[CSF otorrhea: case report and management]. / Le cas clinique du mois. Otorrhée cérébro-spinale: a partir d'un cas clinique, du diagnostic au traitement.

Mr G, sixty-seven years old, was admitted to our hospital for a liver transplant. He suffered from a cirrhosis due to an HBV infection, complicated by an hepatocellular carcinoma. During the perioperative care, a left otorrhea was discovered. According to the clinical history, this otorrhea had been present for six weeks and followed the completion of a myringotomy. The myringotomy had been performed with a view to place a transtympanic ventilation tube for the treatment of a serous otitis media inducing a conductive hearingloss. Clinical, biological, and radiological explorations revealed a CSF leak caused by the fact that the myringotomy had been done in a temporal meningo-encephalocele. A conservative treatment allowed to stop the otorrhea. We present a short discussion about temporal meningoencephalocele and, more generally, about CSF otorrhea.

Sudden sensorineural hearing loss: when ophthalmology meets otolaryngology.

OBJECTIVES: Sudden sensorineural hearing loss is a perplexing entity in otology. Susac's syndrome (also called retinocochleocerebral vasculopathy) is a rare disorder that consists of microangiopathy of the brain, retina, and inner ear, and usually affects women in young adulthood. We describe the clinical aspects, radiographic findings, and management of one such case. CASE REPORT: A 30-year-old woman was admitted to the hospital because of sudden onset of bilateral deafness and headache. During her hospitalization, she developed discrete right hemiparesis and hypoesthesia. RESULTS: Magnetic resonance imaging revealed multiple signal hyperintensities and atrophy of the corpus callosum. The differential diagnosis was a myelinating condition, such as multiple sclerosis or acute demyelinating encephalomyelitis. CONCLUSION: Retinal fluorescein angiography helped the diagnosis of Susac's syndrome.

[Presbyastasis and application of vestibular rehabilitation in geriatrics]. / Presbyastasie et application de la réhabilitation vestibulaire en gériatrie.

Balance disorders can have a major functional impact among the elderly. The main risk is falling. Three elements are implicated in the loss of balance: vision, proprioception and the vestibular system. This article will discuss mainly vestibular damage and its implications. The assessment of balance disorders, particularly in geriatric patients, is based on validated scales composed of several items. These provide scores and are based on the results of chronometric measurements. They can be useful for the application of Vestibular Rehabilitation (VR), a technique improving the adaptation and autonomy of these patients. Vestibular rehabilitation is therefore part of an overall support, the goal of therapy being to improve daily life and to reduce the risk of falls.

[Tympanometry in children in general practice]. / La tympanométrie chez l'enfant en médecine générale.

Accurate diagnosis of otitis media in children is essential but sometimes difficult. Good knowledge of signs and symptoms of acute otitis media and otitis media with effusion is not always sufficient. Tympanometry is an easy investigation that can be useful in general practice. Here is a review of the principle and the limitation of that technique.

Speech discrimination and intelligibility: outcome of deaf children fitted with hearing aids or cochlear implants.

We retrospectively studied outcome of a sample of 36 congenitally deaf children who were fitted with either a conventional hearing aid (HA, N = 14) or a cochlear implant (CI, N = 22), and who received many years of audio-phonatory training by our multi-disciplinary team. In order to rate speech discrimination perception, we developed a new metric of speech discrimination performance based on several existing discrimination tests for the French language. Speech perception skills were measured with and without lip-reading cues. We also studied the evolution of auditory capacity in real-life situations, and the evolution of the intelligibility of spoken language during a five year period. To rate auditory capacity and speech intelligibility, we used commonly used metrics: CAP and SIR. During the five successive years of observation, CAP and SIR scores improve for both the HA and CI children. Improvement, however, is more pronounced for the CI children. At the end of the 5-years period, CAP and SIR scores of CI children are significantly higher than those of HA children. Our study is one of few that evaluates outcome of HA and CI fitting with age matched congenitally deaf children anno 2000.

Diagnosis of hearing impairment: factors of delay.

In a retrospective study based on parents' personal interviews, the diagnosis circumstances were analysed in a group of 88 deaf children (moderate to profound deafness). We reported first the age when the parents emitted doubts, and second the age of diagnosis. It appeared that the age of first suspicions, and of diagnosis, was correlated to the degree of deafness. The population of children was divided in two groups depending on the presence of a delay or not in the diagnosis. The first group (24 children) was diagnosed early because of neonatal screening, or of early suspicions by parents or pediatrician. In the second group (64 children) were a delay was observed, seven causes were identified with variable frequency according to the level of deafness. The first four main causes for delayed diagnosis were: 1) parents, 2) medical refutation, 3) otitis media with effusion (OME), 4) progressive hearing loss. In conclusion, the age of diagnosis and the age of first suspicions were too late. Universal neonatal screening is recommended but do not appear to be the exclusive procedure to reduce the diagnostic's delay. This analysis of the factors of delay, prompted us to recommend: 1) information to parents on deafness, 2) careful attention to parents suspicions, 3) an objective evaluation of auditory function,especially after OME cure and 4) a follow-up of children to identify progressive hearing loss.

[Central auditory processing assessment]. / Evaluation des processus auditifs centraux.

