Romanian Journal of Rhinology Feed

Abstracts of the 8th Congress of the Romanian Rhinologic Society

Wed, 22 Oct 2025 00:00:00 GMT

Childhood neuroblastoma: case presentation and systematic review of the literature

Wed, 22 Oct 2025 00:00:00 GMT

BACKGROUND. Olfactory neuroblastoma (ONB) is a rare tumor in children, with locally aggressive behaviour and difficult surgical access. OBJECTIVE. To analyze the clinical, therapeutic, and prognostic characteristics of pediatric ONB through a systematic review of published clinical cases and the presentation of a maxillary case. MATERIAL AND METHODS. A systematic review was carried out in accordance with the PRISMA guidelines. The search was conducted in PubMed, Scopus, ScienceDirect and Mendeley, including studies published in English up to December 2024. The following descriptors were used: (“esthesioneuroblastoma” AND “neuroblastoma”) AND (“children” OR “child” OR “pediatric”), applying filters by age (<18 years) and clinical case design or case series. Two authors made the selection blindly using Rayyan. Animal studies with no individual description or duplicates were excluded. Methodological quality was evaluated using the CARE guideline. Additionally, a case of maxillary ONB was documented in a 3-year-old girl. RESULTS. 76 patients were analyzed. The most effective therapeutic strategies were multimodal, combining chemotherapy, radiotherapy and surgery. The disease-free survival rate was 61.8%. The clinical case showed a favourable evolution after surgical debulking and neoadjuvant chemotherapy. CONCLUSION. ONB in the pediatric population requires multidisciplinary management. Strengthening collaborative registries and standardising diagnostic and therapeutic protocols is proposed to improve clinical evidence and long-term results.

Nasal hamartomas: a case series and literature review

Wed, 22 Oct 2025 00:00:00 GMT

BACKGROUND. Nasal and nasopharyngeal hamartomas are rare, benign developmental lesions that often mimic other sinonasal pathologies. Misdiagnosis may lead to unnecessary interventions. OBJECTIVE. To present a case series involving three histological subtypes of nasal hamartomas and to review the current understanding regarding their classification, diagnosis, and management. MATERIAL AND METHODS. We describe three patients treated at our institution, each with a distinct subtype of nasal hamartoma: respiratory epithelial adenomatoid hamartoma (REAH), seromucinous hamartoma (SH), and nasal chondromesenchymal hamartoma (NCMH). Clinical, radiological, surgical, and histological data were analyzed. RESULTS. All patients underwent successful endoscopic surgical excision. Postoperative outcomes were favorable with no recurrence during followup. Histological analysis confirmed the diagnosis in each case. CONCLUSION. Nasal hamartomas, though rare, should be included in the differential diagnosis of sinonasal masses. Accurate diagnosis relies on histopathology, and complete surgical excision leads to excellent prognosis.

Rhinophyma – from clinical presentation to definitive treatment: a case-based approach

Wed, 22 Oct 2025 00:00:00 GMT

Rhinophyma is a chronic, progressive dermatological disorder characterized by hypertrophy and hyperplasia of sebaceous glands localized to the nasal region. It is frequently associated with phymatous rosacea in its advanced stages and manifests clinically with significant tissue overgrowth, leading to distortion of nasal contours and, in severe cases, functional impairment such as external nasal valve collapse and airway obstruction. Given the irreversible nature of the structural changes and the lack of spontaneous regression, surgical intervention remains the definitive treatment modality. A recent case of rhinophyma managed within our department provided valuable insights into its clinical features, diagnostic considerations, and therapeutic decision-making. This report presents the essential aspects of the case and reflects on the practical implications for effective management of this condition.

