[Extracranial head and neck neurogenic tumors: report of 47 cases]

Extracranial head and neck neurogenic tumors are rare and usually revealed by histological examination. The aim of this study was to review the clinical, radiological and therapeutic particularities of these tumors

Methods: This retrospective study concerns 47 patients with neurogenic tumors of the head and neck, operated on between 1989 and 2011 [22 years period]. All patients had complete physical examination and ultrasonography was performed when a cervical extension was found. CT scan and MRI were performed in 16 cases. Minimum follow up was 4 years

Results: A sinusonasal tumor was found in 9 cases and a cervical mass was seen in 28 cases. Parapharyngeal extension was observed in two cases

Two patients had tympano-jugular glomic tumors and 8 of them had a cervical soft tissue tumor

Complete surgical resection was performed in 46 patients

Histological examination revealed a benign tumor in 91% of cases [n=43], 24 of them were schwannomas. Malignant tumors were seen in 4 cases: esthesioneuroblastoma [3 cases] and malignant schwannoma [1 case]. These patients received post operative radiotherapy

After surgery, two patients had Claude Bernard Horner syndrome and one had a definitive facial nerve palsy

Conclusion: Extracranial head and neck neurogenic tumors may have several aspects depending on their localisation and their histological type. Surgery, when performed, should be complete with minimum complications

[Neonatal hearing screening with transient otoacoustic emissions: polit study]

Bilateral hearing loss is present in 1-3 per 1000 newborn infants, and in 2-4 per 100 infants in the intensive care unit population. All infants with hearing loss should be identified before 3 months of age and receives intervention by 6 months. If undetected, this will impede speech, language, and cognitive development. In Tunisia, we do not have an exhaustive information on the real importance of the auditive handicap. The aim of our study was to evaluate the feasibility and the practical aspects of a pilot tunisian universal neonatal hearing screening [UNHS] program based on transient evoked otoacoustic emission reporting the incidence of hearing impairment in this population. A prospective study during one year [01/05/2006 to the 30/04/2007]. Transient evoked otoacoustic emission was planned for all live births. If the test could not be practised in maternity or that research was negative, an appointment was delivered for a research of the O.T.E A P in an interval of I week-1 month. Infants who did not meet TEOAE pass criteria underwent diagnostic auditory brainstem response [ABR] testing. During the study period, 3342 live births were recorded, 3260 were included. Total coverage rate was of 41%[1333/3260]. We recorded 3 cases of bilateral hearing loss [0.9%screened infants] and 5 with unilateral sensorineural hearing loss [1.5%screened infants] The incidence of congenital hearing loss in our population seems relatively high. Hearing screening for all neonates using transient evoked otoacoustic emission is feasible but several practical aspects should be revised

[Tumors of salivary glands: anatomical study and clinical epidemiology of a series of 180 cases]

The salivary gland tumors are rare [less than 3% of all tumors] and poorly known. In fact, they are numerous and histologically difficult to diagnose. This work aims to point at the different histological types of salivary gland tumors, to draw out the principal epidemiological, clinical, radiological and histological characteristics, and to compare our cases to those of the literature. Accordingly, we performed a descriptive type study about 180 cases of salivary gland tumors from the departments of pathology and oto-rhino-laryngology of Habib Thameur hospital during 25 years, extending from April 1979 to December 2004. Benign tumors were predominant [88%], while malignant ones represented 12% of our cases dominated by carcinomas. The sex-ratio was 0.96. Parotid gland location was the most frequent one, and pleomorphic adenoma was the most frequent tumor [62%]. Histological diversity of salivary tumors results in difficulties for differential diagnosis. These problems can be solved by a precise diagnostic approach and sometimes by an immunohistochemistry study

Causes and management of failure in endoscopic middle meatus antrostomies

The aim of this study is to analyse the causes and the management of failed endoscopic middle meatus antrostomies [EMMA] in chronic sinusitis and benign sinonasal lesions or tumors. We carried a retrospective study about 257 EMMA cases performed in our department for 201 patients between 1996 and 2006. All patients had complete ORL examination and preoperative sinonasal CT. After surgery, preoperative and postoperative symptoms were compared and nasal endoscopy was performed in all cases. Persistent rhinologic and radiological symptoms were considered as a failure of surgery. In these cases, revision surgery was performed, either by endoscopic approach or by Caldwell-Luc procedure. Mean follow-up period was 2 years. The indication of surgery was the presence of chronic sinusitis, benign lesions or benign tumors in 53.2%, 41.8% and 5% of cases respectively. Seventy-one EMMA procedures failed [27.6%]. Causes of failure were mainly represented by the presence of synechia [38%], ostium stenosis [24%], medical causes and comorbidity [15.5%], persistent or recurrent lesions [15.5%] and missed natural ostium [7%]. Nineteen patients [9.4%] required revision surgery because of persistent symptoms after medical therapy. Either endoscopic or vestibular approaches were performed. Seventy-three percent of the revision cases respond to surgical treatment with complete resolution of symptoms. Failure of EMMA can be due to numerous and variable causes. The management of failed EMMA includes medical therapy, revision endoscopic surgery or vestibular approaches

