Search

The interrogation is essential to trace the genesis of the tinnitus and to appreciate its repercussion. Clinical examination should look for a local, vascular or cervical cause. The ENT consultation with audiogram and tinnitus evaluation is essential to know the characteristics of the tinnitus and to consider the treatment. If tinnitus is accompanied by a decrease in hearing, then wearing hearing aids can correct deafness and decrease the tinnitus. The psychological impact of tinnitus must always be taken into account and the use of a multidisciplinary team is an interesting solution. Medical treatments are not very effective; on the other hand psychotherapies (CBT, TRT and sophrology) bring a real improvement. The doctor's speech must always be supportive and provide therapeutic hope., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

The usual treatments for primary snoring are uvulopalatopharyngoplasty (UPPPP) and laser assisted uvulopalatoplasty, their morbidity is known, particularly considerable postoperative pain. We have performed a prospective study on a population of 23 patients with primary snoring (respiratory disturbance index =6 +/- 1) to 1) evaluates by means of questionnaires the short term (2 month) efficacy of the application of radiofrequency energy at the level of the soft palate, and 2) assess the morbidity associated with this treatment in this population. In the group of patients receiving treatment at three sites in a maximum of three sessions, the short term satisfaction rate was 75 %. The postoperative pain was of minor importance and the use of major analgesics was necessary in 2 cases only. We conclude that this treatment with radiofrequency energy seems to be an effective treatment for primary snoring at short term. The morbidity, specially the pain seems to be distinctly inferior compared to UPPP or laser treatment. Further prospective studies on a larger number of patients and with a longer follow-up are absolutely necessary to confirm these results.

Among 30 children with cholesteatoma undergoing surgery at the Bicetre Hospital between 1985 and 1990, 8 had intact tympanic membranes. Since this represents a larger portion of the patient population than would be expected from previously published data, we under-look a critical analysis of the clinical findings. Among these 8 cases, 2 corresponded to the criteria of congenital cholesteatoma with no history of otitis or trauma and 3 corresponded to acquired types with histories of ventilatory intubation, myringoplasty and accidental trauma. Finally, 3 cases were possibly of mixed origin with lesions typical of congenital epithelial rests and a history of commonplace era infections. Based on these observations, the authors review the clinical characteristics and pathogenesis of congenital cholesteatoma and evoke the etiologic impact of trauma, particularly iatrogenic events such as myringoplasty and ventilatory intubation.

The authors report a case of acute mastoiditis in a four year-old boy due to fusobacterium necrophorum. The importance of the complications (septiciemia, lateral sinus thrombosis, meningitis, osteitis) and the fusobacterium necrophorum are the two majors interests of this observation. A review of the literature is performed.

An open operative technique was used in 36 (38%) of 95 patients with chronic cholesteatomatous otitis followed up by the same surgeon between 1986 and 1990. Although a good anatomical result was obtained in 88% of cases the functional result was less evident, since 57% of patients were left with a liminal tonal loss of less than 30 décibels. The reasons for using an open technique are analyzed, but in only 5% of cases could the possibility of using a closed technique be envisaged, making the classical discussion between open and closed methods of treatments of only academic interest. Petromastoidian evidement with reorganization of the cavity is considered to be effective therapy for cholesteatoma, but indications and technical procedures must be adhered to strictly.

The syndrome combining velar myoclonia with objective tinnitus is rare and, in adults, it corresponds most of the times to a neurological lesion of the dento-olivary tractus. Its functional manifestations are often invalidating and propounded medical treatments uneffective. The authors report a case in which local injection of botulinus toxin allowed to obtain satisfactory functional improvement. Such therapy may prove useful when conventional management is failing.

Limited resection in partial surgery for carcinoma of the larynx leads to discussion of three surgical attitudes: total surgical resection as a matter of principle, additional treatment by radiotherapy, or waiting, with the need for strict surveillance. The present study reports the results of this latter attitude adopted in 23 cases out of 24 of limited resection in a group involving 119 partial laryngectomies (vertical or horizontal) consisting of: 57 cordectomies, 20 hemilaryngectomies, 42 supraglottal laryngectomies. Results of analysis show that there was no recurrence and patients were well with a 3 year follow-up in 19 cases of limited resection out of 24. Overall survival following limited resection was identical to that seen after satisfactory resection, but there was a marked difference with insufficient resection (X2 significant) Following partial laryngeal surgery involving a limit resection, it is felt to be legitimate to temporise as long as the patient can be seen regularly. Such an approach would not seem to modify the overall survival in these patients.

Congenital laryngeal anomalies are a frequent cause of obstructive dyspnea in neonates and young infants, and raise diagnostic and emergency treatment problems. Clinical symptomatology includes stridor of variable severity, obstructive dyspnea and deglutition disorders, but a less typical picture may be seen of apnea, cyanotic episodes, bradycardia and even cardiac arrests. A retrospective study of 687 case-reports of infants treated between 1974 and 1983 was conducted. Lesions included essential congenital laryngeal stridor (laryngomalacia) in 378 cases (50%), of which 15% were severe with respiratory distress and/or deglutition disorders; laryngeal palsy in 161 cases (23%), bilateral in 56 and unilateral in 105 cases; laryngeal incoordination in 23 cases; laryngeal stenosis: 79 cases (11%) including 58 subglottic and 18 dysphragmatic stenoses and 3 atresias; subglottic hematoma: 49 cases; ary-epiglottic or glosso-epiglottic cyst: 15 cases; laryngeal diastema: 11 cases; and bifid epiglottis: 1 case. Clinical, radiologic and endoscopic findings, and the principal therapies used, are discussed for each anomaly.