Frodita Jakimovska, Marina Davceva Cakar and Dejan Dokic
BACKGROUND. Septal deviations are usually diagnosed by a patient’s subjective complaint of nasal stuffiness and a physical examination by the otorhinolaringologist. The decision for surgery is not always based on objective measurements. Acoustic rhinometry and rhinomanometry are objective tools for assessment of nasal patency but is still a controversial subject. In our populations, there are no general accepted methods for screening patients for septal surgery.
OBJECTIVE. To analyse the effectiveness of acoustic rhinometry and rhinomanometry in predicting the outcomes of septoplasty and rhinoseptoplasty and their usefulness in preoperative screening of septal deviations.
MATERIAL AND METHODS. 69 patients were included in this prospective study. Acoustic rhinometry and rhinomanometry were performed before and one year after surgery for the investigation of nasal obstruction. Several parameters were analysed before and after decongestion of the nasal mucosa. VAS (visual analogue scale) was also included for evaluation of the subjective symptom score pre- and postoperatively. After surgery, a short questionnaire was applied to investigate patients’ postoperative satisfaction.
RESULTS. The mean subjective scores of nasal patency improved significantly after surgery with 77%. Several parameters of acoustic rhinometry and rhinomanometry were analysed with binary logistic regression, to evaluate the predictive values on the postoperative satisfaction. The preoperative decongested overall MCA (minimal cross-sectional area) on the deviation side, the decongested bilateral MCA and the decongested Flow ratio had significantly the highest impact on the postoperative satisfaction (p<0.001).
CONCLUSION. Acoustic rhinometry and rhinomanometry as objective tools can serve as objective evidence for the efficacy of septoplasty and rhinoseptoplasty. The parameters of rhinomanometry and anterior rhinometry are useful in the preoperative screening for septal deviations and in predicting postoperative satisfaction between different degrees of nasal septal deviations.
Sinoliths are calculi found particularly in paranasal sinuses, the rarest location being the ethmoid air cells. There were previously reported only 4 cases of unilateral large ethmoidal sinoliths (ES), this one being the fifth report. We report here the incidental bilateral evidence in a 34-year-old female patient evaluated in Cone Beam Computed Tomography (CBCT) of minor ES. The left ES, of 1.6 mm2 sagittal size, occupied the suprabullar cell, in front of the ground lamella and behind the anterior ethmoidal canal. The right ES, of 7.6 mm2, was located behind the ground lamella. The radiodensity of each ES was about 1000 HU, their bone quality being thus assessed. This is the first evidence of bilateral and clinically silent ethmoidal sinoliths. Being small-sized and incidentally found, it seems reasonable to consider that ethmoidal sinoliths could have a higher incidence but they are overlooked due to the lack of clinical manifestations.
In recent years, the clinical importance of laryngeal electromyography (LEMG) has been recognized. This method of investigation proved itself to be a valuable and indispensable tool regarding voice disorder management and requires multidisciplinary approach.
In this article, we focus on the clinical usefulness of LEMG to assess inferior and superior motor neuron integrity by recording action potentials generated by muscle fibers of the larynx in the new field known as neurolaryngology. To facilitate the clinical application of this electrophysiologic test, we present a detailed description of LEMG techniques, which were applied for simultaneous bilateral recordings of the thyroarytenoid, cricothyroid and posterior cricoarytenoid muscles. Also, we analysed and measured the following electrophysiological parameters: 1) insertional activity; 2) spontaneous activity; 3) recruitment; 4) morphology of waveform.
From a practical point of view, in our country, LEMG performance is still not a routine procedure in ENT and Phoniatric Departments. The difficulty of practical use of LEMG in Romania consists in technical limitations and it depends on the physician’s experience regarding the examination technique and also the interpretation of electrophysiological results.
Our current clinical experience shows that the use of LEMG contributes especially to the diagnosis, prognosis and treatment of patients with neurolaryngological disorders.
An irreversible disease, cystic fibrosis (CF), is responsible for affecting multiple organ systems containing epithelia. It is well known that the sinonasal disease caused by CF has consequences for the incidence of the lower airway exacerbations, as well as affecting the quality of life of those patients. This review provides an update by evaluating the available literature regarding pathogenesis, management and treatment of cystic fibrosis patients. To gain a better view of the disease and obtain a higher life expectancy, further studies are needed.
Adriana Neagos, Alexandra Cirticioiu, Alex George Stanciu and Iren Csiszer
OBJECTIVE. The aim of the study was to determine the impact of the nasal pathologies over nasal mucociliary clearance and rhinomanometric parameters.
MATERIAL AND METHODS. This is a retrospective analytical observational clinical study during a period of 6 months, between 2014 and 2015. 123 subjects, 63 of whom had nasal pathology and 60 of whom were healthy controls, were enrolled in this study. The diagnosis of nasal pathology was made based on clinical examination, nasal endoscopy and anterior rhinomanometry. A methylene blue test was used to evaluate the mucociliary clearance.
