Treatment of sleep apnea by ENT specialists during the COVID-19 pandemic.

The treatment of sleep disorders has been strongly impacted by the COVID-19 pandemic. When the lockdown is over, resumption of usual patient care will require precautions to limit the risk of contamination for patients and caregivers. In this document, the French Association of Otorhinolaryngology and Sleep disorders (AFSORL) and the French Society of Otorhinolaryngology (SFORL) put forward a summary of the measures for continuing the treatment of sleep apnoea syndrome in these new practice conditions. Emphasis is placed on teleconsultation, methods of nocturnal sleep studies, the conditions for treatment by continuous positive airway pressure (CPAP) ventilation, and the postponement of more invasive treatments.

Characteristics of transient-evoked otoacoustic emissions (TEOES) in neonates.

Transient-evoked otoacoustic emissions (TEOEs) were measured in 1164 ears from 582 neonates without any risk of hearing impairment in order to define basic characteristics useful in deciding if TEOEs could be considered as "normal" in a screening test. Five neonates had no recordable TEOE and ABR thresholds greater than 30 dBnHL. Technical conditions have been analysed using the intensity of the click stimulation, the time necessary to record TEOEs, and the noise floor in the external ear canal (i.e. A-B magnitude). The TEOE magnitude varied between 6.6 dB SPL and 38 dB SPL (mean = 21.75 dB SPL). Only 5% of the tested neonates had a TEOE magnitude lower than 7.75 dB SPL. The TEOE magnitude for the right ear of a neonate was statistically different from those recorded in the left ear (22.4 dB SPL versus 21 dB SPL). The mean TEOE magnitude for male ears was statistically different from those recorded in female ears (21.4 dB SPL versus 22.1 dB SPL).

[Resistance to activated protein C disclosed by postphlebitic disease. Two cases]. / Résistance à la protéine activée révélée par une maladie post-phlébitique. Deux cas.

INTRODUCTION: Recently, resistance to activated protein C has been discovered. Resistance to activated protein C appears to be the main cause of familial thrombosis. CASE REPORT: Two consecutive patients have been studied. Both have a venous insufficiency associated with eczema in one patient and venous ulceration in the second patient. The two patients had a personal and familial history of venous thrombosis. In both patients, a resistance to activated protein C was found associated with a mutation in the factor V gene in residue 506. DISCUSSION: When a personal or familial history of the venous thrombosis is associated with symptoms of venous insufficiency, resistance to activated protein C must be added to the search for proteins C, S and anti-thrombin III deficiency.

[Hypoglossal nerve in its intralingual trajectory: anatomy and clinical implications]. / Le nerf hypoglosse dans son trajet intralingual. Etude anatomique et applications cliniques.

There is little literature on the intralingual trajectory of the hypoglosal nerve. We performed an anatomical dissection on 6 cadavers and completed our study with histological examinations. The 12th cranial nerve enters the lower part of the tongue laterally, reaching the anterior border of the hypoglossal muscle where it follows the ascending lingual artery medially to terminate anteriorly to the lingual V. Its terminal branches spread out horizontally in each half of the tongue. There is a paramedial branch, found in all cases, which projects downwardly, posteriorly and medially at the basilingual portion of the genioglossal muscle. These anatomic findings indicate that basiglossectomy removing the entire base of the tongue can be performed without functional sequelae. A certain degree of somatotopy is also found with specific fibers reaching the protractor and retractor muscles. This nerve distribution supports attempts at selective electrical stimulation of the hypoglossal nerve with the aim of dilating the upper airways in patients with sleep apnea syndrome.

[Definition of normal criteria of provoked otoacoustic emission in the newborn infant]. / Définition des critères de normalité d'une oto-émission acoustique provoquée chez le nouveau-né.

Evoked otoacoustic emissions (EOE) were recorded with ILO88 in a group of 254 neonates (n = 508 ears) in order to determine the normative data. In this study, it was found that: (i) the mean EOE amplitude was 20.2 dB SPL, (ii) the EOE amplitude of the right ear was significantly higher than those of the left ear, (iii) the mean time necessary to record EOE in both ears was around three minutes, and (iv) EOE spectrum was large (mean = 638-5,611 Hertz). These data permit to precise the clinical interest of EOE for screening auditory function in neonates.