Background: Microsurgical training has traditionally relied on live animal models. While these offer high anatomical and functional fidelity, their use raises increasing ethical, logistical, and economic concerns and alternatives are needed. Methods: We conducted a prospective observational study to assess the subjective and objective validity of a pump-perfused chicken thigh model for microsurgical training. Forty-five residents and surgeons were categorized by microsurgical experience. Thirteen participants underwent motion analysis and blinded video-based scoring. All participants performed arterial end-to-end anastomoses. Face and content validity were evaluated by experienced participants using Likert-scale questionnaires, while construct validity was assessed by comparing operative performance, Stanford Microsurgery and Resident Training scoring (SMaRT) and motion parameters across experience levels. Results: Face and content validity scores were high, with median values of 7.9 (IQR 7.3–8.3) and 8.8 (IQR 6.4–9.0), respectively. Construct validity was demonstrated by significant improvements with experience, including faster operative times (p = 3.05×10−6, ε∼0.59), higher success rates and fewer leaks (p = 1.41×10−5, V(Cramer)∼0.56). Experts displayed smoother, more stable hand movements (lower jerk, tremor, and rotational instability); SMaRT scores effectively distinguished experts from non-experts (p = 0.0014 (r = 1)), and correlated moderately with motion metrics, suggesting complementary roles of expert video assessment and motion analysis in evaluating microsurgical performance. Qualitative differences in motion profiles and gesture structure were apparent between novice and expert participants. Conclusion: The perfused chicken thigh model is a realistic and ethical alternative for microsurgical training with robust face, content and construct validities. Motion analysis might provide an objective complement to expert video-based assessment, suggesting its interest in structured training programs.

Background: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited. Methodology: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months. Results: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months. Conclusions: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.

INTRODUCTION:Odor imagery (OI), or the ability to mentally simulate the presence of a smell, is a difficult cognitive function and is therefore misunderstood in terms of its neural underpinnings. In particular, the diverging results obtained in neuroimaging studies could be explained in part by the characteristics of the visual cues used to trigger this task. In this study, we investigated this question by comparing the effects of plain color patches, pictures, and words during OI using neurophysiological and psychometrical measurements. METHODS:Thirty healthy right-handed participants performed an OI task during a functional magnetic resonance imaging exam. They were instructed to focus on the odors evoked by different types of visual cues. Two 595s functional runs were performed using a block design in which seven individual plain colors, pictures, and odor labels were used as visual triggers for OI. After each functional run, behavioral ratings of success/failure of OI as well as subjective pleasantness and intensity of odor images were collected. RESULTS:The OI task induced activity not only in regions of the olfactory network but also in non-olfactory brain regions. Across visual conditions, we observed activity in the orbitofrontal cortex, insula, supplementary motor area, and dorsolateral prefrontal cortex. Strikingly, no significant activity was found in the piriform cortex despite overall success in the OI task according to behavioral ratings (83% to 93% depending on the condition). CONCLUSIONS:Our findings suggest that OI can occur without significant involvement of the primary olfactory regions, contradicting most of the literature on this topic. Only little behavioral and neurophysiological effects of visual conditions were revealed in our sample of good odor imagers, although semantical cues seem to require fewer cognitive resources to generate odor images. This assumption remains to be confirmed using specific tools for the measurement of cognitive load.

