The Role of Navigation in Frontal Sinus Surgery

ENT navigation has given new opportunities in performing endoscopic sinus surgery (ESS), and improving the surgical outcome of patient treatment. The generally accepted statement that navigated endoscopic sinus surgery (NESS) should be performed only in cases of complex anatomy and pathology has been changing gradually. In this way, NESS will be established as a state-of-the-art procedure, and used on a daily basis. Many surgeons have access to the navigation system but they do not use it on a daily basis. The approach to frontal sinus is one of the most challenging tasks within endoscopic sinus surgery even in cases with normal anatomy and average pathology. In cases of distorted anatomy and extensive pathology, a successful approach to frontal sinus can be a nightmare. Due to this, failure in frontal sinus surgery is the most frequent cause of revision surgery in the entire endoscopic sinus surgery. The use of the navigation system increases the surgeon\u27s confidence and ability to perform a more complete dissection in frontal sinuses. We have created a simplified algorithm for the use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis with and without nasal polyps. The simplified NESS algorithm consists of seven landmarks in four navigation units, which could be called seven must landmarks as they should always be recognised during basic ESS. These landmarks are as follows: 1) maxillary sinus ostium, 2) frontal recess, 3) ground lamella, 4) fovea posterior, 5) sphenoid sinus ostium, 6) orbital wall – anywhere, 7) skull base – anywhere. In using this algorithm, surgeons would become familiar with the navigation system and would receive all facilities which the navigation system offers in its approach to frontal sinus

The Role of Navigation in Frontal Sinus Surgery

ENT navigation has given new opportunities in performing endoscopic sinus surgery (ESS), and improving the surgical outcome of patient treatment. The generally accepted statement that navigated endoscopic sinus surgery (NESS) should be performed only in cases of complex anatomy and pathology has been changing gradually. In this way, NESS will be established as a state-of-the-art procedure, and used on a daily basis. Many surgeons have access to the navigation system but they do not use it on a daily basis. The approach to frontal sinus is one of the most challenging tasks within endoscopic sinus surgery even in cases with normal anatomy and average pathology. In cases of distorted anatomy and extensive pathology, a successful approach to frontal sinus can be a nightmare. Due to this, failure in frontal sinus surgery is the most frequent cause of revision surgery in the entire endoscopic sinus surgery. The use of the navigation system increases the surgeon\u27s confidence and ability to perform a more complete dissection in frontal sinuses. We have created a simplified algorithm for the use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis with and without nasal polyps. The simplified NESS algorithm consists of seven landmarks in four navigation units, which could be called seven must landmarks as they should always be recognised during basic ESS. These landmarks are as follows: 1) maxillary sinus ostium, 2) frontal recess, 3) ground lamella, 4) fovea posterior, 5) sphenoid sinus ostium, 6) orbital wall – anywhere, 7) skull base – anywhere. In using this algorithm, surgeons would become familiar with the navigation system and would receive all facilities which the navigation system offers in its approach to frontal sinus

Učestalost alergijskog rinitisa i s njim povezanih bolesti

The prevalence of allergic rhinitis and related diseases varies from country to country and even within particular countries. The prevalence is difficult to precisely estimate. There is ample evidence showing the rate of allergic rhinitis to be on an increase worldwide over the last decades, especially so in industrialized countries. The increasing prevalence remains largely unexplained merely by lifestyle changes and environmental pollution. Great effort has therefore been invested to identify the possible impacts, which may hopefully help control this "allergic march".Učestalost alergijskog rinitisa i s njim povezanih bolesti znatno se razlikuje među pojedinim zemljama, pa čak i među pojedinim regijama unutar iste zemlje. Nije jednostavno točno procijeniti rasprostranjenost alergijskog rinitisa. Postoje čvrsti dokazi o porastu učestalosti alergijskog rinitisa u svijetu posljednjih desetljeća, poglavito u razvijenim zemljama. Tendencija rasta ove učestalosti još uvijek nije dovoljno razjašnjena uz dva trenutno najizraženija čimbenika tog porasta, a to su zapadnjački način života i onečišćenje okoliša. Ulažu se znatna sredstva i napori u istraživanje porasta alergija u svijetu, pa postoji nada da će ti napori pomoći u zaustavljanju "epidemije" alergija

