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Resumen Las exostosis del conducto auditivo externo (CAE) afectan esencialmente a las personas que practican de forma intensiva deportes nauticos. Las indicaciones quirurgicas se basan en la sintomatologia del paciente, la repeticion de las otitis y la repercusion audiometrica. El estudio preoperatorio de las pruebas de imagen es esencial para limitar los riesgos y las complicaciones. La cirugia requiere un fresado prudente de las exostosis despues de la movilizacion de colgajos cutaneos. Esto se puede realizar segun la tecnica de la «cascara de huevo» o por fresado de medial a lateral. Tambien se puede efectuar una reseccion mediante osteotomos. Las complicaciones son infrecuentes. Se trata esencialmente de traumatismos timpanoosiculares o de trastornos de cicatrizacion postoperatorios. En la mayoria de los casos, la cirugia de las exostosis del CAE permite mejorar la calidad de vida de los pacientes, asi como la audiometria tonal postoperatoria en los casos en los que la indicacion corresponda a una sordera.

Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery. To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery. 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. 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). 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%.

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.

International audience; 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.

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Introduction 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. Observation 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. Discussion 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.

International audience; 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.; Tertiary referral center.

To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery. 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. 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. 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.

International audience; 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.

Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented. To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma. Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting. 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%). 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.

Resume Objectifs La moitie des patients atteints d’une neoplasie des voies aero-digestives superieures (VADS) sont denutris a leur prise en charge. C’est particulierement l’importance de la perte de masse musculaire (sarcopenie) qui semble etre un element fondamental. L’objectif de ce travail etait de determiner l’impact de l’etat nutritionnel et de la sarcopenie sur les complications postoperatoires en cancerologie des VADS. Materiels et methodes Une etude retrospective (novembre 2014–mai 2016) a ete realisee chez 92 patients operes d’un carcinome epidermoide des VADS. Les complications post- operatoires (30 jours apres l’intervention) ont ete colligees et graduees selon la classification de CLAVIEN DINDO (5 stades). L’evaluation nutritionnelle etait : anthropometrique (poids), biologique (albuminemie et Nutritional Risk Index (NRI)), tomodensitometrique (indice de masse musculaire au niveau de la 3eme vertebre lombaire), et fonctionnelle (Short Physical Performance Battery). Cette evaluation avait lieu lors de la prise en charge initiale du patient et une prise en charge nutritionnelle etait instauree si necessaire. Par ailleurs ont ete recueillis les autres facteurs potentiels de complications post-operatoires (performance status, antecedents de radiotherapie, intoxication ethylo-tabagique…) Resultats Cinquante-quatre % des malades etaient denutris selon le NRI. Quarante et un pourcent ont eu une complication de stade ≥ 2. Les complications les plus frequentes etaient l’infection et le trouble de cicatrisation. Le risque de complication etait plus eleve en cas de denutrition (62 % vs 17 %, p Conclusion La denutrition et la sarcopenie sont des facteurs de risques independants de complications post-operatoires.

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International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

The main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (n = 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (n = 24) underwent concomitant endoscopic surgery. A 65.8% (n = 125) of the patients were diagnosed with laryngomalacia, 21.1% (n = 40) with isolated posterior excess of mucosa, 9.5% (n = 18) with another diagnosis and 3.7% (n = 7) with a normal examination. The presence of comorbidity was associated (p 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery.Conclusion: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia. What is Known: • Previous research has established that laryngomalacia is the main aetiology of stridor. • Comorbidities are linked with a poor tolerance of stridor. What is new: • About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery). • Laryngomalacia and isolated posterior excess of mucosa account for 85-90% of the patients seen in consultation for stridor.

Resume Les echecs fonctionnels des protheses ossiculaires totales (TORP) sont dus bien souvent a des deplacements prothetiques. Ces deplacements vont de la simple subluxation a l’extrusion de la prothese en cas de recidive d’une importante retraction tympanique. Plusieurs techniques chirurgicales ont ete proposees pour stabiliser une TORP, la plupart d’entre elles utilisant des materiaux surajoutes non organiques, ou heterologues resorbables. Nous proposons une technique chirurgicale simple, dite du « Tumulus », permettant, quel que soit le type de TORP, avec quelques fragments de cartilage autologue, toujours disponible, parfaitement tolere, et a cout nul, de limiter le deplacement et l’extrusion prothetique. Une analyse de 31 cas ayant beneficie de cette technique n’a revele aucun deplacement de prothese et un seul cas d’extrusion (3,2 %) avec des resultats audiometriques comparables aux meilleurs rapportes dans la litterature.

