Abstracts
Adrian Agius
Mediterranean structural Rhinoplasty-lessons learned in analysis of 925 cases
This presentation analyses the techniques used by the author in Mediterranean rhinoplasty in the last 925 cases.
A description of the techniques is presented together with statistical analysis comparing men and women.
Structural septal techniques are more common in men due to trauma while in women, tip techniques are commoner.
Surgeons carrying out Mediterranean septorhinoplasty should be proficient in septal surgery.
An Boudewyns
Drug-induced sleependoscopy in children with obstructive sleep apnea
Obstructive sleep apnea (OSA) is caused by repeated episodes of partial or complete upper airway obstruction during sleep. In children, this obstruction typically occurs at the level of the adenoids and tonsils and adenotonsillectomy is still considered the first line treatment modality for moderate to severe OSA. However, recent evidence indicates that many children present with multilevel upper airway obstruction during sleep. This is especially true for infants and children with underlying conditions such as craniofacial malformations, syndromes affecting upper airway morphology or upper airway muscle tone, obesity etc.Therefore, tools have been developed to better delineate the site (s) of upper airway obstruction in order to provide an individualized treatment approach.
Drug-induced sleep endoscopy (DISE) is currently the most common employed tool for upper airway evaluation. The aim of this presentation is to discuss the utility of DISE as a selection tool for upper airway surgery in children with OSA and to discuss the available data on treatment outcome after DISE directed interventions. Also, the current limitations of pediatric DISE will addressed.
Nasal obstruction and pediatric obstructive sleep apnea
In the first part of this lecture, I will explain how an increase in nasal resistance will affect upper airway collapsibility and contribute to the occurrence of obstructive sleep apnea. In the second part of the presentation, possible causes of nasal obstruction in children of different ages along with new diagnostic tools, will be discussed. In the last part, I will elaborate on surgical and non-surgical treatment modalities for nasal obstruction and their effect on snoring and obstructive sleep apnea.
Itzhak Braverman
Hillel Yaffe Medical Center, Otolaryngology Head and Neck Surgery, Hadera, Israel; Technion Faculty of Medicine, Haifa, Israel
Comprehensive Evaluation and Treatment of Obstructive Sleep Apnea: From Nose to Epiglottis
Obstructive sleep apnea (OSA) is a common disorder marked by the repetitive collapse of upper airway structures during sleep. This collapse, primarily driven by negative inspiratory pressure, can lead to intermittent hypoxemia, increased blood pressure, and oxidative stress. While polysomnography (PSG) remains the gold standard for diagnosis, measuring severity through the apnea–hypopnea index (AHI), it often fails to identify the anatomical sites of obstruction. Drug-induced sleep endoscopy (DISE) offers real-time visualization of the airway during simulated sleep and often reveals obstruction patterns not evident on PSG. A thorough, multilevel evaluation of the upper airway, from the nasal cavity to the epiglottis, is essential to guide targeted, individualized treatment. Structured Evaluation Approach: This presentation outlines an anatomy-guided method for assessing the nasal cavity, oropharynx, hypopharynx (including the tongue base), and epiglottis. Particular attention is given to epiglottic collapse (EC), an often overlooked yet clinically significant contributor to OSA. The interaction between various anatomical levels is examined, underscoring DISE's role in distinguishing isolated from multilevel collapse. Treatment Considerations: We discuss how treatment plans, ranging from CPAP and mandibular advancement devices to single, or multilevel surgical procedures, are tailored to individual collapse patterns. The rationale for each intervention is grounded in anatomical findings observed during DISE. Clinical Insights: Our experience applying a DISE-based algorithm to a diverse cohort of patients demonstrates the importance of recognizing OSA phenotypes and endotypes. Collapse patterns involving EC, palatal, tongue base, and tonsillar structures were identified and managed accordingly. Conclusion: A complete “nose-to-epiglottis” evaluation is crucial for uncovering the full complexity of OSA. Integrating DISE into clinical assessment enables precise identification of obstruction sites and supports more effective, personalized therapy.
