Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study.

INTRODUCTION: Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate. AIMS: To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists. METHODS: We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1st 2015 and October 31st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis). RESULTS: 1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012). CONCLUSION: We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.

Factors Affecting Neonatal Hearing Screening Follow-up in Developing Countries: One Insitution Prospective Pilot Study.

OBJECTIVE: To detect factors related with loss to follow-up (LTF) in neonatal hearing screening (NHS) program of one institution in a developing country. METHODS: A prospective study was planned based on the data collected in a pilot study conducted a year before in the same institution. In this pilot study, hearing screening was performed before hospital discharge for every infant (1217 newborns) in six months period. Total referral rate was 19.1% (223/1217). Loss to follow-up (LTF) was 38.1% (85/223). Telephonic interviews were done with 50 parents who had not come with their child to the second hearing test. For these telephonic interviews the questionnaire with four sections (socio-demographic information; information about pregnancy, birth, and present health condition of the child; caregiver knowledge of neonatal hearing screening, and reasons for default on follow-up) was created. RESULTS: The mothers participated in this study were 29.1 years (±5.2 SD) of age in average. Place of residence was mostly rural (64%; n=32) with 39.4 Km (±24.8 SD) away from from the rescreen referral center. Their knowledge on neonatal hearing screening, hearing impairment incidence or treatment opportunities was at a very low level. Caregivers' perceptions that follow-up was unnecessary (50%; n=25), was most frequently given reason for follow-up default, followed by newborns bad health condition (12%; n=6) and forgetting about the follow-up visits (8%; n=6). CONCLUSION: The main reason for default in follow-up in our study was caregiver's poor knowledge about this topic.

Prevalence of and factors affecting otitis media with effusion in children in the region from Balkans to Caspian basin; A multicentric cross-sectional study.

OBJECTIVE: The aim of our study was to contribute to the literature about the prevalence of OME by conducting a research in a wide geography examining most of the associating factors together with a questionnaire. Additionally, possible effects of altitudes and latitudes, concordance between the otoscopic examination findings and tympanometric and acoustic reflex test results were evaluated in 4-7 years old children in the same season in different countries. METHODS: In the randomly sampled schools from different regions of different cities where people of different scoioecomonic statuses live, 4-7 year-old children were included in the study. The results of the questionnaire covering the potential factors in OME etiology were evaluated together with the results of the otoscopic examination and tympanometry findings, and also the acoustic reflex findings to direct the interpretation in cases of low amplitude - blunted peak tympanograms which can be interpreted as a "Type B" or "Type As". All the results were gathered in the same season. RESULTS: Ten centers from nine countries participated in the study. A total of 4768 children were evaluated. The frequency of OME diagnosed by otosopic examination was 22.48% (n=1072) and the diagnosis rate when otoscopic examination plus type B tympanometry were taken into account was found as 11.3% (n=539) in general population. Factors increasing the prevalence of OME were found as; mother's educational level (p=0.02), child's age (p=0.006), history of upper respiratory tract infection (p=0.001), smoking father (p=0.01), mother being a housewife or laborer (p=0.01), history of allergy (p=0.001), asthma (p=0.04), or allergy symptoms (p=0.02). No direct relationship was found between altitudes or latitudes and prevalence of OME. CONCLUSION: The important affecting factors found after analyzing all of the potential risk factors in the same model are secondhand smoke exposure, low level of mother's education, mother's occupation, positive history of URTI, and age of the child being less than 7. By paying attention to the factors that increase the prevalence of OME, putting particular emphasis on the preventable ones such as smoking, education, and fighting with allergies could decrease the prevalence of this public health issue.

Does an early discharge of a newborn influence the success of the newborn hearing screening in developing countries? A hospital based study.

