Having an enormous importance not only in one’s quality of life, but also in one’s health and personal safety, the olfactory function assessment has begun to gain more and more interest amongst the ENT practitioners. However, at the moment, there is no worldwide accepted evaluation protocol available despite the fact that studies regarding smell disorders and their evaluation have been published all over the world.
The purpose of this article is to present the olfactory assessment methods practiced today not only in different clinics from Europe and the USA, but also in Romania, because we have recently started to study the olfactory function disturbances. Three of the most interesting clinical cases, assessed in our ENT Department of the “Sfanta Maria” Clinical Hospital between 2015 and 2016, will be discussed in the current paper.
Andreea Catana, Alma Maniu, Doinel Radeanu, Radu A. Popp, Roxana F. Ilies and Iuliu V. Catana
BACKGROUND. Polymorphisms for genes encoding chemosensitive signalling proteins like NOS2 might contribute to the variability in individual susceptibility to nasal polyposis. NO produced by the inducible NO synthase enzyme NOS2A is generated at high levels in certain types of inflammation, so that the role of NOS2 might also be important in nasal polyposis etiopathogeny.
MATERIAL AND METHODS. This is a cross-sectional, randomized, case-control study for the evaluation of the frequency of -954G/C NOS2A2 alleles among patients with nasal polyposis. The study included 91 cases of nasal polyposis diagnosed patients (nasal endoscopy and CT scan examination), and 117 healthy unrelated controls. NOS2 genotyping was carried out using PCR amplification of relevant gene fragment and it was followed by restriction enzyme digestion. Detection of the variant alleles was determined through analysis of resulting restriction fragment length polymorphism (RFLP) followed by gel electrophoresis.
RESULTS. Molecular analysis revealed an increased frequency of NOS2 variant allele in the study group compared to the control group (p=0.019, OR=1.991, CI=1.08-3.67). A statistically significant finding was highlighted among allergic and nonallergic patients with nasal polyposis (p=0.046, OR=0.449. CI=0.208-0.969) and a relationship between nasal polyposis patients with asthma and non-asthmatic patients (p=0.119, OR=1.825, CI=0.875-3.80).
CONCLUSION. The main finding of our study is that -954G/C polymorphism of NOS gene seems to be associated with an increased risk for nasal polyposis.
George Anastasopoulos, Dilyana Vicheva, Eleni-Christina Tsiompanou and Eleftherios Ferekidis
BACKGROUND. The tendency of the nasal polyps for recurrence is well established and recognized. A potentially effective measure to reduce this tendency seems to be the replacement of the mucosa responsible for polyp growth.
MATERIAL AND METHODS. Since February 2012, we have used this method in fifteen patients with intractable polyposis. After a short course of preoperative medication, we performed a detailed computed scan analysis to study the anatomy of the ethmoidal complex and calculate the area and contour of the graft. Under general anaesthesia, we removed the mucosa of the nasal roof and replaced it with a split-thickness skin graft. For maintenance, only a short course of nasal drops every three months seems to suffice.
RESULTS. Excluding the first two cases due to a poor surgical technique, the rest of the cases may be considered successful. All patients experience a functional nose with restored nasal breathing and occasionally olfactory function with only a minimal pharmaceutical aid. Polyps still grow, but they show a much more benign course and are readily responsive to medical treatment. Interestingly, polyps present squamous metaplasia postoperatively. This feature needs further investigation.
CONCLUSION. The method of dermoplasty presents a high potential for control of polyp growth. With only an hour prolongation of surgical time, a minor increase in complication rate and a small increase in morbidity rate, the technique deserves further attention from the rhinological society.
Ricardo de Hoyos, Michele Loglisci, Hugo Anibal Rodriguez and Desiderio Passali
Cervical and parotideal abscess is a rare finding in all populations and even more so in the paediatric population. The antibiotic resistance of the bacteria that cause these diseases can make it very dangerous. We present a paediatric case in which there is a combined left-cervical and parotideal abscess in a female 3-month-old baby who presented fever, pain and cervical swelling.
We present a case of paediatric nasal foreign body removal using a flexible nasopharyngolaryngoscope, which is used both as an endoscope for visualization and as a hook for the rapid and complete removal of the nasal foreign body (“Visual Hook“).
Klaus Vogt, Klaus-Dieter Wernecke, Mara Argale and Krista Kaulina
BACKGROUND. The measurement of the total nasal resistance by rhinomanometry is of special interest in the functional diagnosis of the nasopharynx and retropalatal space. It can be measured by posterior rhinomanometry or estimated by calculating the total resistance from measurements of both sides. Because the standard parameters of the classic rhinomanometry have to be considered as obsolete, Vertex Resistance and Effective Resistance and their logarithmic derivations have been introduced with 4-phase-rhinomanometry.
