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Objectives: To summarize the indications and evaluate the Auditory Brainstem Implant (ABI) performances in neurofibromatosis type 2 (NF2) and other otologics indications, as postmeningitis ossified cochlea., Material and Methods: Main and first indication of ABI is NF2. Emergent indications are bilateral total ossified cochlea, vestibular schwannoma with controlateral lesions, cochlear nerve aplasia or inner ear's malformations. The pre-operative evaluation includes clinical, radiological, lipreading, and psychological status. A translabyrinthine or retrosigmoid approach is performed, depending on tumoral or not tumoral status. The auditory perception with the ABI is evaluated by testing, the words recognition in open-set lists, and the speech understanding with usual sentences., Results: In NF2 patients, best results are obtained in cases of smaller vestibular schwannoma and none, or short term, auditory deprivation. Negative prognostic factors are duration of total hearing loss (>10 years), tumor size (>30 mm), difficulties in electrode array placement, complications during post-operative course and number of active electrodes (<10). In cases of postmeningitis total deafness with totally ossified cochlea, results demonstrate a good benefit reaching these obtained with cochlear implant in post-meningitis deafness., Conclusion: These results show a clear benefit of ABI in NF2 patients, with or without previous tumor removal, in case of small tumor with a short duration of hearing loss. In case of postmeningitis ossified cochlea, results potentially reach those of cochlear implants.

Introduction: Skull base osteomyelitis is an uncommon but severe condition generally secondary to necrotizing otitis externa. The aim of this study was to determine the patients demographics, clinical and radiological findings, and outcomes of this condition., Material and Methods: We prospectively follow 5 patients with a diagnosis of skull base osteomyelitis between 2004 and 2005. Clinical, biologic and imaging data were collected, and also follow-up during treatment., Results: The five patients were men and the average age at presentation was 75 years (63-89). All except one had a previous diabetes mellitus, with a more or less recent clinical story of otitis externa. All of them suffered of headaches and cranial nerve(s) deficits, particularly facial nerve. Diagnosis was made on MRI with gadolinium injection and fat saturation, and Pseudomonas aeruginosa identified as pathogen in all cases. One patient deceased of cranial nerves palsy complication. In 4 cases we found previously a too short or non adapted treatment of necrotizing otitis externa., Conclusions: In the setting of headache, cranial nerves deficit and abnormal skull base imaging on MRI with Fat sat, osteomyelitis should be consider as the likely diagnosis. This complication should be avoided by optimal management of necrotizing otitis externa.

Objective: The aim of this study was to analyse performance of cochlear implants in a retrospective series of adults with postlingually in order to search for predictive factors and identify complications., Methods: Between 1990 and 2003, 134 adult patients were implanted: 129 patients on one side and 5 patients on both sides. Hearing benefit at 6, 12, 24 and 36 months and performance at 12 months were analyzed as function of the etiology, age at implantation, lipreading and speech coding strategy., Results: Compared to performances before implantation, cochlear implants provided significant and rapid improvement at 6 months (p<0.0001). The results were not correlated with age at implantation, etiology or lipreading ability before implantation. Performances were worse in patients with meningitis (p<0.01), but the percentage of improvement was similar between the different etiologies. Major complications were rare: one case of regressive postoperative facial nerve weakness., Conclusion: Cochlear implants provide significant and rapid improvement, with low morbidity. Results are not correlated with age at implantation, etiology or lipreading ability.

Objective: To report a case of labyrinthine hemorrhage with a sudden sensorineural hearing loss and vertigo. This is a rare mechanism of inner ear damage, which may be considered in patients with anticoagulant therapy., Material and Methods: We report a case of sudden sensorineural hearing loss and vertigo in a 73-year-old male on anticoagulant therapy for arrhythmia. An audiovestibular and imaging work-up was performed., Results: Audiometry showed a left profound hearing loss. Videonystagmography demonstrated a left labyrinthine deficit. Hemostasis assessment showed an INR at 7.5 MR imaging evidenced a high intralabyrinthine signal on T1-weighted images without gadolinium and on FLAIR T2-weighted images, suggesting labyrinthine hemorrhage. At clinical follow-up the vertigo regressed but the hearing function was not recovered., Conclusion: Labyrinthine hemorrhage should be evoked in the event of sudden sensorineural hearing loss in patients with anticoagulant therapy. MRI is a useful diagnostic tool in this case.

