ATLAS DE PATOLOGIE ȘI TRATAMENT CHIRURGICAL

Abstracte ORL

09 Mai 2016

Traheotomia la copil

Stelian Lupescu, Marioara Poenaru, Alin-Horia Marin, Iulia-Emilia Lupescu 

Clinica ORL Timișoara, România
Scop. Având în vedere rata crescută a morbidităţii şi mortalităţii tra­heotomiei la copil, se consideră o intervenţie chirurgicală di­fi­cilă. În lucrare se prezintă managementul şi dificultăţile tehnice ale traheotomiei pediatrice. Material şi metodă. În Clinica ORL Ti­mi­şoa­ra, în perioada 2005-2015, au fost efectuate 18 traheotomii la co­pii cu vârsta cuprinsă între 1 și 15 ani. Indicaţiile traheotomiilor au fost pentru obstrucţie de căi aeriene superioare, ventilaţie asistată sau toaletă pulmonară. Au fost utilizate diferite tipuri de canule tra­he­ale. Alegerea canulelor trebuie să ţină cont de indicaţia tra­heo­to­miei. Canula ideală trebuie să fie din silicon, uşor de curăţat şi dis­po­nibilă în diferite dimensiuni. Rezultate. Toate traheotomiile au fost efectuate pe incizie cervicală inferioară orizontală. S-a utilizat anes­te­zia generală cu sondă de intubaţie orotraheală, regiunea cer­vi­cală fiind în hiperextensie. Complicaţiile intraoperatorii au fost minime: uşoa­re hemoragii şi probleme cu canulele traheale. Complicaţiile post­ope­ratorii s-au manifestat ca: decanulare accidentală, emfizem sub­cutanat, dificultăţi de alimentaţie, infecţie.
Concluzii.
  1. Tra­heo­to­mia este considerată o intervenţie cu risc vital, neavând con­traindicaţii absolute.
  2. Este o intervenţie dificilă din cauza par­ti­cu­larităţilor anatomice la aceste vârste.
  3. Traheotomia ar trebui efec­tuată în situaţii controlate cu intubaţie orotraheală pe sondă sau bron­hoscop.
  4. Rata complicaţiilor traheotomiei la copil poate fi în jur de 40%.
Cuvinte-cheie: traheotomie, copil, canulă, complicaţii

Eustachian tube causes

Adriana Neagoş

MD, PhD, University of Medicine and Pharmacy Târgu-Mureş, Otorhinolringology Department, Târgu-Mureş, Romania 
Eustachian tube is an important source of middle ear pathogenesis and has been linked to causing middle ear and mastoid aeration pathology. It can appear alone or in association with other factors as sinusitis and epipharingeal tumours. Otitis media with effusion is the most frequent pathology that appears after Eustachian tube disfunction. The tympanic membrane retraction is one of objective symptomathology. Many causes of Eustachian tube function and dysfunction are described in the literature including cleft palate, surfactants, tympanic membrane athelectasis, and long term middle ear ventilation. The epidemiological studies illustrated that poor Eustachian tube function plays a major role in the pathogenesis of otits media, so it is very important to have a good function of the tube before and after a surgical procedures. Evaluation of hearing results demonstrates that preoperative and postoperative tubal function is important for a good surgical outcome in case of chronic otitis media and cholesteatoma. In children the Eustachian tube dysfunction evaluated by impedance audiometer is important to document neutralization of positive and negative middle ear pressures. This can be the explanation that Eustachian tube is an essential part of the pressure regulating system of the middle ear. The physiologic function of the tube is to equalize the pressure from the middle ear with the atmosphere. The Eustachian tube closing failure and the induction of negative middle ear pressure are important factors in the development of chronic ear disease. 
Keywords: Eustachian tube, otitis media, children

Cytomegalovirus infection - cause of sensorineural deafness

Dana-Teodora Anton-Păduraru1, Oana Teslariu1, Angelica-Cristina Marin2, Ana-Simona Drochioi1

1. University of Medicine and Pharmacy “Gr. T. Popa” Iași, Romania, IIIrd Pediatrics Clinic
2. Pediatric Resident doctor 
First described in 1964, deafness caused by congenital cyto­me­ga­lo­virus infection - a major problem of public health - is today the most frequent cause of sensorineural deafness in children. The pre­valence of congenital cytomegalovirus infection is between 0.2-5% worldwide, and for the sensorineural deafness is 22-41% in chil­dren with clinical symptomatic infection and 6-16% in those with asym­ptomatic infection. Diagnosis of congenital cytomegalovirus in­fection is possible if the virus is isolated during the first 3 weeks of life or if the serum IgM antibodies are found at birth or shortly af­ter birth. After this period, the congenital infection can’t be dif­ferentiated from the acquired infection, which does not associate senso­ri­neural deafness and does not affect the cochlea. In 50% of cases the neonatal hearing screening can’t detect hearing impairment be­cause, usually, the onset of deafness is belated. Deafness caused by cy­to­megalovirus infection can be progressive or with late onset (at pre­schoolers or in the first years of school), requiring more frequent audio­logy monitoring (at birth, at 3, 6, 9, 12, 18, 24, 30, and 36 months and annually until school age) in order to detect and to treat deaf­ness. Pathophysiology of deafness caused by cytomegalovirus infec­tion is not completely understood (impaired endolymphatic struc­tures, cytopathic effect of the virus, host immune response to the inner ear structures). Hearing loss can be unilateral (frequency of 4-8 kHz) or bilateral, and varies from medium to severe. Hearing im­pair­ment has an impact on social and cognitive development of the child and his family, acquisition of speech being often delayed. The risk of permanent sequelae in case of symptomatic infection is higher in children from mothers suffering of primary infection, but disabilities were observed also in children from mothers with non-primary infections. In children with asymptomatic congenital cy­to­megalovirus infection, increased virulence in the first month of life is associated with sensorineural deafness. Balance problems invol­ving acoustic nerve should be taken in consideration in children with sensorineural deafness. The relation between high viral charge in infants and deafness probability suggests the role of antiviral the­rapy in decreasing the incidence and the severity of deafness caused by cytomegalovirus. Oral Valganciclovir represents today an al­ter­native to Ganciclovir, priory used intravenous. Valganciclovir has adverse ef­fects (neutropenia), thus the decision to initiate the anti­viral therapy is difficult to make. Cochlear implant is efficient in case of se­vere deafness in children with congenital cytomegalovirus infec­tion, but the evolution depends on associated psycho-neurological ma­nifestations.  
Keywords: infection, cytomegalovirus, deafness, child

Difficulties in the diagnosis of hearing loss in children

Raluca Enache

ENT Sarafoleanu Medical Clinic, Bucharest, Romania
Hearing represents an important social and cognitive function, the hear­ing loss being an important health problem worldwide. Hy­po­a­cusis is a common pathology found in both adults and children. Chil­dren’s deafness is an issue of large interest in otorhinolaryngology, pri­marily due to its impact upon speech and language development, cog­nitive abilities and social background. Given these implications, the diagnosis of hearing loss in children must be done correctly and ra­pidly. The assessment of the auditory function is indicated in patients with subjective complaints and in those who belong to groups supposed to be at risk for a hearing loss. Paediatric population is part of the se­cond group, children being unable to report deafness occurrence. For this reason, child’s audiometric evaluation can be difficult. It must be car­ried out according to the child age, the degree of cooperation; it must take into account child’s medical history, and the clinician must have a clear systematization of the types and the causes of hearing loss in children.
Keywords: hypoacusis, audiometric evaluation, children

Evaluarea beneficiului auditiv la pacienţii cu implant cohlear

Mădălina Georgescu1,2, Magda Cernea2,3

1. Institutul de Fonoaudiologie și Chirurgie Funcțională ORL „Prof. Dr. Dorin Hociotă”
2. Universitatea de Medicină și Farmacie „Carol Davila” București
Hipoacuzia neurosenzorială bilaterală severă-profundă reprezintă un han­dicap senzorial sever, care împiedică comunicarea naturală, orală, a pa­cientului hipoacuzic cu persoanele din jurul său. Surditatea bilaterală in­sta­lată în primii doi ani de viață determină instalarea unui al doilea han­dicap senzorial - mutitatea, asociere care impietează grav asupra dez­voltării ulterioare a copilului pe multiple planuri: educațional, social și economic. Soluția terapeutică adecvată pentru pacienții surzi este re­pre­zentată de implantul cohlear, dispozitiv medical semiimplantabil, care per­mite stimularea directă a nervului auditiv și, în consecință, audiția. Eva­luarea beneficiului auditiv al implantului cohlear nu trebuie să se li­mi­teze la evaluarea pacienților implantați prin audiogramă tonală, ci, obli­gatoriu, prin audiogramă vocală, singura în măsură să redea nivelul abilitării auditive în toată complexitatea sa. Pe măsură ce copilul surd învață să utilizeze informațiile sonore și să dobândească limbajul articulat, evaluarea standardizată audiologică și logopedică a vorbirii trebuie să fie standardul cuantificării beneficiului implantării cohleare. Prezentăm în lucrare rezultatele obținute în I.F.A.C.F.-O.R.L. la copiii implantați cohlear, care au urmat un program susținut de reglaje periodice ale procesorului de sunet al implantului cohlear și logopedie specializată.
Cuvinte-cheie: surditate, implant cohlear, beneficiu auditiv

Chirurgia endoscopică în managementul patologiei tumorale benigne rinosinusale pediatrice

Codruț Sarafoleanu

Clinica ORL „Sfânta Maria”, Centru de Excelență „CESITO”, UMF „Carol Davila” București
Lucrarea face o trecere în revistă a indicațiilor/limitărilor chirurgiei en­do­scopice în tratamentul patologiei tumorale benigne rinosinusale la pa­cienții pediatrici. Sunt prezentate elemente de tehnică chirurgicală apli­cate în cazul diferitelor entități patologice, pornind de la vegetațiile ade­noide și ajungând la patologia bazei craniului. Se insistă pe pre­zen­tarea modalităților de tratament, pregătire preoperatorie și îngrijiri post­operatorii în cazul patologiei tumorale, cu accent pe prezentarea par­ti­cularităților fibroamelor nazofaringiene. 
Cuvinte-cheie: patologie tumorală, chirurgie endoscopică rinosinusală, fibrom nazofaringian, meningocel

Salivary biomarkers of hpa axis and ans activities

Francesca Romana Patacchioli

Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
Endocrine biomarkers assessment in blood or plasma is often limited. Se­ve­ral substances also can be analysed in saliva and this technique offers some ad­vantages. Saliva sampling can be done anytime, anywhere and multiple collection and assessment of samples during the day could offer a better understanding of daily production of the biomarkers of the endocrine and autonomic nervous systems. Salivary biomarker measures represent a reliable method of investigating hypothalamo-pituitary-adrenal axis and autonomic nervous system activities, avoiding the stressful event of venipuncture and offering the possibility of self-collection by subjects. Salivary cortisol and alpha-amylase are commonly used for monitoring the human body’s response in different physio-pathological conditions. The aim of this presentation is to encourage the use of salivary biomarkers assays in clinical practice and research and also to provide background information on some methodological factors that influence and add variance to bio­marker outcome measurements. In fact, numerous methodological factors could influence human neuro-endocrine measurements and, consequently, can dramatically compromise the accuracy and validity of research. These factors can be categorized into those that are biologic and those that are procedural-analytic in nature. For example, traces of blood might interfere with the results of saliva testing. One major problem, the lack of compliance sometimes seen in outpatient saliva donors, requires strict standardization of both collection and analysis methods to achieve better comparability and assessment of published salivary hormone data. Such effort includes the development of specific and standardized analytical tools, the es­ta­blish­ment of defined reference intervals, and implementation of round-robin trials.
Keywords: salivary biomarkers, hypothalamo-pituitary-adrenal axis, au­to­no­mic nervous system, saliva testing

Sleep pathology in children - practical elements

Adriana Neagoş

 MD, PhD, University of Medicne and Pharmacy Târgu-Mureş, Otorhinolaringology Department, Târgu-Mureş, Romania 
Sleep is important to children, contributing to their physical and men­­tal growth. There are many possible causes for the development of obstructive sleep apnea in children.  Obstructive sleep apnea syn­drome (OSAS) in children has different effects, including deficits in cog­­nition and neuropsychological functions, learning problems, hyperactivity, and nocturnal enuresis. Obstructive sleep apnea in children cha­rac­te­rized by a combination of partial and intermittent obstruction of the upper airway can disturb sleep and normal ventilation. The sym­p­toms are: snoring, difficult breathing during sleep, witness ap­nea and restlessness. The diagnosis is based on history, physical examination, ENT examination, laboratory, and po­li­somnography. All clinical and paraclinical investigations must to be correlated, before establishing the diagnosis, and to evaluate the degree of upper airways obstruction. Hypertrophy of the adenoids and tonsils is a major cause of OSAS in children. These include hyper­trophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. However, OSAS can also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Snoring and obstructive sleep apnea are frequent problems not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. Adenotonsillectomy (ATE) is the the­rapy generally chosen if the child has adenoidal vegetations and/or ton­sillar hypertrophy. Corrective surgery is possible for rare mal­for­ma­tion syndromes. Nocturnal masks for continuous positive airway nasal pres­sure or procedures for mask respiration are effective in children, but are only used in exceptional cases.
Keywords: sleep pathology, OSAS, children

Salivary cortisol in children with obstructive sleep apnea

Cristina Mihaela Ghiciuc1, Sebastian Cozma2, Cătălina Elena Lupușoru1, Francesca Romana Patacchioli3, Lucia Corina Dima-Cozma4

1. Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
2. Department of Otorhinolaryngology, School of Dentistry, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
3. Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
4. Department of Internal Medicine, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
Cortisol, a well-known marker of the hypothalamus-pituitary-adre­nal (HPA) axis activity, is characterized by a circadian rhythm, with mor­ning concentrations significantly higher than evening con­cen­tra­tions. Dysregulations of the physiological rhythms are thought to play a role in the initiation or progression of some diseases, therefore, we wished to explore HPA axis function in children with obstructive sleep apnea (OSA). The results showed that the salivary cortisol con­cen­tration measured in the control group reflected a typical course of the salivary cortisol diurnal trajectory, with the evening va­lue being significantly lower than the value in the morning. The mild and moderate OSA groups showed a comparable trend with a sig­ni­fi­cant diurnal decrease in salivary cortisol concentration du­ring the day. Moreover, we report here that the salivary cortisol con­cen­tra­tion measured in the morning, in both the moderate and mild OSA groups, was significantly higher than that in the control group. In con­clusion, we showed overall significant and severity-dependent in­creases in salivary cortisol production. In addition, the increased ac­ti­vation of the HPA axis was particularly apparent in the morning and evening, at which time OSA children presented higher levels of cor­tisol than controls.
Keywords: hypothalamus-pituitary-adrenal axis, salivary cortisol, obstructive sleep apnea, children

Preclinical indicators of autonomic nervous system activity in pediatric osa

Lucia Corina Dima-Cozma1, Sebastian Cozma2, Cătălina Elena Lupușoru3, Francesca Romana Patacchioli4, Cristina Mihaela Ghiciuc3

1. Department of Internal Medicine, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
2. Department of Otorhinolaryngology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
3. Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
4. Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy 
Obstructive sleep apnea (OSA) syndrome, with an estimated pre­va­len­ce of 1-6% in children, is characterized by hypothalamo-pituitary-adrenal axis dysregulation and earlier activation of the autonomic nervous system activity. The aim of the present study was to explore the interdependencies of the two axes and the reliability of salivary alpha-amylase as a noninvasive marker of autonomic nervous sys­tem activation. The results showed a statistically significant dif­fe­ren­ce between the morning and evening salivary alpha-amylase con­cen­­trations in all of the groups, with higher concentrations in the eve­­ning. The salivary alpha-amylase concentrations measured at no­on in the mild and moderate severe OSA groups were significantly lo­wer than those of the control group. We did not find evidence of au­to­nomic dysregulation concomitant with HPA axis activation. The dif­ferences with other studies from literature could be discussing ta­king in account that our cohort did not include obese children and the duration of the disease was not long enough. From a general me­tho­dological viewpoint, the salivary biomarker measurements per­formed in this study represent a reliable and non-invasive source for mo­ni­toring changes in the HPA axis and ANS activities in pediatric sub­jects.
Keywords: salivary alpha-amylase, autonomic nervous system, ob­­­s­truc­­tive sleep apnea syndrome, hypoxia

The analysis of decision-making factors concerning the indication of tracheobronchoscopy in foreign body suspicion

Florin Anghelina, Mihaela Mitroi, Liliana Anghelina, Sorin Ciolofan, Carmen Mogoanță, Elena Ioniță

ENT Clinic Craiova, UMF Craiova
Objectives. The paper aims to study the factors influencing diagnostic decision-making in tracheobronchial foreign body suspicion in children, all in order to establish an accurate indication for tracheobronchial exploration. Material and method. The retrospective study was per­formed on 106 cases with suspected tracheobronchial foreign body (TFB) in children, hospitalized and treated in the ENT department of the County Clinical Emergency Hospital of Craiova within 5 years. Re­sults. Following history, clinical examination, laboratory findings and tra­heo­bronhoscopy the diagnosis was confirmed in 72.64% of cases and in 22.92% the diagnosis was denied. The high percentage of denied cases is due, on one hand, to exploring those cases where history is suggestive for the diagnosis (the presence of the aspiration episode), in which case the tracheobronchial exploration is mandatory, and on the other hand, to those cases of pneumonia and bronchopneumonia with prolonged evolution and without positive answer to treatment. Analyzing the age group affected and confirmation of diagnosis for the age group 0-1 years, there were no errors in diagnosis. For the age group 1-3 years, the ratio of 15/49 (30.6%) of denied and confirmed is much lower than for the 4-7 years age group (7/9 - 77.77%). Over the age of 7, the ratio 4/11 of denied and confirmed (36.36%) falls within the general margins. Emphysema was the frequent radiological feature found in children. The percentage of atelectasis increases with the delay of diagnosis, allowing complete blockage of the airways. 20% of X-rays were normal. Conclusions. The high percentage of cases discarded after tracheobronchial exploration is given, on the one hand, to the imperative exploration upon reasonable suspicion of foreign body and, on the other hand, to the confusion ge­ne­rated by pre-existing pulmonary pathology. Greater prevalence of de­nied cases encountered in the age group 4-7 years, compared to the other age groups, is probably secondary to a greater degree of freedom gi­ven to the children and less attentive supervision.
Keywords: traheobronhoscopy, tracheobronchial foreign body in chil­dren

