Four cases of audio-vestibular disorders related to immunisation with SARS-CoV-2 mRNA vaccines.

OBJECTIVE: To gain medical insight into the clinical course and safety of otolaryngologic disorders following immunisation with severe acute respiratory coronavirus (SARS-CoV-2) mRNA-based vaccines. DESIGN: Case description. STUDY SAMPLE: We report four cases of transient audio-vestibular symptoms, which occurred shortly after inoculation of two BNT162b2 (Pfizer-BioNTech®) and mRNA-1273 (Moderna®) vaccines. RESULTS: Hearing loss was unilateral in all cases and recovered at least partially: it was associated with persistent gait instability in two cases, after 1 and 7 months. Trigger mechanisms underpinning audio-vestibular impairment remain uncertain. Immune tolerance mechanisms with off-target innate activation of T-lymphocytes may be involved in vestibulocochlear nerve disorders, as for other cranial nerves involvement. CONCLUSIONS: The occurrence of audio-vestibular manifestations following mRNA-based vaccines needs ENT monitoring to support their causality in such rare vaccine-related adverse events. Audio-vestibular disorders appeared of transitory nature, including hearing loss, and should not deter further efforts in large-scale vaccination campaigns against SARS-CoV-2.

[Sudden sensorineural hearing loss : Diagnosis and management in 2021]. / Surdité brusque : diagnostic et prise en charge en 2021.

This article proposes, through a literature review, an updated summary of the initial evaluation, treatment and follow-up of sudden sensorineural hearing loss (SSNHL) based on current guidelines. SSNHL occurs within 72h with at least 30dBHL loss over 3 consecutive frequencies. Diagnosis is medical in the emergency setting, the etiological workup aims at treating known causes, while different pathophysiological hypotheses exist for idiopathic SSNHL. Controversy exists regarding optimal management due to frequent spontaneous recovery. However, corticotherapy remains widely accepted. Prognosis depends on initial severity, age, associated vertigo and shape of the audiometric curve. Hearing rehabilitation in proposed for significant residual hearing loss.

Cet article propose, par une revue de la littérature, une synthèse actualisée de l'évaluation initiale du traitement et du suivi des surdités brusques (SB). La SB est une surdité de perception survenant en moins de 72 heures, et d'au moins 30 dBHL sur 3 fréquences consécutives. De diagnostic clinique, le bilan étiologique vise à dépister les étiologies connues comme un traumatisme acoustique, un accident vasculaire ou un neurinome de l'acoustique. Plusieurs hypothèses physiopathologiques existent pour les SB idiopathiques: virale, vasculaire, pressionnelle et autoimmune. Le traitement est controversé vu la récupération spontanée fréquente, néanmoins la corticothérapie reste largement acceptée. Le pronostic dépend de la sévérité de la perte auditive, l'âge, les vertiges et la forme de la courbe audiométrique. En cas de séquelles auditives, différentes options de réhabilitation auditive sont disponibles.

[Retropharyngeal abscess in children]. / Abcès rétropharyngé de l'enfant.

A retropharyngeal abscess is a collection of pus located behind the posterior pharyngeal wall. Main symptoms include torticoli, pyrexia and odynodysphagia. It can be secondary to upper airway infections, pharyngeal penetrating trauma or idiopathic. Complications are rare, but may be life-threatening due to airway obstruction or infection's spread to the surrounding structures. Surgery is conducted in case of abscess > 2 cm on CT scan images, complication or worsening of the symptoms. This article presents a clinical case with literature review.

L'abcès rétropharyngé (ARP) est une collection de pus située en arrière de la paroi pharyngée postérieure. Les symptômes d'alerte sont la présence d'un torticolis fébrile et d'une odyno-dysphagie. L'origine en est le plus souvent une infection des voies aériennes supérieures (VAS, 45% des cas en moyenne), un traumatisme pharyngé, mais parfois aucune cause évidente n'est retrouvée. Les complications sont rares, mais potentiellement graves en raison du risque d'obstruction des VAS ou de l'extension de l'infection aux structures avoisinantes. En cas d'abcès avéré, un drainage chirurgical est proposé d'emblée en cas de taille > 2 cm sur la tomodensitométrie (grand axe), en cas de complication ou d'évolution secondairement défavorable. Cet article présente un cas clinique avec revue de la littérature.

Meningococcal serogroup W135 epiglottitis in an adolescent patient.

Acute epiglottitis is a severe and potentially life-threatening condition. Since the implementation of Haemophilus influenzae vaccination, the number of cases of epiglottitis has decreased and the proportion of other infectious causes has increased. We report a case of acute epiglottitis in a teenager caused by Neisseria meningitidis, an unusual pathogen.

Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO2 laser approach.

IMPORTANCE: Oesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser. OBSERVATIONS: Pharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up. CONCLUSION AND RELEVANCE: Pharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.