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Hearing loss can seriously impact children's daily life. This study aims to translate and validate the French versions of the hearing performance questionnaires, SSQ-Parent (for 5-18 years old children), and SSQ-Children (for 11-18 years old children).This controlled prospective trial was conducted between April and October 2020. The forward-backward translation method was used, and a test-retest procedure was carried out on a case and a control population. Cases had at least 30 dBHL hearing loss.54 cases (mean age 10.4 years old) and 32 controls (mean age 12.5 years old) answered the SSQ-Parent. 35 cases (mean age 13.1 years old) and 35 controls (mean age 14.3 years old) answered the SSQ-Children.Spearman's correlation coefficients between global scores of the test and re-test were 0.91 (The SSQ-Parent and SSQ-Children revealed excellent statistical properties, and can be used for the evaluation of hearing performance of children.

Purpose To report our experience with endoscopic Thulium LASER for treatment of recurrent TEF after EA surgery, and for H-Type fistulas. Methods A retrospective chart review of consecutive patients undergoing standardized endoscopic closure as first line therapy of recurrent tracheoesophageal fistula (RTEF) and H-type fistula using Thulium LASER, from 2013 to 2019, in a pediatric tertiary care center. Control endoscopic procedure was systematically performed. If persistence of the TEF was noted an external approach was performed. Patient demographics, medical history, symptoms, TEF type, treatment modalities, complications and outcomes were collected. Results Eleven patients with tracheoesophageal fistula were included: six RTEF after primary repair of esophageal atresia and five H-type fistulas. The average age at endoscopic treatment was 19 months (SD 23 months, range 13 days–63 months). Closure of the fistula after single endoscopic procedure with Thulium LASER was obtained in 3 RTEF (50%) and 1 H-type fistula (20%). Six patients with failure of endoscopic treatment were cured after a single external procedure without any complications. One child, treated for H-type fistula, presented a severe complication of Thulium LASER treatment. Median follow-up after last repair was 24 months (range: 14–72 months). All fistulas were successfully treated. Conclusions In H-Type fistula, success rate of Thulium LASER is only 20% and thus should not be used. In contrast, in RTEF, success rate of 50% is achieved, avoiding as many open procedures, and Thulium LASER could be considered as first line treatment. In any case, open surgery is safe and efficient and can be considered as a first-line treatment for H-type fistulas, and as a salvage treatment for endoscopic treatment failures. Levels of Evidence Level IV.

International audience; The respiratory movements of fetal amniotic fluid areconsidered by certains cleft surgery teams to contribute to the growth of the nasal cavities (NC). To assess this functional hypothesis, we considered a group of patients with unilateral choanal atresia (CA) as a model of unilateral absence of amniotic fluid flux in the NC, and compared their NCs shape to age-matched controls. Material and methods: Three-dimensional reconstructions of NC were performed using Avizo 9.7 (Thermo Fisher Scientific, MA, USA), based on CT-scans of 32 patients with unilateral CA and 96 age-and gender-matched controls. Landmarks were placed on anatomical structures of NC. Procrustes superimpositions and principal component analysis were performed. Anatomically relevant Euclidean distances were computed using the coordinates of selected landmarks-maxillary length, piriform orifice width, choanal width-and tested using multivariate analysis. Growth rates between patients and controls for these distances were screened for correlations. Results: The atretic NC was significantly deformed when compared to the control cases: Procrustes distance was 0.28 (P < 0.0001). The maxillary length and width of the atretic choana were significantly decreased compared to controls (À2.95 mm and À1.35 mm respectively, P < 0.001). There were no differences in growth rates between CA and controls, except for the choanal width on the atretic side. Conclusion: NCs in CA were significantly different from controls. More precisely, the maxillary length was significantly reduced in the CA group. There was no other major shape difference between the NC in CA and controls. NC seems to develop despite abnormal fetal ventilation.

BackgroundAchondroplasia is the most frequent FGFR3-related chondrodysplasia, leading to rhizomelic dwarfism, craniofacial anomalies, stenosis of the foramen magnum, and sleep apnea. Craniofacial growth and its correlation with obstructive sleep apnea syndrome has not been assessed in achondroplasia. In this study, we provide a multimodal analysis of craniofacial growth and anatomo-functional correlations between craniofacial features and the severity of obstructive sleep apnea syndrome.Methods A multimodal study was performed based on a paediatric cohort of 15 achondroplasia patients, including clinical and sleep study data, 2D cephalometrics, and 3D geometric morphometry analyses.ResultsCraniofacial phenotype was characterized by maxillo-zygomatic retrusion, deep nasal root, and prominent forehead. 2D cephalometric studies showed constant maxillo-mandibular retrusion, with excessive vertical dimensions of the lower third of the face, and modifications of cranial base angles. All patients with available CT-scan had premature fusion of skull base synchondroses. 3D morphometric analyses showed an aggravation of the craniofacial phenotype with age, predominantly affecting the midface - with increasing maxillary retrusion with age - as well as the skull base - with closure of the spheno-occipital angle. At mandibular level, both mandibular corpus and ramus showed significant levels of shape modifications with age, the highest level concerned the mandibular corpus (+119%). Anatomo-functional studies revealed significant correlation between the severity of maxillo-mandibular retrusion and obstructive sleep apnea syndrome (pConclusionsOur study provides new insights on the impact of FGFR3 activating mutations on craniofacial growth, and highlights anatomo-functional correlation between the severity of craniofacial features and obstructive sleep apnea syndrome.

