Interest of computer tomography in the study of prognostic factors of otosclerosis.

BACKGROUND: Otosclerosis is a primary osteodystrophy of the otic capsule that causes stapedo-vestibular ankylosis. Its diagnosis is suspected on the basis of clinical and audiometric elements, basically in the presence of conductive hearing loss with a normal eardrum. The CT-scan is an essential examination for the preoperative evaluation of otosclerosis. The aim of our study was to evaluate the use of CT-scanning in predicting the functional outcome of otosclerosis surgery by correlating postoperative audiometric results and preoperative CT findings. METHODS: We conducted a retrospective study at the ENT Department in association with the Medical Imaging Department of our hospital, over a period of 8 years, from January 2014 to December 2022 and involving 90 patients (104 ears). RESULTS: The average age of our patients was 40 years with extremes ranging from 22 to 61 years. We noted a sex ratio of 0.38. The preoperative CT-scan showed signs of otosclerosis in 87% of the cases and infra-radiological forms in 13% of the cases. Veillon stage II was the most frequent radiological stage encountered with a percentage of 48%. A good audiometric evolution, defined by a closure of postoperative Air Bone Gap (ABG ≤ 20 dB) and by an improvement of Bone Conduction (BC gain ≥ 0), was recorded in 86 cases (82.7%) for ABG and in 84 cases (80.8%) for BC gain. Scanographic predictive factors of poor postoperative outcome for ABG and BC gain were: advanced stages (Veillon stage III and IV), endosteal effraction, and round window involvement. According to multivariate analysis, only the extent of otosclerotic foci was directly and independently associated with the postoperative audiometric outcome. CONCLUSION: The CT-scan is an essential examination in the preoperative evaluation of otosclerosis. It allows a positive diagnosis to be made and evaluate the extension of otosclerosis. Moreover, thanks to the analysis of the extent of the otosclerosis foci, mainly by the Veillon classification, the CT-scan allows to predict the postoperative audiometric prognosis.

[Thyroglossal duct cysts in adult : clinical and therapeutic features]. / Les kystes du tractus thyréoglosse de l'adulte : particularités cliniques et thérapeutiques.

Thyroglossal duct cysts (TDCs) are rare congenital cervical malformations in adults, which expose to two major risks: infection and malignant degeneration which remains the most dreaded complication in adults. AIMS OF THE STUDY: This study aims to establish the clinical, management of TDC during adulthood, as well as the evolutionary aspects of these malformations in this age group. PATIENTS ET METHODS: This is a retrospective study on 61 adults over 18 years old, undergoing TDC surgery in our department. RESULTS: The average age was 33.7 years with a sex ratio M/F of 1.10.The circumstances of discovery were dominated by a median cervical swelling in 53 patients (86,9%). The swelling was median in 28 cases and located in ad-hyoid in 32 cases. Cervical ultrasound confirmed the diagnosis of TDC in all patients. CT scans were performed on 15 patients. Surgical excision according to the Sistrunk method was performed on all patients. Three of our patients have experienced a degenerated TDC requiring total thyroidectomy with central neck dissection, followed by radioactive iodine therapy. CONCLUSION: CT scan keeps indications in adults. The treatment is surgical in order to prevent the risks degeneration, which is specific complication in adulthood.

Les kystes du tractus thyréoglosse (KTT) sont des malformations cervicales congénitales rares chez l'adulte, exposant à deux risques majeurs : l'infection et la dégénérescence maligne. Objectifs : Etablir les aspects cliniques, thérapeutiques et évolutifs des KTT chez l'adulte.Patients et méthodes : étude rétrospective à propos de 61 patients âgés de plus de 18 ans, opérés pour KTT dans notre département. Résultats : L'âge moyen était de 33,7 ans avec un sex ratio H/F de 1,10. Les circonstances de découverte étaient dominées par une tuméfaction cervicale médiane chez 53 patients (86,9 %). La tuméfaction était médiane dans 28 cas et siégeant en ad-hyoïdien dans 32 cas. L'échographie cervicale a confirmé le diagnostic de KTT chez tous les patients. Une TDM a été réalisée chez 15 patients. L'exérèse chirurgicale selon la méthode de Sistrunk a été pratiquée chez tous les patients. Trois patients ont présenté un KTT dégénéré nécessitant une thyroïdectomie totale et un curage central, suivis d'une irathérapie. Conclusion : La TDM garde des indications devant un KTT chez l'adulte. Le traitement est chirurgical afin d'éviter le risque de dégénérescence, complication spécifique à cette tranche d'âge.

