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Angio-immunoblastic lymphadenopathy is a recently demarcated clinico-anatomical entity. A new case underlines the importance of this lesion in E.N.T. The lesion often progresses like a neoplasm, even though the clinical, biochemical and histological features make one consider it today to be an expression of an immune disorder. Nevertheless, the relationship with malignant lymphoma is discussed and the histological arguments which show an association or an evolution towards malignancy are exposed. The difficulties of treatment are particularly underlined on the basis of this ambivalence; and especially on the basis of the dilemma posed by the necessity for an effective therapy, justified by the invasive and extensive nature of the lesion, and the risks represented by the use of chemotherapy in a patient whose immunity is already disturbed. A statistical analysis of the therapeutic results, from data collected from the literature, illustrates this difficulty but does not allow a universally acceptable attitude to be defined.

Oro-genital and oro-anal practices have nowadays extended to the mouth the scope of clinical signs of previously pure venereal diseases. Through the description of the clinical oro-pharyngeal manifestations of these diseases, this paper is intended only to stress the possibilities nowadays of these diagnoses. Described in this paper are the traumas, and bacterial, viral and mycotic infections that may now affect the mouth after sexual practice.

Evaluation of pain in otolaryngology diseases is indispensable in treating patients. Parallel to the etiological diagnosis of otolaryngology disease, a clinical diagnosis of the pain must be made to determine the weighting of the three causes of pain involved in any acute or chronic condition: the component of nociceptive, neurogenic, and psychofunctional pain. This paper will discuss how pain can be quantified and qualified, and how to identify the status of the neurological system of perception and control of the pain process.

Otoacoustic emissions (OAEs), discovered in 1978, have a well-established cochlear origin. They strongly depend on the outer hair cells and are widely used in experimental research as a means for testing cochlear function. However, outside screening, OAEs are only rarely used in clinical practice. The objective of this paper was to show their vast clinical utility.First, a review of the biophysical and physiological knowledge on OAEs is provided, concerning transient OAEs as well as distortion-product OAEs, recalling the origin and the meanings of these acoustic signals. Several clinical situations are then presented, and the corresponding OAE alterations are explained, such as hearing screening in neonates, diagnosis of hearing impairment with particularities related to the age of the patient, situations critical to the cochlea such as ototoxic treatments, and surgical procedures to the cerebellopontine angle.OAEs appear to be a powerful tool in clinical practice, particularly in hearing screening and diagnosis of deafness. They can also be used to monitor hearing function during cerebellopontine angle tumor resection.OAEs are still rarely used as a diagnostic tool by clinicians despite their clinical value, which should make them a primary choice.

Tinnitus is a common otologic symptom but, despite important advances in the evaluation and management of such symptom, ENTs often fail to address tinnitus properly. Some tinnitus patients report that tinnitus interferes with activities of daily living, such as reading, social interactions, sleep, concentrating on complex tasks. Anxiety and depression are current major disorders associated with tinnitus. Many theories exist regarding mechanisms of tinnitus origin. A number of publications favors the theory of discordant dysfunction of inner or outer hair cells of the organ of Corti. Nevertheless, some authors insist on the possible role of the central auditory pathways. Multiple functional connections between auditory system, limbic system, autonomic nervous system seem crucial in the development of tinnitus. The aim of this paper is to present a new approach in France of tinnitus treatment by cognitive-behavioral therapy (CBT).96 patients with chronic and intense tinnitus were included in the study (38 females, 36 males, mean age 48 years). A CBT was developed after a clinical evaluation based on standardized questionnaires.The two main results are: (i) the importance of anxiety and depression in this population, (ii) the amelioration of tinnitus perception in 750f the included patients.CBT shows promise as a treatment of tinnitus-related distress.

The pattern of neuroma growth is of great importance in choosing the appropriate management. This paper tests the clinical impact of tumor growth rate assessed by volumetry. There is a conviction that some slowly growing tumors could be observed for many years.Volume measurements were performed on T1- weighted MR images (spin echo sequences) after injection of gadolinium using a special dedicated software. The studied group included 17 patients in whom at least two MRI examinations were carried out and tumor growth was confirmed. The intervals between initial and the first follow-up examination were 14.2 months on the average. In 7 cases tumor evolution was observed in 2 periods (3 MRI studies) and in 4 cases in 3 periods (4 MRI studies).The growth rate depended on tumors volume and clinical stage (P0.01). Small tumors can be observed more safely than advanced tumors because their increase in mass is lower.The observation with the tumoral volume measurements appears to be a useful and accurate tool to estimate the tumor growth rate. The growth rate is a major factor for choosing the appropriate management.

Nasal polyposis (NP) is considered as an inflammatory disease for which first line therapy is topical and/or oral corticosteroid. In this paper we attempted to determine the efficacy of endoscopic endonasal surgery followed by topical corticoid in 72 adults suffering from bilateral NP refractory to corticosteroid therapy and to delineate the clinical characteristics of this cohort of patients. NP was confirmed endoscopically and with computed tomography. Visual analog scale for the subjective evaluation and endoscopic examination of the paranasal cavities for the objective evaluation were obtained 3 and 12 months postoperatively. Endoscopic endonasal surgery was based on a radical removal of the NP with wide opening of all the sinuses in the vast majority of the cases. Topical corticoid therapy was started 2 months after surgery. Clinical characteristics of the 72 patients revealed: 29.2% of coexisting allergy; 34.7% of coexisting asthma; 19.4% with food and/or aspirin intolerance. Anterior and posterior ethmoid sinus and maxillary sinus were the most affected sinuses. 53.5% of our patients presented a stage II. One year after surgery we observed that 59.1% of our patients revealed a marked decrease of their symptoms with no polyp on nasal endoscopic evaluation, that 28.8% revealed a marked decrease of their symptoms with recurrence of the NP on nasal endoscopic evaluation and that 12.1% presented moderate to severe symptoms with recurrence of NP on nasal endoscopic evaluation. Based on this experience, we think that endoscopic endonasal surgery will continue to play an important role in the management of NP when the patient becomes refractory to corticoid.

Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripharyngeal obstacles, excessive pharyngeal wall compliance and upper airway dilator muscle dysfunction. The intent of this paper is to provide an overview of the anatomy, histology, physiology and pathophysiology of the upper airway dilator muscles based on previously published articles. The upper airway dilator muscles can be separated in three different systems, main and accessory dilators, local and regional. They act in synergy. Their contraction occurs at the beginning of inspiration, thus maintaining opened the pharyngeal lumen through inspiration. Their action is modulated by several chemo or physical stimuli. In some apneic patients, these muscles demonstrate a dysfunction: hyperactivity during wakefulness, electromyogram wave amplitude reduced, delayed contraction during sleep and abnormal response to stimuli. This dysfunction might be due to neuromuscular histological abnormalities, a "fatigue" phenomenon or a central nervous command abnormality. Current explorations underlining an upper airway dilator muscle dysfunction will enable practitioners to decide which treatment is best and understand therapeutical failures; it will also help develop new therapeutical techniques such as functional electrical stimulation of the hypoglossal nerve/upper airway dilator muscles.

After the discovery of streptomycin 1944, laryngeal tuberculosis became a rare complication of advanced pulmonary tuberculosis. Since that time the clinical aspects of the disease have changed. We analyzed these changes by reviewing 65 papers in English and in French published from 1965 to 1991 involving 738 cases and added our 4 new personal cases. To our knowledge, we report the first two well-documented cases of laryngeal tuberculosis in HIV positive patients. We propose a therapeutic and follow-up protocol for laryngeal and chest specialists treating such patients.

Distortion-product otoacoustic emissions are otoacoustic emissions evoked by two pure tones called primaries and proposed in order to provide a frequency specific investigation of the cochlea. This paper first reports complete input-output functions of distortion-product otoacoustic emissions for conventional audiometric frequencies in a population of 35 neonates without any risk for cochlear function. Distortion-product otoacoustic emissions could be useful, in association with evoked otoacoustic emissions and comportemental audiometry, to precisely evaluate the peripheral auditory system in infants and neonates.

The CO2 laser is being used in several department for primary treatment of limited vocal cord carcinoma. The surgical resection is not the same in several department. One speaks of vaporisation, laser excision, cordectomy, deep cordectomy. The purpose of this paper is to definitive 3 types of laser surgery for glottic cancer = partial cordectomy, cordectomy with exposition, enlarged cordectomy. This classification allow to know with precision the importance of the surgical resection in each case.

The editorial aspect of scientific writing cannot be dissociated from the scientific message it carries. Precision, clearness and conciseness are qualities which express the level of rigour reached in the scientific work presented. By gaining knowledge of the universally accepted rules for medical writing, and abiding by them, authors can expect optimal diffusion of the scientific content and facilitate reader comprehension. This paper outlines the precise rules common to all scientific articles and gives details on the elements on which a biomedical journal bases its decision on whether or not to publish the results of the author's work.