Andrei Bajureanu
Department of Otorhinolaryngology, Nicolae Testemițanu State University of Medicine and Pharmacy;
ENT Department, “T. Moșneaga” Republican Clinical Hospital;
Chisinau, Moldova
Endoscopic Approach to Benign Sinonasal Tumors-our experience
Endoscopic sinus surgery has become the treatment of choice for benign sinonasal tumors, offering optimal visualization, anatomical preservation, and reduced intraoperative complications. This presentation focuses on endoscopic resection techniques for tumors such as inverted papilloma, juvenile nasopharyngeal angiofibroma, and frontoethmoidal osteoma, emphasizing the selection of surgical corridors, bone drilling, and vascular control. The importance of preoperative planning using high-resolution imaging, intraoperative navigation, and long-term follow-up strategies to minimize recurrence risk is highlighted. Clinical experience is correlated with current evidence from the literature, outlining both the advantages and limitations of the endoscopic approach in managing benign sinonasal tumors with invasive potential.
Zsolt Bella
Head of the BKMK Kecskemét, Hungary, University Teaching Hospital,
ENT HNS and Maxillofacial Department
Nasal turbinate management
In addition to septal malformations, we must also focus on the role of the turbinates in the background of proper nasal breathing. In addition to medical therapy, a reduction of the turbinates may be necessary. The anatomical and functional role of the turbinates is complex: breathing, humidification, filtration, warming, bacterial killing are many of the tasks that are linked to the intact mucosal membrane of the turbinates. Uncritical nasal turbinate resection causes irreversible damage to these functions, which can worsen patients' symptoms. In this presentation we will discuss diagnostic options, treatment planning and minimally invasive interventions.
Nenad Arsovič
Cochlear Implantation in Serbia: Advancing with Individualized Protocols in Audiological Care
Cochlear implantation has significantly enhanced auditory rehabilitation outcomes, with continued development of protocols and practices across Serbia. At our clinic, a comprehensive and individualized approach is implemented for each patient, combining auditory, vestibular, and radiological assessments to ensure optimal candidacy and outcomes. Since the introduction of advanced diagnostic protocols in 2019, we have expanded our criteria to include adult patients, reflecting global trends and increasing access to auditory restoration across age groups
Methods:
The study presents the structured diagnostic protocol used in our center, emphasizing a multidisciplinary and patient-specific evaluation process. This includes detailed audiological profiling, vestibular testing, and high-resolution imaging, ensuring precise and personalized preoperative planning.
Results:
More than 100 adult patients have been successfully implanted, demonstrating significant improvements in auditory performance and overall quality of life. The incorporation of vestibular assessment has allowed for refined candidate selection and tailored surgical planning, contributing to enhanced postoperative outcomes in both pediatric and adult populations.
Conclusion:
By prioritizing individualized protocols and expanding candidacy criteria, our clinic exemplifies a modern approach to cochlear implantation. Through comprehensive diagnostics and patient-centered planning, we continue to achieve high standards in auditory rehabilitation and quality of care.
Hans Rudolf Briner
Surgery for olfaction – how to achieve good long-term results
One of the most common reasons for olfactory impairment is inflammatory disease of the nose and paranasal sinuses. In patients with chronic rhinosinusitis not responding sufficiently to medical therapy, endoscopic surgery may help to reduce inflammatory disease and therefore to improve the sense of smell. The concept of surgery is to restore ventilation and drainage of blocked sinuses and to improve the access for topical therapy. To achieve good long-term results for olfaction, a special focus needs to be on the olfactory cleft. Gentle dissection of the olfactory cleft mucosa, avoiding mucosal lesions on corresponding sites of the septal and turbinate mucosa, helps to avoid scars of the olfactory cleft. Furthermore, a gentle and controlled lateralisation of the middle turbinate leads to optimal ventilation and access for topical steroids of the olfactory cleft.
