[Conductive hearing loss with a normal eardrum]. / Surdité de transmission à tympan normal.

Conductive hearing loss with a normal eardrum. Conductive hearing loss with a normal eardrum is defined by a hearing loss in in relation to a disturbance in the transmission of sound waves from a normal eardrum to an intact cochlear nerve. The interest in diagnosing these kinds of hearing loss is due on the one hand to their high frequency, on the other hand to the socio-professional repercussions that they can induce and finally to the fact that a large part of them are accessible to surgical treatment or, hearing aid. The CT-scan contributes to the diagnostic orientation and the preoperative assessment. If the pathologies of the middle ear dominate in frequency the possible causes of conductive hearing loss with a normal eardrum, especially otosclerosis, abnormalities of the inner ear, which can be responsible for conductive or mixed hearing loss, have recently listed thanks to advances in modern digital imaging. After a brief anatomical reminder of the tympano-ossicular system, we will deal with their positive, differential and etiological diagnosis.

Surdité de transmission à tympan normal. Les surdités de transmission à tympan normal sont définies par une diminution de la capacité auditive en relation avec une perturbation de transmission de l'onde sonore depuis un tympan normal jusqu'à un nerf cochléaire intègre. L'intérêt de diagnostiquer ces surdités tient d'une part à leur grande fréquence, d'autre part au retentissement socioprofessionnel qu'elles peuvent induire, et enfin au fait qu'une grande partie d'entre elles sont accessibles à un traitement chirurgical, ou à défaut prothétique. La tomodensitométrie contribue à l'orientation diagnostique et au bilan préopératoire. Si les pathologies de l'oreille moyenne dominent en fréquence les causes possibles de surdité de transmission à tympan normal, avec en tête l'otospongiose, des anomalies de l'oreille interne, pouvant être responsables de surdité de transmission ou de surdité mixte, ont été récemment répertoriées grâce aux progrès de l'imagerie numérique moderne.

Presbycusis and Fitness to Fly.

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient's fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403-408.

[Congenital cysts and fistulas on the neck in adults]. / Kystes et fistules congenitaux du cou chez l'adulte.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Risk factors of cancer occurrence after surgery of oral intraepithelial neoplasia: A long-term retrospective study.

OBJECTIVE: Oral intraepithelial neoplasia (OIN) is a premalignant lesion of oral mucosa graded I through III according to the importance of atypic cells and the thickness of the dysplastic layers. The aim of this study was to evaluate the long-term clinical course of OIN lesions and identify predictive factors of outcomes. METHODS: The clinical, surgical, and follow-up data of the patients consecutively treated for OIN by primary surgical removal in a referral anti-cancer center from November 1998 to March 2009 were retrospectively analyzed. The main outcome parameters were the 10-year disease-free survival (DFS), cancer-free survival (CFS), overall survival (OS), and disease-specific survival (DSS) rates (Kaplan-Meier). RESULTS: Thirty-one patients were included. Patients with positive or close margins (n = 15) had a significantly lower 10-year CFS rate (46.7% vs. 92.38%; P = .004) than patients with negative margins. This predictive factor remained significant in multivariate analysis (hazard ratio, 9.157; 95% confidence interval, 1.4-60.6). There was no significant difference in the 10-year DFS (33.3% vs. 48.7%; P = .2), DSS (92.8% vs. 100%; P = .1), and OS (92.8% vs. 69.6%; P = .2) rates between these two groups. Neither the initial OIN grade nor other clinical or surgical parameters were found to be significant predictors of outcomes. CONCLUSION: In this long-term follow-up study on histologically proven OIN treated by primary surgery, positive or close margins status was the only independent predictive factor of progression to cancer. Therefore, we warmly recommand performing re-resection rather than surveillance in cases with positive margins. Oral intraepithelial neoplasia grading or lesion size were not significant predictors of outcomes. LEVEL OF EVIDENCE: 4. Laryngoscope, 2546-2551, 2018.

Early Tympanoplasty Using a Synthetic Biomembrane for Military-Related Blast Induced Large Tympanic Membrane Perforation.

Introduction: Blast injuries in modern warfare are common, and tympanic perforation is often found. Spontaneous closures of large perforations that encompass greater than 80% of the tympanic surface are rare. Early closure of the tympanic membrane avoids the immediate infectious risk, which potentially complicates the initial management of these war-wounded patients, and allows for safe and early recovery of military activity. This study compared the outcomes of spontaneous closures and early biomembrane myringoplasty in subjects with large blast injury-induced tympanic perforation following a massive explosion. Materials and Methods: This is a retrospective, observational, cohort study military troops with large barotraumatic tympanic membrane perforation. The study investigates early surgical tympanoplasty versus observation for spontaneous closure. The hearing loss, tympanic perforation closure rate, and closure time were noted. Results: Fourteen patients (19 ears) were referred from May 2008 to April 2017, and 6 patients (9 ears) underwent early myringoplasty. A total of 89% (n = 8) and 100% (n = 9) of the ears exhibited successful sealing of the perforation at one and 6 mo, respectively. In contrast, 60% (n = 6) of the 10 ears (8 patients) without initial myringoplasty did not heal spontaneously at 6 mo, and these ears underwent a delayed tympanoplasty procedure. Notably, patients with early myringoplasty suffered lower conductive hearing loss and fewer functional signs remotely. Conclusion: Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients.

