Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre.

RATIONALE: The European Position Paper on Sinusitis (EPOS) guidelines provide composite criteria to evaluate chronic rhinosinusitis (CRS) control, taking into consideration the severity of patients' symptoms, aspect of nasal mucosa and medical intake as parameters of CRS control. OBJECTIVES: To study the degree of CRS control using novel EPOS control criteria at 3-5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores. METHODS: Adult CRS patients (n = 560) who had undergone bilateral FESS for chronic inflammatory sinonasal disease 3-5 years prior to the study were included. Patients received a postal questionnaire asking for control items according to EPOS control criteria, visual analogue scale (VAS) scores for total and individual sinonasal symptoms, sinonasal outcome test (SNOT)-22 and Short Form (SF)-36 questionnaires. MEASUREMENTS AND MAIN RESULTS: About 19.5% of CRS patients were well controlled, with 36.8% of patients being partly controlled and 43.7% uncontrolled. The levels of control corresponded to mean total VAS, SNOT-22 and SF-36 scores. Subgroup analysis revealed that female gender, aspirin intolerance and revision FESS were associated with higher prevalence of uncontrolled CRS, whereas allergy, asthma and smoking status did not alter the percentage of patients in each category of control. In 81 patients attending the outpatient clinic, nasal endoscopy changed classification in only four patients (4.9%). CONCLUSIONS: Based on the novel EPOS control criteria, at least 40% of CRS patients are uncontrolled at 3-5 years after FESS. Therefore, better treatment strategies leading to higher disease control are warranted in CRS care.

EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis.

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

Olfaction in Chronic Rhinosinusitis.

Olfactory dysfunction is a frequent complaint in chronic rhinosinusitis patients and has a significant impact on quality of life. Therefore, it is essential that clinicians are aware of the importance of olfactory dysfunction in chronic rhinosinusitis (CRS) patients and know how to deal with it. Notably, the evaluation of olfactory function (i.e., using psychophysical testing) and imagery of olfactory bulb play an important role in the evaluation of patients and give essential information about the "baseline" olfactory function. Because the high impact of olfactory function on quality of life and medical and/or surgical treatment should be proposed to patients. However, it remains difficult to predict the outcome of treatment as well as long-term efficacy. The first section of this review is dedicated to the assessment of olfactory function. Secondly, we will discuss the etiopathology of olfactory dysfunction in CRS with and without nasal polyps. Finally, we will review literature findings about the efficacy of different treatments on olfactory function.

ENT indications for Hyperbaric Oxygen Therapy.

ENT indications for Hyperbaric Oxygen Therapy. Hyperbaric Oxygen (HBO) therapy is a treatment where patients breathe 100% oxygen while exposed to high environmental pressure in a hyperbaric chamber. This hyperoxygenation has several beneficial effects as an adjunctive treatment in a number of ENT-related conditions and diseases. These can be summarized as anti-ischaemic effects (delivery of oxygen to otherwise ischaemic tissues, reduction of ischaemia-reperfusion damage), anti-infectious effects (bacteriostasis, improved leucocyte phagocytosis bactericidal activity and optimization of antibiotic therapy) and wound-healing effects (stimulation of granulation tissue formation and stabilization). Since HBO therapy has a clear physiologic rationale, a demonstrated effect (although difficult to "prove" with placebo controlled randomized trials) in certain indications and certain side-effects, it is proposed that it should be considered an integral part of the (combined surgical and pharmacological) treatment of patients, and not simply as a supplementation of oxygen. Furthermore, the importance of a well-trained medical and technical staff to ensure proper selection and the correct follow-up of patients should not be underestimated.

External or internal lateral osteotomy: why I choose the external percutaneous approach.

The authors present their surgical experience with the management of patients with dorsum deformities using a precise technique: the external percutaneous approach. The indications for this technique have still not been set out very clearly in the rhinological textbooks or manuals, and so novices (and not only novices) have difficulty in understanding and applying it. We therefore try to systematise and clarify these indications in brief, together with the technical details, providing a comparison with another technique that is in very widespread use at present: the internal lateral osteotomy. Although the external percutaneous approach is not used very often--in our experience in 30% of cases only--we find the results very satisfactory and we recommend it when it is required by the anatomic conditions.

