Le syndrome de Cogan est une vascularite rare touchant préférentiellement les sujets jeunes sans distinction de sexe, associant des atteintes cochléovestibulaires et ophtalmologiques. Malgré le traitement médical, le pronostic de la fonction auditive est réservé avec 50 à 60 % des patients qui gardent une surdité sévère à profonde irréversible et deviennent candidats à l’implantation cochléaire. En suivant la ligne directrice CARE, nous avons reporté 10 cas de patients implantés cochléaires dans le cadre d’un syndrome de Cogan avec évaluation du seuil et du maximum d’intelligibilité avec au moins 1 an d’expérience avec l’implant cochléaire. Dix patients issus de 4 centres étaient implantés cochléaires (14 implants cochléaires) dans le cadre d’un syndrome de Cogan entre 2005 et 2020. Après 1 an d’expérience avec l’implant cochléaire, il était noté une amélioration significative du seuil d’intelligibilité (p = 0,0002) et du maximum d’intelligibilité (p = 0,0002). La présence de signes audio-vestibulaires associés à des manifestations ophtalmologiques doit faire évoquer un syndrome de Cogan. L’atteinte de la fonction auditive est habituellement irréversible et une implantation cochléaire peut être nécessaire. Cette réhabilitation améliore les performances auditives des patients.

INTRODUCTION:Cogan's syndrome is a rare form of vasculitis mainly affecting young subjects of whatever gender, associating cochleovestibular and ophthalmological damage. Despite medical treatment, auditory prognosis is uncertain, with 50-60% of patients showing irreversible severe to profound hearing loss, thus being candidates for cochlear implantation. Following CARE guidelines, we report 10 cases of cochlear implantation in Cogan's syndrome, with assessment of speech reception threshold and maximum intelligibility after a minimum 1 year's experience with the implant.CASE SERIES:Ten patients from 4 centers received cochlear implants (14 implants) for Cogan's syndrome between 2005 and 2020. After 1 year's experience, there was significant improvement in speech reception threshold (P=0.0002) and maximum intelligibility (P=0.0002).CONCLUSION-DISCUSSION:Audiovestibular signs associated with ophthalmological manifestations should suggest Cogan's syndrome. Hearing impairment is usually irreversible. Cochlear implantation may be necessary and improves hearing performance.

Objectives This study aimed to investigate predictive factors for revision surgery in otosclerosis. Methods This was a retrospective, multicentre study in four tertiary centres. The primary objective was to investigate factors that were predictive of the need for revision stapes surgery. Results The ‘revision’ group included 145 patients, and the ‘control’ group included 143 patients. This study identified statistically significant predictive factors for the need for revision surgery: younger age, active smoking status, dyslipidaemia and high blood pressure. There was no statistically significant difference between the two groups in terms of surgical technique or stapedotomy technique. Conclusion This study showed that patients who are candidates for primary stapes surgery with younger age, active smoking status, dyslipidaemia and high blood pressure are at higher risk of needing revision surgery. A holistic approach prior to stapes surgery with multidisciplinary assessment is recommended. These results are important for better patient counselling on expected outcomes and risks.

Objectives: To analyze the performance of cochlear implants in French patients aged 65 and over, implanted between 2012 and 2016, using data from the French national registry for cochlear implants (EPIIC). Materials and methods: The French national registry incorporates patient data from before implantation and for three years after implantation, stratified in different age groups (18-39, 40-64 years, 65-74 years and > 75 years). Here, we assessed the latter two categories. Hearing was assessed using mono- and disyllabic words in a silent background. The Category of Auditory Performance (CAP) scale was also implemented and subjects took the Abbreviated Profile of Hearing Aid Benefit (Aphab) questionnaire. Results: The population aged over 65 accounted for 38% (n=1193) of the 3178 adult implanted patients. The performance for mono- and disyllabic words in silence, the CAP scores and the APHAB questionnaire answers for ease of communication, background noise and reverberation were dramatically improved at one year post-implantation (P < 0.0001 for each score) and remained stable between one and three years thereafter. The percentage improvement was similar across all age groups. The scores for loud-noise intolerance did not change after cochlear implantation in any age group. Conclusion: Cochlear implants improve hearing and communication in subjects aged 65 and over, with comparable efficiency to that achieved in younger subjects. Cochlear implantation should thus be proposed whenever hearing aids provide only limited benefit. However, between 2012 and 2016, cochlear implantation was given to less than 1% of the French population aged 65 and over with profound deafness. (C) 2020 Elsevier Masson SAS. All rights reserved.

