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Endolymphatic pressure measurement is of interest both to researchers in the physiology and pathophysiology of hearing and ENT physicians dealing with Menière's disease or similar conditions. It is generally agreed that endolymphatic hydrops is associated with Menière's disease and is accompanied by increased hydrostatic pressure. Endolymphatic pressure, however, cannot be measured precisely without endangering hearing, making the association between hydrops and increased endolymphatic pressure difficult to demonstrate. Several integrated in vivo models have been developed since the 1960s, but only a few allow measurement of endolymphatic hydrostatic pressure. Models associating measurement of hydrostatic pressure and endolymphatic potential and assessment of cochlear function are of value to elucidate the pathophysiology of endolymphatic hydrops. The present article presents the main types of models and discusses their respective interest., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To describe the reliability of the fully implantable middle ear transducer after successive technological changes., Study Design: Prospective, observational, multicenter study., Setting: Eight tertiary referral centers., Patients: One hundred twenty-three adults were implanted with one of the five successive versions of the fully implantable middle ear implant between September 2005 and July 2012., Methods: The reliability of each generation 2 years after implantation or at the maximal lifetime was reported by means of survival curves. Only technological failures were considered; non-technological failures were excluded from the analysis of reliability., Results: One hundred fifty-seven devices were implanted during the period of study. Fifteen explantations were related to non-technological problems (e.g., infections, extrusions, etc.). One hundred forty-two implants were followed in the analysis of reliability. We observed 32 technical failures at 2 years. At the maximal lifetime of follow-up, 46 implants failed. The end of the follow-up was the first of November 2012. Survival rates at 2 years were 0%, 76.1%, 84.2%, 81.8%, and 100% for each of the successive available versions, respectively., Conclusion: The reliability of the fully implantable middle ear implant improved over generations thanks to successive technological modifications that corrected the observed failures. The latest generation seems to be a reliable fully implantable middle ear implant system up to 22 months after implantation. The need to know the reliability of these active middle ear implants incites the creation of a follow-up register including patient's data and device failures to improve patient management.

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: This study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage., Materials and Methods: Retrospective study including 18 children with a mean age of 38 months [range: 5-67 months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess)., Results: The initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series., Conclusion: Contrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

In cerebellopontine angle (CPA) surgery, postoperative deafness can be due to alteration of cochlear blood flow that is supplied by the labyrinthine artery (LA). In particular, vasospasm is likely to occur and, if so, can be reversed. This work attempted to track down vascular events occurring during CPA surgery. Twenty consecutive patients with vestibular schwannoma were tested with useful preoperative hearing and presence of otoacoustic emissions (OAEs). Distortion-product otoacoustic emissions (DPOAEs), well-known to react within seconds to cochlear ischemia, were used intraoperatively to indirectly monitor cochlear blood flow. Continuous intraoperative monitoring of DPOAEs revealed three different time patterns associated with distinct auditory outcomes. Pattern P1-acute (n = 4) happened when the LA was severed: DPOAEs immediately and irreversibly foundered and led to postoperative deafness. Pattern P2-protracted (n = 7) revealed a progressive deterioration of DPOAEs from the beginning of tumor debulking, likely due to a steady decrease of cochlear blood flow, with postoperative deafness. Pattern P3-unstable (n = 5) corresponded to large DPOAE oscillations between their normal level and noise floor. It was due to acute LA vasospasm that could be reversed in three cases by topical nimodipin. Last, four patients had uneventful cochlear monitoring. In conclusion, cochlear ischemia can occur in vestibular schwannoma surgery, giving three different patterns among which vasospasm can be reversed if detected early.

Objective: Investigation of long-term satisfaction and correlation with audiometric measurements after osseointegrated bone-conduction device (OBCD) surgery for patients with single-sided deafness (SSD)., Patients: Thirty-six patients implanted with an OBCD for SSD., Study Design: Retrospective review in a university medical center., Intervention: Rehabilitative. The patients were implanted after a test with an OBCD worn on a headband during 15 days in a daily use. The patients were implanted if the test gave us satisfaction., Main Outcome Measures: A series of audiometric tests, including speech perception in noise, prosthetic gain, and sound localization measurements, with and without OBCD on headband before surgery and on the transcutaneous implant remote from the surgery. Assessment of benefit and satisfaction using the modified Entific Medical System Questionnaire (EMSQ), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Glasgow Benefit Index (GBI)., Results: The mean follow-up is 2.2 years. Approximately 64% of the patients use their OBCD more than 8 hours per day and 82% more than 4 hours per day. Mean satisfaction score is 7.3/10. The APHAB and GBI show a significant benefit (APHAB ease of communication before and after implantation, +21; GBI total score, +17). These results show an improvement in speech perception in noise with the OBCD, but no differences between the preoperative and postoperative tests. There is no improvement in sound localization. A high level of satisfaction is correlated with good results on the pre operative speech perception in noise., Conclusion: The OBCD is an effective way of rehabilitation for SSD. The BAHA improves the speech perception in noise but provided no significant improvement in sound localization as revealed in the postoperative test. With 3 questionnaires we noticed an improvement in the quality of life with the OBCD.

Objective: To report a case of bilateral vocal cord abductor paralysis in the context of primary herpes simplex infection., Case Report: A 63-year-old man was urgently admitted to hospital with laryngeal dyspnoea associated with dysphagia but without dysphonia. Physical examination demonstrated the vocal cords in a paramedian position with paralysis of abduction. The patient reported primary herpes simplex infection two weeks prior to this episode. HSV serology indicated recent infection and lumbar puncture demonstrated the presence of herpes simplex virus type 1 in the cerebrospinal fluid. Complete resolution of respiratory symptoms was observed after 21 days of treatment with intravenous aciclovir., Discussion and Conclusion: Gerhardt syndrome comprises inspiratory dyspnoea without dysphonia. It used to be mainly due to syphilis, but is now mostly observed in the setting of neurodegenerative disease. The authors report a case of Gerhardt syndrome occurring after an episode of primary herpes simplex infection with the presence of herpes simplex virus in the CSF. Treatment by intravenous antiviral drugs allowed rapid resolution of the symptoms. The pathophysiology of Gerhardt syndrome remains unexplained, but the possible role of herpes simplex infection should be considered in cases of laryngeal palsy., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Studies in animals and in healthy volunteers have demonstrated the central serotonergic analgesic mechanism of action of paracetamol involving the inhibition of this analgesia by tropisetron, a 5-HT3 antagonist. This randomized, double-blind, controlled study aims at studying this interaction in post-operative patients after ear surgery. Thirty-six patients are included in two parallel groups with intravenous paracetamol (1 g) and either tropisetron (T, 5 mg/mL) or placebo (c, NaCl 0.9%) administered at the end of surgery. Numerical pain evaluations are performed every 30 min, six times after awakening. The difference between the sums of numerical scales of both groups [9 ± 10 (T) vs. 6 ± 7 (c)] is not significant, but the tropisetron group displays higher pain scores despite additional rescue analgesia. The limits of this trial call for a much larger study to investigate further this pharmacodynamic interaction., (© 2011 The Authors Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique.)

