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Mesures non invasives de l'activité electrophysiologique des cellules sensorielles et des neurones auditifs. Applications au diagnostic de pathologies de l'oreille interne.

Abstract : Thanks to technology miniaturization as well as digital computing abilities steadily increasing, objective measurement methods and their related devices evolve. Echodia company was created in 2009 with the goal to create new diagnostic tools. The company currently supports my research work through a CIFRE convention.The first part of this thesis presents two non-invasive measurement methods that have been implemented to the diagnosis of cochlear hydrops. The methods are based on the responses of cochlear hair cells to sound stimuli, depending themselves on the resting position of their stereocilia bundles. Cochlear hydrops, a hallmark of Meniere's disease, is likely to disturb this environment. A chemical or mechanical variation of this environment may be observed by various objective exploration methods. The first method is based on an electrophysiological recording. By studying the Summating Potential (SP) of the Electrocochleography (ECOG) we will register activity in the basal part of the cochlea. The second method is based on a sound recording in the external acoustic meatus. By monitoring the phase shifts of Distortion-Product OtoAcoustic Emissions (DPOAE), we will record the apical responses of the cochlea.The second part of this thesis focuses on a study in which we recorded concomitantly the SP (basal) and the DPOAE (apical) in 73 patients with Menière's disease, close to an attack (n = 40) or between attacks without clinical symptoms (n = 33). In the case of DPOAE, the phase at 2*f1-f2 has been studied in response to pure sinusoidal sounds at frequency f1 = 1 kHz and f2 = 1,2 kHz. The power of the two primary was set between 70 and 75dB SPL based on the level of the DPOAE. The SP to Action Potential (AP) ratio has been measured by extra-tympanic electrode in response to 95dB nHL clicks. These two measurements were performed several times during a postural test to evaluate their stability.The normal limit of the phase shift of the DPOAE during a postural test [-18 °, +38 °] was exceeded in 75% of patients near an attack. On these subjects, the study of the SP/AP ratio exceeded the normal value (<0.40) in 60% of cases. In addition, the two types of measurements made on patients near a vertigo attack reveal fluctuations between reiteration. These differences highlight how hydrops hinders the proper functioning of the cochlear mechanics. This short time scales fluctuations might explain the imperfect diagnostic sensitivity of SP and DPOAE tests, as averaging procedures would tend to level out transient fluctuations characteristic of hydrops.
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Submitted on : Wednesday, December 6, 2017 - 4:38:22 PM
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Grégory Gerenton. Mesures non invasives de l'activité electrophysiologique des cellules sensorielles et des neurones auditifs. Applications au diagnostic de pathologies de l'oreille interne.. Médecine humaine et pathologie. Université d'Auvergne - Clermont-Ferrand I, 2015. Français. ⟨NNT : 2015CLF1MM17⟩. ⟨tel-01657432⟩



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