Resume Objectifs Les auteurs exposent la recommandation pour la pratique clinique de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant le role de l’ORL dans la prise en charge du syndrome d’apnees-hypopnees obstructives (SAHOS) de l’enfant. Ce chapitre concerne la place des enregistrements du sommeil dans le diagnostic du SAHOS. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir des articles selectionnes et de l’experience de chacun, des recommandations ont ete redigees et classees en grade A, B ou C ou Accord professionnel selon un niveau de preuve scientifique decroissant, puis relues par un groupe de lecture independant du groupe de travail. Resultats Les enregistrements du sommeil sont presentes selon la classification de l’American Sleep Disorders Association en type 1, 2, 3 ou 4. Leurs modalites de realisation, d’interpretation, indications, avantages et limites sont detailles.

Background First branchial cleft anomalies are rare, accounting for only 10% of all branchial cleft anomalies. We report an even more rare and unique case of a branchial cleft cyst with features of both first and second arch derivatives. Case presentation A 6-year-old boy presented to us with a left conductive hearing loss associated with pre-tympanic keratin debris and an ipsilateral painful cervical mass. He had a past medical history of left ear surgery for presumed cholesteatoma 2 years prior and left neck abscess drainage 6 months prior. CT and MRI revealed a lesion originating in the external auditory canal and extending cervically through a bony canal located medial to the facial nerve and terminating as a parapharyngeal cyst. The complete removal was accomplished in one surgical stage consisting of three distinct steps: robotic assisted transoral resection of the pharyngeal cyst, an endaural approach and a parotidectomy approach. Conclusion We believe that our detailed description of this rare first branchial cleft cyst with pharyngeal extension, possibly a hybrid case between a first and second branchial cyst, can serve as a valuable tool to Otolaryngologists – Head and Neck Surgeons who come across a similar unusual presentations.

This research letter compares computed tomography and magnetic resonance imaging in the 1-year second-stage diagnosis of cholesteatoma.

Resume Objectifs Rapporter une complication inhabituelle des sinusites maxillaires aigues de l’enfant : l’abces premaxillaire. Decrire la presentation clinique, radiologique et biologique ainsi que la strategie therapeutique et l’evolution. Materiel et methodes Etude retrospective incluant tous les patients pris en charge pour abces premaxillaire compliquant une sinusite maxillaire aigue dans deux centres referents d’Oto-rhino-laryngologie entre 1999 et 2017. L’histoire de la maladie, la presentation clinique, les resultats biologiques et radiologiques, les modalites therapeutiques et l’evolution ont ete etudies. Resultats Dix patients ont ete inclus (âge moyen 10 ± 4,2 ans). Tous les patients presentaient de la fievre, une rhinorrhee et un œdeme premaxillaire. Le scanner injecte retrouvait pour tous les patients une opacite complete du sinus maxillaire, sans lyse osseuse, et une collection etendue le long de la cloison inter-sinuso-nasale jusqu’a la region premaxillaire. Dans trois cas, cette collection s’etendait en arriere vers l’espace parapharynge. Les prelevements bacteriologiques retrouvaient le plus souvent un Streptococcus anginosus (n = 4 ; 40 %). Le traitement consistait en une antibiotherapie intraveineuse a large spectre associee a un drainage chirurgical des abces premaxillaires de diametre superieur a 10 mm (n = 9 ; 90 %). Parmi ces neuf patients, sept ont presente une recidive de l’abces necessitant une reprise chirurgicale (78 %) et trois ont necessite un troisieme drainage (33 %). Tous les patients etaient gueris sans sequelle a un mois de suivi. Conclusion Une sinusite maxillaire aigue avec œdeme premaxillaire doit faire evoquer le diagnostic d’abces premaxillaire. Le taux eleve de recidive observe suggere qu’un traitement chirurgical maximaliste associe a une surveillance clinique rapprochee avec examen radiologique sont essentiels.

Objectives To report an unusual complication of pediatric acute maxillary sinusitis: premaxillary abscess. To describe clinical, radiological and biological presentation, treatment strategy and progression. Material and methods A retrospective study included all pediatric patients treated for premaxillary abscess complicating acute maxillary sinusitis in two ENT reference centers between 1999 and 2017. Disease history, clinical presentation, biological and radiological findings, treatment modalities and progression were studied. Results Ten patients were included, with a mean age of 10 ± 4.2 years. All presented with fever, rhinorrhea and premaxillary edema. Contrast-enhanced CT scan systematically found complete opacity of the maxillary sinus, without bone lysis, and extensive effusion along the intersinonasal wall up to the premaxillary region, extending in 3 cases back toward the parapharyngeal space. Bacteriology isolated Streptococcus anginosus most frequently (n = 4; 40%). Treatment comprised intravenous wide-spectrum antibiotics, with surgical drainage of the abscess if > 10 mm (n = 9; 90%). Seven of these 9 patients (78%) had recurrent abscess requiring surgical revision and 3 (33%) required a third drainage. All patients were cured without sequelae at 1 month. Conclusion In case of acute maxillary sinusitis with premaxillary edema, premaxillary abscess should be suspected. The high recurrence rate argues for maximalist surgery associated to close clinical monitoring with radiological examination.

