Papers by Christian Dubreuil
Objective. – Evaluation of the feasability and parental attitudes towards a hearing screening pro... more Objective. – Evaluation of the feasability and parental attitudes towards a hearing screening programme using evoked otoacoustic emissions, implemented in a maternity ward in France.Methods. – A hearing screening test using transiently evoked otoacoustic emissions (TEOAE) was proposed to each baby, and an anonymous questionnaire was given to parents to assess their attitudes towards the screening procedure.Results. – Although the refusal of the
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, 2010
ABSTRACT Objectifs La chirurgie des schwannomes vestibulaires peut se compliquer d’infections gra... more ABSTRACT Objectifs La chirurgie des schwannomes vestibulaires peut se compliquer d’infections graves et potentiellement létales. Une surveillance postopératoire minutieuse est nécessaire pour diagnostiquer ces infections qui demeurent peu fréquentes et dont le tableau clinique est souvent décapité par la chirurgie récente. En cas de fièvre ou de troubles neurologiques postopératoires même minimes, une imagerie doit être réalisée et permet d’éliminer un abcès intracérébral. Présentation clinique Un homme âgé de 39 ans ayant bénéficié de l’exérèse d’un schwannome vestibulaire stade IV du côté droit par voie translabyrinthique s’est présenté à trois mois postopératoire avec des céphalées d’apparition récente et d’intensité croissante, un syndrome confusionnel, une hémiparésie gauche et une fièvre à 38 °C. Le scanner et l’IRM cérébrales montraient une image compatible avec un abcès frontal intracérébral droit d’apparition retardée. Technique Une biopsie stéréotaxique a été réalisée. Les cultures sont demeurées stériles. Les examens histopathologiques ont retrouvé un glioblastome multiforme de grade 4. Conclusion Le tableau clinique du glioblastome multiforme mimait parfaitement celui d’un abcès intracérébral. Son évolution rapide, la normalité de l’IRM initiale et son aspect radiologique en ont fait un diagnostic différentiel d’un abcès cérébral postopératoire. Malgré sa rareté, il est licite devant un tel tableau de ne pas se contenter d’examens bactériologiques et de réaliser une biopsie pour examen anatomopathologique de façon systématique.
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2010
Objectives: Routine vestibular schwannoma surgery can result in serious and potentially lethal in... more Objectives: Routine vestibular schwannoma surgery can result in serious and potentially lethal infectious complications. A high degree of vigilance is necessary to diagnose these uncommon infections and in case of postoperative neurological symptoms, brain magnetic resonance imaging should be performed to eliminate a brain abscess. In some cases, the final diagnosis is not the expected one. Clinical presentation: A 39-year-old man presented three months postoperatively after a vestibular schwannoma removal by translabyrinthin approach with a rapid and progressive history of headaches, confusion, and left hemi paresis with fever. The brain CT and MRI were in favour of a delayed postoperative frontal abscess. Technique: A biopsy under stereotactic guidance was performed. Histopathologic examination revealed WHO grade 4 glioblastoma multiforme. Conclusion: Symptoms and signs of glioblastoma multiforme are congruent with brain abscess. Its rapid evolution, the normality of the first magnetic resonance imaging, and its radiological aspect made it a differential diagnosis of a postoperative brain abscess and should be systematically researched.
Médecine et Maladies Infectieuses, 2003
Objectives – The authors wanted to assess the pharmacokinetic/pharmacodynamic parameters of Augme... more Objectives – The authors wanted to assess the pharmacokinetic/pharmacodynamic parameters of Augmentin® in its pediatric formulation by measuring amoxicillin and clavulanic acid concentration in blood and middle ear fluid.Methods – A multicenter, open pharmacokinetic study, randomized in 5 groups according to sampling time was made on 36 children treated with 80/10 mg kg–1 d–1 for 3 days in 3 intakes per day.
Médecine et Maladies Infectieuses, 1996
Médecine et Maladies Infectieuses, 2004
Les examens neuro-radiologiques (tomodensitomdtrie et/ou imagerie par resonance magnEtique) contr... more Les examens neuro-radiologiques (tomodensitomdtrie et/ou imagerie par resonance magnEtique) contribuent d' une part au diagnostic et d'autre part h l'analyse et au suivi 6volutif des complications de la tuberculose du syst~me nerveux central.
