Pierre Garin

Hearing outcome following laser-assisted stapes surgery.

This article reports the postoperative results of 76 operations addressing otosclerosis. All procedures were performed by the same surgeon and took place within a 4-year period. We compared the postoperative audiometric results of 54 laser-assisted procedures with those of 22 nonlaser operations. Our findings revealed a statistically significant improvement in the air-bone gap closure of the laser-operated patients: the air-bone gap was narrowed to within 10 dB in 72% of laser-operated cases versus 54% in nonlaser cases. Furthermore, laser use does not induce high-frequency sensorineural hearing loss. We believe that a laser entails less risk of inner ear microtrauma and improves the accuracy and reliability of stapedotomy.

Office-based CO2 laser-assisted tympanic membrane fenestration addressing otitis media with effusion.

OBJECTIVE To use the CO2 laser-assisted tympanic membrane fenestration in office settings, under local anesthesia, as the sole treatment for patients with chronic otitis media with effusion (OME). BACKGROUND DATA This new treatment ensures artificial ventilation of the middle ear for several weeks, and provides an intermediate solution between ordinary lancet-made tympanocentesis and transtympanic ventilation tube insertion. The operative technique is already well codified, and preliminary studies have demonstrated that tympanic membrane fenestration does not expose patients to any major hazard. METHODS We treated 30 ears in 21 children and 29 ears in 24 adults. All patients had presented with OME persistent for more than 3 months. The laser tympanostomy was performed under local anesthesia, as an outpatient procedure, using a CO2 flash-scanning laser in conjunction with a handpiece (OTOLAM). Using a power of 12 W to 17 W, a single laser pulse usually sufficed to create a 2-mm-diameter circular perforation in the anteroinferior quadrant of the eardrum. RESULTS The tympanic membrane fenestration allows avoiding ventilation tube insertion in 63% of children and 75% of adults. CONCLUSIONS The CO2 laser-assisted tympanic membrane fenestration seems a valid therapeutic option addressing OME. This study should be pursued on a larger scale to define more precisely the indications of the laser tympanostomy.

Bilateral vibrant soundbridge implantation: audiologic and subjective benefits in quiet and noisy environments.

Abstract Conclusions. The results support bilateral sequential implantation for patients who are not completely satisfied after implantation of one side. Objective. To evaluate the benefit of bilateral Vibrant Soundbridge middle ear implantation as compared with unilateral implantation in quiet and noisy environments. Methods. This was a multicentric and retrospective study of 15 patients with symmetrical sensorineural hearing loss who were implanted sequentially in both ears. The performance of each subject was compared under three conditions: with the right implant activated, with the left implant activated, and with both implants activated. Audiometric tests were compared with self-assessment subjective evaluation by questionnaire. Results. Both qualitative and quantitative assessments demonstrated improvement in speech intelligibility, especially in background noise, but also for low voice intensity in quiet.

Speech Discrimination in Background Noise with the Vibrant® Soundbridge™ Middle Ear Implant

Objective: Evaluate speech intelligibility in competing background noise for monaural users of the Vibrant® Soundbridge™ (VSB) middle ear implant (Symphonix). Patients and Material: Nine adults with moderate to severe bilateral sensorineural hearing loss, and implanted with a unilateral VSB, were included in the study. The patients’ experience of the implant ranged from 9 to 24 months. Retrospective single-subject repeated measures of speech intelligibility in background noise were performed using 2 different test procedures, the Elbaz test and the Garin and Galle test. The patients were tested VSB aided and VSB unaided in a variety of signal-to-noise ratios. The correct-score percentage for each ratio for each condition was averaged for the group of patients and compared with normative data for each test method. Results: The VSB-aided condition showed results approaching normative data for both test methods. At a signal-to-noise ratio of zero, the Elbaz test showed a mean correct score of 55% for the VSB-unaided condition versus 85% for the VSB-aided condition. The Garin and Galle test showed a mean score of 34% for the VSB-unaided condition versus 94% for the VSB-aided condition. Conclusions: Although the unilateral VSB middle ear implant does not restore stereophony, it does improve speech intelligibility in background noise.

High prevalence of SDHB mutations in head and neck paraganglioma in Belgium

Background Recent reports have found genetic mutations in up to one quarter of patients harbouring pheochromocytoma and/or paraganglioma. This high prevalence was mainly due to the discovery of the role of SDH genes. While SDHD has been more frequently associated with the pathogenesis of head and neck paragangliomas, SDHB mutations were mainly associated with malignant and/or extra-adrenal pheochromocytoma/paraganglioma. Objective To look for mutations in susceptibility genes and genotype–phenotype correlations in patients with pheochromocytoma and/or paraganglioma from Belgium. Methods Screening of the coding parts of SDH, VHL and RET genes was performed by SSCP in patients with pheochromocytoma and/or paraganglioma diagnosed at or referred to the Cliniques Universitaires Saint Luc from May 2003 to May 2006. Results Fifty-six unrelated patients were included (36 head and neck paragangliomas, including six familial cases and 30 sporadic cases; 18 abdominal pheochromocytoma/paraganglioma and two paraganglioma of the cauda equina). The overall prevalence of mutations was 41% (n = 23 including 19 head and neck paragangliomas and four abdominal pheochromocytoma/paraganglioma), mainly due to SDH mutations. While SDHD mutations were found in all patients with familial head and neck paragangliomas, in sporadic cases, the prevalence of SDHB mutations (n = 8, 27%) was twice that of SDHD mutations (n = 4, 13%). Patients harbouring SDHB mutations had unilateral late-onset head and neck tumours without evidence of recurrence or malignancy. Conclusion This Belgian series confirms the elevated prevalence of predisposing mutations in patients with head and neck and extra-adrenal paragangliomas, but differs from previous reports by the high frequency of SDHB mutations associated with head and neck paragangliomas without evidence of recurrence or malignancy.

The RetroX auditory implant for high-frequency hearing loss.

Objective: The objective of this study was to analyze the subjective satisfaction and measure the hearing gain provided by the RetroX (Auric GmbH, Rheine, Germany), an auditory implant of the external ear. Study Design: We conducted a retrospective case review. Setting: We conducted this study at a tertiary referral center at a university hospital. Subjects: We studied 10 adults with high-frequency sensori-neural hearing loss (ski-slope audiogram). Intervention: The RetroX consists of an electronic unit sited in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the entrance of the external auditory canal. Implanting requires only minor surgery under local anesthesia. Main Outcome Measures: Main outcome measures were a satisfaction questionnaire, pure-tone audiometry in quiet, speech audiometry in quiet, speech audiometry in noise, and azimuth audiometry (hearing threshold in function of sound source location within the horizontal plane at ear level). Results: Subjectively, all 10 patients are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX. They wear the implant daily, from morning to evening. We observe a statistically significant improvement of pure-tone thresholds at 1, 2, and 4 kHz. In quiet, the speech reception threshold improves by 9 dB. Speech audiometry in noise shows that intelligibility improves by 26% for a signal-to-noise ratio of -5 dB, by 18% for a signal-to-noise ratio of 0 dB, and by 13% for a signal-to-noise ratio of +5 dB. Localization audiometry indicates that the skull masks sound contralateral to the implanted ear. Of the 10 patients, one had acoustic feedback and one presented with a granulomatous reaction to the foreign body that necessitated removing the implant. Conclusion: The RetroX auditory implant is a semi-implantable hearing aid without occlusion of the external auditory canal. It provides a new therapeutic alternative for managing high-frequency hearing loss.

Prevalence and spectrum of SDHx mutations in pheochromocytoma and paraganglioma in patients from Belgium: an update

Since the early 2000s, the prevalence and spectrum of mutations in genes encoding subunits of succinate dehydrogenase (SDHx) were reported in large cohorts of patients with pheochromocytoma (PC) and paraganglioma (PGL) from most Western countries. Unfortunately, in Belgium, no equivalent work was performed thus far. Therefore, the aim of the work was to look for mutations in SDHx genes and genotype-phenotype correlations in patients with PC and/or PGL from Belgium. Screening of the coding parts of SDHx genes and deletion search were performed in all patients with PC and/or PGL referred to the -Cliniques Universitaires Saint-Luc from 05/2003 to 05/2011. Genetic screening was performed in 59 unrelated head and neck (hn)PGLs (8 fami-lial) and 53 PCs (7 extra-adrenal; 3 metastatic). In hnPGLs, 10 different SDHD mutations (3 substitutions, 5 deletions, 2 splice site mutations) were detected in 16 patients, including 7 familial cases and 9 apparently sporadic cases. In the same subset, we found 8 different SDHB mutations (5 substitutions, 1 splice site mutation, 1 deletion, 1 duplication) in 10 patients with sporadic hnPGL without evidence of malignancy. No SDHx mutation was detected in patients harboring PCs and no SDHC mutation whatsoever. In conclusion, in our multicentric database of PC-PGLs from Belgium, (i) the prevalence of SDHx mutations was high in hnPGLs (44% in the whole subset, 37% of apparently sporadic cases); (ii) in sporadic cases, the prevalence of SDHB mutations was high (20%), similar to that of SDHD (18%); and (iii) no SDHx mutation was found in a subset of mostly adrenal, benign PCs.

Vestibular schwannoma and cochlear implantation

Background Cochlear implant speech processors compress a wide acoustical dynamic range of sounds into a smaller electrical dynamic range. Some patients show wider electrical dynamic ranges than others and most of them have good speech perception performance. The knowledge of the average psychoacoustical dynamic range in adults will help the audiologist program children who do not give reliable responses. Aim This study was conducted to analyse the dynamic ranges of experienced Nucleus 22 cochlear implant users with good speech-perception and patients with poor speech-perception performances. Method Thirty-one maps of adult subjects with Nucleus 22 cochlear implants using the SPEAK processing strategy, in bipolar stimulation were analysed. By the time of this study, all of them had used a cochlear implant for over a year. They were divided into two groups: group 1, composed of those with good speech perception for sentences (better than 80%), and group 2, composed of those with speech perception results for sentences worse than 70%. Results Results showed that both dynamic ranges were wide in the two groups (average 50 units). Conclusion Although dynamic ranges vary among subjects and electrodes, a lower variability was observed within the group of patients with better speech perception.

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.

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.