Resume Objectifs Presenter les recommandations de pratique clinique (RPC) redigees en 2017 sous l’egide de la Societe francaise d’ORL-chirurgie de la face et du cou concernant le role de l’ORL dans le diagnostic du syndrome d’apnee-hypopnee obstructives du sommeil de l’enfant. Cette partie est specifiquement consacree aux examens complementaires en excluant les enregistrements du sommeil. Methodes Un groupe de travail multidisciplinaire a redige des RPC classees en fonction de leur niveau de preuve scientifique. La premiere version du texte a ete remaniee en fonction des remarques du groupe de lecture. Resultats A l’issue du processus de redaction, des recommandations ponderees selon leur score GRADE de niveau de preuve scientifique ont ete etablies dans le domaine des examens complementaires en dehors des enregistrements du sommeil, en particulier les explorations fonctionnelles, les marqueurs biologiques, l’evaluation morphologique sous sommeil induit (EMSSI) qui comporte l’endoscopie sous sommeil induit (ESSI) et la cine-IRM.

Resume Objectifs Presenter les recommandations de pratique clinique (RPC) redigees en 2017 sous l’egide de la Societe francaise d’ORL-chirurgie de la face et du cou concernant le role de l’ORL dans le diagnostic du syndrome d’apnee-hypopnee obstructive du sommeil de l’enfant. Ce manuscrit porte specifiquement sur les antecedents et l’examen clinique. Methodes Un groupe de travail multidisciplinaire a redige des RPC classees en fonction de leur niveau de preuve scientifique selon le systeme grade. La premiere version du texte a ete remaniee en fonction des remarques du groupe de lecture. Resultats A l’issue du processus de redaction, des recommandations ponderees selon leur score GRADE de niveau de preuve scientifique ont ete etablies dans les domaines suivants : interrogatoire, avec notamment analyse de l’apport des differents scores d’interrogatoire proposes dans la litterature ; examen physique, y compris la fibroscopie ORL vigile en consultation ; indications d’adressage du patient vers d’autres specialistes que l’ORL.

Purpose The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. Methods This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. Results Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). Conclusion Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. Level of evidence IV.

Resume Objectif Les auteurs exposent les recommandations de la SFORL concernant le diagnostic des malformations lymphatiques cervicales de l’adulte et de l’enfant. Methodes A partir de la revue de la litterature scientifique et de l’experience d’un groupe de travail multidisciplinaire, des recommandations ont ete redigees, puis relues par un groupe de lecture independant, et finalisees dans une reunion de coordination. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Resultats Il est recommande de faire un examen clinique ORL complet afin d’identifier les lesions a risque de complications ou de mauvais pronostic. Il est recommande, en cas de doute diagnostique pour les lesions latero-cervicales et du plancher buccal, de realiser une cytoponction avant une decision therapeutique. Il est recommande d’utiliser une ou plusieurs des classifications validees pour evaluer l’efficacite des traitements et suivre l’evolution de la maladie. Il est recommande, afin d’ameliorer la fiabilite du diagnostic antenatal d’associer IRM et echographie. Il est recommande dans le cadre du diagnostic antenatal d’evaluer de facon precise l’extension locoregionale d’une malformation lymphatique cervicale afin d’en estimer le pronostic, et de rechercher systematiquement des malformations associees afin de guider les propositions therapeutiques.

Objectives The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for the diagnosis of cervical lymphatic malformation in adults and children. Methods A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group, and finalized in a coordination meeting. Guidelines were graded A, B, C or expert opinion, by decreasing level of evidence. Results The SFORL recommends that complete ENT examination should be performed to identify lesions at high risk of complication or associated with poor prognosis. In case of diagnostic doubt, especially in latero-cervical or oral floor lesions, fine-needle aspiration cytology should be performed before therapeutic decision-making. One or more validated classifications should be used to assess treatment efficacy and monitor progression. The reliability of antenatal diagnosis should be ensured by associating MRI to ultrasound. In antenatal diagnosis, the locoregional extension of the cervical lymphatic malformation should be evaluated accurately for prognosis, and associated malformations should be screened for, to guide treatment options.