Resume Introduction La granulomatose avec polyangeite (GPA) est une vascularite necrosante des vaisseaux de petit et moyen calibre associant une inflammation de la paroi vasculaire et des granulomes, peri- et extra-vasculaires, frequemment revelee par une atteinte sinusienne chronique. Observation Nous rapportons l’observation d’un patient âge de 27 ans qui a presente une sinusite frontale aigue hyperalgique prise en charge par traitement medical et chirurgical. Malgre le traitement, la symptomatologie recidivait precocement et le scanner retrouvait des epaississements muqueux sinusiens diffus. Les ANCA diriges contre la proteinase 3 etaient positifs. Un nodule pulmonaire a ete biopsie confirmant le diagnostic de GPA. Le patient a ete traite par une corticotherapie en association avec du rituximab, ce qui a permis d’obtenir une amelioration clinique, biologique et scannographique. Discussion En cas d’atteinte sinusienne localisee aigue et persistante malgre un traitement adapte, de signes generaux associes et/ou de survenue de signes evocateurs de la GPA, l’ORL doit savoir demander un bilan oriente. En l’absence de traitement, la GPA pet etre mortelle en quelques mois. Grâce au traitement actuel, la remission est obtenue dans 80 % des cas avec un taux de survie de 75 % a 10 ans.

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%; P0.001) and sarcopenia (56% vs. 22%; P0.01), with 50% longer hospital stay (P=0.04).Malnutrition and sarcopenia are independent risk factors for postoperative complications.

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.

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. 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. Mean CCa on 20 h after surgery was 2.09 mmol/L (p

I danni centrali dell’udito comprendono, da una parte, le sordita corticali dovute a lesioni cortico-sotto-corticali, che danno dei quadri semeiologici conosciuti da tempo (sordita verbale, sordita corticale e agnosia uditiva), e, dall’altra, dei disturbi dell’udito meno marcati e di identificazione piu recente, come, per esempio, alcuni ritardi di apprendimento nei bambini e alcune sordita dell’adulto in contrasto con soglie uditive periferiche entro i limiti della norma (obscure auditive dysfonction, sordita latente) e alcune presbiacusie con coinvolgimento centrale. Un danno genetico centrale dell’udito, molto frequente, e rappresentato dall’amusia congenita. Queste lesioni sono difficili da diagnosticare e richiedono, per essere rilevate, degli specifici test soggettivi ed elettrofisiologici. La diagnosi di questi danni centrali dell’udito e, tuttavia, importante da effettuare per migliorare la gestione delle persone colpite, in particolare nel bambino nel pieno periodo dell’apprendimento. Le cause sono molteplici e, tra queste, si annoverano i danni ischemici, emorragici, tumorali, infettivi, degenerativi e iatrogeni (soprattutto chirurgici e radiochirurgici). Alcune cause nei bambini non sono “statiche”, ma in relazione con un’asincronia della maturazione delle vie uditive. L’esplorazione all’esame obiettivo puo aiutare l’elettrofisiologia. Queste tecniche, che utilizzano i potenziali evocati precoci, semiprecoci e tardivi, l’auditory steady state response (ASSR) e la speech-auditory brainstem response (ABR), forniscono delle informazioni limitate sullo stato delle vie acustiche centrali, ma possono aiutare a classificare le diverse patologie responsabili e, soprattutto, a identificare i siti di lesione. La diagnostica per immagini (risonanza magnetica nucleare funzionale [RMf], magnetoencefalografia, tomografia a emissione di positroni [PET]) e promettente ma di applicazione clinica ancora ristretta.