Closure of csf-leaks – tips and tricks for success
CSF-Leaks need to be closed to prevent life threatening complications like meningitis or pneumocephalon. Most leaks are accessible for transnasal endoscopic closure. Before closure, the diagnosis must be confirmed and the localisation of the defect must be clear. Autologous material is the first choice for reconstruction of the defect. Fat, fascia and mucosal flaps (free flap od pedicled flap) are most suitable for reconstruction. The margin of the defect must be free of nasal mucosa and a broad contact zone of the margin and the reconstruction material enhances healing. In large defects, a watertight and stable reconstruction can be achieved by suturing the fascia to the dura. Multilayer closure and packing further help to achieve a stable reconstruction. In CSF-leaks with high risk of recurrence, supportive therapy, for example with a lumbar drainage, should be considered.
Cemal Cingi
ENT Specialist, Private Practice, Istanbul, Türkiye
Eskisehir Osmangazi University, Faculty of Medicine, Department of Otorhinolaryngology, Eskisehir, Turkey
Biruni University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul/ Turkey
Steps of endonasal rhinoplasty
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Tip Sutures
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Tip Grafts
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John Fenton
Dept ORL-HNS, University Hospital Limerick & University of Limerick Medical School, Ireland.
A Tale of three titles; Rhinopharyngitis, Nasopharyngitis and Epipharyngitis.
From an ENT perspective, inflammation of the nasal passages is Rhinits and Pharyngitis is when the inflammation involves the entire pharynx. When both the nasal cavities and pharynx are affected as in the “Common Cold”, it is Rhinopharyngitis. Nasopharyngitis is inflammation of the nasopharyngeal mucosa, or is it? Some authors term mucosal erythema of the postnasal space as Epipharyngitis. An equivocation exists in the medical literature whereby Nasopharyngitis, Epipharyngits and Rhinopharyngitis are variously used or are interchanged to describe the same or related condition.
Ask a Rhinologist and a Medical Physician to explain the difference between Rhinopharyngitis, Nasopharyngitis or Epipharyngitis and one will receive various and different answers with overlap, ambiguity and confusion. Ask a non-Otorhinolarnygologist to provide a list of the common complications of Biologics, it will invariably include Nasopharyngitis but none of these patients will have had Nasopharyngoscopy performed. Ask the WHO to define Nasopharyngitis and the International Classification of Diseases-10-Clinical Modification (ICD-10-CM) will be Acute (“Common Cold”) or Chronic (Chronic Rhinitis, Nasopharyngitis and Pharyngitis). Ask Pubmed and you will retrieve more than 26,653 for Rhinopharyngitis, 1,831 for Nasopharyngitis and 56 for Epipharyngitis. The first ever recorded article in 1905 on Medline reporting Nasopharyngitis was also found in a search of Rhinopharyngitis.
The aim of this presentation is to highlight the incongruity between specialties, present a literature review of the terms Nasopharyngitis and Epipharyngitis, investigate their historical use in medical literature and suggest potential solutions. Two-thirds of articles reporting Nasopharyngitis prior to 1960 were related to localised inflammation of the nasopharynx, these had equalised with inflammation of the nose and pharynx by 1992 and currently comprises approximately one third of publications.
It is acknowledged that in healthcare a lack of precision is dangerous when the margin of error is small and while the risk to any patient is minimal in many instances of misnomers, it is incumbent to address any anomaly that may arise. There is undoubtedly tremendous confusion, overlap and lack of accuracy in the term Nasopharyngitis throughout the various aspects of medical literature. This may well imply that it is too late to reverse this evolution and that it may be appropriate for ORL-HNS to adopt the term Epipharyngitis in its stead. The answers could also lie in direct discussions with WHO and a consensus statement from those who work in that area of concurrence where the nose meets the pharynx involving national and regional specialty and subspecialty societies with the assistance of our Discipline’s journal editors.
