A short history of nasal polyposis.

Nasal polyposis was initially considered a tumor, but came to be seen as a chronic inflammatory mucosal disease during the second half of the 20th century. Although pathogenesis remains unclear, this has not prevented progress in diagnosis and treatment, both surgical and medical, based on the hypotheses of chronic rhinosinusitis with type-2 inflammation and autoimmune inflammation maintained by the vestigial olfactory mucosa of the ethmoid.

Audiological comparison between two different clips prostheses in stapes surgery.

OBJECTIVES: To compare audiometric results and complications of stapes surgery with two different types of piston prosthesis, the Portmann Clip Piston (Medtronic) (PCP) and the Soft Clip Piston (Kurz) (SCP). MATERIAL AND METHODS: Study conducted on 64 patients who underwent primary stapedotomy from 2008 to 2011. We matched for each case of stapedotomy with the PCP (Medtronic Xomed Inc. Portmann Clip Piston Stainless Steel/Fluoroplastic) a case with the SCP (Heinz Kurz GmbH Medizintechnik Soft Piston Clip Titanium). Each group consisted of 32 patients, and patients in both groups were matched with respect to gender, age, bilateral or unilateral otosclerosis, otological symptoms (tinnitus, vertigo or dizziness), family history, operated side and the Portmann grading for otosclerosis. The length of the prosthesis used was reported. Post-operative complications such as tinnitus, vertigo, hearing loss and altered taste were documented. Each patient was subjected to a preoperative and postoperative audiogram (follow-up at the second month after the surgery). We used the Student test for statistical analysis. Statistical significance was set at < 0.01. RESULTS: None of the patients experienced a post-operative hearing loss and none required a later revision surgery. No statistically significant difference was found between the two populations regarding demographic data (age, sex, side, bilaterality, family history, stage and lenght of piston) and hearing level (> 0.01) in the air, bone conduction and air-bone gap (ABG). Postoperative complications did not result to be significantly different between the two groups. Also, both groups showed a significant improvement (< 0.01) in the post-operative air, bone conduction and air-bone gap. There was no statistically significant difference (> 0.01) between the post-operative hearing results (bone conduction, air conduction, air-bone gap) using the two pistons. The mean ABG improvement was respectively 16.63 dB in the SCP group and 20.59 dB in the PCP group. CONCLUSION: The titanium Soft clip piston (SCP) is a good alternative to the Portmann clip piston (PCP). Nevertheless there are some differences in the surgical fixing of these two pistons in the correct position.

Cholesteatoma and osteoradionecrosis after radio­therapy of the temporal bone: Surgical aspects.

Introduction: The treatment for head and neck cancer with radiotherapy can cause different alterations of the auditory system. We report two cases of chronic otitis of the external and middle ear secondary to osteoradionecrosis of the temporal bone. This article aims to report the experience of the surgical approach in such condition. Cases report: The first patient was treated with radiotherapy in his childhood for a cerebellar tumor. He developed years later a cholesteatoma which invaded the mastoid cavities through a destruction of the external auditory canal. The second was treated for a malignant parotid tumour 15 years before by surgery and radiotherapy. She developed a chronic otorrhea with a partial destruction of the bony external auditory canal. Both patients were treated by surgery with reconstruction including bone, cartilage, fascia and skin grafts. The outcome was good in both cases. Osteo­radio­necrosis of the temporal bone is a rare but serious complication of radiotherapy for head and neck cancer. This complication can occur even many years after the treatment. Our two cases demonstrate a way to solve this pathology. A long term supervision with regular cares is essential in order to get a good healing. Due to the improvement of the radiation therapy we could expect less complications of this type in the future.

Cholesteatoma presenting as a late complication of cochlear implant surgery: Case report and literature review.

A male patient with post lingual hearing loss was implanted at 16 years of age with a Nucleus cochlear implant (Cochlear) in his left ear. Twenty two years later, he developed a cholesteatoma in relation to the mastoid portion of the facial nerve and in contact with the electrodes array. The cholesteatoma was removed and the ear canal reconstructed. There was no post-operative facial palsy and the cochlear implant was preserved. Although cholesteatoma is a rare complication of the cochlear implant surgery, it still can occur and can be a source of potential damage to the implant. The origin of this late-presenting complication could be excessive bone drilling associated with the pressure caused by the loop of the electrodes array on the posterior canal wall. Implanted patients must have a close and particular long-term follow-up, especially when a surgical breach of the canal wall or a tear of the tympanic membrane have occurred during surgery, as well as in those patients in whom excessive thinning-out of the posterior meatal wall was done.

