DOES AUDIOVESTIBULAR POST-COVID SYNDROME EXIST?

The purpose of this study was to present and analyze patients with audiovestibular post COVID-19 syndrome, and highlight the most characteristic and most common findings. We analyzed 87 patients aged between 20 and 86 years who presented to the Audiology Division between February 1, 2021 and July 1, 2021 after having been isolated due to the SARS-CoV-2 infection. Study patients presented with complaints of persistent hearing loss, tinnitus, and vertigo, lasting for more than 3 months. Study results showed that there was acute sensorineural hearing loss in 4 patients during the SARS-CoV-2 infection. None of the patients experienced complete hearing recovery after 3 months. High frequency hearing loss (at 4 kHz and 6 kHz) occurred bilaterally, and was found in 52 patients. This finding of gradual hearing loss was both the most characteristic and most common in COVID patients. Extensive damage can directly occur to inner ear structures, including hair cells, the Corti organ, and the cochlear nerve because of this viral infection. A total of 73 patients had tinnitus. 68 patients had unilateral tinnitus, and only 5 patients had bilateral tinnitus. Exacerbation of tinnitus was recorded in 12 patients and new-onset tinnitus in 61 patients. Vertigo occurred in 9 patients, all of which were new-onset. A conclusion of our research is that audiovestibular post-COVID syndrome does exist. Further research with more patients and over a longer period is needed to obtain a better and longer effect on the audiovestibular system and audiovestibular complications, as well as an insight into possible recovery.

Analysis of clinical parameters as predictors of hearing recovery in patients with sudden sensorineural hearing loss.

OBJECTIVE: To investigate the impact of certain clinical parameters on likelihood of hearing recovery after SSNHL and to detect potential variables that predict its outcome. METHODS: A retrospective study was conducted in order to identify the clinical parameters which influence hearing recovery after SSNHL. Medical charts of 87 patients diagnosed with SSNHL and treated in the clinic from January 2015 to December 2019 were retrospectively reviewed. The effects of several parameters on the success of the treatment were statistically evaluated. Such parameters studied were age, gender, the severity of hearing loss, audiometric curve pattern, the time treatment was initiated, and metabolic factors. RESULTS: Patient categorization according to tonal audiometric curve results statistically differed in terms of recovery (complete, partial, no recovery) (χ2 = 32.5; p< 0.001). There are 2× more diabetic patients in the group no recovery than in the group partial recovery (OR = 3.1; 95% CI 0.95‒10; p= 0.061), and 5.3× more than in the group complete recovery (OR = 10.4; 95% CI 2.3‒45; p= 0.002) (χ2 = 11.2; p= 0.004). There is a statistically significant correlation between onset of therapy and recovery on a scale of significance of 93% (χ2 = 5.3, p= 0.069). CONCLUSION: In our study tonal audiometry results, diabetes mellitus and onset of therapy were shown to be a statistically significant negative predictive factors for recovery. Results of pure tone audiometry suggest a flat profound curve is statistically associated with the no recovery rates, and a down sloping curve proved to be statistically associated with complete recovery rates. LEVEL OF EVIDENCE: Level 1.

Unusual Mechanism of Facial Nerve Palsy Caused by Penetrating Neck Trauma.

We present a case of a low energy penetrating neck injury with only facial nerve (FN) palsy in the clinical finding. A 32-year-old male patient was admitted to the emergency department with a penetrating injury on the right side of the neck just behind the right ear, accompanied by evident right (FN) palsy, evaluated as House Brackmann grade IV. Computed tomography demonstrated an isolated soft tissue injury in the right retroauricular region without bone fracture, parotid gland lesion, or vascular structure involvement. The FN palsy was treated with corticosteroids (CS), and the patient had an uneventful and complete recovery. This case report presents an unusual mechanism of isolated, extratemporal, blunt injury of the FN after a penetrating neck injury followed by complete recovery.

Albrecht von Graefe (1828-1870) and his contributions to the development of ophthalmology.

