Publications of Philippe LEFEBVRE
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See detailAuditory function and dysfunction:estrogen makes a difference
DELHEZ, Amandine ULiege; LEFEBVRE, Philippe ULiege; Pequeux, Christel ULiege et al

in Cellular and Molecular Life Sciences (2020), 77

Estrogen is the major female hormone involved in reproductive functions, but it also exerts a variety of additional roles in non-reproductive organs. In this review, we highlight the preclinical and ... [more ▼]

Estrogen is the major female hormone involved in reproductive functions, but it also exerts a variety of additional roles in non-reproductive organs. In this review, we highlight the preclinical and clinical studies that have pointed out sex differences and estrogenic influence on audition. We also describe the experimental evidences supporting a protective role of estrogen towards acquired forms of hearing loss. Although a high level of endogenous estrogen is associated with a better hearing function, hormonal treatments at menopause have provided contradictory outcomes. The various factors that are likely to explain these discrepancies include the treatment regimen as well as the hormonal status and responsiveness of the patients. The complexity of estrogen signaling is being untangled and many downstream effectors of its genomic and non-genomic actions have been identified in other systems. Based on these advances and on the common physio-pathological events that underlie age-related, drug or noise-induced hearing loss, we discuss potential mechanisms for their protective actions in the cochlea. [less ▲]

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See detailTranscutaneous Ultrasound for Maxillary Disease Screening in Intensive Care Unit: a Preliminary Study
Benchimol, Lionel ULiege; PIAZZA, Justine ULiege; ROGISTER, Florence ULiege et al

Conference (2020)

Introduction and Aim: Nosocomial airway infections are common and associated with high morbidity and mortality in Intensive Care Unit. Endotracheal intubation duration is an independent risk factor for ... [more ▼]

Introduction and Aim: Nosocomial airway infections are common and associated with high morbidity and mortality in Intensive Care Unit. Endotracheal intubation duration is an independent risk factor for maxillary sinusitis, which is a frequent gateway for pneumoniae, meningitis or sepsis. Diagnosis remains challenging, as CT imaging is not easily repeated in the daily assessment of unstable patients. Our aim was to evaluate the efficiency of transcutaneous ultrasound to screen maxillary sinus infection. Material and Methods: Patients presenting to our ENT department with a same-day sinus CT scan were prospectively included in this pilot study. Maxillary transcutaneous ultrasounds were performed by two independent examiners and scored in supine and sitting positions, blindly to the CT imaging, the clinical and endoscopic evaluations. Ability to diagnose sinusitis, repeatability in different positions and inter-examiners comparison were studied. Ultrasound scores were compared to Lund-Mackay-derived CT scores. Results: 7 patients (5 men and 2 women, median age 60 [56-64]) were enrolled in this experiment. In total, 14 left and right maxillary sinus were studied by same-day sinus CT scan and ultrasound in prone and sitting positions by 2 blind and independent examiners. Ultrasound was able to detect maxillary pathology the majority of the cases, with a sensitivity of 71.4% and a specificity of 87.5% in sitting position. However, sensitivity dropped to 46.8% in prone position, with a preserved specificity of 84.4%. Agreement between examiners was observed in 85.7% cases. Conclusion: Transcutaneous ultrasound was capable of screening for maxillary sinus disease compared with conventional sinus CT scan. A special attention should be paid to patient position, as sitting position improved the screening accuracy. Agreement between examiners could be improved. Moreover, despite its limitations, it is an attractive method for the screening of maxillary disease, allowing the ability to screen and/or monitor infection in unstable patients. [less ▲]

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See detailThe influence of the conservation of respiratory epithelial samples on ciliary functional analysis
Bricmont, Noémie ULiege; Benchimol, Lionel ULiege; POIRRIER, Anne-Lise ULiege et al

Conference (2020)