Objectives: Still today, Menière's disease (MD) can be definitively diagnosed only on post-mortem findings of endolymphatic hydrops. Otoacoustic emission (OAE) phase has been shown to be highly sensitive to intracranial pressure. Preliminary analysis of OAEs in MD patients indicated high sensitivity to slight variations in intracranial pressure. The principal objective of the present study was to confirm this specific sensitivity of OAEs in MD., Patients and Methods: In a prospective study of 32 consecutive cases of acute MD seen in consultation or hospital, 20 patients (23 ears) underwent acoustic phase-shift test: i.e., seated vs. supine OAE phase centered around 1kHz, with results compared to controls., Results: The acoustic phase-shift test was performed in 62.5% of acute patients (58.9% of affected ears). In the control group, the 95% confidence interval for phase shift was between -30° and +45°. Phase shift was significantly elevated, beyond the normal interval, in 18 of the MD patients: range, -80° to +145°. Sensitivity was 90%. Overall, in patients in whom transient evoked OAEs (TEOAEs) were present, positive predictive value was 100% and negative predictive value 92.3%., Conclusions: The acoustic phase-shift test proved useful and powerful in demonstrating pressure imbalance in acute Menière's disease., (Copyright © 2011. Published by Elsevier Masson SAS.)

The presence of endolymphatic hydrops as a marker of Menière's disease (MD) suggests abnormal pressure in the intralabyrinthine compartments of patients and excessive stiffness of sound-sensitive structures. Otoacoustic emissions (OAEs) have been reported to respond to changes in the ear's stiffness, including those produced by intracranial pressure steps, by a characteristic phase shift around 1 kHz, thereby suggesting a noninvasive means of monitoring MD. Here, body tilt was used for modulating intracranial pressure in forty-one patients with definite MD who were tentatively measured at two stages, with and without active symptoms. Their distortion-product OAEs (DPOAEs) were dynamically monitored around 1 kHz every few seconds in response to body tilt. In a control sample of thirty normal ears, the maximum phase rotation of DPOAEs produced by body tilt was between -18° and +37°. In MD ears with the complete set of symptoms, the posture-induced phase shifts in 32 out of 35 tests fell outside the normative interval, and in 10 tests, although DPOAEs were well above noise floor, their phase was always so abnormally erratic that body tilt produced hardly any additional effect. When MD ears were asymptomatic, nine out of 32 posture tests were abnormal. The excessive DPOAE phase shift is consistent with either a too stiff cochlear partition or a displacement of the operating point of outer hair cells by endolymphatic hydrops., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objectives: To assess patient satisfaction with bone-anchored hearing aids (BAHA) and the role of preoperative audiometric testing., Patients and Methods: A telephone satisfaction survey was conducted on all patients implanted between June 1, 2005 and February 1, 2008. Patients with unilateral total deafness underwent preoperative audiometric tests in quiet and in noise and stereoaudiometry with and without BAHA. Patients with a conductive hearing loss underwent preoperative audiometric tests in quiet and in noise and real-life testing at home using a headband. A standardized satisfaction questionnaire derived from the Entific BAHA questionnaire was used., Results: Twenty-two out of 26 patients responded to the questionnaire. Ten patients were implanted for conductive hearing loss (CHL) and 12 for unilateral total deafness (UTD). Mean follow-up was 19 months in the UTD group and 21 months in the CHL group. Sixty-seven percent of UTD and 80% of CHL patients reported improved quality of life. The BAHA was worn for more than 4hours per day by 83% of UTD and 100% of CHL patients, and at least 5 days per week by 67% of UTD and 80% of CHL patients., Conclusion: BAHAs provided real benefit in all situations for CHL patients. In UTD, its benefit basically related to noisy environments. In UTD, satisfaction on preoperative stereoaudiometric testing in noise with and without BAHA was predictive of postimplantation satisfaction. In response to the question "Would you do it again?", 81% of patients answered "Yes"., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Usher syndrome (USH) combines sensorineural deafness with blindness. It is inherited in an autosomal recessive mode. Early diagnosis is critical for adapted educational and patient management choices, and for genetic counseling. To date, nine causative genes have been identified for the three clinical subtypes (USH1, USH2 and USH3). Current diagnostic strategies make use of a genotyping microarray that is based on the previously reported mutations. The purpose of this study was to design a more accurate molecular diagnosis tool., Methods: We sequenced the 366 coding exons and flanking regions of the nine known USH genes, in 54 USH patients (27 USH1, 21 USH2 and 6 USH3)., Results: Biallelic mutations were detected in 39 patients (72%) and monoallelic mutations in an additional 10 patients (18.5%). In addition to biallelic mutations in one of the USH genes, presumably pathogenic mutations in another USH gene were detected in seven patients (13%), and another patient carried monoallelic mutations in three different USH genes. Notably, none of the USH3 patients carried detectable mutations in the only known USH3 gene, whereas they all carried mutations in USH2 genes. Most importantly, the currently used microarray would have detected only 30 of the 81 different mutations that we found, of which 39 (48%) were novel., Conclusions: Based on these results, complete exon sequencing of the currently known USH genes stands as a definite improvement for molecular diagnosis of this disease, which is of utmost importance in the perspective of gene therapy.

