Abstract Head and neck cancers of unknown primary (CUP) represent up to 10% of all cancers located in the head and neck. True cancers of unknown primary, which remain of undetected primary origin after a correct clinical, imaging, surgical evaluation, have a reported frequency of between 1% and 2%. Cancers of unknown primary of the head and neck are a diagnostic challenge, considering that their main clinical manifestation is represented by the appearance of lymph node metastases in the cervical region. In general, the detection of cancers with an unknown starting point is late, difficult, with significant therapeutic failure. The diagnostic-therapeutic approach starts from the histopathological structure of the lymph node metastasis and continues with a correct and complete imaging evaluation. In this review are presented the diagnosis and therapeutic challenges and importance of head and neck cancers with unknown primary.

Abstract The facial nerve, the seventh pair of cranial nerves, has an essential role in non-verbal communication through facial expression. Besides innervating the muscles involved in facial expression, the complex structure of the facial nerve contains sensory fibres involved in the perception of taste and parasympathetic fibres involved in the salivation and tearing processes. Damage to the facial nerve manifested by facial paralysis translates into a decrease or disappearance of mobility of normal facial expression. Facial nerve palsy is one of the common causes of presenting to the Emergency Room. Most facial paralysis are idiopathic, followed by traumatic, infectious, tumor causes. A special place is occupied by the child’s facial paralysis. Due to the multitude of factors that can determine or favour its appearance, it requires a multidisciplinary evaluation consisting of otorhinolaryngologist, neurologist, ophthalmologist, internist. Early presentation to the doctor, accurate determination of the cause, correctly performed topographic diagnosis is the key to proper treatment and complete functional recovery.

Abstract Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms. Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.

AbstractBACKGROUND. Computerized dynamic posturography is the most important battery test designed to assess the ability to use visual, vestibular and proprioceptive cues in the maintenance of posture. Foam posturography reduces the availability of proprioceptive inputs, which makes more difficult the balance control.OBJECTIVE. The objective of the study was to assess the clinical use of foam posturography in evaluating peripheral vestibular dysfunction.MATERIAL AND METHODS. We evaluated 41 patients with vestibular disorders and 41 normal patients by using the sensory organization test in eyes opened, eyes closed and mislead vision conditions with and without the foam. We measured several parameters: the position of the center of pressure, the displacement in the center of pressure in anteroposterior and mediolateral planes and Romberg’s ratio on static and foam rubber.RESULTS. The values of all parameters were significantly higher in patients with peripheral vestibular disorders than in the control group (p<0.05). Also. comparing the Romberg test results, the foam surface used by the patient was larger than the static one.CONCLUSION. Foam posturography can be a reliable test in assessing patients with peripheral vestibulopathy, being also able to identify the visual and proprioceptive dependence levels.

Abstract Cough is a common symptom encountered in medical practice and can occur throughout the life of a person. From a physiological point of view, it represents a mechanism responsible for the elimination of secretions from the airways. At the same time, cough may be the first symptom of an illness. There are many causes that may lead to the emergence of a chronic cough syndrome, the most frequent being pulmonary diseases. Besides the bronchopulmonary pathology, there are a number of extrapulmonary disorders that may manifest with coughing. The first step in evaluating the patient with chronic cough is performing a correct and complete anamnesis, followed by the physical examination of the patient. The treatment of the chronic cough syndrome must address mainly the underlying disease but, in case of failure of the established treatment, the antitussive therapy is used.

Why talking about taste and smell since modern society is dominated at a sensory level by audio-visual? Both smell and taste are integral part of daily life, from the pleasure of perfumes and foods to detecting life-threatening situations, fire or toxic gases. A 1994 study revealed that in America there were 2.7 million adults with an olfactory pathology and 1.1 million with a gustatory pathology1. According to a study conducted between 1998 and 2000, 14 million adults aged 53-97 years old had olfactory problems2. The quality and intensity of odours or taste perception depend on the anatomic and functional status of the olfactory and gustatory epithelium, as well as of the peripheral and central nervous system, since smell or taste sensations are the result of stimulation of the olfactory, trigeminal, glossopharyngeal and vagus nerves. Olfactory stimulation depends on odoriferous particles reaching the olfactory mucosa, a certain type of nasal – orthonasal airflow being necessary. During feeding, apart from the gustatory sensation, a retronasal flow of odorous particles is also achieved.

