Stapedotomija z argonskim laserjem

Namen: Namen raziskave je bil predstaviti rezultate operacij otoskleroze z argonskim laserjem. Metode: V zadnjem letu in pol je bila stapedotomija z argonskim laserjem izvedena pri 47 bolnikih. Pri vseh je bil poseg izveden v splošni anesteziji s transkanalnim pristopom, preoperativno in pooperativno je bil narejen tudi audiogram. Po operaciji smo izračunali spremembo kostnega prevajanja, kostno-zračne razlike in povprečno pooperativno kostno-zračno razliko. Rezultati: Povprečno pooperativno izboljšanje kostnega prevajanja je znašalo 4,4 dB, povprečno izboljšanje kostno-zračne razlike 22,3 dB, povprečna pooperativna kostno-zračna razlika pa je znašala 9,6 dB. Zaključek: Stapedotomija z argonskim laserjem je varna operacija, ki omogoča t.i. operiranje brez dotika struktur. Pooperativni rezultati sluha so zadovoljivi in stabilni, bolniki pa imajo pooperativno malo stranskih pojavov v smislu nestabilnosti in slabosti.Purpose: Presentation of our results of otosclerosis procedures undertaken with the argon laser. Methods: Argon laser stapedotomy was carried out in 47 patients in the last 18 months at our center. The procedure was conducted under general anesthesia using a transcanal approach. Pure-tone audiogram was done pre- and postoperatively. After each procedure, overclosure, closure of the air-bone gap and the average postoperative air-bone gap were calculated. Results: Average overclosure in all patients was 4.4 dBaverage closure of the air-bone gap was 22.3 dB and average air-bone gap was 9.6 dB. Conclusion: Argon laser stapedotomy is a safe procedure that enables surgery without touching middle ear structures. Postoperative hearing results were satisfactory and stablepatients also had few problems with nausea and vertigo

Three-dimensional ultrasound of the head and neck

Izhodišča. Poročila o rabi 3D (prostorskega) ultrazvoka v področju otorinolaringologije so skromna. Večino podatkov, potrebnih za diagnozo bolezni v ORL področju lahko dobimo z običajno ultrazvočno preiskavo. Ena od pomembnejših aplikacij je ocena bezgavk na vratu pri bolniku z malignomi. Metode. V prispevku predstavljamo naše izkušnje s prostorskim ultrazvokom, ki smo ga uporabili pri oceni metastaz na vratu in ugotavljali njihovo prostornino in odnos do večjih žil. Ugotavljali smo tudi prostornino tumorjev ustne votline in jo primerjali s kategorijo T klasifikacije malignih tumorjev TNM. Rezultati in zaključki. Ugotovili smo korelacijo med prostornino tumorjev ustne votline in kategorijo T, ki je statistično značilna (p<0,05). Povprečna velikost tumorja je bila 9,6 cm3. Prostorski prikaz primarnih tumorjev v ORL področju se omejuje na slinavke in ustno votlino, ker ostala področja ultrazvočno niso dostopna. Izračunana prostornina tumorja je lahko pomembna pri načrtovanju zdravljenja in ocenjevanju njenega učinka. Na vratu je večravninski prikaz pomemben, ker z njim lažje ocenimo odnos do velikih žil in njihovo morebitno infiltarcijo. Pomembna je tudi možnost digitalnega shranjevanja podatkov in njihove reprodukcije.Background. Only few reports have been published about the use of the three-dimensional ultrasound in the field of otorhinolaryngology. With conventional ultrasound investigation usually enough information can be obtained. One of the most important ultrasound applications in otorhinolaryngology is investigation in patients with head and neck tumors to establish the extent of metastatic disease. Methods. In the article we present our experience with three-dimensional ultrasound. We used it in patients with head and neck tumors, where we established the volume of lymph nodes and their relations to the carotid artery and jugular vein. We also established the volumes of the oral cavity tumors and made a comparison with the T-cathegory of TNM classification of malignant tumors. Results and conclusions. The average size of all tumors was 9,6 cm3. We found the significant correlation between the tumor volumes and T cathegory (p<0,05). Despite the fact that not all tumors in the field of otorhinolaryngology are accesible for the ultrasound investigation, we think that the tumor volume could be an important parameter in the treatment of patients with head and neck tumors. Three-dimensional ultrasound offers us also better possibilities to recognise the metastatic infiltration of major vessels on three orthogonal planes. One of the important advantages of three-dimensional ultrasound is also in the possibility of digital recording of the obtained data