Pregnancy - induced rhinitis (PIR): neglected disease

Introduction: Pregnancy-induced rhinitis (PIR) is a widely present disease that manifests itself during pregnancy with complete resolution of symptoms after delivery. Aim: In the ambidirectional longitudinal cohort study, the prevalence of PIR is evaluated as well as the appearance and character of its symptoms, and its impact on the quality of life. Methods: Six hundred eighty-one (681) women completed questionnaires about nasal symptoms a day after delivery and each woman with nasal symptoms was interviewed 30 days later and data on symptom duration and quality were recorded. Results: The prevalence of PIR was 31.86% (N=217), 47.14% (N=21) women had no nasal symptoms and 21% (N=143) of participants had prior sinonasal disease. The clinical presentation of pregnancy rhinitis included nasal obstruction as the most common symptom, followed by rhinorrhea, postnasal secretion, nose itching, sneezing, and hyposmia. The median duration of PIR was 4 months with their complete resolution of symptoms between the 2nd and 16th day after delivery in the majority of respondents. PIR was diagnosed significantly more often if the women carried a female child. PIR affected the quality of life during pregnancy in 53.9% women (N=117), with an average VAS score of 8. It seems that pregnancy may affect the course of previously present sinonasal disease (allergic rhinitis, chronic rhinosinusitis, nonallergic rhinitis, or noninfectious rhinitis prior to the pregnancy). Conclusion: PIR is a common clinical entity but still neglected and insufficiently researched. We propose a definition of PIR. PIR is a non-allergic, non-infectious symptomatic inflammation of the nasal mucosa caused by a hormonal imbalance during pregnancy, lasting 6 or more weeks and resolving spontaneously within 4 weeks post-delivery, caracterized with the presence of at least one nasal symptom (nasal obstruction, but also rhinorrheoea, nose itching, sneezing and/or hyposmia)

Učestalost alergijskog rinitisa i s njim povezanih bolesti

The prevalence of allergic rhinitis and related diseases varies from country to country and even within particular countries. The prevalence is difficult to precisely estimate. There is ample evidence showing the rate of allergic rhinitis to be on an increase worldwide over the last decades, especially so in industrialized countries. The increasing prevalence remains largely unexplained merely by lifestyle changes and environmental pollution. Great effort has therefore been invested to identify the possible impacts, which may hopefully help control this "allergic march".Učestalost alergijskog rinitisa i s njim povezanih bolesti znatno se razlikuje među pojedinim zemljama, pa čak i među pojedinim regijama unutar iste zemlje. Nije jednostavno točno procijeniti rasprostranjenost alergijskog rinitisa. Postoje čvrsti dokazi o porastu učestalosti alergijskog rinitisa u svijetu posljednjih desetljeća, poglavito u razvijenim zemljama. Tendencija rasta ove učestalosti još uvijek nije dovoljno razjašnjena uz dva trenutno najizraženija čimbenika tog porasta, a to su zapadnjački način života i onečišćenje okoliša. Ulažu se znatna sredstva i napori u istraživanje porasta alergija u svijetu, pa postoji nada da će ti napori pomoći u zaustavljanju "epidemije" alergija