Autologous costochondral cartilage implant in two cases of velopharyngeal insufficiency.

The velopharyngeal sphincter is critical in enabling the functions of speaking and swallowing. Velopharyngeal insufficiency (VPI) results in hypernasal speech and nasal regurgitation. A frequent cause of VPI is congenital cleft palate, but otolaryngologists sometimes encounter iatrogenic VPI after surgery. Treatment of VPI with prostheses is often successful but not always well tolerated. Many surgical procedures have been proposed to correct palatal length or to enlarge the posterior pharyngeal wall. We report two cases in which autologous costochondral cartilage was used as implant augmentation. This approach is indicated and efficient when the velopharyngeal deficit is less than 5 mm. An autologous costochondral cartilage implant procedure is safe and reversible and can be expected to incite minimal host reaction.

[Relations between vasculotensional disease, sudden deafness and benign paroxysmal postural vertigo: value of anticochlear antibodies]. / Relations entre la maladie vasculotensionnelle, la surdité brusque et le vertige positionnel paroxystique bénin: intérêt des anticorps anticochléaires.

Some vasculotensional diseases may be associated, at a certain point of their evolution, with occurrences of sudden deafness or of benign paroxysmal positional vertigo. It seems that the efficiency of the treatments of sudden deafness and benign paroxysmal positional vertigo is not modified by those associations of pathologies. On the other side, the search for anticochlear antibodies gives a positive result in 45% of the vasculotensional diseases. When the vasculotensional disease is associated with sudden deafness, this percentage increases. On the contrary, it is lower when the vasculotensional disease is associated with benign paroxysmal positional vertigo. The presence of anticochlear antibodies may lead to a corticotherapy in case of failure of the classical treatments.

[The value of flow cytometry in the prognosis and treatment of head-and-neck cancers. Preliminary studies]. / L'intérêt de la cytométrie de flux pour le pronostic et le traitement des cancers de la tête et du cou. Etude préliminaire.

There is no reliable method to determine the malignancy degree of a tumour. Histology is not accurate. TNM classification is very interesting for planning surgical technique but gives little information about cancer aggressiveness. Flow-cytometry is a new technique to measure nuclear DNA quantity with great reproducibility and sensitivity. A normal cell is diploid (2N chromosome) and a tumoral one aneuploid. DNA quantitation is possible on fresh as well as on histological samples stored in formaldehyde or paraffin. Aneuploidy reflects the cancer aggressiveness. Aneuploidy is also correlated with TNM classification. Aneuploid tumors could require a more "aggressive" treatment regardless their size.

Nasal dermoid cyst: diagnosis and management of five cases.

Five cases of nasal dermoid cyst are presented. Three out of five cases were settled during childhood. Three presented a mass with a hole on the external nose with recurrent local infections. One case was wrongly referred for a dacryocystitis. The first one was detected during an infection of the cerebral extension and frontal abscess was assessed by CT scan and MRI. Two patients had other associated congenital abnormalities: hypotrophy of the external ear in one case, multiples malformations in an other. Adequate exposure and cosmetic results are sometimes contradictory to define the best surgical approach. Dermoid cysts and sinuses must be completely removed to prevent recurrence. External rhinoplasty and bicoronal approach are the main procedures for removing these lesions.

The antrochoanal polyp.

The different varieties of choanal polyps are reviewed by the authors according to their implantation pedicle. Their histology, possible pathogenesis, the various symptoms, steps in the diagnostic procedure and differential diagnoses are also described. Finally, the various modes of treatment are discussed, focussing in particular on the surgical methods and the new possibilities offered by developments in the field of endoscopy.

[Techniques of uvulopharyngoplasty for snoring]. / Techniques d'uvulopharyngoplastie pour ronflement.

Snoring is considered abnormal even in children. Breathing difficulties can modify the development of the face and provoke upper respiratory dysfunction. Some surgical techniques are presented.