Andrew Fishman
Sava Memorial Hospital Belgrade Serbia
Making the Transition from Rhinologist to Skull Base Surgeon
Endoscopic technique is being increasingly employed in the field of anterior skull base surgery. So much that it is now considered standard in care most regions of the world. In many countries in the Balkans, there had been a delay in implementation due to the increased cost of needed equipment. Now however, most centers have acquired the basic tools and training. It this point, the younger generations of surgeons will find themselves in a position to expand their skills and collaborate with neurosurgeons to execute these challenging procedures. The aim of this lecture is to present some of the changes that i personally experienced in my operating methods to successfully make this transition. It is my hope that sharing these tips will help advance safe and effective anterior endoscopic skull base surgery in our region of the world that still face many other challenges delivering complex healthcare.
Stephan Hackenerg
Primary Ciliary Dyskinesia – background and future developments
Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disease with initial symptoms in the early postnatal period and early childhood. Major but unspecific symptoms are neonatal respiratory distress syndrome, situs inversus, persistent cough, and chronic nasal congestion, recurrent paranasal sinus disorders with or without polyps, bronchiectasis as well as male infertility. Diagnostics is complex and includes transmission electron microscopy, nasal NO assessment, high-speed video microscopy and genetic evaluations. Future developments include dedicated in-vitro systems to further characterize the functional aspects of the mucosal disease. The talk gives an overview over the current diagnostic procedures, therapeutic options and research. The management of PCD is a multidisciplinary approach, which should be reserved to in highly specialized centers.
Ljiljana Jovancevic
University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia
Clinical Centre of Vojvodina, ENT and HNS Clinic, Novi Sad, Serbia
Imaging as a diagnostic tool in rhinology
The structure of a person’s paranasal sinuses is as unique as a set of fingerprints, so contemporary Rhinology uses both computerized tomography (CT) and magnetic resonance imaging (MRI) as diagnostic imaging tools.
CT is superior to MRI in demonstrating the bony anatomy, osseous margins, the extent and localization of inflammatory lesions and complications. CT has major limitations in the differentiation of soft tissue masses (for that indication, MRI is superior to CT).
CT of the nose and paranasal sinuses should not be used as first, nor as only diagnostic procedure, and should always be interpreted in accordance with symptoms, clinical and nasal endoscopy finding.
The timing of CT scanning, positioning of the patient’s head, the use of suitable CT-scan window, native scan or done with intravenous contrast media, analysis of all 3 projections, knowledge of how is the direct scanning done, proper looking at and analyzing bony changes and mucosal thickenings, are just some of the very important issues that need to be kept in mind when analyzing CT scans.
The radiation dose can be quite high, so indications for CT should always be reconsidered. Nasal endoscopy must be done prior CT scanning. MRI should be added and radiologist consulted whenever in any doubt of correct diagnosis.
Marco Piemonte
Emeritus President of the Italian College of Surgeon (CIC)
Past President of the Italian Society of ORL-H&N Surgery (SIOeChC-F)Biological Therapy in CRSwNP: lights and shadows about an outstanding clinical problem
CRSwNP is a still challenging disease, in spite of the multiple, important and ongoing advances in physiopatology, diagnosis and therapy.
As a matter of fact, in CRSwNP diagnosis and therapeutical could not be restricted and «tout court» simplified in a single classification or in schematic «flow charts», while on the contrary they should always be specified after a precise and attentive evaluation path which considers different parameters like anamnesis (i.e. comorbidities), clinico-objective findings, clinico-instrumental findings (CT in first row), immunobiological items, therapeutical factors (previous therapies, remission, recurrences, resistance, etc.), patient’s subjective ones (QoL, «desiderata», «compliance»).
Of course the clinician shall reach an acceptable matching between any further and deeper diagnostic examination and an affordable and practically sustainable practice (mainly in follow up).