Objective: Preliminary assessment of the efficacy of propranolol on subglottic hemangioma in children on a nation-wide scale., Methods: Multicentric, retrospective study of clinical files of 14 children; pre- and post-treatment endoscopies., Results: Mean age at diagnosis was 2.3 (0.7-4) months. Mean percentage of airway obstruction was 68% (15-90) before propranolol introduction. Propranolol was started at 5.2 (0.7-16) months of age. This treatment was effective in all cases with a mean regression of the stenosis to 22% after 2 weeks and 12% after 4 weeks. Other medical treatments (steroids) could be stopped. In one patient, a side effect of propranolol motivated the switch to another β-blocker. In four patients, treatment was stopped after 5.2 (1-10) months with a relapse in 2 (50%) cases. One of these two patients developed a resistance to propranolol and required a surgical procedure by external approach., Conclusion: This preliminary nation-wide survey confirms propranolol high effectiveness against airways' localization of infantile hemangiomas. Propranolol also allows alleviation or cut-off of previous medical treatments. However, recurrences are possible after early treatment interruption., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Lacrimal sac tumors are usually primary and of epithelial origin. Overall, 55% of lacrimal sac tumors are malignant. Mortality rates for malignant tumors depend on tumor stage and type, with a mean rate of 38%. The main objective of this study was to review our experience with these malignancies and to compare this with the published literature., Patients and Methods: A 15-year retrospective review of all malignant lacrimal sac tumor patients was completed in our department. Seven patients were found to have malignant sac tumors. The mean age was 53 years (range, 32-74 years) with six women and one man. The patients' clinical records were reviewed for data regarding patient symptoms, preoperative investigations, pathology reports, treatment results, and outcome. These data were compared with the available literature., Results: All patients presented with epiphora and a palpable lump of the internal canthus. In two cases, a history of recurrent dacryocystitis was noted. The histological types were as follows: squamous cell carcinoma (n=5), one case of adenoid cystic carcinoma, and one case of malignant lymphoma. Surgery was performed in six cases with additional radiotherapy in four. One patient was treated exclusively with external radiotherapy. The mean follow-up was 68 months (range, 6-204 months). Two patients developed recurrences: three were disease-free at the time of the study., Conclusions: Malignant epithelial lacrimal sac tumors are rare cancers with significant recurrence rates. Correct diagnosis and appropriate therapy require a multidisciplinary management approach. Treatment of these malignant epithelial tumors is first and foremost complete surgical removal with wide excision., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the implication of SLC26A4, FOXI and KCNJ10 genes in unilateral hearing impairment associated with ipsilateral inner ear malformation (Enlargement of the vestibular aqueduct and/or Mondini dysplasia)., Methods: We have gathered 25 patients presenting unilateral hearing impairment and ipsilateral enlarged vestibular aqueduct. For each of the patients, we have analyzed SLC26A4, FOXI1 and KCNJ10 genes sequences., Results: The analysis of SLC26A4 revealed only eight heterozygous SLC26A4 sequence variants, three of them being novel (p.Met147Ile, p.Asn538Asn and p.Leu627Arg). None of the patients carried a second mutation on the other allele. Moreover, the SLC26A4 locus was excluded by segregation analysis in two families. No mutations were present in FOXI1 and KCNJ10 genes., Conclusions: Together, these data suggest that SLC26A4, FOXI1 and KCNJ10 are not major determinants in unilateral deafness and enlarged vestibular aqueduct compared with their implication in Pendred syndrome and non-syndromic bilateral enlarged vestibular aqueduct., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Sinonasal mucosal melanomas account for approximately 1% of all melanomas. These tumors are particularly aggressive, with a recurrence rate between 37 and 54% and a 5-year survival rate between 20 and 46%. Metastases are frequent. The main objective of this study was to analyze all of our cases of sinonasal mucosal melanomas and determine any prognostic factors., Patients and Methods: All our cases of sinonasal mucosal melanoma over a period of 10 years were included. Ten cases were analyzed. The mean age was 71 years (range: 61-85 years) for seven women and three men. The clinical, radiological, anatomopathological, and surgical data as well as the characteristics of disease progression were analyzed. These data were compared to those reported in the literature., Results: The mean follow-up was 36.3 months (range: 2-96 months). The 5-year overall survival was 40%. Seven patients developed local recurrences after a mean follow-up of 16 months (range: 2-27 months) with associated metastases in three cases. Analysis of the prognostic factors showed that tumors classified as T1 and limited to the nasal fossae had a better prognosis., Conclusion: Sinonasal mucosal melanomas are rare tumors with a high mortality rate. Treatment of these tumors requires extensive surgical treatment associated with external radiotherapy., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: Osteoma occurs almost exclusively in the head and neck region, only rarely developing into the internal auditory canal. We report an incidental finding of a case in the radiological evaluation of a patient with left hemifacial spasm., Patients and Methods: A 79-year-old woman consulted for left hemifacial spasm associated with left anacusis. Symptoms occurred up to 30 years prior to the first radiological investigations. Computed tomographic (CT) and magnetic resonance (MRI) images were taken., Results: MRI demonstrated a left internal auditory canal lesion with spontaneous hypointense signal on T1- and T2-weighted images. CT showed the lesion as a typically dense and opaque osteoma. It measured 0.6 cm in maximum size. No surgery was performed because of the slow-growing features of the lesion. Clinical monitoring was recommended., Conclusion: Osteomas are diagnosed incidentally in asymptomatic patients. Our case was symptomatic and raised the question of surgical management. This article discusses the presentation and management associated with this exceptional osteoma location., (Copyright © 2010. Published by Elsevier Masson SAS.)

Objective: To determine whether surgical pitfalls can be anticipated through a preoperative CT-Scan in case of middle ear implantation with a semi-implantable middle ear ossicular stimulator from Otologics (SIMOS). A second outcome measure was to assess the auditory gain obtained in the series., Materials and Methods: A retrospective analysis of 19 consecutive surgical procedure for a SIMOS implantations was achieved. Preoperative Ct-Scans were analyzed and several measurements of the mastoid were taken out from axial transverse views, ie. the distance between the incus and the cortical mastoid bone [d(i-c)], the distance between the sigmoid sinus and the incus [d(i-ss)], the distance between the sigmoid sinus and the cortical bone of the mastoid [d(c'-ss)]. On coronal images, the dura of the middle fossa was described as procident if it was lower than the head of malleus and/or body incus. Auditory gain was calculated on pure tone and speech audiometry with bisyllabic words., Results: All cases were successfully implanted. d(i-c) was on average at 33.1 +/- 2.6 mm in cases easy to implant. One case of contracted mastoid was difficult and led to the impaction of the sigmoid sinus. In this case the distance d(i-c) was shorter at 25 mm than the average minus 2 standard deviations of the others (27.9 mm). Also d(ss-c') was lower at 7 mm than the average minus 2 standard deviations of the others (7.6 mm). Two other cases led to difficult surgical procedures because of a low middle fossa dura. This too low middle fossa dura could be identified on preoperative coronal CT-scans in these two cases. Audiometric gains were remarkable, with an average of 39 +/- 16 dB. In case of severe sensorineural hearing loss the average gain was higher at 46 +/- 9 dB. Two revision-procedures were required, one for a device failure, the second because of skin alteration due to systemic inflammatory disease requiring corticosteroids. Mean follow-up was 50 +/- 22 months., Conclusion: The SIMOS is a powerful middle ear implant that can undoubtedly give a huge audiometric gain. The implantation procedure requires a precise microsurgical operation that can be hampered by anatomical conditions of the petrous bone. A thorough examination of preoperative CT-scan is highly recommended in order to obtain measurements of the mastoid in axial views, and the analysis of the position of the middle fossa dura in coronal views.

Objectives: First, to assess for the performance of the Carina placed on the round window at various European centers; second, to study the follow-up after 2 years and discuss limitations and technical issues; and finally, to further develop our understanding of the principles of acoustic transfer through the round window., Materials and Methods: Eleven patients were included in this retrospective study (7 women and 4 men) from 7 European tertiary referral hospitals (4 centers in France, 2 in Belgium, 1 in Spain). The mean age was 50.8 years (35-71 yr). All patients have multiple previous surgeries (>3 surgical procedures) for otosclerosis (3 patients) or chronic otitis media (8 patients), and in all cases, the stapes was not accessible due to obliteration by sclerotic tissue. Preoperative and postoperative air conduction, bone conduction, as well as aided and unaided thresholds and speech scores were measured., Results: No significant differences were observed between preoperative and postoperative air-conduction and bone-conduction pure-tone averages. The average free field functional gain obtained with the implant ranged from 22 to 42 dB at each individual frequency, with a mean of 29 +/- 5 dB across all audiometric frequencies. Word recognition scores demonstrated significant differences between unaided and implant-aided conditions. Complications included 2 cases of postoperative infection (including 1 anacusis) that required explantation, and 1 case reduced initial benefit, followed by a nonfunctioning device. In 10 patients, postoperative hearing was unchanged. The 8 other patients are using their implant daily., Conclusion: These results show that this option is valid for patients with a fixed footplate and unsuccessful previous surgeries or patients who cannot benefit from a stapedotomy for anatomic reasons. In some cases, access to the round window membrane could represent a limitation. However, these promising initial results establish the need for further works with regard to 3 issues: 1) clinical data studies are needed, including a greater number of patients to confirm these preliminary results; 2) a long-term follow-up must be performed to detect any possible cochlear adverse effects, in particular, on the basilar membrane; 3) the effect of fascia interposition and tip size has to be evaluated in experimental studies.

