Karcinom srednjeg uva

Karcinom srednjeg uva je retko otološko oboljenje. Nastanak malignog procesase uzročno-posledično najčešće povezuje s hroničnim zapaljenskimprocesima srednjeg uva, mada mehanizmi nastanka još uvek nisu sasvimrazjašnjeni. Klinička slika karcinoma nije uvek karakteristična, a tumor sečesto otkriva u odmakloj fazi bolesti. Rana dijagnostika zasnovana na dokazimapodrazumeva preciznu procenu i identifikaciju znakova malignogprocesa. Na ovu bolest treba misliti ako curenje iz uva prate intenzivni bolovi,krvarenje iz uva, pojava periferne paralize facijalnog živca, vrtoglavicai gubitak sluha, mada se slična klinička simptomatologija viđa i kod hroničnihotitisa. Pored toga, karakteristične simptome karcinoma čine i sledećiznaci: promene u predelu temporomandibularnog zgloba, otok u regijiparotidne žlezde, bezbolan otok mastoidnog predela, neurološki poremećaji,iznenadna pojava polipa i granulacija (brzi recidivi polipa i granulacijaposle uklanjanja), znaci otogenih komplikacija, kao i opšta slabost, gubitaktelesne težine i drugi biološki poremećaji. Prilikom dijagnostike karcinomakoriste se opšteprihvaćene preporuke i protokoli lečenja

Application of hydroxyapatite granules in mastoid obliteration

The primary goal of surgical intervention for chronic middle ear disease is to development of a safe, dry, and low-maintenance ear. Persistent moisture, infection, and drainage is problematic in about one-third of patients, but also requiring revision surgery as canal-wall-down mastoidectomy. Despite best practice and continuous care, an open mastoid cavity is a handicap for the patients. The patients usually requires regular cleaning and life-long protection of the ear against water. During life, it could be a source of ear discharge due to irritation mucosal lining. The principle of mastoid obliteration was introduce as early as 1911. Over the years different biological tissues have been used to obliterate mastoid cavities including fat tissue, cartilage, musculo-periostal flap and autogenous bone. However, these tissue all suffer from atrophy or resorption with time. While all the intial reports were on the use of biological tissues, there has been an increasing interest in synthetic materials.Hydrxyaopatite is a well-known biocompatible ceramic with a long history of success in middle ear surgery. Experimental studies have demonstrated that hydroxyapate granulae do not undergo morphological changes after long term inplanatation in the temporal bulae. The purpose of our work is to present an importance of hydroxyapatite granule for mastoid obliteration of open radical mastoid cavities and to point out a new concept as application of nanocrystalline calcium phosphate in otosurgery. In our retrospective review, we found that the majority of individuals undergoing mastoid surgery with obliteration achieved a dry ear and there was a reduction of clinic visits during fellow-up period between 1 to 5 years

Application of hydroxyapatite granules in mastoid obliteration

The primary goal of surgical intervention for chronic middle ear disease is to development of a safe, dry, and low-maintenance ear. Persistent moisture, infection, and drainage is problematic in about one-third of patients, but also requiring revision surgery as canal-wall-down mastoidectomy. Despite best practice and continuous care, an open mastoid cavity is a handicap for the patients. The patients usually requires regular cleaning and life-long protection of the ear against water. During life, it could be a source of ear discharge due to irritation mucosal lining. The principle of mastoid obliteration was introduce as early as 1911. Over the years different biological tissues have been used to obliterate mastoid cavities including fat tissue, cartilage, musculo-periostal flap and autogenous bone. However, these tissue all suffer from atrophy or resorption with time. While all the intial reports were on the use of biological tissues, there has been an increasing interest in synthetic materials.Hydrxyaopatite is a well-known biocompatible ceramic with a long history of success in middle ear surgery. Experimental studies have demonstrated that hydroxyapate granulae do not undergo morphological changes after long term inplanatation in the temporal bulae. The purpose of our work is to present an importance of hydroxyapatite granule for mastoid obliteration of open radical mastoid cavities and to point out a new concept as application of nanocrystalline calcium phosphate in otosurgery. In our retrospective review, we found that the majority of individuals undergoing mastoid surgery with obliteration achieved a dry ear and there was a reduction of clinic visits during fellow-up period between 1 to 5 years

