Retropharyngeal lipostructure in the treatment of velopharyngeal insufficiency: A prospective study and update.

INTRODUCTION: Retropharyngeal lipostructure is a recent procedure in velopharyngeal insufficiency (VPI), offering an effective alternative to heavier surgery. OBJECTIVES: To update and assess retropharyngeal lipostructure as a treatment for VPI in the University Hospital Center of Rouen (France). TYPE OF STUDY: Single-center prospective study, from May 2012 to May 2014. PATIENTS AND METHODS: Six patients (4 girls, 2 boys) presenting with VPI were treated by retropharyngeal lipostructure. Age at surgery ranged between 6 and 12 years. Four of the patients bore a 22q11 microdeletion. Treatment was indicated in case of Borel-Maisonny type 2b (n=2) or 2m (n=4) despite well-conducted speech therapy and of≥50% velopharyngeal sphincter closure on nasal endoscopy. Patients were assessed preoperatively and at 3 months, by a multidisciplinary team. Borel-Maisonny type was assessed by a speech therapist. Nasality was measured on assisted vocal evaluation (EVA®). Sphincter closure was assessed on dynamic MRI. RESULTS: Between 6 and 8cm3autologous fat was injected. At 3months, 4 children showed 1-grade improvement in Borel-Maisonny type. Nasality decreased systematically, from a mean 14.5% preoperatively to 10.5% postoperatively. MRI showed improvement in all cases, with complete closure in occlusive vowels in 3 children. CONCLUSION: EVA® and MRI provide precise objective assessment of VPI. Retropharyngeal lipostructure is a simple, relatively non-invasive, reproducible technique, providing good results in VPI.

Rapidly progressive bilateral postmeningitic deafness in children: Diagnosis and management.

OBJECTIVES: To determine the diagnostic approach to severe or profound bilateral postmeningitic deafness and to propose management guidelines. MATERIAL AND METHODS: A retrospective review of five patients (two adolescents and three infants) with rapidly progressive severe bilateral deafness following an episode of meningitis managed between 2004 and 2010. RESULTS: The two adolescents presented Neisseria meningitidis meningitis and the three infants presented Streptococcus pneumoniae meningitis. Acquired bilateral deafness was diagnosed by audiometry an average of 68.8 days (range: 9-210) after the episode of meningitis. Behavioural audiological testing, adapted to age and state of health, was performed in all patients. Deafness was confirmed by Auditory Brainstem Response tests. All five patients were assessed by computed tomography (CT) and magnetic resonance imaging (MRI) within ten days. T2-weighted MRI sequences showed endolymph changes in four patients. CT scan demonstrated ossification in only one patient. Bilateral cochlear implant was performed in all patients, with complete electrode array insertion for eight implants and partial insertion for two implants (20 and 21 out of 22 electrodes inserted). Good results were obtained with cochlear implants in four cases. CONCLUSIONS: Bilateral deafness can occur immediately or several months after bacterial meningitis, regardless of the micro-organism responsible, justifying screening by behavioural audiological testing adapted to age for two years following bacterial meningitis. Auditory Brainstem Response testing can confirm audiometric findings. When severe or profound bilateral deafness is observed, MRI must be performed urgently to detect endolymph inflammation or ossification. Early bilateral cochlear implantation is recommended in the presence of ossification.

[Role of hypnotherapy in the treatment of debilitating tinnitus]. / Intérêt de l'hypnose dans le traitement des acouphènes invalidants.

OBJECTIVE: Hypnotherapy is currently used for tinnitus therapy in our university hospital. The aim of this study was to evaluate its efficacy. MATERIAL AND METHODS: This study was performed on 110 patients suffering from distressing tinnitus. They were treated during five sessions with hypnotherapy, supplemented by instruction on self-hypnotherapy. A subjective evaluation was done by the practitioner at the end of the sessions of hypnotherapy. Then a questionnaire on psychologic distress (Wilson 1991) was sent retrospectively to the patients. RESULTS: We received 65 responses which were used for this study. Before treatment, the mean value of the Wilson score was 54 (28-104). After treatment, it was: 31 (0-86). 69% of the patients felt an improvement > or = 5 points Wilson score. These results were compared with the evaluation carried out by the practitioner at the end of the sessions of hypnosis. There was a "significant correlation" between the evaluation of the felt benefice, analyzed by the practitioner at the end of the sessions of hypnosis, and by the patient questioned long after the treatment. These results had significant correlation with the evaluation made by the therapist at the end of the five sessions of hypnotherapy. They show, how effective (68% improvement) this therapeutic approach can be. CONCLUSION: Hypnotherapy can be regarded as an effective treatment against distressing tinnitus.

[Universal hearing screening: 10,835 newborns tested in maternity wards of the geographical Department of Eure, France]. / Expérience du dépistage auditif néo-natal systématique dans le département de l'Eure.

OBJECTIVES: The aim of this study was to evaluate Universal Screening using transient evoked otoacoustic emisions (TEOAE) in the geographical Department of Eure -France. MATERIAL AND METHODS: This hearing screening was initially developed at a single maternity ward (September 1999 to December 2002), and then throughout the Department (January 2003 to December 2003). One or two successive TEOAE tests were recorded. In cases of a positive test, a new TEAO was recorded at otolaryngology consultation one month later. If this test was again positive, a new consultation with brainstem auditory evoked potential (BAEP) was scheduled. If hearing loss was suspected following BAEP, an audiometric test was performed. RESULTS: A total of 10,770 newborns were screened (99.38%), 65 newborns were lost to follow-up (0.59%), 18 bilateral hearing losses were identified (1.6/1000), and 5 of them had hearing loss risk factors. CONCLUSION: This study demonstrated that a hearing screening program in the maternity ward using TEOAE is recommended and provides optimal results.

[Management of cleft lip and palate in university hospital of Rouen]. / Prise en charge des fentes faciales et palatines à la clinique chirurgicale du centre hospitalier universitaire de Rouen.

Cleft lips and cleft palates are managed in the department of Pediatric surgery in Rouen for the last 30 years. From the antenatal diagnosis, the parents got in touch with the surgeon who will coordinate this management. Around thirty new patients are treated every year. The chronology of the treatment is of "classic" manner. The cleft lip is repaired at about 3 weeks of age and the palatoplasty is performed after the age of 1 year. In view to maintain the intimacy of the consultation we did not institute multidisciplinary consultations. The other members of the interdisciplinary team will intervene during the follow up depending on the form of the cleft and the encountered problems. The information and the files circulate freely and are discussed together.

[Aging and deafness]. / Sénescence et surdité.

The hearing loss that appears with ageing or presbyacusis should not lead to withdrawal from communication an elderly person. The disorder should be recognised early. The first warning sign is difficulty for understanding in a noisy environment. When an individual indicates this problem, measurements of auditory functions should first be made and regular followed-up should be scheduled or therapeutic measures taken. Such measures generally include a hearing aid that amplifies the affected frequencies and speech therapy to learn lip reading. Some patients may profit from psychological follow-up during this new learning process. The family physician is crucial in the rehabilitation in encouraging the patient to seek medical help as soon as hearing loss begins.