Herniation of the temporomandibular joint into the external auditory canal: Our review of 13 cases.

UNLABELLED: Symptomatic dehiscence of the anterior wall of the external auditory canal is only occasionally encountered during otologic surgery. OBJECTIVE: To propose a technical answer for the reconstruction of anterior wall defects based on the size of the dehiscence. MATERIAL AND METHODS: Retrospective study of 13 cases of dehiscence of the anterior wall (9 male and 4 female patients between 30 and 66 years) operated between 1998 and 2010. The pathologies at the cause of the dehiscence were cholesteatoma (2 cases), chronic otitis externa (3 cases), congenital dehiscence (1 case), 5 cases which appeared after a surgery mainly for exostosis (3 of them previously operated in another center) and 2 cases of accidental breach during canal calibration. The size of the defect measured during surgery was "small" (< 4 mm diameter) in 2 cases, "medium" (between 4 and 8 mm) in 8 cases and "large" in 3 (> 8 mm). The reconstruction was performed in 7 cases through the EAC and in 6 cases an anterior approach of the anterior wall of the EAC was used. In all cases, we could insert a graft anteriorly and this was held in place by the pressure exerted by the temporomandibular joint. Bone paté and temporalis fascia with in most cases a piece of cortical bone graft was used in all cases. RESULTS: The follow up period ranged from 6 to 24 months. In 10 cases the anatomical result was perfect (in 3 cases we encountered some minor complications but with no clinical consequences). In the other three cases there was one with persistent inflammation of the external auditory canal, one case of recurrence of the lateralization of the tympanic membrane and one case which required a revision surgery. CONCLUSION: The reconstruction and the approach are done according to the size of the defect, whether small, medium or large. Complications and revision surgeries have been minimal.

[Unilateral frontal sinus aspergillosis: the combined endoscopic and mini-trephination approach]. / Aspergillose unilatérale du sinus frontal: voie d'abord combinée endoscopique et par clou de Lemoyne.

OBJECTIVE: Aspergillosis is a common fungal infection of the paranasal sinuses. Localization in the frontal sinus is usually secondary to involvement of one of the other sinuses. Isolated frontal sinus aspergillosis is rare and only 5 cases are described in literature. CLINICAL CASE: We report a case of a patient with a frontal sinus aspergilloma associated with ipsilateral chronic ethmoidal and maxillary sinusitis, successfully treated with a combined endoscopic and mini-trephination approach "Lemoyne technique". DISCUSSION AND CONCLUSION: The endoscopic approach to the frontal sinus is considered the best way to deal with frontal sinus aspergilloma, but it is sometimes not sufficient to guarantee the complete removal of the fungus ball. In such cases a mini-trephination of the frontal sinus with associated irrigation provides a more accurate visualization and toilette of the sinus.

[Silent sinus syndrome--two cases report]. / Syndrome des sinus silencieux--a propos de deux cas.

INTRODUCTION: Silent Sinus Syndrome (SSS) is a rare pathology, characterized by retraction of the maxillary sinus walls, leading to enophthalmos, sometimes diplopia and midfacial depression. It is usually not associated with sinonasal symptoms. Sinus ventilation and drainage stops its progression, but usually cannot reverse the process. This empiric treatment supports the Hypoventilation Theory that would explain the pathogenesis of this disorder. MATERIALS & METHODS: We describe two cases of SSS. A 65 year-old-man complaining of enophthalmos with an insidious onset whose CT-Scan confirmed SSS. After he was submitted to drainage surgery, the ocular asymmetry showed slight improvement. The second case describes a 34 year-old-woman with a sudden onset enophthalmos associated with diplopia, in only 5 days. She didn't have nasal or sinus related symptoms. CT-scan revealed SSS due to maxillary and ethmoidal sinus. Early endoscopic surgery enabled reversal of enophthalmos and correction of diplopia.

Vestibular-evoked myogenic potentials after superior semicircular canal obliteration.