PURPOSE: The aim of this article is to show Albrecht von Graefe's contributions to the development of ophthalmology on the occasion of the 150th anniversary of his death. He is regarded as the greatest ophthalmologist of the 19th century. Modern and scientific ophthalmology owes its beginning to him. METHODS: Extensive literature research is made and contacts with institutions for history of medicine as well as medico-historians in the field of ophthalmology. RESULTS: His contributions to ophthalmology were multiple. Von Graefe was the first to introduce iridectomy in acute glaucoma treatment, initiated visual field testing and developed the first tonometer. He made the first classification of glaucoma. Von Graefe was the ophthalmologist who created a special knife for cataract surgery. He was also the first to use Helmholtz' ophthalmoscope. He founded the first ophthalmological society in the world and the second ophthalmology journal which has been published continously up to now. In 1852 he founded famous private eye clinic in Berlin, where he treated many eye patients and educated many prominent ophthalmologists. At the age of 29 he became associate professor of ophthalmology, the first with such a title in Germany. CONCLUSION: Albrecht von Graefe was founder of modern ophthalmology and separated it from surgery. Graefe's contacts, correspondency and meetings at ophthalmological congresses with his teachers, assistants, collegaues also contributed to international co-operation and internationalization in ophthalmology. Although Albrecht von Graefe died before 150 years, he still provokes great admiration and respect in the world of ophthalmology.

Surgical Treatment of Recurrent Metastatic Parathyroid Gland Carcinoma.

AIM: We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient's right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. RESULTS: The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. CONCLUSION: With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.

Treatment Approach to Follicular Thyroid Carcinoma Tumor Thrombus in the Internal Jugular Vein and Brachiocephalic Vein.

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.

Epidemiological characteristics of orbital cellulitis among adult population in the Split region, Croatia.

BACKGROUND: There are few diseases in ophthalmology which could have a fatal outcome, one of them is orbital cellulitis. The aim of this article is to give epidemiological analysis of orbital cellulitis in adult patients in the Split region, Croatia. METHODS: The study was based on a retrospective review of medical records of 53 adult patients with orbital cellulitis treated during the period of 26 years from 1991 to 2016 at the Department of Ophthalmology in the University Hospital of Split. RESULTS: The incidence of orbital cellulitis in adults in the Split region was 0.57. The mean age of the patients was 53.5 ± 19.0 years. Patients were male in 47.2% of the cases and female in 52.8%. The distribution of orbital cellulitis according to seasons shows that it was most common during winter with 20 (37.7%) and in autumn with 16 (30.2%) cases and less frequent in summer with 6 (11.3%) and in spring 11 (20.8%) cases. The most common cause of orbital cellulitis was sinusitis in 33 (62.2%) patients. In total, there were 16 (30.2%) surgical interventions. CONCLUSIONS: Orbital cellulitis in adult patients is a relatively rare disease but with a possible fatal ending and damage to vision. It should be diagnosed quickly and treated adequately, very often in cooperation of an ophthalmologist with an otorhinolaryngologist and a maxillofacial surgeon. Orbital cellulitis appears to be more common in colder months, because sinusitis occurred more often then. It is treated with adequate antibiotic application but in almost one third of cases a surgical intervention was necessary.

PENETRATING ORBITOCRANIAL INJURY.

- A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had sustained stab injury of the right orbit with penetration into the right frontal brain lobe. Multi-slice computed tomography (MSCT) showed penetrating injury and fracture of the right orbital roof without eyeball damage and endocranial impressed bone fragments into the right frontal brain lobe. Urgent surgical intervention was performed by a maxillofacial surgeon and neurosurgeon, including reposition of bone fragments of the orbital roof and cranioplasty. Reconstruction of Tenon's capsule of the right eyeball was performed by an ophthalmologist. From the intraoperative wound swab of the orbit, Bacillus cereus was isolated, therefore the patient was administered ciprofloxacin and rifampicin as recommended by an infectious disease (ID) specialist. Follow up brain MSCT at 15 days and magnetic resonance imaging of the brain at 25 days showed brain edema in the right frontal area and signs of local brain abscess. Intravenous administration of the ciprofloxacin and metronidazole antibiotics with corticosteroids for edema suppression were ordered by the ID physician. Fourteen weeks after this therapy, brain MSCT showed complete abscess regression and no neurologic deficit with only mild psychomotor changes.

Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

PURPOSE OF THE STUDY: The aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics. MATERIALS AND METHODS USED: The study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20. RESULTS: In total 60 children were included in the study. The median of age was 5 years (range 2-9). There were 19 (32%) girls and 41 (68%) boys. Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis. CONCLUSION: Even though we are aware that PSG is the gold standard for diagnostics of SDB there is a significant financial burden for this diagnostic procedure. That is why there is a necessity for establishing good clinical standards and possible formula for OSA severity evaluation. We propose formula which includes Mallampati score and tonsillar size for OSA -risk calculation in order to perform early therapeutic intervention thereby reducing the risk of long-term negative consequences. We recommend this formula as the screening formula in circumstances where PSG is not available, in cases when the "waiting list" is too long or when a child can not cooperate to perform it. In developing countries like Croatia on time intervention with reduced procedure-associated costs is of the utmost importance.

A Foreign Body (Toothbrush) in the Esophagus of a Patient with Hiatal Hernia.

Toothbrush ingestion is rare and most commonly seen in patients with psychiatric comorbidities and in young women with a medical history of eating disorders who try to induce emesis. Long ingested objects, such as a toothbrush, cannot pass the gastrointestinal tract spontaneously and require endoscopic removal or even a surgical approach in cases of unsuccessful endoscopic removal or complication development. We present a case of a 71-year-old male with hiatal hernia without psychiatric or neurological comorbidity who accidentally ingested a toothbrush during oral hygiene routine. After X-ray confirmation, the toothbrush was removed endoscopically.

Historical Contribution of Otorhinolaryngology in Split Region till 1923.

The beginnings of the modern otorhinolaryngology in Croatia started in the second half of the 19th century. Before that, there were only rare attempts of some doctors who published medical papers touching the frame of otorhinolaryngology. Mainly those were the PhD's disertations at Vienna, Budapest and Padua University. Among them there was dr Ivo Manola from Split, who in Padua in 1834 took a doctor's degree dealing with otologic diseases. Dr Nikola Fertilio (Nerezisca the island of Brac, 1861--Trieste, 1928) was the first otorhinolaryngologist out of a hospital in Split and Dalmatia. He studied medicine partly in Graz and Vienna, where he graduated in 1890. During 1903 he finished severeal otorhinolaryngological courses which were held by professors Viktor Urbantschitsch and Alfred Bing and by private doctor assistant professor Markus Hajek. During the winter 1903/04 he attended the "Semestralkurs über praktische Orhenheilkunde" at professor Adam Politzer, founder and managing director of the first Otology Clinic in Vienna and the world in 1873. He worked in Trieste, where he practiced otorhinolaryngology. Dr. Fertilio a specialist for diseases of nose, ear and throat, occasionally, usually during his holidays, came from Trieste to Dalmatia (Split, Zadar, Sibenik, Dubrovnik and Kotor) to treat and operate patients. He was comming to Split from 1904 till 1914. He published and announced his commings in the local newpapers. He used to come in summer, most often in August and stayed from several days till two weeks. He stayed and had a practice in Hotel Bellevue. As there wasn't an otorhinolaryngologist in the regional hospital of Split till 1923, otorhinolaryngological operations were occasionally performed by doctors of other surgical branches. Otorhinolaryngologist dr Aleksandar Dorsner came to Split hospital in 1923 and organized otorhinolaryngological service that he led till 1934.

[DR ALEKSANDAR DORSNER THE FIRST HOSPITAL OTORHINOLARYNGOLOGIST IN SPLIT AND DALMATIA]. / DR. ALEKSANDAR DORSNER - PRVI BOLNICKI OTORINOLARINOLOG U SPLITU I DALMACIJI.

Dr Aleksandar Dorsner (Trebinje, 1892 - Lima, 1967) was the first hospital otorhinolaryngologist in Split and Dalmatia. He graduated from the Faculty of Medicine in Prague in 1919, and specialized otorhinolaryngology in Graz and Vienna. He led and organized otorhinolaryngological service in Split Hospital from 1923 to 1934, and he also had a private practice. Temporarily he also worked outside Split in Dalmatian hinterland and in Sibenik, Zadar and Dubrovnik. Most frequently he performed the following otorhinolaryngological operations: tonsillectomies and adenoidectomies and operations of purulent middle ear inflammations with mastoiditis, nasal polyps, deviated nasal septum, maxillary sinus empyema and otorhinolaryngological trauma. In 1928 he became a member of Otorhinolaryngological section of Croatian Medical Chamber. He participated in the work of the first otorhinolaryngological congress of the former Yugoslavia in 1931, taken place in Zagreb. From 1928 he was a member of Oto-Neuro-Ophthalmological Society. From 1933 to 1937 he was a vice-president of the main board of Free Organization of Dalmatian Physicians in Split. In 1938 he left Split permanently and continued living with his family in Lima (Peru) where he died in 1967. He was an erudite. He lived for his profession which he liked very much and dedicated his life to. He is one of the most meritorious doctors in Split medical history, whom otorhinolaryngology service in Split Hospital started with.

