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Biomedical subjects

P Bertholon

Publications and source records attributed to P Bertholon.

At least 19 recordsLinked to original sources
PubMed2004

[Cochlear otosclerosis and pseudo fourth turn of the cochlea].

OBJECTIVE: To describe different sequences on magnetic resonance imaging (MRI) in otosclerosis with peri-cochlear involvement. METHOD: MRI T1 and T2 sequences with T1 gadolinium injection and computed tomography (CT) scans with millimetric slices on axial and coronal views were obtained. The diagnosis of bilateral otosclerosis was confirmed by surgical exploration. RESULTS: On the CT scan, there was a fourth turn of the cochlea which appeared on the MRI T1 sequence with an intermediate signal and on the T2 sequences with a high intensity signal. After gadolinium injection, there was signal enhancement, suggestive of active otospongiosis. On the CT scan, there was another lesion in front of the cochlea with endosteal involvement. This was no however visible on the MRI, even after gadolinium infusion, in accordance with inactive otospongiosis. DISCUSSION: We reviewed the literature concerning MRI and results in otosclerosis. CONCLUSION: MRI of the labyrinth with T1 sequences and gadolinium injection can be contributive to the diagnosis of otosclerosis to differentiate inactive from inactive otospongiosis. However, prospective studies must be conducted to confirm this hypothesis.

Audiometry, Pure-Tone↗
PubMed2004

Cartilage and tympanoplasty.

This study analyzes the morphological and hearing results obtained with cartilage tympanoplasty in retraction pocket, blunting and tympanic membrane lateralization, and cholesteatoma surgeries. Results obtained 3 years postoperatively in 80 patients operated on with cartilage reinforcement of the tympanic membrane (TM) were compared with those obtained 3 years postoperatively in 100 patients operated on with fascia or perichondrium TM reinforcement. Retraction pocket recurrence was found in the patients operated on with fascia or perichondrium in 24% of cases and only in 8% of cases in patients operated on with partial tympanic membrane cartilage reinforcement. No recurrence was found in patients operated on with a total reinforcement of the TM. Cartilage tympanoplasty with skin graft covering the bony external auditory canal (EAC) was performed in 6 cases of severe blunting and/or tympanic membrane lateralization. 3 years post-operatively, good morphological and functional results were obtained in 3 cases. One or two staged ICW procedures were performed in 390 adult patients (416 ears) suffering from a non operated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Cholesteatomas were operated on with removing the malleus, reinforcing all the tympanic membrane with cartilage and performing an ossiculoplasty with hydroxylapatite prosthesis. The results were compared to those obtained in ICW cholesteatoma surgery with preserving the malleus manubrium, partially reinforcing the eardrum with cartilage and predominantly using an ossicle to perform the ossiculoplasty. Removing the malleus and reinforcing the whole tympanic membrane with cartilage statistically reduced the cholesteatoma recurrence rate for the ICW procedure. This technique, using hydroxylapatite prosthesis for ossiculoplasty gives good hearing results.

Adult↗
PubMed2003

[Failure of regain full function after surgery for otosclerosis: causes, diagnosis and treatment].

OBJECTIVE: The aim of this study was to evaluate the causes, the diagnosis, the treatment and the results obtained by revision surgery, in cases of stapedectomy failures. MATERIALS AND METHODS: Retrospective study of 50 recent cases operated on between January 1997 and December 2001. DIAGNOSIS OF THE FAILURE: All reoperated patients had clinical and audiological assessment; CT scan with virtual endoscopy. RESULTS: The mean time of onset of failure was 23 months. The mean preoperative air bone gap was 25.5 dB. Otoscopy revealed a retraction pocket caused by poor eustachian tube function in 9 cases. CT scan proved to be very effective at differentiating the cause of the failure. OPERATIVE FINDINGS: In 11 cases the prosthesis was too short, in 8 cases the prosthesis had migrated out of the hole of stapedotomy and in 6 cases the piston was fixed in the stapedotomy hole. A partial or complete lysis of the long process of the incus was frequently associated, but in 9 cases it was the only cause of the failure. In all the cases when the piston was displaced, the stapedotomy was found to be covered by a thin mucous membrane, avoiding labyrinthine fistula. In 3 cases, the failure was due to recurrent otosclerosis. In 5 cases the failure was due to a local anomaly at the level of the oval window niche, 2 cases of failure were due to a malleus ankylosis. In 5 cases fibrous adhesion was found between the incus and the mucosa of the promontory. In one case a reparative granuloma was found at the level of the oval window. TREATMENT: In cases of partial lysis of the long process of the incus, a new prosthesis was placed in a 0.4 mm diameter stapedotomy, performed using a KTP laser. A 0.4 mm diameter piston was extended 0.2 mm below stapedotomy to avoid a new extrusion. Indeed some prosthesis extrusion could be due to increased movements of the ossicular chain in cases of eustachian tube dysfunction. In cases of complete lysis of the long process of the incus, or in cases of a very short long process of the incus, a piston was put in the stapedotomy and attached to the malleus manubrium. The results of revision stapedotomy were favorable in the absence of associated fibrous tissue adhesion or local malformation. The air bone gap was found to be less than 10 dB in 40 cases and between 10 and 20 dB in 8 cases. An impairment of the air bone gap was found in 2 cases. No case of bone conduction impairment was found in this series.

