Hasil untuk "Otorhinolaryngology"

Levent Yücel, Ayla Sevim Erol, Salih Cengiz Meral et al.

Abstract The aim of our study is to determine the changes in craniofacial dimensions among populations lived in Anatolia from different time periods. Eight skulls from the second century AD, 20 skulls were from the tenth–eleventh centuries AD, 20 skulls from the sixteenth–nineteenth centuries AD, and 60 contemporary skulls were included in this cross-sectional observational study. Using computerized tomography scans, five craniofacial dimensions were enrolled: glabella-occipital length (GOL), maximum width (MW), basion-bregma height (BBH), bizygomatic width (BZW), nasion-prosthion height (NPH). The differences of craniofacial dimensions between eras, the effect of sex and/or era on craniofacial dimensions were investigated. The GOL dimensions of the second century AD group were found to be significantly higher than contemporary skulls, and the tenth–eleventh century AD group were also found to be significantly higher than sixteenth–nineteenth century AD group and contemporary skulls (p < 0.001). NPH dimensions of tenth–eleventh century AD group were found to be significantly lower than contemporary group (p = 0.002). The main effect of sex, era, and sex-era interaction on GOL was found statistically significant (p = 0.004, p < 0.001, and p = 0.017, respectively). Only sex had a statistically significant effect on BZW (p < 0.001). Our study showed that GOL has decreased and NPH has increased over the centuries in Anatolian societies. Both sex and era influence the change of GOL.

David T. Liu, Gerold Besser, Veronika Moser et al.

Abstract Objectives The aim of the present study was to follow the daily course of patients with olfactory dysfunction and healthy controls and to assess (i) how many times a day, (ii) at which time, and (iii) in which aspect of daily life participants are conscious about their sense of smell. Methods In this longitudinal study, 49 patients with smell loss and 30 healthy participants were enrolled. Olfactory function was assessed using the Sniffin’ Sticks. All participants received paper diaries designed for a 14‐day period, featuring 12 rows representing 12 daily hours and six columns for various daily life aspects. They were instructed to mark their awareness of smell by indicating the relevant row and column in the diary. Following the return of the diaries, a second olfactory test was conducted within the patient group. Results On average, patients were consciously aware of their sense of smell around 8 times daily, while healthy participants noted it about 6.5 times a day. Both groups primarily focused on their sense of smell during activities related to “eating,” followed by considerations in “social life” and “personal hygiene.” Interestingly, distinct patterns emerged: patients peaked in awareness at 8 a.m. and 7 p.m., whereas healthy individuals showed peaks at 6 a.m., 12 p.m., and 7 p.m. Despite regular diary use, we observed no improvement in patients' olfactory function or related quality of life. Conclusion The olfactory diary is a valuable tool unveiling individual smell awareness patterns in patients with smell loss, aiding in counseling and patient management. Level of Evidence 4

Elif Karahan, Tuğba Baloğlu, Sevim Çelik et al.

Objective: The aim of this study was to investigate the relationship between body image and self-esteem in patients scheduled for rhinoplasty. Materials and methods: This descriptive, cross-sectional study was conducted at the otorhinolaryngology clinic of a public hospital between September 2022 and June 2023. The sample consisted of 78 patients who volunteered to participate in the study. The personal information form, body image scale and Rosenberg self-esteem scale were used in the study. Descriptive statistics, t-tests, Mann-Whitney U tests, Kruskal-Wallis variance analysis and Pearson correlation analysis were used for statistical analysis. Results: The study revealed that 41 (52.6%) of the participants were between the ages of 18 and 25, with the majority, 53 (67.9%), being female. The participants displayed high levels of self-esteem (1.18±1.38) and positive body image (157.22±21.56). The scores for self-esteem and body image were similar for different characteristics including age, gender, marital status, education level, occupation/employment, income–expenditure, having children and chronic disease (p>0.05). However, it was noted that individuals without a history of aesthetic surgery had significantly higher body image scores, while those who had undergone aesthetic surgery had higher self-esteem scores (p<0.05). Conclusion and recommendations: Based on the results of this study, it can be concluded that patients who are scheduled for rhinoplasty have high self-esteem and positive body image. Furthermore, there was a weak negative correlation found between body image and self-esteem.

