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Malignant and premalignant lesions of the vocal cords represent an important chapter in laryngeal pathology, raising a number of issues in the literature regarding diagnosis and optimal therapeutic approach. Surgical ablation of malignant tumor formations can be performed classically, by external approach to the cervical region, or endoscopically, transorally, using laser and cold instruments under the operating microscope. Regardless of the surgical technique used, the goal must be the complete tumor ablation, with or without oncological treatment, as determined by a specialized oncological committee. The authors present the case of a patient with laryngeal neoplasm located in the right vocal cord and anterior laryngeal commissure, on a background of chronic white hypertrophic laryngitis with multiple areas of keratin on the left vocal cord. The paper highlights the importance of laser technology in the successful resolution of both benign and malignant vocal cord pathologies, presenting multiple advantages over traditional surgery and offering superior oncological, functional and esthetic outcomes. [ABSTRACT FROM AUTHOR]

Vestibular evoqued miogenic potentials (VEMP) are relatively new, but gained ground rather quickly, being the second test (besides calorics) that evaluate individually the two ears. VEMP testing is complementary to other vestibular tests and brings additional information that help in confirming the diagnosis, identifying the site of injury and appreciating the outcome prognosis. In this paper, we aim to outline VEMP alterations characteristic to different vestibular diseases and to point out the clinical value of recognizing these variations. [ABSTRACT FROM AUTHOR]

Lasers are a relatively recent acquisition in larynx surgery. The use of CO2 laser has seen rapid expansion in the approach to a large variety of benign and malignant laryngeal pathology. Transoral microscopic laser surgery became the method of choice for many of these pathologies of the glottic plane. This paper presents a series of relevant clinical cases and particular situations encountered that showcase the utility of this surgical technology in successfully addressing the most common benign laryngeal lesions. We evoked, commented on and highlighted the most important aspects regarding the chosen approach methods, the surgical details and the particularities of each case, the problems encountered, the benefits and disadvantages of using CO2 laser in these types of diseases and the solutions used to streamline the long-term results and to improve the patients’ quality of life. [ABSTRACT FROM AUTHOR]

The paper shows the impact of the InSitu measurements on the fitting of a hearing aid. The InSitu audiogram is obtained by using the hearing aid as you would use an audiometer in order to obtain results that are not influenced by the volume or shape of the ear canal. Using this procedure, we can avoid having an over or under amplified fitting for the patient’s real needs. If we have differences between the two audiograms, then we will also have a similar increase in gain following am­ plification. At differences of 5, 10, 15 and 20 dB, we will obtain a positive of negative growth by 12%, 24%, 36% and 48% in gain. Any variation of the gain other the one needed by the patient will automatically generate a drop in intelligibility and can even generate a sound so distorted that the patient will refuse to wear the hearing aid. [ABSTRACT FROM AUTHOR]

Septoplasty is one of the most common surgical techniques in the ENT field, and the main reason why it is performed is nasal obstruction. The present paper aims to address the main types of incisions made to approach the nasal septum, with their advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Vestibular schwannoma is a benign, intracranial tumor of the 8th pair of cranial nerves. The incidence of vestibular schwannoma is 3-5.2 cases per 100000 people. It represents 6% of all intracranial tumors and 80% of tumors located in the cerebellopontine angle. In this paper, the authors present the results of a retrospective study of vestibular schwannoma patients who underwent vestibular schwannoma surgery between 2010 and 2019. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is characterized by changes in the lung parenchyma and small airways, leading to persistent respiratory symptoms and chronic airflow limitation. The comorbidities associated with the disease and the presence of the inflammatory response in the lungs lead to the worsening of symptoms and to an increase in the number of visits to the emergency department due to exacerbations. The main risk factor is cigarette smoking, but factors such as occupational exposure, air pollution, genetics, underdevelopment of the lungs during childhood and ageing can also contribute. Although it is a preventable condition, COPD affects more than 3 million people, representing about 6% of all deaths, and is currently the third leading cause of death in the world. The mechanisms that cause impaired respiratory function are multiple and subclassify COPD into several phenotypes: phenotype with predominance of bronchitis, phenotype with predominance of emphysema, eosinophilic phenotype, frequent exacerbator phenotype, rapidly progressive phenotype. The main aim of this paper is a review of the literature that used cluster analysis to deepen the phenotypes met in COPD. [ABSTRACT FROM AUTHOR]