Aim To investigate outcomes of newborn hearing screening (NHS) with transient evoked otoacoustic emissions (TEOAE) depending on the time from the birth to hearing screening. Methods A prospective study was performed in the Cantonal Hospital Zenica, Bosnia and Herzegovina. The NHS with TEOAE was done before hospital discharge for all infants. The total of 1217 newborns were tested during a six-month period, from 1st February to 31st July 2016. The data of 1167 were available for analysis. Those data were divided in four groups depending on the time passed from the birth to hearing screening: Group A (n= 133 newborns, NHS performed in the first 24 hours after birth); group B (n = 294 newborns, NHS performed between 24-36h after birth); group C (n = 184 newborns, NHS performed between 36-48h after birth) and group D (n= 556 newborns, NHS performed later than 48h after birth). Results Total referral rate was 19.1% (n = 223): for group A 30.1% (n=40), for group B 25.2% (n=74), for group C 19.0% (n=35) and for group D 13.3% (n=74). There was statistically significant difference between groups A and C (p=0.03), between groups A and D (p<0.001) and between groups B and D (p<0.001) in total and in well baby nursery (WBN). Conclusion The total referral rates in NHS were high because of early post birth discharge of newborns. The NHS should be performed in infants older than 36 hours according to the results in this study.

Effect of intracuff alkalinized 2% lidocaine on endotracheal tube cuff pressure and postoperative throat symptoms in anaesthesia maintained by nitrous oxide.

Aim To compare the effects of endotracheal tube cuff inflation media, air, saline and alkalinized 2% lidocaine on increase of cuff pressure (CP) during nitrous oxide maintained anaesthesia and on incidence of postoperative throat symptoms (PTS), and to evaluate the incidence of postoperative throat mucosal injuries (PTMI) depending on cuff inflation medium. Methods Ninety patients who had undergone elective surgery were randomly allocated into 3 equal groups per cuff inflation media: air (group A), saline (group S) and alkalinized 2% lidocaine (group L). The CP was monitored immediately after cuff inflation and further 5, 15, 30, 60 and 90 minutes after intubation. The incidence and intensity of PTS, sore throat, hoarseness, dysphagia and cough were evaluated 2, 6 and 24 hours after extubation. The incidence and intensity of PTMI were evaluated 24 hours after exubation using indirect laryngoscopy examination. Results The highest increase of mean CP was recorded in the group A (18.7±4.9), it was significantly lower (6.4±1.1) in the group S, while it remained stable in the group L (0.7±0.7). All PTS occurred less frequently in the group L: sore throat (p<0.001), hoarseness and dysphagia (p<0.05), but the incidence of cough was not significantly different between the groups. The lowest incidence of PTMI was in the group L (p< 0.001). Conclusion The increase of CP contributed to incidence of PTS. The intracuff alkalinized 2% lidocaine was superior to saline and air in the prevention of an increase of CP and reduction of the PTS incidence. There was a strong correlation between the incidence of PTS and PTMI.

Identification of risk factors for hearing impairment in newborns: a hospital based study.

Aim To identify risk factors for hearing impairment presented in neonates born in Cantonal Hospital Zenica (CHZ) and to estimate their influence on outcome of hearing tests in Newborn Hearing Screening (NHS). Methods Retrospective-prospective study was done at the Department of Gynaecology and Maternity. The NHS was performed with transitory evoked otoacoustic emissions (TEOAE) during a six-month period using "Titan" device (Interacoustics, Denmark). The questionnaire was written for the purpose of getting more structured basic information about every newborn and to identify risk factors for hearing impairment. Chi-square test was used to investigate the difference between experimental and control group refer incidence. Results A total of 1217 newborns was screened for hearing impairment of which 259 (21.28%) with one or more known risk factors for hearing impairment. The following risk factors for hearing impairment were identified during the study period: family history of permanent childhood hearing impairment in 42 (3.45%) newborns, prematurity in 39 (3.21%), low APGAR scores in 29 (2.40%), asphyxia in 31 (2.55%), hyperbilirubinemia in 41 (3.37%), admission of ototoxic medication (aminoglycosides) after birth in 155 (12.74%). Conclusion There were many serious risk factors for hearing loss identified in this study. Identification of risk factors for hearing impairment in neonates is necessary because a follow up of the children with risk factors is very important.

Frequency of thyroid cancer in patients operated at Cantonal Hospital Zenica, Bosnia and Herzegovina, in the period 2007-2014.

