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:Telephone use correlates with quality of life, and is one of the most important expectations of cochlear implant candidates. The aim of the present study was to assess the benefit of a progressive intensive 18-session training program, conducted by telephone in cochlear implant recipients. MATERIAL AND METHODS:Nine cochlear-implanted adults underwent telerehabilitation focused on telephone use, with before-and-after assessment of: auditory performance, on Lafon monosyllabic words and MBAA sentences in quiet, cocktail-party noise and by phone; telephone use, on ad-hoc surveys and number of calls per week; and quality of life on ERSA and APHAB questionnaires. RESULTS:Before training, monosyllabic word comprehension was poorer by telephone than by direct voice (64±5.7% vs. 26±5.3%; P<0.05). After the 6-week training, there was improvement in the "note taking" telephone message task (85.0±3.7 vs. 50.0±9.0 out of 100; P<0.001), daily phone use (57.0±4.3 vs. 29±5.4 out of 100; P<0.0001), and number of calls in the week before assessment (0.0±0.0 vs. 11.0±3.0; P<0.0001). CONCLUSIONS:A progressive intensive training program by telephone improved phone use in the daily life of cochlear-implanted adults.

L’utilisation du téléphone est corrélée à la qualité de vie et pouvoir l’utiliser est une attente importante des candidats à l’implantation cochléaire. L’objectif de ce travail est d’évaluer le bénéfice d’une rééducation progressive et intensive de 18 séances menée directement au téléphone, auprès d’adultes implantés cochléaires. Neuf adultes implantés ont bénéficié d’une prise en charge orthophonique à distance, spécifiquement axée sur l’utilisation du téléphone. Ont été évalués avant et après la rééducation : les performances auditives (répétition de mots de Lafon et de phrases MBAA, dans le silence, le bruit et au téléphone), l’utilisation du téléphone (questionnaires ad hoc, nombre d’appels passés par semaine) et la qualité de vie (questionnaires Ersa, Aphab). Avant la rééducation, la compréhension de mots de Lafon est moins bonne au téléphone qu’en voix directe (64 % ± 5,7 vs 26 % ± 5,3, moyenne ± ESM, p < 0,05). Après les six semaines de rééducation, les patients s’améliorent pour la prise en note d’un message téléphonique (85 ± 3,7 vs 50 ± 9, score/100, p < 0,001). L’utilisation du téléphone en vie quotidienne (57 ± 4,3 vs 29 ± 5,4, score/100, p < 0,0001) et le nombre d’appels passés la semaine précédant l’évaluation (0 ± 0 vs 11 ± 3, p < 0,0001) s’améliorent également. Un programme de rééducation progressif et intensif proposé au téléphone permet d’améliorer l’utilisation du téléphone en vie quotidienne des adultes implantés cochléaires.

SUMMARY Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

Context and objective. - Bilateral vestibular schwannomas are the hallmark of neurofibromatosis 2 (NF2), occurring in 95% of patients. These tumors are associated with significant morbidity due to hearing loss, tinnitus, imbalance and facial weakness. As radiosurgery and chemotherapy have been recently introduced in the treatment armamentarium in addition to surgery, a thorough evaluation of vestibular schwannoma natural history is mandatory to determine the role and timing of each treatment modality. Methods. - An exhaustive review of the literature was performed using the PubMed database concerning the natural history of tumor growth and hearing loss in NF2 patients with vestibular schwannomas. Results. - Although some aspects of vestibular schwannoma natural history remain uncertain (pattern of tumor growth, mean tumor growth rate), factors influencing growth such as age at presentation and paracrine factors are well established. Studies focusing on the natural history of hearing have highlighted different patterns of hearing loss and the possible role of intralabyrinthine tumors. The polyclonality of vestibular schwannomas in NF2 was recently unveiled, giving a new perspective to their growth mechanisms. Conclusion. - An uniform evaluation of tumor growth using volumetric evaluation and hearing with standard classifications will ensure the use of common endpoints and should improve the quality of clinical trials as well as foster comparison among studies while ensuring more consistency in decision-making. (C) 2015 Elsevier Masson SAS. All rights reserved.

