Glottal Features in Vocal Assessment Following Thyroidectomy.

OBJECTIVES: Vocal dysfunction is a frequent complication following thyroidectomy that can be associated with a negative impact on patients' quality of life. Although the effect of thyroidectomy on acoustic features has been widely studied, the examination of glottal flow characteristics to assess vocal outcomes following thyroid gland surgery has not been included in empirical research, to date. The goal of our study was to evaluate early and short-term vocal outcomes following thyroidectomy based on the analysis of glottal acoustic features during speech production. STUDY DESIGN: Prospective analytical study. MATERIALS AND METHODS: We evaluated vocal outcomes in patients who underwent thyroidectomy between September 2021 and March 2022. We extracted glottal flow features from their vocal recordings preceding surgery and postoperatively at Day1 and Month1 postoperatively. The extraction of glottal features was performed using a signal processing-based approach. We extracted the following features: Open quotients (OQ1 and OQ2), Quasi-open quotient (QoQ), Closing quotient (ClQ), Amplitude quotient (AQ), Normalized Amplitude quotient (NAQ) and Speed quotients (SQ1 and SQ2). We included 39 patients. OQ2 and QoQ decreased significantly at Day1 and Month1. OQ1 and NAQ decreased significantly at Month1. ClQ remained stable at both postoperative assessments. AQ decrease was not significant at both dates. SQ1 increased at Day1 and Month1 but the change was not significant. SQ2 decreased significantly at both Day1 and Month1. OQ, QoQ, AQ, NAQ, and SQ2 did not recover at Month1. We noted that the decrease of SQ1 and SQ2 correlated significantly with the increase of the Voice Handicap Index-10 (VHI-10) at Month1. CONCLUSION: The analysis of glottal acoustic features can be a reliable modality to detect vocal changes following thyroidectomy. Thyroidectomy was associated with a vocal dysfunction that was manifested by the decrease of open, amplitude, and speed quotients. Glottal features can present a potential tool to objectively assess the effect of thyroidectomy on vocal folds movements.

A juvenile pleomorphic adenoma of the palate.

Salivary gland tumors in children are rare; involvement of accessory salivary glands is exceptional. We report a case of pleomorphic adenoma of the palate in a child (an 8-year-old girl) addressed by her dentist for discovering a swelling in the palate. Clinical examination revealed a firm, non-tender, nodular swelling in the left hard palate, measuring 1.5 cm × 1.5 cm, situated adjacent to the upper left second molar. Physical examination did not show signs of inflammation or surface ulceration. Oral cavity computed tomography scan did not show bone lysis. The tumor was removed with negative margins. No recurrence was noted. We aim to describe the clinical, radiological features, as well as the management of this rare localization of pleomorphic adenoma.

Apocrine Hidrocystoma of the Parotid Gland.

Apocrine hidrocystoma is a cystic tumor originating from apocrine sweat glands. It is predominantly located in the eyelid margins. Here, we report a case of apocrine hidrocystoma of the parotid gland in a 19-year-old man who was referred to our outpatient clinic with a 5-year history of a gradual swelling in the left parotid region. The patient underwent left superficial parotidectomy. Histological examination confirmed the diagnosis of apocrine hidrocystoma. The case is original by the tumor's location: to the best of our knowledge, this could be the first case in English and French literature reporting an apocrine hidrocystoma affecting the parotid gland. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its differential diagnoses.

Traumatic Pseudoaneurysm Arising From Proximal Facial Artery: A Case Report and Literature Review.

Pseudoaneurysms of facial artery usually arise from the distal part of the vessel. Only 4 cases were described in the literature involving the proximal part of facial artery. We present a case of a traumatic pseudoaneurysm involving the proximal part of facial artery. A 50-year-old man was referred to our department for a progressively growing submandibular mass. He was injured by a sharp object during a car crash 30 days ago. After 3 weeks, the patient noted the appearance of a subcutaneous mass in the left submandibular area. Physical examination revealed a freely movable, painful, and pulsatile swelling. Ultrasound and computerized tomography scan showed a nodular lesion in the left submandibular area in continuity with the facial artery. The diagnosis of pseudoaneurysm of facial artery was suspected. The patient was treated by surgery. The pseudoaneurysm was resected with ligation of the proximal and distal ends of the facial artery.

