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

Transoral robotic-assisted supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Procedure development and outcomes of initial cases.

We report on the feasibility and functional outcome of transoral robotic (TORS) supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Cadaveric studies and functional outcome at 3 years using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-H&N35), the Functional Outcome Swallowing Scale (FOSS), the Performance Status Scale for Head and Neck Cancer (PSS-HN), computerized voice analysis, and videotape recordings. Data were compared with a historical cohort of open CHEPs/cricohyoidopexies (CHPs). The EORTC-QLQ-H&N35 scores, FOSS scores, and PSS-HN scores at 3 years of 2 operated patients were 46 and 43, 2 and 1, and 75 of 100 (eating in public) and 100 of 100 (normalcy of diet), respectively. The mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) were 85 HZ and 81 Hz, 8.52% and 6.39%, 28.2% and 13.5%, 0.61 and 0.71, 19 seconds and 15 seconds, respectively. Functional outcome data suggest that the procedure is feasible and safe

Tacrolimus enhances the recovery of normal laryngeal muscle fibre distribution after reinnervation.

AbstractObjectives:To assess the recovery of various muscle fibre types in the posterior cricoarytenoid muscle after laryngeal reinnervation in the rat, and to determine the influence of tacrolimus on this process.Methods:Four groups of rats underwent resection and anastomosis of the left vagus nerve, and were administered either tacrolimus at a low dose or an immunosuppressive dose, or cyclosporin A at a low dose or an immunosuppressive dose. A fifth group received surgery alone, and a sixth group received neither surgery nor drug treatment (healthy group). Muscles were removed for immunohistochemical analysis 45 days after surgery.Results:There was no difference in the proportion of types 1, 2a and 2b muscle fibres, comparing the immunosuppressive tacrolimus group and the healthy group, whereas there were fewer type 1 fibres in the group receiving surgery alone, compared with the healthy group (7 vs 12.1 per cent, respectively; p = 0.0303).Conclusion:Tacrolimus enhanced the recovery of normal laryngeal muscle fibres after reinnervation in the rat, indicating a possible role in laryngeal transplantation.</jats:sec

Spondylodiscitis after transoral robotic surgery: Retrospective 7-case series from the GETTEC group

International audienceBackground: Cervical spondylodiscitis is a rare but severe complication of pharyngeal surgery.Material and methods: This multicenter retrospective study reported all patients in the database of the French head and neck tumor study group (GETTEC) affected by cervical spondylodiscitis after transoral robotic surgery (TORS) for malignant pharyngeal tumor from January 2010 to January 2017.Objectives: To describe cases of post-TORS cervical spondylodiscitis, identify alarm signs, and determine optimal management of these potentially lethal complications.Results: Seven patients from 6 centers were included. Carcinomas were located in the posterior pharyngeal wall. Tumor stage was T1 or T2. All patients had risk factors for spondylodiscitis. Mean time to diagnosis was 12.6days. The interval between surgery and spondylodiscitis diagnosis ranged from 20days to 4.5months, for a mean 2.1months. The most common symptom was neck pain (87%). Infections were polymicrobial; micro-organisms were isolated in 5 cases and managed by intravenous antibiotics, associated to medullary decompression surgery in 3 cases. Follow-up found favorable progression in 4 cases, and 3 deaths (mortality, 43%).Conclusion: This French multicenter study found elevated mortality in post-TORS spondylodiscitis, even in case of limited resection. Surgeons must be aware of this complication and alerted by persistent neck pain, fever, asthenia, impaired or delayed posterior pharyngeal wall wound healing or elevation of inflammatory markers. MRI is the most effective diagnostic radiological examination

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 &lt; 0,0001). Vingt-six (456 %) cas n’avaient jamais fumé contre 9 (7,8 %) témoins (p &lt; 0,0001), 47 (82,5 %) cas n’avaient pas consommé d’alcool contre 31 (27,2 %) témoins (p &lt; 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