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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]

An earlier report by Mecacci and Rocchetti showed a significant, weak, and positive correlation between Evening type as measured by the Morningness-Eveningness Questionnaire and Type A personality as measured by the Jenkins Activity Survey and the Bortner Type A Scale in Italian college students. The present study of 503 Japanese college students yielded a significant and weakly negative correlation. The bases for the different results were discussed in a psychophysiological context. [ABSTRACT FROM AUTHOR]

Purpose. – Sudden idiopathic deafness is a sensorineural hearing loss with no recognized causes at the time of onset. The impairment site is usually localized in the cochlea, but some cases of retrocochlear lesions (e.g., cerebellopontine angle tumors, degenerative neural diseases, neuraxial ischemic lesions) can induce sensorineural deafness. The medical management of patients presenting with sudden deafness aims at detecting a causal mechanism, and at administering emergency therapeutic drugs. The diagnosis of idiopathic sudden deafness can be definitely made when no causes are found. Usually, the impairing mechanism involves the cochlea. The pathophysiology of this sensorineural alteration is still unknown. It is most likely that several mechanisms are associated together, their common point being an impairment to the feedback loop of the organ of Corti.Current knowledge and key points. – It is very likely that reactivation of neurotropic viruses and/or cochlear ischemia are frequent etiologies. Whatever the cause, the treatment is to be administered urgently, and consists of a high-dose corticotherapy at the least. Other treatments have never really proven to be effective. It is secondarily checked that no retrocochlear pathological processes, such as a cerebellopontine angle tumor, is present, in particular in young people.Future prospects and projects. – One of the current objectives is to determine when cochlear ischemia is involved, in a mini-invasive manner, such as with laser Doppler flowmetry, so that the treatment can be optimized. From a therapeutic point of view, early acoustic protection has been proven to be effective in cases of cochlear ischemia in small laboratory animals. Its efficacy in case of sudden deafness, non-exclusive of other causes than ischemia, is being assessed in a multicentric project. [ABSTRACT FROM AUTHOR]

Introduction: In clinical practice, speech understanding in noise is most often evaluated using co-located speech and noise (i.e., without spatial cues). The French Matrix test was indeed validated in this condition of administration. Yet, most hearing aid centers in France are equipped with fiveloudspeaker arrays, which allows for speech to be presented from a single loudspeaker directly in front of the listener (0° azimuth) and noise to simultaneously presented from 4 loudspeakers (45°, 135°, 225°, and 315° azimuth; "diffuse noise"). This configuration is meant to be more representative of «ecological condition». Material and methods: We designed a prospective observational study in normal hearing (NH) and hearing impaired (HI) adults. Data were collected between June 2019 and December 2020 and consisted in: pure-tone air conduction thresholds for each ear using headphones for audiometric frequencies 0.5, 1, 2, 4, 6, and 8 kHz. Unaided monosyllable word recognition in quiet was measured in sound field at 65 dBA using monosyllable words from Lafon, in binaural condition. Unaided sentence recognition in noise was measured in sound field using the French Matrix (binaural performance). Results: 297 listeners across 9 hearing centers completed the study. Unaided SRTs in diffuse noise were significantly correlated with PTA thresholds, age at testing, as well as word and phoneme recognition scores in quiet. Stepwise linear regression analysis showed that SRTs in diffuse noise were significantly predicted by a combination of PTA threshold and word recognition scores in quiet. SRTs were measured in co-located and diffuse noise for 65 listeners (13 NH, 22 Mild HL, 19 Mod HL1, and 11 Mod HL2). With co-located noise, the mean SRT and standard deviation was 4.2±1.1, 0.2±3.2, 2.9±2.6, and 8.4±7.0 dB for the NH, Mild HL, Mod HL1, and Mod HL2 groups, respectively. With diffuse noise, the mean SRT and standard deviation was 8.9±1.4, 2.4±4.6, 1.9±4.3, and 8.8±9.2 dB for the NH, Mild HL, Mod HL1, and Mod HL2 groups, respectively. A RM ANOVA with noise type (diffuse, co-located) as the within-subject factor and hearing status group (NH, Mild HL, Mod HL1, Mod HL2) as the between-subject factor showed significant effects for noise type [F(1, 61)=30.3, p<0.001] and subject group [F(3, 61)=15.3, p<0.001]; there was a signifi- cant interaction [F(3, 46)=4.1, p=0.010]. Post-hoc Bonferroni pairwise comparisons showed that SRTs in diffuse noise were significantly lower than SRTs in co-located noise only for the NH and Mild HL groups (p<0.05 in both cases). For diffuse noise, there were significant differences in SRTs among all groups; for co-located noise, there was a significant difference in SRTs among all groups, except for between the Mild HL and Mod HL1 groups. Linear regression analysis showed a significant correlation between SRTs in co-located and diffuse noise (r2=0.71, p<0.001). Conclusions: The results are consistent with previous studies that found that hearing-impaired listeners had greater difficulty using spatial cues to segregate speech and noise. While diffuse noise may not be suitable for clinical evaluation of speech understanding in noise in hearing- impaired listeners, it may provide additional insights into their "real-world" speech understanding in complex listening environments. Moreover, as our study provides the range of possible values of unaided SRTs, they may serve as references for comparison with aided SRTs, more likely to be measured in a diffuse noise setup than in a co-located noise one. [ABSTRACT FROM AUTHOR]

Résumé La dysplasie fibreuse osseuse (DFO) est une maladie bénigne sporadique congénitale rare qui entraîne des déformations osseuses. Elle est secondaire à une mutation somatique du gène GNAS codant pour la sous-unité α de la protéine G, qui entraîne un défaut de différenciation des ostéoblastes, une prolifération fibreuse médullaire et une hyperactivité ostéoclastique en partie liée à la surexpression de l’IL-6 dans les cellules mutées. L’atteinte peut être monostotique ou polyostotique. Cette mutation affectant également d’autres types cellulaires, des manifestations cutanées (taches « café au lait ») et endocriniennes (puberté précoce, hyperthyroïdie, acromégalie, syndrome de Cushing) peuvent être associées dans le cadre du syndrome de McCune-Albright, mais aussi des myxomes dans le syndrome de Mazabraud ou encore un diabète phosphoré. Le diagnostic de DFO cranio-faciale doit être évoqué devant des céphalées, des névralgies, des atteintes sensorielles (vision, audition, équilibre, olfaction), des troubles fonctionnels (obstruction nasale, dilatation des voies lacrymales, trouble de l’occlusion des mâchoires), des complications infectieuses (sinusites, otites, mastoïdites), et conduire à la réalisation d’un scanner du massif facial et du crâne complété d’une IRM. La biopsie osseuse n’est pas systématique. Un traitement chirurgical est discuté en cas de complication nerveuse, de retentissement esthétique ou d’évolutivité des lésions. En cas de douleur résistante aux antalgiques habituels, les bisphosphonates intraveineux peuvent être proposés. Chez les patients non répondeurs, plusieurs observations suggèrent l’efficacité d’un anticorps monoclonal dirigé contre le récepteur de l’IL-6, ce qui nécessite d’être confirmé par des études randomisées. Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, café au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to assess a correlation between MRI labyrinthine changes detected with IV-gadolinium optimized high-resolution 3D-FLAIR sequences 4 h after injection (OPT4-3DFLAIR) and the type of SSNHL, in terms of frequency alteration and severity. Methods: This was a prospective monocentric study achieved from July 2019 to December 2020. The inclusion criterion was acute hearing loss of at least 30 dB over three contiguous frequencies occurring within a 72-h period, documented by a pure-tone audiometry (PTA). The primary endpoint was the visual assessment of hyperintensity in labyrinthine structures on OPT4-3DFLAIR performed on 3T MRI. Results: Thirty-six affected ears were included (20 men, 15 women; mean age: 54.5 ± 16.3 years) with 69.4% full-spectrum hearing loss. The median hearing loss, expressed as median and interquartile range [IQR] was 91 dB [74–120], with 47.2% of concomitant acute vestibular syndrome. Pathological signal was found in 26 out of 36 ears (72.2%). Basal turn enhancement was found in all abnormal MRIs, with 73.1% of apical turn enhancement and 50% of vestibular enhancement. Seventeen on 19 cases (89.5%) with apical involvement on MRI had low-frequency hearing loss. Vestibular involvement on MRI was significantly associated with a wider frequency range of hearing loss (p = 0.0002) and the severity of SSNHL (84.5 [71.7–92.5] dB versus 120 [85.8–120] dB, p = 0.0158). Conclusion: This report shows that in pathological MRI in SSNHL, a pathologic cochlear base signal is always detected, a cochlear apical turn enhancement matches with low-tone impairment, and a pathological signal within the posterior labyrinth is associated with an impairment of all frequencies and the severity of SSNHL. [ABSTRACT FROM AUTHOR]

Introduction: Hypocalcemia is the most common complication of thyroidectomy, requiring supplementation as well as prolonged hospitalization. Our study’s objective was to determine a corrected calcium (CCa) level on day 1 after thyroidectomy predictive of no calcium and vitamin supplementation.Materials and methods: A single-center prospective study conducted between January 2012 and July 2015 in 396 patients, consisting of 331 cases of total thyroidectomy, with seven completion surgeries. The data collected were age, sex, type of thyroid surgery, etiology, anatomical pathological analysis, and the need for calcium and vitamin supplementation therapy as well as its duration. CCa levels were analyzed 20 and 30 h after surgery then on days 2 and 3. To determine a cut-off value for CCa, a ROC curve analysis was performed. The population was described in terms of numbers and associated percentages for categorical variables, and mean.Results: Mean CCa on 20 h after surgery was 2.09 mmol/L (p < 0.001) and 30 h was 2.06 mmol/L p = 0.02. CCa of less than 2.13 mmol/L was predictive of calcium and vitamin supplementation with 56% sensitivity and 97% specificity. On the evening of day 1, the cut-off value for CCa was 2.06 mmol/L with 67% sensitivity and 65% specificity.Conclusion: This prospective study confirms that CCa on the first morning after surgery is reliable when it is more than 2.13 mmol/L. In total, analyzing CCa on day 1 after total thyroidectomy allows the discharge of 70% of patients on the first day after surgery, with no risk of hypocalcemia. [ABSTRACT FROM AUTHOR]

Background and Aims: Patients with head and neck cancer (HNC) are often malnourished with a low muscular mass at the outset of management. This is thought to be mainly due to poor nutritional intake. The aim of this study was to assess the correlation between tumor metabolic activity, inflammatory status and body composition in HNC patients., Materials and Methods: This retrospective study included 112 patients with HNC. Tumor metabolic activity was assessed using the total lesion glycolysis (TLG) and maximum standardized uptake value (SUVmax). Body composition was measured by the third cervical vertebra skeletal muscle index (C3 SMI). Systemic inflammation was measured by the modified Glasgow Prognostic Score (mGPS) and the neutrophil-to-lymphocyte ratio (NLR). Nutritional status was assessed by the Nutritional Risk Index (NRI)., Results: The majority of patients had advanced tumor stage (75 %). Malnutrition was found in 39.3 % (NRI), and systemic inflammation in 44.7 % (mGPS) and 41.1 % (NLR) of patients. High TLG was associated. with low C3 SMI (p = 0.021), low NRI (p = 0.01), high mGPS (p = 0.001), and high NLR (p = 0.003). A high NLR was associated with a low C3 SMI (p = 0.046) and low body mass index (BMI) (p = 0.01)., Conclusion: Our study establishes a relationship between the high metabolic activity of tumor, the loss of muscle mass, and increased systemic inflammation., Competing Interests: Declaration of competing interest Mathilde Rey: no conflict of interest. Olivier le Bacquer: no conflict of interest. Aurélien Mulliez(:) no conflict of interest. Justine Becaud(:) no conflict of interest. Mathilde Puechmaille(:) no conflict of interest. Marion Chanchou(:) no conflict of interest. Florian Mallet(:) no conflict of interest. Thierry Mom(:) no conflict of interest. Nicolas Saroul: no conflict of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background/Objectives : Vestibular schwannomas (VSs), also called acoustic neuromas, are benign tumors affecting the vestibulocochlear nerve, often leading to hearing loss and balance issues. This condition is particularly challenging in patients with neurofibromatosis type 2 (NF2), where VSs tend to develop bilaterally. Conventional treatments, such as surgery and radiotherapy, although effective, carry risks like hearing loss and nerve damage. Bevacizumab, a VEGF-targeting monoclonal antibody, has emerged as a less invasive treatment option, showing potential for tumor volume reduction and hearing preservation. This systematic review aims to assess the efficacy of bevacizumab in controlling tumor volume, preserving hearing, and identifying associated adverse events. Methods : A comprehensive systematic review was performed using PRISMA guidelines. PubMed and Cochrane Library databases were searched for studies evaluating the effects of bevacizumab on VS, focusing on key outcomes like tumor volume reduction, hearing preservation, and adverse events. Data extraction and quality assessment were independently conducted by two reviewers using the Newcastle-Ottawa Scale. Results : Nine studies involving 176 patients were included. Bevacizumab showed a partial tumor volume reduction (≥20%) in 40% of cases and disease stabilization in 50%, while 10% experienced tumor progression. Hearing outcomes revealed improvement in 36% of patients, stabilization in 46%, and deterioration in 18%. Severe adverse effects, including hypertension and thromboembolic events, occurred in 13% of patients, while 18% reported no side effects. Tumor regrowth was observed in some patients after treatment discontinuation, emphasizing the need for long-term monitoring. Conclusions : Bevacizumab demonstrates effectiveness in managing VS, particularly in NF2 patients, by reducing tumor size and preserving hearing in a substantial proportion of cases. However, the variability in patient response and the risk of adverse events underscore the need for individualized treatment approaches and further research, including randomized controlled trials, to optimize its clinical application.

Purpose: Diagnosis of Menière's disease relies on clinical symptoms. Injected 3T MRI can show endolymphatic hydrops (EH), but correlation with the clinical status of MD, (probable -PMD or definite-DMD) remains doubtful. We revealed endolymphatic pressure disruption through functional exploration and verified if it was associated with an EH through MRI., Materials and Methods: We prospectively analyzed 3D3T FLAIR MRI of DMD and PMD patients. All of them underwent electrocochleography (EcoG), distortion-product otoacoustic emissions (DPOAEs), and videonystagmograhy (VNG). Amplitudes of summating potential (SP) and cochlear nerve action potential (AP) were measured on EcoG. DPOAE-phase was collected at 1 kHz for the 2f1-f2 DPOAE between sitting and laying position. A SP/AP ≥ 40% and a DPOAE phase-shift > 40° revealed pressure disruption., Results: 39 patients (25 women, 53 y.o. 20-78), were included, with 32 DMD ears and 11 PMD ears. MRI was performed in a median of 21 days [0; 68] from the MD incident. Audiovestibular exploration took place 41 days after the crisis [0;83]. MRI revealed an EH in 71.9% and 27.2% of DMD and PMD, respectively. When combining functional explorations and MRI, testing was positive in 97% for DMD and 82% for PMD. When abnormal (59%), VNG mainly showed hyporeflexia in the diseased ear., Conclusion: In patients suffering from DMD or PMD, with endolymphatic pressure disturbances confirmed by combined DPOAE-phase and EcoG, 3T 3D MRI reveals EH mostly in DMD but rarely in PMD. This seems to confirm that disturbance of endolymphatic pressure precedes EH., (© 2024. The Author(s).)

Background : Surgical resection of vestibular schwannomas (VS) can be responsible for single-sided deafness (SSD). Hearing restoration can be a challenge both for the otolaryngologist and the patient. Patients and Methods : In a retrospective series, we analyzed the charts of SSD patients operated on for VS from 2005-2021, checking which type of hearing rehabilitation was chosen. All patients who wanted a hearing restoration underwent a hearing in noise test (HINT) in a stereo auditorium with and without a bone-anchored hearing device (BAHD) worn with a headband on the deaf side. Then, they had a preimplantation one-month trial with the BAHD at home vs. contralateral routing of signal (CROS) or BiCROS (with contralateral signal amplification) hearing aids (HAs). Results : Among 52 charts of the included adult SSD patients, only 29 (56%) eventually chose a hearing rehabilitation device (14 BAHD). Only one BAHD patient required a device explantation for skin complications, but then asked for reimplantation. Another one swapped the BAHD for HAs 2.5 years after. Two patients only occasionally used their BAHD with a headband. Nine patients preferred HAs, mainly BiCROS. Their contralateral hearing was significantly less than BAHD patients ( p < 0.05), and only three used their HAs every day. Conclusions : Hearing rehabilitation in SSD patients after VS surgical resection is chosen in about 50% of cases. In complement of HINT, a real-life comparative hearing trial helps patients chose the best device, with good long-term results when a BAHD is chosen. HAs are preferred when contralateral hearing is altered but are not always worn.

Background : In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods : Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists-MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results : In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion : a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery.

Background: Radiotherapy (RT) plays an important role in the therapeutic management of vestibular schwannoma (VS). Fractionated stereotactic radiotherapy (FSRT) or radiosurgery (SRS) are the two modalities available. The purpose of this article is to review the results of VS RT studies carried out over the last ten years., Materials and Methods: A literature search was performed with PubMed and Medline by using the words vestibular schwannoma, acoustic neuroma, radiotherapy, and radiosurgery., Results: In small (<3 cm) VS, SRS offers a local control rate of >90%, which seems similar to microsurgery, with a favorable tolerance profile. Hypofractionated FSRT (three to five fractions) is a relatively recent modality and has shown similar outcomes to normofractionated FSRT. Hearing preservation may highly differ between studies, but it is around 65% at 5 years., Conclusions: SRS and FRST are non-invasive treatment options for VS. SRS is often preferred for small lesions less than 3 cm, and FSRT for larger lesions. However, no randomized study has compared these modalities.

The cochlear implant is an implanted auditory prosthesis that can restore severe and profound hearing loss. About 20% of patients with congenital sensorineural hearing loss have a malformation of the inner ear. These abnormalities must be investigated before a cochlear implant because they can lead to intra and postoperative complications and/or anomalies. Most labyrinthine malformations are well known; some are less frequent and can be underdiagnosed at the preoperative computed tomography. This report presents the case of bilateral cochlear-facial dehiscence, bony dehiscence between the facial nerve labyrinthine segment, and cochlear basal turn. In our 56-year-old patient, this malformation was misdiagnosed before the cochlear implant and revealed afterward because of abnormal facial nerve stimulation during intraoperative electrophysiological checking., (© 2023 The Authors.)

Background: The determination of cytokines in the postoperative drainage (POD) fluid could be a method for early detection of the development of a pharyngocutaneous fistula (PCF)., Materials and Methods: We conducted a prospective two-center study involving 28 patients. PODs were collected on Day 1 (D1) and Day 2 (D2) postoperatively for determination of a cytokine panel and cytobacteriological examination., Results: Eleven (39%) patients presented with PCF on average 13 ± 5.5 days after surgery. Patients with PCF had higher IL-10 (121 vs. 40.3, p = 0.04, effect size (ES) = 0.98 [0.16, 1.79]) and TNFα level (21.2 vs. 2.2, p = 0.02, ES = 0.83 [0.03, 1.63]) on D2. An IL-10 threshold of 72 pg/mL on D2 was diagnostic of the occurrence of PCF with a sensibility of 70%, specificity of 88%., Conclusion: The determination of cytokines in POD fluid on D2 is a reliable tool for predicting the development of a PCF after total laryngectomy., (© 2023 Wiley Periodicals LLC.)

Introduction: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear., Material and Methods: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of ENT physicians, audiologists, geriatricians and hearing specialists from all over France. They are classified as grade A, B, C or professional agreement according to a decreasing level of scientific evidence., Results: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its face-to-face or remote management., Conclusion: In the case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. Free-field speech audiometry in noise is recommended to measure intelligibility in a realistic environment. Questionnaires in addition to audiometric tests would allow the best assessment of the patient's disability. Hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time since the hearing was fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, that include different training domains to complement face-to-face sessions.

Background: The role of secreted factors from the tumor cells in driving cancer cachexia and especially muscle loss is unknown. We wanted to study both the action of secreted factors from head and neck cancer (HNC) cell lines and circulating factors in HNC patients on skeletal muscle protein catabolism., Methods: Conditioned media (CM) made from head and neck cancer cell lines and mix of sera from head and neck cancer (HNC) patients were incubated for 48 h with human myotubes. The atrophy and the catabolic pathway were monitored in myotubes. The patients were classified regarding their skeletal muscle loss observed at the outset of management., Results: Tumor CM (TCM) was able to produce atrophy on myotubes as compared with control CM (CCM). However, a mix of sera from HNC patients was not able to produce atrophy in myotubes. Despite this discrepancy on atrophy, we observed a similar regulation of the catabolic pathways by the tumor-conditioned media and mix of sera from cancer patients. The catabolic response after incubation with the mix of sera seemed to depend on the muscle loss seen in patients., Conclusion: This study found evidence that the atrophy observed in HNC patients cannot be solely explained by a deficit in food intake.