Factors associated with failure in stapes surgery for otosclerosis: a retrospective study in a tertiary care hospital

Wed, 22 Oct 2025 00:00:00 GMT

BACKGROUND. Otosclerosis is a common cause of conductive hearing loss in adults, most frequently treated with stapes surgery. However, the factors determining surgical success or failure remain controversial. OBJECTIVE. To identify clinical and surgical variables associated with surgical failure in patients undergoing stapes surgery for otosclerosis at a tertiary referral hospital in northwestern Mexico. MATERIAL AND METHODS. An observational, retrospective, cross-sectional study was conducted on 54 patients diagnosed with otosclerosis who underwent surgery between 2022 and 2024. Adult patients with preoperative and 6-month postoperative audiometry were included, while those without audiological follow-up were excluded. Sociodemographic, clinical, surgical, and audiometric variables were analyzed. Surgical failure was defined as a postoperative air–bone gap (ABG) >10 dB. RESULTS. A total of 81.5% of patients achieved surgical success. No significant association was found between surgical failure and age, sex, comorbidities, smoking status, or the type of surgical visualization used. A higher risk of failure was identified in patients who underwent stapedectomy (OR = 13.6, p = 0.001) and in surgeries performed on the left ear. Hearing improved significantly: the global PTA decreased from 59.8 to 40.1 dB (p<0.001, Cohen’s d=4.5). The ABG decreased across all analyzed frequencies, with large effect sizes. CONCLUSION. Stapes surgery is effective in improving hearing in patients with otosclerosis. Intraoperative decisions, particularly the choice of surgical technique (stapedotomy versus stapedectomy), significantly influence outcomes. These findings support stapedotomy as the preferred technique and highlight the importance of standardized audiometric follow-up.

Rhinosinusal involvement in granulomatosis with polyangiitis – clinical insights

Wed, 22 Oct 2025 00:00:00 GMT

BACKGROUND. Granulomatosis with polyangiitis (GPA) is a systemic necrotising vasculitis in which rhinosinusal disease is the most frequent and often earliest manifestation. Because sinonasal symptoms mimic chronic rhinosinusitis and other destructive midline disorders, timely diagnosis is frequently delayed. MATERIAL AND METHODS. This review synthesizes current evidence on the clinical presentation, investigation, diagnosis, and management of rhinosinusal manifestations of GPA, with emphasis on endoscopic, radiologic, serologic, and histopathological findings. It also outlines ENT-specific approaches to local care and their integration with systemic immunosuppression. RESULTS. Sinonasal involvement occurs in 70–90% of GPA cases, commonly preceding pulmonary or renal disease. Characteristic but non-specific endoscopic findings include crusting, ulceration, and necrosis, while imaging may demonstrate mucosal thickening and bony destruction. ANCA serology and biopsy support diagnosis but have limited sensitivity in localized disease, requiring multidisciplinary correlation. Management is centered on systemic immunosuppression (glucocorticoids with rituximab or cyclophosphamide), complemented by local measures such as saline irrigation, debridement, and topical corticosteroids. Surgery is reserved for complications or reconstructive purposes in remission. CONCLUSION. Rhinosinusal disease is both a diagnostic entry point and a major determinant of morbidity in GPA. Early recognition, coordinated multidisciplinary evaluation, and balanced integration of systemic and local therapies are essential to reduce irreversible damage and improve longterm outcomes.

Editorial: What is the relationship between the nose and voice quality?

Wed, 22 Oct 2025 00:00:00 GMT

A review of the vomeronasal organ in humans: an enigmatic sensory structure

Tue, 12 Aug 2025 00:00:00 GMT

The vomeronasal organ (VNO), sometimes known as Jacobson’s organ, is a vestigial anatomical feature in humans whose function and evolutionary relevance remain controversial. While clearly defined and functional in many vertebrates—notably for pheromone detection and behavioural regulation—its role in humans is ambiguous. This review consolidates current morphological, histological, neurological and clinical findings about the VNO, while emphasising developmental trends and population-specific data. Drawing on historical studies, molecular biology and comparative anatomy, we aim to offer a comprehensive perspective on the VNO’s presence and potential roles in human biology.

Designing and obtaining resistance structures through CADCAM technology in the case of fixed prosthetic restorations

Tue, 12 Aug 2025 00:00:00 GMT

The CAD-CAM technology was initiated in the early 1980s, and in the last decade it has developed significantly. Currently, the functionality and aesthetics offered by CAD-CAM systems meet the expectations of patients and thus, in this material, several extremely interesting aspects are presented, regarding the technological process of designing and manufacturing structures made by CAD-CAM technology both from zirconium oxide, but also from other specific modern materials.

Editorial: The psychological impact of sinonasal pathology

Tue, 12 Aug 2025 00:00:00 GMT

Management of acute sinusitis in children: an umbrella review

Tue, 12 Aug 2025 00:00:00 GMT

BACKGROUND. Acute sinusitis in children is a common disease, often secondary to upper respiratory viral infections, which can progress to bacterial infection. Although it is usually self-limiting, it can cause serious complications. The recommendations of clinical guidelines and systematic reviews are variable, which generates uncertainty regarding optimal management. OBJECTIVE. To synthesise the current evidence on the treatment of paediatric acute sinusitis through an umbrella review, identifying effective interventions, recommended guidelines, and knowledge gaps. MATERIAL AND METHODS. An umbrella review of systematic reviews, meta-analyses, and clinical guidelines published between 2000 and 2025 was conducted by searching five databases. PRISMA-Overviews criteria were applied, and methodological quality was assessed using AMSTAR-2. Descriptive synthesis, forest plot, funnel plot (Egger’s test) and an Evidence Gap Map (EGM) were used. RESULTS. Thirteen studies on paediatric acute sinusitis were included. High-quality evidence supported antibiotic use in moderate to severe cases, while mild cases often resolved without treatment. Adjuvant therapies like intranasal corticosteroids and saline irrigation showed modest symptom relief. Surgical interventions were necessary in orbital or intracranial complications, guided by clinical predictors. Guidelines emphasized strict diagnostic criteria, high-dose amoxicillin–clavulanate, and selective imaging. Watchful waiting was considered safe in mild, non-complicated cases with close follow-up. Overall, the evidence supports tailored management based on severity and clinical presentation. CONCLUSION. Not all children with acute sinusitis require antibiotics. Treatment should be individualized and the rational use of antimicrobials encouraged. Relevant evidence gaps persist that require further high-quality paediatric research.

Usefulness of topical intranasal fluorescein for localization of anterior skull base fluid fistulas: a systematic review

Tue, 12 Aug 2025 00:00:00 GMT

OBJECTIVE. This study evaluates the available evidence on the usefulness of topical intranasal fluorescein in diagnosing and localizing nasal cerebrospinal fluid (CSF) leakage. MATERIAL AND METHODS. A systematic review of the literature was conducted to investigate the usefulness and safety of intranasal topical fluorescein for locating nasal cerebrospinal fluid fistulas, following PRISMA guidelines. Articles were searched in databases including Scopus, PubMed, and ScienceDirect, (“Intranasal Fluorescein” AND “Cerebrospinal Fluid Fistula”) OR (“Intranasal Fluorescein” AND “CSF Fistula”) in the publications with no time restriction, in the English language. The chosen articles were evaluated with the Newcastle-Ottawa Scale. A table was used to summarize the results. RESULTS. The 6 included studies on topical intranasal fluorescein to locate CSF fistulas show high effectiveness and safety, with success rates close to 100%. However, limitations include small samples, lack of control groups, and the need for more comparative studies. The methodological quality of the studies is mostly moderate. CONCLUSION. Intranasal topical fluorescein is an effective and safe method to locate intranasal cerebrospinal fluid leaks, with high diagnostic accuracy. It is a less invasive and more economical option compared to techniques such as intrathecal fluorescein. More controlled research is needed to confirm its effectiveness.

