Diagnostic work-up of exercise-induced laryngeal obstruction.

PURPOSE: Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs). METHODS: All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard. RESULTS: Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively. CONCLUSIONS: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management.

Benign recurrent vestibulopathy: MRI and vestibular tests results in a series of 128 cases.

PURPOSE: Benign recurrent vestibulopathy is a recent entity, close to probable Meniere's disease and vestibular-migraine. So far, no study has systematically investigated the presence of endolymphatic hydrops of the lateral semicircular canal in benign recurrent vestibulopathy using magnetic resonance imaging. The aim of this study was to determine magnetic resonance imaging data and vestibular test results in patients with benign recurrent vestibulopathy. METHODS: 128 patients with benign recurrent vestibulopathy included since 2010 were retrospectively analyzed. Patients had magnetic resonance imaging with a delayed acquisition, audiogram, head shaking test, caloric-test, skull-vibration-induced-nystagmus-test, video-head- impulse-test, and vestibular evoked myogenic potential. Endolymphatic hydrops presence was classified into four categories: cochlear, saccular, lateral semicircular canal and association with saccule. RESULTS: In benign reccurent vestibulopathy, 23% of cases showed an endolymphatic hydrops on magnetic resonance imaging, more frequently located in the lateral semicircular canal (59%) and related to the disease duration. The most often impaired tests were caloric-test (49%) with fluctuations of hypofunction in 67% and skull-vibration-induced-nystagmus-test (61%). No correlation between the caloric-test and the presence and location of the endolymphatic hydrops was observed. CONCLUSION: In our series of benign reccurent vestibulopathy, a rare endolymphatic hydrops was most often observed for the lateral semicircular canal and correlated with the seniority of the pathology. Hydrops identified at the magnetic resonance imaging was not correlated with the caloric-test results. Skull-vibration-induced-nystagmus-test and caloric-test were the most often modified vestibular tests.

The first description of cholesteatoma by Hippocrate.

INTRODUCTION: Although otolaryngology became a subspecialty only since the middle of the nineteenth century, many diseases of ENT system, their clinical symptoms, universality and potential seriousness have been described since over 3000 years ago. Texts of the medical school of Cos and its founder Hippocrates (460-370 BC) collected in the Corpus Hippocraticum also contain multiple case reports and treatments for ear diseases. The aim of this study is to analyse an extract of one of Hippocrates' treatise, which apparently describes the first case of cholesteotoma. MATERIAL AND METHODS: We analysed a case from Epidemic by Hippocrates (VII, V, 1-9) from its English translation. RESULTS: Analysis of the description of symptoms allows us to diagnose a complicated cholesteatoma with facial palsy and neuro-meningitis manifestation. CONCLUSION: The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases and their evolution. The study of its history is of high interest to the fields of medicine, especially otorhinolaryngology. It also highlights the diseases and the suffering the diseases have inflicted on mankind since antiquity.

Comparison of the In Vitro and In Vivo Behavior of a Series of NIR-II-Emitting Aza-BODIPYs Containing Different Water-Solubilizing Groups and Their Trastuzumab Antibody Conjugates.

The development of new fluorescent organic probes effective in the NIR-II region is currently a fast-growing field and represents a challenge in the domain of medical imaging. In this study, we have designed and synthesized an innovative series of aza-boron dipyrromethenes emitting in the NIR-II region. We have investigated the effect of different water-solubilizing groups not only on the photophysical properties of the compounds but also on their in vitro and in vivo performance after bioconjugation to the antibody trastuzumab. Remarkably, we discovered that the most lipophilic compound unexpectedly displayed the most favorable in vivo properties after bioconjugation. This underlines the profound influence that the fluorophore functionalization approach can have on the efficiency of the resulting imaging agent.

Bilateral Candidal abscess of the parotid gland: A case report and literature review.

We report the case of a 75-year-old diabetic man who developed a bilateral abscess of the parotid gland. Although a bacterial parotitis was first suspected, cultures of fine-needle aspiration identified Candida albicans as the causal agent. Failure of medical treatment led us to perform a surgical drainage of the right abscess. The patient was then treated with oral fluconazole for 6 weeks, with complete recovery during follow-up. Of interest, the patient had a history of right superficial parotidectomy for a benign tumor 30 years ago. Despite the high prevalence of oral carriage, fungal abscesses of the parotid gland are extremely rare and have only been reported in a few cases. This might be due to the fungal toxicity of the salivary proteins, like histatins. To our knowledge, this is the first report of a Candida albicans abscess of the parotid gland developed bilaterally.

Augmentation-lateralization for Unilateral Vocal Fold Palsy With Airway Obstruction: A New Concept in Laryngology.

