Cortical auditory responses according to hearing rehabilitation in unilateral hearing loss Publication date: Available online 30 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): E. Legris, S. Roux, J.-M. Aoustin, J. Galvin, D. Bakhos Abstract Objective To assess the impact of rehabilitation systems (CROS: Contralateral Routing of Signal; BAHA: Bone-Anchored Hearing Aid; CI: cochlear implant) on cortical auditory evoked potentials (CAEP) and auditory performance in unilateral hearing loss. Subjects and method Twenty-one adults with unilateral hearing loss, using CROS (n = 6), BAHA (n = 6) or CI (n = 9), were included. Seven normal-hearing subjects served as controls. CAEPs were recorded for a (/ba/) speech stimulus; for patients, tests were conducted with and without their auditory rehabilitation. Amplitude and latency of the various CAEP components of the global field power (GFP) were measured, and scalp potential fields were mapped. Behavioral assessment used sentence recognition in noise, with and without spatial cues. Results Only CI induced N1 peak amplitude change (P < 0.05). CI and CROS increased polarity inversion amplitude in the contralateral ear, and frontocentral negativity on the scalp potential map. CI improved understanding when speech was presented to the implanted ear and noise to the healthy ear, and vice-versa. Conclusion Cochlear implantation had the greatest impact on CAEP morphology and auditory performance. A longitudinal study could analyze progression of cortical reorganization.

Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study Publication date: Available online 29 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): E. Vicaut, B. Bertrand, J.-L. Betton, A. Bizon, D. Briche, L. Castillo, J.-B. Lecanu, P. Lindas, B. Lombard, O. Malard, J.-C. Merol, P.-J. Monteyrol, T. Nasser, B. Navailles, V. Prulière-Escabasse, R. Stringini, B. Verillaud Abstract Objectives Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. Materials and methods A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. Results The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. Conclusion In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Osteomalacia secondary to delayed diagnosis of a maxillary mesenchymal tumour Publication date: Available online 21 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): L. Nakhleh, S. Zink, J.M. Raguin, T. Raguin

Premaxillary abscess without bony erosion: An unusual complication of pediatric acute maxillary sinusitis Publication date: Available online 16 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): R. Luscan, E. Truffert, F. Simon, K. Belhous, B. Verillaud, N. Garabedian, N. Leboulanger, V. Couloigner Abstract Objectives To report an unusual complication of pediatric acute maxillary sinusitis: premaxillary abscess. To describe clinical, radiological and biological presentation, treatment strategy and progression. Material and methods A retrospective study included all pediatric patients treated for premaxillary abscess complicating acute maxillary sinusitis in two ENT reference centers between 1999 and 2017. Disease history, clinical presentation, biological and radiological findings, treatment modalities and progression were studied. Results Ten patients were included, with a mean age of 10 ± 4.2 years. All presented with fever, rhinorrhea and premaxillary edema. Contrast-enhanced CT scan systematically found complete opacity of the maxillary sinus, without bone lysis, and extensive effusion along the intersinonasal wall up to the premaxillary region, extending in 3 cases back toward the parapharyngeal space. Bacteriology isolated Streptococcus anginosus most frequently (n = 4; 40%). Treatment comprised intravenous wide-spectrum antibiotics, with surgical drainage of the abscess if > 10 mm (n = 9; 90%). Seven of these 9 patients (78%) had recurrent abscess requiring surgical revision and 3 (33%) required a third drainage. All patients were cured without sequelae at 1 month. Conclusion In case of acute maxillary sinusitis with premaxillary edema, premaxillary abscess should be suspected. The high recurrence rate argues for maximalist surgery associated to close clinical monitoring with radiological examination.

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version Publication date: Available online 13 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): E. Truffert, E. Fournier Charrière, J.-M. Treluyer, C. Blanchet, R. Cohen, B. Gardini, H. Haas, F. Liard, J.-L. Montastruc, R. Nicollas, S. Pondaven, J.-P. Stahl, C. Wood, V. Couloigner Abstract Objectives To present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections. Methods Based on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or “expert opinion”. The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group. Results The main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20–30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3–5 or “Evaluation Enfant Douleur” (EVENDOL) child pain score 4–7) and insufficiently relieved by first-line paracetamol (residual VAS ≥ 3 or EVENDOL ≥ 4); o pain is moderate to intense (VAS 5–7 or EVENDOL 7–10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6 h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72 h.

