Etiologies of Childhood Hearing Impairment in Schools for the Deaf in Mali.

Objectives: To identify the etiologies of hearing impairment (HI) in schools for students who are deaf and to use a systematic review to summarize reports on the etiologies and clinical and genetic features of HI in Mali. Methods: We included individuals with HI that started before the age of 15 years old. Patients were carefully evaluated under standard practices, and pure-tone audiometry was performed where possible. We then searched for articles published on HI in the Malian population from the databases' inception to March 30, 2020. Results: A total of 117 individuals from two schools for the deaf were included, and a male predominance (sex ratio 1.3; 65/52) was noted. HI was pre-lingual in 82.2% (n = 117), and the median age at diagnosis was 12 years old. The etiologies were environmental in 59.4% (70/117), with meningitis being the leading cause (40%, 20/70), followed by cases with genetic suspicion (29.3%, 21/117). In 11.3% (8/117) of patients, no etiology was identified. Among cases with genetic suspicion, three were syndromic, including two cases of Waardenburg syndrome, while 15 individuals had non-syndromic HI. An autosomal recessive inheritance pattern was observed in 83.3% of families (15/18), and consanguinity was reported in 55.5% (10/18) of putative genetic cases. Conclusion: This study concludes that environmental factors are the leading causes of HI in Mali. However, genetic causes should be investigated, particularly in the context of a population with a high consanguinity rate.

[Conservative medical treatment of œso-tracheal fistula]. / Le traitement conservateur médical de la fistule œsotracheale.

œso-tracheal fistulas are a pathological condition characterized by an abnormal communication between the tracheal tree and the esophagus. We here report a clinical case of œso-tracheal fistula due to the ingestion of a foreign body in order to highlight its etiopathogenesis, to evaluate our therapeutic approach and to do a literature review. The study involved a 15 year old patient admitted with dysphagia evolving over the last two months following the ingestion of a foreign body (a piece of bone). œsophagoscopy under general anesthesia allowed extraction of the foreign body. Post-operative EGD transit objectified fistular orifice at the C7 level. The absence of fistular orifice was recorded 30 days after endoscopy during his follow-up EGD transit. Medical treatment is a therapeutic alternative for œso-tracheal fistula and must be based on well-defined criteria.

Cauda equina syndrome and profound hearing loss after spinal anesthesia with isobaric bupivacaine.

A 33-yr-old man undergoing anorectal surgery developed cauda equina syndrome and bilateral profound hearing loss after single-injection spinal anesthesia with isobaric bupivacaine. There was no pain on needle placement. Neurologic assessment found impaired sensation to pinprick in the perineal region, lower extremity paralysis, and bowel and bladder incontinence. In addition, he developed a bilateral profound hearing loss involving the low frequencies, with the left side more affected than the right side. Although hearing impairment can occur with cerebrospinal fluid leakage, the etiology of cauda equina syndrome is uncertain. The simultaneous occurrence of these events has not been previously reported.