Sudden sensorineural hearing loss treatment

Akutna zamjedbena nagluhost je idiopatski, jednostrani gubitak sluha perceptivnog porijekla koji se razvija u manje od 72 sata. Većina pacijenata opisuje buđenje s oštećenim sluhom bez očitog vanjskog uzroka. Oštećenje sluha može biti jedva zamjetno do izrazito, a gluhoća je rijetki ishod. Neki pacijenti imaju i šum u zahvaćenom uhu. Postoje brojni mogući uzroci iznenadnog gubitka sluha (virusni, vaskularni ili autoimuni), ali često uzrok ostane nepoznat pa govorimo o idiopatskom zamjedbenom oštećenju sluha. Dijagnoza se postavlja kod pacijenata s navedenim simptomima i potvrđuje Weberovim testom koji lateralizira u zdravo uho. 35 do 60 % bolesnika se oporavi u potpunosti, uglavnom unutar 2 tjedna. Najbolja metoda liječenja za idiopatsko zamjedbeno oštećenje sluha još nije otkrivena zbog činjenice da mnogo pacijenata pokazuje spontani oporavak, bez obzira na liječenje. Većina otologa preporučuje propisivanje sistemskih kortikosteroida u pacijenata koji nemaju kontraindikacije. Glukokortikoidi su standardna terapija idiopatske zamjedbene nagluhosti. Međutim, s obzirom na to da su sistemski kortikosteroidi povezani s brojnim nuspojavama, rađene su studije njihove primjene intratimpaničnim putem, koje pokazuju nedosljedne rezultate. Postoji također potreba za kvalitetnijim istraživanjem hiperbarične oksigenoterapije u liječenju iznenadnog gubitka sluha. Vremenski okvir za učinkovitu terapiju je kratak, stoga je važno da svaki liječnik bude svjestan ovog stanja kako bi pacijenta uputio otorinolaringologu na vrijeme.Sudden sensorineural hearing loss refers to unexplained, unilateral hearing loss of sensorineural origin developing in less than 72 hours. Most patients describe waking up with hearing loss that has no apparent external cause. Hearing loss can range from barely detectable to profound, with deafness as an uncommon outcome. Some patients experience tinnitus in the affected ear. There are a lot of possible causes of sudden hearing loss (viral, vascular, or autoimmune causes), but often the cause remains unknown and is termed idiopathic sudden sensorineural hearing loss. The clinical diagnosis is made in patients presented with the symptoms mentioned and is confirmed by the Weber test, in which we can see lateralization to the healthy ear. Thirty-five to sixty percent of patients recover completely, most within 2 weeks. The best treatment for idiopathic sudden hearing loss has not been found yet due to the fact that a lot of patients show spontaneous improvement, regardless of treatment. Most otologists stay united in prescribing systemic corticosteroids to patients who have no contraindications. Glucocorticoids are the standard treatment for idiopathic sudden sensorineural hearing loss. However, as systemic steroids are associated with significant side effects, there were studies with intratympanic steroid therapy, which showed inconsistent results. There is also a need to fully investigate the effects of hyperbaric oxygenation for treatment of sudden hearing loss. The time frame for effective therapy is short, so it is important for every doctor to be aware of this condition and refer the patient to an otolaryngologist in time

