Management of nasal polyposis.

These guidelines are modified from the recent EAACI Position Paper. Nasal polyposis is characterized by an inflammatory process, the factors of which are summarized. Recently, Staphylococcus aureus enterotoxins have been identified to modify the disease. A classification system for polyps, grading systems and epidemiologic data are given, frequent comorbidities are discussed. The diagnostic management is based on endoscopy and CT scanning. A score of severity is proposed. The therapeutic management consists of the medical treatment options, which are given with evidence-based recommendations. Surgical treatment is indicated after failure of medical treatment and commonly performed by endoscopy. Nevertheless medical therapy must be continued after surgery to prevent recurrences. Algorithms of decision are finally proposed [corrected]

Universal newborn hearing screening.

Hearing loss is one of the most common congenital anomalies, occurring in approximately 1-2 infants per 1000. Left undetected, hearing impairments in infants can negatively impact speech and language acquisition, academic achievement, social and emotional development. These negative impacts can be diminished and even eliminated through early intervention at or before 6 months of age. Reliable screening tests that minimize referral rates and maximize sensitivity and specificity are available. The goal of universal neonatal hearing screening is to maximize linguistic and communicative competence and literacy development for children who are hard of hearing or deaf. Audiologic and medical evaluations should be in progress before 3 months of age. Infants with confirmed hearing loss should receive intervention before 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children.

Comparative study of standard radiology, sinuscopy and sinusomanometry in the maxillary sinus of the adult (about 465 maxillary sinuses).

The authors examine the correlations among standard X-ray, sinuscopy and sinusomanometry for 465 maxillary sinuses in the adult. Good overall correspondence does exist between radiography and sinuscopy (51.59 to 90.91%) but there is no real correlation between sinusomanometry and a sinuscopy that fails to visualize the ostium. Correlation is excellent when the morphologic appearance of the ostium is studied in conjunction with the sinusomanometric findings (82.09%). This study demonstrates the morphologic and the functional examinations to be rigorously complementary and indissociable.

[Treatment of tinnitus. What hope of recovery? What therapeutic method?]. / Le traitement des acouphènes. Quel espoir de guérison? Quel schéma thérapeutique?

Global therapeutic efficacy was evaluated after treatment of 100 patients with tinnitus. Characteristics of the affection were studied and different therapies applied. After a mean follow up of 4 months, marked improvement was noted in symptomatology in 33% of cases, including 8% of patients indicating total disappearance of tinnitus or its marked reduction. Efficacy of most treatments, notably medication, is open to doubt, while electrophysiological means such as percutaneous and transtympanic electrical stimulation possess specific indications. The need for basic studies of the physiopathology of tinnitus, as well as for extensive multicentre clinical trials to assess the different therapeutic methods used, is stressed.

[A case of very late malignant degeneration of pleomorphic adenoma]. / Un cas de dégénérescence maligne très tardive d'un adénome pléomorphe.

Incomplete excision of a pleomorphic adenoma exposes to a high risk of recurrence and tumor spread, making secondary surgery more difficult or a malignant transformation with a poor vital prognosis likely. Three histological types of pleomorphic adenomas can be observed when the tumor undergoes a transformation, namely the carcinoma ex-pleomorphic adenoma, the true malignant mixed tumor and the benign metastasizing mixed tumour.

[Mediastinal tracheotomy in cervicofacial oncologic surgery. Contribution of the pectoralis major myocutaneous flap]. / La trachéostomie médiastinale en chirurgie carcinologique cervico-faciale. Apport du lambeau myo-cutané de grand pectoral.

Four cases of anterior mediastinal tracheostomy with myocutaneous Pectoralis Major flap are described. Resection of the manubrium, clavicular heads and the cartilages of the first and second ribs is necessary. The use of myocutaneous Pectoralis Major flap give good functional results. No infection or hemorrhage of mediastinal great vessels occurred. The indications of Anterior mediastinal tracheostomy are discussed. Stomal and peristomal recurrences following laryngectomy for carcinoma represents the indication of choice. Stomal recurrences are difficult to treat and the prognostic is poor. Prevention of the stomal recurrences is discussed.

[Comparative studies of thr bibliographic impact of European and American ENT reviews]. / Etude comparative de l'impact bibliographique de revues ORL européennes et américaines.

