Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 2: Treatment

ObjectivesSystematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21^st century.Material and methodsSearch of the Medline, Cochrane and Embase databases for the period 2000 - 2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting treatment of auricular tuberculosis. Extraction of data on pre-established files documenting treatment modalities and results. Reading of articles by two authors. Analysis performed according to SWiM guidelines, evaluating cure, tuberculosis-related death, treatment-related complications, improvement in facial palsy, and hearing sequelae rates.ResultsOne hundred and twenty eight articles: 118 case reports (159 patients) and 10 cohorts (177 patients) from 42 countries were analyzed. Female/male sex ratio was 1.2 with ages ranging from 1 month to 87 years. Medical treatment consisted in 5 to 24 months’ antitubercular antibiotic treatment using 2 to 8 antibiotics. Mastoidectomy, tympanoplasty and facial nerve decompression were associated to medical treatment in 64.7%, 17.4% and 6.2% of cases, respectively. Overall rates of cure, death, treatment-related complications, facial sequelae and hearing sequelae were 96.8%, 2%, 9.5%, 35.8% and 75.5%. In case reports, BCG vaccination did not appear to protect against facial palsy and severe intracranial complications (P > 0.6). There was no significant correlation (P > 0.3) between death and the clinical variables tested, and facial nerve decompression did not appear to influence outcome for facial function (P = 0.4).ConclusionMedical treatment is very effective but not without risk of death, complications and sequelae. It is the same as for pulmonary tuberculosis. Indications for and benefit of major auricular surgery during medical treatment deserve further studies.     

Keys for successful publication in Eur Ann Otorhinolaryngol Head Neck Dis: A STROBE analysis of peer reviews of articles submitted in 2020–2021

ObjectiveTo evaluate reviewing and editorial decision for articles submitted to the European Annals of Otorhinolaryngology Head & Neck Diseases.Materials and methodsA retrospective analysis was made of reviewers’ comments on 1,133 scientific articles (700 original articles, 96 literature reviews, and 337 case reports), originating from 69 countries, consecutively submitted on-line between January 1st, 2020 and December 31st, 2021. The main objective was to document the acceptance rate and decision time. Accessory objectives were to synthesize the main comments and to screen for correlations between acceptance and the main characteristics of first authors, articles and reviewers’ comments.ResultsIn total, 4.1% of submitted articles were accepted. Median decision time differed significantly (P < 0.0001), at 1 month in case of refusal and 4 months in case of acceptance. Reviewers mentioned failure to adhere to the journal's authors’ guide, to use the appropriate EQUATOR guidelines and to adopt the recommended P < 0.005 significance threshold in 94.8%, 54.2%, and 39.9% of cases, respectively. On multivariate analysis, 3 variables significantly impacted acceptance, which increased from 1.3% to 44.6% (P < 0.0001) when an appropriate EQUATOR guideline was used and from 0.3% to 57.4% (P < 0.0001) when the significance threshold was set at P < 0.005, and decreased from 10.5% to 1.1% (P = 0.0001) when the article did not originate from a French-speaking country (member of the Francophonie organization).ConclusionAdhesion to modern scientific medical writing rules increased acceptance rates for articles in the European Annals of Otorhinolaryngology Head & Neck Diseases. Teaching modern scientific medical writing needs to be enhanced in otorhinolaryngology.     

Management of stylohyoid syndrome: A systematic review following PRISMA guidelines

ObjectivesA systematic review of the literature on stylohyoid syndrome treatment was performed according to PRISMA guidelines.Material and methodsThree hundred and forty-nine articles were retrieved in the PubMed and Cochrane databases using the search-terms “stylohyoid syndrome” and synonyms. Articles documenting treatment and outcome with more than 1 month's follow-up were selected. Treatment-related complications and rate of cure, defined as disappearance of symptoms and/or of revelatory complication, were analyzed. Overall analysis was performed for series and a mixed logistic regression model for case reports.ResultsHundred and two articles (12 series, 90 case reports) were selected. The 12 series included 482 patients with pain syndrome managed by styloidectomy, with 84.2% and 73.7% cure rates for cervical and transoral approaches, respectively. There were no complications with the transoral approach, versus 1.2% transient facial paresis with the cervical approach. In the 90 case reports, 112 patients had pain syndrome (Group I) and 16 neurological deficit (Group II). Cure rate in Group I varied significantly (P = 0.005; OR 8.33, 95% CI [2.12–32.81]) from 64.3% following medical treatment (antiepileptics, muscle relaxants, analgesics, per os and/or locally injected anti-inflammatory drugs) to 91.8% following styloidectomy, without any significant impact of surgical approach (P = 0.1; OR 0.17, 95% CI [0.02–1.60]). In Group I, no complications occurred after medical treatment, versus 4.3% and 16.3% after transoral and cervical styloidectomy, respectively. In Group II, cure and complication rates were 87.5% and 6.2%, respectively. Due to the small sample size and heterogeneity of Group II, no statistical assessment of the contribution of styloidectomy to medical treatment (antiplatelet drugs, with or without stenting) was performed.ConclusionStyloidectomy appears to be the treatment of choice for stylohyoid syndrome. The surgical approach does not significantly influence the cure or complications rate.     

