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Half of the patients presenting with head and neck tumor are malnourished at the outset of treatment. Muscle mass loss (sarcopenia) seems to be critical. The aim of the present study was to assess the impact of nutritional status and sarcopenia on postoperative complications in head and neck cancer. A retrospective study for the period November 2014 to May 2016 included 92 patients operated on for head and neck squamous cell carcinoma. Complications at 30 days were graded on the 5-level Clavien-Dindo classification. Nutritional status was assessed anthropometrically (weight), biologically (albuminemia and Nutrition Risk Index (NRI)), on CT (muscle mass index at 3rd lumbar vertebra) and functionally (Short Physical Performance Battery). Assessment was made at the outset of management, and nutritional treatment was initiated as appropriate. Potential risk factors for postoperative complications were assessed: performance status, prior radiation therapy, smoking and alcohol abuse. 54% of patients were malnourished on the NRI. 41% had grade ≥ 2 complications. The most frequent complications were infection and healing disorder. The risk of complications was higher in case of malnutrition (62% vs. 17%; P < 0.001) and sarcopenia (56% vs. 22%; P < 0.01), with 50% longer hospital stay (P = 0.04). Malnutrition and sarcopenia are independent risk factors for postoperative complications. [ABSTRACT FROM AUTHOR]

Functional failure of total ossicular replacement prostheses (TORP) is often due to secondary displacement, ranging from simple subluxation to prosthesis extrusion following recurrence of severe tympanic membrane retraction. Several surgical techniques have been proposed to stabilize a TORP, mostly using superimposed non-organic or resorbable heterologous materials. We describe a simple so-called “tumulus” surgical technique that limits prosthesis displacement and extrusion, regardless of the type of TORP, by using a few fragments of autologous cartilage that are always available and perfectly tolerated at no cost. Review of 31 cases treated by this technique did not reveal any cases of prosthesis displacement and only one case (3.2%) of prosthesis extrusion with audiometric results comparable to the best results reported in the literature. [ABSTRACT FROM AUTHOR]

Objectives The main objective of this retrospective study was to assess functional results in endoscopic Zenker's diverticulum surgery. The secondary objectives were to assess safety, identify recurrence risk factors, and determine optimal management of recurrence. Material and methods From 2000 to 2014, 50 patients underwent endoscopic surgery for marsupialization of Zenker's diverticulum. Regurgitation and dysphagia were assessed on the FOIS scale, pre- and post-operatively. Recurrences and complications rates were determined retrospectively at a minimum 18 months’ follow-up. Results Regurgitation and dysphagia improved in respectively 96% and 86% of patients. There was a 12% rate of complications, mostly minor. Mean hospital stay and time to return to oral feeding were 2.0 and 1.3 days respectively. Nine patients (18%) showed recurrence of symptoms, requiring revision surgery at a mean 2.7 years, performed endoscopically in the majority of cases. Only one recurrence risk factor was identified: small diverticulum size. Conclusion Endoscopic Zenker's diverticulum surgery provided functional improvement in most cases. Safe and effective, it is currently the treatment of choice for Zenker's diverticulum. [ABSTRACT FROM AUTHOR]

Objectives Fibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with café-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome. Methods We report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015. Results Mean age was 43 years (range, 10–72 years). Clinical symptoms comprised headache ( n = 3) and sensorineural disorder: recurrent anterior uveitis ( n = 1), visual acuity loss, epiphora and vestibular syndrome ( n = 1), and hearing loss ( n = 1). All cases were monostotic. The sphenoid bone was most commonly involved ( n = 5), followed by the ethmoid ( n = 1), frontal ( n = 1), fronto-ethmoid ( n = 1), temporal ( n = 1) and fronto-ethmoido-sphenoid ( n = 1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1–6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on. Conclusion Diagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis of small and medium-sized vessels comprising inflammation of the vessel wall and perivascular and extravascular granulomas, frequently presenting in the form of chronic sinusitis. We report the case of a 27-year-old man who presented with very painful acute frontal sinusitis that was managed medically and surgically. The symptoms rapidly recurred despite treatment and CT scan demonstrated diffuse thickening of the sinus mucosa. Anti-proteinase 3 ANCA were positive. Biopsy of a pulmonary nodule confirmed the diagnosis of GPA. The patient was treated with corticosteroids in combination with rituximab, resulting in improvement of the clinical, laboratory and CT signs. In the presence of persistent, acute, localized sinusitis despite appropriate treatment, associated systemic signs and/or the presence of other signs suggestive of GPA, the ENT surgeon must request a targeted work-up. In the absence of treatment, GPA can be fatal within a few months. However, with currently available treatment, remission is obtained in 80% of cases with a 75% 10-year survival rate. [ABSTRACT FROM AUTHOR]

Introduction Sinonasal mucosal melanoma is a rare disease associated with a very poor prognosis. The purpose of this study was to assess the prognostic value of the 2 staging systems published in the literature for these tumours: the American Joint Committee on Cancer (AJCC) Cancer Staging Manual for mucosal melanoma of the head and neck published in 2009 (7th edition) and the AJCC Cancer Staging Manual for cancers of the nasal cavity and paranasal sinuses published in 2002 (6th edition) and the prognostic value of tumour site, either limited to the nasal cavities or with paranasal sinus invasion. Methods A retrospective study was conducted on 18 patients treated between August 1998 and June 2014. Each lesion was staged according to the AJCC Cancer Staging Manual 2002 and 2009 and the following data were collected: age, sex, tumour site, initial symptoms, treatment modalities, follow-up, recurrences and overall survival. Patient survival, from the date of discovery of the melanoma until death, was analysed by Kaplan-Meier survival curves and between-group comparison of survival was performed with a log rank test. Results The mean age at diagnosis was 72 years (range: 54–94) and the cohort comprised 11 women and 7 men. The median overall survival was 80 months, the 1-year overall survival was 82.6% and the 5-year overall survival was 54.5%. The AJCC 2002 staging system presented a statistically significant prognostic value ( P = 0.0476), while no statistically significant prognostic value was observed for the AJCC 2009 staging system ( P = 0.108). Paranasal sinus invasion was significantly associated with a poor prognosis ( P = 0.0039). Conclusion This study demonstrates the superiority of the non-specific AJCC 2002 Cancer Staging Manual. Medical and surgical management must take paranasal sinus invasion into account, as it constitutes a major prognostic factor. [ABSTRACT FROM AUTHOR]

Objective This study was designed to retrospectively review the postoperative results of transnasal transostial sphenoidotomy in 79 patients with isolated chronic sphenoid sinusitis operated between 1995 and 2013 and evaluate the recurrence rate due to postoperative closure of the sphenoidotomy. Patients and methods Seventy-nine patients, 44 women and 35 men (M:F sex ratio: 0.79) aged 10 to 84 years (mean age: 48), were included. The most common presenting symptom was headache in 61% of cases. Visual disturbances were present in three cases. The diagnostic work-up comprised nasal endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) of the sinuses. The surgical indication was based on failure of antibiotic therapy and/or the nature and severity of sphenoid sinusitis. All patients were operated by endoscopic transnasal transostial sphenoidotomy. Samples were taken for histological, bacteriological and mycological examination. Results No intraoperative or immediate postoperative complications were observed. Nature of the lesion: forty-seven patients (59.5%) presented nonspecific inflammatory lesions with negative bacterial or fungal culture and inflammatory mucosal changes, 19 patients (24%) had fungal sinusitis presenting as a fungus ball and 13 patients (16.4%) had documented bacterial sinusitis. Mean postoperative follow-up was 7.4 months (range: 6–48). No recurrence of the sinusitis or symptoms was observed in 71 cases (89.8%). Recurrence: eight cases (10.2%) of postoperative closure of the sphenoidotomy were observed, requiring one (6 cases) or several (2 cases) reoperations with a mean of 16.4 months after the initial procedure. Symptoms of recurrence consisted of varying degrees of headache, with similar symptoms to those of the first episode in 7 cases, and retro-orbital headache in 1 case. Reoperation was performed via a transnasal transostial approach in 6 cases and a transethmoidal approach in 2 cases. Conclusion The transnasal transostial surgical approach is a safe and effective procedure for the treatment of isolated sphenoid sinusitis. However, the recurrence rate due to postoperative closure of the sphenoidotomy observed in our series raises the question of postoperative maintenance of a patent and functional sphenoidotomy. [ABSTRACT FROM AUTHOR]

Introduction Nasal sinus schwannomas are rare tumors, particularly in the frontal sinus. Case report The authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage. Discussion The pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex. [ABSTRACT FROM AUTHOR]

Context Treatment of infected nasal polyposis. Material and methods Multicenter interventional prospective double-blind randomized study with matched groups: treatment with tobramycin aerosol versus isotonic saline aerosol. The study population included 55 patients: 23 receiving isotonic saline aerosol and 32 receiving tobramycin. A novel device (Easynose ® ) was used with an original principle limiting pulmonary deposition and ensuring homogeneous peripheral deposition in the nasal cavities. Objectives The principal objective was to compare bacteriological eradication between tobramycin 150 mg/3 ml versus isotonic saline, both administered by nebulization via the Easynose ® device. Results and conclusion Tobramycin aerosol administered via the Easynose ® device showed significantly better bacteriological eradication than isotonic saline. [ABSTRACT FROM AUTHOR]

Endolymphatic pressure measurement is of interest both to researchers in the physiology and pathophysiology of hearing and ENT physicians dealing with Menière's disease or similar conditions. It is generally agreed that endolymphatic hydrops is associated with Menière's disease and is accompanied by increased hydrostatic pressure. Endolymphatic pressure, however, cannot be measured precisely without endangering hearing, making the association between hydrops and increased endolymphatic pressure difficult to demonstrate. Several integrated in vivo models have been developed since the 1960s, but only a few allow measurement of endolymphatic hydrostatic pressure. Models associating measurement of hydrostatic pressure and endolymphatic potential and assessment of cochlear function are of value to elucidate the pathophysiology of endolymphatic hydrops. The present article presents the main types of models and discusses their respective interest. [ABSTRACT FROM AUTHOR]

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation. [ABSTRACT FROM AUTHOR]

Objective This study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage. Materials and methods Retrospective study including 18 children with a mean age of 38 months [range: 5–67 months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess). Results The initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series. Conclusion Contrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the reliability of magnetic resonance imaging (MRI) for the diagnosis of middle ear cholesteatoma and to determine the contribution of each MRI sequence. Patients and methods: A series of 97 cases was reviewed, corresponding to 89 patients (43 women, 46 men). Each patient was assessed by the following MRI protocol: T1-weighted, T2-weighted, early contrast-enhanced T1-weighted, delayed contrast-enhanced T1-weighted, and diffusion-weighted sequences. All patients were operated, for the first time in 16 cases and for second-look surgery in 81 cases. Radiological findings were compared to surgical and histological findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each sequence. Results: Seventy-four cholesteatomas were diagnosed at surgery. These lesions had a mean diameter of 8.29±5.46mm. The smallest cholesteatoma in this series was 2mm in diameter. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences had a sensitivity of 84.9% and 90.4%, a specificity of 87.5% and 75%, a positive predictive value of 95.4% and 91.7%, and a negative predictive value of 65.6% and 72%, respectively. T1-weighted, T2-weighted, and early contrast-enhanced T1-weighted sequences had a low specificity. Conclusions: MRI is a reliable imaging modality for the diagnosis of middle ear cholesteatoma. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences were discriminant. In the context of postoperative follow-up of cholesteatoma, these sequences allow better selection of cases requiring second-look surgery. [Copyright &y& Elsevier]

Summary: Objectives: Still today, Menière''s disease (MD) can be definitively diagnosed only on post-mortem findings of endolymphatic hydrops. Otoacoustic emission (OAE) phase has been shown to be highly sensitive to intracranial pressure. Preliminary analysis of OAEs in MD patients indicated high sensitivity to slight variations in intracranial pressure. The principal objective of the present study was to confirm this specific sensitivity of OAEs in MD. Patients and methods: In a prospective study of 32 consecutive cases of acute MD seen in consultation or hospital, 20 patients (23 ears) underwent acoustic phase-shift test: i.e., seated vs. supine OAE phase centered around 1kHz, with results compared to controls. Results: The acoustic phase-shift test was performed in 62.5% of acute patients (58.9% of affected ears). In the control group, the 95% confidence interval for phase shift was between –30° and +45°. Phase shift was significantly elevated, beyond the normal interval, in 18 of the MD patients: range, –80° to +145°. Sensitivity was 90%. Overall, in patients in whom transient evoked OAEs (TEOAEs) were present, positive predictive value was 100% and negative predictive value 92.3%. Conclusions: The acoustic phase-shift test proved useful and powerful in demonstrating pressure imbalance in acute Menière''s disease. [Copyright &y& Elsevier]

