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

Introduction: Progressive anosmia, unlike sudden-onset viral or traumatic anosmia, requires endoscopic screening for nasal polyps. In the absence of polyposis, radiological work-up should diagnose and treat any curable pathology. Here, we report the case of a patient treated for olfactory cleft actinomycosis.

Results: A 72 year-old man, without relevant medical history, was referred for progressive hyposmia and unilateral greenish rhinorrhea resistant to well-conducted medical treatment. Nasal endoscopy and imaging suggested a fungus ball in the left olfactory cleft. Endoscopic surgery fully restored olfaction, with histologic confirmation of actinomycetes.

Discussion: The present case highlights the importance of prompt diagnosis in progressive anosmia, and demonstrates the efficacy of exclusively surgical management.

Retrograde cricopharyngeal dysfunction (RCPD) syndrome renders patients unable to belch, causing disabling symptoms that impact quality of life. Injection of botulinum toxin into the cricopharyngeal muscle has been reported as a trial treatment for both therapeutic and diagnostic purposes. We describe the injection technique, under general anesthesia using endoscopy or by transcutaneous injection with electromyographic control.

Case description: A 70 year-old woman presenting T4aN2cM0 laryngeal carcinoma first underwent total laryngectomy with airway reconstruction by cryopreserved aortic allograft. Six months after chemoradiotherapy, she underwent endoscopic surgery to create a neo-laryngopharynx.

Results: At 13 months after primary surgery, day- and night-time breathing was effectively restored, with a little persistent salivary false passage, and a whispering but comprehensible voice after tracheostomy closure. Swallowing was possible for small amounts of soft food, thanks to sustained rehabilitation, although normal feeding was not achieved. The patient showed no episodes of pneumopathy. General health status was good, with no oncologic relapse.

Discussion: This was the first case of laryngeal replacement by cryopreserved aortic allograft, showing progress in the decades-long aim of final tracheostomy closure. The ultimate objective is to achieve swallowing without false passage, by improving various aspects of surgical technique,without, so far as possible, making the procedures more complex by active airway protection systems.

Introduction: To document through a case report the ENT manifestations of the STING-associated vasculopathy with onset in infancy (SAVI) syndrome, remarking their value to achieve the diagnosis.

Case summary: A man in his forties presented with exercise-related dyspnoea and cold-exacerbated painful lesions over the nasal tip, cheeks, ears, and feet since his early childhood. The ENT manifestations included cartilaginous necrosis (both auricles and nasal tip) and a 1-cm anterior septal perforation. A familiar inheritance pattern was evident and genetic studies confirmed the diagnosis of a SAVI syndrome. Therapy with JAK inhibitors was implemented, resulting in a favorable response.

Discussion: SAVI syndrome is a recently described disease with recognizable otolaryngologic manifestations that may be key to clinical suspicion and genetic diagnosis.

Aim: To evaluate the audiometric results of tympanoplasty with stapedectomy and insertion of a synthetic total ossicular replacement prosthesis (TORP).

Material and methods: Retrospective observational study conducted on a cohort of 15 patients (16 ears) aged 10 to 58 years (mean: 36 years) with chronic otitis media (COM) and tympanosclerosis (n=9), stapediovestibular ankylosis (n=3), minor aplasia (n=3) or post-traumatic ossicular dislocation (n=1). Treatment consisted in tympanoplasty with stapedectomy and TORP placement by the same operator, between December 1, 2012 and January 30, 2023, in a French university hospital department, with follow-up ranging from 2 to 92 months (mean: 24 months). The primary endpoint was postoperative change in air conduction (AC) threshold and air-bone gap (ABG). Secondary endpoints comprised change in speech recognition threshold (SRT) and speech discrimination score (SDS) and analysis of complications. The STROBE editorial line was followed and the significance threshold was set at P<0.005.

Results: There was significant improvement in AC threshold (-2 to 25dB, mean: 10dB; P=0.001), ABG (-8 to 26dB, mean: 10dB), SRT (2 to 30dB, mean: 13dB; P<0.0001) and SDS (P=0.001). No patients showed vestibular symptoms postoperatively.

Conclusion: This study suggests that this technique is a possible and safe therapeutic option in selected cases of stapes footplate fixation associated with other ossicular anomalies.