[Neighbourhood noise pollution in housing]. / Pollution sonore de voisinage dans l'habitat.

NEIGHBOURHOOD NOISE POLLUTION IN HOUSING. The discomfort caused by environmental noise in home living space is very frequently observed in our time, its consequences are underestimated. The genesis of this nuisance lies in the poor quality of buildings, which are subject to a series of regulations and obligations that are often not respected, as well as incivism and non-compliance with Public Health Code decrees governing noise emissions from various activities. Physician practitioners or specialists are sometimes solicited by their patients on the repercussions on their health and on the action to be taken to obtain a reduction of this nuisance.

GESTION DE LA POLLUTION SONORE LIÉE AU VOISINAGE. La gêne provoquée par les bruits de l'environnement dans l'espace de vie à domicile constitue une doléance fréquente en milieu urbain. Dans la genèse de ces nuisances interviennent la mauvaise qualité des constructions soumises à une série de réglementations et d'obligations souvent non respectées, et l'incivisme et le non-respect des décrets du code de la santé publique régissant les émissions sonores de diverses activités. Les médecins ou spécialistes sollicités par leurs patients doivent en connaître les conséquences cliniques, socio-comportementales et économiques souvent sous-estimées, et la conduite à tenir pour obtenir une réduction de ces nuisances.

Transmucosal gas-loss rates in middle ears initially filled with O2 or CO2.

This study investigates the role of different gases in clearance of gas in the middle ear cavity (ME) by its mucosal blood flow. A rat model was used to measure gas volume changes in the ME cavity at constant pressure without ventilation. We disturbed the normal gas composition of the ME by filling it with O2 or CO2, measured the consequent changes in gas volume over time and compared these results with previously obtained ones for air and N2. The first 5 min of the primary transient phase (phase I) for O2 or CO2 was characterized by a volume loss decrease of -0.49 ± 0.34 µL and -46.28 ± 8.49 µL, respectively, with volume loss increase for air and N2 differing greatly, at +0.17 ± 0.17 and +2.31 ± 0.81, respectively. The CO2 value of -46.28 µL showed that a volume of gas equivalent to that of the ME cleft volume was eliminated within the first 5 min. In the second phase (phase II), all gases showed a linear decrease in volume, which presumably represents a steady-state gas loss rate. However, the gas loss rate of -0.307 ± 0.170 µL min-1 for O2-filled MEs was significantly higher than the mean of -0.124 µL min-1 for all other gases. We used a previously established mathematical model to calculate the effective ME mucosal blood flow rate under steady-state (phase II) conditions. The blood flow results for O2-filled MEs differed greatly from those of the other gases (89.0 ± 49.28 vs. 26.5 µL min-1, on average), which suggest that the model used to calculate blood flow should be modified if used with O2-filled MEs. Further work should involve a comparison of our method with different methods to verify ME blood flow rate.

Comparison of 3 procedures for hypoglossal-facial anastomosis.

OBJECTIVE: We aimed to evaluate rehabilitation of complete facial palsy with 3 procedures for hypoglossal-facial anastomosis: end-to-end ("original"), partial end-to-end with interpositional jump grafting ("jump") and the new partial end to end without grafting ("modified"). METHODS: A medical jury reviewed videos of 36 patients with complete facial palsy who underwent surgery from 1998 to 2008 by original (n = 13), jump (n = 13), and modified (n = 10) procedures. The jury of 5 ear, nose, and throat surgeons who were blinded to the procedure evaluated rehabilitation by 3 facial nerve grading systems-House and Brackman (HB), Sunnybrook, and Freyss scales-and 3 subjective scores for the face at rest and during voluntary and emotional motions. RESULTS: Recovery time was shorter with the modified and original procedures than jump procedure (5, 6, and 8 mo, respectively). All patients achieved at least good results. Scores on the HB scale (I-VI) were mainly III. HB and Sunnybrook scores did not differ by procedure. Freyss score was better for the modified procedure than original and jump procedures. Scores for the face at rest did not differ by procedure, but those during voluntary and emotional movements were worse for the jump procedure than for other procedures. Synkinesis was more severe with the original procedure than other procedures. CONCLUSION: The 3 procedures give satisfactory results for rehabilitation after surgery for facial palsy. The original procedure should be performed in patients with strong mimic or long-standing facial palsy. The jump procedure is delicate and entails risk of weak reinnervation. The modified procedure is a good compromise in terms of muscle tone and side effects.

[Cervico-facial fascitiis. A major ENT emergency]. / Les cellulites cervico-faciales. Une grave urgence ORL.

Cervical fasciitis is one of the most severe ENT emergencies, requiring immediate management by a multidisciplinary team. Often due to a benign pharyngeal or dental infection, this life-threatening condition leads to extensive necrosis spreading along the fascia of the neck, possibly to the mediastinum. A retrospective analysis of 150 consecutive patients admitted to our institution between January 2001 and December 2006 showed:--a 7% mortality rate;--pulmonary involvement in one-third of cases and hemodynamic failure or mediastinitis in half the patients;--mechanical ventilation for an average of 10 days, intubation for 13 days, tracheostomy for 31 days, intensive care unit management for 17 days, and hospitalization for 26 days; and--functional and esthetic sequelae in about half the patients. These data underscore the extreme severity of cervicofacial fasciitis and the need to pay close attention to any general or functional signs of severe sepsis in patients with apparently mild head or neck infections. Such patients should be urgently referred to a tertiary center for immediate CT scan and surgical drainage of any cervical or thoracic abscesses. Intensive medical care is needed to manage the frequent cardio-hemodynamic failure and secondary pulmonary/mediastinal infections. The only possible predisposing factors so far identified are inadequate initial medical treatment and self-medication with nonsteroidal antiinflammatory drugs.

Endolymphatic sac tumors in von Hippel-Lindau disease: report of three cases.

OBJECTIVES: To illustrate the diagnostic and pathophysiologic issues of endolymphatic sac tumors (ELSTs) and its clinical association with von Hippel-Lindau (VHL) disease and to demonstrate the interest of genetic testing in such cases. STUDY DESIGN: Retrospective analysis of 3 cases of ELST with VHL in 3 different clinical and prognostic situations. MAIN OUTCOMES: The first case was diagnosed on the concomitant finding of a central nervous system lesion. The familial genetic testing revealed the presence of the VHL mutation in an asymptomatic daughter, which justified regular follow-up. In the second case of known VHL syndromic disease, the pathophysiologic role of the endolymphatic sac was questioned, with vertigo as the initial, unique symptom of ELST. In the third case, a giant hypervascularized ELST, initially diagnosed as jugular paraganglioma, was the unique manifestation of VHL disease. The young age of the patient could explain the absence of other tumors. CONCLUSION: Diagnosis of ELSTs may be difficult especially when the original site of the lesion cannot be clearly identified. Such tumors may be revealed or may develop with VHL disease. On presentation of a lytic, vascularized tumor of the posterior face of the petrous bone, clinicians should systematically search for other manifestations of VHL disease and propose a VHL genetic testing for patients, and relatives in case of a positive test, to detect early asymptomatic other tumors. The type of VHL mutation might predict the aggressiveness.

Our experience in the management of petrous bone cholesteatoma.

We present the management of a series of petrous bone cholesteatomas. We performed a retrospective analysis on 28 patients with petrous bone cholesteatoma who underwent surgery between 1991 and 2008 at Lariboisiere Hospital, Paris, France. Main outcome measures included age of patients, surgical approaches, complications, and recurrence. The mean age was 47 years. Five were congenital cholesteatomas and 23 were acquired ones. Seventeen patients had undergone previous mastoid surgery elsewhere. Ninety-six percent of patients presented with hearing loss and 37.5% with facial nerve palsy. The surgical approaches varied according to the classification. Postoperatively, four patients developed facial nerve palsy; two patients, XII nerve paresis; one patient, X nerve paresis; and eight patients, deafness. The mean follow-up was 5 years. Twenty patients had no long-term recurrence. Two cases of petrous apex cholesteatoma presenting with double vision were removed by an endoscopic transsphenoidal approach. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous bone cholesteatoma. Petrous bone cholesteatoma surgery is difficult. Lateral transtemporal and middle fossa approaches are classically used to remove petrous bone cholesteatoma. Recent progresses in endoscopic surgery, using image guidance system, allow removal of the petrous apex cholesteatoma by an endoscopic transsphenoidal approach with minimal morbidity.

Auditory rehabilitation with cochlear implantation in patients with neurofibromatosis type 2.

