Céline Richard

European results with totally implantable carina placed on the round window: 2-year follow-up.

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.

Round window versus cochleostomy technique in cochlear implantation: histologic findings.

Hypothesis Cochleostomy or round window enlargement techniques for cochlear implant electrode insertion result in more abnormal tissue formation in the basal cochlea and are more apt to produce endolymphatic hydrops than round window electrode insertion. Methods Twelve temporal bones from implanted patients were examined under light microscopy and reconstructed with 3-dimensional reconstruction software to determine cochlear damage and volume of neo-ossification and fibrosis after electrode insertion. Amount of new tissue was compared between 3 groups of bones: insertion through the round window (RW), after enlarging the RW (RWE) and cochleostomy (Cochl). The probable role of the electrode was evaluated in each case with hydrops. Results More initial damage occurred in the Cochl and RWE groups than in the RW group, and the difference was significant between RWE and RW in cochlear segment I (p < 0.026). The volume of new bone in Segment I differed significantly between groups (p < 0.012) and was greater in the RWE group than in either the Cochl or RW groups (post hoc p’s < 0.035 and 0.019, respectively). Hydrops was seen in 5 cases, all in the Cochl and RWE groups. Blockage of the duct was because of new tissue formation in 4 of the 5 hydrops cases. Conclusion With the electrodes in this series, implantation through the RW minimized initial intracochlear trauma and subsequent new tissue formation, whereas the RW extension technique used at the time of these implantations produced the greatest damage. Future studies may clarify whether today’s techniques and electrodes will produce these same patterns of damage.

New insight into the bony labyrinth: a microcomputed tomography study.

OBJECTIVES To visualize and quantify the morphology and mineralization of the developing fetal human bony labyrinth, using 3D-microcomputed tomography (3D-microCT) imaging. METHODS Eleven right temporal bones from late second and third trimester fetuses were used in this prospective pilot study. After fixation in 10% formalin solution, all samples underwent a microcomputed tomography (microCT) scan, permitting the 3D imaging of the bony labyrinth as well as the quantitative assessment of mineral density, angular distances and dimensions of inner ear components the progression of ossification was precised with histological observations. RESULTS Our findings show different rates of growth among the semicircular canals, the vestibular aqueduct, the oval window, the round window and the cochlea. The final sizes of the cochlea and round window are achieved at 23 weeks of gestation, with heights of 5mm and 2mm, respectively. The oval window reaches adult size at 35 weeks, whereas the vestibular aqueduct will attain adult size after birth. An increasing degree of torsion of each semicircular canal is observed during fetal development. The superior semicircular canal achieves adult size at 24 weeks, before the posterior and the lateral canals (25 weeks). The time-course of ossification and mineralization observed in structures and confirmed by histology. CONCLUSIONS During this developmental period poorly studied until now, our findings suggest that each part of the bony labyrinth follows distinct growth and ossification kinetics trajectories, some of these reaching their adult size only after birth.

Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging?

Abstract Conclusion: In our experience PET-CT cannot yet reliably predict the need for surgical neck dissection in patients with N0 neck. According to the results of PET-CT the neck dissection should be extended towards unusual lymph node areas. Objective: To analyze the value of PET-CT for the initial N staging, comparing PET-CT data with histopathological results of the modified radical neck dissection. Methods: Fifty patients with previously untreated head and neck squamous cell carcinoma were eligible for inclusion in this study. Modified radical unilateral or bilateral neck dissection was performed in all patients. PET-CT findings and histological findings were compared to determine their diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: In all, 105 levels had pathologically diagnosed metastases: PET-CT was positive in 87 levels and negative in 18 levels. Also, 399 levels had negative postoperative histology findings: PET-CT was positive in 24 levels and negative in 375 levels. The false-positive over-staged and the false-negative under-staged rates were 27% and 12%, respectively.