Cervical lymph nodes represent a common site of metastases for malignancies of the head and neck and, in the absence of a known primary site, the treatment options can be challenging. In patients with a nodular formation with laterocervical localization, the differential diagnosis should always consider the potential metastasis of squamous cell carcinoma of the ENT sphere. This paper emphasizes the importance of a complete physical and imaging examination, as well as histopathological diagnosis, which led to a diagnosis of squamous cell carcinoma originating in the larynx, in an otherwise nonspecific clinical setting. [ABSTRACT FROM AUTHOR]

The uncinate process, the so-called first lamella of the ethmoid, represents the first surgical landmark found during endoscopic ethmoidectomy. Usually, the uncinate process can be found after middle turbinate medialisation. In common practice we are dealing with anatomic variations or different endoscopic aspects of the uncinate process depending on the pathology. In this paper we try to illustrate the different endoscopic aspects of the uncinate process. [ABSTRACT FROM AUTHOR]

HPV-positive oropharynx cancers have an increasing incidence in the last two decades, especially among young nonsmoking adults. Retrospective studies have shown that the prognosis of these cancers is superior than in those HPV negative. The multivariate analysis of prognosis taking into account the HPV status and the TNM staging has led to a new staging system for these particular cancers, published in the 8th AJCC manual. The combined treatment, such as radiochemotherapy or surgery followed by adjuvant radiotherapy, causes serious acute and late toxicities, like mucositis, dysphagia, xerostomia and cervical fibrosis. Given the young age group and the better prognosis of HPVpositive cancers, a series of new strategies to deintensify the treatment have been introduced, such as lower total dose of radiotherapy, omitting chemotherapy or replacing some cytotoxic agents with other less toxic. This paper presents the standard treatment for HPV-positive cancers and a summary of published or still pending studies for deescaladation. We also list the common late toxicities with an impact on the quality of life. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in chronic inflammatory diseases and also in acute administration, for the management of fever and pain. The present paper reviews the appropriateness of NSAIDs’ use in the treatment of COVID-19, analyzing the results of relevant clinical trials. [ABSTRACT FROM AUTHOR]

Pleomorphic adenoma is the most common benign intraorbital tumor. The diagnosis based on clinical and imagistic specific signs, followed by a proper surgical excision, leads to an excellent prognosis in the vast majority of cases. This paper presents a minimally invasive endoscopic transcutaneous approach, through a 20 mm incision, with tumor endoscopically debunking, keeping the tumor capsule intact, with the complete resection of the tumor after its detachment from the right optic nerve. [ABSTRACT FROM AUTHOR]

In the near future, oral and maxillofacial surgeon will have to deal with an increasing number of squamous cell carcinomas of the peri-implant tissues, due to the ever increasing rate of dental implant therapy in edentulous or future edentulous patients. When physicians are diagnosing the patients in early stages, the differential diagnosis is sometimes difficult to set as the onset of oral carcinoma can mimic the clinics of perimplantitis. Most of the times, if they have some sort of distress of their implant mucosa, the patients will address their dentists, who have a lesser experience regarding oral cancer. The authors want to highlight this aggressive pathology, which is not new, but when it affects the peri-implant tissues, it can cause false diagnosis. This paper presents the case of a 68-yearold patient who underwent partial mandible resection for a perimplant mucosa squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Background. During 2016-2017 influenza outbreak, many children needed hospitalization for complications, mainly respiratory complication. In this paper we focus on upper respiratory complications. Objective. To present clinical aspects, especially complications of influenza viruses infection in pediatric patients, during 2016-2017 season. Materials and method. We performed a retrospective observational study including all pediatric patients admitted in the “Prof. Dr. Matei Balş” National Institute for Infectious Diseases, between October 1st 2016 - June 30th 2017. The flu positive diagnosis criteria used epidemiologic context, clinical signs and symptoms suggestive for respiratory viral infection and rapid positive test from nasopharyngeal secretions. We collected and analyzed data regarding age, gender, type of flu virus and complication recorded in medical charts. We used EpiInfo 7 software for statistical analysis. Results. We identified 654 patients with flu diagnosis in the Pediatric Department, with a mean age of five years. Most of the diagnosed children were younger than five years old. Half of the studied children were boys 334 (51%). The most frequent type of influenza virus was A - 485 cases (74.5%). In 99 patients we found type B virus, and in 5 patients we found co-infection with A and B viruses. The highest number of cases was in December, followed by January, 380 and 173 cases, respectively. The number of hospitalized patients was 394 out of 654 (60.2%). Respiratory complications were found in 158 hospitalized children, but we identified 21 patients with myositis, six with encephalitis, and 15 patients with hematologic disturbances. Among the studied childrens, eight had laryngitis, 22 had otitis and 16 had sinusitis. Conclusion. Type A influenza was dominant in 2016-2017 season. Children younger than five year old needed hospitalization, mostly for lower respiratory tract complication, but also for upper respiratory tract and neurologic complications. In order to prevent the outbreaks and hospitalization during flu season, we need a better vaccination coverage, including in young children. [ABSTRACT FROM AUTHOR]

The current paper presents the case of a patient with a retained foreign esophageal body, removed through open surgery (lateral cervical esophagotomy). The foreign body was a partial dental prosthesis with a metal hook that anchored it to the patient's remaining natural teeth. The foreign body was lodged in the esophageal wall and the previous endoscopical extraction attempt had failed. The patient was transferred to our department from a regional hospital where an endoscopic attempt at removing the foreign body had failed. The patient complained of descending odynophagia and dysphagia for solids. After the previous esophageal endoscopy, the patient complained of retrosternal pain and pressure. A CT-scan with contrast of the neck and chest regions was performed. A secondary endoscopical exploration of the esophagus was performed, thus the foreign body's location was precisely identified. We discovered that its metal grappling device was anchored in the lateral esophageal wall thus preventing endoscopic removal without tearing the esophageal wall open. As the patient's current state was degrading (descending pains and risk of mediastinitis), we considered another transfer to be an unfortunate choice, so we chose an open surgery approach. We opted for a lateral cervical esophagotomy. The surgery was performed under general anesthesia, and the retained foreign body was removed. The lateral wall of the esophagus was perforated and torn open vertically at the spot where the metal hook of the prosthesis lodged itself into the muscle wall. A 4‑centimeter incision circumscribed both parietal lesions and allowed the removal of the foreign body without any further damage. Postoperatively, a nasogastric feeding tube was maintained for 14 days. Ten days after the surgery a follow‑up CTscan was performed. The imaging exam did not show any mediastinal or retromediastinal fluids. After the nasogastric feeding tube was removed the patient was gradually allowed back on solids without any complaints. [ABSTRACT FROM AUTHOR]

The frontoethmoidal mucocele is not a very frequent pathology in ENT current practice. When the patient is consulted for the first time by a physician, the mucocele is in exteriorization phase, being associated with complications. The most frequent exteriorization of frontoethmoidal mucocele is orbital exteriorization, so the patient's symptomatology is ocular - exophtalmy, diplopy, the limitation of ocular motility, visual disorders. Ocular pain and headache bring the patient to the physician, although the exophtalmy has more than one year. The authors present in this paper a series of three clinical cases of frontoethmoidal mucoceles with exteriorization, along with their issues of diagnose and treatment. We consider that the external surgical treatment is the only one that allows a complete excision of the lesion and the endonasal endoscopic control is mandatory for a secure catheterization of the frontonasal canal. [ABSTRACT FROM AUTHOR]

Peripheral vestibular syndrome is frequently met in daily ENT practice (30% of patients). History and bedside examination are crucial un differentiating peripheral and central vestibular lesions, as in establishing the aetiology whenever possible. This paper presents a differential diagnostic algorithm for vertiginous syndrome, a specific category of the vestibular lesions, in which clinical presentation is dominated by VERTIGO. It also presents appropriate treatment options for each aetiology. Bimodal treatment - medication (betahystine) and customised vestibular rehabilitation programs - aims to facilitate the physiologic vestibular central compensation process. This will enable more rapid and more complete recovery of the unilateral vestibular lesion. [ABSTRACT FROM AUTHOR]

The sphenoid is one of the paranasal sinuses with the greatest number of anatomic variants. The complexity of the sphenoid sinus requires close clinical and radiological examination, prior to surgery, in order to prevent life-threatening complications during surgery. This paper presents the tomographic particularities of the sphenoid sinus in order to illustrate the importance of proper pre-operative preparation in endoscopic approach to sphenoidal sinus pathology. [ABSTRACT FROM AUTHOR]

Ectopic pituitary tumors are rare and are exclusively found outside the sella turcica, with a presentation that can mimic those of other skull base tumors. The clinical presentation often correlates to the location of the tumor. Sometimes, the ectopic pituitary tumors have a significantly more aggressive behavior than sellar-located tumors. Ectopic pituitary tumors are often misdiagnosed. In this paper, we present the case of a 45-year-old patient reporting violent frontooccipital headache episodes in the past year, for which he performed imaging exams (MRI and CT) that highlighted the presence of a tumor formation at the level of the sphenoid floor. The lesion displayed all the similar magnetic resonance and computer tomographic imaging findings with an erosive growth pattern toward the sphenoid floor. No connection with the pituitary gland was observed. The preoperative presumptive diagnosis was metastasis of an unknown cancer. By a transphenoidal endoscopic approach, we removed a haemorrhagic tumor. No connection between the normal pituitary gland and the tumour was observed. The immunohistochemical analysis showed a prolactinoma. A comprehensive review of literature was performed for the clinical descriptions of ectopic pituitary tumors. Reports of 85 applicable cases were assessed. The most common locations of ectopic pituitary tumors were the sphenoid sinus, clivus, suprasellar space, nasopharynx, and cavernous sinus. In this study, 16 clival tumors were described. [ABSTRACT FROM AUTHOR]