Adult↗
PubMed2002

Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.

OBJECTIVES: To clarify the clinical significance of positional down beat nystagmus (pDBN). METHODS: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. RESULTS: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two. CONCLUSION: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.

Adult↗
PubMed2002

[Benign paroxysmal positional vertigo of the horizontal canal. Clinical features in 25 patients].

OBJECTIVES: To review the clinical features of benign paroxysmal positional vertigo of the horizontal canal (HC-BPPV). PATIENTS AND METHODS: Retrospective study (September 1999 to March 2001) of 25 patients with HC-BPPV. Patients complained of positional vertigo associated with direction changing horizontal positional nystagmus, either geotropic or ageotropic. RESULTS: The horizontal nystagmus was triggered in all patients when rolled to either side in a supine position (head raised 30 degrees) and in 14 patients by the Dix Hallpike manoeuvre. The nystagmus was geotropic in 15 patients and ageotropic in 10. It varies in time in 4 patients with one change in 3 (from geotropic to ageotropic in 2 and ageotropic to geotropic in 1) and 4 changes in 10 days in another patient. In one patient with head trauma, the HC-BPPV was currently associated with ipsilateral posterior canal benign paroxysmal positional vertigo (PC-BPPV), and its characteristic rotatory-up beat nystagmus. Interestingly, 4 patients had a previous history of ipsilateral PC-BPPV and in 5 others an ipsilateral PC-BPPV occurred after the HC-BPPV. Although spontaneous recovery of HC-BPPV was common in most patients, a 270 degrees "barbecue rotation" or a "prolonged position on the healthy side" was effective in some patients. CONCLUSION: Patients with positional vertigo should undergo Dix Hallpike positioning and supine lateral head turns as this latter manoeuvre is more efficient to diagnose an HC-BPPV. Both the transformation of the positional horizontal nystagmus (geotropic-ageotropic) and the association with a PC-BPPV support the diagnosis of an HC-BPPV.

Adult↗
PubMed2002

[Attical fixation of the malleus head associated with obstruction of the round window niche by a high jugular bulb].

OBJECTIVE: To report the case of a 52 year-old-woman presenting with a left mixed hearing loss. Surgical exploration revealed an attical fixation of the malleus head associated with obliteration of the round window by a high jugular bulb. METHOD: Surgical exploration revealed this rare association. Attical fixation of the malleus head was treated by a partial prosthesis. The mobility of the chain was normal at the end of the surgical exploration but it was not possible to search for the round window sign because the niche of the round window was obliterated by an high Jugular bulb. RESULTS: Audiogram was unchanged even if CT-scan confirm the good position of the partial prosthesis. CONCLUSION: Surgical treatment of an attical fixation of the malleus head do not seem to be necessary if it is associated with a simultaneous obliteration of the round window. Indeed, obstruction of the round window by a high Jugular bulb can caused a conductive hearing loss.

Female↗
PubMed2001

Visual vertigo: symptom assessment, spatial orientation and postural control.

Certain patients with balance disorders report a 'visual vertigo' in which their symptoms are provoked or aggravated by specific visual contexts (e.g. supermarkets, driving or movement of objects). In order to determine the causes of visual vertigo (VV), we assessed symptoms, anxiety and the influence of disorienting visual stimuli in 21 such patients. In 17 out of 21 patients, a peripheral vestibular disorder was diagnosed. Sixteen bilateral labyrinthine-defective subjects (LDS) and 25 normal subjects served as controls. Questionnaire assessment showed that the levels of trait anxiety and childhood motion sickness in the three subject groups were not significantly different. Reporting of autonomic symptoms and somatic anxiety was higher than normal in both patient groups but not significantly different between LDS and VV patients. Handicap levels were not different in the two patient groups, but the reporting of vestibular symptoms was higher in the VV than in the LDS group. The experimental stimuli required subjects to set the subjective visual vertical in three visual conditions: total darkness, in front of a tilted luminous frame (rod and frame test) and in front of a large disc rotating in the frontal plane (rod and disc test). Body sway was also measured in four visual conditions: eyes closed, eyes open, facing the tilted frame and during disc rotation. In psychophysical and postural tests, both LDS and VV patients showed: (i) a significant increase in the tilt of the visual vertical both with the static tilted frame and with the rotating disc; and (ii) an increased postural deviation whilst facing the tilted frame and the rotating disc. The ratio between sway path with eyes closed and eyes open (i.e. the stabilizing effect of vision) was increased in the LDS, but not in VV patients, compared with normal subjects. In contrast, the ratio between sway path during disc rotation and sway path during eyes open (i.e. the destabilizing effect of a moving visual stimulus) was increased in the VV patients but not in LDS. Taken together, these data show that VV patients have abnormally large perceptual and postural responses to disorienting visual environments. VV is not related to trait anxiety or a past history of motion sickness. The results indicate that VV emerges in vestibular patients if they have increased visual dependence and difficulty in resolving conflict between visual and vestibulo-proprioceptive inputs. It is argued that treating these patients with visual motion desensitization, e.g. repeated optokinetic stimulation, should be beneficial.

