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Cochlear implants are medical devices indispensable for the treatment of severe-to-profound bilateral sensorineural hearing loss - The most commonly used surgical procedure for cochlear implantation involves temporal bone drilling associating mastoidectomy with a facial recess approach - Improvements in robot-assisted surgery since 2010 have raised questions about the possibility of "simplifying" cochlear implant surgery - This study showed that the use of robotic assistance coupled to CT guidance for cochlear implantation is possible and apparently safe for the entire procedure using a Robot that is already available worldwide. - Several improvements are required to optimize this procedure.

ObjectiveTo evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery.MethodsThis study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study.ResultsWith a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors.ConclusionApart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

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.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Resume Objectifs Evaluer le role des facteurs de risque « cardiovasculaire », de la prise de medicaments alterant la crase sanguine et les signes de gravite chez des patients hospitalises pour epistaxis spontanee. Materiel et methodes Il s’agissait d’une etude monocentrique, retrospective, realisee sur 7 ans dans un centre hospitalier universitaire, ayant inclus 205 patients hospitalises pour epistaxis spontanee. Ont ete notes par patient : les facteurs de « risque cardiovasculaire » (maladie ou antecedent « cardiovasculaire » a risque hemorragique ou thromboembolique, hypertension arterielle, diabete sucre, dyslipidemie), la prise de medicaments modifiant la crase sanguine ; les mesure de la pression arterielle et le taux minimal d’hemoglobinemie au cours de l’hospitalisation. Les patients ont ete separes en deux groupes : epistaxis « graves » et « non graves ». Resultats Il n’existait pas de difference significative entre les groupes de patients concernant l’âge moyen, le sex-ratio, la presence d’un antecedent d’hypertension arterielle et le nombre de facteurs de « risque cardiovasculaire ». Les patients avec une epistaxis grave avaient des mesures de pression arterielle significativement plus basse que dans le groupe non grave. L’hemoglobinemie etait significativement inferieure dans le groupe des epistaxis graves. Il existait un lien entre le nombre de facteurs de risque « cardiovasculaire » par patient et la probabilite d’une transfusion sanguine. Conclusions Les roles reels de ces differents facteurs presumes dans la survenue d’une epistaxis spontanee restent encore a elucider, de meme que les facteurs de gravite.

Resume Objectif 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 prise en charge des epistaxis en premiere intention. Methodes A partir d’une revue de la litterature scientifique par un groupe de travail multidisciplinaire, des recommandations ont ete redigees, fondees sur les articles et l’experience individuelle des membres, puis relues par un groupe de lecture independant afin d’aboutir au texte de synthese. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Resultats En premiere intention, le mouchage, le nettoyage des fosses nasales et une compression bidigitale sont recommandes. En cas de saignement persistant, l’anesthesie locale avec vasoconstriction precede les gestes nasaux a visee diagnostique et therapeutique. Quand l’origine des saignements n’est pas anterieure, l’endoscopie est essentielle, et localise l’origine des saignements dans la plupart des cas. En cas de saignement actif, une cauterisation est realisee si le site de saignement est identifie. S’il n’est pas visualise ou si echec des premieres mesures, un tamponnement anterieur pourra etre realise par un medecin non specialiste ORL. La survenue d’une epistaxis impose, au decours, la realisation d’une endoscopie des fosses nasales par un medecin ORL. Les patients doivent etre informes des gestes a realiser en cas d’epistaxis a domicile et des risques des differents traitements.

Resume Objectif 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 prise en charge specifique des epistaxis dans le cadre d’une maladie de Rendu-Osler. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees, puis relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir au texte final. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Resultats Le diagnostic de maladie de Rendu-Osler s’etablit sur la presence de trois signes parmi les quatre criteres de Curacao. Devant une epistaxis aigue, il est recommande de realiser une compression bi-digitale. L’embolisation est reservee aux epistaxis resistantes. Les mechages avec du materiel non resorbable ou des cauterisations sont contre-indiques. L’education therapeutique est indispensable. Le traitement des telangiectasies de la muqueuse nasale est possible en utilisant differents moyens locaux. En cas de controle insuffisant, il est recommande d’utiliser l’acide tranexamique par voie systemique.

International audience; OBJECTIVES:The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) concerning specific treatment of epistaxis in Rendu-Osler-Weber disease.METHODS:A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.RESULTS:Rendu-Osler-Weber disease is diagnosed from the presence of at least three of Curaçao's four criteria. In acute epistaxis, bidigital compression is recommended. Embolization is reserved for resistant epistaxis. Non-resorbable nasal packing and cauterization are contraindicated. Patient education is essential. Telangiectasia of the nasal mucosa can be treated by various local means. In the event of insufficient control, systemic administration of tranexamic acid is recommended.