[Atypical presentation of a polyp of Killian]. / Cas clinique. Présentation atypique d'un polype de Killian.

The antrochoanal polyp or polyp of Killian is a benign nasal tumour that arises from the maxillary sinus. The polyp originating from the middle turbinate is an entity rarely described in the literature. We report here a rare case of Killian polyp originating from the middle turbinate which was explored by computed tomography and magnetic resonance imaging of the facial bone. The polyp was removed by an endoscopic surgical technique. The extraction was made from the oropharynx. Preoperative recognition of these anatomical variations is particularly important to avoid intraoperative surprises.

Le polype antro-choanal ou polype de Killian est une tumeur bénigne naso-sinusienne qui prend naissance au niveau du sinus maxillaire. Le polype provenant du cornet moyen est une entité rarement décrite dans la littérature. Nous rapportons ici un cas rare de polype choanal provenant du cornet moyen qui a été exploré par tomodensitométrie et par résonance magnétique du massif facial. Le polype été retiré par une technique de chirurgie endoscopique. L'extraction a été réalisée à partir de l'oropharynx. La reconnaissance préopératoire de ces variations anatomiques est particulièrement importante pour éviter les surprises peropératoires.

Pleomorphic Adenoma of the Submandibular Gland in a 10-Year-Old Child: A Case Report.

We report the case of a 10-year-old girl with a painless slowly growing mass that had developed over the course of 2 years in the left submandibular area. Physical examination revealed a firm painless submandibular mass with no other associated signs. Ultrasound graphics were in favor of a sebaceous cyst. Fine-needle aspiration and magnetic resonance images (MRI) concluded to a pleomorphic adenoma of the submandibular gland. The patient underwent left submandibulectomy. Histopathological examination confirmed the diagnosis of pleomorphic adenoma arising from the submandibular gland. The postoperative course was uneventful. Pleomorphic adenoma of the submandibular gland represents a diagnostic and therapeutic dilemma in children. Preoperative evaluation, including MRI and fine-needle aspiration, is recommended. Total submandibulectomy is also recommended to minimize recurrences and to avoid malignant transformation.

Fungal necrotizing external otitis: diagnosis, management and outcomes of 15 cases.

Fungal necrotizing external otitis (NEO) is a rare disease. It is an aggressive and potentially fatal infection. The most commonly reported pathogen is Candida. We aim through this study to share our experience in the management of fungal necrotizing external otitis and discuss its diagnosis tools, anti-fungal treatment choice, and outcomes. We included fifteen patients with diagnosis criteria of fungal NEO; clinical features of NEO with positive culture swabs and/or positive serologic test to a fungal pathogen. The mean age was of 70 years with a prevalence of males. The main symptoms were otalgia (n=15) and otorrhea (n=7). Facial palsy was observed in four cases. Fungal pathogens were Candida(n=10) and Aspergillus (n=5). Complications were observed in eight cases: extension to the temporo-mandibular (n=4), abscess in the retropharyngeal space (n=2), abscess in the parapharyngeal space (n=1) and thrombophlebitis of the internal jugular vein (n=1). Six patients were treated with fluconazole, eight with voriconazole, and one patient with itraconazole. After a mean duration of 52 days of antifungal therapy, fourteen patients have been cured with normalization of the ear symptoms, biological, and imaging features. One patient died of septic shock. No recurrence of the disease was observed after a follow-up of 12 months in all cases.

Post COVID-19 rhinocerebral mucormycosis: a case report and literature review.

The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second and the waves of this disease have led to panic in many countries, and some parts of the world suffering from the fourth wave. In the midst of this pandemic, COVID-19 patients are acquiring secondary infections such as mucormycosis also known as "black fungus disease". Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid mortality and morbidity rate. We report in this paper, a case of a diabetic patient who presented with bilateral nasal obstruction, anosmia, and frontal headache diagnosed with rhinocerebral mucormycosis developing after COVID-19 infection with a favorable outcome after a medico-surgical treatment. Through this case, we aim to aware patricians of this possible association and the importance of early diagnosis to optimize treatment outcomes.

Cartilage Graft in Myringoplasty: What Are the Factors Influencing Hearing Gain?