OBJECTIVES: This study presents an efficient, safe, effective, and novel technique of reconstructive transoral laser microsurgery (R-TLM) for the treatment of unilateral vocal fold paralysis (UVFP) with airway obstruction. It is based on the augmentation of the immobile and potentially flaccid and atrophic side while lateralizing the arytenoid and posterior part of the vocal fold, thus improving breathing without sacrificing phonation and commonly improving it. STUDY DESIGN: Retrospective cohort study through data from medical records and operative notes. METHODS: Patients with UVFP with exertional dyspnea with or without dysphonia were included in this report. The vocal fold is augmented by harvesting the aryepiglottic fold soft tissues and the upper part of the arytenoid and placing them into the paraglottic space as a pedicled microflap, thus augmenting the anterior two thirds of the vocal fold while lateralizing the remaining arytenoid and posterior third of the vocal fold by an internal traction suture to improve airway. Postoperative breathing, phonation and swallowing were assessed. RESULTS: Twenty two cases are reported in the study. Follow-up evaluations ranged from 6 to 12 months. All cases showed successful and durable improvement of breathing and phonation. None required tracheostomy or gastrostomy pre- or postoperatively. CONCLUSIONS: Augmentation-lateralization is a novel, safe, and effective minimally invasive technique that allows airway improvement with good results on phonation in patients with challenging UVFP with airway obstruction.

Lateralization of the Vocal Fold: Results of an Exclusive Transoral Approach.

OBJECTIVE: Vocal fold paralysis in adduction can result in dyspnea. The authors have previously described an original vocal fold lateralization technique performed exclusively through an endoscopic approach. In this work, we studied long and short-term results of this procedure on dyspnea, phonation, and swallowing. STUDY DESIGN: Retrospective cohort study through data from medical records and operative notes. Patients with unilateral or bilateral vocal fold paralysis in adduction who underwent transoral lateralization were included. METHODS: In all patients, under laryngosuspension, a supraglottic laryngotomy was performed with CO2 laser and a lateralization suture was passed through the thyroid cartilage to the vocal process of the vocal fold with the desired tension allowing lateralization of the arytenoid and corresponding vocal fold. We studied evolution of breathing, phonation, and swallowing in all patients who underwent lateralization suture. We tried to correlate symptoms to preoperative and postoperative glottic area, inter-arytenoid distance, and anterior glottic angle. RESULTS: Eighteen patients were included in the study. Three patients were tracheostomy-dependent and were successfully decannulated. All other cases presented short and long-term significant improvement of their dyspnea index score (P < 0.001) in correlation with glottic area enlargement (P < 0.001). There was no statistical difference between preoperative and postoperative voice and swallowing parameters. CONCLUSION: Our transoral lateralization technique allows enlargement of the glottic aperture in case of laryngeal dyspnea secondary to vocal fold paralysis in adduction. This technique optimally preserves laryngeal structures, especially the mucosa. It is reproducible and reliable for all laryngologists experienced in reconstructive transoral laser microsurgery.

Skull Vibration Induced Nystagmus Test: Correlations with Semicircular Canal and Otolith Asymmetries.

BACKGROUND: To establish in patients with peripheral vestibular disorders relations between skull vibration-induced nystagmus (SVIN) different components (horizontal, vertical, torsional) and the results of different structurally related vestibular tests. METHODS: SVIN test, canal vestibular test (CVT: caloric test + video head impulse test: VHIT), otolithic vestibular test (OVT: ocular vestibular evoked myogenic potential oVEMP + cervical vestibular evoked myogenic potential cVEMP) performed on the same day in 52 patients with peripheral vestibular diseases (age < 65 years), and 11 control patients were analyzed. Mixed effects logistic regression analysis was performed to assert whether the presence of nystagmus in SVIN (3D analysis) have an association with the presence of peripheral vestibular dysfunction measured by vestibular explorations (CVT or OVT). RESULTS: We obtained different groups: Group-Co (control group), Group-VNT (dizzy patients with no vestibular tests alterations), Group-O (OVT alterations only), Group-C (CVT alterations only), Group-M (mixed alterations). SVIN-SPV horizontal component was significantly higher in Group-M than in the other groups (p = 0.005) and correlated with alterations of lateral-VHIT (p < 0.001), caloric test (p = 0.002) and oVEMP (p = 0.006). SVIN-SPV vertical component was correlated with the anterior-VHIT and oVEMP alterations (p = 0.007; p = 0.017, respectively). SVIN-SPV torsional component was correlated with the anterior-VHIT positivity (p = 0.017). SVIN was the only positive test for 10% of patients (83% of Group-VNT). CONCLUSION: SVIN-SPV analysis in dizzy patients shows significant correlation to both CVT and OVT. SVIN horizontal component is mainly relevant to both vestibular tests exploring lateral canal and utricle responses. SVIN-SPV is significantly higher in patients with combined canal and otolith lesions. In some patients with dizziness, SVIN may be the only positive test.

Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging.

BACKGROUND/AIM: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. METHODS: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière's disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. RESULTS: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). CONCLUSION: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.