[Isolated facial palsy and occult adenoid cystic carcinoma of the parotid]. / Paralysie faciale isolée et carcinome adénoïde kystique occulte de la parotide.

We report a case of adenoid cystic carcinoma of the parotid disclosed by facial palsy alone. No tumefaction could be detected clinically or at imaging. The diagnosis was established at surgical exploration of the facial nerve. Total extended parotidectomy was completed by radiotherapy of the tumor site.

Hearing status of French youth aged from 18 to 24 years in 1997: a cross-sectional epidemiological study in the selection centres of the army in Vincennes and Lyon.

BACKGROUND: It is currently thought that young adults are at increasing risk of exposure to deleterious sources of noise. To test this possibility we have assessed hearing status of young French men aged between 18 and 24 years in 1997 and study risk factors of deafness in a cross-sectional epidemiological study at selection centres for aptitudes to National Service. METHODS: During the time of the study, 1208 subjects were examined. For each subject, data of an interview, an otoscopy and audiograms were collected. We compared hearing thresholds between subjects with different noise exposures and we determined risk factors of deafness in this population. RESULTS: The prevalence of hearing loss was 9% at medium frequencies (0.5-2 kHz) and 15% at high frequencies (4-8 kHz).We found that 60% of the subjects were regularly exposed to at least one source of loud noise. Acoustic trauma (6%) mostly explained hearing losses. Repeated episodes of otitis media in childhood (17%) also emerged as an important risk factor apparently due to increased sensitivity to noise. In subjects with antecedent of otitis media, hearing impairments were significant in personal stereo users (>1 hour per day) (p<0.001), in those who went to discos and rock concerts (>2 times per month) (p=0.01) and in those who worked in noisy places (p=0.01). In contrast, in subjects without antecedent of otitis, we found no difference in hearing thresholds between noise exposed and non noise exposed subjects. CONCLUSIONS: Loud sound exposure is a true risk factor of early deafness in subjects that had had repeated episodes of otitis media in childhood. This study stresses the need for both prevention policies and information of health professionals and practitioners.

[Petrous surgical approaches in tumors of the cerebellopontine angle]. / Les voies d'abord pétreuses des tumeurs de l'angle ponto-cérébelleux.

Three petrous incisions, performed by an ENT-neurosurgery team, can be used for the resection of tumours of the cerebellopontine angle: transpetrosal incisions (posterior translabyrinthine and transcochlear) which provide large access to the IAM and the posterior surface of the petrous bone, but they sacrifice hearing. The suprapetrosal incision (reserved for tumours in the meatus) and the mastoidoretrosigmoid incision (for tumours less than or equal to 20 mm) preserve the labyrinth in an attempt to preserve hearing. The principal objectives of surgical resection of tumours of the cerebellopontine angle (85% of which are acoustic neuromas) are total resection (to preserve the vital prognosis) and preservation of facial nerve function. Attempts to preserve hearing must be confined to cases selected by a complete clinical otological and audiometric examination.

[Surgery of the parotid gland. Indications. Review of the anatomy]. / Chirurgie de la parotide. Indications, rappels anatomiques.

The surgical division of the parotid gland in three parts or "lobes" in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.

[Isolated sphenoidal aspergillosis presenting as an optic neuropathy]. / Aspergillose sphénoïdale isolée révélée par une neuropathie optique.

Aspergillosis fixation in the sphenoidal sinus is an exceptional occurrence when isolated. The clinical feature is misleading and the diagnosis often difficult; local and regional complications are dreadful. The authors report a case, presenting as an optic neuropathy, and the literature data.

[Preservation of auditory function in the excision of acoustic neuroma]. / Conservation de l'audition dans l'exérèse des neurinomes de l'acoustique.

Selection criteria for the preservation of auditory function during excision of acoustic neurinoma have been defined for a long time, and the means for a successful achievement of such a goal are widely known. Recruitment of special patients, for whom maintenance of an even deeply altered hearing capacity constitutes a requisite for continuation of professional work has lead us to extend indications for the pre- and retrosigmoid approaches recommended by J.M. Sterkers. The authors present a series of 16 patients, in which a single case of cophosis was deplored.

[Tympanoplasty in the treatment of sequelae of blast injuries of the ear]. / Les tympanoplasties dans le traitement des séquelles des blasts auriculaires.

This study deals with 40 clinical files relating to auricular blast injury patients with ensuing eardrum perforation, managed either by tympanoplasty or by placement of a healing support. An analysis of the functional symptoms, the size and localization of the perforation; determination of the presence or lack of immediate post-injury infection, and of the degree and type of hearing loss suffered, permits to define the characteristics of postoperative ear status. A comparison of the study results with published data provides for specifying surgical indications and sheds light on the long-term evolution pattern in such patients.

[Effects of loud music on the Garde Républicaine musicians]. / Effets de la musique de forte intensité chez les musiciens de la Garde Républicaine.

The authors report their observations on the auditory status of 76 musicians belonging to a Republican Guard brass band, and give their interpretation of abnormal findings, as they compare percussion with wind instruments and make reference to literature data. Accompanying signs, such as ear fatigue, noise intolerance, tinnitus, ear-aches, disturbance of sleep, psychic disorders, and disturbances of equilibrium are also taken into account as predisposing factors. Lastly, an attempt is made to bring out some of the characteristics that are specific to each instrument.