[Reconstruction of bone defects in the earcanal with hydroxyapatite]. / Reconstruction des defects osseux du conduit auditif externe par ciment d'hydroxyapatite.

Traditional reconstruction methods of osseous defects within the tympanic frame, most often being the atticotomy, within the framework of chronic otitis media surgery, still do not produce stable or definitive results, usually due to displacement or partial lyse of the transplanted material (cartilage, bone ...). The reconstruction procedure with the aid of hydroxyapatite cement as presented by the authors, allows for a complete, stable and definitive reconstruction.

[Evaluation of the efficiency of ERTL4/6 screening tests for language disorders for children with a 22q11 deletion]. / Etude de l'efficacité des epreuves de repérage de troubles de langage ERTL4/A6 sur des enfants porteurs d'une microdélétion 22q11.

OBJECTIVE: ERTL (Epreuves de Repérage de Troubles de Langage) tests have been designed as a screening test to detect rapidly language disorders. To evaluate the effectiveness of these tests, we have compared them to the form P (NEEL-P) tests for the examination of language in 6 children with a 22q11 microdeletion. MATERIALS AND METHOD: 6 children aged from 4 years and 4 months to 5 years and 4 months, 4 boys and 2 girls have been tested. These tests have been performed in two sessions lasting between 1 and 1 1/2 hour. RESULTS: They are consistent in both tests. ERTL has identified all the children with a disorder. CONCLUSION: These fast tests should be used more often to detect children requiring additional and more complex language and neuropsychological evaluations.

Tinnitus and otosclerosis.

OBJECTIVE: To establish the origin of tinnitus in patients with otosclerosis. METHODOLOGY: We performed a literature review to identify the characteristics of tinnitus in the general population and among patients with otosclerosis. RESULTS: Characteristics of tinnitus among patients with otosclerosis differ from those among the general population, suggesting mechanisms other than those implicated in presbycusis. Considerable improvements in the prevalence of tinnitus following corrective surgery demonstrate the limited contribution of diffuse labyrinth lesions. Middle ear and possibly secondary inner ear dysfunction produced by stapes blockage appear to be major etiopathogenic factors in the development of tinnitus in patients with otosclerosis. CONCLUSION: The conductive hearing deprivation produced by otosclerosis is associated with limited and reversible modifications in the central auditory pathway that are linked to tinnitus.

Today's indications for cochlear implantation.

Today's indications for cochlear implantation. During the last twenty years, the indications for cochlear implants (CIs) extended significantly due to positive experience with CIs, improved CI technology, and safer surgery. This paper reviews the classical and emerging indications for CIs anno 2007. Providing a postlingually deaf adult with a unilateral CI has been the earliest indication and remains the standard indication. However, CIs are also indicated for prelingually deaf adults, and for children younger than one year old. Recently, CIs are also indicated for adults with residual hearing: when best aided sentence recognition scores in quiet are lower than 70%. CIs for patients with residual hearing sometimes imply the use of a bimodal CI; a device that stimulates the cochlea both electrically and acoustically. Another promising evolution is bilateral implantation. Nowadays, it has also become possible to place a CI in the malformed cochlea. When an auditory nerve is absent or when implantation failed despite a functional device, auditory brainstem implants can restore some form of hearing to the deaf.

[Pathophysiology of cholesteatoma]. / La physiopathogénie des cholestéatomes.

OBJECTIVE: To describe the development of cholesteatoma using current knowledge. METHOD: Review of the literature. RESULTS: Cholesteatoma describes a mass of keratin (skin) in the middle ear which consists of a perimatrix and matrix. There are at least three kinds of cholesteatoma in the middle ear one resulting from invagination (retraction's pocket), another from migration and the last one from congenital inclusion. Cholesteatoma needs three successive inflammatory phases, the first leading to a retraction pocket, the second leading to pathology of the epidermis and of the floor of the external auditory canal and the third is the actual phase of cholesteatoma with invasion and middle ear auto-destruction with bone resorption. In this last phase, many factors play a role, collagenasis, osteoclats, cytokines, NO, bacteria and their biofilm and rupture of the retraction pocket. CONCLUSION: Cholesteatoma is an inflammatory disease of the ear caracterised by bone resorption. Current research is starting to appreciate the important role the immune system plays in the pathophysiology of cholesteatoma.

Rehabilitation of high-frequency hearing loss with the RetroX auditory implant.

The RetroX is a new semi-implantable hearing aid which does not occlude the external ear canal. It consists of an electronic unit that plugs into a titanium tube which is implanted under the pinna so as to connect the retroauricular sulcus with the inside lumen of the external ear canal. Implantation requires minor surgery which can be performed under local anesthesia. Moreover, a pre-implant simulator exists and allows patients to try the device before deciding on definite implantation. The RetroX auditory implant is indicated in case of high-frequency sensorineural hearing loss with a steep slope (ski-slope audiogram). We implanted 25 adults suffering from such a hearing loss, and we report their hearing measured after 2.5 to 15 months of use. Four patients developed a persistent granulomatous reaction which disappeared after explantation. Two patients complained of acoustic feedback and needed supplementary fitting. Twenty three of our 25 subjects are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX; they wear the implant daily, from morning until evening. Audiometrically, we observed a statistically significant improvement of the pure-tone thresholds at 1, 2, 4 and 8 kHz. In quiet, the speech reception thresholds decreased by 10 dB SPL and in noise, speech intelligibility increased by 15% for signal-to-noise ratios between -5 dB and +5 dB. Up till now, our patients were implanted monaurally because of financial considerations and our initial inexperience with this new implant. The overall results, however, are promising and nowadays, we advise bilateral implantation for patients who tolerate the first implant. By doing so, we hope to improve hearing in noise and spatial sound perception.