Simple Summary Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract of children. Disease progression is unpredictable leading sometimes to airway compromise and death. The aim of this study was to explore p16INK4a and expression of the RNA of HPV genes E6 and E7 with a chromogenic in situ hybridization (CISH) as biomarkers of JoRRP aggressiveness on a bicentric cohort of forty-eight children. CISH was scored semi-quantitatively as high (2+ score) and low (1+ score) levels of transcription of E6 and E7. Patients with a 2+ score had a more aggressive disease compared to those with a 1+ score. These data are a first step towards the use of biomarkers predictive of disease severity in JoRRP, this could improve the disease management, for example, by implementing adjuvant treatment at the early stages. Abstract Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. Disease progression is unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. The aim of this study was to explore the biomarkers of JoRRP severity on a bicentric cohort of forty-eight children. We performed a CISH on the most recent sample of papilloma with a probe targeting the mRNA of the E6 and E7 genes of HPV 6 and 11 and an immunostaining with p16INK4a antibody. For each patient HPV RNA CISH staining was assessed semi-quantitatively to define two scores: 1+, defined as a low staining extent, and 2+, defined as a high staining extent. This series contained 19 patients with a score of 1+ and 29 with a score of 2+. Patients with a score of 2+ had a median of surgical excision (SE) per year that was twice that of patients with a score of 1+ (respectively 6.1 versus 2.8, p = 0.036). We found similar results with the median number of SE the first year. Regarding p16INK4a, all patients were negative. To conclude, HPV RNA CISH might be a biomarker which is predictive of disease aggressiveness in JoRRP, and might help in patient care management.

OBJECTIVE To describe malformations associated with pediatric congenital cholesteatomas of the middle ear. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS One hundred and seventy-three cases of middle ear congenital cholesteatoma (CC) in 171 children operated between 2007 and 2017. INTERVENTIONS Demographic, clinical, and surgical data were collected from operative reports. MAIN OUTCOME MEASURES We first described the type and rate of malformations associated with CC. Secondly, we compared cholesteatoma features in two subgroups: anterior superior (AS) versus posterior superior (PS) starting point. Third, we compared demographic, clinical, and surgical data between patients with and without malformation. RESULTS CC was associated with malformations in 17 cases (17/173; 9.8%). The main malformation was preauricular fistula (8/173; 4.6%). Other malformations were: one first branchial cleft, two labio palatine cleft, one nasal cyst, two preauricular fibrochondroma, and five other malformations. PS congenital cholesteatomas were diagnosed in older children (4.6 versus 8.6 years, p

Objectives Systematic review of the literature on myringoplasty techniques without tympanomeatal flap elevation in children. Material and methods A systematic review following PRISMA guidelines reported papers on patients under 18 years of age undergoing myringoplasty for chronic tympanic perforation on a transcanal approach without tympanomeatal flap elevation. Tympanic closure rates and audiometric results were analyzed. Results Twenty studies were included. Nine reported the butterfly technique, using a microscope or endoscope, with closure rate of 82.3% (246/299), for perforations of various sizes. Ten reported the fat-plug technique, with closure rate of 86.8% (869/1001), mostly for perforations of less than one-third of the tympanum. Both techniques improved audiometric results. Morbidity was very low. The absence of chronic otitis or co-morbidities (contralateral otitis media with effusion, craniofacial malformations, Down's syndrome) implies that patient selection technique may be necessary to obtain the best results. Conclusion Fat-plug myringoplasty, for small perforations, and butterfly cartilage myringoplasty seem to be reliable procedures in selected patients, with low morbidity in children.

Studying isolated cells from mucosa-associated lymphoid tissues (MALT) allows understanding of immune cells response in pathologies involving mucosal immunity, because they can model host-pathogen interactions in the tissue. While isolated cells derived from tissues were the first cell culture model, their use has been neglected because tissue can be hard to obtain. In the present protocol, we explain how to easily process and culture tonsillar mononuclear cells (TMCs) from healthy human tonsils to study innate immune responses upon activation, mimicking viral infection in mucosal tissues. Isolation of TMCs from the tonsils is quick, because the tonsils barely have any epithelium and yield up to billions of all major immune cell types. This method allows detection of cytokine production using several techniques, including immunoassays, qPCR, microscopy, flow cytometry, etc., similar to the use of peripheral mononuclear cells (PBMCs) from blood. Furthermore, TMCs show a higher sensitivity to drug testing than PBMCs, which needs to be considered for future toxicity assays. Thus, ex vivo TMCs cultures are an easy and accessible mucosal model.

Objective Joint guidelines of the French Pediatric Otolaryngology Society (AFOP) and of the French Society of otorhinolaryngology–head and neck surgery (SFORL) on the management of paediatric otolaryngology patients in the context of the COVID-19 pandemic. Methods A nation-wide workgroup drew guidelines based on clinical experience, national and local recommendations and scientific literature. Proposals may have to be updated on a day-to-day basis. Results In children, incidence of symptomatic COVID-19 (1–5%) is low and of good prognosis. The indications for nasal flexible endoscopy should be drastically limited. If undertaken, full Personal Protective Equipment (PPE) including FFP2 masks are required, as well as use of a sheath. Saline nose wash done by caregivers other than parents at home should require PPE. Unless foreign body tracheobronchial aspiration is clinically obvious, CT-scan should be performed to confirm indication of endoscopy. Surgical indications should be limited to emergencies and to cases that cannot be delayed beyond 2 months (especially endonasal, endopharyngeal laryngo-tracheobronchial procedures). Postponement should ideally be a group decision and recorded as such in the medical file. Surgical techniques should be adapted to limit the risk of viral dissemination in the air, avoiding the use of drills, microdebriders, monopolar cautery or lasers. Continuous suction should be placed near the operating field. In case of confirmed Covid-19 cases, or suspected cases (or in some centres systematically), PPE with FFP2 mask should be worn by all staff members present in the operating room.