Particularităţile tumorilor ORL în oncologia pediatrică

Ingrith Miron

Șef disciplină Pediatrie, Spitalul Clinic de Urgență pentru Copii „Sfânta Maria”; UMF „Gr. T. Popa” Iași
Majoritatea maselor tumorale ale sferei ORL la copil au natură in­fla­ma­to­rie, dar sunt întâlnite și alte etiologii de tip benign sau malign. Tu­morile maligne otorino-laringologice în pediatrie sunt rare, apro­xi­mativ 5% dintre neoplasmele copilului; sub vârsta de 6 ani sunt sem­nalate neu­ro­­bla­stomul și infiltrările leucemice, iar peste 6 ani, rab­do­miosarcomul și alte sarcoame (20,75%), limfomul malign hodgkinian, limfomul ma­lign nonhodgkinian (43,39%). Carcinomul nazofaringian reprezintă o pa­to­logie a copilului mare și adolescentului (15,09%). În ultimii ani s-au fă­cut progrese în caracterizarea variabilităților epidemiologice, fe­no­­tipice, genotipice ale acestor cancere și imu­no­bio­logia a permis un diag­nostic de acuratețe și un prog­nos­tic su­pe­rior prin individualizarea te­ra­peutică. Specialistul ORL este în eșa­lonul acreditat pentru stabilirea di­ag­nosticului în acest tip de afec­țiune și depistarea în stadiul precoce, fapt ce oferă cele mai im­por­tante premise de supraviețuire. Echipa mul­ti­disciplinară care rea­lizează imagistica (CT, RMN, PET-CT), biopsia/re­zec­ția chi­rur­gi­ca­lă, evaluarea imunohistochimică, chimioterapia, ra­dio­te­rapia, eva­lua­rea toxicității medicațiilor (hematologice, digestive, sen­zoriale) rea­lizează împreună cel mai fiabil diagnostic, stadializare și eva­luare a răs­punsului terapeutic. Particularitățile pacientului pe­dia­tric, care li­mitează în anumite situații abordul chirurgical extensiv prin ima­tu­ri­tatea scheletului și acțiunea radioterapiei cu doze mari, com­plicată de morbidități importante, pot cere intervenția precoce adju­van­tă, neo­adjuvantă și/sau concomitentă a chimioterapiei.
Cuvinte-cheie: tumori sfera ORL, copii, echipă multidisciplinară

Management of lateral venous sinus thrombosis secondary to suppurative otitis media - news, controversy

Florin Anghelina, Bogdan Fănuță, Sorin Ciolofan, Carmen Mogoanță, Elena Ioniță, Cristina Bogdan

ENT Clinic of Craiova
Objective. Thrombosis and thrombophlebitis of the lateral venous si­nus (LST) is one of the complications of otic suppurations in children. The paper traced the defining diagnostic features and also the actual treat­ment and its controversy. Material and method. The paper aims to pre­sent the case of LST secondary to mastoiditis in the ENT Department bet­ween 2009 and 2015. Results. A total of 8 cases, out of which 3 were children, had LST secondary to otic suppurations. All patients un­der­went radical mastoidectomy with exclusion of lateral venous sinus (LS) on 7 patients. After mastoidectomy one child was followed-up for over three years by repeated MRI examinations that asserted the re­per­meabilization of the LS. Routine ligation of the internal jugular vein (IJV) is recommended when the thrombus exceeds the mastoid area, when the IJV is interested or when sepsis and pulmonary complications per­sist. There is also controversy regarding anticoagulation treatment. Con­clusions. The therapeutic attitude regarding lateral venous sinus is differentiated depending on the extension of the thrombus, the degree of lumenal narrowing and general septic phenomena, radical mas­to­idec­tomy accompanied or not by exclusion of lateral sinus or ligation of the internal jugular vein.
Keywords: lateral sinus thrombosis, mastoidectomy

Injuries involved in serous otitis media ethiopathogenity at child - histological and immunohistochemical characterization

Carmen-Aurelia Mogoanță1, M.S. Ciolofan1, F. Anghelina1, Elena Ioniţă1, Ioana-Cristina Stanciu2, Alexandra Zbera2

1,2. ENT Departement - University of Medicine and Pharmacy, Craiova
2. ENT Clinic, Emergency Hospital Craiova
Aim. Chronic adenoamigdalites is the prerogative of childhood and are the most common problems in the pathology of inflammatory throat with multiple locoregional complications (acute otitis media, otitis catar­rhal, otitis adhesive, otitis suppurated with deafness, chronic rhinitis mu­co­purulent sinusitis, eye infections and lacrimal tract, respiratory in­fec­tions downward) and remote (glomerulonephritis, rheumatic fe­ver, endocarditis, enteritis, appendicitis, persistent albuminuria). Star­ting from these data, we aimed to investigate histological and im­mu­no­his­tochemical changes some of the tonsillar lymphoid tissue and stro­ma adenoamigdalitis patients with chronic and acute or chronic otic inflam­matory pathology. Methods. In this study we considered a total of 243 pieces, represented by palatine tonsils, tubing and peritubal tissue har­ves­ted from 94 patients aged 3 to 16 years after surgery performed in ENT Clinic from Craiova in the period 1.01.2011-31.12.2015, in which ade­no­idectomy and/or tonsillectomy/amigdalotomy were imposed as a therapeutic necessity. For changes in histological stains there were used: hematoxylin-eosin, impregnation argentic Gömöri and tri­cro­mi­cul green light (Goldner technique - Szeckeli). LSAB technique used im­mu­no­histochemical study of CD20 and CD45 antibodies for the evidence of lymphocyte B and E, respectively, T lymphocytes. Results. The study re­vealed multiple microscopic and immunohistochemical changes in ton­sil structures, both lymphoid tissue stroma and at the level. In all ca­ses studied, lymphoid follicles hyperplasia and hypertrophy occurred with excessive development of germinal center clear as responsive to the presence of specific antigens. Conclusions. Histologically, in chronic hy­per­trophic adenoamigdalit we were able to distinguish two different as­pects: chronic inflammatory hyperplasia in which the hypertrophy fol­licle is accompanied by changes in stroma tonsil in which the fibers col­lagen occurring organized bays thick with tumbling marked fiber re­ti­cu­lin and simple hyperplasia non-inflammatory follicular hypertrophy cha­rac­te­ri­zed by preserving normal architectonic stoma.
Keywords: serous otitis, child, chronic adenoamigdalites

Otitis media in children with somatic pathology

Svetlana Diacova1, Angela Chiaburu1, Sergiu Parii1, Olga Sosnowska1, Doina Chiaburu1, Veronique Desvignes2

1. “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chișinău, Moldova
2. Society “Médecines du Monde”, Clermont-Ferrand, France
Introduction. Otitis media with asymptomatic evolution to chronic forms often needs surgical treatment. Study design. Prospective survey with retrospective charts review. Aim. To analyze and compare the in­ci­dence and clinical evolution of otitis media in children with recurrent and chronic respiratory pathology, gastrointestinal pathology, and healthy children. Material and methods. Children at the age between 1 and 7 years with no any evident ear problem and with recurrent and chronic somatic pathology and healthy children were accepted for the middle ear monitoring. Tympanometry and otoscopy were per­formed every three months during 5 years on each child. Complete oto­rhi­no­la­ryn­gological examination, otomicroscopy and audiological as­ses­sment were carried out for children who failed the screening tests du­ring 3 months. Results. Asymptomatic otitis media with effusion was de­tec­ted in 79% of cases and it became chronic in 22% of ears. Recurrent and chronic course of otitis media was characteristic mostly for children who suffered from respiratory or gastrointestinal tract pathologies with du­ra­tion for more than 2 months. Screening revealed high incidence of otitis media with effusion in children with recurrent and chronic somatic pathology and it predisposition to chronic evolution. Medical treatment in such cases was not effective. Conclusions. Middle ear monitoring in children with chronic and recurrent somatic pathology leads to patients who need comprehensive treatment, including surgical one.
Keywords: otitis media, monitoring, impedance audiometry, oto­sco­py, somatic pathology

Microbial biofilm, etiologic factor in cholesteatomatous otomastoiditis

Doina Vesa, Claudia Ştefan, Nicoleta Maftei

“Dunărea de jos” University - Facultaty of Medicine and Pharmacy Galaţi
Introduction. The microbial biofilm (MB) plays a very important role in the pathogenesis of many ENT infections, including the chronic oto­mastoiditis. There are few studies which prove the MB’s presence at pacients with chronic otomastoiditis. Hypothesis. Our objective is to highlight the MB in patients with chronic otomastoiditis. For achie­ving that, we have proven that the cholesteatoma’s ethiology is se­­condary to the MB’s population’s superpositioning in the mastoid ca­vity. Method. The study was taken on a period of 20 years and tar­geted a group of 26 patients. They have had, since childhood, re­pea­ted medium suppurated otitis. Among them, 2 patients left the study due to moving out of town, one patient refused the con­ti­nua­tion of the study, and 4 other patients healed with sequelae. From the rest of the 19 patients, 7 of them had developed CSOM, and the rest of them had undergone surgical intervention at some point du­ring the disease’s evolution. Conclusions. The hystopathological exa­mi­nation and the biochemical determinations made on some of the patients who were studied support the hypothesis that the cho­lesteatoma’s ethiology could be based on MB, this being iden­ti­fied in some of the studied CSOM cases.
Keywords: microbial biofilm, cholesteatoma, chronic otomastoidits

Hearing disorders - part of fetal alcohol syndrome

Georgiana Russu1, Cristina Rusu2, Alexandra Grosu3

1. Pediatric Pathoogy Department, “St. Mary” Children Emergency Clinic Iaşi
2. Medical genetics Chair, UMPh “Grigore T. Popa” Iaşi
3. Pediatric Resident Physician
 
Fetal alcohol syndrome (FAS) (1-2/1000 newborns), resulting from ma­ternal consumption of alcohol early in the pregnancy, con­sists in: persistent growth failure, low weight, microcephaly, cha­rac­te­ris­tic facial features, congenital heart diseases (especially septal de­fects), minor anomalies of joints and limbs, disorders of central ner­vous system development and function. The complexity, se­ve­ri­ty and frequency of the anomalies depend on the amount of the in­ges­ted alcohol associated or not with other risk factors: low so­cio-eco­nomic level, psychologic disturbances, smoking, drugs. Hea­ring di­sorders determined by maternal alcohol consumption, al­though not classically included in the FAS, and also chronic ear in­fec­tions, are associated in variable severity degrees. Audiologic pro­cedures per­formed in FAS children revealed four main hearing di­sor­ders: de­layed development of auditory function associated with lan­guage di­sorders, sensorineural hearing loss (disorders of middle ear and con­ductive system), intermittent loss of sound vibrations con­duc­tion, hearing loss by central auditory nervous system deficits. Early de­tec­tion of hearing anomalies alleviates the prognosis by early in­ter­ventions.
Keywords: alcohol, pregnancy, hearing loss

Capcanele diagnosticului otomastoiditei acute la copil 

A.M. Buruiană, D.C. Gheorghe, Veronica Epure, A. Borangiu, Laura Buruiană

Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie”, UMF „Carol Davila” București
Otomastoidita acută reprezintă o complicație precoce a otitei medii acu­te, apărând îndeosebi în zilele următoare debutului acesteia. Tabloul cli­nic este destul de tipic și chiar dacă diag­nos­ti­cul pare evi­dent, există di­fi­cul­tăți legate de abordarea clinică și terapeutică. Exa­mi­narea CT are un rol important în decelarea complicațiilor endo- și exo­craniene, fără a exista însă un aspect pa­tognomonic care să indice ne­ce­sitatea intervenției chi­rur­gicale. Antibioterapia administrată pre­spi­talicesc în majoritatea ca­zu­ri­lor menține în stare latentă simp­to­matologia fără a împiedica evo­luția afec­țiunii și respectiv apa­ri­ția complicațiilor. Autorii prezintă criteriile cli­ni­ce de diagnostic și tratament, precum și câteva din cazurile de oto­mas­to­i­dite acute în­tâl­nite în Clinica ORL a Spitalului „M.S. Curie”.
Cuvinte-cheie: otomastoidită, ORL, copil

Quality of life in small children with otitis media

Svetlana Diacova1, Mihail Maniuc1, Lucian Danilov1, Polina Ababii1, Olga Sosnowska1, Thomas J. McDonald2

1. “Nicolae Testemițanu” State University of Medicine and Pharmacy 
2. Mayo Clinic, MN, USA
Introduction. The impact of otitis media and the benefits of their treatment must be measured in terms of well-being, functional status, and quality of life. Aim of the study. To analyze the dynamics of qua­lity of life of children aged 1-7 years suffering from otitis media în func­tion of treatment methods. Material and Methods. Quality of life and general health of children aged 1-7 years of life with a history of oti­tis media were analyzed in a prospective study using elaborated ques­tion­naire. According to questionnaire, parents appreciated quality of life by indexes of physical suffering, hearing loss, speech impairment, emo­tional distress, activity limitations and others on a scale of 7 points (from ”very bad” to ”very good”). Additionally, we analyzed anamnesis data: frequency, duration and characteristic of ear pathology. Complex oto­logy and audiology assessment were used for precise diagnosis. Patients re­ceived medical or surgical treatment.  Quality of life and general health of children were analyzed 4 times during 12 months. Results. Quality of life in children with otitis media with effusion and recurrent otitis media sig­ni­ficantly differs from healthy children data. The most significant and stable positive dynamics of child’s quality of life was registered after sur­gical treatment, which included tympanostomy and adenoidectomy. Po­sitive dynamics of quality of life indexes after medical treatment and ade­noi­dectomy was minor and unstable. Conclusions.  Dynamics of child’s quality of life and general health data is an important factor in se­lec­tion of otitis media treatment.  
Keywords: otitis media, quality of life, general health

Management and rehabilitation measures in postoperative facial paralysis - clinical case study

Veronica Epure, A. Borangiu, D.C. Gheorghe 

Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie”, UMF „Carol Davila” București
Correspondence:  Veronica Epure, e-mail: veronica_epure@yahoo.co.uk
The authors discuss the clinical case of a 12-year-old boy, presenting with extensive cholesteatoma of the middle ear and mastoid bone, who de­ve­loped a severe progressing left facial paralysis after mastoidectomy. Due to unfavourable evolution, early grafting of the facial nerve was performed (with nerve graft harvested from the great auricular nerve). The authors dis­cuss the surgical and rehabilitation possibilities in such cases, based on li­te­rature datas.
Keywords: peripheral facial nerve paralysis, neurografting, elec­tro­myo­gra­phy

Cochlear implantation: straightforward surgery?

E.H. Ştefănescu, N.C. Balica, Marioara Poenaru

UMPh Timişoara
Cochlear implantation has a very low complication rate, but if these com­pli­cations require explantation, the situation becomes very pro­ble­ma­tic, especially in children, for more than obvious reasons. The classic ap­proach (mastoidectomy, posterior tympanotomy, coch­le­os­tomy or round window insertion) is the most used technique all over the world. There are few feared steps - e.g. posterior tympanotomy, with its known risk of inadvertently damage the facial nerve - and this is why alternative tech­niques have been developed. However, these techniques carry their own specific risks which should not be underestimated so there is no risk free option. There is still a debate which insertion method to be chosen: cochleostomy or Round Window (RW). The landmark for both­ is the RW niche, so the first step is to be sure that you have a RW (check­ the CT scan). The insertion angle through the RW membrane is not the optimal one so to see enough of the RW membrane is a pre­re­qui­si­te. Attempts at adequately visualize the RW membrane may end up in accidentally (and sometimes unnoticeably) uncovering the facial nerve and the electrode array being in contact with it.
Per­for­ming a cochleostomy without positively identifying the RW niche is risky business because the chances to end up in the scala vestibuli is ve­ry high. The position of the cochleostomy is of paramount importance for a traumatic insertion. Straightforward surgery? It is for everyone to decide.
Keywords: cochlear implantation, cochleostomy, round window in­ser­tion, insertion angle

Reimplantarea cohleară la copil - cauze şi efecte 

Oana Bitere1, Luminița Rădulescu2,3, Cristian Mârțu2,3, Raluca Olariu2, Sebastian Cozma1,2

1. Spitalul Clinic de Recuperare Iaşi, Compartimentul de Audiologie şi Vestibulogie
2. Universitatea de Medicină şi Farmacie „Grigore T. Popa”, Iaşi, Facultatea de Medicină
3. Spitalul Clinic de Recuperare Iaşi, Clinica ORL
Obiectivul studiului a constat în identificarea cazurilor la care a fost necesară reimplantarea cohleară la copiii implantați în cadrul Spitalului Clinic de Recuperare Iaşi şi analiza cauzelor ce au determinat această procedură de reintervenţie chirurgicală. Material și metodă. Studiul a fost unul retrospectiv, pe 10 ani (2007-2016), fiind efectuată o analiză a cauzelor ce au condus la necesitatea unei reimplantări. Au fost efectuate audiogramele tonale şi vocale după reintervenţie şi comparate cu cele mai bune rezultate obținute cu primul dispozitiv. Rezultate. Dintre copiii diagnosticaţi cu hipoacuzii bilaterale profunde şi/sau severe ce au beneficiat de implant cohlear, la 9 dintre aceştia a fost necesară reimplantarea din cauza apariţiei unor complicaţii medicale/chirurgicale sau a unei defecţiuni a dispozitivului implantat. Rezultatele postoperatorii nu au arătat diferenţe semnificative în ceea ce priveşte percepţia tonală şi înţelegerea vorbirii faţă de scorurile obţinute înainte de reimplantare. Concluzii. Implantul cohlear este o procedură chirurgicală sigură, cu o rată scăzută de complicaţii care să necesite reimplantarea, ce nu produce efecte negative din punctul de vedere al performanței auditive, în unele cazuri existând chiar îmbunătăţirea acesteia.
Cuvinte-cheie: implant cohlear, reimplantare, copii

