Elevated visual dependency in young adults after chemotherapy in childhood

Chemotherapy in childhood can result in long-term neurophysiological side-effects, which could extend to visual processing, specifically the degree to which a person relies on vision to determine vertical and horizontal (visual dependency). We investigated whether adults treated with chemotherapy in childhood experience elevated visual dependency compared to controls and whether any difference is associated with the age at which subjects were treated. Visual dependency was measured in 23 subjects (mean age 25.3 years) treated in childhood with chemotherapy (CTS) for malignant, solid, non-CNS tumors. We also stratified CTS into two groups: those treated before 12 years of age and those treated from 12 years of age and older. Results were compared to 25 healthy, age-matched controls. The subjective visual horizontal (SVH) and vertical (SVV) orientations was recorded by having subjects position an illuminated rod to their perceived horizontal and vertical with and without a surrounding frame tilted clockwise and counter-clockwise 20° from vertical. There was no significant difference in rod accuracy between any CTS groups and controls without a frame. However, when assessing visual dependency using a frame, CTS in general (p = 0.006) and especially CTS treated before 12 years of age (p = 0.001) tilted the rod significantly further in the direction of the frame compared to controls. Our findings suggest that chemotherapy treatment before 12 years of age is associated with elevated visual dependency compared to controls, implying a visual bias during spatial activities. Clinicians should be aware of symptoms such as visual vertigo in adults treated with chemotherapy in childhood

Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care

Thyrotoxic hypokalemic periodic paralysis. Report of three cases

Hypokaliemic thyrotoxic periodic paralysis (HTPP) is an uncommon complication of hypothyroidism. Mostly described among Asian patients, it is rare in the other ethnic groups, in particular in caucasians people. Among the possible mechanisms, modification of potassic flows in relation to anomalies of the sodium-potassium pump were evoked. PATIENTS AND METHOD: We present the cases of three caucasians patients operated on for HTPP. These patients had all previous history of several paretic episodes. The flask paralytic attacks occurred in a brutal way or were preceded by diffuse myalgias. They reached the proximal muscles, especially in inferior limbs. No patient had any respiratory complications. These three patients underwent total thyroidectomy to treat the symptoms of HTPP. RESULTS: In the three cases, a total thyroidectomy allowed the recovery of the symptoms. After a four years average period of post-operative follow-up, no patient presented any repetition of HTPP. The hyperthyroidism is the cause of decompensation of the molecular anomaly. CONCLUSION: In our opinion, surgical treatment (total thyroidectomy) is needed in order to reduce the potential gravity of this pathology

Vestibular compensation following vestibular neurotomy

International audienceObjectives: Four studies assessing vestibular compensation in Meniere's disease patients undergoing unilateral vestibular neurotomy, using different analysis methods, are reviewed, with a focus on the different strategies used by patients according to their preoperative sensory preference. Material and methods: Four prospective studies performed in a university tertiary referral center were reviewed, measuring the pattern of vestibular compensation in Meniere's disease patients before and after unilateral vestibular neurotomy on various assessment protocols: postural syndrome assessed on static posturography and gait analysis; perceptual syndrome assessed on subjective visual vertical perception; and oculomotor syndrome assessed on ocular cyclotorsion. Results: Vestibular compensation occurred at variable intervals depending on the parameter investigated. Open-eye postural control and gait/walking returned to normal one month after neurotomy. Fine balance analysis found that visual perception of the vertical and ocular cyclotorsion impairment persisted at long-term follow-up. Clinical postural disturbance persisted only when visual afferents were cut off (eyes closed). These impairments were the expression of a postoperative change in postural strategy related to the new use of visual and non-visual references. Conclusions: Understanding pre-operative interindividual variation in balance strategy is critical to screening for postural instability and tailoring vestibular rehabilitation. (C) 2015 Elsevier Masson SAS. All rights reserved

Propagation et modélisation numérique de la conduction acoustique par voie osseuse

120e Congrès 2013, 12-14 octobre, Paris - Palais des CongrèsInternational audienceHearing impairment is one of the challenges of the 21st century, It is going to be overcome by the recent advances in assistive hearing aids systems and in particular bone-anchored implants. Their optimization is possible today through better knowledge of how sound waves propagate on the surface of the skull. The aim of our study was to evaluate the modes of propagation of sound waves through bone conduction at the surface of the skull and identify the criteria of attenuation of these waves as a function of time, their trajectory and frequency of the stimulation . An experimental study on isolated human cephalic end was conducted. The excitation was performed by a shaker over a wide frequency band. Eighteen measurement points were determined on the cap where miniature piezoelectric accelerometers were glued. Cochlear vibrations could be collected by recording the movement of the round window using a laser vibrometer. The results identified the preferential conduction pathways of sound waves on the surface of the skull according to the solicitation frequencies. ----------------------------- In French: Le handicap auditif est un des défis du 21° siècle, il est en passe d'être relevé grâce aux progrès récents des systèmes auditifs et en particulier des implants à ancrage osseux. Leur optimisation passe aujourd'hui par une meilleure connaissance des modalités de propagation des ondes sonores à la surface du crâne. L'objectif de notre étude était donc d'évaluer les modalités de propagation des ondes sonores par voie osseuse à la surface du crâne et de déterminer les critères d'atténuation de ces ondes en fonction du temps, de leur trajectoire et des fréquences de stimulations. Une étude expérimentale sur extrémités céphaliques humaines isolées a été menée. L'excitation était réalisée par un pot vibrant couvrant une large bande fréquentielle. Dix-huit points de mesure ont été déterminés sur la calotte où des accéléromètres miniatures ont été collés. Les vibrations cochléaires ont pu être recueillies par l'enregistrement des déplacements de la fenêtre ronde par vibrométrie laser. Les résultats obtenus ont permis d'identifier les voies de conduction préférentielles des ondes sonores à la surface du crâne en fonction des fréquences de sollicitation