Los trastornos centrales de la audicion engloban, por una parte, las hipoacusias centrales debidas a las lesiones corticosubcorticales, que producen cuadros semiologicos conocidos desde hace mucho tiempo (sordera verbal, sordera cortical y agnosia auditiva) y, por otra parte, los trastornos auditivos menos marcados y que se han identificado mas recientemente, como algunos retrasos del aprendizaje infantiles, algunas hipoacusias del adulto que contrastan con unos umbrales auditivos perifericos dentro de los limites de la normalidad (disfuncion auditiva indefinida [obscure auditive dysfunction]) y algunas presbiacusias con un componente central. Existe tambien una alteracion genetica central de la audicion, que es muy frecuente, denominada amusia congenita. Estas alteraciones son dificiles de diagnosticar y requieren pruebas subjetivas y electrofisiologicas especificas para ser detectadas. Sin embargo, es esencial realizar el diagnostico de estas alteraciones centrales de la audicion para mejorar el tratamiento de las personas afectadas, en especial en los ninos que estan en pleno periodo de aprendizaje. Las etiologias son muy numerosas y engloban las alteraciones geneticas, isquemicas, hemorragicas, tumorales, infecciosas, iatrogenicas (sobre todo quirurgicas y radioquirurgicas) y degenerativas. Algunas causas en la edad pediatrica no son «estaticas», sino que se relacionan con una desincronizacion de la maduracion de las vias auditivas. Las pruebas de imagen funcionales (resonancia magnetica funcional, magnetoencefalografia, tomografia por emision de positrones) son prometedoras, pero su aplicacion clinica aun muy limitada.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease with an uncertain pathophysiology. It is characterized by polyps rich in eosinophils, with an activation status already investigated at the tissue level. In a group of CRSwNP patients, we assessed the activation status of circulating eosinophils in the blood before migration into tissues. Methods: Thirteen patients with CRSwNP and 16 healthy volunteers were enrolled. Several biologic parameters were studied: blood count of eosinophils; plasma eosinophil cationic protein; oxidative metabolism by chemiluminescence at baseline or when activated by phorbol 12-myristate 13-acetate or platelet-activating factor, with or without interleukin-5 (IL-5); percent of granulosar cells; and mean fluorescence intensity (MFI) by flow cytometry. Results: The mean number of eosinophils was significantly higher in patients with CRSwNP, whose eosinophils showed increased oxidative metabolism in the basal or activated state significantly decreasing in the presence of IL-5. There was also a higher percentage of CD49d(+), CD25(+), and CCR3(+) cells in patients, and a nonsignificant decrease in descending order in MFI between the control group, patients with normal eosinophil levels, patients with hyper-eosinophilia, and patients with aspirin-exacerbated respiratory disease. Conclusion: This study demonstrates a priming state of circulating eosinophils in CRSwNP patients when compared with healthy controls, as evidenced by the extent of oxidative metabolism, with increased sensitivity to IL-5 and by the observed variations of percent and MFI of CD49d, CCR3, and CD25. This priming is thus found at the peripheral level and occurs before the migration of eosinophils to polyps, reflecting the systemic and not just local nature of abnormalities in CRSwNP.

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.

Resume But du travail L’objectif principal de cette etude retrospective etait l’evaluation des resultats fonctionnels de la chirurgie endoscopique du diverticule de Zenker. Les objectifs secondaires etaient d’evaluer la securite de la procedure, d’identifier les facteurs de risque de recidive et d’en determiner leur conduite en cas de recidive. Patients et methodes De 2000 a 2014, 50 patients ont beneficie d’une chirurgie endoscopique avec marsupialisation d’un diverticule de Zenker. Les symptomes de regurgitations et de dysphagie ont ete evalues par l’echelle FOIS avant et apres chirurgie. Le taux de recidives et le taux de complications ont ete determines de maniere retrospective avec un suivi minimal de 18 mois. Resultats Les regurgitations et la dysphagie ont ete ameliorees respectivement chez 96 % et 86 % des patients. Le taux de complications etait de 12 %, complications le plus souvent mineures. Les temps moyens d’hospitalisation et de reprise alimentaire orale etaient respectivement de 2,0 et 1,3 jours. Neuf patients (18 %) ont presente une recidive de leur symptomatologie initiale et ont necessite une reprise chirurgicale dans un delai moyen de 2,7 annees. Elle a pu etre realisee dans la majorite des cas par voie endoscopique. Un seul facteur de risque de recidive a ete identifie : la petite taille du diverticule. Conclusion La chirurgie endoscopique du diverticule de Zenker permet une amelioration fonctionnelle dans la majorite de cas. Associant securite et efficacite, elle est actuellement la procedure de choix dans le traitement du diverticule de Zenker.

