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

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.

Aim: To determine factors affecting pain on a numeric rating scale (NRS) during office-based voice prothesis exchange. And, secondarily, to review voice prothesis replacement techniques in France.

Material and method: A multicenter prospective observational study was conducted by the Head and Neck Tumor Study Group (GETTEC) between November 2022 and November 2024. A survey questionnaire was filled out by the practitioner after informed consent was obtained from the patient. All laryngectomized patients presenting in consultation for voice prothesis exchange were included. Pain was assessed on a unidimensional 0-10 numeric rating scale.

Results: Three hundred and nine questionnaires were collected. Mean pain rating was 2±2.8. Three factors were associated with significantly lower pain intensity: procedure duration <5minutes (P<0.001), a single attempt (P<0.001), and the status of the practitioner performing the replacement (P=0.002); 2 factors were associated with suggestively lower pain intensity: male gender (P=0.030), and use of a capsule (P=0.011). Pain intensity was not significantly associated with local anesthesia (P=0.4) or the extraction technique (P=0.2). Sixty seven percent of replacements were in emergency contexts, particularly for intra-prosthetic leakage (68%). Local anesthesia was used in 87% of cases. Extraction was by pushing the implant into the esophagus in 52% of cases, and by pulling it out in 48%. Most replacements (75%) required only 1 attempt, and 77% required less than 5minutes (77%). Capsules were used in 23% of cases.

Conclusion: We found a wide range of techniques for replacing a voice prothesis. The procedure is quick and relatively painless. For replacement that is as painless as possible, it is advisable for it to be carried out quickly, using a capsule.

Objectives: To compare early results in isolated ossiculoplasty under potentialized local anesthesia and general anesthesia.

Material and method: A single-center retrospective observational study included 123 consecutive patients treated by isolated ossiculoplasty between September 1, 2019 and March 1, 2021 in a French private hospital. The main aim was to compare the management pathway (operating room time, hospital stay, outpatient management rate, "by-pass" rate of direct return to the outpatient department without passing through the recovery room) according to potentialized local anesthesia versus general anesthesia. Secondary endpoints comprised audiometric results and post- and intraoperative complications (nausea and vomiting, pain, dizziness, crossover). The significance threshold was set at P<0.005. The STROBE guideline was followed.

Results: In total, 123 patients were included: 41 with local and 82 with general anesthesia. The two groups were comparable except for type of surgeon. The rate of outpatient treatment was significantly greater with local anesthesia (93% vs. 55%). Operating time and operating room, recovery room and outpatient room occupancy times were shorter with local anesthesia. Postoperative dizziness was significantly more frequent with general anesthesia. Audiometric results did not differ.

Conclusion: Potentialized local anesthesia can improve organizational management and outpatient rates in ossicular surgery, without impairing the quality of results.