49 research outputs found
Otitis externa maligna u 89-godiÅ”njeg bolesnika sa Å”eÄernom boleÅ”Äu
Malignant external otitis (MEO) is an infection of the external auditory canal and temporal bone. MEO is more common among elderly patients with diabetes mellitus. The usual clinical presentation is severe and persistent ear pain that worsens over the night.Otitis externa maligna infekcija je vanjskog zvukovoda i temporalne kosti. Bolest je ÄeÅ”Äa kod starijih bolesnika sa Å”eÄernom boleÅ”Äu. UobiÄajena kliniÄka slika je jaka i oÅ”tra bol u uhu koja se pogorÅ”ava tijekom noÄi te svrbež
PoteÅ”koÄe s pjevaÄkim glasom u hrvatskih amaterskih i profesionalnih klasiÄnih pjevaÄa
The aim of the study was to describe singing voice handicap in the Croatian professional and amateur classical singers. This cross-sectional study included 69 professionals (median age 47.5 interquartile range 42.0-55.8 years) and 41 amateurs (median age 30.0, interquartile range 25.0-41.0 years). Participants completed the Croatian version of the Singing Voice Handicap Index (SVHI-36), self-rated the severity of singing voice problem on another scale and answered questions about their age, gender, voice type and self-perceived average number of singing hours per week in the past three months. Cronbachās alpha of the Croatian version of the SVHI was 0.97 in amateurs, and 0.98 in professionals. SVHI scores significantly differed across the categories of self-perceived singing voice problem in amateurs (P=0.001) and professionals (P<0.001). Median SVHI score was 16.7 (interquartile range 7.6-29.2) in amateurs and 13.8 (interquartile range 5.9-30.2) in professionals. Higher SVHI score was associated with more severe self-perceived singing voice problem in amateurs (Ļ=0.63, P<0.001) and professionals (Ļ=0.68, P<0.001). Amateurs and professionals did not significantly differ in the self-perceived singing voice problem (P=0.698), nor the SVHI score (P=0.538). Compared to the professionals, amateurs more often reported voice breaks (P=0.009) and the trouble with loud singing (P=0.020), and were less concerned about losing money because of their singing problems (P=0.022). Croatian classical singers mostly had mild singing voice problems. Voice difficulties in amateurs indicate the importance of learning vocal technique. It is necessary to balance work commitments with vocal rest to preserve workability in professional classical singers.Cilj istraživanja bio je opisati poteÅ”koÄe pjevaÄkog glasa u hrvatskih profesionalnih i amaterskih klasiÄnih pjevaÄa. U ovo presjeÄno istraživanje ukljuÄeno je 69 profesionalnih pjevaÄa (medijan dobi 47,5, interkvartilni raspon 42,0-55,8 godina) i 41 amaterski pjevaÄ (medijan dobi 30,0, interkvartilni raspon 25,0-41,0 godina). Sudionici su ispunili hrvatsku verziju Indeksa vokalnih poteÅ”koÄa pjevaÄa (engl. Singing Voice Handicap Index, SVHI-36), samostalno su ocijenili ozbiljnost poteÅ”koÄa s pjevaÄkim glasom na drugoj skali, odgovorili su na pitanja o svojoj dobi, spolu, vrsti glasa te procijenili prosjeÄan tjedni broj sati pjevanja u prethodna tri mjeseca. Cronbachov koeficijent pouzdanosti hrvatskog verzije indeksa SVHI bio je 0,97 u amatera i 0,98 u profesionalaca. Rezultati indeksa znaÄajno su se razlikovali meÄu stupnjevima samoprocijenjenih poteÅ”koÄa s pjevaÄkim glasom u amatera (P=0,001) i u profesionalaca (P<0,001). Medijan rezultata indeksa SVHI bio je 16,7 (interkvartilni raspon 7,6-29,2) u amatera i 13,8 (interkvartilni raspon 5,9-30,2) u profesionalaca. VeÄi rezultat indeksa SVHI bio je povezan s težim samoprocijenjenim poteÅ”koÄama s pjevaÄkim glasom u amatera (Ļ=0,63, P<0,001) i profesionalaca (Ļ=0,68, P<0,001). Amateri i profesionalci nisu se znaÄajno razlikovali u samoprocijenjenim poteÅ”koÄama s pjevaÄkim glasom (P=0,698) niti u rezultatu indeksa SVHI (P=0,538). U odnosu na profesionalce, amateri su ÄeÅ”Äe prijavili pucanje glasa (P=0,009) i poteÅ”koÄe s glasnim pjevanjem (P=0,020) te su se manje brinuli za gubitak novca zbog poteÅ”koÄa s pjevanjem (P=0,022). Hrvatski klasiÄni pjevaÄi veÄinom su imali blage poteÅ”koÄe s pjevaÄkim glasom. Vokalne poteÅ”koÄe u amatera ukazuju na važnost uÄenja vokalne tehnike. Potrebno je balansirati radne obveze i vokalni odmor radi oÄuvanja radne sposobnosti u profesionalnih klasiÄnih pjevaÄa
