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.
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.
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, 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.
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.
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.
Dysphagia is a common disorder associated with a large number of etiologies like aging, stroke, traumatic brain injury, head and neck cancer, neurodegenerative disorders, structural changes or congenital abnormalities. The type of the treatment and its results depend on the type, severity and the cause of dysphagia. The primary goal of dysphagia treatment is to improve the swallowing process and decrease the risk of aspiration.
Along with the existing rehabilitation swallowing treatments, new adjunctive therapy options developed, one of them being the neuromuscular electrical stimulation (NMES).
The authors present the principles of NMES, a small literature review about the results of this therapy and their experience in using transcutaneous NMES in dysphagia patients.
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.
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.