[Recurrent upper respiratory tract infections in children and allergy: a cross-sectional study of 100 cases]

Upper respiratory tract [URT] infections are common in children. The knowledge of their risk factors allows in some cases better management. The aim of our study is to evaluate the role of allergy in this pathology. Through a cross-sectional study about 100 children having recurrent URT infections, we evaluated the prevalence of allergy in order to find a relation between the two pathologies in general, and between allergy and each recurrent pathology. The results were compared with those of a reference group involving 164 children. Our study confirms a statistically significant association between allergy and, recurrent URT infections [p=0,01], also between allergy and rhinopharyngitis [p=0,02], rhinosinusitis [p=0,001] and acute otitis media [p=0,01]. Allergy represents a risk factor for recurrent URT infections, particularly for rhinopharyngitis, rhinosinusitis and acute otitis media. Adequate management of allergy may consequently be beneficial for the treatment and the prevention of these infections

[Chronic laryngitis in adults]

Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specifc aetiology and often irritative factors. To discuss clinic and therapeutic aspects of the pathology. We report a retrospective study about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years [1994-2004]. The average age of the patients was 54, 2 years. Tobacco intoxication was noted in 72,7 of cases and Gastroesophageal reflux in 2 cases. The endoscopic examination of laryngeal lesions, realized in all cases, notes laryngeal keratosis in 88% of cases and congestive laryngitis in 12%. Histological analysis of the lesions reveals a dysplasia in 44% of cases. Clinical and endoscopic follow up of the patients discover malignant development in 5 patients. The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques

Plummer vinson syndrome

Plummer Vinson syndrome is a rare affection which affects mainly white women. It is characterized by dysphagia, iron deficiency and the presence of superior esophageal web. Aim: The purpose of this study is to precise the epidemiological, clinical, paraclinical and therapeutical features of the affection. We report 19 cases of Plummer Vinson syndrome collected over 15 years [1990- 2004]. Dysphagia is the main symptom observed in 100% of the cases. 89,4% of the patients had anemia and 15 hyposideremy. All the patients were treated with iron supplementation and endosco-pic treatment [dilatation and rupture of esophageal webs]. Three patients necessitate multiple sessions of endoscopic dilatation and 15 had favourable evolution. The malignancy was observed in one case

[Idiopathic sudden sensorineural hearing loss what's the appropriate management]

Background: Sudden sensorineural hearing loss remains a challenge in otology, controverse affect mainly etiopathogeny and treatment

Aim: To evaluate our experience in the diagnosis and the treatment of sudden hearing loss

Methods: We report a retrospective study including 30 patients presenting a Sudden sensorineural hearing loss. All patients were hospitalized for treatment. The audiometry evaluated the hearing deafness before and after treatment

Results: The average age was of 48 years. In all the cases no etiology has been found

All The patients were hospitalized and corticotherapy was administrated in all cases. It was associated to hyperbare oxygenotherapy in 7 patients

Recovery was observed mainly in patients with moderate [71.4%] and severe hearing deficiency [69.2%]

Conclusion: corticosteroids are the less controversed treatment of sudden sensorineural hearing loss

[Naso-sinusienne sarcoidosis]

Background: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare

Aim: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47,5 years [42-56]. These cases was diagnosed and treated between January 1998 and December 2003 in the ENT service of the Habib Thameur hospital

Cases: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extention was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization

[ laryngopyocele]

Background: The laryngopyocele is a laryngocele complication

Aim: We report two cases that were treated in Habib Thameur Hospital ENT service

Cases: There were an 81 old woman and a 31 old man who consult for an infectious syndrome with a lateral neck masses. The diagnosis was obtained by clinical and endoscopic examination and was confirmed by CT. The man was operated. On antibiotics were prescribed for both. They had a well recovery

[CT findings in otosclerosis: a series of 11 cases]

Our study's aim is to evaluate the reliability of computed tomography in diagnosis, extension and post-surgical follow-up of otosclerosis. A group of 11 patients was examined during a period of 25 months from 2002 to 2004. All of them had clinically and audiometrically suspected otosclerosis with bilateral conductive hear loss in 7 cases [3 had surgical management], unilateral in 2, and mixed earing loss in 2. High resolution CT was performed once in 8 patients and twice in the 3 operated. CT showed otosclerosis foci in all our study's patients, which was bilateral in 9 and unilateral in 2. The extension of the Lesions varied from type 1A to type 4B according to the otosclerosis staging. Computed tomography is, so far, the most efficient imaging modality in otosclerosis, showing otosclerosis foci when the clinical features are doubtful, allowing an accurate extension of the lesions and detecting complications during post-surgical follow-up