Vlad Budu, Tatiana Decuseara, Ioan Alexandru Bulescu, Lavinia Ilinca and Alexandru Panfiloiu
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.
Neelima Vijayan, Padmanabhan Karthikeyan, Nirmal Coumare Venkataramanujam, Ramiya Ramachandran Kaipuzha and Davis Thomas Pulimoottil
OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis.
MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly.
RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064).
CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.
An irreversible disease, cystic fibrosis (CF), is responsible for affecting multiple organ systems containing epithelia. It is well known that the sinonasal disease caused by CF has consequences for the incidence of the lower airway exacerbations, as well as affecting the quality of life of those patients. This review provides an update by evaluating the available literature regarding pathogenesis, management and treatment of cystic fibrosis patients. To gain a better view of the disease and obtain a higher life expectancy, further studies are needed.
Klaus Vogt, Klaus-Dieter Wernecke, Mara Argale and Krista Kaulina
BACKGROUND. The measurement of the total nasal resistance by rhinomanometry is of special interest in the functional diagnosis of the nasopharynx and retropalatal space. It can be measured by posterior rhinomanometry or estimated by calculating the total resistance from measurements of both sides. Because the standard parameters of the classic rhinomanometry have to be considered as obsolete, Vertex Resistance and Effective Resistance and their logarithmic derivations have been introduced with 4-phase-rhinomanometry.
MATERIAL AND METHODS. In the first part, posterior and anterior rhinomanometry have been compared in a study of 32 volunteers. The disadvantages of posterior rhinomanometry have been apparent because of inconsistent statistic results. To compare both methods is useful in cooperative patients for the diagnosis of postnasal pathological alterations. By analyzing the rhinomanometric databases of 5 hospitals in 10,033 untreated patients and in 8,246 patients after decongestion, the total nasal resistance could be determined.
RESULTS. Because only the logarithmic values for effective and vertex resistances are correlated with the sensing of obstruction, these values have been used to classify the total obstruction in 5 classes. The descriptive data of every class are given. The here-described classes are valid for Caucasian noses. The calculated data can be delivered on request by the authors.
CONCLUSION. The here-presented parameters for measuring the resistance of the nasal airway and the classification of the obstruction from a statistically representative material can be recommended for the daily practice in rhinology and rhinosurgery.
Aru Chhabra Handa, Anup Singh and Jai Prakash Sharma
Wegener’s granulomatosis (Granulomatosis with Polyangiitis) is an autoimmune granulomatous disorder of unknown etiology. The basic pathology is necrotizing granulomatous inflammation with necrotizing vasculitis involving medium-sized blood vessels. The typical triad of involvement of the upper and lower respiratory tracts and the kidneys is observed in varying proportions in individual patients. The sinonasal involvement is observed in the majority of patients and it can be involved in isolation in up to a quarter of affected individuals. The sinonasal changes involve both the soft tissue and bony architecture, with refractory chronic sinusitis associated with erosion of the cartilaginous and bony skeleton and may lead to saddle nose and other facial deformities in advanced cases. The radiology has a contributory role as diagnostic and diseases monitoring aid.
The various radiological findings associated with the disease (bone erosion with osteoneogenesis) have been mentioned in the literature. We present the progression of a radiological abnormality in a patient with a localized form of Wegener’s Granulomatosis and highlight some peculiar appearances observed on radiology in the patient.
Clinical entities of food allergy in allergic rhinitis patients due to IgE-sensitization to cross-reactive aeroallergen and food allergen components are well described, but less data are available regarding allergic reactions to foods containing aeroallergens, either due to food contamination, such as oral mite anaphylaxis, or due to their natural presence in the edible products, such as pollen grains in honey and bee products. There are some potential risks for allergic rhinitis subjects due to ingestion of food products containing domestic mite, insect, fungal and pollen allergens. The knowledge of these risks is useful for the allergists and ENT specialists, especially in the context of climate changes with warmer periods facilitating mite growth in flours, and of increase use of phytotherapy and apitherapy products containing pollen grains.
Vlad Budu, Tatiana Decuseara, Andreea Nicoleta Costache, Loredana Ghiuzan, Lavinia Sava, Monica Hodor, Vadim Palii and Mihai Tusaliu
BACKGROUND. The most frequent benign nasal tumor is the osteoma. It is commonly asymptomatic and usually an incidental finding and can be caused by multiple factors. The therapeutic approach for symptomatic osteomas is strictly surgical.
