Search

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.

OBJECTIVE To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of children who present with signs and symptoms of congenital cholesteatoma. METHODS A two-iterative Delphi method questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group, on the preoperative work-up, the perioperative considerations, and follow-up. RESULTS Twenty-two members completed the survey, in 14 tertiary-care center departments representing 5 countries. The main consensual recommendations were: a precise otoscopic description of the quadrants involved, extensive audiological workup (bilateral tonal, vocal audiometry, and BERA), and a CT scan are required. Facial nerve monitoring and a combination of microscope and telescope are recommended for surgical removal. Clinical and audiological follow-up should be pursued yearly for at least 5 years. First MRI follow-up should be done at 18 months postoperatively if the removal violated the matrix. MRI follow-up duration depends on the initial extent of the cholesteatoma. CONCLUSION The goal of preoperative and follow-up consensus from International Pediatric Otolaryngology Group participants is to help manage infants and children with congenital cholesteatoma. The operative techniques may vary, and experienced surgeons must perform these procedures.

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.

La adenoidectomia y la amigdalectomia son intervenciones quirurgicas que con frecuencia estan indicadas en la infancia. Suelen realizarse en el mismo tiempo quirurgico, aunque su finalidad es diferente y sus indicaciones y postoperatorios tambien son distintos. La morbilidad y la mortalidad de la amigdalectomia no son insignificantes a pesar de los progresos realizados en el tratamiento perioperatorio. Se han elaborado unas recomendaciones de practica clinica (RPC) sobre la amigdalectomia infantil en 2010 por iniciativa de la Societe Francaise d’Oto-rhino-laryngologie, con la colaboracion de la Societe Francaise d’Anesthesie-reanimation y de la Association Francaise de Chirurgie Ambulatoire. La colocacion de drenajes transtimpanicos es un elemento esencial en el tratamiento de la otitis seromucosa. La Societe Francaise d’Oto-rhino-laryngologie publico unas RPC en 2016.

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 main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (n = 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (n = 24) underwent concomitant endoscopic surgery. A 65.8% (n = 125) of the patients were diagnosed with laryngomalacia, 21.1% (n = 40) with isolated posterior excess of mucosa, 9.5% (n = 18) with another diagnosis and 3.7% (n = 7) with a normal examination. The presence of comorbidity was associated (p 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery.Conclusion: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia. What is Known: • Previous research has established that laryngomalacia is the main aetiology of stridor. • Comorbidities are linked with a poor tolerance of stridor. What is new: • About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery). • Laryngomalacia and isolated posterior excess of mucosa account for 85-90% of the patients seen in consultation for stridor.

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.

Introduction The diagnosis and management of type I laryngeal clefts can be controversial and varies across centers and surgeons. Using existing peer-reviewed literature to develop an expert-based consensus will help guide physicians in the treatment of these patients as well as develop research hypotheses to further study this condition. Objective To provide recommendations for the diagnosis and management of type I laryngeal clefts. Methods Determination of current expert- and literature-based recommendations, via a survey of the International Pediatric Otolaryngology Group, using a modified Delphi method. Setting Multinational, multi-institutional, tertiary pediatric hospitals. Results Consensus recommendations include diagnostic workup, medical management, pre-operative, intra-operative and post-operative considerations for type I laryngeal clefts. Conclusions This guide on the diagnosis and management of patients with type I laryngeal clefts is aimed at improving patient care and promoting future hypothesis generation and research to validate the recommendations made here.

Objectives To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. Results Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. Conclusions Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.

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

Warming, filtering, and humidification of inspired air are major functions of the upper airway, which can be negatively altered by local disorders or surgical interventions. These functions have not been described in neonates because of ethical and technical problems difficult to solve. Numerical simulations can get around these limitations. The objective of this study was to analyze physiological nasal airflow and thermal distribution using computational fluid dynamics (CFD) techniques in neonates. CT imaging of neonates was collected from the Pediatric Radiology Department of our center. CFD has been used to simulate nasal airflow numerically, with ambient air set at 19 °C, following the recommendations for a neonate's bedroom. Thermal distribution within the nasal cavity was analyzed and coupled with airflow patterns over complete respiratory cycles. Sixteen patients have been included in the study. During inspiration, important air warming is noticed in the first centimeter of the nasal cavity (+ 8 °C at the anterior end of the inferior turbinate). During the expiration phase, the temperature decreases slightly (- 3 °C) between the pharynx and the nostrils. A model with asymmetric nasal fossae showed that nasal obstruction leads to decreased airflow and abnormally high temperatures in the obstructed side (+ 2 °C at the nasal valve, + 4 °C at the choana). According to our results, the nasal valve area is of crucial importance in air warming in neonates, when ambient air is 19 °C, since about 70% of air warming is performed in this area. When needed, surgical interventions should respect the anatomy of this zone and restore normal airflows and warming. Graphical abstract .