The influence of retinal eye diseases on painting.

In this work the possible influences of some retinal eye problems on paintings of several famous artists are considered. The change of painting styles and artistic expression in different periods and ages in a group of world-wide well-known painters are described and correlated with known or suspected retinal diseases. Some of them largely became recognizable because of that. Contemplations are offered about the effects of retinal diseases in the works of Degas, Munch, Cézanne, O'Keeffe, Constable and Goya. Retinal eye diseases have a significant impact on the work of selected famous painters.

[Famous doctors who stayed on the Croatian coast at the turn of the 20th century]. / Poznati lijecnici koji su boravili na hrvatskoj obali na prijelazu u 20. stoljece.

At the end of the 19th and the beginning of the 20th century many famous persons stayed on the Croatian coast mostly because of touristic and health reasons, than because of natural beauties, scientific or political reasons. Most often they came from Austro-Hungary, Germany or Russia but also from our homelands. Among them were also many famous doctors, some known worldwide. The most distinguished were the surgeon Theodor Billroth, the bacteriologist and a Nobel prize winner Robert Koch, the pathologist Rudolf Virchow, and the psychiatrist Sigmund Freud. They left a deep impression and a big benefit at the area they stayed in.

[Clinico-epidemiological analysis of choroidal melanoma in Split Area, Croatia]. / Klinicko-epidemioloska analiza melanoma zilnice u splitskom podrucju u Hrvatskoj.

Choroidal melanoma is the most common primary intraocular malignant tumour in adults. The aim of the study was to examine epidemiological characteristics of choroidal melanoma in Split-Dalmatia County from 1990 to 2009. In this retrospective study, data on 46 patients from medical documentation of the University Department of Ophthalmology, Split University Hospital Center, were analyzed. According to 2001 census, the Split-Dalmatia County population was 467,676 inhabitants. The incidence of choroidal melanoma was 0.49 per 100,000 inhabitants, which is somewhere in the middle of the incidence between south and north Europe. Choroidal melanoma most commonly appeared in the 7th decade of life. The average dimensions of choroidal melanoma (basis x height) were 13.4 x 8.0 mm. Histopathologic findings according to Callender classification showed the following types of melanoma: epithelioid cell type 8%, spindle cell type 40%, and mixed type 52%. The most common forms of therapy were enucleation 47.8% and brachytherapy 28.3%, which means that patients presented relatively late when choroidal melanoma advanced in size. The Split-Dalmatia County has 1/10 of the Croatian population, so it could be supposed that approximately 25 new cases of malignant melanoma of the choroid are discovered annually in Croatia. For early detection of the disease, regular and complete checkups are necessary, especially in presbyopic population. Study results enabled better evaluation of the disease and better planning of ophthalmologic service in the treatment of this serious eye disease.

[Dr. Juraj Curin: founder of Ophthalmology Department in Split]. / Dr. Juraj Curin: osnivac Ocnog odjela u Splitu.

The paper describes the life and work of an ophthalmologist, Juraj Curin (Gdinj, 1887 - Split, 1947). In 1921, he founded Department of Ophthalmology in Split, although permanent ophthalmologic service had existed at the Old City Hospital in Split from 1902. Dr. Juraj Curin headed Department of Ophthalmology from 1921 till 1936. He graduated from the Prague School of Medicine in 1914 and served residency in ophthalmology in Zagreb in 1921. In 1923, he attended the course on biomicroscopy at University Department of Ophthalmology in Zagreb, organized by Professor L. Koeppe and Professor A. Botteri. Dr. Curin performed a vast range of ophthalmologic surgeries for cataract, glaucoma, strabismus, oculoplastic surgery, dacryocystectomy, retinal detachment, etc. Dr. Curin was also head of trachoma service he founded in 1923. He wrote a scientifically instructive booklet on trachoma and several other papers. From 1923 till 1935, he was the only ophthalmologist in Split. Until 1926, he occasionally was going to Dubrovnik for his private practice there. Between two World Wars, he was working at the Institute of Public Health, Social Insurance Eye Service, for active population in Split. During World War II, he was active in the National Liberation Movement. In 1925, he was treasurer of the Doctors' Free Organization of Dalmatia, and in 1931 auditor at the main board of the Croatian Medical Chamber in Split. Besides his doctor practice, he was also very active in social and political life.