Metastatic renal cell carcinoma to the temporal bone: case report.

We report an extremely rare case of metastasic renal cell carcinoma to the temporal bone which presented initially as a jugulotympanic paraganglioma. The clinical and radiological appearances were misleading.Investigations of concomitant high blood pressure revealed a tumour of the right kidney. Biopsy of the mastoid mass was histologically compatible with a metastasis from a clear cell renal carcinoma. The patient underwent a radical nephrectomy and local external radiotherapy to the head. He also received adjuvant treatment with interferon-_ and interleukin 2. The clinical presentation, the radiological and histological features, the patterns of spread, the treatment options and the prognosis of these tumours are discussed. A review of the literature confirms the extremely unusual occurrence of this localisation.

Tympanoplasty without skin incision of the external auditory canal: preliminary results.

INTRODUCTION: Most tympanoplasty techniques require skin incision of the external auditory canal. This step is not without morbidity and postoperative complications such as delayed healing, granulation tissue, lateralization, blunting and iatrogenic cholesteatoma. For small or midsize non-marginalized tympanic membrane perforations of the posterior or inferior quadrants, a transmeatal approach without incision of the cutaneous epidermis of the external auditory canal can theoretically offer advantages such as rapid healing and reduced postoperative complications. In this paper we present the preliminary results of a tympanoplasty technique with a retroauricular approach without skin incision of the canal and an overlay graft. MATERIALS AND METHODS: We performed 10 tympanoplasties without skin incisions for small or midsize non-marginalized perforations, which do not exceed one third of the tympanic membrane surface, located in the inferior or posterior quadrants. RESULTS: With a minimum follow up of 3 months all patients showed excellent anatomical results without complications. Nine of them closed their average air bone gap at less than 10 dB. CONCLUSION: When anatomically feasible, our technique combines a post auricular approach and the absence of skin incision. It ensures rapid healing, preserves the anatomy of the eardrum and external auditory canal and reduces the risk of blunting and lateralization phenomena. The main difficulty concerns the cleavage of the epidermal and fibrous layer.

[The art of tympanoplasty and its clinical illustration]. / L'art de la tympanoplastie et son illustration clinique.

INTRODUCTION: The development of tympanic membrane surgery is based on 150 years of surgical experiences, medical and technological innovations. There are two major techniques of tympanic membrane reconstruction depending on the graft related to the different anatomic layers of the eardrum. AIM OF THE STUDY: We evaluate different risk factors of the tympanoplasty such as the age of the patient, the tubal function, the middle ear inflammation, the status of the contra-lateral ear, the localization and the size of the perforation, the surgical techniques and the type of the graft. METHODS: We illustrate and comment on those risk factors considering 122 simple tympanoplasties and a large overview of the literature. RESULTS: We show that the graft position doesn't interfere with the surgical results and we specify our attitude to control the risk factors. CONCLUSION: To obtain excellent results, surgical indications have to be extremely rigorous as with surgical techniques.

Overlay versus underlay tympanoplasty. Comparative study of 122 cases.

INTRODUCTION: In tympanoplasty, the most common two techniques for positioning the graft relative to the remnant of both the tympanic membrane and of the annulus, are the "overlay" and the "underlay" techniques. Each technique has advantages and disadvantages. METHODS: One hundred and twenty-two cases over the age of 8 years who had undergone a tympanoplasty for tympanic membrane perforation secondary to chronic otitis media were included. All patients had a minimum 3-month postoperative otoscopic and audiometric follow-up. RESULTS: of 122 cases, 115 tympanoplasties (94%) were anatomically successful. At frequencies of 0.5, 1, 2, and 4 kHz, the mean air-bone gap improved significantly from 21.7 dB preoperatively to 8.4 dB postoperatively giving a mean gain of 13.3 dB. CONCLUSION: In our series the underlay or overlay positioning of the graft does not significantly influence the rate of postoperative perforations or complications with the exception of epithelial pearls, which occur significantly more frequently following the overlay technique for perforations that require fibro-epidermal cleaving across a large area.

Tragal cartilage in tympanic membrane reconstruction.

