Olivier Sterkers - Academia.edu (original) (raw)
Papers by Olivier Sterkers
PubMed, Sep 1, 1979
The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In ... more The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In the pure, tympanic form, a minimal or extended endaural approach is perfectly suitable. -- In tympano-mastoid forms, without involvement or with minimal involvement of the jugular foramen, a prolonged endaural approach may be used for wider operations involving the whole middle ear and mastoid around a bony aqueduct or an exposed VII. --Nevertheless, in the presence of tympano-jugular or tympano-masto-jugular forms, with marked involvement of jugular foramen, the greatest caution is necessary. It would appear that the endaural route may still be suggested but only for certain tumors, with the express reserve that angiographic studies defining its site and extent are favourable. By virtue of more and more highly developed techniques of exploration (scanner with contrast, films in subtraction) which may be used for measurement and precise localization of the tumor, indications for the type of approach may now be defined with even more precision. --It should be noted that if there is the slightest doubt, the slightest reserve, or the slightest fear that an endaural approach might be inadequate to deal with the situation, it should be definitely avoided with preference for a cervico-retro-auricular or cervicopre and retro-auricular approach, or radiotherapy only, or even abstenstion from operation, with observation. It is only if such rules of good sense and caution are respected that minimal, extended, prolonged endaural approaches will retain a worthy place in the surgical treatment of jugular glomus tumors.
PubMed, Sep 1, 1979
The authors report four rare, benign tumors of the larynx: two granular cell tumors; one large, b... more The authors report four rare, benign tumors of the larynx: two granular cell tumors; one large, benign neuroma, weighing 37 g; one pseudo-tumoral amyloidosis, the diagnostic histological criteria of which are defined.
PubMed, Sep 1, 1979
The authors present a case of a large neuroma of the hypoglossal nerve of unusual size and weight... more The authors present a case of a large neuroma of the hypoglossal nerve of unusual size and weight, the precise nature of which could be defined only after excision, since its cystic surface suggested a diagnosis of cystic lymphangioma. The following special features may be noted: The rarety of neuromas of the XIIth cranial nerve; the influence of the relations of the XIIth nerve with the posterior belly of the digastric and the myloid muscle on development of the neuroma; the false, cystic appearance which may lead to an erroneous diagnosis of tuberculosis, which in itself, would be a contra-indication to puncture for cytological examination of fluid; the tendency to hemorrhage at the time of excision; finally, the possible problems related to nerve section.
CNS Drugs, 2001
The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) hi... more The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) histamine and histaminergic agonists act on the vestibular system both peripherally and centrally; and (ii) histaminergic agonists and antagonists interfere with the recovery process after peripheral vestibular lesion. We have focused on betahistine, a structural analogue of histamine with weak histamine
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1982
Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological... more Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological features in the first case leading to intensive discussion. Two such cases had been previously described in great detail in a paper published in 1977. In those patients, the differential diagnosis froma jugular glomus tumor was only established two and a half years later in one case, when excision was necessary because of an intracranial recurrence, and following-re-examination of all sections of jugular glomus tumors previously operated upon, in the other case. Factors enabling detection of meningiomas simulating glomus tumors were also discussed in the original report. Theses included discordance of clinical finding, -minimal signs on arteriography, -the primordial value of contrast computed tomography, -systematic alerting of the pathologist.
Otology & Neurotology, 2003
To determine the prevalence, symptom characteristics, and potential risk factors for vestibular s... more To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. Study Design: Case-control study design embedded within an ongoing cohort of patients undergoing implantation. Setting: Academic medical center cochlear implant research program funded by the National Institutes of Health. Patients: Seventy five eligible consecutive patients undergoing cochlear implantation. Intervention: Medical record review. Main Outcome Measure: Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. Results: Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. Conclusions: Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.
