La vertigine è una lamentela frequente in visita, benché i pazienti raramente si presentino a visita per ciò che il medico chiama «vertigine», cioè un’illusione di spostamento, il più delle volte rotatorio. Il sintomo riferito con maggiore frequenza è un’alterazione dell’equilibrio, dovuta raramente all’orecchio interno. È, quindi, importante far precisare loro le caratteristiche di ciò che essi chiamano vertigine per orientarsi tra le sue diverse cause (dall’orecchio interno all’ipotensione ortostatica, passando per l’accidente vascolare cerebrale o il tumore della fossa posteriore). Il medico deve essere preciso sul sintomo, deve eseguire un esame clinico non solo otorinolaringoiatrico (ORL) e deve anche ricercare dei segni neurologici e misurare la pressione arteriosa del suo paziente. In funzione del contesto, il paziente deve essere affidato a uno specialista (ORL, neurologo o, ancora, internista).

El vértigo es un trastorno frecuente en la práctica médica, aunque los pacientes pocas veces consultan por lo que el médico denomina «vértigo», es decir, una ilusión de desplazamiento, en la mayoría de los casos rotatoria. El síntoma más frecuente es una alteración del equilibrio cuya causa pocas veces está en el oído interno. Por tanto, hay que hacer que el paciente precise las características del síntoma al que denomina vértigo, para identificar sus distintas causas (del oído interno a la hipotensión ortostática, pasando por un accidente cerebrovascular o por un tumor de la fosa posterior). El médico debe determinar con claridad el síntoma, realizar una exploración física, no sólo otorrinolaringológica (ORL), sino también buscar los signos neurológicos y medir la presión arterial del paciente. Dependiendo del contexto, el paciente debe derivarse a un especialista (ORL, neurólogo o incluso internista).

El vértigo es una ilusión sensorial de rotación del campo visual, mientras que el trastorno del equilibrio se manifiesta por sensaciones de ebriedad o por la impresión de titubear. Es esencial caracterizar este trastorno mediante una anamnesis precisa y una exploración física en la que se analicen los pares craneales. Al final de ambas, suele ser posible establecer un diagnóstico. Las afecciones del oído interno suelen inducir un cuadro de vértigo rotatorio y pueden acompañarse de signos auditivos. Sin embargo, algunos accidentes vasculares de la fosa posterior pueden comenzar por un vértigo, por lo que es necesario buscar de forma sistemática los factores de riesgo vasculares.

In a retrospective study performed at the Otolaryngology, Head and Neck Surgery Department, Pitié-Salpêtrière Hospital, Paris from 1991 to March 2007, we determined surgical procedures for the treatment of tegmen breaches in chronic otitis media. Forty-two cases were examined: 76% corresponded to chronic otitis media with cholesteatoma, and 24% to chronic otitis media without cholesteatoma. Twenty-eight cases were operated using a combined approach, eight cases using a single suprapetrous approach, and six cases using a transmastoid approach. A total of 33% of the cases showed a meningocele or a meningoencephalocele treated through either a combined or a suprapetrous approach. No recurrence or neural/meningeal infectious involvement was found after a mean time of 43 months in the 36 long-term follow-up cases operated through the combined or suprapetrous approaches. Two cases included in the study were a loss to follow-up. Three of the former cases had already been operated for supracentimetric fissure using lower approach. Two out of the six patients operated using lower approach presented post surgery cerebrospinal fluid otorrhea. Combined or suprapetrous approaches seem to be best adapted to the treatment of supracentimetric or recurrent tegmen breaches, as well as to the precise examination and repair of meningeal lesions. Treatment for tegmen breach can be achieved in a single intervention, even when there is an ongoing infection of the middle ear. The mastoid approach should be used only for infracentimetric defects when there is no neural/meningeal lesion.

détailler l’anatomie de la ténia et sa participation à la formation du foramen de Luschka, puisque la description de ce foramen est restée imprécise malgré le développement de la chirurgie du récessus latéral du 4e ventricule. La connaissance anatomique précise de ce foramen est devenue indispensable dans le cadre de la mise en place d’implants du tronc cérébral. les dissections ont été réalisées chez 5 sujets. Elles comprenaient 8 abords translabyrinthiques, 2 abords rétrosigmoïdes, et un abord occipital bilatéral avec voie transvermienne. les foramens de Luschka ont été exposés dans les 10 dissections. La ténia constitue la berge antérieure et inférieure du foramen. Le pédoncule cérébelleux inférieur constitue la berge supérieure et postérieure. la constitution du foramen de Luschka reste discutée. Notre étude permet de comprendre que par sa forme hélicoïdale, la ténia délimite, par son bord libre antéro-supérieur, l’entrée du récessus latéral du 4e ventricule. Elle joue donc un rôle important dans la structure du foramen de Luschka. La connaissance anatomique précise de ce foramen est devenue indispensable, notamment chez certains patients cophotiques dans le cadre de la mise en place d’implants au niveau du V4 pour la réhabilitation de leur audition.

