Use of autologous adipose tissue in acute burn wound management: A systematic review.

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

Eustachian tube balloon dilation.

Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.

Increasing use of EQUATOR guidelines in the European Annals of Otorhinolaryngology, Head and Neck Diseases between 2020 and 2022: A SWiM review.

OBJECTIVES: To evaluate the use of EQUATOR guidelines in scientific articles published in the European Annals of Otorhinolaryngology, Head and Neck Diseases between 2020 and 2022. The aim was also to translate the most widely used guidelines into French, in order to promote their dissemination and use in otorhinolaryngology and head and neck surgery. METHOD: The SWiM guidelines were used. Articles published in the European Annals of Otorhinolaryngology, Head and Neck Diseases between January 1, 2020 and December 31, 2022 were retrieved from the PubMed bibliographic database. Editorials, Letters to the Editor and "What is your diagnosis" articles that did not meet any EQUATOR guidelines were excluded from the analysis. RESULTS: Of the 149 eligible published articles, 21.5% (n=32/149) mentioned use of such a guideline. Guideline use by the European Annals of Otorhinolaryngology, Head and Neck Diseases author community progressed from 0% in 2020 to 8% in 2021 and 63% in 2022. CONCLUSION: The analysis carried out in this article and the availability of the French version of the seven EQUATOR guidelines most widely used in the European Annals of Otorhinolaryngology Head & Neck Diseases could stimulate application and compliance by authors who submit their work to the journal of the French and international French-speaking societies of otorhinolaryngology.

Perception of endoscopic endonasal surgery training by French otolaryngology residents: A STROBE analysis of expectations.

OBJECTIVES: To analyze the perception of endoscopic endonasal surgery training by French otolaryngology residents. MATERIAL AND METHODS: A multicenter retrospective observational study was conducted from March to April 2023. Otolaryngology residents from 7 French regions filled out a 27-item questionnaire on their training in endoscopic endonasal surgery. RESULTS: Out of 283 residents contacted, 126 (45%) filled out the questionnaire. Seventy-four (59%) had already partially or completely performed the surgeries specified in their diploma course. The level of mastery of the main steps of endonasal surgery and the level of autonomy were higher in the consolidation stage group than in the basic and advanced stages. Seventy residents (56%) felt they had gaps in their level of training. To improve training, 94 (75%) wished for more dissection sessions, surgical skills assessments each semester and simulation sessions. Eighty-nine (71%) felt they needed to find their own teaching aids and other methods to complete their training. One hundred and thirteen (90%) felt that the lack of funding available for congresses and training courses was detrimental. CONCLUSION: This study highlighted the overall satisfaction of residents with their training in endoscopic endonasal surgery. They expressed a desire for more dissection, simulation and evaluation.

Perception of environmental issues in the head-and-neck surgery room: A preliminary study.

OBJECTIVES: To assess the perception of environmental issues in head-and-neck surgery rooms and to compare the perception of priority environmental issues according to health professionals' age-group, initial training and role in the operating room. METHODS: A multicenter descriptive observational study was conducted in January 2023, contacting health professionals working in the operating rooms of 5 French centers. An anonymous online questionnaire explored the perception of environmental issues according to age, initial training and role in the operating room. RESULTS: Sixty-nine percent of the 387 persons contacted (267/387) completed the entire questionnaire. Ninety-six percent of respondents (256/267) said that they felt concerned about climate change issues and 85% (226/267) felt well-informed. Ninety-three percent (251/267) were willing to make environmental efforts in the operating room. Priorities were to improve waste recycling and reduce the amount of waste for 95% (251/267) and 97% (259/267) of respondents respectively. Those under 40 years of age tended to feel better informed about climate issues (76% [75/99] versus 60% [100/168]; P=0.010). CONCLUSION: Our study showed that the vast majority of health professionals working in head-and-neck surgery rooms in France felt concerned about climate issues and were ready to make an effort. Nevertheless, it seems important to carry out information campaigns dedicated to these environmental issues.