It is known that by influencing stapes stiffness thus the ear's impedance, changes in intracranial and intralabyrinthine pressure induce a characteristic phase shift in otoacoustic emissions (OAE) around 1 kHz in human ears. Thus, if the regulation of pressure in intralabyrinthine compartments were abnormal in Menière patients, OAEs might help detect it. Body tilt, which acts on intracranial pressure, and administration of an osmotically active substance provide two simple ways of manipulating intralabyrinthine pressure. Here, 14 patients with typical signs of an attack of unilateral endolymphatic hydrops were submitted to postural changes and a glycerol test. Their OAEs initially collected in upright position served as references, then OAEs were measured in supine position, and back to the upright posture one and 3h after glycerol intake. Twenty control subjects were also tested for body tilt. The main effect of body tilt and glycerol was a phase rotation of OAEs peaking around 1 kHz. Its frequency dependence matched the one due to a pressure-related change in stapes or basilar membrane stiffness predicted by the ear model of Zwislocki (1962). The average glycerol-induced phase shifts were similar in size in Menière vs. asymptomatic ear and audiometric thresholds were stable after glycerol intake in line with the model predicting little change in the magnitude of the transfer function. These data support a simple conductive pressure-related mechanism explaining the action of glycerol on inner ear responses. The fact that the mean postural shift was three times larger in Menière than asymptomatic and control ears suggests an additional effect in allegedly hydropic ears.

Leptomeningeal carcinomatosis is rare in evolution of head and neck cancers. Prognosis is poor and treatment is through supportive care. We report an atypical rapid post-operative leptomeningeal carcinomatosis after skull base resection for an ethmoidal adenocarcinoma. The anterior skull base resection was near-total and we suspect a seeding of subarachnoid space either before surgery, either during surgical extirpation or from the residual intracranial nodule. It is the first description of rapid LMC after surgery (less than 1 month). Post-operative MRI diagnosed the LMC through the detection of contrast enhancing leptomeningeal nodules at bilateral second and eighth cranial nerves and at bilateral interpedoncular area. A strong index of suspicion along with clinical and radiological correlation is essential to arrive at a correct diagnosis. Otolaryngologists should be aware of the possibility of leptomeningeal carcinomatosis, before or after surgery, in a patient presents with an appropriate constellation of neurologic symptoms and a history of cancer.

Mitochondrial DNA (mtDNA) mutations have been implicated in non-syndromic hearing loss either as primary or as predisposing factors. As only a part of the mitochondrial genome is usually explored in deafness, its prevalence is probably under-estimated. Among 1350 families with non-syndromic sensorineural hearing loss collected through a French collaborative network, we selected 29 large families with a clear maternal lineage and screened them for known mtDNA mutations in 12S rRNA, tRNASer(UCN) and tRNALeu(UUR) genes. When no mutation could be identified, a whole mitochondrial genome screening was performed, using a microarray resequencing chip: the MitoChip version 2.0 developed by Affymetrix Inc. Known mtDNA mutations was found in nine of the 29 families, which are described in the article: five with A1555G, two with the T7511C, one with 7472insC and one with A3243G mutation. In the remaining 20 families, the resequencing Mitochip detected 258 mitochondrial homoplasmic variants and 107 potentially heteroplasmic variants. Controls were made by direct sequencing on selected fragments and showed a high sensibility of the MitoChip but a low specificity, especially for heteroplasmic variations. An original analysis on the basis of species conservation, frequency and phylogenetic investigation was performed to select the more probably pathogenic variants. The entire genome analysis allowed us to identify five additional families with a putatively pathogenic mitochondrial variant: T669C, C1537T, G8078A, G12236A and G15077A. These results indicate that the new MitoChip platform is a rapid and valuable tool for identification of new mtDNA mutations in deafness.

Klebsiella pneumoniae subsp. ozaenae was isolated from the pharynx of a woman with laryngeal scleroma. K. pneumoniae subsp. ozaenae is rarely isolated from clinical infections and has never been reported in laryngeal scleroma, which is usually caused by K. pneumoniae subsp. rhinoscleromatis.

A four-channel device may enhance the sensitivity of electromyography (EMG). Determination of stimulation thresholds (STs) below 0.05 mA improves facial prognostic information after vestibular schwannoma (VS) surgery. To compare intraoperative observations with electromyographic data for predicting the immediate facial function outcome after VS surgery.A total of 111 VS patients operated on and intraoperatively monitored using four-channel facial EMG between October 2002 and September 2003 were included in this multicentre, prospective study. Mascular activity detection was performed in the frontal, orbicularis oculi, orbicularis oris and platysma muscles. Intraoperative observations were made concerning adhesion and nerve stretch, and facial function was graded (House-Brackmann classification) at postoperative Days 1 and 8.Facial function at postoperative Days 1 and 8 was related to the intraoperative nerve STs at the brainstem and in the adhesion zone (range 0.01-3 mA for a response > 100 microV). At postoperative Day 8, good facial function (Grades 1 or 2) was observed in 93% of cases for STs in the adhesion zone of 0.01-0.04 mA, 85% for STs of 0.05-0.3 mA and 79% for STs > 0.3 mA. These STs were related to the degree of tumor adhesion and not to the nerve stretch. The maximal EMG response was detected in the frontal or platysma muscles in 26% of cases, and in the orbicularis oris and orbicularis oculi muscles in 74%.

Distortion product otoacoustic emissions (DPOAEs) are thought to stem from the outer hair cells (OHCs) around the normally narrow place tuned to the primary tone stimuli. They are thus said to be frequency-specific: their local absence should accurately pinpoint local OHC damage. Yet the influence of impaired tuning on DPOAE frequency specificity is poorly documented. Mice with local damage to OHCs were examined. Their DPOAEs were frequency-specific in that audiometric notches were accurately tracked. The same cochleae were further impaired by ischemia or furosemide injection inducing strial dysfunction with flat loss of sensitivity and tuning, while the preexisting pattern of damaged OHCs remained unaltered. Despite the loss of cochlear activity, DPOAEs produced by high-level (> or =70 dB SPL) primaries remained large in about the same interval where they had been initially normal, i.e., that with nondamaged OHCs, albeit with a slight frequency shift, of -1.1 kHz on average. Thus, the ability of DPOAEs to map structurally intact OHCs cannot be a mere consequence of cochlear tuning as it largely persists in its absence. The key element for this correct mapping is likely part of intact OHC structures (e.g., stereocilia bundles) and must have some tuning of its own.

Objective: We describe a case of intraparotid facial nerve schwannoma. About sixty patients with intraparotid tumors have been reported in the literature., Material and Methods: A 89-year-old female patient presented with a history of progressive facial palsy and a left intraparotid mass. The mass was removed by parotidectomy for definitive diagnosis and treatment. We reviewed the findings in comparison with data in the literature., Results: The well-encapsulated tumor arose from the superior branch of the intraparotid facial nerve. As the tumor could not be dissected from the nerve, a segment of facial nerve was sacrificed and repaired by interposing a greater auricular nerve. The final pathological diagnosis was schwannoma arising from the facial nerve., Discussion: This case illustrates the clinical and pathologic features of intraparatid facial nerve schwannoma and points out the pitfalls of diagnosis and treatment. Consensus has recognized total resection surgery with facial nerve sacrifice as the most reasonable treatment for these tumors. We discuss the currently accepted management approach as well as the different treatment modalities for recovering facial function.

