[Surgery for vertigo]. / Chirurgie des vertiges.

Spontaneous recovery or central compensation makes surgical procedures rare in patients with vertigo. Surgery for vertigo proposed after pharmacological or physical therapy fails to eliminate Ménière's disease and some very rare cases of paroxystic positional vertigo. The main target in treating Ménière's disease is to promote vestibular compensation, which is possible only with a nonprogressive and stable deficit leading to readjustment of vestibular reflexes. Surgical procedures can be classified as nondestructive (endolymphatic sac decompression, vestibular nerve decompression, patching of perilymphatic fistulas), selectively destructive (middle fossa or retrosigmoid vestibular neurotomy, lateral semi-circular plugging) and destructive (labyrinthectomy). Surgical indications essentially concern incapacitating vertigo and depend mainly on hearing status. In Ménière's disease, vestibular neurotomy can be regarded as the gold standard considering its good results on vertiginous episodes; however, scoring with functional and quality-of-life scales bring out residual deficiency in some cases.

[Functional anatomy of the facial nerve]. / Anatomie fonctionnelle du nerf facial.

Embryologic individualization of the facial nerve primordium occurs early and emphasizes trigeminofacial connections and variations in the transitional zone (TZ). In the brainstem, the specific nuclei of the facial nerve are located within five columns corresponding to the main functions. Three-quarters of the fibers are of the special visceral efferent group (SVE). Central connections of the facial motonucleus are numerous, particularly with the trigeminal complex but also the cochlear nerves. Only endoneurium surrounds facial nerve fibers in the cerebellopontine angle; central nervous system tissue offers a small extracellular space, lacking collagen and funicular plexus, without epiperineurium: nerve fibers are therefore more susceptible to injury. The segment of a nerve that reveals both CNS and PNS components is referred to as the transition zone. It should be regarded as a "locus minor resistae" because of poor vascularization and CNS myelin deficiency. The acousticofacial reflex is often absent in patients with hemifacial spasm. Early (R1) and late (R2) responses of the trigeminofacial reflex (blink reflex) in patients with hemifacial spasm are of major interest in understanding both peripheral and central mechanisms.

Long-term results of the multichannel cochlear implant.

Clinical results obtained with the multichannel cochlear implant are described in 48 cases of total deafness (27 cases of prelingual and 21 cases of postlingual deafness). The tolerance for implanted material and the survival of the electrode-nerve interface have not yet been altered after more than 5 years. After some months of training the patients, the percentages of phoneme-, word-, and sentence-recognition vary from one patient to another, but depend approximately on the value of the threshold level of the round-window stimulation test, and the degree of socialization of each patient. These results suggest that the multichannel cochlear implant may now be considered as a useful tool in the rehabilitation of totally deaf persons.

Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases.

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital. Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation. The operative and anesthetic technique is described in detail, together with any possible adverse events. The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.

[Unilateral paralysis of the lower cranial nerves caused by lesion of the internal carotid artery]. / Paralysie unilatérale des derniers nerfs crâniens par lésion de l'artère carotide interne.

We report two cases of unilateral, isolated lower cranial nerves (IX, X, XI and XII) palsy: both were due to a lesion of the internal carotid artery in the para-pharyngeal space (a dissection and a pseudoaneurysm). The diagnosis was based upon magnetic resonance imaging and selective angiography. The normality of the external carotid artery on angiography led to the hypothesis of a direct compression of the lower cranial nerves in the para-pharyngeal space, rather than an ischemia of these nerves.

[Painful ophthalmoplegia caused by chronic sphenoid sinusitis. Contribution of imaging]. / Ophtalmoplégie douloureuse par sinusite sphénoïdale chronique. Apport de l'imagerie.

Sphenoid sinusitis is a rare, often misdiagnosed, potentially lifethreatening infection. We report two cases of chronic sphenoid sinusitis presenting as painful ophthalmoplegia. We emphasize the difficulty of the diagnosis due to the deep-seated position of the cavity. The availability of CT and MRI should allow an early diagnosis. Attention has to be paid to the sphenoid sinus on every cranial image. In the chronic as well as in the acute form, the treatment is an emergency. Surgery procedures should be considered when antibiotics are inefficient. Sphenoid sinusitis must be considered in the diagnosis of painful ophthalmoplegia.

[Treatment of total deafness. Indications for and results of the multi-electrode cochlear implant]. / Traitement des surdités totales. Indications et résultats de l'implant cochléaire à multi-électrodes.

