[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.

[Acute acoustic trauma in military personnel. Evaluation of 1 year epidemiologic surveillance]. / Traumatismes sonores aigus en population militaire. Bilan d'une année de surveillance épidémiologique.

OBJECTIVES: Acute acoustic trauma (AAT) refers to damage to sensitive cochlear structures caused by excessive exposure to impulse noise. The aim of this study was to 1) assess the incidence of ATT in French soldiers and 2) to clarify the circumstances under which AAT occurs. PATIENTS AND METHODS: We carried out a prospective study of AAT events reported to medical officers in 1998. RESULTS: The incidence of AAT was 156 per 100,000 person-years (150-161). It was higher in conscripts and in soldiers aged under 31 years. Fifty-seven percent were wearing hearing protectors when the accident took place. CONCLUSION: According to these results, specific preventive programs were planned and should be assessed by epidemiological surveillance of exposed populations.

[Jugular bulb diverticular and facial paralysis]. / Diverticule du bulbe de la jugulaire et paralysie faciale.

The authors report a case where a woman presents a right jugular bulb procidence already known and responsible of a perception deafness. Secondarily, a right facial paralysis is appeared progressively and not regressive even with medical treatment. When the computed tomography as shown an intrapetrous diverticular, the facial paralysis treatment was surgical to decompress the facial nerve. The literature study shoes the rarity of this association facial paralysis and jugular bulb procidence (only two cases), more often responsible of deafness, tinnitus, and vertigo. The diagnosis is given by computed tomography. M.R.I. has not still be evaluated. Then the authors insist on the progressive character of the facial paralysis and on the necessity of a surgical treatment.

[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.

[Comparison of different treatments of acute acoustic trauma]. / Comparaison de différents traitements des traumatismes sonores aigüs.

Comparison between different treatments of acute acoustic trauma. The acute acoustic trauma, induced tinnitus, hearing loss and an fickle otalgia, is a Permanent or a Temporary Threshold Shift. In a retrospect study of 184 patients, or 313 cases, the target of this research was to determinate a possible level of blood dilution resulted during normovolemic hemodilution, and an optimal therapeutic group. In fact, just the dilay of a starting treatment between 0 and 3 days permitted to obtain this group on qualitatives and quantitative criteria; efficiency of the treatment is better than the damages are important. We observed an important post normovolemic hemodilution effect on audition recovery and tinnitus evolution. In return, an optimal hematocrite value hadn't been found between 29 and 35%.

[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.

[Analgesics: their role in current therapeutics]. / Antalgiques: place dans le schéma thérapeutique actuel.

The management of pain has been much developing for the last ten years in French medicine, particularly in O.R.L. It is a well-known fact that all pains are not identical and it is essential to differentiate them well. According to the kind of pain (acute pain, pain induced by a cancer, chronic pain), the attitude to be adopted may be quite different. Therefore, it is essential to master the pharmacology of these analgesic drugs. The aim of this paper is to review the current and everlasting knowledge of these drugs. We shall tackle the latest data concerning the mechanisms of action of analgesics and specify the practical use of morphinic compounds in 1996 and quote the means used in the pain treatment by deafferentation. In conclusion, it seems important to us to bring to mind the consequences of a misuse of analgesics.

[Hearing aids through the ages]. / La prothèse auditive acoustique à travers les âges.

Authors relate the history of acoustic hearing aids, from antiquity to our days, for air and bone conductions. It shows an evolution, more due to physical progress than medical progress, composed with deaf's psychology. The accession of electric amplification will make more than half-century to be imperative.

[Legislative and statutory protection of the hearing-impaired population]. / Protection législative et réglementaire du malentendant.

Ever since the notion of the Recognition of the Nation instituted by the Constituent Assembly in 1790, numerous bills drafted to aid the handicapped, and more specifically the hard-of-hearing, have been adapted. The regulations, institutions, management systems, allowances and benefits are detailed both for the child and for the adult. This paper provides a summary up-date to help both rehabilitators and the handicapped themselves.

[Mucocutaneous leishmaniasis in otorhinolaryngology]. / La leishmaniose cutanéo-muqueuse en ORL.

The authors present a case of mucocutaneous Leishmaniasis of the nose in a patient originally from French Guiana and review the characteristics of this parasitic disease and its importance in the differential diagnosis of lethal midline granuloma. Beyond the exotic pathology of this case, the review of the literature indicates that with the present extension of concomitant leishmaniasis and Hids, authentic autochtonal leishmaniasis may be responsible for otolaryngologic manifestations. The increased prevalence of leishmaniasis associated with AIDS, as well as the presence of mucosal lesions, seems to be underestimated.

[Ophthalmological complications in ORL and maxillofacial surgery]. / Complications ophthalmologiques de la chirurgie ORL et maxillo-faciale.

E.N.T. and maxillo-facial surgery may sometimes cause dramatic eye damage. Following a brief summary of the eye's anatomy and its surrounding parts, the most frequent surgical acts which may cause orbital complications are described. Perfect knowledge of the eye and its surrounding parts enable us to offset the dramatic changes due to the pathology.

[Isolated fractures of the medial orbital wall, surgical indications in 5 cases]. / Fracture isolée de la paroi interne de l'orbite, indications chirurgicales à propos de cinq cas.

Isolated fractures of the medial orbital wall are always blowout fractures. They are usually diagnosed when horizontal diplopia occurs (lateral movements of the globe and Lancaster test). If the medial rectus muscle is encapsulated (forced ductions and CT-scan), the area of restriction has to be explored surgically.

[Current aspects of sinus barotrauma. The impact on treatment, prevention and fitness]. / Aspects actuels du barotraumatisme sinusien. Incidence sur le traitement, la prévention et l'aptitude.

Among the barotraumatism which affects divers and airplane pilots, sinus barotraumatism is one of the less known and studied, as the scarceness of series published can testify. The interest of this study stands in doing an up to date synthesis (recap) of the bibliography, and to understand the "physio-pathologic" mechanism after the exploitation of series of 22 observations. That work will allow a better knowledge of therapeutic on the one hand, and of the "prophylactic" on the other hand.