CNS Drugs, 2001
The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) hi... more The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) histamine and histaminergic agonists act on the vestibular system both peripherally and centrally; and (ii) histaminergic agonists and antagonists interfere with the recovery process after peripheral vestibular lesion. We have focused on betahistine, a structural analogue of histamine with weak histamine
PubMed, Sep 1, 2001
The management of small acoustic neuromas (AN) whether localized in an intracanalar position (sta... more The management of small acoustic neuromas (AN) whether localized in an intracanalar position (stage I) or with a small extension of less then 2 cm into the cerebellopontine angle (stage II) remains under debate. Proposed strategies include surgery, stereotactic irradiation and observation. From 1987 to 1997, among 343 AN referred to our department, 207 were small (83 stage I and 124 stage II). Initially, 72 patients were treated conservatively mainly because of their age (over 60-65) and 132 were operated on. Three patients underwent irradiation because of their poor general condition. Significant tumor growth was observed in 15 cases in the conservative treatment group; 14 of these patients underwent secondary surgery and one irradiation. Among the 146 AN operated on (132 initially and 14 secondarily), 142 small AN were operated on via a transpetrosal approach (64% translabyrinthine, 21% middle-fossa and 15% retrosigmoid) and 4 AN, which became large tumors during the observation period, were treated through the translabyrinthine approach. No mortality was observed in our series. Postoperative complications included 11 CSF leakages necessitating reoperation (8%). In 93% of the cases, postoperative facial function at one year was good. Hearing preservation was attempted in 51 selected cases (pure tone average=50 dB, speech discrimination score 100%) with a 51% success rate (53% and 48% through middle-fossa and retrosigmoid approaches respectively). In our opinion, surgery with this risk-benefit ratio is indicated for small AN, except in the elderly for whom conservative management is preferred and in patients in poor clinical condition with a growing AN, for whom irradiation is recommended.
Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 120 - N° ... more Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 120 - N° 4 - p. 225-230
KARGER eBooks, 2007
To evaluate results of cochlear implantation in patients with far-advanced otosclerosis. Sixteen ... more To evaluate results of cochlear implantation in patients with far-advanced otosclerosis. Sixteen patients with far-advanced otosclerosis had undergone unilateral (n = 13) or bilateral (n = 3) cochlear implantation. Surgical difficulties, incidence of complications and postoperative benefit were analyzed. A full electrode insertion was achieved in all patients without surgical difficulties. All patients demonstrated excellent benefit of cochlear implantation. Binaural implantation still improves speech performances, compared to unilateral implantation. In case of residual cochlear function of one nonoperated side, a stapes surgery, performed during the same surgical time as cochlear implantation, can improve speech scores and restore bilateral hearing. Facial nerve stimulation occurred only in 1 patient. Cochlear implantation is the method of choice for rehabilitation of patients with otosclerosis, presenting profound or total hearing loss. Patients obtain excellent benefit with a low rate of complications.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Oct 1, 2013
Engagement de non plagiat Je soussignée Noiret Amandine, déclare être pleinement consciente que l... more Engagement de non plagiat Je soussignée Noiret Amandine, déclare être pleinement consciente que le plagiat de documents ou d'une partie d'un document publiés sur toutes formes de support, y compris l'Internet, constitue une violation des droits d'auteur ainsi qu'une fraude caractérisée. En conséquence, je m'engage à citer toutes les sources que j'ai utilisées pour écrire ce mémoire. Je soussignée Lavrut Mathilde, déclare être pleinement consciente que le plagiat de documents ou d'une partie d'un document publiés sur toutes formes de support, y compris l'Internet, constitue une violation des droits d'auteur ainsi qu'une fraude caractérisée. En conséquence, je m'engage à citer toutes les sources que j'ai utilisées pour écrire ce mémoire.
