[Cerebral infarction and tuberculosis: case report and literature review]. / Infarctus cérébral et tuberculose : rapport d'un cas et analyse de la littérature.

INTRODUCTION: Although tuberculous meningitis is an uncommon presentation of tuberculosis, it still remains one of the deadliest forms of this disease. In this context, the occurrence of a cerebral infarct is an aggravating factor. OBSERVATION: A 48-year-old Asian man presented himself in the emergency room for dysarthria and dysphagia of progressive onset. Cerebral CT showed a recent ischemic defect of the right internal capsule. Lumbar puncture showed meningitis with low sugar levels. Pulmonary micronodules on the thoracic CT suggested tuberculosis, which was confirmed by a broncho-alveolar lavage. Anti-tuberculosis treatment and early corticosteroid resulted in an improvement of the patient's state. CONCLUSION: Cerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy.

Long-term outcome of childhood hearing deficiency.

This report is based on the questionnaire responses of 95 young hearing-impaired adults (39 with moderate, 20 with severe and 36 with profound hearing loss) who were investigated in the department of paediatric audiology during childhood. Half of the individuals were educated in ordinary school (integration) and half in an institution for hearing-impaired children. Responses on social and professional insertion were compared with audiometric threshold and educational setting. Results indicate that both hearing level and educational environment influence current mode of communication and use of hearing aids. Familial factors also seem to have an influence. Oral communication is a poor predictor of employment, whereas professional qualifications enhance the chances of finding a job. Obtaining a non-professional degree appears to be unsuited for improving the employment rate of the hearing-impaired child.

[Deafness after meningitis and cochlear implant in children]. / Surdité de l'enfant après méningite et implant cochléaire.

The authors have studied 70 postmeningitic hearing losses in children. The deafness was acquired before the age of 2 year-old in 71% of the cases. Profound losses were observed in 50% considering the 1000 Hz at +100 dB, on the best ear as a selection criterion, 31 cases/70 (= 44%) could benefit from a cochlear implant. Among these 31 cases, 71% (= 22 cases) are prelingually deafness, that is which have occurred before the age of 2 years old. In 2 profound deafness cases, a late improvement of initial threshold, brings to consider with caution the 6 to 12 months time limit which is recommended by the different teams. In 3 other cases of moderate or severe losses, an improvement of the thresholds has been also observed. Because of psychological disturbances or other after-effects, a very regular medical following of these children is needed.

[On infantile audiometry: the Bordeaux strategy]. / A propos de l'audiométrie infantile: la stratégie bordelaise.

Infantile "subjective" or behavioural audiometry requires highly skilled pediatric audiologists. It is indeed often said in the majority of centres that any subjective examination is impossible under the age of 3, whereas in our clinic we successfully complete extremely precise tests, including in bone conduction, as from the age of 6 months. The strategy and techniques employed to obtain audiometric curves with headphones as from such an age are described. Subsequently, the statistical studies covering over 600 cases are presented, evidencing the earliness, accuracy and reliability of the curves obtained over nearly 15 years in Bordeaux by the method described.

[Role of electrophysiology in the current diagnosis of deaf children]. / Place de l'électrophysiologie dans le diagnostic actuel de l'enfant sourd.

The role of electrophysiology (auditory evoked potentials) in children up to 3 years old was studied through the feasibility and results of subjective audiometry. In children over six months old, subjective tests are performed systematically or at least tried before using electrophysiology. Electrophysiology is required when audiometry is impossible, and it is often performed when audiometry is abnormal. When subjective tests were not performed first, either because the child is too young or shows a developmental retardation, and the electrophysiological tests are abnormal, it is absolutely necessary to obtain an exact level of hearing as soon as possible using subjective tests. The results of a study on 244 electrophysiologically tested children between the 0 and 3 years of age are presented briefly. In 73% of the cases, the auditory brainstem responses were sufficient for clarifying or confirming the subjective tests. In 27%, they had to be completed be an electrocochleography (ECochG) under general anesthesia. The information based on the ECochG and the comparison data between the ECochG and subjective thresholds are presented. On one hand, this study highlights the double complementarity between audiometry and electrophysiology on the other, the brainstem potentials and ECochG.

[Early audiometry]. / L'audiométrie précoce.

Data obtained from electrophysiology are insufficient both for the audioprosthetist and for the speech therapist. In order to meet the requirements for the increasingly early equipping and training of deaf children, we have developed in the Bordeaux Audiology Laboratory an audiometric strategy making it possible to obtain, as early as 5 to 6 months old, bone curves on the vibrator, and air curves on the head-set. In addition to the auditive information that can be obtained, the test described forms, by its design, the starting point of early training and parental guidance. Its success is based on the relationship that is established between the child and the investigator. Early audiometry is possible. It is essential prior to any therapeutic approach.