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BACKGROUND: Gastroesophageal reflux is a frequent and benign affection. It represents an etiopathological entity in otorhinolaryngology; that may occasion a large variety of ENT manifestations. AIM: To evaluate clinical and pHmetric impact of gastro esophageal reflux on upper airways in adult. METHODS: Prospective study about 95 cases diagnosed and treated at the ENT department of military hospital of Tunis. Clinical features, pH metric profiles and therapeutic approach are reported and compared to the literature. RESULTS: The mean age was 37 years old. Sex ratio was 1.16. Pharyngolaryngeal symptoms dominated ENT manifestations (41 cases). Laryngeal dyspnea, cough and dysphonia were predictive of danger. Positive pH metric rate collated to posterior laryngitis and pharyngitis were respectively 81.2% and 79.1%. Posterior laryngitis, dental erosion and chronic sinusitis, seem to have pejorative significance. CONCLUSION: Otorhinolaryngologist must think about asymptomatic reflux every time when chronic or recurrent ENT affection remain unexplained after complete clinical investigations. PH monitoring confirms gastroesophageal reflux disease.

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BACKGROUND: ENT cancers due to their location and treatment encompass a number of physical symptoms related to swallowing and communication disorders. AIM: To evaluate flight capacity of aircrew personnel with ENT cancer and consequences on fitness and waiver criteria. CASES REPORT: Case 1: A 52 years old smoker pilot whish present laryngeal epidermoid carcinoma staged T3M0N0 and treated by total laryngectomy with curative radio-therapy (70Gy). Metastasis occurred on lumgth and death heaped after acute respiratory failure. Case 2: A 55 years old mechanic whish had rhinopharyngeal undifferentiated carcinoma staged T4N2M0 and treated with radiochemotherapy with favourable follow-up. Inability for flight was proclaimed because of severe psychological impact. Case 3: Concerned a vesiculograpillary carcinoma of thyroid gland occurring in a 46 years old helicopter pilot. After total thyroidectomy and iodine treatment, the patient has obtained complete fitness to flight. CONCLUSION: Fitness to flight can be controversed in ENT cancer occurs. Epidemio-clinical paraclinical, functionnel and operational criterias must be considered when wainer to be proclaimed.

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AIM: To compare preoperative CT scan finding and per-operative lesions in patients operated for middle ear cholesteatoma, METHODS: A retrospective study including 60 patients with cholesteatoma otitis diagnosed and treated within a period of 5 years, from 2001 to 2005, at ENT department of Military Hospital of Tunis. All patients had computed tomography of the middle and inner ear. High resolution CT scan imaging was performed using millimetric incidences (3 to 5 millimetres). All patients had surgical removal of their cholesteatoma using down wall technic. We evaluated sensitivity, specificity and predictive value of CT-scan comparing otitic damages and CT finding, in order to examine the real contribution of computed tomography in cholesteatoma otitis. RESULTS: CT scan analysis of middle ear bone structures shows satisfaction (with 83% of sensibility). The rate of sensibility decrease (63%) for the tympanic raff. Predictive value of CT scan for the diagnosis of cholesteatoma was low. However, we have noticed an excellent sensibility in the analysis of ossicular damages (90%). Comparative frontal incidence seems to be less sensible for the detection of facial nerve lesions (42%). But when evident on CT scan findings, lesions of facial nerve were usually observed preoperatively (spécificity 78%). Predictive value of computed tomography for the diagnosis of perilymphatic fistulae (FL) was low. In fact, CT scan imaging have showed FL only for four patients among eight. Best results can be obtained if using inframillimetric incidences with performed high resolution computed tomography. CONCLUSION: Preoperative computed tomography is necessary for the diagnosis and the evaluation of chronic middle ear cholesteatoma in order to show extending lesion and to detect complications. This CT analysis and surgical correlation have showed that sensibility, specificity and predictive value of CT-scan depend on the anatomic structure implicated in cholesteatoma damages.

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BACKGROUND: Thyroid microcarcinoma is defined as a tumour of one centimeter or less in its greater diameter. Prognoses and therapeutic modalities remain controversial therapeutic guidelines for surgical treatment. AIM: To analyse the anatomical and clinical characteristics and discuss the modalities of care and therapeutic indications of these microcarcinoma. METHODS: We report a retrospective study concerning 13 cases of thyroid microcarcinoma, diagnosted and treated at the ENT department of Military Hospital of Tunis from 1998 to 2007. RESULTS: The mean age was 41 years and sex-ratio was 0.18. Clinical investigation by cervical ultrasonography found an isolated nodule in 30.7% and a multinodal goiter in 69.2%. Lymph node metastasis was precessiving in two cases. Five patients underwent loboisthmectomy and higt patients had a total thyroidectomy. Surgical lymph node removal was practiced for both cases with preceding cervical node involvement. Iodine 131 ablation was necessary every time when total thyroidectomy was practiced. A six years mean follow-up revealed no recurrence or death. CONCLUSION: Thyroid microcarcinoma is favorable long-term prognosis. Therapeutic modalities are closely depending on risk factors such as histology type, tumor size, lymph node involvement and extra thyroid extension.

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