P. Bonfils

Nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis

Background A decrease in nasal nitric oxide (NO) and an increase in exhaled NO have been demonstrated in patients with nasal polyposis (NP).

Evaluation of the combined medical and surgical treatment in nasal polyposis. I: functional results.

Conclusion: This prospective study is the first in the literature to present long-term results of a combined medical and surgical treatment in patients with nasal polyposis (NP) including strict inclusion criteria, analysis of the results in terms of clinical amelioration, polyp size reduction, and steroid consumption. The results of the present study show that combined surgery and corticosteroid therapy is effective in the treatment of NP. Objective: Most publications on outcome after functional endoscopic sinus surgery (FESS) include patients with various pathologies. The aim of this study was to provide reference information for FESS in patients with NP with strict inclusion and exclusion criteria. Materials and methods: This was a prospective study involving 194 consecutive patients. Clinical symptoms, polyp size, and steroid consumption were evaluated before and after FESS (mean follow-up, 74 months). An actuarial analysis using the Kaplan Meier life table method was performed with regard to the 3- and 5-year symptoms control rates. Results: All symptoms were improved after FESS. The 5-year actuarial nasal obstruction control rate was 65.8%. The 5-year actuarial severe posterior rhinorrhea control rate was 82.9%. The 5-year actuarial smell loss and anosmia control rates were 17.7% and 65.8%, respectively. Polyp volume and steroid consumption decreased significantly after FESS.

First bite syndrome.

Based on a review of the indexed medical literature (PubMed database), the authors describe the clinical features leading to the diagnosis of first bite syndrome, the pathophysiology of this syndrome and analyse the various treatment options available to otorhinolaryngologists to manage this syndrome.

Influence of allergy on the symptoms and treatment of nasal polyposis

Conclusion. Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment. Objectives. To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis. Patients and methods. Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean ageu200a=u200a48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean ageu200a=u200a48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop®). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied. Results. In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (pu200a=u200a0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.

Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery

Conclusion. Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). Objectives. To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. Patients and methods. This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop®). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. Results. Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.

Acouphènes et thérapie comportementale et cognitive: Résultats à un an

INTRODUCTIONnTinnitus is a common auditory symptom that interferes with activities of daily living and is often associated with anxiety and depression.nnnMETHODnThis study included consecutive patients with chronic intense tinnitus for more than six months who were treated with Tinnitus Retraining Therapy (TRT), a cognitive-behavioral therapy, after previous treatment failed and after a clinical evaluation based on standardized questionnaires, including the Tinnitus Handicap Questionnaire (THQ). One year after the end of the TRT, the treatment was evaluated by the same standardized questionnaires.nnnRESULTSnThis prospective study included 96 consecutive patients (49 women, 47 men, mean age: 48 years). Tinnitus improved significantly in 75%, where significant improvement was defined as a final THQ score of less than 500 after CBT. This improvement varied according to initial THQ scores and was seen in: all patients with moderate (THQ<500), 70.3% of the patients with intermediate (5001001), and 34.8% of patients with severe (THQ>1000) tinnitus.nnnCONCLUSIONnCBT shows promise as a treatment of tinnitus-related distress.Resume Introduction Les acouphenes sont un symptome auditif frequent qui altere la qualite de vie des patients et qui est souvent associe a une anxiete et une depression. Methodes Des patients consecutifs ayant des acouphenes chroniques et permanents, evoluant depuis plus de 6 mois et vecus comme un handicap, ont ete inclus. Une therapie comportementale et cognitive (TCC) a ete realisee apres une evaluation des acouphenes par des questionnaires standardises et valides. Un an apres la fin de la TCC, le resultat du traitement a ete evalue par les memes questionnaires. Resultats Quatre-vingt-seize patients consecutifs ont ete inclus dans cette etude prospective (49 femmes, 47 hommes, âge moyen 48 ans). Une amelioration significative a ete observee chez 75% des patients quel que soit le questionnaire utilise. L’amelioration a ete qualifiee de “franche“ lorsque le score du Tinnitus Handicap Questionnaire (THQ) final etait 1000). Conclusion La TCC est un traitement prometteur dans le cadre de la prise en charge des acouphenes.

PROKR2 and PROK2 mutations cause isolated congenital anosmia without gonadotropic deficiency

OBJECTIVEnIsolated congenital anosmia (ICA) is a rare phenotype defined as absent recall of any olfactory sensations since birth and the absence of any disease known to cause anosmia. Although most cases of ICA are sporadic, reports of familial cases suggest a genetic cause. ICA due to olfactory bulb agenesis and associated to hypogonadotropic hypogonadism defines Kallmann syndrome (KS), in which several gene defects have been described. In KS families, the phenotype may be restricted to ICA. We therefore hypothesized that mutations in KS genes cause ICA in patients, even in the absence of family history of reproduction disorders.nnnDESIGN AND METHODSnIn 25 patients with ICA and olfactory bulb agenesis, a detailed phenotype analysis was conducted and the coding sequences of KAL1, FGFR1, FGF8, PROKR2, and PROK2 were sequenced.nnnRESULTSnThree PROKR2 mutations previously described in KS and one new PROK2 mutation were found. Investigation of the families showed incomplete penetrance of these mutations.nnnCONCLUSIONSnThis study is the first to report genetic causes of ICA and indicates that KS genes must be screened in patients with ICA. It also confirms the considerable complexity of GNRH neuron development in humans.

Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants

Due to their vasoconstrictive action on the nasal mucosa, ephedrine and pseudoephedrine are highly efficient amines for relief of nasal congestion. As with any vasoconstrictor and as underscored by the French Society of Otorhinolaryngology in its 2011 guideline, these molecules should not be used in patients under the age of 15. Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis. Distribution should be regulated and over-the-counter sales banned.

Postoperative Hemorrhage after Transoral Oropharyngectomy for Cancer of the Lateral Oropharynx

Objective: Assessment of incidence, risk factors, management, and outcome of postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. Methods: Retrospective review of a cohort of 514 cancers of the lateral oropharynx consecutively resected. Results: Incidence of postoperative hemorrhage was 3.6%. In 31.5% of cases, onset was after hospital discharge. No hemorrhages occurred after the end of the fourth postoperative week. Variables associated with increased risk of hemorrhage were advanced age (P = .004), antithrombotic treatment (P = .012), and robotic assistance (P = .009). When the source of hemorrhage could be identified, hemostasis, performed transorally in most cases, was highly effective; no patients in this subgroup showed recurrence. In spontaneously resolved hemorrhage under observation or when no active site of bleeding was found on exploration under general anesthesia, the recurrence rate was 18.1%. Overall, hemorrhage resulted in death in 2 patients. Conclusion: Exploration under general anesthesia in case of active bleeding and observation with discussion of arterial exploration of the ipsilateral external carotid system in patients in whom no source of bleeding can be identified are the keys to successful management of this potentially lethal complication.

Chemotherapy alone in laryngeal squamous cell carcinoma

AIMSnTo evaluate the results of chemotherapy alone in patients with invasive squamous cell carcinoma of the larynx who have achieved a complete clinical response after an induction chemotherapy protocol.nnnMETHODSnA comparison of results in a group of complete responders managed with a chemotherapy alone protocol, matched with those of an incomplete responder group managed with conventional modalities.nnnRESULTSnThe survival rate of the complete responder group was significantly higher than that of the incomplete responder group. No statistically significant difference was noted between the two groups in terms of local failure and nodal recurrence.nnnCONCLUSIONnOur results confirm the fact that chemotherapy alone is a viable option in selected patients with carcinoma of the larynx who have achieved a complete clinical response after an induction chemotherapy protocol. This therapeutic approach allows surgery and/or radiation therapy to be reserved for the management of metachronous second primary tumours.