Corr©lations clinico-tomodensitom©triques dans les surdit©s cong©nitales de lâenfant : une s©rie r©trospective qui suscite r©flexion
Résumé
Objectif : confronter les anomalies TDM retrouv©es dans les surdit©s cong©nitales aux donn©es de lâaudiologie, notamment au type et  la s©v©rit© de la surdit© de ces enfants.
Patients et m©thodes : Nous avons revu les dossiers de 87 enfants atteints de surdit© cong©nitale de types et degr©s variables, qui ont effectu© une TDM des rochers pendant une p©riode de 39 mois dans un centre de r©f©rence tertiaire. Les donn©es collig©es ont ©t© compar©es et corr©l©es entre elles avec un seuil de significativit© de p<0,05.
R©sultats : Le sex-ratio ©tait de 1,35 gar§on/fille pour un ¢ge moyen de 4,6 ans au premier scanner. Cent cinquante oreilles sur 174 pr©sentaient une surdit©, avec une perte auditive sup©rieure  70dB dans 57 cas (38%). La perte auditive moyenne ©tait de 55±35dB. Les anomalies tomodensitom©triques pr©dominaient sur les oreilles pr©sentant une surdit© de perception mod©r©e. Quatre cas dâaplasie dâoreille externe et les anomalies tympano-ossiculaires ©taient les l©sions les plus fr©quentes en pr©sence dâune surdit© de transmission (82,6%) tandis que 66% de l©sions dans les surdit©s de perception ©taient vestibulaires. Vingt trois comblements liquidiens de la caisse du tympan (63,9%) ©taient retrouv©s chez les patients adress©s pour surdit© de perception et ©taient associ©s significativement  une aggravation de la surdit© (p=0,007). La dilatation de lâaqueduc du vestibule ©tait lâanomalie ©l©mentaire la plus fr©quente dans tout lâ©chantillon (12 rochers, 6,9%). Vingt-deux anomalies cochl©aires ont ©t© retrouv©es, parmi lesquelles 8 cas de dysplasie dont 5 (62,5%) ©taient associ©s  une dilatation de lâaqueduc du vestibule. Pour deux patients pr©sentant une cophose, il a ©t© retrouv© une hypoplasie du m©at acoustique interne li©e  une absence du nerf cochl©aire.
Conclusion: La pr©valence des otites s©romuqueuses infracliniques chez les enfants adress©s pour surdit© de perception, r©alisant un tableau de surdit© mixte profonde sâexplique-t-elle par la coexistence de dysfonctionnements de la trompe d'Eustache ou dâanomalies du pharynx dans ces cas sp©cifiques ? Nous recommandons une ©valuation, sur de plus larges ©chantillons, de ces constatations.
SUMMARY
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Objective: To compare CT scan abnormalities found in children with congenital deafness to the audiology data, notably to the type and severity of deafness of children.
Patients and methods: Retrospectively, we studied the records of 87 children with different types and variable degrees of congenital deafness who had a CT scan of that part of the temporal bone lodging the ear within a period of 39 months in a tertiary reference centre. The data gotten were compared and correlated amongst themselves with a threshold significance of p < 0.05.
Results: The sex ratio was 1.35 boy/girl for a mean age of 4.6 years at the first CT scan. One hundred and fifty ears out of 174 presented with deafness, with hearing loss of greater than 70dB in 57 cases (38%). The average hearing loss was 55±35dB. CT scan abnormalities predominated in ears presenting with moderate perception deafness. Four cases of external ear aplasia and tympano â? ossicular abnormalities were the commonest lesions in the presence of transmission deafness (82.6%) while 66% of lesions in perception deafness were vestibular. Twenty three fluid filled tympanic cavity cases (63.9%) were found in patients of perception deafness and were associated with a significant aggravation of deafness (p = 0.007). Dilatation of the vestibular aqueduct was the most frequent elementary abnormality in the whole sample (12 ârochersâ, 6.9%). Twenty two cochlear abnormalities were found, among which 8 cases of dysplasia where 5 (62.5%) were associated with vestibular aqueduct dilatation. For two patients presenting with cophosis, there was hypoplasia of the internal acoustic meatus linked to an absence of cochlear nerve.
Conclusion: The prevalence of sub clinical sero-mucus otitis in children meant for perception deafness, showing features of mixed deafness is explained by the coexistence of malfunctioning of the Eustachian tube or abnormality of the pharynx in these specific cases. For this investigation, we recommend an evaluation on a larger sample.
Key words: CT scan, rocher, congenital deafness, children Â
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