Čujno disanje kod djece - etiologija, dijagnostika, terapija

Čujno disanje kod djece može biti i otežano disanje, a svako otežano disanje je čujno. Postoje tri tipa čujnog disanja: stridor, stertor i wheezing. U području zbrinjavanja otorinolaringologa su prva dva tipa. Stertor ili hrkanje je niskofrekventni zvuk koji nastaje uglavnom u području nosa i ždrijela i uglavnom je inspiratorni, te je najčešće povezan s hipertrofičnim adenoidom. Stridor je visokofrekventni zvuk koji nastaje u velikim dišnim putovima, grkljanu i dušniku i može biti inspiratorni, ekspiratorni i bifazični. Etiologija čujnog disanja može biti u bolestima i anomalijama CNS-a, gastrointestinalnog, kardiovaskularnog i respiratornog sustava. Uzrok je suženje dišnog puta, a disanje postaje čujno kada je opstrukcija više od 50% lumena. Klasifikacija stridora prema etiologiji je sljedeća: kongenitalne anomalije (više od 70% laringomalacija), infektivna stanja (najčešće subglotični laringitis), tumori (najčešće subglotični hemangiom), laringealne traume, strana tijela, jatrogeno (najčešće postitubacijski). Dijagnostika se temelji na specifičnoj anamnezi: prenatalna anamneza, tijek i vrsta poroda, dišni problemi po rođenju, postnatalna anamneza (boravak u JIL-u/intubacija), hitni prijemi i hospitalizacije, je li čujno disanje izraženije u budnom stanju ili spavanju i u kojem položaju, intolerancija napora. U statusu djeteta treba obratiti pozornost na tipične kliničke znakove: širenje nosnica pri inspiriju, perioralna cijanoza, retrakcije prsnoga koša, tahipneja, desaturacija, disfonija/afonija, kašalj, disfagija. U osnovnoj kliničkoj dijagnostici prva metoda je fiberendoskopija dišnih putova, potom MR i CT. Terapija ovisi o uzroku čujnog disanja i kod većine kongenitalnih anomalija je čak i nema, nego se dijete opservira do potpunog spontanog oporavka. Kod teških kongenitalnih anomalija i subglotičnih stenoza različite etiologije indicirano je kirurško liječenje koje može biti endoskopsko ili vanjskim pristupom. Kod infektivnih stanja liječenje je uglavnom konzervativno ili ponekad udruženo s kirurškim liječenjem. Katkada je potrebno učiniti i traheotomiju. Čujno disanje kod djece se ne smije zanemariti, te zahtijeva dijagnostiku kojom se otkriva uzrok i potom pozorno prati dijete do spontanog izlječenja, ili se aktivno liječi, ovisno o izraženosti simptoma

Čujno disanje kod djece - etiologija, dijagnostika, terapija

Čujno disanje kod djece može biti i otežano disanje, a svako otežano disanje je čujno. Postoje tri tipa čujnog disanja: stridor, stertor i wheezing. U području zbrinjavanja otorinolaringologa su prva dva tipa. Stertor ili hrkanje je niskofrekventni zvuk koji nastaje uglavnom u području nosa i ždrijela i uglavnom je inspiratorni, te je najčešće povezan s hipertrofičnim adenoidom. Stridor je visokofrekventni zvuk koji nastaje u velikim dišnim putovima, grkljanu i dušniku i može biti inspiratorni, ekspiratorni i bifazični. Etiologija čujnog disanja može biti u bolestima i anomalijama CNS-a, gastrointestinalnog, kardiovaskularnog i respiratornog sustava. Uzrok je suženje dišnog puta, a disanje postaje čujno kada je opstrukcija više od 50% lumena. Klasifikacija stridora prema etiologiji je sljedeća: kongenitalne anomalije (više od 70% laringomalacija), infektivna stanja (najčešće subglotični laringitis), tumori (najčešće subglotični hemangiom), laringealne traume, strana tijela, jatrogeno (najčešće postitubacijski). Dijagnostika se temelji na specifičnoj anamnezi: prenatalna anamneza, tijek i vrsta poroda, dišni problemi po rođenju, postnatalna anamneza (boravak u JIL-u/intubacija), hitni prijemi i hospitalizacije, je li čujno disanje izraženije u budnom stanju ili spavanju i u kojem položaju, intolerancija napora. U statusu djeteta treba obratiti pozornost na tipične kliničke znakove: širenje nosnica pri inspiriju, perioralna cijanoza, retrakcije prsnoga koša, tahipneja, desaturacija, disfonija/afonija, kašalj, disfagija. U osnovnoj kliničkoj dijagnostici prva metoda je fiberendoskopija dišnih putova, potom MR i CT. Terapija ovisi o uzroku čujnog disanja i kod većine kongenitalnih anomalija je čak i nema, nego se dijete opservira do potpunog spontanog oporavka. Kod teških kongenitalnih anomalija i subglotičnih stenoza različite etiologije indicirano je kirurško liječenje koje može biti endoskopsko ili vanjskim pristupom. Kod infektivnih stanja liječenje je uglavnom konzervativno ili ponekad udruženo s kirurškim liječenjem. Katkada je potrebno učiniti i traheotomiju. Čujno disanje kod djece se ne smije zanemariti, te zahtijeva dijagnostiku kojom se otkriva uzrok i potom pozorno prati dijete do spontanog izlječenja, ili se aktivno liječi, ovisno o izraženosti simptoma