BACKGROUND AND PURPOSE: Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation. MATERIALS AND METHODS: This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software. RESULTS: Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, P < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P < .001) and insertion length (intraclass correlation coefficient = 0.98, P < .001), good for the number of extracochlear electrodes (Cohen κ = 0.63, P = .01), but moderate for the scalar position (Cohen κ = 0.59, P = .02). CONCLUSIONS: Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.

Sudden sensorineural hearing loss (SSNHL) is a common and alarming symptom that often prompts an urgent visit to an ENT specialist. Treatment of SSNHL remains one of the most problematic issues for contemporary otorhinolaryngology: although many meta-analyses and national guidelines have been issued, management is not standardized in terms of medical treatment, and duration and route of administration. We present several methodological suggestions for the study of treatments for SSNHL. These were developed from the existing level of evidence of the main treatments used in SSNHL by experts who convened at the IFOS 2017 ENT World Congress in Paris, France. All panelists agreed that one of the main limitations present in studies on SSNHL is related to the wide heterogeneity, which characterizes both the initial hearing deficit and the amount of hearing recovery. Although evidence of the efficacy of systemic steroids cannot be considered as strong enough to recommend their use, it is still the most widespread primary therapy and can be considered as the current standard of care. Therefore, systemic steroids stand as an adequate control for any innovative treatment. To reduce the number of subjects we suggest that the inclusion criteria should be restricted to moderate to profound levels of hearing loss. The efficacy of trans-tympanic steroids as a salvage therapy was suggested in several reports on small populations and needs to be confirmed with larger randomized controlled trials.

The main manifestation of neurofibromatosis type 2 (NF2) is the development of bilateral vestibular schwannomas (VS). Consequently, one of the most severe functional sequelae is bilateral sensorineural hearing loss, caused by spontaneous tumor progression and/or treatment-related damage (surgery or radiosurgery). Preserving or restoring hearing is still challenging in NF2 no matter the strategy applied to each individual based on the natural history of VS. In this review, the different strategies for hearing preservation or rehabilitation are discussed and illustrated by several cases. A decisional algorithm for NF2 patients with VS is proposed that takes into consideration the tumor size and hearing level.

Objectives: The impact of hearing loss and of auditory rehabilitation (hearing aid, cochlear implant) on quality of life is a crucial issue. Commonly used questionnaires to assess quality of life in these patients (Nijmegen, APHAB, GBI) are time-consuming, difficult for patients to fill out, and show poor sensitivity to small improvements or deterioration. The objective of the present study was to validate a dedicated quality of life scale for hearing-impaired adults with or without auditory rehabilitation. Material and methods: ERSA (Evaluation du Retentissement de la Surdite chez l'Adulte: Evaluation of the Impact of Hearing Loss in Adults) is a self-administered questionnaire. It is divided into 4 domains, each comprising 5 questions graded from 1 to 10. The questions are simple, and formulated so patients will answer according to how they feel at the actual time of the session. Test-retest reliability was measured in 38 patients. Internal coherence and validity against the APHAB questionnaire as gold standard and in relation to hearing performance were measured in 122 patients at auditory assessment. Sensitivity to change in hearing was measured in 36 cochlear implant patients, before and 6 or 12 months after implantation. Results: Test-retest reliability was very satisfactory (p = 0.88). Internal coherence was good for all questions. External validity, comparing ERSA to APHAB scores in the same non-implanted hearing-impaired patients, was good (p = 0.52). Additionally, ERSA scores correlated with hearing performance in adverse conditions (monosyllabic words: p = 0.22; sentences in noise: p = 0.19). In patients tested before and after cochlear implantation, improvement in hearing performance in silence and in noise correlated with an improvement in ERSA score (p = 0.37 to 0.59, depending on the test), but not to GBI score. Conclusion: The ERSA questionnaire is easy and quick to use, reliable, and sensitive to change in hearing performance after cochlear implantation. (C) 2017 Elsevier Masson SAS. All rights reserved.