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Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2008
To compare the clinical and paraclinical picture and the postoperative results of meningiomas of ... more To compare the clinical and paraclinical picture and the postoperative results of meningiomas of the posterior petrous bone and to compare them with those of vestibular schwannomas (VSs) operated on by the same surgical team. A retrospective study of 27 patients (23 females) operated on for meningioma of the posterior petrous bone between 1994 and 2004. These were compared with 424 patients with VS operated on between October 1994 and January 2001. All patients had a full audiovestibular workup before and after surgery. Tumours were classified according to the Desgeorges classification for meningiomas and Koss for the VS. RESULTS-DISCUSSION: For smaller tumours, facial function is better for the VS, whereas other cranial nerves are more frequently affected in the meningiomas. For larger tumours, facial function results are better for meningiomas, but other cranial nerve complications are more frequent, with a 33.3% cranial nerve V complication rate and a mortality rate of 6.6%. Meni...
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 2008
International journal of pediatric otorhinolaryngology, 2007
The purpose of the present prospective study was to obtain normative data for Equitest computeriz... more The purpose of the present prospective study was to obtain normative data for Equitest computerized dynamic posturography (CDP) in children and young adults and to observe the balance maturation process. Equilibrium pattern and SOT of 195 healthy children aged from 6 to 14 years were compared to those of 64 young adults aged 20 years, using Equitest. The mean stability scores for children progressively improve with age and are significantly lower than those of young adults. Furthermore, sensory organization scores were lower in children compared to young adults, whereas visual preference scores were similar for the whole studied groups. According to previous literature, it may be stressed that due to a presumed incomplete development of vestibular system and central nervous system integration, children unlike young adults have lower equilibrium scores, especially when visual information was not available or was incorrect. Our results confirm previous ones obtained in children and yo...
Médecine et Maladies Infectieuses, 1995
I1 s'agit d'une 6tude franqaise prospective, randomis6e, comparative, multicentrique, mende par 4... more I1 s'agit d'une 6tude franqaise prospective, randomis6e, comparative, multicentrique, mende par 41 m6decins g6n6ralistes et 8 spdcialistes ORL r6partis en huit centres pour 6valuer l'efficacit6 et la tol6rance clinique du cefpodoxime-proxetil versus cefixime darts le traitement empirique des otites moyennes aigu6s f6bgiles et douloureuses du nourrisson et de l'enfant. Deux cent quarante-cinq patients ont 6t6 inclus (124 darts le groupe cefpodoxime, 121 darts le groupe cefixime), qui ont re~u apr6s randomisation par un central t616phonique soit du cefpodoxime pendant 5 jours, soit du cefixime pendant 8 jours h la dose de 8 mg/kg/jour. A la fin du traitement, l'analyse en intention de Waiter fait apparaitre des r6sultats cliniques satisfaisants, darts 94 % (116/124) dans le groupe cefpodoxime, contre 93 % (113/121) dans le groupe cefixime avec un rejet de l'indquivalence : p < 0,001. Ces rdsultats sont confirm6s par l'analyse per protocole (n = 227). A la visite du suivi un mois apr~s l'arr~t du traitement, on constate une efficacit6 identique pendant 8 jours, l'analyse en intention de traiter donnant les r6sultats suivants (n = 234) : 79 % (94/119) de r6sultats satisfaisants darts le groupe cefpodoxime contre 74 % (85/115) dans le groupe cefixime. La toldrance a 6t6 bonne avec 5,6 % (7/124) d'effets secondaires d'imputation possible ou probable an cefpodoxime contre 6,6 % (8/121) darts le groupe cefixime (manifestations essentiellement gastro-intestinales). Dans le traitement des otites moyennes aigu6s de l'enfant, cefpodoxime-proxetil prescrit pendant 5 jours est aussi efficace que le cefixime prescrit pendant 8 jours, h la fin du traitement ainsi qu'h la visite de suivi.