Evaluation of simultaneous bilateral same day tympanoplasty type I in chronic suppurative otitis media

ObjectiveTo evaluate the concept of bilateral same day tympanoplasty type I (BSDT) in accordance with the principle of evidence based medicine.MethodsA study with control was carried out in a tertiary care setting in a sample size of 60 patients suffering from chronic suppurative otitis media (CSOM). The patients were divided into two groups of 30 patients each, group-A comprised of unilateral CSOM cases and group-B comprised of bilateral CSOM cases. All the patients underwent tympanoplasty type I by post auricular inlay technique using temporalis fascia graft. BSDT was done in group-B. Graft and audiological success rates were tabulated and put to statistical examination using Student's ‘t’ test. In addition, post-operative pain was measured by visual analogue scale and statistically analyzed.ResultsA graft uptake of 90% and 93% was recorded in group-A and B, respectively. 27 (90%) patients reported an air-bone gap of less than 20 dB post-operatively in group-A and 94% (56 of the operated 60 ears) had an air bone gap less than 20 dB post-operatively in group-B. No case of iatrogenic sensorinueral hearing loss was recorded in this study. Further, pain was not found to be a statistically significant factor detrimental to BSDT.ConclusionBilateral same day tympanoplasty type I is a feasible treatment option in modern otology for a specific group of patients suffering from CSOM.     

Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy

IntroductionChemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck.ObjectiveTo determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO.MethodsData were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy.ResultsA total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%; p = 0.049).ConclusionThe presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.     

The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach

PurposeTo investigate the outcomes of overlay myringoplasty by comparing the endoscopic versus the microscopic approach.Materials and methodsThis is a retrospective comparative study of 181 patients who underwent myringoplasty with overlay techniques between January 2010 and 2016 at Songklanagarind Hospital, Thailand. Group 1 underwent an endoscopic-assisted (n = 90), and group 2 underwent the microscopic-assisted (n = 91) overlay myringoplasty. The outcomes were graft take rates, the audiometric results, the need of canalplasty, complications and operative time. All patients were followed up for at least 6 months.ResultsThe graft take rates were 96.7% in the endoscopic group and 91.2% in the microscopic group, p = 0.22. The operative time was 98.9 ± 11.0 min for the endoscopic group, and 176.6 ± 14.9 min for the microscope group, p < 0.001. There was no need for intraoperative canalplasty in the endoscopic group; however, 4% of cases in the microscopic group required canalplasty, p = 0.12. The postoperative air-bone gap (ABG) closure was not different between both groups, p = 0.09. Postoperative complications including post auricular numbness (p < 0.001), aural fullness (p = 0.002), and ear protrusion (p = 0.005) were found in the microscopic group more than the endoscopic group.ConclusionsEndoscopic overlay myringoplasty provided satisfactory surgical as well as audiometric outcomes when compared with the microscopic approach. The graft take rate and postoperative hearing were similar in both groups. The endoscopic approach seemed to be superior than the microscopic approach in term of operative time, complication, and no need for canalplasty.     

What is the effectiveness of beta-glucan for treatment of acute otitis media?