OBJECTIVE: To analyse vestibular evoked myogenic potentials (VEMPs) characteristics in patients with superior semicircular canal dehiscence syndrome (SCDS) after surgical plugging. MATERIALS AND METHODS: Five surgical plugging of SCD were performed on 4 patients presenting uni- or bilateral SCD. VEMPs were recorded before and after surgery. RESULTS: Postoperative VEMP testing revealed in all cases a normalization of the response on the operated side. DISCUSSION: Patients with SCDS typically have VEMPs with pathologically low thresholds and large amplitude potentials. VEMPs represent a screening investigation for SSCD and a valuable tool in the postoperative follow-up to confirm the successful repair of the dehiscence. In bilateral SSCD cases, VEMPs help to localize the worst side which is operated first. CONCLUSION: VEMPs are essential in both preoperative planning and postoperative monitoring of patients with SCDS.

[Extraction of the esophageal foreign bodies by cervicotomy: our experience about 9 cases]. / Extraction de corps étrangers oesophagiens par voie de cervicotomie: à propos de 9 cas.

OBJECTIVE: To present our experience of the extraction of the esophageal foreign bodies by cervicotomy route. PATIENTS AND METHOD: Descriptive retrospective study from 2006 to 2010 realized in the ENT Departments of Yopougon and Treichville's Teaching Hospital. RESULTS: 9 (3.3%) of 270 patients underwent surgery to remove esophageal foreign bodies. The average age of the patients was of 14.6 years (extremes: 8 months and 49 years). The foreign bodies were fish bone, hook of clothes peg, medallion, denture and weld. Cervicotomy was performed at once in 4 cases and after failure of esophagoscopy in 5 cases. There were 2 complications (pharyngostoma and suppuration of the operating site). CONCLUSION: The cervicotomy must be quickly performed in case of perforation with or without neck abscess, sharp or voluminous bodies.

Otoplasty: special attention in patients wearing hearing aids.

OBJECTIVE: Surgical procedure for the correction of prominent ears (lop ears, bat ears) is very common. Nevertheless in some occasions a post operative narrowing of the external meatus and/or an overcorrection of the pinna can arise. In a patient with hearing loss who wears or who is candidate to wear hearing aids this can have severe consequences. This association (prominent ears and hearing loss) can be isolated or found in some congenital syndromes (Noonan, fragile X syndrome). CASE REPORT: 2 cases of otoplasty in patients wearing hearing aids. The Negrevergne otoplasty technique was used in both cases and a simultaneous meatoplasty was performed with the goal of achieving an external ear meatus of a suitable size for a proper use of hearing aids. Also the overcorrection of the pinna was avoided in using this technique allowing the retention of the behind the ear hearing aid. CONCLUSION: Simultaneous oto-meato-plasty represents a valid solution to avoid post operative inconvenient in patients wearing hearing aids.

[A case of nasal NK/T cell lymphoma in Africa]. / Un cas de lymphome nasal T/NK en Afrique noire.

INTRODUCTION: Nasal NK/T cell lymphoma is an aggressive, locally destructive and necrotizing lesions. It is exceptional rare in Africa. CASE REPORT: We report a 73 year-old patient's case presenting a nasal obstruction with a chronic purulent nasal discharge. The physical examination showed a chronic nasal lesion involving the nose and infiltrating the pyramid. The histopathological examination performed in a french laboratory diagnosed a nasal T cell lymphoma. Chemotherapy was initiated; radiotherapy being unavailable. CONCLUSION: The difficulties in management of nasal NK/T lymphoma cases are due to diagnostic difficulties and therapeutic problems related to the absence of radiotherapy in our work environment.

Acute infectious complications in stapes surgery.

OBJECTIVES: The purpose of this report is to describe the symptoms, management and outcomes of three patients who developed infection related complications within one month after stapes surgery. A literature review of early post-operative complications following stapes surgery will also be presented. SETTING: Private tertiary medical center. PATIENTS: This is a report of three patients diagnosed with otosclerosis who were operated by the senior author in a span of 16 years from 1993 to 2009. RESULTS: The first patient was a young man who experienced complications brought about by recurrent upper respiratory tract infection and Eustachian tube dysfunction due to enlarged palatine tonsils. The second patient was a woman who developed acute suppurative otitis media after stapes surgery of the left ear. When she underwent stapes surgery for the right ear, she had an upper respiratory tract infection two days after the procedure. The third patient was a known diabetic female who developed otitis media and had a prolonged recovery despite being managed by an endocrinologist prior to stapes surgery. Two patients fully recovered and hearing eventually improved on the operated side while one patient did not benefit from stapes surgery. CONCLUSION: Complications in stapes surgery are very rare in the past and at present. However, complications still happen. Effective, timely medical treatment, vigilance and proper follow-up advice always lead to favourable outcomes.

[From barotrauma otitis to a fulminant meningitis]. / De l'otite barotraumatique à la méningite en direct.

