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Background: The olfactory ecto-mesenchymal stem cell (OE-MSC) are mesenchymal stem cells originating from the lamina propria of the nasal mucosa. They have neurogenic and immune-modulatory properties and showed therapeutic potential in animal models of spinal cord trauma, hearing loss, Parkinsons’s disease, amnesia, and peripheral nerve injury.In this paper we designed a protocol that meet the requirements set by human health agencies to manufacture these stem cells for clinical applications. Once purified, OE-MSCs can be used per se or expanded in order to get the extracellular vesicles (EV) they secrete. A protocol for the extraction of these vesicles was validated and the EV from the OE-MSC were functionally tested on an in vitro model. Methods: Nasal mucosa biopsies from three donors were used to validate the manufacturing process of clinical grade OE-MSC. All stages were performed by expert staff of the cell therapy laboratory according to aseptic handling manipulations, requiring grade A laminar airflow. Results: Enzymatic digestion provides more rapidly a high number of cells and is less likely to be contaminated. Foetal calf serum was replaced with human platelet lysate and allowed stronger cell proliferation, with the optimal percentage of platelet lysate being 10%. Cultivated OE-MSCs are sterile, highly proliferative (percentage of CFU-F progenitors was 15,5%) and their maintenance does not induce chromosomal rearrangement (karyotyping and chromosomal microarray analysis were normal). These cells express the usual phenotypic markers of OE-MSC. Purification of the EVs was performed with ultracentrifugation and size exclusion chromatography. Purified vesicles expressed the recognized markers of EVs (Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines) and promoted cell differentiation and neurite elongation in a model of neuroblastoma Neuro2a cell line. Conclusions: We developed a safer and more efficient manufacturing process for clinical-grade olfactory stem cells, these cells can now be used in humans. A phase I clinical trial will begin soon. An efficient protocol for the purification of the OE-MSC EVs have been validated. These EVs exert neurogenic properties in vitro. More studies are needed to understand the exact mechanisms of action of these EVs and prove their efficacy and safety in animal models.

Background Midface skeletal changes through aging have been conceptualized as a clockwise rotation relative to the cranial base. This finding is mainly supported by cross-sectional population studies based on comparisons between groups of individuals in different age ranges. Few papers have evaluated the intra-individual evolution of the facial skeleton, and those that have included only a limited number of patients. Objectives The authors sought to analyze the intra-individual evolution of the facial skeleton. Methods We conducted a retrospective study including patients who underwent 2 separate facial computed tomography scans (T1 and T2) with a minimum gap of 7 years. Employing 3-dimensional reconstructions, we measured and compared 7 facial angles (glabellar, orbital, piriform, maxillary, subdental, chin, gonial) and 6 facial distances (lacrimal crest, orbital floor, piriform, zygoma, labiomental, gnathion) on both computed tomography scans. Results A total of 56 patients (29 males and 27 females) were included. Mean ages at T1 and T2 were 50 and 59 y, respectively. We found a significant decrease between T1 and T2 in facial angles at the midface (glabella, orbital, piriform, and maxillary angles, all P < 0.0001). We found a significant increase in all facial distances between T1 and T2 for the overall population and for men (all P < 0.05). For women, all distances increased, but only piriform and zygoma distances showed significant changes (P < 0.001 and P < 0.04, respectively). Bone remodeling appeared earlier in women. Conclusions Our study confirms the clockwise rotation of the midface during aging. This finding could lead to a better understanding of aesthetic medicine practices.

