[From barotrauma otitis to a fulminant meningitis]. / De l'otite barotraumatique à la méningite en direct.

OBJECTIVES: To report the case of a patient who in the follow-up of a barotrauma otitis presented a fulminant meningitis. CLINICAL CASE: 38 year old man sportsman who presented a barotrauma otitis during scuba diving. In spite of a treatment associating steroids and nasal vasoconstrictor this otitis persisted. Five weeks after the initial episode the patient went back to the clinics in emergency complaining of intense cephalgia for a few hours with impression of faintness without fever. The state of consciousness of the patient then degraded quickly during the conversation. Into the 15 minutes time, the patient slipped of a stuporous state to coma. Hospitalized in emergency in intensive care unit, the diagnosis of an otogenic meningitis with Streptococcus pneumoniae was made. The patient cured without sequelae. CONCLUSION: An inadequate treatment accompanied by a favorable anatomical factor facilitated the diffusion of the bacterial invasive process of the ear drum through the osseous barrier until the dura mater. A banal barotrauma otitis which persists can cause serious complications. An antibiotic must be prescripted starting from stage III, i.e. when there is retrotympanic effusion. In front of a behavioral problem during an otitis, it is necessary to always think of the intracranial complications and not to delay the anti-infectious treatment which must be started as soon as possible. To obtain a complete cure without sequelae, it seems that the adapted anti-infectious treatment must be instaured within a time below 10 hours.

[Loss of visual acuity caused by ethmoidal mucocele cured after endonasal surgery: report of a case]. / Perte d'acuité visuelle par mucocèle ethmoïdale résolutive après chirurgie endonasale. A propos d'un cas.

A posterior and/or ethmoidal mucocele remains a rare occurrence. The condition usually follows a past history of sinonasal surgery. Extension of the lesion may have ophtalmological implications, with the possibility of causing visual impairment. The predilection for a site of origin in the posterior sinuses explains the frequent absence of nasal symptoms, and the usual pattern of discovery by the ophtalmologist. Modern imaging techniques, especially scanning, allows the diagnosis to be made immediately after the first orbital symptoms. By the same token, recent techniques of endoscopic endonasal surgery have radically changed the treatment. Early complete surgical removal holds out hope for remission of the symptoms that led originally to discovery of the mucocele. We report here a case of posterior ethmoidal mucocele causing a visual field defect which reversed completely after endoscopic treatment.

Postintubation interarytenoid adhesion.

Interarytenoid fibrous adhesion is a poorly recognized complication of intubation and is frequently confused with bilateral vocal cord paralysis. Early diagnosis and treatment is essential for optimal management. Otolaryngologists should constantly remain alert for interarytenoid fibrous scar to establish the diagnosis as early as possible, optimizing the probability of restoring normal breathing and quality of life and avoiding an unnecessary tracheotomy. Surgical laser reduction is appropriate in all cases when other miscellaneous laryngeal injury lesions are eliminated. Direct laryngoscopy with careful examination of the posterior commissure and laryngeal electromyography are the 2 main clinical diagnostic aids contributing to establish the diagnosis.

Vallecular acinic cell carcinoma in a 9-year-old girl: report of an unusual case.

An unusual case of acinic cell tumour of the vallecula is presented. Acinic cell carcinoma occurs usually in the major salivary glands. Minor salivary gland location is unusual and vallecular origin exceptional. This peculiar histologic tumour should now be classified as an low grade carcinoma and adequate treatment has to be initiated. The patient, a 9-year-old girl, had undergone a suprahyoid access for total tumor removal with a bilateral neck exploration. Postsurgical radiotherapy has to be done in case with perineural invasion, invaded margins, node invasion or high grade tumor. The clinical and histopathological findings are discussed in the light of the literature.

[Uvular edema. Diagnostic, etiologic and therapeutic management]. / Oedème uvulaire. Prise en charge diagnostique, étiologique et thérapeutique.

