[Exploratory tympanotomy for suspected traumatic perilymphatic fistula]. / La tympanotomie exploratrice dans les suspicions de fistules périlymphatiques post-traumatiques.

UNLABELLED: Firstly reported after stapedectomy, perilymph fistula (PLF), may occur due to trauma. AIM: Preoperative symptoms and therapeutic results are described and analyzed after exploratory tympanotomy for traumatic PLF. MATERIAL AND METHODS: Traumatic PLF was investigated in 90 patients (97 examinations) by exploratory tympanotomy at the Nantes University Hospital from 1995 to 1999. Preoperative symptoms were recorded and compared to results of tympanotomy to determine their diagnostic value. Similarly post-operative recovery was compared to results of tympanotomy. RESULTS: This study showed the value of two symptoms: aural fullness and balance disturbance. During each surgical procedure, systematic grafting was performed even if fistulization was unapparent. The best results were achieved for vestibular symptoms and concerned more vertigo than auditory symptoms. There was no significant difference in postoperative symptoms, between patients with a leak and patients without a leak. CONCLUSION: This demonstrates that the oval and round window should be grafted with connective tissue when an exploratory tympanotomy is performed.

[Relapsing polychondritis revealed by ENT symptoms: clinical characteristics in three patients]. / Symptômes ORL révélateurs de polychondrite chronique atrophiante. Caractéristiques cliniques à propos de trois cas.

Relapsing polychondritis (RP) is a recurrent, chronic and rare disease of unknown etiology, considered as a systemic vasculitis. RP is characterized by inflammation of cartilaginous structures of the ears, nose, respiratory tract and joints. RP is likely initiated by ENT symptoms. Etiology is unknown but the association with HLA-DR4 and the occurrence of antibodies to type-II collagen suggest that an immunologic mechanism is involved in its pathogenesis. Diagnosis is difficult requiring identification of elastic cartilaginous injuries. Delay before diagnosis is usually important after the first attack. Neither serum investigation nor histological confirmation are necessary to establish the RP diagnosis, and ENT symptoms are generally sufficient to achieve the diagnosis. Prognosis is linked to laryngeal, tracheal and cardiovascular involvements. An association with myelodysplasia is acknowledged. Based on these three cases and data in the literature, we review classical diagnostic criteria (McAdam), prognosis and therapeutic outcome.