CASE REPORT. The authors present a patient with giant ethmoido-frontal osteoma, causing the compression of the ocular globe and the right frontal lobe. Considering the intracranial extension, a combined surgical team consisting of an ENT surgeon and neurosurgeon decided to deal with the case. The tumoral mass was removed with no recurrence after a follow-up of two years.
CONCLUSION. Surgery via external and endoscopic approach aims to completely resect the osteoma with frontal sinus origin and orbital or intracranial extension.
OBJECTIVES. We reviewed the relationship between olfactory functions and Behçet’s disease (BD).
MATERIAL AND METHODS. We searched Pubmed, Google, Google Scholar and Proquest Cebtral Database with the key words of “olfactory”, “functions”, “smell”, “nasal” and “Behçet’s disease”.
RESULTS. Behçet’s disease influences the nasal mucosa. Nasal mucosal inclusion causes mucosal ulcers, pain, burning, nasal obstruction, epistaxis, nasal itching and dysosmia. Nasal cartilage deformity is also reported. The higher rate of comorbid chronic rhinosinusitis (CRS) in BD patients may likewise be because of the complex mechanism of the disease inclining the host tissues to bacterial infections. Olfactory functions may decrease in BD. Odor identification may be lower in patients BD.
CONCLUSION. An olfactory dysfunction may be seen in patients with BD. BD patients should be evaluated for the involvement of the olfactory function and may require treatment because of a malfunction of the olfactory system that influences the quality of life. Neurological involvement associated with BD might play a more important role in causing olfactory dysfunction than mucosal involvement.
Frodita Jakimovska, Marina Davceva Cakar and Dejan Dokic
BACKGROUND. Septal deviations are usually diagnosed by a patient’s subjective complaint of nasal stuffiness and a physical examination by the otorhinolaringologist. The decision for surgery is not always based on objective measurements. Acoustic rhinometry and rhinomanometry are objective tools for assessment of nasal patency but is still a controversial subject. In our populations, there are no general accepted methods for screening patients for septal surgery.
OBJECTIVE. To analyse the effectiveness of acoustic rhinometry and rhinomanometry in predicting the outcomes of septoplasty and rhinoseptoplasty and their usefulness in preoperative screening of septal deviations.
MATERIAL AND METHODS. 69 patients were included in this prospective study. Acoustic rhinometry and rhinomanometry were performed before and one year after surgery for the investigation of nasal obstruction. Several parameters were analysed before and after decongestion of the nasal mucosa. VAS (visual analogue scale) was also included for evaluation of the subjective symptom score pre- and postoperatively. After surgery, a short questionnaire was applied to investigate patients’ postoperative satisfaction.
RESULTS. The mean subjective scores of nasal patency improved significantly after surgery with 77%. Several parameters of acoustic rhinometry and rhinomanometry were analysed with binary logistic regression, to evaluate the predictive values on the postoperative satisfaction. The preoperative decongested overall MCA (minimal cross-sectional area) on the deviation side, the decongested bilateral MCA and the decongested Flow ratio had significantly the highest impact on the postoperative satisfaction (p<0.001).
CONCLUSION. Acoustic rhinometry and rhinomanometry as objective tools can serve as objective evidence for the efficacy of septoplasty and rhinoseptoplasty. The parameters of rhinomanometry and anterior rhinometry are useful in the preoperative screening for septal deviations and in predicting postoperative satisfaction between different degrees of nasal septal deviations.
Anca Evsei, Cristina Iosif, Simona Enache, Claudiu Manea and Codrut Sarafoleanu
Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized by pathological and biological heterogeneity. The histological and immunohistochemical diagnosis is the most important step in the appropriate management of these tumors and the prognosis varies according to histological types. Conventional anatomical and functional imaging can be complementary for diagnosis, staging and monitoring of treatment response. Material and methods. Here we report on a case of a laryngeal neuroendocrine small cell carcinoma occurring in a 67-year-old man who was referred to our clinic for clinical reevaluation, diagnosis and treatment. The clinical presentation, the histopathological and immunohistochemical examination and management of this kind of tumor are highlighted. Conclusion. Small cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Very low incidence of neuroendocrine tumors in the larynx and specifically very poor prognosis of neuroendocrine small cell carcinoma encouraged an extensive literature review.