Distortion product otoacoustic emissions emitted by the cochlea at 2f1-f2 in response to pairs of pure tones at f1 and f2 (DPOAE) form a class of otoacoustic emissions and as such, are viewed as a reliable tool for screening outer hair cell (OHC) dysfunctions on a pass/fail basis. However, the persistence of residual DPOAEs from impaired cochleae at high stimulus levels has suggested that above 60-70 dB SPL, instead of reflecting "active" cochlear motion, DPOAEs might represent another "passive" modality: they would thus become unsuitable for analyzing cochlear function. The present work reports the consequences on high- vs low-level DPOAEs of three types of cochlear impairments involving OHCs: progressive OHC degeneration of genetic origin in CD1 mice, complete cochlear ischemia in gerbils, and furosemide injection vs ischemia-reperfusion in gerbils. An alternative to the "active-passive" model was used wherein regardless of stimulus level, cubic DPOAEs are produced by N (probably OHC-borne) nonlinear elements driven by input I and modulated by a function F3 of their operating point o; thus, DPOAE proportional to NI3F3(o). When OHCs degenerated, thereby implying a decrease of N, DPOAE levels also decreased regardless of the stimulus level up to 80 dB SPL, in line with the previous formula but at variance with the prediction of the active-passive concept. Instead of affecting N, the other two experiments impaired the efficiency of the cochlear feedback loop as a result of its electrical drive being decreased by strial dysfunction. As it is well accepted that the impaired basilar-membrane motion, although greatly reduced at low levels, tends to catch up with a normal one at higher levels, it was assumed the same was true with I so that DPOAE levels had to be, and indeed were little affected at high levels while plummeting at low levels, without any need for invoking two modalities for DPOAE generation. Finally, comparisons of furosemide vs ischemia effects revealed additional influences on DPOAEs, possibly accounted for by function F3(o). These results lead to the proposal that although high-level DPOAEs are expected to be poor audiometric indicators, they seem well adapted to assessing the functional integrity of nonlinear elements in OHCs, i.e., presumably their mechanoelectrical transduction channels.

Unlabelled: Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that has a strong affinity for the upper respiratory tract., Objective: To retrospectively study the clinical features of otorhinolaryngological manifestations from 21 WG patients., Patients: Eleven men and 10 women were studied with respectively a mean age of 62.7 (23-79) and 63.9 (53-73)., Methods: Otorhinolaryngological manifestations were recorded before and during the course of WG., Results: Upper respiratory tract involvement occurred in 81% of cases (17/21 patients) and was isolated in 42.8% of cases (9/21 patients). Nasosinusal manifestations occurred in 71.4% of cases (15/21) before and at the time of GW diagnosis. They included bilateral sinusitis (7 cases), nasal crusting (6 cases), purulent rhinorrhea (5 cases), epistaxis (4 cases), nasal ulcers (2 cases), nasal congestion with obstruction (3 cases) and 4 cases of nose deformity (saddle nose or oedema). Otologic manifestations occurred in 28.5% of cases and were never isolated. They included otitis media (3 cases), sudden hearing loss (3 cases), tinnitus (1 case), facial palsy (1 case) and 2 cases of chondritis. Pharyngolaryngotracheal manifestations occurred in 33.3% of cases (7/21). Diagnosis of GW was based on positive ANCA test (95.2% of cases), presence of biologic inflammatory parameters (76% of cases) and histological features. 29 biopsies from nasosinusal lesions on 17 patients were made. 44.8% of the biopsies were contributive with at least one histologic feature of the combination including vasculitis, necrosis and granulomatous inflammation. The best contributive site of biopsy was the paranasal sinus., Conclusion: We report that otorhinolaryngological manifestations occurred in 81% of cases before and at the time of GW diagnosis. These findings indicate that otorhinolaryngologists have a central role to play in early diagnosis of the disease.

Two cases of internal carotid artery aneurysm arising within the petrous bone are described, bringing up to 56 the number of such cases reported to date in the medical literature scanned through Medline. The first case presented as a moderately bleeding tumor of the petrous apex, while the second was revealed by a massive otorrhage. In both cases a pulsatile nasopharyngeal mass was associated with otorrhage. The treatment required in both cases the aneurysm to be embolized in extreme emergency. One patient suffered transient hemiplegia and aphasia that completely recovered, while the second eventually died, although the carotid occlusion had been well tolerated in the first two weeks that followed this procedure. From their own experience and a literature review, we can emphasize the need for arterial extra-intracranial bypass before an aneurysm embolization be proposed, since the neurological issue following internal carotid occlusion cannot be predicted.

Unlabelled: Metastatic carcinoma involving the middle ear space is a rare entity that is little described in the literature. The number of cases seems to be increasing. It is usually recognized that palliative treatment as the most reasonable treatment for this tumors., Case Report: A 59-year-old female patient presented with a history of a metastatic carcinoma involving the middle ear space and mastoid. This metastase occurred one year late in the course of a bladder cancer. Presentation of the lesion included otorrhea and facial palsy complicated by headache and bilateral visual loss in relation with lateral sinus thrombophlebitis and intracranial hypertension. Diffuses metastases in the skeletal system were demonstrated by pretreatment investigations. Treatment was only palliative chemotherapy. Outcome was fatal two months after onset of symptoms., Discussion: This case illustrates the clinical and pathological features of this tumor and the pitfalls of diagnosis and treatment. We will discuss the current accepted management and the difference after diagnosis modalities for this type of metastatic tumor.

A perfect knowledge of the anatomy of the vestibuloacusticofacial pedicle is required to preserve hearing and facial functions during cerebellopontine angle surgery for vestibular schwannoma. A clarification of the anatomy of this pedicle, in particular of its blood supply, is presented here, based on a review of the available literature, as well as on the author's data issued from anatomical dissections on latex-injected fresh specimens, and from radiological images of the cerebellopontine angle. The blood supply to the vestibuloacusticofacial bundle arises from the meatal loop of the anterior inferior cerebellar artery most often exhibited at the porus of the internal acoustical meatus. The labyrinthine artery is particularly exposed to injury between the cochlear and facial nerves. In addition, dissection in between these two nerves is likely to sever vessels directed to these nerves even though the labyrinthine artery is not interrupted. Thus, aside from a direct injury to the labyrinth, auditory function can be impaired through two distinct ischemic lesion types. Although the facial nerve is supplied through three main arterial systems (from the labyrinthine, the middle meningeal, and the stylomastoid arteries), its labyrinthine portion is more likely to suffer from ischemic damage as it is only supplied by meatal arteries. A refinement of our anatomical knowledge of the vestibuloacusticofacial pedicle, from a functional point of view, could arise from laser Doppler measurements of labyrinthine and facial blood flow during surgery, in an attempt to improve our functional preservation rate during therapeutic procedures for vestibular schwannoma.