Sudden sensorineural hearing loss treatment

Akutna zamjedbena nagluhost je idiopatski, jednostrani gubitak sluha perceptivnog porijekla koji se razvija u manje od 72 sata. Većina pacijenata opisuje buđenje s oštećenim sluhom bez očitog vanjskog uzroka. Oštećenje sluha može biti jedva zamjetno do izrazito, a gluhoća je rijetki ishod. Neki pacijenti imaju i šum u zahvaćenom uhu. Postoje brojni mogući uzroci iznenadnog gubitka sluha (virusni, vaskularni ili autoimuni), ali često uzrok ostane nepoznat pa govorimo o idiopatskom zamjedbenom oštećenju sluha. Dijagnoza se postavlja kod pacijenata s navedenim simptomima i potvrđuje Weberovim testom koji lateralizira u zdravo uho. 35 do 60 % bolesnika se oporavi u potpunosti, uglavnom unutar 2 tjedna. Najbolja metoda liječenja za idiopatsko zamjedbeno oštećenje sluha još nije otkrivena zbog činjenice da mnogo pacijenata pokazuje spontani oporavak, bez obzira na liječenje. Većina otologa preporučuje propisivanje sistemskih kortikosteroida u pacijenata koji nemaju kontraindikacije. Glukokortikoidi su standardna terapija idiopatske zamjedbene nagluhosti. Međutim, s obzirom na to da su sistemski kortikosteroidi povezani s brojnim nuspojavama, rađene su studije njihove primjene intratimpaničnim putem, koje pokazuju nedosljedne rezultate. Postoji također potreba za kvalitetnijim istraživanjem hiperbarične oksigenoterapije u liječenju iznenadnog gubitka sluha. Vremenski okvir za učinkovitu terapiju je kratak, stoga je važno da svaki liječnik bude svjestan ovog stanja kako bi pacijenta uputio otorinolaringologu na vrijeme.Sudden sensorineural hearing loss refers to unexplained, unilateral hearing loss of sensorineural origin developing in less than 72 hours. Most patients describe waking up with hearing loss that has no apparent external cause. Hearing loss can range from barely detectable to profound, with deafness as an uncommon outcome. Some patients experience tinnitus in the affected ear. There are a lot of possible causes of sudden hearing loss (viral, vascular, or autoimmune causes), but often the cause remains unknown and is termed idiopathic sudden sensorineural hearing loss. The clinical diagnosis is made in patients presented with the symptoms mentioned and is confirmed by the Weber test, in which we can see lateralization to the healthy ear. Thirty-five to sixty percent of patients recover completely, most within 2 weeks. The best treatment for idiopathic sudden hearing loss has not been found yet due to the fact that a lot of patients show spontaneous improvement, regardless of treatment. Most otologists stay united in prescribing systemic corticosteroids to patients who have no contraindications. Glucocorticoids are the standard treatment for idiopathic sudden sensorineural hearing loss. However, as systemic steroids are associated with significant side effects, there were studies with intratympanic steroid therapy, which showed inconsistent results. There is also a need to fully investigate the effects of hyperbaric oxygenation for treatment of sudden hearing loss. The time frame for effective therapy is short, so it is important for every doctor to be aware of this condition and refer the patient to an otolaryngologist in time

Hitna traheotomija kod trahealne stenoze - prikaz slučaja

Airway management in an emergency department is the first step in critical care of an urgent patient. When orotracheal intubation is not possible due to upper airway obstruction, such an emergency is known as a ‘cannot intubate – cannot ventilate’ situation. Then, emergency tracheotomy is indicated. We present a case of a 70-year-old patient complaining of progressive dyspnea. The patient was conscious, highly tachydyspneic, and tachycardic. Loud stridor and a scar from previous tracheostomy suggested upper airway obstruction. Patient history confirmed previous partial laryngectomy and temporary tracheostomy due to laryngeal cancer 10 months before. Differential diagnosis of tracheal stenosis was set, and an ENT specialist was requested. Flexible fiberoptic laryngoscopy demonstrated a 1-mm subglottic tracheal stenosis. Emergency surgical tracheotomy below the obstruction in awake state using local anesthesia was performed to secure the airway. Early postoperative care was complicated by incipient right-sided pneumonia, which may have provoked narrowing of the existing subglottic stenosis in the first place. Tracheal stenosis is an important differential diagnosis of airway obstruction in patients with previous malignant diseases of the upper respiratory system. Emergency physicians should promptly recognize these situations based on clinical examination to secure appropriate airway management.Zbrinjavanje dišnoga puta u hitnoj službi prvi je korak u procjeni i liječenju hitnog bolesnika. Situacije u kojima orotrahealna intubacija nije moguća zbog opstrukcije gornjih dišnih putova poznate su pod nazivom ‘nemoguće intubirati – nemoguće ventilirati’ (cannot intubate – cannote ventilate). U takvim situacijama indicirana je hitna kirurška traheotomija. Autori prikazuju slučaj 70-godišnjeg bolesnika koji se žalio na progresivni osjećaj nedostatka zraka. Bolesnik je bio pri svijesti, izrazito tahidispnoičan i tahikardan. Glasan stridor i ožiljak od prethodne treaheotomije ukazali su na opstrukciju gornjih dišnih putova. Anamnestički se doznaje da je kod bolesnika prije 10 mjeseci učinjena parcijalna laringektomija i privremena traheotomija zbog karcinoma grkljana. Postavljena je dijagnoza trahealne stenoze i pozvan je specijalist otorinolaringologije. Fleksibilna fiberoptička laringoskopija pokazala je subglotičnu trahealnu stenozu promjera 1 mm. Zbog osiguranja dišnog puta učinjena je hitna kirurška traheotomija ispod mjesta opstrukcije u budnom stanju u lokalnoj anesteziji. Rani poslijeoperacijski oporavak kompliciran je početnom desnostranom upalom pluća koja je možda i izazvala suženje postojeće subglotičke stenoze. Trahealna stenoza važna je diferencijalna dijagnoza opstrukcije dišnih putova u bolesnika s prethodnim malignim bolestima gornjega dišnog sustava. Na temelju kliničkog pregleda nužno je odmah prepoznati ovakve situacije kako bi se primjereno zbrinuo dišni put