Also in CRSwNP the therapeutical approach, as always more often in Medicine, shall be «personalized» («tailor-made») and always more respectful of the modern concept of «Integrated Care Pathways».
In spite of the many studies and advances in this field, many questions are still unsolved, even if the actual knowledge allows reliable hypotheses and current solutions with high rate of cure. Of course, the relatively short period of follow up time by the most modern and innovative therapeutical toools are still leaving some doubt about long term efficacy and safety of these ones.
The most important controversial points (but these are not the only ones) refer to:
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The best therapeutical planning and its significance/affordability ratio
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The best follow up planning during and after therapy, with a very important collateral branch of experimental applied research by Telemedicine
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The choice of which biological drug shall be used (mainly with reference to comorbidities), how long and by which dose shall it be used
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Possible complications or late adverse events in biological therapies
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How to treat “difficult” cases (resistant cases; comorbidities)
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How and when a National Health Service should afford always more expensive therapies
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Shall we rely on new biological drugs in the next future?
Clinical practice in rhinology patient clinics has profoundly changed in the last few years and this fact underlines the need for a thorough and continuous scientific updating not only in the rhinologists’ culture and experience, but also for specific Guidelines and Scientific Literature in the field.
An open-minded and objective approach to modern diagnosis and therapy of CRSwNP shall absolutely be enhanced and improved by further studies and updated scientific discussion.
Jan Plzák
Management of recurrent nasopharyngeal carcinoma
Recurrent nasopharyngeal carcinoma (NPC), which occurs in 10–20% of patients with primary NPC after an initial treatment modality of intensity-modulated radiation therapy (IMRT), is one of the leading causes of death in patients with NPC. Patients with recurrent disease without distant metastases still have a chance of survival, but retreatment often carries more severe toxicity or higher risks. In this group of patients, otolaryngologists and oncologists are committed to developing more appropriate treatment regimens that can prolong patient survival and improve survival therapy. Surgical salvage should be considered in resectable cases (especially for rT1–T2 tumors). Endoscopic nasopharyngectomy is increasingly used over historical external approaches, which still have their indications. Re-irradiation should be considered in patients with unresectable disease or in those who are unsuitable for or reluctant to undergo surgery.
Felice Scasso
Chronic paedriatic rhinosinusitis is always a surgery patology?
INTRODUCTION
Paediatric chronic rhinosinusitis (PCRS) is a common disease in children under 18 year old and
differs significantly from adult chronic rhinosinusitis (CRS) in terms of clinical features.
It is estimated that the incidence of CRS in children and adolescents is up to 4%.
AIM
The aim of this exposure is to review the diagnosis and management of chronic pediatric sinusitis
in light of recent data and advances in both surgical and medical management.
MATERIAL AND METHODS
Analysis of recent literature and guidelines from The European Position Paper on Rhinosinusitis
and Nasal Polyps (EPOS 2020).
RESULTS
Many factors contribute to the development of sinusitis, the main ones are: in younger children
adenoiditis and in older children allergic rhinitis. Inflammation, mucociliary dysfunction and
changes in the microbial environment are other causes of the disease.
The diagnosis of pediatric CRS is made by the presence of two or more of the following
symptoms: nasal obstruction, facial pressure/pain, purulent rhinorrhea and cough for at least 12
weeks.The EPOS guidelines recommend nasal endoscopy as a preliminary objective method to aid
in the recognition of CRS. Another mode to visualize PCRS is computed tomography (CT), but it is
recommended when medical treatment did not control the symptoms and in preparation for
sinus surgery, or even in patients with suspicious complications.
The first line of treatment of PCRS is medical and it is based on: oral antibiotics, intravenous
antibiotics, corticosteroids, nasal saline irrigations and more recently biological drugs.
When medical treatment fails several surgical modalities are available represented by:
adenoidectomy with or without sinus irrigation, balloon catheter dilation, funtional endoscopy
sinus surgery.
