[Acute pseudoperipheric vertigo and Wallenberg syndrome].

We report an atypical Wallenberg syndrome presented with an acute vertigo, preceded by headache, simulating a peripheral vestibular pathology. The first Magnetic Resonance Imaging (MRI) study done in urgencies is negative. Presence of headache, strong lateral ataxia and secondary focally neurological symptoms 48h after the beginning of the crises, lead to a repetition of the MRI which shows a right lateral bulbar infarct.

Négrevergne otoplasty technique.

Objectives: More than 200 different otoplasty procedures have been described in the literature to treat patients with prominent ears. However, no simple "best" technique exists.

Methods: The Négrevergne otoplasty technique was developed by Michel Négrevergne and adopted in the Georges Portmann Institute in France.

[Dehiscence of the superior semicircular canal: approach and CT scan classifications].

Unlabelled: The syndrome of dehiscence of the superior semicircular canal (DCSS) is primarily associated with vertigo and/or hearing loss. The dehiscence may be completely asymptomatic and represent an incidental finding on radiological investigation.

Objectives: To demonstrate the advantages of a volume rendered CT study of the petrous temporal bone of patients with hearing loss, and to demonstrate the effectiveness of its systematic application in the protocols of examination.

[Skull vibration induced nystagmus test].

Objectives: To establish during a consensus meeting the fundamental basis, the validity criteria, the main indications and results of the skull vibration induced nystagmus test (SVINT) which explores the vestibule high frequencies.

Material And Methods: The SVINT is applied on the mastoid process (right and left sides) at 100 Hz during 10 seconds on a sitting upright subject. Total unilateral peripheral lesions (tUVL: operated vestibular shwannomas, vestibular neurectomies) and partial unilateral peripheral lesions (pUVL: preoperative neuromas, Meniere's disease, vestibular neuritis, chemical labyrinthectomies) were studied.

Bilateral cochlear implantation in a patient with long-term deafness.

Purpose Of The Study: 1) To report the case of a 70-year-old patient with a history of auditory deprivation for 80% of his life and who received bilateral cochlear implants and 2) to discuss different aspects of the case, including duration of auditory deprivation, the decision for bilateral implantation, age at implantation, and the use of this treatment modality for tinnitus.

Case Report: A two-stages bilateral cochlear implantation was performed in a 70-year-old patient with long-term deafness without operative or post-operative problems with excellent functional result.

Discussion: Various studies have reported that in patients with long-term auditory deprivation, the results of cochlear implants are delayed and sometimes unsatisfactory when compared to patients with more recent post-lingual deafness.

[The neurotologic evaluation of vestibular schwannomas. Results of audiological and vestibular testing in 100 consecutive cases].

Objectives: To determine the results and sensitivity of a comprehensive audiological and vestibular work-up in patients presenting with vestibular schwannoma (VS).

Material And Methods: One hundred consecutive cases of VS diagnosed from January 2004 to May 2005 were prospectively studied. The tumour size was classified according to Koos classification and hearing was assessed according to the five-stage classification from the Tokyo consensus.

[Vertigo and pathology of the cerebellospinal system].

Central vertigo is most often expressed by a feeling of dizziness, non or badly systematized, but it can also appear, more seldom, like an isolated acute vertigo or associated to other neurological signs. A precise clinical exam can lead to evidence essential clinical informations (significant ataxia, neurological signs, gaze nystagmus, pursuit anomaly,..

[Vertigo and pathology of the cerebello-pontine angle].

Many pathologies of the cerebello-pontine angle can induce vertigo or dizziness. Usually they are due to benign or malignant tumors. Pathophysiology of this vertigo involve lesion of the labyrinth with erosion, of the endolymphatic sac by invasion or compression, or directly by lesion of the vestibular nerve like in vestibular schwannomas.

[Reinforcing tympanoplasty with cartilage mosaic (differences from the palisade technique)].

Objectives: To demonstrate the interest of cartilage mosaic tympanoplasty in the reconstruction of the tympanic membrane.

Materials And Methods: Retrospective series of 103 patients; the authors analyzed their results after cartilage mosaic tympanoplasty, with a mean follow up of 3.5 years (3 to 7 years).

Otoplasty for prominent ears in children. The technique adopted in the Portmann Institute.

The Otoplasty technique adopted in the Portmann Institute is a simple rapid technique that maintains the natural contours of the auricle with minimal risk of infection. The technique involves excision of a large ellipse of skin from the mastoid surface of the auricle and reflection of remaining skin to the edge of the helix. The subcutaneous and muscular tissues on the mastoid bone are excised and the mastoid surface of the auricular cartilage scored with monopolar diathermy.

[Video-nystagmography and vibration test in the diagnosis of vestibular schwannoma. Review of 100 cases].

Objective: To evaluate informations given by the combination of videonystagmography (VNG) including vibratory tests and auditory brainstem responses (ABR) in patients suffering vestibular schwannoma (VS) and try to find the most conclusive test(s). Combination of different functional tests is supposed to improve diagnosis and preoperative evaluation and precise indication for magnetic resonance imaging (MRI) facing audiological and vestibular symptoms.