Cabello R, Bueno-Serrano G, Hernando Arteche A et al.

Ramiro Cabello,1 Gonzalo Bueno-Serrano,1 Alberto Hernando Arteche,1 José Miguel Villacampa,2 Carlos Castilla,3 Carlos Carnero,3 María Garranzo Garcia-Ibarrola,1 Carmen Gonzalez Enguita1 1Department Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 2Department Otorhinolaryngology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 3Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, SpainCorrespondence: Ramiro Cabello, Email rcabello@quironsalud.esIntroduction: Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our “LAP training program for residents”.Material: Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents’ practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey.Results: All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS.Conclusion: Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.Keywords: training, laparoscopy, resident, urology

Johannes Matthias Weimer, Maximilian Rink, Thomas Vieth et al.

Abstract Background Point-of-care Ocular Ultrasound (POCOUS) has gained importance in emergency medicine and intensive care in recent years. This work aimed to establish and evaluate a dedicated ultrasound education program for learning POCOUS-specific skills during medical studies at a university hospital. Methods The blended learning-based program (6 teaching units) based on recent scientific publications and recommendations was developed for students in the clinical part of their medical studies. Experts and trainers consisted of physicians from the Ear-Nose-Throat, radiology, ophthalmology and neurology specialties as well as university educational specialists. Lecture notes containing digital video links for preparation was produced as teaching material. In total, 33 students participated in the study. The education program, including the teaching materials, motivation and subjective gain in competency, was evaluated with the aid of a questionnaire (7-point Likert response format). Objective learning success was assessed on the basis of pre- and post-tests. These covered the skill areas: “anatomical basics”, “ultrasound basics”, “understanding of cross-sectional images”, “normal findings” and “pathology recognition”. Results In the objective assessment of image interpretation, the participants improved significantly (p < 0.001) from pre- to post-test with a large effect size (Cohen’s d = 1.78, effect size r = 0.66). The evaluations revealed a high level of satisfaction with the course concept, teaching materials and the tutors. In addition, a high level of motivation was recorded in relation to continuing to study “ultrasound diagnostics” and “ophthalmologic diseases”. A significant (p < 0.01) positive gain was also achieved in terms of the subjective assessment of competency. This covers areas such as expertise, sonographic anatomy and performing a POCOUS examination as well as recognizing retinal detachment, globe perforation and increased optic nerve sheath diameter. Conclusion The results of this feasibility study show that medical students accept and support a POCOUS-specific education program and are able to develop a higher objective and subjective level of competency. Future transfer to other sites and larger groups of participants seems feasible.

Tirth R. Patel, Andrew D. P. Prince, William J. Benjamin et al.