Summary: Objectives: To assess patient satisfaction with bone-anchored hearing aids (BAHA) and the role of preoperative audiometric testing. Patients and methods: A telephone satisfaction survey was conducted on all patients implanted between June 1, 2005 and February 1, 2008. Patients with unilateral total deafness underwent preoperative audiometric tests in quiet and in noise and stereoaudiometry with and without BAHA. Patients with a conductive hearing loss underwent preoperative audiometric tests in quiet and in noise and real-life testing at home using a headband. A standardized satisfaction questionnaire derived from the Entific BAHA questionnaire was used. Results: Twenty-two out of 26 patients responded to the questionnaire. Ten patients were implanted for conductive hearing loss (CHL) and 12 for unilateral total deafness (UTD). Mean follow-up was 19 months in the UTD group and 21 months in the CHL group. Sixty-seven percent of UTD and 80% of CHL patients reported improved quality of life. The BAHA was worn for more than 4hours per day by 83% of UTD and 100% of CHL patients, and at least 5 days per week by 67% of UTD and 80% of CHL patients. Conclusion: BAHAs provided real benefit in all situations for CHL patients. In UTD, its benefit basically related to noisy environments. In UTD, satisfaction on preoperative stereoaudiometric testing in noise with and without BAHA was predictive of postimplantation satisfaction. In response to the question “Would you do it again?”, 81% of patients answered “Yes”. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Lacrimal sac tumors are usually primary and of epithelial origin. Overall, 55% of lacrimal sac tumors are malignant. Mortality rates for malignant tumors depend on tumor stage and type, with a mean rate of 38%. The main objective of this study was to review our experience with these malignancies and to compare this with the published literature. Patients and methods: A 15-year retrospective review of all malignant lacrimal sac tumor patients was completed in our department. Seven patients were found to have malignant sac tumors. The mean age was 53 years (range, 32–74 years) with six women and one man. The patients’ clinical records were reviewed for data regarding patient symptoms, preoperative investigations, pathology reports, treatment results, and outcome. These data were compared with the available literature. Results: All patients presented with epiphora and a palpable lump of the internal canthus. In two cases, a history of recurrent dacryocystitis was noted. The histological types were as follows: squamous cell carcinoma (n =5), one case of adenoid cystic carcinoma, and one case of malignant lymphoma. Surgery was performed in six cases with additional radiotherapy in four. One patient was treated exclusively with external radiotherapy. The mean follow-up was 68 months (range, 6–204 months). Two patients developed recurrences: three were disease-free at the time of the study. Conclusions: Malignant epithelial lacrimal sac tumors are rare cancers with significant recurrence rates. Correct diagnosis and appropriate therapy require a multidisciplinary management approach. Treatment of these malignant epithelial tumors is first and foremost complete surgical removal with wide excision. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Sinonasal mucosal melanomas account for approximately 1% of all melanomas. These tumors are particularly aggressive, with a recurrence rate between 37 and 54% and a 5-year survival rate between 20 and 46%. Metastases are frequent. The main objective of this study was to analyze all of our cases of sinonasal mucosal melanomas and determine any prognostic factors. Patients and methods: All our cases of sinonasal mucosal melanoma over a period of 10 years were included. Ten cases were analyzed. The mean age was 71 years (range: 61–85 years) for seven women and three men. The clinical, radiological, anatomopathological, and surgical data as well as the characteristics of disease progression were analyzed. These data were compared to those reported in the literature. Results: The mean follow-up was 36.3 months (range: 2–96 months). The 5-year overall survival was 40%. Seven patients developed local recurrences after a mean follow-up of 16 months (range: 2–27 months) with associated metastases in three cases. Analysis of the prognostic factors showed that tumors classified as T1 and limited to the nasal fossae had a better prognosis. Conclusion: Sinonasal mucosal melanomas are rare tumors with a high mortality rate. Treatment of these tumors requires extensive surgical treatment associated with external radiotherapy. [ABSTRACT FROM AUTHOR]

Summary: Objective: Osteoma occurs almost exclusively in the head and neck region, only rarely developing into the internal auditory canal. We report an incidental finding of a case in the radiological evaluation of a patient with left hemifacial spasm. Patients and methods: A 79-year-old woman consulted for left hemifacial spasm associated with left anacusis. Symptoms occurred up to 30 years prior to the first radiological investigations. Computed tomographic (CT) and magnetic resonance (MRI) images were taken. Results: MRI demonstrated a left internal auditory canal lesion with spontaneous hypointense signal on T1- and T2-weighted images. CT showed the lesion as a typically dense and opaque osteoma. It measured 0.6cm in maximum size. No surgery was performed because of the slow-growing features of the lesion. Clinical monitoring was recommended. Conclusion: Osteomas are diagnosed incidentally in asymptomatic patients. Our case was symptomatic and raised the question of surgical management. This article discusses the presentation and management associated with this exceptional osteoma location. [ABSTRACT FROM AUTHOR]

Summary: Objective: To report a case of bilateral vocal cord abductor paralysis in the context of primary herpes simplex infection. Case report: A 63-year-old man was urgently admitted to hospital with laryngeal dyspnoea associated with dysphagia but without dysphonia. Physical examination demonstrated the vocal cords in a paramedian position with paralysis of abduction. The patient reported primary herpes simplex infection two weeks prior to this episode. HSV serology indicated recent infection and lumbar puncture demonstrated the presence of herpes simplex virus type 1 in the cerebrospinal fluid. Complete resolution of respiratory symptoms was observed after 21 days of treatment with intravenous aciclovir. Discussion and conclusion: Gerhardt syndrome comprises inspiratory dyspnoea without dysphonia. It used to be mainly due to syphilis, but is now mostly observed in the setting of neurodegenerative disease. The authors report a case of Gerhardt syndrome occurring after an episode of primary herpes simplex infection with the presence of herpes simplex virus in the CSF. Treatment by intravenous antiviral drugs allowed rapid resolution of the symptoms. The pathophysiology of Gerhardt syndrome remains unexplained, but the possible role of herpes simplex infection should be considered in cases of laryngeal palsy. [ABSTRACT FROM AUTHOR]