Otitis media with effusion in nasal polyposis and outcomes following surgery: A longitudinal observational study.

OBJECTIVE: In patients with nasal polyposis (NP), otitis media with effusion (OME) seems to be a marker of severity of the inflammatory process occurring in those patients. The aim was to assess whether OME could represent a marker of resistance to the surgical treatment of NP. DESIGN: Longitudinal observational cohort study including patients between January 1991 and January 2017. Mean follow-up was 7.4 years. SETTING: Tertiary-care hospital centre. PARTICIPANTS: Patients with NP who underwent surgery (radical bilateral sphenoethmoidectomy). MAIN OUTCOME MEASURES: Four outcomes reflecting resistance to the surgical treatment: a clinical score of rhinologic symptoms, the mean number of systemic corticosteroids treatment per year, the recurrence rate of polyps and the rate of reoperation. RESULTS: A total of 266 patients were included (63.9% of men, mean age 48 years). In multivariate linear mixed-effects regression, when compared to patients without OME, patients with OME presented a similar clinical score of symptoms (coefficient 0.09, 95% confidence interval (CI) -0.25 to 0.06, P-value = 0.24) and a borderline higher mean number of systemic corticosteroids treatments per year (coefficient 0.11, 95% CI 0.003-0.23, P-value = 0.04). In multivariate Cox regression analyses, patients with OME had a similar reoperation rate than patients without OME (hazard ratio (HR) 0.29, 95% CI 0.06-1.50) and a similar recurrence rate of polyps (HR 0.59, 95% CI 0.23-1.53). CONCLUSION: In patients with NP, OME is not a marker of surgical resistance. Those patients should be managed similarly than patients without, and similar outcomes following surgery should be expected.

[Sinonasal polyposis associated with a deficiency subclass immunoglobulin G: Place of substitution immunoglobulins]. / Polypose nasosinusienne associée à un déficit en sous-classes d'Immunoglobuline G: place de la substitution en immunoglobulines polyvalentes.

PURPOSE: To study the effect of the introduction of a substitution by intravenous Immunoglobulins (Ig IV) at patients with immunoglobulins G (IgG) subclasses deficiency and nasal polyposis. MATERIAL AND METHODS: Prospective study concerning five patients with IgG subclasses deficiency and nasal polyposis treated by Ig IV. Rhinologic, otologic and pulmonary symptoms, exacerbations of nasal polyposis, chronic otitis and asthma as well as the number of antibiotics and corticoids treatments were counted during the Ig IV substitution. OBJECTIVES: To study the association between IgIV substitution and the number of exacerbations of nasal polyposis, chronic otitis, asthma and the number of antibiotics and corticoids treatments in patients with IgG subclasses deficiency and nasal polyposis. RESULTS: Five patients with a IgG subclass deficiency and nasal polyposis were substituted. The number of antibiotics and corticoids cures increased at one patient and remained stable at four others. The number of sinus, ear and lung infections as well as the global rhinologic score of symptoms and the endoscopic stage of the nasal polyposis remained stable. In the absence of efficiency of the treatment, this one was interrupted at the end of 6 months for patients n° 1 and n° 3, 24 months for patient n° 4 and 42 months for patient n° 5. CONCLUSION: The current study failed to highlight clinical improvement in patients wih IgG subclasses deficiency and nasal polyposis treated by Ig IV. A previous study had not allowed to find a link between IgG subclasses deficiency and severity of nasal polyposis, what seems to be confirmed by the absence of improvement brought during the substitution of this deficit in the current study.

Extraosseous plasmacytoma of the lacrimal duct.

OBJECTIVE: Extraosseous plasmacytoma (EOP) is a rare plasma cell proliferative disorder that commonly affects the head and neck region. We report the first case of a plasmacytoma of the lacrimal duct. METHODS: A 66-year-old man presented with an isolated plasmacytoma of the right lacrimal duct and was treated surgically. RESULTS: The tumour grew slowly for a few months. CT scan and MRI showed a right lateral nasal mass extending from the right lacrimal duct toward the floor of the right maxillary sinus. The lesion was removed completely by endoscopic nasal surgery. DISCUSSION: EOP accounts for up to 3% of all plasma cell tumours. Management of this rare lesion involves surgery and radiotherapy with or without adjuvant chemotherapy. Guided by a literature review, we discuss the diagnostic and therapeutic management of EOP.

