A. Robier

Cancer of the external auditory canal.

INTRODUCTION Cancer of the external auditory canal is a rare tumour with an annual incidence of one per one million inhabitants. The objective of this study was to evaluate the 5-year overall survival and disease-free survival rates in a series of patients with carcinoma of the external auditory canal and to compare our results concerning the clinical presentation, management and survival with those of the literature. PATIENTS AND METHOD Ten patients were included in this retrospective, single-centre study over a 20-year period. Data concerning age, symptoms, imaging, TNM stage according to the Pittsburgh classification, histology, management, sequelae, recurrences and survival were recorded. RESULTS The mean age of the patients of this series was 60.7 years. Seven patients had a squamous cell carcinoma. The other histological types were undifferentiated carcinoma, adenoid cystic carcinoma and neuroendocrine carcinoma. Staging was based on the Pittsburgh classification with one stage I, one stage III and eight stage IV tumours. Five-year overall survival rates were 100%, 50% and 0%, respectively. The mean 5-year overall survival rate was 35% and the mean 5-year disease-free survival rate was 24%. CONCLUSION Carcinoma of the external auditory canal is a difficult diagnosis when the tumour does not present as a fungating mass protruding from the external auditory canal. The Pittsburgh classification was used for TNM staging of these tumours, allowing comparison of our results with those of the literature. The clinical findings and survival rates observed in this study are comparable to those reported in the literature. These tumours are associated with a poor prognosis on the basis of our results and published data.

A review of 89 revision stapes surgeries for otosclerosis.

OBJECTIVES The aim of this study was to identify the causes and the audiometric results of revision surgery following stapedotomies and stapedectomies. PATIENTS AND METHODS We retrospectively reviewed a series of 89 revisions after surgery for otosclerosis between 1993 and 2008. Intraoperative findings, causes of failure, and pre- and postoperative audiometric results were noted retrospectively. RESULTS The leading causes of failure found intraoperatively included dislocated prosthesis and necrosis of the long process of the incus. The average postoperative air-bone gap was 13 dB. Closure of the air-bone gap to within 10 dB was achieved in 52% of patients. CONCLUSION Stapes revisions had less satisfactory results compared with primary procedures in this series. However, certain precautions during initial surgery should decrease the number of stapes surgery revisions.

Two cases of temporal bone metastases as presenting sign of lung cancer

OBJECTIVE To report the clinical and radiological features of temporal bone metastases and their association with primary lung cancer. CASE REPORTS Both patients complained of headache, cochlear signs or cranial nerve palsy. Computed tomography of the petrous temporal bones and magnetic resonance imaging showed an osteolytic lesion of the temporal bone. The preoperative work-up was completed by chest, abdomen and pelvis computed tomography and positron emission tomography. Bronchoscopic biopsies confirmed the diagnosis of lung cancer. DISCUSSION/CONCLUSION The discovery of an osteolytic lesion of the temporal bone requires an aetiological work-up, including the search for a lung tumour based on the hypothesis of temporal bone metastasis. Positron emission tomography should now be performed in the context of such lesions. Management consists of palliative chemotherapy and analgesic radiotherapy.

Combined local anesthesia and monitored anesthesia care for cochlear implantation

INTRODUCTION Cochlear implantation has become a routine procedure for patients with hearing loss. In some patients, general anesthesia might be contraindicated due to multiple co-morbidities. We describe a successful protocol for cochlear implantation under local anesthesia with light sedation. CASE REPORT An 81-year-old patient presented with profound sensorineural hearing loss. Her past medical history revealed ischemic coronaropathy, managed by stenting. After multidisciplinary evaluation and clear adapted information to the patient, surgery was performed under local anesthesia with light sedation and monitored anesthesia care. The procedure lasted 70 min, and was without incident and under good conditions for the surgeon. During the intervention, the patient was comfortable. No nausea or vomiting was noted. The postoperative period was smooth and uneventful. CONCLUSION We find local anesthesia with light sedation a good alternative to general anesthesia for patients where general anesthesia is contraindicated. An experienced surgical and anesthesiology team is essential to shorten the duration of the procedure.

Oropharyngeal teratomas in newborns: Management and outcome

OBJECTIVES Congenital teratomas of the oropharyngeal cavity are extremely rare and are associated with a high neonatal mortality rate due to severe airway obstruction. Management has been improved with progress in antenatal diagnosis. The authors describe this progress in the light of a series of 4 cases and a review of the literature. METHODS The medical charts of four neonates treated in the department since 1995 were reviewed. The following criteria were studied: age at diagnosis, clinical and radiological features of the tumour, management at birth and outcome. RESULTS All four cases occurred in female neonates with an antenatal diagnosis in two cases, allowing preparation for endoscopy in the delivery room in one case and an EXIT procedure in the other case. Three neonates had to be intubated in the delivery room. Imaging showed invasion of the infratemporal fossa in 3 of the 4 cases. Surgical resection via various approaches to the infratemporal fossa was complete in every case. Adjuvant chemotherapy was administered in one case. CONCLUSION Surgery for these mostly benign tumours is very challenging and requires a multidisciplinary team. Perinatal planning allows appropriate management at birth, decreasing the risk of airway obstruction. Surgery is the mainstay of treatment of teratomas.

Electrophysiological exploration of hearing

Electrophysiologic hearing tests have been developed since the 1960s to determine hearing thresholds objectively. They are now implemented in newborn hearing screening. While they determine thresholds, interpretation requires subjective pure-tone and speech audiometry to determine the type of hearing loss. Each examination tests a different anatomic region, enabling the auditory system to be explored from the organ of Corti to the auditory cortex. Thus, the various objective audiometric examinations are complementary.

Lipoleiomyosarcoma of the larynx.

Lipoleiomyosarcoma is a rare tumor consisting of well‐differentiated liposarcoma and leiomyosarcoma. The ear–nose–throat location of lipoleiomyosarcoma has not been previously described.

A rare middle ear malformation

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 130 - N° 5 - p. 297-298