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Do the turbinates play an important role in obstructive sleep apnea syndrome? – Our experience

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.

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Sinonasal adenocarcinoma with aggressive ocular symptom

Abstract

BACKGROUND. The malignant sinonasal tumour is very rare. Sinonasal adenocarcinoma comprises only 10-20% of all primary malignant sinonasal tumours. The commonest type is the maxillary squamous cell carcinoma. It commonly presents with nasal blockage, nasal discharge and epistaxis during the early stage. Headache and blurry vision may occur at an advanced stage when it has invaded the brain, the eye or the optic nerve.

CASE REPORT. We present a 63-year-old patient with acute progressive worsening unilateral blurry vision and headache for 1 month. Epistaxis with anosmia developed only later. The patient had a neuroimaging by both Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) scan which showed a skull base tumour, but early biopsy was inconclusive. He underwent combined transcranial and transsphenoidal tumor debulking in view of clinical impression of olfactory neuroblastoma. The histopathological examination showed adenocarcinoma. He was sent for postoperative radiotherapy.

CONCLUSION. We highlighted that a patient with sinonasal adenocarcinoma may present initially with the symptom of invasion to neighbouring structures prior to the local symptom.

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The role of ultrasound in the diagnosis of obstructive sleep apnea

Abstract

OBJECTIVE. This study examines the association between the severity of obstructive sleep apnea and the pharyngeal parameters using the ultrasound of the submental region.

MATERIAL AND METHODS. For this study, data obtained from 40 patients, who had undergone investigations in the Galenus Medical Centre in order to diagnose sleep apnea, was analyzed. The following parameters were compared: the transverse diameter of the retrolingual region, the transverse diameter of the retropalatal region and the tongue base thickness. These regions were measured at different moments of respiration such as: during forced expiration, during forced inspiration and while the patients performed Müller’s Manoeuvre. The neck circumference, the body mass index of patients and the severity of sleep apnea obtained from polysomnography were analyzed.

RESULTS. The evaluation of the results revealed: severe obstructive sleep apnea in 16 patients, respectively moderate severity in 10 patients, mild apnea in 4 patients, and no obstructive sleep apnea in 10 patients. Statistically significant results (p<0.05) were found after comparing the parameters obtained in patients with severe apnea versus the parameters in patients without apnea, with mild or respectively moderate apnea.

CONCLUSION. Based on the results obtained, we consider that cervical ultrasound is useful in the diagnosis of severe obstructive apnea, identifying the pathological changes of the anatomical structures that basically cause this category of disease. Due to the fact that in our country ultrasound is a relatively inexpensive method, being also a non-irradiating, repeatable and accessible method, it should be more widely applied also in the field of otorhinolaryngology in order to view structures accessible to this type of imaging.

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Comparative analysis of the data obtained in computerized posturography and videonystagmography for patients with peripheral vestibular deficit

Abstract

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.

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Treatment difficulties in salivary gland cancer

Abstract

Salivary gland cancers are represented by a heterogeneous histologic group of tumors, with low incidence, which may appear both in major and minor salivary glands. This article presents a review of the difficulties which may be encountered in this pathology during the treatment. The diagnosis of salivary gland cancers is often delayed, due to the histopathologic and immunohistochemistry results given in different period of times. There can be several difficulties in following the oncologic pre-treatment protocols, in terms of imaging technique, as MRI, useful for disease staging.

The treatment of salivary gland cancers is complex, due to the local anatomy and their aggressive potential. Because of their decreased incidence, there are few data that investigate the treatment in the case of these diseases. The current therapy available for the patients with salivary gland cancers is represented by complete surgical resection. Several treatment difficulties in cancers of the salivary glands may come from the surgical limitations and the insufficient data for adjuvant and palliative treatment. Due to the limitations of the local health system, there is a heterogeneous distribution of the oncologic centers, lack of equipment, prolonged time to follow general protocols, despite the aspect of case-individualized therapy according to the guidelines. We must not forget the tumor behaviour and individual reactivity of different patients to the same treatment protocol.

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Pain in the cervico-facial pathology: elements of etiopathogenesis, diagnosis and therapeutic principles

Abstract

The authors conduct a review of the etiopathogenesis, the main diagnostic methods and the treatment principles in cervico-facial pain. Pain in otorhinolaryngology is a multifactorial symptom, based on the rich innervation and vascularisation of the cephalic extremity. Pain can be of central or peripheral origin, acute and chronic. With the diversification of methods for exploring pain-generating lesions, different treatment protocols could also be achieved.

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The ethical and moral responsibility of the surgeon, hospital and government for the hospitalization after adenotonsillectomy

Abstract

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.

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Endoscopic orbital decompression in Graves ophthalmopathy - Case report

Abstract

Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.

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MRSA in recurrent frontal sinusitis

Abstract

The authors present a case of recurrent frontal rhinosinusitis, for which the drug therapy was ineffective. To avert the risk of complications, multiple classic and endoscopic surgical procedures were performed on the frontal sinus pathology.

The bacterium involved in this form of rhinosinusitis was represented by a Methicillin-resistant Staphylococcus aureus (MRSA) diagnosed during the first endoscopic approach (the second surgical procedure) for which the treatment corresponding to the antibiogram was followed. At the last hospitalization, the patient has underwent a frontal bilateral drainage surgery (modified Lothrop procedure) and started an adequate anti-MRSA treatment.

The authors wondered whether multiple recurrences of frontal rhinosinusitis are determined by an incomplete drainage, by a persistent infection with MRSA or by both.

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Orbital decompression for inverted papilloma – Case report

Abstract

Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications.

The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.

Open access