Fibromatosis colli – izazov za otorinolaringologe

Fibromatosiscolli,ili fibromatoza vrata, rijetka je benigna infiltrativna proliferacija vezivnog tkiva u sternokleidomastoidnom mišiću, koja se javlja kod 0,4% novorođenčadi. Bolest nastaje dva do četiri tjedna nakon rođenja kao bezbolna oteklina na vratu u projekciji sternokleidomastoidnog mišića. Kontrakcije fibroznog tkiva unutar lezije mogu prouzročiti mišićni tortikolis, što naposlijetku može dovesti do kraniofacijalne asimetrije. Fizikalna terapija glavna je metoda liječenja, a kirurški zahvat nužan je u refraktornim slučajevima i nejasnim situacijama. Diferencijalna dijagnoza otekline na vratu kod novorođenčeta je široka i uključuje upalne i benigne procese, kao i maligne neoplazme. Poseban izazov u diferencijalnoj dijagnozi predstavljaju benigni mezenhimalni tumori, kao što je infantilna fibromatoza koja može biti nepredvidivoga tijeka, a naglim rastom u dojenačkoj dobi može dovesti i do smrtnog ishoda. Autori predstavljaju slučaj muškog novorođenčeta starog dva tjedna koji se prezentirao naglo nastalom oteklinom na desnoj strani vrata. Učinjena je dijagnostička obrada (UZV vrata, MR vrata i aspiracijska biopsija tankom iglom), te je bolesnik prikazan na multidisciplinarnom timu za tumore glave i vrata, uz sudjelovanje dječjeg kirurga i ortopeda. Mogućnosti liječenja svedene su na fizikalnu terapiju, biopsiju lezije ili kompletnu resekciju. Kao optimalni modalitet liječenja izabran je kirurški pristup. Postoperativno se ultrazvučnim pregledima prati oporavak mišića uz zdravo napredovanje djeteta. Zaključno, unatoč dobroćudnoj prirodi bolesti, zdravstvene reperkusije fibromatoze vrata mogu biti značajne u slučaju odgođenog kirurškog liječenja. Jasne smjernice u pogledu zahvaćenosti samog mišića kada je dostatna konzervativna terapija ne postoje, te je na kliničarima teška odluka kada se odlučiti za operativno liječenje koje, kao i u našem slučaju, može imati odličan estetski i funkcionalni rezultat

The Correlation between Iron Deficiency and Recurrent Aphthous Stomatitis: A Literature Review

Aphthous lesions of the oral mucosa are a very common symptom and can be seen in both family medicine practice, dental medicine practice, and dermatology or otorhinolaryngology clinics. Some patients develop a chronic recurrent condition, which is clinically known as recurrent aphthous stomatitis (RAS). These ulcers are round, clearly defined, and can be visible on the movable part of the oral mucosa, with variations in size. A prodromal symptom like the burning or stinging sensation can precede the appearance of lesions. The main reason why patients seek medical help is oropharyngeal pain with lack of appetite. The exact etiopathogenesis of RAS remains unknown. Immune disorders, nutritional deficiencies, allergies, mechanical injuries, and even psychological disorders are being studied as potential causes of this condition. Some authors claim that iron deficiency may be a possible causative factor of RAS due to its role in DNA synthesis, mitochondrial function, and enzymatic activity. In iron deficiency, epithelial cells turn over more rapidly and produce an immature or atrophic mucosa. Such mucosa is vulnerable and can be a fertile soil for chronic inflammation and development of aphthae. Finally, our goals were to describe the clinical aspects and etiology of RAS, as well as to determine whether RAS may be related to iron deficiency, in order to identify potential patients with iron deficiency in everyday work

