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.
BACKGROUND. Functional connection between the stomatognathic system and the acoustic-vestibular apparatus is approached with interest in topical studies, in an attempt to elucidate in depth the cause-effect relationship between pathology and symptom. The temporomandibular joint disorder may be accompanied by a series of otological symptoms such as otalgia, tinnitus and vertigo. For this reason, for a correct diagnosis, a complex clinical examination is required both on the acousticvestibular analyzer and on neighbouring structures.
MATERIAL AND METHODS. We conducted a clinical study, on a group of 97 patients diagnosed with temporomandibular joint disorder (TMJD) and treated for this pathology. All patients included in the study were evaluated by the dentist and the ENT specialist. The patients were treated at the dental clinic and then returned to the ENT clinic two months after completion of the treatment for re-examination, recording changes in otologic symptoms in order to obtain the results of the study.
RESULTS. Of the 97 patients with TMJD, 58 also associated otic symptomatology (otalgia – 74.13%, tinnitus – 53.45%, vertigo – 43.10%). The evaluation done two months after treatment of the temporomandibular joint disorder revealed a significant remission of otalgia (decrease in Mean VAS from 6.05 to 2.49), followed by vertigo (from 5.08 to 2.52) and by tinnitus (from 4.84 to 3.84). Important changes also occurred in the results of the vestibular assessments.
CONCLUSION. The most common otological symptom of patients with TMJD is auricular pain. Otalgia, tinnitus and vertigo can be improved by dental treatment of the temporomandibular dysfunction, auricular pain having the highest rate of remission.
The nasal swell body (NSB) is considered to be an enlarged region of the nasal septum, which is located superiorly to the inferior nasal turbinate and anteriorly to the middle nasal turbinate, with a potential effect upon the airflow nasal valve. The histological studies of the NSB demonstrated that it is a glandular formation, not a venous structure, and it is formed by septal cartilage and bone, as well as a thick mucosa. Recent studies emphasized the functional role of the nasal swell body and it is thought to interfere with the nasal airflow and air humidification, due to its proximity to the internal nasal valve and its histological characteristics (venous sinusoids and seromucinous glands). The nasal swell body is strongly related to the presence of rhinosinusal chronic inflammations (allergic rhinitis and chronic rhinosinusitis) and the septal deviation. In case of the presence of the nasal swell body, surgical treatment is not commonly done, due to the absence of a consensus between the ENT practitioners. Most of them consider surgery as being too aggressive because of the presence of seromucinous glands, with slight impact upon the nasal obstruction. Most probably, the lack of consensus is determined by inconsistent anatomical and histological study results.
Hemorrhagic Hereditary Telangiectasia (HHT) disease, also called Osler-Weber-Rendu (OWR) disease, is a rare and underdiag-nosed genetic disorder characterized by a multisystemic vascular dysplasia. Nosebleeds, acute or chronic digestive tract bleeding and various problems due to the involvement of major organs (liver, lungs, brain) characterize the disease.
Although it was described at the beginning of the 20th century, many patients, GPs and specialists still ignore the disease, its morbidities and the modalities of the treatment.
That is the reason why the authors have decided to publish this review on this familiar, evolving and potentially life-threatening disease, whose management can be sometimes a real nightmare for the clinician.
Inverted or Schneiderian papilloma is a locally aggressive benign tumor with strong recurring tendency and a high potential to transform into a malignant squamous cell carcinoma. Although the clinical characteristics of inverted papilloma, along with the morphological features, have been adequately described, controversy remains with regards to the risk factors and disease etiology. The complete excision of the tumor by surgery is traditionally considered the mainstay of therapy.
This paper updates the state of knowledge and presents our experience from treating 52 patients, diagnosed with inverted papilloma, who underwent surgical treatment in our department. We performed genotyping for Human Papilloma Virus (HPV) for all the patients included in our study group.
OBJECTIVES. Reviewing the literature data related to Lindsay – Hemenway syndrome.
MATERIAL AND METHODS. We searched PubMed and Google Scholar with the key words of “Lindsay-Hemenway syndrome”, “benign positional vertigo”, “vestibular rehabilitation”
RESULTS. Lindsay-Hemenway syndrome is characterized by an association between vestibular neuronitis and BPPV. The specificity of the syndrome consists in the existence of an initial episode of acute vestibular neuropathy manifested by intense vertigo and nystagmus, followed in a variable time frame by episodes of posterior canal BPPV. The treatment of the syndrome consists in a combination of otolith repositioning manoeuvres and vestibular rehabilitation therapy. The physicians involved in treating patients with vestibular disorders should be aware of the existence of this syndrome in order to diagnose and treat the patients accordingly.
CONCLUSION. The Lindsay-Hemenway syndrome is a challenge for the physician. In order to establish a diagnosis, a careful investigation of clinical history and objective examination are needed. The clinician should take into consideration the presence of a sudden vertigo without deafness followed by postural nystagmus, and unilateral labyrinthine hyporeflexia or absence of reflectivity. For a successful therapeutic approach, we should be able to combine manoeuvres of repositioning for BPPV with an appropriate vestibular rehabilitation therapy in order to ensure a correct central compensation of the peripheral unilateral deficit.
Plasmacytoma is a rare, non-epithelial, malignant tumor, affecting soft or bony tissues, which can have a unique location (solitary or extramedullary solitary plasmacytoma), or multiple (multiple myeloma). In the ENT sphere, it is most commonly encountered in its extramedullary form, which develops in the region of the head and neck, at the level of the submucosa. Most commonly, it affects the elderly, who have cardinal symptoms such as unilateral nasal obstruction, nasal or facial swelling, tissue necrosis or mucosal ulcerations, perforation of the nasal septum with dysmorphia of the nasal pyramid, recurrent unilateral epistaxis. Radiotherapy is the treatment of choice for extramedullary plasmacytoma. The prognosis is a reserved one, the risk of recurrence or conversion to multiple myeloma also existing 15 years after treatment.
OBJECTIVE. To evaluate the importance of computerized dynamic posturography in vestibular rehabilitation of patients with unilateral peripheral vestibular deficiency syndrome.
MATERIAL AND METHODS. The study was conducted on a group of 30 patients (33-78 years; mean age (± SD) = 55.8 ± 12.12) diagnosed with unilateral peripheral vestibular deficiency syndrome, which benefited from VR on a posturography platform. Assessment of the patients was made using the Sensory Organization Test before and after eight sessions of rehabilitation. We analyzed the results obtained with eyes open (EO) and eyes closed (EC) on static and foam platform. The following variables were evaluated: Romberg coefficient, statokinesigram (SKG), maximum amplitude of the degree of deviation in anterior/posterior and medial/lateral planes, SKG and the time interval of the game rehabilitation program.
RESULTS. The statistical analysis of the data revealed a strong correlation (p<0.05) for the studied parameters, especially when the test was performed with the eyes closed on foam platform. The analysis of the Romberg coefficient did not show statistically significant results (p>0.05) and the measured values were outside the range of normality even at the end of the rehabilitation program. SKG and the time interval reference of the game showed significant improvement of the parameters (p<0.05); at the end of the rehabilitation sessions, 93.33% of the patients showed full recovery of their deficit.
CONCLUSION. Computerized dynamic posturography has a particularly important role in the evaluation, monitoring and rehabilitation of the patients with peripheral vestibular deficiency.
BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations.
OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders.
MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months.
RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity.
CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.
BACKGROUND. In case of rhinosinusal malignant tumors, it is important to have a unified and simple terminology. The suprastructure refers to the ethmoid sinus, the sphenoid sinus, the frontal sinus and the olfactory area of the nose. The mesostructure includes the maxillary sinus, excepting the orbital wall, and the respiratory part of the nose.
MATERIAL AND METHODS. We will present two clinical cases admitted and surgically treated in our department. The first one is a left-side suprastructure mass in a 39-year-old male patient, with a particular evolution. The second one is a left-side midfacial and suprastructure tumor with 3 prior negative biopsies in a 57-year-old patient. In both cases, we performed an external surgical approach.
DISCUSSIONS. For an external approach in mesostructure malignant tumors, we propose a combined approach using lateral nasal rhinotomies, sub-labial rhinotomies and midfacial degloving. The external approach in malignant tumors of the supra-structure is centred on a classical incision for the frontal sinus or a hemicoronal or coronal approach. There are some clear advantages of the open approach to be considered.
CONCLUSION. The advantages of the external approach are represented by a direct visualization and control of the tumor during the ablative time; a better control for negative margins; a better control of haemostasis; a better chance for en-bloc resection versus piece-meal resection.