Rhinology Future Debates 2018, a EUFOREA Report.

The third Rhinology Future Debates was organized by the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) in 2018 in Brussels. Experts from different specialties and countries, alongside patients, health policy makers and industry representatives discussed relevant topics in Rhinology, in an attempt to improve current clinical practices, through implementation of precision medicine, by empowering patients' participation and the use of eHealth tools. The debates which are available on-line (www.rhinology-future.com) dealt with 5 topics in Rhinology: the adoption of allergen-specific immunotherapy (AIT) by implementing change management strategies, the needs and obstacles in care delivery in respiratory diseases, 3D technology in nose and sinus surgery, ambulatory nasal surgery, and clinical evidence for efficacy of biologicals in CRSwNP and asthma. This report summarizes the outcomes of the brainstorming sessions highlighting novel approaches and unmet needs in the field of respiratory diseases by focusing on integrated care pathways.

Nasal manifestations of systemic diseases.

OBJECTIVES: Signs and symptoms of the sinonasal tract may be originated in any organ system. Distinguishing these from original sinonasal disease poses a great diagnostic challenge. The ENT specialist usually faces an unresponsive or relapsing case, with an atypical presentation. We address this issue by trying to provide a wider perspective when dealing with sinonasal manifestations. METHODOLOGY: We reviewed the literature exploring heterogeneous groups of diseases and systemic conditions that might interfere with normal sinonasal physiology. The most current and valid information have been included in an effort to delineate such manifestations and clarify the distinguishing signs and tests. RESULTS: A great variety of systemic conditions with sinonasal manifestations, including connective tissue, autoimmune, infectious, vascular, hematological, gastrointestinal, and endocrine diseases, were included. We address their distinguishing characteristics and diagnostic work-up. CONCLUSIONS: Signs and symptoms of the sinonasal tract can originate from either local or systemic disorders. The keys to dealing with such disorders are understanding the patterns in which systemic diseases can manifest, and using special diagnostic tools specific to each condition to confirm or rule out particular diagnoses.

The use of the Ligasure vessel sealing system in head and neck surgery: a report on six years of experience and a review of the literature.

BACKGROUND: The Ligasure Vessel Sealing System (LVSS) is a bipolar electrosurgical device with integrated active feedback control, sealing vessels up to 7 mm in diameter. It facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimising thermal injury to adjacent tissues. OBJECTIVE: To report on our experience and review studies relating to the use of LVSS in Otolaryngology-Head and Neck Surgery. TYPE OF REVIEW: Retrospective series. Search strategy and evaluation method: LVSS has been widely used in our department since 2002. All patient records relating to the use of LVSS were reviewed, and compared to surgical procedures done by our team without the use of LVSS, with special regard to operation time and post-operative complications. Furthermore, a Medline search and thorough review was conducted for all pertinent articles on LVSS in Otolaryngology-Head and Neck Surgery, and those articles were reviewed. RESULTS: In our department, LVSS is used for thyroidectomy, laryngectomy, neck dissection, parotidectomy, tonsillectomy procedures, congenital cysts, thryroglossal cysts, and excisions of submandibular gland and parapharyngeal space tumours. LVSS provided sufficient haemostasis, operating time was shorter, and post-operative complications did not differ compared to similar surgical procedures performed without the LVSS. The Medline search revealed 16 studies published by other colleagues regarding the use of LVSS in Otolaryngology Head and Neck Surgery procedures (15 studies in thyroid and 1 study in parotid surgery). The results published were similar to ours. CONCLUSIONS: The use of LVSS in Otolaryngology-Head and Neck Surgery may have several advantages over standard methods. It is a reliable and safe device, providing sufficient haemostasis and reducing operating time.

The risk of foreign body aspiration in children can be reduced with proper education of the general population.

OBJECTIVE: To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children. METHODS: A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999. RESULTS: A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program. CONCLUSIONS: The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.