CONCLUSIONS
The development of CRS in children is multifactorial with the adenoids comprising a larger role
compared to adult CRS. Medical therapy remains first line in the treatment of uncomplicated
pediatric PCRS while surgery is reserved only for cases not well controlled by medication.
Rohit Singh
Professor and Head ENT, Kasturba Medical college, Manipal India 576104
Nasal granulomas a diagnostic dilemma in the developing world
Granulomatous conditions of the nose present significant diagnostic and therapeutic challenges in resource-limited settings. This case series examines distinctive presentations of nasal granulomatous diseases encountered in developing regions, including rhinoscleroma, rhinosporidiosis, tuberculosis, and atrophic rhinitis. Through careful clinical-pathological correlation and innovative diagnostic approaches adapted to resource-constrained environments, we identified key distinguishing features that can guide clinicians working with limited access.
Rhinoscleroma cases demonstrated the characteristic progression through catarrhal, granulomatous, and fibrotic stages, with confirmation by the identification of Mikulicz cells and Klebsiella rhinoscleromatis on culture. Rhinosporidiosis presented with friable, polypoid masses containing pathognomonic sporangia of Rhinosporidium seeberi on histopathology. Nasal tuberculosis manifested with varied presentations, from ulcerative lesions to polypoid masses, requiring differential diagnosis from other granulomatous conditions through demonstration of acid-fast bacilli and nucleic acid amplification tests where available. Atrophic rhinitis cases exhibited the classic triad of fetor, crusting, and atrophy, with persistent diagnostic challenges regarding primary etiology.
Our experience demonstrates that despite technological limitations, a systematic approach combining thorough clinical evaluation, basic histopathology, and selective use of accessible microbiological methods can effectively differentiate these conditions. This case series highlights practical diagnostic algorithms and context-appropriate management strategies to address these challenging conditions.
Andrew Swift
Will endoscopic septoplasty take over conventional techniques?
Septoplasty is one of the most frequently performed operations within specialist ENT practice. Various techniques are described but there has been significant change in how the operation is currently being performed. Endoscopic septoplasty was initially described in the 1990’s but has shown an increasing trend in popularity over recent years. The endoscopic technique has even become the preferred method of septoplasty in some departments.
Whilst this change may seem to reflect good professional development and progress in surgery, the more conventional forms of septoplasty are becoming much less popular. This will inevitably limit experience in conventional techniques that could lead to loss of skill and expertise.
This presentation aims to provide a comprehensive review of septoplasty that considers the benefits and limitations of both endoscopic and conventional septoplasty. Suggestions for future septoplasty surgery and training will be proposed.
Ignazio Tasca
Functional Rhinoseptoplasty
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Septoplasty not a trivial surgery
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Patrizio Tatti
Obstructive sleep apnea impact on obesity and diabetes
Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent sleep-related breathing disorder characterized by repeated episodes of upper airway obstruction during sleep. It is increasingly recognized as a significant public health concern due to its strong associations with metabolic and cardiovascular comorbidities, particularly obesity and type 2 diabetes mellitus (T2DM). Obesity is one of the primary risk factors for OSAS, contributing to upper airway collapsibility and increased fat deposition around the neck and pharynx. In turn, OSAS exacerbates metabolic dysfunction by promoting insulin resistance, systemic inflammation, and sympathetic nervous system overactivity, which are key contributors to the development and progression of T2DM. Furthermore, the intermittent hypoxia and sleep fragmentation typical of OSAS further impair glucose metabolism and worsen glycemic control in diabetic patients. This triad—OSAS, obesity, and diabetes—forms a vicious cycle that amplifies the risk of adverse health outcomes, including cardiovascular disease and reduced quality of life. Understanding the interplay among these conditions is critical for early identification, integrated treatment strategies, and the development of targeted interventions to mitigate their combined impact on global health.