Stimuler électriquement les nerfs vagues et laryngés inférieurs pendant une chirurgie thyroïdienne ou parathyroïdienne, enregistrer les réponses musculaires, interpréter les modifications des paramètres électrophysiologiques et en déduire un pronostic sur la mobilité laryngée. Il s’agit d’une étude prospective au cours de laquelle 151 nerfs vagues et 144 nerfs laryngés inférieurs ont été monitorés chez 114 patients. Parmi eux, 7 patients (14 nerfs vagues) ont été monitorés en continu avec l’électrode APS et chez 15 patients (21 nerfs vagues), le seuil de stimulation a été étudié. La réponse musculaire a été recueillie après stimulation directe du nerf vague et/ou du nerf laryngé inférieur par une sonde monopolaire ou après stimulation directe et répétée par une électrode fixée sur le nerf vague. En cas d’altération du signal du premier côté opéré, la totalisation chirurgicale n’était pas réalisée. La stimulation du nerf vague permet de vérifier l’intégrité du nerf laryngé inférieur et son caractère récurrent, sans risque de faux-négatif. Le seuil minimal de stimulation avant et après la dissection du nerf vague entraînant une réponse supérieure ou égale à 100 μV variait de 0,1 à 0,8 mA. La similitude des réponses à une stimulation supramaximale de 1 mA, en pré- et post-dissection, d’une part et en post-dissection entre le nerf vague et le nerf laryngé inférieur, d’autre part, était corrélée à une mobilité laryngée postopératoire normale. À l’inverse, la diminution de la réponse musculaire en dessous de 100 μV et l’augmentation du temps de latence témoignaient d’un risque de paralysie laryngée. La stimulation du nerf vague permet de suspecter ou d’éliminer une lésion bas-située sur le nerf laryngé inférieur et de détecter un nerf laryngé inférieur non récurrent. Le monitorage « intermittent » apprécie la fonction nerveuse à l’instant de la stimulation, alors que le monitorage « permanent » peut détecter les premiers signes de la souffrance nerveuse annonciateurs d’une possible paralysie récurrentielle postopératoire. En cas d’indication de thyroïdectomie totale, la perte du signal électrique du premier côté opéré doit faire reconsidérer la réalisation d’un geste chirurgical controlatéral dans le même temps.

The management of spinal cord ependymomas in Neurofibromatosis Type 2 (NF2) has traditionally been conservative, in contrast to the management of sporadic cases; the assumption being that, in the context of NF2, they did not cause morbidity. With modern management and improved outcome of other NF2 tumours, this assumption, and therefore the lack of role for surgery, has been questioned. To compare the outcome of conservative treatment of spinal ependymomas in NF2 with surgical intervention in selected patients. Retrospective review at two NF2 centers, Manchester, UK and Paris/Lille, France. In Manchester patients were managed conservatively. In France surgery was a treatment option. Inclusion in the study was based on tumor length of greater than 1.5 cm. The primary parameter assessed was acquired neurological deficit measured by the Modified McCormick Outcome Score. 24 patients from Manchester and 46 patients from France were analyzed. From Manchester, 27% of these patients deteriorated during the course of follow-up. This effectively represents the natural history of ependymomas in NF2. Of the surgical cases, 23% deteriorated postoperatively, but only 2/18 (11%) of those operated on in the NF2 specialist centers. Comparison of the two specialist centers Manchester/France showed a significantly improved outcome (P = 0.012, χ2 test) in the actively surgical center. Spinal ependymomas produce morbidity. Surgery can prevent or improve this in selected cases but can itself can produce morbidity. Surgery should be considered in growing/symptomatic ependymomas, particularly in the absence of overwhelming tumor load where bevacizumab is the preferred option.

Clinical OtolaryngologyVolume 42, Issue 4 p. 871-875 Correspondence: Our Experience Surgical management of petrous apex cholesterol granulomas by an infralabyrinthine approach: our experience with fourteen cases F.Y. Russo, F.Y. Russo Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorD. De Seta, D. De Seta Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorI. Mosnier, I. Mosnier Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorO. Sterkers, O. Sterkers Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorD. Bernardeschi, Corresponding Author D. Bernardeschi daniele.bernardeschi@aphp.fr Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, France Correspondence: D. Bernardeschi, Department of Otology Auditory Implants and Skull Base Surgery, Pitié-Salpêtrière Hospital, 53-87 bd de l'Hopital, 75013 Paris, France. Tel: +33 1 42163112; fax: +33 1 42163114; e-mail: daniele.bernardeschi@aphp.frSearch for more papers by this author F.Y. Russo, F.Y. Russo Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorD. De Seta, D. De Seta Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorI. Mosnier, I. Mosnier Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorO. Sterkers, O. Sterkers Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, FranceSearch for more papers by this authorD. Bernardeschi, Corresponding Author D. Bernardeschi daniele.bernardeschi@aphp.fr Department of Otology Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France Inserm UMR-S 1159, “Minimally Invasive Robot-Based Hearing Rehabilitation”, Paris, France Correspondence: D. Bernardeschi, Department of Otology Auditory Implants and Skull Base Surgery, Pitié-Salpêtrière Hospital, 53-87 bd de l'Hopital, 75013 Paris, France. Tel: +33 1 42163112; fax: +33 1 42163114; e-mail: daniele.bernardeschi@aphp.frSearch for more papers by this author First published: 11 August 2016 https://doi.org/10.1111/coa.12721Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume42, Issue4August 2017Pages 871-875 RelatedInformation

