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National audience; Introduction. La presbyacousie correspond à la diminution physiologique de l’audition due à l’avancée en âge et commence bien avant la sixième décennie. Ces recommandations rappellent les principes du diagnostic précoce de la presbyacousie et les moyens de réhabilitation optimale dès l’apparition des premiers symptômes. Matériel et méthodes. Les recommandations sont basées sur une analyse systématique de la littérature réalisée par un groupe multidisciplinaire réunissant des médecins, des audiologistes et des audioprothésistes provenant de toute la France. Elles sont classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant. Résultats. Le diagnostic de presbyacousie est plus difficile en début d’évolution, mais un certain nombre d’outils sont disponibles pour son diagnostic précoce et sa prise en charge en présentiel, voire à distance. Conclusion. En cas de profil clinique évocateur de presbyacousie chez un sujet jeune, surtout s’il y a plusieurs cas familiaux, il est recommandé de proposer une enquête génétique. Il est recommandé de réaliser l’audiométrie vocale dans le bruit en champ libre pour mesurer l’intelligibilité dans un environnement au plus proche de la réalité. Les questionnaires en supplément de l’audiométrie permettraient d’évaluer au mieux le handicap du patient. Il est recommandé de considérer que la réhabilitation auditive par prothèse auditive ou implant cochléaire peut ralentir ou prévenir le déclin cognitif. Une rééducation combinée auditive et cognitive devrait être proposée, quel que soit le temps écoulé depuis l’appareillage. Il est recommandé d’intégrer des programmes accessibles par smartphones, tablettes ou Internet intégrant différents domaines d’entraînement en complément des séances en présentiel.

Resume Objectifs Durant l’epidemie de Covid-19, l’acces au diagnostic et aux soins des pathologies relevant de l’audiologie medicale a regresse en France, posant un risque de perte de chance pour le patient. Ce guide de conseils de bonne pratique vise a repertorier les solutions techniques existantes permettant d’examiner a distance le patient presentant une plainte en audiologie et a decrire leurs interets et, le cas echeant, leurs limites. Methodes Les conseils ont pu etre elabores a la fois a partir de l’experience clinique des experts medicaux ayant participe a la redaction du guide, et d’une revue extensive de la litterature portant sur les recommandations de pratique clinique en tele-audiologie. Les solutions de tele-audiometrie ont ete recensees sur la base d’une requete par moteur de recherche effectuee en avril 2020, avant verification de leur disponibilite sur le marche europeen. Resultats Des solutions de video-otoscopie permettent la tele-transmission d’images compatibles avec un diagnostic de qualite soit en se connectant via internet a une plate-forme de tele-soin, soit via un smartphone ou une tablette utilisant un systeme d’exploitation iOS ou Android. Selon les memes modalites, il est possible de realiser a distance un examen audiometrique tonal dans les regles de l’art, une audiometrie vocale dans le silence ou dans le bruit ainsi que des explorations fonctionnelles objectives de l’audition. Les examens cliniques et paracliniques peuvent etre consultes par le medecin de facon differee pour etre interpretes (tele-audiologie asynchrone). Ils peuvent aussi etre realises en temps reel chez un patient, a tout âge de la vie, a condition qu’un aidant puisse etre present durant l’installation des transducteurs ou la realisation de l’acoumetrie (tele-audiologie synchrone). Les solutions de teleaudiologie trouvent egalement une application dans la formation a distance des futurs professionnels de sante engages dans la prise en charge des pathologies de l’audition. Conclusion Dans la legislation francaise, la tele-otoscopie est un acte medical qui releve soit de la tele-expertise (avis asynchrone) soit d’un acte de teleconsultation (avis synchrone). L’evaluation subjective et objective de la fonction auditive du patient est aujourd’hui possible a distance a condition de respecter les precautions listees.

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%.

Resume L’action medicale humanitaire, au sens large, englobant les missions d’entraide globale entre medecins ORL, est effective depuis de nombreuses annees. Ces missions, qui reposent sur la volonte propre des participants, n’ont pas ete encadrees par des regles specifiques, sur le plan medical, social, ni ethique. Le temoignage de medecins de certains pays « receveurs » de missions, notamment lors du dernier congres de l’IFOS (International Federation of Otorhinolaryngological Societies), en 2017 a Paris, a mis en exergue l’importance de la bonne coordination des missions entre les equipes fournissant de l’aide et les equipes receveuses. Plusieurs reflexions ethiques ont ete publiees sur le sujet, mais peu concernent les missions d’entraide humanitaire en ORL. Nous presentons une mise au point sur ce sujet, a partir de reflexions menees au sein de la SFORL (Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou) et de l’IFOS, de l’experience de nombreuses missions et d’une revue de la litterature. Une charte specifique de missions d’entraide medicale et humanitaire en ORL a ete elaboree. Cette mise au point est essentielle pour ameliorer la diffusion des connaissances et la formation en ORL a travers le monde en respectant les regles ethiques et socioculturelles indispensables.

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.

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: 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.

Menière’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 anti-inflammatory effect or as a regulator of the 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 trans-cellular water fluxes. In the present study we investigated the hypothesis that dexamethasone could impact water fluxes in the inner ear through direct interaction with 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. We also describe the molecular mechanisms involved in dexamethasone binding and in its regulatory action upon AQP2 function.HighlightsAQP2 water permeability is modulated by dexamethasone at physiological concentrationsThe interaction impacts water fluxes through a direct interaction with the extra-cellular surface of the aquaporinKey interactions implicate conserved residues of the ar/R constrictionNew insights on corticosteroids mode of actions in Menière’s disease treatment

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.

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.

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.

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

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.

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.

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.

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.

Resume Objectifs Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la strategie diagnostique et therapeutique dans la maladie de Meniere. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. Les recommandations ont ete redigees, puis relues par un groupe de lecture independant du groupe de travail. Les recommandations proposees ont ete classees en accord avec le guide d’analyse de la litterature et de gradation des recommandations, publie par l’ANAES (janvier 2000). Resultats Le diagnostic de la maladie de Meniere est pose devant l’association des quatre plaintes cliniques classiques et en l’absence d’une autre cause decelable par IRM. En cas de tableau clinique incomplet, il est recommande de realiser les tests d’explorations audio-vestibulaires objectifs. La prise en charge therapeutique comporte des traitements medicaux et chirurgicaux, conservateurs ou destructeurs de la fonction vestibulaire. La prise en charge medicale repose sur l’hygiene de vie, la betahistine, les diuretiques et l’injection transtympanique de corticoides et/ou de gentamicine. Les principaux moyens chirurgicaux disponibles sont par ordre d’agressivite la chirurgie du sac endolymphatique, la neurotomie vestibulaire et la labyrinthectomie.

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.

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.

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.

International audience; OBJECTIVES:To describe the clinical, histological and therapeutic characteristics of a prospective multicenter series of 95 head and neck adenoid cystic carcinoma patients, and to determine any prognostic factors for disease-free survival.PATIENTS AND METHODS:Ninety-five patients with adenoid cystic carcinoma were included in the Réseau d'Expertise Français Des Cancers ORL Rares (REFCOR, French Rare Head and Neck Cancer Expert Network) database between 2009 and 2012. The primary site was the salivary glands in 39 cases, sinus cavities (including hard palate) in 36 cases, pharynx-larynx-trachea in 14 cases, and lips and oral cavity in 4 cases. The tumor was stage I in 15% of cases, stage II in 23%, stage III in 26% and stage IV in 36%. Nine patients had cervical lymph node involvement and 5 had metastases at diagnosis. Fifty-six percent of patients were managed by surgery with postoperative radiation therapy. During follow-up, 3 patients died, 9 developed metastases and 12 showed recurrence or local progression.RESULTS:Mean follow-up was 18 months. On univariate analysis, disease-free survival correlated with T stage (P=0.05), N stage (P=0.003), resection margins (P=0.04), lymph node involvement on histology (P=0.01), and absence of chemotherapy (P=0.03). On multivariate analysis, disease-free survival correlated with T stage (P=0.01), N stage (P=0.09) and surgery (P=0.005).CONCLUSION:The essential issue in adenoid cystic carcinoma is long-term control. The present results confirm that the reference attitude is radical surgical resection for optimal local control. Adjuvant radiation therapy did not emerge as a prognostic factor. This study also provides a starting-point for translational studies in pathology and genetics.

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.

The advent of hybrid electro-acoustic implants requires precise positioning of the electrode-array (EA) within the cochlea. The cochlea size, that is, the length of the cochlear scala tympani, is often indirectly estimated from distance A by Escude’s method. This technique has been confirmed by anatomical studies, in a bunch of cadaveric specimens, but it is not yet widely established in the field of computed tomography (CT). We compared cochlear duct length obtained by Escude’s method to those directly acquired on CT images. The lengths of cochlear scala tympani were directly measured on CT scans by contouring the external cochlear wall (contouring technique-CoT). In fifteen patients implanted with a straight EA, the length of the EA and the measured length of the cochlea by the CoT were compared, to check the reliability of the CoT. Then, in 200 CT-scans, the length of the cochlear duct was measured by the CoT then compared to Escude’s method. In the 200 CT-scans which served for cochlear length measurements, a significant variability between the cochleae were observed, as expected. At 360°, the correlation between the measurements of the length of the cochlear scala tympani between the two techniques differed, with a difference of 0.2 ± 0.7 mm at 360° (extreme: 2 mm; p

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.

Objectives The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society ( Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou : SFORL) for diagnostic and therapeutic strategy in Meniere's disease. Methods A work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, then read over by an editorial group independent of the work group. The guidelines were graded according to the literature analysis and recommendations grading guide published by the French National Agency for Accreditation and Evaluation in Health (January 2000). Results Meniere's disease is diagnosed in the presence of the association of four classical clinical items and after eliminating differential diagnoses on MRI. In case of partial presentation, objective audiovestibular tests are recommended. Therapy comprises medical treatment and surgery, either conservative or sacrificing vestibular function. Medical treatment is based on lifestyle improvement, betahistine, diuretics or transtympanic injection of corticosteroids or gentamicin. The main surgical treatments, in order of increasing aggressiveness, are endolymphatic sac surgery, vestibular neurotomy and labyrinthectomy.

In vestibular-schwannoma (VS) surgery, hearing-preservation rate remains low. Besides damage to the cochlear nerve, intraoperative cochlear ischemia is a potential cause of hearing loss. Here, we used non-invasive cochlear microphonic (CM) recordings to detect the cochlear vascular events of VS surgery. Continuous intraoperative CM monitoring, in response to 80–95 dB SPL, 1-kHz tone-bursts, was performed in two samples of patients undergoing retrosigmoid cerebellopontine-angle surgery: one for VS (n = 31) and one for vestibular neurectomy or vasculo-neural conflict causing intractable trigeminal neuralgia, harmless to hearing (n = 19, control group). Preoperative and postoperative hearings were compared as a function of intraoperative CM changes and their chronology. Monitoring was possible throughout except for a few tens of seconds when drilling or suction noises occurred. Four patterns of CM time course were identified, eventless, fluctuating, abrupt or progressive decrease. Only the VS group displayed the last two patterns, mainly during internal-auditory-canal drilling and the ensuing tumor dissection, always with postoperative loss of hearing as an end result. Conversely, eventless and fluctuating CM patterns could be associated with postoperative hearing loss when the cochlear nerve had been reportedly damaged, an event that CM is not meant to detect. Cochlear ischemia is a frequent event in VS surgery that leads to deafness. The findings that CM decrease raised no false alarm, and that CM fluctuations, insignificant in control cases, were easily spotted, suggest that CM intraoperative monitoring is a sensitive tool that could profitably guide VS surgery.

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.

The objective was to design in gerbils a model of reversible decrease in cochlear blood flow (CBF) and analyze its influence on cochlear function. In Mongolian gerbils injected with ferromagnetic microbeads, a magnet placed near the porus acusticus allowed CBF to be manipulated. The cochlear microphonic potential (CM) from the basal cochlea was monitored by a round-window electrode. In 13 of the 20 successfully injected gerbils, stable CBF reduction was obtained for 11.5 min on average. The CM was affected only when CBF fell to less than 60% of its baseline, yet remained >40% of its initial level in about 2/3 of such cases. After CBF restoration, CM recovery was fast and usually complete. Reduced CM came with a 35- to 45-dB threshold elevation of neural responses determined by compound action potentials. This method allowing reversible changes of CBF confirms the robustness of cochlear function to decreased CBF. It can be used to study whether a hypovascularized cochlea is abnormally sensitive to stress.

International audience

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 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.