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

Aim: The main aim of this study was to evaluate 6-month closure success in surgery for isolated or non-isolated temporal bone osteomeningeal breach (OMB). Secondary objectives were to analyze complications of closure and correlations between success and breach, treatment and patient data.

Material and method: This was a single-center retrospective observational study of patients who underwent surgery for temporal bone OMB via a middle cranial fossa or transmastoid approach in a French university teaching hospital between 2007 and 2022, with follow-up of at least 6months. Patients with superior semicircular canal dehiscence were excluded. Study data comprised gender, age, body mass index, OMB etiology, mode of discovery, audiometric and radiological data, surgical technique, length of hospital stay and postoperative complications. The primary endpoint was absence of a cerebrospinal fluid leak on MRI at 6months. Fisher's exact test or Chi² test were used for qualitative data and Student t-test for quantitative data.

Results: The closure success rate was 87%: 81% (3 recurrences) in the middle cranial fossa group of 16 patients and 93% in the transmastoid group of 14 patients. Postoperative audiometry showed significant improvement (P=0.0016) for air conduction in the middle cranial fossa group. Five patients (17%) operated on via the middle cranial fossa approach and 1 (7%) operated on via the transmastoid approach had postoperative complications. OMB was in the tegmen mastoideum in 8 patients (29%), tegmen tympani in 7 (25%), tegmen antri in 4 (14%), tegmina antri and tympani in 3 (11%), antri and mastoideum in 1 (8%) and in the whole tegmen in 5 (18%). Eleven OMBs were lateral to the superior semicircular canal, 13 medial and 4 on either side.

Conclusion: The transmastoid approach is indicated in case of associated middle-ear procedures, patients aged over 75years or OMB lateral to the superior semicircular canal. The middle cranial fossa approach is reserved for OMB located medial to the superior semicircular canal patients under 75years of age without associated ossicular procedures. For patients with OMB medial to the superior semicircular canal who require middle-ear surgery, a combined approach can be used.

Introduction: Flight staff are at particular risk of iterative sinus barotrauma. We here report a case of barotraumatic atelectasic frontal sinusitis with dynamic radiologic change in frontal sinus volume.

Case report: A 46-year-old air pilot was referred for right frontal pain occurring at each landing. Two sinus CT scans were taken: one after a period of intense flying and the other after a month without flying. In the right frontal sinus, a type-3 Kuhn cell changed in volume from 6×11×12mm to 13×18×19mm. The alteration involved a modification in the medial wall, which was demineralized and changed position within the frontal sinus. Removal during endoscopic frontal sinusotomy allowed complete resolution of pain.

Discussion: This article reports radiologic change in a frontal sinus wall in a setting of repeated barotraumatic frontal sinusitis with a dynamic atelectasic component. In iterative barotrauma, we advocate imaging at different time points. When the ostial obstruction is identified, functional aeration surgery can be applied.

The main goal for treatment of locally advanced thyroid carcinoma invading the laryngotracheal and esophageal complex, is radical surgical excision and reconstruction of a functional aerodigestive tract. We describe a challenging surgical technique in which a wide laryngotracheal and esophageal defect was functionally reconstructed using a single anterolateral thigh flap. This can represent a good option for a tailored functional reconstruction of extended defects of the aerodigestive tract.

Aims: To determine the optimal stimulation intensity for frontal stimulation with a modified slit lamp holder and to compare the reliability and symmetry of bone-conducted ocular vestibular evoked myogenic potentials (oVEMPs) using two stimulation sites: frontal medial and mastoid.

Methods: This observational study included 33 healthy volunteers (15 women, 18 men; mean age 24.5years) at the University Hospital of Lausanne. Participants underwent otoneurological assessments, and those with normal results were included. Bone-conducted oVEMPs were recorded using a Brüel and Kjaer mini-shaker type 4810. A modified slit lamp holder was used for frontal stimulation to ensure consistent application pressure, freeing the examiner's hands. Mastoid stimulation was performed manually.

Results: The best reproducibility of oVEMP recordings was observed at 70dB nHL. Frontal stimulation demonstrated lower dispersion of data and lower asymmetry ratios of latencies (up to 7%) and amplitudes (up to 50%) compared to mastoid stimulation (up to 40% for latencies). Single stimulations at both frontal and mastoid sites were sufficient to obtain reliable measurements of both utricles.

Conclusion: Frontal stimulation at 70dB nHL using a modified slit lamp holder is recommended for bone-conducted oVEMP recordings due to its superior reproducibility, comfort, and reliability. This study establishes a new standard for optimal stimulation intensity and supports the use of frontal stimulation in clinical practice.

Objectives: To document conservative laryngeal treatment for cT12N0M0 glottic squamous cell carcinoma (SCC) in octogenarians in France in the 21st century.

Material and methods: Retrospective observational study comparing a cohort of 38 octogenarians (Group A) to a control cohort of 107 septuagenarians (Group B), with isolated cT12N0M0 glottic SCC, consecutively managed between 2000 and 2018 at a single French university hospital center. The main endpoints were 5-year actuarial overall and disease-free survival and causes of death, compared between groups. Accessory endpoints were 5-year actuarial local control and laryngeal preservation. 93% of patients were followed until death or for a minimum 5years. The STROBE guideline was used. The significance threshold was set at P<0.005.

Results: The only significant difference in demographic, oncologic and treatment variables between groups was a higher mean Charlson index in Group A (P=0.004). Five-year actuarial survival, at 79% overall, did not significantly differ between groups A and B (80% and 79%, respectively; P=0.30). Five-year actuarial disease-free survival, at 74% overall, did not significantly differ between groups (77% and 73%; P=0.42). Intercurrent disease accounted for 44% of causes of death, with cardiovascular etiology in 71% of cases. Five-year actuarial local control, at 76% overall, did not significantly differ between groups (80% and 75%; P=0.41). Salvage treatment for local recurrence yielded a 94% overall local control rate: 98% in Group A and 93% in Group B. Five-year actuarial laryngeal preservation rate, at 92%, did not significantly differ between groups (90% and 98%; P=0.20).

Conclusion: Conservative laryngeal treatment for cT12N0M0 SCC in octogenarians yielded the same results as in septuagenarians. Improvement in survival will depend on management and monitoring of comorbidity, and particularly cardiovascular comorbidity.

Drug-induced sleep endoscopy (DISE), performed in the operating room, improves airway obstruction phenotyping in obstructive sleep apnea syndrome (OSAS). It pharmacologically approximates human sleep and allows dynamic maneuvers, notably including mandibular advancement, the results of which are predictive of those with a mandibular advancement device (MAD): when obstruction is resolved by mandibular advancement under DISE, a MAD may be indicated. However, individual maximal mandibular advancement in the waking state has to be taken into account, and the MAD should not exceed 75% of this value (MA75), in order to respect temporomandibular joint tolerance. Thus, MA75 needs to be measured and reproduced exactly during DISE in order to assess the clinical indication for MAD in terms of both efficacy and tolerance. The present technical note describes a method for measuring MA75 and reproducing it during DISE with an adapted device so as to select candidates for MAD.