Validated French translation of the ESIT-SQ standardized tinnitus screening questionnaire.

OBJECTIVES: The heterogeneity of tinnitus in terms of etiology, presentation and sometimes severe impact on quality of life hinders treatment and clinical research. The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ) collects standardized tinnitus characteristics for patient subtyping. A validated French translation of the ESIT-SQ is presented here. METHOD: On the initiative of the French Interdisciplinary Tinnitus Association (AFREPA), 3 translators (1 professional translator, 1 clinician and 1 researcher) were missioned to translate the English version of the ESIT-SQ into French, adhering to good practice guidelines. Nine patients were recruited with the help of the France-Acouphènes patient association, to test and validate the translation. Lastly, an exploratory survey of responses to the French questionnaire was conducted online via the Siopi mobile phone application. RESULTS: The French translation of the ESIT-SQ was successfully validated. 105 patients responded to the exploratory survey, and their characteristics are presented here. CONCLUSION: This new validated French translation of the ESIT-SQ will enable epidemiological and clinical data to be collected in French-speaking populations, and thus compiled and compared with data collected with other versions of this questionnaire already published in other languages.

Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic.

OBJECTIVES: In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS: These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS: The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION: The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.

Vestibular disorders: clinician ENT perspective on the need for research and innovation.

OBJECTIVE: Vertigo and dizziness are a frequent reason for medical consultation. However, diagnostic and therapeutic management is sometimes limited, and clinicians are faced with many unmet needs. The purpose of this study was to identify and prioritize these needs. METHODS: A questionnaire methodology was used to determine the need for innovation in vestibular disorder management. The questionnaire was sent to 19 teams in French-speaking ENT centers. We measured the concordance of the panel of experts on 56 questions related to the different vestibular pathologies encountered and the desired modalities of innovations. RESULTS: Thirteen questions were identified as priorities. The needs expressed by the experts had better knowledge of the pathophysiological mechanisms of the main diseases encountered and the development of new treatment modalities. Particular attention was paid to inner ear imaging techniques and the development of specific electrophysiology techniques. DISCUSSION: Some of the anticipated innovations are already under development, such as new inner ear fluid imaging techniques (hydrops visualization using MRI) or in situ treatments (transtympanic dexamethasone or gentamicin injections). Others, such as new electrophysiological techniques, are still not fully developed CONCLUSION: This study provides a snapshot of the needs of the medical profession in vestibular disorder management. It highlights a real concern of the attending personnel, as well as a critical need to optimize the means of diagnosing and treating patients with vestibular disorders.

MRI evaluation of the endolymphatic space in otosclerosis and correlation with clinical findings.

PURPOSE: The purpose of this study was to investigate the clinical features of ears with otosclerosis and their correlation with endolymphatic hydrops and blood-labyrinth barrier (BLB) impairment on 3T magnetic resonance imaging (MRI). MATERIALS AND METHODS: This was a single-center retrospective imaging study. Thirty-nine ears from 29 patients (17 men, 12 women; mean age 52±12 [SD] years; range 27-74 years) with non-operated otosclerosis were included. All patients underwent three-dimensional fluid attenuated inversion recovery (FLAIR) MRI sequences performed 4hours after the intravenous administration of a single dose of gadolinium-based contrast material. MRI examinations were analyzed by two radiologists for the presence of saccular hydrops (SH) and BLB impairment. Results of MRI examinations were compared with clinical findings, hearing levels and extent of otosclerotic lesions based on high-resolution computed tomography findings. BLB impairment was evaluated using the signal intensity ratio, ratio of intensities between the basal turn of the cochlea and the medulla. RESULTS: SH was observed in 1/39 (3%) otosclerotic ears and BLB impairment in 8/39 (21%) while 8/29 patients with otosclerosis (28%) had vertigo. No significant associations were found between SH or BLB impairment on MRI, and the presence of vertigo or the degree of sensorineural hearing loss. CONCLUSION: Clinical manifestations of otosclerosis (sensorineural hearing loss and rotatory vertigo) were not significantly associated with MRI findings such as BLB impairment and endolymphatic hydrops. SH was only observed in one patient with obstruction of the vestibular aqueduct by an otosclerotic focus.

Stability Study of [18F]Fludeoxyglucose and [18F]Fluorocholine in Different Medical Devices for Intravenous Administration.

