Biomedical subjects

Raphaël Maire

Publications and source records attributed to Raphaël Maire.

8 recordsLinked to original sources

PubMed2006

[Professional occupation after cochlear implantation].

This study verifies whether cochlear implants helps deaf adults to maintain or develop their professional occupations. Sixty-seven patients received a questionnaire concerning their professional activities before and after implantation. At the time of implantation 34 were professionally active. After the implantation 29 remained active, 4 of them reporting positive developments in their careers. Five patients became inactive. The previously inactive patients remained inactive. There was no difference in auditory performances between professionally active or inactive patients. Cochlear implants enable most implanted adults to maintain and even progress in their professions. However, deafness still represents an obstacle to social integration as inactive patients who searched for a job were rejected after the job interviews.

Adolescent↗

PubMed2006

Progressive hearing loss in Fabry's disease: a case report.

Fabry's disease is a chromosomal X-linked inherited disease, which causes a lack of the lysosomal alpha-galactosidase A enzyme leading to a cellular accumulation of glycosphingolipids. This accumulation leads to various clinical disorders, including inner ear lesions, with sensorineural hearing loss and dizziness. This article proposes to describe a clinical case of a patient suffering from Fabry's disease with inner ear associated problems and to review the literature focusing on this subject.

Audiometry, Pure-Tone↗

PubMed2006

Diagnostic value of vestibulo-ocular reflex parameters in the detection and characterization of labyrinthine lesions.

OBJECTIVE: To evaluate the power of various parameters of the vestibulo-ocular reflex (VOR) in detecting unilateral peripheral vestibular dysfunction and in characterizing certain inner ear pathologies. STUDY DESIGN: Prospective study of consecutive ambulatory patients presenting with acute onset of peripheral vertigo and spontaneous nystagmus. SETTING: Tertiary referral center. PATIENTS: Seventy-four patients (40 females, 34 males) and 22 normal subjects (11 females, 11 males) were included in the study. Patients were classified in three main diagnoses: vestibular neuritis: 40; viral labyrinthitis: 22; Meniere's disease: 12. METHODS: The VOR function was evaluated by standard caloric and impulse rotary tests (velocity step). A mathematical model of vestibular function was used to characterize the VOR response to rotational stimulation. The diagnostic value of the different VOR parameters was assessed by uni- and multivariable logistic regression. RESULTS: In univariable analysis, caloric asymmetry emerged as the most powerful VOR parameter in identifying unilateral vestibular deficit, with a boundary limit set at 20%. In multivariable analysis, the combination of caloric asymmetry and rotational time constant asymmetry significantly improved the discriminatory power over caloric alone (p<0.0001) and produced a detection score with a correct classification of 92.4%. In discriminating labyrinthine diseases, different combinations of the VOR parameters were obtained for each diagnosis (p<0.003) supporting that the VOR characteristics differ between the three inner ear disorders. However, the clinical usefulness of these characteristics in separating the pathologies was limited. CONCLUSION: We propose a powerful logistic model combining the indices of caloric and time constant asymmetries to detect a peripheral vestibular loss, with an accuracy of 92.4%. Based on vestibular data only, the discrimination between the different inner ear diseases is statistically possible, which supports different pathophysiologic changes in labyrinthine pathologies.

Adolescent↗

PubMed2004

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and viral labyrinthitis: evidence of otolith-canal interaction.

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss alone) and viral labyrinthitis (cochleovestibular loss). MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was evaluated by conventional caloric and impulsive testing. A simplified model of vestibular function was used to analyze the vestibulo-ocular response to rotational stimulation. RESULTS: The results showed a significant difference in h-VOR characteristics between the two pathologies. Patients with vestibular neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR asymmetry between the two rotational directions. In contrast, patients with viral labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in rotation toward the affected ear. CONCLUSION: These findings support the hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral inner ear lesion is not due to canal dysfunction alone, but involves complex adaptive changes in the central VOR that may implicate the otolith system. Based on histopathologic and clinical differences in the two pathologies reported in the literature, we postulate that this otolith-canal interaction is mainly linked to the loss of saccular function.