Management of acute otitis media in children: an umbrella review of clinical practice guidelines and systematic reviews

Tue, 12 Aug 2025 00:00:00 GMT

BACKGROUND. Acute otitis media (AOM) is a frequent cause of paediatric care and antibiotic prescription, affecting up to 75% of children under 5 years of age. Despite the available clinical guidelines, variations in its diagnosis and management persist. OBJECTIVE. To synthesize current evidence on the treatment of childhood AOM, highlighting effective interventions and gaps in clinical knowledge. MATRIAL AND METHODS. An umbrella review of systematic reviews and clinical guidelines published between 2000 and 2025 was conducted. PubMed, Cochrane Library, Virtual Health Library and Epistemonikos were consulted, following PRISMA criteria. We included studies in English (and Spanish in the case of local guides). Two review authors applied the inclusion criteria independently using Rayyan. Methodological quality was assessed with AMSTAR-2. RESULTS. 33 studies were analysed. Eighteen reviews evaluated treatments (antibiotics, surgery, complementary therapies), five addressed prevention (vaccines, xylitol), and the rest epidemiological and implementation aspects. Short-acting antibiotics were as effective as longer-acting antibiotics, with fewer adverse effects. Pneumococcal vaccines significantly reduced the incidence. Xylitol showed moderate benefit. Amoxicillin remains a first-line treatment, with surveillance in mild cases. Gaps persist in the use of corticosteroids, education for caregivers, and monitoring of adverse effects. CONCLUSION. There is strong evidence for the rational use of antibiotics and vaccines. However, more studies are needed on complementary interventions and strategies to improve adherence to clinical guidelines.

Endoscopic management of extensive inverted papilloma: technical challenges and outcomes

Tue, 12 Aug 2025 00:00:00 GMT

BACKGROUND. Inverted papilloma is a clinically significant benign tumor of the sinonasal tract due to its locally aggressive behaviour, potential for malignant transformation, and frequent involvement of anatomically complex regions. Its presentation often mimics other inflammatory or neoplastic conditions, making early diagnosis and tailored surgical management essential for preventing functional and structural complications. CASE REPORT. This case presents a rare and extensive bilateral sinonasal inverted papilloma with externalization through the nasal vestibule, occurring in a patient with a history of prior sinonasal surgery and significant anatomical distortion. The tumor’s aggressive local expansion, associated bone remodelling, and metaplastic ossification posed considerable diagnostic and surgical challenges, successfully managed through advanced endoscopic techniques.

Rhino-bronchial syndrome: A complex and interdisciplinary entity from the otorhinolaryngology perspective

Mon, 26 May 2025 00:00:00 GMT

The rhino-bronchial syndrome is a condition characterised by chronic rhinosinusal inflammation and simultaneous chronic pulmonary pathology (asthma, chronic obstructive pulmonary disease, chronic bronchitis). The most prominent link is between sinonasal pathology, specifically allergic rhinitis, and asthma, characterized by increased eosinophil infiltration in both the nasal and bronchial mucosa, independently of the level of allergen exposure. Chronic rhinosinusitis, especially when associated with nasal polyps, can be an important risk factor for asthmatic patients and vice-versa. The patients with rhino-bronchial syndrome need a multidisciplinary approach by a medical team: otorhinolaryngologist, pneumologist and allergologist.

