THE ROLE OF THE PHONIATRICS IN THE TREATMENT OF THE LARYNGEAL PATHOLOGY

Phoniatrics is the medical specialty that deals with the normal and pathological spoken and sung voice. So any patient presenting with voice and speech disorders, regardless of age, needs phoniatrics and vocal exercises. Depending on the causes that led to dysphonia, phoniatrics exercises will be accompanied by microsurgery and psychotherapy. Today there are a variety of concepts, theories, methods and especially a lot of the vocal exercises that have the aim to achieve the recovery of the voice, according to the schools, authors, the types of the disorder of the voice and the patient needs

CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES – OUR EXPERIENCE

Malignant rhinosinusal tumors (MRST) are less than 1% of malignant tumors of the body and 3% of head and neck cancers. We present a retrospective study of 326 cases of MRST. The aim of this paper is to present our experience in the management of malignant rhinosinusal tumors. Material and method The clinical diagnosis was confirmed by pathological examination of the tumors of the patients included in the study. The treatment protocol included surgery, radio and / or chemotherapy. The patients were followed up for a period of minimum five years. Results and Discussion Pathological examination shows that the carcinomas were encountered in the majority of cases (73,3%) being more frequently diagnosed than lymphomas (18,7%) , sarcomas (58%) and melanomas (1,8%). The majority of carcinoma cases were diagnosed in advanced stages (III and IV) - (57,5%). Methastasis in lymph nodes were present in 20% of the cases. The 5 years survival rate was low but in accordance with those presented in the medical literature. Conclusion MRST have recur locally quite frequently; lymph nodes metastasis were present but without any clinical manifestation in the majority of cases. In terms of histology, squamous carcinomas were found most frequently (70%). The prognosis is influenced by late diagnosis. Five years survival in advanced tumors is under 16 %

HIGHLIGHTING THE PHARYNGOCUTANEOUS FISTULA RISK FACTORS AFTER TOTAL LARYNGECTOMY

Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy involving prolonged hospitalization, additional discomfort and increased treatment costs. This retrospective study, conducted over a 5 year period, included 118 patients that underwent total laryngectomy after larynx carcinoma. Various factors influencing PCF development are discussed. Statistical analisys of the results show an important role of smoking and alcohol abuse, tumor stage and extension, pre-operative radiotherapy and local complications. In studying PCF developing risk factors, multicenter studies are absolutely necessary

Vestibular Manifestations In Retrocochlear Tumoral Pathology

Introduction Retrocohlear tumoral pathology is dominated by the vestibular schwannoma (VS). The VS involve the vestibular division of the 8th cranial nerve and grows slowly leading to a gradual installation of the unilateral vestibular impairment allowing simultaneous achievement of central compensation process. Sometimes only a careful history will reveal a slow imbalance, a tendency to move towards to a certain lateral part. Remarkable progress has been made in the VS early diagnosis so that treatment can take place earlier with good results. Materials and methods A representative case is presented. Beside general, neurological and ENT examination, the diagnostic workup comprised of computerized dynamic posturography, videonystagmography, pure tone audiometry, auditory brainstem evoked response, MRI brainstem evaluation. Results In VS computerized dynamic posturography allows an overall of the vestibular function with polymorphic results. Bithermal caloric testing is, combined to auditory brainstem responses a good tool to diagnose and evaluate unilateral vestibular impairment in vestibular schwannoma. Discussion Detailed history, careful exploration of vestibular and cochlear function can lead to the conclusion of possible retrocochlear injury. For confirmation of its existence and its nature contrast-enhanced CT or MRI are necessary. Conclusion Any unilateral cochlear or vestibular symptoms (unilateral or asymmetric sensorineural hearing loss, unilateral tinnitus, unilateral vestibular impairment of any degree with central compensation or not) should raise suspicion of possible VS

Auditory Function Recovery In Sudden Sensorineural Hearing Loss: 3-Year Study

Objectives: The goal of this study was to assess the post-therapeutic rehabilitation for a group of patients in order to evaluate the conventional treatment of sudden sensorineural hearing loss. Materials and methods: 45 patients diagnosed with sudden sensorineural hearing loss, where clinically examined. A careful examination is needed to exclude life threatening causes such as vascular events and malignant diseases. Conventional treatment that include corticosteroids, antiviral drugs, vasoactive and vitamins (B1, B6) was administered to patients. Results: Post-treatment rehabilitation degree varies. The greatest recovery of hearing has been shown when corticosteroids are started within the first 1—2 weeks after symptom onset. About 45% of patients show good recovery, usually in about 2 weeks. Patients in whom there is no change within 2 weeks are unlikely to show much recovery. Conclusions: In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. It is recommended that patients with sudden sensorineural hearing loss with no clear underlying cause after investigation are treated with a short course of oral prednisolone started within 2 weeks after onset. There is much to learn about pathogenesis of sudden sensorineural hearing loss and more clinical trials are needed to establish evidence-based management

COMPLETE DENTURES FRACTURES – CAUSES AND INCIDENCE

Aim:The purpose of this study was to evaluate the frequency of dentures fractures for a group of patients during two years. Matherial and methods:A questionnaire was designed to collect the data necessary to carry out the assessment of different variables associated with denture fractures. Results and discussions: The instability was the primary factor causing fractures of the lower dentures .Conclusions: According to studies by Hargreaves, the physical properties of acrylate does not deteriorate with age, but clinical function can induce stress that after a period of use can bring damage to material and can hasten fractur

Obstructing Sleep Apnea in Children with Genetic Disorders—A Special Need for Early Multidisciplinary Diagnosis and Treatment

Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life

Anatomical Variants of Internal Carotid Artery—Results from a Retrospective Study

Background and Objectives: The internal carotid artery (ICA) is a vascular structure that can be easily injured during sinus endoscopic procedures, and surgeons should be familiar with its anatomic variants. The aim of this study was to describe the anatomical variations in the internal carotid artery in relationship to sphenoidal sinuses, using computed tomography (CT). Materials and Methods: In this retrospective study, we evaluated the variations of the ICA in relationship to sphenoidal sinuses in a cohort of 600 patients who were assessed between January 2020 and December 2022 in ‘Saint Spiridon’ Emergency Hospital, Iasi, Romania. Descriptive statistics were used to characterize our data. Results: The most prevalent anatomical variant was represented by intrasinusal septa with posterior insertion on the ICA (58.6%), followed by procident ICA (58%) and dehiscent ICA (52%). We could not find any statistical significance regarding demographic characteristics among groups. Conclusions: A thorough CT examination should be performed before functional endoscopic sinus surgery, with the identification of anatomical variants of the ICA, in order to prevent its injury with potentially fatal consequences