Azza Mediouni

Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management

OBJECTIVESnThe aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition.nnnMATERIALS AND METHODSnA retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0.nnnRESULTSnParadoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months.nnnCONCLUSIONnThe occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.

Paralysie faciale périphérique suite à une otite moyenne aiguë

OBJECTSnTo discuss clinical presentation and therapeutic approaches of facial paralysis in acute otitis media.nnnMETHODSnWe present five cases of facial palsy in children with acute otitis media managed in our ENT department during a period of 12 years (2001-2012).nnnRESULTSnThe mean age was 14.2 years; sex ratio was 0.66. All patients presented with a facial asymmetry, but only 3 of them had otalgia before the onset of facial asymmetry. The facial palsy delay was 3.3 days. The ear examination showed that the tympanic membrane was congestive in 4 patients, associated with a bulging in 2 patients, and a small perforation in one patient. Our patients presented grade III to IV initial facial palsy according to House and Brackmann staging. Computed tomography scan revealed a dehiscence of the bony facial canal in one patient. Antibiotic therapy associated with intravenous corticosteroids was administered in all patients. All patients underwent a facial kinesis therapy. A progressive improvement of facial palsy was observed in 4 patients and complete recovery of facial function in one case.nnnDISCUSSIONnConservative treatment associating intravenous antibiotic and corticosteroids with or without myringotomy is the standard approach.

Prise en charge des complications oculo-orbitaires des sinusites aiguës

PURPOSEnDescribe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches.nnnMETHODSnRetrospective study of 29xa0cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012).nnnRESULTSnThere were 23xa0men and 6xa0women. The mean age was 15.75years. The average time until consultation was 7.68xa0days. Sinusitis was ethmoido-maxillary in 20xa0cases, ethmoidal in 6xa0cases, and frontal in 3xa0cases. Orbital extension was grouped according to the Chandler classification: stagexa0I (3xa0cases), stagexa0II (3xa0cases), stagexa0III (15xa0cases), stagexa0IV (8xa0cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22xa0cases. Bacterial cultures revealed streptococcus (2xa0cases), aspergillus fumigatus (1xa0case) and were negative in 8xa0cases. The outcome was favorable in 27xa0cases. In two cases, the outcome was unfavorable with associated intracranial complications.nnnDISCUSSIONnOculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.

Acute Otomastoiditisin Children: Clinical Presentations and Management

Acute mastoiditis (AC) is a serious complication of acute otitis media (AOM) affecting, in most cases, the pediatric population. Diagnosis is usually easy in front of a retro auricular swelling associated to OM. However, this disease may cause significant and even life threatening complications beyond the tympanomastoid system such as peripheral facial nerve palsy, Bezold’s abscess, meningitis, subperiosteal abscess and brain abscess. Management of AC remains controversial raging from conservative treatment in the form of IV antibiotics to more aggressive interventions such as mastoidectomy. This retrospective study represents our experience in the management of AC in the pediatric population. Our purpose was to review and discuss clinical presentations and main treatment modalities of AM.

Ectopic thyroid tissue: unusual differential diagnosis of cervical paraganglioma

Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn’t have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.

Intraparotid ductal ectasia: rare cause of parotid swelling

A 41-year-old patient was hospitalised for a chronic right parotid mass. A cervical ultrasound revealed a cystic mass of the parotid. Cervical MRI found a ductal ectasia of the parotid and submandibular glands associated with a retention cyst of the right parotid. He had a right total parotidectomy. Histopathological examination of the lesion revealed a multilocular cystic mass with a diffuse glandular ectasia of salivary ducts. The patient had an uneventful postoperative course without any recurrence of symptoms.

Paranasal sinus osteomas: Diagnosis and treatment.

INTRODUCTIONnOsteoma is the most common benign tumor of the nose and paranasal sinuses. It is a slow-growing bony tumor, often asymptomatic, occurring mainly in frontal and ethmoid sinuses. Theories regarding the origin of osteomas are still discussed. The aims of the study were to describe diagnosis circumstances in our series and to set out our respective indications for open and endoscopic approaches in the treatment of nasosinusal osteomas.nnnPATIENTS AND METHODSnA retrospective study was conducted on the files of all the patients treated for a paranasal sinus osteoma in our department between 1990 and 2013. Diagnosis circumstances and kind of treatment were collected and analyzed.nnnRESULTSnThe files of 45xa0patients (mean age: 49.2; sex-ratio: 1.19) could be collected. The most common symptom was headache found in all patients. The most common location was the frontal sinus (30xa0cases). Thirty-nine open procedures were performed. Four osteomas were removed under endoscopic assistance. In one case, a combined approach has been used. Overall complication rate was 11.1%. Symptoms improved in all patients. Two recurrences were observed.nnnDISCUSSIONnSurgical indications in paranasal sinus osteomas are theorically well codified. However, approaches remain controversial. In our experience, the preferred approach was the open one. Endoscopic techniques, when indicated, are more challenging and need sophisticated instrumentation and a long learning curve.

Les ethmoïdites compliquées : prise en charge thérapeutique

But de la presentation L’ethmoidite aigue est l’infection bacterienne des cellules du labyrinthe ethmoidal. Il s’agit d’une infection severe, necessitant un diagnostic et un traitement urgents du fait du risque de complications ophtalmologiques et endocrâniennes. Le but de ce travail est d’analyser les caracteristiques therapeutiques des formes compliquees. Materiel et methodes Etude retrospective portant sur 15 cas d’ethmoidites compliquees colliges dans notre service entre 2002 et 2013. Resultats Il s’agissait de 12 garcons et 3 filles. L’âge moyen etait de 7xa0ans avec des extremes de 1 et 3xa0ans. Le delai de consultation moyen etait de 5xa0jours. La fievre etait retrouvee dans 7 cas et des signes rhinologiques dans 10 cas. Neuf patients avaient une exophtalmie, associee a une atteinte de l’oculomotricite et une baisse de l’acuite visuelle dans 3 cas. La biologie a montre un syndrome inflammatoire dans tous les cas. La TDM du massif facial, realisee en urgence chez tous les patients, a objective une cellulite orbitaire dans 5 cas, un abces sous perioste dans 6 cas, un abces orbitaire dans 4 cas dont deux avaient un empyeme frontal associe. L’antibiotherapie initiale etait une monotherapie dans 2 cas, une bitherapie dans 6 cas (cefotaximexa0+xa0fosfomycine) et une tritherapie dans 7 cas (cefotaximexa0+xa0fosfomycinexa0+xa0flagyl). La duree moyenne du traitement par voie parenterale etait de 15xa0jours (11–30xa0jours). Un drainage par voie canthale interne a ete pratique dans 6 cas. L’evolution etait favorable dans 13 cas. Deux patients ont presente une recidive. Le recul moyen etait de 11xa0mois. Conclusion Le traitement des ethmoidites est base essentiellement sur une antibiotherapie precoce a large spectre. Les formes compliquees necessitent un traitement medical plus prolonge associe le plus souvent a un drainage chirurgical.