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Outcomes of mucociliary clearance and rhinomanometrical changes in nasal pathology

Abstract

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.

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Permeabilization surgery of the upper respiratory tract and its effects on sleep fragmentation and REM sleep

Abstract

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.

Open access
Symmetry patterning by the causative organism of rhinosporidiosis in culture

Abstract

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.

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Legal aspects in patients with complications and sequelae after rhinological surgery

Abstract

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.

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MRSA in recurrent frontal sinusitis

Abstract

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.

Open access
Olfactometric assessment - where do we stand today?

Abstract

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.

Open access
Possible association between -954G/C iNOS polymorphism in nasal polyposis. A case-control study in a population group of Northern Romania

Abstract

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.

Open access
The technique of dermoplasty to treat recurrent nasal polyps: preoperative evaluation, surgical details, postoperative endoscopic appearance and histopathologic analysis

Abstract

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.

Open access
An unusual combined parotideal and neck abscess - Case report

Abstract

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.

Open access