Do we need imaging before middle ear surgery? When is imaging useful, when is it mandatory and when is it only interesting, profitable or defensive?

This article summarizes an opinion on preoperative imaging based upon a personal composite of observations and experience in otological and skull base surgery that spans 35 years in several Swiss and US academic centers and 10 years in private practice.

Teaching stapes surgery.

This paper is a review of concepts and methods presented as a tribute to a great pioneer and teacher, Harold Frederic Schuknecht. His book entitled Stapedectomy, published in 1971, is based on past experience of '6,200 stapedectomy operations over a period of 13 years' and on experience gained from teaching the procedure to numerous residents and fellows. His concepts are still valid and represent a solid base for teachers and students of this elegant but precarious procedure.

Anatomic and functional long-term results of canal wall-down mastoidectomy.

The objective of this study was to evaluate, over the long-term, the anatomic and functional outcome of canal wall-down mastoidectomy performed for chronic otitis media with cholesteatoma and chronic otomastoiditis resistant to all conservative treatment. The study was made through a retrospective review of 338 cases of consecutive primary canal wall-down mastoidectomies performed between 1974 and 1998. Included were 259 cases with sufficient data.

Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis.

We analyzed the results of 604 cases of primary stapes surgery performed between 1974 and 1997 with replacement of the stapes by a 0.6- or 0.8-mm Schuknecht Teflon-wire piston.

Histopathology of cochlear implants in humans.

The insertion of an intrascalar electrode array during cochlear implantation causes immediate damage to the inner ear and may result in delayed onset of additional damage that may interfere with neuronal stimulation. To date, there have been reports on fewer than 50 temporal bone specimens from patients who had undergone implantation during life. The majority of these were single-channel implants, whereas the majority of implants inserted today are multichannel systems.

[Long-term results of canal wall down mastoidectomy].

Introduction: This study evaluates the anatomical and functional long-term results of canal wall down mastoidectomy.

Method: We analyse the results of 259 primary, one stage canal wall down mastoidectomies with type III, IV or V ossiculoplasty performed between 1974 and 1998. The indication for surgery was chronic active otitis with cholesteatoma or resistant to conservative treatment.

Multiple myeloma presenting with external ear canal mass.

The manifestations of multiple myeloma are protean and related to bony osteolytic lesions, and to medullar and renal insufficiency. We report a patient who presented with otalgia as the inaugural symptom of multiple myeloma. Local irradiation combined with systemic chemotherapy led to the disappearance of the temporal bone mass and the accompanying symptoms.

Ossiculoplasty by interposition of a minor columella between the tympanic membrane and stapes head.

This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded.

Speech recognition with a CIS strategy for the ineraid multichannel cochlear implant.

Wilson et al. proposed a new sound-processing strategy for multichannel cochlear implants, the Continuous Interleaved Sampling (CIS) strategy. Their study was performed on seven American patients, selected for their excellent performance with the Ineraid multichannel cochlear implant, and involved refined testing of several parameter modifications of the CIS strategy during a 1-week period.

First field trials with a portable CIS processor for the Ineraid multichannel cochlear implant.

The continuous interleaved sampling (CIS) strategy is a promising sound processing strategy for multichannel cochlear implants which provides immediate improvements in speech recognition when tested on Ineraid users: patients with only a few hours of experience (in laboratory testing) with the CIS strategy score better than with the Ineraid prosthesis they used since they, were implanted. The goal of this study was to evaluate the benefits that can be gained by the use of the new strategy in every day life. Two patients, implanted with the Ineraid multichannel cochlear implant, were equipped with a portable numerical processor programmed to implement a high rate CIS strategy.

Modified canal wall-up mastoidectomy with mastoid obliteration for severe chronic otitis media.

Mastoid tympanoplasty with a canal wall-up technique provides better conditions for a healthy skin lining than canal wall-down techniques. The formation of retraction pockets in residual pneumatized cavities is however a major cause of cholesteatoma recurrence with canal wall-up techniques. We have therefore attempted to combine the advantages of both canal wall-down and canal wall-up techniques.

Ineraid cochlear implant in the ossified cochlea: surgical techniques and results.