Los progresos en el conocimiento básico de la compensación vestibular han permitido crear y desarrollar procedimientos de rehabilitación vestibular especializada. Tras un examen otoneurológico destinado a establecer el diagnóstico y determinar los mecanismos involucrados se efectúa una evaluación preterapéutica y se escogen las técnicas de rehabilitación más adecuadas para cada caso: estimulaciones optocinéticas, butaca giratoria, plataforma dinámica, etc. Para aplicar la rehabilitación vestibular a la enfermedad de Maniere se debe realizar un análisis preciso dado que sus síntomas son fluctuantes. En las personas de edad avanzada, es esencial prevenir los riesgos de caída. Como en la mayor parte de las patologías que se tratan con la rehabilitación vestibular, es importante que los pacientes de edad avanzada sean atendidos por un equipo multidisciplinario. Las escalas y cuestionarios sobre los síntomas y su repercusión permiten evaluar la gravedad de los trastornos y la eficacia de los tratamientos.

Resume Objectifs L’objectif de cette etude etait de montrer l’interet et les benefices obtenus par l’utilisation d’une aide auditive controlaterale chez des adultes porteurs d’un implant cochleaire (IC). Materiel et methodes L’etude a porte sur une population d’adultes implantes cochleaires unilateraux, pour une surdite post-linguale bilaterale, avec perte du benefice prothetique d’un cote et poursuite de l’utilisation d’une aide auditive (AA) controlaterale. Il s’agissait de 10 adultes francophones, 4 hommes et 6 femmes, dont la moyenne d’âge etait de 58 ans. Ils etaient implantes depuis 2 ans au moins. Tous les patients utilisaient regulierement des AA bilaterales anterieurement a l’implantation cochleaire. L’evaluation audiometrique a comporte : (1) une evaluation de l’audition residuelle oreilles separees (tonale et vocale), (2) des tests en champ libre : « oreilles nues », IC seul, AA seule et IC et AA, en tonale, vocale dans le calme et vocale dans le bruit. Resultats Les resultats obtenus ont montre que l’intelligibilite etait significativement superieure en condition bimodale, IC et AA, par rapport a ceux obtenus avec l’IC seul, dans tous les tests realises. Dans le calme, les resultats ont montre une intelligibilite qui etait superieure a 50 % pour des mots dissyllabiques, dans 7 cas avec la seule AA, 2 cas avec l’IC et un cas en condition bimodale : IC et AA. Les tests realises avec un rapport signal/bruit a 0 dB ont montre un niveau de comprehension superieur a 50 %, pour un patient avec uniquement son AA, pour 3 d’entre eux avec l’IC et pour 6 en condition bimodale. Conclusion Les resultats obtenus ont montre l’interet du port de l’AA controlaterale a l’IC en termes d’amelioration de la perception auditive dans le calme et le bruit. En cas d’audition residuelle controlaterale a l’IC, une AA doit etre proposee ; et dans les surdites bilaterales progressives, l’IC doit etre proposee des que le patient perd le benefice de l’AA d’un des cotes.