OBJECTIVES:Assessment of the incidence and results of bilateral cochlear implantation in adults and children in France.MATERIALS AND METHODS:Multicenter retrospective study of data in the French national registry of cochlear implantations from January 1st 2012 to December 31st 2016. Functional results from CAP (Category of Auditory Performance) questionnaires and speech audiometry tests, with mono- and di-syllabic word-lists, were compared before and after implantation. Speech audiometry tests were carried out against a noisy background, except before simultaneous implantations.RESULTS:Nine hundred and forty two bilateral cochlear implantations were performed during this period, that is, 16.4% of all cochlear implantations. Five hundred and eighty eight bilateral implantations were performed sequentially. 59% of the bilateral implantations were performed in children. Bilateral implants significantly improved CAP scores in all cases (P<0.001). Auditory performance, with the two types of word-list, were significantly improved after simultaneous implantation (P<0.01). After sequential implantation, the speech discrimination score, already very good with the first implant, reached 63±26% [0-100] with monosyllabic word lists, and 72±28% [0-100] with dissyllabic words. There were more complications due to surgery in bilateral cases than in the entire population of cochlear recipients (9.1% vs 6.4%, P<0.02).CONCLUSION:Hearing is significantly improved by simultaneous cochlear implantation. For sequential implantation, at one year, when auditory results were already excellent from the first implant, in the bimodal condition CAP scores were significantly improved, although there was no further change in speech audiometry in noise.

Objective: Multi-centre study of the National French Registry (EPIIC) of patients with cochlear implants, focusing on infants who were operated-on under the age of 24 months between 2012 and 2016. Patients and methods: A total of 615 profoundly deaf infants, who received cochlear implants (CIs) before their second birthday, were included in the registry by different CI centers. Epidemiological, surgical, speech therapy and school, follow-up data were included in the registry, 12, 24, 36 and 48 months thereafter. The following parameters were studied: type of implantation (uni- or bilateral), complications, cause of deafness, category of auditory perception (CAP), Open-set word recognition score (OSW), speech intelligibility rating, lexical comprehension with EVIP (Peabody), communication mode and type of schooling. Bilateral simultaneous CI (BiCI) and unilateral CI (UniCI) groups were compared. Results: There were 744 implantations. The explantation-reimplantation rate, within the four-year followup, was just 3.6%. Mean implantation age was 16.0 months, and similar in the two groups (BiCI/UniCI). A total of 51% of children had their first implant between 12 and 18 months, and 15% before 12 months. Implantation was unilateral in 52% of cases. Fifty-six percent of the bilateral procedures were sequential, with a mean delay of 16.8 months for the second implantation. The cause of deafness was unknown in 52% of cases. Of the 48% (297/615) of attributed cases, 32% had clear genetic causes. The remaining deafness was due to cytomegalovirus (CMV, 8%), inner-ear malformation (5%) and meningitis (3%). The main complications were from infections (47%) and internal device failure (25%). Four years post-operation, 84% of the UniCI and 75% of BiCI groups had a CAP >= 5, and 83% of UniCl and 100% BiCI had OSW >= 80%. Furthermore 74% of UniCI and 77% of BiCI communicated orally and 85% of UniCI and 90% of BiCI integrated into mainstream schooling. Conclusion: The French Registry of cochlear implants (EPIIC) is the only such national registry in the world. Our analysis illustrates the immediate benefits of, either single or double, cochlear implantation for language, perception skills and schooling. (C) 2020 Elsevier Masson SAS. All rights reserved.