The aim of this work was to determine the role of peripheral facial muscle reinnervation in the central reorganization of the blink reflex (BR) after hypoglossal–facial anastomosis (HFA). An electrophysiological study was performed on seven patients who underwent HFA after facial nerve transection during surgery for acoustic neuroma. HFA was performed within 15 days after surgery in five patients (group 1) and later for the two others (group 2). We studied the motor responses (MR) and the BR evoked on the affected side, before and over 3 years after the HFA. The MR appeared by the third month for the first group, and by the sixth and twelfth for the second group. After 36 months, the amplitude of MR was significantly higher than its control value, showing hyperinnervation of the facial muscles. Study of the BR evoked only an R1‐type blink response that was observed 4 and 6 months after the MR for groups 1 and 2, respectively. This central reorganization appeared closely correlated with muscle reinnervation and its related timing. The occurrence of peripheral nerve–muscle contacts seems to be a necessary condition for reorganization of the trigemino–hypoglossal–facial reflex. Muscle Nerve, 2006

Hypoglossal-facial anastomosis (HFA) is a cross-over between the proximal stump of the hypoglossal nerve (XII) and the distal one of the facial nerve (VII). The hypoglossal axons regrow within the sheaths of facial fibres, allowing the progressive reinnervation of the facial muscles. This model is interesting to study some mechanisms of plasticity of the nervous system for several reasons: 1) It is a quite simple and reproducible model of pathophysiological state. It allows the study of 2) the modifications of the nervous system induced by the HFA, both upwards and downwards to the lesion and 3) the modifications of reflex activities involving intrapontine connections such as the blink reflex. The electrophysiological features of the trigemino-facial (TF) and trigemino-hypoglossal (TG) connections demonstrated that a central reorganisation of the blink reflex (BR) was induced by HFA: the afferent volleys of the TF and TH reflexes elicited by cutaneous and mucosal trigeminal afferents respectively have been shown to project onto common interneurones located within the trigeminal principal sensory nucleus. A long-term prospective study showed: 1) a reinnervation of the facial muscles by the hypoglossal axons is a necessary perequisite for the central reorganisation of BR, 2) a hyperinnervation of the facial muscles by the hypoglossal axons, 3) a transient and regressive cross-innervation of paralyzed face by the healthy contralateral facial nerve.

Le système vestibulaire est un système complexe qui, en dehors du labyrinthe postérieur et des noyaux vestibulaires, met en jeu, pour assurer l’équilibre, les mouvements et la marche des structures centrales telles que le cervelet, le striatum, le thalamus, le cortex frontal et pré-frontal. Les informations qui arrivent au niveau des noyaux vestibulaires ne sont pas uniquement vestibulaires, mais aussi proprioceptives, visuelles et cérébelleuses. L’équilibre est donc lui aussi, une fonction complexe impliquant une concordance des informations vestibulaires, visuelles et proprioceptives ou une compensation par le système nerveux central après une lésion mais aussi une intégrité des structures centrales.

The vestibular system is a complex system involving not only posterior labyrinth but also central structures such as cerebellum, striatum, thalamus, frontal and prefrontal cortex to assure balance, movements and walking. Information reaching the vestibular complex are not purely vestibular but also from visual, somatosensory and cerebellar origins. The equilibrium is also a complex physiological function needing concordance of vestibular, visual and somatosensory information or either central compensation after an injury but also an integrity of the central nervous system.

The authors investigated the evolution of the dynamic features of the cross-innervation process in patients with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis (HFA). Clinical and electrophysiologic investigations were carried out before and over a 3-year period after HFA. Cross-innervation had started by the 10th day, progressed to the seventh to eighth month, then decreased and finally disappeared by the 12th month after HFA. Ipsilateral reinnervation was observed by the fourth month, progressed to the 12th to 18th month, and remained stable for the remainder of the follow-up period.

Tankéré, F; Maisonobe, T; Bernat, I; Lamas, G; Soudant, J; Vitte, E; Bouche, P; Fournier, E; Willer, J C. Author Information

Tankéré, F; Bernat, I; Vitte, E; Earally, F; Willer, J C.; Lamas, G; Soudant, J Author Information

Materials & methods The material of this study comprised 80 cases with hemifacial spasm (HFS) operated for endoscopic assisted microvascular decompression (MVD) between October 1992 and October 1999. This study was held in the ENT department, Nord hospital in Marseille, France; and the ENT department, Alexandria school of Medicine, Alexandria, Egypt. The MVD was performed via a minimal retrosigmoid approach. The CPA was then explored by a 30 degrees endoscope to visualization of the REZ of the facial nerve and the precise location of the conflict’s site. MVD was performed under the microscope with insertion of Teflon sponge in cases of arteries; or in cases of veins, they were coagulated and then dissected away of the facial nerve.

The authors report two cases of patients with word deafness. The word deafness occurred after a head injury for the first patient and after an arterio venous malformation embolization for the second patient. MRI demonstrated bilateral lesions of the inferior colliculi but brainstem auditory-evoked potentials (BAEP) were within normal limits. These cases demonstrated that lesions involving the two inferior colliculi induced pure word deafness but do not affect BAEP.

Vitte, E; Tankéré, F; Sarrazin, J L.; Lévêque, C; Bernat, I; Soudant, J Author Information