Genetic basis of otosclerosis

Uvod Otoskleroza je poremećaj koštane kapsule lavirinta i slušnih koščica uva, koji dovodi do gubitka sluha zbog nemogućnosti provođenja zvuka. Genetički uzrok otoskleroze je nepoznat. Cilj ovog rada je bio da se sačini sveobuhvatni pregled savremenih saznanja o genetičkoj osnovi otoskleroze. Metode Za prikaz podataka o genetici otoskleroze korišćen je narativni pregled literature. Rezultati Genetika otoskleroze nije mnogo izučavana i literaturni podaci o genetičkoj osnovi otoskleroze su oskudni. Međutim, u novije vreme, proširuju se znanja o genetičkoj osnovi otoskleroze. Ovde je prikazan pregled znanja o asocijaciji genetičkih markera i otoskleroze, koja su rezultat analiza genetičke povezanosti, kao i asocijativnih studija gena kandidata i sveobuhvatnih analiza genoma. Zaključak Otoskleroza zbog svoje kompleksnosti nije bolest čija će genetička osnova biti lako rasvetljena. Analize omika i bioinformatika će doprineti razumevanju genetičke osnove otoskleroze.Introduction Otosclerosis is a disorder of the bone labyrinth and stapes resulting in conductive hearing loss. The genetic basis of otosclerosis still remains unknown. We aimed at reporting a comprehensive review of up-to-date knowledge on genetic basis of otosclerosis. Methods Narrative literature review was undertaken to summarize the data about genetics of otosclerosis. Results Genetics of otosclerosis has not been studied extensively and the literature on this topic is scarce. However, knowledge of genetic basis of otosclerosis is recently increasing. We have presented an overview of the knowledge of association of genetic markers with otosclerosis, gained from linkage analyses, candidate-gene studies, and modern high-throughput genomic studies. Conclusion Due to its complex pathophysiology, otosclerosis is not a disease whose genetic base will be easily understood. Multiple omics analysis and bioinformatics will lead to elucidation of genetic basis of otosclerosis

Application of hydroxyapatite granules in mastoid obliteration

The primary goal of surgical intervention for chronic middle ear disease is to development of a safe, dry, and low-maintenance ear. Persistent moisture, infection, and drainage is problematic in about one-third of patients, but also requiring revision surgery as canal-wall-down mastoidectomy. Despite best practice and continuous care, an open mastoid cavity is a handicap for the patients. The patients usually requires regular cleaning and life-long protection of the ear against water. During life, it could be a source of ear discharge due to irritation mucosal lining. The principle of mastoid obliteration was introduce as early as 1911. Over the years different biological tissues have been used to obliterate mastoid cavities including fat tissue, cartilage, musculo-periostal flap and autogenous bone. However, these tissue all suffer from atrophy or resorption with time. While all the intial reports were on the use of biological tissues, there has been an increasing interest in synthetic materials.Hydrxyaopatite is a well-known biocompatible ceramic with a long history of success in middle ear surgery. Experimental studies have demonstrated that hydroxyapate granulae do not undergo morphological changes after long term inplanatation in the temporal bulae. The purpose of our work is to present an importance of hydroxyapatite granule for mastoid obliteration of open radical mastoid cavities and to point out a new concept as application of nanocrystalline calcium phosphate in otosurgery. In our retrospective review, we found that the majority of individuals undergoing mastoid surgery with obliteration achieved a dry ear and there was a reduction of clinic visits during fellow-up period between 1 to 5 years

Facial nerve paralysis as first sign of metastatic breast cancer to the temporal bone

Introduction. Facial nerve paralysis originates from various factors, although in most cases etiology is idiopathic. Temporal bone metastases are quite rare, but should still be suspected in cases when congenital disorders, inflammatory disease, infection or trauma are excluded as cause of facial palsy. We present an unusual case of facial nerve paralysis as the initial sign of temporal bone metastasis of breast carcinoma and discuss diagnostic pitfalls. Case outline. A 70-year-old patient presented with facial nerve palsy, severe otalgia, hearing loss and vertigo. Patient underwent steroid treatment 6 months earlier due to peripheral facial palsy with complete neurological resolution. CT scan revealed osteolytic lesion of the right temporal bone with extension into the parietal bone and soft-tissue. Additional examination confirmed ductal breast carcinoma and osteolysis of the ribs and vertebrae. After four months, the patient with metastatic breast carcinoma to the temporal bone died despite chemotherapy. Conclusion. Temporal bone metastasis of breast cancer is very rare condition with poor prognosis. Late diagnosis and inadequate management of breast cancer are factors that contribute to the temporal bone metastasis formation. Temporal bone metastasis should be excluded in elderly patients, both with and without any history of malignancy, especially in cases of peripheral facial palsy refractory to treatment

Prognostic significance of tympanosclerotic plaques localization and their morphological and histological characteristics for the outcome of surgical treatment

Background/Aim. Tympanosclerosis is a sequela of inflammation of the middle ear usually causing conductive hearing loss. The aim of the study was to determine the significance of tympanosclerotic plaques localization in the middle ear and their morphological and histological characteristics for surgical treatment outcome. Methods. This retrospective study included a total of 73 patients operated on for tympanosclerosis in the Clinic for Otorhinolaryngology, Military Medical Academy (MMA) in a period 1996-2010. The results of surgical treatment as well as the last audiometry findings were analyzed. considering follow-up periods of 6 months to 8 years. The patients were divided into 4 groups according to tympanosclerotic plaques localization in the middle ear and the classification suggested by Wieling and Kerr. The patients were also divided based on intraoperatively noticed morphological characteristics of tympanosclerotic plaques, while the third division was done as per histological findings. Surgical success was assessed using the suggestions of the Japan Otological Society. Results. The analyzed results showed the surgical success especially in the group II according to Wieling and Kerr, while histological findings had no impact on the outcome of the surgery. Conclusion. Surgical treatment has good results especially in patients with the mobile stapes. Results are satisfactory in other localizations, while various morphological and histological characteristics do not have impact on the surgery outcome