Objectives The authors present the clinical practice guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) concerning the role of the ENT specialist in the management of pediatric obstructive sleep apnea hypopnea syndrome (POSAHS). Part 3 is dedicated to the place of sleep recordings in the diagnosis of POSAHS. Methods A multidisciplinary work group was commissioned to carry out a review of the scientific literature on the above topic. Based on the articles retrieved and the group members’ individual experience, guidelines were drafted and graded as A, B or C or Expert Opinion by decreasing level of evidence, then reviewed by an editorial group independent of the work group. Results Sleep recordings are presented according to the American Sleep Disorders Association's classification as type 1, 2, 3 or 4. Their modalities, interpretation, indications, advantages and limitations are detailed.

Resume Objectifs Les auteurs exposent la recommandation pour la pratique clinique de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant le role de l’ORL dans la prise en charge du syndrome d’apnees-hypopnees obstructives (SAHOS) de l’enfant. Ce chapitre concerne le protocole de suivi des enfants traites. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir des articles selectionnes et de l’experience de chacun, des recommandations ont ete redigees et classees en grade A, B ou C ou accord professionnel selon un niveau de preuve scientifique decroissant, puis relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir au texte final. Resultats Un suivi clinique et paraclinique a court, moyen et long terme est necessaire compte tenu du risque de SAHOS residuel, et de recidive de SAHOS liee a une repousse adenoidienne et amygdalienne en cas d’adenoido-amygdalectomie, traitement le plus frequemment realise. Les modalites du suivi sont detaillees apres traitement chirurgical, ventilation par pression positive continue (PPC), traitement orthodontique, reeducation myofaciale, et traitement medicamenteux. Les indications de la nasofibroscopie et de l’enregistrement du sommeil dans le cadre du suivi sont precisees.

Resume Cette recommandation de pratique clinique de la societe francaise d’ORL et de chirurgie cervico-faciale porte sur la prise en charge des otites seromuqueuses (OSM) de l’enfant de moins de 12 ans. Elle evalue par interrogation des banques de donnees MEDLINE et Cochrane Library de 1996 a 2016 en langue francaise ou anglaise les methodes de diagnostic, de bilan de l’otite sero-muqueuse, ainsi que l’efficacite des aerateurs trans-tympaniques et des traitements medicaux et chirurgicaux de l’OSM.

Resume Objectif Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant le role de l’otorhinolaryngologiste (ORL) dans le syndrome d’apnees-hypopnees obstructives (SAHOS) de l’enfant. Ce chapitre de recommandations concerne la place des differents traitements medicaux et chirurgicaux. Methode Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees, puis relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir au texte final. Resultats L’adenoido-amygdalectomie est le traitement de reference du SAHOS d’un enfant presentant une hypertrophie adenoido-amygdalienne. Il est recommande de mettre en place une assistance respiratoire chez un enfant presentant un SAHOS severe en l’absence d’obstacle rhino et/ou oropharynge, apres chirurgie si le SAHOS persiste, en cas de contre-indication a la chirurgie, dans les obstructions complexes liees a des pathologies pharyngolaryngees et laryngees ou des comorbidites, ou comme alternative a la realisation d’une tracheotomie. Les corticoides par voie nasale peuvent etre utilises dans le SAHOS de l’enfant en cas d’obstruction nasale associee.

OBJECTIVES Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies. METHODS Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria. RESULTS Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable. CONCLUSION This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient. LEVEL OF EVIDENCE 5 Laryngoscope, 129:244-255, 2019.

International audience; The Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines concern the management of otitis media with effusion (OME) in children under the age of 12 years. They are based on extensive review of MEDLINE and Cochrane Library publications in English or French from 1996 to 2016 concerning the methods of diagnosis and assessment of otitis media with effusion, as well as the efficacy of tympanostomy tubes and medical and surgical treatments of OME.

Resume L’amygdalectomie est une intervention chirurgicale frequente et banalisee mais parfois associee a des complications potentiellement graves comme l’hemorragie post-amygdalectomie (HPA). Celle-ci peut etre precoce, survenant dans les 6 premieres heures postoperatoires, ou tardive, survenant principalement entre le 5e et le 15e jour postoperatoire. Les principaux facteurs de risque de HPA sont l’âge, le sexe et la technique chirurgicale alors que l’utilisation d’anti-inflammatoires ne majore pas ce risque. Devant le diagnostic de HPA, tardive dans la majorite des cas, la reprise chirurgicale est indiquee dans la moitie des cas. La prise en charge anesthesique de cette hemostase chirurgicale doit prendre en compte l’anemie potentielle plus ou moins hypovolemique du patient et impose une induction en sequence rapide. Cette complication est encore de nos jours susceptible de mettre en jeu le pronostic vital. Une optimisation des nouvelles techniques chirurgicales et une bonne cooperation anesthesiste – chirurgien permettent d’en limiter la morbi-mortalite.

