Monique Decat

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.

Tinnitus specifically alters the top-down executive control sub-component of attention: Evidence from the Attention Network Task.

Tinnitus can be defined as the perception of noxious disabling internal sounds in the absence of external stimulation. While most individuals with tinnitus show some habituation to these internal sounds, many of them experience significant daily life impairments. There is now convincing evidence that impairment in attentional processes may be involved in tinnitus, particularly by hampering the habituation mechanism related to the prefrontal cortex activity. However, it is thus still unclear whether this deficit is an alteration of alerting and orienting attentional abilities, or the consequence of more general alteration in the executive control of attention. In the present study, 20 tinnitus patients were compared to 20 matched healthy controls using the Attention Network Test, to clarify which attentional networks, among alerting, orienting, and executive networks, show differences between the groups. The results showed that patients with tinnitus do not present a general attentional deficit but rather a specific deficit for top-down executive control of attention. This deficit was highly correlated with patient characteristics of years of tinnitus duration and the frequency of coping strategies employed to alleviate tinnitus distress in daily life. These findings are discussed in terms of recent neurobiological models suggesting that prefrontal cortex activity might especially be related to tinnitus habituation. Therapeutic perspectives focusing both on rehabilitation of the executive control of attention and neuromodulation are also discussed.

Labyrinthine fistula after cholesteatomatous chronic otitis media

OBJECTIVESnTo report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre- and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony labyrinth.nnnSTUDY DESIGNnRetrospective case review.nnnPATIENTSnFifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae.nnnSETTINGnTertiary referral center.nnnINTERVENTIONSnDiagnosis and treatment.nnnMAIN OUTCOME MEASURESnClinical, imaging, and surgical correlation of extensive fistulae and bone fistulae.nnnRESULTSnThe incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%).nnnCONCLUSIONSnThe breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre- and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.

Altered top-down cognitive control and auditory processing in tinnitus: evidences from auditory and visual spatial stroop

PURPOSEnTinnitus is the perception of a sound in the absence of external stimulus. Currently, the pathophysiology of tinnitus is not fully understood, but recent studies indicate that alterations in the brain involve non-auditory areas, including the prefrontal cortex. Here, we hypothesize that these brain alterations affect top-down cognitive control mechanisms that play a role in the regulation of sensations, emotions and attention resources.nnnMETHODSnThe efficiency of the executive control as well as simple reaction speed and processing speed were evaluated in tinnitus participants (TP) and matched control subjects (CS) in both the auditory and the visual modalities using a spatial Stroop paradigm.nnnRESULTSnTP were slower and less accurate than CS during both the auditory and the visual spatial Stroop tasks, while simple reaction speed and stimulus processing speed were affected in TP in the auditory modality only.nnnCONCLUSIONSnTinnitus is associated both with modality-specific deficits along the auditory processing system and an impairment of cognitive control mechanisms that are involved both in vision and audition (i.e. that are supra-modal). We postulate that this deficit in the top-down cognitive control is a key-factor in the development and maintenance of tinnitus and may also explain some of the cognitive difficulties reported by tinnitus sufferers.

Les réinterventions dans la chirurgie de l'otospongiose : à propos de 73 cas

Sommaire Objectif : Le but de cette etude a ete devaluer les principales causes et les resultats des reprises dotospongiose. Type detude : Etude retrospective menee sur une serie de 73 reprises de stapedectomie. Lieu : Les reinterventions ont ete realisees dans deux services doto-rhino-laryngologie referents (Fondation Rothschild, Paris, France et Cliniques universitaires Saint-Luc, Bruxelles, Belgique). Methodes : Lanalyse a porte sur les caracteristiques de la population, les indications de la reprise, les causes de lechec, ou de la complication et les resultats fonctionnels. Moyens de mesures : Les resultats auditifs ont ete rapportes en suivant les recommandations de lAmerican Academy of Otolaryngology-Head and Neck Surgery. Nous avons egalement rapporte les resultats en fonction de lutilisation ou non du laser. Resultats : Une surdite de transmission representait la principale indication de reintervention (78%). Les principales anomalies retrouvees lors de la chirurgie etaient : prothese non fonctionnelle (50%), fibrose cicatricielle (32.8%), lyse de lenclume (8.5%), et reproliferation dotospongiose (7.1%). Lorsque la reprise etait indiquee en raison de signes de souffrance labyrinthique, les constats les plus frequemment retrouves etaient : granulome stapedo-vestibulaire (30.7%), fistule perilymphatique (30.7%), et piston intra-vestibulaire (23%). Letude des resultats fonctionnels montrait 51.5% de succes, 68.7% de bons resultats et 9% de labyrinthisation (ne depassant pas 15 dB dans 80% des cas). Lutilisation du laser argon pour 14 patients (19%) a mis en evidence des resultats audiometriques sensiblement meilleurs (61.5% de succes et 77% de bons resultats), mais sans difference statistiquement significative par rapport aux patients operes sans laser. Conclusion : Les resultats de notre serie sont tout a fait comparables aux donnees publiees dans la litterature. On retiendra que les resultats auditifs sont moins bons lors des reprises que lors de la chirurgie primaire, mais un bon resultat peut etre observe dans 2/3 des cas si lintervention est confiee a un chirurgien experimente.