Retropharyngeal course of the internal carotid artery.

A 77-year-old male patient presented with dysphonia. Endoscopic examination demonstrated a distortion of the posterior pharyngeal wall, which was pulsatile. The axial CT showed left internal carotid artery in a retropharyngeal location. An anomalous course of the carotid artery in the retropharyngeal space is an unusual finding that poses a risk of vascular injury during pharyngeal surgery and intubation. Such an anomaly may be congenital (incomplete descent of the third aortic arch) and may be more pronounced in older patients secondary to atherosclerosis and hypertension as occurred in our case noted here.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients.

INTRODUCTION: We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract. MATERIALS AND METHODS: From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed. RESULTS: Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days. CONCLUSION: From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

[Complications of sinusitis]. / Complications des sinusites.

The complications of sinusitis are essentially secondary to ethmoidal and frontal sinusitis, occurring in patients weakened, particularly in case of immunodeficiency or anatomical defects. The gravity is due to the risk of spreading infection in intracranial tissues and orbital cavity. The diagnosis is always to discuss any symptomatology resistant to treatment and the appearance of orbital or neurological signs. The scanner and MRI contribute greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is based on prolonged antibiotic therapy and surgery and requires a multidisciplinary approach involving ENT, ophthalmologist, neurosurgeon and anesthesiologist resuscitator.

Blast injury of the ear by massive explosion: a review of 41 cases.

BACKGROUND: Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear. METHODS: From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed. RESULTS: Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation. CONCLUSIONS: Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.

[Pathological link between teeth and maxillary sinus] / Relations pathologiques entre dents et sinus maxillaire

Pathological link between teeth and maxillary sinus. Pathological relationship between the teeth and the maxillary sinus can be explained by their embryological and anatomical relationships. The floor is centered by the apex of antral teeth: premolars and first molars. Any dental disease process may have sinus consequences. Dental caries are the best example. Iatrogenic pathology, including preimplant surgery and benign or malignant tumors are also responsible for sinusitis. Therapeutic for every etiology avoids the complications and sequelae whose forensic incidence remains low.

Relations pathologiques entre dents et sinus maxillaire. Les relations pathologiques entre les dents et le sinus maxillaire s'expliquent par leurs nombreux rapports, tant embryologiques qu'anatomiques. La paroi inférieure du sinus est centrée par les apex des dents dites antrales : les prémolaires et les premières molaires. Ainsi, tout processus pathologique dentaire peut avoir des conséquences sinusiennes. La pathologie carieuse en est le meilleur exemple. La pathologie iatrogène, notamment la chirurgie pré-implantaire, ainsi que les tumeurs bénignes ou malignes sont également responsables de sinusites. Une thérapeutique adaptée à chaque cause permet d'éviter les complications et les séquelles.

Otosclerosis and Fitness to Fly.

BACKGROUND: When an aircrew member is referred for otosclerosis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of otosclerosis in an aircrew population and to discuss the decisions about their flight waivers. METHODS: There were 27 aircrew members who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined. RESULTS: Out of 16 patients who had surgery, 2 did not obtain a flight fitness waiver afterwards. Among the 14 who received waivers, 12 had no restrictions on their flight fitness. Among the nonoperated patients, 1 of 11 did not obtain a waiver. Seven patients were declared medically fit to fly without a waiver and three obtained a waiver. DISCUSSION: Fitness was based on auditory and balance statuses and the follow-up of these findings. A postoperative CT-scan and the operative report were used to determine the quality of stapes surgery. Professional speech audiometry in noise might be as interesting. The results made it possible to determine a patient's fitness to fly with a waiver, which is more or less associated with restrictions. In our series, only 3 aircrew members out of 27 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who underwent surgery and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant vestibulocochlear assessment, stapes surgery may allow for a safe recovery of aviation activity.

[Epidemiology, diagnosis and treatment of head and neck cancers]. / Épidémiologie, diagnostic et traitement des cancers ORL.

Cancers of the upper aerodigestive tracts are the fourth most common cancer in France. The main risk factors are smoking and alcohol. They do not necessarily present specific signs, making their early diagnosis difficult. A change in the patient's general condition is a late sign leading to a poor prognosis of the disease.

[Obstructive sleep apnea syndrome]. / Syndrome d'apnées obstructives du sommeil.

Obstructive sleep apnea syndrome is a common disorder associated with potentially severe complications. Polysomnography is the gold standard diagnostic tool, while CPAP ventilation is recognized as the most efficient therapy. The numerous symptoms, even though little specific, should be rapidly detected to screen for the syndrome and transfer the patient to an adequate healthcare facility. The severity of the condition depends on the complications it causes.