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This clinical case represents an exception which confirms the rule of indications for the cochlear implant. After a right stapedectomy for otosclerosis on the best ear, a severe buzzing and a cophosis upset the social and affective life of a patient without a particular psychopathological history. After one year of therapeutic efforts, including a device for the non-operated ear and the management of an associated orthodontic disorder, a cochlear implant is envisaged and carried out in June 1996.If you are looking for a nose job or a rhinoplasty in Las Vegas, click here.

The quality Of the results obtained leads us to report this observation despite its atypia. OBSERVATION Mrs. L …, 35, is a former metalworking worker. She has been out of work for three years for a pituitary adenoma. She presented a deafness of left perception evoking a sonorous trauma and a right otosclerosis. Although this right ear was the best, a stapedectomy of this right side was performed in June 1994. This procedure resulted in a cophosis with immediate installation of severe tinnitus. A reoperation a few weeks later proved ineffectual. This patient is sent to us in December 1994. She has a sub-total deafness of the right ear (Figure 1) which, despite some remains on the 1000 and 2000 Hz frequencies, has no intelligibility Even with an overpowering prosthesis (Table I).

She further complains of a subintrant tinnitus aggravated by a persistent right otalgia. In addition, there is a deafness of left perception well improved by the equipment. On the other hand, it presents disturbances of equilibrium with an improperly systematic walking deflection and dizzy sensations in the extended position, but the vestibular tests do not show any objective impairment to evoke a peripheral or central lesion. In addition, there is a disorder of the articulation with interdental gap. (See Figure) (See Figure) From the first examination this patient, who makes responsible for all her troubles the intervention that made her deaf, calls for a cochlear implant. We refuse it of course, explaining to him the reasons: hearing and intelligibility relatively good left, and uncertainty of the result of the implant on tinnitus. We prescribe simultaneously: 1) orthodontic treatment; 2) a psychotherapeutic management, because the impact of deafness and tinnitus is very important on his social life, of course, but also on his family life; 3) re-education through learning to read the lip.

But after six months of hard work, the results obtained are not very encouraging. Certainly the dental articulation has become normal and the right otalgies have disappeared; But tinnitus in the right ear are still as intense, without any regression. Equilibrium disorders also remain unchanged. On the left, it holds an amplifying prosthesis, but this does not satisfy it despite a certain prosthetic gain, with voice audiometry an intelligibility reaching 70 and 80% of the normal for 60 and 80 dB respectively, because right tinnitus leads to Reality, an extremely important masking sound. And above all the psychological repercussion has become considerable.