Extensive ossification of the cochlea is a common finding in patients with total deafness caused by meningitis, labyrinthitis, or otosclerosis. When the cochlea is totally ossified, the prognosis for achieving free-running speech without lip reading is poor. However, subtotal ossification with residual cochlear patency in the upper basal turn, the middle turn, or the apical turn can be maximally exploited by selective insertion of electrodes.

[The use of PCR for detecting pathogenic microorganisms in water].

This replication method, which was introduced in 1985, has been used to find and identify microorganisms in the environment, among others in samples of soil, sediments and waters. A gene or a DNA fragment specific to a microorganism is replicated in vitro by a chain reaction catalyzed by DNA polymerase (PCR: Polymerase Chain Reaction) and analyzed by electrophoretic procedures. At the moment in most legislations bacteriological criteria for drinking water depend on E.

Vowel and consonant identification tests can be used to compare performances in a multilingual group of cochlear implant patients.

Vowel and consonant identification tests were conducted in the sound-only condition in a multilingual group of 13 totally deaf patients who are users of the Ineraid multichannel cochlear implant. Native languages ranged across French, German, Italian, Spanish, Albanian and Swahili. We found high correlations (r > -0.

Diagnosis of cerebellopontine angle tumors.

Between 1980 and 1990, 9,176 patients suffering from otoneurological disorders were investigated in our clinic. Sixty-six (0.72%) internal auditory canal or other cerebellopontine angle tumors (CPAT) were diagnosed.

Geneva experience with the Ineraid multichannel cochlear implant.

Ineraid is a multichannel intracochlear implant of recent design that can provide high levels of speech recognition to totally deaf patients. We chose this device when it became available in 1985 because of our clinical and research interests. We had no commercial ties and could therefore critically assess the value of this implant in an array of patients, including congenital deafness, ossified cochleas and perilingual children.

Exploratory cochleotomy. Assessment of auditory nerve excitability and anatomical conditions in cochlear implant candidates.

The exploratory cochleotomy is a new diagnostic procedure for the selection of cochlear implant candidates. We use this procedure to assess the excitability of the auditory nerve, the patency of the cochlea and to detect undesirable side effects of electrical stimulation, such as facial nerve activation. The exploratory cochleotomy is a limited surgical procedure performed under local anesthesia in adults and light sedation in children.

Electrically evoked auditory brainstem responses in cochlear implant patients.

Electrically evoked auditory brainstem responses (EABR) were recorded in completely deaf patients implanted with Ineraid multichannel cochlear implants. Clear and reproducible EABR were obtained from all patients. Parametric differences with auditory brainstem responses (ABR) were demonstrated and can be explained by the different natures of both types of stimulations (electric versus acoustic).

Indication of a relation between speech perception and temporal resolution for cochlear implantees.

In order to better understand the reasons for success or failure of a cochlear implant system for various patients, it appears necessary to analyze the patients' basic psychophysical capacities in relation to speech perception. Five patients with intracochlear multichannel Ineraid implants were studied in terms of their performance on temporal analysis in relation to their perception of consonants. For temporal analysis we measured the detection of a silent gap in noise and of an interval between two clicks.

Intracochlear potential distribution with intracochlear and extracochlear electrical stimulation in humans.

Intracochlear potential distributions were measured from subjects implanted with the Ineraid multichannel cochlear implant. The electrode array provided direct accessibility for obtaining measurements. Different modes of stimulation were used.

Two genes encoding the soybean translation elongation factor eEF-1 alpha are transcribed in seedling leaves.

A cDNA and a genomic DNA library from soybean (Glycine max L.) were used to identify and sequence two genes coding for the alpha-subunit of the translation elongation factor eEF-1. Within the coding part, the two genes (tefS1 and tefS2) diverge in 80 wobble positions thus yielding an identical protein composed of 447 amino acids.

Analysis of streptomycin-resistance of Escherichia coli mutants.

We previously reported about Escherichia coli transformation experiments yielding streptomycin-resistant cells carrying a C912 to T transition in a plasmid-born 16S rRNA gene. These experiments were based on results obtained with streptomycin-resistant Euglena chloroplasts bearing an equivalent mutation in the single chloroplast 16S rRNA gene. We extended this study and transformed E.

Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear.

Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading.