Bioactive glass in canal wall reconstruction tympanoplasty.

The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.

Low-fidelity otoscopy simulation and anatomy training: A randomized controlled trial.

OBJECTIVES: To evaluate whether the use of low-fidelity otoscopy simulation improved medical students' theoretical knowledge of middle ear anatomy and pathologies compared to traditional teaching methods. METHODS: This was a randomized controlled trial. Simulation workshops were conducted in April 2019 in the Lyon Sud University medical faculty, France. Students were randomly assigned to the simulation group (n=105) or to the control group (n=95). The students in the control group answered a questionnaire evaluating theoretical knowledge (25 true-false questions) before the simulation tutorial, while the students in the simulation group answered the same questions after the tutorial. Both groups also filled out a satisfaction questionnaire for feedback. RESULTS: 196 of the 200 students who participated in the study completed the knowledge assessment questionnaire. Scores were 32.0% higher in the simulation group than in the control group (mean scores, 12.0/20 vs. 9.1/20; P<0.0001). 184 of the 191 students who completed the satisfaction questionnaire (96.3%) were satisfied or very satisfied with the workshop, and all but one (99.5%) recommended keeping it in the curriculum. In the free comments fields, students highlighted the educational value of learning without the stress of patient discomfort. CONCLUSION: Otoscopy simulation is an effective training method, improving theoretical knowledge compared with conventional theoretical training.

Evolution and safety of day-case major ear surgery.

AIMS: To study the evolution of middle-ear surgery in 2019 in relation to the French Health Authority target of 66% day-surgery by 2020. MATERIAL AND METHODS: A single-center retrospective observational study included all patients undergoing otologic surgery between January 2014 and December 2018 in a university hospital center. 1064 of the 1368 patients were scheduled for outpatient surgery: 309 for otosclerosis, 355 for tympanoplasty with or without ossiculoplasty, 376 for cholesteatoma and 24 for other procedures. Two groups were constituted: day-surgery and conventional, according to hospital stay. Surgery time, follow-up duration, number of crossovers to conventional admission, number of emergency postoperative consultations, number of readmissions and data from the phone-call systematically made the day after surgery were analyzed. The main objective was to evaluate the safety of outpatient surgery for major middle-ear interventions compared to a control group managed under conventional admission during the same period. RESULTS: 27 patients (2.5%) required crossover, mainly due to disabling vertigo (57.7%). 53 patients (4.9%) consulted before the scheduled 8th day consultation, because of severe pain (23.5%) or dizziness (34.0%). Only 10 patients required emergency readmission. CONCLUSION: Provided that the inclusion criteria are met, all major middle-ear surgery procedures can be performed as day-surgery under satisfactory safety conditions.

Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic.

AIMS: To assess the benefit of telemedicine consultation during the Covid-19 pandemic. MATERIAL AND METHODS: A prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations. Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors. The significance threshold was set at P<0.005. The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown. The secondary endpoint comprised predictive factors for overall satisfaction. RESULTS: One hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire. Overall satisfaction was 87%. There were no clinically relevant predictive factors significantly associated with satisfaction. Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR=3.40, P-value=0.049; and OR=3.79, P-value=0.049). Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR=0.30, P-value=0.027). CONCLUSION: Telemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients. It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals.

[Aspirin hypersensitivity: characteristics and diagnostic approach]. / Intolérance à l'aspirine : caractéristiques et éléments diagnostiques.

INTRODUCTION: In routine medical practice, the diagnosis of aspirin hypersensitivity (AH) remains difficult. No clinical feature or biomarker is available to reliably confirm this diagnosis and oral provocation tests (OPT) are rarely performed. AIM: To compare asthmatics with and without AH. METHOD: The clinical characteristics of 21 asthmatics with and 24 without AH respectively were determined. AH was defined by a positive OPT. A full blood count was done before and 24 hours after the OPT. RESULTS: The medical history was associated with a weak sensitivity (52%) and a good specificity (96%) for assessing the diagnosis of AH. There was a higher prevalence of AH in women, and a higher frequency of allergic rhinitis in AH, but no characteristic was useful to facilitate the diagnosis of AH in asthmatic patients. Our results demonstrate higher values of platelets in AH patients. Following OPT, in AH patients only, a decrease in blood eosinophils and an increase in neutrophils was observed. CONCLUSIONS: These results confirm that the diagnosis of AH is challenging, with the history having only weak sensitivity. The observation that fluctuations in eosinophils and neutrophils occur following OPT in AH patients only warrants further investigations and suggests a rapid pro-inflammatory role for aspirin.

[Predictive factors of facial palsy of the acoustic neurinoma after retrosigmoid surgery: 230 cases]. / Facteurs prédictifs de la survenue des paralysies faciales du neurinome de l'acoustique opéré par voie rétro-sigmoïde. A propos de 230 cas.