IntroductionAs a supplement, beta–glucan has various therapeutic healing effects generated by the immune cells. It has been scientifically approved and proven to be a biological defense modifier. The aim of this study was to investigate the effects of beta–glucan on treatments administered in an acute otitis media modelObjectivesThis study investigated the effect of beta–glucan on the treatment of acute otitis media in an acute otitis media -induced animal model. Efficacy was evaluated both immunologically and histologically.MethodsThe study sample comprised 35 adult rats, randomly separated into 5 groups of 7: Group 1 (control), Group 2 (acute otitis media, no treatment), Group 3 (acute otitis media + antibiotic), Group 4 (acute otitis media + beta–glucan) and Group 5 (acute otitis media + beta–glucan + antibiotic). Analyses were made of the histopathology and immunology examination results in respect of thickening of the tympanic membrane, epithelium damage, inflammation, and sclerosis. In all groups the serum levels of TNF-α, IL-4, IL-6 and IL-1β were evaluated.ResultsAll serum cytokine levels were significantly lower in the beta–glucan and antibiotic-treated groups compared to the acute otitis media Group. Significant differences in tympanic membrane thickness, inflammation, epithelium damage, and sclerosis values were observed between the acute otitis media + antibiotic and acute otitis media + beta–glucan Groups. According to these parameters, the values in aute otitis media + antibiotic + beta–glucan Group were markedly lower than those of the other groups. There was a significant difference in the acute otitis media + antibiotic + beta–glucan Groups compared to acute otitis media Group (p < 0.001).ConclusionsBoth antibiotic and beta–glucan treatment reduced acute otitis media signs of inflammations in an acute otitis media-induced rat model, decreasing histological damage and cytokine levels. Co-administration of antibiotic and beta–glucan led to a significant reduction in tympanic membrane thickness, inflammation, and epithelium damage. Antibiotic + beta–glucan treatment resulted in a greater decrease in tympanic membrane thickness, inflammation, and epithelium damage than in the other groups. From these results, it can be suggested that beta–glucan, in combination with antibiotics may provide an alternative for the treatment of acute otitis media.     

Topical versus interlesional mitomycin C in auricular keloids

BackgroundThe Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound.ObjectTo compare between topical and intralesional mitomycin C in the treatment of auricular keloids.Patients and methodsProspective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids.ResultsThe two groups showed no significant difference regarding patient or lesion criteria (p > .05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p < .001). However, greater improvement and satisfaction was detected in the topical group.ConclusionBoth topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.     

Kikuchi-Fujimoto disease: Report of 4 cases and review of the literature

IntroductionKikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a benign disease of unknown origin predominantly affecting young women and presenting in the form of cervical lymphadenopathy and/or prolonged fever.Material and methodsThe authors report 4 cases of Kikuchi-Fujimoto disease diagnosed in the Internal Medicine Department of Ibn Sina university hospital in Rabat between 2009 and 2010.ResultsThese 4 women with a mean age of 27 ± 8.6 years [16–37] were admitted with febrile syndrome and cervical lymphadenopathy. The diagnosis was based on histological examination of a lymph node biopsy. The disease was associated with systemic lupus erythematosus in one case and actinomycosis in another case. A favourable course was observed in response to corticosteroid therapy in two patients, antibiotic therapy in one patient and antipyretic treatment alone in the fourth patient.ConclusionIn the light of these four cases, the authors discuss the diagnostic difficulties, the modalities of treatment of Kikuchi-Fujimoto disease and its clinical course.     

Clues for facial canal dehiscence in chronic otitis media

Introduction and objectivesThe goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media.Material and methodsWe examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively.In this study we only evaluated the second portion of the facial nerve canal.ResultsThe global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM).Associations were found between facial canal dehiscence, labyrinthine fistula (p? .001) and facial nerve paralysis (p? .001).Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p = .005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p = .014; OR 4.059) and malleus, incus, and stapes together were eroded (p = .002; OR 4.929).ConclusionsThis study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence.The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles.These findings raise awareness about the usefulness of middle ear findings in predicting FCD, thus providing valuable information for the otological surgeon to avoid iatrogenic injuries.     

Comparación de pacientes con laringectomía total primaria y de rescate

Introduction and objectivesTotal laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.MethodsThe study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.ResultsThe mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026).ConclusionsAlthough organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.     

Aural stimulation with capsaicin prevented pneumonia in dementia patients

ObjectiveIn the present study, we examined the effects of daily application of capsaicin ointment to the external auditory canal for 6 months on the development of pneumonia in elderly dementia patients at high risk of aspiration.MethodsTwenty-nine oldest-old bedridden dementia inpatients at high risk of aspiration were enrolled in the present study. Ointment containing 0.025% capsaicin was applied to each external auditory canal with a cotton swab alternatively once a day for 6 months.ResultsThe incidence of pneumonia during the 6 months before the intervention was 1.80 ± 0.37 in these patients. However, this incidence significantly decreased to 0.40 ± 0.29 (p < 0.01) during the 6 months of the alternative application of capsaicin ointment to each auditory canal. No adverse effect such as otalgia was observed.ConclusionThese findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold’s ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.     

