[Perilymphatic effusion as a complication of otosclerosis]. / Geyser lors de la chirurgie de l'otospongiose.

INTRODUCTION: Stapes gusher means the leakage of perilymphatic liquid when opening the perilymphatic cistern. The perilymphatic liquid with a high pressure gushes with a great flow out of the cistern when the stapedotomy is executed. Otosclerosis surgery sometime brings to light abnormal contact between the inner ear and the sub-arachnoidian spaces in patients who didn't presented ear malformations. It's a very rare event (1/1000) which is different from a much more common and more moderate form of perilymphatic liquids high pressure (1/200). About 4 clinical observations, we compared our experience with other authors in specialist reviews. PURPOSE OF THE STUDY: About four observations, we confronted our experience with that of the literature. MATERIAL AND METHODS: Retrospective study between 1971 and 1998. It was about 3 males and 1 female, without antecedent except one of them who had been operated 5 years before for the opposite ear without gusher but without good audiometric result. They presented a conductive deafness with no answer of the stapedial reflex. We had 4 geysers during the platinotomia which were sealed with some connective tissue. RESULTS: Two patients had a post operative complete sensory hearing loss, one, a sensitive decline of the conduction thresholds (average 50 dB), the last one kept his bone conduction level with a mild sensory hearing loss. The most recent case had a scanner preoperatively which had not shown abnormality except for the focus of otosclerosis. DISCUSSION: Perilymphatic gusher is an unpredictable event that can not be diagnosed before the surgery, nether with clinical facts nor radiological elements. This involves serious consequences concerning not only the continuation of the surgical operation and the prognostic of the hearing but also concerning the danger of secondary meningeal infections. The best way to proceed in case of favourable cases consists in fitting the ossicular prothesis into the stapedotomy, when it's not to wide. Pieces of muscle can be used in some cases, taped on with biologic glu. Various techniques are used to lower the pression of the cerebrospinal liquid: hypertonic solutes, diuretic drugs, lumbar diversion. In all cases, it is necessary to start a wide spectrum antibiotic treatment and a vaccination against pneumococcis. CONCLUSION: The surgeon has to know all the option of the treatment when confronted with this situation in order to try to avoid tricky defect of the inner ear.

[Comparison: tinnitus pain]. / Comparaison acouphène douleur.

After having recalled the different physiologic hypothesis of the tinnitus and those more documented of the pain, the authors noted certain parallelious in the therapeutical approaches of these tow subjectives sensations. They put the emphasis on the necessity, like with pain, to treat the tinnitus as fast as possible in order to avoid a centralisation by actionning of neuronal autonomized circuits.

[Some useful basics of functional anatomy for a better understanding of the pain phenomenon]. / Quelques rappels d'anatomie fonctionnelle utiles à la compréhension du phénomène douloureux.

Cannot simply be considered as a nociception phenomenon: it is more complex than a simple transmission system that conveys this information to the cerebral cortex. It is mainly a psychological event. Numerous regulating and inhibiting effects on incoming pain signals exist, for the most part located in spinal and thalamic areas; only half of these are morphine-dependent. Knowledge of these allows a better approach to chronic pain, using not only medication but also other techniques such as physiotherapy and music therapy analgesia.

[Pain assessment]. / L'évaluation de la douleur.

After recalling the components and the factors influencing the pain, are stated the main reasons which needs for the evaluation of the pain. The different methods allowing an evaluation of the pain are then described with their advantages and disadvantages. These methods are based on, on one hand on questonary with as a support the use of different mono or multidimensional scales and on the other hand a clinical examination. The goal of this proceeding is to elaborate a scale of the pain for a better adaptation of it's therapy.

[Cystic lymphangioma of the neck in adults. Contribution of ultrasonography and computed tomography. Apropos of a case]. / Lymphangiome kystique du cou de l'adulte. Apport de l'échographie et de la tomodensitométrie. A propos d'un cas.

Authors present a case of cystic lymphangioma of the neck in an adult patient. Cystic lymphangioma of the neck can simulate other benign lesions and occasionally extend into the mediastinum. Using computed tomography and ultrasound, the authors are able to confirm the suspected diagnosis, exclude other diagnostic considerations, and demonstrate absence of mediastinal extension. Opportunity of such diagnosis in adult is no frequent.