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

Introduction: The first guidelines of the French Expertise Network on Rare ENT Cancers (REFCOR) on the management of nasal cavity and sinus cancer date back to 2009. The objective of the present study was to update these guidelines using a search of the literature between 2009 and 2020.

Method: The literature analysis was carried out using PRISMA criteria to enrich the previous literature review; 250 studies were selected out of 1696 analyzed. General considerations were formulated, common to all histologies and specific to each. The formalized expert consensus method was used to revise the old guidelines and propose new ones.

Results: The scientific analysis led to 87 recommendations: common to all sinonasal cancers (1 to 10), and for adenocarcinoma (11 to 28), adenoid cystic carcinoma (29 to 42), squamous cell carcinoma (43 to 53), mucosal melanoma (54 to 66), neuroblastoma (67 to 72) and undifferentiated carcinoma (73 to 87). According to first 10 guidelines, management of sinonasal cancer requires multidisciplinary teamwork, specifically trained teams and multidisciplinary tumor board meetings, and the emergence of new anatomopathological entities requires in-depth histological and immunophenotypic investigation.

Conclusion: The present article provides a short version of the updated review validating the first 10 guidelines for diagnostic and therapeutic action on general themes common to all histologies.

The nasal cavities and sinuses are the site of many tumoral entities, which are increasingly well described, especially since the advent of molecular biology. The present systematic review collates the current state of knowledge on six new entities described in the 2017 and 2022 versions of the WHO classification of sinonasal tumors: DEK::AFF2 rearranged squamous cell carcinoma, HPV-associated multiphenotypic sinonasal carcinoma, NUT carcinoma, SMARCB1-deficient and SMARCA4-deficient carcinoma, biphenotypic sinonasal sarcoma, and adamantinoma-like Ewing sarcoma. A systematic literature search was performed on PubMed. The inclusion criteria focused on English-language articles precisely describing the histologic, immunohistochemical, molecular, clinical and prognostic characteristics of these entities. It is essential to be able to identify these entities, as they have distinct profiles in terms of progression and prognosis compared to other sinonasal tumors. The present study exhaustively describes their clinical and pathologic characteristics.

Introduction: The present REFCOR guidelines define indications for radiotherapy in sinonasal carcinoma and mucosal melanoma.

Methods: They result from multidisciplinary consensus based on a critical review of the literature, feedback from expert centers, and a structured process to harmonize clinical practice across France.

Results: Indications for radiotherapy are determined by tumor-specific characteristics and histoprognostic factors. In France, treatment decisions for these tumors are discussed in regional or national REFCOR expert panel multidisciplinary tumor boards. Radiotherapy is most often adjuvant, delivered at a short postsurgical interval, but can be exclusive for unresectable tumors or when surgery is contraindicated. It should be performed by experienced teams. The timing of postoperative treatment and the tumoral and nodal targets are tailored to histology and disease stage; their definition is based on a comprehensive and accurate characterization of surgical specimens, including multibloc resections obtained through open or endoscopic endonasal approaches. Given the anatomical proximity of the paranasal sinuses to highly radiosensitive structures (neurological, optic, otologic, and mucosal), technique and quality are critical for achieving tumor control while minimizing morbidity. Conformal techniques such as IMRT or VMAT represent the current gold standard. Proton therapy may be considered to improve sparing of organs at risk.

Conclusion: The REFCOR guidelines establish a framework for indications for precision radiotherapy within a multidisciplinary patient-centered approach adapted to individual tumor characteristics. For each patient, recommendations are complemented by REFCOR multidisciplinary tumor board discussion in a personalized care pathway.

Post-COVID-19 olfactory dysfunction (PCOD) typically resolves within weeks to months; however, persistent cases exist in approximately 10% of patients beyond a year. This study investigated the role of olfactory cleft adhesions in prolonged PCOD and evaluated surgical intervention as a treatment option. Four cases of PCOD unresponsive to medical therapy underwent endoscopic sinus surgery (ESS) to address bilateral olfactory cleft obstruction identified on computed tomography (CT) scan. Adhesions between the superior/middle turbinates and nasal septum were surgically divided, and silicone plates were inserted to prevent reattachment. All patients reported significant subjective improvements in olfaction within one week of silicone removal. Objective olfactory test scores continued to improve over subsequent months, and postoperative CT scan confirmed improved ventilation of the olfactory cleft. These findings suggest that adhesions formed during inflammatory healing contribute to conductive olfactory dysfunction in Long-COVID cases, distinct from sensorineural or central OD. Surgical intervention may be beneficial for carefully selected patients with PCOD persisting for at least one year, anosmia or severe olfactory loss confirmed by testing, and CT evidence of olfactory cleft obstruction. However, the risks such as mucosal damage and potential worsening or no improvement of OD should be discussed thoroughly. Individualized treatment strategies are recommended, and further studies are warranted to optimize management of persistent PCOD.

