role of minimally invasive surgery in treating nasal symptoms in patients with long lasting allergic rhinitis

Allergic rhinitis is a common condition, affecting about 10-20% of the population. The main symptoms are nasal obstruction, rhinorhea and hyposmia. The treatment is mainly conservative and consists of use of antihistamins, nasal corticosteroid or both. Despite the effectiveness of the medical treatment, permanent nasal changes like mucosal hypetrohy of the inferior turbinates and nasal polyposis occur in many patients with time. In such cases surgery, in addition to the medical treatment, is indicated. The role of the surgery is: 1/ to reduce the volume of the inferior turbinates: 2/to remove nasal polyposis: 3/ to facilitate the ventilation of the paranasal sinuses by enlarging their openings and 4/ to create better conditions for penetration of local steroids into the nasal mucosa. Minimally invasive surgery was performed in 65 patients with allergic rhiniris. Thirty seven of them were male and 28 female, aged from 15 to 64 years. All the patients underwent nasal endoscopy and the pathological changes were classified into 3 groups: 1/mucosal hypertrophy in 45 cases; 2/nasal polyosis in 8 cases or 3/ both in 12 cases. The preoperative and postoperative assessment of nasal function was measured by: 1/visual analog scale [VAS]; 2/ acoustic rhinometry; 3/ rhinomanometry. Surgery consisted of: 1/endoscopic turbinoplasty in 57 case; 2/ polypectomy alone in 7 cases or 3/ polypectomy, combined with infundibulotomy, anterior ethmoidectomy and middle meatus antrostomy in 13 cases. In addition, in cases with marked septal deviations, 7 septoplasties were done. The results of the surgery were evaluated 6 months to ' year after the operation and show marked improvement of the main complains: obstruction, rhinorhea and hyposmia. The following conclusions were made: 1/Minimally invasive nasal surgery is effective in treating the main symptoms of allergic rhinitis. It brings long lasting relieve from the nasal obstruction, nasal secretion and anosmia, 2/By destructing the submucosal blood vessels and hypertrophic glands and maintining the patency and the ventilation of the paranasal sinuses, minimally invasive surgery acts as pathogenic treatment of allergic rhinitis. 3/The use of endoscopes, operating microscope and powered instruments, enhance the results of the surgery. 4/Minimally invasive surgery is a complementary treatment of allergic rhinitis and does not substitute the medical treatment

Voice quality in patients with bilateral vocal cord paralysis before and after surgical treatment

Voice quality in bilateral vocal cord paralysis [BVCP] is usually fair, but breathing is severely impaired. Treatment is directed towards widening of the glottis by using different endoscopic surgical methods. As a results of the surgery the voice becomes worse. In an attempt to evaluate the effect of surgical treatment on voice quality and trying to find the best compromise between breathing and phonation, we used objective voice analysis in 15 patients before and after surgery. Ten of them were treated by CO[2] laser posterior cordectomy and 5 by laser arytenoidcordectomy. All patients were decannulated 1 months after treatment. Phonetography, sonagraphy and computed voice analysis were used for evaluation of phonatory function. Six parameters of the basic tone were messured. In all 15 patients impairment of the voice quality was found. The voice was worse in the patients who underwent arytenoidcordectomy compared to those treated by posterior cordectomy. Concerning voice quality posterior cordectomy should be used with preference in the treatment of BVCP. Arytenoidcordectomy should be used in cases with arytenoids fixation or small and narrow larynx