Reversible hearing loss in a patient with cryptococcosis.

A 16-year-old girl had hearing loss, paroxysmal tremor, gait disorders, and psychiatric disturbances as the initial manifestations of a cryptococcal meningoencephalitis. Imaging demonstrated an obstructive hydrocephalus, and neuro-otological explorations showed a retrocochlear deafness and diffuse brainstem involvement. Emphasis is on the deafness, which rarely occurs as a presenting symptom in this condition, and on its dramatic improvement following antimycotic therapy.

[Instantaneous measurement of acoustic reflex latency in daily practice. The apparatus. Results]. / Mesure instantanée de la latence du réflexe acoustique en pratique quotidienne. Appareillage. Résultats.

Increase in acoustic reflex latency (time between stimulus onset and response) provides a highly specific and sensitive sign for early detection of lesions of the first or second auditory neurones. The performance of a new apparatus, including an Amplaid 702 impedance meter with a specially designed numeric oscilloscope, employed systématically for all audiometric examinations (87 subjects) was compared with that of a reference apparatus (Madsen ZO 73 + Elema Schoenander-jet ink recorder). The new apparatus provided a very simple, precise, and rapid method for measuring acoustic reflex latency. The technique has its limits, however, of critical importance being the determination of the acoustic reflex threshold at close to 1 dB (modification of the apparatus), the means for measuring latency, and the use of three criteria for distinguishing retrocochlear lesions from others. The effect of age on latency, variations in the test-retest results according to the type of deafness, and the influence of averaging techniques are discussed. Typical retrocochlear lesions were rare in this series, and the 5 cases observed are described in detail, followed by a discussion of the advantages and inconveniences of systematic as against selective screening.

[Hypoglossofacial anastomois. Analysis and results on 12 cases and comparison with results of facio facial anastomosis]. / Anastomoses hypoglosso-faciales. Analyse et résultats (sur une série de 12 cas) et comparaison avec les résultats des anastomoses facio-faciales.

Regular facial clinical testing (G. Freyss) and surface integrated electromyography was employed to quantitatively assess the course of 12 hypoglossofacial anastomoses. Recovery was complete after an average period of 4 months, the time before conducting anastomosis (2 to 14 months after onset of facial paralysis) not affecting the quality of results obtained. Age significantly influenced recuperation of remaining tone, but this was always superior to 70 p. cent in relation to the other half of the face. Motor recovery was not affected by age, and was a mean of 51 p. cent after one year (50 to 70 p. cent when compared with the normal half of the face). Lingual sequelae were minimal, early physical therapy compensating for the inevitable resulting synkinesis. Results after hypoglossofacial anastomosis are compared with those obtained by faciofacial anastomoses (published in 1980). The former is a simpler and more rapid technique which produces more constant results and leads to earlier recovery (4 instead of 9 months after faciofacial anastomosis. Tone is also improved and motility satisfactory.

[Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases]. / Stratégie diagnostique du neurinome de l'acoustique. Evaluation de l'efficacité des potentiels évoqués auditifs. A propos d'une série de 50 neurinomes.

The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.