Background The rapid spread of the coronavirus disease 2019 and the implementation of quarantine in many European countries led to a swift change in health care delivery. Telemedicine was implemented in many otolaryngological departments to ensure the continuous care. The purpose of this study is to report our experience about telemedicine in 86 patients consulting virtually in our departments. Methods A total of 86 patients benefited from telemedicine consultation from April to Mai May 2020. Patients and physicians were invited to fulfill a satisfaction survey over the 3 days after the consultation. Results Patients consulted in the following fields: laryngology, voice and swallowing (N=15; 17.4%), head and neck or plastic surgery (N=34; 39.5%), rhinology (N=31; 36.1%) and otology (N=6; 7.0%). Practitioners estimated that the clinical examination would not have changed the consultation issue in 73.2% of cases. The realization of delayed clinical examination was rapidly necessary in 9.3% of cases and useless in 33.7% of cases. Five percent of patients estimated that the consultation did not bring reliable conclusion. Although the majority of patient (87.7%) would recommend telemedicine consultation to friend/family in the context of pandemic, only 44.6% would accept to replace office- consultation by telemedicine consultation outside the pandemic. Conclusion Telemedicine appears to be an interesting alternative approach in situation of pandemic and lock-down. Because the patient motivation to further participate to telemedicine appears to be conditioned by the context, efforts are still required to understand the patient perception, satisfaction and fears in view of future implementation outside pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06624-9.

International audience; Much has been stated about the potential risks of nasal lavages (NL) during the coronavirus disease 2019 (COVID-19) pandemic for COVID-19 patients and surrounding people. Several otolaryngological societies recommended to limit NL, supposing it may be associated with viral spread to lower airway.1 On the contrary, recent studies suggested that NL may be beneficial in upper viral respiratory infectious diseases. In order to take stock of this issue, we conducted a short literature review to address 4 main questions: - What Are the Potential Benefits of NL to COVID-19 Patients? - What Are the Potential Benefits of NL to Personal Contacts/Healthcare Workers Caring for COVID-19 Patients? - What Are the Potential Harms of NL to Patients With COVID-19? - What Are the Potential Harms of NL to Personal Contacts/HCWs Caring For COVID-19 Patients?

International audience; To review the data regarding the expression of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine-2 (TMPRSS2) in head and neck tissue. Scopus, Cochrane Library, Medrxiv, Google Scholar and PubMED/MEDLINE were searched by four independent investigators for studies investigating ACE2 or TMPRSS2 expressions in head and neck tissues. The following outcomes were considered: sample origin (animal versus human); detection method; anatomical location and cell types. PRISMA checklist and modified population, intervention, comparison, outcome, timing and setting (PICOTS) framework were used to perform the review. Of the 24 identified studies, 17 met our inclusion criteria. Thirteen studies were conducted during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. ACE2 and TMPRSS2 were expressed in oral, pharyngeal, sinusonasal human mucosa. The following cell types expressed ACE2: basal, apical, goblet, minor salivary, and endothelial cells. TMPRSS2 was found in goblet and apical respiratory cells. ACE2 and TMPRSS2 were found in the olfactory region, especially in sustentacular non-neural and neural stem cells. Animal studies suggested that ACE2 expression may vary regarding age. There was an important heterogeneity between studies in the methods used to detect ACE2 and TMPRSS2, leading to a potential identification bias. The SARS-CoV-2 receptors, ACE2 and TMPRSS2, are both expressed in many head and neck tissues, enabling the viral entry into the host organism.

International audience; Objectives/Hypothesis: To investigate clinical and radiological features of olfactory clefts of patients with mild coronavirus disease 2019 (COVID-19). Study Design: Prospective non controlled study. Methods: Sixteen COVID-19 patients were recruited. The epidemiological and clinical data were extracted. Nasal complaints were assessed through the 22-item Sino-Nasal Outcome Test. Patients underwent psychophysical olfactory testing, olfactory cleft examination, and computed tomography (CT) scans. Results: Sixteen anosmic patients were included. The mean Sniffin' Sticks score was 4.6 ± 1.7. The majority of patients had no endoscopical abnormality, with a mean olfactory cleft endoscopy score of 0.6 ± 0.9. The olfactory clefts were opacified in three patients on the CT scan. The mean radiological olfactory cleft score was 0.7 ± 0.8. There were no significant correlations between clinical, radiological, and psychophysical olfactory testing. Conclusions: The olfactory cleft of anosmic COVID-19 patients is free regarding endoscopic examination and imaging. The anosmia etiology is not related to edema of the olfactory cleft. Level of Evidence: 4 Laryngoscope, 130:2526–2531, 2020.

