Alexander D. Karatzanis

Septoplasty outcome in patients with and without allergic rhinitis

OBJECTIVE To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and objective measurements and clarify whether patients with nasal septum deviation (NSD) and allergic rhinitis (AR) benefit from septoplasty to the same extent as patients who do not have allergic rhinitis. STUDY DESIGN A prospective study, with consecutive sampling of all patients undergoing septoplasty from June 2005 to February 2007, conducted in a tertiary care otorhinolaryngologic clinic. METHODS One hundred and seventy-six patients underwent septoplasty over the study period. Follow-up data were obtained from one hundred and forty-nine subjects. All participants underwent active anterior rhinomanometry (AAR) and assessed the severity of their symptoms based on a Nasal Obstruction Symptom Evaluation (NOSE) Scale prior to and following septo- plasty. Patients were divided into two groups according to AR status. Comparisons were made between symptoms and rhinomanometry data. RESULTS Following septoplasty, subjective improvement in breathing (decreased NOSE scores) was observed for both groups, the decrease being significantly more substantial in the NSD group. Airflow, as measured during active anterior rhinomanometry, increased in the deviated side following septoplasty in both groups. In the NSD group the increase was significantly high- er than in the NSD and AR group. CONCLUSION The surgeon should proceed with caution when managing patients with allergic rhinitis and nasal septum deviation. These patients are more likely to be less satisfied after septoplasty compared to patients without allergy. Adequate medical management of allergic rhinitis should be the first priority for these cases.

Ligasure versus Cold Knife Tonsillectomy

Objective: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure.

Molecular pathways of lymphangiogenesis and lymph node metastasis in head and neck cancer

Metastasis to regional lymph nodes constitutes the main route toward progression and dissemination of head and neck carcinoma; at the same time it is the most significant adverse prognostic indicator for this disease. In recent years, significant focus has been given on the molecular mechanisms behind lymph node metastasis of head and neck cancer. The aim of this study is to assess the role of growth factor expression and function in association with lymph node metastasis and overall prognosis of head and neck cancer. Current literature, searching for experimental data regarding the molecular pathways of lymph node dissemination of head and neck cancer, is reviewed giving special emphasis on the expression and prognostic significance of specific growth factors. Members of the vascular endothelial growth factor (VEGF), mostly VEGF-C and VEGF-D, with their action through the receptors VEGFR-3 and VEGFR-2, constitute the most extensively studied growth factors associated with lymphangiogenesis so far. High expression of these as well as other molecules, including angiopoietins, insulin-like growth factor, and fibroblast growth factor, has been associated with lymph node metastasis and poor prognosis in head and neck squamous cell carcinoma. Numerous growth factors seem to play an important role regarding the lymph node metastatic potential of head and neck cancer. Further research is necessary in order to further clarify the molecular pathways and introduce novel therapeutic options.

Cochlear Implantation after Radical Mastoidectomy: Management of a Challenging Case

Due to increasing experience and technological improvement, the selection criteria for cochlear implantation have improved. Cochlear implant application can now be performed in selected patients with pathological middle ear lesions. The surgical approach to a patient with a history of bilateral radical mastoidectomy is addressed in detail. The benefits of cochlear implantation in this case are also discussed.

Management of locally advanced laryngeal cancer

BackgroundManagement of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer.MethodsRetrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center.ResultsA total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis.ConclusionThis study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.

Potential Impact of the Financial Crisis on Outpatient Hospital Visits due to Otorhinolaryngologic Disorders in Crete, Greece

The public health effect of financial crises has been emphasized in previous studies. In addition, a series of otorhinolaryngologic disorders and manifestations has been related to psychological factors in the literature. Such conditions include temporomandibular joint disorders, laryngopharyngeal reflux, chronic tinnitus, and vertigo. Focusing on the outpatient database records of a large hospital in Crete, Greece, the objective of this retrospective study was to explore possible occurrence variations within the prementioned otorhinolaryngologic morbidity which may be potentially attributed to increased levels of socioeconomic stress. Results revealed that although the total number of visits between two periods - before and after the beginning of the financial crisis in Greece - was comparable, a significant increase in the diagnosis of two disorders, namely vertigo and tinnitus was found. In addition, a trend toward increased rate of diagnosis for reflux and temporomandibular joint disorders was noted. Potential implications of these findings are discussed. In conclusion, health care providers in this as well as in other countries facing similar socio-economic conditions should be aware of potential changes in the epidemiologic figures regarding specific medical conditions.