OBJECTIVE: A battery of tests for central auditory processing assessment has been designed in French. This battery, BAC for Bilan Auditif Central (central auditory processing), consists of'fbur tyvpes of tests: A speech-in-noise test, a dichotic test, a temporal processing test and a binaural interaction test. MATERIAL AND METHOD: Descriptive statistics were computed on data obtained from 668 subjects ranging from 5 to 85 years old. RESULTS: Tests scores of the speech-in-noise test, the dichotic test and the binaural interaction test showed a normal distribution. Test scores of the temporal processing demonstrates a ceiling effect. Effcts of maturation and involution were clearly visible for all tests. CONCLUSION: The low correlation between scores obtained from the four tests pointed to the need for a battery ofseveral tests to assess central auditory processing.

Anatomophysiology of the central auditory nervous system: basic concepts.

The purpose of this review is to provide an overview of the central auditory nervous system (CANS). Three main relay nuclei are located between the auditory nerve and the primary auditory cerebral cortex: 1- the cochlear nucleus, 2- the contralateral inferior colliculus and 3- the contralateral medial geniculate body. Some fibers of this main ascending pathway branch off to other nuclei such as the nuclei of the superior olivary complex and the nucleus of the lateral lemniscus. Fiber tracts connect the two sides of the ascending pathway at several levels, in such a manner that each ear projects heavier to the contralateral temporal cortex. As sensory information travels within the CANS, its processing occurs not only in a serial order but also in a parallel manner resulting a highly efficient and redundant system. Finally, this review put forth a model of central auditory processing that can serve as the basis for evaluating and addressing the needs of eventual revalidation.

Central auditory processing assessment.

As the acoustic information travels within the central auditory nervous system, the processing of the signal undergoes several levels of serial and parallel "bottom-up" processing influenced by high level cognitive "top-down" processes. Because the multiple location of the operational sites, the central auditory deficits are frequently quite subtle and need a test battery approach to be identified. Each of the four principal processes has at least to be tested: the closure task, the dichotic ability, the temporal ordering task and the binaural interaction function. The purpose of this review is to provide an overview of the psychoacoustic test procedures of identifying lesions or dysfunction's in the central auditory system.

Central auditory processing assessment: a French-speaking battery.

Based on the American Speech-Language-Hearing Association (ASHA) Consensus Statement on central auditory processing and models for their exploration, a battery of audiological tests (Bilan Auditif Central--BAC) has been designed in French. The BAC consists of four types of psycho-acoustic tests: a speech-in-noise test, a dichotic test, a temporal processing test and a binaural interaction test. We briefly describe the rationale of these tests. The BAC is available in digital format. Descriptive statistics were computed on data obtained from 668 subjects divided into 15 age-groups ranging from 5 to 85 years old or over. All subjects had no complaints regarding hearing loss, normal tonal audiometry, and normal intelligence. Tests scores of the speech-in-noise test, the dichotic test and the binaural interaction test showed a normal distribution. Test scores of the temporal processing test did not follow a normal distribution. Effects of maturation and involution were clearly visible for all tests. The low correlation between scores obtained from the four tests pointed to the need for a battery of several tests to assess central auditory processing. We claim that the reported scores represent standard norms for the normal French-speaking population, and believe that the tests will be useful for evaluation of central auditory processing.

Central auditory processing disorders: some cohorts studies.

This paper presents an overview of the use of a French-speaking battery for the assessment of a central auditory processing disorder (CAPD) in a variety of clinical populations: prematurely born children; 8 years old children who had otitis media with effusion in early infancy; children with learning problems and dyslexia; French-speaking children attending Dutch and English schools; adults with King-Kopetzky syndrome and elderly hearing aids users. Population characteristics of each of these groups are presented and discussed.

[Cochlear implants]. / L'implant cochléaire.

A cochlear implant is a technologically advanced medical device that simulates sound in the cochlea by electrically stimulating the hearing nerve. Cochlear implants are designed to help severely or totally deaf individuals who gain little or no benefit from hearing aids. Hearing aids and assistive listening devices amplify sounds. The sounds produced by even the most sophisticated hearing aids may not offer much benefit to people with a severe-to-profound or profound hearing loss in both ears. A cochlear implant is an electronic device that provides the function of the damaged or absent hair cells by providing electrical stimulation to the remaining nerve fibers. The implant provides useful hearing and improved communication abilities to the implant user.

[Recurrent vertigo and basilar megadolicho-arteries]. / Vertiges récidivants et mégadolichoartères basilaires.

Seven patients with basilar megadolicho-artery and predominant otovestibular symptoms are reported. Pathology of this entity, its signs and symptoms, diagnostic tools and treatment options are reviewed.

Detection of Epstein-Barr virus in a case of undifferentiated nasopharyngeal carcinoma by in situ hybridization with digoxigenin-labelled PCR-generated probes.

A case of nasopharyngeal carcinoma is presented. Epstein-Barr viral genome was identified in the neoplastic cells by in situ hybridization with digoxigenin-labelled polymerase chain reaction-generated probes. We report the development of this technique in paraffin-embedded sections and propose that such identification may prove valuable for the diagnosis of this tumour in routine material.