[Ear discharge, otalgia. Diagnostic orientation].
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Cerebrospinal Fluid Otorrhea↗
Biomedical subjects
P Bonfils
Publications and source records attributed to P Bonfils.
A case report of fluctuant sensorineural hearing loss after hepatitis B vaccination.
Hepatitis B vaccine is known to induce accidents and side-effects. We report a case of unilateral fluctuant sensorineural hearing loss with tinnitus after a series of hepatitis B vaccinations. Tinnitus regressed and hearing thresholds were normalized 6 months later. The authors discuss the potential causality of hepatitis B vaccine in the occurrence of fluctuant sensorineural hearing loss and propose a physiopathological hypothesis to explain this unusual case.
Adult↗
Click-evoked otoacoustic emissions and the influence of high-frequency hearing losses in humans.
Click-evoked otoacoustic emissions (cEOAEs) are thought to reflect the presence of highly tuned mechanisms involved in sound processing inside the cochlea. When the sensitivity and tuning of the inner ear are impaired in some frequency range, the spectral components of cEOAEs in the same frequency range are expected to be altered if the previous premise is correct. Although clinical experience does not contradict such an interpretation, fundamental aspects of cEOAE generation and propagation in the cochlea are not clear enough to preclude possible additional influences of remote cochlear places on cEOAE. In order to analyze this possibility, ultra-high-frequency hearing thresholds between 8 and 16 kHz were assessed in 43 human subjects that had clinically normal hearing thresholds in the frequency range of cEOAEs. The magnitude of their cEOAEs was found to be correlated to their average ultra-high-frequency hearing threshold, especially when ears presenting spontaneous otoacoustic emissions were not taken into account (p = 0.002, r2 = 0.29). Age and ultra-high-frequency hearing thresholds were correlated (p < 0.01, r2 = 0.40); thus it is not possible to exclude that aging was the primary cause of the observed trend. The contribution of ultra-high-frequency hearing status to cEOAE magnitude, perhaps in relation to age, seems to explain a significant part of the variance of "normative" emission data and may be of interest for early detection of high-frequency hearing impairments.
Adult↗
Statistical evaluation of hearing screening by distortion product otoacoustic emissions.
The aim of this study was to provide a statistical evaluation of the screening properties of distortion product otoacoustic emissions (DPOEs) in individuals with clinically normal hearing and in patients with pure sensorineural deafness of various degrees. The main informational parameters used were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the analysis of receiver operating characteristic (ROC) curves. For each frequency tested, ears were classified as a function of their audiometric threshold. Two groups were defined relative to an arbitrary reference, the "audiometric criterion." The PPV decreased and NPV increased with increases in the audiometric criterion. Each point of the ROC curve represents the relationship between the false alarm rate and the hit rate for each audiometric criterion ranging between 10 and 75 dB hearing level: the lower the audiometric criterion, the lower the hit rate value, and the lower the false alarm value. The audiometric criterion giving the highest hit rate and the lowest false alarm rate was 55 to 60 dB hearing level for primaries at 60 and 70 dB sound pressure level, or 25 to 30 dB hearing level for primaries at 30, 40, and 50 dB sound pressure level. These two different behaviors of ROC curves are consistent with the hypothesis that DPOEs do not represent activity at a single location along the basilar membrane.
Adolescent↗
Characteristics of transient-evoked otoacoustic emissions (TEOES) in neonates.
Transient-evoked otoacoustic emissions (TEOEs) were measured in 1164 ears from 582 neonates without any risk of hearing impairment in order to define basic characteristics useful in deciding if TEOEs could be considered as "normal" in a screening test. Five neonates had no recordable TEOE and ABR thresholds greater than 30 dBnHL. Technical conditions have been analysed using the intensity of the click stimulation, the time necessary to record TEOEs, and the noise floor in the external ear canal (i.e. A-B magnitude). The TEOE magnitude varied between 6.6 dB SPL and 38 dB SPL (mean = 21.75 dB SPL). Only 5% of the tested neonates had a TEOE magnitude lower than 7.75 dB SPL. The TEOE magnitude for the right ear of a neonate was statistically different from those recorded in the left ear (22.4 dB SPL versus 21 dB SPL). The mean TEOE magnitude for male ears was statistically different from those recorded in female ears (21.4 dB SPL versus 22.1 dB SPL).
Acoustic Stimulation↗
[Nebulization aerosol therapy in otorhinolaryngology. Review of the literature].
