Foreign body (FB) aspiration and ingestion are frequently encountered by emergent otolaryngology services. The authors describe their experience in the management of FB cases in the aerodigestive tract. We carry a retrospective study about 626 patients who came or were referred to our department between 1996 and 2007 with a history or suspicion of a FB in the aerodigestive tract (except nasal and oropharyngeal FB). All of them have undergone rigid endoscopy under general anaesthesia. Children younger than 10 years were the most involved (36.9%) followed by patients between 71 and 80 years old (11.3%). The FB were visible on clinical examination in 39 cases. Chest and neck X-ray, showed radio-opaque FB in 302 cases (48.7%). A total of 626 rigid endoscopies were performed. FB were encountered in 549 patients (87.7%). The most involved sites were the oesophagus (51.9%) followed by the tracheobronchial tree (33.9%) and the hypopharynx (13.5%). Bones (22%) and coins (20.1%) were the most frequently encountered FB. Successful removal was achieved in 521 cases (94.9% of the FB found). The complication rate after rigid endoscopy was 1.3%. FB in the aerodigestive tract are frequent and may lead to severe complications. Removal through the rigid endoscope still has its place as the most reliable method. Prevention and public education for this serious problem should be considered.

Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.

Brown tumor or localized form of osteitis fibrosa cystic is a focal lesion complicating hyperparathyroidism. It's rarely revelatory of the clinical feature and corresponds to a mass with partly cystic and partly solid areas. A 65-year-old man, followed up for hypertension, complained of a progressive swelling in the left paranasal part of the face lasting for 3 months. Physical examination revealed a left paranasal swelling of 4 cm diameter, with a healthy looking skin. CT facial bones found a round formation of 2 cm involving the left maxilla. He received tumor resection by vestibular pathway. Histological examination showed many giant cells. We then discussed the brown tumor diagnosis. The PTH dosage was high: 645 pg/mL (normal: 15 -68 pg/mL). The serum calcium was in the superior normal limit (100 mg/dL). Cervical ultrasound revealed a bottom left parathyroid nodule. A lower left parathyroidectomy was performed. Histological results confirmed parathyroid adenoma. Monitoring was marked by a marked decrease of the PTH serum level then a return to normal values, a normocalcemia and no recurrence of the maxillary tumor with Recoil of 14 months. Brown tumor of the maxilla is rare and should be considered even in absence of hypercalcemia.

Lʼostéite frontale post-sinusitique est définie par lʼextension de lʼinfection du sinus frontal aux structures osseuses adjacentes. Elle constitue une urgence diagnostique et thérapeutique. Le but de ce travail est dʼanalyser les particularités épidémiologiques, cliniques et paracliniques, et de passer en revue les différentes attitudes thérapeutiques devant cette pathologie. Matériel et méthodes : Il sʼagit dʼune étude rétrospective portant sur 31 patients diagnostiqués et traités entre 1996 et 2010. Tous les patients ont bénéficié dʼun examen ORL et neurologique complet, dʼun bilan biologique et dʼune tomodensitométrie du massif facial et cérébrale. Lʼantibiothérapie a été administrée par voie intraveineuse. Le drainage chirurgical du sinus frontal se faisait soit par trépanation, soit par confection dʼun volet frontal, soit par mise en place dʼun clou de Lemoyne. Le drainage par voie endonasale comportait une méatotomie moyenne avec ethmoïdectomie antérieure. La cranialisation du sinus frontal se faisait par voie coronale. Lʼévolution a été évaluée sur des critères cliniques, biologiques et radiologiques. Résultats : Lʼâge moyen était de 24,4 ans (8-62 ans) et le sex-ratio était de 4,16. Les céphalées frontales (10 cas) et les signes dʼhypertension intracrânienne (8 cas) étaient les signes fonctionnels les plus fréquents. Une tuméfaction frontale était notée chez 9 patients, associée dans 5 cas à une tuméfaction orbitaire au niveau de lʼangle interne de lʼoeil. Les signes rhinologiques étaient dominés par la rhinorrhée purulente (9 cas) et lʼobstruction nasale (5 cas). Lʼendoscopie nasale trouvait du pus au niveau du méat moyen dans 12 cas. La TDM a révélé un aspect typique dʼostéite frontale sous forme dʼun foyer dʼostéolyse. Un abcès sous-périosté était associé chez 7 patients. Une extension intracrânienne a été notée dans 15 cas et orbitaire dans 7 cas. Lʼexamen bactériologique a mis en évidence un germe dans 8 cas. Les germes les plus fréquents étaient le streptocoque et le staphylocoque aureus (3 cas pour chacun). Le traitement antibiotique a été instauré dʼemblée chez tous les patients. Pour le traitement chirurgical initial, 9 patients ont bénéficié dʼun drainage frontal et 2 autres dʼun drainage orbitaire. Par ailleurs, 4 patients ont eu un drainage dʼabcès sous périosté seul. Celui-ci a été associé à une cranialisation dʼemblée dans un autre cas. Pour les patients ayant des complications endocrâniennes, un drainage dʼempyème a été réalisé dans 14 cas, associé chez 6 dʼentre eux à une cranialisation dʼemblée. Un drainage dʼabcès cérébral a été pratiqué chez un autre patient. Lʼévolution clinique et radiologique a été favorable chez 24 patients (77,4%). Les sept autres patients ont nécessité une reprise chirurgicale devant la persistance ou lʼaggravation de la symptomatologie clinique. Lʼévolution ultérieure a été favorable. Conclusion :Lʼostéite frontale post-sinusitique est une affection rare et grave. Son diagnostic, qui repose sur la clinique et lʼimagerie, doit être précoce. Un traitement adéquat d...

Otosclerosis is an osteodystrophia of the otic capsule, responsible for hearing loss by blocking of the stapes footplate. The purpose of this study was to evaluate the reliability of computed tomography (CT) in the positive diagnosis of otosclerosis, to compare the radiological findings to those intraoperatively, and to seek a correlation between imaging data and postoperative audiometric results. This is a retrospective study of 60 patients having otosclerosis, treated in our department between 2009 and 2011. All patients underwent an otoscopic examination, pure tone and vocal audiometry, impedancemetry and petrous CT scan. At petrous CT scan, a footplate thickening was found in 9 cases. Labyrinthine bone hypodensity was noted in 51 cases. Sensitivity of CT in the diagnosis of otosclerosis was 100%. Regarding the operative findings and their correlation with imaging, we found that among the 7 facial canal procidences reported intraoperatively, CT had identified 6, with a sensitivity of 86%. Of the 53 facial nerve in normal position intraoperatively, CT had only identified 34, with a specificity of 64%. Regarding the ossicles, there were 6 cases of abnormalities of the incus, among them 3 were identified on CT, with a sensitivity of 50%. The 54 patients with normal ossicular chain intraoperatively were all identified as such on CT, with a specificity of 100% (p = 0.001). For correlation between imaging and postoperative results, it was found that patients with extended otosclerosis had lower postoperative audiometric improvement than those having localized disease (p < 0.05). Computed tomography is necessary for the diagnosis of otosclerosis. It also helps, with good sensitivity and specificity, seeking for anatomical variants that the surgeon could possibly encounter during surgical procedure. Finally, there is a statistically significant correlation between imaging data and postoperative audiometric results, allowing establishing a functional prognosis even before surgery.