The authors investigate the bibliographic impact factor of twelve American and European journals in 1986. Three American journals have the best impact factor: The Laryngoscope 1,531 citations items, Archives of Otolaryngology 1,367 and Annals of Otology Rhinology and Laryngology 1,194. European journals remain far behind. The authors analyse the reason of this scientific success (English language, numerous but short items, large editorial board, commercial sponsoring, strict instructions for authors, special numbers, regular issue and low prices). An European journal is only possible as an association of current journals or as a new and original one (Digest journal composed of selected articles or summaries within Europe).

[Treatment of tinnitus by electrical stimulation of the ear]. / Traitement des acouphènes par stimulations électriques de l'oreille.

After a short historic review of the electrical stimulation in the treatment of tinnitus, the authors recall the fundamental principles of the bases of this therapy. Following the evolution of their ideas on this subject, they present the principles and methods of many different types of stimulation: (Transtympanic, sinusoidal, transcutaneus, auriculotherapy). They also discuss the results of their efficiency which ranges between 10 to 40%. The authors then reached an agreed upon opinion that the transtympanic electrical stimulation in square positive waves which ables them to obtain in nearly 60% of patients a positive effect, and in 23% a long term results is the most preferable one till now. They finally exposed a personal case in which the implantation of a permanent stimulation electrode was needed to be undergone, this is restricted to patients who suffer from unbearable tinnitus with profound deafness.

[Cytomegalovirus and acquired congenital deafness]. / Le cytomégalovirus et les surdités congénitales acquises.

Cytomegalovirus (CMV) is nowadays a frequent causal agent in pediatric acquired hearing loss and should become the principal one in the next few years. CMV is a herpes like virus. Eighty percent of all adults are carriers of this virus in the salivary glands, without any symptom. In the pregnant women, CMV can act by reactivation and give a placental and foetal infection. The pregnant woman is generally asymptomatic when infected. In the infant, besides death in utero, the CMV can produce two clinical types. Ten percent of the congenitally infected infants presented symptoms at birth. In a quarter of them the clinical picture is a severe ictero-hemorrhagic syndrome with infaust prognosis. Most often the clinical picture is an incomplete syndrome with serious neurological, hepatic, developmental, ophthalmic and auditory sequelae. The subclinical form represents 90% of the infected infants. Normal at birth, about 20% of these develop hypoacusis. During the antenatal period, a rise in titre in serologic examination signals a reactivation of the virus. At birth, the diagnosis is by cytodiagnosis and the identification of specific foetal CMV antibodies. The postnatal diagnosis--the most frequent for the otolaryngologist--is based on the concommitant raised titers in both mother and child and/or the presence of other neurological or ophthalmic signs by the child. The prevention is practically impossible. Many medical treatments are studied and nowadays the follow up of a high risk group seems to remain the best attitude.

Hearing aids: statistical study and satisfaction survey of patients in an ENT practice.

The present study is a report on a group of hearing-impaired patients all of whom received prescriptions for hearing aids. The lessons learned are the following: only two out of three patients followed up on their prescriptions. "Behind the ear" hearing aids (BTE) were the type most often fitted (79%) against a much lower number of "in the ear" hearing aids (ITE). Binaural fitting has become more widespread since coverage for two aids has been approved by the insurers. The patient is globally satisfied with his hearing aid. However, one out of two is dissatisfied with his auditory correction in a group conversation situation and this in spite of bilateral fittings. Further verification of the efficacy of stereoacoustic amplification is recommended as well as greater care in the initial programming of the aid. An increase in the marketing and sales of ITE prostheses is advisable thereby perhaps attracting hearing aid candidates otherwise reticent to wear conventional BTE type aids.

Prevention of pre- and perinatal acquired hearing defects, Part I: Study of causes.

After recalling some notions of embryology, the authors review in the light of recent literature the main causes of prenatal acquired hypoacusias (of viral, bacterial, parasitic, endocrinologic, toxic or other origins) and of perinatal acquired hypoacusias (prematurity, neonatal hypoxia, obstetrical traumatism, nuclear icterus, toxicity and others) by following a systematic course (incidence, clinical signs in the mother and child, audiologic diagnosis, anatamopathology, physiopathology, prevention, and treatment).

[Rehabilitation of the hollow cavities using bone reconstruction and biomaterials]. / Revalidation des cavités d'évidement par reconstruction osseuse et bio-matériaux.

The joint use of biocompatible ceramic granules coated with a thin layer of bone dust and temporalis fascia would appear to the authors to offer a solution in the rehabilitation of the radical mastoidectomy cavity. The practical simplicity and the plasticity of the system, as well as the excellent biocompatibility and bioactivity of the materials used, combine to make this a highly satisfactory procedure.

