Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adults.

OBJECTIVES: This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: Eight tests of speech audiometry in noise can be used in France. CONCLUSION: To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adult [Pré-print]

This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. Eight tests of speech audiometry in noise can be used in France. To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

[The role of the small airways in childhood asthma]. / Rôle des petites voies aériennes dans l'asthme de l'enfant.

INTRODUCTION: Asthma, the most common chronic disease in paediatrics, is characterised by an inflammatory process involving the proximal and distal airways, with remodelling of the airways and changes in respiratory function. STATE OF THE ART: Recent studies in children have provided evidence of damage to the small airways identical to that occurring in adults. In fact inflammatory cells as well as structural alterations of the airways have been found in both bronchial biopsies and broncho-alveolar lavage fluid in infants and young children. At the functional level this damage is manifest by a reduction in maximum expiratory flow rates between 25-75% of the vital capacity. It also shows itself by the demonstration of thick walled bronchi and hypodense bands on the high resolution CT scan. It appears that conventional inhaled treatments have no effect on the small airways. Finally the main prognostic factors for this distal damage are respiratory infections and exposure to tobacco in utero. PERSPECTIVES: Damage to the small airways in childhood asthma indicates the need for new therapies aimed at this part of the respiratory system. CONCLUSION: Inflammation and remodelling of the small airways develops early in an asthmatic child whose respiratory system is growing rapidly and persists throughout life.

Contrast material injection for hepatic helical computed tomography. Comparative study of five protocols.

RATIONALE AND OBJECTIVES: The authors develop and compare contrast material injection protocols suitable for hepatic helical computed tomography. METHODS: One hundred twenty-one patients who underwent contrast-enhanced computed tomography (CT) of the liver with spiral CT imaging were evaluated for enhancement of the liver parenchyma and for post-enhancement attenuation of the aorta and portal vein with iohexol. Patients were assigned randomly to five protocols with different flow rates, volume of contrast material, and scan delays. RESULTS: Mean parenchymal contrast enhancement was statistically significantly higher with protocol 5 (biphasic injection of 100 mL of iohexol 300 (g/100 mL) at a flow rate of 1.5 mL/second followed by 25 mL at 2 mL/second; total iodine load = 37.5 g, with a scan delay of 70 seconds). The highest aortic enhancement and the second highest portal vein enhancement were obtained with this protocol. CONCLUSION: The authors suggest an easily tolerated injection protocol able to ensure high parenchymal liver enhancement and satisfactory aortic and portal vein enhancement. This protocol includes a long scan delay (70 seconds), biphasic low flow injection rate, and a relatively low iodine load.