Perinatal stroke is defined as a vascular cerebral injury that takes place before the age of 28 days, and it usually includes the in utero periode. The vascular lesion can, however, happen even in infancy, due to various causes. Stroke has a lower incidence at infant age, but a higher rate of recognition due to the more obvious clinical manifestations. The incidence of stroke reaches 1/3000 children, with long-term consequences on motility, predisposition to epileptic seizures, communication skills and learning ability. Pediatric stroke implies large costs in order to rehabilitate and reintegrate the child socially. This paper aims to analize the evolution of language at a distant point in time, after the occurrence of the injury, with cases from our clinical experience. [ABSTRACT FROM AUTHOR]

Although cerebral otogenic abscess is a rare complication of chronic otitis media, it is the second most frequent complication after otogenic meningitis. This paper presents a case of cerebral otogenic abscess in the temporal lobe, in a patient who suffered from suppurative chronic otitis media. [ABSTRACT FROM AUTHOR]

The authors are presenting their experience in the closure of sellar floor after endoscopic transnasal transsphenoidal approach of pituitary adenomas and craniopharyngiomas. At the end of the surgical intervention, the sellar floor is closed using allografts or xenografts, from adipose tissue, muscle, fascia lata, bone graft to adhesive glue and titanium plates that will ensure the necessary rigidity to the skull base. A resistant retentive cavity can be assured by the dura mater suture with non-absorbable suture 6.0 with a "sliding knot". In the last ten years, the mixed surgical team ENT-neurosurgery has used all the closure methods of the hypophyseal fossa described in the specialty literature. In the current paper the most used methods are presented according to the approached pathology. Conclusions. The efficient closure of the sellar floor creates postoperatively the conditions of a quick scar without complications and with a fast discharge. [ABSTRACT FROM AUTHOR]

Vocal cord injection is more than 100 years old, but it only became notorious in the past 20 years thanks to new materials and visualization technologies, as well as to new injection techniques. This paper overviews the available materials and various vocal cord injection techniques used for treating glottic insufficiency. Depending on the injected material, the vocal cord can be medialized in a span of weeks or years. Glottic insufficiency has a big impact on patients' life quality by preventing easy oral speaking. With a proper material and patient selection, vocal cord injection has nowadays a major role in treating many patients suffering from glottic insufficiency-induced dysphonia. [ABSTRACT FROM AUTHOR]

Vestibular paroxysmia is one of the known ethiologies of the peripheral vestibular syndrome, characterised by repetitive vertigo spells lasting for minutes and tinnitus. It was first described byJannetta (1984) as "Disabling positional vertigo" and its pathogenic mechanism is the vascular arterial/venous compression of the VIII cranial nerve in the nervous system region of the nerve, after its emergence from the internal auditory meatus ("root entry zone"). Clinical studies available in literature agree upon medical treatment as first choice, instead of surgical decompression. This paper presents the principal management landmarks for patients with vertigo spells due to vascular compression of the vestibulocochlear nerve. [ABSTRACT FROM AUTHOR]

Hearing loss is a debilitating disease with a prevalence of 1.6% in children and about 8% in adults in the Eastern Europe. Among people with disabling hearing loss only 20% are interested in hearing improvement possibilities. Of the latter, 15% will abandon the use of amplification. In cases with moderate hearing loss (40-60 dB) conventional hearing aids are the best choice. People with severe hearing loss or greater can benefit from the use of implantable devices. Implantable devices have emerged as a necessity for cases in which conventional hearing aids do not give the expected results (functional hearing) or who, for various reasons, cannot wear conventional hearing aids. In this paper are discussed the indications of implantable middle and inner ear devices, from classical indications, following their evolution to date, and looking in the future to analyze trends in the context of technological development and the improvement of surgical technique. [ABSTRACT FROM AUTHOR]

Foreign bodies in the respiratory pathways represent one of the dramatical chapters of the child's respiratory pathology. Tracheobronchial foreign bodies is a major pediatric emergency, with highest incidence in the first period of childhood and requires full attention and competence of the ENT and anesthesiologist physician, as well as of the pediatrician. In this paper the authors present some clinical cases of tracheobronchial foreign bodies, succesfully managed. [ABSTRACT FROM AUTHOR]

