les indications potentielles de cette nouvelle option therapeutique chez l’enfant. Materiels et methodes Etude prospective sur 18 mois des resultats cliniques et audiometriques d’une implantation d’oreille moyenne par un Vibrant Med-El ® chez un enfant âge de neuf ans presentant une surdite mixte congenitale. Resultats Les seuils auditifs post-operatoires etaient inchanges. Apres 18 mois de recul, les seuils moyens en champ libre avec implant actif etaient a 33,75 dB et le seuil d’intelligibilite a 30 dB. Apres 18 mois, l’amelioration du seuil d’intelligibilite etait de 25 dB par rapport a la periode preoperatoire avec les deux protheses classiques. L’implant a parfaitement fonctionne durant cette periode et l’enfant n’a pas presente de complication. Conclusions La fiabilite de l’implant et la qualite des resultats auditifs obtenus dans notre experience et dans un nombre limite de cas dans le monde font de l’implant d’oreille moyenne Vibrant Med-El ® une nouvelle option therapeutique pour certains cas de surdites par atresie auriculaire congenitale chez l’enfant.

Objectives This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented. Case report The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery. Discussion This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge. Conclusion Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.

We report a technique for surgical repair of laryngotracheoesophageal clefts from type II to IV through an anterior approach that involves performing a tracheoesophagoplasty with Two overlapping flaps (TEP-TOF). We offer a technical description, a retrospective study, and a review of the literature. Ten children were operated on for laryngotracheoesophageal clefts of types II, III, or IV of the Benjamin and Inglis classification by the TEP-TOF procedure. After a median follow-up of 58 months (2 months to 12 years), neither complications nor recurrences were observed. All surgical details of the TEP-TOF procedure, including the approach, the kind of sutures, the method of creating the flaps, and the preoperative and postoperative management, are discussed and compared with the data found in the literature.

Congenital bilateral dacryocystocele was diagnosed prenatally by ultrasonography in 3 female fetuses at 32.5 weeks gestation. After birth, first baby developed respiratory distress and was treated with endoscopic marsupialization of the cysts; the second baby had no respiratory symptoms and had spontaneous resolution of the cysts without surgery. The last one was expected to have a left dacryocystocele in US but the clinical examination after birth showed a bilateral lesion, with predominance on the right side and underwent an endoscopic marsupialization for nasal obstruction. Prenatal diagnosis with ultrasonography facilitated the education of the mothers and staff and helped minimize the risk of potential complications.

Objectives were 1) to review the presentation, natural history, and management of subglottic hemangioma; 2) to assess the affect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon) in the management of subglottic hemangioma; and 3) to present specific guidelines to help determine the best possible treatment modality at the time of initial presentation.Retrospective review in the setting of three tertiary care pediatric medical centers.Methods included 1) extensive review of the literature; 2) a systematic review with respect to age, gender, presentation, associated medical problems, location and degree of subglottic narrowing, initial treatment, need for subsequent treatments, outcome, complications, and prognosis; and 3) statistical analysis to determine the effect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon).In all, 116 patients with a mean age of 4.7 months were treated. The most common location of subglottic hemangioma was the left side. The range of subglottic narrowing was 10% to 99% (mean percentage, 65%). Twenty-six patients (22%) were managed with a single treatment modality, which included conservative monitoring (n = 13), corticosteroid (n = 11), and tracheotomy (n = 2). Ninety patients (78%) required multimodality treatments. Overall, the treatments included conservative monitoring (n = 13), corticosteroid (n = 100), tracheotomy (n = 32), CO2 laser (n = 66), interferon (n = 5), and laryngotracheoplasty (n = 25). Complication rates included the following: conservative monitoring (none), corticosteroid (18%), tracheotomy (none), CO2 laser (12%), interferon (20%), and laryngotracheoplasty (20%). The following variables showed statistical significance in the outcome of different treatment modality: 1) degree of subglottic narrowing (P.001), 2) location of subglottic hemangioma (P.01), and 3) presence of hemangioma in other areas (P.005). Gender (P.05) and age at the time of presentation (P.06) did not show any statistical significance on the outcome of the treatments.Each patient should be assessed comprehensively, and treatment should be individualized based on symptoms, clinical findings, and experience of the surgeon. The authors presented treatment guidelines in an attempt to rationalize the management of subglottic hemangioma and to help determine the best possible treatment modality at the time of initial presentation.