ImportanceSurgical difficulty quantification is crucial to develop educational curricula for progressive training. This need remains unmet in endoscopic endonasal surgery (EES).ObjectiveThe objective was to classify the basic skills and procedures of EES according to the perceived difficulty by experts to build a progressive curriculum.DesignThree-round modified Delphi study.SettingE-survey with an international panel of EES experts.ParticipantsFifty-nine international experts were selected on their publications in the field of EES and medical education and invited to participate. Fifteen experts from 5 countries completed the survey.InterventionA 3-round modified Delphi study was conducted.Main Outcome MeasuresIn round#1, basic skills and EES procedures were identified and the basic skills required for these procedures were listed. In round#2, the expert panel ranked the difficulty of basic skills, and in round#3, the difficulty of the EES procedures. The basic skills were grouped into 3 categories of increasing difficulty, and the subsequently-calculated difficulty of each EES procedure was compared with the experts' score. Consensus was defined at ≥80% agreement.ResultsTwenty-three basic skills and 26 EES procedures were identified. Basic skills were ranked in 3 groups of increasing difficulty, from easiest (navigation with a 0° telescope) to most difficult (suturing in the nasal cavity), with ≥80% agreement. The least difficult procedure ranked was polypectomy, whereas the most difficult was Vidian neurectomy. The correlation between the expert score and the calculated score reached an R2 of .75, reflecting the cumulative effect of these required competencies on procedure difficulty.ConclusionsConsensus was achieved to rank basic skills and EES procedure according to the perceived difficulty by experts.RelevanceThis study provides a basis for quantifying surgical difficulty in EES and pave the way for developing a progressive educational curriculum.

Background Necrotizing otitis externa (NOE) is a rare disease associated with high morbidity and mortality, and there is currently no available accurate biomarker to assess treatment responses. The aim of the current study was to evaluate and directly compare the diagnostic performances of 18-Fluoro-deoxyglucose positron emission tomography (18F-FDG PET) and labeled leukocyte scintigraphy (LS) to monitor treatment responses in NOE. Methods Consecutive patients with NOE who underwent 18F-FDG PET at the end of antibiotic therapy and planar as well as single photon emission computed tomography-labeled leukocyte scintigraphy after completing the initial antibiotic treatment were retrospectively included. Semiquantitative analyses were performed to determine the ratios of affected/nonaffected sides for PET and 4 hour and 24 hour LS acquisitions as well as the kinetic PET ratios (at diagnosis and post-treatment) and LS (4 and 24 hours). The final treatment responses were assessed by 2 experienced ENT physicians based on clinical, otoscopic, and biological data and subsequent 3-month follow-up. Results Seventeen patients (74.0 ± 10.6 years old, 5 women) were included. The best diagnostic performances were obtained with the PET maximum standardized uptake value (SUVmax)-lesion-to-background ratio and the tomographic LS lesion-to-background ratio at the 4-hour acquisition timepoint (thresholds of 4.1 and 1.19, yielding accuracies of 100% and 88%, respectively). In the multivariate analysis, the PET SUVmax-lesion-to-background ratio was the only predictive factor of recovery when associated with all clinical parameters ( P < .001). Conclusion 18F-FDG PET is the first-line imaging modality for evaluating NOE treatment responses, with excellent diagnostic performances. LS with only 4-hour acquisitions appeared to suffice to evaluate NOE treatment responses. Both biomarkers constitute early prognostic biomarkers for predicting antibiotic treatment response in patients with NOE. Trial registration The institutional ethics committee (Comité d’Ethique du CHRU de Nancy) approved the evaluation of retrospective patient data, and the trial was registered at ClinicalTrials.gov (n°2023PI003-404).

Background: Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient’s medical management (outpa-tient care, standard hospital admission, and ICU admission). Methods: A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease. Results: Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.

OBJECTIVES:To assess the experience of subjects with olfactory disorders in their daily life and medical management, and their expectations and proposals for improvement.MATERIAL AND METHODS:A cross-sectional observational study was conducted over the period January 2020 to December 2021, with 300 subjects with olfactory disorders: 222 female, 78 male; mean age 46±15 years. In total, 126 were patients consulting in ENT, and 174 were members of the Anosmie.org patients' association. Participants filled out a questionnaire; free texts were analyzed thematically and coded for various qualitative variables.RESULTS:Olfactory disorders considerably impacted health, safety and quality of life. Non-COVID-19 acute etiologies (non-COVID-19 viral infection, cranial trauma) showed particularly high risk of psychological, social, safety-related and nutritional consequences. Almost all patients (94%) were dissatisfied with their medical management: 28% had received little explanation, and 23% felt their dysosmia was completely neglected, with no exploration and no etiology suggested. Patients wished above all to have follow-up and accompaniment.CONCLUSION:Despite significant impact on health and quality of life, olfactory disorders are neglected by the medical community. Patients should be given an ENT assessment with olfactometry, to establish diagnosis and prognosis. Global multidisciplinary management is necessary, including therapeutic education, and psychological, social and nutritional follow-up.

