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Unlabelled: Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that has a strong affinity for the upper respiratory tract., Objective: To retrospectively study the clinical features of otorhinolaryngological manifestations from 21 WG patients., Patients: Eleven men and 10 women were studied with respectively a mean age of 62.7 (23-79) and 63.9 (53-73)., Methods: Otorhinolaryngological manifestations were recorded before and during the course of WG., Results: Upper respiratory tract involvement occurred in 81% of cases (17/21 patients) and was isolated in 42.8% of cases (9/21 patients). Nasosinusal manifestations occurred in 71.4% of cases (15/21) before and at the time of GW diagnosis. They included bilateral sinusitis (7 cases), nasal crusting (6 cases), purulent rhinorrhea (5 cases), epistaxis (4 cases), nasal ulcers (2 cases), nasal congestion with obstruction (3 cases) and 4 cases of nose deformity (saddle nose or oedema). Otologic manifestations occurred in 28.5% of cases and were never isolated. They included otitis media (3 cases), sudden hearing loss (3 cases), tinnitus (1 case), facial palsy (1 case) and 2 cases of chondritis. Pharyngolaryngotracheal manifestations occurred in 33.3% of cases (7/21). Diagnosis of GW was based on positive ANCA test (95.2% of cases), presence of biologic inflammatory parameters (76% of cases) and histological features. 29 biopsies from nasosinusal lesions on 17 patients were made. 44.8% of the biopsies were contributive with at least one histologic feature of the combination including vasculitis, necrosis and granulomatous inflammation. The best contributive site of biopsy was the paranasal sinus., Conclusion: We report that otorhinolaryngological manifestations occurred in 81% of cases before and at the time of GW diagnosis. These findings indicate that otorhinolaryngologists have a central role to play in early diagnosis of the disease.

Two cases of internal carotid artery aneurysm arising within the petrous bone are described, bringing up to 56 the number of such cases reported to date in the medical literature scanned through Medline. The first case presented as a moderately bleeding tumor of the petrous apex, while the second was revealed by a massive otorrhage. In both cases a pulsatile nasopharyngeal mass was associated with otorrhage. The treatment required in both cases the aneurysm to be embolized in extreme emergency. One patient suffered transient hemiplegia and aphasia that completely recovered, while the second eventually died, although the carotid occlusion had been well tolerated in the first two weeks that followed this procedure. From their own experience and a literature review, we can emphasize the need for arterial extra-intracranial bypass before an aneurysm embolization be proposed, since the neurological issue following internal carotid occlusion cannot be predicted.

Unlabelled: Metastatic carcinoma involving the middle ear space is a rare entity that is little described in the literature. The number of cases seems to be increasing. It is usually recognized that palliative treatment as the most reasonable treatment for this tumors., Case Report: A 59-year-old female patient presented with a history of a metastatic carcinoma involving the middle ear space and mastoid. This metastase occurred one year late in the course of a bladder cancer. Presentation of the lesion included otorrhea and facial palsy complicated by headache and bilateral visual loss in relation with lateral sinus thrombophlebitis and intracranial hypertension. Diffuses metastases in the skeletal system were demonstrated by pretreatment investigations. Treatment was only palliative chemotherapy. Outcome was fatal two months after onset of symptoms., Discussion: This case illustrates the clinical and pathological features of this tumor and the pitfalls of diagnosis and treatment. We will discuss the current accepted management and the difference after diagnosis modalities for this type of metastatic tumor.

Objective: The aim of this prospective study was to determine eosinophilia and ECP (Eosinophilic Cationic Protein) levels in blood and in nasal secretions of patients with nasal polyposis (NP)., Patients: 119 patients with NP were prospectively studied. The control group included 25 patients., Methods: They included: questionnaire about asthma and intolerance to aspirin; nasal endosopic grading; nasal symptoms scoring; allergy testing; measurements of serum and nasal values of eosinophilia expressed as a percentage; measurements of serum and nasal values of ECP expressed in ng/ml; the Spearman correlation test, the T series and Khideux tests were used in the statistical analysis., Results: In NP group, 66 were asthmatic (As) and 53 non asthmatics (NAs), 40 were atopic (ATo), and 79 were non atopic (NAto). Values of nasal eosinophilia and nasal ECP in NP patients were significantly higher (respectively 40.7+/-35.6% and 22.8+/-48.0 ng/ml) than the control group (respectively 3.0+/-14% and 2.1+/-3.6 ng/ml). Nasal and serum eosinophilia values in asthmatic patients (As) (respectively 47+/-36% and 7.6+/-6.3%) were significantly higher (p<0.05) than in non asthmatic patients (NAs) (respectively 32.6+/-33.8% and 4.6+/-3.1%). No difference was found in nasal and serum ECP values between asthmatic and non asthmatic patients. Nasal eosinophilia values were significantly correlated (p=0.02) with nasal scoring in NP patients. No correlation was found between nasal ECP and serum ECP values and clinical scoring., Conclusion: Nasal eosinophilia and nasal ECP values are significantly increased in NP. Nasal eosinophilia seems to be a relevant biological marker of clinical severity (association with asthma and a high clinical score) in NP patients. By contrast, nasal ECP cannot be consider as a marker of clinical severity.

A perfect knowledge of the anatomy of the vestibuloacusticofacial pedicle is required to preserve hearing and facial functions during cerebellopontine angle surgery for vestibular schwannoma. A clarification of the anatomy of this pedicle, in particular of its blood supply, is presented here, based on a review of the available literature, as well as on the author's data issued from anatomical dissections on latex-injected fresh specimens, and from radiological images of the cerebellopontine angle. The blood supply to the vestibuloacusticofacial bundle arises from the meatal loop of the anterior inferior cerebellar artery most often exhibited at the porus of the internal acoustical meatus. The labyrinthine artery is particularly exposed to injury between the cochlear and facial nerves. In addition, dissection in between these two nerves is likely to sever vessels directed to these nerves even though the labyrinthine artery is not interrupted. Thus, aside from a direct injury to the labyrinth, auditory function can be impaired through two distinct ischemic lesion types. Although the facial nerve is supplied through three main arterial systems (from the labyrinthine, the middle meningeal, and the stylomastoid arteries), its labyrinthine portion is more likely to suffer from ischemic damage as it is only supplied by meatal arteries. A refinement of our anatomical knowledge of the vestibuloacusticofacial pedicle, from a functional point of view, could arise from laser Doppler measurements of labyrinthine and facial blood flow during surgery, in an attempt to improve our functional preservation rate during therapeutic procedures for vestibular schwannoma.

