[Menière's disease. Current status].
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Biomedical subjects
Publications and source records attributed to M Negrevergne.
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We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test. The rotatory impulsional test does not present any specific advantage compared to other kinetic test as far as the observation of the preponderance phenomenon. We then compared the preponderance with the results of the caloric tests and came to the following conclusions i) the absence of preponderance does not allow us to predict the absence of vestibular deficit, due to the fact that 37% of the deficits were compensated for including acoustic neuroma; ii) the presence of a preponderance does not allow a priori to say whether it is of vestibular, cervical, or central origin and systematic caloric tests shows that almost one fourth of preponderance observed is not associated with unilateral weakness iii) supposing that a clinical argument allow us to conclude as to the probable vestibular origin of a vestibular preponderance, the direction of this preponderance does not allow us to determine which side is involved. In fact, if the undercompensated deficits are 3 times more frequent than overcompensated deficits, the proportion of preponderance not linked to a significant deficit indicates that the probability of encountering a preponderance related to a specific undercompensated deficit is approximately 50%. We thus did not find in the rotatory impulsional test any specific advantage allowing us to predict the laterality of a vestibular lesion.
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Stapedius reflex can provide useful prognostic information in FPs when the middle ear is normal. Its preservation may have a favorable significance in partial FP and Bell's palsy. Its loss, even though less reliable, can also have some value as an indicator for a poor prognosis in patients with total and herpes zoster FPs. Most importantly, our findings have shown that the SR alone is not sufficient to be of prognostic value, but is useful if combined with other clinical parameters and electrical responses.
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A unichannel extracochlear implant designed and made in our laboratory was tried on several patients. Results to date are very similar in all cases. Very rudimentary auditory information is provided, which can help totally deaf patients.
A few patients who had become totally deaf in adulthood were chronically implanted with an electrode on the round window. Elicitable auditory sensations were limited but proved beneficial enough for a small portable stimulator to be suggested for everyday use. Over a period of several months subjects were monitored several times for a few days at the laboratory and trained to make better use of their prosthesis. Such a device appears safe and patients have become attached to its use. One subject suffering from tinnitus was also given another stimulator delivering positive direct current which suppresses the tinnitus.
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Human AP tuning curves (tone on tone simultaneous and forward masking curves) were measured during transtympanic electrocochleography. For subjects with near normal thresholds, average Q10 dB values (simultaneous masking) were 2.3 at 2 kHz, 3.6 at 4 kHz, and 4.7 at 8 kHz. Patients with threshold elevations of more than 40 dB, resulting from sensorineural hearing loss of cochlear origin, had tuning curves less sharply tuned by a factor of 2-3, with Q10 dB values of 1-2 at 2 kHz and at 4 kHz, and 1-2.3 at 8 kHz. AP tuning curves and single fibre tuning curves (frequency threshold curves) were measured in normal guinea pigs; cochlear fibre tuning is sharper than AP tuning (simultaneous masking) by a factor of 1.8 (2-20 kHz). Assuming that this factor can be applied to the human cochlea, estimates of normal human cochlear fibre Q10 dB values are 4.2 at 2 kHz, 6.5 at 4 kHz, and 8.5 at 8 kHz.
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While investigating the possibilities of electrically induced hearing in cases of profound deafness, we observed that very often an appropriate stimulation of the cochlea could result in tinnitus cancellation. We present here a progress report on that phenomenon, including 15 subjects. Such a cancellation was restricted to tinnitus subjectively localized in the ear under test, we observed no effect on noises localized in the other ear, or centrally. This suppression occurred so long as the cochlea was stimulated and stopped when the stimulation ceased. This phenomenon was very reproducible and did not seem to affect simultaneous normal acoustic hearing. It is hypothesized that this phenomenon acts through an inhibition of abnormal activity of sensorineural elements of the electrically stimulated cochlea.
A series of patients presenting with subsequently surgically confirmed central tumour involving the auditory pathways were investigated using both transtympanic electrocochleography (TT ECochG) and surface recordings of brainstem evoked responses (BER). While ECochG allows a detailed study of peripheral function, BER allow the investigation of neural conduction up to the level of the inferior colliculus. Valuable information can be obtained from: (1) comparison of the amplitudes of the sensory and neural components of the ECochG; (2) comparison of ECochG, BER and auditory thresholds; (3) time interval measurements between the auditory nerve response (N1 on the ECochG) and the inferior colliculus (wave P4-5 on BER); (4) contralateral comparisons. Similar measurements performed in pure cochlear pathologies, mainly in Meniere's disease, yielded very significant differences.
One of the basic functions of the cochlea is to separate out the frequency components which are present in complex sounds. This frequency selectivity can be measured objectively in the clinic from the compound action potential (AP) during transtympanic electrocochleography, using a two-tone masking paradigm. An AP is evoked by a test tone near to threshold, and a measure is made of the frequency bandwidth over which this AP can be suppressed by a continuous pure tone masker. In normal-hearing subjects, this frequency range is 0.17-0.39 octaves (test tone pip at 4 or 8 kHz). In patients with cochlear deafness, this bandwidth is greatly enlarged, ranging from 0.42-2.2 octaves. Some observations suggest that a deterioration in frequency selectivity can occur before any important threshold elevation. The early detection of this could be a warning sign of potential cochlear susceptibility. In the clinic the measure is already of use: a deterioration is a positive indication of cochlear involvement in a hearing loss.
We present a group of 50 patients with retrocochlear pathology, divided on 41 (82 per 100) non tumoral and 9 (18 per 100) tumoral: 8 cerebello-pontine angle meningiomas and 1 intracranial cholesteatoma. The retrocochlear diagnosis of the pathology is assessed by the results of the audiovestibular explorations, specially the electrophysiology (early auditory evoked response, electrocochleography). The neuroradiologic explorations (TAC, MNR) define the tumoral or non tumoral nature of the pathology. We review some technical aspects of the common electrocochleographic practice, as actually is realised by the Bordeaux group; also, the different parameters of a retrocochlear pathologic response. In this group, the electrocochleography was necessary on 64 per 100 of the cases to obtain an electrophysiologic retrocochlear diagnostic.