Chantal Gilain

Tinnitus and otosclerosis

Abstract Fifty patients with otosclerosis and tinnitus were studied for the course of the tinnitus after stapes surgery. Tinnitus disappeared in 64% of the cases, improved in 16%, was unchanged in 14%, and worsened in 6%. The reduction in tinnitus was more favorable after a small fenestra stapedotomy than after a partial stapedectomy with removal of the posterior half of the footplate. An unfavorable postoperative course of tinnitus did not appear to be linked to the postoperative audiometric result. In our study the subjective evaluation of pitch and loudness of the tinnitus did not provide significant information regarding its prognosis.

Pulsatile tinnitus associated with dehiscent internal carotid artery: An irremediable condition?

Dehiscent internal carotid artery (ICA) in the middle ear is a rare condition, with conservative treatment primarily recommended. We report the case of a 63-year-old patient referred to the Ear, Nose, and Throat (ENT) ward for unbearable pulsatile tinnitus. Otoscopy revealed a normal right tympanic membrane, with pulsatile tinnitus but without hearing impairment. Based on imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone, as well as Doppler ultrasound of the internal carotid artery and sigmoid sinus, the diagnosis of ICA canal dehiscence into the tympanic cavity was established, thus excluding the diagnosis of aberrant ICA. Following the patients own request, we undertook surgical correction, with the technique used described in the report. Immediately postoperatively, the pulsatile tinnitus had disappeared, with no surgical complications noted. At the 9-month follow-up, otoscopy revealed a healthy right tympanic membrane and the patient reported no remaining symptoms.

Dynamic Posturography (Equitest): Outcome after Vestibular Neurotomy or Acoustic Neuroma Removal

Objectives: This study has two aims. First, we analyze the results of dynamic computerized posturography (Equitest) achieved by patients who have undergone acoustic neuroma removal or vestibular neurotomy. The examination is performed during the preoperative assessment and at several postoperative consultations. Secondly, after analyzing the results, we evaluate the interest of this type of examination for such patients during preoperative assessment and postoperative follow-up. Patients: 25 patients underwent acoustic neuroma removal and 8 vestibular neurotomy from June 1996 until September 1997. All patients included in the study underwent dynamic posturography follow-up. The schema proposed was an examination before surgery and then 10 days and 1 and 3 months after the operation. Not all patients underwent all examinations (it is a retrospective study). Method: Retrospective case review. Results: 50% of the patients (n = 8) who underwent vestibular neurotomy achieved a normal score at the sensory organisation test (SOT) of the Equitest within the first 6 postoperative weeks. 60% of the patients (n = 25) undergoing acoustic neuroma removal developed a central vestibular compensation 3 months after surgery. Two patients developed an inadequate balance strategy with excessive visual dependence detected by the SOT. Conclusions: According to our experience, the SOT is a useful examination during the follow-up period of patients who have undergone neurootologic surgery. It provides information about the progress of postoperative central vestibular compensation. The dynamic posturography also detects inadequate balance strategies, therefore, allowing a personalized vestibular reeducation adapted to each patient.

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data.

OBJECTIVE After 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center. METHOD The study was retrospective and included all VSB implants bound to the long process of the incus in our tertiary medical center between january 1999 and february 2015. We observed the effect of surgery on residual hearing by comparing bone and air conduction thresholds before and after implantation. The functional results of the implant were quantified by measuring, at several post-operative intervals, the thresholds with the VSB in pure tone audiometry and speech audiometry, in quiet and in noise. RESULTS 53 VSB were implanted in 46 patients aged between 22 and 81 years old (average 53.9). 48 patients (90%) suffered from a sensorineural hearing loss, and 5 patients from a mixed hearing loss due to an otosclerosis (but only 3 of them have undergone stapedotomy). There were no major complications (e.g. facial palsy, dead ear or postoperative infection). The placement of the implant created an insignificant deterioration of the air conduction thresholds (5,6 dB HL) and bone conduction thresholds (2.2 dB HL) at 6 weeks post-implantation. The bone conduction thresholds increased by 4.7 dB HL 2.5 years after surgery in comparison with the preoperative results, which is also considered clinically insignificant. With the implant turned on, the pure tone audiometry thresholds in open field, in quiet, were significantly improved (gain of 13.9 dB on average on frequencies from 250 to 8000 Hz), particularly at frequencies of 1000, 2000 and 4000 Hz as the average gain on these frequencies amounted to 19.4 dB. The speech intelligibility in a cocktail party noise was also improved by 18.3% on average at 6, 52 and 104 weeks post-implantation. CONCLUSION The Vibrant Soundbridge with the electromagnetic vibrator fixed to the long process of the incus is a safe active middle ear implant with no major complications; it has no significant impact on the residual hearing. The VSB is particularly suitable for patients who are unable to wear conventional hearing aids due to anatomical or infectious problems in the external ear canal, or in case of poor audiometric results with conventional hearing aids. The VSB brings significant hearing gain, as it is particularly efficient in frequencies for the speech range and higher, resulting especially in better speech intelligibility in noisy environments.