Acute oedema of the uvula is relatively rare, and often idiopathic. None the less, possible causes should be excluded, such as allergy, infection, trauma or mechanical. Hereditary angioneurotic oedema should be excluded when there are identical recurrent episodes. Although three of our patients had a recent herpetic viral infection, it does not seem likely that this was the cause. Treatment consists mainly or antihistamines, steroids, antibiotics, or specific treatment for hereditary angioneurotic oedema. The clinician must always bear in mind the potential seriousness or this condition as a cause of obstruction of the upper airway. In the light of four recent cases, the authors discuss the diagnosis, cause and treatment of this particular condition.

[Anatomical study of the thyroid foramen in human larynx: a study of 100 dissections]. / Etude anatomique du foramen thyroïdien du larynx chez l'homme: à propos de 100 dissections.

The foramen thyroideum was systematically studied on the specimen of larynx of 50 fresh corpses. Among the one hundred dissections performed, the foramen thyroideum was noted only in one specimen (2 foramen). It was symmetrical not only in the position but also in the diameter. In both of these cases, the foramen thyroideum always contains few vessels and nerves. It's possible physiological role and the origin of the contents of the foramen thyroideum are discussed based on the research literature.

[Otolaryngological manifestations of sarcoidosis. Report of 10 cases and review of the literature]. / Manifestations ORL de la sarcoïdose. A propos de 10 cas. Revue de la littérature.

Sarcoidosis is a systemic chronic granulomatous condition of unknown aetiology. Although the mediastino-pulmonary type is the commonest, the condition may affect the head and neck in a significant number of cases, obliging the practising ENT surgeon to be familiar with the condition. The diagnosis is made by a combination of clinical, biochemical, radiological and histopathological features. We present 10 cases of sarcoidosis with exclusively cervico-facial features which have passed through the department between 1985 and 1996, including a typical nasal case with combined features, and a very rare pharyngeal case. The definitive diagnosis, always with histological confirmation, was sometimes made only after some delay, demonstrating the polymorphic nature of the clinical features, which are rarely pathognomonic. Special investigations, carried out virtually routinely once the diagnosis of ENT sarcoidosis was made, demonstrated only one case of associated pulmonary disease. Treatment was reserved for the symptomatic cases (4 out of 10), and consisted of systemic steroids whose dose and duration was determined by the clinical response.

[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. / Etude prospective des complications ORL de la chirurgie du rachis cervical par voie antérieure (résultats préliminaires).

In order to evaluate complications due to cervical spine surgery using the anterior cervical approach a prospective study was conducted on 125 patients. ENT examination with the fibroscope was employed for all the patients before the procedure. The patients were operated on under general anesthesia and were intubated with an armoured tube, and then were placed in an intensive care unit for 24 hours. Assessment of deglutition and an ENT examination were performed the day after surgery. Before surgery, two cases of vocal cord paralysis were noted. 111 patients (88.8%) presented with subjective disorders: problems such as sore throat, odynophagia, dysphagia, dysphagia with overspill and hoarseness were respectively noted in 55 (44%), 34 (27.2%), 32 (25.6%), 11 (8.8%) and 13 (10.4%) cases. Dyspnoea was found in 2 cases (1.6%). 117 patients (93.6%) presented postoperative anomalies which were found on the posterolateral pharyngeal wall, on the arytenoids and on posterior third of the vocal cords. Inflammatory and/or swollen lesions were slight, moderate, significant or very significant in respectively 22.4%, 22.4%, 15.2% and 1.6% of cases. Very significant circumferential swelling of the pharyngeal wall and of the arytenoids was responsible for two cases of respiratory distress, and the patients required reintubation and return to theatre. Severe pharyngeal lesion correlated with duration of surgery (r = 0.20; p < 0.05), with the number levels of fusion (r = 0.02; p < 0.02) and with the age of the patient (p < 0.02). Six patients presented problems of mobility of the vocal cords: 3 had a right vocal cord paresis which was temporary and 3 had paralysis, also on the right but which persisted. There were no other complications. It is concluded that (i) ENT complications are frequently found in postoperative cervical spine surgery using the anterior cervical approach, some of them being severe. An ENT examination must be performed before the procedure for legal reasons. It is also recommended in the postoperative period in the case of discomfort; (ii) patients need to be placed in an intensive care unit during for the first 24 hours (iii). This study needs to be attended over more patients (iv) comparison with a control group of patients having non cervical surgery and intubated in the same way is needed to differentiate lesions related to surgery or intubation.

