Vibrant soundbridge in aural atresia: does severity matter?

Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94%. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. LEVEL OF EVIDENCE : IV.

Vibrant Soundbridge middle ear implant in mixed hearing loss. Indications, techniques, results.

OBJECTIVES: The aim of this article is to illustrate the aetiologies of mixed hearing loss that can benefit from a Vibrant Soundbridge (VSB) middle ear implant, the techniques performed and the first results. MATERIALS AND METHOD: The authors report their experience of 13 implantations in mixed hearing loss due to otosclerosis, sequelae of chronic otitis media and congenital aural atresia. The VSB implant was implanted alone or in association with another middle ear surgical procedure, on the ossicular chain or on the round window membrane. RESULTS: The average auditory gain for all patients is 32 dB for pure tone thresholds, and 25 dB for speech recognition. It results from the addition of a gain on the conductive hearing loss by direct stimulation of the inner ear, to a gain on the sensorineural hearing loss by amplification. CONCLUSION: Middle ear implants are the only hearing aids affording a gain in both the conductive and sensorineural components of mixed hearing losses.

[Anatomy of nasal obstruction. The recognition of the role of septum. Its application to the surgical treatment of nasal obstruction]. / Obstruction nasale morphologique. Identification et rôle du septum. Application au traitement chirurgical de l'obstruction nasale.

A retrospective study of the records of 392 consecutive patients prospectively operated for non-vasomotor nasal obstruction, has allowed us to identify a syndrome that we would call morphological syndrome. This is caused by anatomical deformities of the nasal septum, inferior turbinate hypertrophy frequently found being the most often only a compensation for the septal deviation. This endonasal abnormality, which can be congenital or post-traumatic, is most frequently of developmental origin and therefore most often found in Caucasian men, whose facial and septal growth is considerable. This morphological syndrome comprises unilateral or bilateral nasal obstruction, noisy nocturnal breathing (20% of patients), a posterior nasal drip (38% of patients), frontal headaches (49% of patients) and recurrent viral or bacterial rhinosinusitis (36% of patients). Other associated symptoms include epistaxis, olfactory dysfunction (hyposmia) and the manifestations of eustachian tube dysfunction. That this syndrome exists is confirmed by the effectiveness of septoplastic operation, performed in our hospital according to the method of Cottle, but without any surgical associated intervention on the inferior turbinates. This operation is an effective treatment both in a global fashion (95% of good results) and in relation to each of the symptoms (except postnasal drip) and is stable in the longterm and well tolerated (minor associated morbidity). This study allow us to re-establish the almost exclusive role of the nasal septum in the genesis of morphological nasal obstruction.

[Complicated isolated inflammatory sphenoiditis (apropos of 23 cases)]. / Sphénoïdites inflammatoires isolées compliquées (à propos de 23 cas).

Isolated inflammatory sphenoid sinusitis, associated with complications are rare. Authors report 23 cases in 8 years. The left sphenoid is the most often involved, in 50 years or more old females. Neurological complications are the most frequent (75% of the cases): isolated headache, neuro-ophtalmologic paralysis, meningitis, before respiratory complications (20%). A bacteriological etiology was found in 60% of the cases, and a fungal etiology in 25%. The treatment is based on a large endoscopic marsupialization of the sphenoid. Recovery is the rule, except for neuro-ophtalmologic paralysis which recovery is inconstant.

[Bacteriology of the nose and sinuses]. / Bactériologie rhino-sinusienne.

The authors, on the basis of 140 cases, analyze the bacterial flora of essentially chronic rhino-sinusitis observed in hospital consultations at the Pellegrin Hospital, the referral centre of the Aquitaine region. Samples taken in the operating theatre from 100 cases, by aspiration and mucosal biopsy, were studied in aerobic and anaerobic media. The results marked by the scarcity of sterile samples and of anaerobic germs, evidence the predominance of an aerobic flora, with in particular Haemophilus influenzae, Staphylococcus aureus and beta-hemolytic Streptococci. No significant difference was recorded between the bacteriology of acute sinusitis as against chronic sinusitis. The flora of sinusitis appear to depend more on the age factor than on the pathogenic type. Branhamella catharralis is present only in patients under 30. The enterobacteria appear in the adult 30-50 year-old age group and, as from the age of 50, are combined by Pseudomonas aeruginosa, which account for 18% of the strains. These two types of germs then appear to be predominant over the Staphylococci and the Haemophilus.

Piezoelectric middle ear implant preserving the ossicular chain.

The authors developed a research program on piezoelectric middle ear implants. A piezoelectric vibrator was implanted on guinea pigs, enabling piezoelectric auditory-evoked recording. The shape and sizes of a vibrator for humans were determined by a human temporal bone study. These human-type vibrators showed good performances in vitro. A particular vibrator for humans that can be implanted on the stapes' head, without irreversibly interrupting the ossicular chain, was designed by the authors.

[Management of post-traumatic facial paralysis. Apropos of 83 cases]. / Prise en charge des paralysies faciales post-traumatiques. A propos de 83 cas.

The authors report a series of 83 cases of post-traumatic facial paralysis. This study shows that 65% of paralysis are related to traffic accidents. In 76% of the cases, the deficit is immediate. The initial clinical evaluation evidences a majority of grade V (68%). The auditive impairment is related in 48% of the cases to transmission deafness, in 41% of the cases, there is impairment of the inner ear; lastly for 11% of the patients, hearing is preserved. The electromyography analyses the gravity of the facial nerve impairment: in 47 cases, clear-cut denervation can be noted. Lastly, for 11% of the patients, hearing is preserved. The electromyography analyses the gravity of the facial nerve impairment: in 47 cases clear cut denervation can be noted. Lastly, the electromyography is supplemented by a scan of the temporal bone which defines the type of fracture. Out of 83 patients, 14 labyrinthine fractures were found. Based on the various tests, the therapeutic decision led to 31 medical treatments and 52 surgical procedures. The latter were performed within a 15-day to 2-month time period for 83% of the patients. The type of surgery depends on the supposed lesional site: 31 mixed approaches (middle fossa and transmastoidal), 15 transmastoidal approaches and 6 tranlabyrinthine approaches. Impairment of the geniculate ganglion is quite frequent. Most often, an edema or a confused aspect is found. Sections are rarer (7 cases). The results are excellent for impairment treated non-surgically. In the surgically treated patients, prognosis is more uncertain, especially if a nerve graft is required.(ABSTRACT TRUNCATED AT 250 WORDS)

[Complications of endonasal microsurgery]. / Complications de la microchirurgie endonasale.

Endonasal microsurgery, which has widely proved its efficacy, is not free of complications. They can be due to the technical act itself. In this case they result of surgery mistake and they induce an effraction of the operatory cavity walls. They can also be due to excessive healing of the nasal mucosa. Then they represent the real cause of failure in this type of surgery. The authors present their experience that they compare with similar cases of the literature.

[Nasal localization of a cicatricial pemphigoid: apropos of a case]. / Pemphigoide cicatricielle de localisation nasale: à propos d'un cas.

The authors reports the case of a 34 years old patient with a cicatricial pemphigoid whose diagnosis was made on a nasal symptomatology, isolated, persistent and with an increasing aggravation over the five last years. This auto-immune bullous disease is quite unusual and has got the trend of a synechia characteristic. The mucous membrane O.R.L. attacks are scarce not to say exceptional in their nasal aspect. The treatment based on Disulone has quickly allowed a progress over a trouble caused by the lesions but had to be interrupted for problems of tolerance.

[Development of a piezo-electrical vibrator for middle ear implant. State of research]. / Développement d'un vibrateur piézo-électrique pour implant d'oreille moyenne. Etat des travaux.

Authors develop a piezoelectric vibrator for middle ear implant. Animal experimentation, on guinea pigs, demonstrated the efficiency and good tolerance of this vibrators. A study on human temporal bones led them to design a vibrator implantable on the stapes for humans. The in vitro study of the performances of this vibrators showed an excellent frequency fidelity between 0.5 and 8 kHz, and output levels over 110 dB SPL. A vibrator for humans, implantable on the head of the stapes, without interruption of the ossicular chain was realized. Its study on human temporal bones in implantation position, has begun, in parallel with a theoretical study with a mathematical model.

[Implants for the middle ear, development of a human prototype]. / Implants d'oreille moyenne, développement d'un prototype humain.

Middle ear implants are a new type of hearing aid. Their principle is direct stimulation of the inner ear fluids, by a vibrator implanted in the middle ear. Two technologies are developed by different teams: electromagnetic vibrators, and piezoelectric vibrators. Middle ear implants should be partially implantable (P-MEI), or totally implantable (T-MEI). Authors develop, concurrently with animal experimentation an in vitro method to measure the performance date of the vibrators. The specifications of a future P-MEI have been defined, and vibrators tested with this method. First results encourage to develop this project.