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.
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.
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.
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.
Codrut Sarafoleanu, Alexis Vuzitas and Claudiu Manea
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.
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.
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.
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.
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.