Abstract Objective Auricular/periauricular cutaneous malignancies can be challenging to manage surgically due to the complex anatomy of the region. Otologists/neurotologists have unique skillsets that are well‐suited to surgically treat these patients. We aim to highlight the role of otologists and neurotologists in providing surgical care of patients with auricular and periauricular malignancies by describing the experience of a single fellowship‐trained neurotologist over a 10‐year period. Methods Retrospective chart review of 387 patients with auricular and periauricular malignancy treated by a single neurotologist between 2012 and 2022 was completed. Tumor histology and procedures performed for each patient were extracted. Additional data was collected for a subset of 84 patients with complex cases requiring selective neck dissection, parotidectomy, lateral temporal bone resection, regional advancement or rotational flap reconstruction, and/or free tissue transfer reconstruction. Results Within the series of 387 patients, squamous cell carcinoma was the most common histology (42.6%, n = 165), followed by basal cell carcinoma (40.8%, n = 158), and melanoma (9.8%, n = 38). Common surgical procedures included wide local excision (61.8%, n = 239), partial/sub‐total auriculectomy 18.3% (n = 71), or total auriculectomy 5.2% (n = 20). Within the 84‐patient subset, median age at diagnosis was 71.9 years. Dermatologists provided most patient referrals (50.0%, n = 42). Most common tumor locations included: auricular (58.3%, n = 49), pre‐auricular (21.4%, n = 18), and parotid (27.4%, n = 23). Revision surgery occurred in 22.6% of cases (n = 19), of which 26.3% (n = 5) for positive margins and 31.6% (n = 6) for recurrence. Mean follow‐up was 22.8 months. Disease‐specific 5‐year survival was 91%. Conclusions We demonstrate the feasibility of an otologist/neurotologist incorporating the surgical management of auricular and periauricular malignancies into their practice. Level of Evidence 4.

Lakshmi Nagendra, Kunal Mahajan, Gunjan Gupta et al.

Objective: Scant data is available on the efficacy and safety of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) for early and rapid reduction of low-density lipoprotein cholesterol (LDL-C) within 4–8 weeks of an acute event in patients with acute coronary syndrome (ACS). We undertook this meta-analysis to address this knowledge-gap. Methods: Electronic databases were searched for RCTs involving patients with ACS receiving PCSK9i in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in 1-month LDL-C post ACS. Secondary outcomes were to evaluate alterations in other lipid parameters and adverse events. Results: From initially screened 194 articles, data from 3 studies was analyzed. After 4-weeks therapy, patients receiving PCSK9i had lower LDL-C [MD -0.95 mmol/L (95%CI:-1.51 to −0.40); P = 0.0007; I2 = 96%, total cholesterol (TC) [MD-1.05 mmol/L (95%CI:-1.83 to −0.27); P = 0.009; I2 = 94%] and triglycerides (TG) [MD-0.27 mmol/L (95%CI:-0.44 to −0.10); P = 0.002; I2 = 0%] compared to controls. After 4–8 weeks therapy, patients receiving PCSK9i has lower apolipoprotein B [MD-27.74% (95%CI:-42.59 to −12.89); P = 0.0003; I2 = 89%] as compared to controls. High density lipoprotein cholesterol (HDL-C) [MD 0.05 mmol/L (95%CI:-0.00–0.11); P = 0.05; I2 = 0%], lipoprotein(a) [MD-20.63 mmol/L (95%CI:-41.86– 0.59); P = 0.06; I2 = 54%] and apolipoprotein A1 [MD 0.02 g/L (95%CI:-0.02–0.07); P = 0.32; I2 = 0%] were comparable between groups. Hospital readmission for ACS was significantly lower in group receiving PCSK9i compared to controls [OR0.25 (95%CI:0.07–0.85); P = 0.03; I2 = 0%]. Occurrence of cardiac death [OR3.75 (95%CI:0.41–34.22); P = 0.24; I2 = 0%], serious adverse events [OR0.71 (95% CI:0.13–3.83); P = 0.69; I2 = 70%] and total adverse events [OR1.01 (95%CI: 0.19–5.30); P = 0.99; I2 = 92%] was comparable between groups. Conclusion: PCSK9i are highly effective in early reduction of LDL-C along with reduction of early hospital readmissions post-ACS.

Shraddha S. Mukerji, Naga Jaya Smitha Yenduri, Eric Chiou et al.