La disnea laringea es una dificultad respiratoria relacionada con una reduccion del calibre de la luz laringea a nivel de una de sus tres regiones (supraglotis, glotis y subglotis). La disnea laringea infantil es una urgencia, en la que se deben identificar los signos de gravedad, porque puede comprometer el pronostico vital. Antes del 6.° mes, las causas principales son congenitas: laringomalacia, angioma subglotico y malformaciones laringotraqueales. Despues del 6.° mes, en la mayoria de los casos se debe a cuerpos extranos o a laringitis virales.

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.

The main objective was to evaluate the bimodal self-rated benefits on auditory performance under real conditions and the quality of life in two groups of cochlear-implanted adults, with or without a contralateral hearing aid. The secondary objective was to investigate correlations between the use of a hearing aid and residual hearing on the non-implanted ear. This retrospective study was realized between 2000 and 2010 in two referral centers. A population of 183 postlingually deaf adults, implanted with a cochlear experience superior to 6 months, was selected. The Speech, Spatial, and other Qualities of Hearing Scale were administered to evaluate the auditory performances, and the Nijmegen Cochlear Implant Questionnaire to evaluate the quality of life. The population was divided into two groups: a group with unilateral cochlear implants (Cochlear Implant-alone, n = 54), and a bimodal group with a cochlear implant and a contralateral hearing aid (n = 62). Both groups were similar in terms of auditory deprivation duration, duration of cochlear implant use, and pure-tone average on the implanted ear. There was a significant difference in terms of pure-tone average on low and low-to-mid frequencies on the non-implanted ear. The scores on both questionnaires showed an improvement in the basic sound perception and quality of social activities for the bimodal group. The results suggest that the bimodal stimulation (cochlear implant and contralateral hearing aid) improved auditory perception in quiet and the quality of life domain of social activities.

La gestione delle stenosi laringotracheali e una vera e propria sfida per l’otorinolaringoiatra, specialmente nella popolazione pediatrica. Le stenosi sottoglottiche si definiscono come una riduzione del calibro del lume della regione sottoglottica rispetto alla norma. Nel corso degli ultimi 30 anni, la tracheotomia di attesa ha lasciato posto a vari trattamenti curativi (chirurgia mini-invasiva per via endoscopica, chirurgia aperta). L’obiettivo del trattamento e triplice: recuperare una funzione respiratoria normale e conservare le funzioni fonatorie e di deglutizione. Questo articolo riassume le varie tecniche e indicazioni chirurgiche nella gestione delle stenosi laringotracheali del bambino. Ogni indicazione deve essere valutata caso per caso, in funzione dello stato generale del bambino e delle caratteristiche della stenosi (grado, altezza, funzionamento delle corde vocali). Questo articolo sottolinea l’emergenza delle tecniche chirurgiche per via endoscopica, con la persistenza dell’interesse delle tecniche di laringotracheoplastica o resezione cricotracheale nel caso delle stenosi di grado elevato. Malgrado la standardizzazione della gestione diagnostica e terapeutica di queste stenosi, il trattamento di una stenosi congenita sottoglottica resta una procedura difficile e gravata dal rischio di insuccessi.

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.

El tratamiento de las estenosis laringotraqueales supone un autentico desafio para el otorrinolaringologo, sobre todo en la poblacion pediatrica. Las estenosis subgloticas se definen como una disminucion del calibre de la luz de la region subglotica respecto a lo normal. En los ultimos 30 anos, la traqueotomia transitoria se ha sustituido por diversos tratamientos curativos (cirugia minimamente invasiva por via endoscopica, cirugia abierta). El tratamiento tiene un triple objetivo: recuperar una funcion respiratoria normal y conservar las funciones fonatoria y deglutoria. En este articulo se resumen las distintas tecnicas e indicaciones quirurgicas en el tratamiento de las estenosis laringotraqueales infantiles. Cada indicacion debe evaluarse caso por caso, dependiendo del estado general del nino y de las caracteristicas de la estenosis (grado altura, funcionamiento de las cuerdas vocales). Tambien se describe el desarrollo de las tecnicas quirurgica por via endoscopica, con la persistencia y el interes de las tecnicas de laringotraqueoplastia o de reseccion cricotraqueal en las estenosis de grado elevado. A pesar de la estandarizacion del diagnostico y del tratamiento de estas estenosis, el tratamiento de una estenosis congenita subglotica sigue siendo un procedimiento dificil y que conlleva un riesgo de fracaso.