Objectives: The present study assessed the interest of a contralateral hearing aid (HA) in adult cochlear implant (CI) bearers.Material and methods: The study recruited 10 French-speaking adult HA bearers with postlingual bilateral hearing loss, fitted for at least 2 years with a unilateral CI after loss of benefit from HA in one ear but continuing to use their contralateral HA: 4 male, 6 female; mean age, 58 years. All had regularly used bilateral HAs prior to CI. Audiometric assessment comprised: (1) individual ear hearing assessment on pure-tone audiometry and speech discrimination; and (2) free-field testing without aid, with CI only, with HA only and with CI plus HA, on pure-tone audiometry and speech discrimination with quiet background and on speech discrimination in noise.Results: Speech discrimination was significantly improved in the bimodal condition (CI plus HA) as compared to CI alone, on all tests. In quiet, discrimination for disyllabic words was > 50% in 7 cases with HA alone, in 2 cases with CI alone and in 1 case in with HA + CI. Under 0 dB signal-to-noise ratio, discrimination was > 50% in 1 case with HA alone, in 3 cases with CI alone and in 6 cases with HA + CI.Conclusion: The present results showed benefit in auditory perception in quiet and in noise with bimodal stimulation. When there is residual hearing in the non-implanted ear, a HA should be fitted; and in progressive bilateral hearing loss, CI should be suggested when HA benefit decreases in one ear. (C) 2015 Elsevier Masson SAS. All rights reserved.

The management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 +/- 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p < 0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+ B+ C from the AAO-HNS classification). Useful hearing (class A+ B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal.

OBJECTIVE:To analyse the anatomical, functional and quality-of-life results when using bioactive glass in mastoid and epitympanic obliteration.DESIGN:Prospective clinical study.SETTING:Tertiary referral centre.PARTICIPANTS:Forty-one cases (39 patients) operated between May 2013 and January 2015.MAIN OUTCOME MEASURES:Anatomical results were evaluated by otomicroscopy 1 year after surgery and using imaging to detect residual disease. Functional results were studied by postoperative hearing gain. Quality of life was assessed with the Glasgow Benefit Inventory questionnaire and the success of surgery by a surgery-specific questionnaire.RESULTS:At 1 year, all patients presented a well-healed external auditory canal, with an intact tympanic membrane. In cases with cholesteatoma (n = 23), no recurrent retraction pockets or residual disease were observed on imaging studies. The overall air-bone gap closure was 7.7 ± 1.84 dB (mean ± se of the mean, P < 0.001, paired t-test). No significant differences were found on hearing results when comparing primary versus revision surgery, canal-wall-up versus canal-wall-down obliterations, type of tympanoplasty and presence of cholesteatoma (multifactor anova). The Glasgow Benefit Inventory improved with an average score of 28 and the success of surgery questionnaire showed a significant improvement in ear discharge and a moderate improvement in hearing and equilibrium.CONCLUSIONS:The use of bioactive glass for mastoid and epitympanic obliteration in canal-wall-down or canal-wall-up tympanoplasties is an effective procedure in both primary and revision surgery. The anatomical and functional results appear to be well correlated with patient experience and to the improvement in quality of life.

Objectives: The aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility.Patients and methods: A prospective study monitored 151 vagal nerves and 144 recurrent laryngeal nerves in 114 patients. Seven patients (14 vagal nerves) underwent continuous monitoring via an automatic periodic stimulation (APS) electrode. In 15 patients (21 vagal nerves), the stimulation threshold was studied. Muscle response was recorded on direct vagal and/or recurrent laryngeal nerve stimulation by a monopolar electrode or direct repeated stimulation via an electrode on the vagal nerve. In case of signal attenuation on the first operated side, surgery was not extended to the contralateral side.Results: The vagal nerve stimulation checked inferior laryngeal nerve integrity and recurrent status, without risk of false negatives. The vagal nerve stimulation threshold, before and after dissection, that induced a muscle response of at least 100 V ranged from 0.1 to 0.8 mA. Similarity between pre- and post-dissection responses to supramaximal stimulation, defined as 1 mA, on the one hand, and between post-dissection vagal and laryngeal recurrent nerve responses on the other correlated with normal postoperative vocal cord mobility. Conversely, muscle response attenuation below 100 V and increased latency indicated a risk of vocal fold palsy.Conclusion: Vagal nerve stimulation allows suspicion or elimination of lesions on the inferior laryngeal nerve upstream of the stimulation point and detection of non-recurrent inferior laryngeal nerve. Intermittent monitoring assesses nerve function at the moment of stimulation, while continuous monitoring detects the first signs of nerve injury liable to induce postoperative recurrent nerve palsy. When total thyroidectomy is indicated, signal attenuation on the first operated side casts doubt on continuing surgery to the contralateral side in the same step. (C) 2016 Elsevier Masson SAS. All rights reserved.