The last decade has seen significant advance in the surgical management of pediatric subglottic stenosis, which remains one of the most fascinating problems of the laryngotracheal complex (LTC). Refined techniques for operating on these fragile structures should reduce cricotracheal scarring to a minimum, thus avoiding a lot of severe postoperative complications in a tricky moment of laryngeal's growing up. Experimental works indicates that the LTC growth is variously affected by longitudinal anterior, posterior or lateral incisions and actually the indications for laringotracheoplasty or cricotracheal resection in children with subglottic stenosis are still unclear. Reports on fetal manipulation of cricotracheal tissues are lacking as well as early effects on airway healing, LTC growth and lung development. The aim of this study was to evaluate if the airway mucosal healing is regenerative and scarless after cricotracheal manipulation in fetuses of New Zealand White Rabbits (NZWRFs). The consequences of fetal incisions on the cricoid growth and lung development are also examined, in a group of 12 NZWRFs, manipulated at 25+/-1 days of gestational age. The does underwent halothane anesthesia and all received a bilateral longitudinal cricoidotracheotomy. Twenty sham-operated fetuses were submitted to a limited cervicotomy (control's group). At the time of retrieval (31+/-0.5 days), en bloc laryngotracheobronchial tree and lungs were collected and processed for histological and morphometric analysis. Parameters recorded included: 1) histological full-thickness examinations focusing on inflammation, foreign body reaction, fibrosis, neochondrogenesis; 2) morphometric analysis, including the fetal Subglottic Diameter (FSD), the fetal Subglottic Area (FSA), the Radial Alveolar Count (rAC) and Computer Assisted Morphometric Colorimetry (CAmc); 3)analysis of lung hypoplasia (LH) by means of lung weight/body weight (LW/BW) ratio, protein and DNA indexes; 4) finally, different fractions of lung tissue phospholipids for lung maturity assessment were studied. Student's t test, when indicated, was performed for statistical analysis (p0.05 = significant). There was no maternal mortality in this study. Ten fetuses were available for a final evaluation (16.6% mortality). In one case only, an incomplete closure of the fetal cricoidotomy was seen and could be probably due to a technical mistake. Mean fetal subglottic diameter and area were respectively 0.13+/-0.05 mm and 3.15+/-0.45 mm2 in both groups. As well as in fetal dermal repair, regeneration of the airway cartilage and mucosa were complete and scarless. LW/BW ratio, DNA content and analysis of different fractions of phospholipids were similar in experimental vs. the control group. These findings suggest that the healing processes were fibrosis-free and without evidence of scars. A complete closure of the incisions was achieved without stenosis of the fetal subglottic region. In addition, it seems that the fetal cricoidotracheotomy doesn't interfere with the laryngeal function which coordinate the amount of liquid leaving the lungs via the trachea. In addition, only a small leakage of amniotic fluid is shown and this could be responsible for normal and mature lungs.

Laryngotracheoesophageal clefts (LTECs) are rare congenital defects of variable severity depending on the extent of malformation. Management of a complete LTEC represents a major surgical and anesthetic challenge. The main problems are achieving adequate operative exposure and maintaining ventilatory support during and after the operation. We describe correction of a type IV LTEC extending down to the carina in an infant who had respiratory distress at birth. Surgical repair was achieved in a single stage by an anterior sternotomy approach on the 11th day of life. The procedure was facilitated by cardiopulmonary bypass. After the operation, the infant was intubated, mechanically ventilated, and sedated. Nissen fundoplication and gastrostomy were carried out on the 11th postoperative day. The child was extubated on the 12th postoperative day. The rationale for this method and its advantages in comparison with other surgical approaches are discussed.