Unlabelled: Nitric oxide (NO) is implicated in the pathophysiology of inflammatory airway diseases. It has been identified as a potential marker of airway inflammation., Objective: The purpose of the study was to assess the concentrations of nasal NO in upper and lower airways in nasal polyposis patients., Patients: 18 nasal polyposis patients (14 men, 4 women) and 21 control subjects (7 men, 14 women), all non asthmatic non smokers, without respiratory infections were prospectively studied., Methods: They included nasal obstruction scoring, nasal endoscopic grading, allergy testing, nasal cytology, flow-volume spirometry and measurement of nasal (NNO) and exhaled NO (ENO) concentrations. NO was measured by a chemiluminescence NO Analyser (Sievers 280). NNO was analysed by aspiration with a constant flow of 3 l/mn. ENO was analysed during a slow expiration (50 ml/s) against a constant resistance of 10 cm H2O., Results: NNO was significantly (p<0,001) decreased in NP group (596.4 +/- 102.06 ppb) compared to control group (2 251.6 +/- 288.6 ppb). ENO was significantly (p<0.05) increased in NP group (45.4 +/- 14.1 ppb) compared to control group (11.2 +/- 1.16 ppb). NNO and ENO were not significantly different between atopic and non-atopic NP patients. NNO concentrations was inversely correlated with the values of nasal endoscopic grading. No correlation was found between NNO concentrations and respectively nasal obstruction scoring and eosinophil count in nasal mucosa., Conclusion: Further studies are necessary to understand the pathophysiology of decreasing NNO and increasing ENO in nasal polyposis. In particular, ENO could be consider as a biologic marker of lower airway inflammation in nasal polyposis.

Unlabelled: The meaning of facial nerve enhancement by gadolinium-enhanced magnetic resonanca imaging (MRI) in Bell's palsy is very discussed. Aim of our study was to define the radiological data in facial Bell's palsy and to correlate them with clinical data., Patients and Methods: 34 patients with facial Bell's palsy were studied prospectively. Each patient had two gadolinium-enhanced MRI. The first MRI was realized during the first ten days. The second MRI was realized three months later. Two patients with facial nerve enhancement localized on the third portion was not clinically normalized at 3 months. Facial nerve enhancement and his precise location was noted., Results: Facial nerve enhancement was noted in 71,5% on first MRI and in 30% on second MRI. Gadolinium-enhancement was predominantly noted on the Fundus. No patients with facial nerve enhancement persisting at three months was clinically normalized at one month., Conclusion: Facial nerve enhancement localized on the fundus and/or on the third portion, persisting at three months, could be consider as a negative landmark of fast clinical facial recuperation.

Objectives: To evaluate the prevalence, the impact-related postoperative complications and the risk factors of vocal cord dysfunction (VCD) after left lung resection for cancer., Methods: From February 1996 to April 1999, a review of prospectively gathered data was performed on 99 consecutive patients who underwent a pneumonectomy (n=50) or a lobectomy (n=49) with a mediastinal lymph node dissection. A fiber optic laryngeal examination was performed preoperatively for all patients and within the first week postoperatively in patients with symptom(s) or sign(s) of VCD or respiratory complications., Results: Thirty-one patients (31%) had a postoperative VCD (group VCD) and 68 (68%) did not (group non-VCD). Mortality rate was 19% in group VCD and 9% in group non-VCD (P=0.13). Group VCD patients developed more pulmonary complications (P=0.014) and cardiac complications (P<0.001) compared to group non-VCD patients. A higher rate of reintubation (P=0.005), pneumonia (P=0.06), arrhythmia (P=0.002), cardiac failure (P<0.001) was noticeable in group VCD and may account for the higher rate of complications in this group. Using multivariate analysis, preoperative radiotherapy (P=0.001) and pneumonectomy (P=0.008) were predictive of postoperative VCD. Hospital stay was 22+/-16 days in group VCD and 13+/-9 days in group non-VCD (P<0.002)., Conclusion: VCD is a frequent event that can lead to dramatic pulmonary complications. We would recommend to track it and to treat it as early as possible.

Cubic difference tone (CDT) otoacoustic emissions are thought to arise from the feedback loop allowing outer hair cells to enhance the sensitivity and tuning of the organ of Corti. The existence of residual CDTs during complete cochlear ischemia is therefore disturbing. That stimulus intensities must exceed 50-60 dB SPL for residual CDTs to be recorded and for level notches to be present in CDT growth functions is often cited as evidence for a two-component, "active/passive" model: one component, the residual one, would originate from a passive, hardly vulnerable mechanism and thus be unsuitable for hearing screening purposes. This model was probed in gerbil ears after complete interruption of the cochlear blood flow. Cochlear potentials and CDTs were controlled simultaneously through continuous monitoring of CDT level and phase for 50 and 60 dB SPL stimuli and group-delay measurements. After a clear initial decay, CDT levels elicited at 60 dB SPL plateaued for several minutes at about 20 dB below initial level, and when early level notches were observed, CDT phase changes remained minor. The CDT group delays decreased by less than 30%. Later CDT level notches were associated with sharp phase reversals but the similarity between CDT characteristics before and after a notch was hardly consistent with a two-component interpretation. When mild sound overexposure (pure tone, 90-95 dB SPL, 15-30 min) had been performed prior to ischemia, little or no ischemic CDT came from the frequency bands where auditory fatigue had been detected (within 1 kHz), irrespective of the stimulus intensity. It suggests that instead of being passive, residual ischemic CDTs were vulnerable and produced according to a near-normal tonotopy by the same mechanisms that were sensitive to auditory fatigue. All the results lined up with a simple feedback model of cochlear function assuming a single CDT source related to mechano-electrical transduction in outer hair cells. More parsimonious than a two-component model, it posits that although early stages of ischemia dramatically impair the overall performance of the cochlea, the nonlinear mechanical stages responsible for the existence of CDTs keep working albeit at higher intensities.

Guinea pigs were exposed to a pure tone at 6 kHz and 80 dB SPL for 30 minutes in order to induce mild reversible auditory fatigue over the 4 hours following exposure. Cochlear monitoring aimed to compare the shifts in round-window compound action potentials (CAP) thresholds to those of 2f1-f2 distortion-product otoacoustic emissions (DPOAE, frequency of stimuli f1 and f2). Both responses were evaluated every 1/10th octave between 6 and 12 kHz for CAP thresholds, and from 4 to about 14 kHz for DPOAEs in response to 50- and 70-dB SPL stimuli. The auditory fatigue turned out to be sufficiently mild that DPOAEs remained present, so that their microstructure could be followed up while the stimulus frequency ratio f2/f1 was swept from 1.06 to 1.30 (fixed f2) so as to derive DPOAE level profiles against f2/f1 and group latencies. CAP thresholds decreased by about 10 dB above 7.2 kHz, whereas DPOAE amplitudes decreased at most f2 frequencies from 6.6 kHz to 15.2 kHz, with the range of decrease being slightly narrower at higher stimulus intensities. While the mean DPOAE shift after 1 hour was around 5 dB irrespective of stimulus intensity, it tended to increase slightly after 2 hours despite stable CAP thresholds. DPOAE profiles against f2/f1 were slightly modified by the auditory fatigue, so that the maximum tended to be reached at lower ratio. No significant variation of DPOAE latencies was found after acoustic overstimulation. These experiments show that complex DPOAE changes were induced by auditory fatigue and their relationship to CAP threshold changes does not seem to be straight-forward. Nonetheless, fine DPOAE recordings might be useful to detect early changes in cochlear mechanics.