Prospective radiological study concerning a series of patients suffering from conductive or mixed hearing loss due to superior semicircular canal dehiscence

The aim of this study is to appreciate the incidence of patients with isolated conductive hearing loss with normal drum due to superior semicircular canal dehiscence (SCD). It is a prospective radiological study. Two hundred and seventy-two patients with a normal drum suffering from isolated unilateral or bilateral conductive or mixed hearing loss were included in a prospective radiological study. A high resolution computerized tomography (HRCT) was performed in all the patients. Those who were found to have a unilateral or bilateral SCD underwent further etiological, clinical, audiologic evaluation. Ten patients with conductive or mixed hearing loss were found to have a unilateral or bilateral SCD. The disease was bilateral in five cases, and most often associated with a dehiscence of the tegmen tympani on both sides, supporting the theory of the congenital nature of the disease. There was no clear correlation between symptoms and the size of the SCD. Because patients were not suffering from incapacitating vestibular symptoms, they were not operated for surgical occlusion of the SCD, and were referred to a hearing aid specialist to improve hearing. Conductive or mixed hearing loss due to SCD is relatively frequent, justifying in our opinion that a systematic HRCT be carried out before surgery of any patient with conductive hearing loss.

Lamina propria of the human vocal fold: histomorphometric study of collagen fibers

BackgroundSince the seminal work of M. Hirano, which defined the three-layered lamina propria of the human vocal fold, there has been confusion in the labeling of each layer. Recent studies described the composition of fibers and interstitial molecules within the lamina propria leading to various biomechanical properties. However, collagen fibers appear as the most important structure component.MethodsWe used an optical analysis and the picrosirius-polarization method to describe collagen fibers from six adult and two fetal human larynges fixed in formalin and frontally sectioned in the middle part of the vocal fold.ResultsThe deep layer of the lamina propria is the most densely organized band of collagen fibers penetrating the superficial muscle bundles of the vocal muscle. The mean thickness of this layer is about 36% of the lamina propria and shows a network of strongly birefringent fibers (collagen type I and III). The superficial layer of the lamina propria is a narrow band of collagen fibers immediately below the basement membrane of the epithelium. The mean thickness of this layer is about 13% of the lamina propria and shows strong birefringent fibers. The intermediate layer is the less densely organized band between the deep and superficial layers. The mean thickness of this layer is about 51% of the lamina propria and shows clear, green weakly birefringent fibers characterized as collagen type III. The fetal lamina propria contains only a monolayer distribution of loose collagen fibers between the epithelium and the vocal muscle.ConclusionThese results help describe the distribution of collagen fibers within the lamina propria of the human vocal fold and have implications to understand the cover-body theory of voice production both in the adult and newborn.

Sources of variability of speech, spatial, and qualities of hearing scale (SSQ) scores in normal-hearing and hearing-impaired populations

Abstract Objective: To identify and quantify sources of variability in scores on the speech, spatial, and qualities of hearing scale (SSQ) and its short forms among normal-hearing and hearing-impaired subjects using a French-language version of the SSQ. Design: Multi-regression analyses of SSQ scores were performed using age, gender, years of education, hearing loss, and hearing-loss asymmetry as predictors. Similar analyses were performed for each subscale (Speech, Spatial, and Qualities), for several SSQ short forms, and for differences in subscale scores. Study sample: One hundred normal-hearing subjects (NHS) and 230 hearing-impaired subjects (HIS). Results: Hearing loss in the better ear and hearing-loss asymmetry were the two main predictors of scores on the overall SSQ, the three main subscales, and the SSQ short forms. The greatest difference between the NHS and HIS was observed for the Speech subscale, and the NHS showed scores well below the maximum of 10. An age effect was observed mostly on the Speech subscale items, and the number of years of education had a significant influence on several Spatial and Qualities subscale items. Conclusion: Strong similarities between SSQ scores obtained across different populations and languages, and between SSQ and short forms, underline their potential international use.

Validation of a French translation of the speech, spatial, and qualities of hearing scale (SSQ) and comparison with other language versions

Objective: To validate a French version of the speech, spatial, and qualities of hearing scale (SSQ), a subjective evaluation of patients’ hearing disability, and to assess SSQ reproducibility across different language versions. Design: The SSQ was translated in accordance with the principles of the ‘Universalist approach’ of cross-cultural adaptation of patient-reported outcome instruments. Scores from a normal-hearing and a hearing-impaired population were compiled and compared, whenever possible, with data from the literature, collected using other language versions. Study sample: One hundred normal-hearing subjects and 230 hearing-impaired subjects. Results: Good reproducibility of scores and inter-subject variability were obtained between several language versions, even if scores found using the French version were slightly lower than those obtained using Dutch or English versions. A comparison of factor analysis outcomes between the English and French versions confirmed good conceptual equivalence across languages and robustness of the SSQ for use in international settings. The three main subscales (speech, spatial, and qualities) confirmed their usefulness in assessing different aspects of hearing disability. Conclusion: This study validated a French-language version of the SSQ, and assessed the reproducibility of the SSQ across subject groups, administration modes, and different countries/languages, confirming its potential as an international standard for hearing disability evaluation.

