Guidelines (short version) of the French Society of Otorhinolaryngology (SFORL) on pediatric cochlear implant indications.

OBJECTIVES: The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou - SFORL) on the indications for cochlear implantation in children. METHODS: A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS: The SFORL recommends that children with bilateral severe/profound hearing loss be offered bilateral cochlear implantation, with surgery before 12months of age. In sequential bilateral cochlear implantation in children with severe/profound hearing loss, it is recommended to reduce the interval between the two implants, preferably to less than 18months. The SFORL recommends encouraging children with unilateral cochlear implants to wear contralateral hearing aids when residual hearing is present, and recommends assessing perception with hearing-in-noise tests. It is recommended that the surgical technique should try to preserve the residual functional structures of the inner ear as much as possible.

[Personal experience of children with a brain injured parent: preliminary study]. / Vécu des enfants dont l'un des parents est cérébrolésé : étude préliminaire.

OBJECTIVE: To explore the impact of the brain injury of a parent on his child's behavioural and emotional symptoms and personal experience. PATIENTS AND SETTING: Nineteen children from 6 to 12 years old at the time of the research having a brain-injured parent living at home and with cognitive impairments. MAIN OUTCOME MEASURES: Case report. Assessment of a questionnaire measures of anxiety, the R-CMAS scale. Qualitative analysis of a semi-structured interview and of the family drawing. RESULTS: Four children (21%) presented pathological anxiety assessed by the R-CMAS scale. The analysis of the semi-structured interview showed that 16 children had a representation of the brain injury. The symbolic place of the brain-injured parent was maintained for all the children and one presented impulsive behaviours. The family drawing analysis showed the lack of relational interaction between the family members in 16 cases (84%). Three children (15%) represented the real disability, and 17 (89%) abnormalities in the bodies' pictorial representation of the personages. These abnormalities concerned the brain-injured parent and the other members of the family. A characteristic sign was the lack of hands or the representation of amputee hands in 14 cases (73%). Another one was the unsteadiness of family members, who were also represented as ghosts or "in the air" in 13 cases (68%). CONCLUSION: Children seem adapted and they have few emotional and behavioural disorders. But there was a strong impact of the disability of the parent on their personal experience and on their perception of "the family body".

[Effect of a hearing aid on progressive hearing loss]. / Impact de l'amplification prothétique sur les surdités evolutives.

A group of 72 children with hearing aids followed in 4 different clinical settings presented progressive increase in sensorineural hearing loss. The mean hearing loss over time, the duration of hearing aid use and the gain were studied to test the hypothesis that continued progression in hearing loss was due to overly powerful amplification. No correlation was found between the progressive increased gain levels were associated with less progression in hearing loss than at lower gain levels. Therefore, the use of hearing aids was not directly and significantly related to the increase in hearing loss in the population studied. However according to the above criteria a few cases (4%) of progressive hearing loss did seem to be associated with hearing aid use.

[Hearing aid for and clinical picture of deaf children with multiple handicaps]. / Appareillage et tableaux cliniques de l'enfant sourd plurihandicapé.

The evolution and the frequency of early detection technics, as well as the choice made in noenatalogy increase to a considerable extent the number of children who show besides an already bad clinical picture in the development field important hearing deficiencies. We bring forward a few clinical reflections resulting from our experience in hearing aid of these children.