Objective: To evaluate the benefit of cochlear implantation in older adults aged 60 Years and over., Methods: Fifty-six profoundly or totally hearing-impaired patients, aged 60 Years and over, were studied retrospectively. At the end of the preoperative evaluation, 28 patients received a cochlear implant. The mean age was 66 Years and the median follow-up was 22.5 Months. Speech perception scores before and after implantation were analyzed in order to evaluate the benefit of cochlear implantation. The speech perception score before implantation was compared to that of the non-implanted patients., Results: There was a significant improvement of the dissyllabic words and sentences scores after implantation. The patients who are over 70 Years performed as well as those who are younger (between 60 and 70 Years). One patient developed a postoperative vertigo due a perilymphatic fistula. There was no flap-related problems. In the non-implanted group (mean age: 68 Years), 18 patients declined the cochlear device because they thought the subjective benefit of their hearing aid was sufficient and 5 patients declined because of surgical risk. The mean age, the cause and the duration of the deafness, and the speech perception scores were similar between implanted and non-implanted patients., Conclusion: This study demonstrates the beneficial effect of cochlear implantation in the elderly. These results suggest that a similar benefit could have been obtained in the patients who declined surgery. An early implantation could reduce the duration of the deafness and preserve binaural sound perception allowing increased performance in older people.

Two cases of progressive bilateral hearing loss associated with superficial hemosiderosis of the central nervous system are reported. This is a rare disease caused by repetitive hemorrhage in subarachnoid spaces with hemosiderin deposits on the brain surface and cranial nerves. MRI provided the etiologic diagnosis in both cases based on typical low-density signals from the brain, the brainstem, and the cerebellar surfaces on T1 and T2 sequences. In one case a fourth ventricle ependymoma, which was the probable cause of hemosiderosis, was also discovered. Based on a literature review, we discuss the pathophysiological hypotheses, the modalities for treating hearing loss including cochlear implantation despite retrocochlear sensorineural hearing loss.

Introduction: Middle ear adenoma is an uncommon tumor. We report two cases and review the relevant literature concerning this rare entity., Material and Methods: Two patients with a middle ear adenoma were operated on in our department. Pre- and postoperative data concerning clinical examination, audiometry, and radiology were obtained. Information concerning intraoperative observations and the pathological examination were also gathered., Results and Discussion: The diagnosis of middle ear adenomas is based on clinical, radiological, and pathological confrontation. The microscopic examination should be combined with histochemical and immuno-histochemical methods in order to evidence the glandular and neuroendocrin components of these lesions., Conclusion: Today, classified as a benign epithelial tumor, the middle ear adenoma is associated with an excellent prognosis provided total excision.

Objectives: To analyze outcome after otosclerosis surgery with stamedeotomy with blood clot sealing., Patients and Methods: Otosclerosis surgery was performed in 150 adult patients between 1997 and 1999 by five surgical teams (70% of the procedures were performed by senior surgeons) and followed for 18 months. Stapedotomy was carried out under general anesthesia with an intrameatal approach in 96% of the cases. Stapedotomy (n=120, 80%) was performed with a drill in 141 cases and by laser in 9 (6%). Ninety percent of the Teflon prostheses had a 0.4 mm diameter and a 4.5 mm length. The footplate opening was sealed with blood clots. Venous interposition (n=30, 20%) was performed in the event of partial or total stapedectomy which occurred in spite of an initial stapedotomy attempt., Results: The preoperative air-bone gap (ABG) was 32 +/- 10.3 dB. The gain in air conduction was 25 +/- 11.7 dB with 75% of the patients having more than 15 dB gain. The ABG was 10 +/- 5.4 dB with 73% of the patients having less than 5 dB gain. The interaural difference was 0.5 +/- 14.1 dB and the bone conduction (BC) variation was 1 +/- 7.5 dB. Functional failures were related to significant intralabyrinthine bleeding and revision procedure. The following factors had not effect on outcome: i) stapedotomy versus partial or total stapedectomy, footplate opening sealed by clots or vein, ii) diameter of the stapedotomy and/or the prosthesis, iii) surgical procedure performed by a junior surgeon., Conclusion: Sealing the stapedotomy opening with blood clots appears to provide reliable and reproducible functional outcome that remains stable over time. In this study, changing from partial to total stapedectomy with vein interposition did not modify the functional outcome.