The present study sought to determine whether there is a correlation between the prevalence of superior semicircular canal (SSC) dehiscence (SSCD) on temporal CT and population age. The secondary objective was to identify anatomic factors for SSCD by studying SSC diameter and its protrusion into the middle cranial fossa. The aim was to determine the acquired or congenital origin of SSCD (Minor's syndrome).A single-center retrospective radiological and anatomic study included 180 CT scans of 354 petrous parts of the temporal bone taken between January and December 2011 in a university hospital center. Bone thickness above the SSC was measured and classified in 4 grades: grade 1,2.5mm; grade 2,2.5mm: grade 3, predehiscent; grade 4, dehiscent. SSC diameter was also measured, as was the height of SSC protrusion into the middle cranial fossa.SSCD was found in 0.8% of cases and predehiscence in 12%. Patients with dehiscence were older; patients with grade 3 or 4 were significantly older than those free of dehiscence (P0.05). There was no significant difference in SSC diameter according to grade. In grade 1, protrusion was greater than in other subjects, with a significant correlation between age and reduced protrusion (P0.05).The study demonstrated a correlation between aging and SSCD prevalence. Reduced SSC roof height with age suggests that SSCD may be an acquired phenomenon, related in some way to aging of the base of the skull.

Resume Objectifs Il s’agissait de determiner l’existence d’une relation entre la prevalence de la dehiscence du canal semicirculaire superieur (CSCS) sur un scanner des rochers et l’âge de la population. L’objectif secondaire etait de mettre en evidence une predisposition anatomique pouvant favoriser la dehiscence du CSCS en etudiant le diametre et la procidence du CSCS dans la fosse crânienne moyenne. Le but etait d’expliquer l’origine du syndrome de Minor comme phenomene acquis ou congenital. Materiel et methode Une etude radioanatomique monocentrique retrospective de 180 scanners de 354 rochers entre janvier et decembre 2011 a ete realisee dans un centre hospitalier universitaire. L’epaisseur osseuse au dessus du CSCS etait mesuree et classee en 4 stades (stade 1 > 2,5 mm, stade 2 Resultats Une dehiscence du CSCS etait retrouvee dans 0,8 % des cas et un stade predehiscent dans 12 %. Les patients avec une dehiscence etaient plus âges. L’âge des patients avec un stade 3 et 4 etait statistiquement plus eleve que celui des patients sans atteinte (p Conclusion Cette etude a montre une relation entre le vieillissement et la prevalence de la dehiscence du CSCS. La diminution de l’epaisseur du toit du CSCS avec l’âge laisse supposer que cette dehiscence du CSCS pourrait etre un phenomene acquis correspondant en quelque sorte a un vieillissement de la base du crâne.

Objectives To determine whether intra-operative neuromonitoring (IONM) of the vagus nerve during thyroidectomy can predict postoperative vocal fold palsy. Design A single-centre, prospective study. Setting University Hospital. Participants A total of 95 patients underwent thyroid surgery. A total of 160 vagus nerves were studied. The amplitude of the action potential of vocal muscles was recorded intra-operatively by indirect supramaximal stimulation of the vagus nerve. All patients underwent flexible fibre-optic laryngoscopy on postoperative day 1 to detect the presence of vocal fold palsy. Main outcome measures The primary outcome measure was the difference of the action potential amplitude of the vagus nerve before and after resection of the thyroid lobe. Statistical analysis determined the amplitude variation cut-off able to accurately predict postoperative vocal fold palsy. Results Transient vocal fold palsy was observed in 4.375% of cases, and permanent fold palsy was observed in 1.25% of cases. A decrease of the action potential amplitude by more than 61% was statistically significantly associated with postoperative vocal fold palsy. A greater than 87% decrease of the amplitude of the action potential was correlated with permanent postoperative vocal fold palsy. Conclusion IONM of the vagus nerve during thyroidectomy may accurately predict postoperative vocal fold palsy.

Resume Objectif Presenter les recommandations de la Societe francaise d’oto-rhino-laryngologie (SFORL) concernant la prise en charge des epistaxis dans le cadre de l’hypertension arterielle. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees, puis relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir au texte final. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Resultats Il est recommande de mesurer la pression arterielle des patients a la phase aigue d’une epistaxis (Grade A), de controler medicalement les chiffres tensionnels eleves a la phase aigue du saignement afin de diminuer sa duree, de surveiller la tension arterielle au decours de l’epistaxis, de controler medicalement les chiffres tensionnels eleves au decours du saignement afin de diminuer le risque de recidive. En cas de persistance de chiffres tensionnels eleves au decours d’une epistaxis severe, il est recommande de demander un bilan cardiovasculaire pour rechercher une maladie hypertensive sous-jacente (Grade B).

Objectives To assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis. Material and methods A single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished. Results There were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion. Conclusion The real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.

Objective:This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.Methods:A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.Results:In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.Conclusion:Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Objectives To compare postoperative complication rates after dissection tonsillectomy in patients operated by outpatient surgery and patients operated by inpatient surgery. Population and methods A prospective, single-centre, observational study was conducted over a period of 1 year. Dissection tonsillectomy was performed in 103 patients (mean age: 4 years) between September 2011 and September 2012. The following parameters were studied: bleeding or inflammatory complication rate, readmissions, unscheduled visits, factors contraindicating outpatient surgery, reasons for failure of outpatient surgery and influence of Postoperative Nausea and Vomiting scores. Results Two patient groups were composed: 54 patients were managed by outpatient surgery (Group O) and 49 patients were managed by inpatient surgery (Group I). The two main factors contraindicating outpatient surgery were age less than 3 years (40%) and preoperative suspicion of sleep apnoea-hypopnoea syndrome (26%). Seven patients of Group O had to stay in hospital (outpatient failure rate of 13%). Postoperative complications were observed in 13% of patients of Group O versus 12.2% of patients of Group I with no statistically significant difference between the two groups. One patient in each group had to be readmitted; no statistically significant difference was observed between the two groups (P = 0.41). PONV scores were very high (2) in all cases. Conclusion Outpatient tonsillectomy in well-selected patients is not associated with a higher postoperative complication rate than inpatient tonsillectomy. With systematic appropriate prophylaxis, Postoperative Nausea and Vomiting scores had no influence on the postoperative course.

Resume Objectifs Comparer les complications postoperatoires apres tonsillectomie par dissection des patients operes en chirurgie ambulatoire et des patients operes en hospitalisation conventionnelle. Population et methodes Une etude observationnelle, prospective, monocentrique a ete realisee pendant 1 an. Cent-trois patients (4 ans de moyenne d’âge) ont beneficie d’une tonsillectomie par dissection de septembre 2011 a septembre 2012. Ont ainsi ete etudies : la survenue de complications hemorragiques ou inflammatoires, les rehospitalisations, les consultations imprevues, les facteurs contre-indiquant la chirurgie ambulatoire, les motifs d’echecs de la prise en charge en chirurgie ambulatoire et l’influence des scores de nausees et vomissements postoperatoires. Resultats Deux groupes de patients ont ete constitues : 54 patients ont ete pris en charge en ambulatoire (groupe A) ; 49 en hospitalisation conventionnelle (groupe H). Les deux principaux facteurs ayant contre-indique la chirurgie ambulatoire ont ete : l’âge inferieur a 3 ans (40 %) et la suspicion preoperatoire d’un syndrome d’apnee-hypopnee du sommeil (26 %). Sept patients du groupe A ont du rester hospitalises (taux d’echec de l’ambulatoire de 13 %). Treize pour cent des patients du groupe A ont presente une complication postoperatoire contre 12,2 % pour les patients du groupe H ; il n’y avait pas de difference statistiquement significative. Un patient dans chaque groupe a du etre re-hospitalise ; il n’y avait pas de difference statistiquement significative (p = 0,41). Les scores NVPO etaient tres eleves (≥ 2) dans tous les cas. Conclusion La tonsillectomie en ambulatoire pour des patients bien selectionnes ne pose pas plus de problemes postoperatoires que l’hospitalisation conventionnelle. En cas de prevention systematique adaptee, il n’y a pas d’influence des scores de nausees et vomissements postoperatoires sur les suites postoperatoires.

Objective The study was designed to assess the prevalence, management and survival of patients with simultaneous squamous cell carcinomas of the oral cavity and hypopharynx (OC/HP). Material and methods A multicenter, retrospective study (2 university hospitals) was conducted between 2003 and 2007 on a series of 96 patients with simultaneous squamous cell cancers of the OC/HP. Results A total of 88 men and 8 women were included in the study: 81 patients presented double sites, 14 presented triple sites and one presented quadruple sites. The tumour sites most frequently observed were: hypopharynx in 61% of cases (involving the pyriform sinus in 42% of cases) and the oropharynx in 59% of cases (involving the palatine tonsil in 30% of cases). Upper aerodigestive tract endoscopy under general anaesthesia revealed a simultaneous lesion not suspected on clinical examination in 45% of patients: the site discovered on endoscopy was hypopharyngeal in 2 out of 3 cases; the tumour was classified T1 or T2 in 95.5% of cases. Patients treated simultaneously for all sites had a better prognosis than patients in whom each tumour was treated separately. The 5-year specific survival was 34% and the 5-year overall survival was 28%. Conclusion The prevalence of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx ranges between 1 to 7.4% in the literature and was 4.6% in the present series. A common treatment strategy for each of the patient's tumours appears to be superior to the current theoretical approach that consists of considering each tumour separately.

Objectives To determine the value of tympanostomy tubes (TTs) in the management of serous otitis media (SOM) and the risk factors for SOM recurrence. Method This single-centre cohort study was performed in the University hospital of Amiens, France; and concerned 215 under-12 children having undergone at least one bilateral TT (Shepard grommet-type) placements for SOM. Results The mean TT retention time was 10 months. SOM recurred in 79 children (62.79%) and thus required a second TT placement (bilaterally in 90% of these cases). Overall, 29.3% of the patients underwent a total of two TT placements, 5.58% underwent three placements and 0.93% underwent four placements. After their first-ever TT placement, 17 children had complications: 10 cases of otorrhoea (4.6%), 4 cases of retraction pocket (1.9%) and 3 perforations of the tympanic membrane (1.4%). At last follow-up, the most common complications were tympanosclerosis (6.9%) and perforation of the tympanic membrane (6.5%). In a multivariate analysis, the only significant risk factors for SOM recurrence were age below 48 months at the time of TT placement, and a TT retention time below 9 months. In contrast, a history of allergy, gastro-oesophageal reflux, prematurity or passive smoking were not significantly associated with recurrence. Conclusion Age at the time of TT placement and the TT retention time were significantly associated with SOM recurrence. The TT retention time and the number of TT placements were not associated with the risk of long-term complications.

