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Mihai Dumitru, Daniel Tweedie, Ion Anghel, Romica Cergan, Codrut Sarafoleanu and Adrian Costache
BACKGROUND. Ultrasonography has been used in rhinology for diagnosing trauma lesions (fractures, hemosinus), second opinion in tumoral pathology, screening for sinusitis, but on a small scale and with future prospects of cost efficiency.
OBJECTIVE. We hope to grow awareness of the possible use of ultrasound in screening for nasal and paranasal sinuses pathology at the level of ENT emergency departments.
MATERIAL AND METHODS. We describe the technique for ultrasound examination of this region, emphasizing the need for a profound anatomical knowledge characteristic for ENT specialists. Any specialist having access to an ultrasound machine is encouraged to experiment with this imaging procedure. Two cases benefited from the use of ultrasonography in order to receive a better management and a swift treatment. One case presented with a maxillary sinus tumor and another with a paranasal tumor neighbouring the orbit.
CONCLUSION. Ultrasonography of nasal and paranasal sinuses permits serial examination without irradiating the patient; it could be implemented as an addition to FAST-like protocols at the level of emergency departments in order to screen for occult head and neck pathology prior to conventional radiology and CT imaging and thus reducing costs
Nicoleta Dumitrescu, Raluca Enache and Codrut Sarafoleanu
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.
BACKGROUND. Olfaction is one the most important senses; however, even nowadays it is incompletely known in humans from an anatomical and physiological point of view, but also as concerns the assessment methods and treatment. The main causes for acquired olfactory dysfunctions involve inflammatory pathology (local or general) and head trauma. Olfactory impairment after traumatic head injury (THI) is more frequent than believed. Today there are a number of tests for assessing the loss of smell, but more studies are needed in order to establish standardized protocols for patients with such pathology after THI. This uncertainty is more and more exploited by malingerers.
OBJECTIVE. The aim of the paper was to find in literature the necessary information in order to permit a correct management of a patient with olfactory impairment after head trauma and to establish new protocols that may help identify malingerers when medico-legal implications exists.
MATERIAL AND METHODS. We studied an amount of works and studies in order to highlight the diagnosis options specialist have, if such a case is encountered (olfactory loss after THI).
RESULTS. Recent studies show that great progress has been made, but more scientific research is needed. Specialists still search correlation between all diagnosis methods.
CONCLUSION. Olfactory disorders are an important topic given their importance in patient quality of life, but also for the medico-legal implications.
Claudiu Manea, Codrut Sarafoleanu, Cristina Iosif and Elena Patrascu
BACKGROUND. Innate immunity represents the first way of protection against different pathogenic agents. Recently, it has been a permanent interest regarding an innate immune molecule, that is known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific result found in the airways, of approximately 25 kDa, whose encoding is realized by adjacent genes located within a region of 300 kb in chromosome 20; these proteins must be detected predominantly in the superior respiratory tract.
MATERIAL AND METHODS. We performed a prospective clinical study on 34 patients with chronic rhinosinusitis and 10 controls, in order to investigate the expression of this protein in nasal tissue of patients affected by chronic rhinosinusitis. We tested the correlation between the existence of this disease and PLUNC proteins positivity.
RESULTS. 100% of controls have a+++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. There were no differences statistically significant between patients with CRSwNP and those with CRSsNP.
CONCLUSION. As a response to different irritating agents (bacteria, viruses, chemical factors), nasal mucosa will react by producing PLUNC proteins. PLUNC proteins have a defensive role in the upper airways mucosa.
Alex George Stanciu, Alexandra Cirticioiu and Adriana Neagos
BACKGROUND. Nowadays, snoring and obstructive sleep apnea are the most common sleep-related breathing disorders (SRBD) found in the medical practice and they are estimated to affect approximately 4% of men and 2% of women in the middle-aged workforce. There are some ENT pathologies that are involved in snoring, and also in obstructive sleep apnea syndrome. The nose plays an important part in both breathing and SRBD. The aim of this study was to determine the role of posterior rhinomanometry in the diagnoses of snoring and obstructive sleep apnea syndrome.
MATERIAL AND METHODS. We present a retrospective observational study that took place during a three-year period, between 2009 and 2012. In this study were included 110 subjects, who have undergone polysomnographic investigations, as well as an ENT clinical examination focused on endoscopy and posterior rhinomanometry evaluation.
RESULTS. The mean age was 46.09 ± 10.91 years, the mean height was 177.58 ± 10.02 cm and the mean weight was 98.45 ± 17.74 kg. Analysing these results, we found a significant correlation between them and the severity of the sleep pathology. The posterior rhinomanometry results were correlated with nasal allergic rhinitis (p = 0.06) and not correlated with other nasal pathology, such as nasal septum deviation. The changes in the size and shape of the tongue base or epiglottis proved to have an important impact upon rhinomanometric values, with a statistically significant value (p = 0.03, respectively p = 0.08).
CONCLUSION. All diagnostic methods must be interpreted in connection with each other.
BACKGROUND. Drug-Induced Sleep Endoscopy (DISE) is a sleep apnea diagnostic procedure which allows direct view the obstruction while inducing sleep using analgosedation with propofol. Many studies highlighted the importance of DISE in finding the level of obstruction and choosing the specific treatment.
MATERIAL AND METHODS. We performed DISE under propofol sedation in 27 patients diagnosed with sleep apnea who addressed to our clinic for further investigation and treatment. We assessed the obstruction type and severity using the Fujita scale, VOTE (velum, oropharynx, tongue base, epiglottis) and NOHL (nose, oropharynx, hypopharynx, larynx). Finally, we correlated the DISE findings with the polysomnographic results.
RESULTS. We observed significant correlations between the obstruction severity seen at DISE and the polysomnographic results. Further, we could decide the appropriate treatment for our patients, whether surgical or not (continuous positive airway pressure - CPAP).
CONCLUSION. Sleep endoscopy represents a very important method in establishing the topographic diagnostic of sleep apnea patients, being useful for the therapeutic decision and the postoperative assessment. We recommend drug-induced sleep endoscopy as elective investigation regarding the diagnostic and treatment of sleep apnea patients.
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.
Adriana Neagos, Alexandra Cirticioiu, Alex George Stanciu and Iren Csiszer
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Klaus Vogt, Klaus-Dieter Wernecke, Mara Argale and Krista Kaulina
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8. Andre R.F., Vuyk H.D., Ahmed A., Graamans K., Nolst-Trenité G.J. - Correlation between subjective and objective evaluation of the nasal airway