Panel 7: otitis media:treatment and complications

Objective: We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources: PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods: All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions: Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice: Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention

Le rôle des psychologues dans les examens en justice

Gorphe F. Le rôle des psychologues dans les examens en justice. In: Bulletin de psychologie, tome 11 n°149, 1958. p. 689

Étude de cas-témoins : carcinomes épidermoïdes de la cavité buccale chez les patients âgés moins de 40ans contre ceux de plus de 40ans

Objectifs Les carcinomes épidermoïdes de la cavité buccale touchent habituellement les personnes âgées de plus 50 ans ayant eu une intoxication alcoolotabagique. Chez les patients de moins de 40 ans, ils sont rares et leur pronostic n’est pas connu. L’objectif est de déterminer le pronostic du carcinome épidermoïde de la cavité buccale chez les patients jeunes. Patients et méthodes Étude rétrospective, monocentrique de type cas-témoin. Les patients inclus étaient atteints d’un carcinome épidermoïde de la cavité buccale traité à l’institut Gustave-Roussy (IGR) de 1999 à 2012. Les patients avaient moins de 40 ans. Les témoins étaient âgés de plus de 40 ans. Deux témoins ont été sélectionnés pour chaque cas et appariés sur le sexe, le TNM et la période de traitement. Résultats Cinquante-sept patients, 44 hommes et 13 femmes (sex ratio de 3,4) ainsi que 114 témoins ont été inclus. L’âge médian était de 32 [19–39] ans pour les cas contre 53 [41–61] ans pour les témoins (p < 0,0001). Vingt-six (456 %) cas n’avaient jamais fumé contre 9 (7,8 %) témoins (p < 0,0001), 47 (82,5 %) cas n’avaient pas consommé d’alcool contre 31 (27,2 %) témoins (p < 0,0001). Cinquante-trois (93 %) cas et 104 (91,2 %) témoins avaient eu un traitement chirurgical (p = 0,69), 29 (51 %) cas avaient reçu une radiothérapie ou une chimioradiothérapie contre 60 (52,6 %) témoins. Les taux de contrôle locorégional à 5 ans étaient de 75 % chez les patients et de 73 % chez les témoins, ceux de survie spécifique à 5 ans respectivement de 79 % et 77 %, (p = 0,7), ceux de survie globale à 5 ans de 76 % et 64 % (hazard ratio : 0,56 [0,3 ; 1,0] ; p = 0,05). Conclusion Le taux de survie globale à 5 ans des patients de moins de 40 ans atteints d’un carcinome épidermoïde de la cavité buccale tend à être meilleur que celui des patients plus âgés, alors que celui de survie spécifique est similaire

Unusual presentation of a first Branchial cleft cyst associated with an abnormal bony canal -a case report-

Abstract Background First branchial cleft anomalies are rare, accounting for only 10% of all branchial cleft anomalies. We report an even more rare and unique case of a branchial cleft cyst with features of both first and second arch derivatives. Case presentation A 6-year-old boy presented to us with a left conductive hearing loss associated with pre-tympanic keratin debris and an ipsilateral painful cervical mass. He had a past medical history of left ear surgery for presumed cholesteatoma 2 years prior and left neck abscess drainage 6 months prior. CT and MRI revealed a lesion originating in the external auditory canal and extending cervically through a bony canal located medial to the facial nerve and terminating as a parapharyngeal cyst. The complete removal was accomplished in one surgical stage consisting of three distinct steps: robotic assisted transoral resection of the pharyngeal cyst, an endaural approach and a parotidectomy approach. Conclusion We believe that our detailed description of this rare first branchial cleft cyst with pharyngeal extension, possibly a hybrid case between a first and second branchial cyst, can serve as a valuable tool to Otolaryngologists – Head and Neck Surgeons who come across a similar unusual presentations

Oral cavity cancers among young people: clinical results and prognostic analysis. Cancers de la cavité buccale chez les sujets jeunes: Résultats thérapeutiques et analyse de facteurs pronostiques

Purpose. - Squamous cell carcinomas of the oral cavity occurring in young people represent a specific entity. Its management and prognosis are controversial. We performed a retrospective chart review of all patients aged less than 40 years old and treated at Gustave-Roussy Cancer Centre for a squamous cell carcinomas of the oral cavity between 1999 and 2011. Methods. - Patients and tumour characteristics, type of treatment and follow-up data were collected. Survival data were analysed according to the methods of Kaplan-Meier and both univariate and multivariate analyses were performed to look for prognostic factors regarding overall survival and progression-free survival. Results. - Sixty-three patients were identified. Median follow-up was 64 months. Most of the tumours were initially located in the mobile tongue (n = 54, 85.7%). Overall 17 patients had died, including 15 from the treated cancer. Overall and progression-free survival rates at 5 years were respectively 79.6% and 68.6%. The corresponding 5 years local, regional and metastatic relapse free survival rates were 80%, 91% and 89% respectively. In the multivariate analysis only the absence of initial surgery (hazard ratio [HR]: 13.5 [2.0; 90.5]; P = 0.007) was prognostic for overall survival, while alcohol abuse (HR: 0.37 [0.15; 0.9]; P = 0.03) and the absence of surgery (HR: 13.6 [2.5; 74.2]; P = 0.002) were associated with a decreased progression-free survival. A younger age (less than 30 year old) was not associated with the risk of recurrence or death. Conclusion. - Survival rates and tumour control probabilities are relatively high among young patients suffering from squamous cell carcinomas of the oral cavity treated at a tertiary centre. The early identification of patients at risk of relapse is currently difficult. The balance between recurrence and treatment toxicity warrants further studies, both on the clinical level and for the development of prognostic biomarker

Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck

Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery

Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

Background: Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a "Pharyngoscore" to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. Methods: Three-hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh-Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. Results: Sixty-five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. Conclusions: The Pharyngoscore is a promising tool for calculating DOE probability before TORS

Severe acute respiratory syndrome coronavirus 2 vaccination for patients with solid cancer: Review and point of view of a French oncology intergroup (GCO, TNCD, UNICANCER).

The impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on cancer care are multiple, entailing a high risk of death from coronavirus disease 2019 (COVID-19) in patients with cancer treated by chemotherapy. SARS-CoV-2 vaccines represent an opportunity to decrease the rate of severe COVID-19 cases in patients with cancer and also to restore normal cancer care. Patients with cancer to be targeted for vaccination are difficult to define owing to the limited contribution of these patients in the phase III trials testing the different vaccines. It seems appropriate to vaccinate not only patients with cancer with ongoing treatment or with a treatment having been completed less than 3 years ago but also household and close contacts. High-risk patients with cancer who are candidates for priority access to vaccination are those treated by chemotherapy. The very high-priority population includes patients with curative treatment and palliative first- or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large volume of lung, lymph node and/or haematopoietic tissue. When possible, vaccination should be carried out before cancer treatment begins. SARS-CoV-2 vaccination can be performed during chemotherapy while avoiding periods of neutropenia and lymphopenia. For organisational reasons, vaccination should be performed in cancer care centres with messenger RNA vaccines (or non-replicating adenoviral vaccines in non-immunocompromised patients). Considering the current state of knowledge, the benefit-risk ratio strongly favours SARS-CoV-2 vaccination of all patients with cancer. To obtain more data concerning the safety and effectiveness of vaccines, it is necessary to implement cohorts of vaccinated patients with cancer