Risk factors for laryngeal lesions in adult acute respiratory distress syndrome: A STROBE-compliant French case-control study.

INTRODUCTION: The global SARS-CoV-2 pandemic led to an increased incidence of post-intubation laryngeal injuries in patients with acute respiratory distress syndrome (ARDS). The primary objective of this study was to identify risk factors for symptomatic laryngeal lesions in patients with Covid-19-related ARDS. The secondary objective was to analyze the progression of these laryngeal lesions. METHODS: A 21 month nested case-control study was conducted in 3 university hospital centers of the Hospices Civils de Lyon (France). Cases encompassed all patients intubated for Covid-19-related ARDS who presented symptomatic laryngeal pathology. The control group consisted of all patients enrolled during the same period for Covid-19-related ARDS without evidence of laryngeal lesions (no specific ENT intervention). Uni- and multi-variate analyses were performed to identify risk factors for the occurrence of laryngeal lesions. RESULTS: Forty-nine patients were included in the case group and 50 in the control group. The only significant risk factor for symptomatic laryngeal injury was the number of reintubations, with an odds ratio of 5.08 (95% CI, 1.40-22.12; P=0.013). No other predictive factors were identified among the variables analyzed: obesity, number of prone sessions, self-extubation, duration of intubation and number of days of curarization. CONCLUSION: The number of reintubations was the sole independent risk factor associated with the development of symptomatic laryngeal lesions in patients managed for Covid-19-related ARDS.

A malignant peripheral nerve-sheath tumor: A CARE case report.

INTRODUCTION: Malignant peripheral nerve-sheath tumor (MPNST) is an extremely rare sarcoma of the nasal cavity and paranasal sinuses. Non-specific clinical and radiological presentation and challenging histological diagnosis make it little known by physicians. We describe a case of maxillary sinus MPNST, following CARE guidelines. CASE REPORT: A 62-year-old woman consulted for swelling of the right cheek and hard palate with several months' progression. CT and MRI revealed a tissue mass in the right maxillary sinus with osteolysis of the orbital and maxillary floors, hard palate and lateral and medial walls of the maxillary sinus. Biopsy confirmed diagnosis of low-grade MPNST. After total resection and 60Gy adjuvant radiotherapy, 2-year follow-up showed no signs of recurrence. CONCLUSION: MPNST in the nasal cavity and paranasal sinuses is very rare. Because of a high risk of recurrence, wide resection should be implemented, possibly completed by radiotherapy if resection cannot be complete because of proximity to at-risk structures.

Recurrent peripartum alveolar soft-part sarcoma: Case report using CARE methodology.

INTRODUCTION: Alveolar soft-part sarcoma (ASPS) is a rare malignant sarcoma with only a few cases reported in the sinus and head and neck region. It shows strong female predominance. Hormone-dependent recurrence was never reported. CASE REPORT: A 35 year-old woman presented nasal cavity ASPS during her first pregnancy, middle-ear ASPS during the second, and a third ASPS in the sinus outside of any peripartum period, with unfavorable progression and metastasis, terminating in death. DISCUSSION: Pathology analysis of the tumors showed positive immunolabeling for progesterone receptors in the two peripartum episodes. This was thus the first report of peripartum recurrence of ASPS with strong progesterone sensitivity, reinforcing the suspected biological link between ASPS and progesterone. This case report may be a preliminary finding suggesting progesterone blockers as a novel treatment for recurrent ASPS.

Surgery for chronic rhinosinusitis with nasal polyps: An update.

This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006-2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10-15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.

Deterioration experienced by French otolaryngology residents in their training during the COVID-19 pandemic: A STROBE analysis.