MATERIAL AND METHODS. In the first part, posterior and anterior rhinomanometry have been compared in a study of 32 volunteers. The disadvantages of posterior rhinomanometry have been apparent because of inconsistent statistic results. To compare both methods is useful in cooperative patients for the diagnosis of postnasal pathological alterations. By analyzing the rhinomanometric databases of 5 hospitals in 10,033 untreated patients and in 8,246 patients after decongestion, the total nasal resistance could be determined.
RESULTS. Because only the logarithmic values for effective and vertex resistances are correlated with the sensing of obstruction, these values have been used to classify the total obstruction in 5 classes. The descriptive data of every class are given. The here-described classes are valid for Caucasian noses. The calculated data can be delivered on request by the authors.
CONCLUSION. The here-presented parameters for measuring the resistance of the nasal airway and the classification of the obstruction from a statistically representative material can be recommended for the daily practice in rhinology and rhinosurgery.
The terminal nerve (cranial nerve zero, cranial nerve XIII, the nerve “N”) was discovered in fish in 1894. In the early 90’s, it was found in human embryos and human adults. In the anterior fossa, it courses on the inner side of the olfactory tract and bulb; it then spreads fibers through the cribriform plate to distribute beneath the nasal septum mucosa. Being provided with intrinsic ganglion cells, its functions are weakly suggested by studies in different species. It may be connected with the visual system, it could act upon the intracranial vascular system, or it could ensure the pathway for pheromone-mediated behaviours. The cranial nerve zero deserves a better attention equally from anatomists and ENT specialists.
BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from the ethmoid bone, with a compact bone structure, sometimes pneumatized. The connection between the pneumatized crista galli and the adjacent paranasal structures is usually performed through an opening similar with a sinusal ostium.
MATERIAL AND METHODS. We performed a retrospective clinical study about the incidence of the pneumatization of crista galli in 196 patients with chronic sinusitis. We evaluated the degree of pneumatization and the drainage pathways of crista galli, trying to correlate the radiological findings with the symptomatology of the patients with crista galli “sinusitis”.
RESULTS. Pneumatization of crista galli was found in 30.1% of cases. From 59 patients with chronic rhinosinusitis and pneumatized crista galli, 66.4% had no opacification, 23.7% various degrees of opacification and 11.9% showed complete opacification. The presence of an opening of the pneumatized crista galli into surrounding air-cells was found in 16.98% of the patients. Headache was encountered in 76.2% of the patients with CRS and pneumatized crista galli sinusitis.
CONCLUSION. When analyzing a CT scan of a patient with CRS, we should also take into consideration the pneumatization of crista galli, which has a high variability. Most of the patients included in our study had also a certain degree of opacification of the pneumatized crista galli. Headache had a higher incidence in patients with crista galli inflammation than in CRS patients who showed no pneumatization or opacification of the crista galli (76.2% versus 60.5% in “simple” CRS patients).
Hereditary angioedema (HAE) is a rare autosomal dominant disease consisting of recurrent angioedema attacks, varying in severity, possibly life-threatening and with frequent involvement of the head and neck areas. The patophysiology of HAE differs from histamine-mediated allergic angioedema. Three types of reduced quality or quantity in various complement or coagulation factors, leading to massive release of bradykinin, increase vascular permeability and produce capilary leakage. Clinical manifestations of HAE include swelling located predominantly in the head and neck area, hands, feet and urogenital area and abdominal pain caused by edema of the gastrointestinal tract mucosa. Diagnosis requires laboratory tests for complement components and genetic tests. A timely and correct diagnosis in the emergency room is of utmost importance, the medical treatment of HAE being substantially different from that of allergic angioedema. Although new therapies are available and in development, airway intervention and surgery are still life-saving procedures and the ENT surgeon is an important part of the multidisciplinary team managing an HAE attack.
Frequently encountered in medical practice, the gastroesophageal reflux (GER) is a chronic condition characterized by the passage of gastric acid or gastric contents into the esophagus. In otorhinolaryngology, the diagnosis of pharyngo-laryngeal or rhinosinusal inflammatory conditions secondary to GER is one of exclusion and it is based on a detailed anamnesis in which we are interested in symptoms, behavioural and medical risk factors, on the ENT clinical examination, the laryngo-fibroscopical assessment, the phoniatric examination, the barite pharyngo-esogastric exam, the upper gastrointestinal endoscopy and the esophageal manometry.
The authors are making a systematization of the contribution of the gastroesophageal reflux has in the ENT pathology, emphasising the sympytoms and the most frequent associated pathological entities.