The acoustic reflection method (ARM) is a non-invasive technique which uses the reflection of acoustic waves to measure the cross sectional area of nasal cavities in adults and patency of endotracheal tubes. Characteristics and volume of normal nasal cavities in pre-school children has so far not been studied. Objective The aim of this study was to determine the optimal ARM recording and the minimal cross-sectional area (MCA) and volume (NV) values in healthy children. Design Prospective monocentric study using the ARM in pre-school children ( Results - Discussion Seventy children (age 2 to 5) were included in the study. Reliable measures were difficult to obtain in children younger than 2 years of age. The use of a standard nosepiece and a single-use surgical filter enabled reliable, serial recordings. Mean MCA values were 0.46, 0.53 and 0.58 cm2 in the 24–35, 36–47 and 48-60 months-old age groups, respectively. Mean NV values were 2.14, 2.59, and 2.86 cm3 in the same age groups. The MCA and NV values were significantly correlated with height, age and weight. In conclusion, the ARM is feasible in children over the age of 2 and seems to be a promising non-invasive tool to study the nasal cavity patency, anatomy, and volume.

Objectives To study recent cases of esophageal injury due to button-battery ingestion in children presenting in pediatric ENT emergency departments of the Paris area of France (Ile-de-France region), in order to propose appropriate preventive measures. Material and method A retrospective descriptive single-center study included all children under 15 years of age, presenting in pediatric ENT emergency departments between January 2008 and April 2014 for button-battery ingestion with esophageal impaction requiring emergency removal. Results Twenty-two boys and 4 girls, with a median age of 25 months, were included. Twenty-five of the 26 batteries had diameters of 20 mm or more. Median esophageal impaction time was 7 hours 30 minutes (range, 2 to 72 hours). The complications rate was 23%. Mean hospital stay cost was €38,751 (range, €5130–119,737). The origin of the battery was known in 23 of the 26 cases: remote control without screw-secured compartment (42.3%), open battery pack (15.4%), children's toy (15.3%), camera (7.7%), watch (1 case) and hearing aid without screw-secured compartment (1 case). Conclusion Esophageal lesions due to ingestion of button-batteries in children are almost always due to batteries larger than 20 mm in diameter, mostly from devices with a poorly protected compartment, or batteries that are not individually packaged. These lesions cause serious complications in a quarter of cases and their management entails high health costs. Legislation requiring screw-secured compartments and individual blisters for batteries could have prevented 69.2% of the ingestions.

Resume Buts Etudier les cas recents de lesion œsophagienne chez l’enfant par ingestion de piles boutons pris en charge aux urgences ORL pediatriques d’Ile-de-France, pour proposer des mesures preventives adaptees. Materiel et methodes Nous avons realise une etude descriptive, retrospective et monocentrique. Les patients inclus etaient tous les enfants, âges de moins de 15 ans, pris en charge aux urgences d’ORL pediatrique entre janvier 2008 et avril 2014 pour l’ingestion et le blocage dans l’œsophage de pile bouton ayant necessite une extraction en urgence. Resultats Vingt-deux garcons et 4 filles ont ete inclus. L’âge median etait de 25 mois. Vingt-cinq piles sur 26 avaient un diametre de 20 mm ou plus. La duree mediane de presence des piles dans l’œsophage etait de 7 heures 30 (2 a 72 h). Le taux de complications etait de 23 %. Le cout d’hospitalisation allait de 10 260 a 110 520€, avec un cout moyen de 38 751€. La provenance des piles etait connue dans 23 cas sur 26 : telecommande sans compartiment visse (42,3 %), paquet neuf ouvert (15,4 %), jouet pour enfant (15,3 %), appareil photo (7,7 %), montre (un cas) et appareil auditif sans compartiment visse (un cas). Conclusion Les lesions œsophagiennes par ingestion de piles bouton chez l’enfant sont dues presque toujours a des piles de plus de 20 mm provenant en majorite d’appareils au compartiment mal protege ou de piles non conditionnees individuellement. Ces lesions sont sources de complications graves une fois sur 4 et leur prise en charge a un cout de sante eleve. Une legislation imposant des compartiments visses pour les appareils concernes et des emballages blisters individuels des piles aurait evite plus de 76,9 % des ingestions.

Introduction The diagnosis and management of type I laryngeal clefts can be controversial and varies across centers and surgeons. Using existing peer-reviewed literature to develop an expert-based consensus will help guide physicians in the treatment of these patients as well as develop research hypotheses to further study this condition. Objective To provide recommendations for the diagnosis and management of type I laryngeal clefts. Methods Determination of current expert- and literature-based recommendations, via a survey of the International Pediatric Otolaryngology Group, using a modified Delphi method. Setting Multinational, multi-institutional, tertiary pediatric hospitals. Results Consensus recommendations include diagnostic workup, medical management, pre-operative, intra-operative and post-operative considerations for type I laryngeal clefts. Conclusions This guide on the diagnosis and management of patients with type I laryngeal clefts is aimed at improving patient care and promoting future hypothesis generation and research to validate the recommendations made here.