This paper reports our experience about intraoperative facial nerve monitoring carried out in 97 patients operated on by a retrosigmoid approach. Intra-operative facial nerve monitoring was performed using a pneumatic sensor which transforms into acoustic signals contractions of facial muscles elicited by mechanical, electrical or thermal stimulations of facial nerve. Long term results showed that a normal facial function (grade I) was achieved in 90.5% of patients, 4 patients were grade II, 2 patients grade III, a total paralysis (grades V and VI) was persistent in 3 patients. Our experience with facial nerve monitoring suggests a modification of the strategy of dissection based upon a preservation of the arachnoid veil and a medial to lateral direction of dissection.

The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described since 1948). As a clinical expression of sarcoidosis, deafness is fluctuant in 50% of all cases, bilateral, and most often associated with facial palsy and uveitis, the vestibular reflexes being reduced. The histological studies demonstrate lesions at all levels from the cochlea to be brain stem, but the main mechanism is an infiltration of the arachnoid vessels. The prognosis of sarcoidosis deafness is usually poor in spite of corticosteroid therapy. This paper is illustrated by 3 cases observed in Avicenne Hospital.

Differentiated carcinoma of the thyroid may generate bone or lung metastases. Some times, thyroid cancer remains latent, and is revealed by the presence of secondary bone tumors. In the present paper, we relate our personal experiences with two patients who had thyroid cancer diagnosed indirectly through the occurrence of distant metastases. The secondary tumors were localized in the right frontal sinus and the cranial vault, respectively. We discuss the diagnostic and therapeutic problems involved with such metastases. We further present a review of the literature dealing with this topic.

Diseases of cranial nerves are very seldom associated with multiple myeloma. However, their occurrence as a harbinger of multiple myeloma seems to bear a particular significance and is worth mentioning. In the present paper, we discuss two cases in which disorders of cranial nerves heralded Kahler's disease. The patients presented with posterior laterocondylar space and cochleovestibular (otoliquorrhea) syndromes, respectively. We stress the diagnostic problems involved and analyze the pathogenesis of diseases of the nervous system associated with multiple myeloma. Diseases of cranial nerves are seldom associated with multiple myeloma. Nonetheless, the clinical setting and laboratory tests will direct the diagnosis. The same does not hold true when one is confronted with Collet-Sicard's syndrome or cochleovestibular syndrome accompanied by otoliquorrhea.

Vertigo is the predominant symptom in labyrinthine dysfunction, and is characterized by an unpleasant modification of the sense of static or dynamic orientation. In order to arrive at a correct clinical interpretation of this symptom and to administer the appropriate treatment, both its etiology and the underlying physiopathological mechanisms need be specified. In the present paper, we shall review a few qualitative concepts, which seem interesting to us and namely concern, on the one hand, the physiopathological mechanisms of vertigo and, on the other hand, the basic principles of the function of peripheral receptors bearing some etiological significance.

Auricular accidents provoqued by lightning and induced by telephone are extremely rare. The authors of this paper relate the case of a young lady suffering from an inflammation of the external auditive canal and of an irritation of the tympanic membrane with an perception's hypacusis of 30 db. A physiological explanation is proposed and two factors come into account:--The acoustic traumatism induced by the thunder;--The burn produced by the electrical current.

The authors report two cases of complete ophthalmoplegia occurring during surgical section of the homolateral vidian nerve for chronic nasal obstruction due in one case to hypertrophic rhinitis and in the other to nasal polyposis. In both cases, whilst there was more or less complete regression of the oculomotor paralyses, unilateral amaurosis persisted as a permanent sequela. This paper is published with the aim of drawing attention to the possibility of complications which are out of proportion with the initial symptomatic discomfort and which may occur whatever the surgical approach used since one of the operations was performed via a pure endonasal approach whilst the other was transmaxillary. In both cases there was no damage to the orbit during surgery and the most likely pathogenesis would appear to be a reflex aciton.

Even if Wegener's disease is a rare condition, it interests many authors. Many recent reports had contributed to a best knowledge of the disease. Nevertheless, it persists a number of questions without yet an answer. In this paper, for example, we present a case of Wegener's granulomatosis, which mimics in the beginning the so-called "lethal midline granuloma", with progressive ulceration of the midfacial tissues and nose. It was highly suspected of being stewart's syndrome--Repeated biopsies gave no evidence of diagnosis. At least, the diagnosis was affirmed only by laparotomy. Pathological findings were typical of Wegener's granulomatosis with lesions interesting the sole digestive tract, lacking the characteristical chest and kidney involvement. The authors insist on the difficulties of the diagnosis, the etiologic considerations, and a better definition and classification of the affection.