Is age a limiting factor for adaptation to cochlear implant

The influence of age on adaptation to cochlear implant (CI) is still being contested in the literature. The aim of this study was twofold. First, hearing outcomes in quiet conditions were compared between CI users implanted over and under the age of 70xa0years. Second, the effect of the duration of auditory deprivation was investigated. The study design is a retrospective review and the setting is in academic tertiary referral center. One hundred and twenty-one postlingually deafened implanted adults participated in this study. Hearing outcomes were compared between 121 postlingually deafened adults implanted under 40, between 40 and 70, and over 70xa0years of age. Speech audiometry measurements were taken at 1, 3, 6, 12, 24 and 60xa0months post-cochlear implantation (pCI), in quiet conditions only. Hearing outcomes were significantly better only at 1xa0year pCI in the youngest group compared to the two older groups. No significant difference was observed between the middle-aged and eldest subjects at any time. The influence of the severe-to-profound hearing loss (SPHL) duration was investigated and found to be equally distributed among the different age groups. Good hearing outcomes in elderly patients are not secondary to a difference in SPHL duration. Age should not be a limiting factor for cochlear implantation decision.

Are bovine pericardium underlay xenograft and butterfly inlay autograft efficient for transcanal tympanoplasty

To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch® (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2xa0months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8xa0% (Pxa0<xa00.0001) and 85.0xa0% (Pxa0<xa00.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1xa0%) and 5 (12.5xa0%) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10xa0dB, compared to 85.0xa0% in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch® graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence.

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.

A key role of the prefrontal cortex in the maintenance of chronic tinnitus: An fMRI study using a Stroop task

Introduction Since we recently showed in behavioural tasks that the top-down cognitive control was specifically altered in tinnitus sufferers, here we wanted to establish the link between this impaired executive function and brain alterations in the frontal cortex in tinnitus patients. Method Using functional magnetic resonance imaging (fMRI), we monitored the brain activity changes in sixteen tinnitus patients (TP) and their control subjects (CS) while they were performing a spatial Stroop task, both in audition and vision. Results We observed that TP differed from CS in their functional recruitment of the dorsolateral prefrontal cortex (dlPFC, BA46), the cingulate gyrus and the ventromedial prefrontal cortex (vmPFC, BA10). This recruitment was higher during interference conditions in tinnitus participants than in controls, whatever the sensory modality. Furthermore, the brain activity level in the right dlPFC and vmPFC correlated with the performance in the Stroop task in TP. Conclusion Due to the direct link between poor executive functions and prefrontal cortex alterations in TP, we postulate that a lack of inhibitory modulation following an impaired top-down cognitive control may maintain tinnitus by hampering habituation mechanisms. This deficit in executive functions caused by prefrontal cortex alterations would be a key-factor in the generation and persistence of tinnitus.

Middle Ear Malformation and Facial Nerve Malposition

Results Hearing was normal in all patients. MRI identified subtle facial nerve enhancement in one of these patients. ENOG was inconclusive in the two patients tested. EMG confirmed axonal injury with denervation in the 1 patient with more delayed recovery. Two infants had complete resolution of facial paralysis within 2 months. The third patient has shown improving facial function with synkinesis at 2 months.