Introduction: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear., Material and Methods: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence., Results: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning., Conclusion: In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021−October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

Spatial cues can facilitate segregation of target speech from maskers. However, in clinical practice, masked speech understanding is most often evaluated using co-located speech and maskers (i.e., without spatial cues). Many hearing aid centers in France are equipped with five-loudspeaker arrays, allowing masked speech understanding to be measured with spatial cues. It is unclear how hearing status may affect utilization of spatial cues to segregate speech and noise. In this study, speech reception thresholds (SRTs) for target speech in "diffuse noise" (target speech from 1 speaker, noise from the remaining 4 speakers) in 297 adult listeners across 9 Audilab hearing centers. Participants were categorized according to pure-tone-average (PTA) thresholds: typically-hearing (TH; ≤ 20 dB HL), mild hearing loss (Mild; >20 ≤ 40 dB HL), moderate hearing loss 1 (Mod-1; >40 ≤ 55 dB HL), and moderate hearing loss 2 (Mod-2; >55 ≤ 65 dB HL). All participants were tested without aided hearing. SRTs in diffuse noise were significantly correlated with PTA thresholds, age at testing, as well as word and phoneme recognition scores in quiet. Stepwise linear regression analysis showed that SRTs in diffuse noise were significantly predicted by a combination of PTA threshold and word recognition scores in quiet. SRTs were also measured in co-located and diffuse noise in 65 additional participants. SRTs were significantly lower in diffuse noise than in co-located noise only for the TH and Mild groups; masking release with diffuse noise (relative to co-located noise) was significant only for the TH group. The results are consistent with previous studies that found that hard of hearing listeners have greater difficulty using spatial cues to segregate competing speech. The data suggest that speech understanding in diffuse noise provides additional insight into difficulties that hard of hearing individuals experience in complex listening environments., Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: JB, EL, and FR are employees of Audilab. JG received salary support from Audilab. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery., Objective: To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery., Methods: A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution., Results: One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (11.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571)., Conclusion: Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Ménière's disease is a chronic illness characterized by intermittent episodes of vertigo associated with fluctuating sensorineural hearing loss, tinnitus and aural pressure. This pathology strongly correlates with a dilatation of the fluid compartment of the endolymph, so-called hydrops. Dexamethasone is one of the therapeutic approaches recommended when conventional antivertigo treatments have failed. Several mechanisms of actions have been hypothesized for the mode of action of dexamethasone, such as the anti-inflammatory effect or as a regulator of inner ear water homeostasis. However, none of them have been experimentally confirmed so far. Aquaporins (AQPs) are transmembrane water channels and are hence central in the regulation of transcellular water fluxes. In the present study, we investigated the hypothesis that dexamethasone could impact water fluxes in the inner ear by targeting AQP2. We addressed this question through molecular dynamics simulations approaches and managed to demonstrate a direct interaction between AQP2 and dexamethasone and its significant impact on the channel water permeability. Through compartmentalization of sodium and potassium ions, a significant effect of Na+ upon AQP2 water permeability was highlighted as well. The molecular mechanisms involved in dexamethasone binding and in its regulatory action upon AQP2 function are described.

Background: To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC)., Methods: Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass index (BMI), serum albumin, nutritional risk index (NRI), and CT scan (skeletal muscle mass index [SMI] at the first lumbar vertebral level)., Results: Before treatment, average BMI was 22.7 ± 4.6 kg/m 2 , serum albumin 38.7 ± 5.8 g/L, NRI 97.6 ± 10.6, and SMI 36.4 ± 7.9 cm 2 /m 2 . After treatment, BMI was 23 ± 4.5, serum albumin 30.2 ± 7.1, and NRI 88.1 ± 9.2. During ICT, 52 (62%) patients developed at least one toxicity ≥ Grade 3. Pre-treatment SMI was the only predictive factor of toxicity irrespective of BMI (p = 0.04)., Conclusion: Low skeletal muscle mass is a predictive factor of toxicity to ICT in HNC., (© 2021 Wiley Periodicals LLC.)