Surgery under COVID: An observational study.

AIM: To evaluate the surgery program strategy adopted in an adult otorhinolaryngology and head and neck surgery department in an area badly affected by the Covid-19 epidemic peak. The main objective was to analyze the reasons for not cancelling surgeries and the postoperative course of operated patients. The secondary objective was to assess the situation of postponed patients. MATERIAL AND METHODS: A single-center observational study carried out during the COVID-19 period in France included 124 patients scheduled for surgery during the period March 21-May 20, 2020. The number and nature of operations, both performed and postponed, were reviewed. RESULTS: A total of 54.0% patients were operated on during the COVID period and 46.0% were postponed. Operations were maintained in urgent or semi-urgent cases. The operated patients did not show any signs of infection during their hospital stay. A total of 29.8% of postponed patients were lost to follow-up and 49.1% were rescheduled. CONCLUSION: The application of national and international recommendations minimized the risk of loss of chance for operated patients without increasing the risk of contamination. The postponement of canceled operations resulted in considerable loss to follow-up. Intensified follow-up is necessary for these patients.

Pneumosinus dilatans associated with nasal polyposis.

OBJECTIVE: Pneumosinus dilatans (PSD) and pneumocele involve the expansion of one or more paranasal sinuses. We present the first cases of frontal PSD and pneumocele associated with nasal polyposis. We also attempt to explain the development of these rare pathologies through this unexpected association. METHODS: Two cases are described. A 31-year-old man presented with chronic rhinosinusitis for many years and a left frontal protrusion. Physical examination found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus without bone destruction. The second patient was a 17-year-old man who presented with a left frontal protrusion and orbital encroachment associated with chronic rhinosinusitis. Physical examination also found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus with focal thinning of the bony sinus walls. DISCUSSION: Focal or generalized thinning of the bony sinus walls differentiates pneumocele from PSD; otherwise, these two entities share the same physiopathological and clinical courses. Many explanations have been proposed for their development including increases in intra-sinus pressure, weakening of bone by tumor invasion, intracranial hypotension, spontaneous drainage of a mucocele, and congenital or hormonal causes. Yet, its physiopathology remains unknown. These two cases support the pressure mechanism of development.

Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa.

GOAL: To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. METHOD: Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R=21) and without (NR=24) robotic assistance, in the period 2006-2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P< .005. RESULTS: Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P=.34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P=.81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P=.05) without significant impact on 5-year actuarial local control (P=0.78). CONCLUSION: Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.

[Bacteriological study of ethmoid specimens from patients with nasal polyposis after ethmoidal surgery]. / Etude bactériologique des cavités d'ethmoïdectomie chez des patients ayant une polypose naso-sinusienne opérée.

OBJECTIVE: To compare the bacteriological and clinical findings in ethmoid specimens from patients with nasal polyposis after radical ethmoidal surgery. PATIENTS AND METHODS: From June to November 2008, 60 patients were prospectively included. For each patient, two samples for each ethmoidal cavity were taken. Aerobic and anaerobic bacterial cultures and fungal cultures were processed and the antibiotic susceptibility was evaluated for each isolated bacterial strain. RESULTS: Pathogenic bacteria were isolated in 48 patients (80%) including predominantly Staphylococcus aureus (60%) or a Gram-negative bacterium. The microorganisms were nearly all susceptible to antibiotics, including the aminoglycosides. No correlation between the presence of pathogenic bacteria and the clinical status of the patients was found. CONCLUSION: In this study, a great number of patients was colonized with pathogenic bacteria. However, the presence of pathogenic bacteria was not correlated with the clinical status of the patients.

Surgical therapy and olfactory function.

