Assessment of the contralateral routing of signal system in unilateral cochlear implantation.

OBJECTIVES: The purpose of this study was to evaluate the contribution of a contralateral routing of signal (CROS) system in unilateral cochlear implants (CI) users. DESIGN: Single-centre prospective interventional study. SETTING: Tertiary referral centre. PARTICIPANTS: Eight unilateral cochlear implants patients with >30% speech perception in silence and >6 months' implantation. MAIN OUTCOME MEASURES: Free-field speech perception assessed by 'vowel-consonant-vowel' pseudoword test and free-field spatial localisation by Fournier lists on five loudspeakers (in silence and in noise). Subjective benefit assessed on the abbreviated profile of hearing aid benefit (APHAB) questionnaire. These tests were performed on the 1st and 15th day of the trial (denoted by D1 and D15, respectively). RESULTS: Contralateral routing of signal-cochlear implants provided significant improvement in speech perception at D1 and D15 in silence (P, respectively, 0.03 and 0.025) and in noise (P 0.012 and 0.036). No improvement in spatial localisation was demonstrated. The abbreviated profile of hearing aid benefit quality of life questionnaire administered at D15 showed overall benefit and a significant difference in ease of communication with versus without contralateral routing of signal. By 6 months, however, 75% of the patients (6/8) had abandoned the system due to trouble in noise (5/6), trouble with the device's wiring (3/6) and onset of headache (4/6). CONCLUSION: Contralateral routing of signal-cochlear implants is an interesting novel option, restoring a binaural effect and providing improved speech perception and non-negligible comfort of hearing in certain patients, without the medical and economic costs of bilateral cochlear implants. However, the drawbacks (especially the difficulty of modulating the signal-to-noise ratio) do not presently allow it to be an effective alternative to bilateral cochlear implants.

Initial management of necrotizing external otitis: errors to avoid.

OBJECTIVES: Diagnostic and therapeutic practice guidelines have been established for classical forms of benign otitis externa. However, these guidelines do not include unusual forms of the disease, especially "invasive" otitis externa. No consensual diagnostic flow diagram has been published in the literature, which frequently results in delayed diagnosis and inappropriate primary care management. The objective of this study was to analyse the primary care management practices of malignant otitis externa (MOE). MATERIAL AND METHODS: Retrospective study of 22 cases of MOE managed in our tertiary care centre over a 6-year period (2004-2010). RESULTS: All but one of the patients presented a systemic or local predisposing factor. The mean interval between onset of the first symptoms and referral to our tertiary care centre was 13weeks (range: 1 to 12months); 77% of patients were referred by a private ENT specialist, 14% were referred by a an emergency department and 9% were referred by a hospital department. Seventeen patients (81%) had received one or more courses of inappropriate systemic antibiotics during this interval (oral in 15 cases, parenteral in two cases, multiple treatments in 13 cases). The mean duration of each course of antibiotics was 12days (range: 7 to 21days). All patients also received local antibiotic ear drops (aminoglycosides or fluoroquinolones). CONCLUSIONS: The practice audit constantly revealed delayed management of MOE, often resulting in inappropriate antibiotic prescriptions. Publication of practice guidelines for primary and secondary care practitioners therefore appears to be essential.

Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature.

Necrotising external otitis (NEO) is a rare but severe bone infection, usually due to Pseudomonas aeruginosa, the management of which is not standardised. Systemic antibiotic therapy is usually prescribed for at least 6 weeks, but no review has been published on this topic. We report our experience and have reviewed the literature regarding antibiotic therapy in NEO. Here we describe a case-series of consecutive NEO cases seen over an 8-year period (2004-2011) in a French tertiary-care teaching hospital. Since 2009 we have shortened the duration of antibiotic therapy to 6 weeks. We also present a review of the literature regarding antibiotic therapy in NEO. We include 32 NEO cases, with positive microbiological cultures in 30 cases. Among the 30 patients with suspected or proven P. aeruginosa infections, 27 received an initial combination therapy of ceftazidime and ciprofloxacin. The duration of antibiotic therapy and length of hospital stay were significantly reduced after 2009 (9.4 ± 3.2 weeks versus 5.8 ± 0.7, P < .0.001; and 18.2 ± 8.7 days versus 11.6 ± 6.9, P = .0.03, respectively). Patient outcomes were favorable in all cases, with a 14-month median duration of follow-up. Our literature review (30 case series) shows that initial combination therapy is associated with better outcomes as compared with single therapy (97 % versus 83 %, P < .0.001). We suggest 3 weeks of initial combination therapy (ceftazidime + ciprofloxacin, high doses) followed by 3 weeks single therapy with ciprofloxacin in susceptible P. aeruginosa NEO. A close collaboration between ear, nose and throat and infectious diseases specialists is needed.

Disorders of smell, taste, and food intake in a patient with a dorsomedial thalamic infarct.

BACKGROUND: We report that a lasting deficit in the hedonic character of olfactory and gustatory perception can be observed in bilateral dorsomedial and intralaminar thalamic lesions. CASE DESCRIPTION: A 68-year-old patient abruptly presented with vigilance disorders associated with a reduction of olfactory and gustatory perceptions. A severe drop in appetite for foods and a weight loss of 10 kg were observed, which were partially reversed with time. Two years later, the main persisting disorder was a change in the quality of perceptions: odors and taste were perceived either in a neutral way, their pleasant character having disappeared, or as unpleasant. However, identification was preserved. MRI showed that lesions principally involved the dorsomedial thalamic nuclei and the adjacent part of the intralaminar nuclei. CONCLUSIONS: This case suggests that the dorsomedial thalamus may play a role in the hedonic perception of food, thus affecting short-term regulation of food intake, and may possibly have a role in the long-term control of body weight.