An aerosol is a suspension of solid or liquid particles in a gas with a negligable rate of fall. Administration with a nebulizer is an administration route just as are the oral, intramuscular or intravenous routes. Nebulization should not be considered as a simple, somewhat mysterious, adjunct, but rather as an effective administration route of active drugs. Drug administration by nebulization is widespread in France, being prescribed by general practitioners and ENT specialists. The main indications involve lund or ENT diseases. In general practice, there are four main indications including two for which there is no convincing evidence of its efficacy (acute and chronic sinusitis) and two for which pneumologists disagree on the "indications" (acute and chronic bronchitis). The aim of this review is to analyse the literature on this administration route for cervicofacial indications and discuss the different drugs used. Current practice will be assessed.
Administration, Inhalation↗
[Dysphagia. Diagnostic orientation].
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Acute Disease↗
[Characteristics of 2F2-F1 distorsion products in adults with normal hearing].
Acoustic distorsion products (ADP) are otoemissions which the cochlea emits in response to stimulation by two pure frequencies, f1 and f2. ADP 2f1-f2 has been widely studied, however little work has been reported on ADP 2f2-f1. We performed a study in 34 adults with normal hearing to determine the normal values (incidence and amplitude) of ADP and compared them with the ADP 2f1-f2. Two f2/f1 ratios were used (1.22 and 1.12). Different behaviors were observed between the two types of ADP. These results suggest that the mechanisms generating the two ADP are different and that, consequently, ADP 2f2-f1 should have clinical implications different than ADP 2f1-f2.
Acoustic Stimulation↗
[Fluctuant perception hearing loss after hepatitis B vaccine].
A 42 year old physician doctor presented with temporary tinnitus after a first dose of a hepatitis B vaccination (Engerix B*). One month after, a fluctuant sensori-neural hearing loss with tinnitus appeared few hours after a second dose of hepatitis B vaccination (Engerix B*). The auditory thresholds varied from 45 dBHL and 0 dBHL for low frequencies below 1.5 kHz. The fluctuant hearing loss and tinnitus disappeared after a 6 month course.
Adult↗
[Prospective study of thromboses of the subclavian vein after setting implantable venous access systems in cervico-facial cancerology].
Seventy-eight consecutive patients treated by chemotherapy for ENT cancers and having a subclavian catheter for venous access were studied prospectively to assess the prevalence of venous thrombosis. Thrombosis of the subclavian vein was demonstrated clinically in 4 patients and by ultrasonography in 7 patients. The prevalence of thrombosis was 14.1%. No clinical or biological predisposition factor could be identified. Subclavian thrombosis mostly occurred during the second month after implantation (91% of cases). Ultrasonography seems the most useful non-invasive technique for the diagnosis of subclavian thrombosis.
Carcinoma, Squamous Cell↗
Screening for neonatal and infant deafness in Europe in 1992.
Many methods of screening for hearing impairment are available. The aim of our study was to determine which ones were really used in 1992. At the request of the British Audiology Society, we conducted an inquiry into the organization of screening for deafness in neonates and infants in Europe. In practice all 6-9 month-old infants are tested with behavioural tests in every country. For the neonates, generally only those at risk for hearing-impairment (about 5%) were tested. The most widely used tests were behavioural ones. Only specialized centers used transient evoked otoacoustic emissions (TEOAEs). This last test assesses the active mechanical properties of the cochlea and allows detection of even mild or unilateral sensorineural deafness.
Audiometry↗
[Deafness in the neonatal period: basis for screening].
Deafness must be recognized in infancy in order to reduce auditory disability to a minimum. To achieve this, it is important to implement screening programmes as soon after birth as possible. In the United States, the Joint Committee on Infant Hearing recommended in 1982 that identification of hearing loss should be screened in the neonatal period. This early detection is now considered critical for optimal rehabilitative outcome. This paper presents the "state of art" neonatal screening principles and procedures. In France, neonatal screening programs for auditory dysfunction are not consistent with these principles. Evoked otoacoustic emissions represent an important advance in screening for hearing loss in normal neonates and babies from neonatal intensive care units. This method records very low intensity sound energy released by the cochlea in response to a brief sound stimulation. These otoacoustic emissions show promise as a rapid, cost-effective means of quickly discharging all babies with normal peripherical auditory systems.
Deafness↗
Transient-evoked otoacoustic emissions and high-frequency acoustic trauma in the guinea pig.