EMC - Otorrinolaringología, Nov 1, 2013
EMC - Otorinolaringoiatria, Sep 1, 2013
L'impianto uditivo del tronco cerebrale è una modalità di riabilitazione dell'udito le cui indica... more L'impianto uditivo del tronco cerebrale è una modalità di riabilitazione dell'udito le cui indicazioni sono rare. Si tratta delle situazioni dove l'impianto cocleare è impossibile o inefficace: presenza di tumori delle vie uditive, ossificazioni cocleari e malformazioni della coclea e del nervo uditivo. La principale è la neurofibromatosi di tipo 2. Le indicazioni sono poste dopo una valutazione pluridisciplinare e il posizionamento del portaelettrodi, la cui configurazione è adattata all'anatomia del tronco cerebrale, è eseguito durante un intervento da parte di un'equipe oto-neuro-chirurgica. I risultati ottenuti dal punto di vista funzionale sono variabili e possono raggiungere, nei casi migliori, quelli ottenuti con un impianto cocleare.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Feb 1, 2018
Objectifs.-L'évaluation de l'impact de la surdité et de sa réhabilitation (aides auditives, impla... more Objectifs.-L'évaluation de l'impact de la surdité et de sa réhabilitation (aides auditives, implant cochléaire) sur la qualité de vie est fondamentale. Les questionnaires couramment utilisés (Nijmegen, Aphab, GBI) sont longs, compliqués à remplir et peu sensibles aux faibles améliorations/détériorations. L'objectif de cette étude est de valider une échelle de qualité de vie destinée aux patients adultes présentant une perte auditive qu'elle soit réhabilitée ou non. Matériel et méthodes.-Le questionnaire d'évaluation du retentissement de la surdité chez l'adulte (Ersa) est un questionnaire auto-administré, divisé en quatre sous-domaines comprenant chacun cinq questions notées de 1 à 10. Les questions sont simples et formulées de faç on à ce que le patient réponde à l'instant présent. La fiabilité test-retest d'Ersa a été mesurée chez 38 patients. La cohérence interne et la validité par rapport au questionnaire Aphab et aux performances auditives ont été mesurées chez 122 patients lors du bilan de surdité. La sensibilité au changement a été mesurée chez 36 patients avant et 6 à 12 mois après l'implantation cochléaire. Résultats.-La fiabilité du questionnaire Ersa (test/retest) est très satisfaisante (= 0,88). La cohérence interne est bonne pour l'ensemble des questions. La validité de structure externe, étudiée en comparant, chez les patients sourds non implantés, les scores Ersa à ceux du questionnaire Aphab, est bonne (= 0,52). Le score Ersa est corrélé aux performances auditives dans des situations d'écoute difficiles (mots monosyllabiques : = 0,22 ; phrases dans le bruit : = 0,19). Chez les patients testés avant et après implantation, l'amélioration des performances auditives dans le silence et dans le bruit est corrélée à l'amélioration du score Ersa (= 0,37 à 0,59 selon les tests), mais pas au score GBI. Conclusion.-Le questionnaire Ersa est un outil facile, rapide d'utilisation, fiable et sensible au changement des performances auditives après une implantation cochléaire.
PubMed, Feb 1, 1998
Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some... more Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some combination of these three. In the past, they have been found at autopsy or as incidental finding at surgery. Since the advent of magnetic resonance imaging (MRI) with intravenous gadolinium contrast, the preoperative diagnosis is possible. We report two cases of intralabyrinthine schwannoma: one case of intralabyrinthine schwannoma extended into the internal auditory canal (IAC), a second case of tumor restricted to the vestibule. No characteristic clinical presentation of this tumor is reported in the literature. In patients with vestibular weakness (vertigo and no response of caloric testing), MRI with gadolinium contrast can make the diagnosis of intravestibular tumor. In patients with the more common IAC acoustic neuromas, MRI can demonstrate extension of tumor into the labyrinth; diagnosing this extension preoperatively is important to plan surgical treatment.
PubMed, Nov 1, 1998
Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via m... more Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via middle cranial fossa approach (MFA: 23 cases) or translabyrinthine approach (TL: 3 cases), 9 cases were supervised by audiovestibular testing and MRI. For the operated patients through MFA the functional hearing (pure tone loss < 50 dB and 100% vocal discrimination) was preserved in 47.8% of cases, facial function was grade I and II in 83% of cases and grade III in 17% of cases. One recurrence was noted and reoperated by TL. For the TL operated patients, the postoperative facial function was normal (grade I) in all cases. Among the 9 supervised cases for reasons of age (more than 60 years), or the tumoral size (< than 5 mm): the tumor in 3 cases did not increase in size, 5 cases increased by 1 mm/year and 1 case increased 1 cm/year (and must be operated). These results show the importance of the middle cranial fossa approach for excision of intracanalicular neuromas and supervising patients with the same tumor according to age, and tumoral size.
PubMed, Sep 1, 1979
The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In ... more The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In the pure, tympanic form, a minimal or extended endaural approach is perfectly suitable. -- In tympano-mastoid forms, without involvement or with minimal involvement of the jugular foramen, a prolonged endaural approach may be used for wider operations involving the whole middle ear and mastoid around a bony aqueduct or an exposed VII. --Nevertheless, in the presence of tympano-jugular or tympano-masto-jugular forms, with marked involvement of jugular foramen, the greatest caution is necessary. It would appear that the endaural route may still be suggested but only for certain tumors, with the express reserve that angiographic studies defining its site and extent are favourable. By virtue of more and more highly developed techniques of exploration (scanner with contrast, films in subtraction) which may be used for measurement and precise localization of the tumor, indications for the type of approach may now be defined with even more precision. --It should be noted that if there is the slightest doubt, the slightest reserve, or the slightest fear that an endaural approach might be inadequate to deal with the situation, it should be definitely avoided with preference for a cervico-retro-auricular or cervicopre and retro-auricular approach, or radiotherapy only, or even abstenstion from operation, with observation. It is only if such rules of good sense and caution are respected that minimal, extended, prolonged endaural approaches will retain a worthy place in the surgical treatment of jugular glomus tumors.
PubMed, Sep 1, 1979
The authors report four rare, benign tumors of the larynx: two granular cell tumors; one large, b... more The authors report four rare, benign tumors of the larynx: two granular cell tumors; one large, benign neuroma, weighing 37 g; one pseudo-tumoral amyloidosis, the diagnostic histological criteria of which are defined.
PubMed, Sep 1, 1979
The authors present a case of a large neuroma of the hypoglossal nerve of unusual size and weight... more The authors present a case of a large neuroma of the hypoglossal nerve of unusual size and weight, the precise nature of which could be defined only after excision, since its cystic surface suggested a diagnosis of cystic lymphangioma. The following special features may be noted: The rarety of neuromas of the XIIth cranial nerve; the influence of the relations of the XIIth nerve with the posterior belly of the digastric and the myloid muscle on development of the neuroma; the false, cystic appearance which may lead to an erroneous diagnosis of tuberculosis, which in itself, would be a contra-indication to puncture for cytological examination of fluid; the tendency to hemorrhage at the time of excision; finally, the possible problems related to nerve section.
CNS Drugs, 2001
The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) hi... more The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) histamine and histaminergic agonists act on the vestibular system both peripherally and centrally; and (ii) histaminergic agonists and antagonists interfere with the recovery process after peripheral vestibular lesion. We have focused on betahistine, a structural analogue of histamine with weak histamine
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1982
Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological... more Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological features in the first case leading to intensive discussion. Two such cases had been previously described in great detail in a paper published in 1977. In those patients, the differential diagnosis froma jugular glomus tumor was only established two and a half years later in one case, when excision was necessary because of an intracranial recurrence, and following-re-examination of all sections of jugular glomus tumors previously operated upon, in the other case. Factors enabling detection of meningiomas simulating glomus tumors were also discussed in the original report. Theses included discordance of clinical finding, -minimal signs on arteriography, -the primordial value of contrast computed tomography, -systematic alerting of the pathologist.
Otology & Neurotology, 2003
To determine the prevalence, symptom characteristics, and potential risk factors for vestibular s... more To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. Study Design: Case-control study design embedded within an ongoing cohort of patients undergoing implantation. Setting: Academic medical center cochlear implant research program funded by the National Institutes of Health. Patients: Seventy five eligible consecutive patients undergoing cochlear implantation. Intervention: Medical record review. Main Outcome Measure: Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. Results: Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. Conclusions: Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.