Objective: To define factors predictive of outcome after ossiculoplasty in adults., Material and Methods: From 1992 to 1998, 220 ossiculoplasties were performed for chronic otitis media in 200 patients (100 men and 90 women), average age 53 years, age range 17 - 82 years. Ninety-four patients (47%) had not undergone prior surgery (99 ossiculoplasties) and 106 (53%) underwent revision procedures (121 ossiculoplasties). Average follow-up was 20 months. All patients were reexamined at consultations 3 and 12 months after surgery and 100 patients (50%) were reexamined at two years. The operations were classified in type II tympanoplasty when the patient presented a normal stapes (n=120), and a type III tympanoplasty when the stapes arch was absent (n=100). Perforations (n=200) were repaired by temporal aponeurosis in 160 cases (80%) and a tragal perichondrium in 40 cases (20%). The materials used included 23 incus autografts (10%), 105 hydroxyapatite composite Goldenberg prosthesis (48%), 55 all-hydroxyapatite Xomed prosthesis (25%) including 20 covered with a thinned tragal cartilage, 19 teflon Klein prosthesis (9%), 12 Ionos prosthesis (5%) and 6 Malleus prosthesis (3%). The results were analyzed from the microscopic aspect and audiometric data for frequencies 0,5 to 3 KHz., Results: Twenty prosthesis luxed or extruded (9%) within an average of 6 months, 15 (12.4%) after a revision procedure and 5 (5%, p<0,05) after an initial procedure. Fifteen perforations (15/200, 7.5%) occurred, 9 with temporal aponeurosis grafts (9/160, 5.6%) and 6 with perichondrium grafts (6/40, 15%, NS). The residual air-bone gap (ABG) was equal to 23 +/- 12,5 dB with 57% of ABG<20 dB at 12 months follow-up. The gain in air conduction was 14 +/- 16,5 dB and the change in air-bone gap 13 +/- 12,3 dB. Some factors could significantly improve functional results: presence of the stapes arch (n=120, p<0,05), first-intention procedure (n=99, p<0,05), and use of all-hydroxyapatite prosthesis in type II (p<0,05) or type III tympanoplasties., Conclusion: Ossiculoplasty with all-hydroxyapatite prosthesis produced satisfactory results in type II or III tympaonoplasties.

Purpose of Study: The aim of this retrospective survey was to define factors which may influence tympanic grafts results., Methods: 260 surgical procedures were retrospectively analyzed between 1992 and 1997 by studying anatomical and functional results with a mean follow-up of 18 months., Results: Global rate of tympanic grafts reperforation was 9.2%. At 18 months, the air conduction gain was 9.5 +/- 11.5 dB, with an 13 +/- 7.7 dB air-bone gap (ABG) and 80% ABG inferior to 20 dB, the change in air bone gap was 9 +/- 10.3 dB. Several factors influencing the results were identified: second hand surgical procedures (40%) had worse functional results than patients from first hand procedures, inflammatory atrial mucosa or obstruction of the eustachian tube (more graft retraction), retracted malleus handle and/or stuck to the promontory (worse auditory results), temporal aponeurosis placed under malleus handle (more reperforation of the graft without hearing difference as to graft placement above malleus handle), association of canal wall-down technique (poor auditory results), surgeon experience (better auditory results)., Conclusion: A first surgical procedure, normal malleus handle and atrial mucosa, no mastoidectomy or canal wall-up technique, a temporal aponeurosis graft placed above malleus handle are predictive factors for anatomical and/or functional good results.