BACKGROUND AND OBJECTIVES: We present the anatomical and functional results on the use of cartilage in myringoplasty and use the data to analyze the factors influencing hearing gain. SUBJECTS AND METHODS: This retrospective study included 161 cases of cartilage myringoplasties collected over an 11-year period (2010-2020). Of the 161 cases, the etiology of the tympanic perforations was simple chronic otitis media in 154 (95.65%) ears and traumatic in 7 (4.35%) ears. The mean preoperative Rinne was 26.20±7.05 dB. The most commonly used approach was retroauricular, and the common graft material was tragal or conqual cartilage. RESULTS: After the follow-up period (mean:15 months), the anatomical success rate was 93.2%; there were nine cases of reperforation, of which three were reoperated with a good final result. The hearing success rate (residual Rinne ≤20 dB) was 91.9% with an average gain of 11.48±8.62 dB. The only factor significantly influencing the anatomical outcome was the history of chronic rhinosinusitis. In univariate studies, several factors influencing the functional result were revealed; the only one retained after elimination of bias was the anatomical result. CONCLUSIONS: We recommend cartilage as the material of choice for myringoplasties as it has been shown to be resistant to predictive factors of failure after tympanic repair surgery. We recommend the adequate management of all chronic rhinosinusitis before performing myringoplasty.

Management of jugular tympanic paraganglioma: a case report.

Paragangliomas could be localized from the skull base to the pelvic floor. Tympanic localization represents the most common benign tumor of the middle ear. Diagnosis is based on clinical signs with a great contribution of radiology. A 40-year-old male presented with isolated tinnitus of the right ear evolving for 18 months. Examination revealed a red bulging right-sided tympanic membrane and a conductive hearing loss. Tomodensitometry and Magnetic resonance imagery showed findings in favor of a right jugular tympanic paraganglioma. The tumor was classified type B according to FISCH classification. The patient underwent surgery consisting in tympanotomy using a retro auricular access route. The postoperative course was uneventful. There was no recurrence during the one-year follow-up. Jugular tympanic paraganglioma diagnosis is guided by a combination of epidemiological, clinical and radiological features. Treatment is still not consensual, but surgery still have its indications in localized forms of head and neck paragangliomas (HNP´s).

[Therapeutic outcomes of nasopharyngeal carcinomas: a single-center study conducted at the Fattouma Bourguiba University Hospital in Monastir, Tunisia]. / Résultats thérapeutiques des carcinomes nasopharyngés: étude monocentrique à l´hôpital universitaire Fattouma Bourguiba de Monastir en Tunisie.

INTRODUCTION: nasopharyngeal carcinomas (NPCs) are relatively common in the Mediterranean basin. Survival has been greatly improved by new radiation techniques and new molecular-targeted chemotherapy. The purpose of our study was to analyze the therapeutic outcomes and to describe the prognostic factors of NPCs. METHODS: we conducted a retrospective study of patients with nasopharyngeal carcinoma on treatment and follow-up in our department between January 1995 and December 2014. Data were collected using a standardized sheet. Statistical analysis was performed using SPSS software. Kaplan-Meier method was used to determine patient´s overall survival. RESULTS: seventy-three cases of NPC were reported. The average age of patients was 48 years. A male predominance was noted. The majority of cancers (56%) were locally advanced tumors (T3-T4). After an average follow-up of 45.5 months, the rate of locoregional recurrences was 19.4%. Three patients (4%) had bone metastases. Five-year overall survival was 65%. Factors positively influencing overall survival were early-stage tumor (TNM classification) and 1.8 Gy single fraction radiotherapy. Local and lymph node recurrence rates were 13.8% and 5.5% respectively, mainly for T4 N2 tumors. Therapeutic sequelae were dominated by seromucous otitis (42.7%), trismus (38.7%), and xerostomia (32%). CONCLUSION: overall survival in patients with NPC has improved, in particular with the advent of concomitant radiotherapy and chemotherapy; however, disabling late toxicity is significant. Good prognostic factors reported in this study include early tumor stage as well as radiotherapy fractionation.

Development of a population pharmacokinetic model and Bayesian estimators for isoniazid in Tunisian tuberculosis patients.

This study aimed to develop a population pharmacokinetic model using full pharmacokinetic (PK) profiles of isoniazid (INH) taking into account demographic and genetic covariates and to develop Bayesian estimators for predicting INH area under the curve (AUC) in Tunisian tuberculosis patients. The INH concentrations in the building data set were fitted using a one- to three-compartment model. The impact of the different covariates was assessed on the PK parameters of the best model. The best limited sampling strategy (LSS) for estimating the INH AUC was selected by comparing the predicted values to an independent data set. INH PK was best described using a three-compartment model with lag-time absorption. The different studied covariates did not have any impact on the PK parameters of the building model. The Bayesian estimation using one-point concentrations gave the lowest values of prediction errors for the C3 LSS model. This model could be sufficient in routine activity for INH monitoring in this population.

