Anatomic and functional results are reported after 3 and 5 year follow up of 94 cases of chronic cholesteatomatous otitis operated upon and kept under surveillance by the same surgeon between 1975 and 1983. Open technics dominated and were justified by seven clinical and epidemiologic factors found alone or in combination in 80% of patients. Results must allow for the high rate of non-attenders (40% at 3 years and 70% at 5 years). Recovery from their cholesteatoma was obtained in 84 and 78% of patients after 3 and 5 years respectively, 52% recovering useful hearing, 2 out of 3 of these due to an open technic. Modified radical mastoidectomy is considered to be undoubtedly the most effective treatment for this type of affection.

Adolescent↗

PubMed1988

[Anatomical and functional evaluation 3 and 5 years later of 94 cases of chronic cholesteatomatous otitis media. Clinical and therapeutic implications].

Anatomical and functional results were evaluated at 3 and 5 years after surgery for chronic cholesteatomatous otitis media in 94 patients treated by the same surgeon between 1975 and 1983. Open techniques predominated and were justified by seven clinical or epidemiologic factors present alone or in association in 80% of cases. Many patients were non-attenders at follow up (40% at 3 years and 70% at 5 years), recovery from their cholesteatoma being noted in 84% and 78% of those attending at 3 and 5 years respectively. Useful audition was recovered in 52%, including 2 of 3 due to an open technique. Petro-mastoid hollow-out with arrangement of cavity and minimal ossicular reconstruction is considered the most effective treatment for this type of affection.

Adolescent↗

PubMed1987

[Chronic nasofacial ulceration disclosing muco-cutaneous leishmaniasis].

Explore the source record for details and available documents.

Adult↗

PubMed1985

[Labial incompetence and maxillodental dysmorphosis].

A definition of labial incompetence is given and emptrasis placed on the fact that this is a symptom of maxillodental dysmorphism (MDD) and not of nasal dyspermeability. Pathogenic features are discussed, the relevant clinical and paraclinical diagnostic features of MDD outlined, and the different alveolodental and/or bony (maxillary or mandibular) dysmorphias responsible for labial incompetence described. Principles of orthodontic and surgical treatment are centered on re-establishment of a correct articulation and therefore labial competence.

Alveolar Process↗

PubMed1985

[Mucoceles of the maxillary sinus. Diagnostic and therapeutic problems. Apropos of 5 cases].

Five cases of the rarely observed maxillary sinus mucocele are reported, one patient with bilateral lesions presenting primary dilatation of the bronchi. A previous history of surgery or injury to sinuses was obtained in all cases, the diagnosis being confirmed by computed tomography imaging. Recovery is usually complete after the Caldwell-Luc operation. One case with exclusion of the sinus is described and the literature reviewed.

Adult↗

PubMed1983

[Instantaneous measurement of acoustic reflex latency in daily practice. The apparatus. Results].

Increase in acoustic reflex latency (time between stimulus onset and response) provides a highly specific and sensitive sign for early detection of lesions of the first or second auditory neurones. The performance of a new apparatus, including an Amplaid 702 impedance meter with a specially designed numeric oscilloscope, employed systématically for all audiometric examinations (87 subjects) was compared with that of a reference apparatus (Madsen ZO 73 + Elema Schoenander-jet ink recorder). The new apparatus provided a very simple, precise, and rapid method for measuring acoustic reflex latency. The technique has its limits, however, of critical importance being the determination of the acoustic reflex threshold at close to 1 dB (modification of the apparatus), the means for measuring latency, and the use of three criteria for distinguishing retrocochlear lesions from others. The effect of age on latency, variations in the test-retest results according to the type of deafness, and the influence of averaging techniques are discussed. Typical retrocochlear lesions were rare in this series, and the 5 cases observed are described in detail, followed by a discussion of the advantages and inconveniences of systematic as against selective screening.

Acoustic Impedance Tests↗

PubMed1983

[Idiopathic and zoster vestibular neuritis. Course and prognosis].

112 cases of vestibular neuritis were studied. 77% were relatively pure lesions, whilst in 23% of cases there were more extensive lesions with abnormalities of the saccadic oculomotor system and BERA abnormalities. Spontaneous nystagmus disappeared in 2 to 3 months in general. In 54% of cases there was complete recovery of absolute reflex activity within normal limits on the affected side. There was restoration of normal difference of reflectivity in 22%. In 13% there was normal absolute reflex activity, normal hypovalence and normal directional preponderance. Age appeared to influence the course of directional preponderance and the extent of lesions on the course of hypovalence. Early mobilisation of the patient is of primordial importance.

Acoustic Impedance Tests↗

PubMed1983

[Measurement of the latencies of voluntary and corrective ocular saccades. Value in otoneurology].

