CHARACTERISTICS OF HEARING RECOVERY IN CHILDREN WITH CHRONIC OTITIS MEDIA WITH EFFUSION AFTER VENTILATION TUBE INSERTION.

The objective was to determine the range of hearing improvement (in dB) post ventilation tube insertion in children with chronic otitis media with effusion (COME), and whether there was a difference in hearing improvement between age groups and genders. This study also investigated whether there was a difference in the mean hearing improvement between the left and right ear, how many months passed before recovery of eustachian tube function, and how long the aeration of the middle ear lasted. The children included in the study were between six and twelve years of age, diagnosed with COME by audiological processing (type B tympanometric recording and conductive hearing loss up to 40 dB on pure tone audiometry) and underwent surgical insertion of ventilation tubes in both ears. Patient data included preoperative tympanometric records, preoperative and postoperative tone audiometry findings, tubometry findings 6 and 10 months after insertion of ventilation tubes, age and gender data, and length of time during which the tubes were in place. The mean hearing improvement of the included patients was 24.2 dB on the right ear and 24.5 dB on the left ear. There was no statistically significant difference between the left and right ear or between the genders. Older age groups had a higher mean hearing improvement compared with the younger age group. Younger age groups had a longer expected period of eustachian tube function recovery, and were expected to have ventilation tubes inserted for a longer period of time. Treatment with ventilation tube insertion resulted in significant improvement in hearing in children where previous conservative therapy failed to recover eustachian tube function and improve hearing. Although children of older age groups had greater preoperative hearing impairment, the recovery of both eustachian tube function and hearing improvement was faster, and the mean length of time that the ventilation tubes had to be inserted was shorter.

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.

ADENOID SIZE IN CHILDREN WITH OTITIS MEDIA WITH EFFUSION.

Otitis media with effusion (OME) is amongst the most common pediatric diseases and the most common cause of hearing loss in children. It is accepted that adenoid hypertrophy (AH) is related to OME incidence. Better understanding of the correlation between the relative size of AH and the incidence of persistent OME may provide evidence to support a more standardized approach to the diagnosis and treatment of OME. A retrospective study carried out between April 2016 and April 2018 collected data on 65 children aged 2-12 years, diagnosed with chronic OME and symptoms of AH, where conservative therapy failed. Pre-diagnostic data were collected from patient history, otoscopy, rhinoscopy, and oropharyngoscopy findings. Diagnostic workup included tympanometry, audiometry, and flexible nasal fiberoptic endoscopy. Adenoid grading was performed according to Cassano method after endoscopic visualization. Of the 65 patients, 37 were male and 28 were female. There was no statistically significant difference according to gender or average age. The highest incidence of persistent OME with AH was recorded in the youngest age groups (2-5 and 6-9 years). The most frequent AH grades were grade II (35.38%) and grade III (50.77%), yielding a statistically significant result. The most common presenting symptoms were hearing impairment, snoring, and nasal obstruction (100%, 64.62% and 60%, respectively). Higher AH grades are critical for persistence of OME and may cause conservative therapy failure.

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.

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.

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.

Aggressive middle turbinate osteoblastoma with intracranial extension: a case report.

INTRODUCTION: Osteoblastoma is an uncommon benign bone tumor that accounts for 1 percent of all primary bone tumors. About 30 to 40 percent of all osteoblastoma cases involve the spine. Osteoblastoma involving the nasal cavity is rare, with only 11 reported cases in the English-language literature, while only four cases of turbinate osteoblastoma have been described. CASE PRESENTATION: We report an unusual case of middle turbinate osteoblastoma associated with right-sided nasal obstruction and severe headache in a 14-year-old Caucasian girl. The tumor involved the right middle turbinate, complete anterior and incomplete posterior ethmoidal cells, and the frontal sinus ostium. Cribriform lamina was, in the most part, consumed by the tumor growth, while the skull base was mostly of normal bone structure. CONCLUSIONS: To the best of our knowledge, this is the first case of middle turbinate osteoblastoma with intracranial spread. Surgical treatment is the only therapeutic option for osteoblastoma.

