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Pulmonary tuberculosis with rhinosinusal and otic manifestations - diagnostic challenge

Abstract

BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases.

MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis.

RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment.

CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.

Open access
Rhinosinusal mucormycosis: Literature review and some particular cases

Abstract

Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential.

Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke.

By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

Open access
Comparison of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Abstract

OBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.

MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.

RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.

CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

Open access
Comparison results of nasal septum suturing and nasal packing following septoplasty

Abstract

BACKGROUND. Septoplasty is routinely used to resolve the deviated nasal septum. To obviate postoperative complications, some surgeons pack both nasal cavities and some other use suturing techniques after septoplasty.

OBJECTIVE. To investigate the efficacy of septal suturing and packing in patients post-septoplasty.

MATERIAL AND METHODS. This study was conducted in the Department of Otorhinolaryngology, Loghman Hakim, Tehran, Iran. 146 patients aged 17 years and above were enrolled for septoplasty. Septal suture was performed in 73 patients (group A) and nasal packing in the other 73 patients (group B). The principal outcomes in terms of bleeding, pain, respiratory problems, septal hematoma, adhesion and perforation were measured over a post-operative follow-up period.

RESULTS. A total of 146 patients, 74% female and 26% male, were enrolled. There were statistically significant differences between the two groups with respect to respiratory problems and patient comfort (p<0.001). The patients in both groups had no septal perforation.

CONCLUSION. Septoplasty using trans-septal suturing without packing can be safe and suitable to prevent or minimize postoperative complications.

Open access
Method of stenting the lacrimal sac after performing dacryocystorhinostomy

Abstract

Lacrimal stents were used in the past to preserve the caliber of the lacrimal pathways after surgery, trauma, reconstruction, etc. Recently, their role in preventing functional epiphora has also been highlighted. Over the years, the stents have evolved and different models, materials and surgical techniques for positioning have appeared. Extensive and accurate knowledge of the type and design of the stent, the correct insertion technique offer optimal results depending on the anatomical area and the type of disorder of the lacrimal pathways. We will present the advantages of a simple catheterization technique for the lacrimal sac, endoscopic post-dacryocystorhinostomy.

Open access
Orbital decompression for inverted papilloma – Case report

Abstract

Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications.

The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.

Open access
Oxidative stress-related pathophysiology in chronic rhinosinusitis with nasal polyps: research challenges

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is considered a multifactorial pathology with negative impact on the quality of life and considerable socio-economic effects. The pathogenesis of CRSwNP has not yet been fully elucidated despite remarkable studies in this field. This limits the pathogenic treatment and, therefore, the pathological process is expressed by a greater tendency of recurrence. Patients with recurrent CRSwNP remain in a severe state and therapeutically uncontrolled. In recent studies, the involvement of oxidative stress (OS) in the pathogenesis of CRSwNP has been more frequently mentioned. CRSwNP is considered a response of the sinonasal tissue on the inflammatory state, associated with OS and production of reactive oxygen species, causing injury to sinonasal tissues. It was demonstrated that the amount of ROS in the nasal polyp tissue corresponds to the severity of CRSwNP.

A literature review on the role of OS in the pathogenesis of CRSwNP was undertaken. The relevant information was identified using a search of electronic databases. Keywords used to highlight relevant papers were a combination of “chronic rhinosinusitis with nasal polyps” and “oxidative stress”.

This review demonstrates that there is a strong relationship between OS and CRSwNP pathogenesis. It is hypothesized that antioxidants may have a preventive role in CRSwNP. Nevertheless, additional research is required to further evaluate the effectiveness of antioxidant therapy.

Open access
Treatment difficulties in salivary gland cancer

Abstract

Salivary gland cancers are represented by a heterogeneous histologic group of tumors, with low incidence, which may appear both in major and minor salivary glands. This article presents a review of the difficulties which may be encountered in this pathology during the treatment. The diagnosis of salivary gland cancers is often delayed, due to the histopathologic and immunohistochemistry results given in different period of times. There can be several difficulties in following the oncologic pre-treatment protocols, in terms of imaging technique, as MRI, useful for disease staging.

The treatment of salivary gland cancers is complex, due to the local anatomy and their aggressive potential. Because of their decreased incidence, there are few data that investigate the treatment in the case of these diseases. The current therapy available for the patients with salivary gland cancers is represented by complete surgical resection. Several treatment difficulties in cancers of the salivary glands may come from the surgical limitations and the insufficient data for adjuvant and palliative treatment. Due to the limitations of the local health system, there is a heterogeneous distribution of the oncologic centers, lack of equipment, prolonged time to follow general protocols, despite the aspect of case-individualized therapy according to the guidelines. We must not forget the tumor behaviour and individual reactivity of different patients to the same treatment protocol.

Open access
Whiplash Syndrome

Abstract

Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.

Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.

Open access
Comparative analysis of features of chronic maxillary sinusitis of various genesis

Abstract

BACKGROUND. There are not many works devoted to the structures of a nasal cavity in odontogenic maxillary sinusitis and to a condition of an alveolar ridge of the maxilla with a rhinogenous genesis of the disease.

MATERIAL AND METHODS. 100 patients (N) with chronic sinusitis hospitalized at the ENT (N=50) and Oral and Maxillofacial Surgery (N=50) Departments were examined. The character of anatomic options of a nasal septum in chronic maxillary sinusitis is estimated according to a cone-beam computed tomography (CBCT) with use of our own developed scheme of coordinates in the form of “triangles” which allows establishing versions of the block of the ostiomeatal complex and nasal septum deviation.

RESULTS. In cases of rhinogenous and odontogenic causes of maxillary sinusitis, the triangle deviation is detected more often, including a perpendicular plate of the ethmoid bone, the vomer and the quadrangular cartilage, contributing to the block of the ostiomeatal complex. This scheme has allowed us to establish a group of patients with the mixed genesis of maxillary sinusitis in the Otorhinolaryngology and MFS Departments (36% and 42% respectively) and that, in its turn, requires a cross-disciplinary approach when choosing a strategy of treatment.

CONCLUSION. In case of rhinogenous genesis of the disease, the bilateral nature of the process with involvement of other paranasal sinuses in the inflammatory process is detected more often. The category of patients with mixed genesis (rhinogenous plus odontogenic) of sinusitis demands a cross-disciplinary approach to diagnosis and making a decision about treatment strategies.

Open access