[Bilateral deafness due to labyrinthitis in a patient with Crohn's disease]. / Beidseitige Ertaubung durch Labyrinthitis bei M. Crohn.

Labyrinthitis with vestibulocochlear dysfunction in chronic inflammatory bowl disease is a rare but well described manifestation or complication. The diagnostic and therapeutic possibilities and limitations of this inflammatory otopathy are presented and discussed in the context of a case report. A bilateral loss of vestibular function and sensorineural hearing loss occurred in a 26-year-old male patient with previously diagnosed Crohn's disease. He was treated with immune suppressive therapy during the onset and development of cochleovestibular symptoms. Diagnostic tests included pure tone audiograms, speech audiometry, caloric tests, VEMPs, and MRI. Therapy included azathioprine, corticosteroids (systemic and intratympanic), monoclonal antibodies, and cochlear implants. Despite immunosuppressive therapy including monoclonal antibodies, the patient progressively lost his hearing. Finally, bilateral cochlear implantation was carried out with good results. The treatment of patients with systemic inflammatory or autoimmune disease affecting the cochlear-vestibular organ is challenging. An interdisciplinary approach is needed. In cases of bilateral deafness, cochlear implantation is a satisfactory treatment and should not be delayed unnecessarily.

[Universal newborn hearing screening--a silent revolution]. / Das allgemeine Neugeborenenhörscreening--eine stille Revolution.

Significant hearing loss is one of the most frequent congenital diseases and present at birth in approximately one in 1000 newborns. During the first years of life, this number of children with permanent hearing loss rises by approximately the same amount. Hearing impairment is not an obvious condition in newborns in most cases and produces very few signs in infancy. Such hearing loss threatens normal speech and personality development. The longer the child is without auditory stimulation by speech, the more difficult it is to acquire the missed linguistic skills. Therefore, early detection and rehabilitation of such hearing loss is crucial. Universal newborn hearing screening is the most effective method to detect such impairment and is based on objective audiometric test methods that were recently developed and adapted for screening requirements. Useful tests are otoacoustic emissions and the auditory brainstem response. This article reviews this new screening tests in general and with special regard to the situation in Switzerland.

[Water precautions after insertion of a tympanostomy tube: necessary or obsolete?]. / Wasserschutz nach Paukenröhrcheneinlage: notwendig oder obsolet?

INTRODUCTION: Since the introduction of tympanostomy tubes by Armstrong in 1952, physicians and patients alike have been concerned about the possible harm associated with water entering the middle ear via tubes. It is the current practice of many physicians to advise patients to avoid water entering the middle ear by using water precautions when swimming. However, the potential harmful effect of water in causing otorrhoea and otalgia still remains controversial. MATERIALS AND METHODS: A prospective study was performed analysing the effect of water exposure in patients with tympanostomy tubes, both those who do and those who do not take water precautions. Between January 1996 and January 1997, patients who had tympanostomy tubes inserted were assigned to one of two groups on the basis of parental preference. Group I consisted of children who were allowed to swim without water protection, while in group II the children were instructed to use water protection whenever swimming. Once assigned, patients remained in that group. The parents were required to keep a diary documenting the number of days the child went swimming and experienced otorrhoea, otalgia or symptoms relating to an upper respiratory tract infection. Of the 86 patients enrolled in the study, comprehensive follow-up information was available in 63 (47 children in group I and 16 in group II). RESULTS: The mean period of follow-up was 8 months. The incidence of otorrhoea/otalgia after swimming was 36% in group I and 25% in group II. The difference between the two groups was not statistically significant (p = 0.39). The symptoms of otorrhoea and otalgia were of short duration and self-limiting in the vast majority of the patients. It was necessary to remove the tympanostomy tube in only one patient. CONCLUSIONS: In patients with tympanostomy tubes swimming without water precaution does not predispose to otorrhoea. On the basis of this study, previous investigations using in vitro models, and the literature, it is currently our practice to permit children to swim without water precautions two weeks after insertion of a tympanostomy tube.

Objective evaluation of normal facial function.

The aim of this investigation was the assessment of normal facial movements using the objective computer-assisted OSCAR method. Computerized black-and-white video images of 20 healthy volunteers were recorded with the face at rest, maximal wrinkling of the forehead, forced eye closure, and forced smiling. The mean regional symmetry index was found to be 91% (SD 6%; range 80% to 99%) for wrinkling of the forehead, 93% (SD 5%; range 82% to 100%) for forced eye closure, and 91% (SD 5%; range 79% to 98%) for maximal smiling. Clinical weighting gave a global symmetry index of 92% (SD 3%; range 88% to 96%). The presented results show that the physiological dynamic asymmetry of the normal face is 7% to 9%. No dominant facial side could be found. The comparison of the results obtained with the OSCAR method with those of the subjective House-Brackmann and Fisch grading systems showed that the physiological asymmetry of facial movements can only be accurately determined with a computer-assisted objective method.