This study demonstrates that the performance of the VSB does not deteriorate for more than 5 yr, without adverse effect. These results confirm the safety and the effectiveness of the VSB with a long-term follow-up.
We report our experience with titanium implants for extra-aural rehabilitation in the mastoid region with a bone-anchored hearing aid (BAHA) and auricular prosthesis. The purpose of this study was to evaluate the clnical status of the soft tissue adjacent to 63 skin-penetrating devices in 43 patients and to compare our findings with those of other reports. Forty-four fixtures have been implanted in 36 patients for the BAHA and 19 in seven patients for the auricular prostheses. The evaluation concerns osseointegration, pain in the mastoid area, skin reaction around the abutment and removal of the abutment. Three implants extruded; one due to trauma and two with no explanation. Follow-up ranged from 3 to 60 months after surgical implantation. The first outpatient check-up was performed at three months after implantation and then every six months. The soft tissue reaction around the percutaneous unit was classified at each control according to the classification proposed by Holgers et al.1 There was no irritation (type 0) in 87.5% of the controls for the BAHA group and in 87.2% for the group of auricular prostheses. No adverse skin reactions were noted in 61.36% of the BAHA group and in 66.66% of the auricular prosthesis group. Results of this study confirm the skin's ability to tolerate a skin-penetrating unit made of pure titanium. The importance of reducing the thickness of the skin around the implant and of local hygienic conditions is emphasized.
We have reviewed the most recent 120 cases of acoustic neuromas operated upon in Bordeaux, France. In so doing, we have defined the strategy required to reach an accurate diagnosis as essentially comprising three stages. The first of these is to understand that the presenting symptom complex may be typical with progressive unilateral hearing loss, tinnitus, etc., or atypical with sudden hearing loss (10%), recovering facial paralysis (3.3%) or a Menière's syndrome (3.3%). Included in the first stage of diagnosis are audiovestibular investigations. An absent stapedial reflex was noted in 41% of our cases and an abnormality in vestibular testing in 95% of cases tested. These findings would be clear indicators to proceed to the second stage of the diagnostic strategy. This second stage comprises electric response audiometry consisting of auditory brainstem response (ABR) testing and electrocochleography (ECochG) employed as a filter for determining which patients should proceed to the third stage of testing. A combination of ABR and ECochG provides the clinician with results of high sensitivity and specificity. The false-negative rate for combined results in our experience has been less than 1%. The final diagnostic stage is radiological imaging, in particular using magnetic resonance imaging (MRI) with gadolinium contrast as the modality of choice. MRI is superior to CAT scanning, especially in the diagnosis of stage I intracanalicular tumors.
The Négrevergne otoplasty technique is a relatively simple and rapid procedure that maintains the natural contours of the auricle with little morbidity by addressing the poorly developed or absent antihelical fold, an abnormally large concha, and a prominent lobule.
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