Otolaryngology: Otolaryngology. Treatment

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, which is characteristic mainly for boys and young men. Structurally, it is composed of the fibrous tissue and thin-walled vessels, which are bleeding from time to time. The tumor is characterized by an aggressive course. Depending on the growth direction, over time it grows into the nasal cavity, paranasal sinuses and skull base, creating a threat to the patient’s life. The major treatment option is surgery. In some cases, the radiation techniques may be used.

The choice of the surgical technique depends on the formation size:

  1. For small tumors, surgery can be performed endoscopically through the natural orifices (mouth or nose). Such an intervention can minimize the tissue trauma.
  2. Another option of removing small JNA is through the palate. The surgeon makes a horseshoe-shaped incision on the upper edge of the gums, excises a portion of the palate on the affected side, and then resects the tumor. Such an access provides a broad overview of the nasopharynx.
  3. Medial tumors, which invaded the nasal cavity or orbit, are removed through the maxillary sinus. The incision in this case is made under the upper lip.
  4. Large JNA, invading the base of the skull, are dissected through the infratemporal fossa.

The day before surgery, the angiography is performed, which allows the embolization (occlusion) of blood vessels feeding the tumor and reduces the risk of bleeding.

JNA is removed to the fullest extent possible. If the total resection is not possible, the formation is excised partially, and the patient is prescribed radiation therapy after surgery. The following techniques are well-proven for angiofibromas:

  1. Stereotactic surgery (Gamma Knife). The tumor residue is affected by a high dose of radiation, which leads to the tumor cell death. The flows of radiation particles are formed so that most of the energy was targeted at the pathological focus. Thus, the healthy tissue is almost not subjected to irradiation. The procedure is performed only once. The effect is manifested over the next 6 to 24 months.
  2. Conformal radiotherapy. The tumor is irradiated precisely from different angles. Consequently, the major impact is targeted exactly at the pathological focus. The surrounding tissues are damaged to a lesser extent than upon conventional irradiation techniques. The sessions are repeated daily for several weeks.

For inoperable JNA, the radiation techniques may be indicated as the main treatment option.

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University Hospital Cologne

9.8/10 from 82 Votes

Department of Otolaryngology

The Department of Otolaryngology provides both diagnosis and treatment of all types of diseases in the field of otolaryngology, for example, head and neck surgery, plastic surgery, vocal cord and voice disorders, incl. speech therapy and allergology.

location_onCountry: Germany
location_searchingCity: Cologne

University Hospital Rechts der Isar of the Munich Technical University

10/10 from 70 Votes

Department of Otolaryngology

The Department of Otolaryngology at the university hospital Klinikum rechts der Isar offers a wide range of services with tests for hearing, balance, respiratory tract, smelling, tasting as well as voical tests.

location_onCountry: Germany
location_searchingCity: Munich

Academic Hospital Schwabing Munich

8.5/10 from 7 Votes

Department of Otolaryngology, Hand and Neck Surgery

The Department of Otolaryngology, Hand and Neck Surgery in Schwabing provides the entire diagnostic and therapeutic range of modern Otorhinolaryngology, Head and Neck Surgery.

location_onCountry: Germany
location_searchingCity: Munich

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Emil Zenev

Head physician:

Dr. med. Emil ZenevCurriculum vitae keyboard_arrow_down

  • 1981 Certificate of maturity (Abitur).
  • 1981 - 1983 Military service.
  • 1983 - 1990 Studied Medicine at the Higher Medical School of Sofia with the state examination and approbation.
  • 1986 Trimester in the First Medical Faculty of Moscow, advanced training at the Department of Cardiosurgery.
  • 1990 - 1991 Doctor-assistant of Otolaryngology, Kyustendil, Bulgaria.
  • 1991 - 1993 Doctor-assistant of Otolaryngology, University Hospital of Sofia.
  • 1993 - 1995 Assistant Doctor, University Clinic of the Free University of Berlin, Benjamin Franklin.
  • 1995 - 2000 The Head of the Department at he the Potsdam clinic, Free University of Berlin.
  • 1995 Examination for the doctor-otolaryngologist, the medical chamber of Brandenburg.
  • 1999 Defense of the thesis with an evaluation of "magna cum laude" - "very good" on the topic "Bipolar thermotherapy of hyperplasia of the" nasal concha".
  • 2000 - 2002 Senior doctor-otolaryngologist at the Bad Lipspringe clinic.
  • 2002 Passing the (optional) exam for a specialist surgeon, the Westfalen-Lippe medical chamber in Münster.
  • 2005 Examination for the specialisation "Plastic surgery and reconstructive surgery" in the Department of Otolaryngology, Head and Neck Surgery, the medical chamber of Munich.
  • 2002 - 2006 Head of the Department of Otolaryngology Clinic Augsburg at the University Hospital  of the Ludwig-Maximilian Munich University.
  • 2007 Defense of doctoral thesis at the University of Sofia: "Surgical treatment of fractures in the middle zone of the face and skull base - Current problems in the treatment of laterobasal and medio-facial fractures, as well as the use of navigation surgery in skull trauma".
  • Since 2007 Partner in the Otolaryngology practice of the PAN clinic in Cologne.
  • Since 01.04.2009 The owner of private practice of the PAN-Clinic am Neumarkt.