Smjernice za iznenadnu zamjedbenu nagluhost
Iznenadna zamjedbena nagluhost je naglo nastali, uglavnom jednostrani, zamjedbeni gubitak sluha nepoznatog uzroka. Dijagnozu je potrebno postaviti Å”to prije, jer raniji poÄetak lijeÄenja poveÄava vjerojatnost oporavka. KliniÄki pregled ukljuÄuje otoskopiju i akumetrijske testove. Dijagnoza iznenadne zamjedbene nagluhosti potvrÄuje se tonskom audiometrijom, koju bi trebalo uÄiniti unutar nekoliko dana od nastanka smetnji. Rutinske laboratorijske krvne pretrage nisu potrebne, kao ni kompjutorizirana tomografija (CT) mozga. Inicijalno sistemsko lijeÄenje kortikosteroidima najbolje je primijeniti unutar dva tjedna od nastanka simptoma, a prema nekim istraživanjima kortikosteroide ima smisla poÄeti davati najkasnije Å”est tjedana od nastanka oÅ”teÄenja. Kao inicijalno lijeÄenje može se primijeniti i terapija kisikom u hiperbariÄnoj komori (HBOT) koju je takoÄer najbolje primijeniti unutar dva tjedna od nastanka simptoma, te u iduÄa dva tjedna kao terapiju spaÅ”avanja. Kortikosteroidi i HBOT mogu se kombinirati. Intratimpanalna primjena kortikosteroida može se primijeniti u sluÄaju neuspjeha prethodne terapije, kao terapija spaÅ”avanja, do isteka ukupno Å”est tjedana od nastanka zamjedbenog oÅ”teÄenja sluha, a iznimno kao inicijalno lijeÄenje kod bolesnika kod kojih su sistemski kortikosteroidi i HBOT kontraindicirani. LijeÄenje antivirusnim, tromobolitiÄkim i vazodilatatornim lijekovima nije indicirano. Spontani oporavak kreÄe se od 31 do 70%, a uz pomoÄ neke od navedenih terapija taj se postotak kreÄe od 80 do 85%
Smjernice za iznenadnu zamjedbenu nagluhost
Iznenadna zamjedbena nagluhost je naglo nastali, uglavnom jednostrani, zamjedbeni gubitak sluha nepoznatog uzroka. Dijagnozu je potrebno postaviti Å”to prije, jer raniji poÄetak lijeÄenja poveÄava vjerojatnost oporavka. KliniÄki pregled ukljuÄuje otoskopiju i akumetrijske testove. Dijagnoza iznenadne zamjedbene nagluhosti potvrÄuje se tonskom audiometrijom, koju bi trebalo uÄiniti unutar nekoliko dana od nastanka smetnji. Rutinske laboratorijske krvne pretrage nisu potrebne, kao ni kompjutorizirana tomografija (CT) mozga. Inicijalno sistemsko lijeÄenje kortikosteroidima najbolje je primijeniti unutar dva tjedna od nastanka simptoma, a prema nekim istraživanjima kortikosteroide ima smisla poÄeti davati najkasnije Å”est tjedana od nastanka oÅ”teÄenja. Kao inicijalno lijeÄenje može se primijeniti i terapija kisikom u hiperbariÄnoj komori (HBOT) koju je takoÄer najbolje primijeniti unutar dva tjedna od nastanka simptoma, te u iduÄa dva tjedna kao terapiju spaÅ”avanja. Kortikosteroidi i HBOT mogu se kombinirati. Intratimpanalna primjena kortikosteroida može se primijeniti u sluÄaju neuspjeha prethodne terapije, kao terapija spaÅ”avanja, do isteka ukupno Å”est tjedana od nastanka zamjedbenog oÅ”teÄenja sluha, a iznimno kao inicijalno lijeÄenje kod bolesnika kod kojih su sistemski kortikosteroidi i HBOT kontraindicirani. LijeÄenje antivirusnim, tromobolitiÄkim i vazodilatatornim lijekovima nije indicirano. Spontani oporavak kreÄe se od 31 do 70%, a uz pomoÄ neke od navedenih terapija taj se postotak kreÄe od 80 do 85%
Long-Term Functional Outcomes after 10 Years of Bilateral Cochlear Implantat Use
The aims were to determine the benefit of bilateral cochlear implantation in a 20 years old patient implanted in Croatia on hearing and speech development. The male patient, after 10 years of deafness, got cochlear implants Med-EL Combi 40+ on both sides in one-stage surgery. The etiology of his deafness was posttraumatic meningitis. Auditory capacity and speech recognition tests were performed for both ears separately and together. Average hearing level on the right ear with right cochlear implant switched on started at 62 dB 1 month after the cochlear implantation and was on 55 dB after 10 years. Average hearing level on the left ear with left cochlear implant switched on started at 55 dB 1 month after the cochlear implantation and was on 32 dB after 10 years. Average hearing level on the both ears with 2 cochlear implants switched on started at 35 dB 1 month after the cochlear implantation and was on 27 dB after 10 years. Long- -term functional outcomes with bilateral cochlear implantation provides advantages over unilateral implantation including improved hearing level, speech perception in noise and improved sound localization