CNS Drugs, 2001
The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) hi... more The aim of this review is to provide clinicians with a picture of the mechanisms by which: (i) histamine and histaminergic agonists act on the vestibular system both peripherally and centrally; and (ii) histaminergic agonists and antagonists interfere with the recovery process after peripheral vestibular lesion. We have focused on betahistine, a structural analogue of histamine with weak histamine
PubMed, Sep 1, 2001
The management of small acoustic neuromas (AN) whether localized in an intracanalar position (sta... more The management of small acoustic neuromas (AN) whether localized in an intracanalar position (stage I) or with a small extension of less then 2 cm into the cerebellopontine angle (stage II) remains under debate. Proposed strategies include surgery, stereotactic irradiation and observation. From 1987 to 1997, among 343 AN referred to our department, 207 were small (83 stage I and 124 stage II). Initially, 72 patients were treated conservatively mainly because of their age (over 60-65) and 132 were operated on. Three patients underwent irradiation because of their poor general condition. Significant tumor growth was observed in 15 cases in the conservative treatment group; 14 of these patients underwent secondary surgery and one irradiation. Among the 146 AN operated on (132 initially and 14 secondarily), 142 small AN were operated on via a transpetrosal approach (64% translabyrinthine, 21% middle-fossa and 15% retrosigmoid) and 4 AN, which became large tumors during the observation period, were treated through the translabyrinthine approach. No mortality was observed in our series. Postoperative complications included 11 CSF leakages necessitating reoperation (8%). In 93% of the cases, postoperative facial function at one year was good. Hearing preservation was attempted in 51 selected cases (pure tone average=50 dB, speech discrimination score 100%) with a 51% success rate (53% and 48% through middle-fossa and retrosigmoid approaches respectively). In our opinion, surgery with this risk-benefit ratio is indicated for small AN, except in the elderly for whom conservative management is preferred and in patients in poor clinical condition with a growing AN, for whom irradiation is recommended.
Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 120 - N° ... more Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 120 - N° 4 - p. 225-230
KARGER eBooks, 2007
To evaluate results of cochlear implantation in patients with far-advanced otosclerosis. Sixteen ... more To evaluate results of cochlear implantation in patients with far-advanced otosclerosis. Sixteen patients with far-advanced otosclerosis had undergone unilateral (n = 13) or bilateral (n = 3) cochlear implantation. Surgical difficulties, incidence of complications and postoperative benefit were analyzed. A full electrode insertion was achieved in all patients without surgical difficulties. All patients demonstrated excellent benefit of cochlear implantation. Binaural implantation still improves speech performances, compared to unilateral implantation. In case of residual cochlear function of one nonoperated side, a stapes surgery, performed during the same surgical time as cochlear implantation, can improve speech scores and restore bilateral hearing. Facial nerve stimulation occurred only in 1 patient. Cochlear implantation is the method of choice for rehabilitation of patients with otosclerosis, presenting profound or total hearing loss. Patients obtain excellent benefit with a low rate of complications.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Oct 1, 2013
Engagement de non plagiat Je soussignée Noiret Amandine, déclare être pleinement consciente que l... more Engagement de non plagiat Je soussignée Noiret Amandine, déclare être pleinement consciente que le plagiat de documents ou d'une partie d'un document publiés sur toutes formes de support, y compris l'Internet, constitue une violation des droits d'auteur ainsi qu'une fraude caractérisée. En conséquence, je m'engage à citer toutes les sources que j'ai utilisées pour écrire ce mémoire. Je soussignée Lavrut Mathilde, déclare être pleinement consciente que le plagiat de documents ou d'une partie d'un document publiés sur toutes formes de support, y compris l'Internet, constitue une violation des droits d'auteur ainsi qu'une fraude caractérisée. En conséquence, je m'engage à citer toutes les sources que j'ai utilisées pour écrire ce mémoire.
