Effets des nuisances sonores sur l’oreille interne

Les effets des nuisances sonores sur l’organisme intéressent principalement le système auditif, mais d’autres atteintes sont possibles. Leur expression est différente d’une personne à l’autre, en raison d’une sensibilité interindividuelle variable. Si les effets d’une exposition unique sont facilement diagnostiqués en raison d’une forte expression clinique, il n’en est pas de même des expositions répétées. En effet, ces atteintes sont volontiers latentes. Leurs conséquences à long terme sur la fonction auditive justifient leur dépistage précoce. Celui-ci est plus ou moins efficace selon que les nuisances sonores sont rencontrées dans un cadre professionnel ou de loisirs. Quel que soit le type d’atteinte, l’évaluation diagnostique et pronostique justifie un examen ORL spécialisé ainsi qu’une audiométrie, complétés, si nécessaire, par d’autres investigations fonctionnelles ou radiologiques. En matière d’exposition aux nuisances sonores sur le lieu de travail, la législation a récemment évolué tant en matière de mesures de protection que de reconnaissance du handicap auditif rattaché à cette exposition au cours de l’activité professionnelle. Les modalités thérapeutiques reposent essentiellement sur la prévention. Dans certaines circonstances, telles que les traumatismes sonores aigus, un traitement d’urgence est parfois proposé. Les développements les plus récents se font dans la direction de thérapeutiques in situ, délivrées le plus près possible de l’oreille interne atteinte

Implantation cochléaire dans les neuropathies auditives

Hearing rehabilitation with cochlear implant (CI) during Auditory Neuropathy/ Dyssynchrony (AN/AD) appears to be a challenge: one of the clinical characteristics of the disease is the loss of effective neural conduction as demonstrated by desynchronisation on Auditory brainstem Response (ABR). Clinical facts demonstrated that in that condition CI could restore speech perception as in other cause of profound sensorineural hearing loss. By now CI devices gives the opportunity to measure neural responses and electrically evoked ABR, in order to determine correlation between clinical responses and electrophysiologic data. Given the variability of causes of AN/AD, each case should be individually evaluated before cochlear implantation.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Réhabilitation auditive

Les modalités de la réhabilitation auditive dépendent de la cause et de la sévérité de la surdité. Les surdités rattachées à des atteintes de l’oreille moyenne peuvent bénéficier de traitements médicaux ou chirurgicaux, par des prothèses ossiculaires, s’il est nécessaire de restaurer la fonction de la chaîne des osselets. Dans les surdités neurosensorielles, surdités d’oreille interne, l’utilisation d’aides auditives est d’emblée envisagée. Dans les cas pour lesquels elles sont insuffisantes, du fait de la sévérité de la surdité, ou non utilisables, pour des raisons d’intolérance, il est possible de recourir à des prothèses implantées ou à des implants cochléaires. Les indications des implants du tronc cérébral restent à ce jour limitées aux surdités totales bilatérales liées à une destruction complète des cochlées et des nerfs cochléaires. Ces orientations thérapeutiques sont choisies après une évaluation multidisciplinaire du malentendant, qui permet de caractériser l’atteinte auditive et son retentissement. Dans tous les cas, la restauration d’une audition bilatérale est à privilégier, dans le but d’améliorer la compréhension globale, en particulier dans les situations bruyantes, et de localiser les sources sonores.Auditory rehabilitation depends of the cause and the severity of the hearing loss (or deafness). Hearing losses dues to middle ear pathologies can beneficiate of medical or surgical treatments, by ossicular prostheses, if it is necessary to restore the function of the ossicles chain. In the sensorineural hearing losses, with inner ear pathology, the use of auditory aid is immediately considered. In the cases for which they are insufficient because of severity of the hearing loss or not suitable because of local non-tolerance, it is possible to use middle ear implant or cochlear implant. The indications of the auditory brainstern implants remain at this day limited to the total bilateral hearing losses due to a complete destruction of cochleae and auditory nerves. These therapeutic orientations are selected after a multidisciplinary evaluation of the deaf person, evaluation that allows the characterization of the hearing loss and its repercussion. In all the cases, the restoration of a bilateral hearing has to be done if possible, making an improvement of the speech comprehension, mainly in the noisy situations, as well as the localization of the sound sources

Vestibular disorders following BNT162b2 mRNA COVID-19 vaccination: A retrospective case series