Unlabelled: Nitric oxide (NO) is implicated in the pathophysiology of inflammatory airway diseases. It has been identified as a potential marker of airway inflammation., Objective: The purpose of the study was to assess the concentrations of nasal NO in upper and lower airways in nasal polyposis patients., Patients: 18 nasal polyposis patients (14 men, 4 women) and 21 control subjects (7 men, 14 women), all non asthmatic non smokers, without respiratory infections were prospectively studied., Methods: They included nasal obstruction scoring, nasal endoscopic grading, allergy testing, nasal cytology, flow-volume spirometry and measurement of nasal (NNO) and exhaled NO (ENO) concentrations. NO was measured by a chemiluminescence NO Analyser (Sievers 280). NNO was analysed by aspiration with a constant flow of 3 l/mn. ENO was analysed during a slow expiration (50 ml/s) against a constant resistance of 10 cm H2O., Results: NNO was significantly (p<0,001) decreased in NP group (596.4 +/- 102.06 ppb) compared to control group (2 251.6 +/- 288.6 ppb). ENO was significantly (p<0.05) increased in NP group (45.4 +/- 14.1 ppb) compared to control group (11.2 +/- 1.16 ppb). NNO and ENO were not significantly different between atopic and non-atopic NP patients. NNO concentrations was inversely correlated with the values of nasal endoscopic grading. No correlation was found between NNO concentrations and respectively nasal obstruction scoring and eosinophil count in nasal mucosa., Conclusion: Further studies are necessary to understand the pathophysiology of decreasing NNO and increasing ENO in nasal polyposis. In particular, ENO could be consider as a biologic marker of lower airway inflammation in nasal polyposis.

Unlabelled: The meaning of facial nerve enhancement by gadolinium-enhanced magnetic resonanca imaging (MRI) in Bell's palsy is very discussed. Aim of our study was to define the radiological data in facial Bell's palsy and to correlate them with clinical data., Patients and Methods: 34 patients with facial Bell's palsy were studied prospectively. Each patient had two gadolinium-enhanced MRI. The first MRI was realized during the first ten days. The second MRI was realized three months later. Two patients with facial nerve enhancement localized on the third portion was not clinically normalized at 3 months. Facial nerve enhancement and his precise location was noted., Results: Facial nerve enhancement was noted in 71,5% on first MRI and in 30% on second MRI. Gadolinium-enhancement was predominantly noted on the Fundus. No patients with facial nerve enhancement persisting at three months was clinically normalized at one month., Conclusion: Facial nerve enhancement localized on the fundus and/or on the third portion, persisting at three months, could be consider as a negative landmark of fast clinical facial recuperation.

Laryngeal chondrosarcoma is a rare tumor that is known for its indolent course and its tendency to ultimate recurrence. According to the actually adopted classification, 95% of the reported cases are of a low-grade type. A consensus recognizing conservative surgery as the most reasonable treatment for these lesions has almost been reached. However, fear of jeopardizing the patency of the laryngeal airway as a result of a wide cricoid excision and also the fear of repeated recurrences could still push some surgeons to perform a total laryngectomy in the case of laryngeal chondrosarcoma. After a brief review of the literature, we will present five cases of laryngeal chondrosarcoma that were treated and followed at the Clermont-Ferrand University Medical Center over the last two decades. These cases exhibit many of the clinicopathologic features of the tumor and illustrate the pitfalls of diagnosis and treatment. In light of this presentation, we will discuss the widely accepted management as well as a newly suggested treatment modality for this disease.

Cubic difference tone (CDT) otoacoustic emissions are thought to arise from the feedback loop allowing outer hair cells to enhance the sensitivity and tuning of the organ of Corti. The existence of residual CDTs during complete cochlear ischemia is therefore disturbing. That stimulus intensities must exceed 50-60 dB SPL for residual CDTs to be recorded and for level notches to be present in CDT growth functions is often cited as evidence for a two-component, "active/passive" model: one component, the residual one, would originate from a passive, hardly vulnerable mechanism and thus be unsuitable for hearing screening purposes. This model was probed in gerbil ears after complete interruption of the cochlear blood flow. Cochlear potentials and CDTs were controlled simultaneously through continuous monitoring of CDT level and phase for 50 and 60 dB SPL stimuli and group-delay measurements. After a clear initial decay, CDT levels elicited at 60 dB SPL plateaued for several minutes at about 20 dB below initial level, and when early level notches were observed, CDT phase changes remained minor. The CDT group delays decreased by less than 30%. Later CDT level notches were associated with sharp phase reversals but the similarity between CDT characteristics before and after a notch was hardly consistent with a two-component interpretation. When mild sound overexposure (pure tone, 90-95 dB SPL, 15-30 min) had been performed prior to ischemia, little or no ischemic CDT came from the frequency bands where auditory fatigue had been detected (within 1 kHz), irrespective of the stimulus intensity. It suggests that instead of being passive, residual ischemic CDTs were vulnerable and produced according to a near-normal tonotopy by the same mechanisms that were sensitive to auditory fatigue. All the results lined up with a simple feedback model of cochlear function assuming a single CDT source related to mechano-electrical transduction in outer hair cells. More parsimonious than a two-component model, it posits that although early stages of ischemia dramatically impair the overall performance of the cochlea, the nonlinear mechanical stages responsible for the existence of CDTs keep working albeit at higher intensities.