Objectives: To determine whether deterioration of dental condition at the outset of management of head and neck cancer (HNC) is a nutritional risk and whether social deprivation is a cause of the poor dental condition observed in HNC patients., Material and Methods: A nutritional assessment form (NAF) and the Nutrition Risk Index (NRI) were used to standardize the nutritional status of 108 patients at the outset of management of HNC (2017-2019). The NAF includes assessment of weight loss over the past 3 months, the amount and difficulty of food intake, and the presence of digestive disorders. Dental condition was assessed by the decayed, filled, and missing teeth acopre (DFM) index and the masticatory coefficient (MC). Dental status and social deprivation were correlated with the EPICES score., Results: A correlation was found between the extent of weight loss and dental condition. The MC was higher in absence of weight loss (46% vs. 27%, p = 0.03) and the DMF lower when weight loss was less than 5% (22.3 vs. 26.9 if > 5% loss of weight, p = 0.005). No correlation was found between dental status and nutritional status. Social deprivation was associated with a lower MC (26% vs. 50%, p < 0.001)., Conclusion: Dental condition is a risk factor for weight loss at the outset of management of HNC but is not a determinant of nutritional status. Clinical relevance Dental condition is no longer considered simply as a source of potential complications after radiotherapy but also as an important factor for nutritional status., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs., Material and Methods: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence., Results: Eight tests of speech audiometry in noise can be used in France., Conclusion: To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other)., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objectives: To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer., Study Design: Single-center retrospective study of prospectively collected data., Setting: Tertiary referral center., Methods: Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival., Results: In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor., Conclusion: Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

Objectives: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations., Methods: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market., Results: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment., Conclusion: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented., Objectives: To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma., Materials and Methods: Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting., Results: Twenty four patients were included. Reconstruction failure was detected by a cerebrospinal (CSF) leak in 79.2%, by an infectious complication without CSF leak (i.e. meningitis) in 12.5%, and in 8.3% by extensive pneumocephalus. Failure was observed during the first week after surgery in 75% of patients, in the second week in 21%, and in 4% after day 15. The delay in discovery of the failure was associated with multilayer reconstruction ( p =.03). Failure was treated surgically in 54% of the patients and medically in 46%, with a similar success rate (85 vs. 100%)., Conclusion and Significance: After carcinologic resection of the anterior skull base, monitoring should be systematic during the first postoperative week. Surgical management of failure is not always necessary.

Purpose: To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery., Methods: All surgical procedures were performed in a dedicated operating room equipped with a robotic C-arm cone beam device, allowing for intraoperative real time 2D FGI and postoperative 3D imaging. Only straight EAs were used. Patients were sorted out in three groups: ANAT, with anatomical concerns; HP, with residual hearing; NPR: patients with no particular reason for FGI. In all cases the angle of EA-insertion was measured. In the HP group pre and postoperative hearing were compared. The radiation delivered to the patient was recorded., Results: Fifty-three cochlear implantation procedures were achieved under fluoroscopy in 50 patients from November 2015 to January 2020 (HP group: n = 10; ANAT group: n = 13; NPR group: n = 27). In the ANAT group, FGI proved to be helpful in 8 cases (61.5%), successfully guiding the surgeon during EA -insertion. On average, the angle of insertion was at 424° ± 55°. In the HP group, a controlled smooth EA-insertion was carried out in all cases but one. The targeted 360° angle of insertion was always reached. Hearing preservation was possible with an eventual average drop of 30 ± 1.5 dB. In the NPR group, FGI helped control the quality of insertion in all cases and appeared very informative in five (17.8%): one EA-misrouting, three stuck EAs, and one case with hidden electrodes out of the cochlea in revision surgery. Final 3D cone beam CT scan double-checked the EA position in all adults. The radiation dose was equivalent to a bit less than four digital subtract radiographs., Conclusion: The FGI is a very useful adjunct in cochlear implantation in all cases of expected surgical pitfalls, in patients with residual hearing, and even in case without preoperative particular reason, with low irradiation.

Purpose For cochlear implant users, the ability to use the telephone is often seen as an important landmark during rehabilitation and an indicator of cochlear implant benefit. The goal of this study was to develop a short questionnaire exploring the ability to use the telephone in cochlear implant users, named Telislife, and test it in a group of experienced users. Method This prospective multicenter study was based on the completion of self-administrated questionnaires. The Telislife includes 20 items using a 5-point Likert scale for answers. Speech recognition scores were obtained with monosyllabic word lists at 70 dB HL. Quality of life was evaluated with the Nijmegen Cochlear Implant Questionnaire. This study included 55 adult patients wearing a cochlear implant for over 1 year. Results The Telislife questionnaire showed excellent reliability (Cronbach's α = .91). A significant correlation was found between Telislife scores and Nijmegen Cochlear Implant Questionnaire scores ( r = .69, p < .001) and speech recognition scores ( r = .35, p = .007). Conclusion Given significant correlations between Telislife scores and both speech recognition and quality of life and given its short form, the Telislife questionnaire appears to be a reliable tool to evaluate cochlear implant outcomes in clinical practice. Supplemental Material https://doi.org/10.23641/asha.13322873.