Background: Primary ciliary dyskinesia(PCD) is an inherited otosinopulmonary ciliopathy in which respiratory cilia are stationary, or beat in a dyskinetic manner. Digital high speed videomicroscopy(DHSV ... [more ▼]

Background: Primary ciliary dyskinesia(PCD) is an inherited otosinopulmonary ciliopathy in which respiratory cilia are stationary, or beat in a dyskinetic manner. Digital high speed videomicroscopy(DHSV) allows ciliary functional analysis(CFA), including beat frequency(CBF) and pattern(CBP). DHSV is highly sensitive and specific for PCD diagnosis, but lacks standardization and evidence-based data. The technical process of ciliated epithelial samples before CFA varies among studies. Of importance, delay after sampling and temperature for samples conservation may impact CFA. However, these parameters have never been compared. Aims: To evaluate the stability of ciliary function over time when nasal brushing samples are conserved either in the fridge, or at room temperature. Methods: Ciliated epithelial samples were obtained by brushing the inferior nasal turbinate from 5 non-smoking healthy subjects. The samples were divided equally, and conserved either at 4°C or at 22°C. Beating cilia were recorded using DHSV at 37°C immediately(T0, then 9 hours after sampling(T9). CFA was assessed by CBF and the percentage of normal CBP. Results: There was no significant difference between CFA performed immediately or 9 hours after sampling, regardless of the sample storage temperature. Conclusion: This pilot study suggested that the stability of CFA may be preserved for 9 hours at 22°C and at 4°C. Larger studies are needed to confirm these preliminary results, notably in pathological conditions. [less ▲]

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See detailNasal Brushing Sampling and Processing using Digital High Speed Ciliary Videomicroscopy - Adaptation for the COVID-19 Pandemic.
Bricmont, Noémie ULiege; Benchimol, Lionel ULiege; POIRRIER, Anne-Lise ULiege et al

in Journal of visualized experiments : JoVE (2020), (165),

Primary Ciliary Dyskinesia (PCD) is a genetic motile ciliopathy, leading to significant otosinopulmonary disease. PCD diagnosis is often missed or delayed due to challenges with different diagnostic ... [more ▼]

Primary Ciliary Dyskinesia (PCD) is a genetic motile ciliopathy, leading to significant otosinopulmonary disease. PCD diagnosis is often missed or delayed due to challenges with different diagnostic modalities. Ciliary videomicroscopy, using Digital High-Speed Videomicroscopy (DHSV), one of the diagnostic tools for PCD, is considered the optimal method to perform ciliary functional analysis (CFA), comprising of ciliary beat frequency (CBF) and beat pattern (CBP) analysis. However, DHSV lacks standardized, published operating procedure for processing and analyzing samples. It also uses living respiratory epithelium, a significant infection control issue during the COVID-19 pandemic. To continue providing a diagnostic service during this health crisis, the ciliary videomicroscopy protocol has been adapted to include adequate infection control measures. Here, we describe a revised protocol for sampling and laboratory processing of ciliated respiratory samples, highlighting adaptations made to comply with COVID-19 infection control measures. Representative results of CFA from nasal brushing samples obtained from 16 healthy subjects, processed and analyzed according to this protocol, are described. We also illustrate the importance of obtaining and processing optimal quality epithelial ciliated strips, as samples not meeting quality selection criteria do now allow for CFA, potentially decreasing the diagnostic reliability and the efficiency of this technique. [less ▲]

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See detailIs baseline SNOT-22 able to predict outcome and localize pathology? A prospective multicentre study
Pottier, Laurence ULiege; de Dorlodot, Clotilde; Ansari, Edward et al

in B-ENT (2020)

Objective: To optimize the use of SNOT-22 by predicting the diagnosis of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Study Design: Cross-sectional multi-center ... [more ▼]

