ResumeBackground: Acute rhinosinusitis (ARS) is one of the most common diseases encountered in the out-patient setting. X-ray of the paranasal sinuses is the gold standard in the diagnosis of ARS with its accessibility and accuracy. Ultrasound examination of the paranasal sinuses is a noninvasive diagnostic method which is an acceptable alternative in the follow-up of the treatment. Aim: To present the application of portable sinuson in the out-patient setting on patients with ARS and its effectiveness. Materials and Methods: 22 patients (12m/10f) underwent X-ray of the paranasal sinuses, which resulted in ARS. The results of the X-rays were compared with the ultrasound examination of the paranasal sinuses with a portable sinuson (SINUSULTRA ULTRAMAX). The examination was repeated on the 1-st and 2-nd week and 2 months after the treatment for ARS. Results: From the 22 patients -10 were with unilateral maxillary sinusitis, 7 with bilateral sinusitis and 5 with pansinusitis. 5 (22%) false positives were registered from the ultrasound examination on the initial check-up, 3 (13%) false negatives were registered on the follow-ups on the 1-st and the 2-nd week, 2 (9%) false negatives were registered 2 months after the treatment for ARS. Conclusion: Ultrasound examination of the paranasal sinuses is a noninvasive, painless, fast and with an adequate degree of accuracy. It is a good alternative for children and pregnant women. Ultrasound examination can be applied in the follow-up of ARS.

International Bulletin of Otorhinolaryngology 25Resume Background: Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder, leading to decreased quality of life, increased risk of cardiovascular morbidity and mortality, increased frequency of automobile accidents. Continuous positive airway pressure (CPAP) remains the first line of treatment for OSA. Many patients are unwilling or incapable to tolerate the treatment and therefore turn to surgical options to alleviate symptoms and sequela of the disease. Аim: To present our experience in the surgical treatment of OSA. Materials and Methods: 50 patients (48 male / 2 female) underwent surgical treatment for OSA in our clinic for a period of 10 years. Subjective complaints were evaluated by interview of the patient and partner pre-and postoperatively, with key factors studied being snoring level (visual analogue 1-10) and Epworth Sleepiness Scale (ESS). Objective data were Body Mass Index (BMI), nasal endoscopy, pre and postoperative polysomnographic data, rhinomanometry, Mallampati score, diagnostic imaging of the nose and sinuses. Results: The mean BMI of the patients was 29.8± 3.4. 21 patients had nasal obstruction for which they underwent surgical treatment. 5 patients had micro or retrognathia. 37 Pateints had a Mallampati score of 3 and 13 of 4. All 50 patients underwent Uvulopalatopharyngoplasty (UPPP) and 6 patients also had Radiofrequency tongue base reduction. There were no serious complications. Subjective improvement in the severity of the symptoms was obtained in 88% (44) of patients. Objective success was obtained in 56% (28) of the patients. Conclusions: Surgical treatment of OSA leads to a significant subjective improvement in the severity of symptoms and acceptable objective results. For maximal results a multidisciplinary approach is required for the complex treatment of OSA.

Background: Functional Endoscopic Sinus Surgery (FESS), supported by a navigation system, is a modern minimally invasive method for diagnosis and surgical treatment of nasal polyposis, acute and chronic sinusitis, benign and malignant tumors of the nasal cavities and skull base, congenital anomalies, severe epistaxis, and a number of other pathological processes in these anatomical areas. Advantages of the method are the improved orientation through navigation, reduced blood loss, sparing of neighboring tissues and structures, optimization of postoperative results, reduction of recovery period and pain as well as the optimized quality of life of the patient. Aim: Presentation of pilot results from the first surgical interventions under Work Package 3 "Endoscopic sinus surgery, supported by a navigation system, in ENT practice", performed in the "Integrated Interdisciplinary Operating Unit with Navigation and Telesurgery Systems" built under the project BG05M2OP001-1.002-0010 "Center of Competence in Personalized Medicine, 3D and Telemedicine, Robot-assisted and Minimally Invasive Surgery" funded by the "Science and education for smart growth" Operational Program and the European Regional Development Fund. Results: The surgical interventions were performed without intraoperative and early postoperative complications; the recovery period was smooth. During the follow-up examinations, we observed good local postoperative status, optimal period of healing and absence of subjective complaints reported by the patients. Conclusion:Our pilot results support the advantages of navigated FESS for safer, more precise and sparing radical treatment of diseases of the nose and nasal cavities. Extended multidisciplinary studies are forthcoming within the project for overall assessment of the significance and applicability of the introduced method in different groups of patients.

Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups. Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital "Dr. Georgi Stranski" -Pleven in 2021. FESS surgery was performed in the "Integrated interdisciplinary operating unit with navigation and telesurgery systems" at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery "Leonardo da Vinci" in Medical University -Pleven. Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines. Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally. Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children.