Objectives: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection., Methods: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice., Results: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice., Conclusions: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

Objective: To assess the efficacy and tolerability of once-daily treatment with budesonide aqueous nasal spray in patients with nasal polyps., Design: Randomized, double-blind, placebo-controlled, parallel-group study., Setting: Sixteen hospital clinics., Patients: One hundred eighty-three patients with moderate-sized nasal polyps causing clinically significant symptoms during a 1-week run-in period., Interventions: Patients were randomized to receive 1 of the following 4 budesonide aqueous nasal spray treatments: 128 microg once daily in the morning and placebo in the evening, 128 microg twice daily, 256 microg once daily in the morning and placebo in the evening, or placebo for 8 weeks. Nasal polyp size was scored and peak nasal inspiratory flow was measured at clinic visits at the beginning and end of the run-in period and after 4 and 8 weeks' treatment. Patients recorded daily peak nasal inspiratory flow, symptom scores (ie, blocked nose, runny nose, and sneezing) and sense of smell on diary cards., Main Outcome Measures: Mean change in nasal polyp size at the end of treatment; mean changes in combined and individual symptom scores., Results: All doses of budesonide aqueous nasal spray significantly (P<.01) reduced polyp size; no significant differences were noted between the 4 treatment groups. The mean improvement in clinic peak nasal inspiratory flow at 8 weeks was 65.9 L/min with budesonide aqueous nasal spray, 128 microg twice daily; 71.6 L/min with budesonide aqueous nasal spray, 256 microg once daily; and 54.6 L/min with budesonide aqueous nasal spray, 128 microg once daily (all P<.001 vs placebo). Combined and individual symptom scores and sense of smell improved significantly in all budesonide-treated groups; the effect on symptoms became apparent within 1 to 2 days of the first dose. Budesonide aqueous nasal spray was well tolerated., Conclusions: Doses of budesonide aqueous nasal spray, 128 microg once daily, were found to be effective in the treatment of nasal polyps, and doses of budesonide aqueous nasal spray, 256 microg once daily, did not show any significant additional efficacy.

Background: The efficacy of systemic antibiotics on the treatment of ventilator-associated infectious maxillary sinusitis (VAIMS) is debated. The objective of this study was to determine the etiologic diagnosis of VAIMS in patients receiving antibiotics., Methods: Patients mechanically ventilated for more than or equal to 72 h, who had persistent fever while on antibiotics for more than or equal to 48 h, underwent computed tomography scan followed by transnasal puncture of involved maxillary sinuses. VAIMS was defined as follows: fever greater than or equal to 38 degrees C, radiographic signs (air fluid level or opacification of maxillary sinuses on computed tomography scan), and a quantitative culture of sinus aspirate yielding more than or equal to 103 colony-forming units/ml., Results: Twenty-four patients had radiographic signs of sinusitis. The mean +/- SD prior durations of mechanical ventilation and antibiotic exposure were 9.5 +/- 4.7 days and 6 +/- 4 days, respectively. Six unilateral and nine bilateral VAIMS were diagnosed in 15 patients. The median number of etiologic organisms per patient was two (range, one to four). The bacteriologic cultures yielded gram-positive bacteria (n = 21), gram-negative bacteria (n = 22), and yeasts (n = 5). Forty percent of causative agents were susceptible to the antibiotics prescribed. Seven patients with VAIMS developed 10 concomitant infections: ventilator-associated pneumonia (n = 5), urinary tract infection (n = 3), catheter infections (n = 2). In all cases of ventilator-associated pneumonia, the implicated agents were the causative agents of VAIMS., Conclusion: In VAIMS patients on antibiotics, quantitative cultures of sinus aspirates may contribute to establish the diagnosis. The frequent recovery of microorganisms susceptible to the antimicrobial treatment administered suggests that therapy of VAIMS with systemic antibiotics may not be sufficient.

Unlabelled: The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients., Materials and Methods: Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment., Preliminary Results: 92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant., Conclusion: Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.

Unlabelled: Adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1), play an important role in the development of the inflammatory allergic response in the nose. ICAM-1 expression on nasal epithelial cells during allergic reaction is regarded as a major hallmark of allergic inflammation., Objective: The aim of the study was to evaluate the levels of soluble ICAM-1 (sICAM-1) in nasal epithelial lining fluid (ELF) in patients with allergic rhinitis., Patients: Seventeen patients with perennial allergic rhinitis (age: 34,6 +/- 14,6) were screened and the results were compared with those from 11 seasonal allergic rhinitis patients (age: 25.9 +/- 7.4) and 10 non-allergic patients., Methods: The study was performed outside the pollen season. The scores of subjective symptoms were estimated by two differents methods. First, on the basis of a visual analog scale for the symptoms including nasal obstruction, rhinorrhea, sneezing and pruritus. This score was called "Autoscore" (fullmark =40 points). Second, on the basis of a four mark scale for each symptom defined (0 =no symptom, 1 =mild, 2 =moderate, 3 =severe). This score was called "Heteroscore" (fullmark =12 points). Specimens of nasal mucosa were collected by brushing the surface of nasal cavity. Levels of sICAM-1 and sECP (soluble Eosinophilic cationic protein) were measured by specific enzyme-linked immunosorbent assay., Results: The levels of sICAM-1 in ELF were significantly higher (p <0.01) in patients with perennial rhinitis compared to patients with seasonal rhinitis outside the pollen season and to non allergic patients. Levels of sICAM-1 in patients with perennial allergic rhinitis were correlated with levels of sECP (p <0.003) and with the four mark scale scores (p <0. 03) but did not correlate with the visual analog scale scores., Conclusions: sICAM-1 increased in nasal secretions during natural perennial rhinitis and could be considered as a representative hallmark for clinical severity and follow-up evaluation in perennial allergic rhinitis.

The aim of this study was to investigate the role of dispositional optimism (DO) as a predictor of health-related quality of life (HRQL) in a sample of upper aerodigestive tract cancer (UADT) patients. A prospective observational study design was used with a cohort of patients from one centre. DO was evaluated using a French version of the Life Orientation Test (the FLOT) translated and validated for this study. HRQL was evaluated using the EORTC QLQ-C30 prior to and 3 months following treatment. The association between FLOT ratings and HRQL was evaluated using linear multiple regression analysis and a two-way ANOVA with repeated measures. Baseline data were gathered on 101 subjects and follow-up data on 88 of these. The sample was dichotomized around the median FLOT score creating 'optimist' and 'pessimist' groups. Before treatment, optimists reported better role, cognitive and emotional function, less pain and fatigue and a better global rating of HRQL than did pessimists. Following treatment, optimists reported better role and cognitive functioning, less pain and better global HRQL than did pessimists. Pessimists reported a greater deterioration in the role domain following treatment than did optimists. At no point did pessimists rate HRQL better than optimists. The results suggest that optimism is associated with better HRQL in French UADT cancer patients.

