[Prevention and management of acoustic traumas]

Exposure to intense noises during a short time can be responsible for permanent damage of the inner ear, even after an isolated exposure. Amplified music (discos, concert rooms) is the first cause of acute acoustic traumas among the young people. Acute acoustic traumas need urgent management and treatment. Exposure to high noise levels during a long time can lead to a progressive and insidious impairment of the inner ear, the hearing loss appearing obvious only after several months or years. Noise-induced hearing loss is irreversible. The functional consequences of acoustic traumas can be socially disabling and can have an important psychological impact. The prevention is based on the information of the patients, notably of the youngest ones, and on the wearing of hearing protectors at the time of risky situations.

Otoacoustic Emissions and Persistent Tinnitus after Acute Acoustic Trauma

OBJECTIVES

To follow up the auditory status of military personnel after an acute acoustic trauma and to identify the possible predictive value of hearing thresholds and otoacoustic emissions during the first 24 hours after the acoustic trauma.

STUDY DESIGN

A group of 24 young military subjects, aged 22 +/- 2.3 years, without any otologic problem before the acoustic trauma, were examined at three time intervals after an accidental acoustic trauma caused by the discharge of a firearm: 24 hours, 72 hours, and 15 days.

METHODS

Each subject was submitted to medical examination and to a questionnaire detailing the circumstances of the acoustic trauma. Pure tone audiometry was performed from 1 to 8 kHz per half octave. Transiently evoked otoacoustic emissions were recorded in the nonlinear mode at 80 dB pSPL, and distortion product otoacoustic emissions were recorded from 1 to 6 kHz, using a distortion product-gram type procedure, at 65/55 dB SPL, with f2/f1 = 1.22. Two groups of subjects were defined: group 1 (n = 8) represented subjects with short-lasting tinnitus (<72 h) and group 2 (n = 16) subjects with long-lasting tinnitus (>72 h).

RESULTS

Hearing thresholds did not differ significantly between these two groups 24 hours after the acoustic trauma. However, otoacoustic emissions showed significantly lower amplitudes 24 hours after the acoustic trauma in subjects showing a longer lasting tinnitus.

CONCLUSION

Otoacoustic emissions appear to be a better predictor of the persistence of tinnitus than hearing thresholds alone 24 hours after an acute acoustic trauma.

Moderate variations of mood/emotional states related to alterations in cochlear otoacoustic emissions and tinnitus onset in young normal hearing subjects exposed to gun impulse noise

This study was designed to test whether under impulse noise exposure mood and emotional states could play a role in the onset of tinnitus and/or could modify cochlear sensitivity objectively measured with distortion product otoacoustic emissions (DPOAEs). The experimental design consisted in a short follow-up study of 54 young military subjects (20+/-2 years old), psychologically normal, with normal hearing, during two consecutive days of target practice rounds. Data collection included an abbreviated version of the profile of mood states (POMSs) inventory [Profile of Mood States, Educational and Industrial Testing Service, San Diego, 1971], questionnaires on tinnitus perception (previous history and after shooting) and DPOAEs measurements before and after shooting. Higher scores of tension-anxiety were found in subjects having previous history of tinnitus. Association between tinnitus previous history and tinnitus after shooting was found significant. Perception of tinnitus after target practice rounds was associated with significantly lower DPOAEs at 3 kHz. The most tense-anxious subjects were found to have DPOAEs decreases of 3.35+/-6 dB at 3 kHz after shooting. This study clearly shows that, in young healthy population, psychologically normal and with normal hearing, moderate variations in mood and emotional states were related to tinnitus onset and DPOAEs alterations. It is possible that stronger variations in mood and/or emotional condition would increase risks of tinnitus and alterations of cochlear sensitivity.

DPOAEs in young normal-hearing subjects with histories of otitis media: evidence of sub-clinical impairments

To investigate the origin of the susceptibility to noise in subjects with histories of otitis media (OM), we assessed early sub-clinical impairments in normally hearing subjects with a history of OM using distortion product otoacoustic emissions (DPOAEs). DPOAEs of 213 normal-hearing subjects aged 18-24 years were obtained and comparisons of DPOAE levels in several groups as a function of OM past infections were tested by ANOVA. A main finding was that young normal-hearing subjects with a history of OM had significantly lower DPOAEs over all octaves tested compared to normal-hearing subjects without antecedent of OM. The mean difference was 3.5+/-1.1 dB in the 2-4 kHz zone, which was especially marked in subjects (n=21) that had undergone a myringotomy (6.6+/-1.5 dB) in the 4 kHz zone. The level of impairment seemed to depend on the severity of the past infection as characterised by the importance and the duration of the infectious effusions.