Otologic disorders in Turner syndrome

IntroductionPatients with Turner syndrome (TS) have craniofacial malformations, such as Eustachian tube hypoplasia and dysfunction and velar dysfunction, which foster acute otitis media. The aim of this study was to inventory pediatric otologic disorders in patients with TS at their first ENT consultation in our center.Patients and methodsWe reviewed the ENT consultation data of pediatric TS patients followed in our center between 2005 and 2015: otoscopy, hearing threshold, and history of acute otitis media or ENT surgery. Data were compared according to karyotype: X monosomy (45,X), mosaic (45,X/46,XX), isochromosome (46,Xi [Xq]), X ring chromosome X (XrX), with Y material, and “other”.ResultsNinety patients, with mean age 11.9 years (± 4.8 years) at first ENT consultation, were included: 29% showed tympanic abnormality on otoscopy, 21% had hearing loss, 24% had history of recurrent acute otitis media; 18% had undergone adenoidectomy, 24% T-tube insertion, and 5.6% tympanoplasty. No particular karyotype was associated with higher risk of hearing loss or acute otitis media.ConclusionPatients with TS showed high prevalence of pediatric otologic disorders; they therefore require close and prolonged ENT follow-up.     

Rhinolith: Examining the clinical,radiological and surgical features of 23 cases

ObjectiveRhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases.MethodsThe medical records and radiological findings of 23 cases, who were operated for rhinolith between January 2010 and June 2018 in Tokat State Hospital, were analyzed retrospectively. The age, gender, the side where rhinolith exists, nidus presence, type of surgery and sinonasal pathologies that accompany rhinolith, and accompanying secondary sinonasal surgeries were examined.ResultsA total of 17 (73.2%) of the 23 cases were female, and 6 (26.8%) were male. The mean age was 24.9 years. The symptoms that were seen in the patients were nasal obstruction (100%), rhinorrhea (82.6%), nasal malodor (78.2%), oral malodor (26%), headache (26%), epistaxis (17.3%), face pain (4,3%), respectively. Nidus could be detected in 6 patients. The most frequent localization of rhinolith was between the inferior concha and the nasal septum (n = 21). The most common concomitant sinonasal pathology in rhinolith was septum deviation (43.4%); and the second most common pathology was mucosal thickening (30.4%) in the maxillary sinus. The surgery type that accompanied rhinolith at the highest frequency was septoplasty (n = 5). Other surgeries were septorhinoplasty (n = 1), antrochoanal polyp excision (n = 1), adenoidectomy (n = 1).ConclusionThe most common symptoms of rhinolith, which is a rare nasal pathology, are nasal obstruction and rhinorrhea. Radiological imaging together with a rigid endoscopy is important especially to evaluate the placement of rhinolith. In addition to this, radiological imaging, evaluation of the sinuses that are not sufficiently evaluated with rigid endoscope are important for planning the type of the operation and secondary surgical procedures which may accompany.     

Cochlear implant complications in 403 patients: Comparative study of adults and children and review of the literature

ObjectivesThe purpose of this study was to assess the postoperative complications related to cochlear implants and to discuss the differences observed between adult and paediatric populations. Cochlear implant complications were defined as any pathological events observed during the postoperative period, whether or not they were directly related to the surgical technique. We therefore recorded all complications, in the broad sense of the term, ranging from acute otitis media to cochlear explantation.Study designRetrospective analysis of cochlear implant patients.Material and methodsAll surgical procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median age at the time of implantation: 51.9 years), and 235 children (median age at the time of implantation: 4.5 years). All postoperative complications were classified as either major (requiring surgical revision or hospital management) or minor (requiring conservative management).ResultsThe global complication rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor complications (60 cases). This complication rate was significantly higher in the adult population (P = 0.004).ConclusionCochlear implantation is a safe hearing rehabilitation surgical technique associated with a low complication rate. However, surgeons must be familiar with these complications in order to ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following revision surgery or device failure. Only the minor complication rate was significantly higher in the adult population.     