Abstract Objectives (1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough. Methods Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar. Conclusion Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi‐disciplinary approach is cost‐effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft‐type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive. Level of Evidence: 2a

Aynur Aliyeva, Vafa Safarova

We present a case of localized nasal endometriosis to contribute to the literature. A primiparous, primigravida, 37-year-old female was diagnosed with nasal septal endometriosis in the presence of history of periodic epistaxis, nasal pain, and nasal fullness. After a nasal biopsy for exclusion of malignancy, a comprehensive general screening was performed on the recommendation of a gynecologist, definitive endometriosis was diagnosed, and oral treatment was initiated. Significant relief was reported in her nasal symptoms during the 1-year follow-up period. We report this case to demonstrate the importance of clinical awareness of periodic cyclic perimenstrual epistaxis, nasal lesions, and nasal pain as a cause of nasal septal endometriosis.

Joanna Radzikowska, Anna M. Czarnecka, Teresa Klepacka et al.

(1) Background: The aim of the present study was to assess the cancer stem cell (CSC) markers CD24, CD44, CD133, and ALDH1A1 in rhabdomyosarcoma (RMS) in children and to define their prognostic role in this group of patients. (2) Methods: The study material was archival tissue specimens collected from 49 patients under 18 years of age and who had been diagnosed with RMS. Immunohistochemistry (IHC) was used to evaluate the expression of the selected CSC markers in the tumor tissue. Expression was evaluated using a semiquantitative IRS scale based on the one developed by Remmele and Stenger and was correlated with the clinical and pathomorphological parameters of prognostic importance in RMS. (3) Results: Expression of the selected CSC markers CD24, CD44, CD133, and ALDH1A1 was demonstrated in 83.7%, 55.1%, 81.6%, and 100% of the RMS patients, respectively. The expression of all of the assessed CSC markers was statistically significantly higher in the study group versus the control group. No significant correlation was found between the expression of the selected CSC markers and clinical and pathological prognostic factors that were analyzed. The expression of the CSC markers did not have a significant influence on RMS survival rates. (4) Conclusions: The results of the conducted study confirm the expression of selected CSC markers in rhabdomyosarcoma tissue in children. The study did not support the prognostic relevance of the expression of any of the assessed CSC markers. However, further studies are needed to fully understand the relevance of the selected CSC markers in RMS carcinogenesis.

Helena Kristiina Orell, Helena Kristiina Orell, Anne Katariina Pohju et al.

AimThis study aimed to determine the prevalence of malnutrition in a head and neck cancer (HNC) population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess its relation to survival. The secondary aim was to compare GLIM criteria to Patient–Generated Subjective Global Assessment (PG–SGA) and Nutritional Risk Screening 2002 (NRS 2002) methods.MethodsThe assessment was performed in a series of 65 curative patients with newly diagnosed HNC in a nutrition intervention study. Malnutrition was defined as PG-SGA classes BC and nutritional risk as NRS 2002 score ≥3 and was retrospectively diagnosed with GLIM criteria in prospectively collected data at diagnosis. Sensitivity, specificity, and kappa (κ) were analyzed. Predictive accuracy was assessed by calculating the area under curve (AUC) b y receiver operating characteristic (ROC) analysis. Kaplan–Meier and Cox regression analyses were used to evaluate association between malnutrition and overall survival (OS), and disease-free survival (DFS).ResultsGLIM-defined malnutrition was present in 37% (24/65) of patients. The GLIM showed 77% sensitivity and 84% specificity with agreement of κ = 0.60 and accuracy of AUC = 0.80 (p &lt; 0.001) with PG-SGA and slightly higher sensitivity (83%) with NRS 2002 (κ = 0.58). Patients with GLIM-defined malnutrition had shorter OS (56 vs. 72 months, HR 2.26, 95% CI 1.07–4.77, p = 0.034) and DFS (37 vs. 66 months, HR 2.01, 95% CI 0.99–4.09, p = 0.054), than well-nourished patients. The adjusted HR was 2.53 (95% CI 1.14–5.47, p = 0.023) for OS and 2.10 (95% CI 0.98–4.48, p = 0.056) for DFS in patients with GLIM-defined malnutrition.ConclusionA substantial proportion of HNC patients were diagnosed with malnutrition according to the GLIM criteria and this showed a moderate agreement with NRS 2002- and PG–SGA-defined malnutrition. Even though the GLIM criteria had strong association with OS, its diagnostic value was poor. Therefore, the GLIM criteria seem potential for malnutrition diagnostics and outcome prediction in the HNC patient population. Furthermore, NRS 2002 score ≥3 indicates high nutritional risk in this patient group.