A severe hypertrophy of the tonsils might be responsible for nightly respiratory problems such as sleep apnea syndrome. Child sleeps for half of the day time and for this reason respiratory problems occurring during sleeping are very important during childhood. If diagnostic and treatment are delayed, respiratory problems may have severe consequences. The diagnostic of sleep obstructive apnea in children is based on clinical suspicion which have to be completed with specific diagnostic tests. This paper is a brief review of definition, complications, positive diagnosticând treatment of the obstructive sleep apnea syndrome (OSAS). The authors also present personal experience in 50 children diagnosed with OSAS in other wards (paediatrics, pneumology). Treatment consisted of surgical reduction of the tonsils by means of coblation, in a time frame of one year (January-Decem ber 2013). [ABSTRACT FROM AUTHOR]

Given the progress of endoscopic surgical techniques detailed knowledge of nasosinusal local anatomy is an essential clinical request for surgeons. In this paper, the aim of the authors is to illustrate the surgical endoscopic technique of sphenoidotomy and to provide a step-by-step description of the main stages of the surgical intervention. [ABSTRACT FROM AUTHOR]

A variety of etiologies underlie the diagnosis of facial palsy in children. The aim of this paper is to bring into attention the complexity of the diagnosis and the multidiscilinary approach that needs to be taken to accurately diagnose and treat this condition in children, requiring a team that includes the pediatric neurologist, the ENT specialist, the oncologist, the neurosurgeon, the cerebral imagery specialist and ultimately the family and parents of the child. All these aspects will be exemplified by clinical cases. [ABSTRACT FROM AUTHOR]

Nowadays, Bezold mastoiditis, as a complication of chronic suppurative otitis media, seldom occurs because of the continuous development of antibiotics. This paper presents a case of Bezold mastoiditis in a patient who suffered from chronic suppurative otitis media, as a result of a trauma during an explosion. [ABSTRACT FROM AUTHOR]

Tuberculosis is one of the oldest pathologies that affect human population, being a significant cause of morbidity/mortality in several countries. Middleear tuberculosis is a rare pathology, often misdiagnosed because of an atipic evolution, as a result leading to severe complications. This paper presents a case of tuberculous otitis media complicated with facial nerveparalysis House Brackmann type V in a patient who underwent multiple middleear surgeries before correct diagnosis was established. [ABSTRACT FROM AUTHOR]

The authors’ aim is to review some considerations derived from the daily clinical practice during the COVID-19 pandemic in one of the most frequent emergencies: the epistaxis. We present both the specific ethiologies of nose bleeding during the pandemic and the therapeutic options according to actual protocols. A particular mention in the paper is attributed to different approach options for the epistaxis patient with SARS-CoV-2 infection, in order to ensure the safety of both health care providers and other inpatients. [ABSTRACT FROM AUTHOR]

Purpose of the paper. To highlight the complication of otic mastoid infection with venous lateral sinus thrombophlebitis, and to present the emergency therapeutic involvement. Objectives of the paper. The correlation of clinical signs, laboratory and imaging paraclinics for the diagnosis of otic mastoiditis and venous lateral sinus thrombophlebitis necessitated emergency medical and surgical treatment for the suppression of the infection. Materials and method. Patients admitted to the ENT clinic during 2009-2015 and diagnosed with thrombophlebitis (nine cases, of which three were children). Results and discussion. Out of the 196 cases of chronic cholesteatoma otic mastoiditis, only nine patients had venous lateral sinus thrombophlebitis (4.5%). Fetid otorrhea, hemicrania and false hyperleukocytosis led to CT scanning to detect the venous lateral thrombophlebitis in eight cases. In one case - a 3-year-old child, feverish, with severegeneral condition, with unaffected eardrums - the MRI exam established the venous lateral thrombosis and mastoid suppuration. The treatment of all patients was represented by antibiotics and corticosteroid therapy, and emergency surgical intervention on the mastoid and sinus outbreaks (thrombus removal, permeabilization, exclusion plugging). All patients evolved favorably. Conclusions. Even though rarely, venous lateral sinus thrombophlebitis from suppurative otic mastoiditis is a serious disease, and the diagnosis and emergency surgical treatment are beneficial to patients in most cases. [ABSTRACT FROM AUTHOR]

