No abstract

We report the use of MRI in the diagnosis, follow-up and therapeutic management of three cases of intralabyrinthine Schwannoma. The diagnosis was based on the history and initial and follow-up MRI findings. The main feature suggesting the diagnosis was a nodular intralabyrinthine mass of low signal intensity on T2-weighted images, and high or isointense signal on T1-weighted images (relative to cerebrospinal fluid), which showed contrast enhancement. Follow-up imaging showed growth of the tumour in one patient. One patient underwent surgery for severe tinnitus. To detect these lesions, MRI should be focussed on the inner ear, using thin-section T2-weighted and T1-weighted images before and after contrast medium. MRI allowed informed surgical planning.

We conducted a retrospective single-center study to describe the clinical features of sinonasal sarcoidosis (SNS) and to determine whether SNS is associated with a particular clinical phenotype of sarcoidosis. Twenty patients with histologically proven SNS (men/women, 7/13; mean age, 32 +/- 9 yr) were compared with control patients with sarcoid but without sinonasal (SN) involvement. Each patient was matched with 2 controls for the date of admittance in our institution. SN involvement occurred in the course of previously known sarcoidosis in 8 patients, whereas it preceded disease diagnosis in 12 patients. Among these 12 patients, 4 initially presented with strictly isolated SNS and 8 had other associated signs related to sarcoidosis. The most common symptoms were stuffiness (90%), anosmia (70%), and rhinorrhea (70%). Lupus pernio was frequent (50%). Local examination was constantly abnormal and showed hypertrophy (75%) and purplish coloring of the nasal mucosa with granulations (50%) on the septum and/or inferior turbinates. Computed tomography scans showed medial lytic lesions, mainly of the septum and/or the turbinates in about half the cases. All patients had negative antineutrophil cytoplasmic antibodies. Patients with SNS had significantly more frequent and severe involvement of vital organs than controls, had a longer history of sarcoidosis, and required systemic treatment more frequently (100% vs. 57.7%, p < 0.001) and for a longer time (78 +/- 42 mo vs. 29 +/- 18 mo, p < 0.0001). Corticosteroids maintenance dosage was high (10.5 +/- 6 mg daily) and mainly depended on SN involvement. Although rare, SN involvement is a severe and recalcitrant manifestation of sarcoidosis representing a therapeutic challenge.

The Digisonic is a fully digitized cochlear implant. Because of its articulated array, its 15 electrodes can be inserted in the cochlea. Each electrode is recessed in a special silastic compartment of the array and has a very large stimulation area thanks to its large microrelief surface area. The small volume of its implanted receiver (flat cylinder diam 29 mm, 6.9 mm thick) allows it to be placed in 2-year-old children. The 128 point FFT of this device supply the patient with a full set of sound information between 64 and 7800 Hz. Electrode stimulation mode is sequential and stimulation rhythm is programmable. Electric crosstalk is decreased by the shape of the electrode array, and optionally by special programming of the neighboring electrodes. The speech therapist may select the width and peak value of each frequency band handled by each functional electrode. Because the versatility of this digitized emitter, many speech coding strategies can be easily programmed as a function of electrode responses or particular scientific considerations. A special version of this device, consisting of 10 separate electrodes, has been designed for use in patients with total obstruction of the cochlea. These insulated wires may be inserted one by one in the inner ear in 10 different recesses gently drilled in the bony cochlea. This device was placed in 46 patients between 1992 and 1994, including 8 young children (aged 2-9 years, mean 5 years) and 9 patients with total cochlear obstruction.