Resume Objectifs Le but de cette etude etait de traduire l’echelle MiRa en francais et de valider son utilisation par les chirurgiens francophones. Materiel et methodes L’echelle MiRa est une echelle d’analyse validee des dysmorphoses nasales. Peu d’outils d’evaluation esthetique sont disponibles en francais. Les recommandations de l’ISPOR et de l’OMS ont ete utilisees pour mener a bien le processus de traduction de l’anglais vers le francais de cette echelle, en cinq etapes. Pour evaluer la fiabilite de l’echelle MiRa dans sa version francaise, nous avons compare statistiquement la repetabilite intra-observateur (comparaison des scores obtenus lorsqu’un observateur evaluait chaque patient deux fois a un mois d’intervalle) et la repetabilite inter-observateur (comparaison des scores obtenus lorsque deux observateurs ont evalue le meme patient) en utilisant le test de Wilcoxon et le coefficient de correlation intraclasse (ICC) (α = 5 %). Objectifs Notre objectif etait d’obtenir une traduction du concept plutot qu’une traduction litterale pour permettre une bonne reproductibilite intra- et inter-observateurs. Resultats Chaque etape nous permettait de faire des changements progressifs vers une traduction conceptuelle equivalente a la version originale. Conclusion L’echelle MiRa est la seule echelle d’analyse esthetique validee dans la litterature pour les dysmorphoses nasales. L’utilisation combinee de deux recommandations internationales de traduction a permis d’obtenir une version francaise parfaitement conforme a l’original. Cette version est utilisable par les francophones.

International audience; Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.

We studied COVID-19 associated mucormycosis based on 17 cases reported nationwide and assessed the differences with India. They differed by frequencies of diabetes mellitus (47% in France versus 95% in India), hematological malignancies (35% versus 1%), anatomical sites (53% lung versus >80% rhino-orbito-cerebral) and prognosis (>80% mortality versus

Microbiome and the immune system are constantly shaping each other, in a mutual aim to thrive, defining the unstable equilibrium of the healthy individual. Microbiome is growingly involved in dysimmune conditions such as allergy, asthma, autoimmunity, and primary or acquired immune deficiencies. The current epidemics of allergic diseases and asthma has long been linked to the microbial environment through the hygiene hypothesis. Progress in the understanding of the microbiome-immune system crosstalk has unraveled a tight connection between microbial communities and the development of allergic diseases and asthma. Disruption of the microbiome affects the immune response of the host and paves the way for disease pathogenesis. Conversely, disease and therapeutic interventions affect microbial communities. We aimed at providing the reader with a view of the state-of-the art of microbiome – immune system crosstalk, with special focus on the loopholes giving potential grip to the pathogenesis of microbiome-related dysimmunity. Keywords: Microbiome, Mycobiome, Immune system, Dysbiosis, Allergy, Asthma, Atopy, Atopic dermatitis, Dendritic cell, Macrophage, Mast cell, Chronic rhinosinusitis

International audience; Objective: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. Methods: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. Results: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. Conclusion: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