International audienceBackground: There are few publications regarding manifestations of vestibular disorders (VDs) following BNT162b2 mRNA COVID-19 vaccination. Purpose: We describe cases of VD potentially related to BNT162b2 vaccination and calculate its reporting rate, in order to enlarge knowledge about this adverse effect. Methods: A retrospective analysis of cases of VD following BNT162b2 vaccination reported to the pharmacovigilance centre of Georges-Pompidou European Hospital (France), in 2021 was performed. In order to identify these cases from the pharmacovigilance database containing all our registered cases, we used the Standardised MedDRA Query (SMQ) ‘vestibular disorders’. Then we analysed cases with vestibular symptoms, based on the association of typical manifestations. The reporting rate was calculated based on the number of VD cases and the number of vaccinated patients. Results: Among 6608 cases reported to our centre related to COVID-19 vaccines during 2021, 34 VDs associated with BNT162b2 administration were included. They were mainly reported in females (79%), 62% occurred after the first dose and 32% were serious. Symptoms had completely resolved in 13 cases (38%). Vertigo was the most common symptom followed by balance disorders. Three patients received second dose without reappearance of VD. The final diagnosis was reported in 10 patients (six cases of vestibular neuritis, two cases of central VD, two cases of benign paroxysmal positional vertigo). The regional reporting rate was 26 [95% CI: 17–34] cases of VD per 1 million persons vaccinated. Conclusion: Although the relationship between vaccination and VD cannot be established, clinicians should be aware of this rare adverse effect

Neuropathie, synaptopathie, atteinte sensorielle, formes partielles de neuropathie, nouvelles étiologies: Variations sur un thème connu

This chapter has a patchwork structure organized in three parts. The first one revisits the question of the adequacy of the Auditory Neuropathy/Auditory Dyssynchrony label for cases in which the causal anomaly is definitely located distally to the nerve fibres. Going beyond the purely semantic dimension, it contrasts an anatomically-based division of the structural components involved with A. Starr's opinion according to which Inner Hair Cells can be considered as specialized neural elements producing neurotransmitters rather man as purely sensory structures. The chapter also draws attention to the possible role of trans-synaptic degeneration of the distal parts of the dendritic processes of the spiral ganglion cells consecutive to a primary lesion of the Inner Hair Cells. The second part of the chapter describes an unusual pattern of results in which Auditory Brainstem Responses are preserved at high stimulus levels only and which is interpreted as indicating a partial Auditory Neuropathy /Auditory Dyssynchrony. The third and last part adds one item to an already long, but most probably yet incomplete enumeration of medical circumstances known to be able to cause an Auditory Neuropathy/Auditory Dyssynchrony by reporting two cases acquired after closed head trauma.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Oral mobility reflects rate of progression in advanced Friedreich’s ataxia

International audienceOur objective was to identify a sensitive marker of disease progression in Friedreich’s ataxia. We prospectively evaluated speech, voice, and oromotor function in 40 patients at two timepoints. The mean disease duration was 20.8 ± 9.8 years and mean SARA score 23.7 ± 8.6 at baseline. Oral motor mobility, assessed by a combination of movements of the face, eyes, cheeks, lips, and tongue, decreased significantly after 1 year (P < 0.0001). The standardized response mean over 12 months was considered as large for oral mobility (1.26) but small for SARA (0.12). Oral mobility could therefore be a sensitive marker in therapeutic trials

Cochlear implant benefits in deafness rehabilitation: PET study of temporal voice activations.

International audienceUNLABELLED: Cochlear implants may improve the medical and social prognosis of profound deafness. Nevertheless, some patients have experienced poor results without any clear explanations. One correlate may be an alteration in cortical voice processing. To test this hypothesis, we studied the activation of human temporal voice areas (TVA) using a well-standardized PET paradigm adapted from previous functional MRI (fMRI) studies. METHODS: A PET H(2)(15)O activation study was performed on 3 groups of adult volunteers: normal-hearing control subjects (n = 6) and cochlear-implanted postlingually deaf patients with >2 y of cochlear implant experience, with intelligibility scores in the "Lafon monosyllabic task" >80% (GOOD group; n = 6) or <20% (POOR group; n = 6). Relative cerebral blood flow was measured in 3 conditions: rest, passive listening to human voice, and nonvoice stimuli. RESULTS: Compared with silence, the activations induced by nonvoice stimuli were bilaterally located in the superior temporal regions in all groups. However these activations were significantly and similarly reduced in both cochlear implant groups, whereas control subjects showed supplementary activations. Compared with nonvoice, the voice stimuli induced bilateral activation of the TVA along the superior temporal sulcus (STS) in both the control and the GOOD groups. In contrast, these activations were not detected in the POOR group, which showed only left unilateral middle STS activation. CONCLUSION: These results suggest that PET is an adequate method to explore cochlear implant benefits and that this benefit could be linked to the activation of the TVA

Processing of voices in deafness rehabilitation by auditory brainstem implant.