OBJECTIVE: The present study had determine the impact of prolonged storage in a cartridge or syringe on the quality of the [18F]-radiopharmaceuticals used in our center [18F]fludeoxyglucose and [18F]fluorocholine). [18F]-radiopharmaceuticals registered as ready-to-use drugs are prepared in multidose flasks. When the change of packaging must be made extemporaneously for the preparation of patient unit doses in a syringe or cartridge, this is under the responsibility of radiopharmacists. As drug quality in medical devices (syringe or cartridge) is not evaluated during the marketing authorization of such radiopharmaceuticals, an evaluation of drug stability in such devices seems interesting. In addition, if there are difficulties in patient care (placement of the catheter, lack of personal, etc.) or equipment problems (technical issue with the automated dispenser delaying the delivery of the prepared dose), the contact time of [18F]-radiopharmaceuticals with the medical devices (cartridge or syringe) increases. METHODS: Appearance, pH, radiochemical purity, sterility and endotoxin tests were made according the current European Pharmacopoeia. Adsorption tests were made according the literature. RESULTS: There was no drug absorption of [18F]fludeoxyglucose or [18F]fluorocholine after 1.5h, which may be related to their hydrophilic nature. No drug radiolysis was observed even after dilution of the radiopharmaceuticals (appearance, pH, and radiochemical purity were unchanged). No impurity from medical devices (cartridge or syringe) was observed, and microbiological aspects remained in specification of the current European Pharmacopoeia. CONCLUSION: These radiopharmaceuticals repackaged in plastic medical devices retained their quality after dispensing and prolonged storage.

Control of vertigo in Ménière's disease by intratympanic dexamethasone.

OBJECTIVE: The main objective was to assess the efficacy of intratympanic dexamethasone injection in controlling vertigo in unilateral Ménière's disease refractory to medical treatment. MATERIALS AND METHODS: A retrospective study included 25 patients with disabling unilateral Ménière's disease, defined according to the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Patients received intratympanic dexamethasone during the monitoring period. Control of vertigo was classified according to AAO-HNS vertigo control index, at 6 months, 1 year, and 2 years after treatment initiation. Complications and progression of hearing were also assessed. RESULTS: Satisfactory control (class A or B) was obtained in 92% of patients (n=23/25) at 6 months, 68% (n=17/25) at 1 year, and 70% (n=16/23) at 2 years. There was no worsening of hearing in those patients who were well-controlled by this therapeutic strategy. No local or systemic complications were observed during follow-up. CONCLUSION: Dexamethasone is part of the management strategy for patients with Ménière's disease refractory to conventional treatment, implemented before destructive treatment. It achieves control of vertigo in 70% of patients at 2 years.

[The radiopharmacy end?]. / La fin de la radiopharmacie ?

In France, radiopharmaceuticals preparation and dispensation are made under the responsibility of a pharmacist. This last one made a pharmaceutical over-specialization in the field of the medical use of radioelements. However, a flaw in the French law allows nuclear medicine units to avoid the presence of the radiopharmacist decreasing so the quality and the safety of the care brought to patients. This article aims at looking for legal solutions to maintain these quality and safety by the empowerment of the radiopharmacist statute while taking into account economic aspects.

[Vestibular dysfunction after cochlear implantation: a national multicenter clinical study]. / Vertiges et troubles de l'equilibre après implantation cochléaire. Analyse préliminaire des données du PHRC national: "Diffusion de la technique des implants cochléaires: etude d'impact des conséquences médicales, sociales et economiques".

Vertigo and dizziness are the most common complications of cochlear implantation. Data of a multicentric study about clinical aspects and cost utility were collected for vertigo and dizziness: incidence, clinical and treatment were analyzed among 469 adults and children. Results demonstrated that 16% of adults and 3% of children experienced dizziness postoperatively. In a few cases a specific mechanism as perilymphatic fistula was identified. In other cases the mechanism underlying delayed vertigo remains speculative and endolymphatic hydrops was suggested.

Relationship between cochleovestibular disorders in hemifacial spasm and neurovascular compression.