The Effect of Topical Tranexamic Acid in Endoscopic Sinus Surgery: A Triple Blind Randomized Clinical Trial.

OBJECTIVE: Our aim is to evaluate the effect of topical tranexamic acid (TA) on bleeding and surgical quality field in the functional endoscopic sinus surgery (FESS). METHODS: A total of 74 patients who underwent FESS due to chronic rhinosinusitis were included. The patients were randomized into 2 groups. TA group (n = 37) received a topical cotton pledget soaked with TA and placebo (PL) group (n = 37) received a pledget soaked with saline solution. RESULTS: A significant effect was noted for the TA group versus the PL group in the grade 1 of the Boezaart scale at 35 minutes (4 for TA group and no case for PL group). This effect was absent for higher grades. We did not notice a significant effect between the 2 groups at 5 minutes. Blood loss was 359 ml in the TA group versus 441 ml in the PL group. No significant change was observed between the 2 groups concerning the blood parameters. No side effects were reported. CONCLUSION: Despite its safety when administrated locally and its low cost, TA provides limited effect on quality of surgical field after 35 minutes of the start of FESS in the patients with chronic rhinosinusitis. This effect was absent at the start of the intervention and when analyzing the blood loss and hematologic parameters.

Red blood cell distribution width in Obstructive Sleep Apnea Syndrome and its association with cardiovascular disease.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular disease (CVD). Red blood cell distribution width (RDW) is reported as a novel marker of cardiovascular disease (CVD) risk. We aimed to investigate the correlation of RDW level with the severity of Obstructive Sleep Apnea Syndrome (OSAS) defined with the apnea-hypopnea index (AHI) and to study the relationship between RDW and CVD in OSAS. METHODS: From retrospective analyses of patients admitted to our department for polygraphy between January 2018 and January 2020, OSAS patients with complete medical records and hemogram analyses were evaluated. RESULTS: The study population consisted of 160 patients (101 females/59 males). The mean age was 52.32 ± 10.83 years. RDW correlated positively with the apnea hypopnea index (AHI) (r=0.392; p < 0.0001) and C-reactive protein (CRP) (r = 0.3, p < 0.001). RDW and CRP were significantly higher in patients with CVD than whom without CVD (p < 0.0001). In multivariate analysis, the independent predictors of CVD in OSAS were RDW (p < 0.0001; OR=3.095; CI: 1.69-5.66), CRP (p=0.046; OR=1.136; CI: 1.002-1.287) and age (p=0.013; OR=1.085; CI: 1.017- 1.157). The cut-off level for RDW with optimal sensitivity and specificity was calculated as 14.45 with sensitivity of 81% and specificity of 75%. CONCLUSIONS: The findings of this study suggest that RDW, a simple, relatively inexpensive and universally available marker could have the ability to predict CVD in OSAS.

Actinomycosis of the middle turbinate.

Actinomycosis is an uncommon bacterial disease caused by actinomyces. Cervicofacial infection accounts for more than 60% of all cases. However, nasal and paranasal sinus involvement has rarely been described. We report herein a case of a patient presenting with middle turbinate actinomycosis.

Nasopharyngeal Metastasis from Breast Carcinoma: A Case Report and a Review of the Literature.

Metastasis to the nasopharynx is a rare clinical entity. Breast carcinoma is one of the primary tumors that can be responsible for a nasopharyngeal metastasis, which is an extremely rare occurrence. We report the case of a 50-year-old woman with a history of a confirmed breast carcinoma under chemotherapy who presented to our department with a unilateral hearing loss and tinnitus. Nasal endoscopy revealed a small bulging mass at the posterior wall of the nasopharynx. The biopsy of the lesion showed an infiltration of the nasopharyngeal mucosa by a mammary adenocarcinoma that was positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2. Computed tomography scan revealed a thickening of the nasopharyngeal mucosa, a pleural and pericardial effusion and diffused secondary bone lesions. The patient received chemotherapy. Control revealed a partial regression of the nasopharyngeal mass. The patient is still under chemotherapy.

Prediction of difficulty in direct laryngoscopy.

To establish easily measurable and reproducible preoperative parameters predicting difficult laryngeal exposure in direct laryngoscopy. A prospective study including 71 patients who underwent transoral microsurgery for benign or malignant lesions of the larynx was performed in our department from January 2021 to November 2021. Physical assessment included the Mallampati score, weight, height, body mass index and measurements of seven parameters in the cervical region. Eleven parameters were measured on the cervical radiography film. Among our patients, 19 were included in the difficult laryngeal exposure (DLE) group. High Mallampati and Cormack scores were significantly associated with DLE (p = 0.005 and p < 0.0001). Limited mouth opening, direct thyromental distance (DTMD) < 67 mm in neutral position, DTMD < 82 mm and sternomental distance < 157 mm at full head extension were statistically related to DLE. For radiological assessment, the effective length of the maxilla and the atlanto-occipital distance were related to DLE. Using stepwise logistic regression, only the effective length of the maxilla and atlanto-occipital distance were selected as independent predictors for DLE (p: 0.015 and 0.001). Preoperative prediction of DLE is useful for both surgeons and patients. The length of the maxilla and the atlanto-occipital distance were found to be independent risk factors for DLE. This highlights the effect of overgrowth of the maxilla, protrusion of the upper teeth and limited extension of the cervical spine as the major risk factors for difficult laryngeal exposure.

Ectopic Cervical Thymic Hyperplasia In A Patient Treated For Hodgkin Lymphoma.

True thymic hyperplasia results from stressful situations such as chemotherapy. It commonly presents as an anterior mediastinal mass; cervical location is exceptional. Here we report a case of a cervical true thymic hyperplasia in a 12-year-old girl who had a Hodgkin lymphoma treated by radiotherapy and chemotherapy. She was referred to our department for a left cervical mass. The PET scan showed a hypermetabolic adenopathy. Mediastinal MRI was unremarkable. The patient underwent resection of the cervical mass under general anesthesia. Pathological examination confirmed the diagnosis of a true thymic hyperplasia. The aim of this paper is to illustrate a case of an incidental ectopic cervical thymic hyperplasia in a patient treated for Hodgkin lymphoma.

Unusual Neurological Manifestation of Langerhans Cell Histiocytosis in an Adult.

Langerhans Cell Histiocytosis is a rare disorder characterized by an abnormal proliferation of Langerhans cells in one or multiple organs. It rarely presents with a central vestibular involvement. We report a case of a multisystem Langerhans Cell Histiocytosis with mucosal, hepatic, and neurological involvement, presenting with dizziness and balance disorders. A 39-year-old woman with a histopathologically confirmed mucosal palatal Langerhans Cell Histiocytosis presented with a history of dizziness for a year. Vestibular examination revealed a saccadic eyes pursuit, an up beating spontaneous nystagmus, a bilateral gaze nystagmus and a prolonged positional nystagmus, in the supine roll test. Pure tone audiometry showed a slight left sensorineural hearing loss at the 8000 Hz frequency. Computed tomography (CT) scan showed a bilateral maxillary sinus fullness and a peripheral osteosclerosis of the surrounding bony walls. Hepatic magnetic resonance imaging (MRI) showed a typical hepatic involvement with a hepatomegaly with countless cysts. Temporal bone CT scan and MRI were normal. Cerebral MRI showed an hyperintense nodular signal at T2 FLAIR weighted images lateral to the right pons, at the level of the left middle cerebellar peduncle and at the left mesencephalon. Balance disorders can rarely present a sign of a degenerative neurological cerebellar involvement. Such a rare manifestation can present in different neurological disorders such as Langerhans' cell Histiocytosis.

Laryngeal Myxoma: A rare localization.

INTRODUCTION: Myxomas are benign mesenchymal neoplasms which arise mainly in the heart. The laryngeal localization is very rare. We aim to describe the clinical, histological and therapeutic features of this condition. CASE REPORT: We report two cases of laryngeal myxomas occurred in male and female patients, presenting with a history of prolonged hoarseness. Laryngoscopy revealed a polypoid mass on the true vocal folds. The lesions were excised with cold instruments. One patient presented a recurrence 4 years after the first surgery. CONCLUSIONS: Laryngeal myxoma should be considered in case of a benign looking vocal fold lesion, especially a vocal cord polyp. Histologic exam is the only tool to confirm the diagnosis. It is treated by surgical resection. In the literature, recurrence is rare in laryngeal site, but patients need to be kept on close follow-up.

Organized Hematoma of the Maxillary Sinus: Report of Two Cases.

INTRODUCTION: Organized hematoma of the maxillary sinus (OHMS) is a rare benign disease that can be locally aggressive. The diagnosis of this condition is challenging. CASE REPORTS: We report two cases of OHMS presented with recurrent nasal bleeding, nasal obstruction and anosmia. Radiological findings were suggestive of a vascularised lesion in the first case and a malignant tumor of the maxillary sinus in the second case. Both patients underwent an endonasal endoscopic surgery, There was no recurrence at 19 months' and six months' follow-up respectively. CONCLUSIONS: OHMS should be included in the differential diagnosis if a patient presents with history of recurrent epistaxis and nasal obstruction and radiological findings reveal an expansible maxillary mass with or without bone erosion. Correct preoperative diagnosis is important to avoid unnecessary extensive surgery. The prognosis is very good and minimally invasive surgery such as endonasal endoscopic surgery can cure it completely.

Bilateral multifocal nodular oncocytic hyperplasia of the parotid gland: a rare entity.

Multifocal nodular oncocytic hyperplasia is an uncommon oncocytic lesion that rarely occurs in the parotid gland. Here, we report a case of a 43-years-old woman who presented with isolated gradual swelling in the 2 parotid regions. She underwent exofacial right parotidectomy. Histologic exam confirmed the diagnosis of oncocytoma arising in a background of multifocal nodular oncocytic hyperplasia with a histological variant of clear cells. Since the lesion was diagnosed as a benign lesion, surgery of the left side was not done. Our case is characterized by: early onset, the histological variant of clear cells and the presence of synchronous oncocytoma. We describe the clinical, histological and therapeutic features of this entity.

Retropharyngeal edema secondary to superior vena cava syndrome revealing Behcet's disease.

Retropharyngeal edema, uncommon in superior vena cava syndrome, can exceptionally represent the first manifestation of Behcet's disease, which should be taken into account in the differential diagnosis of this condition.

[Association of thyrolipoma and thyrolipomatosis: A case report]. / Association thyrolipome et thyrolipomatose : à propos d'un cas.

We report a rare case of thyrolipoma-thyrolipomatosis' association. A 48-year-old patient, with a past history of high blood pressure and chronic renal failure secondary to AA amyloidosis, presented with a midline neck swelling increasing in size since one year. Ultrasound showed a multinodular goiter, the worst nodule was left-lobar and categorized as EU-TIRADS 4. Grossly, cut section of the thyroïd specimen showed a yellow-tan left-lobar nodule measuring 2.5cm, the surrounding tissue had a diffuse yellow-brown appearance with scattered whitish areas. Histopathologic examination revealed that the nodule corresponded to a follicular adenoma.Thyroid fat infiltration was noticed both within the nodule and in the neighboring parenchyma. Thus, the diagnosis of an association thyrolipoma-thyrolipomatosis was rendered. The association of thyrolipoma-thyrolipomatosis is a very rare occurrence of unclear pathogenesis. To the best of our knowledge, this report describes the second case in the literature. The diagnosis is retained on the basis of certain histological features, revealing mature adipose tissue within thyroid gland as a combined nodular and diffuse pattern.

A mutation in SLC22A4 encoding an organic cation transporter expressed in the cochlea strial endothelium causes human recessive non-syndromic hearing loss DFNB60.

The high prevalence/incidence of hearing loss (HL) in humans makes it the most common sensory defect. The majority of the cases are of genetic origin. Non-syndromic hereditary HL is extremely heterogeneous. Genetic approaches have been instrumental in deciphering genes that are crucial for auditory function. In this study, we first used NADf chip to exclude the implication of known North-African mutations in HL in a large consanguineous Tunisian family (FT13) affected by autosomal recessive non-syndromic HL (ARNSHL). We then performed genome-wide linkage analysis and assigned the deafness gene locus to ch:5q23.2-31.1, corresponding to the DFNB60 ARNSHL locus. Moreover, we performed whole exome sequencing on FT13 patient DNA and uncovered amino acid substitution p.Cys113Tyr in SLC22A4, a transporter of organic cations, cosegregating with HL in FT13 and therefore the cause of ARNSHL DFNB60. We also screened a cohort of small Tunisian HL families and uncovered an additional deaf proband of consanguineous parents that is homozygous for p.Cys113Tyr carried by the same microsatellite marker haplotype as in FT13, indicating that this mutation is ancestral. Using immunofluorescence, we found that Slc22a4 is expressed in stria vascularis (SV) endothelial cells of rodent cochlea and targets their apical plasma membrane. We also found Slc22a4 transcripts in our RNA-seq library from purified primary culture of mouse SV endothelial cells. Interestingly, p.Cys113Tyr mutation affects the trafficking of the transporter and severely alters ergothioneine uptake. We conclude that SLC22A4 is an organic cation transporter of the SV endothelium that is essential for hearing, and its mutation causes DFNB60 form of HL.

