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BACKGROUND: Burnout can significantly impact practitioners and their co-workers, and hence patients. There are no data for the prevalence of burnout in French ENT specialists, or for associated risk factors. MATERIAL AND METHODS: A French national cross-sectional online survey was performed on the initiative of the ENT National Professional Council (CNPORL), contacting all ENT specialists whose e-mail address was known to the French Society of ENT, the National Professional Council or the National ENT Union. The 22-question Maslach Burnout Inventory (MBI) was sent out, along with 16 extra questions on possible risk factors. OBJECTIVES: The study sought to assess the prevalence and severity of burnout, using the MBI, and to analyze risk factors. RESULTS: Among the 1936 physicians, 406 contacted responded to the questionnaire (21%). Mean age was 47±14 years (range, 25-77 years); 53% male, 47% female. 196 (48%) reported burnout, including 20 (5%) severe burnout. Independent risk factors for burnout of whatever severity, comprised social interaction issues, history of identified burnout, and medicolegal pressures. Social interaction issues were independently associated with specifically severe burnout. CONCLUSIONS: Burnout affected almost half of respondents. There are identifiable risk factors, for which improvements could be implemented.
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INTRODUCTION: Silent sinus syndrome (SSS) is a rare entity, almost exclusively involving the maxillary sinus, frontal location being very rarely reported. The aim of the present study was to describe clinical and radiological characteristics and surgical treatment using the CARE methodology. RESULTS: One woman and 2 men were referred for chronic unilateral frontal pain with imagery showing silent sinus syndrome. All showed partial or complete liquid opacification of the affected sinus associated with a thin interfrontal sinus (IFS) retracted toward the affected sinus. Functional endoscopic sinus surgery was performed in all cases, with good functional results. DISCUSSION: We describe 3 cases of SSS with IFS involvement. The frontal sinus wall seemed most vulnerable, probably most liable to be weakened by atelectasis. The study suggests that frontal SSS can be an etiology in chronic frontal sinusitis. Preoperative findings of IFS retraction are useful for surgical restoration of frontal sinus ventilation, relieving chronic pain and preventing complications.
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Enoftalmia , Doenças dos Seios Paranasais , Masculino , Feminino , Humanos , Enoftalmia/complicações , Enoftalmia/cirurgia , Tomografia Computadorizada por Raios X , Síndrome , Doenças dos Seios Paranasais/complicações , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/cirurgia , Seio Maxilar/cirurgia , EndoscopiaRESUMO
AIMS: Otosclerosis can severely impact quality of life, but no questionnaire is available in French. The present study aimed to adapt and validate a French version of the SPOT-25. MATERIALS AND METHODS: A controlled prospective study was conducted between September 2021 and April 2022. The translation used the "forward-backward" technique and statistical validation was performed in non-operated adult otosclerosis patients (cases) and a control group. Assessment Internal consistency, discrimination performance and test-retest reliability were assessed on global score, subscores and items. RESULTS: Fifty-one cases and 58 control subjects filled out the test questionnaire and 35 of the 51 cases, also filled out the retest. Internal consistency on Cronbach alpha was 0.95 for the cases. Median total SPOT-25 score was 44 (range, 10-78) for cases and 2 (range, 0-33) for controls (p= P<0.0001). Test-retest reliability on intraclass correlation coefficient was excellent (ICC=0.92; [95% CI, 0.84-0.96]). Individual items all showed satisfactory performance. CONCLUSION: The French version of SPOT-25 was short and easy to use, with satisfactory performance in assessing quality of life in otosclerosis patients.
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Otosclerose , Qualidade de Vida , Adulto , Humanos , Idioma , Otosclerose/cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
COVID-19 research has been produced at an unprecedented rate and managing what is currently known is in part being accomplished through synthesis research. Here we evaluated how the need to rapidly produce syntheses has impacted the quality of the synthesis research. Thus, we sought to identify, evaluate and map the synthesis research on COVID-19 published up to 10 July 2020. A COVID-19 literature database was created using pre-specified COVID-19 search algorithms carried out in eight databases. We identified 863 citations considered to be synthesis research for evaluation in this project. Four-hundred and thirty-nine reviews were fully assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) and rated as very low-quality (n = 145), low-quality (n = 80), medium-quality (n = 208) and high-quality (n = 151). The quality of these reviews fell short of what is expected for synthesis research with key domains being left out of the typical methodology. The increase in risk of bias due to non-adherence to systematic review methodology is unknown and prevents the reader from assessing the validity of the review. The responsibility to assure the quality is held by both producers and publishers of synthesis research and our findings indicate there is a need to equip readers with the expertise to evaluate the review conduct before using it for decision-making purposes.
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COVID-19 , Pesquisa/tendências , Revisões Sistemáticas como Assunto/normas , Humanos , Metanálise como Assunto , Pesquisa/normasRESUMO
PURPOSE: To report the results of Botulinum Toxin A (BTA) for radiation-induced head and neck pain. MATERIALS AND METHODS: This single-center retrospective study included all the patients treated at our institution with botulinum toxin A injections for radiation-induced head and neck pain between 2006 and 2017. Pain was evaluated by each patient on a visual analogue scale (VAS) (between 0 and 10) before, and 1 month after the injection. RESULTS: Sixteen patients were included in this series. The mean value of the pain was 8.5 before and 8 after the first injection. The difference was statistically significant (p<0.01). Major response occurred in 15 patients (VAS≤3 after BTA) and complete response in 11 patients (VAS=0 after BTA). CONCLUSION: Botulinum toxin is an effective treatment for radiation-induced head and neck pain.
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Toxinas Botulínicas Tipo A/uso terapêutico , Cervicalgia/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Radioterapia/efeitos adversos , Adulto , Idoso , Eletromiografia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Estudos Retrospectivos , Escala Visual AnalógicaRESUMO
The Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines concern the management of otitis media with effusion (OME) in children under the age of 12 years. They are based on extensive review of MEDLINE and Cochrane Library publications in English or French from 1996 to 2016 concerning the methods of diagnosis and assessment of otitis media with effusion, as well as the efficacy of tympanostomy tubes and medical and surgical treatments of OME.
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Otite Média com Derrame/terapia , Criança , Humanos , Resultado do TratamentoAssuntos
Neoplasias Ósseas/diagnóstico , Osso Etmoide/patologia , Fibroma Ossificante/diagnóstico , Neoplasias Cranianas/diagnóstico , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Osso Etmoide/cirurgia , Fibroma Ossificante/cirurgia , Gadolínio , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Cranianas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Conduta ExpectanteRESUMO
OBJECTIVES: To report about our 10 years' experience about the treatment of drooling by ultrasound guided botulinum toxin injections. MATERIAL AND METHODS: Retrospective monocentric study including all the patients suffering from drooling and treated by ultrasound-guided botulinum toxin injections into the salivary glands between 2004 and 2015. The etiology of r drooling, the doses of toxin, the injected glands, the size of the glands measured by ultrasonography, the effectiveness of the treatment and the side effects were assessed. RESULTS: Two hundred and ninety-two injections sessions were performed in 61 patients. Exactly 70.5 % of patients reported an improvement after the first session. Parkinson's disease was the main etiology of drooling (43 % of the patients). Eleven patients reported side effects. The salivary gland volume reduced after treatment in 46 % of the patients. DISCUSSION: The interest of ultrasound-guidance is to make sure about the intraglandular injection, to lower the risk for extraglandular diffusion of the toxin responsible for swallowing disorders and to allow for an adaptation of the doses to the volume of the salivary glands, which may vary during treatment.
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Toxinas Botulínicas Tipo A/administração & dosagem , Transtornos de Deglutição/tratamento farmacológico , Glândulas Salivares/diagnóstico por imagem , Sialorreia/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/efeitos adversos , Criança , Pré-Escolar , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Injeções/efeitos adversos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândulas Salivares/efeitos dos fármacos , Glândulas Salivares/patologia , Sialorreia/diagnóstico , Sialorreia/patologia , Ultrassonografia de Intervenção/efeitos adversos , Adulto JovemRESUMO
OBJECTIVES: To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. DESIGN AND SETTING: Multicentre retrospective study in eight tertiary referral hospitals over 17 years. PARTICIPANTS: Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. MAIN OUTCOME MEASURES: Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. RESULTS: In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. CONCLUSIONS: We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery.