Trop d’articles sont encore refusés dans les revues médicales scientifiques, en raison du manque de préparation du manuscrit et de la méconnaissance des règles rédactionnelles modernes qui régissent la rédaction médicale scientifique. Aussi le comité de rédaction des European Annals of Otorhinolaryngology Heads & Neck Diseases a synthétisé les travaux publiés par ses membres depuis 2020 dans les colonnes de la revue scientifique de la société française d’oto-rhino-laryngologie et de la Société internationale francophone d’oto-rhino-laryngologie ainsi que les données de la littérature indexée PubMed dédiées à la rédaction médicale scientifique en oto-rhino-laryngologie au XXIe siècle. Avec cette mise au point construite sur le mode « Faites ! » et « Ne Faites Pas ! », les auteurs espèrent fournir aux auteurs un guide pratique facilitant la publication de travaux scientifiques rigoureux, reproductibles et transparents, en accord avec l’évolution pour une meilleure science souhaitée par la société depuis le début de ce siècle.

ObjectifsÉvaluer l’expérience vécue des sujets atteints de troubles olfactifs dans leur quotidien et leur prise en charge médicale, ainsi que leurs attentes et propositions d’améliorations.Matériel et méthodesÉtude observationnelle transversale, menée de janvier 2020 à décembre 2021, incluant 300 sujets atteints de troubles olfactifs (222 femmes, 78 hommes ; âge moyen 46±15 ans) : 126 patients de la consultation d’ORL et 174 membres de l’association Anosmie.org. Tous les participants ont été invités à remplir un auto-questionnaire. Chaque réponse libre a été analysée thématiquement et encodée sous différentes variables qualitatives.RésultatsLes troubles olfactifs impactaient considérablement l’état de santé, la sécurité et la qualité de vie. Les causes aiguës hors COVID-19 (post-viral non COVID-19 et post-traumatisme crânien) étaient particulièrement à risque de présenter de nombreuses répercussions (psychologiques, sociales, sécurité et alimentation). La quasi-totalité des patients (94 %) étaient insatisfaits de leur prise en charge médicale, 28 % n’ont reçu que peu d’explications et 23 % jugeaient que leur dysosmie a été totalement négligée, qu’ils n’ont bénéficié d’aucune exploration voire qu’aucune étiologie ne leur a été donnée. Les patients souhaitaient avant tout bénéficier d’un suivi et d’un accompagnement.ConclusionMalgré les répercussions significatives des troubles olfactifs sur l’état de santé et la qualité de vie, cette affection reste peu considérée par le corps médical. Tout patient devrait bénéficier d’un bilan ORL à l’aide d’une olfactométrie afin d’établir un diagnostic et un pronostic. Une prise en charge globale et multidisciplinaire est nécessaire, intégrant une éducation thérapeutique, un suivi psychologique, social et diététique.