Malformaţii minore de ureche internă în imagistica CT a copiilor cu hipoacuzie neurosenzorială congenitală

Cristian Mârțu, Luminița Rădulescu, Dan Mârțu, Corina Butnaru, Sebastian Cozma

UMF „Gr. T. Popa” Iași - Spitalul Clinic de Recuperare Iași
Examenul imagistic al urechii prin CT se realizează de rutină în cazul co­piilor cu hipoacuzie neurosenzorială congenitală - candidați la im­plan­tare cohleară - și orientează în stabilirea indicației de implantare coh­leară. Acest studiu își propune să evidențieze și să descrie cele mai frec­vente anomalii anatomice ale urechii interne și a nervului cohlear la copiii cu hi­poacuzie neurosenzorială forma profundă bilaterală, prin evaluarea re­trospectivă a imaginilor CT. Lotul de studiu a fost cons­ti­tuit din 14 co­pii, selectați aleatoriu dintr-un grup cu hipoacuzie neu­ro­sen­zorială non-evolutivă forma profundă bilaterală și comparat prin inspecție vi­zu­ală și măsurători pe secțiuni axiale CT a șapte repere anatomice, cu lo­tul martor format din 14 copii cu auz normal. S-au evi­dențiat anomalii anatomice la 10 pacienți, din care 5 au prezentat o anomalie unică. S-au obținut diferențe cu semnificație statistică în cazul modiolului, al turului bazal cohlear și al diametrului canalului auditiv intern osos. Măsurătorile reperelor anatomice în imagistica CT a urechii interne poate fi utilă în de­tectarea anomaliilor unor repere anatomice importante și poate fi con­si­derată o analiză complementară inspecției vizuale, care are caracter su­biectiv. Corelarea acestora cu evoluția rea­bi­litării după implantare coh­leară poate reprezenta un element de pre­dicție a rezultatelor, util în sta­bilirea indicației preoperatorii.
Cuvinte-cheie: hipoacuzie congenitală, malformații minore, computer tomografie

Laryngeal dyskinezia - clinical consideration

A. Borangiu, A. Buruiană, Veronica Epure, Alexandra Schnaider, D.C. Gheorghe

ENT Clinic, “M.S Curie” Emergency Clinical Hospital for Children Bucharest
Laryngeal dyskinesia or paradoxical vocal fold movement has been defined as abnormal vocal cord adduction during the inspiratory phase. Although rare, it is a serious condition in a newborn where is recognized as a distinct cause of congenital stridor, while in an ol­der child tends to mimic asthma attacks. The paper presents the dif­ficulties encountered in establishing the positive diagnosis and also discusses the questions that still remain regarding the me­cha­nisms behind this pathology and the proper management way in these children.
Keywords: vocal folds, adduction, congenital stridor, laryngeal dyskinesia

Pitfalls and management approach of a congenital subglottic stenosis

D.C. Gheorghe, V. Epure, A. Buruiană, A. Neagu, A. Borangiu 

ENT Clinic, “M.S Curie” Emergency Clinical Hospital for Children Bucharest
Laryngeal subglottic stenosis represent about 15% of al laryngeal mal­for­mations. Objective. To study the surgical options for a late dis­­co­v­ered patient with this disease. Material and method. Case pre­sentation of a child with a large medical record (heart surgery) that was not diagnosed pre­viously, with regard to his laryngeal disease. Clinical data and surgical treat­ment results were reviewed. Results. The laryngeal stenosis was ope­ra­ted (single stage laryngoplasty) and the patient was decannulated after 13 days. Conclusions. Laryngeal subglottic stenosis can sometimes be mis­taken/overlooked when associated with other major malformations. Sur­gery must be tailored to the patient, after careful imagistic evaluation. Plas­ty by endoluminal drilling of the laryngeal cartilages can be of good va­lue for long term management. 
Keywords: laryngeal subglotic stenosisi, ENT, child

The decannulation protocol of the ENT Ward of the “M.S. Curie” Hospital

A. Borangiu, Veronica Epure, A. Buruiană, D.C. Gheorghe

ENT Clinic, “M.S Curie” Emergency Clinical Hospital for Children Bucharest
Lately, advancement of intensive care treatment for children with some serious conditions who require mechanical ventilation (trauma, motor vehicle trauma, complex cervico-facial surgery) led to a rise in the number of children with tracheostomy. In case of a favorable out­come, the possibility to decanulate will arise for these children some­time in the future. The paper presents the decannulation pro­to­col employed in the Pediatric ENT ward of the “M.S. Curie” Hos­pi­tal, emphasizing the steps we take before each decanullation, ae­ro­di­ges­tive endoscopic evaluation being mandatory.
Keywords: tracheostomy, decanullation, endoscopy, protocol

Considerations about laryngeal dyskinesia management in small children

D.C. Gheorghe, V. Epure, A. Buruiană, A. Neagu, A. Borangiu 

ENT Clinic, “M.S Curie” Emergency Clinical Hospital for Children Bucharest
Laryngeal dyskinesia in a newborn and infant can be a challenging diagnosis. Objective. To discuss the ethiology and treatment op­tions for patients with this disease. Material and method. Cli­ni­cal data, investigations and therapy performed for 2 laryngeal dys­kinesia cases were reviewed by studying their medical re­cords retrospectively. Results. Surgical results analysis brings into ques­tion the vocal cord anatomy that could recommend a dif­feren­tia­ted approach. Conclusions. Laryngeal dyskinesia refers to the pa­ra­doxical vocal cord movements that are associated just with ins­­pi­ratory flow through the larynx. Observing the dynamic of the re­spi­ratory laryngeal flow, the disease seem to be an anatomical ab­nor­mality of the vocal cords. The treatment needs to be corelated with this ethiology, for best results. Although some cases need just close monitoring, other patients should be approached surgically. Our paper discusses the possibilities and the risks associated with sur­gery of patients with this condition. 
Keywords: laryngeal dyskinezia, ENT, child

Metal esophageal foreign bodies in children - clinical and therapeutical considerations 

Carmen Aurelia Mogoanță1, M.S. Ciolofan1, F. Anghelina1, Elena Ioniţă2, Ioana-Cristina Stanciu2, Alexandra Zbera2

1, 2. ENT Departement - University of Medicine and Pharmacy, Craiova
2. ENT Clinic, Emergency Hospital Craiova
Aim of the study. Metallic esophageal foreign bodies in children is a frequent pathology, sometimes life-threatening if they are located in the region of the esophagus compared with aortic arch, especially if the metal is sharp esophageal foreign body. Subjective and functional symptoms depends on the detection of the foreign body and the ap­pea­rance or not of the complications (acute esophagitis with mucosal ede­ma, chronic esophagitis, you can continue with perforations of the walls by compression exerted by the foreign body; lethal per­fo­ra­tions aortic esophageal etc.). Dysphagia is the main symptom on­set can be pre­sen­ted most often as dysphagia for solids, liquids swal­lowing is possible, es­pecially if metallic foreign bodies (coins, pins, toys fragments) are lo­cated in front of the esophagus lumen. Eso­pha­geal chest pain is present when foreign bodies are cranial fix. It will be correlated with clinical symp­toms, radiological and endoscopic exa­mination. Material and method. We present you the casuistry of metallic esophageal foreign bo­dies solved at E.N.T. Departement of Craiova in the period 2013-2015, the clinical and therapeutic as­pects. Results. I have met a total of 285 patients diagnosed with oeso­phageal foreign body, including 144 patients with a diagnosis of metallic esophageal foreign body. There are three areas where you can stop the most common foreign eso­phageal bodies: mouth, eso­pha­gus, bronhoaortic region and hiatal re­gion. Esophagoscopy is the key of diagnostic and ensure foreign bo­dy extraction. It will always use general anesthesia. Conclusions. The only treatment possible for eso­phageal foreign bodies is their rapid ex­trac­tion by esophagoscopy in mixed team after it was established the si­tuation of the foreign bo­dy by X-rays. In case of delayed extraction or complications we use in­tensive processes and administer massive an­ti­biotic therapy. The child will be released only when completely healed. 
Keywords: foreign body, metallic, child, esophagoscopy

Role of bronchoscopy in diagnosing asthma in children

Iolanda-Cristina Vivisenco1, Mioriţa Toader1, Corneliu Toader2, Mircea Drăghici3, Valeriu Lupu4, Daniela Neacşu5

1. Spitalul Clinic de Urgenţă pentru Copii „Grigore Alexandrescu”, Bucureşti, România
2. Institutul Naţional de Neurologie şi Boli Neurovasculare, Bucureşti, România
3. Spitalul Dentirad, Ploieşti, România
4. Universitatea de Medicină şi Farmacie „Gr. T. Popa”, Iaşi, România
5. Institutul Naţional de Geriatrie şi Gerontologie “Ana Aslan”, Bucureşti, România
Introduction. Asthma represents ¼ of childhood chronic diseases, being considered a development disease in which the respiratory system and the immune response are disturbed due to the impact with the environmental factors. This condition occurs in children who have a genetic predisposition. Objective and methodology. Re­viewing specialized articles regarding diagnosis of asthma in chil­dren, we intend to bring to the forefront the need for performing a bronchoscopy in subjects diagnosed with asthma, receiving treat­ment, but with unfavorable evolution. We present a series of cli­ni­cal cases diagnosed with asthma, which were investigated by bron­choscopy. Results. The presented cases, properly explored and properly diagnosed, had a very good outcome, with complete hea­ling. Conclusion. Performing a simple bronchoscopy in cases of asth­ma rebellious to treatment can establish the correct diagnosis. A good team work between the pulmonologist, pediatrician, family doc­tor and ENT specialist can solve the cases diagnosed and treated for asthma with an unfavorable evolution, despite the treatment ap­plied correctly.
Keywords: bronchoscopy, asthma, child

Diagnostic difficulties in foreign bodies in children

Mioriţa Toader1, Corneliu Toader2, Mircea Drăghici3, Iolanda-Cristina Vivisenco1, Valeriu Lupu4, Daniela Neacşu5 

1.  “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania
2. National Institute of Neurology and Neurovascular Diseases Bucharest, Romania
3. Dentirad Hospital, Ploieşti, Romania
4. UMPh “Grigore T. Popa” Iaşi
5. “Ana Aslan” National Institute of Geriatry and Geriatrics
Foreign bodies in children represent a pathology that always sur­prises the ENT practitioner. The surprise is on the diverse location of the foreign bodies, that requires exploration and extraction under general anesthesia only. Location of a foreign body in the cavumnasi or in the hard palate is a rare situation in pediatric pathology. 
A tho­rough clinical examination, completed by a correct anamnesis and sub­sequent targeted exploration methods, enables diagnosis and then extraction of these foreign bodies. This paper presents ca­ses of such foreign bodies, which required full attention and skill of the ENT prac­titioner, all of them being resolved without any com­plications. 
Keywords: foreign bodies, diagnostic difficulties

Diagnostic strategies in tracheobronchial foreign bodies

Iolanda-Cristina Vivisenco1, Mioriţa Toader1, Corneliu Toader2, Mircea Drăghici3, Valeriu Lupu4, Daniela Neacşu5

1. “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania
2. National Institute of Neurology and Neurovascular Diseases Bucharest, Romania
3. Dentirad Hospital, Ploieşti, Romania
4. UMPh “Grigore T. Popa” Iaşi
5. “Ana Aslan” National Institute of Geriatry and Geriatrics

Introduction. Tracheobronchial foreign bodies are more common in the age group 1-3 years. Their penetration in the airways is one of the dramatic episodes of pediatric pathology. Methods. The authors present a series of cases of bronchial foreign bodies, hospitalized ini­tially in pediatrics units in territorial hospitals, subsequently trans­ferred to the ENT Unit of the Emergency Hospital for Children ”Gri­gore Alexandrescu” in Bucharest, where they were investigated and treated by bronchoscopy under general anesthesia. Results. In many cases, anamnestic data are of paramount importance for the di­agnosis of foreign body aspiration. More frequent in children than in adults, foreign bodies require the attention and competence of the family doctor, the pediatrician, pulmonologist, ENT specialist, the doctor from the Emergency Room. The cases presented in this paper benefited from rigorous exploration in diagnostic and therapeutic purposes, being successfully resolved. Conclusion. Any child whose anamnestic data suggest aspiration of a foreign body, shall be required to perform bronchoscopy under general anesthesia.
Keywords: tracheobronchial foreign bodies, bronchoscopy, children

Allergy and cystic fibrosis aggravating factors for the chronic rhinosinusitis in child 

Alina Murgu

 ”Gr.T.Popa” University of Medicine and Pharmacy, Iaşi, România; ”St. Mary” Emergency Children Hospital, Iaşi, România
Chronic rhinosinusitis is a rare pathology in children whose clinical ma­ni­festations are most commonly in relation to the anatomic and immune res­ponse correlated with the age of the child. Certain conditions still remain undiagnosed in time, so that the treatment initiated late can be with unfavorable prognostic impact. Thus, chro­nic allergic inflam­mation related to the allergic rhinitis or al­tering the functionality of NaCl channels from the epithelial cell in­duced by the defective gene CFTR (cystic fibrosis transmembrane con­ductance regulator) are the patho­logical conditions that lead to sinus drainage deficit and impaired se­con­dary mucociliary clereance. Early diagnosis is suggested by some characteristic elements of atopy în allergic rhinitis (association of comorbid allergic diseases, personal and/or familial atopy; immuno-al­lergic suggestive investigations) or as­sociation of the systemic symp­toms (respiratory, digestive etc.) to complete form of cystic fibrosis or par­ti­culary clinical elements in atypical form (sino-nasal polyposis; mu­co­cele formation; hypo­pla­sia of the paranasal sinuses; specific bacterial in­fection like pseudo­monas sp.). The therapeutic management is com­plex and will be individualized by the pathology that had caused chronic rhino­sinusitis. In conclusion, the chronic rhinosinusitis in children re­cog­nize many causes, through this having a significant impact on in­fant morbidity. Early diagnosis and individualized treatment must be rea­lized in the multidisciplinary team (ENT physician, pediatrician, allergist, fa­mily doctor) because enhance the quality of life of the child and thus gives a favorable evolutionary prognostic. 
Keywords: chronic rhinosinusitis, child, allergy, cystic fibrosis

Complications of rhinosinusitis in children and their treatment solutions 

Adriana Neagoş

MD, PhD, University of Medicine and Pharmacy Târgu-Mureş, Otorhinolaringology Department, Târgu-Mureş, Romania 
The development of maxillary and ethmoid sinuses in 1 or 2-year-old children is clear and definite. In many babies the sphenoid sinus pneu­matization is defined, but the frontal sinus is not defined. In child­hood the rhinosisnusitis is very common, and osteomyelitis is an unusual com­plication. Acute rhinosinusitis is more common in children than in adults. Staphylococcus aureus is the most frequent etiologic agent. Acute bacterial rhinosinusitis is a common complication of viral upper respiratory infection or allergic inflammation. In children, the diagnosis is based on clinical findings and is confirmed by computed tomography. In children, acute rhinosinusitis is associated with orbital inflammation. Acute rhinosinusitis is frequently associated with se­con­dary orbital infection, most commonly subperiosteal abscess in chil­dren. Subperiosteal abscess and orbital abscess are severe types of orbital infection. Subperiosteal hematoma secondary to sinusitis is rare. In subperiosteal hematoma, the CT findings were similar to those of subperiosteal abscess, so the diagnosis is very difficult. Sub­pe­ri­osteal abscess is the most common intraorbital complication in the pe­diatric population, because the periosteum at the medial orbital wall is loosely attached to the lamina papyracea. To the patients with sus­pected subperiostal hematoma surgery rather than antibiotic ad­ministration should be considered. Conventionally, emergency en­do­sco­pic sinus surgery combined with intravenous antibiotics is the first choice for the treatment of suspected abscess. The treatment is clinical and surgical. Differentiation between subperiosteal abscess and he­ma­toma is important, because surgery is needed for hematoma, but not always for abscess.
Keywords: acute rhinosinusitis, orbital inflammation, endoscopic sinus surgery, intravenous antibiotics

Importanţa screeningului auditiv la preșcolari

Mădălina Georgescu1,2,3, Magda Cernea2,3

1. Reprezentant național EFAS, Institutul de Fonoaudiologie și Chirurgie Funcțională ORL „Prof. Dr. Dorin Hociotă”
2. Universitatea de Medicină și Farmacie „Carol Davila” București
Lipsa identificării și tratării tulburărilor de comunicare survenite în co­pilărie are consecințe negative pe termen lung - rezultate aca­de­mice li­mi­tate, scăderea oportunităților de angajare și dificultăți de integrare so­cială. Hipoacuzia permanentă, uni- sau bilaterală do­bândită în mica co­pi­lărie, este de 10 ori mai frecventă (3-5%) de­cât hipoacuzia congenitală sau dobândită perinatal. Depistarea și intervenția precoce a hipoacuziei și a celorlalte tulburări de co­mu­nicare (văz, limbaj) creează oportunități ega­le tuturor copiilor. Ini­ția­tiva EFAS de a crea un standard ridicat al ser­vi­ciilor de sănătate pen­tru copiii preșcolari și școlari s-a finalizat în Con­clu­zia Consiliului Uniu­nii Europene „Depistarea și tratamentul precoce al tulburărilor de comunicare la copii, inclusiv utilizarea instrumentelor e-sănătate și soluții inovative” (2011/C 361/04). Lucrarea de față prezintă re­zultatele primului screening auditiv la preșcolari efectuat în România.
Cuvinte-cheie: hipoacuzie, preșcolari, screening auditiv

Why neonatal hearing screening?