Purpose of the paper. To highlight the benefits of endoscopic diagnostic and therapeutic exploration in laryngeal pathology. Objective of the paper. To facilitate clinical diagnosis and endoscopic therapy. Materials and method. A 5-year (2013- 2017) study of patients with dysphonic laryngeal, dyspneic and dysphagic laryngeal pathology with telescope-suspended laryngoscope, a camera connected to the monitor under general anesthesia. Endoscopically, 644 patients, aged between 16 and 81 years old, were treated with 818 diagnostic, therapeutic and exploratory-evolutionary laryngoscopies. Results and discussions. The benign princeps pathology was represented by laryngeal polyps (19.56%), followed by myxomas. Malignant tumors were diagnosed in 28.41% of the study group. The excision of benign tumors or biopsy of presumed malignant tumors was performed under the Kantor Berci II telescopic laryngoscope. The advantage of the optical device connected to the video camera and implicitly to the monitor by augmenting the image was that it elucidated the diagnosis and allowed the optimal functional treatment to be applied. Conclusions. Modern telescopic laryngoscopes producing a well-defined peripheral image and a depth of endoscopic focus, alongside the finest instrumentation, allow for accurate excisions and targeted sampling. [ABSTRACT FROM AUTHOR]

Fungal rhinosinusitis has a paramount importance in the last years' practice in sinus pathology affecting one or more paranasal sinuses. Recent researches in the field insist on the etiological elements, on the differential diagnosis with the establishment of surgical protocols according to major and minor criteria for the diagnosis of fungal sinusitis. On this paper the authors insist on imagistic, endoscopic, clinical differential diagnosis, as well as the elective surgical and therapeutic treatments in this pathology. [ABSTRACT FROM AUTHOR]

Described for the first time in the 1990s by Starr, the concept of auditory neuropathy spectrum disorder (ANSD) continues to concern the medical scientific world. The subject is more important as the prevalence of the disease seems to be high among children, and the treatment is far from being standardized. The aim of this paper is to make a review regarding ANSD and also a brief presentation of our ANSD cases. The suspicion of auditory neuropathy occurs when, as a result of neonatal hearing screening, is found that OAE are present, but ABR are absent or abnormal. Another category of newborns at risk are those presenting with neonatal hyperbilirubinemia and hypoxia at birth. A characteristic for patients with auditory neuropathy is the disproportion between tonal auditory thresholds - sometimes normal - and the difficulties in speech understanding or the delay in speech development. The site of lesion might involve several locations in the auditory pathway (either the inner hair cells, or the auditory nerve or the synapse between them). The treatment is difficult, especially since the location of the lesion is difficult to be determined. The conventional hearing aids represent the first choice, and if there is no benefit, cochlear implantation should be recommended. [ABSTRACT FROM AUTHOR]

High-resolution CT is the method of choice for imaging of the middle ear, particularly in cholesteatoma patients. In patients with recurrent cholesteatoma, high-resolution CT can show the extent of tumor tissue in relation to the ossicles, the labyrinthine structures, the epitympanic space, and the mastoid process. Osseous destructions are also reliably depicted. The diagnosis is based on the disclosure of a non-dependent, homogenous soft tissue mass with a focal area of bone destruction. However, if a soft-tissue mass in the middle ear is seen on high-resolution CT, the diagnosis of the mass is not very accurate, because cholesteatoma, mucoid secretion, granulation tissue, fibrous tissue, and cholesterol granuloma cannot be differentiated from one another on high-resolution CT. Magnetic Resonance Imaging (MRI) using standard T1- and T2-weighted sequences shows tissues better than high-resolution CT. Therefore, in some cases, MRI plays an important complementary role to high-resolution CT in the preoperative diagnostic workup. However, MRI with standard T1- and T2-weighted pulse sequences frequently fails to allow the differentiation of cholesteatoma from other soft tissues or mucoid secretions, particularly in patients who have undergone middle ear surgery. Recent studies of diffusion-weighted MRI show that it is sensitive to cholesteatoma. High signal intensity on a diffusion weighted sequence and a soft-tissue mass seen on conventional MRI sequences have a positive predictive value of 100% for cholesteatoma. This paper presents the advantages and disadvantages of using different imaging examination methods in chronic otitis media, exemplified with clinical cases. [ABSTRACT FROM AUTHOR]

In the last years, endoscopic ear surgery has gathered around a lot of followers among ear surgeons, representing, in selected cases, an effective alternative to microscope techniques. Endoscopic surgery of the ear is not simply a technique for performing surgery through the external auditory canal, but it represents the introduction of the concept of functional surgery in order to maintain or restore the anatomy and physiology of the ear as close as possible to the normal condition. In this paper, the author points out the indications and the surgical endoscopic techniques, focusing on the pros and cons of each surgical approach compared to the established surgical ear interventions. [ABSTRACT FROM AUTHOR]