Cholesterol granuloma of the petrous apex are cystic lesions, revealed by otologic and/or cranial nerve palsies, and diagnosed with the help of computed tomography and magnetic resonance imaging. Surgical treatment is not the complete removal of the lesion, but a conservative approach requiring drainage of the cyst and re-establishment of a correct aeration of the cavity. Three cases of cholesterol granuloma of the petrous apex were treated through a transmastoid infralabyrinthine procedure. Through a postauricular approach, a simple mastoidectomy was performed. The third portion of the facial nerve was identified. The posterior and lateral semicircular canals, and the jugular bulb were skeletonized. In two cases, a high diverticulum of the jugular bulb was impacted downwards with wax. The cystic lesion was then opened, and evacuated. The opening must be large to permit a correct aeration of the cavity and prevent stenosis of the drainage site. Hearing and the facial function were preserved in all cases. In conclusion, conservative approach to cholesterol granuloma of the petrous apex provides satisfactory drainage of this intrapetrous deep seated lesion with preservation of hearing and facial nerve function.

Unlabelled: A REAL ENTITY: Deafness resulting from an autoimmune mechanism is suggested by a growing number of clinical and experimental arguments. The audio-vestibular system is known to be involved in a certain number of systemic diseases, particularly Cogan's disease. In other cases, the inner ear alone is involved; deafness may be the first manifestation of a systemic disease or result from a possible immunological mechanism., Clinical Aspects: Autoimmune deafness is very invalidating. Bilateral perception deafness is observed in 80% of the cases and vestibular involvement is found in 70%, Diagnosis: No one simple reliable test is known which can establish the diagnosis of autoimmune deafness. Other causes must be ruled out by appropriate clinical and complementary explorations. For humoral immunity, the western blot method has given promising results suggesting a possible role of the heat shock protein in the underlying immunological mechanism., Treatment: Immediate care is needed but no standard treatment has been defined. High-dose corticosteroids can provide symptom relief, particularly in case of abnormal immunological tests. The role of immunosuppressive therapy, sometimes proposed in case of corticosteroid resistance, remains to be defined.

Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via middle cranial fossa approach (MFA: 23 cases) or translabyrinthine approach (TL: 3 cases), 9 cases were supervised by audiovestibular testing and MRI. For the operated patients through MFA the functional hearing (pure tone loss < 50 dB and 100% vocal discrimination) was preserved in 47.8% of cases, facial function was grade I and II in 83% of cases and grade III in 17% of cases. One recurrence was noted and reoperated by TL. For the TL operated patients, the postoperative facial function was normal (grade I) in all cases. Among the 9 supervised cases for reasons of age (more than 60 years), or the tumoral size (< than 5 mm): the tumor in 3 cases did not increase in size, 5 cases increased by 1 mm/year and 1 case increased 1 cm/year (and must be operated). These results show the importance of the middle cranial fossa approach for excision of intracanalicular neuromas and supervising patients with the same tumor according to age, and tumoral size.

Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some combination of these three. In the past, they have been found at autopsy or as incidental finding at surgery. Since the advent of magnetic resonance imaging (MRI) with intravenous gadolinium contrast, the preoperative diagnosis is possible. We report two cases of intralabyrinthine schwannoma: one case of intralabyrinthine schwannoma extended into the internal auditory canal (IAC), a second case of tumor restricted to the vestibule. No characteristic clinical presentation of this tumor is reported in the literature. In patients with vestibular weakness (vertigo and no response of caloric testing), MRI with gadolinium contrast can make the diagnosis of intravestibular tumor. In patients with the more common IAC acoustic neuromas, MRI can demonstrate extension of tumor into the labyrinth; diagnosing this extension preoperatively is important to plan surgical treatment.

The results of facial nerve surgery in the temporal bone have been evaluated in a review of 34 cases (19 decompressions and 15 reparations). Decompressions of immediate and complete facial paralysis by fracture of the temporal bone that have achieved a good motor recovery resulted from early surgery before the 21st day (50% of grades I and II, 50% of grades III). After this delay, facial recovery did not reach grades I and II any longer. In case of nervous interruption of traumatic origin or after tumoral ablation, direct restoration of continuity by an intermediary grafting fixed with fibrin glue enabled the recovery of a facial function of grade III in 87.5% of the cases. These results point out the importance of an early exploration of traumatic facial paralysis before the end of the third week, and the interest of using a cable graft fixed with fibrin glue to repair directly the facial nerve.