Most cases of total deafness are due to destruction of Corti's organ leaving some of the auditory nerve fibres untouched. When these fibres are electrically stimulated the patient may perceive sounds the pitch of which depends upon the location of the stimulated nerve-endings along the cochlea. An intracochlear electronic device with 12 electrodes implanted in different areas and driven from outside by a portable radiofrequency emitter provides the patient with new hearing and some speech intelligibility. After several months' training words and sentences can be recognized without having recourse to lip reading. Performances depend upon a variety of factors, many of which can be determined prior to implantation. The long-term results obtained in 54 totally deaf patients are reported.

[Value of the monitoring of the facial nerve in the evaluation of facial function in translabyrinthine surgery for acoustic neuroma]. / Intérêt du monitoring du VII sur la fonction faciale dans la chirurgie translabyrinthique des neurinomes de l'acoustique.

Amongst the 62 patients operated for acoustic neuroma using a translabyrinthine approach, the authors study post operatory results at one month of the facial function according to the "House-Brackmann" classification. The analysis consists in 2 homogeneous and comparable series of 34 and 28 patients having benefited or not of a per operatory monitoring of the facial nerve with "NIM 2" neuro monitor. Without distinction of the tumoral sizes 76% of patients show a good facial result when monitorized against 60.7% when not. According to the tumoral size monitoring becomes more interesting: also you will find better results in the monitorized serial (71%) against 29% without. Other factors concerning the facial post operatory functions are also analysed by authors. To the very important part of per operatory monitoring, the anatomical status, microvascularization and physiological state of the nerve al as well as the operator's experience are to be added. All above factors must be considered when evaluating the final post operatory facial result.

[Pathological manifestations of tonsillar hypertrophy (author's transl)]. / Les manifestations pathologiques de l'hypertrophie amygdalienne.

The authors describe the rare but essential indication for tonsillectomy in the child based upon 4 personal cases of pseudolaryngeal dyspnoea during sleep due to prolapse of the tonsils in the hypopharynx. They indicate the grave cerebral and cardiac consequences which could result from neglect of this symptom which at first sight has the characteristics of ordinary snoring. Paediatricians, anaesthetists and laryngologists are equally concerned by this alveolar hypoventilation of high obstructive origin.

[Reduction of bleeding during microsurgery of the middle ear by amiodarone]. / Réduction du saignement dans la microchirurgie de l'oreille moyenne par l'amiodarone.

Operative bleeding was reduced in 47 patients undergoing middle ear microsurgery by means of an intravenous infusion of Amiodarone. Total doses of the order of 1 mg.kg-1 were remarkably effective without adverse effects. This result is attributed to the capacity of Amiodarone to reduce the increase in blood pressure and particularly the tachycardia induced by release of endogenous (operative stress) and exogenous (local adrenaline infiltrations) catecholamines.

[Congenital sensorineural deafness and associated syndromes]. / Surdités de perception congénitales et syndromes associés.

The etiology of perceptive deafness, especially the congenital variety, requires investigation. The presence of a variety of signs associated with deafness constitutes an "associated syndrome" and helps to define a possible genetic origin. These syndromes only represent a small percentage of overall causes of deafness in children, since at most they account for only 10% of cases. Certain syndromes are encountered more often or are well known, others are extremely rare or have only been described recently. The authors report six of these very rare syndromes discovered among their patients: a KID syndrome, a Leopard syndrome, a Norrie syndrome, a Jervell and Lange Nielsen syndrome, a recently described entity called CEE with deafness and an External Neuro-Cochleo-Pancreatic syndrome which would not appear to have been previously described.

[Protracted otitis and subacute mastoiditis in children. A prospective study apropos of 118 cases]. / Otites traînantes et mastoïdites subaiguës de l'enfant. Etude prospective à propos de 118 cas.

Antibiotherapy has lead to a substantial decrease in the number of infants with acute mastoiditis or complications thereof. However, the non-negligible incidence of protracted otitis currently observed has caused one to raise several pathogenid hypotheses, among which subacute mastoiditis figures as one needing to be detected early. This prospective study was conducted on 118 children treated for protracted otitis in the ENT Service at Hopital Trousseau, during the period from january 1987 to december 1988. It allowed us to develop diagnostic and therapeutic strategies to cope with the difficult problem of protracted otitis, taking into account bacteriologic findings and risk factors, among other things.

[Effect of the surgical treatment of cleft palate on pathology of the middle ear. Apropos of 49 cases]. / Influence du traitement chirurgical des fentes vélo-palatines sur la pathologie de l'oreille moyenne. A propos de 49 cas.

The presence of middle ear disease was analyzed in 49 patients with soft palate cleft, and more particularly the influence of surgical repair and early therapy. Clinical examination, impedancemetry and audiometry carried out preoperatively and at follow up more than 3 months after surgery showed that although surgical closure of cleft provokes some improvement (40% of cases) some degree of seromucous otitis persisted in most patients, with a very partial positive influence of early surgery. Other physiopathologic factors are involved in the genesis of seromucous otitis, which cannot be cured by early surgery for soft palate cleft alone.