This report provides an overview of the relationship between olfaction and surgery. Surgery can be considered as treatment for some olfactory dysfunctions. Moreover, olfactory dysfunction can be analysed as a complication of some surgical procedures. An impaired sense of smell is a common problem affecting approximately 65% of patients with chronic sinusitis. Much of the literature about the effect of surgery on the olfactory system is based on subjective reports of olfactory function, which do not accurately assess objective smell dysfunction. A small number of prospective studies have been published. All studies looking at the sense of smell have found overall post-operative improvement compared with pre-operative symptoms. The range of improvement compared with pre-operative scores ranged from 13 to 91%, with a median of 31%. Olfaction dysfunction can be a complication of various surgical procedures such as laryngectomy, septoplasty, rhinoplasty, ethmoidectomy, and some neurosurgical procedures.

Management of stylohyoid syndrome: A systematic review following PRISMA guidelines.

OBJECTIVES: A systematic review of the literature on stylohyoid syndrome treatment was performed according to PRISMA guidelines. MATERIAL AND METHODS: Three hundred and forty-nine articles were retrieved in the PubMed and Cochrane databases using the search-terms "stylohyoid syndrome" and synonyms. Articles documenting treatment and outcome with more than 1 month's follow-up were selected. Treatment-related complications and rate of cure, defined as disappearance of symptoms and/or of revelatory complication, were analyzed. Overall analysis was performed for series and a mixed logistic regression model for case reports. RESULTS: Hundred and two articles (12 series, 90 case reports) were selected. The 12 series included 482 patients with pain syndrome managed by styloidectomy, with 84.2% and 73.7% cure rates for cervical and transoral approaches, respectively. There were no complications with the transoral approach, versus 1.2% transient facial paresis with the cervical approach. In the 90 case reports, 112 patients had pain syndrome (Group I) and 16 neurological deficit (Group II). Cure rate in Group I varied significantly (P=0.005; OR 8.33, 95% CI [2.12-32.81]) from 64.3% following medical treatment (antiepileptics, muscle relaxants, analgesics, per os and/or locally injected anti-inflammatory drugs) to 91.8% following styloidectomy, without any significant impact of surgical approach (P=0.1; OR 0.17, 95% CI [0.02-1.60]). In Group I, no complications occurred after medical treatment, versus 4.3% and 16.3% after transoral and cervical styloidectomy, respectively. In Group II, cure and complication rates were 87.5% and 6.2%, respectively. Due to the small sample size and heterogeneity of Group II, no statistical assessment of the contribution of styloidectomy to medical treatment (antiplatelet drugs, with or without stenting) was performed. CONCLUSION: Styloidectomy appears to be the treatment of choice for stylohyoid syndrome. The surgical approach does not significantly influence the cure or complications rate.

Use of P-values and the terms "significant", "non-significant" and "suggestive" in Abstracts in the European Annals of Otorhinolaryngology, Head & Neck Diseases.

OBJECTIVES: To evaluate the use of P-values and the terms "significant", "non-significant" and "suggestive" in Abstracts in the European Annals of Otorhinolaryngology, Head & Neck Diseases. MATERIALS AND METHODS: Consecutive articles accepted for publication during the period January 2016 - February 2019 were systematically reviewed. Main goal: descriptive analysis of the citation of P-values and use of the terms "significant", "non-significant" and "suggestive" in Abstracts. Secondary goal: analytic study of: (i) correlations between citation of a P-value and the main characteristics of authors and topics; and (ii) misuse of the terms "significant", "non-significant" and "suggestive" with respect to cited P-values, and correlations with author and topic characteristics. RESULTS: In all, 91 articles were included. P-values and the terms "significant", "non-significant" and "suggestive" were cited in 35.1%, 41.7%, 10.9% and 0% of Abstracts, respectively. Citing a P-value did not significantly correlate with author or topic characteristics. There were discrepancies between the terms "non-significant", "significant" and "suggestive" and P-values given in the body of the article in 57.1% of Abstracts, with 30.7% overestimation and 25.2% underestimation of results, without significant correlation with author or topic characteristics. CONCLUSION: Authors, editors and reviewers must pay particular attention to the spin resulting from inappropriate use of the terms "significant", "non-significant" and "suggestive" in Abstracts of articles submitted to the European Annals of Otorhinolaryngology, Head & Neck Diseases, to improve the rigor, quality and value of the scientific message delivered to the reader.

Nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis.

BACKGROUND: A decrease in nasal nitric oxide (NO) and an increase in exhaled NO have been demonstrated in patients with nasal polyposis (NP). OBJECTIVES: The aims were to evaluate the flux of NO from the three compartments of the respiratory tract, namely, upper nasal, lower conducting and distal airways, and to search for relationships between NO parameters and indexes of upper and lower disease activity (bronchial reactivity and obstruction). The effect of medical treatment of polyposis was also evaluated. METHODS: Seventy patients with polyposis were recruited. At baseline, pulmonary function tests (spirometry, plethysmography, bronchomotor response to deep inspiration using forced oscillation measurement of resistance of respiratory system, methacholine challenge, multiple flow rates of exhaled NO and nasal NO measurements) were performed together with an assessment of polyposis [clinical, endoscopic and computed tomography (CT) scores]. RESULTS: Statistical relationships were demonstrated between nasal NO flux and severity scores (clinical: rho=-0.31, P=0.015; endoscopic: rho=-0.57, P<0.0001; CT: rho=-0.46, P=0.0005), and between alveolar NO concentration and distal airflow limitation (FEF(25-75), rho=-0.32, P=0.011). Thirty-six patients were assessed after 11 [7-13] (median [interquartile]) months of medical treatment, demonstrating an improvement in clinical and endoscopic scores, an increase in nasal NO flux, a decrease in NO flux from conducting airways, an improvement in the mild airflow limitation (forced expiratory volume in 1 s, FEF(25-75), even in non-asthmatic patients) and a decrease in the bronchoconstrictor effect of deep inspiration. CONCLUSIONS: The medical treatment of NP improves both airway reactivity and obstruction, whatever the presence of asthma, suggesting a functional link between upper and lower airway functions.

[Sinonasal hemangiopericytomas]. / Hémangiopéricytomes nasosinusiens.

OBJECTIVES: The aim of this study was to report on the clinical, radiological and histological characteristics of hemangiopericytomas, and to discuss our experience with their treatment. MATERIAL AND METHODS: The authors reexamined two recent cases of patients presenting with sinonasal hemangiopericytomas (semiology, CT and MRI results, treatment and follow-up). RESULTS AND DISCUSSION: There was substantial variability of hemangiopericytoma presentation depending on location. Hemangiopericytomas of the nose and paranasal sinuses are considered a distinct entity with a good prognosis. Treatment is based on endoscopic sinus surgery. The histological approach requires the use of immunohistochemistry. Recurrences vary in the literature depending on the initial resection quality. Metastases are rare.

[Tuberculous otomastoiditis: advantage of MRI in the treatment survey]. / Otomastoïdite tuberculeuse: intérêt de l'IRM dans le suivi thérapeutique.

PURPOSE: Mycobacterium tuberculosis is a rare cause of otomastoiditis, accounting for less than a percent of chronic otitis media. The diagnosis is difficult and typically delayed because most physicians are unfamiliar with its presenting features and special laboratory requirements. Such delayed diagnosis leads to delayed treatment onset, and thus, increases complications frequency as irreversible hearing loss, facial palsy or meningo-encephalitis complications. Moreover non specific CT findings do not allow any accurate evaluation of inner ear lesions initially and under treatment. CASE REPORT: We described the first case of MRI of tuberculous mastoiditis and the evolution over a 2-years follow-up period. A patient with a clinical history of chronic otorrhea, resistant to conventional therapy, was referred to our department. CT and MRI permitted to describe the initial lesions and to appreciate the medical treatment efficiency (in order to perform surgery in case of failure or complications). Under medical treatment, MRI showed abscess volume decrease at three months while CT was still unchanged. Remineralization only was observed on CT at 12 months. The patient's healing was obtained after 15 months of antituberculous medication. CONCLUSION: MRI has the advantage over CT to demonstrate directly abscess collections that superimposed to areas of bone destructions within the temporal bone. Initially, MRI allows an accurate evaluation of abscess collections and possible meningo-encephalitis complications. Moreover, MRI precises earlier than CT the improvement of lesions and the efficacy of medical treatment, and thus, permitting us to postpone surgery where it is unnecessary.

