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Abstract: In spite of numerous publications on occupational lung diseases, latex allergy, and the relationship of nose-to-bronchi, the particularities of the clinical, epidemiological and therapeutic aspects of latex allergic rhinitis (LAR) are very little considered in the literature. Based on our own experience and on a review of the literature, we will examine the environmental context of LAR and try to define its most important diagnostic and therapeutic criteria. An early diagnosis of LAR and reduction of exposure to latex allergens before its evolution to asthma, can limit the socioeconomic impact of this condition. [Copyright &y& Elsevier]

Abstract: The indentification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). These two fungal respiratory diseases can be isolated or associated in a sinobronchial allergic mycosis. A retrospective study of a series of 15 cases of AFS fulfilling all the diagnostic criteria reported in the literature (eight isolated AFS and seven AFS associated with ABPA) and the review of the literature highlight the similarities between AFS and ABPA independently of the signs linked to the organs involved (sinuses, bronchi): pathophysiological mechanisms, immunoallergological, biological and mycological features, diagnostic procedure, treatment and follow-up. Therefore, AFS appears to be a sinonasal ABPA-like syndrome. [Copyright &y& Elsevier]

Introduction: Vocal cord dyskinesia or vocal cord dysfunction (VCD) is characterized by intermittent abnormal adduction of the vocal cords leading to airflow limitation at the level of the larynx, in the absence of local organic disease. It may occur in isolation or in association with asthma. The pathophysiology is complex and poorly understood. Wheeze, stridor or apparent upper airway obstruction are the most common symptoms. It occurs in a wide age range, more commonly in women, and diagnosis is often delayed and leads to unnecessary treatments (intubation, tracheostomy and high dose steroids)., Methods: A retrospective study of 15 cases of VCD (8 cases of isolated VCD and 7 cases of VCD with associated asthma) describing the main clinical features and the diagnosis strategy., Results: Apparent upper airway obstruction, with or without associated asthma, requires an ear nose and throat examination with laryngoscopy to confirm the paradoxical adduction of the vocal cords during an acute episode of dyspnoea or during a provocation test with triggers like exercise or exposure to irritants, and for the purpose of differential diagnosis., Conclusions: VCD remains under-appreciated and misdiagnosed, often by mimicking asthma with which it can be associated. A delayed diagnosis by emergency specialists, pulmonologists and ear nose and throat surgeons leads to unnecessary treatments and morbidity before specific therapy can be given., (Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the value of CT for diagnosis and follow-up of AFS. Evaluation of characteristic CT features of AFS., Methods: Retrospective review of 12 cases of AFS presenting with all published diagnostic criteria (1) chronic rhinosinusitis refractory to standard management (2) CT features of chronic sinusitis (3) anatomopathologic, immunoallergologic, biochemical and mycologic criteria. CT findings were correlated with surgical findings and reviewed by one ENT and two radiologists to assess the diagnostic value of different CT features, alone or in association., Results: AFS was isolated in 6 cases, and associated with allergic bronchopulmonary aspergillosis (ABPA) in 6 cases. CT showed pan- or polysinusitis, unilateral or bilateral, with mucosal thickening, sinus opacification frequently heterogeneous, bony changes, fluid trapping, and with pseudotumoral appearance in 3 cases., Conclusion: CT findings alone are not specific or pathognomonic but may suggest AFS in the correct clinical or immunoallergologic setting. It may alert the physician to the need for complementary work-up, exclude the presence of associated lung disease, and better adapt treatment and follow-up.

Introduction: The identification of allergic fungal sinusitis (AFS) is much more recent than that of allergic broncho-pulmonary aspergillosis (ABPA) and may still be incomplete and controversial. Their association has been only rarely reported in the literature. Is it a matter of a fortuitous association or of a well defined and/or new nosological rhino-bronchial entity?, Methods: A retrospective study was undertaken from a series of 10 cases of AFS with 4 cases associated with ABPA and fulfilling all the diagnostic criteria described in the literature., Results: The association of AFS and ABPA may be concomitant (2 cases) or not (2 cases) with a possible time lag of several years between the onset of naso-sinal and broncho-pulmonary disease, even after recovery from the original episode. Treatment comprising steroids, endoscopic surgery (4 cases) combined with anti-fungal drugs (2 cases), led to resolution (2 cases), a considerable improvement (1 case) and therapeutic failure in 1 case (follow up longer than 4 years in all cases)., Conclusion: The association, concomitant or remote in time, of AFS and ABPA emphasises the unity of the upper and lower airways as well as the pathophysiological relationship between these two fungal respiratory diseases. The prevalence of this association remains low and the treatment is not standardised.

Background: We analyzed the main characteristic features of the respiratory epithelium mucociliary system and the different tests of ciliary beat and mucociliary transport (mucociliary clearance). This knowledge is necessary for an often interdisciplinary diagnosis and treatment of primary ciliary dyskinesia., Methods: Review of the literature and personal experience of the different tests of ciliary structure and function., Results: This disease is characterized by abnormalities in ciliary structure/function. The genetic mechanisms and the ultrastructural abnormalities that are involved are heterogenous compared to the relative homogeneity of the clinical presentation., Conclusion: The diagnostic criteria are compatible clinical features (chronic upper airway and bronchopulmonary infections, situs inversus...) coupled with tests of ciliary structure and function.

Unlabelled: Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function., Objective: We analyzed the main clinical features and test results of PCD in order to evaluate their usefulness for diagnosis., Patients and Methods: Retrospective study of 35 cases of PCD evaluated by the same team, with nasal brushings in all cases (special light microscopy) and electron microscopy and/or by isotopic mucociliary clearance study in some., Results: In a cohort of 145 patients with suspected PCD, the diagnosis of PCD was established in 35 cases using a combination of compatible clinical features coupled with the study of nasal brushings: 13 females and 22 males, average age at time of diagnosis 25 years, situs inversus in 12 patients (34%)., Conclusion: In the absence of consensus in the literature for diagnosis of PCD, we propose the association of the following diagnostic criteria: upper airway and bronchopulmonary infections beginning often early in the life, more inconstantly situs inversus, familial cases of PCD, consanguinity, infertility and permanent and ubiquitous abnormalities of ciliary structure/function. Nasal brushing with ciliary study (special light microscopy) seems to be an easy and reliable diagnostic criterion. Electron microscopy is necessary for proving ultrastructural abnormalities.

Objectives: Diagnosis, nosological individualization, and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We present ten cases of allergic fungal sinusitis and review the literature to highlight the main clinical, radiological, biological, immunoallergological, mycological, and therapeutics features., Material and Methods: This retrospective study included ten patients (six men and four women, mean age 45 years) with allergic fungal sinusitis diagnosed on the basis of all diagnostic criteria reported in the literature., Results: Six patients had isolated allergic fungal sinusitis which was associated with allergic bronchopulmonary aspergillosis in the four others. Treatment combined endoscopic sinus surgery and corticosteroids, which provided good results in six patients and average results in three. Treatment failure was observed in one patient., Conclusion: As in the case of allergic bronchopulmonary aspergillosis, a set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The most appropriate endoscopic sinus surgery and the best corticosteroid regimen remain to be determined.

We report 13 cases of nasosinusal sarcoidosis. Sarcoidosis is a chronic, non caseating granulomatous disease. Nasosinusal involment is rare or exceptional and may be isolated (1 case in our series) or associated (12 cases in our series) with other lesions of the chest, skin, liver, spleen, bone, eyes, salivary glands, peripheral lymph nodes or with neurosarcoidosis. The clinical and CT features are various and often non specific. Nasal biopsy guided by physical examination is easy and constitute the main diagnostic criterion. The course of nasosinusal sarcoidosis is variable and no standard treatment has been established. Response to local or systemic corticosteroid therapy is also variable. The recurrence is frequent after tapering off or interrupting corticosteroids that also have important side effects.

We report 4 cases of allergic reaction to formaldehyde-containing root canal sealant after endodontic care: 2 anaphylactic shocks and 2 local reactions with generalized urticaria. Allergic IgE mediated mechanisms were suggested by the clinical presentation, skin tests and high levels of anti-formaldehyde IgE. These infrequent but potentially severe reactions after canal treatment led us to examine the involved mechanisms, the diagnostic procedure and the possibility of prevention in odontostomatology.

Purpose: Evaluate the contribution of CT for the diagnosis of caseous fungal and not fungal sinusitis, mostly of dental origin and often improperly called aspergillus sinusitis., Material: and methods. About 50 cases of caseous maxillary sinusitis, including 34 fungal sinusitis, the authors analyse the most important CT criteria. All patients underwent thereafter surgery, and the removal material was submitted to mycological investigations., Results: Constructive and destructive modifications of the bone walls, fillings of sinus cavities and middle meatus are aspecific signs of chronicity. Dental origin foreign bodies and microcalcifications are more evocative but also non specific. Only the mycological investigation leads to the diagnosis of fungal and identifies by round fifty percent cases to the exact nature of fungal., Conclusion: There are no valid predictive criteria for fungal etiology by CT investigation.

Discussion is about the different types of naso-sinusal polyps, isolated inflammatory polyps and some other ambiguous types like inverted papilloma, so-called haemorrhagic polyps, pseudo-polyps and reactional polyps collecting very heterogeneous and various clinical, CT and evolutive entities.

CT was performed in three patients with plasmacytoma of the maxilla and mandible. CT allows improved depiction of the tumor and associated local invasion and bony destruction but remains non-specific. Histology is mandatory for diagnosis and work-up necessary to confirm the solitary nature of the lesion. Intraosseous intramedullary lesions often evolve to multiple myeloma after a few years whereas extramedullary lesions, commonly involving sinonasal structures, typically remain solitary.

We analyse the most important clinical, CT, surgical, histopathological, biological, biochemical, mycological and bacteriological features of caseous sinusitis, i.e. chronic, poorly symptomatic sinusitis which are resistant to usual treatment. CT shows an opacity of the maxillary sinus with often a hyperdense foreign body (dental overfilling) but no valid predictive criteria for fungal etiology. The endoscopic or surgical procedures point out a caseous mass often called fungal mass or aspergilloma. The biochemical composition of this mass (water, proteins, lipids) is similar to that of tissues surrounding the sinus. The calcium value is variable and shows no correlation with CT imaging. The qualitative and quantitative analysis of the metals (zinc, lead, silver, copper, iron) is of relevance for exogenic origin (dental overfilling). The fungal etiology is inconstant (20 cases) after the mycological investigations. We discuss the nosologic and diagnostic features of caseous sinusitis, fungal or not, and which are often or too often called aspergillosis sinusitis.

The authors report an uncommon case of caseous dental sinusitis with infection or superinfection by mocorales and actinomycetes. The patient was healthy, without diabetes mellitus, but was treated for lymphoma 18 years before. This observation leads to a discussion of nosologic, diagnostic and therapeutic features of caseous sinusitis, dental or not, fungal or not, which are often or too often called aspergillosis sinusitis. The recovery of the patient was complete after surgery, amphotericin B and hyperbaric oxygen.

The authors report an uncommon case of maxillary sinusitis due to Microsporum canis. To their knowledge this is the first observation in which a zoophilic dermatophytic fungus which grows usually on keratin has been isolated in a dental maxillary sinusitis in human. This observation makes it possible to discuss nosologic and diagnostic features of dental caseous sinusitis and fungal sinusitis which are often or too often called aspergillosis sinusitis.

The authors report a series of 350 patients referred for clinical investigation of nasal polyps between 1980 and 1990. 93 patients were followed for more than 5 years. Allergy to inhalants was rarely found (2.8%). Detailed study of past rhinosinusal and bronchial symptoms often revealed a history of vasomotor rhinitis (nasal hyperreactivity HRN) preceding the nasal polyposis by a mean interval of 8 years. The ratio non-allergic vasomotor rhinitis/nasal polyps was 4.31 in women (41.4% of the patients) and 1.74 in men (58.6% of the patients). Treatment is usually based on the use of local corticosteroids. However, because of the variable clinical pattern of nasal polyposis treatment may be medical alone or both medical and surgical, and always requires a long clinical follow-up. Intolerance to aspirin is a factor of poor prognosis. A 15% failure rate was noted among patients intolerant to aspirin.

The carbacholine nasal test assesses "nasal hyperreactivity", particularly its parasympathetic component, in vasomotor rhinopathies. This simple, reproducible test has been applied to two groups of subjects: a group of 26 healthy subjects without any rhinopharyngeal and/or allergic affections, and 10 patients with aperiodic non-allergic (6 cases) or allergic (4 cases) vasomotor rhinopathy, the 4 cases with allergy including 3 allergic to house dust mite and one to house dust mite and grass pollen. Nasal reactivity to carbacholine was evaluated by measuring the amount of rhinorrhea following variable concentrations (1/1000, 1/100, 1/25) and volumes (0,10 to 0,50 ml) of carbacholine solution. Nasal secretion was markedly increased in patients with a vasomotor rhinopathy (1.80 +/- 0.65 ml) when compared with control subjects (0.64 +/- 0.17 ml). The main conclusions to be drawn from this study, and possible applications of this test in rhinology are discussed.

Principal characteristics of clinical and paraclinical pictures of nasosinusal aspergillosis (NSA) in 35 patients are analyzed and allow distinction of three main types of this nasosinusal fungal lesion. Localized, non-invasive nasosinusal aspergillosis (NINSA) is frequently of dental origin and presents as a chronic maxillary sinusitis resistant to conventional treatment. Serology is negative or non-significant for Aspergillus and recovery is complete after surgery. Invasive nasosinusal aspergillosis (INSA) affects debilitated patients (diabetes, immunodepression, malignant blood disease...), and presents with bone destruction, extension to orbit, base of skull and intracranial region, following an acute or subacute course with positive serology for Aspergillus. Early, wide surgical eradication is combined with local and general antifungal therapy but prognosis is poor. Allergic nasosinusal aspergillosis (ANSA), of more recent description, combines chronic sinusitis with severe nasosinusal polyposis, and specific histologic and immunologic features. Its course is favorable with corticoid therapy but long-term results are unknown.