[Cochlear implantation in the adult and the child. Results of the Marseille experience between 1991 and 1999. / L'implantation cochléaire chez l'adulte et l'enfant. Résultats de l'expérience Marseillaise entre 1991 et 1999.

The rehabilitation of patients with profound bilateral deafness has been notable in the 1990s for the use of cochlear implantation. In 1991 a cochlear implantation programme was inaugurated by the ENT team at the Timone University Hospital, in partnership with the Public Assistance for Marseille Hospitals, allowing funding for six implants each year. This article presents the main results of this programme. Between March 1991 and November 1999, 94 patients with profound bilateral deafness were assessed. Forty patients (29 adults and 11 children) were thought to be unsuitable. To date 27 adults (4 with prelingual deafness) and 22 children have been rehabilitated using a cochlear implant. Patient selection was carried out by a multidisciplinary team. It has been possible to quantify the degree of deafness and the excitability of the auditory nerve in the adult, the cochlear permeability, and the motivation and personality of the patients. Postimplant evaluation has allowed us to study the various factors resulting from wearing an implant. In adults, testing was carried out using open lists. In children, education methods were added to perceptive, expressive and behavioural performance to arrive at a profile. The results are presented and discussed in comparison with those found in the literature.

Preservation of hearing in acoustic neuromas treated by gamma knife surgery.

138 acoustic schwannomas were treated by Gamma Knife surgery from July 1992 to May 1994. Cases with neurofibromatosis were excluded because of differences in the patterns of growth and development of tumors in these cases. Hearing was evaluated by tonal and vocal audiometry and classified using the Gardner and Robertson score. 104 patients were observed at 3 years after treatment. Hearing studies, the relation of tumor volume to hearing, central and marginal dose, number of shots and preoperative brain-stem-evoked responses (BER) were all recorded. 70% of patients with normal hearing maintained a useful hearing, and 50% of patients with useful hearing maintained serviceable hearing. No correlation was found between hearing preservation and tumor volume, central and marginal dose and number of shots. Gamma Knife surgery seems to be superior to microsurgery with regard to preservation of useful hearing.

[Selection of electrophysiological investigations for diagnosis in idiopathic facial palsy. Twenty years experience in an ENT department]. / Les explorations électrophysiologiques des paralysies faciales idiopathiques. Standardisation après vingt années de pratique dans un service ORL.

Electrophysiological exploration of the facial nerve requires different tests to differetciate the importance of the block, denervation and canal conduction. We must answer five questions: 1) Assessing the degree and the phase of the nerve lesion, 2) Deciding on the advisability of a facial decompression in the early stage of the palsy, 3) Evaluating the prognosis, 4) Choosing the best therapeutic approach, 5) Detecting facial hyperkinesis in an infraclinic period. In order to answer these questions, we select the following methods: 1) Quantified Electroneuronography should be applied as early as the 2nd day after onset, repeated on the 7th and 10th days. Unfortunately this is not always possible for practical reasons. In any case a minimum of two investigations should be performed during the 12 first days. 2) We add Computer EMG in order to control the evolution of the blocked fibers with regard to denervated fibers. 3) Blink reflex and Stapedius reflex are investigated from the 3rd day. After the acute phase of the palsy, recovery is detected by the reappearance of the blink and stapedius reflexes and the evolution of the computed EMG. These tests are sufficient for answering the five questions mentioned above without discomfort for the patient.

[Bone anchored auditory prosthesis. Indications, clinical and audiometric results]. / La prothèse auditive à ancrage osseux (BAHA). Indications, résultats cliniques et audiométriques.

Fourteen patients with conductive or mixed hearing loss were fitted with 16 BAHA. Three patients had congenital malformation of the auditory canal. Eleven patients had sequelae after bilateral chronic otitis media. All implants were osseointegrated. In 81% of the patients, no skin reactions around the abutment occured. The subjective evaluation was investigated by means of a questionnaire. All patients preferred their BAHA to their previous hearing aid and 93% are globally satisfied. Patients were evaluated in sound field, preoperatively and postoperatively using warble tones (mean on the average pure tone threshold at 0.5 1 and 2 kHz of 51.5 dB unaided to 22.6 dB aided with BAHA), speech reception threshold (mean of 51.1 dB unaided to 21.9 dB aided with BAHA) and speech discrimination. In three cases, we find an "antenna" effect, an improvement in reception wearing the Titanium screw and the abutment without the hearing aid connected.

[Early diagnosis of acoustic neurinoma. Tumors less than 2 centimeters]. / Le diagnostic précoce du neurinome de l'acoustique. Tumeurs de moins de 2 cm.

Computerized gas meatography ( CGM ) represents the must reliable method for detection of stages I and II of acoustic neurinomas. A critical study of its indications was conducted based of results in a series of 14 tumors of less than 2 cm diameter and of 43 CGM . Although early auditory evoked potentials are currently the most significant selection criteria, procedures for detecting retrocochlear lesions remain unchanged, particularly for the ENT specialist.