International audience; Purpose: Most questionnaires designed to evaluate patient-reported outcomes regarding scarring are available in English. The objective was to generate a validated French version of the SCAR-Q questionnaire.Methods: The SCAR-Q questionnaire (including Appearance, Symptom and Psychological impact scales) was translated into French using a translation-back-translation process in accordance with international guidelines (ISPOR and WHO). For validation, two hundred patients consulting in our tertiary center completed the questionnaire. We tested scale reliability (Cronbach's α), floor/ceiling effects and item redundancy (inter-item correlations). Structural validity was tested using confirmatory factor analysis (CFA) with the robust weighted least squares (WLSMV) estimator and Delta parameterization. Model fit was examined using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Correlations between scales and scale repeatability were tested (Spearman coefficient, Intra-class-coefficient).Results: Four steps were required to obtain a translation consistent with the original version. Two hundred patients completed the questionnaire for validation. Internal consistency analysis found Cronbach's alphas > 0.7 for all scales (0.90 < α < 0.97). No floor or ceiling effect was found for all items (max = 85%). A ceiling effect was observed for all scales. Appearance and psychosocial impact scale items showed redundancy, with many inter-item correlations above 0.7. The CFA of the original structure displayed a reasonable fit, with RMSEA = 0.065, CFI = 0.974 and TLI = 0.972. Scales were positively correlated (0.45 < ρ < 0.65; p < 0.001). Test-retest intra-class correlation coefficients ranged from 0.94 to 0.99 for all scales.Conclusion: A French version of the SCAR-Q questionnaire is validated, ready for use.

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

International audience; Purpose: To evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP).Methods: This was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor.Results: Forty-seven out of the 63 patients had an ipsi- or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001).Conclusion: These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.

The purpose of this article is to give rhinologists advice on how to adapt their standard practice during the COVID-19 pandemic. The main goal of these recommendations is to protect healthcare workers against COVID-19 while continuing to provide emergency care so as to prevent loss of chance for patients. We reviewed our recommendations concerning consultations, medical prescriptions and surgical activity in rhinology.

Objectives/Hypothesis: Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design: DELPHI survey. Methods: Twenty-seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results: The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high-definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ-specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre- and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions: International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence: 5 Laryngoscope, 131:E732–E737, 2021.

PurposeThe COVID-19 pandemic has caused significant confusion about healthcare providers’ and patients’ pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic.MethodsPubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.Results15 international publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients’ COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited.ConclusionsSinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing use of PPE is essential with sinus and anterior skull base surgery.

Purpose Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. Methods A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. Results Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /3/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. Conclusion Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations., European Archives of Oto-Rhino-Laryngology, Springer Verlag, 2020

Aims The aim of this study was to translate the MiRa scale into French and validate its use for French-speaking surgeons. Material and methods ISPOR and WHO recommendations were used to carry out the translation process from English to French in five steps. The MiRa scale is a validated analysis scale of nasal dysmorphoses. Few tools are available in French for French-speaking surgeons. ISPOR and WHO recommendations were used to complete the five-step translation process from English into French. To assess the reliability of the MiRa scale–French version, we statistically compared intra-observer repeatability (comparison of scores obtained when one observer assessed each patient twice at a one-month interval) and inter-observer repeatability (comparison of scores obtained when 2 observers assessed the same patient) using the Wilcoxon test and the intraclass correlation coefficient (ICC) (α = 5%). Objectives Our goal was to obtain a translation of the idea or concept rather than a literal translation to enable good intra- and inter-observer repeatability. Results Each step allowed us to make changes gradually working towards a conceptual translation equivalent to the original version. Conclusion The MiRa scale is the only aesthetic analysis scale validated in the literature for nasal dysmorphoses. The combined use of two sets of translation recommendations, with a five-step translation-back-translation process, made it possible to obtain a French version perfectly in line with the original. This version is usable by French-speakers.

International audience; Background and purpose: Post-viral olfactory dysfunction is well established and has been shown to be a key symptom of COVID-19 with more than 66% of European and US patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for general practitioner, otolaryngology or neurology consultation in the next few months – evidence regarding recovery will be essential in counselling our patients. Methods: This was a prospective survey-based data collection and telemedicine follow-up. Results: In total, 751 patients completed the study, of whom 477 were females and 274 males. The mean age of the patients was 41 ± 13 years (range 18–60). There were 621 patients (83%) who subjectively reported a total loss of smell and 130 (17%) a partial loss. After a mean follow-up of 47 ± 7 days (range 30–71) from the first consultation, 277 (37%) patients still reported a persistent subjective loss of smell, 107 (14%) reported partial recovery and 367 (49%) reported complete recovery. The mean duration of the olfactory dysfunction was 10 ± 6 days (range 3–31) in those patients who completely recovered and 12 ± 8 days (range 7–35) in those patients who partially recovered. Conclusions: According to our results, at this relatively early point in the pandemic, subjective patterns of recovery of olfactory dysfunction in COVID-19 patients are valuable for our patients, for hypothesis generation and for treatment development.

International audience; Computational fluid dynamics and septal deviations-Virtual surgery can predict post-surgery results: A preliminary study including two patients

Nasal airway obstruction (nasal obstruction) is a common symptom affecting the quality of life of patients. It can be estimated by patient perception or physical measurements. Computational fluid dynamics (CFD) can be used to analyse nasal ventilation modalities. There is a lack of comparative studies investigating the correlations between CFD variables and patient perception or physical measurements.Our goal was to define correlations between CFD variables and patient perception and physical measurements. We also aimed to identify the most reliable CFD variable (heat flux, WSS, total pressure, temperature…) characterising nasal breathing perception.Systematic literature review using PRISMA guidelines.The selected studies were obtained from the US National Library of Medicine (PubMed) online database, MEDLINE (Ovid), Google Scholar and the Cochrane Library using a combination of MeSH terms (nose, paranasal sinus, fluid dynamics, rhinology) and non-MeSH terms (CFD, nasal airway, nasal airflow, numerical, nasal symptoms). Studies that did not incorporate objective or subjective clinical assessment were excluded.We compared all results obtained by authors regarding CFD variables and assessment of nasal airway obstruction (clinical or physical).To compare nasal obstruction with CFD variables, most authors use CFD-calculated nasal resistances, airflow, heat flux, wall shear stress, total pressure, velocities and streamlines. We found that heat flux appears to be the CFD variable most closely correlated with patient perception. Total pressure, wall shear stress and velocities are also useful and show good correlations. Correlations between CFD-calculated nasal resistances and patient perception are stronger after correction of the nasal cycle.The growing number of CFD studies on the nose has led to a better understanding of nasal obstruction. The clinical interpretation of previously unknown data, such as WSS and heat flux, is opening up new horizons in the understanding of this symptom. Heat fluxes are among the best CFD values correlated with patient perception. More studies need to be performed including temperature and humidity exchanges.

The authors report the cases of 9 patients eventually diagnosed with methanogenic archaea refractory or recalcitrant chronic rhinosinusitis, a condition known to involve various anaerobic bacteria but in which the role of methanogenic archaea is unknown. The authors retrospectively searched these microorganisms by PCR in surgically-collected sinusal pus specimens from patients diagnosed with refractory sinusitis, defined by the persistance of sinus inflammation and related-symptoms for more than 12 weeks despite appropriate treatment. Of the 116 tested sinus surgical specimens, 12 (10.3%) from 9 patients (six females, three males; aged 20–71 years) were PCR-positive. These specimens were further investigated by fluorescence in-situ hybridization, PCR amplicon-sequencing and culture. Methanobrevibacter smithii was documented in four patients and Methanobrevibacter oralis in another four, one of whom was also culture-positive. They were associated with a mixed flora including Gram-positive and Gram-negative bacteria. In the latter patient, “Methanobrevibacter massiliense” was the sole microorganism detected. These results highlight methanogenic archaea as being part of a mixed anaerobic flora involved in refractory sinusitis, and suggest that the treatment of this condition should include an antibiotic active against methanogens, notably a nitroimidazole derivative.

International audience; Objectives: The primary objective of this study was to determine how computational fluid dynamics (CFD) could be correlated to clinical evaluation of nasal airway obstruction (NAO) in a population of patients with symptomatic septal deviation (SD). The secondary objective was to determine whether CFD could define which side was the more obstructed. Design: This was an observational study. Settings: Few publications have attempted to correlate CFD with clinical evaluation of NAO. This correlation would permit validation and improved interpretation. This study was performed in a university research laboratory specialised in fluid mechanics. Participants: We included patients referred for septal surgery at our centre. Age range was 19-58 years. Preoperative CT scans were performed. All patients with non-structural causes of NAO such as rhinitis, sinusitis or tumoral/autoimmune processes (ie, not due to anatomic obstruction) were excluded. Main outcome measurement: For each nasal fossa, we compared CFD data (total pressure, heat flux, wall shear stress, temperatures, velocity and nasal resistances) with both patient perception scores and rhinomanometry using the Spearman correlation test (r s). Perception scores were graded from 0/4 to 4/4 on each side, based on the patient interview. We also compared CFD-derived nasal resistances with rhinomanometry-derived nasal resistances. Results: Twenty-two patients complaining of NAO with SD were analysed, and 44 analyses were performed comparing each side with its CFD data. Regarding correlations with patient perception scores, the best values we found were heat flux measures (r s = 0.86). Both rhinomanometry and CFD-calculated nasal resistances had strong correlations with subjective perception scores (r s = 0.75, P < 0.001 and r s = 0.6, P < 0.001, respectively). We found a statistically significant difference between RMM-NR and CFD-NR (P = 0.003). Heat flux analysis allowed us to distinguish the more obstructed side (MOS) and the less obstructed side (LOS) in 100% of patients. Conclusion: This study aimed to enhance our ability to interpret CFD-calculated data in the nasal airway. It highlights and confirms that heat flux measures are very closely

International audience; Fungus ball is the most common form of non-invasive fungal rhinosinusitis. Aspergillus fumigatus (between 44.8% and 75%) and Aspergillus flavus (14%) are the two most common species recovered. However, recent advances in mycological laboratory methods have enhanced the detection and identification of fungi within fungus balls. Fusarium species, sometimes recovered from other forms of fungal rhinosinusitis such as allergic fungal rhinosinusitis or acute invasive fungal rhinosinusitis, are poorly associated with sinonasal fungus ball. Here, we describe two further cases of a fungus ball due to Fusarium proliferatum and provide the first description of this fungal pathogen with a fungus ball of odontogenic origin. These case reports demonstrate that uncommon fungal species such as Fusarium spp. might be underestimated as agents of sinusal cavity fungus ball. Enhanced mycological detection and diagnostic techniques might give rise, in the near future, to the emergence of new or rare fungal species associated with this clinical entity.

The COVID-19 pandemic has caused significant confusion about healthcare providers' and patients' pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic.PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.15 International publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients' COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited.Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing the use of PPE is essential with sinus and anterior skull base surgery.

Epistaxis is defined as flow of blood from the nasal fossae and is a common and benign disorder in the great majority of cases which does not require medical care. It may however become a genuine medical or surgical emergency because of the amount, repeated episodes or patient's medical vulnerability (such as coronary artery disease patients). Epistaxis may be either primary or a symptom of an underlying disease. Four levels of problems need to be answered faced with epistaxis: recognizing it, and in particular not missing “epistaxis” due to swallowed blood or venous hemorrhage, which falls outside of the scope of interventional radiology; establishing the amount and its repercussions, particularly as a decompensating factor in another disease; investigating its cause and in particular never missing a tumor (male adolescents); obtaining hemostasis. Epistaxis varies not only in type and cause but must be considered in its clinical context. Arterial embolization is a treatment of choice for severe refractory epistaxis and some hemorrhages. When carried out by trained operators, it is an effective method with few risks of complications and is increasingly being used in reference centers (Brinjikji et al.). It remains, however, a method which is less widely used than surgery, particularly in the United States where in a series of 69,410 patients treated over the last 10 years for refractory epistaxis, 92.6% underwent surgical ligation, 6.4% embolization and 1% combined treatments (Brinjikji et al.). Epistaxis is occasionally catastrophic and requires extremely urgent management. In each case, close collaboration with the surgeon, the presence of an intensive care anesthetist and at least sedation are all factors which improve management and therefore the results of embolization. All patients and/or their friends/close family should have given “reliable, clear and appropriate” information.