Šum u uhu - sadaŔnje stanje i terapija privikavanjem
Tinnitus is an abnormal noise in the ear. About six percent of the general population suffers from what they consider to be "severe" tinnitus. Tinnitus can come and go, or be continuous. It can sound like a low roar, or a high-pitched ring. Tinnitus may be bilateral or unilateral. The causes of tinnitus are various, e.g., inner ear injury, 8th nerve lesion, injury of the brainstem, and rarely of the brain. There also are many extracranial causes of tinnitus. Upon making the diagnosis of tinnitus, medical therapy may occasionally help lessen the noise even though the cause has not been identified. Current therapy for tinnitus, so-called tinnitus retraining therapy, first includes learning about what does actually cause the tinnitus. This process is called habituation of reaction. Tinnitus then becomes quieter for long period of time and may eventually disappear, or becomes part of the background .sound of silence (habituation of perception). In some cases, changes in the inner ear function may be important in triggering the occurrence of tinnitus (e.g., Meniere\u27s disease or acute acoustic trauma); however, the retraining approach works independently of the triggering factor. Despite the importance of hearing loss, a recent study in tinnitus patients showed that there was no significant difference in hearing between the tinnitus group and control group of healthy subjects.Å um u uhu je pojava nenormalne buke u uhu. Otprilike 6% populacije pati od tzv. jakog Å”uma u uhu. Å um se može pojaviti i nestati, ali može biti i trajan. Može zvuÄati poput duboke tutnjave ili zvonjave visokih tonova. Može nastati u oba uha ili samo u jednom. Uzroci Å”uma mogu biti razliÄiti, npr. oÅ”teÄenje unutarnjeg uha, ozljeda osmog moždanog živca ili moždanog debla, ili pak rjeÄe ozljeda mozga. Ekstrakranijski uzroci Å”uma takoÄer su brojni. Nakon postavljanja dijagnoze osjet buke u uhu može se ublažiti upotrebom lijekova, iako uzrok Å”uma jo. nije utvrÄen. U suvremenom naÄinu lijeÄenja Å”uma, tzv. lijeÄenju metodom privikavanja (tinnitus retraining therapy), najprije treba utvrditi Å”to je zapravo prouzroÄilo nastanak Å”uma. Taj se proces zove "privikavanje na nastalu situaciju". Å um se tako može ublažiti na dulje vrijeme, a na kraju može i sasvim nestati ili se stopiti sa zvuÄnom pozadinom (habituacija percepcije). Promjene u unutarnjem uhu u nekim sluÄajevima mogu potaknuti naglu pojavu Å”uma u uhu (npr. Meniereova bolest ili akutna akustiÄka trauma), ali valja naglasiti da lijeÄenje metodom privikavanja daje dobre rezultate bez obzira na to Å”to je u osnovi nastanka Å”uma. UnatoÄ važnosti gubitka sluha najnovija ispitivanja u bolesnika sa Å”umom pokazuju da nema znaÄajnih razlika u sluhu izmeÄu bolesnika sa Å”umom i skupine zdravih ispitanika
Hidradenoma of the External Auditory Canal: Clinical Presentation and Surgical Treatment
The aim of this article is to present clinical features, diagnostic procedures and surgical treatment of a rare ear tumor. We report a case of 78 year old female with hidradenoma of the external auditory canal. Patient had a sensation of pain and fullness with permanent ottorhea from the right ear for one year. Temporal bone computed tomography showed a tumor of the external ear, 6 centimeters in diameter, without bone, temporomandibular joint or intracranial invasion; the tumor was limited medially by the tympanic membrane. Biopsy was performed and pathohistology finding was: hydradenoma
nodulare atypicum. Surgical intervention and wide tumor removal in general endotracheal anesthesia was performed. One year after the surgery there was no sign of tumor recurrence. Hidradenoma is rare ear tumor arising from the epithelial cells of sweat glands of the external auditory canal. Radiological evaluation and pathohistology confirmation of hidradenoma is necessary and wide excision of the tumor is the treatment of choice