OBJECTIVE: To evaluate the impact of the first three waves of COVID-19 on the academic and surgical training of ENT and Head and Neck Surgery residents in France. MATERIAL AND METHODS: Observational, retrospective study. A 55-item survey of academic education and surgical training was sent to ENT residents in five major French regions (Île-de-France, Rhône-Alpes Auvergne, Occitanie, Grand Est, Grand Ouest) from August to October 2021. RESULTS: Eighty-nine out of 135 residents (66%) responded. Two-thirds considered that surgical training was more affected than academic education, with reductions evaluated of 50-75%, 25-50% and 0-25% for the first three waves, respectively. Residents in Île-de-France, Rhône-Alpes Auvergne and Grand Est were the most affected by the first wave (75-100% reduction in surgical activity, in parallel to increased admissions). Otology, rhinology and functional exploration were the most affected, whereas pediatrics and oncology were spared. Seventy-one of the 89 residents (79.7%) felt that the first wave impacted their career, while this proportion decreased to 39.3% and 44.9% for the second and third waves, respectively. CONCLUSION: The first wave of COVID-19, compared to the following two waves, severely impacted the surgical training of French ENT residents, especially in regions severely impacted by the pandemic, while academic education was relatively safeguarded by the implementation of e-learning alternatives.

French health insurance data for chronic rhinosinusitis with nasal polyps between 2011 and 2018: A STROBE-compliant analysis.

AIMS: The main aim of the present study was to report the annual volume of surgeries performed for chronic rhinosinusitis with nasal polyps (CRSwNP) in France, based on health insurance data. The secondary objectives were to describe the different characteristics of the surgeries and their complications, and to estimate the number of patients eligible for biotherapy. MATERIAL AND METHODS: This was a descriptive observational retrospective study using data from French national health insurance databases for the period 2011-2018. Inclusion criteria comprised all hospital stays with procedures related to CRSwNP according to the French Common Classification of Medical Acts and consistent with French practices. RESULTS: Ninety-two thousand one hundred and fourty one patients (92,141) for 92,884 admissions for CRSwNP surgery were analyzed, providing an accurate representation of CRSwNP surgery in France between 2011 and 2018. The revision surgery rate for patients operated on in 2011 was 13.0% (1,457/11,212), corresponding to an average annual rate of 1.86% over 7 years. In the 11,750 sinus surgery admissions in 2018, the complications rate was only 0.65% (77/11,750). CONCLUSION: Sinus surgery is safe (0.65% complications) and reliable (estimated revision rate, 5.5%: 5,078/92,884). This study provides the first evaluation of the target population for biotherapy in France.

Surgical and instrumental options for chronic rhinitis: A systematic review and PRISMA meta-analysis.

BACKGROUND: There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical treatment? Various targets (turbinates and secretory nerves) and techniques (surgical, laser, cryotherapy, radiofrequency and phototherapy) have been reported, but benefit varies between reports. The aim of this systematic review and meta-analysis was to evaluate results of surgical and instrumental procedures in CR care. METHODS: Two systematic reviews of the US National Library of Medicine, Cochrane Library, Web of Science and Embase databases were conducted in October 15, 2021 (registration numbers CRD42021284257 and CRD42021295227). A database watch was performed until submission of the manuscript. The review focuses on total nasal symptom score (TNSS) and quality of life (QoL) after treatment. All controlled studies reporting nasal surgery/instrumental procedures in adult patients with CR were included. RESULTS: The database search yielded a total of 5628 articles; after eligibility screening, 2091 patients were included from 21 studies. QoL results favored surgery/instrumental procedures over medical treatment (SMD -1.27; 95% CI [-2.38; -0.16]; I2=97%), as did TNSS (SMD -1.40; 95% CI [-2.30; -0.50]; I2=98%). The small number of studies and their heterogeneity did not allow meta-regression to be performed. CONCLUSION: This systematic review supports the use of surgical/instrumental procedures to improve nasal symptom score and QoL of adult patients with CR poorly controlled by medical treatment.

Chronic nasal dysfunction: A clinical case illustrating the concept in practice.