Adult↗
PubMed2000

Reorientation of a visually evoked postural response during passive whole body rotation.

Visually evoked postural responses (VEPR) to a roll-motion rotating disk were recorded from normal subjects standing on a yaw axis motorised rotating platform. The disk was fluorescent so that subjects could be tested in an otherwise dark room. Movements of the head and centre of foot pressure were measured while subjects looked at the disk with their eyes and head in the primary position and while the rotating platform moved the subjects randomly to 0, +/-45 degrees and +/-90 degrees angles from the visual stimulus. Subjects were instructed to maintain fixation on the centre of the rotating disk but the amount of horizontal eye and head movement used was not specified. Platform rotational velocity was set near threshold values for perception of self-rotation (approximately 2 degrees/s) so that subjects would find it difficult to reconstruct the angle travelled. The data showed that the VEPR occurred in the plane of disk rotation, regardless of body position with respect to the disk, and despite the subjective spatial disorientation induced by the experiment. Averages of the response revealed a good match (gain=0.95) between disk orientation and sway direction. The horizontal gaze deviation required to fixate the centre of the disk was largely achieved by head motion (head 95%, eye 5%). The results confirm previous results that VEPRs are reoriented according to horizontal gaze angle. In addition, we show that the postural reorientation is independent of cognitively or visually mediated knowledge of the geometry of the experimental conditions. In the current experiments, the main source of gaze position input required for VEPR reorientation was likely to be provided by neck afferents. The results support the notion that vision controls posture effectively at any gaze angle and that this is achieved by combining visual input with proprioceptively mediated gaze-angle signals.

Adult↗
PubMed1998

[Significance of lasers in surgery of cerebellopontine angle tumors].

The use of the laser in otology has demonstrated its effectiveness and safety. The aim of this paper is to show its application in otoneurosurgery. After comparing the advantages and disadvantages of various lasers (Yag, CO2, KTP), we soon opted for the KTP laser, which we have since used exclusively in otology and otoneurosurgery. 25 patients with cerebello-pontine angletumours were operated using the KTP laser (22 neuromas and 3 meningiomas). Although in the absence of rigourous methodology it is difficult to assert the superiority of the laser over the classical techniques of resection, the results seem better since we have been using the laser for otoneurosurgery, especially for facial function. In any case, the laser is merely an instrument, which it is necessary to learn to manipulate; it does allow lesions to be vaporized without traction, and has a haemostatic action. It should never be used directly in contact with nervous structures, especially nerves. It seems to us to be most helpful in dealing with large and very vascular tumours.

Cerebellar Neoplasms↗
PubMed1996

[Intrapetrous cholesteatoma].

Intrapetrous cholesteatomas correspond to lesions extending beyond the classical limits of impairment at the level of the middle ear. This paper analyzes 31 cases of which only 2 are definitely primary, the other 29 probably being secondary. In 5 cases, a cholesteatoma had been previously removed by an open or semi-open technique. Such cholesteatomas, that are found at all ages (from 12 to 74), affect both sexes equally. They are easy to diagnose when the symptomatology combines a history of otitis, damage to facial motoricity, mixed deafness or anacusis and a tympanic aspect of cholesteatoma. They are much more difficult to diagnose in the absence of any facial deficit, of major deafness, and even more so if the tympanum is closed. CT-scanning and MRI now enable a precise study of the nature of the complaint and its extension. Surgical treatment requires full mastery of all the techniques of otoneurosurgery, the procedure depending very much upon the seat and extent of the intrapetrous cholesteatoma.

Adolescent↗
PubMed1993

[Post-traumatic syringomyelobulbia and inferior vertical nystagmus].

A case of post-traumatic cervico-thoracic syringomyelia was complicated, 3 years after the injury, by a bulbar extension manifested by a downbeat vertical nystagmus which became a source of disabling oscillopsia. The syringobulbia was visualized at MRI. The usefulness of syringostomy in such a case is discussed.

Adult↗