The delay between the stimulus and the voluntary eye saccade is the only parameter of the saccadic system which can be measured by using standard apparatus. Taking manually the measurements made on records obtained by using minicomputer; the authors show that such manual measurement of latencies is easy and yet sufficiently accurate to be of great clinical value. The latencies of voluntary saccades are normal in peripheral pathology (less than 250 milliseconds). Latencies of voluntary saccades are significantly increased in extrinsic brain stem lesions: tumours (in particular ponto cerebellar tumours), meningitis, head injury; but the velocity of the saccade is normal. This effect goes in parallel with impairement of the smooth pursuit. In intrinsic brain stem lesions (multiple sclerosis, acute brain stem stroke, oculomotor paralysis) latencies are increased bilaterally and above all, there is a significant slowing of the saccade. The role of fatigue increased latencies in some patients of this series. Two populations can be discerned in vestibular neuritis: one normal and one with abnormal smooth pursuit and increased saccadic latencies.

Brain Diseases↗

PubMed1983

[Cholesteatoma arising from the internal acoustic meatus after conservative antro-atticotomy for decompression of the facial nerve].

Two patients developed cholesteatomos following conservative surgical treatment of facial palsy by antro-atticotomy of the bony framework. As the middle ear was not affected the lesions probably arose from the internal auditory meatus, and this was confirmed in one case. The association of stenosis of the external auditory meatus due to sliding and retraction of the external ear raises the question of the need for its correction to prevent this rare complication.

Child↗

PubMed1983

[Equipment and technic allowing a quantitative study of pursuit eye movements and saccadic movements].

Study of following eye movements (posterior oculogyric pathway) and saccadic eye movements (anterior oculogyric pathway) represents the principal advance in nystagmography in the past ten years. Use as a visual stimulus of the LED bar developed by one of the authors (E.U.) has proved to be clinically easy and gave results identical to those of the reference stimulation system (laser + mobile mirror). It is possible to quantify performance and abnormalities of these two oculogyric pathways using parameters calculated: - either using a micro-computer (Aurelia); - or manually following a technique which the authors describe in detail indicating normal results and limits in their variations. These parameters for the foveal following system are gain and total movement. For the saccadic system, they are the maximum speed of the saccade, latent period and its accuracy. Using such quantitative analysis, it has become possible not only to draw a distinction between peripheral and central disorders, but also to describe different topographical groups: lesion of the cerebellopontine angle, cerebellar lesion, intrinsic lesion of the brain stem or parietal lesion. These different patterns are illustrated by examples.

Electronystagmography↗

PubMed1982

[Comparative efficacy of multidirectional and computed tomography in the diagnosis of tumors of the pontocerebellar angle (author's transl)].

Extensive investigation of 41 patients highly suspected of having pontocerebellar angle tumors led to the detection of 21 surgically confirmed tumors. Precise criteria, involving numerical rating of sensitivity and specificity, were applied to compare the diagnostic reliability of multidirectional and computed tomography. An analysis of the diagnostic value of internal auditory canal anomalies demonstrated the obvious superiority of 3 mm as against 6 to 9 mm scanner sections, and the good correlation between the anomalies detected by these thin scanner sections and those obtained by tomography. Above all, however, the efficacy of thin scanner sections appears to be markedly superior to that of tomography, as 80 p.cent of tumors were visualized without false positives even when the internal auditory canal was normal. The number of cisternography examinations was thus considerably reduced. This efficacy of thin scanner sections varied as a function of the tumor size : all those of 2 cm diameter or more were detected by the scanner, 50 p.cent of those between 1 and 2 cm by both the scanner and tomography, the latter being more effective for detecting tumors less than 1 cm in diameter. The availability of the 4th generation scanner will markedly increase its effectiveness.

Cerebellar Neoplasms↗

PubMed1982

[Acoustic variation after surgery for severe Bell's palsy].

Auditory thresholds were studied before and after surgical decompression of the facial nerve in 35 patients following either transmastoidal (20 cases) or transmastoidal and suprapetrosal (15 cases) operations. Seventeen of the patients were under 40 years of age at the time of surgery, which did not affect hearing in the opposite ear. However, auditory threshold levels fell in the operated ear. These were of the bone conduction type, and possessed characteristics of an acute hearing lesion (maximal in the 4000 frequency range and improving progressively) of 0 to 35 dB (mean 5 dB). Possible causes of the hearing loss are discussed.

Adult↗

PubMed1982

[Hypoglossofacial anastomois. Analysis and results on 12 cases and comparison with results of facio facial anastomosis].

Regular facial clinical testing (G. Freyss) and surface integrated electromyography was employed to quantitatively assess the course of 12 hypoglossofacial anastomoses. Recovery was complete after an average period of 4 months, the time before conducting anastomosis (2 to 14 months after onset of facial paralysis) not affecting the quality of results obtained. Age significantly influenced recuperation of remaining tone, but this was always superior to 70 p. cent in relation to the other half of the face. Motor recovery was not affected by age, and was a mean of 51 p. cent after one year (50 to 70 p. cent when compared with the normal half of the face). Lingual sequelae were minimal, early physical therapy compensating for the inevitable resulting synkinesis. Results after hypoglossofacial anastomosis are compared with those obtained by faciofacial anastomoses (published in 1980). The former is a simpler and more rapid technique which produces more constant results and leads to earlier recovery (4 instead of 9 months after faciofacial anastomosis. Tone is also improved and motility satisfactory.

Adult↗