- [Show abstract] [Hide abstract] ABSTRACT: Bad breath is a condition that has health and social implications. This paper provides a comprehensive review of the classification of halitosis, it's etiology, it's prevalence, diagnosis and treatment strategies for the condition. Halitosis is affecting about 25-30% of world's population. It includes categories of genuine halitosis, pseudo-halitosis and halitophobia. It is believed that in 80-90% of cases halitosis origins in the oral cavity and the most common causes are: gingival pathologies, caries and poor oral hygiene. Extraoral sources of halitosis are responsible for 10-20% of all cases and are caused by poor diet, alcohol abuse, tobacco smoking, certain drugs and diseases of other parts of digestive tract as well as some systemic conditions. Diagnostics of halitosis includes subjective methods (examiner's sense of smell) and objective methods (instrumental analysis). Simple, subjective examination is considered a "golden standard" in clinical practice. In case of pathological halitosis identifying the direct cause of halitosis is essential. After excluding, or after successful treatment, of all oral pathologies, in case of remaining fetor ex ore identification and treatment of halitosis often requires multidisciplinary approach. Many unknowns remain in causes and mechanisms of halitosis. It can significantly impair quality of life, social interactions, lead directly to depression,low self-esteem or other mood disorders, therefore it is important to properly identify, treat and continue research on halitosis.
- [Show abstract] [Hide abstract] ABSTRACT: Background. One of the most important problems in head and neck oncology is early diagnosis of laryngeal cancer. Despite the introduction of new therapeutic methods and improvement of surgical techniques, patients' 5-year survival rate still depends primarily on the stage of the disease at the moment of introduction of appropriate treatment. Objectives. The goal of this study was to assess the efficacy of autofluorescence endoscopy (AFE) in diagnosis of laryngeal lesions. AFE examinations were carried out on out-patient basis, without general anesthesia and without using any photosensitizing agents (topical or systemic). Sensitivity and specificity of AFE alone, as well as AFE combined with classic white-light endoscopy, were calculated. Material and Methods. 129 patients (30 women and 99 men) at the age between 22-89 with various laryngeal pathologies entered the study. Patients did not receive any photosensitizing agents. No tissue staining was used. Occasionally, the patients received local 10% Xylocaine anesthesia before the examination. All examinations were performed using modified laryngeal endoscopic setup. All patients underwent classical white-light endoscopy followed by AFE examination. Sites of possible pathologies were noted for further biopsy. The results obtained during white-light endoscopy and AFE were then compared to histopathological findings. Sensitivity and specificity were calculated. Results. Suspected malignant lesions were confirmed in 63 out of 72 cases when using white-light endoscopy, and in 71 out of 72 during AFE (p = 0.0087). In precancerous lesions, 9 out of 19 were identified during white-light endoscopy, while AFE allowed to properly identify 16 out of 19 precancerous lesions (p = 0.0166). In all lesions, histologically classified as benign, the authors received 18 false positive results (white-light endoscopy) and 7 false positive results with AFE (p = 0.0072). Overall sensitivity of AFE was 95.6% and specificity was 81.6%. For white-light endoscopy the results were 79.1% and 52.6% respectively. Combined specificity of both methods was 96.7%. Conclusions. AFE is an effective, supplementary method of diagnosing pathologies of the glottic as well as supraglottic region of the larynx, that can be used in routine out-patient care. AFE is completely safe and has a very high sensitivity in detecting invasive cancer as well as early precancerous lesions (starting from LIN II). It allows to precisely visualize the extensions of the lesion and can be used to diagnose changes in supraglottic region. AFE can also be used in monitoring patients after treatment and in early detection of possible recurrence.