Recurrent Adenomatous Neuroendocrine Tumor of the Middle Ear: A Diagnostic Challenge.

Middle ear adenomatous neuroendocrine tumor (MEANT) poses a diagnostic challenge. Clinical symptoms are nonspecific. Definite diagnosis is made by histopathological analysis of the tumor after a complete surgical resection based on an extensive computed tomography/magnetic resonance imaging (CT/MRI). Controversial terminology of the neoplasm arises from the differentiation of this tumor composed of both endocrine and exocrine glands. Middle ear (ME) localization is rare and less aggressive than gastrointestinal tract or lung localizations. Nevertheless, clinical and CT/MRI analyses are necessary follow-ups for preventing or detecting recurrence or metastasis. A case of a female patient aged 26 with recurrent middle ear neuroendocrine adenoma is presented herein.

Benign intracranial hypertension with recurrent spontaneous cerebrospinal fluid rhinorrhoea treated by laparoscopic gastric banding.

We present the case of a 45-year-old woman presenting with a spontaneous cerebrospinal fluid (CSF) rhinorrhoea. A CSF leak, arising from a posterior ethmoidal left cell, was closed using an underlay procedure with a turbinate composite graft with applied fibrin glue. Twenty-three months later the CSF rhinorrhoea recurred. Recurrence was imputed to morbid obesity (BMI 48) responsible for benign intracranial hypertension. The patient underwent a laparoscopic adjustable gastric banding. CSF rhinorrhoea gradually decreased during the 12 months following surgery, in correlation with the weight loss, until total resolution was achieved. To our knowledge, this is the second reported case of a spontaneous CSF leak treated by bariatric surgery. This observation strengthens the theory that severe obesity can cause benign intracranial hypertension which can lead to CSF leak.

Smell disorders in ENT clinic.

Olfactory disorders may have several causes. Nasal polyposis or chronic sinusitis can result in nasal obstructions that block the access of odorants to the olfactory epithelium, and this can explain the development of olfactory disorders. On the other hand, when nasal endoscopy has revealed that the nasal cleft is free of inflammatory or tumoural disease, olfactory disorders may be explained by neuroepithelial or central nervous system disturbances. This paper will provide information about current approaches to smell disorders in otorhinolaryngology. Major causes will be reviewed as outcomes after medical or surgical treatment. An algorithm will also be given to standardise clinical investigations, including psychophysical olfactory testing, imaging and electrophysiological examinations.

Conservation laryngeal surgery for selected pyriform sinus cancer.

AIMS: This study reports the treatment of a cohort of patients with pyriform sinus squamous cell carcinoma, using conservative surgery and radiotherapy. METHODS: Thirty-four patients with pyriform sinus SCC were treated between 1986 and 2001, using partial laryngopharyngectomy with or without complementary radiotherapy. Seventy-six percent had stage III-IV lesions. Quality of life questionnaire and clinical examination were used for evaluation of laryngeal function. RESULTS: Conservation surgery was undertaken. All patients underwent neck dissection. Two thirds of the patients received post-operative radiotherapy. Reconstruction was achieved by local muscular flap in 13 cases, radial forearm free flap in 18 and pectoralis major flap in three. Five-year overall and disease-specific survival rates were 50 and 65%, respectively. Successful laryngeal function preservation with local control was achieved in 80% of the patients. CONCLUSION: Partial laryngopharyngectomy is a suitable treatment for early and selected advanced stage pyriform sinus carcinoma with a good functional and oncologic outcome.

Extracranial sinonasal tract meningioma: a case report.

Extracranial meningioma is an unusual tumor, mainly found in the head and neck area. Before surgical removal and histopathological examination, this diagnosis is rarely considered. We report a case of an extracranial meningioma located in the frontal sinuses of a 65-year-old-woman. Symptomatology included trouble of vision due to bilateral exophtalmos and mild headaches. Bilateral exophtalmos was secondary to the development of huge frontal mucoceles. These mucoceles grew slowly due to the frontal recesses blockage by the extracranial meningioma. External approach was performed with removal of the mucocele walls and of the extracranial meningioma itself. The frontal recesses were blocked with synthetic cement, and orbital roofs were reconstructed with a polydioxanon-sheet (PDS). Frontal sinuses were excluded and filled with bone bank grafts. A review of the literature on extracranial meningioma and a discussion about the surgical management of this case are proposed in this paper.

Computer assisted surgery and endoscopic endonasal approach in 32 procedures.

UNLABELLED: Computer aided surgery (CAS) is now routinely introduced in the ENT surgical field especially in endoscopic endonasal surgery. OBJECTIVE: Using a frameless computer aided surgery for endoscopic endonasal approach (SurgiGATE ORL TM), we tried to evaluate the practical use of such a system, to calculate supplementary installation time of the procedure, to determine the number of matching attempt (referencing) before starting optonavigation and to determine its clinical accuracy. PATIENTS AND METHODS: Thirty two patients underwent endoscopic endonasal surgery with the help of CAS; 13 revision cases (2 nasal polyposis, 7 paranasal sinus mucoceles, 4 frontal recess stenosis) and 19 primary cases (16 inflammatory diseases, 3 benign tumor removal). Paired points matching was used as referencing before optonavigation. Clinical accuracy of CAS was calculated at two confidence points during optonavigation and measured in multiples of the pixel size on CT Scan. RESULTS: Number of matching attempts before starting optonavigation was; mean 1.8 (1-4). Supplementary installation time of the system was; mean 15 minutes (10-40). Clinical accuracy at two confidence points was always between 0.5 mm and 2 mm. (6 < 0.5 mm, 16 < 1 mm, 10 < 2 mm). There was no major complication during surgery neither no side effect due to the use of the CAS except for one case who presented a slight tongue edema due to a wrong position of the dynamic reference base (maxillary splint) during the procedure. CONCLUSIONS: CAS and optonavigation using the surgiGATE ORL TM is safe and efficient in endoscopic endonasal surgery. The accuracy of the system is sufficient and its use appropriate for primary either revision rhinologic procedures.

Office-based CO2 laser-assisted tympanic membrane fenestration addressing otitis media with effusion.

OBJECTIVE: To use the CO2 laser-assisted tympanic membrane fenestration in office settings, under local anesthesia, as the sole treatment for patients with chronic otitis media with effusion (OME). BACKGROUND DATA: This new treatment ensures artificial ventilation of the middle ear for several weeks, and provides an intermediate solution between ordinary lancet-made tympanocentesis and transtympanic ventilation tube insertion. The operative technique is already well codified, and preliminary studies have demonstrated that tympanic membrane fenestration does not expose patients to any major hazard. METHODS: We treated 30 ears in 21 children and 29 ears in 24 adults. All patients had presented with OME persistent for more than 3 months. The laser tympanostomy was performed under local anesthesia, as an outpatient procedure, using a CO2 flash-scanning laser in conjunction with a handpiece (OTOLAM). Using a power of 12 W to 17 W, a single laser pulse usually sufficed to create a 2-mm-diameter circular perforation in the anteroinferior quadrant of the eardrum. RESULTS: The tympanic membrane fenestration allows avoiding ventilation tube insertion in 63% of children and 75% of adults. CONCLUSIONS: The CO2 laser-assisted tympanic membrane fenestration seems a valid therapeutic option addressing OME. This study should be pursued on a larger scale to define more precisely the indications of the laser tympanostomy.

Conservation surgery for laryngeal and hypopharyngeal cancer.

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.