European Archives of Oto-Rhino-Laryngology, 2014
To assess the contribution of multidisciplinary team meetings (MTM) on vestibular schwannoma mana... more To assess the contribution of multidisciplinary team meetings (MTM) on vestibular schwannoma management as well as to (1) compare professional compliance to national guidelines and (2) study the percentage of loss to follow-up in cases of conservative management by radiologic observation. A retrospective descriptive study of MTMs held between January 2011 and May 2013 in a tertiary referral center. Patients were classified in three groups according to the MTM decision (observation, surgery or radiotherapy). A total of 363 cases were discussed during the study period (29Â months). One hundred and ninety-four decisions (53.4Â %) were for conservative management with radiologic observation, 130 (35.8Â %) for surgery, and 39 (10.7Â %) for radiation therapy. The sex ratio was 0.94, and the patients had a median age of 59Â years (range 18-86Â years). Most of the vestibular schwannomas (74.2Â %) were small (stages I and II). Global concordance between the MTM decision and International Radiosurgery Association guidelines was 88.7Â %. Twenty-three percent of the 104 files that were discussed in MTMs between January 2011 and July 2012, for which conservative management was decided, were lost to follow-up by 18Â months. Management of vestibular schwannoma remains controversial, but it usually depends on the evolutive status. MTMs improve practice and facilitate the creation and maintenance of local registries. Future studies in MTMs are warranted to evaluate the benefit and evaluated if MTM could optimize long-term follow-up, limiting loss to follow-up in the observation of vestibular schwannomas that may be evolutive.
International Journal of Pediatric Otorhinolaryngology, 2008
The objective is to investigate a new therapeutic option for treatment of conductive hearing loss... more The objective is to investigate a new therapeutic option for treatment of conductive hearing loss in children with Franceschetti syndrome. A Carina fully implantable device with the MET V transducer for conductive applications was implanted in a 14-year-old male suffering from bilateral conductive hearing loss (mean PTA loss: 70 dB on the right ear and 64 dB on the left ear) secondary to Franceschetti (a.k.a Treacher Collins) syndrome with bilateral agenesis of external ear canal and ossicular malformation. Postoperative unaided PTA was unchanged by the surgical procedure. When the implant was activated, mean PTA was 29 dB improved on the implanted ear. The capacity of the Carina MET ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device may be a viable treatment for children with agenesis of external auditory canal and severe malformation of the middle ear. However, these initial results need to be furthered by: (1) additional studies including a greater number of patients to confirm these preliminary results and (2) a long-term follow-up must be carried out to detect possible long-term cochlear adverse effects, in particular on the basilar membrane.
Annales d'Otolaryngologie et de Chirurgie Cervico-faciale, 2008
To illustrate by this case report that Acremonium must now be considered as a differential diagno... more To illustrate by this case report that Acremonium must now be considered as a differential diagnosis in cases of maxillary fungus balls. Seventy-seven-year-old woman consulted for persistent pain of the right maxillary sinus, with rhinorrhea and nocturnal coughing. Computed tomography (CT) of the sinuses showed a heterogeneous opacification of the right maxillary sinus with well-defined hyperdense foci suggesting aspergillosis. She underwent a middle meatus antrectomy by an endonasal approach. Six months after the surgery, her symptoms were gone and had not recurred. Mycological examination found Acremonium. Acremonium is a genus of saprobic fungi that rarely cause disease in humans. Infection with Acremonium has recently been described in immunocompromised patients. We describe the first case of fungal maxillary sinusitis caused by Acremonium in an immunocompetent person. Clinically and radiologically, the initial diagnosis was aspergillosis. Acremonium must be considered together with aspergillosis in all situations of fungus ball chronic sinusitis.