Laryngomucocele as an unusual late complication of subtotal laryngectomy. Case report.

We report an unusual case of laryngomucocele occurring after subtotal laryngectomy. Laryngoceles generally have a congenital origin in a long-preexisting saccule, and their association with laryngeal carcinoma is well known. Laryngocele is usually favored by the increase of intraglottic pressure caused by the laryngeal carcinoma. However, an iatrogenic secondary laryngomucocele occurring after a surgical procedure is uncommon. We report in detail the physiopathologic conditions leading to the creation of this lesion.

[Comparative intensity-pressure study of patients with a voice prosthesis]. / Etude comparative intensité-pression chez les patients porteurs d'implant phonatoire.

We have studied the qualities of the voice of the laryngectomized patients and theirs possibilities to modify the intensity depending to the pressure. During the measurement, it was necessary to explain to the patient how to use the material and it was an opportunity to help him in the way to product a voice prosthesis. Most of the patients produced a higher intensity with a higher pressure. However, some of them obtained high pressures without producing a voice. These patients modified the use of the prosthesis or could have an oedema for example. In conclusion, these measurements show that there is a relation between intensity and pressure but not absolutely in relation with a better voice quality.

Primitive pharyngeal dyskinesia associated with upper airway collapse in an infant.

We report a case of total collapse of the upper pharyngeal airway in a slightly premature baby, resulting in a noisy breathing disorder. Primary immaturity of the central nervous system contributing to pharyngeal muscle hypotonia has been implicated in association with the increase in nasal pressure. The infant experienced complete resolution of symptoms a few weeks after the placement of a nasopharyngeal tube. This case report demonstrates the difficulty in diagnosis and management. The developmental spectrum and exploration are reviewed.

Horizontal glottectomy: functional and oncological results.

The authors report on their experience with 25 cases of horizontal glottectomy and discuss the functional and oncological results of this operation. Indications for this procedure are T1a and T1b glottic carcinomas. The overall three-year and five-year survival was respectively 94 and 88 per cent. Distant metastasis appears to be the major long-term failure, three patients dying of lung carcinoma. Short functional rehabilitation was observed in all cases. Decannulation was achieved in 100 per cent of the cases and none of our patients had laryngeal stenosis. The average time of removal of the nasogastric tube was 11.8 days. Because of its high local control and reduced functional after effects, horizontal glottectomy appears to be a reliable and safe procedure for limited glottic carcinomas and must be included in their therapeutic management.

[Syncopal neuralgia of the glossopharyngeal nerve caused by tumoral invasiveness. Therapeutic management. Apropos of 2 cases]. / Névralgie syncopale du glossopharyngien par envahissement tumoral. Conduite thérapeutique. A propos de deux cas.

Cases of glossopharyngeal neuralgia are relatively rare, and are occasionally secondary to an upper cervical carcinomatous invasion. The combination with syncopal episodes suggests the creation of a reflex pathway between the glossopharyngeal nerve and the vagus nerve by connections between the bulbar nuclei. The fact that the syncopal episode is systematically preceded by a neuralgic crisis enables its differentiation from other active vasomotor phenomena. Treatment is based essentially on pain-killers and occasionally, in the event of escape, by a neurosurgical resection of the root of the glossopharyngeal nerve and of the upper part of the vagus nerve. In the light of two recent cases, the authors recall the therapeutic management and the physiopathological mechanism of this particular form of neuralgia.

