[Sound injuries after surgery of otosclerosis]. / Traumatismes sonores après chirurgie de l'otospongiose.

Surgery for otosclerosis means that the sound protection due to the fixation of the footplate does not exist anymore. As the Corti hair cells have been fragilized by proteolytic enzymes, it is absolutely necessary to reconstruct the sound mechanism in order to maintain the vibration of the perilymph absolutely within acoustical physiologic limit of movement. The means to realize this reconstruction are presented in this paper, as well as the results.

[The development of tinnitus in the postoperative period of otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss, modification of tinnitus by medical or surgical treatment, allow to suspect the origin of tinnitus due to otospongiosis and to give the patient a practically always confirmed prognosis. Audiometric localization of tinnitus is essential, as it is the best clue to etiology, treatment and prognosis of otospongiosis tinnitus. As far as irreducible tinnitus are concerned, as anxiety is the most pejorative parameter, not discouraging the patient is very important.

[Improvement in hearing as a function of type of platinectomy or platinotomy performed in the surgical treatment of otospongiosis]. / Amélioration de l'audition en fonction du type de platinectomie ou de platinotomie effectué dans la chirurgie de l'otospongiose.

The footplate fenestra should be performed in its posterior third part to avoid pressure of the piston on the membranous labyrinth, situated very close to the footplate in 2% of the cases in otosclerotic patients. Gain in bone conduction differs according to the size of the fenestra performed. Low frequencies improve most when the whole posterior third part of the footplate is removed; the audiometric gain is better for high frequencies when a 0.8 mm stapedotomy is performed. These findings demonstrate the interest of a more or less enlarged fenestra according to the language spoken by the patient, since the different languages use mainly high or low frequency phonemes.

[Prognosis for tinnitus after surgery for otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss and modification of the former by both surgical and medical treatment provide sufficient data to suggest its origin and to give the patient a prognosis confirmed in practically every case. Audiometric localization of the tinnitus is essential, since this allows establishment of the etiology, treatment and prognosis of the symptom. When tinnitus is irreversible, the hope of a possible recovery must be given to the patient to avoid the inevitable anxiety produced.

[Result and treatment of tinnitus in our clinic]. / Bilan et traitement des acouphènes dans notre clinique.

The authors propose a test consisting in performing injections of Renovaine, a very strong anaesthetic drug, in the external ear duct in order to reduce momentarily severe and decompensated tinnitus. They discuss the usefulness of this test and develop two concepts to explain its action. They make a pragmatic approach of the tinnitus etiopathogeny.

[Means of fixing a transmission device to the center of a mobile footplate]. / Moyen de fixation d'une transmission au centre d'une platine mobile.

The authors present a new fixation device for any bony or prosthetic transmission system to the center of a mobile footplate in the absence of the stapes crura. It is a disc-shaped silicone sponge, with a central hole, fitting the bottom of the oval fossa and thus securing the maintenance of the bony or prosthetic transmission in the center of the mobile footplate, and reducing the risk of shifting of the transmission system, which is always possible in case of tympanic retraction. The silicone sponge allows as well a more physiological transmission, because the footplate will vibrate from top to bottom thanks to a central force vector, thus giving better audiometric results. The biocompatibility of the silicone sponge eradicates any phenomenon of intolerance from the tissues.

[Computer technology in otospongiosis. 2. Statistics on 15 years of stapedectomy]. / Apport de l'informatique dans l'otospongiose. Deuxième partie. Statistiques sur 15 ans de stapédectomies.

To complete their two previous data processing studies on systematization of parameters for otospongiosis and on statistics concerning the otospongiotic disease itself, the authors now develop the study of postoperative functional results obtained over 15 years stapectomies performed according to various techniques. The characteristic of this study is that the functional results are not considered only from the operative technique point of view, but that they also take into account all the factors having an influence upon the functional results, i.e. mechanical operative factors, otospongiotic cochlear factors and, finally the patient's general factor. This work is divided in three parts. The first part considers statistical data drawn from investigating elements taken over a period ranging from 1960 to 1975 from operative findings, surgical techniques and operative complications, particularly during reoperations, i.e., the mechanical part of hearing improvement in otospongiosis surgery. The second part deals with the problem of the medical postoperative care in stapedial surgery and with that of postoperative complications and the therapy used to combat them. It is the study of the cochlear support problem considering both the cochlear fragility facing the operative trauma, and the cochlear deterioration due to the enzymatic action of the otospongiotic microfoci of the lateral wall of the cochlear duct and of the vestibular side of the footplate. The third part is the statistical study made both by means of data processing and of manual investigation, on the long term functional results obtained, on one hand by the surgical solution of the stapedial fixation's mechanical problem, and on the other, by the medical solution of the cochlear problem considered both from the enzymatic and vascular point of view. This study of stapedectomies' long term functional results allows the authors to draw the conclusions which seem to result logically from this very elaborated statistical study concerning near 17000 stapedectomies performed from 1960 through 1975.