Subspecialist training program in pediatric otorhinolaryngology of UEMS ORL-HNS section

The ORL Section and Board of Otorhinolaryngology-Head and Neck Surgery of the European Union of Medical Specialists (UEMS) developed pediatric ORL subspecialty program. The program was created with support and consultation of the European Society of Pediatric Otorhinolaryngology. It is divided into four sections: Pediatric Otology, Pediatric Rhinology and Facial Plastic Surgery, Pediatric Laryngology and Phoniatrics and Pediatric Head and Neck Surgery. After completion of the program, the trainee is supposed to achieve an advanced level of competency. The aim of the program is to serve as a guideline for training centers, enabling them to meet the European Standard as set out by the European Board of UEMS through competency based assessments

Prognostička vrijednost IL-5 u sinusnom ispirku kod bolesnika s kroničnim maksilarnim sinusitisom

The aim of the study was to evaluate subjective outcomes in patients with chronic rhinosinusitis after steroid/antibiotic endosinusal treatment and to test the hypothesis that pretreatment levels of the cytokine interleukin-5 in sinus fluid could predict response to endosinusal steroid/antibiotic treatment. Twenty-four patients with symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than three months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated nasal/chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage collected at inclusion was analyzed for interleukin-5 concentration. Endonasal treatment led to improvement with symptom alleviation in ten (52.6%) patients (responders), whereas unchanged or worsened condition was recorded in nine (47.4%) patients (nonresponders). Significant improvement was noted for overall sinusitis symptom score (p=0.02), and for obstruction, postnasal drip, headache, sneezing and cough (p<0.05) in the study group as a whole. There was a positive correlation of baseline interleukin-5 level in sinus lavage with the improvement rate of overall sinusitis symptom score (p<0.01) and improvement rate of nasal secretion score (p<0.01). Results indicated the increased interleukin-5 levels in sinus fluid to predict good response to endosinusal steroid/antibiotic treatment.Cilj studije bio je procijeniti subjektivne ishode u bolesnika s kroničnim rinosinusitisom nakon endosinusne steroidne/ antibiotske terapije, te ispitati pretpostavku prema kojoj bi se iz prijeterapijske razine citokina interleukina-5 u sinusnoj tekućini mogao predvidjeti odgovor na ovu vrst liječenja. U studiju je bilo uključeno 24 bolesnika sa simptomima kroničnog rinosinusitisa. Kriteriji za uključivanje u studiju bili su trajanje simptoma sinusitisa duže od tri mjeseca i zadebljanje sluznice maksilarnih sinusa za više od 6 mm, tj. maksilarni sinusitis. Bolesnici s astmom, polipozom, nedavnom infekcijom, sistemskom uporabom steroida ili prethodnom operacijom sinusa bili su isključeni. Bolesnici su endosinusno primali 2 mg deksametazona i 40 mg gentamicina po maksilarnom sinusu kroz 5 dana. Bolesnici su ocjenjivali nosne simptome i simptome specifične za kronični rinosinusitis, i sami ispunili anketni obrazac o simptomima sinusitisa na početku i 30 dana nakon ispitivanja. Koncentracija interleukina-5 analizirana je u sinusnom ispirku uzetom na početku studije. U desetoro (52,6%) bolesnika je nakon endonazalne terapije nastupilo poboljšanje s ublaženjem simptoma (bolesnici s terapijskim odgovorom), dok je u devetoro (47,4%) bolesnika stanje ostalo nepromijenjeno ili se je pogoršalo (bolesnici bez terapijskog odgovora). Značajno je poboljšanje zabilježeno za ukupni zbroj simptoma sinusitisa (p=0,02), te za opstrukciju, postnazalni drip, glavobolju, kihanje i kašalj (p<0,05) u cijeloj skupini. Nađena je pozitivna korelacija između bazalne razine interleukina-5 u sinusnom ispirku i stope poboljšanja sveukupnog zbroja simptoma sinusitisa (p<0,01), kao i stope poboljšanja zbroja za nazalnu sekreciju (p<0,01). Rezultati su pokazali kako povišene razine interleukina-5 u sinusnoj tekućini predskazuju dobar odgovor na endosinusnu steroidnu/antibiotsku terapiju

