1st Otolaryngology (ENT) Clinic of Head and Neck Surgery

• Tonsillar diseases
• Adenoid hypertrophy
• Cystic swellings
  1. Thyroglossal duct cyst
  2. Dermoid cysts
  3. Lymphangiomas
  4. Hemangiomas
  5. Ranula
• Branchial cleft cysts
• Laryngoceles
• Lipomas
• Inflammations and abscesses of the cervicofacial region
• Solid tumors

Pathological conditions of the nose and paranasal sinuses constitute a common clinical problem. The 1st ENT Clinic, with extensive experience in modern and innovative endoscopic, imaging, and surgical techniques, provides individualized therapeutic management for each patient. The conditions managed include:

• Allergic rhinitis
• Impaired nasal breathing and sensation of nasal obstruction
• Nasal valve dysfunction
• Acute and chronic rhinosinusitis
• Nasal polyps
• Deviated nasal septum
• Epistaxis (chemical cauterization, electrocautery, endoscopic surgical management)
• Nasal trauma
• Tumors of the nose and paranasal sinuses
• Inverted papilloma
• Juvenile angiofibroma
• Osteoma
• Paranasal sinus mucoceles
• Skull base tumors
• Cerebrospinal fluid leak
• Aspirin-exacerbated respiratory disease (AERD)

This syndrome is a chronic inflammatory disorder of the paranasal sinuses and the lungs. Patients present with a clinical picture resembling an allergic reaction following the intake of aspirin and non-steroidal anti-inflammatory drugs. The symptoms include:

• Nasal congestion (obstruction)
• Rhinorrhea
• Lacrimation
• Flushing of the face and neck
• Cough
• Wheezing
• Dyspnea
• Chest pain (chest tightness)
• Pruritus (rare)
• Nausea or gastric pain

Diagnosis – Management

Approximately 40% of patients with asthma, nasal polyps, or chronic rhinosinusitis present with this syndrome, previously referred to as “Samter’s triad.” These patients develop nasal polyps and, in the majority of cases, exhibit persistent asthmatic manifestations.

Therapeutic management is challenging and consists of corticosteroid administration as well as endoscopic surgical removal of nasal polyps. Multiple pharmacological treatments for asthma are often required to adequately control this clinical syndrome.

Hearing loss, balance disorders, and tinnitus significantly affect an individual’s quality of life. These conditions negatively impact professional performance as well as the ability to perform routine daily activities. The

Unit provides individualized care for patients of all ages in the evaluation and management of the full spectrum of otological, neurotological, and surgical conditions, including:

• Infections of the external and middle ear
• Chronic otitis media
• Otitis media with effusion – placement of ventilation tubes
• Cholesteatoma
• Otosclerosis – conductive hearing loss
• Benign tumors of the ear, such as acoustic neuroma and paragangliomas
• Sudden hearing loss
• Cerebrospinal fluid otorrhea
• Malignant tumors of the ear and skull base
• Tinnitus
• Facial nerve dysfunction
• Vertigo and balance disorders
• Benign paroxysmal positional vertigo
• Instability
• Ménière’s disease
• Vestibular migraine
• Acoustic neuroma

For the diagnosis and investigation of the above conditions, the following are performed:

• Pure-tone audiometry
• Tympanometry
• Acoustic reflex testing
• Auditory brainstem evoked potentials

Functional assessment of the labyrinth

• Videonystagmography
• Posturography

Rehabilitation Unit for Vertigo and Balance Disorders

Balance disorders are a common clinical problem that often negatively affect patients’ quality of life. As multiple different conditions may cause balance impairment, accurate diagnosis is essential for the patient to receive appropriate and effective management of their condition.

Head and neck neoplasms, from the early signs in the oral cavity to the symptoms of thyroid gland cancer, constitute a highly distinct group, as they affect the individual’s speech and expression, as well as their social interaction.

Traditional surgical techniques for head and neck neoplasms have a good therapeutic outcome, but they cause drastic changes to anatomical structures such as the tongue, the mandible and the larynx. These changes may lead the patient to isolation and depression.

Newer minimally invasive surgical techniques, however, have shown impressive results, not only in terms of the patient’s physical condition, but also in terms of their psychological state. These innovative surgical techniques reduce skin scars, maximize the patient’s natural appearance and significantly improve their psychological behavior.