Aim To determine frequency and type of thyroid cancer (TC) as well as gender and age distribution of patients operated at the Department of Ear, Nose and Throat (ENT), Cantonal Hospital Zenica, Bosnia and Herzegovina. Methods A retrospective analysis of data obtained from an operating protocol and disease history of patients operated in the eightyear period (2007- 2014) was made according to the frequency and type of thyroid cancer, as well as age and gender of the patients. χ2 test was used for statistical with p<0.05. Results A total of 818 surgeries of the thyroid gland were conducted, in 714 (87.29%) female and 104 (12.71%) male patients. Malignancies were diagnosed in 74 (9.05%) patients, of whom 64 (86.49%) were females and 10 (13.51%) were males, resulting in the gender prevalence of 8.96% and 9.62%, respectively. The most often presented type was papillary carcinoma, in 48(out of 74, 64.86%) patients, followed by follicular carcinoma in 10 (13.51%), medullary carcinoma in four (5.41%), Hurthle cell carcinoma in four (5.41%) patients, while anaplastic carcinoma was found in one (1.35%) patient. The number of diagnosed malignancy varied from 0% (in 2007) to 13.91% (in 2014) (p=0.05). Conclusion The prevalence of thyroid cancer is low, but has an increasing trend. A large number of unnecessary surgeries on thyroid gland was performed. Preoperative diagnostic procedures for diseases of the thyroid gland in Cantonal Hospital Zenica should be improved in order to avoid unessential surgeries.

Papillary thyroid carcinoma in a female patient with squamous cell carcinoma of the larynx.

The larynx and thyroid gland are the most common sites for head and neck malignancies. The existence of two primary cancers are rare and especially if they are in the same region, and both are very invasive. Subglotic laryngeal cancer is the rarest, with only 1% frequency of all laryngeal cancers. We are reporting on a case of a forty-seven- year-old female urgently admitted to the Ear, Nose and Throat (ENT) Clinic in Tuzla, with severe respiratory insufficiency. The patient underwent total laryngectomy, total thyreoidectomy, radical and functional neck dissection. Histological examination showed laryngeal squamous cell carcinoma and papillary thyroid carcinoma.

Quality of life in patients with larygeal/hypopharyngeal cancer following total/partial laryngectomy.

AIM: To estimate the quality of life (QOL) of patients with carcinoma of larynx/hypopharynx using the EORTC QLQ-C30 and QLQ-H and N35 questionnaires in relation to the reference values (RV), total (TL) / partial (PL) laryngectomy/ pharyngectomy, combined treatment (surgery, radiotherapy, chemotherapy) (CT) and the time elapsed since surgery. METHODS: The questionnaires were answered by 45 patients in the first 6 months of 2011. Sixteen (35.6%) patients had PL and 29 (64.4%) TL. Postoperatively, CT was performed in 34 (75.6%) patients (group A), and 11 (24.4%) patients (group B) only had surgery. The time elapsed from surgery of ≤12 months was found in 11 (24.4%) patients in the group A1, and 34 (75.6%) of more than 12 months in the group B1. Comparison was made between all scales of the questionnaires, global (GS), functional (FS) and general symptomatic (GSS) QLQ-C30 and specific symptomatic scale (SSS) QLQ-H and N35. RESULTS: Comparing our results from all scales of both questionnaires with RV there was no statistically significant differences, except for SSS relating to speech problems (p=0.052574). Comparing PL and TL there was a decrease in FS (p=0.025517) and increased problems with speech, swallowing, sensation, coughing and social contact in SSS (p=0.017595) in TL. Comparing A and B groups, there was a decrease in FS (p=0.00531) increase of all symptoms in GSS (p=0.043388) and SSS (p=0.0505385) in the A group. Comparing A1 and B1 groups better FS (p=0.042271) was registered in A1. CONCLUSION: Quality of life of our patients is not significantly different from the QOL of similar patients in the world. Comparing all groups, QLQ-C30 and QLQ-H and N35 showed us clear differences in QOL and their clinical use is justified.