Transient-evoked otoacoustic emissions (TEOE) disappear when hearing loss exceeds 40 dB in the range 1-4 kHz, due to impairment of cochlear outer hair cells. Early screening of sensorineural hearing losses is based on this finding. However, little is known as to the frequency specificity of TEOE abnormalities in a damaged cochlea. TEOE were recorded in 18 normally hearing guinea pigs in a range from 1.5 to 5 kHz before and after exposure to loud pure tones (3-10 kHz, 95-105 dB SPL, 1-10 min). The thresholds of eighth-nerve compound action potentials (CAP) were monitored with a round-window electrode; it was confirmed that acoustic overexposure resulted in typical high-frequency threshold elevations (10 to 50 dB). Most TEOE components were found at lower frequencies at which CAP thresholds did not change. However, a significant linear regression was found between their amplitudes and the percentage of basal cochlea with unaltered CAP thresholds (r = 0.69, p < 0.0001). Two alternative hypotheses are proposed to account for this correlation. Either acoustic trauma induced some minute cochlear damage at places tuned to low frequencies and TEOE were more sensitive to it than CAP thresholds, or significant contributions to lower-frequency TEOE came from the most damaged cochlear places tuned to much higher frequencies.
Acoustic Stimulation↗
[Definition of normal criteria of provoked otoacoustic emission in the newborn infant].
Evoked otoacoustic emissions (EOE) were recorded with ILO88 in a group of 254 neonates (n = 508 ears) in order to determine the normative data. In this study, it was found that: (i) the mean EOE amplitude was 20.2 dB SPL, (ii) the EOE amplitude of the right ear was significantly higher than those of the left ear, (iii) the mean time necessary to record EOE in both ears was around three minutes, and (iv) EOE spectrum was large (mean = 638-5,611 Hertz). These data permit to precise the clinical interest of EOE for screening auditory function in neonates.
Hearing Disorders↗
[Detection of deafness in newborn infants].
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Cochlear Microphonic Potentials↗
[Cervicofacial cancerology: complications of implantable systems of venous access. Prospective study].
OBJECTIVE: Implantable systems for venous access are widely used in cervicofacial cancer. We prospectively evaluated complications related to this type of venous access in our cancer patients. METHODS: From September 1991 to September 1993, an implantable system for venous access was installed in 164 patients with epidermoid carcinoma of the upper respiratory and digestive tracts. The systems were implanted in the subclavian vein by 20 different operators (mean number of implants per operator = 8.2). All catheters were tunnelized. Chemotherapy was a combination of 5 fluorouracil and cisplatinum. RESULTS: Immediate complications included impossible implantation (n = 12, 7.3%), pneumothorax (n = 5), false passage (n = 4), haematoma (n = 3), arterial puncture (n = 2) and abscess of the thoracic wall (n = 1). During use, complications included extravasation (n = 4), catheter thrombosis (n = 2), venous thrombosis (n = 2) and infection at the site of implantation, desinsertion of the catheter from the chamber, haematoma at the site of implantation and septicaemia (n = 1 each). The rate of complications was related to implantation (17% of the implantations) or to use (8%). CONCLUSIONS: The rate of complications due to implantable venous access systems is relatively low, suggesting that these systems are acceptable for ambulatory chemotherapy.
Antineoplastic Combined Chemotherapy Protocols↗
Role of congenital hypothyroidism in hearing loss in children.
No significant difference was found for the auditory thresholds at conversational and high frequencies between 42 children with congenital hypothyroidism treated with L-thyroxine and an age-matched control group, regardless of the cause of the thyroid failure or hormone level and the age at the start of treatment.
Adolescent↗
Auditory threshold evaluation by distortion-product oto-acoustic emissions using decision support system.
Distortion-product oto-acoustic emissions (DPOEs) were measured in 102 normal-hearing and hearing-impaired ears to examine the sensibility, specificity, positive predictive value and negative predictive value of this test in a real clinical setting using two decision support systems. The first model only considered the presence or the absence of DPOEs in response to a 52 dB SPL stimulation intensity. The second model used two consecutive tests: i) the presence or the absence of DPOEs in response to a 52 dB SPL stimulation intensity, and ii) evaluation of the slope of each DPOE input-output function. The sensitivity of these two models varied between 1 and 0.83 whereas the specificity varied between 0.95 and 0.72 as a function of the frequency tested. The first model proved to be a very sensitive test, but the introduction of a second criterion of decision (i.e., the slope of DPOE input-output function) did not enhance the validity of the test.
Acoustic Stimulation↗