Recovery from sudden sensorineural hearing loss may be linked to chronic stress levels and steroid treatment resistance
Purpose This article investigates the possible connections between the level of chronic stress and success of steroid therapy in patients with sudden sensorineural hearing loss (SSNHL). Method A single-center, retrospective, longitudinal cohort study on 55 patients in a tertiary referral otology center was examined. Patients diagnosed with SSNHL between 2014 and 2017 were asked to complete a Measure of Perceived Stress (Brajac, Tkalcic, DragojeviÄ, & Gruber, 2003 ) questionnaire. Inclusion criteria were patients > 18 years of age, SSNHL diagnosed within 4 previous weeks, completed steroid treatment, and complete documentation. Results There were 30 patients (55%) that showed significant improvement in their pure-tone audiogram (PTA) hearing threshold average (ā„ 15 dB) after steroid treatment. Two-step cluster analysis identified 3 clusters based on average PTA hearing threshold recovery and average Measure of Perceived Stress scores. The difference between pretreatment and posttreatment hearing levels was significantly higher in the cluster with moderate stress compared to clusters with mild and high stress levels (Kruskal-Wallis test, Friedman test, p < .001). There were no significant differences in average PTA hearing threshold recovery after steroid therapy between groups of patients with mild and severe stress. Conclusion Patients with moderate stress levels show significantly better results after steroid treatment for SSNHL than patients with low or high stress levels
Usporedba postoperativnog praga sluha nakon stapedotomije ovisno o tipu proteze: retrospektivna analiza
Stapes surgery is generally performed to treat otosclerosis, and there are numerous
surgical techniques and prosthesis materials available. Critical evaluation of postoperative
hearing outcomes is crucial for identification and further improvement of treatment options. This
study is a non-randomized retrospective analysis of hearing threshold levels before and after stapedectomy
or stapedotomy in 365 patients during a twenty-year period. The patients were classified into
three groups depending on the prosthesis and surgery type: stapedectomy with Schuknecht prosthesis
placement and stapedotomy with either Causse or Richard prosthesis. The postoperative air-bone gap
(ABG) was calculated by subtracting the bone conduction pure tone-audiogram (PTA) from the air
conduction PTA. Hearing threshold levels were evaluated preoperatively and postoperatively from
250 Hz to 12 kHz. The results showed air-bone gap reduction <10 dB in 72% patients, 70% of patients,
and 76% of patients using Schucknechtās prosthesis, Richard prosthesis, and Causse prosthesis,
respectively. The results did not differ significantly between three prothesis types. Choice of prosthesis
should be made individually for each patient, but surgeon competency is still the most important
outcome variable, regardless of prosthesis type.Stapedotomija ili stapedektomija su metode izbora za lijeÄenje otoskleroze, a postoji velik broj proteza koje se koriste u
obje kirurÅ”ke tehnike. Konstantna evaluacija postoperativnih ishoda sluha kljuÄna je za vrednovanje najboljeg tipa i materijala
za koriÅ”tenih u kirurÅ”kom lijeÄenju otoskleroze. Ovo je istraživanje nerandomizirana retrospektivna analiza pragova sluha
prije i nakon stapedektomije ili stapedotomije u 365 pacijenata tijekom desetogodiŔnjeg razdoblja. Pacijenti su na temelju
tipa operacije i proteze svrstani u tri grupe; stapedektomija s postavljanjem Schuknechtove proteze, stapedetomija s Causse
ili Richardovom protezom. Postoperativni ABG izraÄunat je oduzimanjem BC PTA od AC PTA. Tonskim audiogramom
su evaluirani pragovi sluha prijeoperativno i postoperativno u rasponu od 250 Hz do 12 kHz. Rezultati pokazuju smanjenje
zraÄno-koÅ”tanog prozora na <10 dB u 72% pacijenata s Schucknecht protezama, dok je u grupi pacijenata s Richardovim
protezama takvih pacijenata bilo 70%, a u grupi pacijenata s Causse protezama 76%. Rezultati su bili sliÄni za sve tri promatrane
opcije. Odluka o tipu operacije i proteze trebala bi biti individualna za svakog pacijenta, a ishod operacije ne ovisi
o tipu proteze