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 cafe-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.

Resume Objectifs La dysplasie fibreuse osseuse (DFO) est une maladie osseuse benigne, congenitale, sporadique et rare dans laquelle l’os est remplace par du tissu fibro-osseux renfermant une osteogenese immature. Une evolution sarcomateuse est exceptionnelle. Les lesions sont soit uniques (forme monostotique), soit multiples (forme polyostotique). La DFO peut etre associee a une hyperpigmentation maculaire cutanee et a une endocrinopathie dans le cadre du syndrome de McCune-Albright ou a des myxomes dans le syndrome de Mazabraud. Methodes Nous rapportons dix observations de patients suivis pour une DFO cranio-faciale dans notre centre entre 2010 et 2015. Resultats L’âge moyen etait de 43 ans (10–72 ans). Les symptomes cliniques etaient des cephalees (n = 3), et des troubles neurosensoriels (uveite anterieure a repetition [n = 1], une baisse progressive de l’acuite visuelle epiphora et syndrome vestibulaire [n = 1] et hypoacousie [n = 1]). Tous presentaient une forme monostotique. La lesion de DFO etait frontale (n = 1), fronto-ethmoidale (n = 1), ethmoidale (n = 1), sphenoidale (n = 5), temporale (n = 1) et etendue (fronto-ethmoido-sphenoidale ; n = 1). Cinq patients ont ete traites par pamidronate, un bisphosphonate injectable : trois ont evolue favorablement entre 1 et 6 mois apres le debut du traitement (disparition des cephalees ou du syndrome vestibulaire), les 2 autres etaient cliniquement stables. Deux patients ont ete operes. Conclusion Le diagnostic de DFO cranio-faciale doit etre evoque devant des cephalees, des nevralgies faciales, des atteintes sensorielles, des troubles fonctionnels ou des complications infectieuses de la sphere ORL. Une approche medico-chirurgicale est utile a la prise en charge de ces patients.

Resume Introduction Le melanome muqueux des cavites nasales est une pathologie rare et de mauvais pronostic. Les objectifs de cette etude sont, d’une part, l’analyse de la valeur pronostique de deux classifications tumorales : la classification TNM specifique des melanomes muqueux, de l’American Joint Committee on Cancer (AJCC) de 2009 et la classification TNM des carcinomes des cavites nasales et des sinus de 2002 et, d’autre part, l’analyse de la valeur pronostique selon la localisation tumorale, limitee aux cavites nasales ou avec envahissement sinusien. Methodes Etude retrospective portant sur 18 patients pris en charge entre aout 1998 et juin 2014. Chaque lesion a ete classee selon la stadification tumorale TNM 2002 et 2009. Les donnees recueillies etaient l’âge, le sexe, la localisation de la lesion, les symptomes initiaux, les modalites therapeutiques, le suivi, les recidives et la survie globale. La survie des patients, depuis la date de decouverte du melanome jusqu’au deces a ete analysee a l’aide de courbes de survie selon la methode de Kaplan-Meier et la comparaison de survie entre groupes a ete realisee a l’aide du test du Log-Rank. Resultats L’âge moyen au diagnostic etait de 72 ans (54–94) et la cohorte comportait 11 femmes et 7 hommes. La mediane de survie globale etait de 80 mois. La survie globale a 1 an etait de 82,6 %. La survie globale a 5 ans etait de 54,5 %. La valeur pronostique selon la classification TNM 2002 etait statistiquement significative ( p = 0,0476) et statistiquement non significative ( p = 0,108) selon la classification 2009. La valeur pronostique de l’envahissement sinusien etait pejorative et significative ( p = 0,0039). Conclusion L’analyse de ces resultats montre une superiorite de la classification tumorale TNM non specifique de 2002. La prise en charge therapeutique, chirurgicale ou medicale doit tenir compte de l’envahissement sinusien, qui est un facteur pronostique pejoratif important.

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.