Prognostička vrijednost IL-5 u sinusnom ispirku kod bolesnika s kroničnim maksilarnim sinusitisom

The aim of the study was to evaluate subjective outcomes in patients with chronic rhinosinusitis after steroid/antibiotic endosinusal treatment and to test the hypothesis that pretreatment levels of the cytokine interleukin-5 in sinus fluid could predict response to endosinusal steroid/antibiotic treatment. Twenty-four patients with symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than three months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated nasal/chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage collected at inclusion was analyzed for interleukin-5 concentration. Endonasal treatment led to improvement with symptom alleviation in ten (52.6%) patients (responders), whereas unchanged or worsened condition was recorded in nine (47.4%) patients (nonresponders). Significant improvement was noted for overall sinusitis symptom score (p=0.02), and for obstruction, postnasal drip, headache, sneezing and cough (p<0.05) in the study group as a whole. There was a positive correlation of baseline interleukin-5 level in sinus lavage with the improvement rate of overall sinusitis symptom score (p<0.01) and improvement rate of nasal secretion score (p<0.01). Results indicated the increased interleukin-5 levels in sinus fluid to predict good response to endosinusal steroid/antibiotic treatment.Cilj studije bio je procijeniti subjektivne ishode u bolesnika s kroničnim rinosinusitisom nakon endosinusne steroidne/ antibiotske terapije, te ispitati pretpostavku prema kojoj bi se iz prijeterapijske razine citokina interleukina-5 u sinusnoj tekućini mogao predvidjeti odgovor na ovu vrst liječenja. U studiju je bilo uključeno 24 bolesnika sa simptomima kroničnog rinosinusitisa. Kriteriji za uključivanje u studiju bili su trajanje simptoma sinusitisa duže od tri mjeseca i zadebljanje sluznice maksilarnih sinusa za više od 6 mm, tj. maksilarni sinusitis. Bolesnici s astmom, polipozom, nedavnom infekcijom, sistemskom uporabom steroida ili prethodnom operacijom sinusa bili su isključeni. Bolesnici su endosinusno primali 2 mg deksametazona i 40 mg gentamicina po maksilarnom sinusu kroz 5 dana. Bolesnici su ocjenjivali nosne simptome i simptome specifične za kronični rinosinusitis, i sami ispunili anketni obrazac o simptomima sinusitisa na početku i 30 dana nakon ispitivanja. Koncentracija interleukina-5 analizirana je u sinusnom ispirku uzetom na početku studije. U desetoro (52,6%) bolesnika je nakon endonazalne terapije nastupilo poboljšanje s ublaženjem simptoma (bolesnici s terapijskim odgovorom), dok je u devetoro (47,4%) bolesnika stanje ostalo nepromijenjeno ili se je pogoršalo (bolesnici bez terapijskog odgovora). Značajno je poboljšanje zabilježeno za ukupni zbroj simptoma sinusitisa (p=0,02), te za opstrukciju, postnazalni drip, glavobolju, kihanje i kašalj (p<0,05) u cijeloj skupini. Nađena je pozitivna korelacija između bazalne razine interleukina-5 u sinusnom ispirku i stope poboljšanja sveukupnog zbroja simptoma sinusitisa (p<0,01), kao i stope poboljšanja zbroja za nazalnu sekreciju (p<0,01). Rezultati su pokazali kako povišene razine interleukina-5 u sinusnoj tekućini predskazuju dobar odgovor na endosinusnu steroidnu/antibiotsku terapiju