The importance of the differential diagnosis in rhinology: respiratory epithelial adenomatoid hamartoma of the sinonasal tract

IntroductionRespiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the nasal and paranasal sinuses. It was first described in 1995 by Wenig and Heffner, and only about 60 cases have been published since then.Material and methodsWe present 6 case studies of nasal cavity hamartoma diagnosed and treated at our institution between 2005 and 2010. We also conducted a literature review and comprehensive study of the differential diagnosis of this condition, both clinical and pathological.ResultsThe male-female ratio was 5:1, with a mean age of 63.1 years. The most frequent symptoms were nasal obstruction, rhinorrhea and loss of smell. All cases were treated with endoscopic sinus surgery, without recurrences in the follow-up period (28.2 months; SD = 11.5 months).ConclusionWe suggest that differential diagnosis should be made on the basis of nasal polyps, antrochoanal polyps, inverted papilloma and low-grade adenocarcinoma. This review of published cases is of equal interest to both pathologists and otorhinolaryngologists.     

Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck

ObjectiveTo examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.Study designRetrospective review.MethodsThe records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed. Initial treatment consisted of: surgery alone (6 patients), surgery with post-operative chemoradiotherapy (4 patients), and primary radiation therapy with concurrent chemotherapy (6 patients).ResultsThe median survival for patients treated by surgery followed by postoperative chemoradiotherapy was 30 months compared to 7 months and 9 months for patients treated by surgery alone and upfront chemoradiotherapy, respectively (p = 0.20). The 2-year locoregional control was 18% for patients treated with upfront chemoradiotherapy, 37% for patients treated with surgery alone, and 78% for patients treated with surgery plus chemoradiotherapy (p = 0.49).ConclusionWhile the potential role of selection bias must be considered, multi-modality therapy using surgery and post-operative chemoradiotherapy yielded the most favorable outcomes for SNUC and should be recommended whenever feasible.     

Anatomo-radiological study supporting the use of ipsilateral nasoseptal flap for the transpterygoid management of temporo-sphenoidal meningoceles. A review of 21 cases

ObjectivesSurgical treatment of temporo-sphenoidal meningoceles involves the reduction of the meningocele, watertight closure and defect coverage with a nasoseptal flap (NSF). It can be performed contralaterally or ipsilaterally: in the latter situation, the pedicle of the flap must be dissected into the pterygopalatine fossa. The objective of this study was to evaluate the benefit of using an ipsilateral NSF in transpterygoid approaches for the management of temporo-sphenoidal meningoceles, compared to a contralateral NSF, based on a radiological study.Material and methodsRetrospective monocentric study of 21 cases, between 2002 and 2018. Measurement of the NSF lengths, and lengths needed to cover the defect were evaluated on the preoperative scanner. Early and later failure and complication rates were evaluated.ResultsSeventeen cases of temporo-sphenoidal meningoceles with available CT scan were identified. The mean duration of follow up was 27.9 months [1–147]. Theoretical lengths of the ipsi and contralateral NSF were comparable: 71.4 ± 7.8 mm vs. 78.8 ± 8 mm, P = 0.729. In 8 cases/18 (42%), the theoretical length of the contralateral NSF was not long enough to cover the defect beyond the V2 (mean lack of 8.87 ± 6.6 mm). In all cases, the theoretical length of the ipsilateral NSF was sufficient to cover the defect. In the case series, failure and complication rates were similar.ConclusionThe use of an ipsilateral NSF for the transpterygoid management of temporo-sphenoidal meningoceles, although more complex, allows a better coverage of the defect, compared to the contralateral NSF, which is not long enough in 42% of cases.     

Accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea

IntroductionThe use of handheld devices that assess peripheral arterial tonometry has emerged as an auxiliary method for assessment and diagnosis of obstructive sleep apnea syndrome.ObjectiveTo evaluate the accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea.MethodsContemporary cohort cross-sectional study. Thirty patients with suspected obstructive sleep apnea underwent peripheral arterial tonometry and assisted nocturnal polysomnography concomitantly.ResultsThe mean apnea/hypopnea index by peripheral arterial tonometry was significantly higher than that by polysomnography (p < 0.001), but the values of both sleep studies were significantly correlated (r = 0.762). There was a high correlation between variables: minimum oxygen saturation (r = 0.842, p < 0.001), oxygen saturation < 90% (r = 0.799, p < 0.001), and mean heart rate (r = 0.951, p < 0.001). Sensitivity and specificity were 60% and 96.2% (AUC: 0.727; p = 0.113), respectively, when at a threshold value of 5 events/h. In severe cases (≥30 events/h), the result was a sensitivity of 77.8% and a specificity of 86.4% (AUC: 0.846, p = 0.003).ConclusionPeripheral arterial tonometry is a useful portable device for the diagnosis of obstructive sleep apnea; its accuracy is higher in moderate and severe cases.