PAN Clinic Cologne

9/10 from 14 Votes

Department of Otolaryngology

The Department of Otolaryngology offers top-class treatment methods. With the state-of-the-art methods and devices, such as ENT navigational system (the first in North Rhine-Westphalia), the highly-qualified physicians deal not only with general otolaryngology but also perform ear microsurgery,...

location_onCountry: Germany
location_searchingCity: Cologne

DKD HELIOS Clinic Wiesbaden

9.2/10 from 5 Votes

Department of Otolaryngology

The practice of Otorhinolaryngology of the DKD HELIOS Klnik Wiesbaden has the modernist equipment, and offers comprehensive diagnostic, countseling and therapy in the field of diseases of the nose, throat and ear.

location_onCountry: Germany
location_searchingCity: Wiesbaden

Academic Prosper-Hospital Recklinghausen

9/10 from 23 Votes

Department of Otolaryngology, Head and Neck Surgery

The Department of Otolaryngology, Head and Neck Surgery at the Academic Prosper-Hospital Recklinghausen offers surgery of middle ear, nose and paranasal sinuses, oral cavity and throat including the upper esophagus, larynx and neck surgery as well as reconstructive plastic and aesthetic surgery of the face and neck.

location_onCountry: Germany
location_searchingCity: Recklinghausen

University Hospital Frankfurt am Main

10/10 from 97 Votes

Department of Otolaryngology

The Department of Otolaryngology covers the entire spectrum of modern otolaryngology. The special focuses include diagnosis and treatment of hearing impaired and deaf children and adults.

location_onCountry: Germany
location_searchingCity: Frankfurt am Main

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Rudolf Leuwer

Head physician:

Prof. Dr. med. Rudolf LeuwerCurriculum vitae keyboard_arrow_down

  • 1981 - 1987 Study of Medicine at the University of Bonn.

Professional Career

  • 1988 - 1989 Assistant in the Department of Neurosurgery at the University Hospital Bonn.
  • 1989 - 1994 Assistant, Department of Otolaryngology, University Hospital Hamburg-Eppendorf.
  • 1993 Recognized as Otolaryngologist.
  • 1994 - 1997 Senior Physician, Department of Otolaryngology, University Hospital Hamburg-Eppendorf.
  • 1997 - 2005 Leading Senior Physician of the Department of Otolaryngology, University Hospital Hamburg-Eppendorf.
  • Since 2012 Chairman of the Association of German Chief Physicians (Otolaryngologists).
  • Since 2005 Head of the Department of Adult and Pediatric Otolaryngology, Head and Neck Surgery at the HELIOS Clinic Krefeld.
  • Since 2011 Head of the HELIOS Clinic Krefeld.

Scientific Activities

  • 1998 PhD defense. Subject:  "Polarographic measurement of pO2 changes on the surface of the human brain under the influence of pentoxifylline."
  • Since 1995 Control of 8 clinical trials with the vote of the Ethics Committee of the Medical Association of Hamburg.
  • 1997 Habilitation in the field of otolaryngology, Hamburg. Subject: "EMG analysis of the eustachian tube muscular dysfunction".
  • 1997 Venia Legendi in Otolaryngology, Faculty of Otolaryngology of the University of Hamburg.
  • 1999 Temporary appointment as C3 Professor in Otolaryngology, University of Hamburg (at the same time awarding the academic title of "Professor").
  • 2001 Award "Anton von Tröltsch-Preises" of the German Society of Otolaryngology, Head and Neck Surgery (DGHNO).
  • 2003 Dr. Günther Buch Prize 2002, Johanna and Fritz Buch Scientific Foundation, Hamburg.
  • 2004 - 2005 Chairman of the Section of Biology and Natural Sciences of the Medical Association of Hamburg.
  • 2004 W3 Professor, Otolaryngology, Ruhr University Bochum (successor to Prof. Dr.  H. Hildmann) "tertio loco".
  • Since 2005, Member of the Subcommittee on Implanted Hearing Aids at ASTM International (International Commission on Standardization: American Society for Testing and Materials).
  • 2005 Board Member of the Medical Faculty (Otolaryngology), University of Hamburg.
  • Since 2011 Honorary Professor of the Hanoi Medical University, Vietnam (implementation of Cochlear Implantation Program at the Hanoi Medical University).

HELIOS Clinic Krefeld

9.7/10 from 38 Votes

Department of Adult and Pediatric Otolaryngology, Head and Neck Surgery

The Department of Adult and Pediatric Otolaryngology, Head and Neck Surgery offers the full range of services in these medical fields. The main task of the department is the timely detection of hearing impairments and their competent, effective treatment.

location_onCountry: Germany
location_searchingCity: Krefeld

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