Resume Objectif Analyser de facon retrospective les resultats postoperatoires de la sphenoidotomie transnasale transostiale chez 79 patients presentant une sphenoidite chronique isolee et operes entre 1995 et 2013. Evaluer le taux de recidives par stenoses ostiales secondaires. Patients et methodes Soixante-dix-neuf patients âges de 10 a 84 ans (âge moyen = 48) ont ete inclus. Il s’agissait de 44 femmes et de 35 hommes (sex-ratio H/F = 0,79). Les cephalees presentes dans 61 % des cas etaient le signe d’appel le plus frequent. Des troubles visuels etaient presents dans trois cas. L’evaluation diagnostique reposait sur l’examen endoscopique endonasal, l’examen tomodensitometrique des sinus (TDM) et l’imagerie par resonance magnetique (IRM). L’indication operatoire etait posee sur la resistance au traitement medical antibiotique et/ou sur la nature et la gravite de l’atteinte. Tous les patients ont ete operes par voie transnasale transostiale sous controle endoscopique. Des prelevements a visee histologique, bacteriologique et mycologique etaient realises. Resultats Aucune complication per- ou postoperatoire immediate n’a ete notee. Nature de l’atteinte : il s’agissait dans 47 cas d’une atteinte inflammatoire non specifique avec analyse bacteriologique negative et remaniement inflammatoire de la muqueuse (59,5 %), dans 19 cas d’une atteinte fongique endocavitaire pure type balle fongique (24 %), dans 13 cas d’une atteinte bacterienne documentee (16,4 %). La duree du suivi postoperatoire etait en moyenne de 7,4 mois (6–48). Dans 71 cas (89,8 %), aucune recidive de l’atteinte et de la symptomatologie n’a ete notee. Recidives : 8 stenoses secondaires de la sphenoidotomie (10,2 %) ont conduit a une (6 cas) ou plusieurs (2 cas) reprises chirurgicales dans un delai moyen de 16,4 mois par rapport au geste initial. La symptomatologie etait reapparue sous forme de cephalees d’intensite variable. Dans 7 cas, il s’agissait d’une reapparition des signes initiaux et dans un cas d’une apparition secondaire de cephalees retro-orbitaires. Les reprises chirurgicales ont ete effectuees par voie transnasale transostiale dans 6 cas et par voie trans-ethmoidal dans 2 cas. Conclusion L’abord chirurgical par voie transnasale transostiale est un traitement efficace et sur des atteintes inflammatoires sphenoidales isolees. Le taux de recidives par stenose secondaire de la sphenoidotomie dans notre serie pose cependant la question du maintien d’une sphenoidotomie ouverte et fonctionnelle en postoperatoire.

Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.

L’ingestione di corpi estranei esofagei e una situazione particolarmente comune nella pratica clinica. Interessa sia la popolazione pediatrica (la maggior parte dei corpi estranei viene ingerita tra i 6 mesi e i 6 anni) che la popolazione adulta. Il sito di maggiore ristrettezza esofagea e il sito di principale incastro dei corpi estranei ingeriti. La maggior parte di essi passa spontaneamente. L’anamnesi permette, nella maggior parte dei casi, la diagnosi di corpo estraneo esofageo e situazioni diagnostiche difficili sono rappresentate da quelle situazioni in cui l’anamnesi e impossibile (bambino, adulto con handicap mentale, ecc.). La clinica, piu o meno completata dalla diagnostica per immagini, permette, tuttavia, di porre diagnosi nella maggioranza dei casi. L’urgenza terapeutica dipende in gran parte dalla tolleranza del paziente al corpo estraneo, ma anche dalla natura di questo corpo (pila a bottone, corpi estranei taglienti, ecc.). Le modalita di trattamento sono molteplici (astensione, trattamento medico, fibroscopia flessibile o endoscopia rigida) e dipendono dalle competenze locali nella gestione, ma anche dalla natura del corpo estraneo. La presenza ma anche l’estrazione del corpo estraneo sono una fonte di complicanze di cui bisogna conoscere l’esistenza per una gestione ottimale.