Adolescent↗

PubMed2004

[Vertigo].

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Adult↗

PubMed2003

Efficacy of the Semont maneuver in benign paroxysmal positional vertigo.

OBJECTIVES: To assess the efficacy of the Semont maneuver in the treatment of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal and to evaluate the possible effect of various factors on the efficacy of this maneuver. DESIGN AND SETTING: Retrospective study in an outpatient clinic. PATIENTS: Two hundred seventy-eight patients presenting with symptomatic, unilateral BPPV of the posterior semicircular canal, exclusively treated with the Semont maneuver. INTERVENTIONS: During the first consultation, each patient was treated with a Semont maneuver. When BPPV persisted, this maneuver was repeated during follow-up visits, performed at weekly intervals. MAIN OUTCOME MEASURES: Patients were considered cured when vertigo disappeared within 30 days (allowing up to 4 maneuvers). RESULTS: More than 90% of patients were cured after a maximum of 4 maneuvers, and 83.5% were cured after only 2 maneuvers. The efficacy of the maneuver decreased each time it was repeated (from 62.6% at the first maneuver to 18.2% at the fourth). The duration of symptoms before initial consultation and the etiology of BPPV had a significant effect on the maneuver's efficacy (P<.001 and P =.002, respectively), whereas age (P =.12), sex (P =.06), and affected side (P =.20) had no effect. CONCLUSIONS: The Semont maneuver demonstrated a 90.3% cure rate after a maximum of 4 sessions. Patients consulting late (>6 months after the beginning of symptoms) or having traumatic BPPV had lower recovery rates than patients without these factors (74.7% vs 96.5%).

Adolescent↗

PubMed2002

Infection screening in sudden and progressive idiopathic sensorineural hearing loss: a retrospective study of 182 cases.

OBJECTIVE: To evaluate a systematic infectious screening program for patients who present with sudden or progressive sensorineural hearing loss (SHL) of unknown cause (negative history and clinical examination). METHOD: Retrospective study of 182 patients with idiopathic SHL. One hundred six patients presented with sudden SHL, and 76 presented with progressive SHL. Serologies for herpes simplex and varicella-zoster viruses (immunoglobulin M and immunoglobulin G titers), Lyme disease (enzyme-linked immunosorbent assay), syphilis (fluorescent treponemal antibody absorption or microhemagglutination-Treponema pallidum test) and human immunodeficiency virus were performed. RESULTS: The serologies were negative in 179 patients. Two patients had positive serologies for Lyme disease and another tested positive for syphilis. Both cases of suspected Lyme disease were later excluded by Western blot analysis and lumbar puncture (two false-positives). The patient with serologic syphilis was diagnosed as having latent syphilis after neurosyphilis was excluded. CONCLUSION: The infection screening was positive in only 1 (0.6%) of 182 patients: the patient who was diagnosed with latent syphilis. On the basis of these results and taking into account the cost of systematic screening, we propose that serologic tests be limited to patients with suspect histories or symptomatologies, except for patients with a diagnosis of syphilis.

Adolescent↗

PubMed2002

[Otoneurologic manifestations related to HIV infection: case report of facial paralysis and review of the literature].

A case of peripheral facial palsy revealing a recent HIV infection is reported. Facial paralysis is frequent in HIV patients. Its etiology depends on the stage of the disease. At all stages, Bell's palsy is the most important cause and can reveal the seropositivity. Among the other HIV otoneurological manifestations, hearing loss is frequent and of multiple origins. It is associated with early abnormal auditory brainstem responses. Vestibular dysfunction in HIV infection mostly concerns advanced stages of the disease even though early pathologic electrophysiologic findings are noted.

Adult↗