[Dr. Samuel Serge Voronoff (1866-1951) or "the quest for eternal youth"]

Samuel Serge Voronoff, a French physician and surgeon of Russian origin was the Khédive's personal physician from 1896 to 1910 and the instigator of modern medicine in Egypt. He was later a student and friend of Alexis Carrel as soon as 1910 and directed a service of bone grafts during World War I. Between 1912 and 1949 he published the results of his experimental work at his Voronoff Foundation of the Collège de France and at Grimaldi where he performed homografts of endocrine glands of cattle and corresponding heterografts between great primates and man. Contested since 1922 by his colleagues for his results however histologically confirmed and improved durable, Voronoff who had an audience in the Académie des Sciences will proceed his research with success during the period preceding World War II. He grafted old people in senior homes and Government cattle in Algeria, training followers in Italy and California. In 1939 he gave all his research facilities at the Collège de France to René Leriche (1879-1955) and remained on the American continent until 1945. At that time his theories became obsolete in view of the progress in endocrinology and his laboratories were destroyed during the war. He died in Lausanne in 1951 at 85. The recent epidemics caused by HIV suggests to study the work he performed in the Collège de France.

[Reflections on percutaneous tracheotomy. Regarding a retrospective study of 106 cases with major burns]

About ten years ago, a new technique for tracheotomy was invented in the United States and has tended to replace the surgical technique in intensive care units. Percutaneous tracheotomy is performed by the intensive care unit physician working in the unit at the patient's bedside. Progressive expansion seems to be the method of choice. Physicians at the Center for burn victims at the Percy Army Hospital have used this technique since 1994. We performed a retrospective study of 106 cases, between 1994 and 1998, and reviewed the international literature. Percutaneous tracheotomies were performed via a vertical cutaneous discharge incision and appeared to be particularly interesting for patients with major burns who are difficult to transport and risk secondary infections. Three early and serious complications were observed, emphasizing the need of a peroperative endotracheal fiberoptic endoscopic control. Three tracheal stenoses were observed: however respiratory tract burns had occurred all three of these patients. In the literature, most of which has been written by intensive care physicians, it is rather surprising to note the enthusiasm for percutaneous tracheotomy based on the high risk of complications of the surgical technique. Moreover, possible late after effects of percutaneous tracheotomy remain unknown as few survivors have been seen again late after use of this recent technique.

[A cause of intubation failure: a subglottic bridge]

We report the case of a patient with a history of facio-thoracic burns, the treatment of which included prolonged intubation, whose trachea could not be intubated because of a subglottic obstacle. The ventilation was easily controlled with a laryngeal mask. At the end of surgery for postburn cheloids, laryngoscopy through the laryngeal mask showed a transversal subglottic laryngeal band, a probable sequela of the previous prolonged intubation. The band was resected one week later. The conventional indicators for difficult intubation cannot detect the laryngotracheal obstacles to tracheal tube insertion.

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement]

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

[Anatomo-clinical criteria of cutaneous melanoma with spontaneous and complete regression. Apropos of a case]

We report a case of a 73 year old man presented a spontaneously and completely regression cutaneous malignant melanoma with cervical lymph node metastasis, confirmed by clinical and histopathologic observations. The authors examine the features of regression of primary malignant melanoma through a review of the literature.

Bacteremia during tonsillectomy

To determine the risk of bacteremia during tonsillectomy, we cultured blood specimens that were taken from 32 children during surgery and tonsillar swabs that were obtained just before excision, and compared the results with quantitative cultures of the excised tonsillar tissue. Twenty-five children had Haemophilus influenzae within the tonsillar tissue (density range, 10(3) to 10(8) colony-forming units per gram), and seven had Streptococcus pyogenes (density, 10(3) colony-forming units per gram in one case, 10(5) colony-forming units per gram in one case, and 10(6) colony-forming units per gram in five cases). Twelve perioperative blood cultures were positive; H influenzae was found nine times, and Micrococcus species was found one time, and alpha-hemolytic streptococci were found two times. Haemophilus influenzae was always present in the corresponding tonsillar specimens, although there was no apparent relationship between the density of colonization of the tonsillar tissue and a positive blood culture.

[Maxillary Aspergillus sinusitis. Comments apropos of 20 cases]

About a series of 20 aspergillus maxillary sinusitis, the correlation between this pathology and previous dental treatments is emphasized. In some cases such as sinusitis can occur without any dental pathology and/or in absence of foreign body on the X-rays. C.T. findings are the basis of the diagnosis. Surgical treatment, using endonasal micro surgery, has been performed in all cases.