Los cuerpos extranos esofagicos es una situacion particularmente frecuente en la practica clinica. Afecta tanto a la poblacion pediatrica (la mayoria de los cuerpos extranos ingeridos se observan entre los 6 meses y los 6 anos) como a la poblacion adulta. La localizacion de enclavamiento esofagico es el principal lugar de impactacion de los cuerpos extranos ingeridos. La mayoria de ellos pasan de forma espontanea. En la mayoria de los casos, la anamnesis permite establecer el diagnostico de cuerpo extrano esofagico. Las situaciones dificiles corresponden a aquellas en las que dicha anamnesis es imposible (ninos, adultos con deficiencia mental, etc.). No obstante, la clinica, completada en mayor o menor medida con pruebas de imagen, permite establecer el diagnostico en la mayoria de los casos. La urgencia terapeutica depende esencialmente de la tolerancia del paciente al cuerpo extrano y de las caracteristicas de este (pila de boton, cuerpos extranos cortantes, etc.). Las modalidades terapeuticas son multiples (abstencion, tratamiento farmacologico, fibroendoscopia o endoscopia rigida) y dependen de las competencias de manejo de cada centro, asi como de las caracteristicas del cuerpo extrano. Tanto la presencia como la extraccion del cuerpo extrano son una fuente de complicaciones que deben conocerse para proporcionar un tratamiento optimo.

Fino al 1980, la fisiologia cocleare sembrava gravitare intorno a una tonotopia passiva fornita dalla membrana basilare, di cui due grandi scienziati (Helmholtz e Bekesy) avevano proposto e, poi, dimostrato il comportamento vibratorio sotto l’effetto di suoni di frequenza diversa. La complessita delle tappe presinaptiche dell’analisi periferica dei suoni e apparsa solo piu di recente, innanzitutto con la scoperta di due categorie di cellule sensoriali dai ruoli differenti, le cellule ciliate esterne amplificatrici e le cellule ciliate interne trasduttrici. Lo studio dei loro ciuffi stereociliari ha, poi, rivelato un’architettura altamente specializzata nei confronti di una meccanotrasduzione dalle performance che raggiungono i limiti ultimi della fisica, reagendo con precisione a delle pressioni acustiche la cui ampiezza copre un intervallo da uno a un milione, per delle deflessioni della soglia uditiva che oltrepassano appena il picometro. L’avvento della genetica, seguito rapidamente da quello della fisiologia molecolare, ha, poi, permesso di scomporre i meccanismi fisiologici, molecola per molecola, per cominciare a comprendere realmente come vengono messe in atto le performance uditive normali, il modo in cui vengono influenzate in maniera diversa secondo la fisiopatologia del deficit e come diagnosticare con precisione la disfunzione e risalire alla sua origine. Riguardo alle stereociglia e alla meccanotrasduzione, lo studio delle sinapsi uditive ha rivelato l’esistenza di sottili meccanismi di neurotrasmissione per la codifica accurata delle intensita e delle strutture temporali fini. E progredito anche lo studio dei fluidi endococleari, della loro produzione, della regolazione della loro composizione ionica e della loro pressione e del riciclaggio degli ioni coinvolti nella trasduzione. Lo scopo di questo articolo e quello di riassumere lo stato delle conoscenze di anatomia macroscopica e fisiopatologia molecolare, a sostegno della logica che dovrebbe ormai permettere di individuare la causa precisa della sordita neurosensoriale, al fine di correggere i disturbi della percezione che essa comporta e di prendere in considerazione degli approcci terapeutici.

The authors report a case of a malignant melanoma of the nasal cavity that is a rare tumor and very aggressive, constituting 1% of all melanomas. It appeared in a patient 54 years after he was treated for a hereditary retinoblastoma. Its symptoms are nonspecific, and often marked by epistaxis. Its diagnosis is histological, supported by immunohistochemistry. Its prognosis is often unfavorable, and characterized by the occurrence of metastases and recurrences. Because of the risk of secondary cancer that exists in any survivor of hereditary retinoblastoma, we must think of possible mucosal melanoma of the nasal sinus in these patients in cases of chronic epistaxis. The prognosis of this tumor depends on its early diagnosis and surgical treatment.

Hasta la decada de 1980, la fisiologia coclear parecia gravitar alrededor de una tonotopia pasiva lograda gracias a la membrana basilar, cuyo comportamiento vibratorio bajo el efecto de sonidos de frecuencias variables habia sido propuesto y despues demostrado por dos grandes cientificos (Helmholtz y Bekesy). La complejidad de las etapas presinapticas del analisis periferico de los sonidos no se dilucido hasta mas recientemente, primero con el descubrimiento de dos categorias de celulas sensoriales con funciones diferentes, las celulas ciliadas externas amplificadoras y las celulas ciliadas internas transductoras. El estudio de sus penachos de estereocilios ha mostrado una arquitectura muy especializada alrededor de una mecanotransduccion, con rendimientos que se situan en los limites ultimos de la fisica, capaces de una reaccion precisa a presiones acusticas cuya amplitud abarca un intervalo de uno a un millon, con deflexiones en el umbral auditivo que apenas superan el picometro. La aparicion de la genetica, seguida rapidamente de la de la fisiologia molecular, ha permitido descomponer los mecanismos fisiologicos, molecula a molecula, para comenzar a comprender realmente los rendimientos auditivos normales, como se afectan de diversos modos segun la fisiopatologia del deficit y como diagnosticar con precision una disfuncion y encontrar su origen. En paralelo a los estereocilios y la mecanotransduccion, el estudio de las sinapsis auditivas ha revelado la existencia de mecanismos sutiles de neurotransmision que permiten una codificacion precisa de las intensidades y de las estructuras temporales finas. Tambien se han obtenido progresos en el estudio de los liquidos endococleares, de su produccion, de la regulacion de su composicion ionica, de su presion, del reciclado de los iones implicados en la transduccion. El objetivo de este articulo es recapitular el estado de los conocimientos que van desde la anatomia macroscopica a la fisiopatologia molecular, para poder llegar a la causa precisa de una hipoacusia neurosensorial con el fin de solucionar los trastornos perceptivos que provoca y plantear pistas terapeuticas.

Resume But Traiter les patients ayant une polypose naso-sinusienne surinfectee. Patients et methodes Etude interventionnelle, prospective, randomisee en deux groupes paralleles (patients traites par une solution de tobramycine en aerosol versus solution saline isotonique administree en aerosol), en double insu et multicentrique. La population etudiee comprenait 55 patients : 23 patients recevant la solution saline isotonique et 32 patients recevant la tobramycine. Un nouveau dispositif (Easynose®) a ete developpe utilisant un principe original qui limite le depot pulmonaire et qui garantit un depot peripherique et homogene dans les cavites nasales. Objectifs L’objectif principal de cet essai etait de demontrer la superiorite d’une solution de tobramycine dosee a 150 mg/3 mL, solution pour inhalation par nebulisation par aerosoltherapie avec l’appareil Easynose® versus solution saline isotonique administree en aerosoltherapie par nebulisation avec le meme appareil, en termes d’eradication bacteriologique. Resultats et conclusion La superiorite en termes d’eradication bacteriologique de la tobramycine administree en aerosoltherapie avec l’appareil Easynose® a ete demontree de facon significative par rapport a la solution saline isotonique.

Resume La mesure de la pression endolymphatique interesse a la fois les chercheurs travaillant sur la physiologie et physiopathologie de l’audition et les praticiens ORL ayant en consultation des patients souffrant de maladie de Meniere ou de syndromes apparentes. Il est communement admis que l’hydrops endolymphatique est associe a la maladie de Meniere et qu’il s’accompagne d’une augmentation de pression hydrostatique. Pourtant, la mesure precise de la pression endolymphatique ne pouvant pas etre effectuee sans danger pour l’audition chez un patient, cette association entre hydrops et augmentation de pression endolymphatique n’est pas evidente. De nombreux modeles integres in vivo ont ete mis au point depuis les annees 1960, mais seuls quelques uns permettent la mesure de la pression hydrostatique endolymphatique. La mise au point de modeles de ce type, associant les mesures de pression hydrostatique, du potentiel endolymphatique et la verification de la fonction cochleaire est precieuse pour tenter d’elucider la physiopathologie de l’hydrops endolymphatique. Les principaux types de modeles et leur interet sont exposes et discutes ici.

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 70years. 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.

