A retrospective study of 43 cases of fungal malignant external otitis.

Malignant external otitis (MEO) has a frequent bacterial origin, but we are currently witnessing the emergence of fungal agents, which poses difficulties in diagnosis and management. The aim of our work is to analyze the epidemiological and clinical profile of fungal MEO and to study the antifungal susceptibility of fungi involved. Our study is retrospective collecting 43 patients treated for fungal MEO between 2010 and 2019. Clinical, biological, and radiological data were collected from patient hospitalization records. Identification of yeasts was done by YST vitek®2 card. The antifungal susceptibility testing was performed for yeasts by the AST vitek®2 card and for other fungi by the E-test technique. The average age was 66 (± 12) years. We noted a male predominance in 63 % (n=27). Diabetes was found in 86%. Otalgia was a constant symptom. Cranial nerve palsies were observed in 16% (n=7) of cases. CT showed bone lysis in 74% (n=31>) of cases and Tc99 bone scintigraphy revealed hyperfixation in 100% (n=43) of cases. Candida spp. (n=21), Aspergillus spp. (n=18), and Geotrichum capitatum (n=2) were isolated. No resistance to antifungals has been demonstrated for Candida yeasts. Geotrichum capitatum isolates were resistant to fluconazole and caspofungin. Aspergillus isolates were resistant to amphotericin B and caspofungin in 50% (n=9) and 72% (n=12) of cases, respectively. Our study proves the predominance of Candida yeasts and Aspergillus as the fungal agents involved in MOE. Mycological diagnosis allows the identification and antifungal susceptibility testing. Thus, it allows using of the appropriate antifungal treatment and improves the prognosis of the disease.

Successful treatment of rhino-facial mucormycosis in a diabetic patient.

Mucormycosis is a rapidly progressing and lethal infection caused by fungi of the order mucorales. The disease occurs mostly in patients with uncontrolled diabetes or other predisposing systemic conditions. We report a case of rhinofacial mucormycosis in a 39-year-old diabetic patient. The diagnosis was established by clinical examination, imaging, and confirmed by mycological examination. Rhizopus arrhizus was isolated. He was successfully treated with amphotericin B, surgical resection, diabetes control and hyperbaric oxygen therapy.

Predictive factors for post-total thyroidectomy hypocalcaemia.

INTRODUCTION: Post total thyroidectomy hypocalcemia is a frequent and serious complication of thyroid surgery. Predictive Factors of its risk, justifying the prescription of preventive treatment are to be determined. AIM: To identify the predictive factors of hypocalcemia secondary to total thyroidectomy. METHODS: We report a retrospective study involving 260 patients operated with total thyroidectomy at the ENT department of the military hospital of Tunis over a period of 5 years. A statistical study was carried out to find out predictors of hypocalcemia. RESULTS: Our patients were women in 85% of cases with an average age of 49 years. The incidence of postoperative hypocalcemia was 31.9%. Hypoparathyroidism was definitive in 1.1% of cases. Univariate statistical analysis identified the following factors: presence of cervical swelling at the initial physical exam, gradual onset of mass, thyroid nodule size greater than 4 cm, preoperative calcium level <2.25 mmol/L, one-shot thyroidectomy operating time, histological appearance of thyroiditis and accidental excision of a parathyroid gland. The factors retained in the multivariate study were: gradual onset of mass, nodule size> 4 cm, preoperative calcium level <2.25 mmol/L and histological appearance of thyroiditis. CONCLUSION: Post total thyroidectomy hypocalcemia is linked to intrinsic factors of the thyroid, preoperative calcium level, preoperative and intraoperative parathyroid lesions. Its prevention would include: supplementation of patients with hyperthyroidism or with low preoperative calcium levels, systematic identification of the parathyroid glands and their reimplantation in cases of devascularization.

[Clinical and phmetric evaluation of gastro-esophageal reflux impact on upper airways in adult]. / Evalution clinique et phmétrique de l'impact du reflux gastro-oesophagien sur les voies aérodigestive supérieures chez l'adulte.

BACKGROUND: Gastroesophageal reflux is a frequent and benign affection. It represents an etiopathological entity in otorhinolaryngology; that may occasion a large variety of ENT manifestations. AIM: To evaluate clinical and pHmetric impact of gastro esophageal reflux on upper airways in adult. METHODS: Prospective study about 95 cases diagnosed and treated at the ENT department of military hospital of Tunis. Clinical features, pH metric profiles and therapeutic approach are reported and compared to the literature. RESULTS: The mean age was 37 years old. Sex ratio was 1.16. Pharyngolaryngeal symptoms dominated ENT manifestations (41 cases). Laryngeal dyspnea, cough and dysphonia were predictive of danger. Positive pH metric rate collated to posterior laryngitis and pharyngitis were respectively 81.2% and 79.1%. Posterior laryngitis, dental erosion and chronic sinusitis, seem to have pejorative significance. CONCLUSION: Otorhinolaryngologist must think about asymptomatic reflux every time when chronic or recurrent ENT affection remain unexplained after complete clinical investigations. PH monitoring confirms gastroesophageal reflux disease.

[Preoperative CT Scan in middle ear cholesteatoma]. / Apport de la tomodensitométrie dans le bilan pré opératoire de l'otite moyenne chronique cholestéatomateuse. A propos de 60 cas.

AIM: To compare preoperative CT scan finding and per-operative lesions in patients operated for middle ear cholesteatoma, METHODS: A retrospective study including 60 patients with cholesteatoma otitis diagnosed and treated within a period of 5 years, from 2001 to 2005, at ENT department of Military Hospital of Tunis. All patients had computed tomography of the middle and inner ear. High resolution CT scan imaging was performed using millimetric incidences (3 to 5 millimetres). All patients had surgical removal of their cholesteatoma using down wall technic. We evaluated sensitivity, specificity and predictive value of CT-scan comparing otitic damages and CT finding, in order to examine the real contribution of computed tomography in cholesteatoma otitis. RESULTS: CT scan analysis of middle ear bone structures shows satisfaction (with 83% of sensibility). The rate of sensibility decrease (63%) for the tympanic raff. Predictive value of CT scan for the diagnosis of cholesteatoma was low. However, we have noticed an excellent sensibility in the analysis of ossicular damages (90%). Comparative frontal incidence seems to be less sensible for the detection of facial nerve lesions (42%). But when evident on CT scan findings, lesions of facial nerve were usually observed preoperatively (spécificity 78%). Predictive value of computed tomography for the diagnosis of perilymphatic fistulae (FL) was low. In fact, CT scan imaging have showed FL only for four patients among eight. Best results can be obtained if using inframillimetric incidences with performed high resolution computed tomography. CONCLUSION: Preoperative computed tomography is necessary for the diagnosis and the evaluation of chronic middle ear cholesteatoma in order to show extending lesion and to detect complications. This CT analysis and surgical correlation have showed that sensibility, specificity and predictive value of CT-scan depend on the anatomic structure implicated in cholesteatoma damages.