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

Postoperative monitoring of free flaps has traditionally been based on clinical assessment, interpretation of which may be subjective. The Cook-Swartz implantable Doppler probe enables continuous objective real-time monitoring of blood flow at microvascular anastomoses. We report our experience with a cohort of 181 consecutive patients operated on between 2019 and 2025. Arterial placement of the probe was preferred after an initial experience of venous monitoring, and provided a clear and easily interpretable signal. The device demonstrated excellent diagnostic accuracy, with a positive predictive value of 100% for the detection of vascular anomalies. However, early detection does not always guarantee flap salvage. Clinical examination remains indispensable, particularly for detecting venous thromboses that may be overlooked on arterial monitoring alone. The Cook-Swartz implantable Doppler system is a reliable easy-to-use adjunct to clinical monitoring of free flaps in head and neck reconstruction.

The present cross-sectional study compared efficacy between two quality-of-life questionnaires for cochlear implanted children: CIQOL-10 Global and PEACH. Forty cochlear implanted children, aged 18 months to 15 years, were included over a 3-month period. Children not wearing the implant, from non-French-speaking families, with psychomotor retardation or neurologic deficit were excluded. Ease of filling out the questionnaires and their relevance were assessed on Visual Analog Scales. The aim was to select the questionnaire better adapted to an implanted pediatric population. PEACH scored significantly better than CIQOL for ease of use and relevance, particularly for under-6 year-olds. On average, 3 of the 10 CIQOL questions went unanswered for children aged≤6 years, versus just 1 out of 13 for PEACH. PEACH, being easier to answer and more relevant, particularly for younger children, can optimize follow-up of cochlear implanted children.

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: 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.

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.

Subglottic stenosis is a rare but potentially life-threatening condition in pediatric patients. We report the case of a 13-year-old male with a history of neonatal hypoxia, prolonged intubation, and multiple failed airway surgeries, presenting with a Myer-Cotton grade IV subglottic stenosis. Imaging and endoscopic evaluation revealed complete subglottic obstruction, absence of the anterolateral cricoid arch, and preoperative apparent absence of either vocal folds. A complex laryngotracheal reconstruction was performed, involving complete laryngofissure, placement of a posterior costal graft, and a horizontally oriented anterior costal graft to address the extensive anterolateral cricoid defect. Additionally, absorbable pediatric osteosynthesis plates were used in a novel fashion to stabilize the lateral laryngeal walls, providing structural support without permanent materials. Postoperative evolution was favorable, with airway patency and spontaneous ventilation achieved through a Montgomery T-tube. This case illustrates the importance of individualized surgical strategies in managing severe airway stenosis and proposes a novel combination of reconstructive techniques for complex pediatric cases with extensive laryngeal deformities.