CONCLUSIONS: New technological developments will most probably improve the efficiency of auditory brainstem implantation (ABI). Meanwhile, cochlear implantation in patients who have undergone prior reductive surgery, and who have maintained a positive electric stimulation, is an excellent alternative for rehabilitating complete and bilateral hearing loss in patients with neurofibromatosis type 2 (NF2). Auditory results are far better than those reported after ABI. Long-term follow-up will be necessary to demonstrate the validity of this strategy. OBJECTIVES: ABIs restore some degree of auditory perception in NF2 patients with bilateral and complete hearing loss, but results are often inadequate for maintaining social and professional activities. The aim of this study was to report the results of auditory rehabilitation by cochlear implantation in three cases of NF2. PATIENTS AND METHODS: This was a retrospective study undertaken in a tertiary referral center. The first patient had undergone previous surgery for a left grade III vestibular schwannoma (VS) and then underwent irradiation for a right grade I VS. Two years after irradiation, he suddenly lost his remaining hearing. Electric promontory stimulation was positive and cochlear implantation was performed. The second patient had undergone surgery for a left grade III VS and followed for a right grade II VS. She suddenly lost her remaining hearing. A cytoreductive surgery was performed and the cochlear nerve was preserved. Postoperative electric stimulation was positive. She was then implanted with a cochlear implant. The third patient presented with a right stage III and a left stage I VS. She first underwent a subtotal removal of the left VS with immediate cochlear implantation. She then underwent removal of the right VS stage III with no possible preservation of the cochlear nerve. RESULTS: All three patients had excellent postoperative speech performance and were back to work 3 months after implantation. Imaging follow-ups at 4, 2, and 1 year, respectively, do not show any evolution of the tumor.

Surgical treatment of facial nerve schwannomas.

Facial nerve schwannomas are rare. They occur all along the nerve's course from the cerebellopontine angle to the parotid region. Clinically, intracranial facial nerve schwannomas often present with facial nerve paralysis or hearing loss and may initially be misdiagnosed as vestibular schwannomas. Modern imaging techniques allow diagnosis and evaluate tumor location, size and extension. Functional tests evaluate facial nerve and hearing function. All this information results in an individual management plan. Microsurgery, stereotactic radiosurgery and observation are the therapeutic options. Surgery is planned depending on tumor features and the preoperative functional status. Subtemporal, transmastoid, translabyrinthine and retrosigmoid approaches are the principal routes. Preservation of facial nerve function is the main surgical difficulty. Anatomical nerve conservation, nerve resection with immediate grafting or delayed hypoglosso-facial nerve anastomosis are possible. The main predicting factors of postoperative facial function are the degree and duration of facial paralysis before surgery. Observation is an option for small tumors and asymptomatic patients. In these cases, a close follow-up is mandatory. The optimal timing for surgery is critical: waiting maximizes the time with good facial function, but increases the risk of hearing loss by cochlea erosion and lowers the chances of postoperative facial nerve recovery once paralysis has occurred. The role of radiosurgery is still to be determined: it seems suitable for inoperable patients and recurrent tumors.

Taste deficits after middle ear surgery for otosclerosis: taste somatosensory interactions.

The aim of this study was to evaluate the postoperative consequences of chorda tympani reclining during middle ear surgery for otosclerosis. Electrogustometric taste thresholds were measured at 11 loci on the tongue and the soft palate in 14 patients before surgery, and 8 d, 1 month and (in some cases) 6 months after surgery. A significant increase in thresholds was observed on the ipsilateral side of the tongue after surgery. The extent of the deficit and the recovery time course depended on tongue locus. The tip of the tongue displayed a limited deficit, suggesting bilateral chorda tympani innervation. The edge of the tongue was less impaired than the dorsal or the lateral tip loci; it may be dually innervated by both chorda tympani and glossopharyngeal nerves in humans, as already shown in rats. Likewise for the fungiform papillae located just anterior to the circumvallate papillae. Somatosensory early complaints suggest a derepression of chorda tympani on lingual nerve signals. In a second stage, relief of complaints before electrogustometric threshold recovery suggested trigeminal compensation of the chorda tympani deficit. Relief of complaints seems to involve central integrative processes, whereas the evolution of electrogustometric threshold represents the actual recovery time course of chorda tympani peripheral sensitivity.

Mutations associated with succinate dehydrogenase D-related malignant paragangliomas.

OBJECTIVE: Hereditary paraganglioma (PGL) syndromes result from germline mutations in genes encoding subunits B, C and D of the mitochondrial enzyme succinate dehydrogenase (SDHB, SDHC and SDHD). SDHB-related PGLs are known in particular for their high malignant potential. Recently, however, malignant PGLs were also reported among a small minority of Dutch carriers of the SDHD founder mutation D92Y. The aim of the study was to investigate which SDHD mutations are associated with malignant PGL. DESIGN: Case histories; collaborative study between referral centres in France, the USA, and the Netherlands. PATIENTS: Six unrelated patients with metastatic PGLs of either sympathetic or parasympathetic origin. MEASUREMENTS: Assessment of SDHD mutations underlying malignant PGL. RESULTS: Germline SDHD mutations underlying metastatic PGL were G148D, Y114X, L85X, W43X, D92Y, and IVS2+5G-->A. CONCLUSION: Our findings indicate that malignant SDHD-related PGL is associated with several mutations besides D92Y.