OBJECTIVE: To investigate the evolution of cochleovestibular symptoms before, during, and after microvascular decompression (MVD) of the facial nerve in hemifacial spasm. STUDY DESIGN: Prospective study in patients with hemifacial spasm. Among our 13 patients who underwent MVD of the facial nerve from 1995 to 1997, 6 had associated cochleovestibular disorders confirmed by neurotologic tests. RESULTS: In four of these patients, a concomitant compression of the eighth and facial nerves was found at surgery. Preoperative magnetic resonance angiography studies had shown three cases of this double neurovascular compression. Intraoperative auditory brainstem response monitoring showed that interposition of Teflon between vessel and facial nerve was highly critical to the auditory function. Auditory brainstem response monitoring was used to guide the surgeon during this critical phase. Surgery improved at least one cochleovestibular symptom in each patient. CONCLUSIONS: The authors propose two pathophysiologic hypotheses. First, the concomitant facial and cochleo-vestibular symptoms may be due to a hyperactivity of both the facial and vestibular nuclei. According to theories about cryptogenic hemifacial spasm, the origin of this hyperactivity could be an ectopic excitation focus. However, the two nerves may have different sites of ectopic excitation. According to the second hypothesis, a pulsatile compression of the facial nerve may be transmitted to the eighth nerve. This could take place even if only the facial nerve is in contact with a vascular loop.

[Cochleovestibular disorders associated with hemifacial spasm: an outcome after microvascular decompression of the facial nerve]. / Troubles cochléo-vestibulaires associés au spasme de l'hémiface: évolution après microdécompression vasculaire du nerf facial.

Twelve patients underwent microvascular decompression by retrosigmoid approach to relieve severe hemifacial spasm. The surgery was done under intraoperative monitoring of the auditory function. Assessment at Day 2, Day 10, 2 months and 6 months after the operation found that the surgery had resulted in 9 recoveries, 3 improvements and 1 failure. Brain stem auditory evoked potentials monitoring showed that the interposition of Teflon between the vascular loop and the facial nerve is a critical stage for the auditory function. Six of the twelve patients were also complaining of cochleo-vestibular disorders: vertigo and tinnitus, or hearing loss and tinnitus, or vertigo alone. The surgery improved at least one of these cochleo-vestibular symptoms in each one of the patients. There was one hearing improvement, vertigo disappeared in three cases out of four, and tinnitus disappeared in four cases out of five. The possibility of a concomitant compression of cochleo-vestibular and facial nerve was investigated using cochleovestibular tests, radiological data and intra-operative findings.

[Rotatory impulse test does not replace caloric tests]. / L'épreuve rotatoire impulsionnelle ne remplace pas les tests caloriques.

We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test. The rotatory impulsional test does not present any specific advantage compared to other kinetic test as far as the observation of the preponderance phenomenon. We then compared the preponderance with the results of the caloric tests and came to the following conclusions i) the absence of preponderance does not allow us to predict the absence of vestibular deficit, due to the fact that 37% of the deficits were compensated for including acoustic neuroma; ii) the presence of a preponderance does not allow a priori to say whether it is of vestibular, cervical, or central origin and systematic caloric tests shows that almost one fourth of preponderance observed is not associated with unilateral weakness iii) supposing that a clinical argument allow us to conclude as to the probable vestibular origin of a vestibular preponderance, the direction of this preponderance does not allow us to determine which side is involved. In fact, if the undercompensated deficits are 3 times more frequent than overcompensated deficits, the proportion of preponderance not linked to a significant deficit indicates that the probability of encountering a preponderance related to a specific undercompensated deficit is approximately 50%. We thus did not find in the rotatory impulsional test any specific advantage allowing us to predict the laterality of a vestibular lesion.

Early dental loss in Sjögren's syndrome. Histologic correlates. European Community Study Group on Diagnostic Criteria for Sjögren's Syndrome (EEC COMAC).

Early dental loss is a well-known complication of Sjögren's syndrome. Forty percent (n = 16) of 39 consecutive patients with the syndrome had early dental loss. Dental loss correlated positively with histologic grading at lip biopsy. There was no significant correlation with any other feature of Sjögren's syndrome, including saliva flow. In 11 partially edentulous or completely edentulous patients, dental loss occurred 9 years on average before the first symptom of xerostomia. Early dental loss may reflect a silent involvement of the salivary glands and suggests that changes in saliva biochemistry occur long before xerostomia.

'Oncocheck': an international external quality assessment scheme for immunoassays of tumor markers.

Starting from November 1990, an international External Quality Assessment Scheme (EQAS) for immmunoassays of tumor markers has been organized. Presently, 238 laboratories from France, Germany, Italy, Japan and Spain participate in the scheme. In this report the main features of the EQAS and data processing are outlined. Results collected during the 1992-cycle allow evaluation of the state of the art of AFP, CEA, CA 19-9, CA 15-3, CA 125 and PSA immunoassays. According to their analytical performances, the 6 tumor marker immunoassays can be classified into several groups, the first including AFP and CA 15-3 for which both total variability and within-kit agreement are good. For CEA assay, performance can be considered as satisfactory even though further improvements of between-lab agreement would be welcome. For the 3 other tumor markers, the higher total variability indicates an urgent need for a better standardization by improvement of either both within-kit and between-kit agreements (CA 19-9) or between-kit agreement mainly (PSA, CA 125).

