Service ORL

Joué-lés-Tours, France

Service ORL

Joué-lés-Tours, France
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Cancer of the upper aerodigestive tract is a disease of the mucous membranes, often influenced by alcohol or tobacco intoxication, especially long-term addictions. Once mainly a male cancer, it is now affecting more and more of the female population in direct relation to the increase in tobacco addiction. An overview of the evolution of the pathologies and their treatments. © 2013 Elsevier Masson SAS.


Barry B.,Service ORL | Ortholan C.,Center hospitalier Princesse Grace
Cancer/Radiotherapie | Year: 2014

Head and neck cancer is frequently associated with alcohol and tobacco consumption but there is an increasing incidence of oropharyngeal carcinoma associated with oncogenic type-16 human papillomavirus (HPV). The clinical profile of these patients is distinct from that of other patients, with an earlier onset, 1/1 male to female sex ratio, cystic cervical nodes. Detection of intratumoral viral DNA is essential to confirm the role of HPV. According to several reports, the prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in HPV-negative oropharyngeal carcinoma or associated with tobacco consumption. The future lies in vaccination of women against cervical cancer but vaccination of boys will be certainly necessary. © 2014 Société française de radiothérapie oncologique (SFRO).


Ayari S.,Service ORL Pediatrique | Aubertin G.,Service de Pneumo pediatrie | Girschig H.,173 Route de Desvres | Van Den Abbeele T.,Service ORL | Mondain M.,Montpellier University Hospital Center
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

Laryngomalacia is defined as collapse of supraglottic structures during inspiration. It is the most common laryngeal disease of infancy. Laryngomalacia presents in the form of stridor, a high-pitched, musical, vibrating, multiphase inspiratory noise appearing within the first 10 days of life. Signs of severity are present in 10% of cases: poor weight gain (probably the most contributive element), dyspnoea with permanent and severe intercostal or xyphoid retraction, episodes of respiratory distress, obstructive sleep apnoea, and/or episodes of suffocation while feeding or feeding difficulties. The diagnosis is based on systematic office flexible laryngoscopy to confirm laryngomalacia and exclude other causes of supraglottic obstruction. Rigid endoscopy under general anaesthesia is only performed in the following cases: absence of laryngomalacia on flexible laryngoscopy, presence of laryngomalacia with signs of severity, search for any associated lesions prior to surgery, discrepancy between the severity of symptoms and the appearance on flexible laryngoscopy, and/or atypical symptoms (mostly aspirations). The work-up must be adapted to each child; however, guidelines recommend objective respiratory investigations in infants presenting signs of severity. © 2012 Elsevier Masson SAS.


Klossek J.M.,Service ORL | Annesi-Maesano I.,French Institute of Health and Medical Research | Annesi-Maesano I.,University Pierre and Marie Curie | Pribil C.,Glaxosmithkline | Didier A.,Toulouse University Hospital Center
International Archives of Allergy and Immunology | Year: 2012

Background: Ocular symptoms remain widely neglected while they concern the majority of subjects with allergic rhinitis (AR) and impair their daily activities. We describe the characteristics of ocular symptoms in subjects suffering from AR in the French INSTANT study and their impact on daily activities. Methods: This cross-sectional observational survey was carried out in November 2006 using face-to-face interviews. Results: 31.7% of the population-based sample (n = 4,019) suffered from AR and 52.0% of AR subjects (n = 663) described ocular symptoms. Men had significantly less ocular symptoms than women (odds ratio 0.71, 95% CI 0.57-0.89). 57.5% of subjects suffered from ocular symptoms for >5 years, 30.2% for >6 months in the past 12 months, and 92.2% during the pollen season. The troublesome ocular symptoms were itching eyes (51.1%), watery eyes (38.6%), red eyes (6.6%) and swollen eyelids (3.6%). The trigger factors were pollens (51.3%), household dust and mites (34.8%), pets (12.2%) and air pollution (3.8%). Ocular symptoms had a negative impact on daily activities (blurred sight 47.8%, reduction in daily activities 38.8%, reduction in efficacy at work 25.8%, sleep disturbances 16.3%, and sick leave 12.9%). They were diagnosed in 38.9% of subjects and followed up in 34.8%. Treatment for ocular symptoms was prescribed to 35.4% of subjects and to 61.9% of subjects with a regular follow-up care. Conclusions: This survey confirms the impact of ocular symptoms on AR patients' lives and suggests that they are still neglected and undertreated. © 2012 S. Karger AG, Basel.


Servagi-Vernat S.,Center Hospitalier University | Ali D.,University of Paris Descartes | Roubieu C.,Service ORL | Durdux C.,University of Paris Descartes | And 2 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2015

Adjuvant radiotherapy after surgery or exclusive radiotherapy, with or without concurrent chemotherapyis a valuable treatment option in the great majority of patients with head and neck cancer. Recent technicalprogress in radiotherapy has resulted in a decreased incidence of xerostomia. Another common toxicityof radiotherapy is dysphagia, which alters the nutritional status and quality of life of patients in remission.The objective of this review is to describe the physiology of swallowing function, the pathophysiology ofradiation-induced dysphagia and the various strategies currently available to prevent this complication. © 2014 Elsevier Masson SAS. All rights reserved.