Objective: To optimize the use of SNOT-22 by predicting the diagnosis of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Study Design: Cross-sectional multi-center study. Settings: ENT departments of 3 tertiary referral hospitals. Methods: Baseline SNOT-22 from 66 healthy volunteers and 383 rhinology patients were collected blindly prior to diagnosis. Participants were then categorized in 4 groups according to their diagnosis: control, medical rhinologic condition, functional nose surgery, sinus surgery. Difference between groups was assessed by a multinomial logistic regression adjusted for age, gender, history of nose surgery and trauma. Results: The 22 items of SNOT differed significantly among the 4 groups (p <0.05). Control subjects showed the lowest SNOT-22 scores for all items. Patients requiring sinus surgery and those listed for nose surgery exhibited a specific pattern of SNOT-22 score. Nasal and extranasal rhinology symptoms were more specific to the diagnosis than psychological or sleep dysfunction domains. Conclusion: Distinct SNOT-22 patterns were associated to subjects diagnosis. SNOT-22 was not only able to score severity, but could also localize the disease, orientate the diagnosis and predict the need for surgical treatment. In the era of pandemic risk, SNOT-22 may be the easy telemedicine tool the primary care needs for a better referral pattern. [less ▲]

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See detailBaseline SNOT-22 as Outcome Predictor: a Powerful Tool just at Hand
POIRRIER, Anne-Lise ULiege; DE DORLODOT, Clotilde; ANSARI, Edward et al

Poster (2019, June 29)

Introduction: SNOT-22 was initially designed for rhinosinusitis, but was recently validated in various nose conditions. We sought to optimize the use of SNOT-22 by predicting the outcome of patients and ... [more ▼]

Introduction: SNOT-22 was initially designed for rhinosinusitis, but was recently validated in various nose conditions. We sought to optimize the use of SNOT-22 by predicting the outcome of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Material and Methods: Sixty-six healthy volunteers and 383 patients presenting to the rhinology clinic of 3 ENT academic departments participated in this prospective cross-sectional multi-centre study. SNOT-22 from all participants were collected blindly prior to diagnosis. Participants were then categorized in 4 groups according to their outcome: control, medical rhinologic condition, functional nose surgery, sinus surgery. Difference between groups was assessed by a multinomial logistic regression adjusted for age, gender, history of nose surgery and trauma. Results: The 22 items of SNOT differed significantly among the 4 groups (p <0.05). Control subjects showed the lowest SNOT-22 scores for all items. Patients requiring sinus surgery and those listed for nose surgery exhibited a specific pattern of SNOT-22 score. Nasal and extranasal rhinology symptoms were more specific to the diagnosis than psychological or sleep dysfunction domains. Conclusion: Distinct SNOT-22 patterns were associated to subjects outcome. SNOT-22 was able to differentiate patients from controls, to score severity, and could further provide an accurate description of pathology. Baseline SNOT-22 could help localize pathology in the sinus or in the nose and predict the need for surgical treatment. [less ▲]

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See detailImpact of the European Union directive on driving licences on a Multidisciplinary Sleep Clinic: a Cohort Study
POIRRIER, Anne-Lise ULiege; VERMEIRE, Pierre ULiege; BRUWIER, Annick ULiege et al

Poster (2019, June 29)

Introduction: The threat of Obstructive Sleep Apnea (OSA) for motor vehicle accident has led to a revision of annex III of the European Union directive on driving licences that was implemented in all ... [more ▼]

Introduction: The threat of Obstructive Sleep Apnea (OSA) for motor vehicle accident has led to a revision of annex III of the European Union directive on driving licences that was implemented in all member states from December 31, 2015. In Belgium, it was followed by a shift in funding for OSA from January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments delivery and monitoring by authorised medical opinion. Multidisciplinary Sleep Clinics have long existed, bringing together sleep specialists, dentists, orthodontists and surgeons. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Material and Methods: Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. Results: There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline OSA severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered respectively with p = 0.0189 and p = 0.0466) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. Conclusion: Sleep multidisciplinary team meeting changed patient selection and management after the implementation of the new funding rules for OSA. The shift in funding often resulted in treatment options change, reaching more people and offering more options. [less ▲]