OBJECTIVES: To report the case of a patient who in the follow-up of a barotrauma otitis presented a fulminant meningitis. CLINICAL CASE: 38 year old man sportsman who presented a barotrauma otitis during scuba diving. In spite of a treatment associating steroids and nasal vasoconstrictor this otitis persisted. Five weeks after the initial episode the patient went back to the clinics in emergency complaining of intense cephalgia for a few hours with impression of faintness without fever. The state of consciousness of the patient then degraded quickly during the conversation. Into the 15 minutes time, the patient slipped of a stuporous state to coma. Hospitalized in emergency in intensive care unit, the diagnosis of an otogenic meningitis with Streptococcus pneumoniae was made. The patient cured without sequelae. CONCLUSION: An inadequate treatment accompanied by a favorable anatomical factor facilitated the diffusion of the bacterial invasive process of the ear drum through the osseous barrier until the dura mater. A banal barotrauma otitis which persists can cause serious complications. An antibiotic must be prescripted starting from stage III, i.e. when there is retrotympanic effusion. In front of a behavioral problem during an otitis, it is necessary to always think of the intracranial complications and not to delay the anti-infectious treatment which must be started as soon as possible. To obtain a complete cure without sequelae, it seems that the adapted anti-infectious treatment must be instaured within a time below 10 hours.

Drop weld thermal injuries to the middle ear.

Drop weld injuries to the tympanic membrane and middle ear caused by hot sparks or molten slag are a rare but significant injury. Steel workers and welders who are regularly exposed to flying sparks and molten metal slag are predisposed. This type of transtympanic thermal injury occurs when the slag literally drops into the external auditory canal and burns through the tympanic membrane. A spectrum of severity of injury occurs which includes chronic tympanic membrane perforation, chronic otorrhoea, facial nerve injury and deafness. Chronic tympanic membrane perforation is the most common sequelae and is perhaps one of the most challenging of all perforations to repair The combination of direct thermal injury and foreign body reaction results in continuing or recurrent suppuration. The foreign body reaction is due to the embedding of metal slag in the promontorial mucosa. We present a case of drop weld injury to the left tympanic membrane, resulting in chronic middle ear inflammation, otorrhoea and tympanic perforation. CAT scan clearly demonstrated a metallic promontorial foreign body with localised bone erosion. We emphasise the importance of removing these foreign bodies and recommend a cartilage reinforced underlay tympanoplasty technique to repair these perforations. Transtympanic thermal trauma is a preventable occupational injury, which is best, avoided by earplugs and increased awareness.

How to manage post stapedotomy reparative granuloma.

UNLABELLED: Different techniques for restoration of hearing in patients with conductive hearing loss due to otosclerosis have been developed with excellent hearing improvement in most of the cases. However, nowadays complications and failures still compromise expected results and necessitate revision surgery. OBJECTIVE: This article aims to report the management of reparative granuloma after stapes surgery. CASE REPORT: A case of poststapedotomy sudden sensory hearing loss is described. A reparative granuloma was found and removed during revision surgery. All the symptoms including hearing and tinnitus returned to normal. This patient did not present vertigo. CONCLUSION: Hypothesis to explain this evolution is exposed. Reparative granuloma is an emergency and needs as soon as possible a revision surgery.

Type III ossiculoplasty with mastoid cortical bone--"in situ" shaping of the ossicle.

The authors describe their technique to harvest a cortical bone ossicle. It consists of sculpting and shaping the ossicle while it is still attached to cortical bone. The technique is simple and safe.

Surgery of the semicircular canals.