Otolaryngologic manifestations of small vessel vasculitis

OBJECTIVE The aim of the present study is to review the clinical manifestations associated with small vessel vasculitis (SVV) as they pertain to the head and neck region. METHODS A retrospective analysis was performed, including 34 individuals that filled the American College of Rheumatology criteria for the diagnosis of necrotizing vasculitis. Seven patients were classified as suffering from Wegeners granulomatosis (WG), 18 from microscopic polyangitis (MPA), and the remaining 19 were unclassified (unclassified small vessel vasculitis, USVV). RESULTS The percentage of ENT manifestations in the early clinical picture of WG patients was 86%, dropping to 44.5 and 22% for MPA and USVV patients, respectively. The overall percentage of ENT manifestations for SVV patients in their initial clinical profile was 47%. CONCLUSION The results of our investigation highlight the importance of an ENT clinical examination as a guide for diagnosis of an important percentage of SVV patients.

Molecular pathways and genetic factors in the pathogenesis of laryngopharyngeal reflux

The prevalence of laryngopharyngeal reflux (LPR) has been constantly rising in the western world and affects today an alarmingly high percentage of the general population. Even though LPR and gastroesophageal reflux disease (GERD) are both the product of gastroesophageal reflux and seem to be sibling disorders, they constitute largely different pathological entities. While GERD has been for a long time identified as a source of esophageal disease, LPR has only recently been associated with head and neck disorders. Despite the high incidence of LPR and its great impact on patients’ quality of life, little is known regarding its pathogenesis. On the other hand, studying the molecular and genetic basis of a disease is of fundamental importance in medicine as it offers better insight into the pathogenesis and opens new, disease-specific therapeutic trends. The aim of this study is to enlighten any known or suspected molecular mechanisms that contribute to the pathogenesis of LPR, and to suggest new trends for future research.

Management of advanced carcinoma of the base of tongue.

Base‐of‐tongue carcinoma is a relatively rare disease with aggressive behavior and poor prognosis. Up to date no consensus exists regarding the ideal management strategy for each stage of the disease. This study aims to evaluate the experience of a single head and neck oncology center in the management of advanced stage base‐of‐tongue cancer.

Implications of laser assisted tympanostomy in adults.

Objectives: To assess outcome in adult individuals undergoing laser-assisted tympanostomy without ventilation tube placement. Study Design: Case series with 2-month follow-up. Setting: Faculty practice, research protocol, tertiary care academic medical center. Patients and Method: Laser-assisted tympanostomy was performed on a total of 142 ears (108 individuals). Indications included serous otitis media with effusion (66 ears/47 patients), functional eustachian tube dysfunction (48 ears/36 patients), acute otitis media (19 ears/16 patients), and endoscopic visualization of the middle ear (9 ears/9 patients). Intervention: The laser-assisted tympanostomy procedure is performed with a CO2 laser under local anesthesia on an outpatient basis. Main Outcome Measures: Patency time of the tympanostomy, presence of fluid after the closure of the tympanostomy, tympanometry and tone audiometry findings, relief of symptoms. Results: Middle ear disease was resolved after the closure of tympanostomy in 47.9% of patients with serous otitis media with effusion. In 79.1% of patients with functional eustachian tube dysfunction, symptoms were diminished. All patients with acute otitis media had a satisfactory outcome. Laser-assisted tympanostomy was found to be quite helpful in patients undergoing middle ear endoscopy. Conclusions: Laser-assisted tympanostomy without ventilation tubes provides a safe alternative surgical option in adult patients in certain cases. The selection criteria for this procedure are addressed in detail.