Mechanical explanation of the on-off effect (diphasic impedance change) in otospongiosis.

Impedancemetry gives important information in otospongiosis, both for relative compliance and impedance audiometry. The detection of the stapedius reflex is facilitated by recruitment in some audiometric types of otospongiosis and enables us to solve many of the masking problems which are particularly difficult in this disease due to the very important cross-hearing (or cross-over). Diphasic impedance changes (on-off effect) once detected must be systematically investigated since they allow us to detect otospongiosis early on. This sign is absolutely characteristic of the onset of a stapediovestibular involvement and is of primary interest in this disease because of its early appearance - before any classical audiometric change and any air-bone gap, i.e. before deafness. Diphasic impedance changes must thus be systematically investigated in case of so-called unilateral otospongiosis, in the audiometrically normal ear, and for the detection of otospongiosis in otospongiotic families. It is also helpful in confirming the otospongiotic origin of sensorineural losses before an air-bone gap appears. Our experience with routine stapedectomies and impedance audiometry measurements have led us to a purely mechanical explanation of the on-off effect, i.e. the response of an elastic system to a deformation with a different mechanism of the two inverse peaks, with a different mass and thus a different inertia. This mechanical explanation fits perfectly with anatomical findings. Everything occurs as if the evolutive stages of the onset of the stapediovestibular involvement were defined in impedancemetry, starting from the normal stapedius reflex, first by mixed forms, then by a pure on-off effect, finally by the disappearance of the stapedius reflex.

[Contribution of data processing in otospongiosis. Part I. Statistics on otospongiosis]. / Apport de l'informatique dans l'otospongiose. (Première partie). Statistiques sur la maladie otospongieuse

The use of data processing in their otology clinic allowed the authors a better approach to otospongiosis and to its treatment, thus completing the knowledge of the otospongiotic disease according to their enzymatic concept. An important material has been gathered since 1959 to the present (June 1, 1974), based on more than 16 000 stapedectomies and nearly 100 000 otology out-patients. It has been studied both through a conventional method and an informatic one on the computer of their clinic. Statistical data, apparently valuable, could be drawn from this mass of information for each patient, starting from his first consultation and following him through his secondary consultations, operation, immediate postoperative follow-up and various postoperative check-ups performed. It also takes into account the general state of the patient and all the accidents which may happen during a remote postoperative period. First of all, the authors give the data for these statistics established according to the systematization of the parameters for otospongiosis they have previously published in 1973. In the first part, they gather statistical data obtained about the otospongiotic disease itself, some of which differ from the classical notions of frequency or importance. These statistical conclusions confirm some percentages stated by other authors (predominance of the woman and of the white race, severity of the disease in the young, etc.), but differ in relation to the number of deafs, the percentage of unilateral otospongiosis in comparison, to the bilateral ones, the importance of pure cochlear otospongiosis, the separate valuation of audiometric stages and that of anatomic types, the relation between age and anatomic type, finally the respective frequency of pre-and postoperative vertigos. In the second part, which will be presented later, the authors will study the postoperative functional results obtained within a period of 15 years by stapedectomy according to three techniques. But the particularity of this study will be the fact that functional results will not be considered only from the operative point of view, but from the whole of the factors acting upon the functional result, i.e.: operative mechanical factor, otospongiotic cochlear component, finally general state of the patient. We will thus have a better knowledge of this very peculiar disease of the otic capsule, hat is otospongiosis, characterized by its two phases: a first lytic phase provoked by an enzymatic factor, then a second rebuilding phase according to a pseudo haversian process. During the long progression of the disease, these two phases intermingle and juxtapose much more than they follow each other in the course of time.