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.
Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification because a combined (mixed) phenotype exists in many individuals and different endotypes of rhinitis subgroups are overlapping. Due to the variety of pathophysiologic mechanisms (endotypes) and clinical symptoms (phenotypes), it is difficult to develop clear guidelines for diagnosis and treatment. This study aims to review the types of allergic and non-allergic rhinitis, providing a thorough analysis of the pathophysiological background, diagnostic approach, and main treatment options.
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.
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