Newborn hearing screening

Introduction: Prevalence of sensorineural hearing loss is 1-3 per 1,000 newborns. Transient evoked otoacoustic emission (TEOAE) and automated auditory brain stem responses (AABR) are most frequently used methods in newborn hearing screening programmes. Objective. The aim of this study was to examine hearing function in newborns with and without risk factors for hearing loss. We investigated accuracy and feasibility of two automated technologies: transient otoacoustic emissions (TEOAE) and auditory brain stem response (AABR) in early detection of hearing loss. Method. In prospective study, 907 newborns were tested on both ears with transient evoked otoacoustic emissions (TEOAE). If results were "refer", we performed automated brain stem response (AABR). Two stage screening protocols were used with two screening technologies (TEOAE, AABR). Results. Results showed screening pass of 86.3% of the newborns in the first protocol and 99.3% in the second. Six (0.7%) newborns had positive screening results for hearing loss. They were referred for additional audolologic tests (otoacoustic emissions, tympanometry, and auditory brain stem response) to confirm or exclude hearing loss. Audiologic examination was performed up to the third month of life. We confirmed unilateral sensorineural hearing loss in two babies. Average test time per ear was 21.3±19.4 s for TEOAE and 135.3±67.9 s for AABR. Conclusion TEOAE, AABR tests are confidential, noninvasive and feasible methods and can help to detect hearing impairment

Chronic suppurative inflammation of the middle ear in children

INTRODUCTION Chronic suppurative inflammation of the middle ear (HGO) in children represents one of the most frequent infections in childhood, even in children from developed industrial countries. We can distinguish two types of chronic suppurative inflammation: first - HGO without cholesteatoma and second HGO with cholesteatoma. OBJECTIVE The objective of the paper was to point out the characteristics of chronic suppurative inflammation of the middle ear in children and possible methods of treatment. METHOD From 2000 to 2005, our retrospective study involved 92 children, aged 2 to 16 years, treated for chronic suppurative inflammation of the middle ear and subsequent otogenic complications. The diagnosis was established based on clinical symptoms, otoscopic and otomicroscopic findings. Treatment included the removal of the pathological process, reconstruction of the hearing chain and prevention recurrence. RESULTS We performed 111 surgical interventions. Children were divided into two groups: in the first group, we performed 56 surgical interventions in 48 children diagnosed with chronic suppurative otitis without cholesteatoma, and in the second group we performed 55 surgical interventions in 44 children who were diagnosed with chronic otitis with cholesteatoma. In the first group we performed mastoidectomy in 17 (32.5%) children, mastoidectomy and posterior aticotomy in 5 (9.5%), miringoplasty in 22 (35.8%), timpanoplasty type II in 5 (9.5%), timpanoplasty type III in 3 (5.6%) and timpanomastoidectomy in 4 (7.1%) children. In the second group, consisting of children diagnosed with cholesteatoma of the middle ear, we performed 47 first act surgeries, using closed technique in 17, and open in 30 cases. We performed timpanoplasty type III in 17 (30.9%) and timpanomastoidectomy in 17 (30.9%), and timpanoplasty type II in 9 (16.4%), timpanoplasty type IV in 10 (18.2%) and mastoidectomy in 2 (3.6%) children. In the group treated by closed surgical technique recurrence occurred in 5 (29.4%), and in those treated by open technique in 3 (10.3%). Two children had bilateral cholesteatoma. CONCLUSION Further research should be directed toward the identification of different types of factors and pathogenesis of HGO. Treatment of this decease is still considered controversial. Hinolon drops could represent a promising option in the treatment of HGO. The main objective in the treatment of cholesteatoma should be the improvement of the open technique to prevent retraction pockets, decrease of the rate of residual or atelectatic process and the improvement of hearing results

Unexpected bony structure in tonsillar fossa during tonsillectomy

Introduction. The elongated styloid process is a very rare clinical entity. In most cases it is asymptomatic, but also could cause Eagle’s syndrome. We presented a rare case of the anatomic variation of styloid process and its clinical implication. Case report. In the left tonsillar fossa an unexpected bony structure was found during the routine tonsillectomy on a 16-year-old female patient. Computed tomography showed the elongated styloid process. No further treatment was necessary because it was asymptomatic in the follow-up period. Conclusion. The elongated styloid process is a very rare condition, but physicians should be aware of it and keep it in mind in order to make the diagnosis in patients with suggestive symptoms