The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of JNA were treated at our institution from 1975 to 1999. Thirty-three male patients aged between 8 and 25 years (mean 15.3) were included. Twenty-nine patients underwent primary surgical treatment at our institution and four were treated for recurrence following primary surgery elsewhere. Tumors were staged according to Fisch's staging. Preoperative embolization was performed in 22 cases. Surgical techniques consisted of the transantral approach, lateral rhinotomy approach, transmaxillary via midfacial degloving approach, and the subtemporal preauricular infratemporal fossa approach. Tumors were classified stage I in seven cases, stage II in 11, stage III in 13 and stage IV in two. The mean delay between the initial symptom and surgery was 14 months overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12 for stage IV. The transantral approach was used in 11 patients, lateral rhinotomy approach in 11 cases, transmaxillary via midfacial degloving approach in three patients, and pre-auricular infra-temporal approach in eight patients. Mean follow-up after surgery was 56 months. Six patients had recurrent tumors. Surgery is the gold standard for treatment of JNA. Modern imaging techniques allow accurate diagnosis and staging of JNA. Our experience and a review of the literature shows that the surgical approach should be selected according to tumor stage.

The objective of this study was to review the characteristics of congenital nasal pyriform aperture stenosis (CNPAS) in a series of 20 children seen between 1993 and 1996. The diagnosis was made by physical examination and computed tomography scan. A single central maxillary incisor was detected in 12 cases (60%). Three children had morphological abnormalities of the pituitary gland shown on magnetic resonance imaging. One child had an antidiuretic hormone deficiency, and another child had a growth hormone deficiency. Two children had craniosynostoses, 1 of which was Apert's syndrome. All patients underwent operation by a sublabial approach, and 1 was referred for a columellar necrosis after nasal stenting. After surgery, all patients showed improvement, and the nasal stenting was usually removed 1 week after surgery. Follow-up revealed normal breathing. In conclusion, CNPAS was previously considered to be an unusual cause of nasal obstruction in neonates and infants. The number of cases treated recently in our department suggests that this newly recognized entity is more common than expected.

The objective of this study was to assess the long-term results of partial laryngectomy for benign neural tumors of the larynx. We reviewed 8 patients with laryngeal involvement — 7 with neurofibromatosis and 1 without — treated between 1980 and 1994. The mean age was 6.5 years. A partial laryngectomy was performed in 7 cases. All the tumors were located in the aryepiglottic folds. Clinical, radiologic, and endoscopic follow-ups were used for evaluating recurrence. A good laryngeal airway, swallowing without aspiration, and voice quality were sought in assessing the functional results. Five patients had good functional results with no recurrences. One patient died of malignant transformation and metastatic dissemination of his disease. To summarize, partial laryngectomy is a relatively safe and effective procedure, even in childhood, for treating this rare localization of neurofibromatosis. A malignant transformation of the tumor is possible and carries a poor prognosis.

The authors report a series of eight cases of isolated tracheoesophageal fistula without esophageal atresia (or an H type fistula), treated in three pediatric ENT departments. This is a rare malformation whose diagnosis requires investigation for associated anomalies. The clinical signs are mainly respiratory but also digestive and the symptomatology can be severe. The diagnosis can be made with a barium swallow combined with cineradiography, but a tracheoesophageal endoscopy remains the investigation of choice. The treatment is surgical. In most cases, the fistula is accessible by a right or left cervicotomy, depending on the surgeon's practice, with a much lower postoperative morbidity as compared to a thoracotomy. The postoperative management was straightforward in most of our cases. We discuss the role of gastro-esophageal reflux with respect to postoperative morbidity as well as systematic treatment for reflux peri-operatively. The pros and cons of the various surgical approaches are also discussed.