Objective: Evaluate in France the outcomes of cochlear implantation outside the selection criteria, off-label. Material and methods: This is a prospective cohort study including adults and children having received a cochlear implant (CI) in an off-label indication, that is outside the criteria established by the "Haute Autorite de sante (HAS)" in 2012. The data was collected from the "EPIIC" registry on recipients who received CIs in France between 2011 and 2014. Speech audiometry was performed at 60 dB preimplantation and after one year of CI use, as well as an evaluation of the scores of the quality of life with the APHAB questionnaire, the scores for CAP and the professional/academic status in pre- and post-implantation conditions. Major and minor complications at surgery have been recorded. Results: In total, 590 patients (447 adults and 143 children) with an off-label indication for CIs were included in this study from the EPIIC registry (11.7% of the whole cohort of EPIIC). For adults, the median percentage of comprehension using monosyllabic word lists was 41% in preimplantation condition versus 53% after one year of CI use (P< 0.001) and 60% versus 71% in dissyllabic word lists (P< 0.001). The CAP scores were 5 versus 6 in pre- and post-implantation conditions respectively (P< 0.001) and the APHAB scores were statistically lower after implantation (P < 0.001). In the children cohort, the median percentage of comprehension using monosyllabic word lists was 51% in preimplantation condition and 65% after CI (P< 0.001), and 48% versus 82% (P< 0.001) for dissyllabic word lists. The CAP scores were 5 versus 7 respectively in pre- and post-CI conditions (P< 0.001). Thirty-two minor complications (5.4%) and 17 major complications (2.8%) were reported in our panel of off-label indication patients. Conclusion: These results suggest that a revision of the cochlear implantation candidacy criteria is necessary to allow more patients with severe or asymmetric hearing loss to benefit from a CI when there is an impact on quality of life despite the use of an optimal hearing aid. (C) 2020 Elsevier Masson SAS. All rights reserved.

Cochlear and brainstem implants have been included on the list of reimbursable products (LPPR) in France since March of 2009. The implants were initially inscribed for 5 years, after which an application for renewal with the French National Commission for the Evaluation of Medical Devices and Health Technologies (Commission Nationale d’évaluation des dispositifs médicaux et des technologies de santé – CNEDiMTS) was required [Haute Autorité de santé, 2009]. Upon registration to the list of reimbursable products, the companies and the reference centers for cochlear and brainstem implants were asked to set up a post-registration registry called EPIIC. This article reports the evolution in the EPIIC registry of the general indicators for 5051 patients over the five years from 2012–2016.

This study concerns the results of cochlear implantation in children and adults from French cochlear implantation centers, monitored at one, two and three years by the Cochlear Implant French Registry EPIIC. This multicenter study enrolled 2603 subjects (1667 adults and 936 children) implanted in one ear. The following parameters were studied: hearing overall performances, monosyllabic or dissyllabic word perception, speech intelligibility, self-assessment questionnaire of Cochlear Implant (CI) benefits (Abbreviated profile of Hearing aid Benefit); professional activity and schooling. This study confirms the ceiling effect in adults' performances after the 1st year and the progressive growth in children's performances. It also shows that the contralateral hearing aid enhances performances compared to the CI alone condition, in all follow-up sessions. The French register of CIs is the only worldwide register of systematic follow-up on a period of three years and more of all adults and children implanted in a country.

Les auteurs exposent les recommandations de la Société française d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant les indications d’implant cochléaire chez l’adulte. À partir d’une revue de la littérature scientifique par un groupe de travail multidisciplinaire, des recommandations ont été rédigées, fondées sur les articles et l’expérience individuelle des membres, puis relues par un groupe de lecture indépendant afin d’aboutir au texte de synthèse. Les recommandations proposées ont été classées en grades A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant. Il n’y a pas de limite d’âge supérieur à l’implantation cochléaire chez l’adulte sous réserve de l’absence de démence avérée et d’une autonomie au moins partielle. Une bilatéralisation d’implantation cochléaire peut être proposée en cas d’apport insuffisant de l’implant unilatéral pour la localisation spatiale, la discrimination de la parole dans le bruit et l’amélioration de la qualité de vie. Une évaluation de l’audition binaurale doit précéder la bilatéralisation. Une réhabilitation combinant une stimulation acoustique et électrique doit être proposée au patient, en cas de préservation de l’audition résiduelle sur les fréquences graves. Une évaluation de la qualité de vie doit être réalisée avant et après implantation cochléaire.