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See detailENT Surgical Training in 2018: National Cross-sectional Study
ROGISTER, Florence ULiege; CAMBY, Séverine ULiege; ANSARI, Edward et al

in B-ENT (2019), 15

Objectives: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to ... [more ▼]

Objectives: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to be developed. Methodology: We conducted a broad national survey among ENT Belgian trainees from all universities of the country. The questions included self-assessment, training objectives, training quality and training tools. Results: There were 94 trainees contacted and the overall response rate was 59.5% ; 35.7% of trainees evaluated their level of overall surgical competence at 3/5 compared to an ideal mastery. More than a half (55%) of trainees did not know the training objectives and 73% did not know the basic surgical procedures that a qualified ENT surgeon should be able to perform. The main mode of learning (41%) was the observation of a senior and repetition under supervision (companionship). The results showed mainly logistical and economic drawbacks, on which it seems possible to act using learning methods based on the implementation of organized training sessions, associated with different learning tools such as surgical and procedural simulation. Some of these are already available in our country but remain difficult to access or to develop. Conclusion: This study revealed a real demand and motivation from trainees and could serve as a basis to sketch a teaching scheme improving skills and confidence of future surgeons. Additional studies are needed to identify the most effective ways for implementing this type of teaching within the constraints of the surgical curriculum and teaching hospitals resources. [less ▲]

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See detailA prospective audit of acute ENT activity in a university teaching hospital
Atta, Lucas; Delrez, Sophie ULiege; Asimakopoulos, Asimakis et al

in B-ENT (2019), 15

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this 24-hour availability. Our goal was to audit the ... [more ▼]

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this 24-hour availability. Our goal was to audit the emergency ENT activity in our institution. Methods: A prospective audit of all ENT emergency referrals was carried out over a one-month period in an academic hospital. Descriptive statistics were produced for age, sex, origin, admission time, diagnosis, management, and patient outcome. Results: A total of 190 patients (109 men and 81 women) were referred to the ENT emergency service over the study period (mean, 6.1 cases/day). Mean age was 47.9 (SD ±23.6) years. Most admissions (76.4%) occurred during normal working hours, and 62.0% of patients were self-referred. The mean complaint duration before admission was 7.6 (±13.7) days. One third (33.2% patients) required ambulatory treatment, a quarter (24.7% patients) had a minor ENT procedure, 18 (9.5%) required admission to the ward, and 8 (4.2%) required surgical treatment. Severity of diagnosis or management between patients did not differ with referral by a physician (GP or specialist) and self-referral. At 30 days, 3 (1.6%) patients died, 106 (55.8%) benefitted from an ENT follow-up, 65 (34.2%) were referred to another physician (GP or specialist), and 16 (8.4%) were lost to follow-up. Conclusions: The results of this workload audit suggest that emergency ENT activity is justified in our hospital. Restricting emergency ENT cover to patients referred by a GP or another physician would not improve patient selection. [less ▲]

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See detailEvaluation of Surgical Simulation in Temporal Bone Surgical Radio-Anatomy Learning
ROGISTER, Florence ULiege; SALMON, Caroline ULiege; GHUYSEN, Alexandre ULiege et al

Conference (2019, March 28)

Background Lack of data regarding efficiency of simulation-based teaching, in particular high-fidelity virtual reality, constitutes a major drawback for its implementation in the medical training. However ... [more ▼]

Background Lack of data regarding efficiency of simulation-based teaching, in particular high-fidelity virtual reality, constitutes a major drawback for its implementation in the medical training. However, it provides a structured, safe and supportive environment to familiarize with complex anatomy and practice surgical skills. We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Materials and Methods 15 Belgian otorhinolaryngology residents completed 5 sessions of simulation in antro-mastoidectomy using VOXEL-MAN Tempo® surgical simulator. Technical mistakes and surgical parameters were recorded. Before and after training period, residents completed a temporal bone radiological anatomy test available online (http://www.radioanatomie.com). Pre- and post-simulation scores were compared as primary endpoint by non-parametric Wilcoxon test using RCmdr (https://www.r-project.org). As secondary endpoint, residents’ surgical skills following simulation training were blindly assessed on cadaveric human temporal bones using a reproducible scale by seniors otologist surgeons of our department. Correlation between radiological testing and dissection scale were evaluated by Spearman regression. Finally, trainees completed a survey on the device itself. Results Performance on radiological testing significantly increased with a mean improvement of 28 ± 12.12 (Wilcoxon p = 0.0011). Surgical results on cadaveric specimens were not correlated to surgical simulation parameters. Higher results on radiological testing were associated with higher scores on dissection scale, suggesting that subjects who succeeded better at dissection were those who knew best anatomy. Among residents, 80% felt this tool suitable for early surgical education, and 84.6% queried further information on simulation techniques. 100% of trainees would integrate this tool within their learning of temporal bone's radiological and surgical anatomy. Conclusions High-fidelity virtual reality simulator improved temporal bone anatomy teaching and specifically increased knowledge of temporal bone radiological anatomy. Acknowledgement No conflict of interest. [less ▲]

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See detailSurgical Simulation in Temporal Bone Surgical Radio-Anatomy Learning
ROGISTER, Florence ULiege; SALMON, Caroline ULiege; GHUYSEN, Alexandre ULiege et al

in B-ENT (2019, February 23)

Introduction and Aim: We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Methods: Fifteen ENT residents completed a radiological ... [more ▼]

Introduction and Aim: We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Methods: Fifteen ENT residents completed a radiological temporal bone anatomical testing before and after five training sessions on the VOXEL-MAN Tempo® surgical simulator. Secondary investigation: residents also completed a personal subjective assessment after these training session and residents’ technical skills were assessed on cadaveric temporal bones. Results: Primary outcome: Residents significantly improved their performance on the temporal bone radiological anatomy test after completing virtual training on the simulator. Secondary outcomes: The personal assessment survey indicated that 100% of the residents would integrate this virtual tool within the learning methods. No significant correlation was found between virtual simulator performances and surgical performances on cadaveric model, but a significant correlation was shown between the anatomical testing result and the performances on cadaveric model. Conclusions: This study suggested that a high-fidelity virtual reality simulator, the VOXEL-MAN Tempo® device, improved teaching of temporal bone anatomy and specifically increased trainees’ practical knowledge regarding radiological anatomy of temporal bone. [less ▲]

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See detailENT Surgical Training in 2018: National Cross-sectional Study
ROGISTER, Florence ULiege; CAMBY, Séverine ULiege; LEFEBVRE, Philippe ULiege et al

in B-ENT (2019)

Introduction and Aim: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential ... [more ▼]

Introduction and Aim: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to be developed. Material and Methods: We conducted a broad national survey among Belgian population within the North-part and South-part universities of the country. The questions included self-assessment, training objectives, training quality and training tools. Results: 35.7% of trainees evaluated their level of overall surgical competence at 3/5 compared to an ideal mastery. More than a half (55%) of trainees did not know the training objectives and 73% did not know the basic surgical procedures that a qualified ENT surgeon should be able to perform. The main mode of learning (41%) was the observation of a senior and repetition under supervision (companionship). The results showed mainly logistical and economic drawbacks, on which it seems possible to act using learning methods based on the implementation of organized training sessions, associated with different learning tools such as surgical and procedural simulation. Some of these are already available in our country but remain difficult to access or to develop. Conclusion: This study revealed a real demand and motivation from trainees and could serve as a basis to sketch a teaching scheme improving skills and confidence of future surgeons. Additional studies are needed to identify the most effective ways for implementing this type of teaching within the constraints of the surgical curriculum and teaching hospitals resources. [less ▲]

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See detailResponsiveness of acoustic rhinometry to septorhinoplasty by comparison to rhinomanometry and subjective instruments.
ANSARI, Edward; ROGISTER, Florence ULiege; LEFEBVRE, Philippe ULiege et al

in Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2019)

OBJECTIVES: Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods' responsiveness ... [more ▼]

OBJECTIVES: Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods' responsiveness to change. We evaluated the responsiveness of acoustic rhinometry to nasal valve surgery by comparison to rhinomanometry and patient-reported outcome instruments. DESIGN: Prospective case-control study Setting: Tertiary referral University Hospital Participants: Sixty consecutive patients with internal nasal valve dysfunction and 20 healthy volunteers as control group were enrolled. Prospectively collected data included acoustic rhinometry, rhinomanometry, NOSE scale, SNOT-23 questionnaire, visual analogue scale and demographics. MAIN OUTCOME MEASURES: Primary endpoint was the responsiveness of acoustic rhinometry to functionnal septorhinoplasty surgery at 3 months. Secondary endpoints were ability of acoustic rhinometry to reflect "known group" differences and correlation to subjective symptoms. RESULTS: Acoustic rhinometry was highly responsive to septorhinoplasty (p<0.0001) while anterior rhinomanometry was not (p=0.08). Based on the quartiles of the post-operative change in NOSE score, patients were classified as respectively non responders, mild, moderate and good responders to surgery. Logistic regression model showed that acoustic rhinometry was able to discriminate non responders to responders to surgery (p=0.019), while anterior rhinomanometry failed (p=0.611). Sensitivity and specificity of acoustic rhinometry were significantly higher (ROC area=0.76) than rhinomanometry (ROC area =0.48). Acoustic rhinometry was also superior than rhinomanometry to discriminate patients from control subjects, and agreed better with patients-based subjective questionnaires. CONCLUSIONS: Our study confirms and quantifies the responsiveness of acoustic rhinometry to nasal valve surgery, with a higher sensitivity and specificity than rhinomanometry. This article is protected by copyright. All rights reserved. [less ▲]

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See detailCarotid blowout syndrome in patients with nasopharyngeal carcinoma: three cases
Detroux, Valentine; Goffart, Yves; Maris, Dana et al

in B-ENT (2019), 15

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC ... [more ▼]

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC cases treated with irradiation and complicated by bleeding from the internal carotid artery. The first case presented with multiple episodes of limited nosebleeding followed by massive bleeding. Bleeding was initially stopped by internal carotid artery embolisation. A few months later, meningitis related to skull base osteoradionecrosis occurred and the patient died from sceptic shock. The second case was admitted to the hospital with severe repetitive epistaxis and despite several attempts to manage the bleeding, the patient passed away. The third case presented with a massive epistaxis that resolved itself without any treatment. Spontaneous occlusion of the internal carotid artery occurred without any neurological defects. A nasopharyngeal muscle flap was constructed to prevent meningitis. CBS is a rare but life-threatening complication that requires emergency treatment. Re-irradiation and skull base radioosteonecrosis are strong predisposing factors. [less ▲]

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See detailImpact of a Shift in Treatment Funding on a Multidisciplinary Sleep Clinic: a Cohort Study
VERMEIRE, Pierre ULiege; FANIELLE, Julien ULiege; BRUWIER, Annick ULiege et al

in B-ENT (2019)

Introduction and Aim: A shift in Obstructive Sleep Apnea (OSA) funding was implemented in Belgium on January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments ... [more ▼]

Introduction and Aim: A shift in Obstructive Sleep Apnea (OSA) funding was implemented in Belgium on January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments delivery and monitoring by authorised medical opinion. Multidisciplinary Sleep Clinics have long existed, bringing together sleep specialists, dentists, orthodontists and surgeons. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Material and Methods: Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. Results: There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline OSA severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered respectively with p = 0.0189 and p = 0.0466) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. Conclusion: Sleep multidisciplinary team meeting changed patient selection and management after the implementation of the new funding rules for OSA. The shift in funding often resulted in treatment options change, reaching more people and offering more options. [less ▲]