Psychiatric approach to tinnitus

Tinnitus is a symptom with a significant incidence in the general population, usually of unclear etiology, that can cause serious difficulties in people\u27s daily functioning, significantly impair the quality of life, and have a negative impact on mental health. The paper aims to present a brief overview of current knowledge about this frequent and unpleasant phenomenon, including epidemiology, etiology, clinical presentation, diagnosis, and treatment. The paper highlights contemporary theories of tinnitus that link damage to the peripheral organ of hearing and the consequent neuronal changes involved in the subjective experience, which are the target sites for treating psychological disorders associated with tinnitus. The psychiatric approach to tinnitus is aimed not so much at reducing the sound intensity as at reducing the negative experience of this phenomenon and preventing the development or worsening of existing psychological disorders. The results of previous researches indicate numerous therapeutic options for treating tinnitus, including drugs, cognitive-behavioral therapy, and neuromodulation techniques with promising results

GENDER DIFFERENCES IN THE INCIDENCE AND CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN EMERGENCY MEDICINE

Cilj: Glavni cilj ovog istraživanja bio je ispitati postoje li spolne razlike u učestalosti, dobnoj distribuciji i kliničkoj prezentaciji kod bolesnika s akutnim infarktom miokarda koji su zatražili intervenciju Hitne medicinske službe. Metode: Učinjena je retrospektivna analiza baze podataka našeg Zavoda za hitnu medicinu u razdoblju od travnja 2014. do listopada 2019. godine. Koristili smo program e-Hitna te uključili sve bolesnike s dijagnozom akutnog infarkta miokarda (I21 prema MKB- 10 klasifi kaciji). Za sve bolesnike analizirali smo nekoliko karakteristika: dob, spol, prisutnost šećerne bolesti te tri kliničke karakteristike (bol u prsima, poremećaj svijesti, hemodinamska nestabilnost). Rezultati: Ukupno je uključeno 377 pacijenata s dijagnozom akutnog infarkta miokarda. Muškaraca je bilo 219 (58,1 %), a žena 158 (41,9 %) (p < 0,001). Prosječna dob obolijevanja muškaraca iznosila je 64 godine, a žena 73 godine (p<0,001). Nije zabilježena razlika u pojavnosti šećerne bolesti između spolova (p=0,88). Što se tiče kliničkih karakteristika bolesnika, nije zabilježena razlika u pojavnosti i jačini boli u prsima (p=0,07) te hemodinamske nestabilnosti (p=0,49) između muškaraca i žena. Međutim, žene češće imaju poremećaj svijesti (62,2 %) u odnosu na muškarce (37,8 %) (p<0,01). Rasprava: Akutni infarkt miokarda češći je u muškaraca što potvrđuju i brojne studije. Naše istraživanje pokazalo je da se infarkt miokarda javlja u starijoj dobi kod žena s razlikom prosječne dobi obolijevanja od čak 9 godina. Takva razlika tumači se drugačijim utjecajem rizičnih čimbenika na razvoj kardiovaskularnih bolesti između spolova te protektivnim djelovanjem estrogena u žena prije menopauze. Od navedenih kliničkih karakteristika poremećaj svijesti javlja se češće u žena što je u skladu s mnogim istraživanjima koja navode da žene češće imaju atipične simptome. Zaključak: Kardiovaskularne bolesti se javljaju češće u muškaraca, ali su glavni uzrok smrti u oba spola. Muškarci obolijevaju i do 10 godina ranije, ali spolne se razlike starenjem smanjuju. Potrebna su daljnja istraživanja o uzroku razlika u kliničkoj prezentaciji akutnog infarkta miokarda između spolova.The main objective of this study was to investigate whether there are gender differences in the incidence, age, distribution and clinical presentation of patients with acute myocardial infarction requiring emergency medical intervention. Retrospective analysis of the data base of our Department of Emergency Medicine from April 2014 to October 2019 was performed. We used the e-Hitna program and included all patients with acute myocardial infarction (I21 according to the ICD-10 classifi cation). For all patients involved, we analyzed the following characteristics: age, gender, presence of diabetes, and three clinical characteristics (chest pain, disorders of consciousness, and hemodynamic instability). A total of 377 patients with acute myocardial infarction were included. There were 219 (58.1%) men and 158 (41.9%) women (p<0.001). The average age of men and women was 64 and 73 years, respectively (p<0.001). There was no gender difference in the incidence of diabetes (p=0.88). Regarding clinical characteristics of patients, there was no difference in the incidence and severity of chest pain (p=0.07) and hemodynamic instability (p=0.49). However, women were found to be more likely to have a disorder of consciousness (62.2%) than men (37.8%) (p<0.01). In conclusion, acute myocardial infarction is more common in men, as confi rmed by numerous studies. Our study shows that myocardial infarction occurs in older women, with a 9-year difference in the average age. Such a difference is interpreted by different infl uence of risk factors for the development of cardiovascular diseases between the genders and the protective effect of estrogen in women before menopause. Of these clinical characteristics, consciousness disorders occur more frequently in women, which is consistent with numerous studies reporting that women have atypical symptoms more often. In conclusion, cardiovascular diseases occur more frequently in men, but are the leading cause of death in both genders. Men have myocardial infarction 10 years earlier on average, but gender differences are decreasing with age. Further studies on the cause of differences in the clinical presentation of acute myocardial infarction between genders are required