Transcranial magnetic stimulation and subjective tinnitus. A review of the literature, 2014-2016.

Subjective tinnitus is a symptom in many ENT pathologies, for which there is no curative treatment. It may be poorly tolerated by some patients, who develop attention or sleep disorder or even major anxiety and depression, severely impairing quality of life. Pathophysiological models of the genesis and maintenance of tinnitus symptomatology highlight maladaptive cerebral plasticity induced by peripheral hearing loss. Although not fully elucidated, these changes in neuronal activity are the target of various attempts at neuromodulation, particularly using repetitive transcranial magnetic stimulation (rTMS), which has been the focus of various clinical studies and meta-analyses. A recent consensus statement (Lefaucheur, 2014) reported level-C evidence (possible efficacy) for rTMS using low frequency (1Hz) tonic stimulation targeting the left cerebral cortex. However, many questions remain concerning the use of this technique in everyday practice. The present article reports a recent literature review using the search-terms "tinnitus" and "rTMS" in the PubMed and Cochrane databases for April 2014 to December 2016.

[Management of vertigo and dizziness]. / Vertiges et troubles de l'équilibre : démarche diagnostique.

Balance disorders presenting with symptoms of dizziness and vertigo are due to various diseases. Clinical approach gives the opportunity to identify emergency situations and most common causes, among them the first one being the benign paroxysmal positional vertigo. Oculomotor assessment is pertinent as major clinical orientation, particularly between peripheral and central diseases. These clinical findings support the respective indication of modern imaging and/or vestibular tests, focused on the direction of presupposed diagnosis. On elderly the risk of falls and their complications needs a specific evaluation.

Idiopathic unilateral vocal-fold paralysis in the adult.

GOAL: To analyze the characteristics of adult idiopathic unilateral vocal-fold paralysis. MATERIAL AND METHODS: Retrospective study of diagnostic problems, clinical data and recovery in an inception cohort of 100 adult patients with idiopathic unilateral vocal-fold paralysis (Group A) and comparison with a cohort of 211 patients with isolated non-idiopathic non-traumatic unilateral vocal-fold paralysis (Group B). RESULTS: Diagnostic problems were noted in 24% of cases in Group A: eight patients with concomitant common upper aerodigestive tract infection, five patients with a concomitant condition liable to induce immunodepression and 11 patients in whom a malignant tumor occurred along the path of the ipsilateral vagus and inferior laryngeal nerves or in the ipsilateral paralyzed larynx. There was no recovery of vocal-fold motion beyond 51 months after onset of paralysis. The 5-year actuarial estimate for recovery differed significantly (P<0.0001): 53.2% in Group A versus 17.9% in Group B. In Group A, recovery occurred before the end of the second year following paralysis onset in 93% of cases. On univariate analysis, recovery in Group A was associated with younger age (P=0.0033), shorter time to consultation (P<0.0001), and absence of oncologic history (P<0.028). In case of non-recovery in Group A, malignant tumor along the ipsilateral vagus or inferior laryngeal nerve was found in 17.2% of cases, 81% of which manifesting during the 30 months following the onset of vocal-fold paralysis. CONCLUSION: In non-traumatic vocal-fold paralysis in adult patients, without recovery of vocal-fold motion, a minimum three years' regular follow-up is recommended.

[Choanal stenosis: a rare complication of radiotherapy for nasopharyngeal carcinoma]. / Sténose choanale post-radique: une complication rare de la radiothérapie des carcinomes nasopharyngés.