Introduction Velopharyngeal insufficiency (VPI) is usually managed, besides speech therapy, by performing a velopharyngoplasty. An alternative approach is autologous fat grafting (AFG) of the posterior pharyngeal wall. About 5% of the population has internal carotid arteries (ICA) with an aberrant course. This anatomic variation can be responsible for surgical difficulties while when performing a velopharyngoplasty, and therefore lead surgeons to only consider a speech reeducation of VPI. However, AFG is does not bear such surgical morbidity. Objective The aim of this study is to retrospectively determine AFG efficiency on VPI in patients with aberrant ICA's courses who cannot benefit from a velopharyngoplasty, by comparing pre- and postoperative Borel Maisonny score (BMS) and intelligibility (Intell). Methods We conducted a retrospective study in 2 centers, including children with VPI and aberrant ICA's courses who underwent an AFG of the posterior pharyngeal wall from 2004 to 2015, in addition to speech therapy. Results Nine patients (4–11 years old) underwent the surgical procedure, 8 of them presenting a 22q11 microdeletion. All improved their VPI by AFG of the pharyngeal wall according to BMS and Intelligibility after a 10 months follow-up. The effect was stable after 3 years of follow-up. No severe complication (apnea, vascular injury) occured. Conclusion AFG of the pharyngeal wall, associated with speech therapy, seems to be a safe procedure for patients with VIP and aberrant ICA's courses. Multiple procedures are possible if needed.

Objective To provide recommendations for the comprehensive management of airway obstruction in patients with Robin Sequence. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). Results The consensus statement provides recommendations for medical specialists who manage infants with Robin Sequence including: evaluation and treatment considerations for commonly debated issues in post-natal airway obstruction, assessment of antenatal obstruction and perinatal airway management. Conclusion Consensus recommendations are aimed at improving management of airway obstruction in patients with Robin Sequence.

Objectives To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. Results Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. Conclusions Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.

Autologous Complete Tracheal Replacement Management of tracheal stenosis in a child is complex. This letter describes the 4-year follow-up of a child who underwent an autologous complete tracheal replacement.

Objectives To evaluate the use of P-values and the terms “significant”, “non-significant” and “suggestive” in Abstracts in the European Annals of Otorhinolaryngology, Head & Neck Diseases. Materials and methods Consecutive articles accepted for publication during the period January 2016 – February 2019 were systematically reviewed. Main goal: descriptive analysis of the citation of P-values and use of the terms “significant”, “non-significant” and “suggestive” in Abstracts. Secondary goal: analytic study of: (i) correlations between citation of a P-value and the main characteristics of authors and topics; and (ii) misuse of the terms “significant”, “non-significant” and “suggestive” with respect to cited P-values, and correlations with author and topic characteristics. Results In all, 91 articles were included. P-values and the terms “significant”, “non-significant” and “suggestive” were cited in 35.1%, 41.7%, 10.9% and 0% of Abstracts, respectively. Citing a P-value did not significantly correlate with author or topic characteristics. There were discrepancies between the terms “non-significant”, “significant” and “suggestive” and P-values given in the body of the article in 57.1% of Abstracts, with 30.7% overestimation and 25.2% underestimation of results, without significant correlation with author or topic characteristics. Conclusion Authors, editors and reviewers must pay particular attention to the spin resulting from inappropriate use of the terms “significant”, “non-significant” and “suggestive” in Abstracts of articles submitted to the European Annals of Otorhinolaryngology, Head & Neck Diseases, to improve the rigor, quality and value of the scientific message delivered to the reader.

Background Knowledge about airway dimensions during child growth is of paramount importance for pediatric clinical practice. Decisions about airway management in children are based on relatively limited, imprecise, or incomplete data about airway size. Aims The aim of this work was to determine the anatomical development and size of airway structures from birth to adolescence using high-resolution computed tomography scans and to study the correlation between airway measurements and biometric data. Methods We conducted a retrospective study of all high-resolution computed tomography scans including the respiratory tract, performed in our tertiary pediatric center (for reasons unrelated to airway symptoms) between June 1, 2016, and October 15, 2017, on children aged from 1 day to 14 years old. On each scan, 23 measurements of the larynx, trachea, and mainstem bronchi were performed. Patients were stratified into 16 groups according to their age. We calculated median value for each measurement in each group. Statistical models were calculated to explore correlation between measurements and age or weight. Results A total of 192 scans were included (127 boys/65 girls). The mean age was 7 years. The correlations between airway measurements and age or weight were always significant. The relationship between measurements and age was found to be suitably represented by a cubic polynomial equation suggesting that the airway has a rapid growth phase in the first 3 years, followed by a slow growth phase and a second rapid growth phase during adolescence. The most relevant biometric parameter was age concerning 21 of the measurements. Conclusion This comprehensive anatomical database of upper airway dimensions provides important data in the field of pediatric airway anatomy, particularly relating to the cricoid. We demonstrated that laryngeal, tracheal, and bronchial parameters correlate better to age and have three different growth phases.

