[Performances of imaging investigations and scintigraphy for pre operative hyperparathyroidism]

Hyperparathyroidism is a frequent affection. Therapeutic management is based on surgical removal of pathological glands. Therapeutic results are ameliorated thanks to preoperative imaging approach. To evaluate performances of different imaging investigations and scintigraphy for preoperative parathyroid localization. Retrospective study about 26 patients with confirmed hyperparathyroidism. After radio-surgical and histological correlation, scintigraphy showed the best rate of sensitivity [92.3%], compared to other morphologic imaging [ultrasonography: 66.6%, CT-scan: 33.3% and MRI: 66.6%]. The specificity was the same [100%]. No difference was obseved for both scintigraphic modalities. Our results compared to the literature showed that scintigraphy is the most satisfying for preoperative localization of abnormal parathyroid glands in hyperparathyroidism

[Clinical and phmetric evaluation of gastro-esophageal reflux impact on upper airways in adult]

Gastroesophageal reflux is a frequent and benign affection. It represents an etiopathological entity in otorhinolaryngology; that may occasion a large variety of ENT manifestations. To evaluate clinical and pHmetric impact of gastro esophageal reflux on upper airways in adult. 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. 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. 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]

To compare preoperative CT scan finding and per-operative lesions in patients operated for middle ear cholesteatoma. 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. 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 [sp‚cificity 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. 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

[Head and neck cancer of aircrew personnel in aeronautical medical expertise]

ENT cancers due to their location and treatment encompass a number of physical symptoms related to swallowing and communication disorders. To evaluate flight capacity of aircrew personnel with ENT cancer and consequences on fitness and waiver criteria. Case 1: A 52 years old smoker pilot whish present laryngeal epidermoid carcinoma staged T3M0N0 and treated by total laryngectomy with curative radio-therapy [70Gy]. Metastasis occurred on lumgth and death heaped after acute respiratory failure. Case 2: A 55 years old mechanic whish had rhinopharyngeal undifferentiated carcinoma staged T4N2M0 and treated with radiochemotherapy with favourable follow-up. Inability for flight was proclaimed because of severe psychological impact. Case 3: Concerned a vesiculograpillary carcinoma of thyroid gland occurring in a 46 years old helicopter pilot. After total thyroidectomy and iodine treatment, the patient has obtained complete fitness to flight. Fitness to flight can be controversed in ENT cancer occurs. Epidemio-clinical paraclinical, functionnel and operational criterias must be considered when wainer to be proclaimed