International audienceThe superior temporal sulcus (STS) is specifically involved in processing the human voice. Profound acquired deafness by post-meningitis ossified cochlea and by bilateral vestibular schwannoma in neurofibromatosis type 2 patients are two indications for auditory brainstem implantation (ABI). In order to objectively measure the cortical voice processing of a group of ABI patients, we studied the activation of the human temporal voice areas (TVA) by PET H(2)(15)O, performed in a group of implanted deaf adults (n=7) with more than two years of auditory brainstem implant experience, with an intelligibility score average of 17%+/-17 [mean+/-SD]. Relative cerebral blood flow (rCBF) was measured in the three following conditions: during silence, while passive listening to human voice, and to non-voice stimuli. Compared to silence, the activations induced by voice and non-voice stimuli were bilaterally located in the superior temporal regions. However, compared to non-voice stimuli, the voice stimuli did not induce specific supplementary activation of the TVA along the STS. The comparison of ABI group with a normal-hearing controls group (n=7) showed that TVA activations were significantly enhanced among controls group. ABI allowed the transmission of sound stimuli to temporal brain regions but lacked transmitting the specific cues of the human voice to the TVA. Moreover, among groups, during silent condition, brain visual regions showed higher rCBF in ABI group, although temporal brain regions had higher rCBF in the controls group. ABI patients had consequently developed enhanced visual strategies to keep interacting with their environment

Brain voice processing with bilateral cochlear implants: a positron emission tomography study.

International audienceMost cochlear implantations are unilateral. To explore the benefits of a binaural cochlear implant, we used water-labelled oxygen-15 positron emission tomography. Relative cerebral blood flow was measured in a binaural implant group (n = 11), while the subjects were passively listening to human voice sounds, environmental sounds non-voice or silence. Binaural auditory stimulation in the cochlear implant group bilaterally activated the temporal voice areas, whereas monaural cochlear implant stimulation only activated the left temporal voice area. Direct comparison of the binaural and the monaural cochlear implant stimulation condition revealed an additional right temporal activation during voice processing in the binaural condition and the activation of a right fronto-parietal cortical network during sound processing that has been implicated in attention. These findings provide evidence that a bilateral cochlear implant stimulation enhanced the spectral cues associated with sound perception and improved brain processing of voice stimuli in the right temporal region when compared to a monaural cochlear implant stimulation. Moreover, the recruitment of sensory attention resources in a right fronto-parietal network allowed patients with bilateral cochlear implant stimulation to enhance their sound discrimination, whereas the same patients with only one cochlear implant stimulation had more auditory perception difficulties

Speech Performance and Sound Localization in a Complex Noisy Environment in Bilaterally Implanted Adult Patients.

International audienceObjective: To evaluate speech performance, in quiet and noise, and localization ability in adult patients who had undergone bilateral and simultaneous implantation. Study Design: Prospective multi-center study. Methods: Twenty-seven adult patients with profound or total hearing loss were bilaterally implanted in a single-stage procedure, and simultaneously activated (Med-El, Combi 40/40+). Subjects were assessed before implantation and at 3, 6 and 12 months after switch-on. Speech perception tests in monaural and binaural conditions were performed in quiet and in noise using disyllabic words, with speech coming from the front and a cocktail party background noise coming from 5 loudspeakers. Sound localization measurements were also performed in background noise coming from 5 loudspeakers positioned from -90 degrees to +90 degrees azimuth in the horizontal plane, and using a speech stimulus. Results: There was a bilateral advantage at 12 months in quiet (77 +/- 5.0% in bilateral condition, 67 +/- 5.3% for the better ear, p /=60% for the better ear, n = 19) and 'poor performers' (n = 8). Subjects were also categorized as 'asymmetrical' (difference between their 2 unilateral speech scores >/=20%, n = 11) or 'symmetrical' (n = 16). The largest advantage (bilateral compared to the better ear) was obtained in poor performers: +19% compared to +7% in good performers (p < 0.05). In the group of good performers, there was a bilateral advantage only in cases of symmetrical results between the 2 ears (n = 10). In the group of poor performers, the bilateral advantage was shown in both patients with symmetrical (n = 6) and asymmetrical results (n = 2). In bilateral conditions, the sound localization ability in noise was improved compared to monaural conditions in patients with symmetrical and asymmetrical performance between the 2 ears. No preoperative factor (age, duration of deafness, use of hearing aids, etiology, etc.) could predict the asymmetrical performance, nor which ear would be the best. Conclusion: This study demonstrates a bilateral advantage (at 12 months after the implantation) in speech intelligibility and sound localization in a complex noisy environment. In quiet, this bilateral advantage is shown in cases of poor performance of both ears, and in cases of good performance with symmetrical results between the 2 ears. No preoperative factor can predict the best candidates for a simultaneous bilateral implantation