Characterization of mucosal biofilms on human adenoid tissues.

OBJECTIVES: To demonstrate the presence of mucosal biofilm in adenoid tissue using double staining for visualization of both the bacterial matrix and the bacterial cells. To identify bacterial species present on the surface of the studied adenoids. STUDY DESIGN: Prospective study. METHODS: A total of 39 specimens of adenoidectomy were removed from children with chronic and/or recurrent otitis media. The specimens were prepared for light microscopy using Gram staining, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Double staining was performed with CLSM to visualize both the bacteria and the glycocalyx matrix. Nine adenoids on which bacterial biofilms were visualized with CLSM were used for identification of bacterial species by 16S-DNA polymerase chain reaction (PCR) amplification and homology analysis. RESULTS: Of the 39 adenoids investigated, 22 (54%) showed evidence of mucosal biofilms. Gram staining, SEM and CLSM showed the presence of bacterial cells, organized in bacterial microcolonies. CLSM with double staining demonstrated mucosal biofilms by showing the presence of both bacteria and the glycocalyx. The use of 16S-DNA polymerase chain reaction (PCR) amplification and subsequent sequence analyses identified the presence of Corynebacterium argentoratense, Streptococcus salivarius, Micrococcus luteus, and Staphylococcus aureus. CONCLUSIONS: This study demonstrates that adenoid tissue in children with chronic or/and recurrent otitis media contains mucosal biofilms in 54% of the cases. The existence of living bacteria has been demonstrated. Further studies are required to describe the panel of bacteria that can be harbored in the biofilms present in adenoids and the mechanisms involved in the physiopathology of otitis prone children.

[Vestibular schwannoma (acoustic neurinoma). Natural history and quality of life]. / Schwannome vestibulaire (neurinome de l'acoustique). Histoire naturelle et qualité de vie.

Management of patients with vestibular shwannomas has gradually improved with the development of stereotaxic radiotherapy, our better understanding of these tumours' natural history, and the increasing accent placed on quality of life. The aim of this study was two-fold:--to evaluate the natural history and tumor growth in a series of 386 patients presenting with small- or medium-sized tumors amenable to conservative management; and ii) to compare quality of life in 356 patients undergoing surgery (n = 198), radiosurgery (n = 23) or conservative management (n = 135). The annual tumor growth rate was < 1 mm in 58.6% of patients, 1-3 mm in 29.2%, and > 3 mm in 12.2%. The overall growth rate did not differ significantly between intrameatal and extrameatal tumors (1.02 +/- 1.8 and 1.40 +/- 3.1 mm/y, respectively). The tumor growth rate was not related to sex, age, initial hearing status or initial tumor grade. Late diagnosis was the only factor significantly associated with the tumor growth rate. All three treatment modalities had a negative impact on QOL, but surgery led to a significant deterioration. This study supports a conservative "wait-and-scan" policy for patients with small tumours, most of which are slow-growing. Long-term radiological controls are needed even for non growing tumours. Surgery significantly degrades quality of life.

Relationship between dynamic balance and self-reported handicap in patients who have unilateral peripheral vestibular loss.

OBJECTIVE: The purpose of this study was to investigate whether Dizziness Handicap Inventory (DHI) score is related to postural performance as assessed by dynamic posturography. STUDY DESIGN: Retrospective study. SETTING: Outpatient in a tertiary referral center. PATIENTS: Ninety-two complete unilateral vestibular loss patients, categorized into 3 groups according to the postlesion stage: 1 to 2 months (n = 32; age, 47.6 +/- 10.7 yr), 4 to 7 months (n= 23; 47.1 +/- 8.37 yr), and 1 year and older (n = 37; 49.2 +/- 9.5 yr). MAIN OUTCOME MEASURES: Dizziness Handicap Inventory and dynamic balance measured with a seesaw platform moving either in the anterior-posterior or in the mediolateral direction. RESULTS: The mean DHI score was 25.8 +/- 18.7 and the range was 0 to 68. Dizziness Handicap Inventory scores did not differ significantly between the different unilateral vestibular loss groups studied. No difference was detected between the groups for the 3 subscores (emotional, functional, and physical), except that the older-than-1-year group had a significantly higher physical score than the 2 others. No correlation was found between DHI scores and postural indicators for either direction of the platform. However, patients unable to maintain balance when the seesaw platform moved in the mediolateral direction had significantly higher DHI scores than those who did not fall. CONCLUSION: Even if they are not directly related, we suggest that DHI and dynamic posturography are complementary approaches for appreciating the vestibular compensation process and are thus useful for postoperative counseling for vestibular loss patients.