To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3–2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3–2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23–74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7

OBJECTIVE(S):To determine the accuracy of conventional and diffusion-weighted (DWI) MRI for the differential diagnosis between mucopyocele and mucocele using surgical diagnosis as a reference. METHODS:This retrospective study included patients referred to our institution between March 2017 and February 2024 for paranasal sinus MRI to characterize an expansile non-enhanced sinus filling on CT. The T1 and T2 signal intensities were recorded, as well as the presence of restriction diffusion, of the penumbra sign, the double rim sign, and the presence of parietal micro-abscesses. Quantitative apparent diffusion coefficient values were also recorded. RESULTS:The study included 74 patients aged 18 to 88 years (mean age: 60.4 ± 17.7 years). Of these, 43 had a mucopyocele and 31 had a mucocele. The T1 high signal intensity was different amongst groups as an hypersignal was present in 35.5% of mucoceles and only 4.7% of mucopyoceles (p = 0.02). The T2 signal did not differ between the two groups (p = 0.59). The double rim sign and the presence of parietal micro-abscesses demonstrated 96.8% and 100% specificities, respectively, but were predominantly located in the maxillary sinus. The penumbra sign exhibited a sensitivity of 60.5% and a specificity of 67.7%. All mucopyoceles exhibited a diffusion restriction with an apparent diffusion coefficient of less than 0.78 × 10-3 mm2/s. CONCLUSION:DWI is the most useful MRI tool for the accurate differential diagnosis between mucopyocele and mucocele in non-enhanced sinus fillings. LEVEL OF EVIDENCE:3 (case-control study) Laryngoscope, 135:1008-1014, 2025.

Introduction Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent condition affecting approximately 2% of the population. Medical treatment consists long-term use of intranasal corticosteroids and short-term use of oral corticosteroids, in adjunct with saline solution rinses. Surgical management is proposed in patients who failed after medical treatment. In France, two biologics are reimbursed in case of severe uncontrolled CRSwNP despite medical treatment and endoscopic sinus surgery. Waiting for head-to-head biologics comparison, studies should report the efficacy and safety of biologics in large real-life cohorts. This study protocol describes the aims and methods of a prospective, observational, national, multicentric cohort of patients with CRSwNP treated with biologics.Methods and analysis The BIOlogics in severe nasal POlyposis SurvEy is a French multicentre prospective observational cohort study. The main aim is to assess the efficacy and tolerance of biologics in patients with CRSwNP, with or without association with other type 2 diseases, and to determine the strategies in case of uncontrolled disease under biologics. Patients over 18 years old requiring biologics for CRSwNP in accordance with its marketing approval in France (ie, severe nasal polyposis, with lack of control under nasal corticosteroid, systemic corticosteroids and surgery) are invited to participate. Collected data include topical history of surgical procedures and biologics, medication and use of systemic corticosteroids, visual analogical scales for specific symptoms, Sino-Nasal Outcome Test-22 questionnaire, nasal polyp score, asthma control test, Lund-Mackay score on CT scan and IgE concentration and eosinophilic count on blood sample.Trial registration NCT05228041/DRI_2021/0030.

Cette mise au point visait à évaluer les indications chirurgicales dans la prise en charge de la polypose nasale (PN). Elle a été conduite et rapportée conformément aux critères stipulés par les recommandations Synthesis Without Meta-analysis. Depuis la base de données PUBMED, 1098 articles ont été identifiés entre 2000 et 2021 à l’aide des mots clés « nasal polyps » et « surgery ». Après screening et analyse, 39 publications ont été retenus. L’efficacité de la chirurgie dans la polypose nasale mesurée par le score spécifique de qualité de vie SNOT-22 est établie. L’amélioration olfactive est attendue chez 50 % des patients. Le taux de reprise chirurgicale est d’au moins 10–15 % à 4 ans, mais la maladie peut être contrôlée plusieurs années, avec un délai entre la chirurgie et la récidive symptomatique pouvant dépassant 10 ans. Les critères médicaux de recours à la chirurgie ne sont pas consensuels dans la littérature mais plusieurs auteurs retiennent comme indication fiable à la chirurgie l’échec d’un traitement médical local bien conduit sur au moins 8 semaines et le recours à plus de 2 cures d’une corticothérapie systémique. Aucune étude ne permet aujourd’hui de préciser la supériorité d’une technique chirurgicale par rapport à une autre.