An in vivo model in the Mongolian gerbil is used to assess the auditory changes during reversible cochlear ischemia. This model allows the recordings of cochlear potentials (microphonics, summating potential and compound action potential) and otoacoustic emissions (cubic difference tones, CDTs), together with laser Doppler cochlear blood flow (CBF) measurements, over reversible cochlear ischemia. Ischemia is achieved by compression of the eighth nerve complex at the porus of the internal acoustical meatus, whereas the compression release allows the reperfusion to occur. While CBF monitoring permits to objectively determine the degree of ischemia and reperfusion, the combined analysis of cochlear potentials and CDTs makes it possible to point out the preferential site of main functional damage within the cochlea, i.e., outer hair cells (OHCs), inner hair cells, or ganglia cells. At least three ischemia-reperfusion sequences can be used on one side, and sometimes both ears can serve for experiments. This model could be applicable for testing drugs with alleged protective effects against cochlear ischemia and/or reperfusion, in treated vs. non-treated animals.

Cochlear ischemia induces a sensorineural hearing loss, in part through a fast functional impairment of outer hair cellls. Assuming that the cochlea is rendered fragile during ischemia and reperfusion and that stimulation itself can jeopardize its functional recovery, we used a model of reversible selective cochlear ischemia in Mongolian gerbils to establish what type of sound exposure can be deleterious during and immediately after reversible ischemia. Several groups of gerbils were used, with different ischemia durations and levels of sound exposure. Control groups were only exposed to tones at 80 and 90 dB SPL during 30 min, while other groups underwent complete and fully reversible blockage of the labyrinthine artery, during 5.5 or 8 min, and were exposed to 60 or 80 dB SPL tones during 30 min. The amount of ischemia and reperfusion was measured by means of laser Doppler velocimetry, whereas outer hair cells' function was continuously monitored through distortion-product otoacoustic emissions (DPOAEs). The losses of DPOAE levels after 8 min transient ischemia and 60 dB SPL exposure were as large as those induced by 80 dB SPL exposures combined with 5.5 min ischemia, or 90 dB SPL exposures without ischemia, with a maximum loss around 25-30 dB, half an octave above the stimulus frequency. These results give evidence for an extremely high cochlear vulnerability to low-level sound exposure when associated with reversible ischemia. This vulnerability may have important clinical consequences in patients with cochlear circulatory disturbances.

Acute postoperative pain has seldom been assessed in head and neck cancer surgery. The estimation of actual pain is more difficult when communication is impaired by tracheotomy or tracheostomia. The aim of the present prospective study was the assessment of analgesia level during the first 48 postoperative hours after head and neck cancer surgery. The analgesic procedure involved intra-venous morphine injected by means of a PCA pump (Patient controlled analgesia). Thirty patients were thus treated after cancer surgery of the larynx or the oropharynx. The protocol included during 48 hours the assessment of pain, using a visual analogic scale (VAS) every fourth hour, while recording the total injected dose of morphine, the localisation of pains, as well as the occurrence of side-effects. The control of postoperative pain was shown to be satisfactory, with a VAS grade smaller than 3 at time zero and kept below this value during 48 hours. At the end of this period, the mean total dose of morphine injected was 38 mg. No case of respiratory depression was even seen. It can be concluded that PCA seems to be an efficient procedure for controlling postoperative pain in head and neck cancer surgery. This technique proved to be better than delivering analgesia on requirement.

We conducted a retrospective study of six patients presenting a parapharyngeal tumor and an analysis of data of the literature and recall classification of these tumors and their anatomo-clinics characters, therapeutic and diagnostic problems highlighting. These tumors are rare and have various origins, their treatment is almost always surgical by cervical approach which can be undertaken only after a rigorous exploration, systematically associating computed tomography scan and magnetic resonance imaging. Transoral resection is strongly advised against as it is potentially harmful.

Objectives: To assess the intensity of postoperative pain after laryngeal surgery for cancer and the efficacy of analgesic injections at fixed hours., Design: A prospective clinical study performed during the 3 days following laryngeal cancer surgery., Setting: A university medical center., Patients: Fifteen men (age range, 38-74 years) having just undergone a partial or total laryngectomy for epidermoid carcinoma., Interventions: The analgesic treatment consisted of intravenous administrations at fixed hours (propacetamol or nalbuphine hydrochloride), with the possibility of rescue doses on demand. Pain and anxiety were assessed by means of visual analog scales (graduated from 0-10) every 3 hours on postoperative day 1, then every 6 hours on postoperative days 2 and 3. Objective criteria, ie, heart and respiratory rates and mean blood pressure, were measured with the same schedule., Main Outcome Measures: Postoperative pain and anxiety intensities and their variations were analyzed. Correlations between postoperative pain and other criteria were researched., Results: Postoperative pain had a high initial level (maximum median, 7), then decreased and reached a score of 3 at the 30th hour. Unpredictable individual peaks of pain were reported. Anxiety was never high (maximum median, 4). No individual correlation was found between pain and objective parameters., Conclusions: After laryngeal surgery for cancer, pain can reach high levels, particularly in the first hours following recovery. Analgesic administrations at fixed hours are not effective enough. Postoperative analgesic treatment should aim to prevent the high initial pain and be individually adapted.

