Percutaneous dilatational tracheostomy for saturating influx of COVID-19 patients: Experience of military ENT physicians deployed in Mulhouse, France.

OBJECTIVES: The main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination. MATERIAL AND METHODS: A single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy. RESULTS: Eighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage). CONCLUSION: This study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.

Nasal or canthal-alar parentheses: A study of the facial base of the nose.

OBJECTIVES: The facial implantation of the osseous nasal pyramid corresponds to the piriform aperture, the shape of which is projected on the facial skin in the form of bracket-shaped parentheses. The objective of this study was to compare inter-parenthesis width with subjective visibility on frontal photographs. MATERIAL AND METHODS: The "patient" group came from a retrospective cohort of photographs taken ahead of septorhinoplasty. The "model" group photographs were collected from the Web or magazines. Nasal parentheses were first judged subjectively as frank or faint. Then, independently, parenthesis width was measured by computer in pixels and converted into millimeters by iris-dependent calibration. Inter-parenthesis width was compared statistically with the frank/faint assessment, according to gender and group. RESULTS: A total of 113 photographs were included: 46 patients (19 women, 27 men) and 67 models (43 women, 24 men). Sixty-seven of the 113 nasal parentheses appeared frank (59.3%), more frequently in men than women (70.6% vs 50.0%, P=0.02) and in patients than models (69.6% vs 52.2%, P=0.06). Inter-parenthesis width was significantly greater in frank than faint presentations (34.9±3.5mm vs 30.7±3.4mm, P<0.0001), in men than women (35.2±4.1mm vs 31.5±3.1mm, P<0.0001), and in patients than models (34.9±4.0mm vs 32.0±3.6mm, P<0.0001). CONCLUSION: Frank nasal parentheses correspond to wider facial implantation of the nose.

VIIIth nerve cavernous hemangioma mimicking a stage 1 acoustic schwannoma.

OBJECTIVE: To report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. METHODS AND RESULTS: We report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. CONCLUSIONS: When considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity.

[Acute acoustic trauma, a retrospective analysis about 225 military cases]. / Traumatismes sonores aigus: analyse rétrospective de 225 cas militaires.

OBJECTIVES: Studying the epidemiology, the evolutionary audiometric profile and the after-effects of acute acoustic trauma managed in military environment. Assessing the influence beyond the audiometric recovery of earplugs, precocity of the treatment and hyperbaric oxygen therapy. MATERIALS AND METHODS: This retrospective cohort gathered 225 military cases of acute acoustic trauma hospitalized between 2003 and 2008. The cochlear supportive therapy associated intravenous methyl-prednisolone and pentoxyfilline, completed sometimes with hyperbaric oxygen therapy. The evolution was appreciated with pure-tone audiometry at the admission, at the end of hospitalization and one month after. Perceptive deafness and recovery shifts were statically calculated on 109 ears. RESULTS: On the 225 cases, 90% were males, middle-aged of 23 years. Initially 95% of the patients complained about tinnitus, associated with hearing loss felt for 71%. The left ear was more frequently affected. The initial audiometric loss was average of 34 dB HL, concentrated on 4000 and 6000 Hz frequencies. The therapy allowed an average recovery of +18,3 dB in a month. The audiometric sequela concerned 40% of the cases, and residual tinnitus a third. These rates were significantly higher with people whose initial hearing loss average exceeded 40 dB HL. Concerning the audiometric recovery and the after-effects, no significantly difference was found between the groups treated before or after 12 hours. There were either no difference with the earplugs and hyperbaric oxygen groups. CONCLUSION: Despite the effectiveness of early corticotherapy, after-effects of acute acoustic trauma remain frequent and invalidating. Its prevention suffers from non-observance and malposition of earplugs.

Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.

INTRODUCTION: Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. CASE REPORT: A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. DISCUSSION: Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment.