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  • Author: Codrut Sarafoleanu x
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Open access
Original study. The clinical value of foam posturography in assessing patients with peripheral vestibular dysfunction – our experience

Abstract

BACKGROUND. Computerized dynamic posturography is the most important battery test designed to assess the ability to use visual, vestibular and proprioceptive cues in the maintenance of posture. Foam posturography reduces the availability of proprioceptive inputs, which makes more difficult the balance control.

OBJECTIVE. The objective of the study was to assess the clinical use of foam posturography in evaluating peripheral vestibular dysfunction.

MATERIAL AND METHODS. We evaluated 41 patients with vestibular disorders and 41 normal patients by using the sensory organization test in eyes opened, eyes closed and mislead vision conditions with and without the foam. We measured several parameters: the position of the center of pressure, the displacement in the center of pressure in anteroposterior and mediolateral planes and Romberg’s ratio on static and foam rubber.

RESULTS. The values of all parameters were significantly higher in patients with peripheral vestibular disorders than in the control group (p<0.05). Also. comparing the Romberg test results, the foam surface used by the patient was larger than the static one.

CONCLUSION. Foam posturography can be a reliable test in assessing patients with peripheral vestibulopathy, being also able to identify the visual and proprioceptive dependence levels.

Open access
Hereditary angioedema - an otolaryngologist’s perspective

Abstract

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.

Open access
Advantages of VMAT-IMRT technique in nasopharyngeal cancer

Abstract

BACKGROUND. Radiotherapy, associated with chemotherapy, is the main method of treatment in both early and advanced stages of nasopharyngeal carcinoma. Intensity modulated radiation therapy (IMRT) provides high doses of radiation to the primary tumor, sparing the organs at risk. Volumetric modulated arc therapy (VMAT) is one of the most promising radiation methods which produces superior target coverage, improving the protection of organs at risk and reduces treatment time.

MATERIAL AND METHODS. We performed a retrospective study on 30 patients diagnosed with nasopharyngeal cancer and admitted in “Sfanta Maria” Clinical Hospital between October 2012 and December 2014. All patients have undergone VMAT-IMRT associated with induction or concurrent chemotherapy. At the end of the treatment, patients were followed up at one, three and six months, and then every six months for 2 years.

RESULTS. At the end of the radio-chemotherapy treatment, 27 patients (90%) had a complete tumor and lymphatic response and 3 of them (10%) presented a partial response. At the end of the follow-up period, we observed 5 patients with recurrences, including 2 deceased.

CONCLUSION. VMAT-IMRT in association with chemotherapy treatment is well tolerated by patients. The good results reflected in high rates of cured patients, the low incidence of side effects, recommend this treatment plan as an optimal indication for nasopharyngeal tumors.

Open access
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.

Open access
Endoscopic and histological staging: Deciding factors in the treatment of chronic rhinosinusitis

Abstract

Chronic rhinosinusitis represents an inflammatory condition of the nose and paranasal sinuses, characterized by two or more symptoms. The diagnosis of acute rhinosinusitis is made, most often, clinically; however, in the case of chronic rhinosinusitis, imaging, bacteriological, as well as the histological investigation are necessary in order to establish the diagnosis and to exclude other diseases that have caused and/or are associated with rhinosinusitis. Different scores (clinical, imagistic) have been described over time, being considered as important factors in the therapeutic decision (surgical or conservative) in patients with chronic rhinosinusitis. The authors present their experience in using and relying on endoscopic and histological scores.

Open access
What is new in tympanoplasty?

Abstract

Medicine is in an era of technical development and innovation. Creating a tympanic membrane by using a 3D printer can exceed the disadvantages that classic graft materials have. The field of otolaryngology can be experiencing a paradigm shift towards the use of 3D-printer.

Open access
The impact of gastroesophageal reflux in the ENT pathology

Abstract

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.

Open access
Difficulties in the surgical management of head and neck cancer patient

Abstract

Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.

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