[Vertigo in non-vascular diseases of the central nervous system]. / Les vertiges dans les affections non vasculaires du système nerveux central.

Excluding vascular involvement, vertigo due to a central vestibular syndrome reflects a median or paramedian lesion of the brain stem or the cerebellum. Recurrent attacks of vertigo usually occur with peripheral lesions. Persistent acute vertigo with peripheral destruction can reveal ischemia of the brain stem. Central positional vertigo is rare and has symptomatology that is different from that of benign positional vertigo. Persistent instability has a symptomatology that is more difficult to analyse and is usually associated with a central vestibular syndrome when it is organic. Diagnosis of a central vestibular syndrome is based on detection of well-defined clinical or electronystagmographic signs of which abnormal nystagmus is primordial. Some of them such as inferior vertical nystagmus or dissociated nystagmus can localise the site. MRI has become the diagnostic procedure which is best adapted for identifying the most frequent aetiologies such as tumors, congenital malformations and multiple sclerosis.

[Value of auditory evoked potentials and electrocochleography in the diagnosis of small acoustic neuromas. Our experience on 131 cases]. / Valeur des potentiels évoqués auditifs et ECoG dans le diagnostic des petits neurinomes de l'acoustique. Notre expérience sur 131 cas.

The auditory brainstem responses, in a series of 131 patients with surgically confirmed acoustic neuroma, are reported. Six groups have been individualized according to the value of the I-V interpeak latency, the synchronisation of the waveform shape and the need to perform an electrocochleography. If we exclude the sixteen cases of profoundly deafness, or cophosis, where ABR and ECoG don't permit the recording of waves, the electrophysiological investigations allowed to provide the diagnosis of retrocochlear lesion in 115 patients, for a rate of 98.26%. This high degree of sensitivity favorably with data reported in literature, and supports the reliability of this method for detection of acoustic neuroma. According to these results, our diagnosis workup of a patient suspected of having an acoustic neuroma, presenting normal ABR findings, is presented.

Influence of the level of hydration on the renal response to a protein meal.

Recent studies have suggested that the renal effects of high protein intake could be mediated, at least in part, by vasopressin and/or an increase in the urinary concentrating activity. The present study investigated the influence of the level of hydration, and hence of the activity of the concentrating process, on the renal response to an acute oral protein load. Clearance studies were performed before (Control) and during three hours after a protein meal (1.5 g/kg body wt protein as cooked meat) in ten healthy volunteers. This study was performed twice at a two to three week interval under either constant low (LowH) or high (HighH) hydration. In spite of the marked difference in initial diuresis (3.1 +/- 0.3 in LowH vs. 13.9 +/- 0.7 ml/min in HighH) and urine osmolality (501 +/- 42 in LowH vs. 99 +/- 3 mOsm/kg H2O in HighH), a similar relative decrease in urine flow rate was observed following the meal in both conditions. TcH2O increased progressively by 70% in LowH whereas CH2O decreased by 40% in HighH. Plasma vasopressin showed a progressive increase with time in LowH (from 1.10 +/- 0.26 in control, to 1.98 +/- 0.35 pg/ml at the third hour after the PM, P < 0.05) but not in HighH (0.53 +/- 0.09 to 0.70 +/- 0.17 pg/ml). Glomerular filtration rate (inulin clearance) increased significantly on the second post-prandial hour under LowH but not under HighH. Excretions rates of Na, Cl, K, and urea increased after the meal, however, not to the same extent nor with the same time course in the two conditions. Significant positive correlations were observed between GFR and TcH2O, urine osmolality, or the ratio of urine-to-plasma urea concentrations in LowH. These results suggest that the protein-induced hyperfiltration is partially blunted by a high water intake, and hence is dependent, directly or indirectly, on the urine concentrating activity.

Bioluminescence enhanced enzyme immunoassay for human alpha-atrial natriuretic peptide using luciferin-luciferase.

A sensitive bioluminescent enzyme immunoassay (BEIA) for the determination of human alpha-atrial natriuretic peptide was developed. The usable ranges of the standard curve extend from 10 pg to 400 pg for the one-step method and from 2.5 to 50 pg for the two-step method.