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Traumatismos do Nervo Facial/etiologia , Complicações Intraoperatórias , Mastoidectomia/efeitos adversos , Otite Média/cirurgia , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Europa (Continente)/epidemiologia , Traumatismos do Nervo Facial/diagnóstico , Traumatismos do Nervo Facial/epidemiologia , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The management of hypervascular ENT tumors is usually complex and requires a multidisciplinary approach because of the risk of serious intra-operative bleeding and of potential injuries to cranial nerves and/or large cervical vessels. Over the last four decades, advances in neuro-interventional radiological procedures have produced a range of adjunctive endovascular techniques in addition to conventional surgery. A pictorial essay in ENT specialty is presented in this article highlighting the most relevant innovations in interventional radiology.
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Otolaringologia , Radiologia Intervencionista , Hemorragia/terapia , Humanos , Artéria Oftálmica , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Zumbido/terapiaAssuntos
Granuloma de Células Plasmáticas/diagnóstico , Laringoscopia , Doenças Nasais/diagnóstico , Pseudotumor Orbitário/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Gadolínio , Granuloma de Células Plasmáticas/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Procedimentos Cirúrgicos Nasais/métodos , Neoplasias Nasais/diagnóstico , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pseudotumor Orbitário/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: Facial nerve injury is a rare complication of middle ear surgery. To date there is no widely accepted consensus on the use of intraoperative facial nerve monitoring during middle ear surgery, whereas its use has been proved as a valuable adjunct in neurotologic surgery. The purpose of our study was to identify introperative facial nerve monitoring practice patterns in France for middle ear surgery. METHODS: A 19-item survey has been made up by three experienced otologists under the auspices of the French Otology and Neurotology Association. With the support of the French Society of Otolaryngology--Head and Neck Surgery, the survey was electronically sent by email to 1249 practicing ENT with a valid email address. Answers were analyzed two months later. RESULTS: Among 1249 email sent, 299 were opened (24%) and 83 answers were collected (6,6%). Of the respondents, 66% had access to intraoperative facial nerve monitoring. Otolaryngologists involved in academic setting were influenced by their teaching duty in 27%. Intraoperative facial nerve monitoring should not be required for stapes surgery, ossiculoplasty, myringoplasty for, respectively, 92%, 93 % and 98% of the respondents. In cochlear implantation, 78% of ear surgeons used facial nerve monitoring. Answers were more controversial for chronic ear surgery, ear atresia and middle ear implant. Revision surgery and CT scan can influence answers. CONCLUSION: Despite a low response rate, results of this national survey revealed interesting findings. For most of the respondents, intraoperative facial nerve monitoring was not indicated in stapes surgery, myringoplasty and ossiculoplasty. The use of intraoperative facial nerve monitoring for cochlear implantation was supported by the majority of respondents. Variations in response rate were more significant for chronic ear surgery, including middle ear cholesteatoma, and for ear atresia surgery.
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Otopatias/cirurgia , Orelha Média/cirurgia , Nervo Facial/fisiologia , Monitorização Intraoperatória/métodos , Padrões de Prática Médica , França , Humanos , Pessoa de Meia-Idade , Otolaringologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND PURPOSE: Stapes surgery for otosclerosis can be challenging when the oval window niche is narrow. We analyzed the reliability of CT to evaluate the height of the OWN and propose a quantitative criterion to distinguish normal and narrow OWNs. MATERIALS AND METHODS: Fifty-six patients were scheduled for primary stapes surgery and, with available preoperative CT scans, were prospectively enrolled in the study at a tertiary care hospital. OWN height was measured on coronal CT and qualitatively evaluated during surgery. CT findings and surgical observations were matched to determine the preoperative imaging criterion of a narrow OWN. RESULTS: OWN was found to be narrow during surgery in 8 of 56 patients (14%). On CT, mean OWN height measurement was 1.1 mm for the narrow group and 1.8 mm for the normal OWN surgical cases. The cutoff between normal and narrow OWN was computed at 1.3 mm by using discriminant analysis and at 1.4 mm with boxplot analysis. These CT cutoff values allowed a correct classification of "normal" and "narrow" OWN, compared with visual evaluation during surgery. CONCLUSIONS: Measurements of the OWN height provide an accurate and relevant evaluation of this region before otosclerosis surgery. A width below 1.4 mm should be considered at risk for technical difficulties during the stapes footplate approach.