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

La adenoidectomia y la amigdalectomia son intervenciones quirurgicas que de indicacion frecuente en el nino. A menudo se realizan en la misma intervencion, aunque sus finalidades son distintas, al igual que sus indicaciones y el postoperatorio. La amigdalectomia se asocia a una morbimortalidad significativa a pesar de los progresos realizados en el tratamiento perioperatorio. En 2010, se elaboraron unas recomendaciones sobre la amigdalectomia en la infancia, bajo la iniciativa de la Societe Francaise d’Oto-rhino-laryngologie, junto con la Societe Francaise d’Anesthesie-reanimation y la Association Francaise de Chirurgie Ambulatoire. La colocacion de tubos de drenaje transtimpanico es un elemento esencial en el tratamiento de la otitis seromucosa. En Francia, las recomendaciones difundidas por la Agence Nationale d’Accreditation et d’Evaluation en Sante han permitido precisar adecuadamente estas indicaciones.

L’adenoidectomia e la tonsillectomia sono degli interventi chirurgici di indicazione frequente nel bambino. Spesso eseguiti nello stesso tempo operatorio, sono due interventi con finalita differenti, le cui indicazioni e i cui postumi operatori sono distinti. La morbilita e la mortalita della tonsillectomia sono non trascurabili, malgrado i progressi realizzati nella gestione perioperatoria. Delle raccomandazioni relative alla tonsillectomia del bambino sono state elaborate nel 2010 su iniziativa della Societa francese di otorinolaringoiatria e con la Societa francese di anestesia-rianimazione e l’Associazione francese di chirurgia ambulatoriale. Il posizionamento di aeratori transtimpanici e un elemento essenziale nella gestione dell’otite sieromucosa. Le raccomandazioni diffuse dall’Agenzia nazionale di accreditamento e di valutazione in sanita hanno permesso di precisare bene queste indicazioni.

Objective To provide recommendations for the workup of hearing loss in the pediatric patient. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group. Results Consensus recommendations include initial screening and diagnosis as well as the workup of sensorineural, conductive and mixed hearing loss in children. The consensus statement discusses the role of genetic testing and imaging and provides algorithms to guide the workup of children with hearing loss. Conclusion The workup of children with hearing loss can be guided by the recommendations provided herein.

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 To develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. Results Consensus recommendations including pre-operative, intra-operative, and post-operative considerations, as well as sedation and nutrition management are described. These recommendations are based on the collective opinion of the IPOG members and are targeted to (i) otolaryngologists who perform tracheotomies on pediatric patients, (ii) intensivists who are involved in the shared-care of these patients, and (iii) allied health professionals. Conclusion Pediatric peri-operative tracheotomy care consensus recommendations are aimed at improving patient-centered care in this patient population.

International audience; While the positive benefits of pediatric cochlear implantation on language perception skills are now proven, the heterogeneity of outcomes remains high. The understanding of this heterogeneity and possible strategies to minimize it is of utmost importance. Our scope here is to test the effects of an auditory training strategy, "sound in Hands", using playful tasks grounded on the theoretical and empirical findings of cognitive sciences. Indeed, several basic auditory operations, such as auditory scene analysis (ASA) are not trained in the usual therapeutic interventions in deaf children. However, as they constitute a fundamental basis in auditory cognition, their development should imply general benefit in auditory processing and in turn enhance speech perception. The purpose of the present study was to determine whether cochlear implanted children could improve auditory performances in trained tasks and whether they could develop a transfer of learning to a phonetic discrimination test. Material and methods: Nineteen prelingually unilateral cochlear implanted children without additional handicap (4-10 year-olds) were recruited. The four main auditory cognitive processing (identification, discrimination, ASA and auditory memory) were stimulated and trained in the Experimental Group (EG) using Sound in Hands. The EG followed 20 training weekly sessions of 30 min and the untrained group was the control group (CG). Two measures were taken for both groups: before training (T1) and after training (T2). Results: EG showed a significant improvement in the identification, discrimination and auditory memory tasks. The improvement in the ASA task did not reach significance. CG did not show any significant improvement in any of the tasks assessed. Most importantly, improvement was visible in the phonetic discrimination test for EG only. Moreover, younger children benefited more from the auditory training program to develop their phonetic abilities compared to older children, supporting the idea that rehabilitative care is most efficient when it takes place early on during childhood. These results are important to pinpoint the auditory deficits in CI children, to gather a better understanding of the links between basic auditory skills and speech perception which will in turn allow more efficient rehabilitative programs. (C) 2016 Elsevier B.V. All rights reserved.

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.

Les enfants deficients auditifs ont un retard d’acquisition de la Theorie de l’Esprit variant de 2 a 8 ans. L’objectif de l’etude etait de determiner le delai d’acquisition de cette capacite chez des enfants sourds profonds implantes cochleaires en fonction de l’âge au moment de l’implantation et du langage oral. Un retard de 2 ans et demi est retrouve dans la population d’etude. Il existe une tendance non statistiquement significative pour une meilleure reussite des sujets implantes avant l’âge de 3 ans aux epreuves de Theorie de l’Esprit. La maitrise des etats mentaux a ete correlee au niveau de la comprehension orale.

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.