The levels of distortion product otoacoustic emissions (DPOAEs) were measured in a strain of hearing-impaired mutant mice (CD1) at various stages of outer hair cell impairment and compared to those of a control inbred strain (CBA/J). Parallel measurements of cochlear potentials and auditory brainstem evoked responses (ABRs) were performed and surface preparations of organs of Corti were observed using phalloidin staining of filamentous actin. Comparison of DPOAEs (elicited by stimulus levels of 60 and 70 dB SPL) with standard functional tests allowed the categorization of CD1 ears into two groups on the basis of the presence or absence of DPOAE, which corresponded to mean ABR thresholds greater or less than 40 dB nHL respectively. When adopting ABR threshold as the gold standard, this procedure yielded rates of false-positives and -negatives ranging from 5 to 16%. However, individual predictions of electrophysiological function from DPOAE levels were not accurate, owing to their large variance, and attempts to optimize stimulus levels did not reduce this variance. In contrast, the profiles of DPOAE level vs. f2 exhibited large correlations with ABR threshold profiles as a function of f2. It was also noteworthy that the mean levels of DPOAEs in CD1 mice recorded in frequency intervals with normal ABR thresholds were significantly smaller than those of CBA/J mice. Although hearing loss was revealed early both by DPOAEs and by other functional tests, surface preparations often remained normal until about 3-4 months of age.

Inverted papillomas (IPs) are rare benign tumors of nasal epithelium with high recurrence rates and malignant transformation potential. Their etiology is still uncertain, and the mechanism of their growth has not yet been fully described. The purpose of this study was to detect, quantify, and compare cell proliferation, apoptosis, and apoptosis inhibition in hyperplastic epithelium from IPs and in inflammatory nasal polyps (NPs). IP samples were obtained after surgical removal of tumor in 13 patients, and NPs were sampled during endoscopic ethmoidectomy in 10 patients with nasal polyposis. Cell proliferation and apoptosis inhibition, respectively, were assessed by immunohistochemical identification of the proliferating cell nuclear antigen (PCNA) and the oncoprotein Bcl-2. Apoptosis was evaluated by analyzing the DNA fragmentation. Cell proliferation and apoptosis were significantly higher in IPs than in NPs (P = .0002 and P = .043, respectively), while apoptosis inhibition was significantly lower in IPs than in NPs (P = .001). Concerning IPs, cell proliferation was significantly higher than apoptosis (P = .0029) and apoptosis inhibition (P = .0015). The increase in epithelial cell proliferation seemed to be greater in IPs with dysplasia than in IPs without dysplasia. Increased epithelial cell proliferation, but not apoptosis and apoptosis inhibition, seems to be involved in the development of IP.

Objective: To determine the significance of cross-sectional areas obtained by acoustic rhinometry., Design: Comparison of data obtained by acoustic rhinometry and computed tomography (CT)., Setting: Outpatient clinic., Patients: Nine adults with nasal obstruction due to turbinate hypertrophy., Main Outcome Measures: Acoustic rhinometry and CT were performed after nasal decongestion. The acoustic area-distance curve was analyzed based on 3 notches (A1, A2, and A3) corresponding to 3 local minimal areas. Computed tomographic measurements were made in the coronal plane at 0.5-cm intervals, and the narrowest sections in the anterior (S1), middle (S2), and posterior (S3) parts of the nasal cavity were selected. Mean specific section areas and volumes were computed by integration of the acoustic area-distance curves using the same procedure for the 2 methods., Results: Significant correlations were found between acoustic and CT areas in the anterior nasal cavity (A1 vs S1, P < .001; A2 vs S2, P < .005). Acoustic and CT anterior volumes from A1 to A2 and from S1 to S2 were significantly correlated with each other (P < .005). No correlation was found between acoustic and CT areas measured at the posterior part of the nose (A3 vs S3). A weak correlation was evidenced between acoustic and CT posterior volumes from A2 to A3 and from S2 to S3 (P < .05)., Conclusions: Acoustic rhinometry may be particularly well suited to the evaluation of anterior nasal geometry during clinical studies. At the posterior part of the nose, acoustic measurements may be of limited clinical relevance.

Ischemia and reperfusion are involved in numerous sensorineural pathologies. A model of reversible cochlear ischemia has been designed in Mongolian gerbil. Selective labyrinthine ischemia of variable duration (4-10 min) was achieved through a posterior transcranial approach. Ischemia and reperfusion were controlled with the help of laser Doppler velocimetry. Functional changes were monitored every 1-10 s throughout experiments, using cochlear potentials and otoacoustic emissions. After interruption of blood flow, all signals rapidly began to decay. In contrast to cochlear potentials, otoacoustic emissions always exhibited a plateau before reaching noise floor only after approximately 4-5 min. Upon ischemia release, cochlear blood flow recovered instantly and completely and cochlear potentials rapidly improved in most cases, in contrast to otoacoustic emissions that underwent a delayed decay after immediate partial recovery. The phase and group latency of otoacoustic emissions exhibited only small changes throughout ischemia and reperfusion, suggesting adaptive rather than damaging mechanisms. Cochlear function returned to normal after 5 min 30 s ischemia but longer complete ischemia sometimes led to irreversible damage despite the systematic presence of some recovery just after ischemia release. This behavior suggests that reperfusion in itself can be deleterious to a sensorineural organ and this model can be useful for identifying the noxious mechanisms of ischemia and reperfusion.

CT patterns of a relapsing polychondritis affecting the laryngeal cartilages are reported in a 42-year-old man with a 10-year medical history of this disease, corresponding to an irregular enlargement of the cricoid, thyroid cartilages and tracheal rings, with a moderate endoluminal narrowing. CT is useful to differentiate this rare inflammatory disease from others causes of airway narrowing, and could help in certain cases of diagnosis of beginning polychondritis.

A 74-year-old man with multiple myeloma developed facial and cervical cellulitis and severe sepsis as a complication of surgery (alar region basal cell carcinoma). The etiological agent was, surprisingly, penicillin-resistant Streptococcus pneumoniae (PRSP). The patient successfully received 16 days of antibiotics. Amoxicillin was given as monotherapy during the last 14 days of treatment. PRSP can be responsible not only for otitis media, pneumonia or meningitis, but also for various other types of infection in patients with predisposing factors.