Objective:To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre.Methods:This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia.Results:Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032).Conclusion:Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

Objective:To evaluate the presence of cardiovascular risk factors and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients.Methods:A single-centre retrospective study of 80 patients hospitalised for idiopathic sudden sensorineural hearing loss was conducted over a 6-year period. Mean pure tone hearing thresholds were assessed by pure tone audiometry.Results:Twenty-three of 80 patients (28.75 per cent) initially had no cardiovascular risk factors. Forty-five patients had hyperlipidaemia, 22 patients had hypertension, 7 patients had diabetes mellitus and 7 patients were obese. No statistically significant difference was observed between patients with complete versus partial sudden sensorineural hearing loss (p = 0.0708) concerning the cardiovascular risk factors. At long-term follow up, the hearing recovery rate was not significantly different between the two groups of patients (p = 0.7541).Conclusion:The lack of a clear relationship between idiopathic sudden sensorineural hearing loss and cardiovascular risk factors suggests that sudden sensorineural hearing loss has a predominantly multifactorial disease profile regardless of hearing impairment severity.

Objectives The authors present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society ( Societe Francaise d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou : SFORL) on epistaxis in high blood pressure. Methods A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Results It is recommended to measure the blood pressure of patients in acute-phase epistaxis (Grade A); to control high blood pressure medically in the acute phase of bleeding, to reduce its duration; to monitor blood pressure at the waning of nosebleed; and to control high blood pressure medically in the waning phase to reduce the risk of recurrence. In case of persistent high blood pressure on waning of severe epistaxis, it is recommended to prescribe cardiovascular evaluation to screen for underlying hypertensive disease (Grade B).

International audience; OBJECTIVE:The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy.METHODS:A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence.RESULTS:Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment.

Summary Objective The authors present the guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) on patient information ahead of thyroid surgery. Methods A multidisciplinary medical team was tasked with a scientific literature review on this topic. The texts retrieved were analyzed by an independent committee. A joint meeting drew up the final guidelines. The strength of the recommendations (grade A, B or C) was based on levels of evidence. Results It is recommended that the results of preoperative exploration and the indications for surgery should be explained to the patient. Patients should be informed as to the type of surgery, surgical objectives, risks and consequences. It is mandatory to obtain the patient's written consent before surgery. Conclusion Appropriate medical information is a critical step in patient management.

Resume Objectif Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant l’information du patient avant chirurgie de la glande thyroide. Methodes Un groupe de travail multidisciplinaire a ete charge de rediger une revue de la litterature scientifique sur le theme etudie. Les textes ainsi obtenus ont ete relus par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir a la version finale de la recommandation. Les recommandations proposees ont ete classees en grade A, B ou C selon un niveau de preuve scientifique decroissant. Resultats Il est recommande d’expliquer au patient les resultats des explorations preoperatoires et les raisons qui amenent a proposer l’acte chirurgical. Le patient doit etre informe du type de chirurgie proposee, de ses buts, risques et consequences, ainsi que de ses modalites de prise en charge. Il est obligatoire de recueillir le consentement ecrit du patient avant chirurgie. Conclusion L’information delivree par le chirurgien est un temps essentiel de la prise en charge du patient.

Resume Objectifs Etudier la morbidite de l’evidement du compartiment central dans les cancers thyroidiens differencies de souche vesiculaire. Patients et methode Une etude retrospective concernant 83 patients (61 patients operes de thyroidectomie totale et 22 patients operes de thyroidectomie totale et evidement central) a ete realisee. Les calcemies postoperatoires et la mobilite laryngee ont ete etudiees et comparees statistiquement (test du Chi2, test exact de Fisher). Resultats Il n’existait pas de difference significative entre les deux groupes concernant la survenue d’une paralysie recurrentielle ou d’une hypoparathyroidie definitive. En revanche, il existait une hypocalcemie transitoire plus frequente en cas d’evidement central associe a la thyroidectomie (p = 0,02). Conclusion L’evidement du compartiment central associe a la thyroidectomie totale n’augmente pas le risque de paralysie recurrentielle ou d’hypocalcemie definitive, mais il est responsable d’une augmentation du taux d’hypoparathyroidie transitoire.

International audience; OBJECTIVES:The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults.METHODS:A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work-group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.RESULTS:In first-line, clearing out blood-clots and bidigital compression are recommended. In case of persistent bleeding, local anesthesia with a vasoconstrictor is essential before nasal diagnostic and therapeutic procedures. When the origin of bleeding is not anterior, nasal endoscopy is an essential procedure, identifying the bleeding site in most cases. In case of active bleeding, cauterization is recommended but is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.