Introduction: Drug-induced sleep endoscopy (DISE) is widely used for assessment of obstructive sleep apnea, using either disposable or reusable fiberendoscopes. The present study compared the environmental, economic and social impact of DISE between disposable and reusable fiberendoscopy.

Methods: Ten DISE procedures were analyzed. The carbon footprint, expressed in kgCO₂eq, included patient and staff transport, operating room energy consumption, waste management, medical device production, delivery, and sterilization. Financial costs and healthcare professionals' perceptions were also evaluated via structured questionnaires.

Results: The baseline carbon footprint of a DISE procedure (excluding the endoscope) was 23.95kgCO₂eq. Using a disposable fiberendoscope increased the total footprint to 65.05kgCO₂eq, while a reusable endoscope resulted in an extra 14.18kgCO₂eq. Financially, a single procedure cost €206 with the disposable device versus €17.60 with the reusable one. Professionals associated reusable fiberendoscopes with better quality, ecological benefit and lower cost, but noted concerns about infection control and the complexity of sterilization. Disposable devices were preferred for their ease of use but criticized for their environmental and economic impact.

Conclusion: Reusable fiberendoscopes offer clear environmental and economic advantages over disposable ones, without compromising clinical outcome. Promoting their use can help reduce the ecological footprint of healthcare systems while maintaining high-quality care.

Benign paroxysmal positional vertigo is one of the commonest forms of vertigo. The lateral semicircular canal is involved in 5-30% of cases, although this is probably an underestimation. Diagnostic and therapeutic procedures depend on otolithic debris location in the canal, and require a certain expertise. The difficulty in diagnosis lies in locating the debris and determining the affected side, which are prerequisites for effective therapeutic maneuvers. The present study describes the main diagnostic and therapeutic techniques for lateral semicircular canal lithiasis.

Aim: The ABR (auditory brainstem response) and ASSR (auditory steady-state response) electrophysiological tests are fundamental for accurate early diagnosis of hearing loss in young children, and are included in objective hearing assessment, particularly in neonatal post-screening. The main aim of the present study was to compare hearing thresholds obtained by ASSR, ABR and behavioral audiometry at different frequencies. The secondary aims were to compare these in the severe to profound hearing loss group, and to determine the sensitivity and specificity of ASSR and ABR in the diagnosis of hearing loss in young children so as to improve diagnostic strategy.

Material and methods: A retrospective observational study was carried out between January 2017 and June 2020, following STROBE guidelines. Data from 112 children (218 ears) aged 2 months to 4 years tested by ASSR, ABR and behavioral audiometry were analyzed.

Results: Hearing thresholds were comparable between ABR and ASSR, including in the severe to profound deafness group. Sensitivity and specificity of ASSR were 0.922 and 0.892 respectively, and for ABR 0.907 and 0.730.

Conclusion: In most cases, hearing thresholds were comparable between ASSR and ABR, and especially in the severe to profound deafness group. ASSRs are now part of the systematic diagnostic work-up, providing information complementary to ABR. The accuracy of the ASSR test has been improved by incorporating corrective factors from pediatric databases. Considering children's limited sleep time, the excellent correlation between ABR and ASSR at 2000-4000Hz suggests that assessment should begin with ABR and continue with ASSR at 1000 then 500Hz in order to broaden the frequency range studied. Diagnosis of moderate hearing loss remains a challenge, with high rates of improvement and loss to follow-up; incorporating bone-conduction ASSR or ABR could facilitate management by rapidly ruling out any additional conduction factor.

Introduction: Sclerotherapy is one of the treatment modalities for macrocystic lymphatic malformations. Nerve complications related to the toxicity of the sclerosing agent have already been described. We report the first known case of bilateral hypoglossal nerve palsy following ethanol sclerotherapy.

Case summary: An 11-year-old boy underwent ethanol sclerotherapy for a monocystic lymphatic malformation of the floor of the mouth. He presented with bilateral paralysis of the XII cranial nerves postoperatively, which fortunately resolved within approximately 5 months.

Discussion: The potential side effects associated with the diffusion of the sclerosing agent must be anticipated even beyond the predictable anatomical limits. Paralysis related to local ethanol toxicity is reversible in most cases.