EMC - Otorrinolaringología, Nov 1, 2013
EMC - Otorinolaringoiatria, Sep 1, 2013
L'impianto uditivo del tronco cerebrale è una modalità di riabilitazione dell'udito le cui indica... more L'impianto uditivo del tronco cerebrale è una modalità di riabilitazione dell'udito le cui indicazioni sono rare. Si tratta delle situazioni dove l'impianto cocleare è impossibile o inefficace: presenza di tumori delle vie uditive, ossificazioni cocleari e malformazioni della coclea e del nervo uditivo. La principale è la neurofibromatosi di tipo 2. Le indicazioni sono poste dopo una valutazione pluridisciplinare e il posizionamento del portaelettrodi, la cui configurazione è adattata all'anatomia del tronco cerebrale, è eseguito durante un intervento da parte di un'equipe oto-neuro-chirurgica. I risultati ottenuti dal punto di vista funzionale sono variabili e possono raggiungere, nei casi migliori, quelli ottenuti con un impianto cocleare.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Feb 1, 2018
Objectifs.-L'évaluation de l'impact de la surdité et de sa réhabilitation (aides auditives, impla... more Objectifs.-L'évaluation de l'impact de la surdité et de sa réhabilitation (aides auditives, implant cochléaire) sur la qualité de vie est fondamentale. Les questionnaires couramment utilisés (Nijmegen, Aphab, GBI) sont longs, compliqués à remplir et peu sensibles aux faibles améliorations/détériorations. L'objectif de cette étude est de valider une échelle de qualité de vie destinée aux patients adultes présentant une perte auditive qu'elle soit réhabilitée ou non. Matériel et méthodes.-Le questionnaire d'évaluation du retentissement de la surdité chez l'adulte (Ersa) est un questionnaire auto-administré, divisé en quatre sous-domaines comprenant chacun cinq questions notées de 1 à 10. Les questions sont simples et formulées de faç on à ce que le patient réponde à l'instant présent. La fiabilité test-retest d'Ersa a été mesurée chez 38 patients. La cohérence interne et la validité par rapport au questionnaire Aphab et aux performances auditives ont été mesurées chez 122 patients lors du bilan de surdité. La sensibilité au changement a été mesurée chez 36 patients avant et 6 à 12 mois après l'implantation cochléaire. Résultats.-La fiabilité du questionnaire Ersa (test/retest) est très satisfaisante (= 0,88). La cohérence interne est bonne pour l'ensemble des questions. La validité de structure externe, étudiée en comparant, chez les patients sourds non implantés, les scores Ersa à ceux du questionnaire Aphab, est bonne (= 0,52). Le score Ersa est corrélé aux performances auditives dans des situations d'écoute difficiles (mots monosyllabiques : = 0,22 ; phrases dans le bruit : = 0,19). Chez les patients testés avant et après implantation, l'amélioration des performances auditives dans le silence et dans le bruit est corrélée à l'amélioration du score Ersa (= 0,37 à 0,59 selon les tests), mais pas au score GBI. Conclusion.-Le questionnaire Ersa est un outil facile, rapide d'utilisation, fiable et sensible au changement des performances auditives après une implantation cochléaire.
PubMed, Feb 1, 1998
Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some... more Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some combination of these three. In the past, they have been found at autopsy or as incidental finding at surgery. Since the advent of magnetic resonance imaging (MRI) with intravenous gadolinium contrast, the preoperative diagnosis is possible. We report two cases of intralabyrinthine schwannoma: one case of intralabyrinthine schwannoma extended into the internal auditory canal (IAC), a second case of tumor restricted to the vestibule. No characteristic clinical presentation of this tumor is reported in the literature. In patients with vestibular weakness (vertigo and no response of caloric testing), MRI with gadolinium contrast can make the diagnosis of intravestibular tumor. In patients with the more common IAC acoustic neuromas, MRI can demonstrate extension of tumor into the labyrinth; diagnosing this extension preoperatively is important to plan surgical treatment.
PubMed, Nov 1, 1998
Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via m... more Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via middle cranial fossa approach (MFA: 23 cases) or translabyrinthine approach (TL: 3 cases), 9 cases were supervised by audiovestibular testing and MRI. For the operated patients through MFA the functional hearing (pure tone loss < 50 dB and 100% vocal discrimination) was preserved in 47.8% of cases, facial function was grade I and II in 83% of cases and grade III in 17% of cases. One recurrence was noted and reoperated by TL. For the TL operated patients, the postoperative facial function was normal (grade I) in all cases. Among the 9 supervised cases for reasons of age (more than 60 years), or the tumoral size (< than 5 mm): the tumor in 3 cases did not increase in size, 5 cases increased by 1 mm/year and 1 case increased 1 cm/year (and must be operated). These results show the importance of the middle cranial fossa approach for excision of intracanalicular neuromas and supervising patients with the same tumor according to age, and tumoral size.