Maria Stamatin, Gabriela Ildiko Zonda, Andeea Avasiloaiei, Luminiţa Păduraru

”Gr. T. Popa” University of Medicine and Pharmacy Iași, Romania; Department Mother and Child, Division of Neonatology; ”Cuza-Voda” Maternity Hospital Iași; Level III Regional Center of Neonatal Intensive Care
Hearing loss affects about 1-3 out of every 1000 live births. The initial signs of hearing loss are very subtle. Moderate-to-severe hearing loss in young children may remain undetected until well beyond the new­born period, and milder hearing loss and unilateral hearing loss may not be diagnosed until school age. Failure to detect children with con­genital or acquired hearing loss may result in lifelong deficits in speech and language acquisition, poor academic performance, social mal­adjustments, and emotional difficulties. Without appropriate op­por­tunities to learn language, these children will fall behind their hea­ring peers in communication, cognition, reading, and social-emo­tional development. Such delays may result in lower educational and em­ployment levels in adulthood. To maximize the outcome for infants with hearing impairment, the hearing of all infants should be screened at no later than 1 month of age. Early identification of hearing loss and appropriate intervention within the first 6 months of life have been demonstrated to prevent many of these adverse consequences and facilitate language acquisition. Transiently evoked otoacoustic emis­sions is a suitable test for neonatal hearing screening because it is a sim­ple, non-invasive, short duration and cost effective method, with 99.7% negative predictive value. All these characteristics make it a good pri­mary neonatal hearing screening tool. Systematic neonatal hearing scre­ening is the most effective tool for early detection of hearing im­pair­ment, allowing early diagnosis and immediate intervention for an im­proved intellectual, linguistic, emotional and social outcome.
Keywords: neonatal hearing screening, hearing impairment, timely diagnosis, early intervention

Neonatal audiological test or hearing screening în Moldavian area - where are we?

Luminiţa Păduraru, Andreea Avasiloaiei, Gabriela Ildiko Zonda, Maria Stamatin

”Gr. T. Popa” University of Medicine and Pharmacy Iași, Romania; Department Mother and Child, Division of Neonatology; ”Cuza-Voda” Maternity Hospital Iași; Level III Regional Center of Neonatal Intensive Care
In developed countries many neonatal centers practice neonatal hearing screening using several methods and strict guidelines. In Romania, first tests were performed in 2007. In Moldavian area only one level III center reached a screening rate of over 98% in 2011. Objective. The study aims to evaluate the level of implementing a screening protocol in Moldavian counties and steps left to be reached in order to advance from hearing testing to hearing screening for all neonates. Material and methods. We evaluated 15501 newborns cared in Level III Maternity ”Cuza-Vodă” between August 2013 and December 2015. We also identified the existing equipment and staff or such needs in order to extend or implement screening in other level III centers from Moldavia, based on a survey addressed to those centers. Results. From over 99% newborns tested in pilot center, 12% to over 14.70% were identified at high risk for hearing impairment, 15% to 18% were refered to audiologist and from them 34 were diagnosed with different stages of congenital hearing loss and benefited from cochlear implant in first months of life. Conclusions. Hearing testing after birth has to become hearing screening based on general guidelines implemented in all hospitals. This will give the possibility to early detect all cases in need of quick intervention to provide hearing chances and a good neurodevelopmental status with an improved quality of life.
Keywords: neonatal audiological test, hearing screening

Criteria for diagnosis and forecast of sensorineural hearing loss in children on the basis of the analysis of the risk factors

Anghelina Chiaburu, Ion Ababii, Doina Chiaburu-Chiosa, Constantin Jucovschii

“Nicolae Testemițanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
The etiological diagnosis with maximum accuracy has a major importance in the problem of sensorineural hearing loss in children. Many researches have allowed to identify a series of factors acting at different stages of ante-, intra-, or postnatal period that would contribute to the installation of hearing loss in children. The goal. The discriminant statistical analysis of the risk factors, in the periods ante-, intra-, or postnatal for identification and forecasting of sensorineural hearing loss in children, based on their. Materials and methods. In 110 children aged between 0-36 months, with different forms of sensorineural hearing loss, have been studied 57 risk factors; children with a history of deafness within the family (genetic forms) were excluded from the study group. The distribution by age was: 0-12 months - 21 children (19.09%); 13-36 months - 89 children (80.91%). The distribution in accordance with the degree of hearing loss was: children with moderate form - 29 (26.36%), severe - 51 (46.36%), deep - 30 (27.28%). Results. The single factor discriminat analysis under F-criterion has allowed the demonstration of the following factors, in the antepartum period: harmful professional conditions of mother 17.43% (p<0.05), chronic somatic disease of the mother 18.35% (p<0.05), the intragenitale diseases 37.61% (p<0.01), CMV 24.77% (p<0.001), the administration of ototoxic drugs 92.61% (p<0.05), the intranatal period - palogical extended birth (EBRD) 40.91% (p<0.01), accelerated delivery 28.18% (p<0.001), asphyxia 64.55% (p<0.001), prematurity 16.36% (p<0.05), hipotrophy 20% (p<0.05), hemolytic jaundice 13.64% (p<0.05); the postnatal period - meningitis 20% (p<0.05), craniocerebral trauma 22.73% (p<0.05), the administration of ototoxic drugs 47.27% (p<0.001). For forecasting the installation of hearing loss in children on the basis of the risk factors, we appeal to the multifactorial analysis and the interconnection of factors. The discriminating analysis “step-by-step” highlighted the 9 factors of the ante- and intranatal periods: pathological birth (F=56.715), asphyxia at birth (F=5.371), low Apgar score ≤7 (F=12.154); prematurity (F=20.322), forceps (F=4.455), circular umbilical cord (F=3.510), hemolytic jaundice of the newborn (F=2.622), IVA during the pregnancy (F=5.359), pyelonephritis at the mother (F=2.824). The discriminating analysis “step-by-step” highlighted the 7 factors of the postnatal period: the administration of ototoxic drugs (F=26.512), craniocerebral trauma (F=12.388), meningitis (F=5.645), cytomegalovirus (F=9.492), acute viral infection with high fever (F=4.196), neuroinfections (F=3.184), complications after vaccination (F=2.622). The discriminating analysis using these variables allows the forecasting of the sensoroneural hearing loss in children in 84.40% of cases. Conclusions. Highlighting the factors with the major contribution in the outbreak of deafness and the principle of forecast allow the development of measures to prophylaxis and etiologic diagnosis of sensorineural hearing loss in children.
Keywords: sensorineural hearing loss, risk factors, discriminating analysis, forecast, prophylaxy

Schizofrenia cu debut după implantare cohleară: cauză de dezimplantare. Prezentare de caz

Andreea Szalontay1,3, Luminița Rădulescu1,4, Dan Mârțu1,4, Sebastian Cozma1,2

1. Universitatea de Medicină şi Farmacie „Grigore T. Popa” Iaşi, Facultatea de Medicină
2. Spitalul Clinic de Recuperare Iaşi, Compartimentul de Audiologie și Vestibulogie
3. Spitalul Clinic de Psihiatrie „Socola” Iași
4. Spitalul Clinic de Recuperare Iaşi, Clinica ORL
Implantul cohlear este o proteză auditivă implantabilă, singura soluție disponibilă pentru pacienții cu hipoacuzii severe și profunde care nu au beneficii cu proteze auditive convenționale. Pacienții cu patologie psi­hiatrică diagnosticată în momentul recomandării implantului cohlear pot avea contraindicație relativă în funcție de afecțiune. Prezentăm ca­zul unei tinere diagnosticate cu hipoacuzie neurosenzorială profundă bi­laterală postlinguală, cu limbaj bine conservat și fără afecțiuni psihiatrice, care a primit un implant cohlear la vârsta de 19 ani. După doi ani de evoluție favorabilă, cu performanțe excelente auditiv-verbale, pacienta a prezentat un debut de schizofrenie, cu halucinații vizuale și auditive. Patologia s-a agravat, pe fondul nerespectării tratamentului psihiatric. Pacienta prezenta halucinații auditive puse pe seama implantului și a so­licitat explantarea sub amenințarea cu suicidul. La insistențele sale și ale familiei, dispozitivul auditiv a fost explantat. La 4 ani după dez­im­plan­tare, după tratament psihiatric, pacienta și familia solicită din nou implantarea cohleară, motivând evoluția favorabilă a patologiei psi­hia­trice și nevoia pacientei de a comunica. Recomandarea de implant coh­lear și intervenția în acest caz s-au făcut cu doi ani înaintea debutului afec­țiunii psihiatrice. Explantarea dispozitivului auditiv compromite șan­sele de comunicare auditiv-verbală și de reinserție socială, dar în­de­părtează un posibil trigger pentru manifestările schizoide. Cazul pre­zen­tat ilustrează un tipar de evoluție nefavorabilă a unui pacient surd cu implant cohlear, pe fondul apariției unor comorbidități fără legătură cu cauza surdității. Apreciem că în prezent nu există instrumente de pre­dicție a unui posibil comportament deviant, astfel încât să poată fi evi­tate eșecurile reabilitării auditive prin implant cohlear. Nu există de ase­menea nici o certitudine cu privire la evoluția cazului din punct de ve­dere psihiatric după explantare, motiv pentru care nici reimplantarea nu poate fi luată în considerare.
Cuvinte-cheie: implant cohlear, schizofrenie

Implantarea bilaterală la copilul cu surditate congenitală

Luminița Rădulescu, Cristian Mârțu, Dan Mârțu, Sebastian Cozma

UMF „Gr. T. Popa” Iași - Spitalul Clinic de Recuperare
Implantarea cohleară bilaterală simultană sau secvențială suscită o lar­gă dezbatere în lumea medicală de specialitate. Decizia de im­plan­ta­re si­mul­tană trebuie bine cântărită. Fiecare pacient trebuie să fie evaluat se­pa­rat. O limitare ar putea fi: creșterea timpului operator, care implică un risc cres­cut al anesteziei generale, greutatea copilului, prezența auzului rezidual în a doua ureche, capacitatea părinților de a acoperi costurile de întreținere a două implanturi, unele comorbidități asociate etc. În ceea ce privește im­plan­tarea secvențială, întrebarea este: „există sau nu există o vârstă critică sau un interval critic” pentru im­plantarea celei de-a doua urechi la copiii deja im­plan­tați unilateral? Studiile de până acum au rezultate contradictorii. Un stu­diu foarte recent, publicat de Gordon și Papsin (în ianuarie 2016), arăta că cel de-al doilea implant la copiii cu surditate bilaterală congenitală trebuie să fie realizat în termen de 18 luni, dar este corect de spus că nu există un acord uni­versal valabil în ceea ce privește momentul optim pentru al doilea implant în cazul implantării secvențiale. În același timp trebuie cunoscut faptul că im­plan­tarea celei de-a doua urechi salvează de fapt urechea pentru viitor. În cele din urmă, dar nu în ultimul rând, trebuie luate în considerare normele exis­tente care permit implantarea copiilor cu surditate bilaterală congenitală în vârstă de până la 6 ani.
Cuvinte-cheie: implantare cohleară, surditate congenitală, ORL

Incidenţa neuropatiei auditive în screeningul auditiv la nou-născuţi

Sebastian Cozma1,2, Oana Bitere2, Luminița Păduraru1, Maria Stamatin1, Raluca Olariu1, Cristian Mârțu1,3, Luminița Rădulescu1,3

1. Universitatea de Medicină şi Farmacie „Grigore T. Popa” Iaşi, Facultatea de Medicină
2. Spitalul Clinic de Recuperare Iaşi, Compartimentul de Audiologie și Vestibulogie
3. Spitalul Clinic de Recuperare Iaşi, Clinica ORL
Introducere. Neuropatia auditivă include pacienții care prezintă drept caracteristică existența unui paradox în cadrul efectuării testelor obiec­ti­ve: conservarea otoemisiunilor acustice tranzitorii și alterarea sau absența po­tențialelor evocate acustic. Pacienții cu această patologie prezintă pra­guri auditive diferite, putând prezenta auz normal sau hipoacuzie de diverse grade. Aceștia sunt capabili să răspundă la sunete în mod co­res­punzător, dar capacitatea lor de a decoda vorbirea și limbajul poate fi deteriorată, mai ales în prezența zgomotului. Scopul studiului a fost ace­la de a identifica toate cazurile de neuropatie auditivă care au fost de­pis­tate în cadrul programului de screening universal al hipoacuziei în populația de nou-născuți din municipiul Iași, într-o perioadă de patru ani (februarie 2012 - martie 2016). Material şi metodă. Studiul efectuat a cuprins în baza de date toţi nou-născuţii care nu au trecut testul de scre­ening din maternitate sau care l-au trecut, dar au prezentat factori de risc pen­tru surditate şi s-au prezentat în Compartimentul de Audiologie al Spi­ta­lu­lui Clinic de Recuperare Iaşi pentru faza de diagnostic. Identificarea neu­ropatiei auditive a fost posibilă cu ajutorul testelor obiective: oto­emi­siunile acustice și potențialele evocate auditive de trunchi cerebral, coroborate cu teste subiective auditive. Rezultate. În cei patru ani incluşi în stu­diu au fost identificaţi 24 de copii cu neuropatie auditivă. Dacă la 20 din­tre aceştia au fost diagnosticate hipoacuzii de diverse grade (uşoare, me­dii, severe sau profunde) simetrice sau asimetrice, la unii dintre subiecţi fiind surprins caracterul fluctuant al surdităţii, la patru pacienţi auzul s-a în­cadrat și a rămas în limite normale bilateral. Concluzii. Screeningul auditiv universal la nou-născuți oferă șansa identificării copiilor cu neu­ro­pa­tie auditivă, care necesită o abordare diagnostică și terapeutică diferită în comparație cu pacienții cu pierdere auditivă periferică obișnuită. Di­ag­nos­ticul precoce este esențial în stabilirea strategiei de supraveghere sau a strategiei terapeutice în funcție de fiecare caz. 
Cuvinte-cheie: neuropatie auditivă, screening auditiv

Comorbidity between hypoacusia, mental retardation and language disorders - a necesity of a multidisciplinary approach

Andreea-Silvana Szalontay1, Alexandra Boloș1, Ioana-Smaranda Lupușoru2, Sebastian Cozma3

1. Lecturer in Psychiatry, PhD in Medicine, UMPh “Grigore T. Popa” Iaşi, consultant psychiatrist
2. Student at UMPh “Grigore T. Popa” Iaşi, General Medicine, VIth grade
3. Lecturer, ENT, PhD in Medicine, UMPh “Grigore T. Popa” Iaşi, ENT consultant
In recent decades, advances in genetic research, in neurobiology and the therapeutic approach brought major changes in the understanding and management of mental retardation. The nosology of the disorder and the concepts of this entity have developed over the years and today it is no longer be regarded as sickness, but a ”complex syndrome”, which may include genetic damage or a specific medical condition. Children with mental retardation may associate: hearing impaired in 10% of cases, seizures, chronic infantile encephalopathy in 30% to 60% of cases, conduct disorder, anxiety, hyperkinetic syndrome, learning or language disorders. Currently, in all countries, there are programs focused on care of children with mental retardation, adapted to the socio-cultural issues, involving multiple medical specialties such as pediatrics, pediatric neurology, physiotherapy and kinesiology, ENT, psychiatry, psychologist and also psychopedagogy specialist. In a case with hearing loss is particularly important to consider not only the severity of the disease, but also the period of the onset of it. The fact is crucial for the understanding of the deviations that occur in the development of children with hearing loss and preventing misdiagnoses as a mental retardation. Hearing loss installed early, during the period in which the child’s speech was not yet totally developed, usually determined language disorders, unless special measures are initiated (like an auditory prosthesis). In cases of hearing loss installed later, at an age when the child’s speech is formed, its development will be continued, but keeping a number of inadequacies caused by hearing loss. However, for children with mental retardation, a delay in speech will be developed. Many children have dyslalic speech and a reduced vocabulary. They understand basic speech, but more complex verbal expressions are not always accessible to them. Comorbidity with hearing loss will result in a more difficult language development in these children, that requires a collaborative team with psychiatrist, ENT specialist, psychologist, logoped, with the possible detection of early sensory impairment and, as much as possible, adjusting it, to allow the development to a maximum capacity of these children. It is necessary to apply early action, to stimulate individual available capacity by using specific psycho-pedagogical measures. Thus, they can obtain self-service skills acquisition, assimilation of school knowledge, to the extent possible, an increase in the autonomy of these children, through learning behavioral schemes. They should use appropriate treatments for correcting auditory or visual difficulties and motor ones.
Keywords: hearing loss, mental retardation, multidisciplinary, children

