[Laryngeal involvements in systemic diseases : a discussion based on a case report.] / Manifestations laryngées des maladies de système : cas clinique.

Systemic diseases can affect the larynx. The most common laryngeal involvements, although often unknown, consist in inflammatory laryngitis, laryngeal ulcers, cricoarytenoid arthritis, recurrent laryngeal nerve paresis and subglottic stenosis. The clinical case we report is more uncommon, but representative of autoimmune diseases : vocal folds bamboo nodes in a young female patient, age 34, suffering from active rheumatoid arthritis. In the present article, we detail the current knowledge of this pathology and later discuss different laryngeal involvements of systemic diseases by lesion type et their management.

Les maladies de système peuvent affecter le larynx. Leurs manifestations laryngées les plus fréquentes, bien qu'elles soient souvent méconnues, sont les laryngites inflammatoires, les ulcères laryngés, les arthrites crico-aryténoïdiennes, les parésies récurrentielles et les sténoses sousglottiques. Le cas clinique que nous rapportons ici est plus rare, mais caractéristique des maladies auto-immunes : des noeuds de bambou des cordes vocales chez une jeune patiente de 34 ans souffrant d'une polyarthrite rhumatoïde. Dans cet article, nous détaillons les connaissances actuelles sur cette pathologie et discutons ensuite les différentes manifestations laryngées des maladies de système par type de lésion et leur prise en charge.

[CSF otorrhea: case report and management]. / Le cas clinique du mois. Otorrhée cérébro-spinale: a partir d'un cas clinique, du diagnostic au traitement.

Mr G, sixty-seven years old, was admitted to our hospital for a liver transplant. He suffered from a cirrhosis due to an HBV infection, complicated by an hepatocellular carcinoma. During the perioperative care, a left otorrhea was discovered. According to the clinical history, this otorrhea had been present for six weeks and followed the completion of a myringotomy. The myringotomy had been performed with a view to place a transtympanic ventilation tube for the treatment of a serous otitis media inducing a conductive hearingloss. Clinical, biological, and radiological explorations revealed a CSF leak caused by the fact that the myringotomy had been done in a temporal meningo-encephalocele. A conservative treatment allowed to stop the otorrhea. We present a short discussion about temporal meningoencephalocele and, more generally, about CSF otorrhea.

Connectivity graph analysis of the auditory resting state network in tinnitus.

Thirteen chronic tinnitus patients and fifteen age-matched healthy controls were studied on a 3T magnetic resonance imaging (MRI) scanner during resting condition (i.e. eyes closed, no task performance). The auditory resting-state component was selected using an automatic component selection approach. Functional connectivity (correlations/anti-correlations) in the extracted network was portrayed by integrating the independent component analysis (ICA) approach with a graph theory method. Tinnitus and control groups showed different graph connectivity patterns. In the control group, the connectivity graph was divided into two distinct anti-correlated networks. The first one encompassed the auditory cortices and the insula. The second one encompassed frontoparietal and anterior cingulate cortices, brainstem, amygdala, basal ganglia/nucleus accumbens and parahippocampal regions. In the tinnitus group, only one of the two previously described networks was observed, encompassing the auditory cortices and the insula. Direct group comparison showed, in the tinnitus group, an increased functional connectivity between auditory cortices and the left parahippocampal region surviving multiple comparisons. We investigated a possible correlation between four tinnitus relevant measures (tinnitus handicap inventory (THI) and tinnitus questionnaire (TQ) scores, tinnitus duration and tinnitus intensity during the scanning session) and the connectivity pattern in the tinnitus population. We observed a significant positive correlation between the beta values of the posterior cingulate/precuneus region and the THI score. Our results show a modified functional connectivity pattern in tinnitus sufferers and highlight the role of the parahippocampal region in tinnitus physiopathology. They also point out the importance of the activity and connectivity pattern of the posterior cingulate cortex/precuneus region to the development of the tinnitus associated distress. This article is part of a Special Issue entitled: Tinnitus Neuroscience.

[Regeneration of hair cells and auditory neurons in the ear]. / Régénération des cellules ciliées et des neurones auditifs de l'oreille.

Most of deafness have a neuro-sensory origin and are characterized by a loss of hair cells and auditory neurons in the spiral ganglion. At the moment, hearing aids are the only treatment available. To restore hearing in a patient suffering from deafness, it is necessary to study the mechanisms that might lead to the regeneration of neurosensory structures of the inner ear. HAIR CELL REGENERATION: The production of hair cells and supporting cells is terminated during embryonic development of the cochlea in mammals. However, several recent arguments suggest that new hair cells can be produced by the sensory epithelium of mammals. We first identified the presence of progenitor cells in the organ of Corti. In a second approach, the molecular mechanisms underlying the production of new hair cells have been studied. NEURONAL REGENERATION: The study of the development of the ear, cultures of neurons and analysis of animals invalidated for specific genes reveal that a number of growth factors are important for the maintenance and repair of neurons in the inner ear. These molecules induce the survival of auditory neurons in vitro and in vivo. The signaling pathways intra-cellular are analyzed with a better understanding of the mechanisms that lead to survival or death of neurons hearing and with the identification of new pharmacological agents that promote survival of neurons hearing in diseases of the inner ear. These molecules can be administered locally in the inner ear. IN CONCLUSION: Recent studies on the regeneration of neurosensory structures of the inner ear suggest that eventually it will be possible to replace the hair cells in the cochlea of mammals and to reinnervate them by auditory neurons in order to restore hearing in patients suffering from deafness.

[Tympanometry in children in general practice]. / La tympanométrie chez l'enfant en médecine générale.

Accurate diagnosis of otitis media in children is essential but sometimes difficult. Good knowledge of signs and symptoms of acute otitis media and otitis media with effusion is not always sufficient. Tympanometry is an easy investigation that can be useful in general practice. Here is a review of the principle and the limitation of that technique.

[Rapid antigen tests in acute pharyngitis]. / Intérêt d'un test diagnostique rapide dans la prise en charge des angines chez l'adulte.

Acute pharyngitis is one of the most common illnesses for which adults seek medical help from primary care physicians. Approximately 15% of cases in adults are caused by group A beta-hemolytic Streptococcus. Strategies of management should aim at identifying the latter with a view to prevent the development of complications. Rapid Antigen tests have a reported specificity of more than 95%. Antibiotic therapy is only recommanded for patients with positive rapid antigen test results and those with risk factors.

Synovial sarcoma of the larynx: case report and literature review.

Synovial sarcoma is a rare mesenchymal malignancy which represents 8.5% of all soft tissue sarcomas and usually occurs in the lower extremities of young adults. Because the incidence in the head and neck region is very low, only 13 patients with endolaryngeal localisation have been reported so far. We present here a case of aryepiglottic synovial sarcoma. The tumour was completely resected, under suspension micro-laryngoscopy, using a CO2 laser. No recurrence was observed three years after the surgery. Complete surgical excision is the treatment of choice. The role of chemotherapy and radiotherapy is still debated. However, this tumour has a poor prognosis because of the occurrence of distant metastasis.

[Prevention of deafness]. / Prévention de la surdité.

About 17% of the population is affected by deafness. Etiologies may vary but the result is often the degeneration of the hair cells and the auditory neurons induced by factors present in environment of the individual. Therefore, the modification of this environment is crucial to preserve the neurosensory structures of the inner ear. In this paper, we will review two major causes of deafness: drug induced and sound trauma induced hearing loss for which a protective strategy can be available. Aminoglycosides and platin derivatives are toxic for the inner ear and the understanding of the pathophysiology of the ototoxic effects allowed to develop new therapeutic strategies to prevent the death of hair cells and auditory neurons. Sound trauma results from exposure to loud sound for prolonged period of time. The most common cause is professional. Prevention strategy includes collective and individual measures, as well as a careful information of the medical personal. Some new drugs are also in a developmental stage.