Objectives: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection., Methods: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice., Results: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice., Conclusions: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

Distortion product otoacoustic emissions (DPOAE) are increasingly used as an objective test for noninvasive hearing screening. When two pure tones with frequencies f1 and f2 are sent to the cochlea, the most prominent DPOAE is the cubic one produced at 2f1-f2, and this presentation will mainly emphasize its properties. DPOAEs are undoubtedly generated by cochlear nonlinearities. It is widely held that they arise from certain stages of sound processing by the outer hair cells (OHC) and that OHCs ensure normal cochlear sensitivity and tuning. Thus, DPOAEs should provide a privileged tool for monitoring the harmful effects of loud sound because OHCs are known to be one of the main targets of NIHL. Although DPOAEs provide the clinicians with a reliable screening limit of about 30 dB HL around f2, no reliable relationship has been found thus far between possible residual DPOAEs and either hearing loss or amount of impaired sensory cells. Furthermore, puzzling contradictory findings have been reported as to the presence of DPOAEs despite a large hearing loss (i.e. >30-40 dB) notably with high-level stimuli. These observations raise the following issues. What is the generation site of DPOAEs in a normal or pathological cochlea (OHCs, basilar membrane, place tuned to f2, 2f1-f2, places basal to f2.)? Is it necessary to account for interferences between several discrete sources, arising from different locations or different mechanisms and possibly exhibiting differential susceptibility to sensory cell damage? Do DPOAE changes depend on the nature of OHC pathology (NIHL, anoxia, ototoxic drugs, genetics.)? Once a source of DPOAE is characterized, is there any means of modelling the physiological process of its generation and deriving what might quantitatively relate DPOAE amount to sensory cell activity and thresholds? The goal of this presentation is to examine these issues, review the available data and propose a comparatively simple model.

Background: The efficacy of systemic antibiotics on the treatment of ventilator-associated infectious maxillary sinusitis (VAIMS) is debated. The objective of this study was to determine the etiologic diagnosis of VAIMS in patients receiving antibiotics., Methods: Patients mechanically ventilated for more than or equal to 72 h, who had persistent fever while on antibiotics for more than or equal to 48 h, underwent computed tomography scan followed by transnasal puncture of involved maxillary sinuses. VAIMS was defined as follows: fever greater than or equal to 38 degrees C, radiographic signs (air fluid level or opacification of maxillary sinuses on computed tomography scan), and a quantitative culture of sinus aspirate yielding more than or equal to 103 colony-forming units/ml., Results: Twenty-four patients had radiographic signs of sinusitis. The mean +/- SD prior durations of mechanical ventilation and antibiotic exposure were 9.5 +/- 4.7 days and 6 +/- 4 days, respectively. Six unilateral and nine bilateral VAIMS were diagnosed in 15 patients. The median number of etiologic organisms per patient was two (range, one to four). The bacteriologic cultures yielded gram-positive bacteria (n = 21), gram-negative bacteria (n = 22), and yeasts (n = 5). Forty percent of causative agents were susceptible to the antibiotics prescribed. Seven patients with VAIMS developed 10 concomitant infections: ventilator-associated pneumonia (n = 5), urinary tract infection (n = 3), catheter infections (n = 2). In all cases of ventilator-associated pneumonia, the implicated agents were the causative agents of VAIMS., Conclusion: In VAIMS patients on antibiotics, quantitative cultures of sinus aspirates may contribute to establish the diagnosis. The frequent recovery of microorganisms susceptible to the antimicrobial treatment administered suggests that therapy of VAIMS with systemic antibiotics may not be sufficient.

The spectral quasi-periodicity of transient-evoked otoacoustic emissions (TEOAE) is well acknowledged since Zwicker described a preferred spacing of 0.4 bark between consecutive peaks in the spectrum of otoacoustic emissions from normal ears. While there is scarce evidence of any anatomical reason for this regularity, several functional models of the cochlea have predicted that the structure of emission spectra reflects important characteristics of cochlear filters. In an attempt to check such predictions, the average regularity of TEOAE spectra was studied in three groups of human subjects, normally hearing adults, healthy neonates, and adults suffering from noise-induced hearing loss. Significant differences in emission periodicities were found. Around 1 kHz, the preferred spacing was close to 130 Hz in normally hearing adult ears and neonates. In contrast, no clear periodicity was found in the group of damaged ears, even though they had clinically normal pure-tone audiometry below 2 kHz. Around 4 kHz, the preferred spacing was close to 240 Hz in normal adults and neonates, whereas TEOAEs were absent in many impaired ears. A phenomenological model assuming that TEOAEs stem from the responses of a slightly disarrayed bank of highly tuned filters predicts that the filter width would be the same in healthy young adults and neonates. In contrast, ears suffering from high-frequency hearing loss could exhibit early damaged filters. The proposed method might provide an objective assessment of parameters otherwise difficult to evaluate, especially in neonatal cochleas.

Background: Cochlear ischemia is likely involved in sensorineural hearing loss after cerebellopontine angle (CPA) surgery., Objective: To demonstrate the type of vascular damage to the cochlea, apart from arterial section, that can be induced by CPA surgery., Methods: The effects on measures of both cochlear blood flow (CBF) and distortion-product otoacoustic emissions (DPOAEs) of partial or total mechanical compressions of the internal auditory artery (IAA) were compared in young adult rabbits., Results: When preocclusion baseline activity was compared with postocclusion CBF and DPOAEs, it was clear in the majority of cases that total compressions lasting < or =7 minutes produced the same full recoveries for both measures as did the shorter obstructions of only a few minutes. By contrast, both short and long partial occlusions in which ischemia was interrupted by periods of poor reperfusion (<50% of the initial CBF value) resulted in delayed and prolonged recoveries. In addition, at times, full recovery was not achieved, particularly for DPOAEs, because of vasospasm-like activity., Conclusion: Vasospasm of the IAA was induced by a systematic series of IAA compressions and releases that did not provide for full reperfusion. These data support the concept that vasospasm should be prevented whenever hearing preservation is attempted in CPA surgery.

Unlabelled: The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients., Materials and Methods: Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment., Preliminary Results: 92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant., Conclusion: Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.