Introduction Desmoid-type fibromatosis (DF) is a rare benign lesion known for its local aggressiveness. The tumor management still remains under debate. Primary head and neck (HN), represents the second most prevalently affected sitein children with DF. This study aims to analyze the specificity of HN-DF in children, focusing on long-term effects of the tumor and therapies. Methods This retrospective multicenter study analyzed children treated for a HN-DF between 1993 and 2013. All medical files were reviewed and their outcomes analyzed according to the initial therapies provided. Results Sixteen children were selected. Mandibular and submandibular areas were the main locations (11 cases). Eight children underwent chemotherapy as first-line therapy with tumor control in 3 cases and 5 cases needing additional treatment. Six children underwent primary surgery: isolated in 3 cases and with additional treatment after tumor progression in 3 cases. A wait-and-see attitude was adopted for 2 children without any additional treatment in 1 case, and followed by additional chemotherapy in the other case. Total burden of treatment to control the disease was a biopsy (1 case), surgery (3 unique cases, 1 multiple case), surgery with chemotherapy (6 cases), and exclusive medical therapies (5 cases). Surgical postoperative sequelae were facial palsy (cases of parotid gland affection), XIth cranial nerve sacrifice or sensory impairment. Conclusion HN-DF is a local and extensive disease that is difficult to control with surgery alone. Sequelae are frequent due to the initial tumor location or therapies. Initial conservative strategies need to be discussed in a multidisciplinary way in order to try to control the disease with the minimal morbidity.

Objectives To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This manuscript specifically focuses on diagnostic investigations apart from sleep studies. Methods A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group. Results At the end of the process, guidelines were established and graded regarding diagnostic investigations apart from sleep studies, in particular respiratory functional tests, biological markers, and morphologic assessment under induced sleep (drug-induced sleep endoscopy (DISE) and cine-MRI).

Objectives To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This article focuses specifically on medical history and physical examination. Methods A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group. Results At the end of the process, guidelines were established and graded regarding the following points: interview and analysis of the various interview scores recommended in the literature; clinical examination with awake upper-airway endoscopy; and indications for referral to non-ENT specialists.

International audience; Introduction: acoustic rhinometry (AR) is a non-invasive method measuring the nasal volume (NV) and the nasal minimal cross-sectional area (MCA), reflecting nasal obstruction. The first objective of this study was to measure and compare NV and MCA between 3 groups of children: "achondroplasia", "Down syndrome" and "control". The control group corresponded to children with suspicion of sleep disorder disease and without cranio-facial malformation. The second objective was to correlate AR measurements with the obstructive apnea-hypopnea index (OAHI).Methods: prospective study between February and July 2017, in a tertiary care center. The following data were collected: demographic characteristics, medical and surgical history, NV, MCA, and OAHI.Results: 83 children were included. The mean NV was lower in achondroplasia group compared to control group: 2.75 cm3 vs 3.60 cm3 (p = 0.02, 95% CI [0.0694, 0.7456]). Negative correlation was found between the NV and the OAHI for children with achondroplasia (T = -0.37; p = 0.02).Conclusions: AR is an effective tool for assessing nasal obstruction in children. Nasal obstruction was correlated to OAHI in achondroplasia. AR could become a routine tool in the management of nasal obstruction of children with cranio-facial malformations.

Objective To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of young infants who present with signs or symptoms of choanal atresia. Methods A two-iterative delphi method questionnaire was used to establish expert recommendations by the members of the International Otolaryngology Group (IPOG), on the diagnostic, intra-operative, post-operative and revision surgery considerations. Results Twenty-eight members completed the survey, in 22 tertiary-care center departments representing 8 countries. The main consensual recommendations were: nasal endoscopy or fiberscopy and CT imaging are recommended for diagnosis; unilateral choanal atresia repair should be delayed after at least age 6 months whenever possible; transnasal endoscopic repair is the preferred technique; long term follow-up is recommended (minimum one year) using nasal nasofiberscopy or rigid endoscopy, without systematic imaging. Conclusion Choanal atresia care consensus recommendations are aimed at improving patient-centered care in neonates, infants and children with choanal atresia.

Resume L’obstruction nasale chez l’enfant est un symptome tres frequent pouvant relever de nombreuses etiologies. Le diagnostic clinique facile ne doit pas faire oublier la recherche d’un retentissement general et d’une etiologie rare. Le choix des explorations complementaires sera guide par les orientations diagnostiques. Bien que l’obstruction nasale soit sans gravite dans la grande majorite des cas, elle peut mettre la vie en jeu chez le nouveau-ne et le nourrisson. Un catalogue exhaustif des etiologies d’obstruction nasale chez l’enfant est impossible et inutile. Cependant, il est pertinent d’etablir une distinction entre les obstructions nasales chez le nourrisson et celles chez l’enfant plus âge, dont les causes sont tres differentes. En dresser la liste des plus frequentes ou des plus graves permet de faciliter la pratique clinique. C’est ce que propose la presente mise au point.