Between 1987 and february 1994, 162 consecutive patients with acoustic neuroma were operated on by an otoneurosurgery team, using transpetrous approaches (89% translabyrinthine, 8% middle fossa and 3% retrosigmoid). The relationship between the clinical, audiometric and vestibulographic characteristics and the post-operative facial nerve function were evaluated. In acoustic neuromas with cerebello-pontine component inferior to 3 cm without central neurologic signs (ic: central controlateral auditory and/or ipsilateral vestibular pathway alteration), good post-operative facial nerve function was achieved in 80% of cases. In acoustic neuromas superior to 3 cm with alteration of the central vestibular and auditory pathways, a good result was obtained in only 30% of cases which correlated negatively with preoperative facial dysfunction. These results underline the value of preoperative facial and audiovestibular examinations in predicting the postoperative facial nerve function following surgery for acoustic neuroma.

A case of temporal bone chrondroblastoma is reported. The presenting symptom was a serious otitis. The finding on physical examination was partial facial palsy. The tumor was removed through a middle fossa approach. Chondroblastoma is a rare tumor that represents 1% of all primary bone tumors. In the temporal bone only 34 cases have been reported. The histologic diagnostic should be difficult. Radical excision is suggested regarding its tendency to recur.

This is a retrospective report of 41 tegmen breaches observed in 2 different populations : 27 patients among a series of 252 cases of operated chronic otitis (6.7%) and 14 patients admitted for management of tegmen breach and dura mater involvement. The most frequent cause was chronic otitis (36 cases, including 6 due to iatrogenic causes); there were also 2 cases of petrus fracture, 2 cases of intracranial hypertension and 1 idiopathic case. Computed tomography revealed a bony breach in 97% of the cases. Encephalo-meningocele was associated in 11 cases (31%). In these cases, MRI confirmed the preoperative diagnosis. Treatment via the mastoid route allowed removal of the infectious process and via the suprapetrous route allowed closure of the breaches in the bone and dura mater as well as treatment of associated cephaloceles, except in case of major infection where the cephalocele was closed in a second operation.

Twenty five cases of malignant tumors of the petrous bone are presented. Prognosis depends on the histology and on the local invasion which dictate the possibility of curative surgery. Squamous cell carcinoma of the middle ear and other invasive tumors have a bad prognosis, and in spite of the progress of modern image technology, the peripetrous extension of the tumors are often underestimated. Actuarial two years survival for squamous cell carcinoma was 38%. Total excision needs at least a subtotal petrous resection with, in some cases meningal and internal carotid resection. In all cases, surgery was followed by radiation. Low grade malignant tumors had a better prognosis and required a more limited resection. In these cases, when necessary, facial nerve can be repaired by a cable graft at the time of initial surgery.

Petro-clival meningiomas are rare tumors. Because of their deep location in the posterior fossa, many surgical approaches have been proposed, generally with severe post-operative morbidity and mortality. Thirty-six meningiomas of the petrous apex (34 posterior surface of petrous bone meningiomas, 2 clivus meningiomas) were operated, via a trans petrosal approach, from 1983 to 1993. In 14 cases, the trans-labyrinthine (TL) approach, extended by drilling the bone above the internal auditory canal (IAC) was performed (39%). In 18 cases the TL approach was extended in a subtemporal, transtentorial approach (50%). In one case (2.5%), after rerouting the facial nerve posteriorly, the TL approach was extended anteriorly in a transcochlear approach. The retro-sigmoïd approach was performed in one case (2.5%). The extended middle fossa approach was performed in two cases of clivus meningiomas (5%). Total excision was obtained in 27 cases (75%). By using the Laser, quality of resection is increased. Most complications and morbidity were encountered with tumors extending towards the cavernous sinus. Extended translabyrinthine approach allows total excision in most of cases of petro-clival meningiomas. For clivus tumors or tumors invading the cavernous sinus, the extended middle fossa approach and subtotal petrosectomy are proposed respectively.