Canal wall up tympanoplasty for cholesteatoma with intact stapes. Comparison of hearing results between cartilage and PORP on stapes and impact of malleus removal and total reinforcement of the tympanic membrane by cartilage

OBJECTIVES To compare the results obtained with canal wall up (CWU) tympanoplasty for cholesteatoma using cartilage or an hydroxyapatite (HA) PORP positioned on the head of the stapes and to analyse the impact of malleus removal and total reinforcement of the tympanic membrane with cartilage. MATERIALS AND METHODS Retrospective study of 128 cases (99 adults, 29 children) operated between 2003 and 2012 for cholesteatoma by CWU tympanoplasty with use of a cartilage graft (90 cases) or a PORP (38 cases) on the head of the stapes. Audiometric results were analysed according to the International Bureau for Audiophonology (BIAP) criteria and were submitted to statistical analysis. All ossiculoplasties were performed during the first operation and only 39% of patients required surgical revision. The malleus was preserved in 79 cases and sacrificed in 49 cases. RESULTS With a follow-up of 2 years, the residual mean air-bone gap was 16.8 dB in the cartilage group (gain of 7.6 dB; P = 0.001) and 15.8 dB in the PORP group (gain of 8.5 dB; P = 0.002). The air-bone gap was less than 20 dB in 67.6% of cases in the cartilage group and 70.4% of cases in the PORP group. No significant difference was observed between the 2 techniques and no significant difference was observed according to whether or not the malleus was preserved in either the cartilage group or the PORP group. CONCLUSION These results confirm the value of cartilage graft placed on the head of the stapes as ossiculoplasty technique in cholesteatoma operated by CWU tympanoplasty, giving comparable results to those obtained with a PORP. Malleus removal did not induce any reduction of the quality of hearing obtained. Total reinforcement of the tympanic membrane with cartilage appeared to decrease the cholesteatoma recurrence rate (8.5%).

Identification of target proteins involved in cochlear Otosclerosis

Hypothesis Investigation of differential protein expression will provide clues to pathophysiology in otosclerosis. Background Otosclerosis is a bone remodeling disorder limited to the endochondral layer of the otic capsule within the temporal bone. Some authors have suggested an inflammatory etiology for otosclerosis resulting from persistent measles virus infection involving the otic capsule. Despite numerous genetic studies, implication of candidate genes in the otosclerotic process remains elusive. We employed liquid chromatography-mass spectrometry (LC-MS) analysis on formalin-fixed celloidin-embedded temporal bone tissues for postmortem investigation of otosclerosis. Methods Proteomic analysis was performed using human temporal bones from a patient with severe otosclerosis and a control temporal bone. Sections were dissected under microscopy to remove otosclerotic lesions and normal otic capsule for proteomic analysis. Tandem 2D chromatography mass spectrometry was employed. Data analysis and peptide matching to FASTA human databases was done using SEQUEST and proteome discoverer software. Results TGF&bgr;1 was identified in otosclerosis but not in the normal control temporal bone specimen. Aside from TGF&bgr;1, many proteins and predicted cDNA-encoded proteins were observed, with implications in cell death and/or proliferation pathways, suggesting a possible role in otosclerotic bone remodeling. Immunostaining using TGF&bgr;1 monoclonal revealed marked staining of the spongiotic otosclerotic lesions. Conclusions Mechanisms involved in cochlear extension of otosclerosis are still unclear, but the implication of TGF&bgr;1 is supported by the present proteomic data and immunostaining results. The established role of TGF&bgr;1 in the chondrogenesis process supports the theory of a reaction targeting the globulae interossei within the otic capsule.