Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media-A Systematic Review.

Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope's advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air-bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach.

Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review.

Background: In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. Methods: A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. Results: In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea-hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. Conclusions: In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings.

Management of Capillary Hemangioma of the Sphenoid Sinus.

Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus and a review of the literature in the last ten years. Results: Clinical and endoscopic examination of the nose, radiologic assessment and particular histologic features contribute to the correct diagnosis of capillary hemangioma of the nose and paranasal sinuses. Conclusions: Transnasal endoscopic resection of capillary hemangioma located in the nose and paranasal sinuses is a valuable treatment method with good outcomes.

Endoscopic assessment of sinonasal mucormycosis with SPIES: The 'battlefield' sign.

Sinonasal mucormycosis is an extremely challenging pathology for the ear, nose and throat (ENT) surgeon from a therapeutic point of view. The disease affects immunocompromised patients and exhibits lethal potential. Although the diagnosis is relatively easy to suspect due to the distinctive clinical aspects which consists of black crusting present in the nasal fossae able to be confirmed by biopsy, the treatment requires resection of all affected tissue with safety limits. Due to the tendency of invasion associated with this fungal infection and taking into account the location involved (the sinonasal area) and the grave condition of these patients, it is extremely important to perform only the minimal resection necessary, but that includes all tissue infected by the fungus. This article presents a minimally invasive method of evaluation that can be performed during endoscopic surgical intervention and that aids the surgeon to better evaluate the affected area. It is associated with no additional risks for the patients, but it helps the surgeon to perform the intervention efficiently while not damaging healthy tissue. The authors consider that the method presented will aid the surgeon during the endoscopic surgical intervention in evaluating the lesion and resecting all the affected tissue while preserving healthy areas.

Transnasal endoscopic assisted dacryocystorhinostomy.

Transnasal endoscopic dacryocystorhinostomy is a good alternative for external DCR. It is considered a safe and efficient technique with successful results, comparable or even better than the external technique. Advanced knowledge of the endoscopic anatomy and the lacrimal system is necessary to perform the procedure safely, and to obtain good surgical outcomes. The aim of the paper is to analyze the changes of the endoscopic technique and to improve it. The transnasal endoscopic dacryocystorhinostomy surgical technique is described in a "step by step" manner. Also the surgical technologies that can be used for this intervention are presented, focusing on the cold instruments.

Transnasal endoscopic orbital decompression.

Transnasal endoscopic orbital decompression is a viable alternative for external orbital decompression. Today, it can be performed due to the great development of endoscopic technology and specific endoscopic surgical instruments. It requires strong anatomic knowledge and skilled hands. We present our experience with endoscopic orbital decompression focusing on the surgical technique used in our department. The surgical maneuvers must be firm and gentle protecting the local risk elements and respecting the orbital content.

Rare metastasis of renal carcinoma in the frontoethmoid-orbital region - case report and review of the literature.

A tumor located in the region of the paranasal sinuses and the orbit is not usually a metastasis, but a primary tumor. Even more, renal cell carcinoma (RCC) is very rarely the cause of metastasis in the paranasal sinuses or the orbit. Up to the present moment, few cases have been reported in the literature of such an association. The aim of the authors is to highlight the rare case of a male patient presented with ptosis, frontal swelling, minor headaches and epistaxis, as the only symptoms, but in which the mass located in the left frontoethmoidal region with extension to the orbit proved to be a RCC metastasis, thus leading to the diagnosis of the primary renal tumor. We must underline the need for clinical suspicion and the importance of accurate histopathological and immunohistochemical investigations, in such rare cases, where they are crucial in obtaining the right diagnosis.

Diagnostic and therapeutic aspects in malignant sinonasal lymphoma.

Among head and neck malignancies, lymphoma is the second most frequent cause. They can develop in the head and neck lymph nodes or as extranodal determinations. The onset of malignant lymphoma outside of lymph node registers increasingly frequent, currently over 30% of malignant lymphoma are diagnosed as taking place outside the lymph nodes. The aim of this paper is bringing in discussion and the presentation of current elements on the diagnosis and treatment in case of malignant sinonasal lymphoma, a pathological entity with a growing incidence. This study is a retrospective one, from January 2008 through December 2013, and included 31 patients admitted to "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT (Ear, Nose & Throat) Surgery, Bucharest, Romania, and diagnosed with malignant sinonasal lymphoma. Despite progress in terms of immunological techniques, cytogenetic and molecular histological outlining of malignant lymphomas, correct diagnosis and appropriate therapy of malignant sinonasal lymphoma is still a problem for the clinician and pathologist, as multidisciplinary collaboration of ENT-Hematology-Pathology-Radiotherapy being essential in this regard.

Clinical and histological aspects with therapeutic implications in head and neck lymphomas.

Malignant lymphoma (ML) is one of the major issues in modern medical practice, with an increasing incidence in recent years, which makes it, together with leukemia, the most frequent form of neoplasia affecting young people. The onset can occur both inside and outside the lymph nodes, with a quarter of the lymphomas with extranodal onset being located in the head and neck. The purpose of the paper is to conduct a retrospective study over a period of six years on patients diagnosed and admitted to the clinic with malignant lymphomas located in the head and neck, discussing their different histological variations. It emphasizes the importance of the histopathological examination and, in particular, of the immunohistochemical tests, in determining the histological subtype of the lymphoma, as the immunohistochemical and cytogenetic data of the malignant cell play a major role in the evolution and prognosis of patients. The study leads to the conclusion that, in spite of the advancements of the immunological, cytogenetic and molecular techniques, the diagnosis and histological determination of malignant lymphomas continue to be a challenge to clinicians and anatomical pathologists. Of particular importance in the efforts made for the accurate diagnosis and proper treatment of the ENT (ear, nose and throat) malignant lymphomas is the interdisciplinary collaboration between the ENT specialist, the hematologist, the anatomical pathologist, the oncologist and the nutritionist.

Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study.

BACKGROUND AND METHODS: An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2(®)), and the Hospital Anxiety and Depression Scale. RESULTS: During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12-14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259). CONCLUSION: Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo.

Total laryngectomy - past, present, future.

In a period in which therapeutic approaches for malignant laryngeal tumors are focused on the principle of "organ preservation", total laryngectomy is a well coded surgical procedure, addressed to the advanced laryngeal cancer which is not suitable for conservative techniques or in case of their failure. The main objective of this work is to summarize the important events that have marked the evolution of this surgical technique to the current formula. Also this paper aims to identify, in our own casuistry, some elements of strategy and surgical technique required, in our opinion, for a successful therapeutic intervention. The fundamental significance of the study is that we must learn from the past, perform our surgeries at contemporary standards and look to the future for new solutions and approaches of the advanced laryngeal malignancies.