Revalidation of radical mastoidectomy cavities: reconstruction with bone dust and bio-materials.

The joint use of biocompatible ceramic granules coated with a thin layer of bone dust and temporalis fascia would appear to us to offer a solution in the rehabilitation of the radical mastoidectomy cavity. The practical simplicity and the plasticity of the system, as well as the excellent biocompatibility and bioactivity of the materials used, combine to make this a highly satisfactory procedure.

[Comparative study of standard radiology, sinusoscopy and sinusmanometry of chronic sinus pathology in the adult]. / Etude comparative entre la radiologie standard, la sinusoscopie et la sinusomanométrie dans la pathologie sinusale chronique de l'adulte.

The aim of this study is to establish a correlation between Standard X-ray, sinuscopy and sinusomanometry, in case of chronic maxillary sinusitis. One hundred and fifty-three adults maxillary sinuses were studied. A good positive correlation was found between radiology and sinuscopy (44,5-89,5%). There is no correlation either between X-Ray and sinusomanometry, nor between sinuscopy (excluded ostium) and sinusomanometry. On the other hand, a very good correlation exists between maxillary ostium morphology and sinusomanometry (84,1%). The authors concluded that morphological and functional investigations of sinusal pathology are complementary and cannot be dissociated.

Usefulness and limitations of sinus echography in the child.

The authors report their preliminary experience in B-mode maxillary sinus echography. The experience takes into account a series of 52 sinuses of children under 10. The study revealed that maxillary sinus echography is a rapid, harmless and quite specific method (i.e. a method which reports few false positives when the existence of possible artifactual echoes is not disregarded), sensitive for secretions, less sensitive for polyps and mucosal thickenings, mainly posterior ones. The method is hampered by the presence of the anterior bone wall, which creates artifacts and thus false positives; yet, it is probably in the child where this handicap is the smallest since normally, in the child, the bone wall is the thinnest. Echography appears to be a really complementary method for radiology, but--according to this preliminary experience, at least--it cannot still pretend to act as a substitute for it. The reproducibility of the method and its reliability, among others in relation to sinusoscopy, are still to be investigated with more accuracy.

A clinical correlation between hypozincemia and tinnitus.

We examined a group of 115 patients suffering from tinnitus and have attempted to find a statistically significant correlation between the tinnitus experienced and low blood zinc levels (hypozincemia). No particular correlation could be made between the nature of the tinnitus experienced and hypozincemia except for the continuation of head noises, these being more frequently associated with hypozincemia when they are intermittent. Two hypotheses of pathogenesis are proposed to explain this phenomenon and are based on the importance of zinc to the syntheses of enzymes and proteins.

[The zinc sulfate overload test in patients suffering from tinnitus associated with low serum zinc. Preliminary report]. / Epreuve de surcharge au sulfate de zinc chez des patients souffrant d'acouphènes associés à une hypozincémie. Rapport préliminaire.

This work studies the efficiency of the zinc overloading in the treatment of patients suffering from tinnitus with hypozincemia. The authors have positive results about 52% of cases: in 15% there was a good amelioration and in 37% there was a little but significant amelioration of their symptoms. The authors have also found on that this type treatment with zinc of overloading is more efficient in males than in females. It is also more efficient in types of tinnitus of a continuous character than in other types.

Management to prevent high-sited recurrence of pharyngo-laryngeal cancers.

The development of reconstructional techniques in cervico-facial surgery has led to the proposal of surgical solutions, in conjunction with radiotherapy, for the extensive epidermoid carcinomas of the oropharynx and hypopharynx that were formerly rejected by the surgeon. However these stage III or IV epidermoid carcinomas carry a heavy proportion of "high" recurrences, i.e. situated in the parapharyngeal, oropharyngeal and rhinopharyngeal regions. The reasons for this are: the lymphatic continuity between the oro- and hypopharynx and the parapharyngeal regions and the base of the skull; the limitation of neck dissections higher up at the tip of the mastoid and the lower parotid border; the limitation of postoperative irradiation directed upwards. Therefore for these lesions we propose an extended therapeutic programme comprising pre-operative chemotherapy based on cisplatinum, bleomycin and methotrexate, an adequately wide surgical resection followed by reconstruction and an irradiation extending upwards by two lateral fields to the oropharynx, the rhinopharynx and the parapharynx.