La otalgia es un dolor que se localiza en la región auricular, cuyo origen está en el oído (otodinia) o es ajeno al oído (otalgia refleja o secundaria, que se percibe en el oído). Una otalgia obliga a buscar en primer lugar una patología del oído en el pabellón auricular, el conducto auditivo externo y el tímpano. Si la exploración del oído es normal, se debe pensar en un dolor irradiado a partir del aparato masticador, la parótida o la orofaringe, con la búsqueda sistemática de una causa tumoral. En los lactantes, hay que buscarla ante cualquier síntoma indirecto (modificación de la conducta habitual del niño), que es la única expresión posible del dolor de los más pequeños. La otitis media aguda es la causa más frecuente, con gran diferencia, de otalgia en niños, pero también hay que plantear otras causas, la mayoría benignas, pero potencialmente graves. El tratamiento se basa en las medidas terapéuticas precisas de las diversas etiologías, por una parte, y en el tratamiento sintomático del dolor por vía tópica y sistémica.

L’otalgia è un dolore localizzato nella regione auricolare, dovuto a una causa auricolare (otodinia) o a una causa extra-auricolare (otalgia riflessa o secondaria, avvertita nell’orecchio). Un’otalgia deve innanzitutto portare a ricercare una lesione dell’orecchio a livello del padiglione auricolare, del condotto esterno e del timpano. Se l’esame dell’orecchio è normale, si prendono in considerazione i dolori irradiati dall’apparato masticatorio, dalla parotide o dall’orofaringe, con la ricerca sistematica di una causa tumorale. Nel lattante, occorre ricercarla di fronte ad ogni sintomo indiretto (cambiamento nel comportamento abituale del bambino), che è l’unica espressione possibile del dolore del bambino molto piccolo. L’otite media acuta è di gran lunga la causa più frequente di otalgia nel bambino, ma bisogna considerare anche altre cause, per la maggior parte benigne, ma potenzialmente gravi. Il trattamento si basa da un lato sulla terapia precisa delle diverse eziologie e, dall’altro, sul trattamento sintomatico del dolore per via locale e generale.

Las malformaciones del oído interno suponen el 20% de las sorderas congénitas infantiles. Se manifiestan por una sordera mixta o de percepción endococlear y, en menos ocasiones, retrococlear. Sólo se acompañan de signos radiológicos en el 20% de los casos y suelen ser aisladas. Son muy numerosas y deben distinguirse en dos categorías: membranosas (80%) u óseas (20%). Las malformaciones membranosas implican a las células ciliadas, sin anomalía del hueso laberíntico. Las malformaciones óseas pueden identificarse por las pruebas de imagen (tomografía computarizada de los peñascos y resonancia magnética) y dan lugar a dificultades quirúrgicas. En algunas malformaciones puede realizarse una rehabilitación audioprotésica convencional, mientras que otras requieren una implantación coclear e incluso una orientación hacia un implante del tronco del encéfalo. El diagnóstico de estas malformaciones es esencial para conocer el perfil evolutivo de la sordera, informar de él a los progenitores y escoger el tratamiento de rehabilitación más adecuado.

Durant l’épidémie de Covid-19, l’accès au diagnostic et aux soins des pathologies relevant de l’audiologie médicale a régressé en France, posant un risque de perte de chance pour le patient. Ce guide de conseils de bonne pratique vise à répertorier les solutions techniques existantes permettant d’examiner à distance le patient présentant une plainte en audiologie et à décrire leurs intérêts et, le cas échéant, leurs limites. Les conseils ont pu être élaborés à la fois à partir de l’expérience clinique des experts médicaux ayant participé à la rédaction du guide, et d’une revue extensive de la littérature portant sur les recommandations de pratique clinique en télé-audiologie. Les solutions de télé-audiométrie ont été recensées sur la base d’une requête par moteur de recherche effectuée en avril 2020, avant vérification de leur disponibilité sur le marché européen. Des solutions de vidéo-otoscopie permettent la télé-transmission d’images compatibles avec un diagnostic de qualité soit en se connectant via internet à une plate-forme de télé-soin, soit via un smartphone ou une tablette utilisant un système d’exploitation iOS ou Androïd. Selon les mêmes modalités, il est possible de réaliser à distance un examen audiométrique tonal dans les règles de l’art, une audiométrie vocale dans le silence ou dans le bruit ainsi que des explorations fonctionnelles objectives de l’audition. Les examens cliniques et paracliniques peuvent être consultés par le médecin de façon différée pour être interprétés (télé-audiologie asynchrone). Ils peuvent aussi être réalisés en temps réel chez un patient, à tout âge de la vie, à condition qu’un aidant puisse être présent durant l’installation des transducteurs ou la réalisation de l’acoumétrie (télé-audiologie synchrone). Les solutions de téléaudiologie trouvent également une application dans la formation à distance des futurs professionnels de santé engagés dans la prise en charge des pathologies de l’audition. Dans la législation française, la télé-otoscopie est un acte médical qui relève soit de la télé-expertise (avis asynchrone) soit d’un acte de téléconsultation (avis synchrone). L’évaluation subjective et objective de la fonction auditive du patient est aujourd’hui possible à distance à condition de respecter les précautions listées.

Objectives: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations. Methods: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market. Results: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous teleaudiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment. Conclusion: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected. (c) 2020 Published by Elsevier Masson SAS.

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:The aim of this study was to evaluate peri- and post-operative complications related to cochlear implantations. We searched for risk factors predicting these complications and analyzed the complications in the youngest and most elderly.STUDY DESIGN:Retrospective analysis of cochlear implant patients.MATERIALS AND METHODS:All patients who underwent cochlear implantation in France between January 2012 and December 2016 were anonymized and registered in the EPIIC database. This population included 3483 adults and 2245 children. Their demographic and surgical data and their incidence of peri- or post-operative complications, including their severity, whether major or minor, were all indicated.RESULTS:The global complication rate was 6.84%. The risk of complication was higher in initial implantation versus reimplantation (P<0.0001). The risk was also higher for bilateral implantation versus unilateral (P<0.0001). Complications were more frequent for patients with cochlear malformation (P=0.002). There was no difference in complication rates across age groups; babies under 1 year old, and the elderly over 80 and even over 90, did not have more complications than the rest of the population. Patients treated in the daily care unit had no more complications than those who were hospitalized for one night or more (P=0.64).CONCLUSION:Cochlear implantation is a safe technique with a low incidence of complications. The absence of increased risk in patients at the extremes of the age spectrum justifies offering this solution to all, without age limitation.

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 aims to determine the frequency and causes of cochlear explants with re-implantation (ERI) after 5 years' follow up of the patients included in the French national EPIIC (étude post-inscription des implants cochléaires) registry tracking patients with cochlear implantation. This multicenter, descriptive prospective study was conducted on 5051 patients enrolled in the EPIIC database between January 2012 and December 2016. Ninety-five patients (1.9%) received a primary implant and an ERI during the study. Of these, four benefitted from two ERIs. The number of ERIs was significantly higher in the pediatric population than among adults. The explantation and reimplantation were performed simultaneously in 86% of cases. The reasons for explantation were: in 46.4% of cases linked to a malfunction of the implant, and in 39.3% of cases for medical or surgical reasons. The number of electrodes inserted was significantly higher after the ERI than after the first implantation. There was just one post-ERI infection for these 95 explanted and re-implanted patients. As well as explantation with reimplantation rarely being necessary, it generally presents no major surgical difficulty and in most cases it allows a better integration than in the first implantation.

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.