Multidisciplinary approach regarding tinnitus in children and adolescents

Alexandra Boloș1, Andreea-Silvana Szalontay1, Sebastian Cozma2

1. Lecturer in Psychiatry, PhD in Medicine, UMPh “Grigore T. Popa” Iaşi, consultant psychiatrist
2. Lecturer, ENT, PhD in Medicine, UMPh “Grigore T. Popa” Iaşi, ENT consultant
Tinnitus is one of the most common otologic symptom, but probably the most troublesome. Tinnitus causes a number of physical and psy­cho­lo­gical consequences, that interfere with quality of life of the patient. Many authors believe that the presence of tinnitus in children as a matter of lesser importance than the adult because it meets less frequently and would be a fleeting symptom, inoffensive for them (Graham, 1981). In addition, the prevalence of tinnitus during adolescence and even in young adults is increasing, possibly as a consequence of the in­creased ambient noise (Bulbul SF, Shargorodsky J). In a study realized by Nodar per 2,000 children, followed-up for 11 years, he observed that the in­cidence of tinnitus is 13% among children who had a normal audio­gram, 23% to 60% of cases of children with hearing disorders, 44% of those with secretory media otitis. However, only three percent of all of them declared spontaneously its presence because they consider ed it nor­mal. But, even if this symptom is not presented spontaneously in chil­dren, it can cause abnormal behavior. The relationship between tin­nitus and psychological factors is complex, a dual one, because the pre­sence of tinnitus had an important impact on functioning and on well being. Thus, if the well beeing is damaged, that may worsen tinnitus (Rauschecker, 2010). In this context, the presence of anxiety can be an im­portant factor in the differentiation in terms of subjective tinnitus se­verity. This relationship is still controversial, especially because the an­xiety has both a cognitive dimension, as well as somatic one, which were poorly studied, particularly in children and adolescents who have ex­pe­rienced tinnitus. Also, children with tinnitus had more frequent sleep dis­turbances or learning disorders. Tinnitus has many and varied causes, but most commonly otorhinolaryngological diseases, especially since this noise-induced hearing loss. But, physicians should not only focus on the disease in the hearing, as the cause of tinnitus and to consider that pa­tients must learn to live with tinnitus, commonly called an incurable pro­blem. Various therapeutic approaches like pharmacologic therapy (psy­chotropic medications), non-pharmacological therapy, sur­gical the­ra­py or brain stimulation have generated different results, which led him to consider the role of psychological factors, hence the need for mul­ti­disciplinary approach to the subject.
Keywords: tinnitus, multidisciplinary, psychologic factors, children

Aspecte specifice ale protezării auditive a copilului de vârstă foarte mică

Anca Modan

Centrul de îngrijire a auzului AUDIOLOGOS
Introducere. Am pornit de la următoarea ipoteză: protezarea auditivă a copilului de vârstă foarte mică necesită adoptarea unor metode de amplificare și de purtare specifice comparativ cu a celorlalte grupuri de pacienți. Metode. Am alcătuit un eșantion de 10 copii cu vârsta de până în 6 luni protezați în perioada noiembrie 2010 - noiembrie 2015. Pentru fiecare dintre acești copii am analizat algoritmul de prescriere a câștigului protetic care a dat rezultatele audiometrice cele mai bune, tipul de olivă care a fost cel mai bine tolerat și metodele de purtare care au fost încununate de succes. Părinții au completat chestionarul „Little Ears” pentru evaluarea progreselor auditive făcute de copil în urma purtării protezelor auditive. Rezultate. În cazul folosirii metodelor prescriptive ale amplificării fără ajustarea suplimentară a câștigului protetic pentru frecvențele audiometrice marginale, se vor obține amplificări exagerate ale frecvențelor joase și foarte înalte. În privința materialelor utilizate pentru realizarea olivei, pentru copiii cu hipoacuzii ușoare - moderate, datorită dimensiunilor extrem de mici ale conductelor auditive externe la această vârstă, precum și datorită laxității cartilajelor, s-au dovedit mai ușor de realizat și pur­tat olivele din material dur, în contradicție cu recomandările care se întâlnesc în general de a utiliza siliconul. Concluzii. Pentru co­piii de vârstă foarte mică, până în 6 luni, sunt necesare ajustări ale algoritmilor de prescriere a amplificării, chiar și atunci când sunt fo­losite metode prescriptive pediatrice, și în general olivele trebuie adaptate conformației și consistenței conductului auditiv extern.
Cuvinte-cheie: protezare auditivă, copil, olive, amplificare, hipo­acu­zie

 

Auditory evoked potentials test of the trunk of the brain in the diagnosis of sensorineural hearing loss in children with perinatal pathology of the central nervous system

Ion Ababii, Anghelina Chiaburu, Svetlana Diacova, Doina Chiaburu-Chiosa

“Nicolae Testemițanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
The Goal. The study of the special features of the electro­en­ce­pha­lo­graphic response and auditory evoked potentials limits of the trunk of the brain in the diagnosis of sensorineural hearing loss in children with perinatal pathology of the central nervous system. Materials and methods. Audiological examination by the recording of the auditory evoked potentials test of the trunk of the brain has been carried out in the center of the Audiology IMSP IMsiC. The study group included 110 children (the main group) with various neurological disorders and sensorineural hearing loss and 30 children (the control group) with normal hearing, the age of the children being between 1-36 months. In accordance with the degree of hearing loss, the children from the main group have been divided in: 29 children with moderate hearing loss, 51 with severe hearing loss and 30 with deep hearing loss. Recording evoked potential has been conducted in accordance with the conditions and the parameters required, the children being in a state of physiological sleep or on medication. Results and discussions. The value of the auditory threshold determined on the basis of wave V of the potential hearing aids in group of children with moderate hearing loss was 61.69 dB±1.09 dB; in children with severe hearing loss was 76.92±0.64 dB; in the group of children with profound hearing loss this was 97.69±0.96 dB. In the main group the auditory evoked potential have been determined by a pathological trend, determined by the lack of all the components of the times the waves I, III and V deleted, irreproducible. The wave I in cases of moderate hearing loss has been detectable 84.03%, in cases of severe hearing loss was absent in 16.67% and absent in 53.33% in the group with profound hearing loss. The comparative analysis of the results obtained reveals a prolongation of the latency of the waves I, III, V and the interval I to V from the control group. We studied the auditory evoked potentials in the dynamics to 43 children with hearing loss, 9 of them with moderate hearing loss, 22 with severe hearing loss and 12 with profound hearing loss, in all cases after the neurological treatment. It has been found an improvement in the shape of the wave form that allowed the identification of the waves I and III, in several cases in relation to the initial examination. If in the group with moderate hearing loss wavelength III to the initial examination has not been possible to identify only in 25% of cases, then the lengthwise examination in 50%, the group of children with severe hearing loss in 35.71% from 16.67% at the initial inspection and 41.67% from 16.67% in the group of children with profound hearing loss. During the longitudinal control it was noted an improvement in the identification of the waves and the waveform in its entirety. So if at the time of the initial examination in the group with severe hearing loss the auditory evoked potentials have been absent in 22.73% of cases where the examination in the dynamics their lack was found only to 4.55%. In the group with profound hearing loss of the 75% of the cases for which the first examination has recorded the absence of the auditory evoked potentials, at the repeated examination it has been confirmed the absence in just 8.33% of cases. These results confirm the sensitivity of the auditory evoked potentials the turmoil at the level of the central nervous system. Conclusions. The auditory evoked potential test of the trunk of the stroke is an objective method, reliable, in the diagnosis of hearing loss in children with perinatal pathology of the central nervous system remains a the reference method in the complex audiological exam.
Keywords: auditory evoked potentials, child, ENT

The role of early intervention for multi-sensory impaired children

Coca Marlena Vasiliu, Mara-Ştefania Potop, Daniela Gurgu

Special Technological High School „Vasile Pavelcu” Iași; Early Intervention Center for Sensory Impaired Infants Iași
The services provided within the pale of Early Intervention Center in Iaşi are offered by a multi-disciplinary team. Part of this team are specialists in early intervention (speach therapist, kinetotherapist), neonatologist, ENT and ophthalmologist doctors and not in the very least the child’s parents. The parents are playing a key part in our team and within their role as ”co-therapist” they are following on, at home, the steps we started at our Center. In the Case Study we are presenting an example of demarche accomplished by our Center. This consists of: functional evaluation in all areas of development and determining the priorities accordingly, planning the therapeutical intervention, periodical eva­lua­tions followed finally by the resized interventions focused on every par­ticular case. Adela was included in our program in December 2013, dr. Cozma Sebastian being the one that referenced her. Adela was born on the 20th of May 2013, having only 27 weeks at her gestational age. Her birth weight was 850 grams (1.87393 lb), having an Apgar score of 4 (four) after one minute. Among her many diagnostics we are men­tio­ning: rethinopathy of prematurity st.2+ AO- surgically operated and bi­laterally REFER answer at the audiometrical testing.
Keywords: early Intervention, multi-sensory impaired children, multi-disciplinary team, cochlear implant

Modul în care alegerea optimă a parametrilor AGC influenţează inteligibilitatea vorbirii la pacienţii cu diferite patologii generatoare de hipoacuzie

Anca Modan

audiolog, Centrul de îngrijire a auzului „Audiologos”
Introducere. Am pornit de la două ipoteze: 1. Modularea și limitarea amplificării prin sistemul de control automat al amplificării (AGC) înglobat în protezele auditive au influență și asupra inteligibilității vorbirii, nu doar a confortului audiției. 2. Influența sistemului de control automat al amplificării asupra inteligibilității vorbirii este dependentă de patologia care a generat hipoacuzia. Metode. Am ales cele mai frecvente trei tipuri de patologii generatoare de hipoacuzie întâlnite mai des în practica audiologică: otoscleroza, neuropatia auditivă și presbiacuzia. Pentru fiecare patologie am testat opt pacienți protezați bilateral. Sistemul de control automat al amplificării acționează prin două componente: punctul de declanșare al compresiei (CK) și rata de compresie (CR). Pentru teste am setat parametrii sistemului AGC în trei moduri diferite, pentru fiecare pacient în parte: CK scăzut (sub 55 dB) și CR mare (peste 2.00), CK moderată (55 dB) și CR moderată (2.00) cu CK ridicat (peste 55 dB) cu CR mică (sub 2.00). Fiecare pacient a efectuat o audiogramă vocală în câmp liber cu cele trei setări ale AGC. Rezultate. Pentru pacienții cu otoscleroză, inteligibilitatea vorbirii este maximă, în condițiile utilizării unei CR moderate, însoțită de CK moderat. Pentru pacienții cu neuropatie auditivă, inteligibilitatea vor­bi­rii a fost maximă, în condițiile utilizării unui CK mare cu o CR mică. Pentru pacienții cu presbiacuzie, inteligibilitatea vorbirii este ma­xi­mă, în condițiile utilizării unui CK mare, cu o rată de compresie mi­că, dar confortul perceput al sunetelor înconjurătoare este diminuat în aceas­tă combinație de parametri. De aceea, combinația optimă a pa­ra­metrilor AGC pentru pacienții cu presbiacuzie s-a dovedit a fi tot CR mo­derat cu CK moderat.
Cuvinte-cheie: AGC, proteza auditivă, compresie, inteligibilitatea vorbirii, hipoacuzie

Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program – a valid instrument for the evaluation of the neonatal hearing screening

Mirela-Cristina Stamate

UMPh Cluj-Napoca
Objective. Parent satisfaction is a new concept in healthcare service. As the Neonatal Hearing Screening Program is still being implemented in Romania, it is important to study parent satisfaction because the success of the hearing screening depends on the parent’s cooperation and the parent satisfaction measures the quality and the usefulness of neonatal hearing screening. We aim to validate the Romanian version of The Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program. Methods. This study included 137 participants, who vo­lun­teer to complete the questionnaire after the hearing screening. A sam­ple of 30 participants was asked to complete a second copy of the questionnaire a month later. Results. The hearing screening program was well received by the parents, who reported high levels of overall satisfaction (98.5%) and satisfaction regarding the information prior to testing (68.4%), the medical staff responsible for hearing testing (61.3%) and the appointment schedule (67.4%). The Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program showed a good internal consistency, strong test-retest reliability and positive significant correlations between overall satisfaction with the other dimensions of the questionnaire. Conclusion. The Parent Satisfaction Questionnaire with the Neonatal Hearing Screening Program translated and adapted for Romanian-speaking patients proved to be valid and reliable for assessing parent satisfaction with the hearing screening.
Keywords: neonatal hearing screening, parent satisfaction question­naire, hearing loss

Terapii creative în abordarea copiilor cu implant cohlear

Magdalena Cernea1, Mădălina Georgescu2

1. Otomed Medical Center
2. UMF „Carol Davila”
Scop. Lucrarea pune în discuție problematica expresivității copiilor cu implant cohlear aflați între cele două lumi: cea a surzilor și cea a celor cu auz normal. Terapia logopedică specifică, de lungă durată, le oferă posibilitatea învățării limbajului verbal în defavoarea celui mimico-gestual, însă nu le asigură mijloacele de exprimare a emoțiilor. Material și metodă. Sunt ilustrate două tipuri de terapie: terapia prin joc și dra­materapia, adaptate vârstei și particularităților copiilor. Metodele te­ra­peutice au fost aplicate pentru trei grupuri de copii cu vârste cuprinse între 3 și 18 ani, cu ocazia a două tabere naționale de vară desfășurate în anul 2015. La programul terapeutic au participat 43 de copii hi­po­acuzici și 20 de copii cu auz normal. Rezultate. Rezultatele indică o îm­bunătățire a strategiilor de exprimare și de comunicare ale copiilor participanți la grupurile de terapie, indiferent de vârstă. Două dintre cele trei grupuri au finalizat programul terapeutic cu un spectacol de teatru prezentat în fața părinților și specialiștilor. Concluzii. Copiii cu implant cohlear necesită abordări terapeutice creative de reabilitare, pentru a preveni tulburările afective care pot apărea ca urmare a dificultăților de exprimare a emoțiilor.
Cuvinte-cheie: implant cohlear, terapie prin joc, dramaterapie, expre­si­vi­tate

Some data about first fourteen CI cases in children in Republic of Moldova

Andrei Antohi1, Alexandru Sandul1, Sergiu Vetricean1, Anghelina Chiaburu1, Diana Chirtoca2, Valeriu Fortuna3, Doina Chiaburu4

1. USMPh “Nicolae Testemiţanu”
2. Audiology Physician, USMPh “Nicolae Testemiţanu”
3. ENT Resident Physician, USMPh “Nicolae Testemiţanu”
4. ENT Resident Physician, USMPh “Nicolae Testemiţanu”
Objective. To evaluate the functional results of first 14 cases of CI sur­ge­ries in children in Republic of Moldova. Study design. Re­tro­spective ca­ses. Patients. Six girls of average age 3.57 years old, and seven boys of ave­rage age 4.14 years old. For all of them, the di­ag­nosis was: congenital sen­sorineural bilateral severe-profound hea­ring loss. All patients cor­responded to CI requirements. They were in good physical and psychical con­ditions. No contraindications marked. One postlingual girl of 17-years-old with acquiring  profound hea­ring loss. All prelingual patients wore hearing aid at least one year be­fore surgery. Surgery. Cohlear im­plan­tation using a round window in­sertion technique for 12 pacients and coch­leos­tomy for 2 children. Lo­cation. Central University Hospital. Main outcome measures. All patients underwent interventions without com­plications. In all of them were done three PO fittings. A team including an audiologist, speech therapist, psychologist has been working on re­ha­bilitation. Results. To appreciate hearing improvement they used free field au­dio­metry. The average increase of hearing at different frequencies was from 30 to 60 dB. Coclusion. Cohlear implantation is still the only so­lution in sensorineural bilateral severe-profound hearing loss. 
Keywords: cohlear implantation, child, ENT

Sensorineural hearing loss related to the agenesis of the corpus callosum

Andreea Rusescu, Simona Șerban
 

“Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest
The authors present the case of a 7-year-old child who suffers from moderate bilateral sensorineural hearing loss and hyperkinesis, who is wearing hearing aids since the age of three but without any benefits in his speech development, and who presented to our clinic to assess the performance of the hearing aids. The objective audiometry using tympanometry reveals the presence of fluid in both middle ears. Brainstem evoked response audiometry (BERA) was done under general anesthesia, after the drainage of the fluid from the middle ear and this raised the suspicion of a left retrocochlear lesion. The imaging examination does not reveal any mass process but shows the absence of the corpus callosum, hydrocephalus and dif­fuse cortical atrophy. The benefit of the hearing aids is reduced because the malformation of the key brain structure affects speech processing as well as the speech production. This is a rare case of brain malformation which associates the sensorineural hearing loss and the internal hydrocephalus. The recovery is limited as the de­velop­ment of special communication strategies is not favoured by the maximum neuroplasticity period anymore.
Keywords: agenesis of the corpus callosum, bilateral sensorineural hearing loss, hydrocephalus, speech development

Acute ethmoiditis in children with orbital complications

V. Budu, A. Coman, T. Decuseară, A. Pamfiloiu, A. Costache, A. Guliga, C. Ioniță, M. Tușaliu

 “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest
The complications of acute ethmoidal rhinosinusitis in children have de­creased considerably since the advent of antibiotics, even though we face constantly with them. The most common complications in acute eth­moidal rhinosinusitis in children are the orbital cellulitis. Infec­tion can spread directly through lamina papyracea (being a thin bone in children that separates theethmoid from the orbit) or vascular dis­se­mi­nation. Medical therapy consists in intravenous antibiotics and sinus drainage. The therapeutic algorithm begins with drug therapy, but in case of failure or progression of ocular symptoms it is necessary an en­do­scopic surgical ethmoid drainage. The authors present their own ex­perience of endoscopic orbital decompression in complicated acute eth­moiditis in children.
Keywords: ethmoid rhinosinusitis in children, orbital cellulitis, en­do­scopic orbital decompression

Evaluation and management of antroachoanal polyps in children

Gheorghe Iovănescu, Alina Anglitoiu, Delia Horhat, Karina Marin, Roxana Popa, Dana Gidea

“Victor Babeş” University of Medicine and Pharmacy; Emergency Hospital Timișoara County , ENT Pediatric Department, Timişoara, Romania
Correspondence: Gheorghe Iovănescu, e-mail: giovanescu@gmail.com
Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. ACPs are almost always unilateral, although bilateral ACPs have been reported in literature. The most common presenting symptoms are nasal obstruction and nasal drainage. Nasal endoscopy and computed tomography (CT) scans are required for making the diagnosis and the treatment planning. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. The purpose of this study was to review the epidemiology, etiopathogenesis, clinical features, the preoperative evaluation, pathology, differential diagnosis, treatment and com­plications of ACPs on a trial of 18 cases in the last 5 years. For all patients we performed functional endoscopic sinus surgery (FESS) and we didn’t perform Caldwell-Luc procedure for none of them. For 8 patients we used combined endoscopic middle meatal surgery and transcanine sinoscopy and these patients have presented no relapse. From another 8 patients, 3 patients presented relapse. Conclusions. FESS for complete removal of ACPs is an extremely safe and effective procedure. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.  
Keywords: antrochoanal polyps, child, nasal endoscopy

