Les acouphènes

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

TRT: efficacité après un an de traitement.

INTRODUCTION: Tinnitus Retraining Therapy (TRT) (which aims to induce changes in the mechanisms responsible for transferring signals from the auditory system to the limbic and autonomic systems) is a method for treating Tinnitus and decreased sound tolerance. An individualised explanation of Jastreboff's neurophysiological model allows greater insight and motivation on the part of the patient. Previous studies have demonstrated that daytime TRT is effective. As sleep forms a significant component of the distress associated with Tinnitus however, we hypothesised that night-time TRT could represent a useful tool in the treatment of this disabling condition. MATERIAL AND METHODS: 46 patients were studied (30 male, 16 female). Patients were selected from an ENT outpatient clinic. Patients with significant psychological disability were excluded. Patients were reviewed twice by their doctor and 5 times by a therapist over 12 months. Treatment consisted of 8 hours nighttime white noise stimulation, at progressively increasing intensity. Although several objective assessments of response were undertaken, patients' subjective testimonies were considered a more accurate signal of success. RESULTS: In total, 80% of patients had a satisfactory response after 1 year of treatment. 20% had no response. Patients were subcategorised according to Jastreboff's categories as follows: 1. Tinnitus (n = 6), 100% improved; 2. Tinnitus with hearing loss (n = 16); 62% improved; 3. Hyperacusis (with or without Tinnitus) (n = 16), 88.5% improved; 4. Hyperacusis (with or without Tinnitus, exacerbated by noise) (n = 8), 75% improved. CONCLUSION: Tinnitus is a symptom rather than an illness, and TRT gives patients greater control, allowing re-integration of normal perception. Night-time TRT is an effective treatment for Tinnitus and decreased sound tolerance. It has the potential advantage over day-time TRT of rapidly improving sleep and decreasing use of sedative hypnotics, a secondary effect noted in the personal testimonies of our cohort of patients. Further studies are needed to confirm this advantage, in view of the significant risks associated with long-term use of benzodiazepines. When investigating therapies for Tinnitus, it is necessary to measure success in terms of quality of life, as it is to this that the patient attaches the most importance

Overlay versus underlay tympanoplasty. Comparative study of 122 cases

Introduction: In tympanoplasty, the most common two techniques for positioning the graft relative to the remnant of both the tympanic membrane and of the annulus, are the "overlay" and the "underlay" techniques. Each technique has advantages and disadvantages. Methods: One hundred and twenty-two cases over the age of 8 years who had undergone a tympanoplasty for tympanic membrane perforation secondary to chronic otitis media were included. All patients had a minimum 3-month postoperative otoscopic and audiometric follow-up. Results: of 122 cases, 115 tympanoplasties (94 %) were anatomically successful. At frequencies of 0.5, 1, 2, and 4 kHz, the mean air-bone gap improved significantly from 21.7 dB preoperatively to 8.4 dB postoperatively giving a mean gain of 13.3 dB. Conclusion: In our series the underlay or overlay positioning of the graft does not significantly influence the rate of postoperative perforations or complications with the exception of epithelial pearls, which occur significantly more frequently following the overlay technique for perforations that require fibro-epidermal cleaving across a large area.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Syndrome de Guillain-Barré et hypoacousie.

Guillain-Barré's Syndrome and hearing loss. A child presenting Guillain-Barré's syndrome, together with bilateral hearing loss is presented. The incidence of hypoacusis is unknown. The necessity of behavioural audiometry and electrophysiologic testing is stressed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe