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A 68-year-old patient presents with chronic right-sided otorrhea associated with hypoacousis and chronic cough. Otoscopy showed multiple perforations of the right eardrum. The search of acid-fast bacilli was positive for direct examination of sputum and negative for the examination of ear pus. A antituberculosis treatment has been initiated.

The congenital cholesteatoma is a rare benign tumor whose diagnosis is mainly made during childhood. Otoscopic examination shows a white retrotympanic collection with or without hearing loss. In case of a late diagnosis, the disease will spread to the surrounding structures, leading to ossicules destruction, facial palsy, sensorineural hearing loss and vestibular dysfunction. Surgery is the therapeutic gold-standard, with different techniques chosen based on the cholesteatoma's extension. Patient should benefit from a long term medical and radiological (MRI) follow-up.Le cholestéatome congénital est une tumeur bénigne rare mais dont la fréquence augmente de par une optimisation du diagnostic, celui-ci étant de plus en plus précoce. Le diagnostic est souvent posé devant une masse blanchâtre rétrotympanique visible en otoscopie associée ou non à un trouble auditif. En cas de diagnostic tardif, l’extension de la maladie peut engendrer de graves complications nerveuses (faciales), auditives et vestibulaires. Sa prise en charge est chirurgicale, le type de technique étant guidé par le stade d’extension du cholestéatome. Le suivi post-thérapeutique va bénéficier de l’apport de l’IRM et se déroulera sur le moyen et long terme.

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

The hearing disorders of the child between 3 and 12 years are dominated by the conductive hearing loss. The questioning, looking for risk factors, as well as the otoscopy are essential to detect and diagnose a hearing disorder. Screening tests help to identify the children with risk of hearing loss. Then, the child is sent for diagnosis towards an ENT specialist or a specialized structure. In spite of the frequency of the conductive hearing loss, in case of the slightest doubt, a sensorineural hearing loss must be always looked for by a puretone audiometry examination via the headphones.

The otoscopy is a major point in a daily practice. The otoscope is usually used. In an ENT practice, the microscope is the main instrument but presents limits. The use of rigid endoscopes allows to refine considerably this otoscopy. In ear surgery, the endoscopy of the middle ear for ear chronic diseases has evolved, from an additional tool to the microscope towards an exclusive surgical procedure with its own indications, advantages and limits.

A persistent stapedial artery is a rare vascular malformation. This diagnosis is based on CT scan and intraoperative findings.The case of a 19-year-old woman with a persistent stapedial artery found during stapes surgery is reported. This vascular malformation was explored with a CT scan showing the bilaterality of this anatomical variation and signs of associated otosclerosis.This malformation was successfully coagulated with laser allowing the stapedotomy to be completed.A persistent stapedial artery is not a contraindication to stapedotomy because it can be safely coagulated during the same procedure.

Respiratory and/or food allergy is common in children. Serous otitis media is also very frequent in children, especially those between 3 and 6 years of age. On the other hand, in spite of promising animal studies, a cause-and-effect relation between these two conditions in man has not been established. Concerning the treatment, avoidance of food allergens may be as efficacious for an active serous otitis media as for avoidance of a new episode. Conversely, antihistamines do not appear to be efficacious, at least with respect to being curative.

Jugular and tympanic paragangliomas are the most frequent tumors of the middle ear. They appear as a reddish, pulsatile, retrotympanic mass. Patients complain from hearing loss and pulsatile tinnitus. Tumors are most often benign. Secretory forms are rare. Angio-MRI and CT-scan are gold standard. MIBG or octreotid scintigraphies are helpful to rule out multiple lesions. The treatment consists in surgery alone, radiotherapy alone or association of both. Often, embolisation prior to surgery decreases hemorrhagic risks. Vital prognosis is good. The functional outcome is critical in extensive tumors.

Most frequent complication of children upper respiratory tract infections, acute otitis media is the leading cause of bacterial infections and one of the leading causes of antibiotic prescriptions. Under the combined effect of Prevenar immunization and the reduction of the use of antibiotics in France, the highly resistant strains of pneumococci (those which posed therapeutic problems) decreased moreover of the three quarter. Non typable H. influenzae became the main bacteria responsible of AOM, and resistance to the beta-lactams by change of penicillin binding proteins is an emergent problem in France. The diagnosis of purulent OMA is based on a triad: recent onset functional (otalgia) and generals (fever) signs, middle ear effusion and tympanic membrane inflammation. The official French guidelines suggest prescribing antibiotics (amoxicillin-acid clavulanate-cefpodoxime proxetil) only for purulent acute otitis media diagnosed in an unquestionable way, systematically in the child of less than two years, only for the most symptomatic forms after this age, while making use of the history and the clinical and bacteriological correlations to choose antibiotic.

To assess reliability of the diagnosis of Acute Otitis Media (AOM) given by General Practitioners (GPs) compared with the diagnosis of Otorhinolaryngologists (ORLs) considered as the reference diagnosis.Every GP had to include 6 children aged 1 to 4 years for whom he suspected or diagnosed AOM. Parents had to accept to consult the ORL participating in the survey within 48 h.24 GPs took part in the survey and included at least 1 child, which amounts to a final 57% acceptability rate. Two hundred and eight eardrums were included in the survey. 21.9% of assumptions or diagnosis of AOM (30/137) were declared null by the ORL. GPs diagnose AOM with certainty only in 54% of all cases. The diagnosis and the assumption of AOM were respectively confirmed in 83.8% of all cases and 71.4% by the ORL. The combination of redness and bulge and isolated redness accounted for respectively 44.3% and 26.2% of the main otoscopical factors reminiscent of the AOM according to GPs. In the case of redness plus bulge, the diagnosis was confirmed in 83% of all cases by the ORL as opposed to 75% regarding the isolated redness. AOM was suspected in 57.1% of the eardrums little or not visible with no sign of infection and was not confirmed in 25% of all cases.The global overdiagnosis was 21.9% and 25% when the otoscopy is hindered by the presence of cerumen or when the eardrums show inflammation alone. Even though the overdiagnosis was lower than the reported one in literature, post-graduate teaching on the various cerumen removal techniques and the use of pneumatic otoscopy should contribute to improve the quality of diagnosing AOM.

The aim of this study was to evaluate the causes, the diagnosis, the treatment and the results obtained by revision surgery, in cases of stapedectomy failures.Retrospective study of 50 recent cases operated on between January 1997 and December 2001. DIAGNOSIS OF THE FAILURE: All reoperated patients had clinical and audiological assessment; CT scan with virtual endoscopy.The mean time of onset of failure was 23 months. The mean preoperative air bone gap was 25.5 dB. Otoscopy revealed a retraction pocket caused by poor eustachian tube function in 9 cases. CT scan proved to be very effective at differentiating the cause of the failure.In 11 cases the prosthesis was too short, in 8 cases the prosthesis had migrated out of the hole of stapedotomy and in 6 cases the piston was fixed in the stapedotomy hole. A partial or complete lysis of the long process of the incus was frequently associated, but in 9 cases it was the only cause of the failure. In all the cases when the piston was displaced, the stapedotomy was found to be covered by a thin mucous membrane, avoiding labyrinthine fistula. In 3 cases, the failure was due to recurrent otosclerosis. In 5 cases the failure was due to a local anomaly at the level of the oval window niche, 2 cases of failure were due to a malleus ankylosis. In 5 cases fibrous adhesion was found between the incus and the mucosa of the promontory. In one case a reparative granuloma was found at the level of the oval window.In cases of partial lysis of the long process of the incus, a new prosthesis was placed in a 0.4 mm diameter stapedotomy, performed using a KTP laser. A 0.4 mm diameter piston was extended 0.2 mm below stapedotomy to avoid a new extrusion. Indeed some prosthesis extrusion could be due to increased movements of the ossicular chain in cases of eustachian tube dysfunction. In cases of complete lysis of the long process of the incus, or in cases of a very short long process of the incus, a piston was put in the stapedotomy and attached to the malleus manubrium. The results of revision stapedotomy were favorable in the absence of associated fibrous tissue adhesion or local malformation. The air bone gap was found to be less than 10 dB in 40 cases and between 10 and 20 dB in 8 cases. An impairment of the air bone gap was found in 2 cases. No case of bone conduction impairment was found in this series.