Although airway epithelium is known to be modified during chronic respiratory diseases, epithelial cells have rarely been precisely quantified. We therefore intended to evaluate epithelial cell distribution in inflammatory airways, using a cytological approach. Nasal airway cells in 12 patients with nonallergic chronic rhinitis were sampled by brushing, quantified after cytocentrifugation and compared to those from eight controls. Cell populations were quantified after May-Grünwald Giemsa staining and alpha-tubulin immunolabelling to demonstrate ciliary differentiation. When compared to controls, rhinitis patients exhibited lower percentages of ciliated cells (59 +/- 4 versus 32 +/- 2%, respectively), and higher percentages of goblet (24 +/- 3 versus 37 +/- 2%) and basal cells (9 +/- 1 versus 18 +/- 2%). After tubulin immunolabelling, positive staining was specifically detected in cells with cilia (LC+), and in the cytoplasm of some small round cells without obvious cilia (LC-). Fewer immunolabelled cells were detected in rhinitis patients than in controls (with significantly lower percentages of LC+ and higher percentages of LC-). Nasal brushing is an effective technique for quantification of airway epithelial cells. Tubulin immunolabelling is useful to detect ciliated cells and distinguishes another cell population, possibly preciliated cells. These cytological findings suggest the presence of modifications of epithelial differentiation and proliferation, possibly related to local chronic inflammation.

Respiratory symptoms are frequent after bone marrow transplantation (BMT). Most studies focus on lesions of the lower respiratory tract. However, sinusitis is also common in this setting, especially after allogeneic BMT. The nasal respiratory epithelium is the first line of airway defense and is very similar to the bronchial epithelium, especially in terms of ciliary beat frequency and ultrastructural pattern of ciliated cells. We have prospectively studied the nasal respiratory epithelium of 20 marrow recipients (four autologous, 16 allogeneic) with or without sinusitis, by brushing and biopsy of the median turbinate between 2.5 and 148 months after transplant. Samples were studied for ciliary beat frequency, cytology, ultrastructural pattern and HLA-DR expression. We found that 17 of our 20 patients had abnormalities of their nasal epithelium, mainly consisting of either squamous metaplasia or heterogeneous axonemal defects of peripheral and central microtubules. No relationship between these findings and the presence of acute or chronic sinus infection, previous irradiation, graft-versus-host disease or immunosuppressive therapy could be demonstrated in this preliminary study. These abnormalities probably have multiple causes. Prospective studies are needed to determine the respective roles of treatments, infections and immune disorders associated with BMT in these abnormalities, and to know their natural evolution over time and their impact on the occurrence of upper or lower respiratory tract infections.

Objective: To detect, quantify, and compare respiratory epithelial cell proliferation in nasal mucosa and polyps from patients with nasal polyposis., Design: Cohort study., Setting: Patients and samples were selected at the Hôpital Intercommunal de Créteil (France). Flow cytofluorometry and immunohistochemistry were performed at Hôpitaux Tenon and Mondor (Université Paris [France] VI et XII)., Patients: Twenty-one patients undergoing endoscopic ethmoidectomy for treatment of nasal polyposis., Methods: In 10 cases, epithelial cells were removed from frozen inferior turbinate mucosa and polyps by mechanical disaggregation and were then analyzed by flow cytofluorometry, providing the cell DNA content (propidium iodide labeling) and the percentage of S-phase cells. In 11 cases, inferior turbinate mucosa and polyps were fixed in formaldehyde and embedded in paraffin. Proliferating cell nuclear antigen expression in the epithelium was quantified by immunohistochemistry; a proliferating cell nuclear antigen index was calculated for each sample in the basal area, suprabasal area, and full height of the epithelium., Results: All cell populations studied were diploid, and percentages of S-phrase cells were significantly higher in nasal polyps than in mucosa. Proliferating cell nuclear antigen indexes were significantly higher in nasal polyps than in the suprabasal area and full height of the mucosal epithelium., Conclusion: Cell proliferation is increased in epithelium from nasal polyps. Epithelial damage caused by inflammatory mediators could induce this increased cell proliferation via epithelial repair processes. Inflammatory cells could up-regulate epithelial cell proliferation by secreting growth factors.

Although a high prevalence of hypertension has been observed in snorers, whether there is a direct link between hypertension and snoring remains controversial. It has recently been demonstrated that an abnormal amount of breathing effort during snoring is responsible for sleep fragmentation even in the absence of sleep apnea syndrome criteria. We hypothesized that sleep fragmentation during snoring may be a direct risk factor for the development of hypertension. On the basis of polysomnographic data, 105 nonapneic patients between 40 and 65 years of age referred for snoring with social impairment were selected and categorized as snorers with (n=55) or without sleep fragmentation (n=50) based on whether the arousals index was 10 or greater or less than 10/h of sleep, respectively. Sleep distribution did not differ between the two groups, except for a longer duration of wake after sleep onset (58 +/- 43 min vs 42 +/- 38 min) and a shorter duration of slow-wave sleep in the group with sleep fragmentation (72 +/- 34 min vs 97 +/- 34 min). Although there were no statistically significant differences between the snorers with and without sleep disruption in terms of age (51.3 +/- 7.7 vs 48.6 +/- 6.0 years), body mass index (26.9 +/- 4.0 vs 27.2 +/- 5.5 kg/m2), sex ratio, respiratory indexes during sleep, daytime sleepiness, and daytime tiredness, prevalence of systemic hypertension was significantly higher in the sleep-fragmented group (20/55 vs 7/50). This significant difference persisted (16/51 vs 6/49) when patients using antihypertensive drugs with possible effects on the CNS were excluded. Our data suggest that sleep fragmentation is common in patients who seek medical help for snoring with social impairment and may play a role in the development of hypertension.

Unlabelled: Postoperative pain has rarely been assessed after ENT surgery for cancer. Its evaluation is difficult because of the frequent lack of speech after this type of surgery., Objectives: to assess postoperative pain after pharyngeal and laryngeal surgery for cancer., Patients and Method: prospective study in 13 men (38-71 ans) operated on by total laryngectomy with or without partial pharyngectomy. A standardised treatment using propacetamol and nalbuphine was systematically prescribed. Pain, anxiety and relief were assessed with the help of visual analogue scales (VAS). Heart rate, mean blood pressure and respiratory rate were evaluated too., Results: mean postoperative pain was maximal just after recovery (6,64 +/- 2,14 cm) then decreased regularly. Initial mean score of anxiety was 3,14 +/- 3 cm and then was decreasing too. Anxiety and pain did not correlate except in 2 cases. None of the 3 objective parameters correlated with pain., Conclusion: postoperative pain can be assessed reliably after pharyngolaryngeal cancer surgery and is probably underrated. Its high initial score indicates that efforts must be focused on pre-emotive analgesia. Its high individual variability let us hypothesise that PCA systems should be effective.

