ABSTRACT
OBJECTIVES: To describe the clinical features, radiological findings, treatment and outcomes of three cases of endolymphatic sac tumors (ELST). METHODS: Retrospective analysis of three cases of ELST. RESULTS: The first patient had a large ELST invading the labyrinth after a long history of vertigo. He was recurrence-free 1 year after retrolabyrinthine surgical removal. In the second case, an acute peripheral facial nerve paralysis associated with ipsilateral sensorineural hearing loss led to the diagnosis. A translabyrinthine approach was used to remove the tumor, which recurred three times over 10 years. The third patient was a young woman suffering from von Hippel-Lindau (VHL) disease and referred for a sudden sensorineural hearing loss due to an intralabyrinthine hemorrhage secondary to a 2 mm-large endolymphatic sac-confined ELST. Her hearing was totally lost after the deafness recurred 1 month after this first episode. MRI demonstrated a small bilateral ELST. The patient refused surgery on the deaf side. CONCLUSION: ELST are difficult to diagnose due to the wide variety of their presentations. Patients with ELST should be screened for VHL disease. Dural invasion and tumor hypervascularization increase the risk of local recurrences after surgery. Early surgical resection may lead to complete tumor removal and inner ear preservation.
Subject(s)
Ear Neoplasms/diagnosis , Ear Neoplasms/surgery , Endolymphatic Sac/surgery , Labyrinth Diseases/diagnosis , Labyrinth Diseases/surgery , Adult , Audiometry, Pure-Tone , Ear Neoplasms/pathology , Endolymphatic Sac/pathology , Endoscopy , Facial Paralysis/etiology , Female , Hearing Loss, Mixed Conductive-Sensorineural/etiology , Hearing Loss, Sudden/etiology , Humans , Labyrinth Diseases/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Reoperation , Retrospective Studies , Tomography, X-Ray Computed , Vertigo/etiology , Young Adult , von Hippel-Lindau Disease/diagnosis , von Hippel-Lindau Disease/pathology , von Hippel-Lindau Disease/surgeryABSTRACT
The objective was to assess outcomes of nasal septoplasty without turbinectomy using validated subjective instruments and to correlate results with patient satisfaction. The prospective observational study was conducted in a tertiary referral center. The method included the use of NOSE and RhinoQoL questionnaires to assess patients before and 6 months after Cottle septoplasty without turbinectomy. Patient satisfaction was measured on a visual analog scale. Data were compared by the non-parametric Wilcoxon test. Minimal Clinically Important Differences (MCIDs) were calculated. Correlations between post-operative scores and patient satisfaction were assessed using the Spearman test. Univariate analysis was performed to assess predictors of improvement. One hundred patients were enrolled. Their mean age was 43.4 years and 28% had allergic rhinitis. There was a highly significant improvement in each score at 6 months (p < 0.00001). The MCID for the NOSE was comprised between 5 and 7.5, whereas the mean change was 35.2 points. They ranged from 3.8 to 6.1 for RhinoQoL scores, whereas mean changes were comprised between 12.6 and 20.9. Allergic rhinitis was a predictive factor of less improvement (NOSE p = 0.04-RhinoQoL p = 0.0001). Mean patient satisfaction was 8.2 ± 1.8. Post-operative NOSE and RhinoQoL frequency scores were moderately correlated (r = 0.380; r = 0.356, respectively) whereas bothersomeness and impact scores were highly correlated with patient satisfaction (r = 0.459; r = 0.443, p < 0.00001, respectively). This study shows that the NOSE and RhinoQoL questionnaires can be used in English- and French-speaking populations to perform pre- and post-therapeutic assessment. These validated instruments show that septoplasty without turbinectomy allows management of nasal obstruction and its burden.
Subject(s)
Nasal Obstruction/surgery , Nasal Septum/surgery , Otorhinolaryngologic Surgical Procedures/methods , Quality of Life , Surveys and Questionnaires , Adult , Aged , Female , Humans , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Psychometrics , RhinitisABSTRACT
OBJECTIVE: Until now, there has been no validated and specific questionnaire in French allowing the assessment of nasal obstruction and its consequences on quality of life. The aim of this study was to validate the French translation and sociocultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Quality of Life Survey (RhinoQOL) self-questionnaires. STUDY DESIGN: Prospective instrument validation study. SETTING: French tertiary referral center. SUBJECTS AND METHODS: The questionnaires were translated into French and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a population with symptomatic septal deviation (n = 50). The psychometric properties (reliability, reproducibility, validity, responsiveness) were assessed by test-retest procedure, internal consistency, correlation intra- and interscores, and response sensitivity between both populations. RESULTS: There was no statistical difference in both responses obtained from the control population after the test-retest procedure. Internal consistency was 0.86 for the NOSE and 0.57, 0.67, and 0.83 for the scores of the RhinoQOL (frequency, bothersomeness, and impact, respectively). There was always a strong correlation between all NOSE variables and RhinoQOL scores (r > 0.40; P < 10(-3)). Effect size showed a high sensitivity to change. CONCLUSION: The French versions of both questionnaires appear to be as reliable, valid, and sensitive to change as the English versions. Their association was strong, allowing assessment of nasal obstruction in all its dimensions.