Yunyan Xia, Kai You, Yuanping Xiong

BackgroundObstructive sleep apnea (OSA) is associated with hypertension; however, the associations between cardinal features of OSA, such as intermittent hypoxia (IH) and sleep fragmentation (SF), and blood pressure remain unclear. We performed this study to address this issue.MethodWe investigated 335 subjects with the polysomnography (PSG) tests. Data, including basic characteristics, PSG parameters, and blood pressure, were collected. We calculated p-values for linear trends of blood pressure across oxygen-desaturation index (ODI)/microarousal index (MAI) quartiles. Logistic regressions were used to determine the risk factors for abnormal blood pressure and to detect the multiplicative interaction between ODI and MAI with blood pressure.ResultsAfter adjusting for multiple variables, compared with subjects with lower ODI quartiles, those with higher ODI quartiles had significant higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p for trend = 0.010 and 0.018, respectively). And compared with subjects with lower ODI quartiles, those with higher ODI quartiles were also more likely to have abnormal DBP and hypertension after adjusting for multiple variables. Similarly, compared with subjects with lower MAI quartiles, those with higher MAI quartiles had significant higher SBP and DBP, and were more likely to have abnormal DBP and hypertension. No significant multiplicative interactions between ODI and MAI with blood pressure were detected.ConclusionSubjects with more severe IH/SF had significant higher blood pressure and were more likely to have abnormal DBP and hypertension than those with less severe IH/SF. No interaction between IH and SF on the relationship with blood pressure was shown.

Ming‐Hsien Tsai, Hui‐Shan Huang, Hui‐Ching Chuang et al.

Abstract Objectives To evaluate the importance of depth of invasion (DOI) in patients with pathologically low‐risk feature stage I oral squamous cell carcinoma (OSCC) managed by primary tumor resection alone. Methods Patients with stage I OSCC, at pathologically low risk, underwent primary tumor resection without neck dissection were enrolled retrospectively between 2007 and 2015. Low risk was defined as the absence of positive or close margins, lymphovascular invasion, perineural invasion, worst pattern of invasion‐5, and poor differentiation in histologic grade. The primary endpoints included overall survival (OS), cancer specific survival (CSS), local recurrence free survival (LRFS), and regional recurrence free survival (RRFS). A nomogram based on the DOI was established for predicting RRFS. Results A total of 198 patients were enrolled in this study. DOI was the only prognosticator to achieve statistical significance in all primary endpoints according to univariate analysis. Patients with DOI <3 mm tumor showed better five‐year OS, CSS, LRFS, and RRFS than those with DOI ≥3 mm tumor. The concordance index of the nomogram model without DOI was 0.684, which could increase to 0.733 when DOI was included in the calculation. Conclusion Patients with pathologically low‐risk stage I OSCC correlate with a higher chance in occult neck metastasis if increasing DOI (≥3 mm) is noticed. Indeed, the chance of occult neck metastasis is significantly higher in this group (14% vs. 2%) than in those with DOI <3 mm. Elective neck dissection is advised if DOI is ≥3 mm to achieve better clinical outcomes. Level of Evidence 4.

Yang Xu, Wen Yang, Yao Song et al.

Aida Sharifi Haddad, Behzad Aminzadeh, Seyed Ali Alamdaran et al.

