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

Introduction: Giant arachnoid granulation can induce lateral sinus stenosis with sigmoid sinus dehiscence, causing pulsatile tinnitus with pulsatile tympanic membrane without retrotympanic mass.

Case report: A 78 year-old man presented unilateral left pulsatile tinnitus since 2009, with recent aggravation. Otoendoscopy showed a pulsatile tympanic membrane, in which movement was halted by jugular compression or Valsalva maneuver. CT angiography and MRI found large arachnoid granulation causing left lateral sinus stenosis and eroding the sigmoid sinus wall. Stenting resolved the tinnitus, while the eardrum remained pulsatile.

Discussion: Giant arachnoid granulation can induce lateral sinus stenosis and sigmoid sinus dehiscence, with turbulent venous flow and pulsatile tinnitus. The erosion can transmit cerebrospinal fluid pulsation to the sigmoid sinus and then to the tympanic membrane, where it is visible on otoscopy when the membrane is fragile.

Objectives: Because access to sleep recordings is limited, there is a need for new reliable tools for pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) diagnosis. A score calculated from a 30 minutes-home sleep video recording (VR) has already been proposed in 1996 with interesting results. The main objective of this pilot study was to assess the reliability of a similar score applied to reference PSG VR and calculated on two different time windows (30 and 10minutes).

Methods: A retrospective monocenter study was made on 16 children suspected of OSAHS, that underwent VR during overnight PSG. Video analysis was made during the second complete sleep cycle. A 30-minute risk score (RS30) and a 10-minute risk score (RS10) were established by analyzing seven parameters. The RS30 and RS10 were correlated with clinical examination data, a sleep questionnaire, the obstructive-apnea-hypopnea index (OAHI) and the oxygen desaturation index (ODI) from synchronized PSG results.

Results: There was a significant correlation between both the RS30 and RS10, the OAHI and ODI. A RS30 ≥6.09 was predictive of an OAHI ≥5 per hour with a sensitivity of 83% and a specificity of 90%. A RS10 ≥6.50 was predictive of an OAHI ≥5 per hour with a sensitivity of 67% and a specificity of 100%.

Conclusion: A risk score based on PSG VR shows a good correlation with PSG results, confirming previous reports. Further work should focus on applying this risk score to home sleep VR for the diagnosis of pediatric OSAHS.

Introduction: Injection laryngoplasty with hyaluronic acid (HA) is currently the first-line treatment for glottic insufficiency, significantly improving vocal function. Some rare inflammatory laryngeal reactions have been reported, managed conservatively by corticosteroids and antibiotics.

Case report: An 83-year-old woman with longstanding dysphonia due to left laryngeal paralysis was treated by medialization with hyaluronic acid injection under local anesthesia. Postoperative course featured onset of dyspnea 42h after injection, with a large laryngeal edema, unimproved by conservative medical treatment. CT showed edematous infiltration of the left hemilarynx, greater than the injected volume. Given the lack of clinical improvement, emergency tracheotomy was performed. Progressive absorption of the edema allowed decannulation 3weeks later.

Discussion: We report a rare complication after medialization by HA injection: a severe inflammatory laryngeal reaction significantly impairing airway function and threatening vital prognosis. The case highlights the critical need for close monitoring after medialization and for appropriate management in case of dyspnea onset.