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Drug-induced sleep endoscopy – decisional factor in obstructive sleep apnea treatment

Abstract

BACKGROUND. Drug-Induced Sleep Endoscopy (DISE) is a sleep apnea diagnostic procedure which allows direct view the obstruction while inducing sleep using analgosedation with propofol. Many studies highlighted the importance of DISE in finding the level of obstruction and choosing the specific treatment.

MATERIAL AND METHODS. We performed DISE under propofol sedation in 27 patients diagnosed with sleep apnea who addressed to our clinic for further investigation and treatment. We assessed the obstruction type and severity using the Fujita scale, VOTE (velum, oropharynx, tongue base, epiglottis) and NOHL (nose, oropharynx, hypopharynx, larynx). Finally, we correlated the DISE findings with the polysomnographic results.

RESULTS. We observed significant correlations between the obstruction severity seen at DISE and the polysomnographic results. Further, we could decide the appropriate treatment for our patients, whether surgical or not (continuous positive airway pressure - CPAP).

CONCLUSION. Sleep endoscopy represents a very important method in establishing the topographic diagnostic of sleep apnea patients, being useful for the therapeutic decision and the postoperative assessment. We recommend drug-induced sleep endoscopy as elective investigation regarding the diagnostic and treatment of sleep apnea patients.

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Endoscopic orbital decompression in Graves ophthalmopathy - Case report

Abstract

Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.

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Evolution of microbial etiology in acute and chronic rhinosinusitis and its role in the current management of antibiotic treatment

Abstract

BACKGROUND. Acute and chronic rhinosinusitis (CRS) are common conditions worldwide. In most cases, the etiology of acute rhinosinusitis (ARS) is viral, but there can be cases complicated by bacterial infection. The bacterial pathogens responsible for acute bacterial rhinosinusitis (ABRS) in most cases are Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. In recent years, some changes regarding this issue have been communicated. Also, the pathophysiology of CRS becomes a problem due to the increasing percentage of resistant or recurrent cases.

OBJECTIVE. To identify the bacterial spectrum in patients diagnosed with ABRS and CRS and to establish the actual resistance rates of the most prescribed antibiotics for these affections in order to initiate the correct antibiotic treatment.

MATERIAL AND METHODS. We performed a prospective study on 40 adult patients with ABRS and 70 patients with CRS. The standard microbiological procedures were performed in order to identify the involved microorganisms. The Antibiotic Susceptibility Test of the clinical isolates was performed to routinely used antibiotics according to EUCAST.

RESULT. ABRS: A total of 21 types of pathogenic bacteria were isolated. The results indicated changes in the percentages of the traditionally involved bacteria, other species of streptococci and Staphylococcus aureus representing important pathogens. Almost half of the samples were polymicrobial. CRS: 12 bacteria were incriminated for CRS, Staphylococcus aureus and Pseudomonas aeruginosa being the most frequently identified pathogens. Regarding the antibiotic treatment, we established that in our country the resistance rates are higher than the ones communicated by WHO (especially for macrolides) and the fluoroquinolones seem to be the class with the highest safety profile.

CONCLUSION. Study results demonstrate some changes of the bacteriologic spectrum in ABRS in this geographic area. The pathogens responsible for CRS are found in approximately the same percentage as presented in other studies. Antibiotic treatment demands attention considering the increasing trend of antibiotic resistance of the bacteria causing ABRS and CRS.

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Infected nasopalatine cyst or neoplasm

Abstract

The cyst is accumulated fluid or mass in a cavity lined by pathological epithelium. The mandible and the maxilla are bones with high prevalence of cyst formation in the human body. Cystic affections, with or without bone destruction of the hard palate, are considered benign tumours. We present the case of a 20-year-old young man with a cystic lesion of the hard palate having lasted for 7 months.

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Polysomnography outcomes on patients with obstructive sleep apnea after upper airways repermeabilization surgery

Abstract

BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery.

OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control.

RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sleep from 41.5 minutes initially to 67.8 minutes (increased value with 63.37 percent).

CONCLUSION. The benefits of nasopharyngeal repermeabilization surgery are represented by decreasing the severity of respiratory events and, second to this, lowering the number of arousals. By reducing the number of arousals, one will obtain a better percentage regarding the deep sleep phase - REM, having a beneficial effect on reducing the daytime sleepiness – which is a major symptom that patients are present.