[Statins Use in Elderly Patients]. / Place des statines chez le sujet âgé.

The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients <80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain. In very elderly patients, there are no randomized trials relative to the impact of statins on morbi-mortality in primary prevention as well in secondary prevention. Adverse effects in the elderly seem to be statistically similar to those occurring in young people , but the prescription in very old people should be individualized, taking into account the life expectancy, the life quality, the comorbidities, and especially the risk of drug interactions.

Cadmium and nickel in blood of Tunisian population and risk of nasosinusal polyposis disease.

Nasosinusal polyposis (NSP) is a chronic inflammatory disease of the nasal mucosa. Although the pathophysiology underlying NSP formation is not fully understood, environmental factors appear to be contributed the development of this disease. A case-control study of Tunisian patients was examined to assess the levels of cadmium (Cd) and nickel (Ni) in blood and reparse the association between the exposure to these metals and the risk of nasosinusal polyposis disease. Mean blood levels of Cd in patients (2.2 ± 12.8 µg/L) were significantly higher than those of controls (0.5 ± 0.7 µg/L). Levels of blood Cd were positively correlated with tobacco smoking and chewing among controls. The Cd and Ni concentrations among control (p = 0.001) and patient (p = 0.018) tobacco consumers (smoking, chewing, and shisha) were significantly higher than those nonconsumers. Additionally, Ni blood levels of patient and control smokers were significantly higher than those of nonsmokers. Cd levels in blood samples of NSP patients occupationally exposed for more than 14 years were eight times higher than that of nonexposed. Drinking water was also found to be incriminated as exposure sources. Among risk factors, shisha consumption, environmental exposure, and occupational exposure presented the most significant association with NSP disease (odds ratio (OR) = 14.1, 10.1, and 1.7, respectively). High levels of blood Cd (OR = 3.5) were strongly associated with NSP disease (p = 0.027). Ni blood levels were shown to be associated with the four stages of polyps in both nasal cavities (right and left) (p < 0.05). This investigation suggested a potential role of toxic metals in the mechanism of NSP disease development. Exposure assessment investigations encompassing a wider population are needed.

Biomonitoring of cadmium, chromium, nickel and arsenic in general population living near mining and active industrial areas in Southern Tunisia.

The human health impact of the historic and current mining and industrial activities in Tunisia is not known. This study assessed the exposure to metals in the population of Southern Tunisia, using biomonitoring. The aim of this pilot study was to evaluate metal exposure on 350 participants living near mining and active industrial areas in the South of Tunisia. Blood specimens were analyzed for metals (Cd, Cr, As, and Ni) by Atomic Absorption Spectrometer equipped with Zeeman background correction and AS-800 auto sampler by graphite furnace and graphite tubes with integrated L'vov platform. The sample population was classified according to different age groups, sex, smoking habit, sea food and water drinking consumption, occupational exposure, amalgam fillings and place of residence. The blood As, Cd, Cr and Ni values expressed as mean ± SD were 1.56 ± 2.49, 0.74 ± 1.15, 35.04 ± 26.02 and 30.56 ± 29.96 µg/l, respectively. Blood Cd and Ni levels in smokers were 2 and 1.2 times, respectively, higher than in non-smokers. Blood Cd levels increase significantly with age (p = 0.002). As, Cd and Ni were significantly correlated with gender and age (p < 0.05). Cd level in blood samples of subjects occupationally exposed was 1.3 times higher than that of non-exposed. Blood metals were not significantly affected by amalgam fillings, place of living and sea food and drinking water consumption. This first biomonitoring study of metal exposure in the South of Tunisia reveals a substantial exposure to several metals. The pathways of exposure and health significance of these findings need to be further investigated.