D.T. Nguyen

Respiratory epithelial adenomatoid hamartoma of the nose: an updated review.

Background This study was designed to update clinical and imaging features as well as treatment outcomes of the nasal respiratory epithelial adenomatoid hamartoma (REAH). Data sources included case reports, original articles, and reviews published in English or French in PubMed from 1995 to date. Methods Only published articles that met Wenigs histological criteria for the diagnosis of REAH were included. Results REAH is not rare and is probably underdiagnosed. It is usually observed in the fifth decade of life with a 3:2 male/female predilection. REAH can be represented in two forms: as an isolated lesion (less frequent) or in association with an inflammatory process (especially nasal polyposis). It was observed in 35–48% of patients undergoing endoscopic endonasal surgery for nasal polyposis. Its origin is found, in most cases, in the olfactory cleft, which is exhibited on computed tomography (CT) scans by widened opacified olfactory clefts without bone erosion. Resection of REAH from the olfactory clefts does not worsen, but instead, can improve the sense of smell after surgery. Conclusion Looking for REAH on CT scans and during endoscopic examination can lead to its diagnosis and help avoid aggressive surgical procedures and their complications. Endoscopic resection is the treatment of choice. The removal of REAH constitutes a specific surgery on the olfactory clefts, which can improve nasal obstruction as well as sense of smell. Whether REAH can be defined as a hamartoma, an inflammatory reactive process, or a neoplastic lesion remains to be determined.

Assessment of quality-of-life outcomes after surgery for nasal polyposis with the DyNaChron questionnaire

AbstractThis prospective study assesses outconmes at 6xa0weeks and 7xa0months after radical ethmoid surgery in 65 patients with nasal polyposis using a new and detailed instrument, the DyNaChron questionnaire, which was filled in the day prior to surgery and at 6xa0weeks and 7xa0months after surgery at follow-up visits. Before surgery, the leading bothersome symptoms were olfactory disturbances (7.74xa0±xa02.81) and nasal obstruction (6.66xa0±xa02.28). After surgery (6th week and 7th month), there was a clear improvement of all symptoms including nasal obstruction, olfactory disturbances, anterior rhinorrhea, postnasal discharge, facial pain/headache and cough in comparison to baseline (pxa0<xa00.0001). Nasal obstruction was the most improved symptom (effect size of 2.24). At 7th post-operative month, the sense of smell continued to improve slightly. By contrast, the postnasal discharge score that was significantly improved at 6th post-operative week tended to worsen at 7xa0months (pxa0=xa00.0045). Before surgery, strong psychosocial impacts were observed in association with nasal obstruction and anterior rhinorrhea. The physical impacts of each symptom were proportionally correlated to the symptom score before and after surgery. The quality of life (QOL) related to each symptom was clearly better at 6xa0weeks and remained steady at 7xa0months after surgery. In conclusion, olfactory disorders and postnasal rhinorrhea were the main remaining symptoms after sinus surgery despite a global improvement of symptoms and quality of life. The earlier time point to stabilize QOL outcomes of endoscopic sinus surgery could be suggested at 6xa0weeks after surgery.

How to assess olfactory performance with the Sniffin’ Sticks test ®

The Sniffin Sticks test (Burghardt(®), Wedel, Germany) is a psychophysical test developed by Hummel in 1997 and validated in several European countries. It allows semi-objective assessment of the patients olfactory performance by means of 3subtests: threshold test, identification test and discrimination test. Although it is difficult to perform the test completely and systematically in routine clinical practice, it is one of the essential tools to assess an individuals olfactory performances and to monitor the course of these performances as a function of physiological (ageing) or pathological events. The purpose of this article is to explain the technical modalities of the Sniffin Sticks test and to discuss possible adaptations of this test.

Structure of the lateral mass of the ethmoid by curved stacking of endoturbinal elements

CONTEXTnAccording to evo-devo theory, the embryonic development of the nasal organ mimics its phylontogenic formation: the lateral masses of the human ethmoid bone develop by curved onion stacking of the endoturbinals (the horizontal bone septa of the mammalian olfactory chamber) under the impact of facial and skull-base remodeling, rather than by pneumatization of cavities communicating via ostia.nnnOBJECTIVESnTo assess the frequency of the onion structure on coronal CT.nnnMATERIAL AND METHODSnThree independent examiners performed a retrospective descriptive study of coronal CT scans taken ahead of septorhinoplasty between June 2010 and December 2012 in adult patients without history of sinonasal surgery.nnnRESULTSnFifty patients were included. In the anterior right and left and posterior right ethmoid, an onion arrangement of the endoturbinals was systematically found on at least 1xa0view, and on 60% of views taking all ethmoid compartments together. Two endoturbinals were generally involved, but a rolling-up of 3xa0endoturbinals was also observed, significantly more frequently in the posterior compartments (P=0.004 on the right side, P=0.012 on the left).nnnCONCLUSIONnThe onion structure of the lateral masses of the ethmoid can be observed on coronal CT scans. This structure confirms evo-devo theory. The ethmoid thus appears fundamentally different from the paranasal sinuses, suggesting that the pathogenesis of nasal polyposis and ethmoidectomy techniques need to be reconsidered.

Olfactory exploration: State of the art.

Olfactory disorders are fairly common in the general population. Exploration, on the other hand, is seldom performed by ENT specialists, even in reference centers. There may be three reasons for this: this particular sensory modality may seem unimportant to patients and/or physicians; available treatments may be underestimated, although admittedly much yet remains to be done; and olfactory exploration is not covered by the national health insurance scheme in France. Advances in research in recent decades have shed light on olfactory system functioning. At the same time, several techniques have been developed to allow maximally objective olfactory assessment, as olfactory disorder is sometimes the first sign of neurodegenerative pathology. Moreover, objective olfactory assessment may be needed in a medico-legal context. The present paper updates the techniques currently available for olfactory exploration.

Facial pain/headache before and after surgery in patients with nasal polyposis

Abstract Conclusion: Endoscopic surgery improved facial pain/headache and physical-psychosocial impacts in patients with nasal polyposis. However, one fifth of patients still experienced residual pain after surgery, requiring neurologic counseling to look for the non-sinonasal cause of their symptoms. Objective: Considering the limited amount of literature on facial pain/headache in patients with nasal polyposis, this prospective study assesses facial pain/headache and its impacts on the quality-of-life (QoL) before and after endoscopic surgery. Methods: Facial pain/headache was assessed, using the DyNaChron questionnaire, in 107 patients with nasal polyposis 1 day prior to surgery and 6 weeks after surgery. All patients were operated on endoscopically on the bilateral ethmoidal labyrinths and olfactory clefts. Results: Moderate or severe facial pain/headache was reported by 50% of the patients before surgery and by 20% after surgery. Post-operatively, 79.44% of patients reported no/very mild pain (vs 47.66% pre-operatively) and 20.56% moderate/severe pain (vs 52.33% pre-operatively). The pain was statistically reduced after surgery among patients with previous surgery (p = 0.0006). The scores of all analysed impacts of pain improved after surgery. However, patients with grade 1 polyps seemed to have less benefit from the surgery for facial pain/headache than those with more severe nasal polyposis.

Nasal polyposis (or chronic olfactory rhinitis)

The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis.

Chronic respiratory rhinitis

The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.

Endoscopic surgery of the olfactory cleft

The olfactory cleft is the specific site of development of many tumours (respiratory epithelial adenomatoid hamartoma, intestinal-type adenocarcinoma, neuroblastoma, inverted papilloma, glomangiopericytoma, etc.) and is also the site of CSF rhinorrhoea via the cribriform plate (cribri-rhinorrhoea). Olfactory cleft surgery must therefore be considered to be a specific type of surgery, complementary to ethmoidal labyrinth surgery and anterior skull base surgery. Olfactory cleft tumours can be resected according to five different surgical procedures: olfactory cleft mucosal resection, partial resection of the olfactory cleft, total resection of the olfactory cleft, unilateral endoscopic anterior skull base resection, and bilateral endoscopic anterior skull base resection. The diagnosis and closure of cribri-rhinorrhoea (i.e. documented CSF rhinorrhoea, demonstrated to arise from the cribriform plate during endoscopic examination of the olfactory cleft under general anaesthesia in a patient with no localizing signs on imaging) completes this range of treatment options.

Awareness of obstructive sleep apnea-hypopnea syndrome among the general population of the Lorraine Region of France

OBJECTIVEnObstructive sleep apnea-hypopnea syndrome (OSAHS) seems to be underdiagnosed. The aim of this study was to assess awareness of OSAHS among the general population of the Lorraine Region of France.nnnMETHODSnA descriptive epidemiological study was carried out from July to November 2015 in the Lorraine Region, using an anonymous questionnaire that assessed knowledge of OSAHS-related symptoms and complications. The survey was also circulated on the Internet via social media. Exclusion criteria comprised age under 18 years, refusal to fill out the questionnaire and linguistic barrier.nnnRESULTSn1307 subjects filled out the survey: 1020 on paper format and 287 via the Internet. About two-thirds of the population recognized a majority of symptoms. However, there was a significant lack of knowledge of complications, especially cardiological and neurological. Suffering from OSAHS, having had higher education, and being under 40 years of age, were factors linked to better awareness of the syndrome. Internet respondents also showed better awareness.nnnCONCLUSIONnDespite encouraging results regarding OSAHS symptoms, the general population showed limited awareness of its complications. Innovative educational campaigns must be organized to inform practitioners and the general public about the disease and raise awareness of its complications.