Endoscopic sinus surgery (ESS) is a highly effective surgical technique. Nevertheless, functional outcomes could be improved by using various techniques of postoperative care. There is no standardized approach to postoperative care. Some authors claim that there is no role for the postoperative care, while others report complex treatment strategies in the postoperative period. This paper presents different therapeutic approaches for the postoperative care of ESS patients. Nasal saline irrigation techniques are outlined, the treatment with topical and systemic corticosteroids is discussed, and studies using drug eluting stents are presented. Following an experimental study on sinusitis in rabbits, we have introduced cryotherapy in the management of ESS patients. We present the results of two clinical studies on the effect of cryotherapy on patients submitted to ESS. [ABSTRACT FROM AUTHOR]

The authors present their experience in endoscopic ablation of benign and malignant voluminous rhinosinusal tumors exemplified by some cases: solitary fibrous tumor, juvenile fibromatosis, etmoid-orbital fibrosis dysplasia, poorly differentiated invasive carcinoma in the right naso-ethmoidal region, cystic adenoid carcinoma in the right rhino-maxilloethmoidal region. This paper focuses on the key moments of the surgical intervention (macroscopic complete ablation, efficient intraoperatory hemostasis, management of complication, postoperatory treatment) and tries to establish the advantages and disadvantages of endoscopic vs. classic surgery. The authors recognize the limits of this type of minimally invasive approach in some cases (invasion of anterior wall of maxillary sinus, invasion of frontal sinus), but emphasize the subtlety of this method in interaction with the key anatomic elements (orbital periosteum, skull base), respecting at the same time the essential rules of preserving the patient's quality of life. [ABSTRACT FROM AUTHOR]

Rhinosinusal endoscopic surgery, originally emerging as an alternative to open surgery, has become lately, especially due to technical developments, the gold standard in the surgical treatment of both inflammatory and tumoral pathology. The lower morbidity, the higher functional results and the much diminished expenses with hospitalization and patient care have made the endoscopic alternative the first choice for rhinologist surgeons around the world. The paper presents the author's experience regarding the indications and limits of rhinosinusal endoscopic surgery, discussing elements related to the surgeon's learning curve, the patient's preparation for surgery, and other elements contributing to surgical success. [ABSTRACT FROM AUTHOR]

Although at the present time rhinosinusal endoscopic surgery provides an appreciable therapeutic success, some patients require revision endoscopic sinus surgery (RESS). The challenges that may arise during the revision surgery are due in particular to the lack of anatomical features or the presence of postoperative adhesions - aspects that may lead to confusion, increasing the chance of the occurrence of intraoperative complications. The paper makes a review of the main pre- and intraoperative measures that help maximize the chances of successful surgical gesture. Thus, aspects related to the patient's fine radiological preparation, informed consent for revison surgery, the use of ENT navigation in such particular cases etc. are discussed. [ABSTRACT FROM AUTHOR]

The assessment of the patient with dizziness is based on a careful history, a thorough clinical examination, and a series of vestibular functional explorations: computerized posturography, video-/electronistagmography with caloric and rotational testing, vestibular evoked cervical miogenic potentials. In principle, a perfect correlation should be made between the data obtained from the anamnesis, those obtained in the clinical examination and the results of the vestibular functional explorations. The paper presents some clinical cases in which we see either a good correlation between the paraclinical assessment and the clinical examination, or different inconsistencies are found. The conclusion is that in establishing the diagnosis of the patient with dizziness it is advisable to use all available means and analize each case individually because there can be both concordances and inconsistencies, perfectly explained by a good knowledge of the pathophysiology of the vestibular disorders and also the limitations of the different modalities of clinical or paraclinical evaluation. [ABSTRACT FROM AUTHOR]

The authors present their experience in endoscopic ablation of benign or malignant tumors of the skull base, exemplified by the choice of several cases in which the approach was made by a pluridisciplinary team (ENT, neurosurgery, oral and maxillofacial surgery) by a combined approach, transcranial and endoscopic transnasal, for the management of the meningioma, carcinoma and malignant melanoma. The paper focuses on key moments of interventions (complete macroscopic ablation, efficient intraoperative hemostasis, reconstruction and repositioning of anatomic landmarks using plates of biocompatible titanium, management of complications, postoperative care) and try to demonstrate the benefits of a surgical approach in a mixed team when appropriate (ENT - NSY - OMS). [ABSTRACT FROM AUTHOR]