INTRODUCTION: Management of chronic perforation and severe posterior and/or attic Retraction Pocket (RP) or atelectasis of the tympanic membrane continues to be one of the most difficult problems for otologists. AIM OF THE STUDY: To analyse the usefulness of the tympanic membrane reconstruction with tragal cartilage. MATERIALS AND METHODS: The study included 27 patients with chronic perforation or severe RP operated by the same surgeon, using tragal cartilage tympanoplasty. Seven supplementary procedures were required for recurrent cholesteatoma (second-look surgery). RESULTS: There has been no recurrence of the retraction and the perforation. Nineteen ossicular reconstructions were necessary with acceptable hearing results. CONCLUSIONS: Tragal cartilage has made a significant improvement in the tympanic membrane reconstruction procedure. A large thin cartilage combined with a titanium prosthesis can provide an excellent anatomical result, perfect stability and good functional outcome. When the eardrum is intact, we still use allografts of costal cartilage for the management of the retraction pocket or titanium prosthesis.

Tinnitus and otosclerosis.

Fifty patients with otosclerosis and tinnitus were studied for the course of the tinnitus after stapes surgery. Tinnitus disappeared in 64% of the cases, improved in 16%, was unchanged in 14%, and worsened in 6%. The reduction in tinnitus was more favorable after a small fenestra stapedotomy than after a partial stapedectomy with removal of the posterior half of the footplate. An unfavorable postoperative course of tinnitus did not appear to be linked to the postoperative audiometric result. In our study the subjective evaluation of pitch and loudness of the tinnitus did not provide significant information regarding its prognosis.

Labyrinthine fistula after cholesteatomatous chronic otitis media.

OBJECTIVES: To report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre- and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony labyrinth. STUDY DESIGN: Retrospective case review. PATIENTS: Fifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae. SETTING: Tertiary referral center. INTERVENTIONS: Diagnosis and treatment. MAIN OUTCOME MEASURES: Clinical, imaging, and surgical correlation of extensive fistulae and bone fistulae. RESULTS: The incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%). CONCLUSIONS: The breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre- and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.

Results of cerebellopontine space imaging by magnetic resonance during one year.

The authors present the results of a retrospective study concerning 231 magnetic resonance imaging (MRI) of the cerellopontine space requested by the otologists of the department between September 1996 and September 1997. The motives of imaging were sensorineural hearing loss (44%), vertigo and unsteadiness (25.5%), tinnitus (16.5%) and other (13%). The MRI was abnormal in 18% of the cases and the diagnosis of acoustic schwannoma was made in 10% of the cases.

[Functional results of velopharyngoplasty: apropos of 55 cases]. / Résultats fonctionnels de vélopharyngoplasties: à propos de 55 cas.

From 1991 until 1998, 55 three to twelve year-old patients underwent a velopharyngoplasty to correct velopharyngeal insufficiency. They had indeed severe hypernasality with or without gross reflux of food matter into the nasal cavities or behavioural disturbances. Eighty-two percent had a closed cleft palate. Forty percent presented with mental retardation, heart diseases or multiple syndromal defects. They all had had a previous speech therapy for a long (months) or a very long (years) period of time. In the post operative period, hypernasality disappeared totally or partially in eighty-five percent; reflux disappeared in almost all cases. Middle ear pathologies were not more frequent and were also less severe. Behavioral disturbances associated with a severe speech defect were also less pronounced.

Use of costal cartilage in middle ear surgery.

Use of costal cartilage in middle ear surgery. Tympanic membrane retraction often occurs in otologic pathology. In an effort to reduce this pathology, the surgical procedure considered incorporates the use of a new material which diminishes retraction and allows freer movement of the eardrum. Since 1991, we have been using costal cartilage allograft obtained from donors and treated to prevent disease transmission. The allografts were used for tympanoplasty, retraction pockets and attic reconstruction. More than 150 patients were treated and the results evaluated in order to determine the indications of this new material.

The relevance of using tragal cartilage in tympanoplasty.

Chronic endotympanic depression is a pathological situation which leads to tympanic atelectasis, retraction pockets and cholesteatoma. It is also at the origin of tympanoplasty failure. Tragal composite perichondrium-cartilage graft is a procedure which gives good results in these difficult surgical cases.

[Chronic osteomatous otitis media: apropos of 2 cases]. / L'otite moyenne chronique ostéomateuse: à propos de deux cas.

Osteomatous chronic otitis media is an extremely rare clinical entity. Fleury has described three types: a massive type, a diffuse attico-antral type, and a localised type. This latter is equivalent to a state of chronic inflammation of the middle or outer ear, accompanied by bony excresscences of osteomatous type. Here we add two additional cases to the few which are to be found in the literature on this subject. We would also like to emphasize the practical-surgical difficulty of treating such cases, with the vital structures of the middle ear hidden (facial nerve, lateral semicircular canal, and ossicles), and would advise the greatest care when tackling these surgically.

Cochlear implantation in patients with Cogan's syndrome: a review of four cases.

Cogan's syndrome is a rare disorder that is characterized by a rapid onset of bilateral severe sensorineural hearing loss associated with vertigo and tinnitus, ocular involvement (most commonly an interstitial keratitis) and variable systemic symptoms. We review our experience with four cases treated in our department. We describe their symptoms, the evolution of their disease, the diagnosis, and the radiological investigations with computed tomography and/or magnetic resonance imaging. When medical treatment with corticosteroids failed and no benefit could be obtained with hearing aids at each patient's end stage, all patients received a cochlear implant with excellent results. The considerations for implantation in these patients are discussed.