Abdellaoui A.,Service ORL | Tran Ba Huy P.,Service ORL
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2013

Objectives: To identify epidemiological, socioeconomic, audiometric and environmental factors of success and failure of hearing-aid prescription, and to assess hearing-aid efficacy at 6-9 months after prescription. Patients and methods: A prospective nationwide survey was conducted in France on 184 patients with age-related hearing loss. Inclusion data were collected by a questionnaire filled out by the ENT specialist and patient, and with a second questionnaire filled out by telephone contact with the patient 6-9 months later. Results: One-third of patients failed to fulfill the prescription, either for financial reasons or for lack of interest in correcting their disability. For the other two-thirds, the factors favoring consultation with a hearing-aid fitting specialist seemed to be: leisure activity requiring good hearing, living in a couple or family, spontaneous initial ENT consultation, strong motivation, monthly income greater than €1200, longstanding hearing impairment, and difficulty in listening to television and following a conversation in noise. Eighty percent of hearing-aid trials were successful; 60% of prescriptions were thus followed by hearing-aid purchase. The main three criteria determining purchase were the advice of the hearing-aid fitting specialist, and the price and the effectiveness of the apparatus on trial. In the four daily life situations presented in the questionnaire, the hearing-aid was worn for 8 hours or more in 90% of cases, found useful in 70% and proved satisfactory in 70%. Age-related hearing loss, whether metabolic or sensorineural, benefited from hearing-aid correction in 86% of cases. Conclusions: Indications for hearing-aid prescription should take account of the patient's degree of motivation, awareness of disability, and income. The advice of the ENT and hearing-aid fitting specialists plays a key role in the patient's acceptance of the hearing-aid. Hearing-aids seem to enhance quality of life significantly in age-related hearing loss subjects. © 2013 Published by Elsevier Masson SAS.


Martin C.,Service ORL | Prades J.-M.,Service ORL | Richard C.,Service ORL
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

Tympanoplasty now frequently uses cartilage to repair bone lysis in the external auditory canal (EAC) and to reinforce the tympanic membrane. Once in place, however, the cartilage may complicate ossiculoplasty by obstructing visualization of the stapedial region. Posterior tympanotomy, when included in the tympanoplasty procedure, may provide an interesting means of positioning the ossiculoplasty. © 2012 Elsevier Masson SAS. All rights reserved.


Kharrat S.,Service ORL
La Tunisie médicale | Year: 2010

BACKGROUND: Chondrosarcomas are slow-growing malignant tumors that usually arise from cartilaginous structures. It may occur in the head and neck region with a predilection for the maxillofacial skeleton, where it has been reported to occur particularly in the mandible and maxilla. Chondrosarcoma of the sinonasal tract is very rare. AIM: Report a new case CASE: We present the case of a 43-year-old man presenting with an incidental finding of a chondrosarcoma of the maxillary and ethmoid sinus with nasal extension. The tumor was completely resected using a transnasal endoscopic approach. Treatment has followed by a radiation therapy and the patient was considered free of disease at her 5 years follow-up. CONCLUSION: Surgery is the mainstay treatment of chondrosarcomas. In selected patients, complete resection can be achieved using transnasal endoscopic approach.


Martin C.,Service ORL
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2011

Very surprising diagnoses have sometimes been made of the illness from which Vincent van Gogh suffered. Most of them can be safely ignored; the diagnosis of Ménire's disease, however, put forward by K. I. Arenberg, deserves attention. This diagnosis was first criticized in a doctoral thesis in 1992 in the university of Saint-Etienne (France), and again in a book published by Henri André Martin in 1994, and the present study is based on these. Analyzing van Gogh's pathology presupposes awareness of the family context in which he lived, his eventful life, his artistic career and of his correspondence, which notably provides no support for a diagnosis of Ménire's disease. Analysis, indeed, enables Ménire's disease to be categorically eliminated in favor of temporal epilepsy, as confirmed in 1956 by Gastaut following the diagnosis initially made half a century earlier by Dr Rey. Van Gogh's illness is an example of the contradictory changes in affect, behavior and personality to be observed in epileptic patients. Absinth intoxication doubtless aggravated van Gogh's epilepsy and may account for certain prolonged episodes of confusion. It would be wrong, however, to speak of alcoholic dementia rather than of a probable epileptic psychosis or other pathology such as hallucinatory psychosis, or delirious attack, either isolated or related to late-onset schizophrenia. Apart from certain episodes of severe mental disorder, however, van Gogh's exceptional creativity was maintained up to the very end. Like any other artist, his temperament was expressed in his art, exalted rather than impaired by his illness. © 2011 Elsevier Masson SAS. All rights reserved.


Francois M.,Service ORL
Revue Francaise d'Allergologie | Year: 2015

Normal breathing is through the nose, with the mouth closed. Open mouth breathing in children has short-term drawbacks such as dry lips, cheilitis and halitosis, but it may lead to poor stimulation of upper maxillary growth with aesthetic and orthodontic consequences. Clinical examination is often sufficient to identify the cause or causes of open mouth breathing. The three preponderant etiologies are piriform aperture stenosis, enlarged adenoids and allergic rhinitis.

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