The first description of otoscopy is in the ancient Sanskrit medical text Sushruta Samhita. Later, in 1921, the microscope was introduced in the otological use by the Swedish otologist Carl Olof Nylen, being only partially accepted by his colleagues due to the limited optical performance. In 1950, as a result of Carl Zeiss's efforts, the otomicroscope was redesigned, becoming widely used ever since. In the 1960s, the otomicroscope allowed the development of new surgical techniques (e.g., surgery of otosclerosis etc.). Referring to otoendoscopy, 1967 was the year of the first report on the use of endoscopy in ear examination, and shortly, in 1982, Nemura published the first report of examining the middle ear by a myringotomy. The real beginning of ear surgery using the endoscope was in the 1990s. This paper shows to what extent endoscopy is useful in ear surgery. The history of otoendoscopy is written under our eyes; the future is the one that will validate the value of the method. [ABSTRACT FROM AUTHOR]

This paper studies the patology and radiology imaging in inflammatory diseases of the sinonasal cavities. Chronic sinusitis results from either persistent acute inflammation, or repeated episodes of acute or subacute sinusitis. There are several forms of chronic sinonasal inflammation, including chronic bacterial sinusitis, allergic sinusitis, fungal sinusitis and vasomotor sinusitis. In addition, as a result of previous inflammation, retention cysts and polyps may occur. Plain radiography has a limited role in the management of sinusitis. Non contrast computed thomographic images (CT) can define the nasosinusal anatomy much more precisely. However, clinical correlations are needed to avoid overdiagnosis of sinusitis because of nonspecific CT findings. The use of CT is tipically reserved for difficult cases or to define anatomy prior to sinus surgery. Magnetic Resonance Imaging (MRI) cannot define bone anatomy as well as CT. MRI is only used to differentiate soft tissue structures, such as in cases of suspected fungal infections, neoplasm or complicated cases - orbital or intracranial spread of infection. The recurrent or refractory symptoms, despite treatment, or the suspicion of complicated infection, abcess or neoplasm need further evaluation, to decide surgical procedures. [ABSTRACT FROM AUTHOR]

Lately, there has been a growing pressure from both patients and a part of the medical staff to use laser surgery in ENT, as well as in other surgical specialties, forgetting that laser is just a surgical instrument and not a panacea. In laryngeal microscopic surgery, CO2 laser has become an extremely useful tool in solving benign or malignant tumor pathology. The paper presents the indications and limitations of the use of laser in the vocal cord pathology, emphasizing the adaptation of the working parameter settings for each surgical technique. It brings into discussion the existence of electric artifacts on the surgical resection edges - an extremely important aspect in the histopathological assessment of the tumor extension. There are presented elements of surgical technique or of pre- or intraoperative preparation of the patient that can contribute to the success of surgery. [ABSTRACT FROM AUTHOR]

Morbid obesity is a major health issue which affects an increased number of people, no matter what age, from children to elders. Every medical team must deal with specific and complex problems of this kind of patients, especialy surgeons and anesthesists. All patients with morbid obesity, some of them only apparently healthy, have a number of particularities and co-morbidities which require proper evaluation and treatment in order to achieve an acceptable risk level. This paper presents our experience of 15 years of bariatric surgery, with more than 3000 patients, our standard program of preoperative management and the particular situations in severe obstructive sleep apnea, severe cardiac disease, intraabdominal high pressure syndrome etc. The difficulties of orotracheal intubation in patients with severe obesity are well known. We present our experience in different techniques for intubation, with special focuse on the use of flexible intubation video endoscope. In conclusion, we analyse our results in bariatric surgery and, from this point of view, the importance of a proper preoperative management of the patients with morbid obesity. [ABSTRACT FROM AUTHOR]

Lipoma of the larynx is quite a rare pathology. This paper describes a successful treatment of a 37-year- old male patient with large (approximately 2.8x2cm) symptomatic laryngeal lipoma using fibroendoscopic approach. A complete diathermoexcision of the tumor was performed by polypectomy snare, introduced through the working channel offiberbronchoscope, under the local anesthesia. A follow-up exam performed 5 years and 10 months later didn't reveal any evidence of the tumor. The method of treatment is proposed as a cost-effective option for selected cases. [ABSTRACT FROM AUTHOR]

In this paper, the author reviews the CT-scan exam for the rhinosinusal pathology. We begin by presenting the normal anatomic structures and anatomic variants on CT imaging. Particular CT scan aspects of each paranasal sinus are presented. The author is focused on anatomical, clinical and imagistic correlations of the rhinosinusal pathology (malformations, inflammatory, benign or malignant tumors), which are very important for the preoperative imagistic diagnosis and surgical therapeutic indication. [ABSTRACT FROM AUTHOR]