INTRODUCTION: We illustrate the diagnostic method for chronic nasal dysfunction by an observation in which the clinical history was compared to preoperative responses on the DyNaChron self-administered questionnaire, with ENT interpretation of the sinonasal CT scan preceding and guiding nasal endoscopy. CASE REPORT: The initial suspicion of rhinitis medicamentosa was transformed by the radiological and endoscopic findings of chronic respiratory rhinitis signs. Prick tests showing sensitivity to dust mites then suggested an allergic origin of the mucosal inflammation, which affected neither the olfactory nose nor the paranasal sinuses. A septal deviation hampering visualization of the right ethmoidal reliefs completed the clinical picture. Inferior turbinate hypertrophy secondary to allergic inflammation could have been aggravated by prolonged daily use of nasal vasoconstrictors. Failure of medical treatment combining nasal lavage, topical corticosteroids and an attempt at weaning led to effective medical and surgical management combining septoplasty, bilateral inferior turbinoplasty, continuation of topical corticosteroids and initiation of allergen immunotherapy. In addition to complete relief of nasal obstruction and abandonment of nasal vasoconstrictors, improved sense of smell completed the restoration of nasal comfort. DISCUSSION: It is helpful to conceive the nose as being anatomically and pathophysiologically a triple organ and to evaluate therapy in terms of improvement in each symptom.

Bioactive glass in canal wall reconstruction tympanoplasty.

The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.

Prevalence and Characteristics of Altered Sense of Smell/Taste During Covid-19 first wave: A French Nationwide Cross-sectional Study.

AIM: Altered sense of smell and/or taste is a leading symptom of SARS-CoV-2 infection, but its prevalence at a population-level is unknown. METHODS: From a questionnaire addressed to a representative subset of the French general adult (≥18-year) population over a 6-week period during the first French lockdown (April 7 to May 19 2020), self-reported new cases of altered sense of smell and/or taste were collected. RESULTS: From 29,660 participants, new altered sense of smell and/or taste was 2.18% and 2.11% after direct standardization on the French population representing more than 1,110,000 subjects in France. Moreover, 0.5% of participants reported a positive SARS-CoV-2 test, among which 47.4% reported a newly altered sense of smell and/or taste. Male participants, younger ones together with those presenting with chronic condition had higher odds of reporting a newly altered sense of smell and/or taste. CONCLUSION: This study provides an accurate estimate of new cases of altered sense of smell and/or taste in the general population at a nationwide level during the Covid-19 first wave.

Nasal polyposis and cystic fibrosis(CF): review of the literature.

The aim of this study was to address whether NP might be a predictive factor for severity of CF. The authors collected data from the literature on NP as a unique or associated sign in CF and reviewed the clinical and molecular aspects of CF associated with NP. CF genotypes and clinical severity in NP(+) vs. NP(-) patients were reviewed, taking into account pulmonary function, frequency of P. aeruginosa lung infection, frequency of allergy, nutritional status, and exocrine pancreatic function. The CFTR gene was also analyzed in a patient with isolated severe NP as the unique feature of CF. This review of the literature showed a `milder` phenotype in `NP+` vs. `NP-` CF patients, contrasting with a marked association between NP and `severe` CF mutations. In addition, a complex genotype was identified, associating four heterozygous variants, namely p.Q493X (a severe mutation) on the paternal allele, and p.V562I, p.A1006E, and (TG)11(T)5 (IVS8-5T) on the maternal allele, in a case of CF presenting as isolated NP. The authors speculate that genetic/environmental factors associated with NP might attenuate the functional impact of `severe` CF mutations. The overrepresentation of CF carriers among patients with isolated NP also advocates the need for CFTR molecular screening in such populations for genetic counselling purposes.

Evolution and safety of day-case major ear surgery.