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Otosclerose/diagnóstico por imagem , Otosclerose/cirurgia , Janela do Vestíbulo/diagnóstico por imagem , Janela do Vestíbulo/cirurgia , Cirurgia do Estribo/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Janela do Vestíbulo/anormalidades , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Middle ear cholesteatoma is an aggressive form of chronic otitis media requiring surgical therapy. The surgical strategy depends on the location of the lesion, its extensions to the middle ear and mastoid, the anatomical conformation of the tympanomastoid cavities and the health status of the patient (as well as his or her interest in aquatic leisure activities). For several years, imaging of the ear has been a routine test in the preoperative work-up of the disease. National guidelines for the topic "Imaging of non-operated middle ear cholesteatoma" were prepared in October 2010, for the annual congress of the French Society of Otolaryngology Head and Neck Surgery (SFORL), by a panel of experts from the SFORL, represented by the French Association of Otology and Neuro-otology (AFON), and the French Radiological Society (SFR), represented by the French Society of Head and Neck Imaging (CIREOL). These guidelines are presented in the present article.
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Colesteatoma da Orelha Média/diagnóstico , Imageamento por Ressonância Magnética , Tomografia Computadorizada Espiral , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Meios de Contraste/administração & dosagem , Orelha Interna/patologia , Orelha Média/patologia , Humanos , Otite Média/complicações , Otite Média/diagnóstico , OtoscopiaRESUMO
INTRODUCTION: Mastoid osteoma is a rare benign tumour. In this article, the authors report two new cases of mastoid osteoma and discuss the modalities of diagnosis and management. CASE REPORTS: Both patients presented with a retroauricular mass that had been slowly increasing in size over several years. The patients consulted for the cosmetic deformity induced by the lesion or moderate tenderness. The diagnosis was based on the clinical presentation and non-contrast CT. The osteoma was surgically resected in one patient. DISCUSSION/CONCLUSION: Mastoid osteoma is a rare, slowly growing, and usually asymptomatic benign tumour. Diagnosis is based on clinical findings and CT. Surgery is indicated for symptomatic or cosmetically unacceptable osteomas.
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Neoplasias Ósseas/patologia , Processo Mastoide/patologia , Osteoma/patologia , Adulto , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Osteoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Osteomas of the temporal bone are benign osseous tumors usually located to the external auditory canal. Osteomas involving the middle ear are very rare. We report the case of a patient presenting with a progressive hearing loss caused by a middle ear osteoma involving the incus and contiguous to the tympanic segment of the facial nerve. This report highlights the value of CT scan in the work-up of conductive or mixed hearing loss with normal tympanic membrane. The management of middle ear osteoma is discussed.
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Neoplasias da Orelha/diagnóstico por imagem , Perda Auditiva Condutiva/etiologia , Bigorna/diagnóstico por imagem , Osteoma/diagnóstico por imagem , Estribo/diagnóstico por imagem , Membrana Timpânica , Adulto , Audiometria , Neoplasias da Orelha/complicações , Neoplasias da Orelha/patologia , Neoplasias da Orelha/cirurgia , Ossículos da Orelha/diagnóstico por imagem , Feminino , Humanos , Bigorna/patologia , Bigorna/cirurgia , Invasividade Neoplásica , Osteoma/complicações , Osteoma/patologia , Osteoma/cirurgia , Procedimentos Cirúrgicos Otológicos , Estribo/patologia , Cirurgia do Estribo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Arachnoid granulations play a role in CSF drainage. They are primarily located adjacent to cerebral venous sinuses. They may arise on a bony surface causing progressive bony erosion. We report two cases of arachnoid granulations eroding the posterior wall of the temporal bone. The aim of this paper was to illustrate the clinical presentation, and the imaging findings of arachnoid granulation of the posterior wall of the temporal bone. They remain asymptomatic in most cases, but they might cause a communication between the subarachnoid space and mastoid air cells, increasing the risk of bacterial meningitis, subdural empyema, and other intracranial infections. Differential diagnoses are also described, including endolymphatic sac tumours.
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Aracnoide-Máter/anormalidades , Osso Temporal/patologia , Aracnoide-Máter/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Palatal tremor is a rare neurotological disorder responsible for objective tinnitus in children. Palatal tremor may be symptomatic of an underlying neurological disease or essential when a cause cannot be identified. We report a case of an essential palatal tremor in a 10-year-old girl complaining of clicking tinnitus. No treatment was undergone as she was not obviously bothered by the ear-clicking sound. Different treatment modalities have been used for distressing tinnitus related to palatal myoclonus. Recently several publications reported satisfactory results with botulinum toxin injection, which seems to be the treatment of choice.