OBJECTIVES: To determine predictive factors influencing postoperative facial palsy during retro sigmoid approach in vestibular schwannoma surgery. MATERIAL AND METHODS: Retrospective study over 230 patients with vestibular schwannoma, mostly stade I and II, operated by retro sigmoid approach, by the same oto neuro chirurgical team between 1993 and 2004. Pre and post operative parameters taken into consideration: quantitative: age and sex, audiometric parameters, duration of clinical symptoms; qualitative: tumor anatomic factors and facial nerve function according to House Brackmann classification. RESULTS: 8 days after surgery, 92% of patients have a normal or subnormal facial nerve function, 5% a facial paresis and 3% a paralysis. After one year, only 4% of patients still have a grade III to VI paralysis. Latency of vertigo with facial nerve paralysis is 4.33 vs. 1.97 year in absence of paralysis. Hearing conservation is 85% without facial nerve paralysis vs. 58% with facial nerve paralysis; Wave III latency (PEAP) with facial nerve paralysis is 4.54 vs. 4.28 ms if not. CONCLUSION: Significant predictive factors of facial nerve palsy outcome are: age, post surgery hearing conservation, wave III latency, difficulty in tumor dissection, vertigo latency.

[Traumatic luxation of the stapes: radiology and surgical outcome]. / Luxation traumatique de l'étrier dans le vestibule: aspect radiologique et conduite à tenir.

OBJECTIVES: To describe the value of high resolution computed tomography scan (HRCT scan) in post traumatic hearing loss. METHOD: HRCT scan of the temporal bone in millimetric cut with axial and coronal views was performed. RESULTS: CT scan confirmed pneumolabyrinth with intact stapes depressed deeply into the vestibule. Surgical exploration was performed and the stapes was gently removed from the vestibule. CONCLUSION: CT scan confirmed the diagnosis and studied the stapes integrity. Hearing deteriorated postoperatively is increased in case of stapes fracture. When a luxation of the stapes into the vestibule is suspected, it is important to determine how deeply and whether it is fractured. When such a case is encountered, high resolution CT scan of the temporal bone must be performed to confirm the diagnosis and to confirm integrity of the stapes.

Pre- and intraoperative predictive factors of facial palsy in vestibular schwannoma surgery.

CONCLUSION: S These results support previous ones with regard to FN risk factors in VS surgery. However, they also provide new preoperative factors that influence postoperative FN function, such as clinical symptoms, the nature of the surgical procedure (use of laser) and ABR results. OBJECTIVE: To determine pre- and perioperative factors influencing facial nerve (FN) outcome in vestibular schwannoma (VS) surgery. MATERIAL AND METHODS: A total of 424 patients undergoing VS surgery were included in this retrospective study. Patients were divided into two groups according to the existence or absence of a FN palsy during the 8 days following surgery (Groups 1 and 2, respectively). Various parameters were evaluated preoperatively as follows. Quantitative parameters: age; duration of clinical symptoms; pure-tone audiometry (PTA) results; speech reception threshold; speech discrimination score; auditory brainstem response (ABR) results; and transient-evoked otoacoustic emission amplitude. Qualitative parameters: gender; side of the tumor; angle between the tumor and the internal auditory canal (VS/IAC angle) < or = or > 30 degrees; MRI aspect (n = 69); surgical approach; ease of the surgical procedure, the use or non-use of laser dissection; and the histological Antoni's type of the tumor. RESULTS Pre- and perioperative factors that differed significantly between Groups 1 and 2 were as follows. Quantitative factors: tinnitus duration was longer and PTA and ABR results were worse in Group 1. Qualitative factors: heterogenous/cystic MRI aspect, use of retrosisgmoid and middle fossa approaches, easy surgical procedure, dissection without laser and Antoni's type A were more frequently found in Group 1.

[Antibiotic-impregnated prostheses: eclectic indications]. / Prothèses imprégnées d'antibiotiques: des indications éclectiques.

OBJECTIVE: Infection is a major complication in vascular stents. Stents impregnated with gelatine and dipped in Rifampicin have been shown to resist methicillin-resistant Staphylococcus aureus in both animal experiments and in man. It has been suggested that all aorto-ilio-femoral stents should be treated. To evaluate this method, we reassessed all stent infections observed in our patients who had undergone revascularization of the lower limbs from January 1985 to 1994. We excluded stents implanted for ruptured aneurysms or implanted in patients with a past history of local infection on vascular stents. RESULTS: The rate of septic complications observed during the first year was 1% for all patients in the series, 0% for aorto-aortic and aorto-biiliac stents and 0.7% for aorto- bifemoral stents. These rates are similar to those reported in the multicentric study directed by Goeau Brissonière using antibiotic impregnated stents. The extra cost involved in using such stents for aorto-ilio-femoral revascularization was estimated in this series at 2,180,000 Francs. The costs resulting from the three infections was estimated at 960,000 Francs. CONCLUSION: Based on the findings in this series, antibiotic impregnated stents should be indicated only in selected patients due to the extra cost: past history of local infection, ruptured aneurysms, femoro-tibial stents, cross or axillo-femoral revascularization for which the rate of stent infection is 6.3 - 3.2 and 1.4%, immunodeficient patients, multiple reoperations, post-irradiation arteritis and situations known to involve major risk of infection.