Unlabelled: Adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1), play an important role in the development of the inflammatory allergic response in the nose. ICAM-1 expression on nasal epithelial cells during allergic reaction is regarded as a major hallmark of allergic inflammation., Objective: The aim of the study was to evaluate the levels of soluble ICAM-1 (sICAM-1) in nasal epithelial lining fluid (ELF) in patients with allergic rhinitis., Patients: Seventeen patients with perennial allergic rhinitis (age: 34,6 +/- 14,6) were screened and the results were compared with those from 11 seasonal allergic rhinitis patients (age: 25.9 +/- 7.4) and 10 non-allergic patients., Methods: The study was performed outside the pollen season. The scores of subjective symptoms were estimated by two differents methods. First, on the basis of a visual analog scale for the symptoms including nasal obstruction, rhinorrhea, sneezing and pruritus. This score was called "Autoscore" (fullmark =40 points). Second, on the basis of a four mark scale for each symptom defined (0 =no symptom, 1 =mild, 2 =moderate, 3 =severe). This score was called "Heteroscore" (fullmark =12 points). Specimens of nasal mucosa were collected by brushing the surface of nasal cavity. Levels of sICAM-1 and sECP (soluble Eosinophilic cationic protein) were measured by specific enzyme-linked immunosorbent assay., Results: The levels of sICAM-1 in ELF were significantly higher (p <0.01) in patients with perennial rhinitis compared to patients with seasonal rhinitis outside the pollen season and to non allergic patients. Levels of sICAM-1 in patients with perennial allergic rhinitis were correlated with levels of sECP (p <0.003) and with the four mark scale scores (p <0. 03) but did not correlate with the visual analog scale scores., Conclusions: sICAM-1 increased in nasal secretions during natural perennial rhinitis and could be considered as a representative hallmark for clinical severity and follow-up evaluation in perennial allergic rhinitis.

An in vivo model in the Mongolian gerbil is used to assess the auditory changes during reversible cochlear ischemia. This model allows the recordings of cochlear potentials (microphonics, summating potential and compound action potential) and otoacoustic emissions (cubic difference tones, CDTs), together with laser Doppler cochlear blood flow (CBF) measurements, over reversible cochlear ischemia. Ischemia is achieved by compression of the eighth nerve complex at the porus of the internal acoustical meatus, whereas the compression release allows the reperfusion to occur. While CBF monitoring permits to objectively determine the degree of ischemia and reperfusion, the combined analysis of cochlear potentials and CDTs makes it possible to point out the preferential site of main functional damage within the cochlea, i.e., outer hair cells (OHCs), inner hair cells, or ganglia cells. At least three ischemia-reperfusion sequences can be used on one side, and sometimes both ears can serve for experiments. This model could be applicable for testing drugs with alleged protective effects against cochlear ischemia and/or reperfusion, in treated vs. non-treated animals.

Cochlear ischemia induces a sensorineural hearing loss, in part through a fast functional impairment of outer hair cellls. Assuming that the cochlea is rendered fragile during ischemia and reperfusion and that stimulation itself can jeopardize its functional recovery, we used a model of reversible selective cochlear ischemia in Mongolian gerbils to establish what type of sound exposure can be deleterious during and immediately after reversible ischemia. Several groups of gerbils were used, with different ischemia durations and levels of sound exposure. Control groups were only exposed to tones at 80 and 90 dB SPL during 30 min, while other groups underwent complete and fully reversible blockage of the labyrinthine artery, during 5.5 or 8 min, and were exposed to 60 or 80 dB SPL tones during 30 min. The amount of ischemia and reperfusion was measured by means of laser Doppler velocimetry, whereas outer hair cells' function was continuously monitored through distortion-product otoacoustic emissions (DPOAEs). The losses of DPOAE levels after 8 min transient ischemia and 60 dB SPL exposure were as large as those induced by 80 dB SPL exposures combined with 5.5 min ischemia, or 90 dB SPL exposures without ischemia, with a maximum loss around 25-30 dB, half an octave above the stimulus frequency. These results give evidence for an extremely high cochlear vulnerability to low-level sound exposure when associated with reversible ischemia. This vulnerability may have important clinical consequences in patients with cochlear circulatory disturbances.

Impairment to the cochlear blood flow likely induces many types of sensorineural hearing loss. Models using several small laboratory animals have been described in the literature that permit the simultaneous monitoring of the cochlear blood flow with laser-Doppler flowmetry and cochlear function using evoked responses. However, these models have not permitted a direct application of the resulting knowledge to the human condition, primarily due to differences in the translucence of the otic capsule between species. In the present study, to approximate conditions relevant to the human patient, the rabbit was utilized to develop a procedure in which laser-Doppler flowmetry could be used to measure the cochlear blood flow in an animal with an opaque otic capsule. At the same time, the cochlear function was monitored non-invasively using distortion-product otoacoustic emissions. In this manner, a laser-Doppler probe was positioned in the round window niche and the cochlear function measured using distortion-product otoacoustic emissions during a systematic series of ischemic episodes. Cochlear ischemia was produced by deliberately compressing the eighth nerve complex at the porus of the internal acoustic meatus, for periods lasting from 1-3 min, while cochlear blood flow and distortion-product otoacoustic emission measures were obtained simultaneously before, during and following the occlusion. Results demonstrated that the cochlear blood flow sharply decreased within 1 s after compression onset, whereas distortion-product otoacoustic emissions showed obstruction-induced changes after a delay of several seconds, provided that the blood flow decreased, at least 40%. Similarly, upon release of the compression, the cochlear blood flow began to recover within 1 s, whereas the recovery of the corresponding distortion-product otoacoustic emissions was slightly delayed. Although not apparent in the distortion-product otoacoustic emission recovery time course, the cochlear blood flow consistently overshot its initial baseline value during the recovery process. Thus, although cochlear ischemia produced changes in the distortion-product otoacoustic emission activity that generally followed the resulting alterations in the cochlear blood flow, the detailed relationship between the two measures was complex.

Acute postoperative pain has seldom been assessed in head and neck cancer surgery. The estimation of actual pain is more difficult when communication is impaired by tracheotomy or tracheostomia. The aim of the present prospective study was the assessment of analgesia level during the first 48 postoperative hours after head and neck cancer surgery. The analgesic procedure involved intra-venous morphine injected by means of a PCA pump (Patient controlled analgesia). Thirty patients were thus treated after cancer surgery of the larynx or the oropharynx. The protocol included during 48 hours the assessment of pain, using a visual analogic scale (VAS) every fourth hour, while recording the total injected dose of morphine, the localisation of pains, as well as the occurrence of side-effects. The control of postoperative pain was shown to be satisfactory, with a VAS grade smaller than 3 at time zero and kept below this value during 48 hours. At the end of this period, the mean total dose of morphine injected was 38 mg. No case of respiratory depression was even seen. It can be concluded that PCA seems to be an efficient procedure for controlling postoperative pain in head and neck cancer surgery. This technique proved to be better than delivering analgesia on requirement.

Objective/hypothesis: Examine and compare in detail the time courses of the auditory brainstem response (ABR) wave I amplitude and latency to the distortion-product otoacoustic emission (DPOAE) amplitude and phase measured in the rabbit model following deliberate obstruction of cochlear blood flow (CBF)., Methods: Using a posterior fossa craniotomy in five rabbits, the internal auditory artery (IAA) was compressed with a probe. ABR and otoacoustic emission were continuously monitored before, during, and after the compressions., Results: ABR wave I amplitudes demonstrated measurable decreases at a mean of 28.3 s after IAA compression, whereas DPOAE amplitudes decreased after a mean of 14.8 s. Wave I latencies began to increase at a mean of 18.3 s after occlusion, while DPOAE phase measures changed after a mean of only 4.8 s following IAA compression. The time-course patterns were similar for the amplitudes of both ABR wave I and DPOAE., Conclusions: ABR wave I amplitude follows a similar, though delayed (by approximately 10 s) time-course pattern to that of the DPOAE following IAA compression. The implication of these findings for intraoperative auditory monitoring is that changes in many currently employed measures will lag actual surgically induced alterations in CBF by at least 20 to 30 s.