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Leboulanger N.,Service dORL et de chirurgie cervico faciale | Fauroux B.,Service de pneumologie pediatrique | Fauroux B.,French Institute of Health and Medical Research
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2013

Introduction: Obstructive diseases of the upper airways are common in children and sometimes difficult to manage. Non-invasive positive-pressure ventilation (NPPV) consists of delivering continuous positive pressure during all or part of the respiratory cycle via a non-invasive interface (face mask or nasal mask, or nasal prongs). NPPV is the treatment of choice for severe obstructive sleep apnoea in children and should be considered prior to tracheotomy and is also indicated in the case of persistent sleep-disordered breathing following surgical treatment, a frequent situation in children with a malformation of the head and neck or upper airways. Discussion: A simple ventilator, able to deliver continuous positive airway pressure, is sufficient is most cases in otolaryngology. The interface represents the major technical limitation of NPPV, especially in infants for whom no appropriate commercial interface is available. A sleep study before and after initiation of NPPV, followed by regular follow-up examinations, is essential to confirm correction of gas exchanges and sleep quality in response to NPPV. Conclusion: Finally, NPPV must be performed in a specialized paediatric centre with specific expertise in this field. © 2012 Elsevier Masson SAS. All rights reserved. Source


Lefaucheur J.-P.,University Paris Est Creteil | Brugieres P.,Service de Neuroradiologie | Guimont F.,Aix - Marseille University | Iglesias S.,University Paris Est Creteil | And 3 more authors.
Neurophysiologie Clinique | Year: 2012

Objective: Repeated transcranial magnetic stimulation (rTMS) of auditory cortex has been proposed to treat refractory chronic tinnitus, but the involved mechanisms of action remain largely unknown. The purpose of this pilot study was to evaluate the impact of rTMS on auditory cortex activity in a series of tinnitus patients, using for the first time both functional magnetic resonance imaging (fMRI) of the brain and auditory evoked potentials (AEPs). Method: In six patients with chronic, lateralized refractory tinnitus, we performed five sessions of neuronavigated rTMS delivered at 1. Hz over the secondary auditory cortex (defined on morphological MRI), contralateral to tinnitus side. The effects of rTMS were assessed on clinical scales, fMRI, and AEPs (N1 and P2 components). Results: The clinical impact of rTMS on tinnitus was good for three patients (25-50% improvement of tinnitus severity compared to baseline), moderate for two patients (15% improvement), and null for one patient who had the most severe tinnitus at baseline. The changes induced by rTMS on fMRI data varied with the baseline level of auditory cortex activation before rTMS. This baseline level of activation was itself related to the severity of tinnitus. Thus, cortical stimulation increased auditory cortex activation in patients who had less severe tinnitus and low level of activation before rTMS, whereas it decreased auditory cortex activation in patients who had more severe tinnitus and higher level of activation before rTMS. Regarding AEPs, rTMS decreased N1 amplitude in all patients, except in the patient who had the most severe tinnitus at baseline and showed no improvement after rTMS. Conversely, P2 amplitude decreased after rTMS only in patients with severe tinnitus, at least for auditory stimulation contralateral to tinnitus, but increased in patients with less severe tinnitus. Conclusions: The changes produced by rTMS in auditory cortex activity, as assessed by fMRI and AEPs, appeared to depend on a process of disease-related homeostatic cortical plasticity, regardless of the therapeutic impact of rTMS on tinnitus. © 2011 Elsevier Masson SAS. Source


Maire R.,Service dORL et de chirurgie cervico faciale | Meylan P.,Institute Of Microbiologie
Revue Medicale Suisse | Year: 2011

The clinical significance of facial palsy hinges on its psychosocial consequences. While its causes are very numerous, several infections account for a majority of cases: Lyme disease, geniculate zoster (Ramsay Hunt syndrome), while the role of HSV-1 in essential (Bell's) palsy remains controversial. Essentials of facial palsy management are discussed, including the importance of the functional grading of palsy, the complexity of Lyme disease serological diagnosis, and its treatment using doxycycline, antiviral and steroids treatment of geniculate zoster, while regarding essential facial palsy, only steroids, but not antiviral have been shown to improve functional recovery. Source


Lazard D.S.,French Institute of Health and Medical Research | Giraud A.-L.,French Institute of Health and Medical Research | Gnansia D.,MXM Neurelec | Meyer B.,Service dORL et de chirurgie cervico faciale | And 3 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

The cochlear implant (CI), by enabling oral communication in severely to profoundly deaf subjects, is one of the major medical advances over the last fifty years. Despite the globally very satisfactory results, individual outcomes vary considerably. The objective of this review is to describe the various factors influencing the results of CI rehabilitation with particular emphasis on the better understanding of neurocognitive mechanisms provided by functional brain imaging. The following aspects will be discussed: 1. Peripheral predictors such as the degree of preservation of nerve structures and the positioning of the electrode array. 2. The duration of auditory deprivation whose influence on brain reorganization is now becoming more clearly understood. 3. The age of initiation of hearing rehabilitation in subjects with pre-lingual deafness influencing the possibility of physiological maturation of nerve structures. 4. The concepts of sensitive period, decoupling and cross-modality. 5. In post-lingually deaf adults, brain plasticity can allow adaptation to the disability induced by deafness, subsequently potentiating CI rehabilitation, particularly as a result of audiovisual interactions. 6. Several studies provide concordant evidence that implanted patients present different phonological analysis and primary linguistic capacities. The results of CI rehabilitation are dependent on factors situated between the cochlea and cortical associative areas. The importance of higher cognitive influences on the functional results of cochlear implantation justify adaptation of coding strategies, as well as global cognitive management of deaf patients by utilising brain plasticity capacities. © 2011 Elsevier Masson SAS. Source


Mortuaire G.,Service dORL et de chirurgie cervico faciale | De Gabory L.,Service dORL et de chirurgie cervico faciale | Francois M.,Service dORL et de chirurgie cervico faciale pediatrique | Masse G.,Cabinet de medecine generale | And 4 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2013

Introduction: Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis. These products, very effective to rapidly improve nasal congestion, are sometimes available over the counter and can be the subject of misuse, which is difficult to control. The Société Française d'ORL has recently issued guidelines concerning the use of these decongestants in the doctor's office and the operating room. Materials and methods: The review of the literature conducted by the task force studied in detail the concepts of "rebound congestion" and "rhinitis medicamentosa" often reported in a context of misuse, particularly of topical nasal decongestants. The clinical and histopathological consequences of prolonged and repeated use of nasal decongestants have been studied on animal models and healthy subjects. Results: Discordant results have been obtained, as some authors reported a harmful effect of nasal decongestants on the nasal mucosa, while others did not identify any significant changes. No study has been able to distinguish between inflammatory lesions induced by chronic rhinosinusitis and lesions possibly related to the use of nasal decongestants. Discussion: The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis. Conclusion: Nasal decongestants are recommended for the management of acute rhinosinusitis to reduce the consequences of often disabling nasal congestion. They are also recommended during rhinoscopic examination and for preparation of the nasal mucosa prior to endonasal surgery. © 2012 Elsevier Masson SAS. Source

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