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See detailRhinologic Emergencies: a Prospective Audit in a University Teaching Hospital
ROGISTER, Florence ULiege; ATTA, Lucas; Delrez, Sophie ULiege et al

Conference (2018, April)

Aims: Increasing pressure to reduce healthcare cost threatens the provision of acute ENT coverage round the clock. Our goal was to audit our emergency rhinologic activity over a one-month period. Methods ... [more ▼]

Aims: Increasing pressure to reduce healthcare cost threatens the provision of acute ENT coverage round the clock. Our goal was to audit our emergency rhinologic activity over a one-month period. Methods: A prospective audit for all emergency ENT referrals was carried out from May 1st to May 31th 2017. Descriptive statistics were produced for age, sex, origin, time of arrival, diagnosis and outcome. A specific subgroup analysis was performed for rhinologic emergencies. A basic cost analysis was ran. Results: Over the study period, 190 patients were referred to the ENT emergency service. Twenty percent patients presented with nose or sinus complaint (36.8% with otological or neuro-vestibular primary complaint, 43.2% with laryngeal or neck complaint). Nose and throat complaints were more likely to present at night or on weekends. Ear complaints were more likely to present during business hours. Rhinologic complaint was more likely to require technical or surgical management than ear or throat complaint. Patients with nose complaint required minor procedure in 43.2% cases (35.6% of the total minor procedures), and required surgical procedure in 13.5% cases. Among the total ENT emergency surgical procedures, 62.5% were rhinologic ones, involving the nose (50%) or the sinus (12.5%). Ear or throat initial complaint were more likely to require no treatment or ambulatory management. Conclusion: The emergency rhinologic activity is justified in our hospital. An initial rhinological complaint was more likely to require specific ENT management than other complaints. ENT cover is an efficient service provision, especially for rhinologic emergencies. [less ▲]

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See detailBaseline SNOT-22 as Outcome Predictor: a Powerful Tool just at Hand
ROGISTER, Florence ULiege; DE DORLODOT, Clotilde; ANSARI, Edward et al

Conference (2018, April)

Aims: SNOT-22 was initially designed for rhinosinusitis, but was recenty validated in various nose conditions. Nose or sinus complaint is a common cause of consultation in primary care or ENT clinic ... [more ▼]

Aims: SNOT-22 was initially designed for rhinosinusitis, but was recenty validated in various nose conditions. Nose or sinus complaint is a common cause of consultation in primary care or ENT clinic. Therefore we sought to optimize the simple and versatile instrument SNOT-22. Our aim was to determine the outcome of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22 in a multi-centre study. Methods: Sixty-six healthy volunteers and 383 patients presenting to the rhinology clinic of the ENT academic departments of Godinne, Liege and Brussels participated in this study. SNOT-22 from all participants were collected blindly prior to diagnosis. Participants were then categorized in 5 groups according to their outcome: control, medical rhinologic condition, sinus surgery, functional nose surgery. SNOT-22 items relevant to each group were determined by multinomial logistic regression. Results: Control subjects showed the lowest SNOT-22 scores for all items. Medical rhinologic patients had lower scores than surgical patients. Patients requiring sinus surgery and those listed for nose surgery exhibited a specific pattern of SNOT-22 score. Most relevant items were #1 need to blow nose, #5 post-nasal discharge, #6 thick nasal discharge, #10 facial pain and #21 sense of smell. Conclusions: Distinct SNOT-22 patterns were correlated to subjects outcome. SNOT-22 was able to differentiate patients from controls, to score severity, and could further provide an accurate description of pathology. Baseline SNOT-22 could localize pathology in the sinus or in the nose and predict the need for surgical treatment. [less ▲]

