Cemal Cingi, Erdem Atalay Cetinkaya, Osman Halid Cam, Fatih Oghan and Nuray Bayar Muluk
Headache is a common complaint which otolaryngologists frequently have to evaluate and treat in practice. Migraine, tension, cluster and sinus-rooted headaches are the most confronted ones in primary visits. Therefore, considerations of multidiscipline may be required to diagnose the rhinogenic and non-rhinogenic headaches. Rhinogenic headache is a distinct type of headache that has attracted an increased amount of attention in the recent years. The mechanism of headache is not yet known. In fact, the treatments of the above-mentioned headaches are different, but they may intersect in some cases. Non-steroid anti-inflammatory drugs (NSAID) and opioids are often used in headache treatment. Codeine, a well-known opioid derivative, has been prescribed for analgesia for a long time. This review aims to discuss the possible use and efficiency of NSAID and codeine combinations in the treatment of rhinogenic headaches.
Vlad Andrei Budu, Tatiana Decuseara, Silviu Crac, Alexandra Gheorghe, Alexandru Panfiloiu and Cristina Goanta
Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.
Andreea Marza, Codrut Sarafoleanu and Gabriela Musat
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.
BACKGROUND. Sinonasal polyposis represents a chronic inflammatory condition characterized by nasal obstruction, reduction in the sense of smell and impaired quality of life. Intranasal steroids play an important role in preventing the postoperative recurrences in these cases. We carried out a study to evaluate and compare intra nasal budesonide and intranasal fluticasone propionate in the postoperative management of ethmoidal nasal polyposis.
MATERIAL AND METHODS. 106 patients with ethmoidal polyposis were treated with endoscopic polypectomy and were postoperatively started and maintained on intranasal steroids. 54 patients were managed with budesonide and 52 patients maintained on fluticasone propionate nasal spray. The patients were followed-up for 6 months and recurrences and control of symptoms evaluated.
RESULTS. There was a statistical difference in the SNOT-22 (p<0.0001) and Lund-Kennedy scores (p=0.015) between patients using fluticasone propionate as compared to those using budesonide intra nasal spray by the end of the 6th month.
CONCLUSION. Both intranasal budesonide and fluticasone propionate are effective in controlling symptoms after endoscopic sinus surgery in patients with sinonasal polyposis; however, intranasal fluticasone propionate was more efficacious than budesonide in the control of postoperative symptoms.
Angioedema with life-threatening site is one of the most impressive and serious reasons for presenting to the ENT doctor. Among different causes (tumors, local infections, allergy reactions), an important cause is the side-effect of the angiotensin converting enzyme (ACE) inhibitors drugs. ACE-inhibitors-induced angioedema is described to be the most frequent form of bradykinin-mediated angioedema presented in emergency and also one of the most encountered drug-induced angioedema. The edema can involve one or more areas of the head and neck region, the most affected being the face, the lips, the tongue, followed by the larynx, when it may determine respiratory distress and even death.
There are no specific diagnosis tests available and the positive diagnosis of ACE-inhibitors-induced angioedema is an exclusion diagnosis. The authors performed a review of the most important characteristics of the angioedema caused by ACE-inhibitors and present their experience emphasizing the diagnostic algorithm.
Andreea Catana, Alma Maniu, Doinel Radeanu, Radu A. Popp, Roxana F. Ilies and Iuliu V. Catana
BACKGROUND. Polymorphisms for genes encoding chemosensitive signalling proteins like NOS2 might contribute to the variability in individual susceptibility to nasal polyposis. NO produced by the inducible NO synthase enzyme NOS2A is generated at high levels in certain types of inflammation, so that the role of NOS2 might also be important in nasal polyposis etiopathogeny.
MATERIAL AND METHODS. This is a cross-sectional, randomized, case-control study for the evaluation of the frequency of -954G/C NOS2A2 alleles among patients with nasal polyposis. The study included 91 cases of nasal polyposis diagnosed patients (nasal endoscopy and CT scan examination), and 117 healthy unrelated controls. NOS2 genotyping was carried out using PCR amplification of relevant gene fragment and it was followed by restriction enzyme digestion. Detection of the variant alleles was determined through analysis of resulting restriction fragment length polymorphism (RFLP) followed by gel electrophoresis.
RESULTS. Molecular analysis revealed an increased frequency of NOS2 variant allele in the study group compared to the control group (p=0.019, OR=1.991, CI=1.08-3.67). A statistically significant finding was highlighted among allergic and nonallergic patients with nasal polyposis (p=0.046, OR=0.449. CI=0.208-0.969) and a relationship between nasal polyposis patients with asthma and non-asthmatic patients (p=0.119, OR=1.825, CI=0.875-3.80).
CONCLUSION. The main finding of our study is that -954G/C polymorphism of NOS gene seems to be associated with an increased risk for nasal polyposis.
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