[The dilated vestibular aqueduct syndrome]. / Le syndrome de l'aqueduc du vestibule dilaté.

The authors analyse the clinical, radiological and audiometric findings in a population of 89 ears of 49 patients. There was no correlation between bone malformation and auditory deficit which was often profound. This anomaly occurs during the 7th week of embryogenesis and represents one facet of the dysplasia of Mondini.

[Treatment of tinnitus by mean of electric transcutaneous stimulation (author's transl)]. / Traitement des bourdonnements d'oreille par stimulation électrique percutanée.

In about a third of cases transcutaneous stimulation during a few minute by mean of electric square waves substantially improves severe tinnitus. This very simple treatment must be frequently repeated two or three times to be successful. If a notable improvement is not obtained after two or three attempts, failure must be considered as certain. The parameters of these stimulation are described and clinical results are reported. The mechanism of these improvement is uncertain.

[Multiple electrode cochlear implants : clinical results (author's transl)]. / Résultats cliniques de l'implant cochléaire à multi-électrodes.

Multiple electrode cochlear implants were employed in 34 patients with total deafness (25 cases of acquired deafness of an adult age, and 22 cases of congenital or neonatal deafness). Complications encountered initially (eardrum perforation, receiver breakdown) are no longer observed, but emphasis has also to be placed on the reliability of the electrode-nerve interface, which remained unaltered after a follow-up period of nearly five years. The advantages of the method are that it enables frequency discrimination, followed by that of phonemes and finally words and phrases, without the need for up-reading, results being variable from one case to another. Results are dependent on the effectiveness of the electrode-nerve interface and the intellectual development of the patient. Only measurable objective results are reported.

[The value of fibroscopy in laryngotracheal stenosis (author's transl)]. / Intèrêt de la fibroscopie dans les sténoses laryngo-trachéales.

The authors report the results of 297 fibroscopies in 69 patients suffering from laryngotracheal stenosis. These examinations were carried out either before treatment or for follow-up purposes. The majority of patients had undergone respiratory intensive therapy. The underlying reason for this intensive therapy was analysed, as well as the techniques used : intubation 26 %, tracheotomy 33,5 %, intubation followed by tracheotomy 40 %. Results of fibroscopy before treatment (111) are described, emphasizing the fact that this fibroscopy was adequate in the great majority of cases (96 %) to reach a decision as to wether surgery was necessary or not, and this even though certain patients had suffered severe respiratory failure. Follow-up fibroscopies (185) were useful in all cases for aspiration of the patient and observation of the suture. In 17 cases, the opportunity was taken to remove a polyp and in 10 cases removal of a suture. Finally, the authors emphasize the safety of this method of investigation (4 % of untoward incidents) which they feel to be necessary and adequate in the evaluation of laryngotracheal stenosis.,

[Thyroid metastases of digestive carcinomas (author's transl)]. / Métastases thyroïdiennes des cancers digestifs.

The authors report a case of thyroid metastasis of a rectal carcinoma 9 years after excision of the primary tumour. They study the prevalence of thyroid secondary localisations of the chief primary tumours responsible, the time before appearance of the metastasis, and clinical and histological features on the basis of cases reported in the literature. They then describe the pathogenic factors and criteria in prognosis which is always grave, as a result of the dissemination of metastases.

[Osteoid osteoma of the ethmoid bone (author's transl)]. / Ostéome ostéoïde de l'ethmoïde.

Osteoid osteoma can be distinguished from compact osteoma by the presence in its centre of a cavity (nidus) which is distinctly visible on tomography or CT scans. Contrary to osteomas, osteoid osteomas are rarely found in facial sinuses. The authors report on one exceptional case located in the ethmoid bone and review the clinical and anatomicopathological features of this benign tumour.

[Emergency tracheobronchoscopy in children with burns]. / Trachéo-bronchoscopie en urgence chez les enfants brûlés.

Smoke inhalation affects the upper airways and lung parenchyma, causing the burn victims' death rate to increase substantially. Early diagnosis is hard to obtain, as clinical signs of complications will be delayed. However, both improved chances for survival and a lower incidence of sequelae depend on how soon treatment is initiated. The smoke inhalation syndrome suspectacle from the case history cannot be confirmed without due paraclinical investigations. The authors retrace their experience with 42 children hospitalized at the Hôpital Trousseau Burn Unit. They stress the importance of emergy ENT endoscopic assessment for obtaining the diagnostic and therapeutic data necessary for taking adequate measures.