Luminita Radulescu talking on the evaluation and treatment of inner ear malformation.
What a joy it was to meet friends and colleagues for my first overseas conference in five years! Some 250 delegates convened in glorious sunshine in Bucharest to hear the latest developments in the management of paediatric cholesteatoma, airway surgery, cochlear implantation and endoscopic sinus surgery. President of the Romanian Society of Pediatric ORL, Professor Dan-Christian Gheorghe (Bucharest) and his predecessor and founding member of the society Professor Gheorghe Iovanescu can be immensely proud of their work.
Some of the delegates remembered a first meeting organised by Professor Iovanescu (pictured right with Ray Clarke) in Timisoara in the west of Romania some 15 years ago, with a dozen or so participants. It was truly gratifying to see just how the subspecialty has grown in Romania. There is huge enthusiasm among local ENTs to provide up-to-the minute care for children and to participate in cutting-edge research and development.
The presentations were a mix of updates on local practice both in Bucharest and beyond, supplemented by some excellent presentations by invited overseas guests. A highlight for me was an update by Professor Antonio Della-Volpe (below) on single-sided deafness, emphasising the importance of continued support and surveillance for these children as many – especially those with cytomegalovirus (CMV) infection – go on to develop profound hearing loss in adolescence.
Professor Viorel Zainea and Professor Magdalena Chirila gave a timely update on their management protocols for recurrent respiratory papillomatosis (RRP). There are now well structured IPOG (International Pediatric Otolaryngology Group) guidelines to help decision-making in RRP and the emphasis is very much on surgery that conserves the normal laryngeal structures as so many of these children need multiple interventions. We still hope that HPV vaccination and newer medical therapies may transform the management of this condition.
Prof Iovanescu updated us on his experience with PESS or paediatric endoscopic sinus surgery including in cystic fibrosis, and although evidence is uncertain that sinus surgery in childhood alters the growth pattern of the facial skeleton, he stressed it is wise to minimise bone removal. There were superb presentations by Romanian experts on cholesteatoma, tympanoplasty, and head and neck tumours.
International guests included Professor Gabor Katona who gave us a perspective on OSIA 2 implants in children from his unit in Hungary. A team from Lyon gave a fascinating account of their multidisciplinary approach to balance disorders in children, emphasising the important role a trained physiotherapist can provide in rehabilitation.
Professor Sonia Ayari (Lyon) and Professor Farouk Unal (Istanbul) spoke about stridor in the infant, and Professor Unal showed us some superb results with pinna reconstruction for microtia.
My overriding impression from this meeting was that paediatric otorhinolaryngology in Romania is in extremely fine shape. There is an excellent screening programme for congenital deafness, an expanding state-of -the-art cochlear implant programme and a number of centres with real expertise in the management of airway pathology, head and neck tumours and sino-nasal diseases in children.
The future certainly looks good, and I hope to return to a fascinating country with a dedicated and enthusiastic paediatric ORL society. Prof Iovanescu’s vision and determination have certainly paid off.
Ray Clarke BA, BSc, DCH FRCS, FRCS(ORL).