Pleomorphic adenoma is the common benign tumor of glandular tissue occurring in the head neck region. The authors report a case localised in the nasal septum, which is an uncommon site for this tumor. Symptoms include unilateral nasal obstruction and intermittent nasal bleeding. Local surgical resection with histologic clear margins is the treatment of choice but long term follow-up is recommended.

A case of rhabdomyosarcoma of the tongue in an adult male is reported. The diagnosis of this rare lesion is difficult and should be considered in every growing mass of the head and neck region. It is based on the pathologic examination of tissue samples guided by immunohistological methods. In this case the examination revealed an embryonal type. The tumoral progression is rapidly fatal unless an aggressive therapeutic regimen including surgery and radiotherapy is instituted. In this manner dramatic improvement in survival rate has been achieved in recent years.

Antimicrobial sampling was performed in the external auditory canal and in the mastoid cavity when possible in 80 middle ears operated on during the last 15 months. These samplings concerned 20 cholesteatomas. 25 suppurative chronic otitis, 25 non suppurative chronic otitis and 6 miscellaneous. In 20 out of 80 cases (25%), one or several microbial agents were identified: cholesteatomas (35%), suppurative chronic otitis (38%), non suppurative ones (4%) and miscellaneous (16%). In most cases a staphylococcus or a negative gram agent was sensitive to amoxycillin-clavulanique acid. When sampling was performed in the mastoid cavity, the agent was not sensitive to this antibiotic (80% of cases). This study demonstrates that a prophylactic therapy against aerobic and anaerobic agents is necessary in non suppurative chronic otitis whereas the antimicrobial therapy must be adapted in other pathologies.

The position of the jugular bulb is extremely variable. A high jugular fossa with a diverticulum of the jugular bulb can alter the inner ear function with neurosensory hearing loss, vertigo and tinnitus. Six cases of jugular bulb diverticulum with vertigo mimicking Meniere's disease were operated on and followed up from 6 months to 4 years. The jugular bulb was approached through a mastoidectomy and the diverticulum was decompressed downward using bone wax. The vertigo disappeared after surgery in all the cases. These observations suggest that an abnormality of the jugular bulb should be considered as a possible origin of Meniere's disease and that vertigo can be cured by downward decompression of the diverticulum.

We report three cases of small cerebellar infarcts mimicking labyrinthine dysfunction. A sudden rotatory vertigo might be the only presenting symptom of a cerebellar infarct. In these cases, the clinical features may closely mimick an acute peripheral labyrinthine disorder. However, the absence of nystagmus or a direction changing nystagmus with different eye position and the normality of caloric responses may be suggestive of a cerebellar infarct. This syndrome may be explained by the involvement of the nodulus, part of the flocculo-nodular complex, that has primary vestibular connections. Cerebellar infarcts mimicking labyrinthine dysfunctions involved usually the cerebellar territory of the posterior inferior cerebellar artery (PICA). Infarcts may be limited to the territory of the medial branch of the PICA which supplies the nodulus.

Hemangiomas of the temporal bone are benign, vascular and are tumors. The diagnosis is in most cases made during the operation because the symptoms are non conclusive. Two cases were recently observed: one simulating a Meniere disease while the tumor was developed close to the jugular bulb and the endolymphatic sac; the second invaded the geniculate area and the petrous apex and was revealed by a progressive facial palsy.

The tumors of the middle and posterior portion of the skull base may extend extracranially. The spread of the tumors towards the infratemporal fossa is rare. Among 23 skull base tumors with extracranial extension which were diagnosed during the last 5 years, only two middle ear epidermoid carcinomas extended into the infratemporal fossa. Subtotal surgical removal of tumors was obtained in both cases through a subtotal petrectomy with an ultrasonic aspiration of the extracranial extension followed by transcutaneous irradiation. One case is followed free of disease 2 years and a half after the beginning of the treatment. The spread of the tumor into the infratemporal fossa might not be of poor prognosis.

Eight defects of the tegmen tympani or antri have been operated on during the last two years. Among these cases, 4 brain herniae were associated with the defect of the tegmen. Magnetic resonance imaging permitted to evaluate accurately the space occupying lesions into the mastoid cavity and disclosed the brain and/or meningeal herniations. The defect of the tegmen was oblitered through a middle fossa approach whereas the hernia was resected through a mastoid approach when necessary.