Resume Objectifs La Societe francaise d’ORL a organise un groupe de travail afin de rediger un consensus formalise sur la prescription de nebulisations a visee rhinologique. Ce consensus formalise aborde les principes de l’aerosoltherapie a visee rhinologique et les indications de cette therapie. Materiels et methodes La methodologie utilisee suit les regles publiees par la Haute Autorite de sante en janvier 2006 : « Bases methodologiques pour l’elaboration de recommandations professionnelles par consensus formalise » (disponibles sur le site Internet de la HAS a l’adresse « http://www.has-sante.fr »). La methode choisie est dite RAND/UCLA (« RAND appropriateness method ») dans sa version courte (sans groupe de lecture). Le choix de la version courte a ete dicte par le fait que cette conference de consensus concerne un theme tres cible dont les experts sont peu nombreux. Resultats L’aerosoltherapie de type sonique avec embout nasal doit etre privilegiee afin de permettre au traitement d’acceder aux meats moyens. Le groupe recommande de nebuliser les medicaments disposant d’une AMM pour la pathologie bronchopulmonaire au rythme de deux seances de dix minutes par jour pendant sept jours minimum. Les indications de l’aerosoltherapie a visee rhinologique sont : les rhinosinusites œdemato-purulentes, les rhinosinusites subaigues (4 a 12 semaines d’evolution), les exacerbations de rhinosinusite chronique et les suppurations rhinosinusiennes postoperatoires (> 1 mois). Une surveillance audiometrique lors des nebulisations repetees d’aminosides est necessaire. Conclusion L’aerosoltherapie a visee rhinologique est un outil therapeutique pour le traitement des rhinosinusites œdemato-purulentes, des rhinosinusites subaigues, des exacerbations de rhinosinusite chronique et des suppurations rhinosinusiennes postoperatoires. Les regles de prescription emises dans ce consensus permettent d’optimiser son efficacite.

Resume But de l’etude Analyser l’apport du scanner dans l’orientation de la prise en charge des abces retro-pharynges chez l’enfant et de la place de la ponction percutanee guidee par le scanner comme alternative au drainage chirurgical. Patients et methodes Etude retrospective incluant 18 enfants d’âge moyen de 38 mois [5–67 mois] entre 2006 et 2011, presentant une atteinte infectieuse retro-pharyngee. Tous les enfants ont eu un scanner cervical injecte initial. Les donnees cliniques, radiologiques, therapeutiques et bacteriologiques ont ete recueillies. Les resultats radiologiques ont ete correles aux donnees chirurgicales et a celles des ponctions percutanees (presence ou non d’une collection). Resultats Le scanner initial a permis de detecter 14 abces, 3 lymphadenites pre-suppurees et un œdeme retro-pharynge. Un cas de lymphadenite pre-suppurative a evolue vers l’abcedation apres echec de l’antibiotherapie et a ete traite chirurgicalement. Le drainage chirurgical a retrouve une collection purulente dans 11 cas et pas de collection dans 3 cas. Quatre ponctions percutanees radio-guidees ont ete realisees avec succes. Trois cas ont ete traites par antibiotherapie seule (2 lymphadenites et 1 œdeme retro-pharynge). Les analyses bacteriologiques retrouvaient dans 78,5 % des cas des streptocoques pyogenes du groupe A de sensibilite intermediaire aux aminoacides et certains resistants aux macrolides. La valeur predictive positive du scanner initial en faveur d’une collection etait dans notre serie egale a 78,8 %. Conclusion Le scanner cervical injecte est un outil fondamental pour la prise en charge d’une infection retro-pharyngee chez l’enfant. Il permet de faire le diagnostic d’abces et de confirmer l’indication de drainage chirurgical et/ou de ponction radio-guidee. La ponction percutanee scannoguidee fait partie dans notre experience des outils therapeutiques des abces retro-pharynges.

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.

OBJECTIVES Multidisciplinary team meetings (MTM) are essential in the choice of a therapeutic strategy in head and neck cancer. In many centres patients attend MTMs and are examined by the team. The aim of this study was to assess the influence of the patient's presence on therapeutic decisions. STUDY DESIGN Prospective study of 119 consecutive patients. METHODS Two therapeutic situations were compared: the therapeutic decision taken following discussion of the patient's file in the MTM (D1) and the therapeutic decision taken after examination of the patient during MTMs (D2). Concordance between the two situations was measured. RESULTS Concordance between D1 and D2 was 97%. No factors likely to decrease concordance were identified. Decisions taken during MTMs were acted upon for 97% of the patients. CONCLUSION The presence of the patient during MTMs is not essential if the files are thoroughly presented and discussed.