Objectives The purpose of this study was to assess the postoperative complications related to cochlear implants and to discuss the differences observed between adult and paediatric populations. Cochlear implant complications were defined as any pathological events observed during the postoperative period, whether or not they were directly related to the surgical technique. We therefore recorded all complications, in the broad sense of the term, ranging from acute otitis media to cochlear explantation. Study design Retrospective analysis of cochlear implant patients. Material and methods All surgical procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median age at the time of implantation: 51.9 years), and 235 children (median age at the time of implantation: 4.5 years). All postoperative complications were classified as either major (requiring surgical revision or hospital management) or minor (requiring conservative management). Results The global complication rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor complications (60 cases). This complication rate was significantly higher in the adult population ( P = 0.004). Conclusion Cochlear implantation is a safe hearing rehabilitation surgical technique associated with a low complication rate. However, surgeons must be familiar with these complications in order to ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following revision surgery or device failure. Only the minor complication rate was significantly higher in the adult population.

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(®), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(®) is about 96%. BAHA(®) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(®) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.

Summary Sensorineural hearing loss is the most common form of sensory impairment in children. As a precise aetiological diagnosis has major prognostic and management implications, it is useful to evaluate the contents of the aetiological investigation of sensorineural hearing loss in France. This article presents a retrospective review of professional practices by comparing the aetiological investigation of hearing loss in children with a cochlear implant and children without a cochlear implant. Patients and methods One hundred and seven children under the age of 18 years with unilateral or bilateral sensorineural hearing loss attending the paediatric ENT department for the first time between January 2007 and January 2009 were included in the study. Data from the clinical interview and all complementary investigations were analysed. Results The various aetiologies of hearing loss were classified as genetic, acquired, or unknown in each of the two populations. Hearing loss was of unknown origin in 52% of the 87 non-implanted children and 15% of the 20 children with a cochlear implant. Conclusion This study demonstrates the heterogeneous practices in terms of aetiological investigation of sensorineural hearing loss as a function of the target population. A more systematic aetiological investigation was performed in children fitted with a cochlear implant, requiring multidisciplinary management. This study indicates the need to define a standard aetiological investigation for all children with sensorineural hearing loss.

• Current concepts in laryngotracheal reconstruction include lumen augmentation with interposition of autogenous costal cartilage. In an effort to reduce potential increased morbidity at the donor site, the use of porous hydroxyapatite was compared with autogenous costal cartilage in an experimental study. Ninety-nine New Zealand rabbits were randomly operated on to receive autogenous costal cartilage (n=32), hydroxyapatite covered by a perichondrium graft (n=33), or hydroxyapatite alone (n=34). Rabbits were killed at 3 months after the surgery. Clinically (n=85), no difference was found among the groups. Histologically (n=81), grafts (n=54) in the group receiving autogenous costal cartilage were greater than in those receiving the hydroxyapatite. Concerning the value of epithelial layer covering the graft, the rate of inflammation, the cricoid-graft interface, and the graft viability, no difference was noted among the groups. In the group in which no graft was found (n=27), a fibrous bridge maintaining a cricoid distraction was noted in 23 cases. This study shows the possible value of hydroxyapatite in the animal model, but before clinical application, the natural course of the fibrous bridge must be documented. (Arch Otolaryngol Head Neck Surg.1993;119:87-91)