Thirty four patients with a chronic otitis were evaluated prospectively by magnetic resonance imaging (MRI) to delineate its contribution in the diagnosis of middle ear masses. The results were correlated to the CT and the surgical and pathological findings. MRI permitted to differentiate the inflammatory tissues from either cholesteatoma, cholesterol granuloma and cerebromeningeal hernia.

The electrochemical and osmotic composition of the inner ear fluids has been studied during experimental endolymphatic hydrops in guinea pig. The data showed that the modifications of the electrochemical composition of endolymph has been detected only after more than 2 weeks after the hydrops induction. The endocochlear potential, the K and Cl concentrations, and the osmolality progressively decreased between 6 and 9 weeks of hydrops. The longitudinal gradients disappeared. After 24 weeks of hydrops, the endocochlear potential was 50% of the initial value whereas the K and Cl concentrations and the osmolality were higher than that measured at 9 weeks but remained lower than contralateral, normal values. These results suggest that the alterations of the electrochemical and osmotic composition of endolymph that were observed during the evolution of experimental endolymphatic hydrops in guinea pig are related to an alteration of the permeabilities of the Reissner's membrane induced by an increase of hydrostatic pressure.

Selection criteria for the preservation of auditory function during excision of acoustic neurinoma have been defined for a long time, and the means for a successful achievement of such a goal are widely known. Recruitment of special patients, for whom maintenance of an even deeply altered hearing capacity constitutes a requisite for continuation of professional work has lead us to extend indications for the pre- and retrosigmoid approaches recommended by J.M. Sterkers. The authors present a series of 16 patients, in which a single case of cophosis was deplored.

Inappropriate secretion of antidiuretic hormone or Schwartz-Bartter syndrome is considered to be a paraneoplastic endocrine syndrome, most frequently associated with a small cell anaplastic carcinoma of the lung. The authors present a case of sub-glottal laryngeal carcinoma discovered several months after the onset of clinical (disturbances of conscious level) and laboratory (hyponatraemia, hypochloraemia, blood hypo-osmolarity which preservation of urinary sodium output) manifestations which form the original features of this syndrome, the criteria of which are reviewed. The y conclude by the need for complete examination, not excluding unusual sites of primary tumour.

The authors report four rare, benign tumors of the larynx: two granular cell tumors; one large, benign neuroma, weighing 37 g; one pseudo-tumoral amyloidosis, the diagnostic histological criteria of which are defined.

The action of mannitol upon the inner ear fluids was studied experimentally by means of kinetics of mannitol entry into cochlear perilymph and endolymph in rats. A daily two hours infusion of 10% mannitol induces an osmotic water flow from cochlear fluids toward plasma. Following this therapeutic protocol, progressive, non-tumoral sensorineural hearing loss is enhanced in 32% of the cases. The rate of hearing improvement is larger than 50% in case of Ménière's disease. For sudden hearing loss, 75% of the cases are improved by mannitol, and 92% of the cases when the delay between the hearing loss onset and the mannitol therapy is less than two weeks. Sudden hearing loss should be considered as a sensory emergency.

The authors report 5 cases of congenital cholesteatoma of the temporal bone where the diagnosis was made earlier in each successive case. The first diagnosis was made on the basis of a total paralysis of the facial nerve, the last was made on the basis of a transitory paralysis of the facial nerve associated in the majority of cases with deafness or reduced hearing. Early removal preserves fonction of the VII and VIIIth nerve and is the justification for a systematic X-ray in the Stenver's incidences to be carried out in any facial weakness even if it is transitory. The surgical approach of choice is the middle fossa approach. There is no drainage necessary because these cholesteatomas are not infected.

Since 1967, 103 cholesteatomas of the middle ear have been operated. A "reconstructive cholesteatectomy" was done in 89 cases. A recurrence was observed in 13,5%, usually after three years. A good functional result was obtained in 40%. The surgical technique is actually, a tympanoplasty with an open superior cavity, for the largest cholesteatomas.