Les auteurs exposent les recommandations de la Société française d’oto-rhino-laryngologie et de la chirurgie de la face et du cou (SFORL) concernant les indications de l’implant cochléaire chez l’enfant. Un groupe de travail multidisciplinaire a été chargé d’effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l’expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Les recommandations proposées ont été classées en Grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant. Il est recommandé de proposer chez l’enfant ayant une surdité bilatérale sévère/profonde une implantation cochléaire bilatérale et une chirurgie avant 12 mois de vie. En cas d’implantation cochléaire bilatérale séquentielle chez un enfant sourd sévère/profond, il est recommandé de réduire le délai entre les deux implantations, de préférence sous 18 mois. Il est recommandé d’inciter les enfants implantés cochléaires unilatéraux à utiliser une aide auditive controlatérale s’il existe une audition résiduelle et d’évaluer leur perception avec des tests dans le bruit. Il est recommandé de proposer une technique chirurgicale préservant au mieux les structures fonctionnelles de l’oreille interne.

The authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding indications for cochlear implantation in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent reading group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. There is no upper age limit to cochlear implantation in the absence of proven dementia and if autonomy is at least partial. Bilateral implantation may be proposed if unilateral implantation fails to provide sufficiently good spatial localization, speech perception in noise and quality of life, and should be preceded by binaural hearing assessment. Rehabilitation by acoustic and electrical stimulation may be proposed when low-frequency hearing persists. Quality of life should be assessed before and after implantation.

Objectives: The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (Societe francaise d'oto-rhino-laryngologie et de chirurgie de la face et du cou - SFORL) on the indications for cochlear implantation in children. Methods: A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Results: The SFORL recommends that children with bilateral severe/profound hearing loss be offered bilateral cochlear implantation, with surgery before 12 months of age. In sequential bilateral cochlear implantation in children with severe/profound hearing loss, it is recommended to reduce the interval between the two implants, preferably to less than 18 months. The SFORL recommends encouraging children with unilateral cochlear implants to wear contralateral hearing aids when residual hearing is present, and recommends assessing perception with hearing-in-noise tests. It is recommended that the surgical technique should try to preserve the residual functional structures of the inner ear as much as possible. (C) 2019 Elsevier Masson SAS. All rights reserved.

Abstract Objective: Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation. Method: Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed. Results: Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p < 0.001). No significant difference was observed between the local anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment. Conclusion: Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.

The objective of this study is to evaluate the safety and efficacy of a new transcutaneous bone-conduction implant (BCI BB) in patients with conductive and mixed hearing loss or with single-sided deafness (SSD), 1 year after surgical implantation. The study design is multicentric prospective, intra-subject measurements. Each subject is his/her own control. The setting is nine university hospitals: 7 French and 2 Belgian. Sixteen subjects with conductive or mixed hearing loss with bone-conduction hearing thresholds under the upper limit of 45 dB HL for each frequency from 500 to 4000 Hz, and 12 subjects with SSD (contralateral hearing within normal range) were enrolled in the study. All subjects were older than 18 years. The intervention is rehabilitative. The main outcome measure is the evaluation of skin safety, audiological measurements, benefit, and satisfaction questionnaires with a 1-year follow up. Skin safety was rated as good or very good. For the mixed or conductive hearing loss groups, the average functional gain (at 500 Hz, 1, 2, 4 kHz) was 26.1 dB HL (SD 13.7), and mean percentage of speech recognition in quiet at 65 dB was 95 % (vs 74 % unaided). In 5/6 SSD subjects, values of SRT in noise were lower with BB. Questionnaires revealed patient benefit and satisfaction. The transcutaneous BCI is very well tolerated at 1-year follow up, improves audiometric thresholds and intelligibility for speech in quiet and noise, and gives satisfaction to both patients with mixed and conductive hearing loss and patients with SSD.

