[Benefit of skull vibration-induced nystagmus test in occupational medicine]. / Intérêt du test de vibration osseux vestibulaire en médecine du travail.

BACKGROUND: Nystagmus induced by vibrations (NIV), has been optimized by the present authors this last decade. The skull vibration-induced nystagmus test (SVINT) can be designated as a high-frequency global "vestibular Weber test" and can be considered as an office-based examination to detect vestibular asymmetry. The aim of this study is to define the tolerance of the SVINT as well as its comparison to the simplified caloric test of Veits (CTV) in normal workers during the pre-employment visit at the occupational medicine center. MATERIAL AND METHODS: The vestibular function has been evaluated by the SVINT and the CTV in 87 healthy workers. The tolerance of the two procedures has been evaluated by a 4-items questionnaire (nausea, vomiting, sweating, asthenia). RESULTS: The caloric test was normal in each worker. The SVINT was positive in one patient who had a partial unilateral vestibular dysfunction related to trauma. The mean duration of the procedure was 15 min for CTV and 1 min for SVINT. Side effects (nausea, vomiting, sweating, asthenia) were present in 50% of the workers following CTV and in only one patient after SVINT. The SVINT demonstrated significantly less side effects for each item (p < 0.0001). CONCLUSIONS: SVINT is a valid, rapid, low-cost clinical screening test and does not cause patient discomfort. It is suggested that this test which explores vestibular high frequencies and is not modified by vestibular compensation is useful for the diagnostic screening of workers' vestibular dysfunction, when combined with other vestibular tests and complements the CTV.

Sclerosing polycystic adenosis of the parotid gland: diagnosis and management.

OBJECTIVE: To describe diagnostic and therapeutic management of a rare parotid lesion: sclerosing polycystic adenosis. PATIENT AND METHOD: We report a case of persistent right intraparotid tumefaction. RESULTS: A 68-year-old man was referred with a right parotid nodule of 2 years' evolution. Cytology diagnosed pleomorphic adenoma, verified on MRI. Conservative subtotal parotidectomy diagnosed sclerosing polycystic adenosis. Over 1 year's regular follow-up, there were no signs of local recurrence. CONCLUSION: Sclerosing polycystic adenosis of the parotid gland is a rare and recently described entity presenting several analogies to the much more frequent cystic mastitis. Although benign and well-delimited, it requires complete exeresis of the parotid, due to a non-negligible risk of recurrence.

[Endostenting using a Y-stent for hematoma after thoracic aorta surgery]. / Endostenting par prothèse en Y sur hématome après chirurgie de l'aorte thoracique.

OBJECTIVE: To describe the diagnostic and therapeutic management of extrinsic tracheobronchial compression after thoracic aorta surgery. PATIENT AND METHODS: We report the case of a female patient with Marfan syndrome. RESULTS: A 27-year-old woman with Marfan syndrome presented respiratory distress after type III dissecting aneurysm of the descending aorta from extrinsic compression (hematoma) of the lower third of the trachea and the left bronchial stump. We placed a Y-stent (Y-Tracheobronxane, Novatech SA, France), thus restoring a satisfactory channel. A few days later, the patient developed right congestive heart failure from compression of the left pulmonary artery secondary to the progression of the hematoma. Medical treatment for this cardiological complication and the progressive resorption of the hematoma made it possible to remove the stent after 21 days with no dyspneic recurrence. CONCLUSION: Placing a Y-stent is possible and effective and has few iatrogenic consequences in cases of extrinsic tracheobronchial compression from a hematoma occurring during heavy thoracic vascular surgery. With surgical revision impossible given the risks, stent placement allows progressive resorption of the hematoma, thus ending the compression of the bronchial tree.

[Bilateral hypopharyngocele]. / Hypopharyngocèle bilatérale.

OBJECTIVE: Describe the management of bilateral hypopharyngocele in a trumpet player. MATERIAL AND METHOD: Case report of a professional trumpet player suffering from bilateral hypopharyngocele. RESULTS: A professional trumpet player was referred for an ORL consultation after he noticed that a bad sound was produced while he was playing associated with cervical pain. A CT scan demonstrated an asymmetric bilateral hypopharyngocele with no other abnormality. Because of the mild symptoms and the professional context, a successful conservative approach was used with antireflux medications. He was advised to seek professional instruction in order to improve his technique. On follow-up examination 6 months later, he had had no further problems since adopting the corrected techniques. CONCLUSION: Pharyngoceles are rare and easily misdiagnosed. Because of the mild symptoms and the professional context, a conservative medical approach should be proposed (antireflux medications) combined with specific orthophonic and physical therapy to modify breathing and trumpet playing techniques.