But de la presentation L’hypoplasie de l’orifice piriforme est une malformation congenitale tres rare, souvent consideree comme une forme mineure d’holoprosencephalie. L’individualisation de cette malformation est recente, et date de la fin des annees 1980. Elle peut etre isolee ou associee a d’autres malformations congenitales. L’objectif de cette etude est de presenter les cas d’hypoplasie de l’orifice piriforme diagnostiques et pris en charge dans notre service. Materiel et methodes Il s’agit d’une etude retrospective portant sur tous les patients chez lesquels une hypoplasie de l’orifice piriforme a ete diagnostiquee dans notre service au cours des 20 dernieres annees. Resultats 10 patients ont ete inclus. 3 etaient de sexe masculin (30 %), 7 etaient de sexe feminin (70 %). Cliniquement, 8 patients ont presente une detresse respiratoire le jour de la naissance, un a 15 jours et un a 2 mois. Des malformations etaient associees chez 4 patients (40 %). Sur le scanner, la largeur maximale de l’orifice piriforme etait mesuree a 6,6 mm en moyenne, une incisive mediane unique etait retrouvee chez 5 patients (50 %). Dans une cas, une holoprosencephalie etait retrouvee chez un cousin germain de la mere ainsi que la notion de difficultes respiratoires importantes en periode neonatale chez cette derniere. 8 patients ont ete operes (80 %). La technique chirurgicale etait la meme pour tous les patients, consistant en un alesage de l’orifice piriforme a la fraise diamantee par abord vestibulaire, avec calibrage post-operatoire. Le suivi des patients, d’une duree moyenne de 55 mois, mettait en evidence une bonne permeabilite des fosses nasales chez tous les patients. Seuls 3 patients ont necessite une 2eme anesthesie generale pour des soins locaux (decroutage, retrait du calibrage). 2 patients n’ont pas ete operes et ont beneficie de soins locaux avec application de serum adrenaline. Conclusion L’hypoplasie de l’orifice piriforme est une malformation rare, dont le pronostic respiratoire est bon en cas de prise en charge adaptee. La difficulte est de savoir evoquer ce diagnostic devant une detresse respiratoire du nouveau-ne ou du nourrisson et de rechercher les malformations associees possibles. Un geste chirurgical est parfois necessaire pour passer un cap.

Nasal polyposis in children is a rare pathology that is difficult to treat, with results that are often disappointing. The aim of this paper is focused on the surgical possibilities of ethmoidectomy by endonasal approach. Thirty-nine ethmoidectomies were performed in 24 children with a mean age of 12 years (cystic fibrosis, n = 7; Woakes' syndrome, n = 2; isolated polyposis, n = 15). The decision for surgical treatment was based upon the severity of initial symptoms, principally nasal obstruction, lack of improvement after medical treatment, and the assurance of good surgical follow-up. Twenty-three children were followed up for a mean of 3 years. Complete recurrence was noted in 13% of the cases (n = 3). In all the other cases, including those with partial recurrence, the lives of the children were transformed. Ethmoidectomy by endonasal approach is reliable if the appropriate surgical techniques are strictly followed. It has proven its efficacy in children with nasal polyposis with results that are very encouraging compared to previously proposed therapies.

Objectives To assess whether a classification system for congenital cholesteatoma (CC) can be derived from analysis of a large clinical sample of cases and to assess whether such a classification system is a reliable guide for surgical intervention, reexploration, and hearing outcome. Design A retrospective review of clinical and surgical records of 119 patients with CC. Setting Four tertiary care children's hospitals. Patients One hundred nineteen children with CC (age range, 2-14 years). Results Congenital cholesteatomas in the anterior mesotympanum were treated successfully with exploratory tympanotomy. Congenital cholesteatomas involving the posterior superior quadrant and the attic usually had concurrent involvement of the incus and stapes and often required a canal wall up tympanomastoidectomy and a second look for its control. Congenital cholesteatoma involving the mastoid usually involved all of the ossicles, was inconsistently controlled with canal wall up tympanomastoidectomy, and had a poor prognosis for restoration of conductive hearing loss. The mean ± SD age of children with CC was 5.6 ± 2.8 years, while that of children with acquired cholesteatoma was 9.7 ± 3.3 years. Conclusions The sequence of spread of CC, involving 3 sites, suggests a natural classification system. The CC usually originates in the anterior superior quadrant, but does not consistently remain there, and may variably occupy the middle ear and mastoid and result in ossicular destruction and conductive hearing loss. The location of CC and the involvement of the ossicles is an accurate predictor of the type of surgery necessary for its control and for the success of hearing restoration.

Objectives To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions. Design A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral). Setting Two tertiary care children's hospitals. Patients Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years). Results Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss. Conclusions Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.