RESULTS. The subjects with nasal pathology had nasal septum deviation (No=50), chronic rhinitis (No=42), rhinosinusitis (No=15) and nasal polyposis (No=17). The mean total air flow in inspiration in nasal pathology patients group was 546.7 ml/s (millilitre/second), with a median of 594 ml/s, comparing with the control group who had the mean air flow of 865.5 ml/s, with a median of 866.5 ml/s. In expiration, the mean air flow in those with nasal pathology was 603.9 ml/s and a median of 611 ml/s, comparing with the control group who had the mean air flow of 871.1 ml/s and a median around 872 ml/s. The mean time from the application of methylene blue liquid to first seeing it in patients with nasal pathology was 23.41 minutes for the right nostril and 23.32 minutes for the left nostril, comparing with the control group who had the mean of mucociliary clearance of 6.76 minutes for the right nostril and 6.93 minutes for the left one.
CONCLUSION. The results obtained in anterior rhinomanometry and methylene blue liquid test showed that nasal pathology does affect nasal physiology and it is an important factor to evaluate the mucociliary clearance.
Ionut Tanase, Claudiu Manea and Codrut Sarafoleanu
Usually, patients with sleep disorders may complain of tiredness, fatigue, daytime sleepiness, difficulty in concentrating, and can reach up to falling asleep in inappropriate situations – condition known as the Pickwick syndrome. To avoid these unpleasant symptoms, a series of surgical procedures regarding the anatomical structures involved in sleep apnea were developed.
The article is a general review regarding the sleep disorders and the influence of upper airways permeability on the quality of sleep and the sleep staging distribution. Also, we present some preliminary data obtained in a clinical study underwent in CESITO Centre “Sfanta Maria” Hospital, Bucharest, involving patients with sleep pathology that had polysomnographic evaluations before and after various surgical procedures of nasal and pharyngeal permeabilization.
AIMS. To determine that permeabilization surgery of the upper airway tract may be used successfully in order to decrease the sleep fragmentation and increase the time of slow-wave sleep.
CONCLUSION. 6 months after the permeabilization surgery of the upper airway tract, the polysomnography reveals that the arousals index decreased and the sleep architecture undergoes changes that consist in decreasing the Stage 1 and Stage 2 sleep, therefore REM sleep reaches a better score.
Dhara B. Dhaulakhandi, Alok K. Ravi, Lalit C. Garg and Karvita B. Ahluwalia
Rhinosporidiosis is a chronic polypoidal infection of the nose, conjunctiva and other sites, believed to be caused by a fungus, Rhinosporidium Seeberi, with a doubtful taxonomy. Polyps contain histological round bodies and the exact mode of infection is not known. The round bodies are filled up with spherules. In tissue the organism forms spherical round bodies approaching 50-500µ in diameter that contain innumerable single-celled organisms that mature at different rates. Mature organisms are approximately 7-9µ in size and escape through a pore that develops in the wall of the round body. The round body does not exist in nature outside the host.
The organism in rhinosporidiosis was believed to be uncultivable, until we cultured it for the first time in our laboratory. We further modified the culture medium and succeeded in culturing the causative agent of the disease in CBEML (Cell Biology and Electron Microcopy Laboratory) medium. Here we present some of the peculiar conspicuous features of the organism in culture leading to symmetry patterning.
BACKGROUND. In time, the field of surgery has developed, introducing new techniques for old diseases. Along with this evolution, postoperative complications occurred and patients denounced doctors for insufficient medical care or inappropriate surgical approach. We observed an increased number of reclamations from patients who underwent rhinological surgery. All of those patients considered that medical care and the surgical act were improper, with poor outcome.
MATERIAL AND METHODS. The purpose of our presentation is to sum all the causes that motivate the patients to formulate claims and to start the legal prosecution, in order to obtain financial compensation and the doctor’s conviction. We included all the patients who referred to our clinic (even if they were first treated by us or another surgical team), complaining of postoperative: persistent purulent rhinorrhea, nasal obstruction, crusts, cacosmia or anosmia, epistaxis, epiphora, unaesthetic nasal aspect. Some of these patients, before or after receiving our care, denounced the initial caregiver.
RESULTS. Their main complaints involved poor preoperative notifications regarding the surgical method, risks and potential complications, extensive surgery, wrong surgical indication, inexperienced surgical team, poor postoperative care. Even if they were first treated in our clinic or not, these patients received medical and surgical care to correct all the negative post operatory outcomes. Some of the patients still pursued the legal pathway, engaging all the resources to prove doctor’s medical guilt.
CONCLUSION. To avoid medico-legal situations, guidelines need to be established for the ENT surgeons, in order to confer a healthier work environment with minimum risks and complications.
Vlad Budu, Andreea Costache, Tatiana Decuseara, Alexandru Coman, Alexandra Guliga, Raluca Baican, Alexandru Panfiloiu, Ioan Bulescu, Cristina Goanta, C. Ionita and Mihail Tusaliu
The authors present a case of recurrent frontal rhinosinusitis, for which the drug therapy was ineffective. To avert the risk of complications, multiple classic and endoscopic surgical procedures were performed on the frontal sinus pathology.
The bacterium involved in this form of rhinosinusitis was represented by a Methicillin-resistant Staphylococcus aureus (MRSA) diagnosed during the first endoscopic approach (the second surgical procedure) for which the treatment corresponding to the antibiogram was followed. At the last hospitalization, the patient has underwent a frontal bilateral drainage surgery (modified Lothrop procedure) and started an adequate anti-MRSA treatment.
The authors wondered whether multiple recurrences of frontal rhinosinusitis are determined by an incomplete drainage, by a persistent infection with MRSA or by both.