Introduction: The management of thyroid nodules has been proposed based on US features and information obtained from Fine-Needle Aspiration Cytology (FNAC). In this study, we checked the diagnostic value of ultrasound in comparison with FNAC in probably benign nodules of thyroid. Materials and Methods: Patients with thyroid nodules referred to the Radiology department from 2015 to 2020, were classified into five types based on the American College of Radiology/thyroid imaging reporting and data system (TI-RADS) standards. The patients with TI-RADS III-V were examined by FNA biopsy. Subsequently, the collected data of 535 patients having thyroid nodules with TI-RADS III were statistically analyzed. Results: The mean age of the patients was estimated at 46.57. The analysis of TI-RADS III cases examined by the FNA biopsy revealed that 99.1% of the cases were diagnosed with benign lesions. The mean size of benign and malignant nodules was 27mm and 41mm, respectively. There was no significant correlation between the size of the nodules or patients age, and thyroid malignancy (P-values > 0.05). Conclusion: There was a very low chance of malignancy (0.9%) in thyroid nodules with thyroid imaging classification of TI-RADS III. Furthermore, no meaningful correlation was observed between the size of the nodules and their malignancy. Therefore, the use of FNAC, based on the current guidelines, on thyroids for nodules larger than 2.5 cm might need to be revised.

Afshin Ostovar, Safoora Pordel, Ali Movahed et al.

Allergic rhinitis (AR) is a prevalent disease affecting the quality of life of patients throughout the world. This study aimed to assess the prevalence of AR and its association with chronic rhinosinusitis (CRS) in the adult population living in Bushehr, southwestern part of Iran. In this population-based study, a total of 5420  individuals aged 15-65 years were selected through a multi-stage, cluster, random sampling method from which 5201 of them completed the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (Response rate=96.1%). The prevalence of AR, based on Allergic Rhinitis and Its Impact on Asthma (ARIA) classification (mild or moderate; intermittent or persistent) was calculated and the association of AR and CRS was evaluated using a multiple logistic regression model. The overall prevalence of AR was 28.8%, and for the intermittent and persistent AR were 25.9% (out of which 81.34% were moderate to severe) and 74.1% respectively. Moreover, the prevalence of AR was significantly higher in health workers and smokers (p=0.002 and p<0.001, respectively). Furthermore, an association was found between AR and CRS (p<0.001, aOR: 4.68, 95%CI: 4.07-5.39), and also, between the persistent AR and CRS as compared with the intermittent (p<0.001, aOR: 4.21, 95%CI: 3.40-5.22). The present study showed that the prevalence of AR in Bushehr (Southwestern part of Iran) was significantly high. In addition, the results indicated a strong association between AR and CRS, especially in individuals with moderate to severe persistent AR.

Markus Nieminen, Katri Aro, Antti Mäkitie et al.

Background Early diagnosis of head and neck cancer (HNC) will improve patient outcomes. The low incidence of HNC renders its detection challenging for a general practitioner (GP) in primary health care (PHC).Patients and methods To examine these challenges, our cohort consisted of all patients visiting PHC centres in the City of Helsinki in 2016. We chose 57 ICD-10 codes representing a sign or symptom resulting from a possible HNC and compared data for all new HNC patients.Results A total of 242,211 patients (499,542 appointments) visited PHC centres, 11,896 (5%) of whom presented with a sign or symptom possibly caused by HNC. Altogether, 111 new HNCs were diagnosed within the Helsinki area, of which 40 (36%) were referred from PHC. The median delay from the initial PHC visit to the referral to specialist care was 5 days, whereby 88% of patients were referred within one month.Conclusions Despite the low incidence of HNC and the large number of patients presenting with HNC-related symptoms, GPs working in PHC sort out potential HNC patients from the general patient group in most cases remarkably effectively.KEY MESSAGESFor every head and neck cancer (HNC) patient encountered in the primary health care, a general practitioner (GP) will meet approximately 6000 other patients, 100 of whom exhibit a sign or a symptom potentially caused by a HNC.Despite the low incidence of HNC, GPs referred patients to specialist care effectively, limiting the median delay from the initial appointment to referral to only 5 days.

