Immunologic alterations in patients with sensorineural hearing disorders.

The autoimmune etiology suspected for some forms of hearing loss, supported by the clinical efficacy of steroid therapy, is thought to involve immune complexes, autoantibodies directed to the inner ear and/or cellular effectors. We report a study performed in 57 individuals with sudden deafness (n = 17, group 1) or progressive sensorineural hearing impairment (n = 40, group 2). A severe depletion in CD3+ and CD4+ peripheral lymphocytes was observed in group 1 and a marked decrease of CD8+ cells levels was observed in both groups. Group 2 patients frequently had anti-nuclear and anti-thyroid antibodies, while anti-cochlear antibodies were found in both groups (respective incidences, 75 and 71%). Anti-cartilage antibodies, found with a similar frequency in both groups, were not correlated with anti-cochlear antibodies. These data suggest that different immune disorders are involved in the development of sudden and progressive deafness, while both types of sensorineural hearing impairment involve immune abnormalities.

[Reconstruction of the mandibular symphysis using a revascularized free flap of the scapula. Surgical technic]. / Reconstruction de la symphyse mandibulaire par lambeau libre revascularisé de scapulaire. Technique chirurgicale.

In cases of surgically removed mandibular symphysis malignancies, the bone and mouth floor were reconstructed using osteo-musculo-cutaneous flaps. In our experience, the latter provide the best results. Removed in dorsal decubitus, they allow floor replacement. During the dissection of the tumor site, we also preserve labial and chin structures, which favours a good restoration of phonation and swallowing.

[Reconstruction of the mandibular arch using free vascularized iliac and scapular grafts. Arguments in favor of using scapular grafts]. / Reconstruction de la symphyse mandibulaire par transferts osseux vascularisés libres iliaques et scapulaires. Arguments en faveur de l'utilisation du lambeau scapulaire.

In 12 cases of surgically removed mandibular symphysis malignancies, the bone and mouth floor were reconstructed using osteo-musculocutaneous flaps from the iliac crest or free osteo-cutaneous scapular flaps. In our experience, the latter provide the best results. Removed in dorsal decubitus, they allow floor replacement. During the dissection of the tumor site, we also preserve labial and clin structures, which favours a good restoration of phonation and swallowing.