BACKGROUND. Chronic nasal obstruction due to chronic hypertrophic rhinitis is a very common health problem encountered in rhinology. In most of the cases, pharmacologic therapy is the treatment of choice. However, when the turbinate swelling becomes irreversible, it is refractory to both local and general medical treatment. In all these cases, inferior turbinate surgery may be a choice. OBJECTIVE. The aim of this study was to assess the efficacy of CO2 laser vaporization of the inferior turbinate mucosa for chronic hypertrophic rhinitis, by using the 4-phase-rhinomanometry. MATERIAL AND METHODS. We performed a prospective study on 39 adult patients diagnosed with chronic hypertrophic rhinitis refractory to medical treatment. CO2 laser turbinoplasty was performed in all patients under local anesthesia. The preand post-treatment evaluation, performed at 1, 3 and 12 months after surgery, consisted in clinical examination, nasal endoscopy and 4-phase-rhinomanometry. RESULTS. CO2 laser turbinoplasty restored nasal flow, with a significant statistical reduction of total nasal airway resistance (p<0.05), as confirmed by the 4-phase-rhinomanometry in 25 patients (64.1%) at one month and in 32 of the patients (82.05%) at three months post-treatment. The re-evaluation performed at 12 months after surgery showed a persistence of a normal nasal patency in 30 patients, representing 76.92%. CONCLUSION. The CO2 nasal turbinectomy is an effective treatment for nasal obstruction due to inferior turbinates hypertrophy. The effectiveness of turbinate surgery depends on the hypertrophy of the submucosal layer, which can be estimated if preand post-treament nasal air flow are compared by using 4-phase-rhinomanometry. KEywORDS: hypertrophic rhinitis, turbinoplasty, 4-phase-rhinomanometry, CO2 laser turbinoplasty

Abstract The term monosymptomatic nasal obstruction does not refer to the isolated nasal obstruction, but to a nasal pathology in which nasal obstruction is the predominant symptom. Four nasal structures may be involved in the isolated monosymptomatic nasal obstruction: the inferior nasal turbinates, the nasal septum or the nasal valve. Since the phenomenon of nasal obstruction can be due to various diseases, correct assessment of the patient is very important. Correctly performed anamnesis and clinical and paraclinical evaluations can help determine the definite diagnosis and choose the therapeutic strategy indicated in each individual case. In this review the authors present the proper therapeutic approach for each type of monosymtpomatic nasal obstruction, emphasizing the need of a preoperatory detailed and correct investigation and diagnosis.

Abstract Neck pathology in children involves many diseases with similar clinical expression. Different disorders in paediatric practice may be clinically manifested by a cervical tumefaction. The cervical tumefaction can be represented by adenopathies or tumors. Cervical adenopathies may be unilateral or bilateral; the cause of their occurrence may be infectious, inflammatory, tumoral or may be associated with rare diseases. Tumoral cervical tumefactions can be represented by: congenital cervical cysts and fistulae, cystic lymphangiomas, thyroid swellings, malformations and cervical tumors detected antenatally. A correct diagnosis is established after a complete clinical and paraclinical assessment. In this article the authors make a review of the types of cervical tumefactions in children, emphasising the diagnostic protocol.

Corresponding author: Ramona Ungureanu email: ramonaung@yahoo.com Ramona Ungureanu1, Dorin Sarafoleanu2,3 1ENT Department, CDT “Dr. Victor Babes”, Bucharest, Romania 2ENT&HNS Department, “Sfanta Maria” Hospital, Bucharest, Romania 3“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Quality of life in patients with chronic hypertrophic rhinitis after CO2 laser turbinoplasty ORIGINAL STUDy