Material And Method: A prospective study of 100 patients with VS.

[Multi-frequency impedance measurement and Meniere's disease. Analysis of the results of TEFLAG].

We present today our preliminary results of the TEFLAG test performed on 58 patients suffering from Meniere's disease. This test completed in 1993 has already led to a 4-stage classification of noise induced hearing losses. On the one hand, it is based on the morphological study of susceptance B curves, and on the other hand, on the study of the resonant frequency (RF) of the annular ligament of the stapes, provided by a multifrequential impedancemeter.

[Multi-frequency tympanometry in experimentally-induced cochlear lesions in chinchillas and guinea pigs].

Objectives: To establish that susceptance-conductance tympanograms at a probe-tone frequency of 2 kHz reflects the status of the annular ligament (AL) and through it of the cochlea.

Methods: Experimental study in 5 chinchillas and 22 guinea pigs. Six validating experiments were used: blockages of the stapes and of the round window membrane (RWM), fistula of the RWM, fluid removal from the cochlea, injection of saline in the scala tympani (ST) and acoustic trauma (AT).

[Middle ear physiology].

The middle ear forms part of the sound transformer mechanism, together with the outer ear and the conducting system of the inner ear. An intermediate sensory organ, sensitive to acoustic vibration, and linked to the inner ear, the middle ear made its appearance during the period of adaptation of marine creatures to a terrestrial habitat; its presence is therefore a phylogenetic requirement. It is classical to ascribe three functions to the middle ear: the transmission of acoustic vibrations from the tympanic membrane to the cochlea, impedance matching between the air in the external auditary meatus and the labyrinthine fluids, and protection of the inner ear by means of the acoustic reflex.

[Rotatory impulse test does not replace caloric tests].

We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test.

[Genetic deafness and Pendred syndrome].

The authors present two cases of genetic deafness in a brother and his sister. The girl has shown to suffer from a deafness belonging to Pendred's syndrome; in this case, the development of hearing symptomatology since her puberty is presented as an aggravated crisis of deafness and tinnitus coinciding with her menstruation, what suggests a possible endolymphatic hydrops depending of hormonal factors; the lack of knowledge about the ethyopatogenic mechanisms in this field generates therapeutic difficulties hard to solve.

[Multifrequency impedance audiometry and study of occupational deafness: "Teflag", a new test].

The mechanical acoustic theory compares the annular ligament of the stapes to an elastic plot; plot # 2. The coupled stapedial muscle and annular ligament partly ensure the dampening of acoustic impulses (low frequencies in particular) and helped by the stapes footplate, their transmission, by hydraulic pressure to the liquids of the cochlea. This muscle ligament couple represents the true impedance adaptor for the middle ear region.

[Tympanoplasty in clinical practice: use and results].

The halt in the use of allografts has resulted in the use in clinical practice in humans of a product that has been known for at least thirty years: collagen. Interesting experimental animal studies have been performed with the type I and type III collagen currently used: the Tympanoplast. This collagen, already used in numerous medical fields (digestive, renal and neuro-surgery) is of bovine origin.

[Peroperative catheterization of the Eustachian tube].

Peroperative catheterization of the Eustachian tube is an exploratory and management technique enabling a better understanding of the pathological phenomena, resulting in a more effective therapeutic orientation for short term lesions (infection). In the long term, tubal rehabilitation becomes a logical complement.

[Deafness after meningitis and cochlear implant in children].

The authors have studied 70 postmeningitic hearing losses in children. The deafness was acquired before the age of 2 year-old in 71% of the cases. Profound losses were observed in 50% considering the 1000 Hz at +100 dB, on the best ear as a selection criterion, 31 cases/70 (= 44%) could benefit from a cochlear implant.

[Electrocochleography and topographic diagnosis].

We present a group of 50 patients with retrocochlear pathology, divided on 41 (82 per 100) non tumoral and 9 (18 per 100) tumoral: 8 cerebello-pontine angle meningiomas and 1 intracranial cholesteatoma. The retrocochlear diagnosis of the pathology is assessed by the results of the audiovestibular explorations, specially the electrophysiology (early auditory evoked response, electrocochleography). The neuroradiologic explorations (TAC, MNR) define the tumoral or non tumoral nature of the pathology.

[Stapedial reflex in nontumor retrocochlear pathology].

The authors study the different parameters of the stapedius reflex on a 55 patients group with retrocochlear and non tumoral diagnostic is assess by electrophysiologic (BERA, Electrocochleography) and neuroradiologic explorations (TAC), Meato-cisternography, NMR). We realise an comparative study between the results of this group and the results of 2 other groups (98 acoustic neuromas and 104 endocochlear diseases). The test has a moderate sensibility and none specificity in this kind of pathology, because the high percent of false negative (30%), and the positivity on 95% of acoustic neuromas and on 74% of endocochlear diseases.