Houda Chahed

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

OBJECTIVES The 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. MATERIALS AND METHODS A 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. RESULTS Paradoxical 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. CONCLUSION The 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

OBJECTS To discuss clinical presentation and therapeutic approaches of facial paralysis in acute otitis media. METHODS We 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). RESULTS The 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. DISCUSSION Conservative treatment associating intravenous antibiotic and corticosteroids with or without myringotomy is the standard approach.

A novel frameshift mutation (c.405delC) in the GJB2 gene associated with autosomal recessive hearing loss in two Tunisian families

OBJECTIVES Mutations in GJB2 are found to be responsible for 50% of congenital autosomal recessive non-syndromic hearing loss, one of the most important mutations in this gene is the c.35delG, which is responsible for the majority of GJB2 related deafness in the Tunisian population. The aim of this study was to determine the molecular etiology of hearing loss in two Tunisian individuals. METHODS We screened two Tunisian individuals affected by congenital, bilateral, profound, sensorineural hearing loss for mutations in GJB2 gene using PCR and direct sequencing. RESULTS We identified a novel frameshift mutation in the GJB2 gene, the c.405delC resulting in a truncated protein (p.Tyr136Thrfs*32). It was found in compound heterozygosity with the c.35delG in two non-consanguineous unrelated families from Tunisia. One patient underwent a cochlear implant at 4 years. Initial evaluations post-implantation indicate a successful cochlear implant outcome since the patient began to acquire language abilities and auditory sensation. CONCLUSIONS With this novel GJB2 mutation, the mutational spectrum of this gene continues to broaden in our population. The occurrence of biallelic GJB2 mutations for the other deaf girl, despite the neonatal pain and hypotension due to complicated delivery, led us to confirm the importance of GJB2 screening for cochlear implant candidates regardless of the etiology of deafness in populations with a relatively high frequency of GJB2 mutation carriers.

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.

Rare Localization of Lymphoma

Objective: Primitive Thyroid Lymphomas (PTL) are rare tumors. Women in the sixth or seven- th decade of life are more commonly affected. In the present study, we report a case of primitive thyroid lymphoma and we review the epidemiology, the clinical presentation, the diagnosis, and the treatment of this rare disorder. Case Report: A 47-year-old woman presented to our department reporting a recent-onset neck mass since 3 months. Clinical examination revealed an enlargement of the thyroid gland with a 2.5 cm-firm left nodule. Cervical ultrasound was done. The patient had a thyroidectomy as- sociated with bilateral Central Lymph Node Dissection (CLND). The diagnosis was a transfor- mation of a Mucosa-associated lymphoid tissue (MALT) lymphoma into an aggressive Diffuse Large B-Cell Lymphoma (DLBCL). Conclusion: The most common type of primary thyroid lymphoma (PTL) is diffuse large B-cell lymphoma, which behaves in a more aggressive manner than mucosa-associated lymphoid tissue lymphoma. Treatment and prognosis of PTL depend upon the histology and stage of the tumor at diagnosis.