During the last two decades, 602 tumors of the internal auditory canal and of the cerebello-pontine angle were operated on, using the trans-temporal approaches. Among these tumors, 548 were unilateral acoustic neuromas, that were removed by the trans-labyrinthine approach (57%), the retro-labyrinthine-retro-sigmoid approach (33%) and the middle fossa approach (M.F.) (6%). Five fatalities occurred (1%). The facial nerve was preserved in 94% with an immediate normal function in 58%. The auditory function was preserved in 23% (51 cases).

A comparative study of the acoustic reflex in 92 cases of acoustic neuromas and 40 otological syndromes with a normal meatography. There was complete deafness in 22% of the acoustic neuroma cases and 7.5% of the "false neuromas". A deafness less than 75 dB was observed in 72 VIII nerve and 37 "false neuroma cases, where the acoustic reflex was studied: --reflex absent in 29% of VIII nerve and 11% of "false neuromas"; --decay of reflex in 22% of VIII nerve and 5% of "false neuromas"; --non-pathological reflex in 17% of VIII nerve and 30% of "false neuromas". Hearing was preserved post-operatively in 19 cases out of 55 operations (the retro-sigmoid and middle fossa routes). The acoustic reflex without Decay is an element two times more favourable than a reflex with Decay in cases with preserved hearing.

Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological features in the first case leading to intensive discussion. Two such cases had been previously described in great detail in a paper published in 1977. In those patients, the differential diagnosis froma jugular glomus tumor was only established two and a half years later in one case, when excision was necessary because of an intracranial recurrence, and following-re-examination of all sections of jugular glomus tumors previously operated upon, in the other case. Factors enabling detection of meningiomas simulating glomus tumors were also discussed in the original report. Theses included discordance of clinical finding, -minimal signs on arteriography, -the primordial value of contrast computed tomography, -systematic alerting of the pathologist.

In the surgery of acoustic tumors it is possible to preserve audition and, indeed, imperative, if the neuroma is bilateral. In this work, we describe our technique by the retro-sigmoid route which allowed us to preserve hearing in 36% of cases and facial motor movements in 82% of cases (61 operations).

The schwannomas of foramen jugulare are infrequent although progress in diagnosis of these tumors have been obtained by CT scan. We report five cases of the caudal nerves that where developed into the foramen jugulare. One may suspect these tumors in presence of any minimal, unilateral defect of otological, facial and pharyngo-laryngeal functions. The surgical approach to the tumors depends of both its location and its symptomatology. The mastoid-retro-sigmoid approach allow in most cases to preserve the eight and seven nerve functions.

Cholesterol granulomas arise scarcely within the middle ear cavities revealed by a conductive deafness. They appear on the CT scan as a non specific mass developed in the middle ear cavities with bone defects. MRI allow the diagnosis as cholesterol granulomas is defined by hyperintensity on all sequences.

The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In the pure, tympanic form, a minimal or extended endaural approach is perfectly suitable. -- In tympano-mastoid forms, without involvement or with minimal involvement of the jugular foramen, a prolonged endaural approach may be used for wider operations involving the whole middle ear and mastoid around a bony aqueduct or an exposed VII. --Nevertheless, in the presence of tympano-jugular or tympano-masto-jugular forms, with marked involvement of jugular foramen, the greatest caution is necessary. It would appear that the endaural route may still be suggested but only for certain tumors, with the express reserve that angiographic studies defining its site and extent are favourable. By virtue of more and more highly developed techniques of exploration (scanner with contrast, films in subtraction) which may be used for measurement and precise localization of the tumor, indications for the type of approach may now be defined with even more precision. --It should be noted that if there is the slightest doubt, the slightest reserve, or the slightest fear that an endaural approach might be inadequate to deal with the situation, it should be definitely avoided with preference for a cervico-retro-auricular or cervicopre and retro-auricular approach, or radiotherapy only, or even abstenstion from operation, with observation. It is only if such rules of good sense and caution are respected that minimal, extended, prolonged endaural approaches will retain a worthy place in the surgical treatment of jugular glomus tumors.

The authors have observed the complete regression of a facial palsy in a tuberculous otitis by precocious decompression of the nerve and anti-tuberculous medical treatment.