Humanitarian action, in the broad sense, including global outreach missions by ENT physicians, has been effective for many years. These volunteer missions have not had any specific regulatory framework, be it medical, social or above all ethical. The testimony of ENT physicians in certain "recipient" countries, in particular during the 2017 Paris Congress of the International Federation of Otorhinolaryngological Societies (IFOS), revealed the importance of adequate coordination between "provider" and "recipient" teams. Several ethical reports have been made, but few specifically focused on ENT outreach. The present review is based on feedback from several missions given to the French Society of OtoRhinoLaryngology and Head and Neck Surgery (SFORL) and IFOS, and on a review of the literature. A specific charter of global outreach and humanitarian missions in ENT has been drawn up. This review is essential for optimizing the sharing of knowledge and training in otorhinolaryngology across the world while respecting mandatory sociocultural and ethical rules., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objectives: 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., Materials and Methods: 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., Results: 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)., Conclusion: Malnutrition and sarcopenia are independent risk factors for postoperative complications., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives/hypothesis: PENTOCLO treatment, associating pentoxifylline, tocopherol, and clodronate, resolves radiation-induced fibrosis. The main aim of the present study was to prospectively assess efficacy in mandibular osteoradionecrosis (ORN)., Study Design: Prospective cohort study., Methods: Twenty-seven patients with mandibular ORN were included in the Pentoclauvergne Study between January 2014 and February 2016. After an initial 28-day phase of antibiotic, antifungal, and corticosteroid therapy, they received the PENTOCLO association daily until cure or a maximum of 24 months. The main assessment criterion was exposed bone area (EBA); secondary criteria comprised the Subjective, objective, management, and analytic (SOMA) score., Results: Under PENTOCLO, EBA decreased by 28% at 2 months, 55% at 6 months, and 92% at 24 months; the SOMA score decreased by 23%, 38%, and 50%, respectively. A complete treatment course cured 76.5% of patients at a mean 9.6 months., Conclusions: PENTOCLO is a simple, well-tolerated, and effective treatment for mandibular ORN., Level of Evidence: 4 Laryngoscope, 130:E559-E566, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Stereotactic radiosurgery (SRS) is a common treatment option for vestibular schwannomas. Historically, a dose de-escalation of the marginal prescribed dose from 16 Gy to 12-13 Gy has been done to limit toxicity without reducing local control (LC). We aimed to retrospectively report outcomes of Linac-based SRS for vestibular schwannomas treated with different doses., Methods: Included in the study were 97 stage 1 (1%), 2 (56%), 3 (21.5%), and 4 (21.5%) vestibular schwannomas treated with Linac-based (Novalis ® ) SRS from 1995 to 2019. No margin was added to the GTV to create the PTV. The median marginal prescribed dose was 14 Gy (range: 12-16 Gy) before 2006 and then 11 Gy for all patients (61 pts). Mean tumor volume was 1.96 cm 3 , i.e., about 1.6 cm in diameter. Mean follow-up was 8.2 years., Results: Following SRS, LC at 3, 5, and 10 years was 100%, 98.4%, and 95.6%, respectively [100% for those with ≤ 13 Gy as the marginal prescribed dose (NS)]. Toxicity to the trigeminal nerve was reported in 7.2% of cases (3.3% and 0% for transient and permanent toxicity for 11 Gy). The marginal prescribed dose was the only significant predictive factor in univariate and multivariate analysis (HR = 1.77, 95% CI = 1.07-3.10, p = 0.028). Toxicity to the facial nerve was reported in 6.2% of cases. The marginal prescribed dose was again the only significant predictive factor in univariate and multivariate analysis (HR = 1.31, 95% CI = 0.77-2.23, p = 0.049)., Conclusion: Linac-based SRS for stages 1-3 vestibular schwannomas provides excellent outcomes: a 10-year LC rate of over 95%, with a permanent facial or trigeminal toxicity rate of under 5%. A marginal prescribed dose of 11 Gy seems to decrease nerve toxicity and facial toxicity in particular, without reducing LC. Prospective studies with longer follow-up are needed., (Copyright © 2020 Dupic, Urcissin, Mom, Verrelle, Dedieu, Molnar, El-Ouadih, Chassin, Lapeyre, Lemaire, Biau and Khalil.)