European Annals of Otorhinolaryngology-Head and Neck Diseases最新文献

Treatment of nosebleeds in Osler-Weber-Rendu disease (OWRD) is a therapeutic challenge. Intranasal anti-angiogenic sprays are a promising solution, requiring scientific validation, leading us to conduct the present study.

Objective: The main objective was to determine the minimum effective dose of bevacizumab by intranasal spray to treat epistaxis in OWRD: i.e., the dose resulting in≥50% reduction in the number of nosebleeds at 1 month of treatment compared to the month prior to inclusion for 60% of patients. The secondary objectives were to assess treatment efficacy at 3 and 6 months and progression in the number and impact of nosebleeds, and to document pharmacokinetics.

Materials and methods: The study, named EROSB (treatment of epistaxis in patients with OWRD using a bevacizumab intranasal spray), under the French Hospitals Clinical Research Program (PHRC-I 2013), was selected by the Inter-regional Clinical Research and Innovation Group (GIRCI). It was a phase I/II prospective single-blind study based on 10 cohorts of 3 patients each, using the Continual Reassessment Method (CRM) to determine the minimum effective dose of bevacizumab.

Results: Due to difficulties in recruiting enough patients, the study was stopped after inclusion of 15 subjects. The CRM method identified 64mg as the minimum effective dose. However, this result is not interpretable due to the small number of subjects.

Conclusion: The EROSB study did not succeed in identifying a minimum effective dose of bevacizumab, administered as intranasal spray that could reduce the number of nosebleeds compared to the month prior to inclusion. However, the initial results indicated almost no systemic passage of the substance.

Objective: The esthetic problems inherent to peripheral (PFP) are frequent causes of complaint. Make-up is advocated as a form of therapy and can alleviate symptoms of depression. The aim of the present study was to collect data on make-up habits in female PFP patients and assess links with esthetic and/or functional complaints.

Material and methods: Two questionnaires were drawn up to compare make-up habits in female PFP patients and women in the general population. The first was sent out between September and December 2019, to 39 House-Brackmann grade III PFP patients (group A), and the second on-line questionnaire was sent to a control population of 1385 women (group B).

Results: PFP patients used make-up more often than controls at weekends (χ²=16.38; P=0.0009) and while at home (χ²=8.21; P=0.042), and more often with foundation (χ²=17.21; P=0.0006) and lip make-up (χ²=59.31; P<0.0001). The greater their functional complaint, the less they made up their eyes. The greater their self-confidence and the more they felt attractive, the less they made up their lips.

Conclusion: The differences in make-up use found in the present study aimed to mask facial palsy and were related to the esthetic complaint, impacting social life.

Free-flap reconstruction for recurrence of head-and-neck cancer with vessel depletion is a technical challenge, and the literature is sparse. The present technical note describes the key-points of an approach harvesting the internal mammary pedicle. Results are reported in 3 patients, and pros and cons are discussed.

Background: Burnout can significantly impact practitioners and their co-workers, and hence patients. There are no data for the prevalence of burnout in French ENT specialists, or for associated risk factors.

Material and methods: A French national cross-sectional online survey was performed on the initiative of the ENT National Professional Council (CNPORL), contacting all ENT specialists whose e-mail address was known to the French Society of ENT, the National Professional Council or the National ENT Union. The 22-question Maslach Burnout Inventory (MBI) was sent out, along with 16 extra questions on possible risk factors.

Objectives: The study sought to assess the prevalence and severity of burnout, using the MBI, and to analyze risk factors.

Results: Among the 1936 physicians, 406 contacted responded to the questionnaire (21%). Mean age was 47±14 years (range, 25-77 years); 53% male, 47% female. 196 (48%) reported burnout, including 20 (5%) severe burnout. Independent risk factors for burnout of whatever severity, comprised social interaction issues, history of identified burnout, and medicolegal pressures. Social interaction issues were independently associated with specifically severe burnout.

Conclusions: Burnout affected almost half of respondents. There are identifiable risk factors, for which improvements could be implemented.

Objective: To determine the frequency and modality of post-treatment monitoring of primary salivary gland cancer.

Material and methods: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method.

Results: Clinical monitoring should be adapted to the risk of recurrence: initially every 3 months and progressively spaced out, becoming annual after 5 years. Post-treatment head and neck and chest imaging is recommended at 3 months. Local and regional monitoring can then be carried out yearly or twice yearly with contrast-enhanced head and neck imaging. An annual chest CT scan is recommended for high-grade tumors. For lesions at high risk of late recurrence, very prolonged annual surveillance (up to 15 years) is recommended, including screening for pulmonary metastases.

Conclusion: Given the wide range of malignant salivary gland tumors, the modalities and frequency of post-treatment monitoring must be adapted to the expected course of the disease.

Objective: To determine the indications and modalities for resection in the management of primary sublingual and minor salivary gland cancer, and the specific features of each primary location.

Material and methods: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method.

Results: Histological evidence (submucosal biopsy) is recommended before surgical treatment of minor salivary gland carcinoma. Surgical treatment is recommended, with optimal oncologic margins, adapted to anatomical factors, histologic type and grade and functional consequences, with reconstruction if necessary.

Conclusion: Treatment of primary minor salivary and sublingual gland cancer is surgical, with wide resection margins. The modalities of resection and reconstruction are highly dependent on tumor location, extension and histologic type.