Successful hearing improvement with direct acoustic stimulation in a patient with schizophrenia

A direct acoustic cochlear implant provides its power directly to the inner ear by vibrating the perilymph via a conventional stapes prosthesis. Our experience with a patient with severe mixed hearing loss due to otosclerosis is described. Case report. The patient, a 47-year-old male, had a pre-operative speech recognition score of 10 per cent and had been treated for many years for schizophrenia, both of which made him a poor candidate for a direct acoustic stimulation device. Nevertheless, the surgery was performed, which preserved the pre- operative bone conduction level and significantly improved hearing. His speech recognition score rose to 100 per cent. He uses the device all day and his auditory hallucinations have subsided. Improvement of schizophrenia symptoms has enabled the patient to reduce his psychiatric medications intake. Conclusion. Hearing restoration was the main reason for the reduction of auditory hallucinations in our patient. Hearing loss is a potentially reversible risk factor for psychosis, but this association is often overlooked

Jugular paraganglioma treatment at the UMC Maribor

Background: Jugular paragangliomas are rare, almost exclusively benign and slowly growing tumors. Arising from the cells of paraganglia in jugular bulb, they infiltrate the temporal bone and later grow intracranially. Because of insidious onset, their diagnosis is relatively late. Patients at presentation usually complain of pulsatile tinnitus and hearing loss, lasting for years. Also common are palsies of the cranial nerves in the area of tumor growth – i.e., facial, glossopharyngeal, vagal, accessory and hypoglossal nerves. Surgical resection is the standard treatment, though technically demanding because of difficult approach to the lateral cranial base and vital structures in the area. The team for treating such patients comprises an ENT specialist, interventional radiologist and a neurosurgeon. The purpose of this article is to review clinical experiences with the treatment of jugular paragangliomas at our Department of ENT and Maxillofacial Surgery of the University Medical Centre Maribor. Methods: We reviewed the documentation of ten patients treated for jugular paraganglioma in the last 15 years, and presented the clinical data in a table. Results: Nine patients were treated by preoperative embolization and surgical resection. Surgery was contraindicated in one patient with highly dominant venous drainage on the side of the tumor and aplastic transverse sinus on the opposite side. She was treated by primary radiotherapy. One patient with intracranial tumor growth was treated by subtotal resection and adjuvant radiotherapy. At presentation, lower cranial nerve palsies were present in 60 % of our patients. With the other 40 % we managed to preserve the nerve function postoperatively. Facial nerve function practically normalized in all patients with anterior transposition of the nerve. Our patients were provided with postoperative rehabilitation and corrective procedures such as vocal cord medialization and BAHA hearing aid implantation. Discussion: Despite the risks, the surgical treatment is effective in halting the disease and preserving cranial nerve function. The results of our work demonstrate that our patients are provided with a thorough and comprehensive care

Functionalisation of silicone by drug-embedded chitosan nanoparticles for potential applications in otorhinolaryngology

Silicones are widely used medical materials that are also applied for tympanostomy tubes with a trending goal to functionalise the surface of the latter to enhance the healing of ear inflammations and other ear diseases, where such medical care is required. This study focuses on silicone surface treatment with various antimicrobial coatings. Polysaccharide coatings in the form of chitosan nanoparticles alone, or with an embedded drug mixture composed of amoxicillin/clavulanic acid (co-amoxiclav) were prepared and applied onto silicone material. Plasma activation was also used as a pre-treatment for activation of the material&rsquo;s surface for better adhesion of the coatings. The size of the nanoparticles was measured using the DLS method (Dynamic Light Scattering), stability of the dispersion was determined with zeta potential measurements, whilst the physicochemical properties of functionalised silicone materials were examined using the UV-Vis method (Ultraviolet-Visible Spectroscopy), SEM (Scanning Electron Microscopy), XPS (X-Ray Photoelectron Spectroscopy). Moreover, in vitro drug release testing was used to follow the desorption kinetics and antimicrobial properties were tested by a bacterial cell count reduction assay using the standard gram-positive bacteria Staphylococcus aureus. The results show silicone materials as suitable materials for tympanostomy tubes, with the coating developed in this study showing excellent antimicrobial and biofilm inhibition properties. This implies a potential for better healing of ear inflammation, making the newly developed approach for the preparation of functionalised tympanostomy tubes promising for further testing towards clinical applications