AIMS: To study the evolution of middle-ear surgery in 2019 in relation to the French Health Authority target of 66% day-surgery by 2020. MATERIAL AND METHODS: A single-center retrospective observational study included all patients undergoing otologic surgery between January 2014 and December 2018 in a university hospital center. 1064 of the 1368 patients were scheduled for outpatient surgery: 309 for otosclerosis, 355 for tympanoplasty with or without ossiculoplasty, 376 for cholesteatoma and 24 for other procedures. Two groups were constituted: day-surgery and conventional, according to hospital stay. Surgery time, follow-up duration, number of crossovers to conventional admission, number of emergency postoperative consultations, number of readmissions and data from the phone-call systematically made the day after surgery were analyzed. The main objective was to evaluate the safety of outpatient surgery for major middle-ear interventions compared to a control group managed under conventional admission during the same period. RESULTS: 27 patients (2.5%) required crossover, mainly due to disabling vertigo (57.7%). 53 patients (4.9%) consulted before the scheduled 8th day consultation, because of severe pain (23.5%) or dizziness (34.0%). Only 10 patients required emergency readmission. CONCLUSION: Provided that the inclusion criteria are met, all major middle-ear surgery procedures can be performed as day-surgery under satisfactory safety conditions.

The medical uses of manosonic nebulizers (AMSA®) in 2018.

AIMS: The purpose of repeated application of manosonic nebulizers (AMSA®) is to ensure active Eustachian tube rehabilitation and optimal middle-ear drug diffusion. In response to recent changes in marketing authorizations issued by the French National Drug Safety Agency (ANSM), the present study investigated how AMSA® is used in the Auvergne-Rhône-Alpes Region of France. MATERIAL AND METHODS: A prospective non-interventional regional 1-year survey was conducted in 701 general practitioners and community and hospital ENT physicians in the Auvergne-Rhône-Alpes Region, using a questionnaire sent by mail with a reminder at 2 months. Percentage responses were compared on Chi2 test with alpha risk of 5%. Non-respondents were excluded. ENDPOINTS: The main endpoints were rate of AMSA® prescription, and prescription modalities in a specific geographical territory (Auvergne-Rhône-Alpes Region) in 2018. RESULTS: 93% of the 114 respondents prescribed AMSA®, with 4,000 prescriptions in 1 year. 66.7% prescribed this treatment to avoid recourse to myringotomy. Mean treatment duration was 2 weeks (50.9% of respondents). The most frequent nebulized substance was saline serum (68.4% of respondents), sometimes associated to corticosteroids or mucolytics. CONCLUSION: The majority of physicians in the Auvergne-Rhône-Alpes Region, and notably the ENT physicians, were AMSA® prescribers for the treatment of Eustachian tube dysfunction and its consequences. However, the duration and modalities of use of AMSA® were very heterogeneous, and further studies are needed to standardize prescription.

[Mandibular advancement device and multidisciplinary consultation of sleep-disorders]. / Orthèse d'avancée mandibulaire et consultation pluridisciplinaire sur les pathologies du sommeil.

BACKGROUND: Multidisciplinary consultation of sleep-disorders can include recommendation of a mandibular advancement device (MAD) for some patients with obstructive sleep apnea syndrome (OSAS). AIM: To assess the outcomes of patients for whom an oral MAD was prescribed following multidisciplinary consultation for OSAS in a University Hospital Center. METHODS: All patients referred by hospital or community specialist who had visited this specialized service from December 2015 to December 2017 and to whom an MAD was prescribed were included in this study. The objective was to analyze their clinical course after this consultation and to assess the effectiveness of these devices in this population. RESULTS: In all, 184 patients were seen by the multidisciplinary consultation between December 2015 and December 2017. An MAD was offered to 148 patients and 70 of these went on to have one. Of these 52 of them received follow-up polygraphy (PG) with it in place. This confirmed effectiveness in 18 cases (decrease of at least 50% of the AHI. The average AHI went from 34.8/hr to 22.5/hr. Sixty-five of the 148 patients were lost to follow-up. CONCLUSION: After specialized consultation on sleep-disorders, only one-third of the patients to whom an OA was prescribed had polygraphic exam. OA was less effective than in equivalent series. Correctives measures (such as a multidisciplinary standard sheet) have been set up to ensure a close follow-up of patients.