Choanal stenosis is usually a congenital anomaly in children. Acquired choanal stenosis after radiotherapy for nasopharyngeal carcinoma is a very rare pathology; only two publications report seven cases in the literature. We describe the clinical history, preoperative evaluation, surgical treatment and outcome of a case of acquired choanal stenosis after radiotherapy. The patient, a 56-year-old woman, presented with a history of nasopharyngeal carcinoma (T2- NO-MO) one year before that had been successful treated with radiotherapy (68 Gy). At the end of radiotherapy, she complained of complete nasal obstruction, anosmia and hearing loss due to a bilateral serous otitis media. Bilateral complete choanal stenosis was confirmed by endoscopy and CT scan. Functional endoscopic surgery was performed, and nasal stents were left in place for 3 weeks. One year after, the patient have good airflow, and a patent nasopharynx without choanal stenosis. In conclusion, choanal stenosis is an unusual complication of radiotherapy that can be successfully treated with transnasal endoscopic resection.

[Evaluating the knowledge of nasal polyposis in patients, GPs, and ENT specialists]. / Evaluation des connaissances sur la polypose nasosinusienne chez des patients, des médecins généralistes et ORL.

OBJECTIVES: To evaluate education for adults with nasal polyposis (NP) and compare their knowledge and opinions on NP to those of a group of general practitioners and a group of ENT specialists. MATERIAL AND METHODS: Prospective study conducted on 87 consecutive subjects (33 patients with NP, 20 GP, and 34 ENT) using a questionnaire to evaluate the knowledge on NP (general, medical, and surgical information). RESULTS: The results obtained from the three groups of subjects (patients, GP, ENT) differed significantly on "overall knowledge of the disease." Patients and GPs showed similar results. The ENT group had significantly better results. CONCLUSION: Education in a this type of chronic disease of the upper respiratory tract seems necessary for the management of NP. This study also underscores the need for information transfer on NP from ENT specialists and GPs.

[Multifocal nodular oncocytosis hyperplasia of the parotid gland]. / L'hyperplasie oncocytaire nodulaire multifocale de la glande parotide.

OBJECTIVES: Oncocytic lesions rarely affect the parotid gland, accounting for less than 1% of all salivary lesions. The WHO classification described three main types: diffuse oncocytosis, focal nodular oncocytosis hyperplasia, and oncocytoma. Multifocal nodular oncocytosis hyperplasia of the parotid gland represents an extremely rare, non-tumorous pathology of the parotid gland. MATERIAL AND METHODS: We report a case of multifocal nodular oncocytosis hyperplasia of the parotid gland in a 70-year-old woman who was referred for a left preauricular mass that had gradually increased in size over the last 2 years. No lymph node of the neck was palpable. RESULTS: MRI demonstrated multiple bilateral lesions of the parotid glands. Total parotidectomy, preserving the facial nerve, was performed. CONCLUSION: We discuss the physiopathology and the treatment of multifocal nodular oncocytosis hyperplasia and provide a review of the literature.

Nasal inflammation induced by a common cold: comparison between controls and patients with nasal polyposis under topical steroid therapy.

The evolution of nasal inflammation during a common cold in patients with nasal polyposis under topical steroid treatment is not clearly defined in the literature. Objective of this study was to analyse nasal inflammation during a common cold in patients with nasal polyposis under topical steroid treatment in comparison with control subjects. Two groups of subjects (35 consecutive patients with nasal polyposis receiving medical treatment, and 17 control subjects without any symptoms of chronic rhino-sinusitis) were studied: 10 patients with nasal polyposis and 11 controls had a common cold during a one-year follow-up period. Nasal lavage was performed at baseline and during the common cold. Soluble inflammatory mediators and permeability markers were determined in the nasal lavage fluid, as well as total and differential counts of the cells present. At baseline, no significant difference between controls and patients was observed, except for eosinophils. Paired comparisons between baseline and cold in controls revealed that all measured parameters, except for eosinophils, increased in the second nasal lavage. In nasal polyposis patients, the total cell neutrophil counts tended to increase. However, most of the concentrations of soluble parameters did not vary significantly in the second lavage, except for interleukin-6. In conclusion nasal inflammation markers appear to be similar in patients with and without nasal polyposis during a common cold when nasal polyposis patients are under topical steroid treatment.