Endoscopic surgical treatment of rhinosinusitis in children

Mihail Maniuc, Polina Ababii, L. Danilov, Diana Chirtoca, Alexandru Didencu, Daniela Rusu-Ungureanu

State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Chişinău, Republic of Moldova
Introduction. The aim of the study was to improve the endoscopic surgical treatment of recurrent and chronic rhinosinusitis in chil­dren. The study included 215 children with recurrent and chronic rhi­no­si­nu­sitis aged between 5 and 15 years. 140 children were male (65%) and 75 patients were female (35%). The inclusion criteria in the study were the clinical signs and symptoms of the disease, persisting after multiple medical treatments for more than one year. Materials and method. Patients have been divided into two groups, according to the surgical method used. The first group was composed of 84 children with recurrent and chronic rhinosinusitis, on which the standard endoscopic surgery was applied. In the patients from group II (131 children) the minimally invasive endoscopic sinus surgery in our modification (includes partial resection of processusuncinatus and limited ablation of all anatomical structures of ostiomeatal com­plex) was performed. The research was conducted according to the pros­pective statistic and clinical methods, based on analytical and de­scriptive research. Results. The results of the treatment have been as­sessed based on the clinical and endoscopic examination, functional ex­plorations, hospitalization time, and the number of recidives. The pa­tients were considered recovered if all the symptoms were absent over a period of 36 months. The hospitalization time for the 1st group was 6.15 ± 0.24 days and for the 2nd group was 4.26 ± 0.26. The results at the end of the recovery period were very good and good in 73.7% of the cases in the 1st group and in 85.7% in the 2nd group; satisfactory in 21% in the 1st group, and in 12.4% in the 2nd group; in 5.3% of patients from the 1st group and in 1.9% of those in the 2nd group who were sub­ject to treatment, the results were not satisfactory. Conclusions. 1. Endoscopic approach is the best choice for surgical treatment of re­cur­rent and chronic rhinosinusitis in children and 2. The minimally in­va­sive endoscopic surgery has advantages compared to the standard method.
Keywords: sinuses, rhinosinusitis, endoscopy, minimally invasive sur­gery

 

Unilateral choanal imperforation - our experience

V. Budu1, Tatiana Decuseară1, I. Bulescu2, C. Ioniţă1, A. Coman1, A. Panfiloiu1, Andreea Costache1, Alexandra Guliga1, M. Tuşaliu1

1. Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest
2. UMPh “Carol Davila”, Faculty of Medicine, Department of Anatomy
Introduction. Choanal imperforation is the most frequent congenital nasal malformation. Bilateral choanal imperforation is incompatible with life. Unilateral choanal atresia or stenosis can go unnoticed for several years but bilateral choanal atresia is usually diagnosed early because of its incompatibility with life. Materials and methods. 6 patients with unilateral choanal imperforation have been operated between May 2014 and April 2106 in “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Department I. Using an endoscopic ap­proach a stent was introduced in the affected nasal cavity. It was main­tained in position for 3 months. No nasal packing was needed. Results. All patients underwent routine preoperative endoscopic inspection of their nasal cavity. Mean age varied between 12 and 18 years old. Stent has been maintained in position for 3 months in 5 patients and one was spon­ta­neously eliminated. There was no reintervention in any pa­tient until now. Conclusion. Endoscopic endonasal surgery may be considered as the mainstay of treatment with minimal complications, high rate of suc­cess and fast recovery. 
Keywords: choanal imperforation, endoscopic surgery, stent

Deviaţia septului nazal în aspectul rinosinuzitelor recidivante şi cronice la copii. Tratamentul chirurgical endoscopic

Maniuc Mihail, Ababii Polina, Danilov Lucian, Chirtoca Diana, Didencu Alexandru

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”
Actualitatea temei. Sinuzitele paranazale recidivante şi cronice la copii reprezintă entităţi patologice destul de frecvente în practica cotidiană, reprezentând un capitol dificil, cu o frecvenţă de până la 38%. De­viaţia septului nazal joacă un rol important în patogeneza ri­no­si­nu­zitelor recidivante şi cronice. Studiile clinice sugerează o depistare a patologiei rinosinuzale la pacienţii supuşi rinomanometriei, care a con­firmat deviaţia septală şi obstrucţia nazală. Se menţionează că in­cidenţa patologiei rinosinuzale severe creşte în prezenţa deviaţiei sep­tului nazal în regiunea complexului ostiomeatal diagnosticat prin exa­men computer tomografic al nasului şi sinusurilor paranazale. Scopul lucrării. Determinarea căilor de optimizare ale diagnosticului şi tra­ta­mentului chirurgical endoscopic al deviaţiei septului nazal în cazul ri­no­sinuzitelor paranazale recidivante şi cronice la copii. Materiale şi me­tode. Studiul a cuprins 120 de pacienţi cu vârste între 8 și 17 ani, cu pa­tologie inflamatorie recidivantă şi cronică, refractari la tratamentul con­servator, repartizaţi în trei loturi a câte 40 (X²=0; p>0,05). Exa­mi­narea clinică a inclus: examenul oto­ri­nolaringologic general, ri­no­metria acustică, rinomanometria, en­doscopia nazală, examenul com­pu­ter tomografic etc. În funcţie de tratamentul chirurgical aplicat, pa­cienţii au fost divizaţi în trei loturi a câte 40 de pacienți. Lotul I de pa­cienţi operaţi prin metoda endoscopică standard, lotul II - 40 de pa­cienți trataţi prin metoda de chirurgie endoscopică rinosinuzală mi­nim invazivă. Lotul III - 40 de pacienţi operaţi după tehnica minim in­vazivă, completată cu operaţii ale structurilor endonazale, inclusiv, la care s-a efectuat intervenţie chirurgicală endoscopică a septului na­zal. Rezultate. Com­­puter tomografic se pot determina localizarea pre­cisă a de­vi­a­ţiei şi caracterul acesteia (deformaţie, îngroşare, pneu­ma­ti­zare). Re­zultatele computer tomografiilor ne-au demonstrat o de­pis­tare frec­ven­tă a deviaţiei septului nazal în cadrul pacienţilor din lo­tu­rile de stu­diu, cu o cazuistică de 78 (65%): segmentul anterior 37 (30,9%), posterior 15 (12,5%), anteroposterior 26 (21,7%). La pacienţii lo­tului III s-au efectuat într-un singur act operator abordul şi corecţia ano­ma­liilor şi variantelor anatomice depistate şi explorarea funcţională en­do­scopică minim invazivă sinuzală în funcţie de răspândirea pro­ce­sului inflamator al sinusurilor paranazale: în 34 de cazuri a fost efec­tuată septoplastia endoscopică, în 24 - rezecţia submucoasă a concha bullosa, în 22 - rezecţia cornetului paradoxal curbat. Concluzii. Chi­rur­gia endoscopică ca nouă abordare a deviaţiilor septului nazal în as­pectul rinosinuzitelor recidivante şi cronice la copii constituie unul din imperativul principal în algoritmul de tratament al rinosinuzitelor re­ci­divante şi cronice persistente la tratament. Posibilităţile medicale teh­nice moderne - metodele chirurgicale endoscopice rinosinuzale, per­mit noi poziţii de abordare chirurgicală a deviaţiei septale în di­rec­ţia cruţării majore a acesteia. Astăzi, termenul de „rezecţie sub pe­ri­condromucoasă” nu presupune operaţia clasică după Killian, ci în­lă­turarea cruţătoare a segmentelor deviate, adică chirurgia minim in­va­zivă a septului nazal sub control endoscopic.
Cuvinte-cheie: rinosinuzită, deviația septului nazal, chirurgie endo­sco­pică endonazală

Sfenoidal sinus hamartoma - case report

Fănuță Bogdan, Anghelina Florin, Dina Monica, Cristina Bogdan, Mădălina Zamfir

ENT Clinic of Craiova

Introduction. Hamartoma is a pseudotumor developed from the same cellular components as the organ where it apears, but with mo­dified architecture. Material and Methods. It was conducted a case study of a child with acute sphenoid treated at the ENT Clinic Cra­iova. Results. Our patient, a child aged 7 years, had permanent fron­tal headache relieved from the use of anti-inflammatory. Clinical exa­mination revealed tenderness on palpation of the left frontal re­gion, the anterior rhinoscopy showed nasal congestion and minimum se­cre­tion in olfactory slot. Sphenoid sinus CT revealed a left sinus oc­cu­pied by amorphous mass. Endoscopic was practiced left sfe­no­ido­tomy with suction secretions and excision of mucosal lesions at this level. HP examination raised the suspicion of a hamartoma. There were performed IHC:GFAP, chromogranin; synaptofizina; NSE; S 100-negative, AE1/AE3 - positive diffuse intense and respiratory epithelium, EMA - positive weak and focal in the respiratory epithelium, Vim intensely positive and diffuse mesenchymal cells, IHC appearance non-tumor lesion confirms the diagnosis of HP, most likely hamartoma. Post­operative evolution was favorable. Conclusion. With unknown etio­logy, most likely malformation, hamartoma with localization in the sphe­noid sinus is very rare. Surgical treatment aimed at removing all pa­tho­logical lesions of the sinus.
Keywords: hamartoma, sphenoiditis, sphenoid sinus

Nasal permeability after endoscopic surgical treatment in children with chronic and recurrent rhinosinusitis

M. Maniuc, Polina Ababii, Angela Chiaburu, Diana Chirtoca, Svetlana Diacova, A.Didencu, Daniela Rusu-Ungureanu

State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Chişinău, Republic of Moldova
Background. The aim of the study was to determine the efficiency of acoustic rhinometry (AR) in evaluation of nasal permeability in children with chronic and recurrent rhinosinusitis subjected to the surgical treatment. Our work is based on comparative study of nasal permeability after surgical treatment of 215 children with chronic rhinosinusitis. The age of the children was 5-15 years old, 140 boys (65%) and 75 girls (35%). Methods. In conformity with the method of the treatment all patients (215 children) were divided in 2 groups. In the patients from group I (84 children) the standard endoscopic sinus surgery was performed. In the patients from group II (115 children) the minimally invasive endoscopic sinus surgery was performed. 30 healthy children were as a control group. Nasal permeability was estimated by means of acoustic rhinometry. We have estimated the volume of the nasal cavity V (0-5 cm) and the Minimal Cross-sectional Area (MCA) before the treatment, on the 3rd, 24th, and the 36th week after surgical treatment. Results. In healthy children the value of volume of nasal cavity was 5.6±0.28 cm3 in right side and 6.9±0.16 cm3 on the left side, in children with rhinosinusitis the value of volume was statistically significant decreased: 2.75 ±0.22 cm3 in the right side and 3.15±0.20 cm3 on the left side. In healthy children the values of MCA1 and MCA2 estimated before decongestion were 0.59±0.32 cm2 and 0.82±0.17 cm2. In patients from group I before surgical intervention the value of MCA1 was 0.34 ±0.16 cm2,and MCA2 was 0.54±0.14 cm2. In patients from group II we determined MCA1=0.36±0.21 cm2 and MCA2=0.50±0.12 cm2 respectively. On the 3rd week, we attested an increase of V and MCA values in both groups, with a more significant increase in patients from group II. In the 36th week after the treatment, in patients of the study groups, the investigational indices approached, by their value, the results attested in the control group with better results in group II. Conclusion. 1. In children with rhinosinusitis before surgery nasal volume and MCA is decreased, compared to the one of healthy children. 2. The AR results can be used for the evaluation of the efficiency of the surgical treatment of the rhinosinusitis. 
Keywords: acoustic rhinometry, rhinosinusitis, volume of the nasal cavity, nasal permeability

Soft tissues Ewing’s sarcoma in pediatric patient - a case report

Marioara Poenaru, Nicolae Balica, Horațiu Ștefănescu, Stelian Lupescu, Mihaela Prodea, Delia Horhat, Cristian Sărău

UMPh “Victor Babeș” Timișoara; Emergency Hospital Clinic Timișoara
The Ewing family of tumors is the second most common malignant bone tumor (after osteogenic sarcoma) in children and adolescents. These tu­mors can also occur in soft tissue, presenting in a similar manner to rhab­domyosarcoma. Nearly half of all patients with Ewing’s family tu­mors are between 10 and 20 years of age. Ewing’s tumor was originally described in 1921 by James Ewing as an endothelioma. In the recent years, it became clear that Ewing’s sarcoma, in fact, derives from a primitive neuroectodermal cell. Soft tissues Ewing’s sarcoma in head and neck re­gion represents between 2-4% of all Ewing’s tumors. We present the case of an 11-year-old female patient with soft tissues Ewing’s sarcoma hos­pi­talized in the ENT Clinic Timișoara for diagnosis and treatment me­thods. The clinical signs and symptoms and extra bone localization at pre­sentation represent the particular aspects of this case.
Keywords: soft tissue sarcoma, Ewing sarcoma of the head and neck

Particularities of the family environment in children with cochlear implant

Violeta Necula

”Iuliu Hațieganu” UMPh Cluj-Napoca
Introduction. The role of cochlear implant in deaf children de­ve­lop­­ment is well known. However, the results are highly variable and depends on several factors such as age of implantation, other diseases, the quality of rehabilitation process. But the most im­por­tant role belongs to the family, to family environment in which the child develops. Material and methods. The question­naire “Family En­viron­ment Scale” was sent to 98 families who had at least one cochlear implanted child who had more than 1 year of experience. One of the parents was asked to fill out the question­naire which include also general informations about the child and the family. Results. A total of 58 families responded to the question­naire and accepted to participate in the study. Mean values were higher com­pared with normal families in the areas of cohesion, ex­pres­siveness, intelectual-cultural orientation and organization, but the organization score mean value exceeded the normal values (between 40 and 60). The independence and the conflict areas had lower values than nor­mal families but did not eceeded the lower limit of normal (40). Con­clu­sions. The families included in study are heavily involved in the rehabilitation process which mean various educational, intelectual and cultural activities. Rehabilitation pro­cess requires a huge effort from family, many sacrifices, hard work and training for all members. The high determination, the cohesion and the excessive organization may explain the low level of in­de­pen­dence of these family mambers. 
Keywords: cohlear implant, family environment, child

Particularităţi în evoluţia neuronitei vestibulare: complicaţii și „vindecarea cu defect”. Aspecte de diagnostic și tratament 

L.G. Mărceanu

Medic primar ORL; Societatea Română de Neurootologie; Facultatea de Medicină, Universitatea Transilvania Brașov
Neuronita - sau nevrita vestibulară - este cea mai frecventă mo­no­neu­ropatie de nerv cranian generatoare de sindrom vestibular peri­fe­ric în patologia umană. De cauză frecvent virală (herpes virus), afec­tea­ză de regulă adolescentul și adultul tânăr, iar de multe ori vin­de­ca­rea sa este incompletă sau se complică. În evoluția unei neuronite ves­ti­bulare, în afara situației favorabile de vindecare ad integrum, pu­tem întâlni frecvent aparția mai multor tipuri de manifestări, une­le sechelare, altele reprezentând complicații, însoțite de compensarea ves­ti­bu­lară mai mult sau mai puțin instalată: 1. sindrom Lindsay He­men­way (VPPB de CSP sec) și sindrom otolitic sec; 2. afectarea au­di­tivă secundară („în doi timpi”); 3. compensări parțiale ale funcției vestibulare, leziuni parcelare/diseminate; 4. sechele de recuperare ale VOR (vertije vizuale-cinetice); 5. afectări psihopatologice (de fa­ză acută, subacută și cronică: anxietate, atac de panică, sindrom pos­tu­ral fobic și depresia). Aceste manifestări particulare din evoluția unei neuronite vestibulare ridică probleme delicate de diagnostic și o atitudine terapeutică adecvată.
Cuvinte-cheie: neuronită vestibulară, sechele, complicații

Unusual vertigo etiologies in pediatric patients

Eugen Ionescu 

MD, Neurotologist, Service d’Audiologie et Explorations Otoneurologiques, Groupement Hospitalier Est, CHU Lyon, France
In 2015, 110 pediatric vestibular assessments were performed in our tertiary Audiologic & Neurotologic Center of Lyon. Out of these, 50 procedures (45.4%) were related to the systematic evaluation we use to practice before and after Cochlear Implantation surgery. As previously reported, various degree of balance and vestibular im­pair­ment is frequent in syndromic and non-syndromic deaf young pa­tients. Migraine or equivalencies such Benign Paroxsymal Vertigo (Child­hood Vertigo) was found to be the first cause of imbalance in nor­mal hearing children. On the one hand, these results follow the avai­lable statistics considering vertigo etiologies in children. On the other hand, we present a series of cases in which etiologies are very rare or not reported to date in pediatric population. Posttraumatic En­do­lym­phatic Hydrops: 2 cases with clinical signs of hydrops after coh­lear implantation surgery (an 8-year unilateral implanted boy and one 17-year bilaterally implanted girl) and 1 case of delayed hydrops af­ter severe head concussion associating extra labyrinthine petrous bone fracture and iterative attacks of vertigo but no hearing loss in a 8 years old boy; Internal Auditory Canal/Meatus stenosis: 2 girls (9 and 17 years old), in both cases the clinical symptoms were bilateral pro­gres­sive sensorineural hearing loss, imbalance and iterative ver­ti­go. Vestibular paroxysmia: 16-year-old girl presenting a micro vas­cu­lar compression syndrome of the VIIIth cranial nerve. Method. All pa­tients underwent audio vestibular assessment including: Pure Tone and Vocal Audiometry, Brain Evoked Auditory Responses, VHIT (ICS-Otometrics and/or Synapis Ulmer II), VNG and cervical Vestibular Evo­ked Myogenic Potentials. In 4 cases of patients presenting severe and repetitive vertigo attacks the patients and their parents were in­struc­ted to record eyes movements with a smartphone within crisis pe­riod. This method helped us to identify and to characterize the type of nystagmic movements and subsequently the side of the vestibular im­pairment. All patients were evaluated with cerebral and inner ear 3T RMI sometimes including volumetric studies of the saccular mem­branous structures. Conclusion. The vestibular assessment is con­ti­nuously developing. In pediatric population in whom evaluation and po­si­tive diagnosis are difficult especially in very young subjects, the cli­ni­cian must be aware that some vestibular disease thought to be rare at this age may occur. The most difficult diagnosis challenge re­mains just like for the adults, the iterative vertigo with no auditory symp­toms or signs. 
Keywords: vertigo, secondary endolymhatic hydrops, vestibular paro­xys­mia

Vertijul la copil - diagnostic şi tratament

Ioana-Alexandra Vodă

Medic primar ORL, Doctor în Știinţe Medicale, competenţe în Vestibulogie şi Reeducare vestibulară, Clinica Nova Explorări ORL - Clinica Vertijului, Bucureşti
Corespondență: Ioana-Alexandra Vodă, e-mail: vodaorl@yahoo.com; ivoda@clinicanova.ro 
Lucrarea prezintă sindromul vestibular periferic, cu particularităţile spe­ci­fice copilului. Diagnosticul la copilul mic este dificil, fără o anamneză pre­cisă, uşor de condus în cazul copiilor mari şi adolescenţilor. Simp­tomatologia specifică vertijului, relevată de semnele clinice - ame­ţeli, instabilitate, laterodeviaţia mersului, capul aplecat, imo­bi­litate prelungită, evitarea anumitor mişcări, răul de maşină, de lea­gă­ne - asociate anxietăţii sunt practic puţinele semne ce conduc la un diag­nos­tic. Investigaţiile specifice - testul Romberg, Fukuda, vi­deo­nis­tag­mo­scopia, testul vibrator, Head Shaking test, audiometria, im­pe­dans­metria, probele calorice şi scaunul rotator, uşor de realizat după 4-5 ani, sunt explicate şi conduc la diagnosticul corect. Majoritatea pa­to­logiilor sunt vertije poziţionale otolitice, care cu o simplă repoziţie Se­mont sau Eplay se vindecă, urmate de neuronite vestibulare, unde exer­ci­ţiile acasă egalizează asimetria vestibulară reziduală, apoi sindroamele ves­tibulare periferice posttraumatice - dehiscenţa de canal, fistule la­bi­rin­tice şi boala Ménière, rară la copil. Sunt prezentate pe scurt metode de recuperare şi reeducare vestibulară pentru fiecare patologie şi un al­go­ritm de diagnostic orientativ.
Cuvinte-cheie: sindrom vestibular periferic, copil, vertij poziţional otolitic

Cochleo-vestibular neurovascular conflict in the pontocerebellar angle in children: case report

S. Cozma1,2, Cristina Hera1, Oana Bitere2, C. Mârțu1,3, Dragoș Negru1,4, Luminița Rădulescu1,3

1. University of Medicine and Pharmacy “Grigore T. Popa” Iaşi, Faculty of Medicine
2. Rehabilitation Clinical Hospital Iaşi, Audiology and Vestibulogy Department
3. Rehabilitation Clinical Hospital Iaşi, ENT Clinic
4. Clinical Emergency Hospital ”Sfântul Spiridon”, Radiology and Medical Imaging Laboratory
The vascular microcompression of the vestibulocochlear nerve (VIII) by the anterior inferior cerebellar artery (AICA) has been described in the literature as a cause of otoneurologic symptoms (tinnitus, ver­ti­go, deafness). It is revealed by the magnetic resonance studies (MRI) in about 4-13% of patients with this manifestations. Clinical symp­toms depend on the modality of joining between the artery and nerve (in one point, longitudinal, circular, intimate contact). It is bi­la­teral in about 5% of cases. In children with vestibular paroxysmia is one of the causes, along with BPPV, vestibular migraine and psy­cho­logical disorders (somatization). Treatment (with small doses of car­bamazepine) is indicated if symptoms affect the quality of life. Sur­gical intervention (decompression) is reserved for the cases re­sis­tant to drug therapy. We present a pediatric case with cochleo-ves­ti­bular syndrome whose cause has been established with difficulty be­cause of the history of paroxysmal vertigo with sudden fall. Cli­nical features included, since the first presentation, unilateral neu­ro-sensorial hearing loss, tinnitus and vestibular deficit on the same side. Hearing loss has been fluctuating over the surveillance pe­riod, and the vestibular manifestations included rotator vertigo, in­sta­bility and sudden fall. The diagnosis needed both auditory and vesti­bular protocol, as the complementary examinations (pediatric, oph­thal­mologic and imaging study). Positive diagnosis was based on MRI that confirms the existence of a neurovascular conflict (CNV) of the eigth nerve. The evolution under medical treatment is favorable, by thinning frequency of crises and relieving the intensity of those. CNV can be a cause of paroxysmal cochleovestibular manifestations in childhood, and for this reason MRI study of the pontocerebellar angle and of the internal auditory canal must be done for the con­fir­mation of the positive diagnosis, but also to exclude other causes (acoustic neuroma, multiple sclerosis).
Keywords: neurovascular conflict, nerve VIII, paroxysmal vestibular child

Insuficienţa respiratorie nazală la copil, consecinţele acesteia asupra dezvoltării maxilarului superior și implicaţiile în tratamentul ortodontic

Gabriela Mușat

Universitatea de Medicină și Farmacie „Carol Davila”; Clinica ORL, Spitalul Clinic „Sfânta Maria”, București; 
„Centrul de excelență pentru cercetarea mecanismelor tulburărilor senzitiv-senzoriale și studiul patologiei inflamator-infecțioase, tumorale și obstructive a căilor aero-digestive superioare“ (CESITO)
Introducere. Există numeroase studii în literatura de specialitate re­fe­ritoare la legătura dintre insuficiența respiratorie nazală și dez­vol­ta­rea aparatului dento-maxilar. Fluxul aerian nazal este important pen­tru creșterea laterală a maxilarului superior și scăderea înălțimii bol­tei palatine. În această lucrare se analizează influența obstructivă na­za­lă din adenoidita cronică hipertrofică asupra dezvoltării aparatului den­to-maxilar. Material şi metodă. Am efectuat un studiu comparativ în­tre două loturi de pacienţi: un lot de pacienţi cu adenoidită cronică şi sindrom de compresie de maxilar care au fost operaţi practicân­du-se adenoidectomie şi un lot de pacienţi la care această intervenţie nu a fost efectuată. Ambele loturi de pacienţi au fost tratate ortodontic. Au fost detectate diferenţe semnificative statistic între cele două grupuri de pacienţi privind dezvoltarea maxilarului superior şi durata medie a tra­tamentului ortodontic. Concluzii. Persistența obstrucţiei nazale în­târ­zie recuperarea funcţională a pacienţilor cu sindrom de compresie de maxilar care efectuează tratament ortodontic. Evaluarea ORL prin exa­men clinic, endoscopic, rinomanometric este necesară la aceşti pacienţi. Tra­tamentul chirurgical al adenoiditei cronice hipertrofice restabileşte res­piraţia nazală şi diminuează durata tratamentului ortodontic, fa­vo­rizând dezvoltarea aparatului dento-maxilar. 
Cuvinte-cheie: obstrucție nazală, adenoidită cronică, anomalii dento-maxilare, permeabilizare nazală

Public health policies in Juvenile-onset Recurrent Respiratory Papillomatosis 

Magdalena Chirilă

“Iuliu Haţieganu” University of Medicine and Pharmacy of Cluj-Napoca, Romania; Otorhinolaryngology Head & Neck Surgery Department
Background. Recurrent Respiratory Papillomatosis (RRP) is the most com­mon benign neoplasm of the larynx among children caused by HPV sub­types 6 and 11, and the second most frequent cause of chro­nic child­hood hoarseness after vocal nodules. Juvenile-onset RRP is thought to be acquired during delivery, but there are other factors. Method. The vac­cines anti-HPV are not going to replace the need for Pap screening or for RRP surgeries. They don’t protect against all of the oncogenic HPV types and they don’t make established infections go away. But the vaccines should substantially reduce the number of ab­normal Pap smears, the num­ber of follow-up retest colposcopies and biopsies, and the number of surgeries to remove premalignant cer­vical lesions, and they may sub­stan­tially reduce the number of new cases of RRP in children. The cost-be­nefit analysis seems to favor the approach of mandatory vaccination, es­pecially if you combine it with other late childhood vaccines. Results. HPV Research Group of Euro­pean Laryngological Society is working to es­ta­blish anti-HPV 6 and anti-HPV 11 antibody levels in a cohort of actively trea­ted RRP patients with the idea that if some of the these patients have low levels despite their infection, they might benefit from therapeutic ad­mi­nis­tration. Con­clusion. We are going to begin a surveillance study to see if we can influ­ence the incidence and prevalence of this disease over time, and we have planned a double-blind, crossover, therapeutic trial in a co­hort of es­ta­blished RRP patients.
Keywords: recurrent respiratory papillomatosis, HPV, child

Chirurgia endoscopică a patologiei inflamator-infecţioase rinosinusale pediatrice

Claudiu Manea

Clinica ORL „Sfânta Maria”, Centrul de Excelență „CESITO”, UMF „Carol Davila” București
Implicațiile rinosinuzitelor în afectarea calității vieții pacienților pe­dia­trici sunt bine cunoscute. Din acest punct de vedere, eforturile lu­mii ORL-istice internaționale pentru managementul acestor afec­țiuni sunt din ce în ce mai susținute. Lucrarea prezintă indicațiile ac­tua­le ale chirurgiei endoscopice, precum și principalele tehnici chi­rur­gicale folosite în tratamentul patologiei inflamator-infecțioase ri­no­sinusale pediatrice. Se insistă pe prezentarea particularităților teh­nicilor chirurgicale adaptate tratamentului pacienților pediatrici. Se discută complicațiile chirurgiei endoscopice rinosinusale, precum și principalele modalități de management ale acestora.
Cuvinte-cheie: chirurgie endoscopică rinosinusală, indicații, com­pli­cații

Complications of acute and chronic adenoiditis in children

Ion Anghel1, Anca Simioniuc2, Rodica Urs3, Alina Georgiana Anghel4

1. ENT professor, “Colţea” Clinical Hospital, Bucharest
2. PhD student, “Carol Davila” University of Medicine and Pharmacy, Bucharest
3. ENT resident, “Colţea” Clinical Hospital, Bucharest
4. ENT Doctor, DAMC, Bucharest
Adenoiditis is an affection of the superior airways, especially in new­borns and small children (rare occasions of adult occurrence) and is produced by an allergen, or bacterial, or viral infection of the pha­rynx adenoid tis­sue Luschka. Acute adenoiditis has a sudden of­fset, mild fever/no fe­ver, nasal obstruction, loud respiration, pus secretions, coughing, es­pe­cially at night. Untreated or treated incorrectly, ade­no­iditis can cause se­vere complications such as otitis media, ade­ni­tis, acute ery­the­ma­tous or erythemato-papulous angina, la­ryn­gitis, tracheitis, bronchitis, pneu­mo­nia, or gastrointestinal dis­orders. Chro­nic adenoiditis is the consequence of hypertrophy of the ade­noidal ve­ge­tation and has a chronical evolution that can determine serious com­pli­cations. Symptoms are similar to the acute form, except the fact that they are permanent and represent the core that increases the frequency of the respiratory infections. In the chronical form, simp­toms persist, the most important being nasal obstruction, mouth res­piration, nasal voice, sleep apnea, adenoidal face, ear diseases and recurrent superior airways infections. In many cases, distinction between the symptoms and the complications of adenoiditis is un­clear or arbitrary, because of this reason we try to use our current level of understanding regarding the physiopathological mechanisms in­volved in this affliction and try to sketch a fair difference. 
Keywords: acute adenoiditis, chronic adenoiditis, adenoid vegetation 

Vaccinotherapy in the conservative complex treatment of chronic tonsillitis in children

Lucian Danilov, Ion Ababii, Mihail Maniuc, Polina Ababii, Svetlana Diacova, Alexandru Didencu, Olga Barghier

“Nicolae Testemițanu” State University of Medicine and Pharmacy of Chișinău, Republic of Moldova
The purpose of the research was to analyze the effectiveness of the therapy SynflorixTM” vaccine in the conservative complex treatment of chronic tonsillitis in children. Material and method. The clinical study included 68 children with uncomplicated chronic tonsillitis who were divided into two groups: 1-34 children undergoing treat­ment with the vaccine „SynflorixTM” concomitantly with standard therapy; Lot 2 - 34 children receiving standard therapy (tonsil gaps washing with antiseptic solution sprinkling tonsils Lugol solution). Immunological investigations were carried out before and after three months of treatment, which included: the functional activity of T cells and specific sensitivity of cells; CD16 lymphocyte content; phagocytic ability of neutrophils; the level of circulating immune complexes (CIC); Complement hemolytic activity (AHTC); titer content cytokines IL-8, IL-1β, TNF-α, IL-4. Results. CIC levels really decreased after treatment only in children from group 1 (p<0.01, to treatment - 290 ± 27; after - 187 ± 16.2), in group 2 was observed only a downward trend. In children from the first group, the increase phagocytic activity of neutrophils was more robust (p<0.001, up - 4.2 ± 0.14 after - 5.2 ± 0.19) compared with children from Lot 2 (p <0.05 by - 4.7 ± 0.27; after - 5.3 ± 0.18). Dynamic content in CD-16 treatment was really increased only in children from the first group (p <0.01, up -14.6 ± 0.28 ± 0.23 after -15.8). Post-treatment, the AHTC remained truthful highest in children from Lot 1, compared with children from Lot 2 (p <0.05, 60.4 ± 1.36; 55.8 ± 1.42). The functional activity of T lymphocytes in dynamics conclusive treatment increased more in children of group 1 (p<0.001, 65.9 ± 0.70, 68.4 ± 0.65), than those from group 2 (p<0, 05 66.8 ± 0.79, 69.2 ± 0.67). The titer of Streptococcus antigens and T lymphocytes increased after treatment only in children from group 1 (p<0.05, 3.5 ± 0.30, 4.2 ± 0.16). Proinflammatory cytokine, TNF-α, reduced after treatment more significantly in group 1 (p<0.001, 1.5 ± 0.1, 0.7 ± 0.08) compared with group 2 (p<0.05, 1.5 ± 0.13, 1.0 ± 0.16). The levels of IL-8 and IL-1β cytokine tended to decrease after treatment in both groups. The titres of anti-inflammatory cytokine IL-4 were higher after treatment in children from group 1, than those from group 2 (p<0.05, 21 ± 1.19; 15.8 ± 2.17). The number of acute upper respiratory tract infection really decreased over 2 years in group 2 (p<0.001 by the treatment - 5.7 ± 0.18 by - 1.3 ± 0.42). In group 1, the decrease was less significant (6.4 ± 0.30, 2.8 ± 0.32). Post-treatment, the number of antibiotic therapy prescriptions dropped more truthful in children of group1. Conclusion. The vaccine „SynflorixTM” normalizes the immune reactivity of children with chronic tonsillitis and has a positive clinical effect at a high level.
Keywords: vaccine, SynflorixTM, treatment, chronic tonsillitis

Obstructive sleep apnea syndrome in children

Ion Anghel1, Anca Simioniuc2, Rodica Urs3, Alina Georgiana Anghel4

1. ENT professor, Colțea Clinical Hospital, Bucharest
2. PhD student,”Carol Davila” University of Medicine and Pharmacy, Bucharest
3. ENT resident, Colțea Clinical Hospital, Bucharest
4. ENT Doctor, DAMC, Bucharest
The respiratory pathology during sleep includes a number of diseases of the superior airways, from snoring to obstructive sleep apnea syndrome (OSAS). In adults, undiagnosed and untreated OSAS is associated with hypertension and other cardiovascular associated diseases; in children, respiratory pathology during sleep may result in serious consequences. Obstructive sleep apnea syndrome in children, left untreated for a long period of time, may result in behavior, cognitive and physiological deficits. In the past years, a lot of progress has been made in sleep medicine in children, but a lot of problems concerning the factors involved in fenotipical variability and pathogenic mechanisms of OSAS remain misunderstood. OSAS can cause a large number of nocturnal symptoms (snoring, increase of respiration effort, nocturnal sweating, agitated sleep, enuresis), and daylight symptoms (mouth respiration, nasal obstruction, nasal voice, attention and behavior deficits). OSAS diagnosis, and also assessing the severity of the condition are realized through the use of polysomnography, and early treatment will determine the severity of this entity. In children, tonsil hyperplasia plays a key role in compromising the permeability of the superior airways during sleep, tonsillectomy being the right treatment path. Children with complex forms of OSAS associated with cranio-facial or neurological anomalies can be treated with different types of surgical procedures or other types of non-surgical therapies. This presentation tries to sum up our current level of knowledge regarding the etiology and mechanism of OSAS in children, the risk factors, as well as the current methods of diagnosis and treatment. 
Keywords: obstructive sleep apnea, children

Diagnostic and treatment of esophageal foreign bodies - case presentation

Mioriţa Toader1, Corneliu Toader2, Iolanda-Cristina Vivisenco3, Mircea Drăghici4, Valeriu Lupu5, Daniela Neacşu6

1. “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania
2. National Institute of Neurology and Neurovascular Diseases Bucharest, Romania
3. “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania
4. Dentirad Hospital, Ploieşti, Romania
5. UMPh “Grigore T. Popa” Iaşi
6. “Ana Aslan” National Institute of Geriatry and Geriatrics
Introduction. Foreign bodies are more frequently diagnosed in chil­dren than in adults, being often a pediatric emergency. The oral route is often implicated in this pathology, due to the exploratory curiosity specific for the pediatric age. Methods. The authors pre­sent a statistical study about esophageal foreign bodies, with spe­cial reference to the metallic ones. Patients were hospitalized, in­ves­ti­gated and treated in the ENT Department of the „Grigore Ale­xan­drescu” Emergency Hospital for Children in Bucharest. Conclu­sion. The diagnosis of esophageal foreign bodies is based on the anamnestic data, followed by radiological examination, than en­do­scopy under general anesthesia. The outcome depends on the ac­curacy and rapidity of diagnosis and the precocity and precision of treatment. 
Keywors: child, metallic esophageal foreign bodies