But de la presentation Le but de ce travail retrospectif est de comparer en termes de prise en charge et de resultats les stenoses sous-glottiques chez des enfants porteurs de pathologies neurologiques centrales et d’enfants indemnes sur ce plan. Materiel et methodes Dans une serie d’enfants operes d’une stenose sous-glottique, les dossiers de patients atteints d’une affection neurologique centrale ont ete selectionnes. Ils ont ete compares a ceux des autres enfants operes de la meme chose pour les criteres suivants : grade, âge, technique (RCT, LTP en un temps ou en deux temps, voie endoscopique), duree du calibrage, tracheotomie pre- et post-operatoire, gastrostomie, reprise alimentaire, duree du sejour en soins intensifs et du sejour hospitalier. Resultats Sur 223 enfants operes d’une stenose sous-glottique, 68 (30,5 %) etaient porteurs d’une pathologie neurologique associee. Les parametres suivants se sont averes statistiquement differents entre les deux groupes A (porteurs d’une affection neurologique) et B (sans atteinte neurologique associee) : mediane d’âge 43 mois dans le groupe A versus 13 mois dans le groupe B(p Conclusion Dans notre serie, il apparait que les stenoses sous-glottiques de l’enfant different entre les patients porteurs et non porteurs d’atteintes neurologiques par la plus frequente necessite d’une tracheotomie pre-operatoire, un recours plus frequent aux techniques en deux temps et, par consequent, a une duree moyenne de calibrage post-operatoire superieure chez les patients avec atteinte neurologique. Le recours aux techniques en deux temps s’explique par la necessite de protection des voies aeriennes et par la plus grande frequence des tracheotomies pre-operatoires. En revanche, moyennant l’adaptation des methodes therapeutiques, les resultats sont identiques entre les deux populations.

But de la presentation L’atresie choanale est une malformation congenitale rare, estimee a environ une naissance sur 12000. Les techniques chirurgicales de prise en charge de ces atresies choanales ont evolue sur les 30 dernieres annees. Les objectifs de cette etude etaient d’analyser les caracteristiques cliniques et les resultats chirurgicaux des patients operes d’atresie choanale dans notre service sur les 30 dernieres annees, et d’analyser les facteurs pouvant influer sur les resultats chirurgicaux. Materiel et methodes Il s’agit d’une etude retrospective monocentrique portant sur tous les patients operes d’une atresie choanale entre novembre 1983 et decembre 2013. Les analyses statistiques ont ete realisees grâce aux logiciels IBM SPSS et R, le seuil de significativite retenu etait de p Resultats 101 patients ont ete inclus, pour 133 fosses nasales operees. 65,3 % etaient de sexe feminin, tandis que 34,7 % etaient de sexe masculin. 38,6 % des atresies etaient localisees a droite, 29,7 % a gauche, 31,7 % des atresies etaient bilaterales. L’atresie etait de type osseux dans 69,3 % des fosses nasales, mixte dans 28,7 %, et de type membraneux dans 2,0 %. Le taux total d’anomalies associees s’elevait a 42,6 % des patients, et 17,8 % presentaient une association CHARGE. 37,6 % des fosses nasales n’ont ete operees qu’une fois, le nombre moyen d’interventions etait de 2,12. L’âge inferieur a 6 mois, et le poids inferieur a 5 kg lors de la 1ere chirurgie etaient des facteurs pejoratifs sur le succes de la chirurgie. Les enfants operes par techniques endonasales avaient de meilleurs resultats chirurgicaux que ceux operes par voie transpalatine, mais cette difference etait liee au poids de l’enfant. L’application de mitomycine et le calibrage des fosses nasales ne modifiaient pas le resultat de la chirurgie. Conclusion Cette etude met en evidence l’interet d’operer les enfants atteints d’atresie unilaterale le plus tard possible et d’utiliser une voie endonasale sauf si le calibre de la fosse nasale ne le permet pas. Dans les cas ou ces conditions ne peuvent etre reunies, l’utilisation d’une voie transpalatine reste possible et ne semble pas alterer le pronostic.

Objective To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. Design Retrospective review of files from January 1983 to September 1998. Setting Pediatric otolaryngology departments from 2 referral centers. Patients Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. Interventions Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. Main Outcome Measures Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. Results The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. Conclusions Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.