The inferior concha bullosa: A rare condition with great functional impact

Mon, 26 May 2025 00:00:00 GMT

BACKGROUND. Pneumatization of the turbinate is also known as concha bullosa (CB). Concha bullosa is most commonly found in the middle turbinate; its occurrence in the inferior turbinate is very rare. MATERIAL AND METHODS. A search of the literature was conducted using PubMed, Medline, Google and Google Scholar search engines using the keywords “inferior turbinate and concha bullosa”, “inferior turbinate and pneumatization”, covering the period from 1990 to 2024. Only case reports published in English were included in the study. RESULTS. We found twenty publications with a total of 21 cases that fit the above inclusion criteria for the analysis, with our case being the 22nd. Our patient was a 32-year-old male who presented to the ENT outpatient department with complaints of nasal obstruction for two years. Diagnostic nasal endoscopy was performed and a diagnosis of deviated nasal septum (DNS) to the right and left inferior turbinate hypertrophy was made. He was started on intranasal steroids and decongestants but did not improve. Hence, CT PNS was done and revealed a left inferior concha bullosa along with right-sided DNS. Septoplasty was carried out and the left inferior turbinate was excised. Gross appearance of the turbinate confirmed the diagnosis. CONCLUSION. Pneumatization of the inferior turbinate is a very rare anatomical anomaly. It is often asymptomatic and diagnosed incidentally on a CT scan. It can present as nasal obstruction, recurrent rhinosinusitis, and headaches. Treatment depends on the severity of symptoms.

Editorial: Precision medicine in rhinology: Redefining diagnosis and treatment in the era of molecular individualization

Mon, 26 May 2025 00:00:00 GMT

Safety of intrathecal fluorescein in the repair of anterior skull base fluid fistulas: An umbrella review

Mon, 26 May 2025 00:00:00 GMT

BACKGROUND. The use of intrathecal fluorescein to detect cerebrospinal fluid (CSF) fistulas remains controversial, as it is employed empirically and not authorized for intrathecal administration due to concerns about its safety via this route. OBJECTIVE. This study evaluates the available evidence on the safety of intrathecal fluorescein for diagnosing and localising nasal cerebrospinal fluid leaks. MATERIAL AND METHODS. An umbrella review was independently conducted by two researchers, following the appropriate methodology and PRISMA guidelines, to evaluate the available evidence on the safety of intrathecal fluorescein for diagnosing and localising cerebrospinal fluid leakage. Articles were searched in databases including Scopus, PUBMED, Google Scholar, Mendeley, and ScienceDirect (“intrathecal fluorescein” AND (“CSF fistula” OR “cerebrospinal fluid leak”) AND (“repair” OR “diagnosis”)) from January 2015 to January 2025. Selected articles were evaluated using the ASMTAR Scale 2 rating. RESULTS. Of 446 studies reviewed, only 3 met the inclusion criteria. The results suggest that intrathecal fluorescein is safe when used with proper dosing and protocols, although concerns remain regarding its long-term safety. The need for standardization in dosing and further studies to evaluate chronic effects is emphasized. CONCLUSION. Its use at low doses (10-25 mg) is generally safe, though standardization and long-term data on adverse effects are lacking. Despite its advantages, further research is essential to establish uniform protocols and enhance its safety in clinical practice.

Sinonasal inverted papilloma: From etiology to treatment

Mon, 26 May 2025 00:00:00 GMT

Inverted papilloma is a benign tumor that can become malignant. It most commonly develops on the lateral rhinosinusal wall and has a maximum incidence in the ethmoid cells. In most cases, it occurs unilaterally, the main symptom being nasal obstruction. Treatment can generally be performed through endoscopic sinus surgery, involving total resection due to its malignancy potential and risk of recurrence. Given the increased interest in this pathology, we present the most important aspects of sinonasal inverted papilloma, from etiology to therapeutic management, exemplifying with a case from our own experience.

Maxillary osteomyelitis: A brief review of the literature and case report

Mon, 26 May 2025 00:00:00 GMT

Maxillary osteomyelitis is a rare but severe inflammatory disease with significant destructive potential. Although its incidence has decreased in recent decades due to the widespread use of antibiotics and improved oral hygiene, it remains a considerable challenge in terms of early diagnosis and appropriate therapeutic approach. The authors present a suggestive clinical case, namely a 58-year-old female patient with maxillary osteomyelitis of odontogenic etiology, accompanied by a review of the specialized literature.