Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - New Medicine 2/2002, s. 58-60
Lidia Zawadzka-Głos, Anna Bielicka, Mieczysław Chmielik
Assessment of hearing in children in postoperative treatment of choanal atresia
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head: prof. Mieczysław Chmielik M.D.
Summary
Choanal atresia is a congenital abnormality often coexisting with other developmental abnormalities. The treatment of choice in this condition is surgical restoration of choanae patency using a transnasal or transpalatal operative approach. After surgical treatment, separators are fixed for several weeks in the posterior choanae and nasopharynx. Surgical transpalatal intervention and extended retention of separators in the posterior choanae and nasopharynx may cause auditive tube dysfunction and otitis media with effusion. The aim of this work was the estimation of the occurence of otitis media with effusion in children under post-operative treatment after choanal atresia depending on the surgical approach applied. A summary of the period 1959-2002 in the Department of Paediatric Otorhinolaryngology in Warsaw shows that 175 operations were performed because of choanal atresia. A group of 11 children operated on choanal atresia between 1996-2002 was examined. Acoustic impedance audiometry was performed in all children. Bilateral choanal atresia was recognised in 4 children, and unilateral choanal atresia in 7 children. A tympanometry curve type B was obtained in 4 children, but a tympanometry curve type A was found in 7. In the examined group we did not find a dependence between the type of operative approach in the surgical treatment of choanal atresia and otitis media with effusion occurrence.
INTRODUCTION
Choanal atresia is a rare congenital abnormality occurring with a frequency of 1 in 5000-8000 births. The cause of choanal atresia is heterogenic factors, or the aetiology of this abnormality is multiple. The persistence of the nasobuccal membrane or disturbances of the buccopharyngeal membrane recanalization are the classical basis for choanal atresia. Choanal atresia usually coexists with other congenital abnormalities (1). In 1945 Durword, Lord and Polson described 390 cases of choanal atresia coexisting with other congenital abnormalities. However, these authors maintained that the coexistence of these abnormalities was accidental. In 1981 Pagon suggested the term CHARGE for a definition of abnormalities often connected with each other. The term CHARGE denotes: C – coloboma, H – heart disease, A – atresia choanae, R – retarded growth and development and/or central nervous system anomalies, G – genital hypoplasia, E – ear anomalies and/or deafness (2, 3, 4, 5, 6). Genetic examinations prove that a specific chromosomal aberration is responsible for CHARGE. Very rarely choanal atresia may appear in a family (7). Congenital choanal atresia was described for the first time by Roeder in 1775. The first documented operation for this condition was performed by Emmert in 1861.
Table 1. A chart of choanal abnormality types, coexisting diseases, surgical approaches and tympanometry results in children with choanal atresia treated from 1996-2002.
InitialSexAgeType of abnormalityCoexisting abnormalitiesSurgical approachAcoustic impedance audiometry
R.P.M7 mBilateralDevelopmental anomaly of the ribs
Psychomotor development retardation 
Dystrophy
TransnasalTympanometry curves - type B 
Absence of a stapedial reflex
P.S.M4 mBilateralCongenital heart disease 
Anal atresia
Hypothyreosis
TransnasalTympanometry curves - type A 
Absence of a stapedial reflex at 4000 Hz
M.A.F9 mBilateralProgressive choroidal atrophy of right eye
Congenital heart disease
Decreased muscle tone
Psychomotor development retardation
Perceptive hearing loss
TransnasalTympanometry curves - type B
 Absence of a stapedial reflex
N.M.M1 mBilateralCongenital heart diseaseTranspalatalTympanometry curves - type A
Presence of a stapedial reflex
J.J.M8 yr.Left-sidedNoTransnasalTympanometry curves - type A 
Presence of a stapedial reflex
H.P.F1.5 yr.Right-sidedIris defect of the right eyeTransnasal 
Transpalatal
Tympanometry curves - type B 
Absence of a stapedial reflex
G.A.M1 yr.Right-sidedCongenital heart diseaseTranspalatalTympanometry curves - type A 
Presence of a stapedial reflex
W.P.M5 yr.Right-sidedNoTranspalatalTympanometry curves - type B 
Absence of a stapedial reflex
A.J.M1 yr.Right-sidedPsychomotor development retardationTransnasalTympanometry curves - type A 
Presence of a stapedial reflex
C.E.F14 yr.Right-sidedNoTranspalatalTympanometry curves - type A 
Presence of a stapedial reflex
S.D.F3 yr.Left-sidedNoTransnasalTympanometry curves - type A
 Presence of a stapedial reflex

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Piśmiennictwo
1. Leclerc J.E., Fearon B.: Choanal atresia and associated anomalies. Int. J. Pediatr. Otorhinolaryngol. 1987 Oct, 13(3):265-72. 2. Kaplan L.C.: Choanal atresia and its associated anomalies. A further support for the CHARGE Association. Int. J. Pediatr. Otorhinolaryngol. 1985 Mar, 8(3):237-42. 3. Thelin J.W. et al.: CHARGE syndrome. Part II. Hearing loss. Int. J. Pediatr. Otorhinolaryngol. 1986 Dec, 12(2):145-63. 4. Wright C.G. et al.: Auditory and temporal bone abnormalities in CHARGE association. Ann. Otol. Rhinol. Laryngol. 1986 Sep-Oct, 95(5 Pt 1):480-6. 5. Duncan N.O. et al.: Choanal atresia and associated anomalies: the CHARGE association. Int. J. Pediatr. Otorhinolaryngol. 1988 May, 15(2):129-35. 6. Robier A. et al.: Choanal atresia and deafness. Int. J. Pediatr. Otorhinolaryngol. 1986 Sep, 11(3):311-4. 7. Brown D.P., Israel S.M.: Audiologic findings in a set of fraternal twins with CHARGE association. J. Am. Acad. Audiol. 1991 Jul, 2(3):183-8. 8. Cozzi F. et al.: Clinical manifestations of choanal atresia in infancy. J. Pediatr. Surg. 1988 Mar, 23(3):203-6. 9. Schwartz M.L., Savetsky L.: Choanal atresia: clinical features, surgical approch, and long-term follow-up. Laryngoscope, 1986 Dec, 96(12):1335-9. 10. Bergstrom L., Owens O.: Posterior choanal atresia: a syndromal disorder. Laryngoscope 1984, 94:1273-1276. 11. Ranocha C. et al.: Niewykształcenie nozdrzy tylnych – postępowanie operacyjne. Otolaryngologia Polska, 1997, t L (suplement 22), 398-403. 12. McIntosh W.A.: Trans-septal approach to unilateral posterior choanal atresia. J. Laryngol. Otol. 1986 Oct, 100(10):1133-7.
New Medicine 2/2002
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