Raluca Enache, Dorin Sarafoleanu and Codrut Sarafoleanu
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.
Alexis Vuzitas and Codrut Sarafoleanu
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.
Cristina Sanda and Codrut Sarafoleanu
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.
Violeta Melinte and Codrut Sarafoleanu
Congenital anosmia, isolated or as a symptom of Kallmann or Klinefelter syndrome, is a rare condition found in young patients and children. Anosmia is detected during childhood, being reported by the patient or by his/her family. Besides the clinical examination and olfactometric evaluation, imaging is mandatory for the olfactory pathways investigation. Multidisciplinary approach is needed for these patients in order to determine the etiology of the smell loss. In the current paper, we are presenting the case of an 11-year-old child diagnosed in our ENT Department with congenital anosmia.
Violeta Melinte, Oana Musteata and Codrut Sarafoleanu
Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed.
The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring into discussion the treatment applied for patients diagnosed with hereditary hemorrhagic telangiectasia.
Codrut Sarafoleanu, Violeta Melinte and Gabriela Musat
Adenotonsillectomy is one of the most performed surgical procedures in otorhinolaryngology. When it comes to hospitalization duration, there are no general available truths. Every patient is unique and only the physician should decide for how long he/she has to remain in the hospital after adenotonsillectomy, taking into consideration the used technique, the intraoperatory evolution and also the associated risk factors.
The authors present some general aspects of this theme and their own point of view in what adenotonsillectomy is concerned in terms of ethics and moral responsibility of the surgeon, hospital and government for the hospitalization after the surgical intervention.
Nicoleta Dumitrescu and Codrut Sarafoleanu
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.
Violeta Melinte and Codrut Sarafoleanu
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.
Carmen Badea, Codrut Sarafoleanu and Andreea Marza
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.