In order to obtain an accurate evaluation of nasal and paranasal sinus disease in cystic fibrosis patients, 75 patients with a proven cystic fibrosis diagnosis have been investigated using the following standard techniques: questionnaire, ENT examination, endoscopical examination, sinus X-rays, and in 31% of the cases a CT scan. The analysis of results shows that nasal obstruction is the most frequent symptom (32%) and that nasal polyps are present in 43% of the cases. Endoscopic examination seems to be of great interest in giving a more accurate picture of nasal and paranasal sinus disease. Analysis of CT scan images leads the authors to describe a new and specific entity in nasal and paranasal sinus disease in cystic fibrosis patients: the pseudomucocele. In this report, the authors discuss the various aspects of pseudomucocele, attaching particular importance to the CT scan results.

Background: This article reviews 12 cases of isolated sphenoid sinus disease: chronic inflammatory sinusitis (7), mucoceles (2), aspergillus lesions (2), and isolated polyp (1)., Methods: Criteria for diagnosis were based on clinical symptoms, nasal endoscopic evaluation, and computed tomography (CT). Magnetic resonance imaging was used only in cases of bone erosion and when patients presented with vision problems. All patients were treated by functional endoscopic sphenoidotomy. Any postoperative complications were noted., Conclusion: The reported good results, on the basis of regression of functional symptoms and with nasal endoscopic and CT evaluation, suggest that intranasal sphenoidotomy under endoscopic control is a safe and effective method of treatment of nonmalignant isolated sphenoid disease. The mean follow-up is 26 months.

The authors use case studies to illustrate the respective benefits of CT and MR imaging in the management of sphenoid sinus disease. Because the sphenoid sinus is located deep in the skull base adjacent to vital neurological and vascular structures, surgery involves a certain risk. The improved quality of imaging now available provides essential information on which to base therapeutic options. Since CT and MR findings make it possible to increase the precision of the pretherapeutic evaluation and to determine neurological and vascular involvement, these imaging studies have become an integral part of the successful management of sphenoid sinus disease.

Analysis of nasal cytology provides useful information for the diagnosis of rhinitis. This analysis represents an interesting tool for objective assessment of nasal pathology. The purpose of this study was to describe the brushing method for obtaining nasal cytologic specimen. Samples were carried out from nine adult patients with chronic nasal obstruction. In all cases, the cytologic specimen had a good amount of well-preserved cells, easy to identify on morphological criteria. A differential cell count was performed on the different epithelial cell types present in the specimen and the results are reported in the present study. In conclusion, brushing method is non invasive and allows to precisely evaluate both epithelial and inflammatory cells present in the nasal mucosa.

The treatment of paranasal sinus mucoceles must assure complete removal and prevention of recurrence. In order to clarify the precise indications for endoscopic management, a retrospective study was undertaken on 16 patients with paranasal sinus mucoceles treated by this method. All of the patients underwent endoscopic exploration with or without an associated bicoronal approach. The follow-up period varied between 3 months and 46 months with a mean of 24. The results were considered satisfactory if the patient's symptoms disappeared and follow-up endoscopy revealed persistence of sinus permeability. Functional endoscopic surgery can be considered as an alternative method in treatment of sinus mucoceles. Only mucoceles confined to the lateral wall of the frontal sinus, and the extended mucoceles, seem to be an out of the way place to endoscopic sinus surgery alone. In these cases, the access has to be completed by an external approach. Concerning adequate recanalization of the nasofrontal duct, results seem encouraging, however a long-term follow-up is necessary to obtain an accurate assessment of the results.

Cultures of respiratory epithelial cells were obtained from nasal polyps collected in patients with and without primary ciliary defect. The ciliary beating frequency and the ciliary beating heterogeneity were determined on native and cultured tissues. We observed a significantly higher (p < 0.01) ciliary beating frequency of cultured ciliated cells, when compared with ciliated cells from the native tissue. The ciliary beating frequency of the cultured ciliated cells from the patient with primary defect (7.9 +/- 2.1 Hz) was significantly lower when compared with the beating frequency of the ciliated cells from the control subject (12.4 +/- 2.0 Hz). In addition, the percentage of ciliated cells characterized by a beating frequency lower than 8 Hz was 90.7% in the native tissue and 47.5% in the cultured tissue from the patient with ciliary primary defect. In the patient without ciliary primary defect, 90% of the cultured ciliated cells had a homogeneous ciliary beating, whereas in the patient with primary ciliary defect, only 47% of the ciliated cells had a homogeneous ciliary beating. These results suggest that the culture of respiratory cells associated with the functional activity measurement of the ciliated cells represent another way of precisely determining the extent of the primary ciliary dyskinesia defect.

The expression of the voltage-dependent anion channel (VDAC) "Porin 31 HL" and its cellular and subcellular immunocytochemical localization in the human respiratory epithelium were studied with monoclonal and polyclonal antibodies using immunofluorescence and immunogold labelling with light (LM) and transmission electron microscopy (TEM), respectively. Porin was identified in the apical domain of the ciliated cells and in the basal cells of the respiratory epithelium. Immunogold labelling was present in the apical plasma membrane and subapical vesicles of the ciliated cells. In pre-embedded freshly dissociated surface epithelial cells, porin could also be identified with TEM at the outer part of the plasma membrane of basal cells. By LM double immunolabelling, both porin and cystic fibrosis transmembrane conductance regulator (CFTR) were identified in the apical domain of ciliated cells but not in basal cells where CFTR was never identified. On Western blots of solubilized total membrane protein preparations from the same frozen surface epithelial respiratory cells, the antibodies recognized a group of 3 proteins of 31, 60 and 130-140 kDa with a strong reactivity for a 31 kDa protein, corresponding to the porin and a protein of 170 kDa which is consistent with mature CFTR. These results suggest that porin might be part of a multi-component chloride channel complex which could interact with CFTR.