INTRODUCTION: Chronic otitis media with effusion is the most common otic pathology found in paediatric population. The most frequent cause of middle ear effusion among children is adenoid hypertrophy. The aim of this study was to prove if adenoidectomy is the most effective therapy for otitis media with effusion. MATERIALS AND METHODS: The retrospective study included 119 child patients diagnosed with middle ear effusion and chronic rhinoadenoiditis. The diagnostic protocol included clinical and paraclinical examination (otic endoscopy, tympanogram, tubal manometry). In all patients the adenoidectomy was performed. The revaluation was performed at one and three months after surgery and consisted in the evaluation of the otic symptoms. RESULTS: The follow-up made at one month revealed that 43.70% of the patients presented a complete recovery of the Eustachian tube function, in 37.81% of the cases there was a mild Eustachian tube dysfunction and 18.49% of the children still had retrotympanic effusion. At three months after surgery most of the children (109) presented a total recovery of the otic disease, but in 8.40% of the cases the middle ear effusion persisted despite the good evolution of nasal symptoms. CONCLUSIONS: Adenoidectomy can be considered an effective therapy choice for otitis media with effusion. But there are cases in which, despite the surgery, the middle ear effusion persists because of the anatomical and physiological peculiarities of Eustachian tube in children. In all these cases other medical measures should be taken (tympanotomy, tympanostomy tubes). INTRODUCTION Otitis media with effusion (OME) is the inflammatory status of the middle ear, defined by the presence of effusion behind an intact tympanic membrane. It is one of the most common otic pathology found in paediatric population. OME is a highly prevalent condition among children, at least 80% experience one or more episodes by age four1. 30% of the children have three or more episodes until age of six, the pick incidence being in the first two years of life (68%)2,3. At a young age, the Eustachian tube function and the inflammatory response of the nasopharynx lymphoid tissue are two important factors in the development of otitis media with effusion. The presence of the retrotympanic fluid is a significant cause of childhood morbidity, being the primary cause of hypoacusis found in these children. This is why a correct management is important. There is an enormous controversy regarding the efficacy of the various medical and surgical treatments of otitis media with effusion4. First used in 1885, adenoidectomy represents the removal of the hypertrophic adenoid tissue5. This procedure resolves the mechanical obstruction of the Eustachian tubes and can be the key in the management of OME. In the following study we wanted to show the efficiency of adenoidectomy in treating otitis media with effusion in children. MATERIAL AND METHODS The retrospective study was performed during 14 months on 119 pediatric patients aged 3 to 6 (the mean age: 4.35) with otitis media with effusion and adenoid hypertrophy. The demographic data showed boys/girls ration of 1.08/1, meaning 62 boys/57 girls. 02 RJR 02 2011.qxd:Interior 4/26/11 11:57 AM Page 80

BACKGROUND: Fungal rhinosinusitis are more and more present in otorhinolaringological practice, but still frequently underdiagnosed. This is due to the fact that, until now, there is no diagnostic algorithm widely accepted. Also the therapeutic approach is still controversial. OBJECTIVE: To evaluate the efficiency of various diagnostic methods used for noninvasive fungal rhinosinusitis. MATERIAL AND METHODS: Prospective study on 111 consecutive patients diagnosed with non-invasive allergic or non-allergic fungal rhinosinusitis. All the patients underwent surgery and had histopathologic identification of fungal material. We evaluated the efficiency of mycological and radiological diagnostic methods. RESULTS: Anatomopathologic exam is superior to mycologic culture methods in our experience, and the sensibility of this examination method is influenced by the type of sampling (endoscopic, intraoperatory, by sinusoscopy etc.). CT scan is the most valuable radiologic method in the diagnosis of fungal rhinosinusitis, in 80,77% of cases we encountered characteristic radiologi cal findings. CONCLUSIONS: The diagnostic algorithm for fungal rhinosinusitis involves the coordination between several diagnostic tracks: histopathology, mycologic exam, allergy and immunology tests and radiologic examination. In Romania, the histopatological exam remains the most reliable diagnostic test for the detection of fungal infection. In what it concerns the radiological examinations, CT scan is the “golden standard” for this condition.