Introduction Traumatic perilymphatic fistula is not a rare event with regards to sport activities or traffic accident. However, iatrogenic damage to the inner ear can occur following the common use of grommets and ventilation tube insertion. Objectives To report an unusual case of insertion of aeration tube into the vestibule trough the stapes footplate. Resumed Report A 62-year-old woman experienced iatrogenic penetration into the vestibule from a ventilation tube inserted for retraction pocket management. The event was misdiagnosed both by the surgeon and by the emergency room physicians, leading to delay in the management. However, preservation of the hearing function lasted for 2 weeks prior to deafness, thanks to the valve of Bast, which preserved the cochlear fluid. Conclusion This case gives us the opportunity to stress the need for systematic clinical examination of traumatic injury to the ear and to recommend performing multiplanar millimetric computed tomography scan with accurate interpretation. Traumatic injuries should be referred to a dedicated traumatic emergency referral center.

Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.

Objectives The present clinical practice guidelines cover the entire field of management of post-tonsillectomy pain. Given the French and European regulatory restrictions on the use of codeine, an update appears necessary to clarify the management of post-tonsillectomy pain in adults. Method A work group approached the issue of pain management, following the chronological pathway from initial consultation to postoperative period. As exhaustive a study of the literature as possible assessed the pain impact of the various surgical techniques and the efficacy of the various analgesia schedules. Results Guidelines on the management of post-tonsillectomy pain in adults were drawn up and graded, based on the levels of evidence of selected articles and on work group consensus. The guidelines stress the importance of patient information and seek to harmonize practice, reduce the risk of postoperative complications and above all improve control of post-tonsillectomy pain in adults.

Context: Sinonasal paragangliomas have rarely been reported in the literature. They are often aggressive. Patient: We report an original case of sinonasal paragangliomas with a tumor recurrence diagnosed 13 years after resection of the primary tumor. Somatostatin receptor scintigraphy and [18F]-fluorodeoxyglucose positron emission tomography/computed tomography were the most sensitive functional imaging techniques, and they ruled out distant metastases. Interestingly, [18F]-fluorodihydroxyphenylalanine positron emission tomography/computed tomography was negative, a feature that may be considered a sign of functional dedifferentiation. Screening for germline mutations of the SDHB, SDHC, SDHD, SDHAF2, VHL, MAX, and TMEM127 was negative. Conclusion: The diagnosis of malignancy remains challenging at initial diagnosis, and patients should be followed during their entire lifetime.

SummaryObjectivesTo describe our experience in the management of vascular malformations of the parotid area.Materials and methodsThis was a retrospective study. Among 614 parotidectomy performed between 1998 and 2008 at our institution, 10 cases (1.6%) of vascular malformations have been identified. Clinical features and management of these patients were analyzed.ResultsClinical presentation was usually related to that of a benign, slow-growing and asymptomatic tumor. There was a marked female predominance (90%). In any case, the diagnosis of vascular malformation could be obtained with certainty preoperatively. Surgical excision was performed most often referred to diagnosis. Sixty percent of vascular malformations were located in the superficial lobe of the parotid gland. On the histological we found a classic look with benign vascular proliferation of endothelial cells in the walls. The vessel lumen was either the head of a congestion or thrombosis or calcification (phleboliths).ConclusionVascular malformations of the parotid gland, rare disease, are mainly venous. The terminology is based on clinical data, scalable, histological and hemodynamic as classified by the International Society of Study of Vascular Anomaly (ISSVA). Despite advances in imaging including MRI they remain difficult to diagnose. The treatment of reference is surgical excision.

International audience; Schizophyllum commune is a common basidiomycete fungus that is rarely involved in human disease. The medical records of patients operated on for fungal rhinosinusitis (FRS) in two University Hospitals between 2012 and 2014 were reviewed. Within the two-year survey, six female, and notably no male, patients were diagnosed with S. commune rhinosinusitis. Mean age was 44.6 years at diagnosis (30 to 68 years). Mean time between onset of symptoms and diagnosis was 8.5 months (2 to 12 months). All six patients were immunocompetent and had no particular host factor for FRS. S. commune was identified using MALDI-TOF mass spectrometry and identifications were confirmed via DNA sequence analysis. Chronic invasive fungal rhinosinusitis was diagnosed in three of our six patients. Based on histological findings, antifungal treatment was delivered in association with surgery. The basidiomycete fungus S. commune is an emerging cause of rhinosinusitis probably as a direct consequence of the recent technological progress in fungal identificationmethods (DNA sequencing and MALDI-TOF mass spectrometry).

IntroductionFrailty is characterized by increased vulnerability to stressors that poses the older subject at risk of adverse health-related outcomes, including hospitalization, disability and mortality. Early identification of community-dwelling frail older subjects is important in order to implement preventive strategies against negative health-related outcomes, in particular disability. Validated brief screening tools are needed to detect frail community-dwelling elders.Materials and methodsThe aim of the present study, promoted by the European Union Geriatric Medicine Society (EUGMS) working group on “Frailty in older persons”, is to determine the agreement between the Gérontopôle Frailty Screening Tool (GFST) (administered by the general practitioner) and the Fried’ criteria for frailty phenotype as reference measure (administered by a blinded assessor). The study is performed in older primary care patients in nine European countries after translation of the GFST into eight languages.ResultsThe sample (n = 109 older patients,) included 37.6%, 56.9%, and 5.5% robust, pre-frail or frail, and disabled individuals, respectively. The GFST showed a sensitivity of 71.0%, a specificity of 70.2%, a positive predictive value of 75.9% and a negative predictive value of 64.7% at the identification of non-disabled frail elders. The positive and negative likelihood ratios were 2.38 and 0.41, respectively. In logistic regression models only slow gait speed (odds ratio [OR]: 19.65, 95% confidence interval [95% CI]: 4.69–82.35) and mobility issues (OR: 18.04, 95% CI: 3.11–104.78) were significantly associated with the condition of frailty in the absence of disability.ConclusionsOur findings demonstrate an overall moderate agreement between the GFST and the frailty phenotype.

Summary Objectives The small size of endoscopic laser cordectomy (ELC) specimens frequently leads the histopathologist to assess excision margins as pathologic. The present study sought to assess the prognostic value of margin status in terms of overall and of recurrence-free survival in a population of T1a glottic carcinoma operated on by ELC. Material and methods Sixty-four records of T1a squamous-cell carcinoma treated between 1996 and 2006 were retrospectively analyzed. Overall and recurrence-free survival for the group with negative margins (group 1) and with positive margins (group 2) were analyzed following Kaplan-Meier. The influence of resection margin histologic status was assessed on Log Rank test. Results Six female and 58 male patients were included. Forty (62.5%) had negative margins (group 1) and 24 (37.5%) positive margins (group 2). Overall five-year survival was 97% (95% in group 1 and 100% in group 2). Five-year recurrence-free survival was 94% (91.7% in group 1 and 95% in group 2). There was no significant difference in overall or recurrence-free survival according to resection margin histologic status. Conclusions The present results show that margins considered positive after laser resection do not significantly impact carcinologic course, while still requiring close surveillance. The most generally recommended attitude is control endoscopy with biopsy at 10 weeks.