NIJEMI AKUTNI INFARKT MIOKARDA KOD BOLESNIKA SA ŠEĆERNOM BOLESTI U IZVANBOLNIČKOJ HITNOJ MEDICINI

Aim of the Study: Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis specifi ed by ICD-10 classifi cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non-diabetic patients (non-DP). Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was signifi cantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM infl uences clinical presentation of AMI. It is important to emphasize the importance of such fi ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signifi cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this fi nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signifi cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.Cilj: Nijemi akutni infarkt miokarda (AIM) se pojavljuje češće u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipičnu prezentaciju te se zbog toga nedovoljno dijagnosticira AIM u bolesnika s dijabetesom, nije još dovoljno istraženo. U ovoj studiji pokušali smo utvrditi pojavljuje li se bol u prsištu kod AIM rjeđe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju uključili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa “e-hitna” i “BIS” te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolničke hitne medicinske službe u našoj županiji, bili prevezeni u Opću bolnicu “Dr. Josip Benčević”, hospitalizirani te im je kao otpusna dijagnoza postavljena prema klasifi kaciji MKB-10 bila u spektru dijagnoze I21 (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), tj. AIM. Dijabetes je zabilježen kod bolesnika koji su bili na inzulinu ili oralnim hipoglikemicima, uključujući dijabetes tip 1 i tip 2. Rezultati: U studiju smo uključili 180 bolesnika koji su doživjeli AIM. Od tog broja ih je 35 (19,4 %) imalo dijabetes (DP), a 145 (80,6 %) nije imalo dijabetes (ne-DP). Bol u prsištu nije bila prisutna u devet (26 %) DP i 13 (9 %) ne-DP (p=0,007). Nije bilo značajne razlike u distribuciji prema spolu ni u jednoj skupini bolesnika (p=0,35). Muškaraca je bilo 60 % u DP i 68 % u ne-DP. Prosječna dob značajno se razlikovala u dvjema skupinama. U DP je prosječna dob bila 69 godina, a u ne-DP 64 godine (p=0,034). Rasprava: Akutni infarkt miokarda u bolesnika s dijabetesom može se prezentirati izmijenjenom kliničkom slikom i zbog toga se često istraživao. Neki istraživači su pokazali da je atipična ili nijema prezentacija infarkta češća u bolesnika s dijabetesom, dok drugi nisu pronašli razlike u usporedbi s nedijabetičarima. U ovoj studiji smo primijetili da je izostanak boli u prsištu kao karakteristika nijemog AMI učestaliji u dijabetičara s AIM. To dovodi do zaključka da dijabetes utječe na kliničku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolničkoj hitnoj medicini gdje se bolesnici često prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetičara koji su doživjeli AIM bila je značajno veća nego u nedijabetičara. Unatoč činjenici da je dijabetes rizični čimbenik za razvoj AIM, ovaj rezultat možemo tumačiti činjenicom da je dijabetes zastupljeniji u starijoj populaciji. Zaključak: Bol u prsištu se javlja rjeđe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetičari imaju veće izglede da razviju nijemi AIM.