The role of contact endoscopy in screening for premalignant laryngeal lesions: a study of 141 patients.

At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients--51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified.

A battery in the stenotic esophagus of a child with a congenital tracheoesophageal fistula.

A case of a three-year-old male child who was admitted to our hospital with the suspicion that he had swallowed a battery approximately one hour before admittance. The parents believed that it was a button-shaped lithium battery approximately 12 mm in diameter. A chest X-ray was taken immediately, and a battery was identified in the esophagus at the fifth thoracic vertebra. By reviewing the child's medical history, we found that the child had had surgery the day after birth due to congenital atresia of the esophagus and a tracheoesophageal fistula type III b. An esophagoscopy was performed one hour after admittance, and the battery was found to be partially past the scar from the first surgery. Because of that, the battery was pushed further toward the stomach, out of fear that retrieving the battery through the scarred section of the child's esophagus could damage the stenotic wall. Upon the next X-ray of the abdomen, the battery was observed in the stomach. The child was monitored, and X-rays were taken over the next several days. The battery was evacuated in stool eight days after it had been ingested.

Primary laryngeal NK/T-cell non-Hodgkin lymphoma: a case report.

The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-term follow-up is advisable for the timely detection of possible local or distant recurrences, which are common.

Cigarette smoking and progression of laryngeal lesions.

The association between cigarette smoking and an increased risk of laryngeal carcinoma has been demonstrated in numerous studies. The aim of the present study was to assess the prevalence of smoking habit in patients with different laryngeal pathologies. The prevalence of cigarette smoking was compared between patients with laryngeal tumors and those with nonmalignant laryngeal lesions. Data on all patients with indications for direct microlaryngoscopy at the Clinic for Otorhinolaryngology of the University Hospital Center Split, during a five-year period were analyzed. The study included 562 patients with various laryngeal pathologies, divided into three groups as follows: group 1, benign lesions; group 2, precancerous lesions; and group 3, tumors. The majority of patients (82.92%) had a long history of smoking. The proportion of smokers was lowest in benign lesion group (72.13%), higher in precancerous lesion group (81.48%) and highest in malignant lesion group (97.14%). There was a statistically significant difference in the prevalence of cigarette smoking between patients with laryngeal tumors and those with benign or precancerous lesions (p < 0.001). The mean number of cigarettes per day was 20.54 +/- 14.80, and was lowest in benign lesion group (15.67 +/- 13.41) and highest in malignant lesion group (26.33 +/- 12.70). The mean length of smoking habit was 26.44 +/- 16.92 years, ranging from 19.57 +/- 16.03 years in benign lesion group to 35.20 +/- 12.12 years in malignant lesion group. Study results clearly pointed to the increased prevalence of laryngeal diseases in smokers, with a significant difference between patients with benign laryngeal lesions and those with laryngeal tumors.

Beta2-microglobuline plasma level and painful shoulder in haemodialysed patients.

Painful shoulder in patients on chronic haemodialyis is most often associated with dialysis arthropathy or accumulation of deposits containing modified fibrils of beta2- microglobuline especially in bones and joints due to insufficient elimination during the therapy. The aim of this study is to investigate whether there is connection between painful shoulder and plasma level of beta2-microglobuline and to corroborate that with morphologic parameters found in proved amyloidosis. It has to be emphasized that even other causes may contribute the development of painful shoulder. Real time sonography and conventional plain radiographs of the 108 shoulders were performed in 54 patients receiving chronic haemodialysis as a treatment of terminal renal failure (without previous history of rheumatoid arthritis), 27 symptomatic with persistent pain and stiffness in both shoulders and lasting for more than 6 weeks and restriction of movements in various degree and 27 asymptomatic. Plasma level of beta2-microglobuline, CRP and uric acid were taken periodically as routine procedure during a one year prospective trial, as well as plasma level of calcium, phosphor and alkaline phosphatase. Plasmatic level of beta2-microglobuline is strongly connected with painful shoulder in dialyzed patients, as well as CRP as sign of acute inflammation. That is proved by morphologic parameters associated with histological proved amyloidosis in patients on long term dialysis, more then 10 years.