Cochleovestibular manifestations in Fabry disease: Importance of screening and systematic ENT evaluation

OBJECTIVES

Fabry disease (FD) is an X-linked inherited lysosomal storage disease. It is a multisystem pathology that can include ENT disorders. The aim of the present study was to investigate the cochleovestibular manifestations of FD, in order to show the importance of screening and systematic ENT evaluation.

MATERIAL AND METHODS

A single-center retrospective study included 14 male and 23 female FD patients. Hearing impairment was defined as hearing loss greater than the 90^th percentile for at least one frequency. Vestibular impairment was defined by lateral semicircular canal dysfunction. Age, ongoing enzyme replacement therapy (ERT) and organic (renal, cardiac and cerebrovascular) complications were used as severity markers.

RESULTS

Hearing impairment was found in 62.6% of cases, mostly at high frequencies, and was associated with age, ERT, and cardiac and cerebrovascular disorder. It affected 46.7% of asymptomatic adult patients. Vestibular impairment was found in 56% of cases, associated with age; it affected two-thirds of ERT patients, more than 60% of patients with organic complications, and 50% of asymptomatic adult patients.

CONCLUSIONS

More than half of patients had ENT involvement. All FD patients should undergo early ENT screening for diagnostic, prognostic and therapeutic purposes. Systematic complete ENT follow-up with auditory and vestibular evaluation should be performed regularly, even for heterozygous women.

Experience with Transcordal Silicone Stents in Adult Laryngotracheal Stenosis: A Bicentric Retrospective Study

BACKGROUND

Benign stenosis involving laryngeal and upper tracheal structures represents a therapeutic challenge. Open surgery and endoscopic management have to be discussed by a multidisciplinary board in order to evaluate the risk and benefit for each patient.

OBJECTIVE

The objective of this retrospective study was to report the experience of two French centers with transcordal silicone stents (TSS) in the endoscopic management of benign laryngotracheal stenosis (BLTS) in adults, with focus on efficacy, safety, and tolerability.

METHODS

We performed a retrospective chart review of all cases of BLTS treated with TSS between January 2001 and June 2017 at two tertiary centers in France: the Centre Hospitalier Régional Universitaire de Strasbourg and the Hôpital Nord de Marseille.

RESULTS

A total of 17 patients were included. Eleven had a tracheostomy at initial management which consisted of 8 T-tubes and 9 strictly endoluminal stents placements. The main complications were minor aspirations in 5 patients (29%), granulation in 3 patients (18%), migration in 2 patients (12%), and severe dysphonia in 3 patients (18%). After a mean duration of 18.3 months, 11 patients (65%) had had their TSS definitely removed, 13 patients were tracheostomy free (76%), and a TSS remained in place in 4 patients (24%).

CONCLUSIONS

Adult BLTS treatment with TSS placement is associated with low morbidity and excellent clinical outcomes, with a large proportion of patients free of airway instrumentation on long-term follow-up.

Well-differentiated, pedunculated liposarcoma of the hypopharynx

INTRODUCTION

Liposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia.

CASE REPORT

The authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma.

DISCUSSION

Well-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence.

[Artificial organs]

Research has been fighting against organ failure and shortage of donations by supplying artificial organs for many years. With the raise of new technologies, tissue engineering and regenerative medicine, many organs can benefit of an artificial equivalent: thanks to retinal implants some blind people can visualize stimuli, an artificial heart can be proposed in case of cardiac failure while awaiting for a heart transplant, artificial larynx enables laryngectomy patients to an almost normal life, while the diabetic can get a glycemic self-regulation controlled by smartphones with an artificial device. Dialysis devices become portable, as well as the oxygenation systems for terminal respiratory failure. Bright prospects are being explored or might emerge in a near future. However, the retrospective assessment of putative side effects is not yet sufficient. Finally, the cost of these new devices is significant even if the advent of three dimensional printers may reduce it.

Value of fine-needle aspiration in evaluating large thyroid nodules

BACKGROUND

The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter.

METHODS

In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm.

RESULTS

The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results.

CONCLUSION

Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck 39: 32-36, 2017.

Method for dealing with severe aspiration using a new concept of intralaryngeal prosthesis: A case report

BACKGROUND

Deglutition disorders are frequent in patients treated for cancer of the oropharynx, and are responsible for severe aspiration and, in some cases, may require the use of enteral nutrition by gastrostomy or tracheotomy.

METHODS

We present the case of a patient with a medical history of infiltrating laryngeal carcinoma treated by partial laryngectomy and radiochemotherapy, presenting severe aspiration causing significant weight loss. The patient received a new intralaryngeal prosthesis to prevent aspiration with the objective of regaining safe oral nutrition and closure of the tracheotomy.

RESULTS

Deglutition tests after postimplantation demonstrated significantly improved airway protection and recovery deglutition, allowing the patient to return home with resumption of varied solid and a liquid diet.

CONCLUSION

For a patient presenting severe aspiration, the intralaryngeal prosthesis allowed a resumption of oral feeding without exclusion of the larynx or airway protection by tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-E2507, 2016.

[Surgical treatement by intracapsular enucleation of cervical peripheral neural sheath tumors]

Schwannomas and neurofibromas are benign tumors of the peripheral neural sheath tumors (PNST), representing 5% of soft tissue tumors. Cervical PNST are mainly located on the vagus nerve or in the sympathetic nervous system. The treatment is based on a tumor resection with preservation of nerve function. Classical surgery consists in total tumor removal after dissection of the nerve and is frequently complicated by nerve paralysis. The authors describe a simpler surgical technique consisting in a resection of the intracapsular enucleation of PNST that can limit the risk of nerve injury without increasing recidivism. The description of this surgical technique is illustrated by its use in a type I neurofibromatosis patient with a large vagal nerve neurofibroma.