Thérapie, 2007
To analyse recent acute painful conditions for which general practitioners (GPs) would prescribe ... more To analyse recent acute painful conditions for which general practitioners (GPs) would prescribe aspirin. Prospective observational study investigating GPs&amp;amp;amp;amp;amp;amp;#39; prescription of aspirin to adult patients with acute pain of &amp;amp;amp;amp;amp;amp;lt; or =5 days of duration. Pain intensity was graded on a 100 mm visual analogue scale (VAS) prior to and at the 48th hour of aspirin therapy. 4765 patients (53.9% males), aged 42.6 +/- 14.7 years, with recent acute pain (2.2 +/- 1.2 days) were enrolled. Aspirin was prescribed at a mean daily dose of 3g, for musculoskeletal pain (40.8%), headaches and/or migraine (30.7%), ENT pain (23.2%) or dental pain (9.5%), some patients having complained of different types of pain. Pain relief was assessable in 3793 patients (79.6%). In this population, pain intensity was reduced by 65% within 48 hours, from 63.5 +/- 16.7 mm to 22.2 +/- 17.1 mm on the VAS. The rate of responders (decrease &amp;amp;amp;amp;amp;amp;gt; or =75 % on VAS) was 39.6%; however it varied markedly across the different painful disorders. Our survey suggests that GPs may prescribe aspirin for acute pain states similar to those for which they prescribe over-the-counter non aspirin non steroidal anti-inflammatory drugs.
Presse Medicale, 2004
Objective Acute maxillary rhinosinusitis (AMRS) is a pathology in which the pain is often severe ... more Objective Acute maxillary rhinosinusitis (AMRS) is a pathology in which the pain is often severe and requires appropriate treatment. Although the use of antibiotics is widely documented, the interest of short cycles of corticosteroids in the treatment of the functional manifestations of AMRS is based on professional experience. The aim of this study was to assess the efficacy and tolerance to prednisone administered for 3 days in addition to antibiotherapy in patients presenting with an AMRS. Method This was a double blind, randomised study in parallel groups and controlled versus a placebo, involving patients aged over 18, presenting with an AMRS confirmed by X-ray and endoscopy, having developed less than 5 days and complaining of spontaneous pain assessed as ≥ 50 millimetres on a visual analog scale (VAS). Together with cefpodoxime, the patients received either prednisone (0.8 to 1.2 mg/kg) for 3 days or a placebo. The primary efficacy endpoint was the mean of the differences versus the baseline value of pain (MPID -mean pain intensy difference) assessed on the VAS from Day 1 to Day 3. The secondary endpoints assessed were the mean of the differences in intensity of nasal obstruction, assessed in the same way as the MPID, the time lapse before the orally expressed relief of the pain (PRID -pain reflief intensity difference) and the administration of paracetamol during the first 3 days. Results 289 patients (placebo 147, prednisone 142) were assessable for analysis in intent-to-treat (ITT). The global spontaneous pain on inclusion, measured by a VAS was of 73.0 ± 14.1 mm. The assessments made during the first 3 days of treatment showed a statistically significant difference in favour of the prednisone group regarding MPID: -4.82 mm (CI 95% -9.25; -0.40) (p = 0.03), nasal obstruction -5.0 mm (CI 95% -9.1; -0.8) (p = 0.02) and consumption of paracetamol (p = 0.03). There was no difference between the two groups after the end of the antibiotherapy. The tolerance measured
The Laryngoscope, 1998
ticularly the compulsive anatomic and clinical study of the lymphatic drainage of the floor of mo... more ticularly the compulsive anatomic and clinical study of the lymphatic drainage of the floor of mouth. Although cure rates were not elucidated in the paper, I would expect them to be similar to those reported by Drs. Barton and Ucmakli (Treatment of Squamous Cell Carcinoma of the Floor of Mouth. SGO 1977;125:21). Specifically, they detailed experience with 102 patients who had stage I or I1 floor-of-mouth squamous cell carcinomas, achieving a 5-year s d v a l rate of 89%. They dubbed their procedure, which bears a close resemblance to that described by Dr. DiNardo, a mono bloc, essentially a resection of floor of mouth in continuity with the ipsilateral submandibular and sublingual areas (bilateral if midline lesion), reserving irradiation for nodes positive for disease. My experience over the past 20 years with the mono bloc technique remains favorable. 4. Huelke DF, Moore JL, Compton "W, Samuels J, Leyine RS. Upper extremity injuries related to airbags deployments. J 'IFauma 1995;4:482-8. 5. Duma SM, Kress TA, Porta DJ, Woods CD, Snider JN, Fuller PM, Simmons RJ. Airbag-induced eye injuries: a report of 25 cases. J Dauma 1996;41:114-9. 6. Barton ED. Airbag safety: deployment in an automobile crash with a fall from height. J Emerg Med 1995;13:481-4.