Traditional tonsillectomy and adenoidectomy compared with radiofrequency tonsil and adenoiditis reduction or coablation

Ion Anghel1, Anca Simioniuc2, Rodica Urs3, Alina Georgiana Anghel4

1. ENT professor, Colţea Clinical Hospital, Bucharest
2. PhD student, “Carol Davila” University of Medicine and Pharmacy, Bucharest
3. ENT resident, Colţea Clinical Hospital, Bucharest
4. ENT Doctor, DAMC Bucharest
Tonsillitis and adenoiditis represent the inflammation of the tonsils, pharynx and Waldeyer’stonsillar ring (adenoid tonsil, lingual tonsil, palatine tonsil and tubal tonsil). The common causes are represented by the infection with adenovirus, Streptococcus sp., Haemophilus influenzae airborne through Pflugge drops and not so often through digestive tract or by contact. Surgery is indicated if chronicity or failure of antibiotic and anti-inflammatory treatment using traditional tonsillectomy procedure or by performing radiofrequency tonsil reduction or coablation. Traditional tonsillectomy under general anesthesia implies excision of the tonsil using the scalpel and electrocauterisation and traditional adenoidectomy using Beckman Adenoid Curette with hemostasis. This procedure has disadvantages as longer recovery time, intraoperative bleeding and also possible bleeding in the recovery time. Radiofrequency tonsil reduction uses Surgiton with high-frequency and low temperature and it has a lot of advantages compared with the traditional procedure. Among this advantages, there are: short operation time, absence of intraoperative bleeding, lower infection rate, shorter recovery time and lower postoperative pain. This procedure cannot be used for treating hypertrophic tonsils and also a variety of adenoiditis and these are treated using the traditional method. This presentation aims at exposing the advantages and disadvantages of both surgical technics at the current level of knowledge.  
Keywords: adenoidectomy, tonsillitis, radiofrequency

Ultrasonographic differential diagnosis in pediatric salivary glands pathology

Mihai Dumitru1, Codruţ Sarafoleanu2, Ion Anghel3, Adrian Costache1, Romica Cergan1 

1. UMPh ”Carol Davila” Bucharest
2. ”Sfânta Maria” Clinical Hospital Bucharest
3. Colțea Hospital Clinic, Bucharest
Purpose. Salivary glands pathology is rare in pediatric population with predominance of benign lesions. However, recently malignant cases have a rising frequency in children and are reported up to 40-60% of the cases encountered. Therefore is necessary to im­ple­ment sonography as a central element in the management of pediatric cases with salivary glands pathology. Material and method. We performed a systematic review of 30 recent articles on the subject of salivary glands pediatric pathology and the use of ultrasonography as central diagnostic tool. We analyzed the data regarding sensitivity and specificity of various sonographic cha­rac­teristics: shape, dimensions, ecogenicity, borders, and blood ves­sels. Results. From the point of view of benign cases, the most fre­quent pathology is the mucocele with a higher prevalence as a re­sidual mass after mumps, on the second place being chronic re­cur­rent parotiditis, followed by pleomorphic adenomas and he­man­giomas that count for 90% of the salivary benign masses. Con­cerning malignant cases, these are mostly epithelial tumors with a predominant localization at the level of the parotid gland and symp­to­matic after the age of 10. Recently using sonography together with fine needle aspiration biopsy enabled an increase in accuracy of the diagnosis with a minimal trauma of the pediatric patient and in­crease in family compliance towards the treatment proposed. We will illustrate with personal cases the sonographic criteria used in the differential diagnosis of pediatric salivary glands pathology.
Con­clusions. Salivary glands ultrasonography in pediatric cases is credited with 98.5% sensitivity, an 80% specificity in detecting tu­mo­ral lesions with a positive predictive value of 84.2% and a negative pre­dictive value of 70%. The major advantages of this diagnostic ima­ging modality are lack of irradiation, enabling successive exams and a more human interaction with the pediatric patient ensuring their compliance.
Keywords: pediatric, salivary, glands, sonography
Acknowledgements: This paper was supported by UMPh “Carol Da­vi­la’’, project number: 33895/11.11.2014.

Corelarea răspunsului OEA cu patologia prematurului - studiu statistic

Balazs A.1, Alice Lukacs-Juncu2, Adriela Turcu3, Manuela Cucerdea4, Drasoveanu C5

1. Clinica ORL Târgu-Mureş
2. CMI Lukacs-Juncu Alice Târgu-Mureş
3. Clinica Prematuri Târgu-Mureş
4. Clinica Neonatologie Spitalul Judeţean Târgu-Mureş
5. Clinica ORL Târgu-Mureş
Scopul lucrării. Având în vedere introducerea recentă a testării auzului la nou- născut pe scară largă în Târgu Mureş, am considerat util pentru mai multe specialităţi implicate efectuarea unui studiu centralizat şi actualizat asupra rezultatelor practice ce decurg din acest demers. Material şi metodă. Am analizat un lot de 340 de nou-născuţi pe perioada anului 2014. 137 au avut vârste gestaţionale mai mici sau egale cu 37 săptămâni, iar 134 dintre aceştia au fost testaţi OAE la naştere. S-au urmărit informaţii din perioada sarcinii, din momentul naşterii si din perioada perinatală. S-a analizat impactul prezenţei infecţiilor, a tratamentelor cu sau fără potenţial ototoxic la prematur. S-au urmărit suferinţa hipoxică a nou-născutului, malnutriţia intrauterină,  tratamentul precoce postnatal, prezenţa unor malformaţii. Rezultate. OAE au fost efectuate in 2 – 14 zile postnatal și au fost apoi retestați după aproximativ 2 luni cei care au prezentat rezultat REFER unilateral sau bilateral.50% dintre cei născuți între 25- 30 săptămâni au avut cel puțin un REFER, 35,06% dintre cei între 31- 35 săpămâni, doar 15,15% la 36-37 săptămâni. S-au efectuat corelaţii cu scorul Apgar. După 2 luni 24 de sugari deveniseră PASS bilateral, 11 nu au revenit la testare, 10 REFER 6 unilateral, 4 bilateral. Toți cei 10 au avut medicație ototoxică pentru infecții severe, vârste diferite cuprinse între 25- 34 săpămâni de sarcină, diverse patologii și riscuri care au fost analizate. Ei reprezintă 10,31% din totalul celor tratați cu Gentamicină sau Amikacină din lotul testat. Concluzii. Testarea auzului nou-născutului și apoi urmărirea celor cu deficit este necesară în toate maternitățile. Prematuritatea și complicațiile infecțioase și hipoxice, dar mai ales tratamentul ototoxic pot determina deficiențe de auz într-un număr semnificativ de cazuri. Preluarea rapidă a cazurilor de către specialiștii ORL și elaborarea planului individual de recuperare auditivă este imperios necesară.
Cuvinte-cheie: prematur, otoemisiuni acustice, medicaţie ototoxică, hipoacuzie, complicaţii neonatale

Aspects on the problem of sensorineural hearing loss in children in the Republic of Moldova - achievements and perspectives

Anghelina Chiaburu, Mihail Maniuc, S. Diacova, A. Antohii, Doina Chiaburu-Chiosa

”Nicolae Testemițanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
Sensorineural hearing loss in children remains a current issue and a complex medico-social aspect given the frequent incidence and its repercussions on the child development. In the Republic of Moldova, at the Republican Audiology Centre, there are registered 1600 children, aged 0-18 years old, with various forms of deafness. Aim. Optimization of early diagnosis of hearing loss in children with drawing up an individual tactics of prosthetics and psycho-pedagogical recovery. Material and methods. In the period 2010-2014 there were diagnosed with bilateral sensorineural deafness 515 children, with their age ranging from 1 month to 15 years. The diagnosis was made according to the Algorithm Diagnosis of Deafness Children developed by the Department of Otorhinolaryngology based on the SUMP “Nicolae Testemițanu”. Complex audiological examinaton is chosen depending on the age of the child and includes impedansmetria, OEA and PDA recording, PAETC recording, behavioral audiometry, pure tone and vocal audiometry, also the genetic specialist consultation, ophtalmologist, cardiologist, nephrologist etc. Recovery of bilateral auditory prosthesis comprised the 8-channel digital hearing aids, provided free bt the national and cochlear implant program, performed for the first time in 2014. Results. Evaluation study group reveals that 131 children (25.43%) were aged between 1 month to 3 years; 297 (57.66%) children were 3-7 years; 87 (16.89%) children were aged between 7 and 15 years. According to the degree of the deafness, there are assigned 515 children, with profound sensorineural deafness - 119 (23.10%) children ; severe form - 283 (54.95%) children; 91 (17.66%) with moderate form, and 22 (4.27%) children with mild form of hearing loss. The average age of diagnosis in case of severe and profound form of deafness varies between 20.5 months +/-1.5 (P<0.001) and 36.1 +/- 1.8 (P<0.001). Binaural prothesis with hearing aids: 457 (88.73%) children, 32 (6.21%) children with cochlear implant. Psycho-pedagogical rehabilitation is performed in preschool institutions specialized in the country jointly with the republican Center of audiology specialists. Conclusion. Early diagnosis of deafness in children is a goal in successful prosthetic rehabilitation and in psycho-pedagogical children with deafness necessary for implementing in the republic the universal hearing screening program in children. 
Keywords: sensorineural deafness, auditory prosthesis, cochlear implant, prosthetic rehabilitation, psycho-pedagogical rehabilitation

Frontal sinus fractures in children

Veronica Epure, D.C. Gheorghe 

“M.S Curie” Emergency Clinical Hospital for Children Bucharest, UMPh “Carol Davila” Bucharest
Correspondence: Veronica Epure, e-mail: veronica_epure@yahoo.co.uk
Due to necessity of huge impact forces, fractures of the frontal sinus rarely occur isolated; they are mostly seen in association with other craniofacial or skull base lesions. The treatment of frontal sinus fractures in children has become more conservative in the last decades, due to increased accuracy of imaging techniques and endoscopy. Craniofacial CT is the gold standard in such cases. The choice of the treatment varies in each particular case, depending on the presence of rinoliquoreea or the involvement of nasofrontal recesses; the aim is to be as conservative as possible, in order not to interfere with the growing of the child’s face. The authors present two cases of complex facial trauma, both involving the posterior wall of the frontal sinus; still, the management was conservative in those cases.
Keywords: frontal sinus, fracture of the posterior wall of the frontal sinus, CSF fistula, nasofrontal canal, craniofacial CT

Kartagener syndrome - case report

Adina Zugravu, Oana Harabagiu, Marcel Cosgarea

ENT Clinic Cluj-Napoca
Background. Kartagener syndrome is a rare congenital disease characterised by a clinical triad of symptoms: situs inversus, chronic rhinosinusitis and bronchiectasis. Although congenital ciliary defect is recognised as the main cause of this syndrome, it remains difficult to treat the associated airway infection. Case report. A 3-year-old male patient presented with nasal obstruction, seromucous rhinorrhea, left exophthalmia. He also had situs inversus. Electron microscopic evalua­tion of his nasal mucosa revealed ciliary defect and confirmed the diag­nosis of Kartagener syndrome. He underwent adenoidectomy. Af­ter a month he presents reappearance of the nasal obstruction with mu­co­purulent rhinorrhea and left exophthalmia. ENT exam reveals bi­la­teral nasal polyposis. We performed FESS with bilateral polypecto­my fol­lowed by long-term postoperative debridement of the sinonasal ca­vity and medical therapy (nasal irrigation, mucoactive agents, steroids and antibiotics). This treatment reduced chronic rhinosinusitis and pro­tected against subsequent airway infection in a 3-year follow-up. Con­clusion. FESS is effective for relieving both chronic rhinosinusitis and airway infection of Kartagener syndrome in the long term.
Keywords: Kartagener syndrome, primary ciliary dyskinesia, rhinorheea, sinusitis

Expunerea la zgomot şi tinitusul

Andrada Bilcă1, Anca Modan2

1. audioprotezist, Centrul de îngrijire a auzului „Audiologos”
2. audiolog, Centrul de îngrijire a auzului „Audiologos”
Introducere. Am pornit de la următoarea ipoteză: 1. Pacienţii care prezintă traumă sonoră, cu scăderea pragului tonal liminar pe frecvența de 4.000 Hz, prezintă adesea tinitus. Prin stimularea preferențială a segmentului auditiv corespunzător zonei afectate printr-o protezare specifică, se poate obține diminuarea tinitusului. Metode. Am creat un eșantion de opt pacienți cu media pragurilor auditive în domeniul auzului normal și care prezentau traumă sonoră, cu scăderea pragului auditiv tonal liminar, la frecvența de 4.000 Hz. Toți acești pacienți s-au adresat centrului nostru pentru rezolvarea tinitusului care însoțea trauma sonoră. Am efectuat audiograma tonală liminară la căşti pentru fiecare pacient pentru confirmarea traumei sonore și pentru determinarea frecvenței specifice tinitusului. În locul protocolului clasic de mascare a tinitusului cu ajutorul unui generator de zgomot înglobat într-o proteză auditivă, fiind vorba despre pacienți cu media pragurilor audiometrice în limite normale, am realizat mascarea tinitusului printr-un câștig protetic țintit strict pe frecvența tinitusului. Rezultate. După purtarea protezelor o perioadă de 2-6 luni, tinitusul dispare în totalitate, sau apare atât de rar, încât nu mai reprezintă un factor perturbator pentru pacient. La întreruperea utilizării protezelor pe timpul zilei, tinitusul tinde să reapară cu o frecvență și intensitate supărătoare, la câteva săptămâni după renunțarea la proteze. Concluzii. Metoda amplificării țintite pe frecvența tinitusului reprezintă o metodă care înlocuiește cu succes metoda mai greoaie de mascare a tinitusului prin purtarea de proteze auditive generatoare de zgomot.
Cuvinte-cheie: traumă sonoră, tinitus, audiogramă, proteză auditivă

Preclinical studies of a new drug combination of ear drops form

Sergiu Parii1, Livia Uncu1, Eugeniu Nicolai1, Vladimir Valica1, Mihail Maniuc2

1. Scienticic Center for Drug Research, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
2. Laboratory of ENT, Scienticic Center for Drug Research, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova 
Introduction. Modern methods of the treatment of otitis include pharmacologically different medicinal combinations. It has been developed a preparation in the form of ear drops, which is a combination of ciprofloxacin hydrochloride and Basil oil, used in inflammatory nonsuppurative and suppurative diseases of external and middle ear. Objective. The preclinical safety and efficacy evaluation of ear drops on laboratory animals. Material and methods. Toxicity study was carried out using 48 mice and 15 laboratory rats. Acute toxicity was estimated by average LD50 studies (fixed dose procedure establishing acute-toxic class). Experimental otitis was modeled on rats. The first group was given the studied preparation, the second group - similar separate concentrations of ciprofloxacin and basil oil, third group received a reference preparation. Healing was determined by: otoscopy, Preyer reflex, blood counts. Results. It was reported low toxicity (toxicity class 5) and LD50 >1000 mg/kg. At the first group healing was found out after 5 days of treatment; at second and third groups - after 6 days. No morphological changes in the internal organs were observed. Also the number of animal deaths was reduced. Conclusions. For the first time it is offered the form of ear drops, the combination of a fluorchinolon and an antibacterial herbal remedy, in the treatment of inflammatory diseases of the ear without perforation of the eardrum. Research results can serve as a premise for clinical evaluation of the efficacy and safety of the medicinal product.
Keywords: otitis, ear drops, treatment, ciprofloxacin, basil oil

ENT paediatric emergencies’ epidemiology in Hospital X

Mikahil Kubilay Tutuncuoglu

APHP Assistance Public Hôpitaux de Paris
Objective. Relatively few in incidence compared to other paediatric emer­gencies, paediatric ENT emergencies require a particular at­tention from the physicians. The objective of this study consisted first to target the clinical profile of the studied population, as well as to evaluate and as­sess the incidence and the severity of paediatric ENT emergencies in the Hospital X. Methods. This is a retrospective study on 47 cases of ENT paediatric emergencies which were found in the emergency department of the Hospital X, through ap­pro­xi­mately 3 months, from July the 1st of 2013 until September the 30th of 2013. The study was done in the summer, with a normal average temperature. The studied variables were age, gender, and varying disorders presented by the patients. The emergencies which occurred in foreign bodies included emergencies in the nasal cavities, external auditory meatus and esophagus. Haemmorrhagic emergencies were included by epitaxis and ear dis­charges. Infectious emer­gen­cies included, showed us mastoiditis and acute otitis media. The res­pi­ra­tory emergencies illustrated us laryngitis in­fec­tions. Other cau­ses of consultation in paediatric emergencies were for ver­tigo and orthopedic causes (which will be not integrated in our study). Re­sults. High predominance of infection was especially found in boys in comparison to girls. Boys were between 1 and 5 years old with a per­centage of 66%. An account of 82% boys compared to 18% of girls was also observed. The emergencies involved respectively: respiratory emer­gencies (4%), haemorrhages (15%), infectious emergencies (15%), and foreign bodies (64%). Infectious emergencies mostly affected the ears in 4% of infections. The most frequent described pathology were laryngeal infections, ex­clu­ding tracheal and bronchial foreign bodies. Mastoidis came in the first po­sition of infectious pathology with an accuracy of 11%. Conclusion. In op­position to haemorrhagic emergencies, especially met in 10 to 15 year-old-aged studied po­pu­lation, foreign bodies were rather met in 1 to 5 year-old-aged children. Hae­morrhagic emergencies were most common in 10 to 15 year-old-aged people. Foreign bodies were rather met in 1 to 5 year-old-children. The results of our study demonstrate the high incidence of foreign bodies correlated with the age.
Keywords: emergencies, epidemiology, foreign bodies, incidence
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