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See detailA Prospective Audit of Acute ENT Activity in a Teaching Hospital.
Goffinet, Maxime ULiege; ATTA, Lucas; Delrez, Sophie ULiege et al

in B-ENT (2018, March 03)

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this service provision round the clock. Our goal was ... [more ▼]

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this service provision round the clock. Our goal was to audit the emergency ENT activity in our institution over a one-month period Material and methods: a prospective audit for all ENT referrals from the emergency department was carried out from May 1st to May 31th 2017. Descriptive statistics were produced for age, sex, origin, time of arrival, diagnosis and patient outcome. Results: a total of 190 patients (109 men and 81 women) were referred to the ENT emergency service over the study period (mean 6.1 case per day). Mean age was 47.9 (±23.6)year (range 1-95). Most patients were ambulatory (75.8%) and came from the area. Most admissions occurred during normal working hours (76.4%) and 62.0% patients came by self reference. The mean complaint duration before admission was 7.6 (±13.7) days (range 0-92 days). One third (33.2% patients) required ambulatory treatment. A quarter (24.7% patients) underwent a minor ENT procedure. Eighteen (9.5%) patients required admission to the ward (mostly for intravenous antibiotic). Eight patients (4.2%) required surgical treatment. There was no difference in the severity of diagnosis or management between patients referred by a physician (GP of specialist) and patients presenting spontaneously. At 30 days, 3 (1.6%) patients died (one of ENT cancer, two of unrelated cause), 106 (55.8%) benefited from an ENT follow’up, 65 (34.2%) were referred to another physician (GP or specialist), 16 (8.4%) were lost to follow’up. Conclusions: The workload suggests that emergency ENT activity is justified in our hospital. Restricting emergency ENT cover to patients referred by a GP or another physician would not allow for a better patient selection. [less ▲]

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See detailPost-irradiated Carotid Blowout Syndrome in patients with Nasopharyngeal Tumor: about 3 cases
DETROUX, Valentine ULiege; GOFFART, Yves; COLLIGNON, Laurent et al

in B-ENT (2018, March)

Introduction Rupture of the internal carotid artery (Carotid blowout syndrome) is a rare complication of irradiated nasopharyngeal tumor. We report three cases nasopharyngeal tumors treated with ... [more ▼]

Introduction Rupture of the internal carotid artery (Carotid blowout syndrome) is a rare complication of irradiated nasopharyngeal tumor. We report three cases nasopharyngeal tumors treated with radiotherapy complicated with bleeding of the internal carotid artery presenting as a massive epistaxis. Case Series The first case presented a few episodes of small nose bleeding before a massive one. Internal carotid embolisation was performed to stop the bleeding. Unfortunately, few month later, he presented a meningitis related to skull base osteoradionecrosis and died from sceptic shock. The second case was transferred to our hospital with severe repetitive epistaxis that had been occurring for hours. No endovascular treatment was possible in his case and he died in intensive care unitthe dayof his admission. The thrid case presented one massive epistaxis which stopped without any treatment or compression. A spontaneous occlusion of his internal carotid artery occured without any neurological defects. He recently benefited from a nasopharyngeal muscle flap for the coverage of the carotid artery. These three patients all presented with a history of nasopharyngeal tumor handled by radiotherapy. Pathogenesis, treatment, and outcome are discussed on the light of a comprehensive literature review. Conclusions Carotid blowout syndrome secondary to radiation therapy is rare but life-threatening. Re-irradiation and skull base osteoradionecrosis are strong predisposing factors. [less ▲]

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See detailDerivation of cochlear cells from human iPSCs for modeling hereditary hearing loss
Czajkowski, Amandine ULiege; Grobarczyk, Benjamin; Borgs, Laurence et al

Conference (2017, November 24)

Detailed reference viewed: 26 (7 ULiège)