The authors report the case of a 75 years old insulin dependent diabetic man presenting a malignant otitis externa with facial nerve paralysis. Despite prolonged, adequate parenteral antibiotic therapy, the patient's clinical status did not improve. The addition of hyperbaric oxygen as a complementary treatment was followed by the regression of clinical signs and the resolution of infection. Based upon a review of the literature, the authors discuss the indications for this therapy and the problems involved in defining the criteria of cure in malignant otitis externa.

Oral manifestations of herpes zoster are very less common than cutaneous. Only a few cases of oral herpes zoster in children had been already described. Authors report a case of maxillary superior nerve's herpes zoster. Oral lesions are encountered in case of viral disease of the second and third branch of trigeminal nerve (VII, VIII). Dental pain is usually the first sign and can induce misdiagnosis. The diagnosis is based on the specific ulcerative lesions, strictly unilateral, developed in the field of sensitive innervation of the maxillary nerves. The use of antiviral drugs seems to be actually the best treatment.

The authors use case studies to illustrate the respective benefits of CT and MR imaging in the management of sphenoid sinus disease. Because the sphenoid sinus is located deep in the skull base adjacent to vital neurological and vascular structures, surgery involves a certain risk. The improved quality of imaging now available provides essential information on which to base therapeutic options. Since CT and MR findings make it possible to increase the precision of the pretherapeutic evaluation and to determine neurological and vascular involvement, these imaging studies have become an integral part of the successful management of sphenoid sinus disease.

Aspergillosis of the sphenoid sinus is a rare entity. The authors report four cases of non invasive aspergillosis sinusitis, three isolated cases and one with nasal polyps. All cases were treated by functional endoscopic surgery. Good results were noted with a mean follow-up of 18 months. Frequency, clinical features, treatment, and etiopathogenesis of sphenoidal aspergillosis are discussed.

Eight inverted papillomas were evaluated for the presence of human papillomavirus (HPV) DNA. The techniques used were Southern Blot Hybridization in five cases and Polymerase Chain Reaction (PCR) in three cases. All eight lesions contained the characteristic features of inverted papillomas. Two lesions showed areas of dysplastic change and one lesion contained koilocytes. In three patients, invasive squamous cell carcinomas were found. The presence of HPV was noted in one of these specimen of inverted papilloma with squamous cell carcinoma. Specific testing for HPV types 6, 11, 16, 18 and 33 on this specimen was negative, thus indicating that the specimen is associated with a different HPV type. The results of this study, with only one case of positive HPV testing, leads us to question the precise role of HPV as an etiological agent in nasal inverted papillomas. The fact that this single positive case did not test positive for the HPV type 16 suggest that this is not the only "high risk" HPV type associated with the progression of inverted papilloma to a carcinoma.

The cytological study of the nasal mucosa is one the essential steps toward a better understanding of the physicopathological mechanisms involved in chronic affections of the nose. The development of a reliable, reproducible noninvasive technique to obtain cells in the prerequisite for this analysis. The brush technique is based on the use of a small cylindric nylon brush which is rotated as it is moved back and forth across the nasal mucosa to harvest the various cell types present on the surface of the mucosa. The specimen obtained is centrifuged and examined under an optical microscope. A semi-quantitative analysis is carried out to determine the relative richness of the specimen in epithelial cells (ciliated, qoblet and basal cells) and in inflammatory cells (neutrophils, basophils, eosinophils, lymphocytes, and monocytes). A precise differential cell count is then performed. According to the results obtained, an immunologic marker study of lymphocyte subsets may also be done using the same specimen. This technique may be used in both children and adults and permits cell harvest from various sites within the nasal fossa. Already tested in the study of the activity of cilia, this method is promising for the cytological study of the nasal mucosa. The brush method and other techniques of cell harvest are described and compared.

Twelve patients with nasal polyposis were examined with magnetic resonance imaging (MRI) prior to surgical ethmoidectomies (20 ethmoidectomies). MRI signal was analyzed in correlation with surgical findings in order to define the semiology of nasal and sinuses polyps. One of the most important point of this semiology is based on the analysis of sequences after administration of gadolinium. MRI seems an interesting method for analysing the extension of nasal polyposis and could be useful for ENT surgeons before an endoscopic nasal surgery.

The authors report about 18 cases of inverted papillomas treated between 1981 and 1991. The average age of the patients is 51 years, with a marked male predominance. The average follow-up is of 4 years. The most often noted revealing sign is unilateral nasal obstruction. A history of polypectomy and nasosinual surgery is found in 45% of the cases in our series. The treatment was surgical in all cases, including 4 De Lima's procedures, 11 procedures through a paralateronasal approach, 2 ethmoidectomies through an endonasal approach, and 1 degloving for a septal lesion. Endonasal surgery was performed for two limited tumors, for which the diagnosis of inverted papilloma never could be made preoperatively. The recurrence rate observed in our series is 5%. Out of 18 patients, 4 presented with a malignant change, either at once (2 cases) or some time after the primary exeresis of the inverted papilloma (2 cases). In the light of the results, and after analyzing the literature, the authors reassert the necessity of radical exeresis for inverted papilloma. Rhinosinual endoscopy must remain a diagnostic means and never is an indication of exeresis of inverted papilloma. The authors emphasize the difficulty of the histological diagnosis and set forth the various problems arising from the malignant degeneration of inverted papillomas. Recent discoveries on viral etiopathogenesis and on the oncogenic potential of the type-16 papilloma virus may allow characterizing the evolutive and prognostic features of inverted papillomas in the future.

Over a 3 year period the authors have managed 12 immune competent patients with aspergillosis of the maxillary sinus by intranasal sinus surgery using only a middle meatal approach. An enlarged middle meatal window was formed by resection of the superior surface of the inferior turbinate. especially designed curve suction tubes and forceps were used to reach all areas of the maxillary sinus in order to perform a macroscopically complete resection of all lesions. On no occasion Aspergillus was the alternative use of an inferior meatal window or a Caldwell-Luc approach necessary. The authors conclude that the use of a middle meatotomy for the surgical treatment of aspergillosis of the maxillary sinus makes it possible to assure complete resection, to adapt post-operative care and to permit prolonged aeration of the sinus.

The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.