Parapharyngeal metastasis from papillary thyroid microcarcinoma.

Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type and its pattern of metastasis are usually lymphatic. Lymphatic metastasis to parapharyngeal space is rare and have been reported, so we report the case of a 50-year-old male patient who had an occult papillary carcinoma of the thyroid presented as right lateral node of the neck and a nodal involvement of the right parapharyngeal space.

Castelman's disease of the neck: a case report and literature review.

Castleman's disease is a rare pathology, poorly understood. It is considered as a lymphoproliferative disorder, described for the first time in 1954, which may be confused with other causes of lymphadenopathy. We report in this paper the case of a young women presenting with left latero-cervical lymphadenopathy. All the investigations were negative except a large high-vascularized level II cervical lymphadenopathy. We performed a cervicotomy. The extemporaneous histological exam was non-contributive. We decided to perform a complete level II and III left cervical lymphadenectomy. The diagnosis of unicentric Castleman's disease was confirmed based on the final histological study of the specimen, and the absence of other cervical and extra-cervical lymphadenopathy. The patient is free of recurrence at the time of reporting this article.

Pediatric naso-sinusal inverted papilloma: report of a case and literature review.

Inverted papilloma is a rare nasosinusal tumor that mainly occurs in adults during the 5th decade. The occurrence in children is exceptional and only few cases have been reported in the litterature. Clinical and radiological findings mimic other benign nasosinusal pathologies; therefore, diagnosis is based on histopathology either via biopsy or following surgical excision. Here we present a rare case of pediatric inverted papilloma in a 11-year-old child and we discuss clinical, radiological, therapeutic and evolutionary features through a literature review.

The role of imaging in the management of sinonasal mucoceles.

Mucoceles are slow-growing paranasal sinus cystic masses whose clinical presentation varies according to the affected sinus. Diagnosis is often radiological, based essentially on CT scan. The aim of this work was to study the radiologic characteristics of mucoceles on CT scan and MRI. We conducted a retrospective study of patients with mucoceles explored by imaging and operated on in our department. In our series, fronto-ethmoidal sinuses were the most frequently affected (81%). Facial scan confirmed the diagnosis in the majority of cases. Magnetic resonance imaging (MRI) was performed in 4 cases. Eleven patients were operated on by endonasal approach, three by external approach and one by combined surgical approach. Recurrence was observed in two patients after an average delay of 24 months. CT scan is considered the method of choice in the investigation of mucoceles. MRI is indicated in some cases to assess any orbital or intracranial extension.

Epidermoid cyst of the tonsil: a rare finding.

Epidermoid cysts (ECs) are benign lesions that can be encountered throughout the body, but with a low incidence in the head and neck (1.6 to 7%). In oral cavity, the most common affected site is floor of the mouth, but tonsillar location remains extremely rare (less than 0.01%). Here we present an epidermoid cyst of the right palatine tonsil which was incidentally detected in a patient who consulted for a chronic headache.

[The importance of fine needle aspiration biopsy in the diagnosis of parotid tumors]. / Intérêt de la cytoponction à l'aiguille fine dans le diagnostic des tumeurs parotidiennes.

This study aimed to determine the diagnostic value of fine needle aspiration biopsy (FNAB) and of its contribution to the management of parotid tumors. We conducted a retrospective study of 47 patients who had undergone parotidectomy as well as preoperative fine needle aspiration biopsy. The study highlighted that eighty one percent of patients had a benign tumor while 19% of patients had a malignant tumor. The sensitivity and specificity of FNAB were 78% and 92% respectively. Parotid tumors were correctly classified as malignant or benign in 89% of cases, overall accuracy was 64.4%. FNAB is a reliable examination providing preoperative informations about the treatment plan and the postoperative course.

Primary papillary carcinoma of the thyroglossal duct in a 14-year-old female: case report and review of the literature.

Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.

A rare location of thyroglossal duct cyst in a newborn.

Thyroglossal duct cyst of the tongue is a rare entity. Occurrence in the anterior part of the tongue is exceptional. We report in this paper a rare case of thyroglossal cyst of the anterior part of the tongue, discovered in a five-days-old newborn at delivery. Images have shown a cystic mass with homogenous liquid content. A transoral complete resection of the lesion was performed, with no postoperative complication. The histological analysis confirm the diagnosis of lingual thyroglossal duct cyst. There were no recurrence with a follow-up of eight months.