L'implantation cochléaire est réalisée sous anesthésie générale dans une grande majorité des cas. Cependant, pour certains patients âgés ayant de nombreuses comorbidités, il y a un risque de réaliser cette chirurgie sous anesthésie générale et la récupération post-opératoire peut être plus longue. Pour ces patients, la possibilité de réaliser l'implantation cochléaire sous anesthésie locale est utile. Peu d'études ont décrit cette procédure sous anesthésie locale avec sédation. L'objectif de cette étude est d'évaluer la possibilité de réaliser une implantation cochléaire sous anesthésie locale et sédation. Vingt patients opérés sous anesthésie locale et sédation, groupe AL et 41 patients opérés sous anesthésie générale, groupe AG, ont eu la pose d'un implant cochléaire pour surdité profonde bilatérale de juin 2011 à février 2014. Nous avons comparé pour les deux groupes la durée d'intervention, la durée d'hospitalisation postopératoire et la survenue de symptômes postopératoires précoces (douleur, vertiges, nausées). Dans le groupe AL, la tolérance de l'anesthésie locale a été analysée de façon objective par la survenue d'un symptôme per-opératoire (douleur, vertiges) et de façon subjective par questionnaire. Les durées d'intervention, d'hospitalisation post-opératoire et la survenue de symptômes périopératoires sont similaires dans les 2 groupes. Elles sont respectivement de 86 ± 27 vs 123 ± 35 minutes, 1,2 ± 0,8 vs 1,1 ± 0,3 jours (p < 0,05 %). En post-opératoire précoce, les patients ne présentent aucun symptôme dans 85 % vs 71 % des cas. Au cours d'une implantation cochléaire sous anesthésie locale, les patients ne présentent aucun symptôme dans 60 % des cas. Ils peuvent présenter des douleurs, des vertiges ou des nausées. Un traitement symptomatique par voie veineuse permet de juguler ces symptômes. L'implantation cochléaire sous anesthésie locale est bien tolérée. Elle permet une implantation cochléaire chez des patients pour qui l'anesthésie générale est contre-indiquée, notamment les personnes âgées présentant de nombreuses comorbidités.

De nombreux traitements complémentaires à la chirurgie ont été proposés pour le traitement des cancers différenciés à faible risque de récidive : 100mCi, 30mCi, et absence d'iode radioactif. La tendance actuelle est à diminuer la dose d'iode. Le but de cette étude est d'évaluer l'efficacité de l'administration d'iode chez ces patients. Les dossiers des patients qui ont présenté un CDT sur une période de 10 ans ont été étudiés de manière rétrospective. Seuls les patients à faible risque de récidive selon le définition du consensus européen ont été inclus (T1b, T1m ou T2, N0Nx). Le traitement chirurgical, l'histologie, la biologie, les modalité de l'administration d'iode radioactif ont été étudiés. La rémission a été définie par une thyroglobulinémie basse avec une imagerie négative lors du bilan à 6 mois après le traitement chirurgical. Une analyse statistique uni et multivariée a été réalisée en fonction des traitements reçus et des facteurs de risque de récidive actuellement reconnus. Cent quinze patients ont été inclus avec un suivi moyen de 67 mois. Onze patients (9,5 %) n'ont pas eu d'irathérapie. La rémission a pas été obtenue chez 94 patients (81,7 %). L'analyse multivariée a révélé que la non-rémission était significativement corrélée à la plurifocalité (OR = 3,28 IC95 % 1 ; 10 762) et à l'effraction de la capsule tumorale (OR = 5991 IC95 % 1294 ; 27 732). Cette étude suggère que dans une population principalement traitée par administration de 100mCi d'iode 131, le taux de non-rémission reste élevé pour des cancers à faible risque. En particulier pour les tumeurs plurifocales et/ou en rupture capsulaire, des doses plus élevées peuvent être nécessaires pour obtenir la rémission.

Conclusion: The comprehensive Hearing Preservation classification system presented in this paper is suitable for use for all cochlear implant users with measurable pre-operative residual hearing. If adopted as a universal reporting standard, as it was designed to be, it should prove highly beneficial by enabling future studies to quickly and easily compare the results of previous studies and meta-analyze their data. Objectives: To develop a comprehensive Hearing Preservation classification system suitable for use for all cochlear implant users with measurable pre-operative residual hearing. Methods: The HEARRING group discussed and reviewed a number of different propositions of a HP classification systems and reviewed critical appraisals to develop a qualitative system in accordance with the prerequisites. Results: The Hearing Preservation Classification System proposed herein fulfills the following necessary criteria: 1) classification is independent from users' initial hearing, 2) it is appropriate for all cochlear implant users with measurable pre-operative residual hearing, 3) it covers the whole range of pure tone average from 0 to 120 dB; 4) it is easy to use and easy to understand.