The Laryngoscope, 2000
To determine in patients with acoustic neuromas the predictive factors of hearing preservation ac... more To determine in patients with acoustic neuromas the predictive factors of hearing preservation according to clinical, radiological, and electrophysiological parameters and to evaluate, for each of these predictive factors, the percentage of patients with preserved hearing. The study involved 107 candidates for hearing preservation attempt. Mean age was 49.7 +/- 11.4 years. Quantitative and qualitative parameters were prospectively studied. Quantitative parameters were age, duration of functional complaints, hearing loss assessed by pure tone and speech audiometry, and auditory brainstem responses (ABRs). Qualitative parameters (expressed in percentage of presence) were sex, functional complaints, vestibular deficit revealed by vestibular testings, well-shaped ABRs, wave I, III, or V of ABRs, and transient evoked otoacoustic emissions (TEOAEs). Patients were divided into two groups according to whether their hearing was preserved (52.3%) or not preserved (47.7%). First, quantitative and qualitative factors were compared between both groups to identify predictive factors. Second, all patients were considered together and the percentage of hearing preservation was determined according to the presence of each predictive factor. The results confirmed the predictive value of classic parameters such as preoperative hearing level, radiological data, and trace of ABRs. They also emphasized the predictive role of other parameters such as short duration of hearing loss, presence of wave III in ABRs, and presence of TEOAEs. The size of the tumor and the preoperative hearing levels are longstanding predictive factors of hearing preservation in acoustic neuroma surgery, and candidates for hearing preservation are therefore now selected according to these factors. This study added more recent predictive factors and, among the 10 factors identified as predictive, the most relevant to hearing preservation were the presence of TEOAEs (69.7%), short duration of hearing loss (66.7%), and presence of wave III in ABRs (66.7%).
The Laryngoscope, 1998
One hundred sixty-eight patients admitted for acoustic neuroma removal were involved in this stud... more One hundred sixty-eight patients admitted for acoustic neuroma removal were involved in this study. In all cases, the size of the tumor and the presence or absence of tinnitus and vertigo or dizziness were evaluated. Investigated functional procedures included bilateral measures of pure-tone audiometry (PTA), auditory brainstem response (ABR), electronystagmography (ENG), and transient evoked otoacoustic emissions (TEOAEs). Thirty-five patients (21%) had normal preoperative TEOAEs in the affected ear, whereas 133 patients (79%) failed to show reproducible responses. The aims of this study were 1. to evaluate what distinguishes patients with preoperative TEOAEs in the pathological ear (group A) from those who had no TEOAE (group B); and 2. to determine in cases of attempted hearing preservation whether preoperative TEOAE presence in the neuroma ear (group C) was predictive of postoperative hearing preservation compared with the group of patients without TEOAEs (group D). The presence of vertigo or dizziness was significantly less frequent, the age was lower, and preoperative mean PTA loss in both ears was lower in group A compared with group B. Frequency of the other studied parameters and ABR threshold were similar in both groups. When hearing preservation was attempted, the mean preoperative PTA loss of group C patients was lower in both ears compared with group D. However, postoperative mean PTA loss did not significantly differ in the two groups. In group C, the percentage of hearing preservation (66.6%) was significantly higher than the percentage of deafness (33.4%), whereas in group D the percentage of postoperative preserved audition and deafness did not significantly differ (respectively 44.4% and 55.6%). The findings suggest that 1. TEOAEs in ears with acoustic neuromas are found in younger patients with a lower preoperative mean PTA loss and are accompanied by fewer functional complaints, perhaps because preserved TEOAEs indicate a better preservation of inner ear vasculature; and, 2. along with radiological and electrophysiological investigations, TEOAE presence in the pathological ear could provide an additional criterion or predictive factor for the successful outcome of attempted hearing-conservation surgery in ears with acoustic neuromas.
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Papers by Christian Dubreuil