Objective To evaluate the effects of a partial resection of the anterior cricoid arch on the growth of the laryngotracheal complex in an animal model and to study the lumen caliber and cross sectional surface area following resection as the animals are allowed to grow. Laryngeal, subglottic, and tracheal measurements in the infant and pediatric larynges in autopsy specimens are also investigated. Design A controlled animal study was done comparing the operated rabbit group to the nonoperated group. Twenty-nine infant rabbits were compared to a control group of ten rabbits. In addition, autopsy dissections were performed on infant and pediatric larynges to obtain measurements of various laryngeal and cricoid relationships. Methods Thirty-nine pasteurella-free New Zealand white female rabbits between the ages of 8 and 11 weeks were used in this study. In the experimental group, cricotracheal resections were performed by removing the anterior cricoid cartilage and the first tracheal ring. A primary anastomosis was then performed. The animals were kept alive for 4 months and then humanely euthanized. The laryngeal complex was then removed and histological sections of the cricotracheal region were mounted on glass slides and stained with H&E. Measurements were taken of the cricoid and upper tracheal lumen and cross-sectional area. Results Twenty-seven of the study group survived until the time of sacrifice. All of the control group survived during the study period. The two groups were comparable in regard to weight, lumen size, and cross-sectional area. There were no statistical differences between the groups. Conclusions The e-perimental data support the hypothesis that partial cricotracheal resections can be performed safely and effectively in young rabbits. The potential clinical significance is described in light of the autopsy data.

Bulbar and pseudobulbar symptoms are diagnostic criteria of amyotrophic lateral sclerosis (ALS). One of the earliest symptoms of bulbar involvement is voice deterioration. Until now voice assessment in ALS patients has been done mainly by perceptual analysis. The objective parameters, including acoustic measures, one aerodynamic measure and the maximal phonation time, have been measured only in a few small series of patients. The first purpose of this prospective study was to determine which vocal parameters discriminate ALS patients with bulbar involvement from control patients. The second was to identify sensitive parameters for early detection of voice deterioration due to bulbar involvement in pre-symptomatic ALS patients. The voices of 63 female ALS patients, including 40 with bulbar symptoms (sALS patients) and 23 without bulbar symptoms (aALS patients), were studied using an objective voice analysis system that allows simultaneous analysis of acoustic and aerodynamic parameters. Measurements were compared with those obtained in 40 normal female subjects (control patients). Five of eight acoustic parameters were significantly different among the three groups: jitter, coefficient of variation for frequency, shimmer, number of harmonics, and maximum phonatory frequency range. Three aerodynamic parameters, phonatory airflow, cycle-to-cycle variation for phonatory airflow, and coefficient of variation for phonatory airflow were significantly different between sALS patients and control patients. No aerodynamic parameter allowed discrimination between aALS patients and control patients. This study shows that acoustic parameters are more sensitive than aerodynamic parameters for early detection of bulbar involvement. Nevertheless, the measurements used can predict bulbar involvement in 73% of those in the sALS group, but only in 52% of those in the aALS group.

Hypothesis: Objective analysis of the outcome of phonosurgery is needed to allow comparison of different surgical techniques or indications, or both. We tried to demonstrate that measurement of mean oral airflow during the production of a sustained vowel could be used in combination with acoustic measurements such as jitter or shimmer for assessment of voice improvement after phonosurgery. Study Design: This prospective study included 27 consecutive patients who underwent phonosurgery during a 3-month period. Method: Perceptual analysis served as the “gold standard.” Objective measurements (oral airflow, jitter, shimmer) on the most stable portion of a sustained vowel /a/ were made using the EVA system (SQ-Lab, Aix-en-Provence, France). Results: Oral airflow was significantly greater in patients with poor perceptual results than in patients with good perceptual results. Jitter and shimmer were not significantly different because of the dispersion of the values. Discriminant factorial analysis showed that a combination of jitter, shimmer, and oral airflow was able to identify patients with good or poor perceptual results in 77% of cases. Conclusions: Oral airflow allows simple, quick, and reliable assessment of the outcome of phonosurgery and can be used in everyday clinical practice.