INTRODUCTION:The introduction of biotherapies has significantly changed the management of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). These drugs are generally reserved for severe or recurrent CRSwNP. Thus, the concepts of severity of the disease and treatment response must be mastered by otorhinolaryngologists. However, a clear definition of these concepts in CRSwNP is missing.METHODS:This article focuses on definitions of severity and treatment response in CRSwNP by providing an expert consensus among French rhinologists, using a Delphi study.RESULTS:The severity assessment should seek the presence of uncontrolled asthma, olfactory disorders, nasal blockage, impaired quality of life (QOL) and cumulative annual dose of systemic corticosteroids.The treatment response should assess the presence of olfactory disorders, nasal blockage, QOL impairment, response to background therapy, resistance and/or dependence to oral corticosteroids, cumulative annual dose of systemic corticosteroids, response to surgery and to biologics.A failure after polypectomy should not be considered as a failure of surgical management of CRSwNP and must discuss the realization of an extended sinus surgery procedure before the prescription of biologics.CONCLUSION:Definitions of severity, control of CRSwNP, as well as therapeutic strategies to improve patients' QOL achieved high level of consensus.

Purpose: The objective was to assess the local oncological outcomes of endoscopic versus external sur-gical treatment of sinonasal intestinal-type adenocarcinomas (ITAC) and the factors of recurrence.Methods: a retrospective non-randomized case-control multicenter study was carried out, including 452 untreated sinonasal ITACs recruited from 10 tertiary referral centers. The tumors were re-classified ac-cording to the UICC 2017 (pT). Survival curves were obtained using the Kaplan-Meier method. Univariate analysis was done with the log-rank test. Multivariate analysis was performed with a Cox model adjusted for age, T stage, and radiotherapy. A binary logistic regression compared surgical complications and performed two supplementary analyses on positive margins.Results: We compared 195 and 257 patients operated by the external and endoscopic approach, respectively. The mean follow-up was 59.2 +/- 48.7 months. Post-operative margins were invaded in 30.6 versus 18.9% of patients, respectively (p = 0.007). The overall recurrence rate was 33.8 versus 24.6%, respectively (p = 0.034). There was a significant difference in favor of the endoscopic approach regarding local recurrence-free survival thanks to better surgical margins in univariate and multivariate analysis (Odd Ratio = 2.01 (1.2-3.36) p = 0.0087). The complication rate (Odds Ratio = 3.4 (1.79-6.32) p < 0.001) was significantly lower in the endoscopic group. The histological positivity of signet-ring cells shows a statistically significant difference in recurrence-free survival (p = 0.0028).Conclusion: the oncological control of ITAC is better through the endoscopic approach, with negative margins and the absence of signet-ring-cells, two independent factors of recurrence.(c) 2022 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Too many articles are still rejected by scientific medical journals due to lack of preparation of the manuscript and of knowledge of the modern editorial rules that govern scientific medical writing. Therefore, the editorial board of the European Annals of Otorhinolaryngology Heads & Neck Diseases summarized studies published by its members since 2020 in the columns of the scientific journal of the French Society of Otorhinolaryngology and the International Francophone Society of Otorhinolaryngology and data from the PubMed indexed literature dedicated to scientific medical writing in otolaryngology in the 21st century. The authors hope that this review, in the form of a list of "Dos and Don'ts", will provide authors with a practical guide facilitating publication of rigorous, reproducible and transparent scientific studies, in accordance with the movement toward better science that society as a whole has been fighting for since the beginning of this century.

It was at the dawn of the 18th century that "hay fever" was first identified as such. The symptoms were exhaustively described in all their aspects by a physician who was particularly well-informed as he himself suffered from this catarrhal condition every year in the flowering season. But it then took many other discoveries to understand the pathophysiology, starting by identifying the role of pollens, conceptualizing the principles of the reaction and giving it the name of allergy, and then developing the first screening and identification tests of individual sensitization. This historical article describes the major discoveries and key actors that contributed to the current knowledge of pollinosis and, more broadly, of allergic rhinitis.