K. Tae

Copyright © 2020 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinical and Experimental Otorhinolaryngology Vol. 13, No. 2: 93-94, May 2020 https://doi.org/10.21053/ceo.2020.00402

P. Hellings, G. Scadding, C. Bachert et al.

1 KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; 2 University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; 3 University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; 4 Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands; 5 RNENT Hospital, Huntley Street, London, UK; 7 Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; 8 Division of ENT diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden; 9 Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China; 10 Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden; 11 Personalized Medicine Asthma and Allergy Clinic, Humanitas University and Research Hospital, Milan, Italy, and SANI-Severe Asthma Network Italy; 12 Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; 13 Ear, Nose, and Throat (ENT) Department, Flinders University, Bedford Park, South Australia, Australia; 141st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece; 15 European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium; 16 Dept of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; 17 Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; 18 Dept Clin Pharm and Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands; 19 Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London; 20 MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; 21 Rhinology and Skull Base, Applied medical research center, University of New South Wales, Sydney, Australia; 22 Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia; 23 Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom; 24 Department of Otorhinolaryngology Head and Neck surgery, Odense University Hospital, Denmark; 25 University of Southern Denmark, Odense, Denmark; 26 Center for Rhinology and Allergology, Wiesbaden, Germany; 27 Mainz University Allergy Center, Mainz, Germany; 28 Royal National Throat, Nose and Ear Hospital, UCLH, London, UK; 29 Optimum Patient Care, Cambridge, UK; 30 Observational and Pragmatic Research Institute, Singapore; 31 Academic Primary Care, University of Aberdeen, Aberdeen, UK; 32 Monash Health, Monash University, Melbourne, Australia; 33 Usher institute, University of Edinburgh, Edinburgh, UK; 34 The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, United Kingdom; 35 NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; 36 University of Southampton, Southampton, United Kingdom; 37 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Skåne University Hospital, Malmö, Sweden; 38 Helsinki University Hospital, Helsinki, Finland; 39 Imperial College London, London, UK; 40 Royal Brompton and Harefield NHS Trust, London, UK; 41 Clinical Medicine, Griffith University, Southport, QLD, Australia; 42 Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 43 Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany; 44 Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Charite, Berlin, Germany. Rhinology 58: 6, 618 622, 2020 https://doi.org/10.4193/Rhin20.246

G. D. Tarasova, I. M. Kirichenko, E. V. Mirzabekyan

The article highlights that rhinitis is the most common disease, it is divided into 3 main phenotypes: infectious (IR), allergic (AR) and non-infectious non-allergic (NAR). There are also combined forms.IR is a viral disease. Its clinical picture is described, the frequent failure of patients to consult a doctor for this disease is noted, which contributes to the development of complications and its chronization.The authors described the characteristic features of the AR clinic with “oral Allergy syndrome“.It is noted that NAR is a heterogeneous disease, which is divided into at least 6 subphenotypes: drug, taste, hormonal, atrophic, idiopathic and rhinitis of older people. The authors analyze the reasons for their occurrence. There is also a professional form of rhinitis.All these phenotypes are United by the symptom of difficult nasal breathing, which also occurs in chronic rhinosinusitis and “empty nose“ syndrome.Other causes of nasal breathing disorders are also mentioned.In the treatment of patients with almost any of the rhinitis phenotypes, the main ones are irrigation-elimination therapy and the appointment of topical decongestants (TD). An important role is played by avoiding the causes that activate the course of rhinitis, and educating the population to properly organize the individual treatment process.Topical vasoconstrictor drugs are the leading topical remedies that eliminate nasal breathing difficulties. They are sold in our country in the usual access and if used incorrectly can cause the development of medical rhinitis and many serious consequences. The methods of correct administration of the drug in the form of drops and spray, as well as its age-related dosages, are disclosed