Current and future challenges in otorhinolaryngology

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Epistaxis represents a commonly encountered manifestation in the ENT Emergency Department. Healthcare providers working in the ENT Emergency Department are at high risk of COVID-19 infection both because of the high viral load in the upper airways and because of the asymptomatic presentation of COVID-19 disease. Special focus is needed for managing the balance between appropriate patient care and ensuring the safety of healthcare workers. Adequate preparation and modification of the procedures for bleeding control to minimize risk of spread is necessary. While managing, attention should be kept on less invasive methods with avoidance of aerosol-generating activities. Nonetheless, proper use and disposal of personal protective equipment is of utmost importance in stopping the spread of COVID-19.
</abstract>

Management of epistaxis during COVID-19 pandemic

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<bold>BACKGROUND.</bold> Mucormycosis is an emerging angioinvasive, potentially fatal infection caused by the ubiquitous filamentous fungi of the order Mucorales of the class Phycomycetes. They occur particularly in metabolically decompensated diabetic patients.
<bold>OBJECTIVE.</bold> To evaluate the factors associated with survival in a group of diabetic patients with rhino-orbito-cerebral mucormycosis.
<bold>MATERIAL AND METHODS.</bold> A case-control study of a series of cases from January 2013 to May 2020 was designed. Patients with diabetes mellitus and a diagnosis of rhino-orbito-cerebral mucormycosis were included. The clinical findings were considered, as well as age, gender, laboratory and radiological results, and mortality. For the statistical analysis, we used descriptive statistics, Mann Whitney U test. We considered a p-value equal to or less than 0.05 to indicate a statistically significant association or difference. Likewise, the odds ratio was used to determine the relative risk.
<bold>RESULTS.</bold> 19 cases were included, with an average age of 60.8 years and female gender predominance. In 100% of the cases, nonseptate hyphae were identified in histopathological studies. We had a mortality of 7 (36.8%), where the rhino-orbital complications were the most frequent. The findings of CRP ≤23.1mm/L, an absolute neutrophil count ≥13.2 x1000 /µl and absence of bone erosion in the simple tomography, the rhino-orbital stage, could be related to greater survival.
<bold>CONCLUSION.</bold> Our series presented mortality close to 40%. Age &lt;64 years, CRP ≤23.1mm/L, absolute neutrophil count ≥13.2 x1000 /µl and absence of bone erosion in the simple tomography, rhino-orbital stage were associated with a better survival in our series.
</abstract>

Factors associated with survival in diabetic patients with rhino-orbito-cerebral mucormycosis

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<bold>BACKGROUND.</bold> In our ENT practice, we have encountered situations where we had to evaluate and treat patients complaining of symptoms after a previous surgery. All these patients were capable and entitled to seek for legal advice as much as medical care. We felt the need to record their physical and emotional status and to monitor their evolution in these fields. For this reason, we created a questionnaire to help us not to disregard some important or delicate aspects of their condition.
<bold>MATERIAL AND METHODS.</bold> After evaluating all the existing ENT questionnaires, we decided to create a custom one in order to assess more of the sensitive topics as anger, sadness, regret or frustration. Questions needed to be asked in a certain manner and must be presented in a well-thought order, respecting some basic rules. The evaluation scale needed to be very clear, simple to complete and compare, and identical for all the questions.
<bold>RESULTS.</bold> Creating a questionnaire was a challenging task that led us to an 18-question survey, equally covering symptoms, feelings and quality of life. We used the test only for the patients who presented after a sinonasal surgery and who suggested that their symptoms were caused by the previous intervention.
<bold>CONCLUSION.</bold> A questionnaire is a simple and cheap way to evaluate patients. If the topics needed to be documented are not stated in a classic validated survey, a new evaluation instrument can be created. For patients with complications and sequelae after sinonasal interventions, we designed a new questionnaire that can be used to compare their treatment progression.
</abstract>

“Carol Davila” University of Medicine and Pharmacy

Medical and psychosocial evaluation of patients with complications after sinonasal surgery: Creating a questionnaire

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<bold>OBJECTIVE.</bold> To evaluate the effects of steroid-impregnated middle meatal packing on post-operative outcome after endoscopic sinus surgery.
<bold>MATERIAL AND METHODS.</bold> We performed a prospective clinical study on 26 randomly selected patients, older than 12 years, with chronic rhinosinusitis, who failed medical management and who were operated on by endoscopic sinus surgery at Al-Imamain Al-Kadhimyain Teaching Medical City over a period of 12 months. Patients were divided into two groups: the 1st with middle meatal packing soaked with steroids (triamcinolone) and the 2nd group with middle meatal packing alone, without steroid. The two study groups were followed-up postoperatively for adhesions, crustations and nasal discharge over a period of three months.
<bold>RESULTS.</bold> The study showed a significant reduction in early nasal crustations (p-value=0.048) and nasal discharge (p-value=0.033) after endoscopic sinus surgery in patients who received triamcinolone-impregnated middle meatal packing. Synechia formation was significantly lower in the steroid-impregnated group one month after surgery (p-value=0.021), but no difference at one week (p-value=0.089). At the three-month follow-up, comparing the two groups, the following variables were not statistically significant: crusts (p-value=0.22), nasal discharge (p-value=0.26), synechia (p-value=0.074).
<bold>CONCLUSION.</bold> There are significant reductions in the incidence of early crustations, synechia, nasal discharge in patients who received triamcinolone middle meatal packing following endoscopic sinus surgery.
</abstract>

Effects of steroid-impregnated middle meatal packing on the postoperative outcome after endoscopic sinus surgery

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We present a case of a 48-year-old male patient who was admitted in our clinic for right nasal obstruction, antero-posterior mucopurulent rhinorrhea, recurrent right micro-epistaxis, hyposmia, cacosmia and right hemicrania. ENT findings and CT scan detects proliferative, polylobate, vascularized tumor formation occupying the right nasal nostril, with muco-purulent secretions lining the tumor formation. The tumor pushes the intersinusal wall to the side and the nasal septum to the contralateral nostril. The apparent origin is at the level of the right middle nasal meatus, but we could not identify a clear limit from the nasopharynx lateral and posterior wall. Resection of the entire tumor formation was performed under endoscopic control. The histopathological outcome revealed undifferentiated carcinoma; immunohistochemical tests were performed and support the myoepithelial origins.
</abstract>

Sinonasal undifferentiated carcinoma: Case report and short literature review

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Woakes’ syndrome is a rare entity, defined as severe recurrent chronic rhinosinusitis with nasal polyps, which has as a consequence the deformation of the nasal pyramid, produced by the continuous pressure and the inflammation maintained by the size of the polyps. This paper reviews the main features of Woakes’ syndrome by describing a clinical case.
The patient presented to the ENT Outpatient Clinic for aggravation of an obstructive nasal respiratory syndrome, associated with rhinor-rhea, headache, anosmia and deformity of the nasal pyramid. The ENT clinical examination, the nasal endoscopic examination and the craniofacial CT scan established the diagnosis of Woakes’ syndrome. Functional endoscopic sinus surgery was performed. The follow-ups performed at 10 days and later, a month after surgery, showed a favourable evolution, without signs of local recurrence and a narrowing of the nasal pyramid compared to the preoperative moment. Proper management and proper adherence to the therapeutic protocol are factors that can prevent the onset of this syndrome.
</abstract>

“George Emil Palade” University of Medicine and Pharmacy

Woakes’ syndrome: Case report

AHEAD OF PRINT

Volume 14 (2024): Issue 54 (April 2024)

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Volume 9 (2019): Issue 36 (December 2019)

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Volume 5 (2015): Issue 17 (March 2015)

Romanian Journal of Rhinology

Rhinology, as an important part of Otorhinolaryngology, addresses a very frequent and diverse pathology, with important interdisciplinary implications. In the last decades, this medical field was the beneficiary of new technical means for accurate and effective investigation, treatment and research. The needs of modern medicine - over-specialization, interdisciplinary approach and evidence-based medicine, lead to the situation that the international rhinologic societies are the most dynamic and appreciated.  The Romanian Journal of Rhinology is the official scientific publication of the Romanian Rhinologic Society, and it is trying to fill the existing gap in the Romanian ENT literature, promoting modern publishing and criteria according to the international standards. Romanian Journal of Rhinology appears quarterly with the purpose to publish original articles, original clinical reports, clinically relevant experimental studies and short communications presenting new results of general interest. Its aim is to concentrate and provide information concerning care, cure and prevention of different rhinologic disorders and borderline pathology. With a peer review by an important national and international editorial board, the journal provides clinical and clinically related information written by authors from all over the world.  Journal’s business model  Romanian Journal of Rhinology is an Open Access journal. The submission and publication of the articles are free of charge, in both print and electronic publication. The publisher covers all costs – editing, printing, copyediting, typesetting, long-term archiving, journal management.  Romanian Journal of Rhinology is the journal of the Romanian Rhinologic Society; thus, one of the financial sources for publication is represented by the Society from the manuscript fees.  Advertisements represent another important founding source. The decision regarding the type of advertisements, acceptance/rejections, the price offering is made by the Publishing/technical Editor, the Editorial Board having no decision power on this aspect. Advertorials and publicity about pharmacological devices, drugs, supplements related to rhinologic and otolaryngologic pathologies can be taken into consideration. In case of Advertorials, with an important scientific content, the medical data presented will have the approval of the Journal’s Editors.  There is also available the annual subscription for individuals and companies. The contact person is also the Publishing/technical Editor.  Publication schedule  The Romanian Journal of Rhinology is published quarterly:   January-March (publication month: February)  April-June (publication month: April)  July-September (publication month: July)  October-December (publication month: October)  Editorial process  The Romanian Journal of Rhinology uses a standard scheme for the evaluation process of the submitted articles. All manuscripts are strictly reviewed for originality, correctness, methodology, quality of the medical information, suitability for the journal’s medical field, ethical nature.  The Editors reserve the right to refuse any manuscript which does not correspond to the submission guidelines.  Peer-review is the system used to assess the quality of a manuscript before it is published. Independent researchers in the otorhinolaryngology area assess the submitted manuscripts for originality, validity, and significance to help editors determine whether the manuscript should be published in their journal.  After submission:   All manuscript are treated as confidential documents, all being assigned with a registration number (for example, RJR010121 (day of submission)(month of submission) (the last two numbers of the year of submission)). All communications between the editors, the author(s), the reviewers are made by using this identification number.  Technical review performed by the editor-in-chief, associated editors, members of the editorial board analyses – the importance of the subject, presentation clarity, relevance, plagiarism index. Submissions that fail to fulfil all requirements are rejected. This process last for a few days after submission.  Review process. The Romanian Journal of Rhinology has a double-blind reviewing process, in which the reviewers do not know the names of the authors, and the authors do not know who reviewed their manuscript. Therefore, the authors are required to submit a blind manuscript without the authors’ names and affiliations on the title page or in the text and a separate title page with the names of the authors, affiliations, and information about the corresponding author. After the initial assessment for, submissions are sent to at least two experts in the field who are asked to evaluate whether the manuscript is scientifically coherent, easy to read, useful in the field, and whether the manuscript should be accepted, rejected or revised. The review process will take approximately 2 weeks. After the review process is completed, the corresponding author will receive an e- mail about the evaluation results of the submitted manuscript: accepted, revision or rejection. If the e-mail contains suggestions and comments for revising the manuscript, the authors should make the changes and return to the editor within 2 weeks; if not, the manuscript is considered rejected. If the manuscript is accepted for publication by the reviewers, it is forwarded to the Editor-in-Chief. The final decisions are made by the Editor-in-Chief based on the recommendations of reviewers reports and the journal’s editors. Where necessary, they will consult with members of the Editorial Board. The Editor-in-Chief may advice the corresponding author to make necessary revisions in order to publish the article. The final form of the article will be sent to the main author for the last approval from his/her part (if there are minor changes these should be send in no more than 1 week).  The publication process after the article’s submission may take 45 days, average. All accepted articles are assigned with a DOI number.  The Romanian Journal of Rhinology follows the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals and required ICMJSE to be listed as a journal that follows these recommendations.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 