[Vocal rehabilitation after total laryngectomy: 15 years' experience with phonation implant]. / Réhabilitation vocale aprés laryngectomie totale: 15 ans d'expérience avec l'implant phonatoire.

Progress in voice rehabilitation after total laryngectomy is probably the most significative event of the last 15 years. The first to realise this procedure in France, the authors describe the state of the art in this field with a study of 160 cases. The results are in the main very positive with approximately 85% of success with all rehabilitation technics used currently. The future is establishing total functional rehabilitation of the larynx with new techniques researched specially in Europe with several groups : GREL, EGFL, BIOMED I program of Europe "Artificial Larynx" and so on... The work goes on and we shall see whether the next 15 years will be as satisfying as the last 15 years.

New artificial connective matrix made of fibrin monomers, elastin peptides and type I + III collagens: structural study, biocompatibility and use as tympanic membranes in rabbit.

Experiments leading to the conception and development of a new artificial connective matrix based on collagen-elastin-fibrin associations are presented. Preliminary evaluation of this biomaterial as an artificial tympanic membrane is described. Morphological evaluation was performed by histopathological and scanning electron microscopic studies. Biocompatibility was documented by subcutaneous implantation and experimental grafting in rabbits was performed with histopathological studies of the tympanic grafted membranes. The positive results obtained in this experimental study enable future studies in humans to be prepared.

[Development of artificial collagen-elastin conjunctive matrix for tympanoplasty. Concept and 1st results of animal experiments]. / Développement d'une matrice conjonctive artificielle "collagène-élastine" comme matériau de tympanoplastie. Conception et premiers résultats expérimentaux chez l'Animal.

We developed a new biomaterial designed to replaced loss of tympanic tissue. This new material has an original collagen-elastin structure which can be used to create an new artificial conjunctive matrix. The concept and the first experimental results are reported.

[Non invasive naso-sinusal aspergillosis. Contribution of endonasal microsurgery. Apropos of 16 cases]. / Aspergillose naso-sinusienne non invasive. Apport de la micro-chirurgie endonasale. A propos de 16 cas.

The authors report on 16 new cases of non-invasive nasosinusal aspergillar sinusitis over a period of 4 years. They stress the importance of the local inducive factors in such apparently healthy patients. The value of treatment by endonasal microsurgery is underlined, enabling the positive diagnosis and cure of these chronic sinusites that do not respond to medical treatment.

[Mucocutaneous leishmaniasis in otorhinolaryngology]. / La leishmaniose cutanéo-muqueuse en ORL.

The authors present a case of mucocutaneous Leishmaniasis of the nose in a patient originally from French Guiana and review the characteristics of this parasitic disease and its importance in the differential diagnosis of lethal midline granuloma. Beyond the exotic pathology of this case, the review of the literature indicates that with the present extension of concomitant leishmaniasis and Hids, authentic autochtonal leishmaniasis may be responsible for otolaryngologic manifestations. The increased prevalence of leishmaniasis associated with AIDS, as well as the presence of mucosal lesions, seems to be underestimated.

[ORL cancers in patients under the age of 45 years. Epidemiology, prognosis and treatment: apropos of 106 cases]. / Cancers à localisation O.R.L. chez des patients de moins de 45 ans. Epidémiologie, pronostic et prise en charge: à propos de 106 cas.

106 ENT localized carcinomas (97 men and 9 women) in adults under 45 years old are reviewed. The mean age was 40.0 years old and most suffered from an alcoholic and/or nicotine addiction. 89.6% expressed an epidermoid carcinoma and buccal cavity and larynx lesions represented the most frequent locations, followed by the pharynx. Overall survival does not differ from that of an older population but some locations seem to have a very poor prognosis: mobile tongue, vallecula, piriform sinus and amygdala. On the other hand, the laryngeal locations confirm their favorable prognosis.