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Raluca Enache and Dorin Sarafoleanu

Abstract

The term monosymptomatic nasal obstruction does not refer to the isolated nasal obstruction, but to a nasal pathology in which nasal obstruction is the predominant symptom. Four nasal structures may be involved in the isolated monosymptomatic nasal obstruction: the inferior nasal turbinates, the nasal septum or the nasal valve. Since the phenomenon of nasal obstruction can be due to various diseases, correct assessment of the patient is very important. Correctly performed anamnesis and clinical and paraclinical evaluations can help determine the definite diagnosis and choose the therapeutic strategy indicated in each individual case.

In this review the authors present the proper therapeutic approach for each type of monosymtpomatic nasal obstruction, emphasizing the need of a preoperatory detailed and correct investigation and diagnosis.

Open access

Raluca Enache and Dorin Sarafoleanu

Abstract

Cough is a common symptom encountered in medical practice and can occur throughout the life of a person. From a physiological point of view, it represents a mechanism responsible for the elimination of secretions from the airways. At the same time, cough may be the first symptom of an illness. There are many causes that may lead to the emergence of a chronic cough syndrome, the most frequent being pulmonary diseases. Besides the bronchopulmonary pathology, there are a number of extrapulmonary disorders that may manifest with coughing. The first step in evaluating the patient with chronic cough is performing a correct and complete anamnesis, followed by the physical examination of the patient. The treatment of the chronic cough syndrome must address mainly the underlying disease but, in case of failure of the established treatment, the antitussive therapy is used.

Open access

Dorin Sarafoleanu and Raluca Enache

Abstract

Neck pathology in children involves many diseases with similar clinical expression. Different disorders in paediatric practice may be clinically manifested by a cervical tumefaction. The cervical tumefaction can be represented by adenopathies or tumors. Cervical adenopathies may be unilateral or bilateral; the cause of their occurrence may be infectious, inflammatory, tumoral or may be associated with rare diseases. Tumoral cervical tumefactions can be represented by: congenital cervical cysts and fistulae, cystic lymphangiomas, thyroid swellings, malformations and cervical tumors detected antenatally. A correct diagnosis is established after a complete clinical and paraclinical assessment. In this article the authors make a review of the types of cervical tumefactions in children, emphasising the diagnostic protocol.

Open access

Codrut Sarafoleanu and Raluca Enache

Abstract

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.

Open access

Raluca Enache, Dorin Sarafoleanu and Codrut Sarafoleanu

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

Dorin Sarafoleanu and Raluca Enache

Abstract

Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.

Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.

Open access

Nicoleta Dumitrescu, Raluca Enache and Codrut Sarafoleanu

Abstract

BACKGROUND. Nasal obstruction may trigger obstructive sleep apnea syndrome (OSAS) and it is considered to be a cofactor in its pathophysiology. However, the relation between cause and effect still remains a matter of debate.

MATERIAL AND METHODS. 18 patients diagnosed with chronic hypertrophic rhinitis and obstructive sleep apnea syndrome were included in the present study. All patients underwent nasal surgery as the single treatment for their sleep breathing disorders. Rhinomanometric (total nasal airflow, logReff, logVR) and polygraphic parameters (apnea-hypopnea index - AHI, snore flags index – SFI) were evaluated pre- and 2 months postoperatively.

RESULTS. There was a statistically significant difference between the values of the preoperative and postoperative total nasal airflow (p-value<0.0001). In case of AHI, there was a decrease in its value from 31.56 preoperatively to 30.03 postoperatively, but the difference was not statistically significant (p=0.937). The SFI, on the other hand, presented a significant decrease (p=0.05), from a mean value of 93.15 preoperatively to 56.02 after the surgery. The correlation of the total nasal airflow with AHI and SFI, revealed that nasal surgery had an important impact upon snoring characteristics (r=0.24) and less upon OSAS severity (r=0.21).

CONCLUSION. The nasal cavity obstruction contributes less to OSAS, but still represents a disorder that needs to be corrected in case of such patients. Turbinates reduction surgery may be applied in the treatment of OSAS and combined with palate and/or tongue surgery.

Open access

Gabriela Musat, Laura Florina Neaga and Raluca Enache

Abstract

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.

Open access

Raluca Șoșdean, S Pescariu, B Enache, Ri Macarie and Raluca Marca

Abstract

Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients.

Materials and methods: We retrospectively analyzed all 228 resynchronization patients implanted at the Timișoara Institute of Cardiovascular Medicine between January 1st, 2000 and January 1st, 2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulationdetection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients).

Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12.5%) in group A, 8 (9.87%) in group B and 5 (6.75%) in group C (p = 0.51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p = 0.36). Cephalic vein was of high quality in 59.8% of cases.

Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique.

Open access

Anamaria Andreia Ulmeanu, Andreea Didilescu, Raluca Enache, Gabriela Musat and Codrut Sarafoleanu

Abstract

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.