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The role of ultrasound in the diagnosis of obstructive sleep apnea

Abstract

OBJECTIVE. This study examines the association between the severity of obstructive sleep apnea and the pharyngeal parameters using the ultrasound of the submental region.

MATERIAL AND METHODS. For this study, data obtained from 40 patients, who had undergone investigations in the Galenus Medical Centre in order to diagnose sleep apnea, was analyzed. The following parameters were compared: the transverse diameter of the retrolingual region, the transverse diameter of the retropalatal region and the tongue base thickness. These regions were measured at different moments of respiration such as: during forced expiration, during forced inspiration and while the patients performed Müller’s Manoeuvre. The neck circumference, the body mass index of patients and the severity of sleep apnea obtained from polysomnography were analyzed.

RESULTS. The evaluation of the results revealed: severe obstructive sleep apnea in 16 patients, respectively moderate severity in 10 patients, mild apnea in 4 patients, and no obstructive sleep apnea in 10 patients. Statistically significant results (p<0.05) were found after comparing the parameters obtained in patients with severe apnea versus the parameters in patients without apnea, with mild or respectively moderate apnea.

CONCLUSION. Based on the results obtained, we consider that cervical ultrasound is useful in the diagnosis of severe obstructive apnea, identifying the pathological changes of the anatomical structures that basically cause this category of disease. Due to the fact that in our country ultrasound is a relatively inexpensive method, being also a non-irradiating, repeatable and accessible method, it should be more widely applied also in the field of otorhinolaryngology in order to view structures accessible to this type of imaging.

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Sphenoid rhinosinusitis associated with abducens nerve palsy – Case report

Abstract

The cases with sphenoid sinusitis associated with abducens nerve palsy are rarely cited in the literature. We present the case of a 41-year-old patient who was hospitalized for right hemicrania and ipsilateral paresis of the abducens nerve, without any other ENT previous pathology. The ENT, ophthalmologic, neurological and paraclinical evaluations (nasal endoscopy, MRI examination) have established the diagnosis of right sphenoid rhinosinusitis complicated with unilateral abducens nerve palsy. In such cases, it is important to make a differential diagnosis with tumor pathology as well as that of an infection outbreak located intracranially. In this case, the patient’s evolution was favourable after endoscopic surgical treatment of the sphenoid rhinosinusitis.

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Clinical and imagistic correlations in the inflammatory pathology of nasosinusal cavities

Abstract

This article reviews the pathophysiology and the clinical and imaging diagnosis of rhinosinusal inflammations.

Chronic sinusitis usually develops after an incompletely treated acute sinusitis.

Complications occur through fungal superinfection, osteomyelitis, extension of the inflammatory process in the orbit or adjacent meningoencephalic structures.

The imaging investigation is indicated as the symptoms get worse, for the elucidation of sinus contents, for establishing the therapeutic protocol, for identifying and finding solutions to solve nearby complications.

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Difficulties of olfactometric evaluation in patients accusing smell disorders after head trauma

Abstract

Head trauma is considered to be the third cause of olfactory function disorders. Olfactometric assessment in patients accusing anosmia following head injury produced by car accident or aggression is important, because most of them are involved in law trials in order to obtain financial compensations from the author. It is compulsory to use both subjective and objective olfactory evaluation methods combined with a detailed anamnesis, a complete ENT examination and a good cranio-facial imaging (computed tomography or MRI) in order to exclude malingerers and to obtain an accurate diagnosis.

“Sfanta Maria” ENT Department from Bucharest is the only center in Romania where the olfactory function in completely investigated. We use chemosensory (Snap and Sniff Test and n-Butanol Dynamic Olfactometry) and electrophysiological tests (electric olfactory evoked potentials of the olfactory bulb).

Unfortunately, we confront with a series of difficulties in what concerns the smell function evaluation: 1) there is scarce information in the literature regarding the olfactory electric evoked potentials; 2) the electric olfactory evoked potentials register only the electrical activity in the olfactory bulb; 3) in case of olfactory impairment medically confirmed, we cannot establish a cause-effect relationship between the disturbance and the event; 4) the most accurate electrophysiological assessment method currently available in Europe is the time-frequency analysis of chemosensory event-related potentials, but we do not dispose of the necessary equipment yet; 5) sometimes patients do not give us the informed consent for a complete olfactory evaluation.

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