OBJECTIVE: Nasal obstruction is one of the most common upper airway symptoms and it can have a great impact upon health. A consequence of nasal airway resistance is Eustachian tube dysfunction. The aim of the study was to make an objective evaluation of the impact of nasal obstruction upon Eustachian tube function by comparing the results of rhinomanometry and tubal manometry. MATERIAL AND METHODS: An 18 months retrospective study was performed on 139 adult patients. Observations included nasal endoscopic examination, tympanometry and stapedian reflex, rhinomanometric recorders of the nasal airway resistance and tubal manometry for evaluating the Eustachian tube function. RESULTS: A nasal airway resistance range between 0.41-1.17Pa/cm3/s was found. The middle ear pressure was found at values between -50 and -387daPa. The comparison of both test results showed that there was a specific distribution of the Eustachian tube dysfunction grades according to the degree of the nasal obstruction. The data analyzes showed a statistically significant correlation between the grade of nasal obstruction and the degree of the Eustachian tube dysfunction (p<0.0001). CONCLUSIONS: Nasal obstruction and Eustachian tube dysfunction represent two related pathologies, regarding the fact that the severity of the nasal airway resistance can influence the grade of Eustachian tube dysfunction.

Monosymptomatic posterior rhinorrhea is a common syndrome found in medical practice, being the starting point for many pulmonary and ENT diseases. It is a solitary symptom, not accompanied by other clinical manifestations (nasal obstruction, anterior rhinorrhea, impaired smell, itching or sneezing) and it is giving the patient the sensation that something is dripping down into the oro and hypopharynx. Border pathology, posterior rhinorrhea consequences may bring the patient in Respiratory or ENT Clinics. A correct diagnosis and an appropriate treatment is the main objective in the management of this syndrome. The purpose of the article is to present this syndrome with its consequences and the main therapeutic methods.

The aim of our study was to determine the importance of p53, PCNA and Ki-67, evaluated by immunohistochemistry, in the treatment and prediction of the laryngeal carcinoma. Out of a total of 319 patients with laryngeal carcinoma that underwent surgery in our department between 1999 and 2007, we performed a retrospective study on 71 cases who benefited by immunohistochemical guidance before the beginning of the treatment. All these patients have been followed-up two to five years after surgery. The values of p53, PCNA and Ki-67 are strongly correlated with the histological grading, by means of descriptive statistics (confidence level 95%); the mean values of these three markers corresponding to each HP grade. A highly statistical significant positive correlation (r = 0.84, p < 0.001 ) between the values of p53 and PCNA was observed. The values of p53, PCNA and Ki-67 in the patients from this study are strongly correlated with the absence of the loco-regional lymph node metastases, by means of descriptive statistics (confidence level 95%). Ki-67 only is correlated significantly to the presence of lymphatic metastases in the regional lymph nodes (stage N1, N2 or N3 TNM). P53 and PCNA are not correlated significantly with the presence of the metastases in the regional lymph nodes.

Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting symptom in adults seeking medical care. Given the fact that the variety of diseases that can produce this symptom is great, the correct management of chronic cough should include a close cooperation between pneumologist, gastroenterology specialist and otorhinolaryngology specialist, in another words a multidisciplinary approach. The purpose of this article is to reveal this symptom from the otolaryngologist perspective, emphasising on the main diseases involved, and also on the diagnosis and treatment alternatives of chronic cough.

A 28-years-old patient with pansinusitis and orbital abscesses to odontogenic infection origin were present. Treatment, complication and evolution are discussed.

LAUP (Laser Assisted Uvolo - palate Plasty) is a new and effective surgical method for the elimination of habitual snoring. This method is based on the progressive enlargement of the airspace in the oropharynx by restructuring and reshaping the uvula, soft palate and posterior pillars by successive '' vaporization's '' (or laser-strip carbonization) utilizing the CO2 laser. Our experience includes 295 patients treated over the last two years with very satisfactory results : elimination or improvement of snoring was reported in 71,17% (210 patients) and we used very successfully Orofar to relieve throat pain. Advantages of this technique are that it is simple, reliable, safe, bloodless, underlocal anesthesia, without hospitalization Disadvantages are the multiples and successive sessions, the high technical effort and cost of the laser.

Our immuno-histo-therapeutical study reffers to 325 cases of chronic sinusitis followed and treated in our department in the last two years.This study wants itself to be a diagnostic and therapeutic algoritm of different kinds of sinusitis followed histological, clinical and immunological. Our work reveals that there are three kinds of chronic sinusitis : a reversible, b. partial reversible, c. irreversible. Each kind of sinusitis benefits by an adequate treatment, wich have to be medical, surgical or combined.