Forms and types of head and neck neoplasms treated at the ENT Clinic:

Neoplasms:

• Oral cavity (tongue, lips, hard palate, floor of the mouth, gums)
• Nose, paranasal sinuses and nasopharynx
• Oropharynx (tonsils, base of the tongue, soft palate)
• Larynx
• Hypopharynx
• Salivary glands
• Thyroid gland
• Skin of the head and neck
• Cervical lymphadenopathies (of unknown primary site) and metastatic.
• HPV+ Head & Neck Neoplasms

The main causes implicated in the development of head and neck neoplasms are tobacco and alcoholic beverages. However, infection with HPV (human papillomavirus) has recently become a major factor in HPV+ head and neck neoplasms that occur in the tonsils, as well as in other areas such as the base of the tongue. The good news is that HPV+ patients show very good therapeutic outcomes. They also have a better prognosis than other forms of head and neck neoplasms. Another beneficial factor is that HPV+ patients can be treated with less aggressive chemoradiotherapy regimens. This reduces the side effects of treatment regimens without affecting the therapeutic outcome.

Minimally invasive surgical techniques

• TLS (Transoral Laser Surgery): Transoral Laser Surgery
• TOVS (Transoral Videopharyngolaryngoscopic Surgery): Transoral Videopharyngolaryngoscopic Surgery
• Laser Clinic

Personalized therapeutic treatment

This new therapeutic method involves testing cells obtained from biopsies for genetic mutations. These are changes in genes that may be associated with the type of cancer the patient has developed. Certain chemotherapeutic drugs are more effective than others for neoplasms with specific mutations. Molecular analysis of a neoplasm can improve the selection of the therapeutic method that is most appropriate and effective for the patient. This is called genomic testing.

The Center specializes in the surgical management of thyroid and parathyroid gland disorders, including:

• Multinodular goiter - total thyroidectomy
• Thyroid nodules - partial or total thyroidectomy
• Graves’ disease - total thyroidectomy
• Thyroid cancer - total thyroidectomy and cervical lymph node dissection
• Parathyroid gland disorders, such as parathyroid adenoma

The Unit manages diseases of the parotid, submandibular, and other salivary glands, including:

• Sialolithiasis
• Sialadenitis
• Benign and malignant salivary gland tumors

The Unit focuses on the diagnosis and management of disorders of voice, speech, language, communication, and swallowing. Specifically, it manages conditions such as:

• Hoarseness
• Vocal cord paralysis
• Spasmodic dysphonia
• Dysphonia
• Dysphagia
• Zenker’s diverticulum
• Neurological disorders of the larynx
• Subglottic stenosis

For the diagnosis of the above conditions, the following are performed:

• Endoscopic examination of the pharynx and larynx using a flexible endoscope
• Stroboscopy
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

A significant proportion of the population suffers from sleep apnea caused by partial or complete obstruction of the upper airway, which, if left untreated, may lead to arterial hypertension and other cardiovascular diseases, headache, and memory impairment.

The Unit provides a comprehensive diagnostic approach for patients with sleep apnea syndrome and snoring who have not responded successfully to conservative treatment or who are interested in surgical treatment options.

Therapeutic management includes:

• Detailed medical history, physical examination, and endoscopic evaluation of the head and neck (sleep endoscopy)
• Nasal surgery: correction of deviated nasal septum, reduction of inferior turbinates, nasal valve reconstruction, and removal of nasal polyps
• Palatal surgery: uvulopalatopharyngoplasty, tonsillectomy, radiofrequency-assisted palatal surgery, and palatal implants
• Base of tongue surgery: lingual tonsillectomy and radiofrequency treatment of the tongue base

The term "second opinion" constitutes a valuable resource for patients facing complex medical conditions or uncertainty regarding therapeutic options. Additionally, depending on the place of residence and ability to travel, patients may have limited access to specialized tertiary healthcare services.

The online second opinion program provides timely expert consultation for complex pathological conditions involving the head and neck region (nose, ear, oral cavity, oropharynx, larynx). This approach helps avoid unnecessary and costly travel and accommodation away from the patient’s place of residence.

The program is user-friendly and confidential. The process involves online submission of the patient’s medical record by the treating physician.

The medical file must include:

• Recent medical history (not older than 2 months)
• Imaging studies
• Laboratory examinations

For oncological cases, the following are mandatory:

• Histopathological report
• Initial therapeutic approach (e.g., chemoradiotherapy protocols, surgical reports if applicable)

How the program works

Typically, a response is provided within seven working days from receipt of the medical file. The program includes:

• Detailed evaluation and re-assessment of the medical record by a highly specialized medical team
• Assessment of diagnosis of a new neoplasm or metastasis
• Evaluation of the patient’s overall condition or revision of diagnosis
• Proposal of an alternative therapeutic plan to the treating physician
• Management of patient inquiries and concerns
• Continuous communication with the patient and the treating physician to ensure full understanding of the proposed treatment strategies or referrals

Important notice

• The online second opinion program does not apply to emergency cases.
• In case of an emergency, patients should contact their treating physician or the nearest on-call hospital.