Otorhinolaryngology, Head and Neck Diseases

Prestin autoantibodies screening in idiopathic sudden sensorineural hearing loss Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): H. Tovi, H. Ovadia, R. Eliashar, M.A. de Jong, M. Gross Abstract Objectives To define the clinical association of serum prestin autoantibodies and their impact on prognosis, as specific serum diagnostic markers in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Design Sera from 63 patients with ISSNHL were screened prospectively for the presence of prestin autoantibodies by an enzyme-linked immunosorbent assay (Elisa) test. Serum was assayed for anti-prestin IgG antibodies using recombinant human prestin (SLC26 A5). Demographic, clinical, and audiometric variables were analyzed. Results Two patients (3.17%) had demonstrable anti-prestin antibodies in serum (exact 95% CI: −1.16% to 7.5%). No statistically significant association was found between prestin autoantibodies and demographic or audiologic parameters. Conclusions This preliminary and novel study does not support the presence of an active humoral immune reaction against prestin in ISSNHL.

A submucosal tumor at the base of the tongue Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): A. Ko, C.L. Hyun, G.C. Lim

Endoscopic transnasal transseptal pituitary surgery Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): V. Favier, J. Boetto, C. Cartier, F. Segnarbieux, L. Crampette Abstract Pituitary surgery is performed via a transsphenoidal approach in the vast majority of cases according to various methods that have changed over the years. A microscopic transseptal approach via a sublabial mucosal incision or a nasal mucosal incision has also been extensively used. An endoscopic transnasal approach was first described in the 1990's, followed by the concept of a microscopic transseptal approach and an endoscopic strictly endonasal approach. We use an entirely endoscopic transseptal transsphenoidal approach via an incision in the nasal mucosa for both access and tumour resection. This procedure has a number of advantages: strictly midline approach to the sella turcica, large operative field, no interference between instruments and a low rate of nasal complications.

Symptomatic head and neck lipomas Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): Y. Najaf, C. Cartier, V. Favier, R. Garrel Abstract Introduction Lipomas are very common benign lumps that could be encountered in any part of the body but with limited proportion being present in the head and neck region. Case summary In this article, three different cases of symptomatic cervical lipomas were illustrated, with their different diagnostic as well as therapeutic approaches and will be discussed in light of medical literature. Discussion These cervical tumors tend to grow slowly giving variable signs that include dysphagia, dyspnea, dysphonia due to the mass effect of surrounding structures or can be present as simple as a cosmetic concern. Clinicians must bear in mind the malignant transformation of lipomas, which can be challenging to diagnose. With this article, authors will try to highlight the importance of maintaining a good communication between surgeons, pathologists and radiologists as an essential part of the medical management.

Hypertrophic recurring lichen planus of the external auditory canal Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): A. Košec, M. Kostić, J. Ajduk, M. Ries Abstract Introduction We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss. Case summary A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically. Discussion Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure.

Scedosporium apiospermum invasive sinusitis presenting as extradural abscess Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): N. Khoueir, B. Verillaud, P. Herman Abstract Introduction Chronic invasive fungal rhinosinusitis (CIFR) is a rare entity generally observed in immunodepressed subjects. The pathogen most frequently identified is Aspergillus spp. Imaging generally reveals invasive pseudoneoplastic features. We report a case of Scedosporium apiospermum (S. apiospermum) CIFR with an atypical clinical and radiological presentation. Case report A 72-year-old immunocompetent man presented with chronic headache, neck pain and bilateral limitation of lateral gaze. Imaging revealed an isolated left sphenoidal lesion with marked bone changes and an extradural abscess over the clivus. Large endoscopic sphenoidotomy with type II rhinopharyngectomy was performed and the diagnosis of S. apiospermum CIFR was based on histological examination and fungal culture. The patient refused all medical treatment and did not present any signs of recurrence after 1 year of follow-up. Discussion S. apiospermum is a fungal species rarely isolated in CIFR. The present case was revealed by an atypical clinical presentation including isolated sphenoidal infection complicated by bilateral abducens nerve paralysis and extradural abscess. Imaging was also unusual, revealing features of fibrous dysplasia or bacterial osteomyelitis rather than the typical pseudoneoplastic appearance. The patient was successfully treated by surgery alone, which may therefore be sufficient treatment in immunocompetent subjects.

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): H. Álvarez-Neri, P. Villamor, E. Ortiz Hernandez, J. Penchyna Grub Abstract Introduction Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall. Case summary We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event. Discussion Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.

MERRF syndrome (Myoclonic Epilepsy with Ragged Red Fibres) presenting with cervicothoracic lipomatosis Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): F. Carré, R. Hervochon, C. Foirest, F. Tankéré Abstract Introduction Patients with MERRF syndrome (Myoclonic Epilepsy with Ragged Red Fibres) usually present with encephalomyopathy. However, progressive, recurrent cervicothoracic lipomatosis may be rarely observed. Case report The authors report 4 cases of MERRF syndrome associated with lipomatosis. In 3 patients, the diagnosis of MERRF syndrome was established on the basis of the clinical features of the lipomas and clinical interview revealing a personal or family history of lipomas and myopathy. Discussion In the presence of extensive spinal lipomatosis, the presence of other clinical signs of MERRF syndrome in the patient or the patient's family must be investigated. A diagnosis of MERRF syndrome can guide appropriate genetic counselling.

Guidelines (short version) of the French Society of Otorhinolaryngology (SFORL) on cervical lymphatic malformation in adults and children: Diagnosis Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): J. Lerat, A. Bisdorff-Bresson, M. Borsic, C. Chopinet, V. Couloignier, N. Fakhry, P. Fayoux, F. Jegoux, A. Larralde, N. Leboulanger, R. Nicollas, S. Pondaven Letourmy, SFORL work group Abstract Objectives The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for the diagnosis of cervical lymphatic malformation in adults and children. Methods A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group, and finalized in a coordination meeting. Guidelines were graded A, B, C or expert opinion, by decreasing level of evidence. Results The SFORL recommends that complete ENT examination should be performed to identify lesions at high risk of complication or associated with poor prognosis. In case of diagnostic doubt, especially in latero-cervical or oral floor lesions, fine-needle aspiration cytology should be performed before therapeutic decision-making. One or more validated classifications should be used to assess treatment efficacy and monitor progression. The reliability of antenatal diagnosis should be ensured by associating MRI to ultrasound. In antenatal diagnosis, the locoregional extension of the cervical lymphatic malformation should be evaluated accurately for prognosis, and associated malformations should be screened for, to guide treatment options.

Regulatory aspects of prospective and retrospective clinical research in France in 2018 Publication date: April 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 2 Author(s): P. Gorphe, C. Jannin Abstract In France, the so-called "Jardé law" (named for its proposer) on human research, implemented since 2016, defines the regulatory and legal framework for "prospective" studies, formerly known as "biomedical research" or "common care". Three categories are distinguished: type 1 is at-risk drug or non-drug interventional research, type 2 is low-risk, low-burden interventional research, and type 3 is non-interventional research. The decrees of April 12, 2018 precisely define a list of research categories for types 2 and 3, thereby clarifying the regulatory procedures. The Sponsor registers the trial on the database of the National Drug Safety Agency (ANSM), or the European EudraCT database for drug studies, to obtain an identification number. Regulatory procedures are undertaken with the IRB and ANSM and then the Data Protection Commission (CNIL). Retrospective research on previously collected data (other than genetic) does not come under the Jardé law, and is governed by the 1978 data protection law, updated by the application decree of December 2016 and the law No. 2018-493 of June 20, 2018 on protection of personal data. This article presents a clarification of the key methodologic and regulatory steps.