Two further cases of a meningioma of the ear simulating a glomus tumor are reported, pathological features in the first case leading to intensive discussion. Two such cases had been previously described in great detail in a paper published in 1977. In those patients, the differential diagnosis froma jugular glomus tumor was only established two and a half years later in one case, when excision was necessary because of an intracranial recurrence, and following-re-examination of all sections of jugular glomus tumors previously operated upon, in the other case. Factors enabling detection of meningiomas simulating glomus tumors were also discussed in the original report. Theses included discordance of clinical finding, -minimal signs on arteriography, -the primordial value of contrast computed tomography, -systematic alerting of the pathologist.

The choice of a therapeutic strategy for the treatment of mucosal malignant melanomas from upper digestive and respiratory tracts remains difficult. This is due to the very low frequency of such malignancies and to the subsequent scarcity of data on parameters of diagnosis and prognosis. Such informations have been available on cutaneous malignant melanoma as they have been known for a longtime and occur with much higher frequency. Parameters of diagnosis and prognosis have been determined from randomised clinical traits. Based on such parameters a more efficient therapeutic strategy can be applied to the various clinical cases. In this paper we review these parameters and in particular those which seem to apply to the mucosal malignant melanomas from upper digestive and respiratory tracts. Finally we report on currently used therapeutic protocols and we present recent data from the literature on adoptive immunotherapy of malignant melanomas in mice.

The Lasthenie de Ferjol Syndrome associates an iron-deficient anemia by blood auto-spoliation with mental disorders. In this paper, the authors present an oropharyngeal form of this disease. Based on this case review (and those reported in the literature), they remind us this syndrome's mains characteristics, underlying how exceptional and particular this clinical report is. At least they point out how to diagnose, manage, and treat patients with this strange illness.

In this work we deal with so called "sudden deafness" of unknown etiology. By careful study of previous work done by different authors the disease seems to be due to vascular disorders. On this basis we tried a polyvalent therapeutic scheme for the treatment of "sudden deafness" the results of which are given in this paper. Emphasis is given to the fact that the earlier the commencement of treatment the better the result.

Surgery for otosclerosis means that the sound protection due to the fixation of the footplate does not exist anymore. As the Corti hair cells have been fragilized by proteolytic enzymes, it is absolutely necessary to reconstruct the sound mechanism in order to maintain the vibration of the perilymph absolutely within acoustical physiologic limit of movement. The means to realize this reconstruction are presented in this paper, as well as the results.

The paper reviews the question of nerve grafts in iatrogenic facial palsies caused lesion of the tympanic or mastoid portion. The approaches used by different specialists are discussed and the controverse on the question is analyzed. The authors present their experience in six cases of successful operations.

Out of 150 rhinoplasties carried out over 3 years in a Surgical Department. 20% of cases had previously undergone one or several surgical procedures. Based on these cases, the authors analysed the principal factors producing failure in cosmetic rhinoplasties and proposed a preventive strategy. The osteocartilaginous dorsum and point of the nose are considered separately in this paper.

Appreciating the difficulties in interpreting tonal audiograms using the classifications previously suggested, the authors, inspired by a paper by Wedenberg, have compared phonetic studies of phonemes and tonal audiograms. By this method they have obtained a simple audiometric pattern indicating both the degree of auditory loss and the rate of the curve. This is of value, from the point of view of classifying audiograms, for deciding on possible hearing-aids and for auditory education.

The authors, going on with their investigations of the otospongiotic micro-foci by means of scanning electron microscopy method, state their discoveries concerning the micro-foci of the footplates vestibular side, left aside too often up to now. On this vestibular side of the footplate, they have managed to find much more numerous pathological alterations than usually admitted. There are three types of lesions: 1. Strongly cellular micro-foci, most of them composed of histiocytes. 2. Fibrous micro-foci, containing numerous fibroblasts and looking like otospongiotic micro-foci of osteoid lamellae overhanging the tympanic side of the footplate and grasping it in the way of a lobster-claw. 3. A small number of scattered microlesions, having no relation with the two previous types, and seeming due to numerous initial otospongiotic micro-foci originated from one or several cells with altered metabolism on the footplate' side itself. The localization of these micro-foci of the footplate's vestibular side is extremely interesting for the knowledge of the otospongiotic disease, because they are in direct contact with the vestibule. They can thus spread their hydrolytic enzymes into the labyrinthine fluids as well as the otospongiotic micro-foci of the lateral wall which have been described by the authors in numerous papers.