Very painful acute frontal sinusitis revealing granulomatosis with polyangiitis Publication date: Available online 5 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): M. Montero, T. Mom, P. Smets, L. Gilain Abstract Introduction Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis of small and medium-sized vessels comprising inflammation of the vessel wall and perivascular and extravascular granulomas, frequently presenting in the form of chronic sinusitis. Observation We report the case of a 27-year-old man who presented with very painful acute frontal sinusitis that was managed medically and surgically. The symptoms rapidly recurred despite treatment and CT scan demonstrated diffuse thickening of the sinus mucosa. Anti-proteinase 3 ANCA were positive. Biopsy of a pulmonary nodule confirmed the diagnosis of GPA. The patient was treated with corticosteroids in combination with rituximab, resulting in improvement of the clinical, laboratory and CT signs. Discussion In the presence of persistent, acute, localized sinusitis despite appropriate treatment, associated systemic signs and/or the presence of other signs suggestive of GPA, the ENT surgeon must request a targeted work-up. In the absence of treatment, GPA can be fatal within a few months. However, with currently available treatment, remission is obtained in 80% of cases with a 75% 10-year survival rate.

Postoperative amaurosis after ethmoidectomy revealing Leber's hereditary optic neuropathy Publication date: Available online 3 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): J. Perruisseau-Carrier, C. Debry, S. Riehm, I. Djennaoui

Masson tumor as a neck mass Publication date: Available online 1 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): M. Alotaibi, V. Geisler, H. Olze, S. Knopke Abstract Introduction A Masson's tumor is a benign, intravascular tumor, typically located in the fingers. Histologically, a Masson's tumor is characterized by an intravascular endothelial papillary projection associated with thrombi, without atypia or necrosis. The CD 31 and CD 34 stains are the most efficient immunohistological markers to identify the vascular origin. Case summary A 54-year-old man presented with a right lateral neck mass for 3 weeks. The CT scan of the neck showed an oval, well-circumscribed cystic mass, measuring 20 mm × 9 mm, situated over the right sternocleidomastoid muscle, with a peripheral vessel draining into the right anterior jugular vein. The mass was excised surgically, and a pathological report indicated a thrombosed material inside the lumen of a small vein with a differentiated papillary structure; neither nuclear atypia nor necrosis were seen. The patient had an uncomplicated recovery and completed 8 months of follow-up appointments without any evidence of recurrence. Discussion Intravascular papillary endothelial hyperplasia (IPEH) can be differentiated from angiosarcoma by lack of extension to the perivascular tissue and absence of necrosis and atypia. The pathogenesis is still unknown; surgical excision is the method of treatment. This is an extremely rare presentation of Masson's tumor.

Hyperparathyroidism in pregnancy and 99mTc-MIBI scintigraphy Publication date: Available online 1 August 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): E. Malheiro, N. Chabbert-Buffet, J.-N. Talbot, S. Périé Abstract Introduction Primary hyperparathyroidism (PHPT) during pregnancy can be responsible for serious maternal and foetal complications and should be treated by elective low-risk, minimally invasive surgery. Preoperative assessment of hyperfunctioning parathyroid glands is classically based on high-resolution neck ultrasound (US) and 99mTc-sestamibi/123I scintigraphy. However, administration of any radiopharmaceutical during pregnancy must be limited and justified and US alone may be sufficient to localize an abnormal parathyroid gland. Case report We report the case of a 4-month pregnant woman with severe primary hyperparathyroidism, in whom US failed to localize the abnormal parathyroid gland. 99mTc-sestamibi scintigraphy was performed in preference to 18-fluorocholine (FCH)-PET/CT on the basis of a multidisciplinary decision. As 99mTc-MIBI demonstrated an hyperfunctioning right inferior parathyroid, 123I was not administered. A large right paravertebral parathyroid adenoma was successfully removed, as confirmed by decreased postoperative serum parathyroid hormone and calcium levels. The eutrophic newborn infant was delivered at term, with normal serum calcium and TSH levels. Discussion In pregnant women with primary hyperparathyroidism, US alone may be sufficient when it localizes the abnormal parathyroid gland, allowing elective low-risk minimally invasive surgery. Otherwise, a multidisciplinary approach is mandatory to select the radiopharmaceutical that can be safely used to identify the hyperfunctioning parathyroid gland with minimal risks for the foetus.

Soft swelling of the external auditory canal Publication date: Available online 26 June 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): G. Ciavarro, M. Falcioni