Resume Objectifs Evaluer l’interet de la chirurgie en tant que moyen diagnostique et therapeutique dans la prise en charge de la tuberculose lymphonodale cervicale. Materiel et methode Une etude retrospective du 1 er janvier 1998 au 31 decembre 2007 concernait 30 patients atteints de tuberculose lymphonodale cervicale. La population comportait 60 % d’autochtones avec un âge moyen de 47,1 ans et une predominance feminine (73,33 %). Resultats Les adenopathies etaient le plus souvent sus-claviculaires, unilaterales, fermes, en moyenne de 3 cm de grand axe. Une exerese ganglionnaire a ete realisee a but diagnostique chez 22 patients et a mis en evidence des lesions specifiques granulomateuses et gigantocellulaires avec necrose caseeuse chez 21 patients sur 22. Cinq adenopathies abcedees ont necessite un drainage chirurgical et trois evidements ganglionnaires de rattrapage ont ete realises apres un traitement medical bien conduit. Conclusion La chirurgie garde une place preponderante dans la prise en charge diagnostique et therapeutique de la tuberculose lymphonodale cervicale.

Resume Objectifs Etudier et comparer les complications postoperatoires de la thyroidectomie totale dans le cadre des goitres multiheteronodulaires benins et de la maladie de Basedow. Materiel et methode Une etude retrospective sur 41 mois concernant 176 patients (139 goitres multiheteronodulaires benins et 37 maladies de Basedow) a ete realisee. Les calcemies postoperatoires, la mobilite laryngee et les complications hemorragiques ou infectieuses ont ete etudiees et comparees statistiquement (test de Kruskal-Wallis). Resultats Il n’existait pas de difference significative concernant la survenue d’une paralysie recurrentielle, d’une complication hemorragique ou d’une hypoparathyroidie definitive. Il existait en revanche une hypocalcemie postoperatoire precoce (j1) plus frequente en cas de maladie de Basedow. Conclusion La thyroidectomie totale dans le cadre de la maladie de Basedow est une chirurgie sure, moyennant une preparation medicale preoperatoire rigoureuse.

Sinonasal cavities: CT imaging features of anatomical variants and surgical risk. Anatomical variants of the sinonasal cavities are common. About 15 major variants are described (nasal septal deviation is present in up to 62% of the population). Because the may lead to complications at the time of endovascular procedures or endoscopic sinonasal surgery (vascular, nervous, or osseous injury), there detection has medicolegal implications. Knowledge of anatomical variants by radiologists and ENT surgeons is thus required. We will describe these variants, their imaging features, frequency, implications and associated risk of potential complication.

Objective:To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.Materials and methods:We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.Results:A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).Conclusion:The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

Objectives:To analyse and compare chest radiographs and cervicothoracic computed tomography scans taken prior to thyroid surgery, in order to locate and predict thoracic extension of substernal goitres.Method:This eight-year, retrospective study included 223 patients who had undergone total thyroidectomy for benign, substernal, multinodular goitres. Chest radiographs and computed tomography scans were reviewed by two physicians (a senior ENT surgeon and a senior radiologist).Results:The most frequent mode of extension was anterior or prevascular, seen in 76 per cent of cases, especially on the left side. Fifty-nine per cent of goitres did not reach the aortic arch and 11 per cent extended beyond the aortic arch. A cervical surgical approach was performed in approximately 99 per cent of cases.Discussion:Thorough examination of computed tomography scans is essential in order to identify and classify substernal goitres and to decide the best surgical procedure. A cervical surgical procedure is almost always sufficient and safe for the surgical management of substernal goitres.Conclusion:Computed tomography appears to be the best imaging modality for identifying and characterising substernal goitres. Surgical management is almost always via a cervical approach and does not differ from that used for benign cervical goitres. In the future, magnetic resonance imaging may be used; its results would need to be compared with those of computed tomography.

Resume Le depistage de la surdite s'inscrit dans une demarche de prevention secondaire des handicaps dans la mesure ou la surdite a des consequences sur le developpement cognitif, langagier et affectif de l'enfant. Toutefois, informer les parents d'un dysfonctionnement sensoriel potentiel des les premiers jours de vie de l'enfant peut etre a l'origine d'une desorganisation des premieres relations parents–enfant, et certains professionnels emettent un avis reserve quant aux benefices reels d'un depistage pratique pendant la periode neonatale qui s'avere sensible a bien des egards. C'est pourquoi plusieurs etudes se sont penchees sur cette question et emettent des conclusions contrastees. Ainsi, le travail que nous presentons vise a evaluer, a l'aide d'entretiens semi-directifs, le retentissement d'un programme de depistage de la surdite, sur l'anxiete parentale et la qualite des interactions parents–enfant, selon le moment ou le test est realise (quatre jours vs deux mois). Les resultats montrent qu'un resultat positif entraine une augmentation importante de l'anxiete maternelle qui altere son etat psychologique general, et ce, d'autant plus que le test est realise pendant la periode neonatale. Cela se traduit par des profils interactifs specifiques dans lesquels les meres des enfants depistes positifs presentent moins d'assurance dans la facon dont elles gerent l'interaction avec leur bebe.

Nasal obstruction is a frequent symptom of consultation in paediatric otorhinolaryngology. Usually, adenoid hypertrophy is the cause. Sometimes the examination reveals the presence of polyps in the nose. The antrochoanal polyp of Killian is particularly frequent in childhood. The obstruction is usually unilateral, but the posterior extension of a bulky polyp to the oropharynx can cause a major discomfort, sometimes a respiratory distress. We report the observation of a 10-year-old patient presenting a bulky polyp of Killian, visible in the oropharynx and then discuss the features of this polyp in the literature.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 122 - N° 3 - p. 127-133

Sujet Il s’agit d’une revue de la litterature concernant les otoliquorrhees spontanees en rapport avec des fistules osteo-dure-meriennes du tegmen tympani. Cas cliniques Deux patients ont ete suivis par une double equipe ORL et neurochirurgicale pour des otoliquorrhees spontanees bilaterales. La symptomatologie otologique etait au premier plan. Des fistules osseuses bilaterales des tegmen tympani ont ete mises en evidence par la tomodensitometrie. Le traitement a ete chirurgical par voie sus petreuse. Discussion/Conclusion Les otoliquorrhees spontanees en rapport avec des fistules osteo-dure-meriennes du tegmen tympani sont rares. Elles se rencontrent chez des sujets adultes habituellement sans antecedent otologique. L’anomalie est congenitale. La symptomatologie otologique (diagnostic differentiel d’une otite sereuse) est le plus souvent au premier plan. Il existe un risque de meningite bacterienne. Le diagnostic est affirme par la tomodensitometrie des rochers et par l’IRM. Le traitement est chirurgical avec plusieurs approches possibles (otologique et/ou neurochirurgicale) en fonction de l’importance des lesions. L’evolution est le plus souvent favorable apres le traitement chirurgical adapte.

Resume Propos. – Les inhibiteurs d'enzyme de conversion de l'angiotensine (IEC) sont utilises depuis une vingtaine d'annees, et constituent un reel progres dans la prise en charge de l'hypertension arterielle ou de l'insuffisance cardiaque. Leur tolerance est en general bonne et la toux constitue l'effet indesirable le plus frequent. L'angio-œdeme realise un œdeme localise et soudain des tissus sous-cutanes et des muqueuses et surviendrait chez 0,1 a 0,5 % des patients sous IEC. Methodes. – Nous rapportons 19 cas d'angio-œdeme apres prise d'IEC repertories au centre regional de pharmacovigilance d'Amiens. Resultats. – La face est une localisation constante chez les 19 patients de notre serie. Plus trompeuses peuvent etre les localisations aux muqueuses digestives (1 cas) ou genitales (1 cas). Le delai d'apparition est variable, immediat dans un tiers des cas, retarde apres plusieurs annees dans un autre tiers. La survenue d'une atteinte laryngee peut etre responsable de deces (1 cas). Conclusion. – Le mecanisme physiopathologique est actuellement inconnu. Il pourrait dependre d'une accumulation de bradykinine. Le traitement impose l'arret definitif de tout IEC. Les antagonistes des recepteurs de l'angiotensine II peuvent etre une alternative mais doivent etre introduits avec precaution.

This surgical anatomic study aimed to determine (1) the anatomic relation of the laryngeal inferior nerve with the inferior thyroid artery, (2) the existence of extralaryngeal branches of division of the nerve and (3) the size of the nerve seen macroscopically. Two hundred and fifty-one patients underwent thyroid surgery during a period of 30 months. There were 50 males and 201 females. The male population underwent 28 total thyroidectomies, 13 left lobectomies and 9 right lobectomies. The female population underwent 124 total thyroidectomies, 33 left lobectomies and 44 right lobectomies. On the right side: the nerve was found superficial to the artery in 70.24% of females and 51.35% of males, the nerve was divided in 23.81% of females and 21.62% of males and seemed unusually thin in 14.29% of females and 5.41% of males. On the left side: the nerve was found superficial to the artery in 87.26% of females and 95.12% of males, the nerve was divided in 15.29% of females and 14.63% of males and seemed unusually thin in 10.83% of females and 2.44% of males. In conclusion, the inferior laryngeal nerve is characterized by its important anatomic variations, especially on the right side. These variations might be different even between males and females. Knowledge of these variations is very important in order to best identify and preserve the inferior laryngeal nerve during thyroid surgery.

Objectives:This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess.Subjects and method:This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded.Results:The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post-operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days).Discussion and conclusion:Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department.

The recurrential nerve palsy (RNP), the hypocalcemy and bleeding are traditional complications of the thyroid surgery. The objective is to bring back the postoperative rates of complications and to compare them with the patient's history and the goiter features (CT-scan extensions and weight) in order to identify predictive factors of these complications.One hundred and seventeen patients with a goiter below the subclavicular vessels on the cervicothoracic CT-scan and with a benign extemporane histopathology were operated between february 1997 and January 2004 and included in this retrospective study. The initial clinical assessment reports the respiratory and digestive functional signs, researches a palpable mass and studies the mobility of the vocal folds. The post-operative complications rates (RNP hypocalcemy and bleeding) are analyzed according to the patient's history and the goiter extensions in order to correlate these factors with the complications occurence.Five unilateral RNP occurred and two of them remained permanent, particularly for patients with thyroid surgery history (NS). The right/left or anterior/posterior extensions did not seem determining factors. Nevertheless the volume of the goiter suspected by the tracheal latero-deviation seems to play a role but without statistical confirmation. Among the thirty-four hypocalcemies, six were defined like permanent, without correlations with the surgical history nor the systematic identification of parathyroid glands. The volume and the younger age of the patient tend nevertheless to support the hypocalcemy. Three post-operative bleeding cases were reported, which one needed a reoperation, with a correlation with thyroid surgical history. None the factors among volume, extension or the age of the patient seem to play a role.The cervico-thoracic CT-scan is essential since echography does not manage to identify the lower pole of the gland. It helps to define the goiter and to analyze its extensions, very usefull to predict surgical difficulties in the preoperative information of the patient. Complications occurrence seems related on the volume and the thyroid surgical history.

The emergency in the treatment of sudden hearing loss. A controversial dogma?Does the delay in instigation of treatment in cases of sudden hearing loss affect the outcome?109 patients were included in this study. Sudden hearing loss is a much discussed subject in the literature. The authors agree on the concept of therapeutic emergency. This retrospective study aims to analyze the value of precocity in starting treatment on hearing improvement.The therapeutic time delay does not appear to be a significant factor and sheds doubt on the rule of therapeutic emergency.The authors remain nevertheless prudent on these conclusions. A larger number of cases should be studied. The question of a national versus placebo study is also laid.

Anatomical variants of the sinonasal cavities are common. About 15 major variants are described (nasal septal deviation is present in up to 62% of the population). Because the may lead to complications at the time of endovascular procedures or endoscopic sinonasal surgery (vascular, nervous, or osseous injury), there detection has medicolegal implications. Knowledge of anatomical variants by radiologists and ENT surgeons is thus required. We will describe these variants, their imaging features, frequency, implications and associated risk of potential complication.

The purpose of this study was to evaluate the advantages of surgery for diagnosis and treatment of cervical lymph node tuberculosis.This was a retrospective study from 1st January 1998 to 31st December 2007 including 30 patients with cervical lymph node tuberculosis. The population included 60% autochthones with a mean age of 47.1 years and a female predominance (73.33%).The lymph nodes were most often supraclavicular, unilateral, firm, and a mean 3 cm at its largest span. Lymph nodes were excised for diagnosis in 22 patients, which demonstrated specific granulomatous and giant cell lesions with caseous necrosis in 21 patients out of 22. Five abscessed adenopathies required surgical drainage, and three cases required repeated lymph node cleaning after well-conducted medical treatment.Surgery retains an important place in the diagnosis and treatment of cervical lymph node tuberculosis.

To study and compare postoperative complications of total thyroidectomy for Graves disease and multinodular benign goiters.A retrospective study on 176 patients (37 with Graves disease and 139 with multinodular benign goiters) over a period of 41 months was conducted. Postoperative calcemia and laryngeal palsy as well as hemorrhagic and infectious complications were studied and statistically compared using the Kruskal-Wallis test.There was no statistical difference concerning the occurrence of postoperative laryngeal palsy, hypoparathyroidism or hemorrhagic complications between these two groups of patients. Only a more frequent immediate postoperative hypocalcemia (day 1) in the Graves disease group was found.Total thyroidectomy in the surgical management of Graves disease, after a cautious medical preoperative preparation, appears to be a safe technique. Total thyroidectomy must be performed instead of subtotal thyroidectomy in order to avoid recurrences.

Purpose of the study:We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.Materials and methods:Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.Results:Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.Discussion:Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.Conclusion:The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

To determine the value of technetium-99m bone scintigraphy in the screening of bone metastases in the systematic initial extension assessment of upper aerodigestive tract suamous cell carcinomas; to identify risk factors of these bone metastases for better screening.In this prospective study, the initial assessment of tumoral extension was systematically associated with bone scintigraphy. Only patients with no malignant tumors were included in the study. Any skeletal fixation identified was then analyzed with standard radiography and/or tomodensitometry and with the patient's clinical progression to confirm whether or not the fixation was metastatic. The sensitivity and specificity of bone scintigraphy was then calculated. A correlation between bone pain or hypercalcemia and confirmed bone metastases was also systematically sought to determine whether these factors were predictive of bone metastases so as to better target the screening.Among the 55 patients included in the study, three had confirmed bone metastases. All were detected by the bone scintigraphy, with a sensitivity of 100%. However, the 20 false-positive results gave a low specificity of 62%. Bone pain was described by two patients, but they were among the three metastatic patients. Specificity was 100%, but the sensitivity was only 67%. Three patients had hypercalcemia: the three metastatic patients. The sensitivity and specificity were 100%. In the tumoral status of the three patients with bone metastasis, tumors were small, classified as T1 or T2, but with substantial node involvement, classified N3, and with invasion of the internal jugular vein in two cases.The incidence of bone metastases in the initial extension assessment was low; consequently, they are not sought systematically. However, their presence radically changes the prognosis and the therapeutic management, raising the question of screening. The technetium-99m bone scintigraphy has limits, with many false-positive resulting the need for additional investigations. Defining the risk factors for bone metastases would improve screening. Two questions remain: what factors are involved? The bone pain and the hypercalcemia must be analyzed with a larger number of cases, but they seem to be nonspecific. The node involvement stage could be a more reliable parameter, in particular in cases of jugular vein invasion; what method should be used? In the future, the PET scan could be the key procedure not only in the locoregional extension assessment, but also for general extensions, in a single procedure investigating the whole body.

To report, compare the clinical signs and the radiological signs of retrosternal goitre (cervico-thoracic goitre) and try to establish a correlation between clinical signs and radiological extent.One hundred and seventeen patients with a goitre beyond the sub-clavian vessels in cervico-thoracic CT-scan and with a benign histopathology examination after thyroid surgery in the head and neck department, University Hospital, Amiens, France between February 1997 and January 2004 were included in this retrospective study. The initial clinical assessment includes the respiratory and swallowing functional signs, palpable mass and mobility of the vocal cords. A correlation is analyzed between the extent of the goitre, the anatomic relations with the trachea and oesophagus and clinical signs.Dyspnea is the commonest of the functional signs (39.3%) for young subjects (p0.05), due to tracheal compression regardless of the side of extension of the goitre. Dysphagia (16.2%) is not correlated with the extent of the goitre in this series. A cervical palpable mass is present in 69.2% of cases.The cervico-thoracic CT-scan is the key examination of the assessment of a retrosternal goitre making it possible to appreciate its features, its anatomic relations and its tracheal involvement sometimes announced by respiratory disorders, the presence of a dysphagia should alert to the possibility of posterior extension which can not be felt during the cervical palpation.

Objectives: To describe the features of an oropharyngeal and hypopharyngeal myxoma.Materials and methods: Case report of a 34-year-old patient operated upon for a dual-location tumour, and review of the literature.Results: The myxoma is a rare tumour. Various head and neck locations have been described, but not (to our knowledge) a tumour in both the oropharynx and the hypopharynx. Multiple synchronous locations must be searched for, particularly regarding cardiac myxoma.Conclusion: The myxoma is a rare, benign tumour, even rarer in the head and neck. Surgical treatment must be complete in order to avoid recurrences, and should be performed after assessment for cardiac involvement.

Summary Objectives A discussion concerning the relevance of universal newborn hearing screening has been conducted in France since the end of the 1990s. As a contribution to the choice of strategy to be implemented, we evaluated and compared the results of this screening and its impact on the parent–infant relationship as a function of the time at which screening was performed: during the infant's stay in the maternity unit, in the first strategy (strategy 1), or 2 months after birth, in the second strategy (strategy 2). Patients and method Five thousand seven hundred and ninety infants participated in the study: 3202 were included in the first strategy and 2588 were included in the second strategy. Within this population, 143 mother–infant pairs were submitted to psychological assessment. We compared the number of infants screened, the number of first positive tests, the number of false-positive tests and the number of infants not reviewed after screening. Adverse effects on the parent–infant relationship were evaluated in terms of maternal anxiety and the quality of early interactions. Results A statistically significant difference in favor of newborn screening was demonstrated for the number of infants screened: 95.72% for the first strategy [95.0%; 96.4%], 64.18% for the second strategy [62.3%; 66.0%]; the number of first positive tests: 1.11% during newborn screening [0.7%; 1.5%], 3.13% in the second strategy [2.3%; 4.0%]; the number of false-positive tests: 0.29% in the first strategy [0.10%; 0.49%] and 2.65% in the second strategy [1.88%; 3.42%]; and the number of infants not reviewed after screening: 8.8% during newborn screening [0.0%; 18.4%] and 38.5% in the second strategy [25.2%; 51.7%]. Analysis of the results of the psychological assessment showed that screening per se did not have any impact on maternal anxiety or on the quality of early interactions, regardless of the screening strategy used. However, the result of the test had a significant impact. Announcement of a positive result increased maternal anxiety and induced a deterioration of the mother's psychological state which affected the quality of early interactions. As the number of positive results is significantly lower in newborn hearing screening, there are consequently fewer psychological side effects with this strategy than with the second strategy. Conclusion This study demonstrates that universal newborn hearing screening is the most efficient strategy.

Aims: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery.Materials and methods: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination.Results: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery.Conclusion: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.