INTRODUCTION: Surgery of the semicircular canals is seeing a revival as recently we have witnessed the development of specialized surgeries for each canal. OBJECTIVES: The aim of this work is through a review of the literature to describe these different surgeries while stressing on certain surgical aspects, their respective indications, results and their risks. DISCUSSION: 1: The surgery of the posterior canal relates to the benign paroxysmal positional vertigo resistant to the medical treatments. The results are very good but the indications have become rarer since the introduction of the repositioning maneuvers. 2: The surgery of the lateral canal is the most frequent and the oldest because of chronic otitis and especially cholesteatomas. It is now well codified and is subject to various factors. Plugging of the lateral canal in Menière's disease has just been described and interesting results on vertiginous crises have been reported. Its interest and its place in the treatment of this disease are still to determine. It can be an alternative to surgical management but also to the gentamycin injection. 3: The dehiscence of the superior semicircular canal must be systematically sought after when confronted with a Menière-like disease, a suspicion of perilymphatic fistula or a conductive deafness evoking an otosclerosis with preserved stapedial reflexes. Very often these dehiscences of the superior canal are asymptomatic. High density scans of the petrous bones provide the diagnosis but it is necessary to obtain a 3D view to ascertain the dehiscence. A radiological classification of the dehiscence in 3 types has been proposed. It appears to be of help during surgery. Videonystagmography with and without vibrator and vestibular myogenic evoked potentials allow the determination of the side responsible for the symptoms in case of bilateral dehiscence. The surgery usually through a middle fossa approach will be proposed only to the symptomatic and incapacitated patients. The results are promising. 4: Finally the authors discuss the cochlear risk of this surgery and the types of material used to occlude or cover the canal. CONCLUSION: The otologists must generally know these indications as this type of surgery entails very good results with a relatively moderate risk on hearing.

[Dehiscence of the superior semicircular canal: approach and CT scan classifications]. / Déhiscence du canal semi-circulaire supérieur: approche et classification scanographiques.

UNLABELLED: The syndrome of dehiscence of the superior semicircular canal (DCSS) is primarily associated with vertigo and/or hearing loss. The dehiscence may be completely asymptomatic and represent an incidental finding on radiological investigation. OBJECTIVES: To demonstrate the advantages of a volume rendered CT study of the petrous temporal bone of patients with hearing loss, and to demonstrate the effectiveness of its systematic application in the protocols of examination. To propose a radiological classification of DCSS with a therapeutic application. MATERIAL AND METHOD: The examination technique which was performed in incremental mode (axial and frontal sections) and in "volume rendered" mode, on a high resolution apparatus is described. The authors studied 154 scans of the petrous temporal bone obtained by this technique. They correlated the cases of DCSS with the indications for the radiological examination. Each 3d CT scan was studied and the type of fistula described. The authors propose a classification of fistulae into three types, depending on 3d CT scan appearance. RESULTS: Out of 154 CT scans of the petrous temporal bone (77 patients), 13 cases of DCSS were discovered. DCSS was bilateral in 4 cases. The primary indication for investigation was the assessment of conductive or mixed hearing loss. The "volumetric" technique was compared with standard imaging techniques and/or reconstructed images in the superior canal plane. The correlation was perfect in all the cases. The description of the fistulae allowed a classification into 3 types: Type I (symmetrical fistula, 8 cases); Type II (asymmetrical fistula, 3 cases) corresponding to the canal dome; Type III (2 cases) involving the foot of the canal. CONCLUSION: The increased frequency of DCSS in this series (prevalence of 17% against 0.5% in post mortem studies) is probably explained by the selection bias of the patients and also by the systematic application of this novel radiological technique. We propose to include this protocol in all CT scans of the temporal bone, particularly when investigating symptoms consistent with a syndrome of Minor or the Tullio phenomenom. This system of classification makes it possible to describe the fistula and to specify its location. This should prove to be a valuable aid for pre-operative planning and intra-operative localisation of the fistula.

Post-traumatic otosclerosis: coincidence or trigger factor?

OBJECTIVE: The etiology of otosclerosis is poorly understood and environmental as well as genetic factors have been implicated. In this paper we will present 3 cases of otosclerosis with a clinical history of trauma and we will discuss with a literature review the place of trauma in otosclerosis etiology. CLINICAL CASES: 3 patients with clinically diagnosed otosclerosis, operated, and with a clinical history of previous head trauma. DISCUSSION AND CONCLUSION: It is probable that environmental factors could be involved in the development of the disease and we think that trauma could be one of them. The mechanisms by which it could results in otosclerosis remain unknown. However these cases appear to be rare and under studied.

Otologic surgery in HIV-infected patients.

As the lifespan of patients with HIV continues to increase secondary to improvements in antiretroviral medications, patients can keep the virus in a latent state for a longer period of time than ever before. As a result, patients live longer with infection and demand a higher quality of life during the course of the disease. The most important decision in the management of otologic manifestations of AIDS is whether the patient should be operated. The surgery of HIV-infected patients includes two important issues: Risk of transmission of HIV to health care workers and delay of wound healing. In this paper we describe the three otologic procedures of two HIV-infected patients managed successfully without complication. We, like many others, believe that otolaryngologists should apply strict surgical criteria to HIV-infected patients for otologic procedures and should not withhold rational therapy because of the patient's HIV status.